T Nation

Dr. Ryan Making Housecalls


#1

I'll be on tonight and Thursday. Any questions??


#2

If i ask nice, would you take a looksy at my MRI/back thread?


#3

As a chiropractor, what's your opinion on osteopathy, especially compared to what you do?


#4

DA MAN,

I posted a big long reply to it earlier tonight. It probably hasn't gone through yet.

Take care,

Ryan


#5

Hey doc,

I am doing pretty well in rehab for my left ankle, but my left calf is 3 inches smaller than my right one.

What's the best exercises I can do to bring the left calf up to snuff ? while at the same time avoiding a re injury.


#6

ZEN,

Chiropractic and Osteopathy have similar origins. From what I recall of the history, the osteopaths thought that altered vascular function resulted in problems, whereas chiropractic focused on nerve function.

From a spinal manipulation stand point, chiropractors use more specific, short lever adjusting techniques and osteopaths use more long lever techniques.

The major shift took place around the 60's if I remember correctly, when the AMA offered inclusion to both osteopaths and chiropractors. The osteopaths accepted whereas, chiropractors declined in order to maintain their own autonomy (Bad move in retrospect as it resulted in them being ostracized by the AMA for several decades, and this prejudice still occurs to some degree).

Since then, osteopaths have the ability to prescribe medicine and perform surgery. I personally do not know any osteopaths that practice in a traditional manner. The ones know are either surgeons or have a family practice type atmosphere where they might do limited musculoskeletal treatments. In fact, one osteopath refers patients to my office all the time.

Personally, I would like to be able to prescribe limited meds and perform injections or some minimally invasive procedures. However, unfortunately a sect of straight chiropractors usually campaign against expanding the scope of practice. This does nothing but hold the profession back.

I hope that answers your question, if not, let me know.

Take care,

Ryan


#7

Yes, its just what I wanted, your point of view. Thanks greatly for your candor, for I know because of the diverging techniques, there has been some arguing on both sides. And since chiro are making a go at more legitimity, they're badmouthing osteo. Not all, but most, and the they and our official position is shady at best in the canadian legislation. At least that's the situation here in Canada. I really hope for future development in the mentality of Quebec College des Medecins (province's highest autority on health matters) would loosen up their hold, because they're currently trying to undermine and limit the pratice of both chiro and osteo. I'm studying osteopathy, and one of the first thing they made us aware of is how we stand in regard of the law. Some manipulation have been limited to MD, namely almost anything pertaining to cervical manipulation. That's an abberation in my opinion, especially since USA seems more so more open-minded about alternative medecines. Great talking to you, and I hope to exchange more in the future, doc.


#8

Atreides,

Can you perform one leg calf raises on a block or stair?

You can hold a db in one hand while bracing for stability with the other.

I would also perform some one leg standing where you try to balance on one foot to help restore proprioception. As you get better you can practice it on an unstable surface.

I would also do some dorsiflexion type exercise and inversion/eversion exercises with a band.

Check with Mike to see if he has any special exercise he has done. I read in one of his posts that he has sprained both of his ankles numerous times.

Let me know if you have any follow-up questions.

Take care,

Ryan


#9

Zen,

Congratulations on your studies. How far along are you?

I can't believe they are trying to allow only MD's to adjust the C-spine. What training do MD's in Canada get in spinal manipulation? Didn't some Canadian Neuro's do some Csp manipulation/stroke article a couple years ago. It seems I recall something to that affect.

If it makes you feel better, no chiros that I know speak poorly of osteopaths. One of the best neurosurgeons in Houston is a D.O.. I look at it this way, there are good/bad MD's, DC's, DO's, PT's. I'd much rather focus on the bad docs, than stereotype a profession based on these bad docs.

I bad mouth more chiro's actually, since it's those idiots that give the profession a bad name and cause me to have to fight more battles.

Feel free to contact me anytime. I look forward to hearing from you.

Take care,

Ryan


#10

Thanks Doc, it gives me hope for the future.

I'm doing first year, after my B.sc in kinesiology and a year of science to put me on the same level as MD and physiotherapist.

The main difference here is that you don't need to attend medicine school to obtain your D.O. What makes it more difficult is that there is no official status for both chiro and osteo. Most doc aren't even sure it's useful. MD are all-powerful and encompass every aspect of health here, even though after discussing with some students, it appears obvious that their anatomy studies are minimal, to say the least.

One couldn't tell much more about the rotator cuff save that it was situated in the shoulder. Yet, they are the only one with the 'ability' (read: legal right) to diagnose, even though without the correct specialty like orthopedics, a generalist can diagnose you with skeletal disorders.

The problem is most MD are not aware of the usefulness of other alternatives to pills, and even those you will tell their clients to see a chiro or osteo will be hard put to endorse the science at the basis of our manipulations. And like I said, in Canada, especially in Quebec, they got have the last say on all health matters and their official stand is not very positive.

Oh well, it'll be up to me and others to pionneer the way into comprehension, and further their understanding of others health practices. The greatest thing that can happen to the mediical community here is to accept that they can't cover everything and be the final judges in all debates pertaining to health, healthcares and appropriate therapy.


#11

Alright, it's Thurs. night, and I'm ready for some questions,


#12

I'm starting to think this must be what it feels like to get picked last in gym class.


#13

Oc Day Yan Ray:

Irst Fay:

O Day Ou Yay Peak Say Ig Pay Atin Lay?

Econd Say:

This is a question that has always crossed my mind before falling asleep...

Do you find that there is any difference in sleeping positions in regard to muscle developement or posture development?

Kids are always raise sleeping on their sides. Yet as adults we are taught that sleeping on our backs is better. I can't sleep on my back because I snore like all hell, so I am forced to sleep on either side. Would I be better off trying to rotate side to side each night?

I will have follow up questions, just getting that topic out there.


#14

Where's the love for the good doc? A shame! (You are a personal fave of mine for recognizing my old avatar as being the UConn Husky).

Any thoughts on simple things people can do in order to put themselves on the road to better posture and overall structural alignment? Should people be doing different types of static stretching? A great focus on posture in the workplace if you are a desk jockey (like myself)? I find that I am always slouching at work and as someone who has suffered low back problems off and on these last few years, I know that's simply not helping me much.

Thanks in advance.

Kuz


#15

Hi Doc,

I have a mild strain on my wrist. when i bend it back too far and to the side it strains a little. can i brace it and still train? it seems to be ok if i brace it and apply pressure but not too much.

hope this post is not too late!

thanks in advance doc!


#16

Tri GWU,

Side sleeping is fine. I recommend placing a pillow between your legs to prevent your pelvis from torquing.

Also, I have found that by placing a pillow snuggly behind your back, you can lean back on it just enough to relieve some pressure from the 'down' shoulder. It also prevents the upper arm from falling forward across your body.

It is fine to turn from side to side.

Let me know if you have any other questions.

Take care,

Ryan


#17

Kuz,

The following is a Cool Tip I posted in Feb. It deals with helping to improve posture while sitting

Get on a Roll

Sit much? Using a lumbar roll will help to decrease the strain on the lumbar spine discs, joints and muscles. Sitting increases lumbar compression and without support, the lumbar lordosis flattens out. Due to the viscoelastic qualities of these structures, tissue "creep" occurs, which further increases the risk of developing low back pain.

Make your own roll by taking a towel, folding it in half lengthwise and rolling it up. Rubber bands will keep it rolled up. Sit all the way back in your chair and place the roll behind your low back, in the curve. This works in the car and on airplanes as well as at your desk. Try it!
g.

This actually helps to keep you from slumping as an added bonus.

I have my patients perform several different stretches depending on what their symptoms are.

Definitely make sure your desk ergonomics are set up properly.

If you have any other questions, let me know.

Ryan


#18

Blaze,

As long as the bracing gives proper support and training does not recreate or exacerbate your symptoms, you should be fine.

Keep me posted. Let me know if the problem continues.

Take care,

Ryan


#19

Wow. Now that you've answered that... I can sleep at night!


#20

I've got another one...

It seems as though when anyone gets back pain they immediately think to grab a heat pack.

Do you have any good rules of thumb on when you'd recommend a heat pack vs. an ice pack.

I think society has associated the ice pack and back as two extreme enemies. In your experience, are there times when people jump for an heat pack when they really should be jumping for an ice pack?