"The biggest mistake people make in life is NOT making a living at doing what they most enjoy."

- Malcolm S. Forbes (1919-1990)

CHIROPRACTIC COALFACE

There is a temptation in such a file to list cases that make the chiropractor seem like a demigod, able to diagnose and treat all mysterious conditions! Such is not my intention. Each patient in the chiropractic clinic is individual, his or her condition unique, and the treatment is almost always a challenge. Some people respond very quickly, almost miraculously, but many require hard work on the part of your chiropractor. After all the condition often relates to something that happened many, many years ago. Hard work, and honest cooperation is what makes for successful outcomes.

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CHIROPRACTIC COALFACE:

Headache - could it be coming from your jaw joint?

The long and the short of it, is that just touching the right Tempero mandibular joint, the temporalis muscle and the external pterygoid muscle were red hot. I won't pretend the treatment was fun, but Anja was much improved within weeks. She now comes for treatment every two months - today was one of those days. She has absolutely no headaches anymore.

Update: Anja came in for her 2 monthly adjustment this week. It's been so good we have made her next appointment in three months. It's now two years down the road - quite a dishy young woman in the making! The change in her demeanor without headaches is really quite amazing.

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CHIROPRACTIC COALFACE:

Neck pain - do you know the SIX MONTH RULE?

If you've had neck pain and headaches for more than six months, research shows that it will probably never go completely away, no matter what you do. So, you have a six month window to deal with your neck pain.

We don't in chiropractic promote the idea that you must run off to your doctor for every snivel, or your chiro for every little pain. But, if you neck pain hasn't subsided after a decent period of time, please don't wait 6 months and then expect a miracle from your chiropractor. You probably won't have it.

Miss P a very attractive 23 year old young woman consulted me three months ago with headaches and suboccipital neck pain of about six months duration. Fortunately just in time. She had an atlas subluxation from an an old fall off her bicycle. She came in this morning for her 5 week follow up, and has had no headaches at all. So we are spacing the treatments further out.

Miracles we do at once. The impossible takes a little longer ...! Neck pain anatomy >>

CHIROPRACTIC COALFACE:

MERALGIA PARESTHETICA - pain or numbness in the upper thigh

About 6 months ago, in the same week, two women, we'll for convenenience call them Mrs A and Mrs Z, consulted me with the same problem, one of the less common conditions, called Meralgia Paresthetica. A pinched nerve in the groin that can either cause either just numbness on the side of the upper thigh, and sometimes on the anterior thigh, and frequently a severe tingly nerve pain. Electic shocks. It belongs to what we call a "double-crush" syndrome - almost invariably the nerve is affected in both the high lumbar spine and the groin. Now that I understand it, it's become a condition that I treat with great confidence. More about UPPER THIGH PAIN, MERALGIA PARESTHETICA ... CHIROPRACTIC COALFACE

Both responded well in the first week with much reduced pain in the leg, but the family of one of the women, Mrs Z, persuaded her that she ought also to consult her doctor. I had no good reason to disagree as Meralgia Paresthetica is (rarely) also caused by a tumour or abscess lying deep in the pelvis. Mrs Z stopped coming - her doctor said it was far too serious a condition for a Chiropractor, and in any case no treatment is known to work.

Mrs A continued to respond well. She has no pain any longer and now comes in every two months for maintenance.

Mrs Z phoned yesterday to inform us she's having a back operation next week. Sigh, so needless.

CHIROPRACTIC COALFACE Read more about Ankle exercises …

CHIROPRACTIC COALFACE:

POSTERO MEDIAL DISK HERNIATION - look the Leaning tower of Pisa?

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CHIROPRACTIC COALFACE

There are two main kinds of lumbar disc antalgias:

• Leaning towards the pain.

• Lean away from the pain.

The first, the so-called Postero-medial disc protrusion is much easier to manage from a chiropractic standpoint, but both types take 6 weeks to heal. This P-M type is thus prone to relapse.

Mr S has the PM type, leaning towards the pain, and responds very quickly, often coming up straight after one or two adjustments of his spine and sacrum. He thinks I have golden hands! He then has minimal pain for several weeks until the next relapse occurs.

He is very thorough with his exercises, is careful, does every thing right, cannot be faulted, except ... he is a heavy smoker.

New research from the NY University Medical Centre Hospital reveals that patients with Rheumatoid Arthritis who stop smoking have fewer swollen and painful joints, and lower CRP; this is a marker found in the serum of patients with acute inflammation.

Every chiropractor knows that treating smokers with acute joint conditions is far more difficult. Read more about Postero Medial disk herniation …

Update to CHIROPRACTIC COALFACE: Two months ago Mr S took the brave decision to quit the weed. That, together with a heel lift for a short leg, have made a dramatic difference. He's now coming in every six weeks.

Quite clearly she suffers from Polymyalgia Rheumatica. Touching almost any muscle causes radiating pain, what we call an Active Trigger Point.

Within two weeks she was off the crutches, and now after 6 weeks she declares she is 80% better. We are both well pleased. Read more about Chiropractic treatment of Foot Pain.

Recent research suggests that a simple heel lift may also help with neck pain. I'll keep you informed on how they progress.

CHIROPRACTIC COALFACE Read more … NECK PAIN.

Mrs Debets is a vivacious young woman who consulted me three weeks ago with a very sore low thoracic spine after her company took the whole management team for an outing. To a golf pro for a fun day. She had never played golf in her life.

What she didn't tell me was that she and her husband had been trying for over a year without success to have a child.

The low thoracic spine is a vulnerable area, being what we call a transitional area from the very stable thoracic spine (because of the ribs) to the highly mobile lumbar spine. It's a common area of complaint for a condition known as Maignes syndrome. CHIROPRACTIC COALFACE

Such excursions are in my opinion foolish. Over the years I have seen so many injuries to persons completely unused to a particular activity. In any event, Mrs Debets developed an acute facet joint injury in her lower mid-back.

In my first years in practice I tended to treat only the presenting complaint, until one day I read a research project revealing that the degree to which patients were healed of other "medical" conditions by chiropractic was dependent on how many areas of the body the chiropractor treats.

On finding a profound sacral subluxation, Mrs Debets admitted to a nagging stiff low pelvic are of some years duration. She could remember no specific injury, and it was never bad enough to do anything about it.

The long and the short of it is that Mrs Debets gleefully told me this morning that she is pregnant. Working back, we calculated that conception occurred the night after her second sacral adjustment. INFERTILITY CHIROPRACTIC ... An aside. I always address smoking and obesity ONCE, AND ONCE ONLY, firmly, at the first consultation. And then hold my tongue. Happily she told me this morning that after she and hubby had repeated the home preg test three times, unable to believe their good fortune, they had both decided to quit.

Smoking will knock the last ten years off your life. More if you are unlucky, and the end will be S-H-one-T. CHIROPRACTIC COALFACE

He has kept healthy so long because of his commitment to the WALKING benefits. Really the pain in his foot was not coming from the degenerative joints and soft bones, but from a severe plantar myofascitis. He is responding magnificently to chiropractic care of the foot.

CHIROPRACTIC COALFACE:

Her little daughter was an altogether tougher nut. A fall from a swing one year ago resulted in constant headaches and neck pain. The real problem was not her neck but gaining her confidence to let me do something about it. Fortunately, and it's a big fortunately, she responded very quickly, and after three or four visits she has no pain, and no fixations. I didn't have to treat her which was a relief to us both. The treatments have been a drama to say the least.

Treating even children against their will raises many ethical questions, and I didn't like tricking her into letting me adjust her. In any case, she was too smart after the first couple adjustments.

In thirty years in practice I have come to appreciate the trust of parents who let you adjust their children. Kids don't bounce - many of those childhood injuries result in a life time of pain.

Fortunately for him he was treated by an obviously excellent surgeon, fifty years ago. He has no neurological complications which so often accompany spina bifida vera. But he has constant low back pain for ten years.

After the examination I concluded that his pain had nothing to do with the spinal bifida and, while there were risks, it was worth taking on his case. We started gently, and are now manipulating his back quite forcefully. He (and I!) are very pleased. He is responding quite nicely, and playing golf without much difficulty.

There are no real guidelines for chiropractors, but I am personally reluctant to manipulate a joint more than 25 times a year, and that may too much. She has been doing it about 1000 times per year. Self manipulation in my experience leads inevitably to neurological complications.

Illness is cumulative. Injury + self-manipulation + tum-sleeper = serious problems. The first challenge is to get her to change her habits. The next to fix the problem. Watch this space!

What struck me yesterday, oddly, was not that Vincent, after only one adjustment, was totally cured. What blew me over was that I didn't recognise him. Five months ago he was a miserable, almost shrunken, fearful human being. In five months, Vincent is transformed, a new person. There has been an explosion of growth, and a complete personality change. There are few things more humiliating and painful for a teenager. I literally did not recognise him.

The good wife has warned me. Apparently I am on the verge of becoming a smug jackanapes! Yesterday that was true. Today I was brought back firmly to planet Earth when a patient with a very serious sciatica with a footdrop, one that I thought we were winning with, took his surgeon's advice. He's scheduled for the knife on Monday.

"Most people live...in a very restricted circle of their potential being.

They make very small use of their possible consciousness, and of their soul's resources in general, much like a man who, out of his whole bodily organism, should get into a habit of using and moving only his little finger."

- William James, psychologist.

CHIROPRACTIC COALFACE

CHIROPRACTIC COALFACE: Mr Tom Prooi consulted me this week with pain in the neck running down his right arm. The pain began about six weeks ago after he carried his son on his neck at a musical concert. Six weeks of PT reduced the pain by about 40% but he noted that his arm was becoming weak.

What was significant was that rotation of his head to the right, and particularly looking up, immediately provoked pain down his right arm to the first and second fingers. A neurological tension test for the brachial plexus of nerves was postive, and there was the beginning of weakness in a shoulder muscle.

Carrying a child on the neck thus frequently overstrains the neck. My tentative diagnosis was a facet syndrome, though a disc injury is possible. He has never had neck pain before, no trauma, so my thoughts were that a slipped disc is unlikely. Watch this space!

Two weeks later: Tom has no pain in his arm now, he is sleeping well but, worryingly, on right rotation and extension, he immediately gets tingling in his arm. He is well satisfied, but I must confess I am less happy. I am thinking a disc protrusion is a distinct possibility. Pain in the arm, a true brachial neuralgia, ARM PAIN. pinched nerve in the neck, is probably the most challenging condition that a chiropractor faces.

Four weeks later: Tom continues to improve.

Ten week update: Tom has no pain, and I have discharged him, recommending he come back in two months for a grease and spray.

Suddenly, two weeks ago he had a severe spasm in the back, with tingling in the leg. In terror that another such attack was imminent, he made an appointment. Yesterday, after only one treatment, he is 70% better, and to my horror back on the tractor. I stressed: rehab is essential, and the altho the pain has receded, he had better work on a minimum of six weeks before healing is complete.

The worst backs are those which get half better, and then a setback before healing is complete.

My advice. Never take an acute low back for granted. They can be bastards. Do the exercises faithfully, and don't play silly buggers until your chiropractor gives you the green light.

An analogy. Twice recently in the European Football Cup, Turkey one a seemingly lost match in injury time. The opposition relaxed, thinking the match won. Don't let the surgeon score any goals in injury time! It happens. The acute low back is vulnerable for six weeks or more after injury.

Update: Six weeks has passed and he is having little trouble. The apple and pear picking season is about to begin in Holland. Dutch pears are the best I have ever tasted! His next appointment is scheduled for two months time. I wonder if he will survive the picking season ... it's heavy work.

For more information about the so-called slipped disk, click here … SLIPPED DISK ...

The headaches I must confess are being more difficult, but then he's had dreadful headaches for twenty years. For ten days after an adjustment he has no headaches, and then they start up again. The good news is that he is using half the headache medication he was three months ago. I was hoping for better ... it can be difficult at the chiropractic coalface.

The coccyx was very tender (deep down in the crease between the buttocks) and interestingly a very marked Sacro-Iliac fixation.

Nobody was more astonished than I, when he reported yesterday that just one adjustment of the SI joint, and an external manipulation of the coccyx, has decreased the pain by 50%. Miracles we do at once, the impossible takes a little longer! This is rather unusual, a chronic problem like that often requires a proper course of treatment at the Chiropractic Coalface, then rehab, followed by an occasional treatment.

Update. Jan is back riding his bike with no problems. I have scheduled him for a two months review. For more about chiropractic management of the coccyx, click here … COCCYX PILLOW.

CHIROPRACTIC COALFACE: Mrs Hol, a lady in her mid thirties consulted me recently with severe headaches. Whilst she had been suffering for many years, the last three weeks were simply terrible. She was ashen faced.

Her history revealed one source of the problem (constipation - she had at most one bowel movement in ten days), and the examination revealed two possible causes: an acute left TMJ syndrome, with significant facial pain, HEAD NECK PAIN ... and a cervical facet syndrome. NECK PAIN ... She also reported a whiplash injury some ten years earlier.

Just one treatment of her jaw joint, cleared the severe headache of the last three weeks, but niggling headaches remained. She was reluctant to change her diet, saying my suggestions were too radical, but on further enquiry, it was the recent death of her father from bowel cancer (in his 50"s, also suffering from constipation) that finally convinced her. She reported yesterday that she has had bowel movements of three consecutive days this week since start on my simple and effective constipation treatment. BEETROOT CONSTIPATION ... In addition she was experiencing quite significant buttock, lateral thigh and groin pain that is now nearly over since the commencement of treatment of her iliotibial band stretch syndrome. At the end of the day, does it really matter whether it was the treatment of her jaw joint at the Chiropractic Coalface, or her neck or the change of diet that is fixing her headaches? Does it really matter whether it was the adjustment of her sacro-iliac joint or the salads, fruit and beetroot that has fixed her constipation?

She is still having some mild headaches, but no longer takes any medication. Rome wasn't built in a day. Neither were Aachen or Cologne as they say in Holland. Got those three T-shirts? All three are definitely worth a visit.

There were four very significant findings:

• very restricted dorsiflexion of the right ankle (an old ankle sprain that was never corrected),

• wasting of the peroneus longus muscle on the side of the lower leg,

• a fixation in the sacro-iliac joint, and

• a very positive Noble's test.

There were also some signs of a patello-femoral pain syndrome.

To cut a long story short, he is doing very nicely with the iliotibial band stretch (at home) and my treatment of his ankle and sacro-iliac joint. The pain is already about 70% less in about two weeks, and I will allow him to resume training soon. On a flat surface.

Update: he told me today he ran for the first time in a year this morning - without pain.

New update: He ran for 30 mins yesterday, without pain. I'm having to restrain him! His best time? A very creditable 2hr, 24 mins, some twenty years ago. We chatted about who will be the first to break the two hour barrier, as Roger Bannister did to the four minute mile.

What was the difference? The Derefield test indicated a sacral lesion and, since I have been adjusting the sacrum, he has been improving. He is vigilant about the exercises, and I have no doubt that also helps. An MRI shows significant loss of disc space, and fluid within the body of the vertebra. Deep seated inflammation. I think the Thompson drop table is making the difference. SACROILIAC JOINT TREATMENT ... Needless to say, the Chiropractic Coalface is an extremely interesting place to work. How many people, with their 60th staring them in the face, are TOTALLY satisfied with their career path!

There was only marginal improvement for the first two weeks of treatment (and the treatment of the groin is very painful), but she stuck it out and yesterday she reported that the condition is 70% better. After only one month of treatment. This is not an unusual complaint, and it's not only related to pregnancy, though pregnant women seem more prone. For more information about this very awkward syndrome, click here … LEG PAIN DURING PREGNANCY >>

CHIROPRACTIC COALFACE: Mr Boersma is a successful middle-aged businessman. He is extremely fit. Last summer (July) he and his family went to a Greek island resort for two weeks. One night he developed severe chest and arm pain (left) and was rushed to hospital.

An aside: Many people get sick on holiday. Tip: Take a day or two at home before rushing off. And a day at the end of your holiday. Release of stress is the single most important part of a holiday. Should rush and bother getting off on holiday simply add to the stress of life ...

To cut a long story short, he had exhaustive tests, both in Greece and after returning to the Netherlands. Unfortunately no one thought to do Adsons test /videosearch?q=adsons+test&hl=en&sites earch=#q=utube%20adson's%20test&hl=en&sitesearch= , (careful, choose the right test, two are listed here) a standard orthopaedic test that every chiropractor learns at Uni and uses on a daily basis when patients present with arm pain.

The heart-related tests all proved negative despite further episodes of chest pain and tingling in his left arm, and another midnight ordeal in the Emergency rooms. Almost every night for a whole year he was wakened with tingling in his arm.

The only significant fact that came out of the history, was that day he played tennis, throwing the ball up with his left hand. This raises the clavicle and first rib, using the scalene muscles in the neck and closes down the so-called Scalene Triangle. THORACIC OUTLET SYNDROME >> Mr Boersma reported yesterday that after only five treatments of the first rib in the neck, over a six week period at our Chiropractic Coalface (he has to travel extensively on business out of Holland), the condition has almost completely resolved. We are now into the rehabilitative part of the treatment to ensure he doesn't relapse. Strengthening the shoulder girdle, and stretching the scalene muscles is important.

Another aside: His medical insurance company could have saved themselves a small fortune, should they have encouraged their clients to visit the chiropractic coalface. I must remember to ask him to tot up the cost in Euros over the last year of all his medical costs. Sadly there are none so blind as those who will not see. (French proverb)

To cut a long story short, I am having great difficulty restraining Juliana. Free from her headaches and malaise she is painting the town! Last Friday night she and her husband went 'op stap', a Dutch phrase for partying, got involved in street dancing in a local village celebration, and wining and dining not possible since the accident. Needless to say, the chiropractic coalface is a profound place to work.

Jull's test is particularly significant. It indicates marked weakness of the deep neck flexor muscles, proved many times in research to atrophy and become weak after trauma. She was quite unable to hold her head steady for the required 10s.

Perfect? Far from it. Rehabilitating back to as near-normal neck as possible, and a bruised ego is going to be difficult. But she's a quite different person to the woman who consulted me two months ago. Body language alone speaks volumes.

CHIROPRACTIC COALFACE: Whilst it may seem from this little chiropractic coalface list that every patient has unique and interesting problems, probably 70% of every chiropractor's life is taken up with the humdrum - routine maintenance of the body. There is lots of research showing that an occasional regular treatment helps prevent gradual deterioration again. So we have heaps of people coming in every two or three months for an adjustment.

We chiropractors are roundly criticised for this, and I confess to having struggled conceptually with maintenance care for many years. I have gradually come round to the opinion that those folk who have an occasional, regular treatment, have fewer problems, and generally less treatment (and it costs less money) than those who wait until it is painful again.

Having said that, there are a good many people who, after a course of treatment, and a faithfully done set of home exercises, have no more troubles for years. They are the exception though.

So you see, it was a wonderful week at the chiropractic coalface. True, some patients with whom it was not going so well. Not yet, Aachen and Cologne weren't built in a day, as they say in Holland, nor does chiropractic fix thirty years of damage in a few short weeks.

Been to Rome, Aachen and Cologne? If not, and you love to travel, add them to your next holiday in Europe. You won't be disappointed.

Apologies for all the "CHIROPRACTIC COALFACE" signs. Google demands it so the page gets Brownie points!