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Old 06-21-2009, 04:20 AM   #11
Todd Dent
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Re: CrossFit Chiropractors?

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Originally Posted by John Casey View Post
Bill,

Completely off topic (although I think what you're doing is awesome), but I have a question. Well, first a statement. In high school, my best friend's dad did all my chiropractic work. I've never had anyone else work on me, but I think going to the chiropractor is GLORIOUS. I get home maybe once a year now, so I don't get to see him often. I'm hesitant to try anyone else. What should I look for in shopping around for a good chirpractor?

I know this question wasn't posed to me, but I'll throw my two cents in anyway.

I totally understand why you'd want to find someone you can trust. It's like anything else.

Interview the Doc. Get to know him or her. If they smell right, you'll know.

Hope it helps.
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Old 06-25-2009, 08:26 PM   #12
Bill Houghton
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Re: CrossFit Chiropractors?

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Originally Posted by Christine Reinhart View Post
I am so thankful to have found this link! A brief history about myself...I have been CrossFitting for 2 years, and after having completed my PhD last year, I decided to make a career change. I have just finished my first year of chiropractic school at Canadian Memorial Chiropractic College in Toronto and I couldn't be more excited about the decision to pursue a career in this field. However, I have met very few chiropractors that participate in or advocate for CrossFit. I'm wondering if any of you have had similar experiences?

Some of my classmates (who are somewhat familiar with CF), are highly critical of this style of training, mostly due to how hard we push ourselves (i.e., our bodies). It seems that many people are uncomfortable with the level of intensity at which we train on a regular basis, and feel that it is unsafe to advise "regular people/patients" to train in this manner. For those of you already in practice, I am curious to know if/how you have gone about incorporating CF into your treatment plans. Do you recommend CF to everyone (I'm using this term broadly), or only to patients with specific training goals?

And one final comment/question (I have so many!). I recognize that DCs have extensive training in anatomy and biomechanics, and as such, I'm wondering what some of you think about particular "CF movements" and how they may affect the spine, intervertebral discs, and paraspinal musculature. More specifically, I am concerned about the effects of repetitive compressive forces that are imposed on the back when performing full ROM sit-ups, or knees-to-elbows for example (namely, movements that put the lumbar spine into flexion while under relatively high compressive force). Although my knowledge of biomechanics is relatively limited, I have encountered literature (see research from Dr. Stu McGill's lab) showing that we are ill-advised to perform and recommend these kinds of movements.

Thank you for giving me a place to communicate these ideas, and I look forward to hearing your opinions!

Christine, MSc, PhD, & DC in training

Hi Christine (Dr. Reinhart )

Congratulations on your choice of careers. Chiropractic and CrossFit are made for each other. I am a 24 year DC and the care our profession provides has always been functional.

To the critics, the name of the game is scaling. You wouldn't start one of your acute patients anywhere near the WOD level. Common sense dicatates. I am gradually moving CrossFit into my practice. I am looking at two spaces tomorrow for possible locations. My plan is to introduce patients to the fundamentsl movements in the office as part of their care. Then, invite them to a free class to bring them up to speed on the potential for health, quality of life, longevity, etc... with CF. It is really a match made in heaven. We can totally change their lives with CF and provide an amazing service with our chiropractic care.

Bill
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Old 06-26-2009, 11:07 AM   #13
Christine Reinhart
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Re: CrossFit Chiropractors?

Hi Bill. I appreciate your response. I too agree that CrossFit and chiropractic care has the potential to change many lives in a positive way, and I aim to do just that! Indeed it is necessary to scale CF workouts for anyone who is new to this style of training (or perhaps hasn't exercised in a while), and I think that this should be done regardless of whether or not the patients have specific injuries/nagging conditions, or are completely pain-free. However, stemming from my original post, a question still remains for me. Do you (or any other DCs out there), feel that ALL CF movements are safe for the back (healthy or otherwise) over the long term? Let me elaborate on what I am getting at.

Although the work has been done in animal models, research from Dr. Stu McGill's lab has shown that herniations (posterior and posterior-lateral regions of the annulus) can occur with relatively modest joint compression but with highly repetitive flexion/extension moments. To simplify, you only have "X" number of flexion/extension moments until the disc is going give out! Some examples of "repetitive flexion/extension moments" would include CF WODs with relatively high numbers of sit-ups, knees to elbows, and if done improperly, burpees (i.e., these movements eliminate lumbar lordosis while simultaneously adding compressive force to the spine). It is also known that relatively younger patients (let's say 25-50 years old, as opposed to 50-70 years old) are more at risk for having disc herniations, and is this not the prime demographic for the majority of CrossFitters?

I love CrossFit, and I have also come to enjoy figuring out how to get others involved in CF while at the same time promoting healthy backs! If the research is correct, then although CF exercises may not cause a herniation directly, the repetition of certain movements may more rapidly lead to a person experiencing a "herniation event" (which could be as simple as bending down to pick up a pencil!) Perhaps as health care professionals, we should be recommending a "modified" style of CF that takes into consideration, the long term longevity of the back...which could mean substituting the full flexion sit ups etc. for movements that are more back friendly?

Please fellow colleagues, share your thoughts! My understanding of the biomechanical properties of the body is something that is new to me, so I am looking to learn something from those of you with more experience than myself.
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Old 06-26-2009, 07:15 PM   #14
Bill Houghton
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Re: CrossFit Chiropractors?

Christine,

My reply is based on an accumulation of experience, study and the working models that have developed from them, and not from any specific research that refutes Dr. McGills conclusions. An exercising individual with proper nutrition and rest intervals would be strengthening their discs. I don't buy into the idea that overuse is the primary mechanism in disc problems in humans. If you consider the time the average person in an industrialized nation sits, especially during the spines developmental years - from birth to age 20 - you start to see why there is an epidemic of disc problems. There is an epidemic of subluxated, hypomobile individuals with atrophy and degenerative changes. When those individuals later have back pain and imaging studies are performed, they are told that disc herniation is the cause of their problem. Disc herniation is the RESULT of their problem, not the cause. Atrophy is the cause of their problem from hypomobility. I recall from my college studies that during trauma a vertebra will fracture before a healthy disc will show any signs of damage, yet people are told they herniated a disc bending over with no load on their spine (your herniation event). This just doesn't add up. The better explanation would be that their spine had been degenerating for years, the disc was weakening from atrophy, they bent over and had a pain initiating event. I have seen hundreds of patients over the years with a very similar history. When we take our focus off the disc and put our focus on restoring motion, their symptoms resolve. Our care is fundamentally a from of exercise because we use motion as our main intervention. Motion initiates the same response that exercise does. A beautiful part of being a CrossFitting DC is that we can initiate the care necessary to restore function before we move patients into the CF movements. It is a win/win/win. Could we (DC’s) even require our clients have a palpatory and x-ray evaluation of their spine before starting in our box? In the long run, we would be doing them a huge service. If you are starting an exercise program like CF, you can gradually rehabilitate motion enough to resolve back pain, shoulder pain, neck pain etc.., (see recent CF Journal articles) but think of the added benefit of having those levels mobilized by a professional prior to starting the program or even concomitantly? Again, it is a win/win/win.

Bill

P.S. Win/win/win = patient, doctor, world. Less cost, less disability, better quality of life, etc...
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Old 07-01-2009, 06:40 PM   #15
Christine Reinhart
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Re: CrossFit Chiropractors?

Bill, thank you for your reply. I apologize for taking so long to respond (been a little busy the past few days). Indeed, you have given me a lot to think about. I have gone back to McGill's book, and have been reading some other papers regarding the impacts of specific exercises on the spine. While I find your theory interesting (i.e., that atrophied discs are more susceptible to injury as opposed to healthy discs), I am having trouble finding agreement in the literature. Intuitively, it makes sense that a body that isn't being used or challenged regularly, should be in a relatively weakened/atrophied state, but when it comes to discs specifically, the science suggests that damage is incremental and occurs over time (from repeated flexion/extension moments). Furthermore, it seems that "younger" and presumably healthier or better hydrated discs are more likely to rupture/herniate than "older" discs. Another concept that I struggle with is the fact that I am not in practice, and I am inclined to think that although the theoretical knowledge is valuable, the hands-on day-to-day work with patients may tell a different (and perhaps more accurate?) story. As you mentioned, you have been in practice for many years and have seen many patients. I suspect that with the culmination of these experiences, you begin to notice patterns. You discover what works and what doesn't. All of this is very interesting to think about and I hope that by participating in this type of dialogue with an experienced practitioner such as yourself, I will be able to figure out how I can best help my future patients (hopefully with aspects of CrossFit). For now, I am still reading, thinking, reflecting, and looking for any pearls of wisdom I can manage to acquire. Thanks again for sharing your thoughts!
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Old 07-02-2009, 03:06 AM   #16
Bill Houghton
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Re: CrossFit Chiropractors?

Christine,

If you get a chance to check out Dr. James Chestnut's books or articles, you will find a wealth of support for the atrophy/degeneration model I suggested. You can Google him.

Bill
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Old 07-09-2009, 11:33 PM   #17
Andy Abele
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Re: CrossFit Chiropractors?

Hi all. Glad to see so many DC's in the CrossFit community. I'd like to first say that my intention is not to offend anyone, but I do have a slightly different opinion than most of the folks posting here. So if you don't agree with me, don't be offended. It's just my opinion and you're entitled to yours, as well. Who's to say who's really right? Certainly not me.

Our profession seems to have a bit of an identity crisis. Take for instance the topics brought up in this thread: joint mobilization, disc herniations, having PVC pipes in the office, rehab, etc. None of this is chiropractic.

Breath in... Breath out... It'll be okay. There's still a big job to do as a chiropractor practicing real chiropractic. You see, there's nothing unique about joint mobilization to "improve" range of motion when a chiropractor does it verses when a PT, or DO, or MD does it. In fact, people have been doing joint manipulations based on palpation way before chiropractic was ever around. And guess what, some of those other professionals out there know quite a bit more about spinal biomechanics than most chiropractors. For instance, someone rightfully mentioned Dr. Stu McGill in regards to spine health. Notice that he very much IS the right person to reference, yet he very much is NOT a chiropractor. When it comes to general spinal hygiene, a well educated sports physiologist or someone with a degree in kinesiology will probably be a better choice. And when it comes to rehab and physical therapy, do I really have to say that someone trained specifically in PT would be a better choice? By the way, how PT's aren't up in arms about chiropractors doing physical therapy, I'll never understand. Conversely, every time someone touches the spine, chiropractors have a hissy fit and file law suits. Double standard?..

Furthermore, this is not a matter of simple opinion or philosophy. This is a matter of legislation. In it's infancy, chiropractic survived countless legal battles with the medical community (who were already doing joint manipulation for therapeutic reasons) based on one simple fact; what chiropractors were doing at that time (less so nowadays) was separate and distinct from therapeutic manual medicine. We survived because a few people were able to prove in court that chiropractors had a job to do that no one else could do (this remains true today). That job is to find objective, scientific evidence of a vertebral misalignment causing irritation to the central nervous system, to adjust to correct that condition, and to then establish objective, scientific evidence of a successful correction. That's all. And when that service can be provided skillfully, wow! Some really amazing things happen. Truth be told, real chiropractic is hard. Extremely hard. It's a lot easier to palpate, manipulate, hear a crack, and say "job well done" with out any real clinical evidence that the patient is better off. It's time we be honest with ourselves and recognize that "muscle testing", palpation, leg checks, and even ROM are not objective measures of nervous function. Real chiropractic requires some form of objective measures of autonomic nervous function to justify the adjustment, and finally to determine when an adjustment was successful. The bottom line is that "chiropractic" without clinical consideration of nervous function is not chiropractic.

So once again, what's unique about a chiropractor doing that verses a PT, DO, or MD? Many chiropractors may be making claims of reducing afferent bombardment, improving proprioception, etc., etc. The problem is that chiropractors aren't the only ones claiming this afferent model. If that's all there is, there's no need for the chiropractic profession to exist. Some in our profession might say, "well, no one can move bones like a skillful DC," as though that's an excuse to claim a new profession. Bone-setters have been around way longer than chiropractors. Just because we spent the majority of out time refining the methods of other professions, doesn't mean we have the right to claim it as our own. The only thing that chiropractors can claim is the right to correct irritation to the central nervous system caused by a subtle vertebral misalignment, as proven by clinical evidence. Without hard, clinical evidence, all you have is good intentions, and that's just not enough.

So I say, "come on"! Let's REALLY take the CrossFit model to our practices! Glassman didn't try to be the "be-all and end-all" of the CrossFit instructors. He brought in people who were the tops in their respective fields and let them do their thing: Tate for powerlifting, Bergener for olympic lifting, some other dudes for gymnastics, rowing, running, and some guy was even brought in to teach the jump rope for crying out loud! Let's apply THAT model to our chiropractic practices. Let's let CrossFit affiliates keep the PVC pipes. Let's let the PT's keep the stretchy cords and "bio-freeze." Let's let the DO's do their thing. But let's do the job that no one else can do. Let's do real chiropractic with real consideration of nervous function, and nothing else.

Thanks for reading.

Last edited by Andy Abele : 07-09-2009 at 11:37 PM.
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Old 07-11-2009, 04:54 AM   #18
Bill Houghton
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Re: CrossFit Chiropractors?

Andy Abele wrote: "Our profession seems to have a bit of an identity crisis. Take for instance the topics brought up in this thread: joint mobilization, disc herniations, having PVC pipes in the office, rehab, etc. None of this is chiropractic." "The only thing that chiropractors can claim is the right to correct irritation to the central nervous system caused by a subtle vertebral misalignment, as proven by clinical evidence. Without hard, clinical evidence, all you have is good intentions, and that's just not enough"

Andy, I tend to agree with you here. I am not sure you can do anything to a vertebra without an effect on the muscles, discs, ligaments, tendons, vasculature, etc... How long can a spinal joint be subtly misaligned before there is a change in the tissues associated (discs, muscles, tendon, ligs, vasculature)? Are you saying we can isolate our focus to the bone and the nerve only? If there are degenerative changes/atrophy developing in a spinal segment isn't there always going to be nerve irritation? Work on a rat model at Palmer pretty convincingly shows habituation/increased afferent activity with mechanically induced joint restriction. They were able to look at the first synapse in the cord of the mechanically restricted segments and found increased size of the neurotransmitter sites in every case. This is basic science. Our clinical science has been strong for our entire existence. The difference between clinical and basic science was explained to me as the black box model. People go into the chiropractors office (black box), the chiropractor does something to the patient (basic science) and when the patients leave the office, they report reduction/elimination of pain, improved function, better mental capacity, etc... (clinical science). We ARE getting stronger in our basic science. I think you will see in our lifetimes some pretty strong evidence to support some of our working models of subluxation, nerve involvement, etc... The basic science work does a wonderful job of shedding light on the mechanisms by which our clinical results have been obtained.


Thanks for contributing to the post.

Regards,

Bill
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Old 07-15-2009, 01:12 PM   #19
Justin Springer
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Cool Re: CrossFit Chiropractors?

Hey everyone,

I am glad I found this thread, I am in my senior year of my undergrad and will start chiro school next fall, either Bridgeport or Life (haven't decided yet). I am also a level 1 trainer. I have a vision of opening a chiro practice in conjunction with a crossfit gym, because I too agree they can work together nicely.
Bill I saw that you were working on this same concept, I would be very much interested to hear about how you put it all together and what your clients/patients are saying about this approach. Also, if there are any other models/approaches to this concept out there that you all may know about please let me know, I would love to see how others are doing this.
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Old 07-15-2009, 03:27 PM   #20
Bill Houghton
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Re: CrossFit Chiropractors?

Justin,

I can hear your enthusiasm - its great. I initially opened up some space in my office, brought in PVC pipe, had some sandbags made but slowed down at that point. I decided I couldn't get to where I wanted using my office space. We have wood floors and 8' ceilings. So now, another level I trainer and I are opening up a box together. That way I can have patients report to the gym as part of their rehab and "require" them to attend an intro session to learn about the connection with health and fitness. I believe they will get very enthusiastic about the possibilities and sign up to be clients at the gym. I see it as a win/win/win.

Keep in touch.

Bill
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