chirojoe

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Thoughts on care and prevention

Back in the High Life Again

We all know time flies. I would add that it doesn’t just fly, it accelerates. It’s hard to believe it’s been almost two years since my last article. For the three of you who subscribe to this blog, your wait is over!

Through the years, I’ve been privileged to have experienced almost everything I treat my patients for: headaches, neck pain, back sprains, disc issues, shoulder injuries. It helps me relate to their story, helps me come up with a treatment plan, and helps to put them at ease.  The reason it took me so long go get back to writing is I now have two new issues to deal with: hip and low back arthritis. While the hip derailed me for most of the last two years, the low back story comes first.

Arthritis?  That Sounds bad!

I am cautious when throwing around the “A” word with my patients. No one wants to hear they have it and often it generates unnecessary anxiety.  The textbook definition of arthritis is simply, “inflammation of a joint.” In the biz we most often use it to mean a progressive condition leading to joint damage, starting with erosion of bone-protecting cartilage that allows the bony surfaces to glide against each other. It can be a quick or slow process. It can remain hidden without symptoms or it can cause debilitating pain. It can be caused by faulty biomechanics or postural faults (osteoarthritis) or by metabolic or autoimmune conditions (rheumatoid, lupus).

osteoarthritis.png

In the early stages, arthritis might not show up on x-ray. If it progresses to where it does, one can see one or more of the following:

  • loss of joint space as cartilage degenerates

  • sclerosis, or whitening of bony structures, as joint fluid seeps through the broken down cartilage and irritates the bone

  • bone spurs called osteophytes

  • in the spine, loss of disc height and any of the above.

Severity and progression of symptoms will vary from person to person and depend on lifestyle, habits, genetic composition, and removal of any contributory factors.

As for myself, I’ve had it in my neck since my thirties but once I dealt with it, got it treated and changed some habits, I rarely notice it. When I do, it’s a reminder that I’ve been slacking off on my self-care. With the line of work I’m in, I shouldn’t be surprised it showed up in my low back, but I was surprised at how it went from fine to bad without me even knowing (maybe I was just in denial?).

They say 50 is the new 35

I really don’t know if “they” say that, but I sure do tell everybody that.  In April of 2015 I not only turned 50 (enough time has passed that I can type that out loud), but also went back to competitive rowing. I had taken the 2014 season off, so I was excited to get back on the water.  Masters rowers, like myself, compete in groups according to age, and 4 of us were now “D” rowers (the 50-55 age category for USRowing). This was the year for us old people to shine!

One week into training, I, the team chiropractor, sprained my back in the boat. The irony wasn’t lost on me, nor anyone else.

Rowers are usually rather tall. Being 5’8″ (formerly 5′ 9″) in a sport where height is an asset and in college they don’t even look at you unless you’re way over 6′, every bit of forward bend helps.  Not having forwardly bent in over a year, that’s where I was lacking. The coach saw it and I could feel it.

There’s a slight chance I was overcompensating.

So I took time off, rested, iced, stretched, got adjusted, massaged, and was able to get back in the boat a week later, conveniently on my 50th birthday. And, it was a “D” Mens 4+ and was one of the best rows I can remember for early in the season.

I should have paid attention to the fact that we were doing high intensity work on my first day back after injury (I tell my athlete patients NEVER to do this), but rowers think they’re invincible, chiropractors think they’re invincible, and it was only 5:30 AM. I wasn’t turning 50 till that afternoon at 4:14. So, I could still act like an invincible rower in his 40s.

All went well until the last 20 strokes, when I felt that little twinge that let me know my back was fatiguing. Of course, being invincible and still in my 40s, I kept going and five strokes later it froze. I gave the coach the “I’m done and get me back to the dock immediately” signal, the same one I had given him the week before, and saw the disappointment in his face. Our coxswain had to carry the boat back to the rack in my place.

A Picture is Worth a Thousand Words

There is nothing like spraining your back twice in two weeks in public to start thinking like the patient instead of the doctor. I spent my 50th birthday getting glamour shots of my low back.

I’ll tell you what’s demoralizing about getting x-rays done on your 50th birthday: Filling out the forms! You would think in today’s computer age the system would be able to do the math and subtract 1965 from 2015, but no…they maliciously had a box for “age”. I considered writing 49 because it still wasn’t 4:14 PM, but finally, I accepted that the AARP card arrived in the mail for a reason and wrote 50. At least I got a “Happy Birthday” from the receptionist and a “Happy Birthday, whoah, Happy BIG Birthday!” from the x-ray tech.

It can be both a blessing and a curse that I can read my own x-rays. This time it was a  curse; my lumbar spine was one of the ugliest I have seen in almost 25 years of reading x-rays. Not the worst, just the ugliest. Staring back at me was pretty advanced arthritis in the form of bone spurs and significant loss of disc height.

Looking at a normal spine from behind (left image), notice the crisp clear lines and good disc spaces in between the vertebrae.  Yes, that’s me on the right. Those bone spurs are called “bridging osteophytes” and look like something Sigourney Weaver battled in the Alien movies of the ‘80s.

Looking at a normal spine from behind (left image), notice the crisp clear lines and good disc spaces in between the vertebrae.

Yes, that’s me on the right. Those bone spurs are called “bridging osteophytes” and look like something Sigourney Weaver battled in the Alien movies of the ‘80s.

Here on the left, in a side view, we can see the disc spaces clearly, as well as the spaces behind the vertebral body out of which the nerves to the legs pass. On the right, not so much.

Here on the left, in a side view, we can see the disc spaces clearly, as well as the spaces behind the vertebral body out of which the nerves to the legs pass. On the right, not so much.

Needless to say, I was a bit disillusioned that night at bowling. Not because of the big “Happy 50th Birthday” balloon floating above our table nor the announcement my teammates had them make over the loudspeaker, but because I suddenly felt old, I knew where that forward bend had disappeared to, and I had to be careful to not further injure myself hurling my ball down the lane.

You would think that I would have learned from the episode 10 years ago when I saved a pyrex dish from early death by tile floor but tweaked my back… and then went to work, only to freeze over my second patient. I had to be carried out of my office by three of my friends. But no, “do as I say, not as I do!”

Bowlers are like rowers and chiropractors: they are invincible and don’t let a silly little back sprain keep them from competing.

My last lumbar x-rays were 20 years ago in school because my fellow intern needed one more x-ray credit to finish his internship. Back then I had textbook perfect lumbar spinal anatomy. Now, all I could think about was what I could have done differently over those 20 years to prevent what I now saw.


“But when you’re born to run It’s so hard to just slow down”


Listen to Yourself/Your Body

The paradox in my mind was frustrating and I beat myself up for a while. As a Doctor of Chiropractic I preach prevention, posture, and a healthy lifestyle. Though I started out being the chiropractic poster boy, as the years went by I got more and more complacent, distracted, and, well, lazy. I’m sure now that those forces (from a very physical job and a sport in which I turn my body to the right a thousand times in a practice five days a week) settled into my spine just at the same time that my periods between regular adjustments and stretching were getting longer.

Doctors really do make the worst patients.

Hindsight being hindsight, I can’t change the past but I can learn from it. The good news is, the body adapts to positive forces also, and while I won’t undo the arthritis, I can manage it. I now have a standing appointment to get adjusted by a colleague regularly. I’m doing much better at stretching and foam rolling. I’ve taken control of my sleep habits instead of my schedule controlling them. Will I row competitively anymore? Very possibly. I think I can get some of that forward bend back but I also realize I can’t train like I did in my thirties. But I can still train! There’s a 75-year-old rower in our sister club at our boathouse. That can be me if I want it bad enough.

What have I learned from my ugly arthritic spine? Nothing I didn’t know before, except that I can no longer ignore that I am not invincible and what I tell my patients applies to me as well:

  • We’re not supposed to age painfully. Pain is often a sign that some negative process has been developing for a while. Don’t ignore pain that doesn’t resolve on its own in a day or two.

  • Add in some form of stretching into your daily routine. Every week, the entire body should get stretched and/or foam rolled.

  • Sleep and rest are important, no matter what age. Collagen, which holds the body together, repairs itself during rest and sleep and it takes longer to do it the older we get.

  • Just like seeing the dentist for a checkup even if your teeth feel fine, it’s a good idea to get your body checked regularly, especially if you’re in a repetitive motion sport or job. Try to balance out the forces on the body structures affected.

Nothing in life is guaranteed, including whether or not I could have avoided the arthritis. An ounce of prevention, though, is worth a pound of not having to cut short your rowing season. 50 may be the new 35, but I will have to help it along a little.