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Old 02-26-2007, 11:11 PM   #1
Yael Grauer
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Well, here's my stumper! I started going to this chiropractor/ART guy who I thought could help me with my lordosis. He told me I had lumbar facet syndrome and some pelvic tilt and that I needed to strengthen my glutes and core so that I'd be standing straighter. On the paperwork to give to my insurance company he also wrote that I have "acquired kyphosis" and "cervicothoracic myofascial pain syndrome" but never mentioned these things to me.

Anyways, he gave me a bunch of stretches to do and told me to stand up every half hour if I'm seated for a long period of time. He also told me not to do any Russian twists, stiff-legged deadlifts, GHD situps (or any situps really, as I am relegated to partial curl-ups), leg lifts, etc. (Basically not to do any core exercises other than the ones he gave me.) In the meantime I also got Nike Frees and stopped wearing heels (for now!)

I had some pretty good improvement in a short period of time--in about two or three weeks the stretches which seem so hard now seem easy and almost useless (except the hip flexor stretch), I have improved mobility and virtually no lower back pain, and somehow I've managed this even while squatting far heavier than ever before.

Anyway, here's my questions:

1. How "real" are these "syndromes" anyway? It seems like there's debate about whether lumbar facet syndrome actually even exists, and all of the stretches/traction he's done to try to separate my facet joints don't seem like they've ever done anything at all. Also is "cervithoracic myofascial pain syndrome" anything more than another term for lower back pain?

2. Do chiropractors get more money from insurance companies if they list off more syndromes? (Sorry, I'm a bit of a skeptic.)

3. If I did in fact have "acquired kyphosis," or another acquired condition, wouldn't it be something that could be un-acquired? My chiropractor told me that my "condition" was a permanent thing and was just my "own personal plumbing" and the way I was built. I'm okay with doing my stretches every day forever, but I'm confused about the difference between an "acquired chronic condition" and "one's personal plumbing." It seems like if it was just the latter there'd be no point in stretching, getting adjustments, etc.

4. I assumed that if the muscles I needed to strengthen were firing off correctly it would reduce the whole anterior pelvic tilt and lordosis issue, which is something that would reflect physically (i.e. I could see the change if I stood sideways and looked in the mirror)...is that true? I tried to ask my DC about this he gave me a vague answer and asked me if I was just seeing him for "cosmetic reasons."

5. Assuming that I had an "acquired condition" that will be UNACQUIRED (as evidenced by maximum mobility, lack of pain and kick core/glute activation), what happens if I start doing all of my forbidden exercises? Are Russian twists and SLDLs and (gasp!) real sit-ups or even decline sit-ups forbidden forever, or just if they cause pain? I tried to ask my guy this a couple weeks ago, but received a lecture about how athletes are bad patients instead of an answer. (Yes, I'm going to find a new DC if I decide I actually even need one...but I seem to be having a bad luck streak.)

(Message edited by treelizard on February 26, 2007)
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Old 02-27-2007, 02:11 AM   #2
Lynne Pitts
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So, T-liz,
You do what this guy says, are better in 2 short weeks, and think he's a quack? I could see all the cynical skepticism if you had been seeing him for 3 mos and nothing was better, but...

BTW, consider yourself lucky your insurance covers DC; mine doesn't and I pay out of pocket. If he has to put something particular down so you get covered, how is that a bad thing?

Glad to hear you're getting some relief, in any case.
Lynne

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Old 02-27-2007, 08:52 AM   #3
Yael Grauer
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Yes, I should be happy, I know. LOL. I guess I'm wondering if me feeling better has anything to do with going to a chiropractor--it could simply be the stretches and change of shoes... Also I'm a bit frustrated at being unable to get information on what is temporary and what isn't. But mostly I'm wondering whether I should be relegated to baby excercises for core work forever (especially since it seems to be due to a syndrome that I'm not convinced actually exists).

Work/home friendly article from Spine University on lumbar facet syndrome being a myth: http://www.spineuniverse.com/treatme...facetmyth.html

I guess I'm posting this here because I was wondering if other people who were told not to do, say, Russian twists and reverse hypers are now able to do them.
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Old 02-27-2007, 10:31 AM   #4
William Hunter
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First off, I agree with Lynne. Feeling better in two weeks is not too shabby. Beware of the DC that tells you on the first day that it'll take 6 mos to a year to feel better. Second, it's probably a combination of all the things that have been done/implemented. This also scores points for your chiro, since he was willing to have you do things outside the office to help your progress. Again, beware when you get no helpful instructions/exercises and are required to come in for dozens of visits. Third, ART is not taught in Chiro school (at least I don't think it is). This guy spent thousands of dollars to gain this type of expertise to help get patients better faster. This reduces the average # of treatments you'll need, but hopefully will enhance his rep in the area, stimulating referrals.

To your questions:
1) Yes, all these syndromes exist. However, acquired kyphosis is referring to your thoracic spine (midback) and CT MFPS refers to the junction to your neck and upper back. A patient with excessive lumbar lordosis often has an increased thoracic curve and forward head translation. This is also referred to as Upper Crossed Syndrome and entails multiple tight muscles as well as some weak/inhibited ones. CT MFPS is not describing anything in your low back. BTW, excessive lordosis is also associated with Lower Crossed Syndrome, which he probably described to you even if he didn't use those terms.

2) Manipulation codes are broken down into how many regions are treated ie, 1-2, 3-4, 5-6. If he treats your low back, mid back and neck, that's the 3-4 code. Extremities such as hips and shoulders, ankles etc also cost extra. Soft tissue treatment such as ART, Graston, ischemic compression, PNF all cost extra. For an uncomplicated low back pain case you may not need to treat full spine, but often there are compensatory problems that should be addressed. Since your DC sounds like he's got a concrete plan I would defer to his judgement.

3) Some DC's really work hard to change postural distortions. Not such an easy thing to do. Others are more concerned with function. Can you do the things you want to do without pain or restriction? With a mature adult spine it gets harder to make changes. You said you feel better so maybe something good is going on.

4) Again, I don't think you'll see anything too drastic, like you being 2" taller b/c your spinal curves are no longer excessive. IMO your posture and your gait are kind of like your fingerprints, an individual marker. Posture is really a lot of attention to detail, throughout the day. It's easy to get distracted and revert to the old slouch and pooch.

5) Whether you want to hear it or not, YOU got yourself into this mess, and ultimately you will have to get yourself out of it, with or w/o his help. He won't send the Chiropractic Police to your house if you stop coming in. Maybe you two just have personality conflicts and you need to move on. I can't really answer this question.

Just for kicks, why don't you go back to doing everything you did before which landed you in this mess and see if it happens again. It might soften your attitude towards this guy, or you may do just fine.

Full disclosure: I am a DC as well, but I'm no homer. I'll gladly throw another chiro under the bus if he's acting like a skank, tarnishing our collective reps (which we really don't need any more of). I've invested nearly ten thousand dollars on continuing ed since I graduated. I work hard on my patients and spend quality time with them. I DON'T COME CHEAP, but with a combo of multiple soft tissue treatments, spinal and extremity manipulation, exercise prescription and PT referral I typically get the job done in fewer visits than those I'm in town with.
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Old 02-27-2007, 05:03 PM   #5
Yael Grauer
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I was expecting to see less excessive spinal curves--not drastic, but noticeable. If I just went by how my back was feeling that would mean whether or not I have a "syndrome" would depend on how much sleep I got the night before and my choice of footwear.

I actually switched to this chiropractor because I heard he did ART and spent a long time with each client, and because he gives you the stretches to work on. My last chiro would give you one stretch but wouldn't have time to explain it because he was always swamped with clients. So this guy did give me some stretches (and about five minutes of ART my first treatment--he says I don't need it any more) and my first appointment was about a half hour but the following three were about five minutes long.

I'm pretty sure the stretches and the shoes are the main difference, but now I want to figure out whether I have all these "conditions" or not.

Anyway, thanks for the info!!
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