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The Loneliness of the Injured Doctor aka The Psychology of a Headspace Conversation by Someone Who Knows Better

As a principled chiropractor, I walk a fine tightrope on a daily basis between two worlds: mechanism and vitalism.

Patients usually present to a typical* chiropractic office complaining of one of two conditions, chronic non-specific mechanical (CNSM) neck pain and/or back pain. From time to time, patients present with headaches, shoulder pain, knee pain and assorted muscle aches. These conditions represent, by some estimates, 70% or more of the conditions accounted for in primary care office and ED presentations around the country each year, so it’s not surprising that folks would look to a DC to address these issues quickly and efficaciously.

No doubt, chiropractic care is a phenomenal band-aid as an essential treatment for CNSM back and neck pain in short doses. The average chiropractor can ameliorate back pain in <6 visits…when no other primary diagnosis will fit. Will this so-called ameliorative, i.e. small dose, short-term chiropractic care fix the problem? No freaking waynor will so-called “wellness” or “maintenance” care unless the cause of the problem has been identified and corrected. The bitter irony here is that a chiropractic adjustment, when performed by a master chiropractor, digs so much deeper than the neurological mirage known as pain. Stay with me.

To understand why – and furthermore to understand where I’m going with this – we have to first understand the neurology of pain. In the early 1980s, awash in research from the likes of scholars like Michael Merzenich who discovered that the brain “doesn’t waste real estate” when confronted with somatotopic insult, a text book was written by Ronald Melzack and Patrick David Wall that expounded upon a theory first postulated in 1965 called “gate control” otherwise known as “pain gate.”  The book weighs a metric ton and costs upwards of $300 in its most recent manifestation, the 6th edition. Simply put, M & W proposed that mechanoreception from quick Ab afferents (i.e. movement circuitry) fire antithetically with respect to slower Ad and C nociceptive afferents (i.e. “pain” or more appropriately “noxious” stimulus circuitry). Think of it like a gate: when movement circuits are firing, the gate swings open, away from the “pain” or “noxious stimulus” circuits. When “noxious stimulus” circuits are firing, the gate swings closed, away from the movement circuits. According to M & W, you can’t have both, which means movement theoretically down-regulates somatotopic pain integration in the cortex in a habitual way, i.e. neurological pathways that fire frequently create “habits.”  Got all that?  Good, great, wonderful. Further down the rabbit hole we go…

Chronic injury and disease are poorly reconciled in Western society because our healthcare economy is founded upon a culture of cognitive dissidence. We believe what we want because it’s convenient. I frequently reference the scholar Thomas Kuhn, author of The Structure of Scientific Revolutions, who wrote [in paraphrased form] that humans can only tolerate so much peculiarity within the confines of their own paradigm before their world views [in the Heideggerian sense (http://www.iep.utm.edu/heidegge/)] begin to breakdown around them. In summary, we tend to follow the path of least resistance even if it kills us. This is why we dump more money into the birthing process, for example, and boast some of the poorest infant and maternal mortality and morbidity outcomes and highest caesarean section rates in the developed world. Healthcare policy in the US generally tends to follow this pattern. Our guidelines are woefully inadequate and antiquated. Evidence-based medicine is a sham because it requires subscription to a research model, i.e. the holy randomized controlled trial (RCT) that is far removed from the realities of private practice, which includes the doctor’s clinical acumen, expertise and experience. One thing is certain although it’s not accounted for in the Evidence-Based Medicine world: healing takes patience and time. This is easily forgotten in an environment awash in “magic bullets” and “miracle pills.” We good?

This brings us to the problem: headspace. Today, I would consider myself a CrossFit athlete. Certainly, I’ve been an athlete all of my life. I’ve trained in martial arts since I was 8 and wrestled until I was 18. I’ve probably backpacked close to 4000 miles in my lifetime. I did some waterskiing in college and still love to snowboard whenever I can. When I was 16 I shattered my left collarbone snowboarding. My doctor opted to brace and immobilize my shoulder for about 12 weeks, but did not perform surgery. I was ok with that decision. At that point, I felt that the three surgeries I’d had as an infant were enough. Later that year I tore my medial meniscus at a wrestling tournament, which ended my season. Again, no surgery warranted, but it certainly hit me hard. The year following, I broke my nose an estimated 5 times in various wrestling matches. I’m sure I’ve been concussed more times than I could count on two hands and to say that I’ve whiplashed myself while head-banging at various metal shows over the years would be an understatement. It wasn’t until I had a colleague x-ray my neck a short time after I re-injured my left shoulder (for a third consecutive time) performing a muscle up at my local CrossFit box that I realized I’d been judging my health by symptomatology, precisely what I’ve been teaching my patients not to do for my entire career. In sum, my nervous system had adapted to a barrage of noxious stimuli for years until it could not adapt any more. Was the cause of my problem the pain in my neck and shoulder? No dum-dum, it was the years of pounding I’d taken in my youth.

DB Lat CervicalDB APOMDB Axial Cervical

You see health is elusive, intangible. The neurology of adaptation is complex and is often overlooked as a route to assisting people regain vitality after a chronic injury. As a doctor, the health of my patients has always trumped my own. And that brings us back to headspace. When I started lifting at my local CrossFit box 3 years ago, I’d ignored the fact that I’d endured years of chronic damage to my skeletal system and, by association, my nervous system – the master control system that communicates to and regulates every cell in my body – that could not be glossed over with repetitive axial loading and metabolic conditioning. My shoulder, my knee and particularly my cervical spine had been through the wringer and certainly weren’t going to fix themselves (if you don’t know what you’re looking at in the films above, suffice it to say I’m messed up).

Through this most recent extended recovery phase, I’ve learned a hard lesson: that not even I am immune to chronic disease. I had to hit rock bottom to realize this by enduring weeks of pain while adjusting my patients. I’ve also come to the realization that this is the first time in my life I’ve truly, unequivocally taken my health seriously. Sure I get adjusted, eat clean, stay away from meds and try not to stress out too much, but have never taken specific steps to improve myself in the face of what seems like insurmountable challenges. Frankly, I’ve never felt that I’ve been so catastrophically injured that I couldn’t rise from the dead if necessary. This time it’s different and it has reminded me that vigilance is the price we must pay to live healthy, vital, prosperous lives. No one is immune and we all carry the stress born out of varying degrees of traumas, toxins and thoughts.

I’m reminded of a story that a friend and colleague once shared with me about the importance of absolute commitment to congruency. [For those of you who’ve heard this story, forgive me if I don’t get all the fine details correct.] As a chiropractor, he’d been under patchwork care with various doctors for years; DCs tend to get checked for vertebral subluxations when we can, often at seminars and conferences, but rarely with the alacrity we expect from our patients because we’re all too busy running our practices. When he was in his late 30s or early 40s he was diagnosed, seemingly out of the blue, with a life-threatening pulmonary condition that could not be treated medically. As a high subscriber to vitalistic philosophy, he questioned his faith in a manner of speaking because he could not reconcile the fact that his body, in all of its infinite wisdom and design, could fail him in this way. He was approached by his long-time family chiropractor at some point during his convalescence and asked when he’d truly been examined by a chiropractor last, someone who knew his listings, his scans, his test results, his x-rays, etc. Of course, his answer was something along the lines of, “years.” At that point, he had his chiropractor evaluate him and establish a schedule of care that would allow his body to heal accordingly. Whether or not he’d be cured of his life-threatening condition was inconsequential, but he knew that a clear nervous system wouldn’t hurt. Over the next several months, he literally baffled his medical doctors with his remission and what should have been a six month death sentence turned into a flash-in-the-pan medical oddity.

The moral here is that we can only lie to ourselves for so long. Health is not a weekend retreat; it’s a lifestyle and it requires a ton of work. This is the crux of vitalistic philosophy. I’ve been under patchwork chiropractic care now for close to 10 years. Not until recently have I been under the high-quality, specific, intent-driven care that I give to my patients. I can hold an atlas adjustment for approximately 11 days and I’ve been getting checked and adjusted by other chiropractors for a long damn time. Some of my patients and fellow athletes are so chronically sick and injured that they can barely hold adjustments for 24 hour periods. The question is then, why in the face of absolute indicators that we are damaging ourselves, do we continue to drive ourselves into the grave? Specifically, if you cannot hold a chiropractic adjustment and maintain a clear nervous system for more than 24 hours, why would you only get checked once per month and continue to lift, run and sit while simultaneously expecting to get results? [Cue cognitive dissidence rant.] This is where vitalism and mechanism clash. CrossFit has been the topic of many a chiropractors’ blog** over the past several years, particularly after Kevin Ogar broke his spine during a failed snatch attempt in 2013 (http://kevinogar.com). The overwhelming rhetoric in these web entries centers on the false premise that symptom amelioration is a means to an end: that true health arises from a symptom free body. While this is certainly an inclusive statement, the inherent logical fallacy is that health is not an absolute, black-and-white state; it is a spectrum. Symptoms are usually a sign that the body has failed to adapt to chronic stress and has fatigued. Chiropractors are generally skilled at towing the line, but it’s a genuine rarity to find a doctor of any specialty principled enough to look objectively at both the causes and effects of chronic dis-ease. To the folks in denial I say, “who the hell cares about how you feel if you stay sick and injured?” You may feel better from a quick band-aid treatment, but you’re still just one small step away from fatigue again. I still have a long road to travel in order to repair my spine and nervous system, but you’d better believe I’ll be committed and I’d expect anyone who comes through my door to do the same.

Dr Daniel Bronstein is the director of Beacon Chiropractic in Grover Beach CA. He focuses the bulk of his practice on objective straight chiropractic care for pregnant women, infants, toddlers, children and families. For more information or to schedule a complimentary consultation, you may contact his office at 805.481.1566 or visit his website at www.chirobeacon.com

This article originally appeared @ http://projectmisinformation.com/?p=79 on July 1st, 2014.

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Typical generally equates with what the average uninformed healthcare consumer expects when they first visit a new healthcare provider.

**For reference, google “CrossFit and chiropractic” and see what pops up. One of the only folks in our field who has written extensively on CrossFit and chiropractic from an objective perspective is Dr Lindsey Mathews. You can find a sample of her work here: http://breakingmuscle.com/health-medicine/how-to-choose-the-right-chiropractor-for-you

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