This week the Integrative Approaches to Pain Blog Series brings us to an interview I did with Dr. Katherine Iacuone of Desert Valley Chiropractic in Phoenix, Arizona.
For years I poo-pooed the notion of seeing a chiropractor, as I was not about to have someone twist, jerk and snap my very expensive, very fused back. Turns out that was very small minded thinking.
I met Dr. Katherine over a year ago and discovered that she and her chiropractor husband both use something called the activator method. To explain it in layman's terms: they have a hand held device that controls the type and location of pressure used on a very specific part of the body to align someone to their very own normal. No twisting, cranking or anything of the such. They both are also able to keep from rolling their eyes when you refer to the device as a "thwacker."
Treatments at Desert Valley Chiropractic helped tremendously with getting my knees sorted when I first moved to Arizona and seeing them for my wrist was an obvious solution... when I was ready to admit I needed help.
Before we get too far, it's time for the ceremonial disclaimer.
DISCLAIMER: None of the information in this blog series is meant to take the place of your healthcare provider’s advice. Continue with your existing pain management plan and seek medical care as needed. Inform your healthcare provider of any changes, alternative treatments and self-care techniques you decide to implement.
Sheila Amir: Patient (new or existing) comes in for treatment on an injured wrist. Presents with significant pain in wrist due to aggravating a longstanding repetitive injury. Shows the significant inward slant at wrist compared to other. Going through our first appointment, walk through exactly where you would start and what course of action you would recommend?
Dr. Katherine Iacuone: With a new patient we always go though a detailed history of the condition as well as a physical exam including orthopedic testing. If we deem it is medically necessary we will send a patient out for imaging such as an MRI or x-ray.
With an established patient we do a similar but slightly briefer exam and history of the current injury.
SA: I noticed that during our appointments for my wrist you also adjust my hips and knees as well. Why is that? Additionally, as a lot of this issue is related to the neck and descending down the shoulder/scapula and down the arm, can you walk through that and discuss how removing tension in lower back will help upper?
DKI: This is just like the song " leg bones connected to the hip bone!" we treat the patient as a whole person. We want all the joints stabilized and aligned. We tend to work from the bottom up, making sure we have a good foundation on all the corrections we are making.
SA: When one side of the body is injured, the other side automatically picks up the slack to keep us moving along. Often this compensation can result in another injuring or even progressing the existing injury. What do you recommend in this situation?
One of the reasons we adjust both sides it to off set some of the compensation on the left side. We will try to correct and heal the right and be proactive with the left.
SA: Do you feel that strengthening the other portions of the body that aren’t injured would be a positive or negative thing long and short term?
DKI: My best advice is speak to a skilled trainer about that. You don’t want to build that other side up to where it is way stronger, but you do want to build up the structure. Worst case scenario is when you go to rehab the other you have the strengthen the other side to help you. You can play catch up with the injured side.
Things like yoga are always a plus as it focuses on balancing.
SA: When you see injuries like this, what is your recommended course of treatment? Frequency? Duration?
DKI: This is a significant issue. You have 10/10 pain and a loss of function. You are looking at three times a week for at least a month.
SA: What do you recommend to support the adjustments that you make?
DKI: One of the reasons that we do a three time a week protocol is to support the correct through repetition. You actually use the adjustments to support themselves by repeating the correction until it stabilizes and begins to heal. We’re moving the bones a small amount on each visit. Sticking with the care plan is the best supportive thing you can do.
SA: Would you recommend that your treatments stand alone or be integrated into other approaches?
DKI: I love an integrated approach, acupuncture is one of my favorites and yoga makes for a great balanced rehab!
SA: What are your thoughts on using more than one type of treatment in a day? For example, if I come in here on a Monday for an adjustment, is it a good idea or bad idea to do acupuncture or physical therapy within the same day?
DKI: Do what works for you and allows you to stick to your care plans. If PT, yoga and Chiropractic are too much for you in one day spread them out. If it works for you and it is the only way to keep with a care plan, go for it. Look for offices like ours that try to make scheduling as easy as possible!
SA: Does taking pain medications or anti-inflammatory medications prior to adjustment affect the quality of the adjustment good or bad? (You know you've dealt with pain personally and professionally for over 20 years when you ask questions like this!)
DKI: No. I don’t think so. The bones are still going to lay where they are at. I may be a bad chiropractor when I say this, but in some ways taking an anti-inflammatory medication may reduce the inflammation enough to make the adjustment flow better.
I like to see my patients take as little as possible. I’m a big believer that if you need the medicine, take the medicine and let’s work to get you off them as soon as possible.
SA: Do you see a difference between the outcome of your patients and their nutrition?
DKI: Yes. I think that nutrition and supplements, are the building blocks for the bio chemistry that you need to rebuild. If you are giving your body what it needs to repair and heal you will get better.
If you are eating pro-inflammatory foods… If you’re fueling with nuggets, what biochemical building blocks did you give yourself to repair? If you’re regularly eating your fruits, vegetables, turmeric and other anti-inflammatories, eating better as a whole, you will heal better.
Anti-inflammatories won’t heal you or build you, you have to give yourself the nutrients you need to heal.
SA: What is the difference in heal rate between someone who exclusively uses chiropractic care and someone who uses chiropractic along with other approaches (acupuncture, physical therapy, etc.) what is the difference in heal rate?
DKI: Lots of individuals do great with just chiropractic. With chiropractic care you need 10 to 12 visits to see if it works for you. If you’re not seeing any progress in 8 visits, you need to start looking at integrating other approaches. Most people start to see improvement in 12 visits and we go from there into stabilizing the area and they do great.
Ending it on a high note.
As I progressed through my 12 adjustments with Dr. Katherine pain became more localized to three or four specific areas in my hand and wrist rather than unbearable pain throughout the area. Katherine noted this as progress and remarked that it was time to transition back into my activities I had been missing so much!
Dr. Katherine informed me that, “the first 12 treatments we focus on getting out the pain and seeing if this type of treatment will work for you. The next 12 [treatments] become about restoring function and lifestyle. Now we want to see how the joints can move. How many activities you can return to and add in. Reducing pain and restoring function and lifestyle is generally what I tell patients. Corrective treatments then restorative.”
Honestly all I heard is that I was progressing well enough to go back to yoga soon. YES! While I still have a long ways to go, it is affirming to see that the time and effort invested in actively addressing my injury from many angles was paying off.
Not only is it nice to have relief from the intense levels of pain, it’s great to see a light at the end of the tunnel. When you’re in the grips of pain it’s hard believe there will be better days.
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