Understanding musculoskeletal injuries through the health of the overall architectural structure and chiropractic care
I was recently speaking with a medical radiologist who said to me, “So let me get this straight. You’re saying that if someone has a normal lordotic cervical curve and they’re in a motor vehicle accident, and someone else who has an abnormal cervical curve is in an identical accident, the individual with the abnormal curvature will fare worse than the individual with a normal cervical curvature, assuming all circumstances surrounding this accident are identical.”
“Exactly,” I said.
“Makes sense,” he answered.
The anatomy of musculoskeletal injuries
Most offices have endured that older overweight patient who’s driven a truck for 35 years and went to a chiropractor 28 years ago for “a bone being out” and didn’t need to go back for a second visit. “Well, doc, that bone’s out of place again.” At least, that’s what this patient thinks. After many years in practice and much experience gained along the way, I’ve come to the conclusion that the public has no understanding of how the body works or heals. We’ve all been trained wrong by the media, the medical community, our academic establishments and our governmental agencies. Back pain is not the enemy.
Back pain is a result of tissue becoming injured through trauma, repetitive activity or abnormal overloading. Once symptoms come on, we now have two objectives: Balance the abnormal loading and heal the injured tissue to the level or degree to which it can heal.
Two patients immediately come to mind when I want to explain how the body works. The first is a 22-year-old male who’s had severe low-back pain for the past three years. So much so, he’s basically stopped his life. Dropped out of college, no exercise, minimal activity. Incredibly, he’s been to 30 doctors and therapists over this amount of time. All of them attempted their recipe for success, but the fact that he came to me, his 31st appointment, is suggestive they didn’t provide him with appropriate solutions.
The failure in this case was that no one thoroughly diagnosed this patient from a biomechanical perspective and no one provided the appropriate treatment to allow the injury to heal. Upon standing X-ray while barefoot, he had a 9.6-mm difference in femoral head height (Fig. 1). Upon MRI of the low back, he had a significant protrusion at L5. He was proud to tell me he wore his podiatrist-recommended custom orthotics constantly. Upon X-ray of the low back with them on, his femoral head height difference grew to 11.4 mm (Fig. 2). Most of the treatment he received was medication, stretches, chiropractic adjustments and home exercises. He never received the appropriate combination of treatments and recommendations — and no one even knew about his femoral head height difference. That too needed to be addressed.
My second patient is a 27-year-old professional runner originally from Kenya and now residing in Boulder, Colo. For 18 months she’d suffered with heel pain, despite running 85-95 miles per week. She visited 10 doctors and therapists, and none of them ever told her what her problem was, nor how to fix it. She then flew to Albany, N.Y., where we examined, X-rayed and took an MRI of her heel. No one had done any imaging up to this point. Upon X-ray, we found a heel spur (Fig. 3) and upon MRI we found bone marrow edema, or inflammation (Fig. 4). This is better known as a stress reaction.
Any intelligent person might ask, why is only one heel injured? Both feet have taken the same number of steps. The reason is her unique biomechanical imbalances. A standing X-ray of her low back while barefoot showed she had an 8-mm difference in femoral head height (Fig. 5), but when we X-rayed her with her custom orthotics on, the femoral head height was reduced to 1.5 mm (Fig. 6). Now that the biomechanics are improved, the appropriate treatment to heal the stress reaction was provided and she resumed running pain-free after 18 months of suffering.
Maggs Law of Tissue Tolerance
“When the loading of a tissue exceeds the capacity of that tissue, compensatory physiological changes occur.”
I spend much of my day teaching people how the body works. I begin by telling them we are all born as Crooked Man (Fig. 7). And then we have a lifetime of slips and falls and bad habits, and the tissue accumulates all these stresses. If our life was a ballgame, our musculoskeletal status would be the score of the game and our life would represent the game itself. So, if there’s a herniated disc, that’s the score. If there’s a chronic strain/sprain of the right knee, that’s the score.
The body is nothing more than the accumulation of all the stresses, injuries, bad habits and hereditary weaknesses we’ve collected during our lifetime. I tell them, “The body keeps a perfect scorecard of every banana peel we ever step on.”
What’s more, I tell patients the body doesn’t lie. They’ll come in with an acute low back and when I ask them what they did to cause it, they say “Nothing!” I proceed to tell them that the body doesn’t lie. People lie, but the body doesn’t. Now, they may not remember what they did, or they may not know the body accumulates stresses over one’s lifetime. But the body is telling the truth.
The biomechanical evaluation
No one has ever recommended that we can get a relatively accurate status report of a patient’s musculoskeletal system even when they’re not injured. We’re all taught how to examine an injured patient, but not an asymptomatic patient. Remember, underneath every injury is Crooked Man. There are a series of biomechanical faults that will play a role in this patient’s future regarding vulnerability to injury and premature degeneration.
When looking at Crooked Man, we can see that all imbalances originate in the feet. The human being is an architectural structure, and the foundation is paramount for maximum balance.
For the biomechanical evaluation:
1. A digital laser foot scan is performed on all patients to measure the amount of space under each foot and to get an exact impression of both feet. Anything but two perfectly balanced feet demands the recommendation of custom orthotics.
2. We then perform a physical exam, looking at joint ranges of motion, leg length, internal or external foot rotation, muscle compliance, etc.
3. We finish with two standing X-rays of the low back and two standing X-rays of the neck, all taken with the patient barefoot.
Managing health, not just alleviating symptoms
The human body is not just a diagnosis when injured; it’s an architectural structure that will be influenced by gravity, aging and stresses over the course of a person’s lifetime. The doctor of the future is one who will help a person manage and maintain the health of this structure, not just alleviate symptoms when they arrive.
Our jobs should be to improve overall loading of the body, improving and maintaining joint mobility. All of this will improve quality of life, and that’s what patients are looking for. There’s no profession more qualified than the chiropractic profession to provide such care.
TIM MAGGS, DC, has been in practice for 40 years, and now specializes in the evaluation, care and treatment of middle and high school athletes. He is the developer of The Concerned Parents of Young Athletes™ Program, designed to raise awareness of sports biomechanics. He writes for Foot Levelers and can be reached at CPOYA.com.