FREQUENTLY ASKED QUESTIONS – FAQ
A skilled Chiropractic Adjustment is a highly specific, typically quick, shallow and highly directional force or “impulse”, to create a desired change in a body part or bio-mechanical system – like the back, neck, or shoulder. An adjustment and may also be used to create nerve impulses, reflex changes, improve circulation, posture, movement and performance. Often, the result is referred to as a “release” or a “correction”.
The forces applied in an adjustment are typically referred to as “High Velocity Low Amplitude” (HVLA) impulses. Decompressing or moving a joint space or a tissue does more than re-arrange things; nerve signals are generated and reflexes triggered, endorphins are released, pressure is eased and circulation changes in the region. Often the term “restrictions” are used as a shorthand term, but these typically refer to more than just a “stuck” joint. There is a belief that restrictions which may exist in a biological system decrease flow and performance of the system and in the entire organism. The adjustment then is intended to optimize function.
Chiropractic Manipulative Therapy or “CMT” describes a treatment using chiropractic adjustments.
I have a wide range of manipulative therapies available to fit the patient and the situation, from ultra-gentle to more forceful. I can customize the depth and type of techniques I use to fit your body and comfort level. I typically use “Diversified” manual adjusting – the most accepted and well-researched technique – along with low-force, neutral “flexion-distraction” techniques, backed up with Instrument-based adjusting using a modern, gentle, chiropractic impulse tool. For some patients, we will use only the Impulse Tool, based on comfort level and any contraindications that may be present. It can all be quite effective, espescially when applied at the right time and with the right intention.
Mobilization is a low amplitude “slow” movement typically used to retrain movement, restore natural joint range, stretch and elongage structures, and free tissues. It could be described as “gently moving a body part through its normal range”. This is often used before or after an adjustive maneuver, or can be used by itself. While a joint may “release” during a low velocity mobilization, it does not then become a manipulation, even though partial correction may occur. Mobilization is performed along very specific joint or tissue planes.
Ahh, Self Adjusting or self manipulation. Can you do it? Unfortunately, no. This is probably my most Frequently Asked Question. First of all, a skilled adjustment is highly technical, very specific, and is performed for a very specific reason – which does not require “getting a pop”. “Pops” are nice, but they are mostly irrelevant. And what are you specifically “adjusting”, anyway? When a chiropractor “adjusts” a motion segment, we know exactly what we are contacting – and why; we know exactly how much to move (and not to move), when to apply the brakes, exactly what result we want to produce, what the implications are of the release – and what is going to be required next. Most people are thinking it’s a “pop” that feels better – it isn’t – it’s the relative movement or balancing. Relative to what, right? Do you know what I am referring to?
Doctors of Chiropractic also know “when not to do it”. I encounter people all the time who self-manipulate joints sometimes multiple times a day, every day. Sometimes, even – just for “fun”. Really? Hmmm. Can you imagine what would happen to your body if you went to a chiropractor twice a day, every day? Hyper-mobilization or even injury could result, even from a proper adjustment performed too often. People sprain themselves all the time and end up coming in to me (or they get sprained in a “bear hug” by an over-zealous companion…). Or, they create a monster of a hyper-mobilized slack suspension that tweaks itself in an out on a dime, with all sorts of muscular implications; this is not “fun”, in the long run, please believe me. I mean – you can do it, if you must – but I will see you in the clinic after a while and it’s hard to back the hypermobility out of the system.
Further, there are the mechanics of “self manipulation” to be considered. The chiropractic adjustment proceeds from a slack, “gapped” position, and is fast, brief, shallow and limited. Most chiropractic adjustments involve “gapping” a joint – requiring lift. Lift is not really possible when you are performing it on yourself… you can typically only “jam down”. Also, when a person self-manipulates, they typically wind everything up as tightly as possible, and then torque even farther – hoping something in there will make a noise, and maybe it will feel better. Once cranked beyond that endpoint, the momentum of this action will predictably overstretch the support tissues of the most vulnerable joint every time – not even necessarily the problem joint. Twisting and pulling and jamming your neck and head into certain positions can also twist vascular structures making you vulnerable to stroke. There are even people that I won’t adjust manually, out of concern that they have put themselves into a high-risk category.
Self manipulation seems to get less and less fulfilling and people seem to do it more and more, like a slippery slope.
Again, an adjustment is very specific. Leave it to a professional. I think that in most cases where I have met a frequent self-adjuster, that we have been able to help them re-train themself and abandon this habit.
It’s important to note that we are not a “walk in for a quick pop” clinic – and we don’t necessarily recommend those clinics, either. A basic session at Blue Heron Chiropractic is far more than “basic”; it includes a full and customized review of progress and discussion of the expected plan for the day; patients are open-back gowned (waist up) for basic work, get hot packs, soft tissue massage (percussion or myofascial release), chiropractic manipulative therapy, basic exercise/movement coaching if applicable, and a refreshing therapeutic topical spray or gel on involved areas (if applicable). On the way out, we will review the Plan. A re-examination or diagnostics, for example for a new injury, problem, symptom or worsesning are often additional services, depending on complexity and time involved. Specialty services, like Graston Technique myofascial release, Kinesiotape, Cold Laser are additional services you can elect although occasionally the doctor will demo them for you.
Bundled services such as “Basic” or “Expanded” are described this way for people to more easily visualize prices specifically under DMPO, the self-pay discound fee schedule. Outside of that, all services under regular insurance sessions are itemized, unless the insurance contract is “per diem”, and very few are. We can discuss this with you at your next appointment or on the phone if you give us a call.
50 minute sessions are always considered expanded, ehanced, or complex.
Treatment plans are based on what’s involved with a correction, and then needs for reinforcement and retraining functionality (Support). For example, we like to get a patient back at least within one week, or maybe even as soon as 48 hours later – to follow up on a first visit. This allows us to reinforce a correction and help the body “hold” it.
With a new or “acute” or ongoing problem, or something that involves trying to diagnose an issue, we will typically want to get back within 1-3 weeks. After that period of time, it is harder to connect treatments together to maintain momentum that can support healing.
Treatments then spread out until we reach the new “baseline” or we see correction or resolution of the episode. A”well patient” treatment plan is more realistically a “support plan” and is ideally at least once a season (three or four times a year). It is up to you – it’s always your choice – but sometimes your body makes the call.
A great analogy can be made with dental hygeine. If your gums tend to form deep pockets, your dentist will typically encourage you to come back for more frequent cleanings in order to prevent bone loss. If you tend to be prone to joint dysfunction, inflammation, recurrent sprains, degenerative joint disease or even systemic health issues – a Chiropractic Physician might want to get you back a little more frequently. This will be customized for your situation.
In some cases – and particularly in functional medicine, like Chiropractic – delay could be detrimental to your health or slow your recovery. It could put you at risk for developing a chronic condition.
We like to get a patient back within one week to follow up on a first visit.This allows us to reinforce a correction and help the body “hold” it. 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”. We like to see a “well patient” a minimum of once a season (3 or 4 times a year). I sometimes see patients with conditions that are recurrent (“episodic”) once every 3 weeks to 30 days. It’s your choice, and there is no pressure, 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.
Nobody should be telling you to come back forever. At the same time, you may decide to stay on a supportive treatment plan, like a health “pit-stop”. 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”.
Core Stability is an important concept. Range of Motion is not relevant and maybe even hazardous without stability at the core. Less stable areas are prone to injury and breakdown (degeneration). Clinical Instability is not necessary for someone to need improvement with their Core Stability. Core stability often involves deep “intrinsic” musculature and ligaments, rather than large voluntary muscles like the big muscles in your back – however – all must contribute together. “Range of Motion” is not always the goal… sometimes we need to DECREASE motion to gain stabilization.
Physical Therapy encompasses a wide range of physical treatments, including Ultrasound, Massage, Electrical Stim, Exercise, Taping, Graston Myofascial Technique, Cold Laser, Hot and Cold packs and more. “PT” is not limited to Physical Therapists, and yes, we have that and more at Blue Heron. When appropriate, we do refer out to Physical Therapists for more intensive attention, for example, if a person cannot perform their own exercises.
Mind-Body Connection is not a “woo-woo” concept, although it is often mocked. If your mind and body were not connected, you would fail. If you don’t know what’s going on with your body, you can’t thrive. If your connection is highly tuned, you can prosper. If the connection is exaggerated, you may overload.
Research shows that your mind – and the way your thoughts & understandings – connect it to your body, is as important as the physical wiring. Many people who believe they “know their own body” actually can be coached to know a more effective and healthier body.
I sometimes see patients – with conditions that are chronic and recurrent – once every three weeks to thirty days. However, we will schedule what will work for you.
With some recurrent problems, like Arthritis, we seek to make the episodes fewer and farther between, as well as decreasing the severity and duration.
Some people consider the “popping” of a joint the “signature” of a chiropractic manipulation, but it really isn’t. With joint manipulations, we move or “gap” a joint space or move a body within the limits of its physiological barrier. At the end range, gas in a joint may create a “popping” release, but not always. Other manipulations or “adjustments” can involve freeing soft tissue adhesions, or restoring a joint plane, or reflexively stretching a muscle, or decreasing a nerve impingement. The “pop” is really not necessary, biut some people find it satisfying. It can be risky to “insist” on a pop.
Chiropractic Orthopedics is a specialty within the sphere of Chiropractic that focuses on the balance between structure, function, and vitality, with a focus on body mechanics (orthopedics). We feature Orthopedics addressing issues without a focus on unescessary or excessive medication, and as an alternative to many surgical interventions.
Chiropractic Orthopedists complete an additional 3 years of post-graduate education, must pass a challenging Board Examination to become either a Dipolomate or a Fellow, and have additional Continuing Education requirements. Less than 6% of chiropractors in the US have succesfully acquired this credential.
Kinesiotaping (K-tape, Rock Tape, etc various products…) is a taping modality that provides, besides a small amount of structural “guidance”, if not support, a pumping action to the lymphatics that accelerates healing. It is NOT just for olympic athletes. Check it out here: Kinesiotape
Low Level Laser (Cold Laser) as used in chiropractic clinics is typically a blend of Red light and Far-Red light. Some lasers are coherent (fine, burning points of light) and some deliberately less focused, bathing a wider point, not cutting, and “cold”. It is all about the wavelength and certain other technical details, but Laser can stimulate healing, decrease pain, and improve movement in a joint. Laser can also heal scars, but that is a different setting. Look here Cold Laser “LLLT”
Some conditions return to plague the body, such as when low back pain returns because of arthritic degeneration or decrease Core Stability. Those “returns” or “flare ups” are called “episodes”. Insurance does not like to pay for “incurable” problems, but it HAS TO pay for episodes, by definition. So, if a problem is “the same old same old”, we qualify it as an “episode” – it’s why we ask all those questions.
Many insurance plans are limiting treatment plans to “Episodic Care” – such that they force us to “start, cure and release” you, say within 6 weeks, and then start you back up at the next “episode”. They may limit restarts or punish “false-starts”. This is why you must follow the instructions and return for the proper treatment plan so that you don’t get a denial.
Highly-tuned race cars up at Portland Speedway stop for adjustments and tire changes every few laps, even if they are not “broken”. They follow a schedule – like a “Treatment Plan”. On a pit-stop visit, we are likely to use heat packs, soft tissue massage, adjusting, soothing natural medicine rubs, and discuss exercise, sleep, Vitality and diet. Our promise: it’s intended to work for you.
A recent analysis of treatment methods for new injuries suggest that many physicians (both chiropractic and medical) as well as most patients, are confused as to whether heat or ice should be used after an injury. The general advice is that applying ice for the first 24 to 48 hours followed by heat is based on the often inaccurate assumption that the patient has progressed beyond the acute inflammatory phase to the repair phase of healing according to a “normal” time scale. As a clinician since 1996, having attended over 20,000 treatment visits, I have seen that many patients show signs of acute inflammation for as long as a week or more after the original injury. Therefore, overuse or premature application of heat can prolong the normally short-lived inflammatory response.
My guidelines are as follows:
~ Within the first 48 hours of an injury, ICE ONLY;
~ For the next 72 hours (within the first 5 days after the injury), Heat and Ice can be alternated, always ending with Ice (this includes after “hot tubs”!), then,
~ After 6 days, MAYBE – Heat-only can be applied, or Heat/Ice/Heat ending with Heat. Remember, heat is really for muscle tightness in a “well” muscle, not broken or torn structures.
If there is residual pain in between treatments, or “soreness” to the touch in the area… consider ICE.
Two more “guidelines” (to be applied only after the 48 / 72 / 6-day rule!): If no body position is pain-free – use Ice; If there are pain-free positions, but there is pain with muscle contraction – MAYBE use Heat. Remember, “stiffness” in the morning with some mild pain might seem like a time for Heat. However, at the end of the day, the activities of your day may have triggered a recurrence of an inflammatory response, hence a return of constant pain in the evening – and thus heat is not best. For muscle fatigue spasm only (no injury) use heat. When in doubt – remember you can ASK!
This is an electrical muscle testing scanner (EMG) that can take painless readings with electrodes, not needles. It’s an expensive piece of equipment, but a remarkably inexpensive test compared to a “Needle EMG”.
The MyoVision company, Precision Biometrics, makes two types of scanners, a Static Surface EMG exam, where the patient is not moving, and a Dynamic Range of Motion EMG, where the patient moves through activities like bending the neck or low back. At Blue Heron Chiropractic, we have both options. The first one, the “Static” test, is performed with the person standing, and shows the electrical activity (potential) in a muscle that might be either too tight or too loose. The “Dynamic” test adds bending and can show actual pain signals, muscle “guarding” or bracing, improper muscle tension as well as loss of range of motion in a region while the patient moves.
Wellness does not arrive and “stay” around; it’s a moving target. It is far easier to maintain a patient’s “wellness” than it is to correct a problem. For you, it is far more responsible to take an hour off from an afternoon at work than it is to lose a week in pain due to injury or flare-up.
What about problems that tend to return?I sometimes see patients with conditions that are chronic and recurrent, once every three weeks to thirty days. However, we will schedule what will work for you.
Fancy machines in clinics are great, but not necessary. Low-Tech Rehab is a high-tech strategy I follow to get my patients rehabilitating without the need for fancy and expensive equipment. I want to give you simple exercises that you can perform at home, maybe with a floor mat or a Theraband(tm) resistance band – movement retraining programs that you might actually do!
We have an exercise plan for every part of the body and every objective, even if it is sitting at a desk. We like to use progressive strategies that grow as you get more experience. I like to use movements based on Martial Arts, Plyometrics, Pilates, Physical Therapy Balls, TheraBand Resistance bands, Theratube, Body Blade, and simple weights you can use at home.
Unfortunately no, you cannot do it effectively. Besides knowing the special dynamics of the particular tape and the anatomy involved, it’s impossible to maintain the proper tension by yourself, or to pre-position the body part opposite the direction of function in order to apply the tape while balancing everything else. Self-applied Kinesiotape or amateur applications of tape are attractive but mostly innefective – come let me do it. Tape me in NE Portland after a Car Accident? (Kinesiotape)
Craniosacral Therapy is essentially a mobilization technique developed by an Osteopath, Dr. Upledger of the Upledger Institute, which is a very low-force-to-non-force, non-invasive technique for creating physiological response and promoting balance in the body. Some practitioners treat the mind-body connection using this technique alone. For some patients, this might not be enough intervention by itself. At Blue Heron Chiropractic, I blend it into my Diversified treatment.
There are a lot of techniques out there, and some of them have really fancy names. A lot of them are basically re-named and re-packaged versions of other adjustments, but some have some real sophistications that are nice. Some of them “try a little too hard” to claim to be “the best”. I blend and mix many famous as well as new and innovative strategies together. After 22 years of doing this, starting with having been a Technique Instructor at the chiropractic college, I can do most if not all of the good stuff, and if I think it will work for you, we may bring it into play. Simultaneously, we might not need to “re-invent the wheel” in order to call it a fancy name.
The short-long answer is really, “no, but as a ‘Mixer’. I may use some of the concepts and maneuvers from DNFT with some of the things I do. I usually don’t use any one mono-style”. DNFT, or Direct Non-Force Technique is an older-school technique that is great but may have had some limitations. There hasn’t been much recent research and DNFT didn’t really carry into the present day lexicon; but there are providers out there doing it and many do a nice job in a lot of cases. You may have had a great experience and want more of what you remember. We can find out what you are really looking for, but let me say this – it’s really about the result, not the name of the style that gets used. I want you to get the results, and so I blend and mix many famous as well as new and innovative strategies together. After 24 years of doing this, starting with having been a Technique Instructor at a leading chiropractic college, I bet we come up with what can work for you. I think it will work, we may bring it into play.
Do I need a new bed? That’s a good question. Typicaly, Mattresses and Boxsprings are declared “expired” at the end of their warranties… about 3 years. Many of my patients come in to me talking about beds that are ancient, sagged, the springs softened. Many “Frames” (legs) are cheap afterthoughs. A bed that is “bad” still looks like a bed; just like a bad tire on your car is still black, round, and inflated. I do like to recommend people upgrade their sleep surface – you are lying on it half your life. See the webpage Beds
We can often improve on those “permanent” conditions. I sometimes see patients with conditions that are recurrent once every three weeks, or sooner, until the condition stabilizes or does not return.
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 – they may not even notice the stiffness at all. If they do, an ibuprofen helps. During the day, if this person sits or drives for a long time, they may notice this stiffness again. Aft the end of that long day of activity, this person may feel stiff – but not necessarily. If they “overdo it”, they may have a “fare-up” with more stiffness in the morning; after “taking it easy” for a day or two, they are then back to the same old same old morning stiffness. They just “deal with it.” This may be worsening, lasting longer, and flare-ups becoming more frequent, or things may just 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”.
And yes, this is manageable – and treatable.
Yes, I am a GLBTQ – affirming provider. We work with you and can even be sensitive to your pronouns. We even easily handle name changes, couple, partners, spouses, etc.
In the purely medical vernacular – which does not specifically target function – a subluxation is a joint derangement that is “less than a dislocation”. The medical model typically simplifies this and limits subluxation to a traumatic origin. In the Chiropractic model – which focuses on function – a subluxation is any joint derangement or dysfunction with functional, nerve, blood supply or organ effects, which can occur without trauma. Subluxation can be painful, and effects can be local or can be broadcast away from the immediate region – sometimes creating symptoms in other body parts.
ChiroHealthUSA (CHUSA) is a Discount Medical Provider Organization (DMPO). Basically, a patient who wishes to pay out-of-pocket can elect to pay $49 to join the DMPO for a year, and get access to CHUSA’s discounted Fee Schedule that is typically 30-50% less than our published rates (the State statutorially allowed fees). The same $49 also includes membership for your immediate family members for one year, and can be used at other clinics around the country. There are some limitations to the applicability to the DMPO, but it is essentially available to everyone. Call for more information – but basically – it saves you money.
X-rays are important diagnostic tools that all Chiropractors are trained to order and read. Chiropractors can also read, interpret and discuss advanced imaging MRI and CT Scans, and consult on diagnostic ultrasound studies. Some chiropractic offices have basic X-ray rooms inside their facilities, although these are then expensive to maintain and to keep modernized. At Blue Heron Chiropractic, we are a facility that refers out for radiologist-level X-rays, advanced imaging (MRI) and reporting. That way, modern digital studies are kept in professional libraries that are accessible to your other providers on the internet. We have several local facilities we use, with different locations around Portland. Sometimes insurance guidelines will specify which facilities we can send you to. We can typically get you plain film studies in the same day, while advanced imaging requires scheduling and sometimes pre-authorization.