The Core Defined

Written by: Jeffrey Sergent, DC

This is a debated topic. A fun nerd-fight if you will? I find the difficult part is really defining the core. Many different groups and clinicians have different muscle groups associated with their definition of the core. But I suppose I will define my own opinion of the groups of muscles that define core and why.

Outer core muscle examples

I like to divide the core into 2 parts: the outer core and inner/deep core. The outer core is what most people typically think of the core as: Rectus abdominis (6 pack muscles), obliques (inner and outer), transverse abdominis, quadratus lumborum (QL), latissimus dorsi and erector spinae. This creates the outer shell. For example, if you think of a can of soda, they would be the outer aluminum shell.

The deeper or inner core muscles create the top and bottom of that can. This would be the diaphragm, pelvic floor, multifidus, longus colli and longus capitis (deep neck flexors). I do include neck muscles, dnf, in the core. My reason for this is basically that the spine works as a unit. If the neck is too far out of alignment, then the lower back will be too. To see what I mean try to do this easy exhale technique on yourself: Place your hands on your low back and now protrude, or jut your neck and chin forward.  Feel how the lower back follows, resulting in increased muscle activation down there.

        

Deeper/Inner core muscles

Deeper/Inner core muscles in the neck.

The reason for the distinction of inner and outer core is in the development of performance and rehab. The goal is to be able to create a brace and muscle stiffness that don’t allow the spine to move. This stiffness protects the spine from mechanical stress during lifting, bending, sitting, standing... pretty much everything. If there is inefficiency in the core, then the energy will be displaced from the muscle and stiffness to the only still structure: the spine.

Really the purpose of the core is to create intra abdominal pressure and stiffness. Let's go back to the can analogy. If you had only the outer shell, no top or bottom, you would be able to deform it without much effort. Now add a lid and bottom, the inner core. This creates more rigidity and stiffness, making you put in a little more effort to crush that can. Now imagine increasing the pressure within by carbonating and shaking up the can. This creates an even greater stiffness. At this point that can would be pretty difficult to deform, and unless someone gets thirsty would last quite a bit longer than any of the individual parts of the can on their own.

Photo sources: www.slamdunk.ru, mikescottdpt.com, www.cityedgephysio.com.au

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Dr. Jeffrey Sergent is a certified Clinical Rehab Specialist and Chiropractor. He earned his Bachelor's Degree in 2004 from Michigan State University and his Doctorate Degree from the National University of Health Sciences in 2008. His special interests include Trigger Point Therapy, the Functional Movement System, Developmental Kinesiology, Pain Neuroscience and nutrition for chronic pain. Currently he practices at Goodyear Chiropractic Health Center in Milwaukee, Wisconsin.

Rants from a Chiropractor: Part 1

Written by: Jeffrey Sergent, DC


What is Chiropractic?

I get this several times a week and find it difficult to answer in two minutes.  I know… if you are an expert at something you should be able to define it quickly. Well, I have a hard time with this answer for a few reasons:  

1. People have no idea what a chiropractor is or have a misconception of what a chiropractor is.  
2. There are a variety of different chiropractic techniques, specialties and philosophies.  
3. I love what I do and could talk about it till the cows come home.

I am going to take a stab at answering what a chiropractor is and what they do by addressing these three reasons... and I'm sure I’ll go on further rants.

1. People have no idea what a chiropractor is or have misconceptions of what a chiropractor is.

I want to start this section off with a crazy real story that happened to me. On a normal Thursday afternoon (okay, the day could be wrong) I had a new patient on my schedule and, as I usually do, I was reading through the new patient’s paper work.

Age: 23

Gender: Male

Ethnicity: Caucasian

Complaints: Lower back pain and pain down the leg

Everything seemed normal. I continued to read…

Reason for today's visit: Hit by a car

"Okay!?" I think to myself. Reading on…

Prior Care: Emergency room

Prior Treatment: none

So I sat there assuming in my office (like I know you are not supposed to) that he was cleared and released. I then walked down the hall to the exam room smug thinking I can help this young guy out. As I opened the door, I suddenly became completely overwhelmed with shock.  The 23-year-old male was sitting cocked to the right with a walker. “This is not right," I thought to myself.  Then, as we went through his history he told me about how he was struck by a car going about 25-30 mph as he crossed the street THAT MORNING.  My jaw had to be hanging open, and I must have been looking absolutely dumbfounded. What was this guy doing here?! I asked him what the E.R. did for him.  He responded that they took a bunch of x-rays and CT scans. "I have a cracked pelvis, broken leg and something to my spine," he informed me.  At this point, I began to think this was a prank and I was getting Punkd... haha Ashton Kutcher. But I was wrong. The young gentlemen could not bear any weight on his left side because of the pain in his likely broken pelvis.  In fact, he couldn’t weight bear at all without the walker because of the broken leg and the ‘something to his spine’.  Being blunt I asked, "What would you like me to do? Why did they let you leave the hospital? You need an orthopedic surgeon." Everything spilled out quickly.  His response was priceless: "Well, I know chiropractors break backs and fuse them back together quickly. I thought you could just fuse mine back." My mind drifted… “If only I was that good”... then quickly back to reality "WHAT?!"

Seriously though, I needed an adjustment to realign my jaw...

In the end this young gentlemen left the Emergency Room against medical advice, saying he was going to a chiropractor. (I can’t even imagine what those ER docs thought.)  He was also on street drugs that he didn't want to admit to taking. To add to this insane situation, somehow between the ER and my office he contacted an attorney which he proceeded to threaten me with.  His last words to me as I called an ambulance: "You'll hear from my attorney. I’ll own you!"

From this story I learned that some people believe that chiropractors break bones and put them back together. Luckily, I have never heard this again from anyone and still find it hard to believe.  Now when people ask me what a chiropractor is, I think of this story.  How would I describe what I do so that this guy would have understood?

I like science, research and math. Let’s go through this realm to answer this question:

Chiropractic started out as a science experiment, truly.  D.D. Palmer, "The Father of Chiropractic,” was into the healing arts.  He was, at the time, a magnet healer amongst other things.  One day, while examining a gentleman who was deaf he noticed that he had vertebrae in his upper back that were different than the others. He knew that nerves from the spine supplied energy and communication to the organs and muscles (this was the 1880's, neuroscience had a ways to go).  He hypothesized that this man was deaf due to the malpositions or subluxations in his upper back. D.D. proceeded to do a direct thrust to correct these subluxations and suddenly the man could hear again.  D.D. then went on to create and develop the theory of chiropractic and subluxations.  He went through treating patients by classifying their subluxations and correlating them to conditions. Even to his death he continued to hypothesize and evolve chiropractic.

He also dabbled in charity work on the side, 

annually delivering countless Christmas gifts to deserving children across the world.

Today, chiropractors and researchers continue to clarify some of these first findings and develop better understanding.

As far as education goes, chiropractors today need a Bachelor’s Degree to enter chiropractic school. Some do allow entry with 90 credits, but all states require a Bachelor’s plus a Doctorate of Chiropractic to practice.  Chiropractor school is considered a 5 year post-graduate program.  Most schools are 3.25 years all year round, or 10 trimesters, which create the 5 year credit due to having no breaks. The first 2 years are similar to medical school, physical therapy school and naturopathic school.  Lots of basic sciences; anatomy, neuroscience, biochemistry, physiology, pathology, histology, etc., with some additional clinical classes: basic exam, palpation, soft tissue.  At the end of the 2nd year is when most of the schools of thought diverge: Medical school gets into pharmacology.  PT: exercise, modalities, manual therapy.  Chiro: Manipulation(adjustment), soft tissue, diet/nutrition, exercise, radiology. Naturopath: botanicals, herbs, homeopathy, exercise, pharmacology, manual therapy.  

Medical school then goes on after graduation for residency that can take several years. Residency and fellowship vary based on specialty. Most take at least 2 years. There are specialties in the other fields, but most are done through post graduate or fellow programs, and are not a necessity to practice like MD/DO.

Chiropractic does has evidence for validity, effectiveness and cost savings.  Recently in JAMA, chiropractic was determined to be the best option for patients experiencing neck pain, especially when combined with exercise.

That being said there is not currently evidence for all practices performed by chiropractors.  We are in a field that works a little differently than let’s say pharmacology.  Pharmaceutical companies start with pathology and develop a drug to interact with the known mechanisms.  Then this drug is put into trials, after which it is released into the public via pharmacies when deemed safe. 

On the other hand, chiropractic and other manual therapies start in our clinics.  We start to help more patients get better based off a basic science principles or applied sciences through clinical experience and knowledge. Then, after more clinicians start to use these techniques and they become widely practiced, they will have the funding to start researching. 

Basically it is the opposite way of most research and development.  Also on that note, it is difficult to have a double blind random control trial of exercise or manual therapy.  Even a single bind is difficult to create, because people know when they are moving or being moved.  A sham or placebo group is difficult to create. Right now there are new ways of researching and developing our evidence.

To be continued...

Photo sources: tvtropes.org, www.chiroone.net, sportsmedicinesalary.org

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Dr. Jeffrey Sergent is a certified Clinical Rehab Specialist and Chiropractor. He earned his Bachelor's Degree in 2004 from Michigan State University and his Doctorate Degree from the National University of Health Sciences in 2008. His special interests include Trigger Point Therapy, the Functional Movement System, Developmental Kinesiology, Pain Neuroscience and nutrition for chronic pain. Currently he practices at Goodyear Chiropractic Health Center in Milwaukee, Wisconsin.

The Doctor Behind JFK: A Tribute to Janet Travell, MD

Written by: Jeffrey Sergent, DC

I have been thinking for a few years, I need to start blog posting. (I go on many rants throughout a day, most of which people probably don’t want to hear).  I have started a blog, but I really never got to the posting part.  So, as my dedication to the new year the rest of 2014, I want to give this year to my mentors, role models and influences.  I'm going to start with a person that came way before me, but has had tremendous effect on medicine, chiropractic, manual therapy and movement therapies.  She is not well known outside of those communities by name, but many know the phrases she developed and treatments she created.  Her name is Janet Travell, MD, the founder and author of Myofascial pain syndrome (better known as trigger points) and pioneer of integrated medicine.  

Dr. Janet Travell in the 1920s.

Janet was a fascinating woman from the beginning.  She was way ahead of her time.  First off she was a woman who went to college and onto medical school in a time when that was not popular, graduating in 1929. Her career began as an ambulance surgeon, and then on to a professorship at Cornell. Eventually, she began research on the topic of arterial changes in response to medications.  After her tenure there she relocated to New York to continue her research on arterial conditions at Beth Isareli Hospital. During her time there she began working with the orthopedic surgeons on treating patients with back pain. She would use the work of Dr. Dudley Morton, "father of trigger points" as the basis for her continued work.  This section would define the rest of her life as she used a variety of injections, spray and stretch, and oral medications. In fact, her methods are still used today.

In the 1950's Dr. Janet Travell started to see her most famous patient, John F. Kennedy.  JFK had suffered a significant lower back injury during World War II. His patrol boat was involved in a major collision, fracturing several vertebrae and damaging many of his ligaments and muscles.  After the war he had several surgeries to correct the damage, however, this was a time before MRI and CT scans. They basically did exploratory surgery into his back. 

...As a side note, I have spoken to surgeons and other spine specialists who relayed to me that during that time they would just cut out the multifidi and rotatares because they were thought of as useless.  Today we know that not to be true, and there are even whole therapies based on activating the multifidi... 

Back to our story... JFK continued to have significant back pain after theses surgeries.   The story goes that he was going to give up his political career due to pain and the demands that came with the territory.  He was referred to Dr. Travell based on the results she was getting on these types of cases in New York.  Thus, she began treating him with injections, medications and braces. As a result he was able to go on with his political career, becoming a senator and of course eventually the President of the United States. JFK believed in her so much that he brought her to the White House as his personal physician.  

"President-elect Kennedy and Janet Travell, M.D.

November, 1960 by sea wall, Palm Beach"

Janet became the first woman to serve in this position and one of the few who was non-military, as most often a high-ranking military physician holds this place. During this time she continued to use techniques including spray and stretch, medications and injections. This was also when she prescribed her most famous addition, the JFK rocking chair.  She believed that he needed exercise throughout the day to keep his legs strong and reduce his pain.  In addition, JFK was wearing a lumbar brace most hours of the day.  Today some believe that this brace was the fatal reason that JFK was shot the second time. It is speculated that the brace restricted his movement from falling forward and almost caused him to spring back up into the second shot. 

Dr. Travell's daughter Janet Powell Pinci 

posing in a Kennedy Rocker in 1984.

Dr. Travell went on to serve Lyndon Johnson till the end of his term.  She then dedicated her time to writing and researching Myfascial pain and trigger points.  She wrote both Myfascial Pain Syndrome and Trigger Point Therapy. These are very detailed, in-depth books. Furthermore, there are two volumes that seem to be 500 pages each. In the practice we refer to these beauties as the red books, due to their red binding.

Dr. Travell was a leader and a pioneer in a field that is still innovating and evolving.  Although she created and defined an entire area of medicine, to this day she has yet to be reviled in that arena.

I have to thank Dr. Travell for influencing me on trigger point therapies, soft tissue and manual therapies. She has taught me that we need to integrate therapies; exercise, medication, injections and manual therapy.  Thinking of her also reminds me that as I get older I need to continually keep an open mind to new and evolving treatments, just as she continued to research into her last days. Lastly, she reminds me that we always need to treat people as individuals and find what will work for them specifically, as she did with the rocking chair in JFK's situation, and for the thousands she treated throughout her lifetime. 

Thank you Dr. Travell.

Janet Travell, MD 

1901-1997

Photography source: www.janettravellmd.com 

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Dr. Jeffrey Sergent is a certified Clinical Rehab Specialist and Chiropractor. He earned his Bachelor's Degree in 2004 from Michigan State University and his Doctorate Degree from the National University of Health Sciences in 2008. His special interests include Trigger Point Therapy, the Functional Movement System, Developmental Kinesiology, Pain Neuroscience and nutrition for chronic pain. Currently he practices at Goodyear Chiropractic Health Center in Milwaukee, Wisconsin.

Top 5 Crazy Chiropractic Myths

Over the years chances are you have known someone who regularly visited a Chiropractor for their back problems. Maybe you have even gone to see one yourself. On the other hand, you have also probably heard a lot about Chiropractors through the grape vine, often placing them in a not so credible light. The truth is, many people actually have no idea what Chiropractors really do. However, for decades now Chiropractors have fought the good fight to gain the credibility that they deserve.

That being said, today I’m going to help shed some light on the truth behind Chiropractic care, beginning with my list of the Top 5 Chiropractic Myths:

1. Chiropractors aren’t real doctors

• To become a certified Chiropractor a person must earn a Doctorate (8 or more years of study) from an accredited university. They also must pass both national and local licensing exams, not to mention the hundreds of required clinical hours in a clinical setting.

Dr. Corey Schneider

Don't let his lack of white lab coat fool you, he's a real doctor.

2. Chiropractic care is not Scientific

• Just because Chiropractors do not prescribe medication, does not mean it is not a scientific practice.  Maybe this is a good comparison: while Medical Doctors study methods to delay death, Chiropractors study methods to enhance life. The profession assesses the spine and other joints (i.e. knee, shoulder, elbows, etc.) and the supportive soft tissues adjoining the area in order to establish proper body mechanics and movement. Chiropractors then evaluate if pain and dysfunction are due to degenerative changes, arthritis, weakness, nerve entrapments, disk hernias and more. In order to do this, Chiropractic Doctors must have a firm understanding of the human body and scientifically proven healing methods.

3. Chiropractic adjustments are painful and potentially harmful

• Occasionally you might feel a little discomfort during an adjustment, especially if you have never had one before, however, usually these will not hurt at all. In fact, quite often the patient experiences a great sense of relief afterwards. Furthermore, when performed by a licensed Doctor adjustments are incredibly safe! 

On the other hand, I wouldn't recommend the at home approach...

4. Once you start going you can’t stop

• Of course this is not true. It’s a free country after all. Returning to a Chiropractor is just like going to the gym to keep fit or visiting the dentist to avoid cavities. Patients who return often do because they liked the results (i.e. better sleep patterns or a wider range of movement), and would like to continue seeing these positive results.

5. Chiropractic care is too expensive

• According to a study done in 1996, 87% of Chiropractic patients who had been seeing a Chiropractor for a longer period of time not only considered their health to be exceptional, but also experienced fewer chronic conditions linked with aging and took less medications. This ultimately saved them a lot of money on health related costs. In addition, depending on your insurance provider, Chiropractic care is often included.

102-year-old French Cyclist Robert Marchand

I'd say an outcome like this would be a pretty good ROI.

(Image source: bicyclinghub.blogspot.com)

Sooo… Have I convinced you yet? If not, Goodyear Chiropractic Health Center always has its doors open, and Dr. Corey Schneider would be happy to sit down with you and tell you more about all of the benefits of Chiropractic Health!

(Sources: Coulter et al TopClinChiro, www.goodyearhealth.com

www.acatoday.org, www.connerlychiropracticcenter.com, 1023blakefm.com)

Welcome!

This is the blog associated with Goodyear Chiropractic, Integrated Pain and Health Center and Fusion Gym, three sister companies all based at 5261 N. Port Washington Rd in Glendale, Wisconsin. Together these companies are on a mission to restore and maintain exceptional, pain free movement and health for people from all walks of life all over the world… or at least in the greater Milwaukee, Wisconsin area.

So if you are looking for information, news, advice or ramblings on health make sure to check back often. We will have posts covering everything from exercise, nutrition, chiropractic, pain management, acupuncture, naturopathy, massage therapy, and much more. Or if you just cannot wait to get moving again feel free to email us at info@goodyearhealth.com or drop by our office.

But for now, we hope you all have a Happy Thanksgiving!