S01_E18 - Sit up straight! We're Talking to a Chiropractor...

Speaker 1: 0:03

Welcome to the healthy matters podcast with Dr. David Hilton, primary care physician and acute care hospitalist at Hennepin healthcare in downtown Minneapolis, where we cover the latest in health healthcare, and what matters to you. And now here's your host, Dr. David Hilton.

Speaker 2: 0:20

Hey everybody. It's Dr. David Hilton, your host of the healthy matters podcast. Today. We're gonna talk about chiropractic care. Have you ever wondered what happens in a doctor of chiropractic's office? What conditions do they see? What can you expect? Well, I have an expert on the subject with me here in the studio today to talk about it. Dr. Rick printin is a chiropractor has been a colleague of mine for more years than I can remember. And he's gonna help us out with that topic, Rick. Thanks for being here.

Speaker 3: 0:46

You're welcome, Dr. Hilton. Good to see you. It's

Speaker 2: 0:48

Great to see you too. So you're a doctor of chiropractic care. What are the common things you see in, in your practice?

Speaker 3: 0:54

In order? The most common are back pain, low back pain, middle back pain, followed by neck pain and then headaches. Those are the big three that we commonly see.

Speaker 2: 1:02

So I also, in my primary care practice, I see a whole bunch of back pain, tons of back pain. I feel a little at a loss, knowing what to do. I don't have your skill set in the anatomy of the body, frankly, and what to do about it. So, you know, what do I have? Well, I got pills. I got that. What can someone expect when they come to your office? Having had back pain for months or years, even.

Speaker 3: 1:24

Sure. So what the typical experience we'll take a history, we'll find out. How did you hurt yourself? Did you sleep wrong? Did you bend and lift something? Did you fall? Was there some sort of trauma involved? So we'll try to get that history. And then at Hennepin healthcare, we've got the access to all the different types of treatments that they've had. Like, say, for example, if you prefer a patient, I can see your assessment and find out what happened. Uh, we'll examine them, go through motor sensory reflex evaluation range of motion. We'll feel the back for spasm challenge, the joints. In case we have to do a mobilization or a manipulation to the joint or to the spine, set up a treatment plan, uh, arrive at a diagnosis order, any imaging that we need and then start working them, usually a series of four or six sessions.

Speaker 2: 2:04

And your practice is embedded in the same place where I work. You're in this big eight city block, major urban hospital campus. Your practice is right here, uh, commingling with everybody else, with physical therapists, with acupuncturists, with surgeons, with primary care doctors like me. How do most people get in to see you? Are they referred or do they come walking in off the street?

Speaker 3: 2:27

Both. But the great majority it's about 90% now are referred from the providers within Hennepin. So from primary care, the different specialty cares refer and about 10% tend to find us through their insurance.

Speaker 2: 2:38

Tell me about how, you know, nothing's a hundred percent effective. How effective are the treatments you have? And I'm asking you to like self critically, look at your practice. How effective is it at treating back pain?

Speaker 3: 2:48

We think quite effective. But what we'll do is we know, I know, you know, doing this for 30 years, that within six sessions, I can either help someone or not. But the beautiful thing at Hennepin is we have so many different resources. I've got acupuncture, I've got physical therapy. I can referral for some massage therapy. We've got all the different, maybe even psychotherapy. If a, if a patient needs that we've got yoga therapists that are, that are physical therapists, we've got Tai Chi and Chi gone type of treatments that the integrative health, physical therapists work with. So many different types of treatments. So if I'm not affected, we can call on someone else.

Speaker 2: 3:23

What causes. Now this is a big general question. What causes back pain. Okay. So I get it. If somebody broke their yeah. And listeners probably understand if you break your a bone or something that hurts, but the, the kind of the chronic back pain what's going on in the human body there,

Speaker 3: 3:35

Posture is the biggest underlying.

Speaker 2: 3:37

I thinks a lot.<laugh> cause right now I'm sitting like I'm slouching down. I got my coffee in one hand. My feet are about six feet in front of me and I'm all slouching down and you're sitting perfectly

Speaker 3: 3:46

Posture is one of them. That's the, one of the biggest underlying

Speaker 2: 3:50

Calls. Okay. Don't mind me while I sit up straight now. Really? Okay. Say more about that. Yeah.

Speaker 3: 3:54

So our, our spine, as you look at it from the side has a normal S shape curve. And as we sit all slumped over, like you were describing, yeah. The head pushes forward and our back turns into more of a C than an S. So what that does is it separates the spinal joints and puts them under stress. And then it squeezes the disc from front to back and pushes that disc material that's mobile, backward and hits the back of the ligament that can generate pain. So

Speaker 2: 4:18

It's more like a C than an nest. So I'm envisioning that. And I, I, I look at a lot of x-rays in people's spine, so I get that, but for a listener. So if you're looking at the side from your neck down to your tailbone is a C that bulges backwards.

Speaker 3: 4:31

Correct? So as you look at you from the side, normally we should have the ears over the shoulders, shoulders over the hips, a little indent in the lower back, as well as the neck.

Speaker 2: 4:41

That makes perfect sense. I like how you've just explained that to me. And I'm probably super guilty of that. Okay. My wife is gonna probably be listening to this and she's gonna say, she's convinced my wife, Julie is convinced that it's not too long of a future. The human species is gonna have a curvature of their head looking forward, because we're always hunched over our cell phones. Can you comment on that? Is that a thing, you know, people are texting on their phones and they're always looking down. If you walk through the hospital hallways, this isn't a great thing, but you'll see a lot of people walking and texting and looking down, or they're reading the paper. I don't know what they're doing on their phones.

Speaker 3: 5:15

Comment

Speaker 2: 5:16

On that. If you would there, doctor

Speaker 3: 5:17

It's called tech neck and tech neck tech neck. Yeah. Yeah. There's a name for it. There is. There is. And the head is Judd forward an inch, two inches, five inches, six inches. The chin is on the chest, which just pinches that area of the neck to the upper back region. It's one of the major causes that we're seeing of neck and back pain. And then also there's C epidemic back pain, you know, we're much less active. So we're laying on the couch. We're streaming. I don't know how many episodes of whatever your favorite is. And then we're finally say I gotta get up and move. And then we run our exercise. We heavily after being couch potatoes for two years. So

Speaker 2: 5:50

You kind of describe my last two years there.

Speaker 3: 5:52

Right? But the technique is a real thing with, that had been forward. We see a lot of that. So you can imagine the middle back muscles are all pulled apart and separated and the chest muscles become tight and the neck muscles become tight. Cuz again, we've got that C type of curve. Look to us.

Speaker 2: 6:06

What tips do you have for people to a avoid tech neck and uh, B if you've got I'm I'm so tense in my trapezes muscles, the ones here, the big ones under your shoulders, how do you avoid it? And what can you do about it?

Speaker 3: 6:19

We try to explain just what we're doing right now. Try to explain this is what's happening. And I've got some models in my room and some posters of what proper looks like. And then most people are rounded forward. So I'll put them into that proper positioning. And sometimes it's a little tender or sore because their bodies already adapted to that sea shaped curve. It's just a lot of work. It's a lot of hard work. There aren't really any gadgets or support that you can use to help. You've just gotta work at it. But most people are pretty smart. You can lay out what needs to happen and slowly work toward it. There's no magic bullet. People are pretty responsive to try it.

Speaker 2: 6:51

Is there a way to stretch your, you? We always say, oh, you gotta stretch. You know, I tell people that all the time, be active, walk, do your things. And then I always say, eh, you should stretch, but it sounds sort quaint. Does it? How do you stretch your neck muscles? And is it helpful for people to

Speaker 3: 7:05

Try that? It absolutely is. And how do you do it? So if you can imagine sitting up very straight and then like, someone's gonna push their hand into your face and you're gonna pull it backward. And as you pull it backward, you can lift your head upward, which will help try to restore the curve of the neck. Also, we talk about opening and pulling the shoulders backward, opening up the chest and squeezing the shoulder's

Speaker 2: 7:27

A proud chest. Kind

Speaker 3: 7:28

Of like the proud chest. Exactly.

Speaker 2: 7:29

I'm doing it right now. So, but when you pull your neck back that doesn't look attractive.

Speaker 3: 7:33

It does. And you should probably do that in the privacy of work.

Speaker 2: 7:35

Yeah. You've got four chins<laugh> right. So, but that actually is a, a I'm hugely cause my, one of my kids even said when we were driving one day and she says, dad, your, your head like sticks forward. And I think that, you know, I'm, I'm super guilty at this. Do you see bill in the clinic for that? Or is it mostly lower back?

Speaker 3: 7:52

Neck is secondary, but lower back is primary, but it's probably, percentagewise 55% to 45%. So it's really close, really close. And neck pain is actually increasing as time goes on.

Speaker 2: 8:02

We've been talking with Dr. Rick print and he is a chiropractor here. He's a friend and colleague of mine for many, many years at Hennepin healthcare in downtown Minneapolis. We're gonna take a short break, but when we come back, I wanna talk about a couple of topics. I want to hone in a little bit on low back pain, uh, cuz it's so common and what people maybe can do to prevent it and what they might expect when they come to your clinic. And then I'd like to ask you to comment on how chiropractic care fits into our larger systems of healthcare. So we will do that right after this short break. So stay with us.

Speaker 1: 8:32

You're listening to the healthy matters podcast with Dr. David Hilton, have a question or a comment for the doctor become a part of our show by reaching out to us@healthymattersathcmed.org. Or give us a call at six one two eight seven three talk. And now let's get back to more healthy conversation.

Speaker 2: 8:52

We're back. We're talking to Dr. Rick printin, a chiropractor here at H in healthcare, low back pain. So Rick, you said that's probably the number one thing you see in the clinic. First of all, before we talk about what you would do in your practice, we talk people through that. Is it inevitable? It's so common. How does one prevent low back pain?

Speaker 3: 9:12

Low back pain is almost inevitable. As we were walking up on two feet and two legs. There's a tremendous amount of stress that comes down in the lower lumbar, low back vertebrae in the sacrum and the ileum or the supporting structures of the pelvis. So it's almost inevitable. I think there's very few people that I've ever talked to that have never had an episode of low back pain. So prevention is really movement and exercise and correct posture again with the correct posture, it starts with supporting your lower back with a pillow or a chair to maintain the normal, lower doses or a lower dose.

Speaker 2: 9:44

Yep. Why is it called lower doses? I know that's a little side side note, but

Speaker 3: 9:47

Yeah, I think it is a Latin term. Yeah. Okay. But it's just the, the normal curve of the lower back. But if you can have that supported, that's where it all starts and then try to avoid the bending and lifting, you know, with straight legs, try to squat. As you bend and lift, maintain the normal curves of your back. As you're bending and lifting, we talk about keeping the nose and toes in line. Try not to twist the spine too much when you bend and lift in the office, you know how we look at it and how we care for it. I'll take a history and try to find out how you did it. And they don't know. Yeah. Sometimes you don't, sometimes people just wake up with pain, but usually we can talk about that, that, oh, you know what I did, I, I drove up to Duluth and I golfed on the weekend. Oh, I had this really hard hit and felt a twinge. And that I drove back then my back was sore, but sometimes people sleep wrong. They'll sleep in a folded up position and they can pinch a joint or irritate something in the back. So sometimes it is pretty insidious most of the time. There's a reason though. But then we try to arrive at a diagnosis. What cause it, is it a disc problem? Is it a joint problem? Did you pull a muscle? Most back pain goes away in two weeks, but it's those that hang on. It's about 80% that typically go away. But if pain persists or comes back again and again, then we wanna try to find the cause of it.

Speaker 2: 10:55

Is there a role for x-rays?

Speaker 3: 10:57

Absolutely. If there's any sort of trauma involved or if there's, um, oh, immunocompromised patients or heavy steroid use that type of thing. And then again, the beauty working ahead, uppin is most of that's been done beforehand and most of the referrals come from primary care. So I'll just message back and say, Hey, I'm thinking, you know, they've got, uh, this type of situation going on. I'd really like to see what's happening. The big one is MRI scan. Yeah. If they had a situation going on for a while, where you suspect an infection tumor or a disc lesion, we really wanna see what's happening in

Speaker 2: 11:28

There. So do you like it when people come with their MRIs already done?

Speaker 3: 11:31

I do. Yeah, I do. I always

Speaker 2: 11:33

Struggle with that about when to order an MRI because everybody wants one on the day after they hurt their back. You know, I was shoveling snow. We're here in Minnesota. I was shoveling snow and I really hurt my back and it hurts a whole lot. I can barely move. And I generally tell people that, yeah, yep. I believe you. But I don't get an MRI then because you know, that happened yesterday and it's, unless there's a warning sign for something significantly bad, but for someone who's had it recurring or, uh, significant back pain that doesn't go away after weeks or months, I often do then get an MRI that probably helps drive what you do. If you have that, if it's a neurologic thing versus a bony thing versus a muscular thing, doesn't it?

Speaker 3: 12:10

It absolutely does. And one of the hardest conditions to work with the stenosis or narrowing of the spinal canal, and it can either be in the middle or when the nerves exit off to the side, those are really challenging to try to work with because it's a bony compression in that we really have to have an x-ray to see what's happening typically over age 55 or 60 is where we'll. We'll see that.

Speaker 2: 12:30

So talk to me about what I might expect when I'm on your table. Sure. What are you gonna

Speaker 3: 12:34

Do? Sure. So what we'll do is assess to find out, okay, what's happening here. And if it is a joint problem, meaning like you can turn full 45 degrees one way, but only 10 degrees the other way, you know, why is there a muscle that's so spasmed up on that site? Or is there a joint that's blocking that area? And if it's a joint blockage we'll get in, I'll let you face down a, have you do a series of some back bend, stretches and exercises, push against it. I may lay you on your side and mobilize or work the joint almost like you'd hold your finger and kind of wiggle it back and forth, you know, kind of get those joint motion happening again. And joint restriction will come from, oh, like we talked about again, the posture or from past injury where wears down the pad in between the joint. And it becomes very sticky and very tight and it adheres together. Then we avoid the movement because there's pain or pain avoidance type of individuals, but we've gotta eventually start getting that area moving again. Otherwise we have asymmetric movement of spine.

Speaker 2: 13:25

Can you feel that with your hands, can you feel a tight joint or a muscle that is asymmetric from the other side?

Speaker 3: 13:32

You really can. Yeah. It takes some training, but that's what we're trained to do. And, and we, we can,

Speaker 2: 13:36

Yeah. So then do you manipulate those joints? What does that mean?

Speaker 3: 13:40

Yeah, we will. If it's indicated it's a, we call it a cavitation or like a little pop or the crack of the joints. Some people will feel, and it's just air escaping out of the joint, but we don't have to cuz you can mobilize or move the joint and get just to the same outcome as a manipulation.

Speaker 2: 13:55

So speaking of training, you said you're good at this, you know, you've got special training. What did you have to do to train, to be a chiropractor?

Speaker 3: 14:00

Sure. So I got my undergraduate degree from St. Thomas years ago, Becca was in the college of St. Thomas now the university and then four years of chiropractic school. And the first two years of chiropractic school were more of all the basic sciences. And then after that, it was more training towards spine related conditions and issues and problems and how to treat them.

Speaker 2: 14:17

You mentioned earlier, you listed off 3, 4, 5, 6 other types of health professionals that you have available as your colleagues, uh, in our healthcare system. Can you talk for a bit about how chiropractic care fits in the larger scheme of healthcare? I think a lot of people would be interested in knowing that.

Speaker 3: 14:35

Sure. So we at Henman, we're up on the third floor, it's the neuroscience area. So we're acupuncture chiropractic and physical therapy in our wing, just on the hall is neurosurgery our fantastic neurosurgeons. We've got our TBI traumatic brain injury, our PM and I, our physical medicine rehabilitation and then all the therapies, occupational physical therapy and um, all the other speech therapists all within the same area. So the way chiropractic fits in, I, I can give you an example of a case I just saw today. If you don't mind do

Speaker 2: 15:03

That. Yeah, that'd

Speaker 3: 15:03

Be great. Okay. So the example was, uh, non-English speaking gentleman, just a wonderful gentleman that unfortunately was getting out of his car and another vehicle came past and struck his left leg. So much trauma. He was taken to, uh, Hennepin here. And unfortunately he lost his leg, but as an amputation above the knee, which is very

Speaker 2: 15:22

Challenging, that's challenging. That's high up. Yeah.

Speaker 3: 15:24

High up. Exactly. So he went through all of his therapy, all of his gate training. This happened in 2016. And so it's been several years ago that this happened and he just went back to orthopedics, um, where he initially started with and had back pain that was getting worse and worse over the last six months, they referred him to me. Then I'm also gonna bring in acupuncture, get him back to the gate therapist and get him back into physical therapy so he can have a multimodal approach. And then lastly, he's going back to his pain specialist for any medication management or if he needs a spinal or a joint injection. So it's a whole team that's gonna be working with him.

Speaker 2: 15:59

I can't actually describe a better system than you just did.

Speaker 3: 16:03

It's fantastic. Just to be involved with the people, uh, that are working. It's just, it's just amazing. It's really,

Speaker 2: 16:09

How did you land here?

Speaker 3: 16:10

That's a great story. It was, oh, I had my own private practice for 13 years in St. Paul and I worked real closely with our medical group in St. Paul years ago. And I knew I didn't wanna do this all by myself. There were four of us that were working together in the office and uh, this opportunity a woman named pat cull had what was called the alternative medicine clinic 30 plus years ago, acupuncture only. And she is looking for a chiropractor. So she interviewed, I interviewed her, we talked and I started on a trial basis because they weren't quite sure if they wanted chiropractic here 21 years ago or 23 years ago. I'm sorry, but we did. And it's, uh, grown since then. We now have eight chiropractors, eight acupuncturists and seven holistic physical therapies and six different clinics that we work with.

Speaker 2: 16:51

That is awesome. I happen to know the person you referenced, pat callin. She was a pioneer in developing, uh, this practice here at Hennepin healthcare. She really was. And um, and it's going strong to this day with you and your colleagues. So let's shift gears a little bit, um, Dr. Print and talk about headaches. I've talked about this with so many patients. I've talked to other people, even on this podcast about the treatment of headaches, what role does chiropractic care have in the treatment of

Speaker 3: 17:18

Headaches? So first of all, we have to try to identify which kind it is. And we love the referrals from primary and especially neurology because they've already differentiate, diagnosed a lot of the nasty type of things. It's

Speaker 2: 17:28

Not a brain tumor in there or something,

Speaker 3: 17:29

Not a brain tumor, you know, not an aneurysm, that type of thing. So usually we'll see, uh, tension headaches, but tension headaches can be mixed in with migraine. Migraine is really challenging to try to get rid of. It's a, it's a multi cause approach, but usually people with headaches have a lot of tension in the neck and the upper back area. And there's a little nerve called the greater exhibital nerve at the base of the skull. And if we sit and again, that part

Speaker 2: 17:53

You're really gonna make me think back through my neuro anatomy class. I think it was sick that day<laugh>

Speaker 3: 17:58

So the greater exhibital nerve is at the base of the skull. And if we sit in that slouch position, the skull will rock backward and then irritate that nerve and then muscle will spasm up around it. So a lot of times it's self traction, manual traction, mobilizing stretching the neck, doing tissue work and doing some of these exercises. Now that we talked about earlier, do

Speaker 2: 18:16

You have the strongest hands in the world?

Speaker 3: 18:18

<laugh> they get tired? Believe me at the end of the week, usually by Friday, I could

Speaker 2: 18:22

Really? Yeah. Cause I can imagine that I I'm still on headaches here, but you know, you got the back of the head here thing and, and I can imagine you, you know, I've got this picture in my head of somebody lying on a table and like you're pulling their head out yeah. Or something or trying to loosen up those muscles or mobilize those muscles. Is that what

Speaker 3: 18:35

You do? That is what we do. Yeah. Yeah. And, uh, we see patients about every 20 to 40 minutes if it's a new or an existing patients and yeah, we do, but it, uh, we get through our day in, we, we do just fine.

Speaker 2: 18:46

You have to go see one of your colleagues then to, to manage the problems that develop from UC and other patients maybe

Speaker 3: 18:52

Believe us. So we have self-care yeah. Within our group, absolutely

Speaker 2: 18:55

Shift a little bit of, of gears here about safety. Cause uh, patients always want rightfully so, uh, there's a risk and a benefit to everything that's done in healthcare. There's nothing that has perfect benefit and there's nothing that's completely risk free, but chiropractic care is as far as I know, a very safe, uh, modality, what are the risks of chiropractic treatments that you do? And uh, how do you minimize those?

Speaker 3: 19:17

Absolutely. So there are risks whenever you touch someone or put your hands on without a doubt. Right? Right. So what we do is look at the osteo person and really careful with them. So what we would absolutely do, no manipulation, we just people

Speaker 2: 19:30

With weak

Speaker 3: 19:30

Bones, people with weak bones, correct. Yep. So we do more stretching and that type of thing with them, a lot of instruction, almost like a physical therapist would do in the, in the office, uh, for people with other strokes, we don't wanna do any neck type of manipulation or movement. There's an artery that runs through the neck, up into the brain. So we're very careful with that. Anybody who has dizziness, uh, they call it a thunder clap, headache or headache that develops just out of the blue, really cautious with them. And luckily we've got our neurology clinic right down the hallway or urgent care we can send them to. So there's always an inherent risk whenever you touch on, we try to minimize that through the history, looking at the chart and just talking to the patient. What

Speaker 2: 20:10

About when people have neurologic symptoms with their back pain? Um, I don't know if I get through a day's clinic in primary care, without somebody talking first about their low back pain, but some of them with low back pain, that pain shoots down their leg. It's, you know, sciatica, sciatic, pain, big, huge bundle of nerves that go from your lower back, down all the way to your tootsy toes. That's a neurologic thing, the nerves getting pinched or whatever. What, what do you do in that situation?

Speaker 3: 20:41

Those are great cases that I love to work with. And we partner usually with our neurosurgery or our PM and our team with that. So typically first of all, you have to find out if it's a herniated disc or if it's that stenosis that we are talking about. And usually it's 90 plus percent of the herniated discs don't require surgery, but sometimes they do, if they have foot drop, if they have a thing called co equina, which is compression of the spinal cord causing really nasty symptoms into the groin and down the legs. But we talked a little bit about, you know, when should you order an MRI or how do you, what do you do the ordering of the MRI? There are some standards where greater than six weeks, uh, progressing symptoms, pain, that's, uh, unrelenting foot drop. You know, that type of a thing.

Speaker 2: 21:24

If your foot, if the toes of your foot are dropping down and you're hitting it on the stairs, when you walk for

Speaker 3: 21:29

Instance, correct, or you can't go up the stairs, if there's muscle atrophy where the muscles are weakening, but specific treatment, we can partner with our, our medical, um, colleagues sometimes they'll do, it's called a med dose pack or a steroid burst in order to try to shrink some of that inflammation that's happening. There's special exercises lying in your side, lying in your stomach that can really help that low back disc herniation. So we reinforce those exercises. We don't do too much manipulation over the herniated just cuz it's so sore anyway, but we use, uh, little gentler techniques and then traction. And then our physical therapist here at hen been have traction devices that really respond well to the, is

Speaker 2: 22:06

It like sandbags?

Speaker 3: 22:08

It's not like sand, but there's a table that slides or moves back and forth really much more motorized now. Yeah. Yep. Yep.

Speaker 2: 22:13

You know, like hang a bag of sand off somebody's leg or something and do

Speaker 3: 22:17

No, no, no, no. If you don't wanna do that,

Speaker 2: 22:18

People, people think traction, they probably thinking of these like medieval devices, you know, and it's not that bad. Huh?

Speaker 3: 22:24

Not that bad. It's a motorized device. That's you're you are strapped in, but it's very calculated.

Speaker 2: 22:28

Yeah. Yeah. It's it's the rack.

Speaker 3: 22:30

<laugh> the rack.

Speaker 2: 22:31

It's not the rack. You mentioned a few things that I do wanna make sure listeners, um, have heard about the warning signs for when you have low back pain. And you mentioned some of you mentioned caught Aquina syndrome, caught a, um Aquina is ho it looked cuz the nerves down in the spine in your lower spine that your spinal cord kind of turns into little fibers, doesn't it sort of looks like the tail of a horse. Yes. And so if you, if you have that damage to those areas, you can get foot drop or you can get in incontinent of your bladder and your bowel and, and those are, those are warning signs that you, you listeners you do need to go seek care immediately. I, I Al also add if you are a cancer patient that has new, low back pain or any of these neurologic symptoms, another warning sign. So listeners, um, uh, make sure you know that if you're getting those new neurologic symptoms, especially if you're a cancer patient, um, but otherwise Dr. Print and his team are the, are people that you can go see and get some good relief, um, for your low back pain. Rick, would you have time for a couple of questions from

Speaker 3: 23:30

Listeners? Absolutely.

Speaker 1: 23:32

Okay. So we got this question from Kim in St. Paul. She says I was playing tennis last weekend and in a twisting motion, I seem to have pulled something in the inside muscles of my back. How can I go about getting relief for this? Is it better to start with ice or with heat? Thanks

Speaker 3: 23:48

Advice is ice for sure start with. And usually those type of conditions will resolve within a couple of weeks, but if they persist, you've already given it a week. If it persists more than two weeks, the chiropractic evaluation would be, would be absolutely, uh, recommended in that situation, especially, uh, tennis. It's a, it's a twisting type of emotion of the back. So you could have strained or you rotated a joint in the back. You

Speaker 2: 24:08

Said a twisting motion. I've seen that so many times and there's so many ways that can happen shoveling snow when you're like leaning down, you're not bending your legs at all. Then you twist to throw heavy snow.

Speaker 3: 24:19

Yes, absolutely. You can kind of see the physics involved, how much pressure is applied to the spine when you're have a weight on the end of a shovel and you're twisting and turning, and you're doing that a hundred, 200, 300 times. So the repetitious amounts of doing that, just strains it irritates and sprains the joint.

Speaker 2: 24:34

So to summarize that you would start with ice

Speaker 3: 24:36

Yeah. Start with ice for sure. And then there are some stretches that can work in the stretches that I love. There's a physical therapist called Robin McKenzie in it's McKenzie type of therapy, stretches that are really effective for those types of back issues. Um, and it's typically lying on your stomach and gently going backward to try to bring those joints back together. Nice and easy, relatively pain free.

Speaker 2: 24:58

So the McKenzie Institute, that sounds like a great tip. We'll put a link to that in the podcast description onto the next question.

Speaker 1: 25:04

And we got another question from Dave and Egan. He says, I have trouble lifting my arm above my head. On one side, I can't put my finger on a particular injury, but it's been sore for about six months now. And I'm not seeing much improvement. I'll likely be going in for an evaluation. But curious if you had an opinion as to what might be going on,

Speaker 3: 25:22

Shoulder injuries are really challenging to work with. And usually we look first toward the rotator cuff muscle. It's a, it's a series of four muscles that hold the joint in place. Typically it's an overuse situation where there's so much work going forward that the, the ball of the shoulder actually rolls forward. Slightly. The muscles in the back of the shoulders become weak and, and the front of the tendons become impinged and irritated. So you can have a bursitis tendonitis type of situation, but it takes a long time for those soft tissues to heal. And we really have to rehabilitate it with, uh, strengthening of the back of the shoulder muscles.

Speaker 2: 25:56

Do you think Dave will ever be pitching in the world series?

Speaker 3: 25:59

I don't think so though. Depending on his age

Speaker 2: 26:01

He might be, but I, I I'm glad that question was asked because that after back pain might be, um, really common in my, my practice people in it's months after months after months. And they're, they're struggling to, um, to get better, those connective tissues, those tendons, those muscles don't just heal instantly. Do

Speaker 3: 26:19

They, they take a long time and it's probably one of the most frustrating type of diagnosises to give someone and, and the rehabilitation on it is long and slow. And you really have to take your time. They will take three to six to nine months to a year to come around, but you have to stick with it. Yeah.

Speaker 2: 26:33

That that's such a key point. It, you stick with it. It can take a while. I often tell people think of the miraculous range of motion in your arm and what the human shoulder is capable of doing. You can, some people can throw a baseball a hundred miles an hour, but the rest of us can, um, comb our hair and we can golf and we can play tennis and we can do all the things we can do because your shoulder can move in so many planes of motion. It's just like an incredible joint, but it's incredibly complex.<laugh> very complex. Yeah. And it takes a while to heal. So I often tell people be patient. It might be a year, you know, and they look at me like say what the shoulder's gonna hurt me for a year. And I go, it might, it might, but<laugh>, but we'll, we'll work on it together. So that's a great question. I appreciate, uh, Dave sending that in and thank you Dr. Rick print and for being on the podcast today. Oh, you're welcome. Dr. Hilton. My pleasure. I appreciate you being on the show. You've given us lots of really good tips. I've learned something as always listeners. Thank you for joining us for this episode and keep your questions and comments coming, and we will get to them on a future episode. And if you're enjoying the healthy matters podcast, please leave us a review. Tell your friends and subscribe. I hope you'll join us for the next episode and in the meantime, be healthy and be well.

Speaker 1: 27:44

Thanks for listening to the healthy matters podcast with Dr. David Hilton. For more information on healthy matters or to browse the archive, visit our website@healthymatters.org to catch all the latest from Dr. Hilton and the healthy matters podcast. Follow us on Twitter at Dr. David Hilton. Finally, if you enjoyed this podcast and would like to support us, please leave us a review and share the healthy matters podcast with your friends and family. The healthy matters podcast is made possible by Hennepin healthcare in Minneapolis, Minnesota, and engineered by John Lucas at highball executive producers are Jonathan Koto and Christine Hill. Please remember we can only give general medical advice during this program. And every case is unique. We urge you to consult with your personal physician. If you have more serious or pressing health concerns until next time, be healthy and be well.