Transcript
CHARLIE: Welcome back to SpineCast. We’re visiting again with Dr. Sean Riley. Sean, thanks for being with us here today.
Dr. RILEY: Thanks, Charlie.
CHARLIE: Tulsa Spine and Rehab, just so you know, is an integrated clinic providing chiropractic and physical therapy, massage therapy, yoga, naturopathic medicine, including acupuncture. You’ll find it all under one roof, and that’s what they stand for. Now, Sean, we’re all familiar with the idea of getting our cars’ four wheels aligned. It’s important so the car operates well, but I’ve also heard you talk about the importance of our own alignment. Can you explain that?
Dr. RILEY: Sure. That’s a great analogy, Charlie. Just like if your alignment’s off, you potentially have one tire that’s going to wear out. It could affect different things in the vehicle. Very similar to what’s going on in our bodies. Another quick analogy I’ll give you. If you were building a house, and my foundation was crooked, or it was off, once you build the house on top of that foundation, obviously the roof might not be level, the walls will not be straight. Very similar to the analogy you gave about the car, and so I talk to patients about identifying areas of deficiency, or limitation, if you will. Those areas may be alignment within the spine, and/or a diminished range of motion in another part of your body, and so it’s very important that we identify the limitation, and then make the correction. That correction may come from joint manipulation or adjustments. We’ve talked about that in the past. It may come from exercise recommendations. Let’s say your right hip doesn’t internally or externally rotate like the left. Well, that potentially is deficiency that could create another issue. I talk to patients that were symmetrical, and what that means, or we should be symmetrical. What that means, Charlie, is that we have an equal right and a left side. If there’s a breakdown, some area, typically asymmetrically on one side, there’s going to be some form of compensation, and that’s potentially where the injury may occur.
CHARLIE: That’s interesting you say that about the compensation because I was just sitting here thinking what you were talking about with regard to the car. You know if your car is out of alignment, you’re kind of pulling on it to keep it straight in the road, and like you say, it’ll wear your tires out sooner. With us, with our bodies if we’re out of alignment, first of all, how can we tell we’re out of alignment? It’s easy enough to tell your car’s out of alignment or your house is out of level. How can we tell we’re out of alignment?
Dr. RILEY: Yeah. Back to the analogy real quick, Charlie. You mentioned about if your car was out of alignment, and it relates to your front left tire is worn down. I take my car in. It doesn’t make sense just to change the tire does it?
CHARLIE: Right.
Dr. RILEY: You have to address, “Why did that tire wear down,” and that speaks back to your point is we’re trying to identify those areas, the alignment issues of the car. Typically, that’s done through examination. We go through functional movement screenings, and all these fancy tests, and different things that we’re trying to identify. We’re looking for range of motion. We’re looking for areas of restriction, or tightness, loss of mobility. All these types of things that we’re doing in the clinic are identifying these areas or these limitations, these deficiencies. It’s so important, as I’ve grown through practices that we’ve implemented, incorporated more movement type testing. What that means Charlie, is I’m not just going to lie you down and take a range of motion finding, or quantify external internal rotation, a number. I want to see you move and different things because obviously I’m just not laying down throughout the day. I mean I’m moving. I’m staying active. I might not be able to bend very well. I might not be able to extend or rotate my thoracic spine. All these limitations, like I said, can potentially create a compensation, which could lead to an injury. I’ve had patients that will come in and they’ll say, “You know, Sean, I feel like my right leg is shorter than my left.” That’s a way to self-identify if maybe there’s an issue in the pelvis, for instance. The pelvis rotates up a little high on the right, draws the right leg up a little short. They might just feel there’s a little imbalance. You’re not able to rotate your head as far to the right. I talk about all these fancy functional screens, and all this stuff that we’re able to do in the clinic. I think as a patient, throughout the day, you might be able to identify some of these limitations with just simple movement patterns like I had mentioned. “I’m unable to internally rotate my shoulder when I go to put my seatbelt on. I don’t feel like it moves as well that way.” So the mobility thing, the restriction thing, Charlie, is the way I equate to the alignment in the car. We’re trying to identify these areas that aren’t moving that well, and make the appropriate corrections.
CHARLIE: So we’re going to wind up feeling like our left side is going to be more sore than the right or whatever, and we can tell by saying, “Okay, can I reach to this far with both arms,” or something. We’re going to look for those kind of warning signs that maybe we’re out of alignment.
Dr. RILEY: Yeah. Kind of. You know more so, Charlie, when we have pain we’ve passed the threshold. Meaning, “Okay. There’s an issue.” Not necessarily a serious issue. You might just have left shoulder soreness or tightness. Typically, that means there might be an inflammatory response going on. You’ve irritated the tissue. The joint might be a little irritated, and now I have discomfort and pain. Once we’re there, okay, now we try to manage the shoulder issue. A lot of times what’s happening is the deficiencies, those limitations, are kind of underlying. I don’t know if that makes sense. Then from that limitation, the compensation and the episode occurs, and that’s typically what brings a patient into the clinic. So I want to focus more on, okay, being properly assessed for a stability issue, weakness in the hip, tightness in some other area. Hopefully through those areas we can make the appropriate recommendations so they don’t have the episodes, so they don’t have the compensation, so they don’t have the soreness in the shoulder.
CHARLIE: What are the early warning signs we should watch for?
Dr. RILEY: Well, like I had mentioned, day-to-day type activity. When you notice that when you go to turn around, you’re not able to rotate as well to the right as you are the left. That’s a little bit of a warning sign because like I had mentioned, we’re symmetrical. We should have equal motion on the right and left. I’ll tell you what’s funny, Charlie, that’s kind of the norm for most of us these days, and a lot of us just get away with it. We’ll go months, maybe a year or two without having much of an issue, and then when we just do a little something incorrectly, or move just right or wrong, and boom we have an issue. It’s a tough thing to determine when you’re exercising at the gym, if you’re doing a certain exercise, and you’re like, “Man, I was able to do 30 reps on the right, and only eight on the left.” Okay. That’s a warning sign. There’s a deficiency there related to stability. I always talk to patients. That’s one of the most important things that we do in this clinic early on is we’re trying to identify those limitations, and make the appropriate recommendations so they don’t have those episodes.
CHARLIE: Once we do identify that we have an alignment issue, what’s the solution to this with you?
Dr. RILEY: Like you mentioned, identification’s first off, and then a game plan. That game plan could include a host of things, but typically it’s going to be some form of manual therapy, so we identify restriction and tightness within a joint that potentially leads to dysfunction, or pain, or inflammation. We want to mobilize that joint to reestablish normal motion. I mean that makes sense. We should have normal motion throughout our spine and our joints. When there’s a breakdown and a restriction somewhere, it potentially causes a problem. So manipulation early on, manual therapy, deep tissue massage. We want to address the joint or the muscle. From there, very, very important, we want to make appropriate exercise recommendations on how to overcome the limitation, and how to manage it moving forward. We’ve talked about self management and preventing reoccurrence. I think that’s so important, relatively easy to solve the problem. The challenge comes from preventing reoccurrence, and reducing frequency. So it’s important that you give these patients a game plan moving forward on some simple things that they could do on a daily basis, or two to three times a week, to prevent it from coming back.
CHARLIE: The key to knowing if you’re out of alignment, and from what I’m hearing you say Dr. Riley, is watch for deficiencies. When you see one, act on it, get in to see you.
Dr. RILEY: Absolutely, and just because there’s a deficiency doesn’t mean it’s going to create a serious or a significant problem. But what happens is these deficiencies, or these limitations, potentially can be cascading and cumulative in effect, and now we have a handful of these things, and it’s creating more significant problems. So I talk to patients, “Don’t let pain be your guide always.” We’re wired like that, Charlie, obviously. “I hurt. I’m going to go to the doctor.” I think that maybe awareness is very important throughout our day-to-day lives. If you start to notice you’re not able to get up and move, seated to standing, as quickly, different types of situations at the gym, in and out of your car, looking over your right shoulder, those small little instances throughout the day could actually be little warning signs that potentially could create something a little more serious. That’s when I recommend the patients get in, get checked out appropriately, and develop a solid treatment plan.
CHARLIE: But the bottom line, don’t put it off, act sooner rather than later before it becomes an acute problem.
Dr. RILEY: Absolutely.
CHARLIE: All right. You can learn more about being in alignment, and watching for your deficiencies, and taking action at tulsaspineandrehab.com. You can also subscribe to Dr. Riley’s weekly newsletter. He packs it full of tips and suggestions to help get you moving. Thanks again for spending time with us today, Dr. Riley.
Dr. RILEY: Thank you, Charlie.
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