Reflecting on these past ten years I have been looking ahead to what the next ten years might bring. Of the many challenges I foresee, the most difficult is educating the aging population. In my six years in clinical practice I have spent a fair amount of time talking with and attempting to better understand their point-of-views on life, their health and wellness goals and most specifically in my office, pain and the options for it’s management. For many of them they lived through the modernization of medicine: the miracle of antibiotics, the advancement of surgical procedures and new “improved” options for pain management. The problem with these “advancements” is that it has romanticized pharmaceuticals (consequently creating an entire generation reliant on prescription medications while sparking an opioid epidemic), put surgical procedures in a “fix it all” light and of this generation of patients with very little control of their own health and well-being.
We as a society, aside from a small percentage of the population have abandoned all efforts to get off medication and manage our own health with choices we make on a daily basis, namely diet and lifestyle. The mainstream medical field says “Oh, you have neck/back/shoulder/hip/wrist/ankle (etc) pain, better get in to see that orthopedic for some pain medicine and maybe physical therapy.” Six weeks of physical therapy later, “oh, it’s not working doc what are my other options?” Surgery. Society and Physicians alike are seeking out invasive, drastic treatment options without giving an honest effort in conservative care.
By saying conservative care, I don’t want to appear to limit the table to just Chiropractic as there is a wealth of resources for options in alternative care such as: physical therapy, nutritional/functional medicine specialists, health coaches, personal trainers/exercise physiologists, energy healing, medical initiatives and many more. The options to get to the “root” cause of dysfunction/pain are endless, yet patients presenting with low back/neck/shoulder/knee pain for months on end, with no red flags, believe surgery is the only option.
At the end of this blog post there is an excerpt from a peer reviewed research article detailing tissue physiology and the timeline for healing. We at Catalyst believe this timeline should be respected and treated with the approach that correlates with patients specific healing phase. If there are further complications, re-injury or failure to progress with conservative measures, then surgery should be considered.
To be clear, I have personally referred patients for injections and spinal surgery after a trial of conservative care with failure to resolve or progress but this referral is up to a professional to judge when it becomes necessary, not your family, friends or acquaintances who has had something “similar.” A recent encounter with a patient revealed their biggest concern about their low back pain was what to tell their friends and family so they would quit pestering them with advice on what to do, not actually fixing her low back pain! Society’s mentality of the “problem” and how to “fix” it is largely based on “someone said they read on webMD that it’s this and I should seek injection/surgery/scope/etc to fix it.”
The population who are the most guilty of this mentality also tend to be the age group that is entering or just entered retirement. They have worked their entire lives in pursuit of the American Dream, many have reached it and have absolutely earned their retirement but the problem is now they have the time and money to reap the fruits of their labor and their bodies can’t keep up. They can’t enjoy the cruise because they can’t walk the length of the ship. They can’t tend their garden due to pain somewhere. They can’t work on their hobby because of hand numbness. Of these patients that present to my office the ones that make a recovery are the ones who seek conservative care first or their doctor referred them to conservative care.
Additionally, the patients who make a recovery have a positive outlook on their life, seeing this as a speed bump not taking on a mentality of being “broken.”
Why I bring this whole conversation to the surface is because these patients are my most difficult cases and my most frustrating failures in clinic. The overwhelming majority of these failures are due to my inability to convince these patients they need to change their movement habits to change their pain. If you can’t walk for 5 minutes without limitations, garden, or enjoy your hobbies; you are deconditioned. To me, I am more worried about their level of deconditioning than I am about the level of pain! It is a fast demise to the human body that has become sedentary but our society has evolved into one of 9-5 desk jockeys whose hobbies involve video games and social media scrolling.
You know the stories you hear about 90+ year old relatives that is self sufficient and thriving in their own environments? They are active in mind and body and have been the duration of their lives. So in an attempt to remedy my frustrations and inspire our community, we are starting a new movement education program at Catalyst Wellness. The scope of the program is to return people to function, optimal function. We’ve named it Catalyst Directed Performance. Though this service was conceived through the necessity of keeping aging populations active and independent; we can and will tailor it to the person who wants to get-in-shape and doesn’t know where to start. The athlete who, through injury, can’t compete anymore. We don’t want to be the gym replacement but the catalyst to getting you back to performance.
Over the years we have built relationships with local gyms and based on your goals and proximity can refer you to join their establishments for those people looking for true strength and conditioning. We can communicate with the gyms about your limitations and goals. For the people looking for improvements in activities of daily living we are capable and ready to help.
Don’t sit idle and let time pass you by. Take action and plan, make it fun, make it diverse and if you don’t know where to start or would like a helping hand, our staff at Catalyst Wellness is here eager to help.
See below the aforementioned excerpt on tissue physiology.
The Physiology of Sports Injuries and Repair Processes
By Kelc Robi, Naranda Jakob, Kuhta Matevz and Vogrin Matjaz
Submitted: May 9th 2012Reviewed: October 10th 2012Published: May 15th 2013
DOI: 10.5772/54234
After the injury, the wound site is infiltrated by inflammatory cells. Platelets aggregate at the wound and create a fibrin clot to stabilize the torn tendon edges. The clot contains cells and platelets that immediately begin to release a variety of molecules, most notably growth factors (such as platelet-derived growth factor, transforming growth factor β, and insulin-like growth factor -I and –II) causing acute local inflammation. During this inflammatory phase that usually lasts three to five days, there is an invasion of extrinsic cells such as neutrophils and macrophages which clean up necrotic debris by phagocytosis and together with intrinsic cells (such as endotenon and epitenon cells) produce a second pool of cytokines to initiate the reparative phase [2-4].
In reparative phase (three to six weeks) large amounts of disorganized collagen are deposited at the repair site with granulation tissue formation, together with neovascularization, extrinsic fibroblast migration, and intrinsic fibroblast proliferation. After four days fibroblasts infiltrate the wound site and proliferate. They produce extracellular matrix, including large amounts of collagen III and glycosaminoglycan [2-4].
In the remodeling phase, there is a decrease in the cellular and vascular content of the repairing tissue, and an increase in collagen type I content and density. Eventually, the collagen becomes more organized, properly orientated, and cross-linking with the healthy matrix outside the injury takes place. Matrix metalloproteinase degrade the collagen matrix, replacing type II collagen with type I collagen. The remodeling stage can be divided into a consolidation and maturation phase. At the end of the consolidation phase, at about 10–12 weeks, and with the beginning of the maturation phase, the fibrous tissue is converted to a stronger scar tissue. Around the fourth week collagen fibers are being longitudinally reorganized so that they are aligned in the direction of muscle loading. During the next three months the individual collagen fibers form bundles identical to the original ones. After the healing process is complete, cellularity, vascularity, and collagen makeup will return to something approximating that of the normal tendon, but the diameters and cross-linking of the collagen will often remain inferior after healing. This phase lasts for months or years, usually between 6 weeks and 9 months or more. However, the tissue continues to remodel for up to 1 year. The structural properties of the repaired tendon typically reach only two thirds of normal, even years after.
