Blue Heron Chiropractic
Dana Sibilla, DC DABCO

FREQUENTLY ASKED QUESTIONS

Q: How do I apply Ice Packs? A: Ice packs are best when they are flexible and not filled with hard ice cubes. They need a moist conductor to get the cold into your skin. They can also burn the skin if they are put on dry, or left in place for too long. Typically, an ice pack can be in place from 4 to 8 minutes.
1. The patient should must be able to distinguish hot or cold (note, diabetics or people with nerve damage may not be able to tell if they are too cold).
2. the treatment will progress with a feeling of Cold, then Burning, then Aching, then Numbness. Ideally, we wish to reach the numbness level to get the maximum benefit.
3. If you wet a towel or two layers of paper towel, and then squeeze out the water, this can be placed in between your skin and the pack and this will help the cold get into the area.
4. Do not lie on top of an ice pack.
5. See the suggestions on the Info Base web page for "heat or ice".
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Q: Do I have to come back forever?
Nobody should be telling you that. You will likely return for the benefits and for the satisfaction of being proactive about your health. Statistically, patients that go to see chiropractors return after their acute event because they appreciate the results. Like dental hygiene, we perform "spinal hygiene".  It's often your choice, but don't neglect the fact that many problems build slowly and can be alleviated by an occasional "pit-stop". You don't only return to your dentist after a tooth falls out, do you?
On a pit-stop visit, we are likely to use heat packs, soft tissue massage, adjusting, soothing natural medicine rubs, and discuss exercise and diet. Our promise: it's intended to work for you.
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Q: How Often do I need an Adjustment?
I like to get a patient back within one week to follow up on a first visit. If someone is doing "great", I often send them off for three weeks to confirm that, then follow up - this allows me to establish a new "baseline".  I like to see a "well patient" a minimum of once a season (four times a year). I sometimes see patients with conditions that are recurrent once every three weeks. It is up to you, it's your choice, but sometimes your body makes the call. A patient with a traumatic injury, like a strain or sprain or a whiplash, needs to be adjusted much more frequently during the acute intensive phase of the case, before rehabilitation begins.
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Q: "I woke up and my Neck froze";
Q:"My range of movement is decreased",
Q: "I have sharp pain in my back when I breathe";
Q: There is pain going down my leg(s)";

Q: "One of my Legs is Shorter than the other", isn't that normal?

This isn't an anatomical "normal" but it isn't an atypical human abnormality, either. This can be anatomical and developmental, reflecting an actual leg length inequality, which may effect your posture and spinal development. It can be the result of an injury or a surgery (ie., loss of joint space at the knee). It can be functional, where your pelvis rotates and carries one leg upward with it, making it functionally shorter. It can be creating a short term problem, or permitting a long term problem to develop, or not effecting you at all. We treat these problems differently depending on which one is there (and you could even have a different issue on either side). Sometimes we will apply a heel lift, others a shoe orthotic, others may respond well to functional adjusting. Some need none. Some need all three.
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Q: "I am stiff in the morning"; (Read the "Morning Stiffness Hypothetical")

The Morning Stiffness Hypothetical
This hypothetical person is either fairly active, very active or a totally sedentary couch potato. It doesn't actually matter. For a while now, typically more than six months, when they wake in the morning, they are stiff, and some mornings more than others. They get themselves out of bed, maybe with difficulty, and sometimes after stretching a bit, moving down the hall or taking a shower, they feel quite a bit better. At this point they may not even notice the stiffness at all. Maybe an ibuprofen helps. During the day, if this person sits for a long time, or drives for a long time, they may notice this stiffness again. After a long day of activity, this person may feel stiff, but not neccesarily. If they "overdo it", they may have a "fare-up" of bit more stiffness in the morning; they baby it for a day or two, and then they are back to the same old same old morning stiffness and just deal with it. This may be worsening, lasting longer, and flare-ups becoming more frequent, or things may just seem to be staying the same. Sometimes with advances in age, or with increases in body weight and belly girth, or decreases in activity/exercise, this person wonders, "is this getting worse?"

Is this you?

This is not an uncommon story. It is the profile of someone who most likely has Osteoarthritic degeneration in their joints. Don't despair. There are things that you (and me, as your doctor) can do, Read more about Arthritis under "I am stiff in the morning, at the end of the day or when I stay in one position too long".
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Q: "I am stiff in the morning, at the end of the day or when I stay in one position too long";

Frequent morning stiffness, particularly in multiple sites (multiple joints, different ends of your spine, one or more places than you can put a single finger on at once) in the absence of an injury, is quite possibly the sign of degenerative change at joints in a region. Single joints (knee, wrist, shoulder, finger) may also degenerate after trauma. Following an injury, a single joint may degenerate, causing an entire region to be problematic, but only because of a single joint. When you put your finger on that joint, it may be painful, or when you spring the joint, it may hurt. Entire regions of your back may be stiff, either in the morning on waking, or after activity, or after maintaining a single position for a while. An example might be if you sit too long, or fall asleep on a couch. Note that if an area is also hot and swollen, there may be something additional occurring. The Chiropractic Orthopedics Paradigm, including a functional, full-body holistic perspective, is good for diagnosing and treating this problem. We have to take a lot of factors into account. Let's not jump at a decision. Let's treat this conservatively if we can. Oh, and by the way, you simply can't treat everything with hot packs, sorry.

Osteoarthritis is the most common form of arthritis. This is the form that usually comes with age and most often affects the fingers, knees, and hips. Sometimes osteoarthritis follows an injury to a joint. For example, a young person might hurt his knee badly playing soccer. Then, years after the knee has apparently healed, he might get arthritis in his knee joint.

What's the definition of Osteoarthritis?
1. A non-inflammatory degenerative joint disease occurring chiefly in older persons, characterised by degeneration of the articular cartilage, hypertrophy of bone at the margins and changes in the synovial membrane. It is accompanied by pain and stiffness, particularly after prolonged activity. (On-line Medical Dictionary) - (Source - Diseases Database)
2. Chronic breakdown of cartilage in the joints; the most common form of arthritis occurring usually after middle age - (Source - WordNet 2.1)

Now. Don't be fooled by the phrases "occurring chiefly in older persons", or "usually after middle age". Osteoarthritis can be found in young patients, even ones without prior injury. And what constitutes injury? Does subtle postural failure, chronic excessive overload or overuse, and repetitive strains due to an overweight condition count as injuriy? They certainly can. There is also a trick to describing diagnoses, and here it is: Symptoms of osteoarthritis (even severe ones) can show up long before the Xray findings. And how soon before? No research has tied this down, it seems to vary with body chemistry. We are typically not going to film a 20 year old to check for arthritis unless sympotms are severe. And if we do film that 20-something and there is nothing there, does that mean they don't have arthritis? Technically yes, but they may be in the process of developing it. Should we treat them for it? Yes. The treatment for Arthritis or developing arthritis? Similar.

The bottom line is this. If you have chronic recurrent stiffness in the morning, which becomes forgotten with movement, but then gives way to stiffness after activity, and stiffness with prolonged postures or positions, there is some form of joint degeneration occurring, be it systemic, metabolic, post-traumatic, or infection based. There are ways to treat this. Let's diagnose it! Note also that I will typically not apply an official diagnosis of osteoarthritis in a "suspected" or "developing case", until it can be confirmed by x-ray. We will probably refer to you as having "dysfunctional joints" and there will be a note for me and only me to watch for suspected joint degeneration. We will not label you with a diagnosis until we can differentially narrow it down. However, you can begin doing things for yourself, and making lifestle changes, that will support you in recovering or maintaining yourself.

Note that with a diagnosis of Osteoarthritis, it is also important to consider whether there is an underlying condition causing Osteoarthritis. Underlying medical conditions are other medical conditions that may possibly cause Osteoarthritis. I will also treat persons with arthritic conditions differently. A major percentage of patients who have had painful reactions to being adjsuted by a chiropractor have some sort of undiagnosied degenerative conditions underlying that act up when they are mobilized. We can eliminate this by doing "Diagnostic Detective" work. There are specialized forms of arthritis that look like osteoarthritis initially. Sometimes lab work is ordered to focus in on what may be the cause.
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Q:"I carry all my stress in my....";
Q: "Feels like a golf ball in my upper back muscles (above/behind/under my shoulder blade)";
Q: "I have Frequent Headaches";
Q: "My back frequently 'goes out'";
Q: "I have a pinched nerve";
Q: "I have numbness in my hands or feet";


Q: "I had no pain when it happened but the next day I couldn't move";


Q: No Doctors understand me!
Careful attention must be paid to the way you relate your problems, or the willingness you have to give up information on problems. The doctor has to be a good listener and be attentive. It's important that patients arrive at the clinic looking to get better, and with a cooperative attitude.

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