Wednesday, May 25, 2011

Don't know what to do for shoulder pain?

Hello again!

May is here and we have already had a few beach worthy days! The reason many of us live in New York is about to be upon us. There is no better place in the world when the weather is nice. Accessibility to one of the greatest cities in the world, beautiful beaches, and the wine country out east makes Long Island unparalleled in summer entertainment. Be smart and be safe when you take part in the festivities.

Of course sun block is the first thing you want to make sure you have. When the weather really starts getting warm I'll send out a posting regarding what type of sun block you should choose. Hint... 50 doesn't protect you much better than 15 and it could be toxic.

Exercise rates go up in the summer, but so do hospital visits. Don't fall into the "it's warm outside so I'm going to run 10 miles for the first time in 4 years" category. Ease into things.

Today's informative posting is in regards to the scope of practice of Chiropractic care. If you choose to read on you will surely learn something valuable for yourself, your co workers, your friends, and your family. If you don't have the time to read the full article right now, do it later, you'll be glad you did.


As everyone knows already, Chiropractic care is the best treatment out there for the resolution of issues like neck and low back pain, but there is a lot of other stuff out there that Chiropractic not only can help with, but does help every day here at Island Chiropractic.

Issues like headaches, hip pains, tingling fingers, and aching shoulders get treated here at Island Chiropractic every day. Today I want to discuss shoulder treatments with you for a few minutes.

The shoulder is the most mobile joint in the body. It has to be, think about all of the ways you use it. Your shoulder helps plant your flowers, grab a plate off the top shelf, throw a ball, raise your hand in class, write with a pen, open doors, eat dinner, even turn your head! The list goes on. Usually by the time someone presents to our office complaining of shoulder pain, they have already been through the ringer. General Practitioner to orthopedist to physical therapist to pain management back to orthopedist for surgical opinion back to pain management for shots back to physical therapy for stim and ice. It's a viscious cycle that costs a lot of time, money, and effort. Now, don't confuse what I'm saying to mean that orthopedists and physical therapists can't help shoulder, because they can. BUt let's go through their options for doing so:

Orthopedists - Orthopedists have three real options for treatment. They image first, then they decide if you are a surgical candidate, if you are not, they usually will give you a pain injection and pain meds to go home with until your problem disappears like magic. They also can refer you out to pain management or to physical therapy.

Physical Therapy - Physical therapy can be fantastic for injured shoulders when performed correctly. A half hour to an hour of rigorous exercises under strict supervision for form coupled with stim and heat or ice can really help a shoulder. There are also situations however when physical therapy is completely innefective. If your shoulder problem is brought on by scar tissue or adhesion in the muscular or other soft tissue structures of the shoulder, all of the exercise in the world won't fix your problem when done in the absence of soft tissue manipulation. It's like studying for hours for the wrong test. Grades don't usually reflect the work put in when you do that. Great physical therapy when coupled with great chiropractic is an extremely effective combination utilized here at Island Chiropractic and Next Step Physical Therapy,

So what can Chiropractic possibly do for the shoulder? Well, depending on the office you attend, chiropractic can be extremely beneficial. Here at Island Chiropractic, we utilize very specific soft tissue manipulation techniques to remove scar tissue or adhesion that you might not even be aware is present, without surgery, without medication, and without exercise... Until your body is ready for exercise. Visits take about 10 minutes after the initial evaluation is performed (initial visit takes about a half hour to 40 minutes and is on;y performed once) and the specific structures that need to be worked on are determined. Patients who undergo this type of treatment see immediate results. The take two and call me in the morning days are over. You will know immediately, and without any question, that the treatment performed has made a positive, permanent impact on your physiology.

Don't take my word for it though. I included here an excerpt from a news letter written by Eric Cressey. Cressey runs Cressey Performance in Bostom Mass. where he treats millions of dollars in pitching shoulders each year. From amateur to professional, this is the guy you go to in the boston area for shoulder work in pitchers and for rehab in non athletes.

"As you can probably imagine, given that I deal with a ton of baseball players – and the fact that I’ve written about shoulder pain a ton over the past decade – a lot of people initially come to Cressey Performance because their shoulder hurts... there are three initiatives that I think are the absolute most important places to start in just about every case...

First, I’m a huge advocate of soft tissue work with a skilled manual therapist. In our office, we have a massage therapist and chiropractor. Whether you’re a regular exerciser or not, tissues can get dense, nasty, and fibrotic, and integrating some hands-on work can dramatically reduce an individual’s symptoms and improve range-of-motion instantly. Understandably, not everyone has access to a qualified manual therapist all the time. <--- YOU DO! Dr. Sean is trained in Active Release Techniques and Integrative Diagnosis techniques!

The second area where you really can’t go wrong is incorporating thoracic spine mobilizations. The thoracic spine has direct interactions with the lumbar spine, rib cage, cervical spine, and scapulae; as a result, it has some very far-reaching effects. Unfortunately, most people are really stiff in this region – and that means they wind up with poor core and scapular stability, altered rib positioning (which impacts respiration), and cervical spine dysfunction. Fortunately, mobilizing this area can have some quick and profound benefits.

Last, but certainly not least, you can almost always work on forward head posture from the get-go with someone whose shoulder hurts. Additionally, working on cervical rotation is extremely valuable."

The above quotation was taken directly from the following website: <- click here if you are interested in full text.

Again, I am not minimizing the importance of orthopedic surgeons and physical therapists. There are many situations in which they are the best course of treatment for a given injury. Fractures, surgical rehab, full muscle tears, and surgery are areas where the ortho/therapist team is tremendous. This posting is meant to inform you of the scope of chiropractic care.

For more interest in active release techniques or integrative diagnosis which Dr. Sean is trained in, see the following links.

Monday, March 7, 2011

You might be somebody's hero...

"Work like you don't need the money, love like you've never been hurt, and dance like no one is watching", Randall G. Leighton. Well, what if people are watching you dance? Who would those people be? What would they think? How would they react?

We spend all the time in the world thinking about how we can better ourselves. We read blogs, we listen to speakers, we take classes, and we make sacrifices all in the quest for self improvement. These are good habits, without them, we are doomed to repeat the mistakes of our predecessors. If you're not moving forward, you're moving backwards, and you recognize that. So reach over your shoulder and pat yourself on the back, you deserve it. Self improvement is your dance. So the question is... Who's watching?

When I talk to patients about changing their life styles to allow for healthier eating, I often get asked the same question; "What are my kids going to do?" Commonly patients tell me that "All my kids eat is bread and pasta, they love it." I love this question because the answer is so clear; "Don't you love those things also? What are you going to do?" We need to always remember that other people are more capable than we give them credit for. It's admirable that your immediate thought is considering the welfare of others before you consider your own. But it's foolish to believe that others would not value the positive change in their lives the same way that you will. The fact is, I'm not a parent. I hope to be one in the future, but right now my advice to parents comes from my experience with patients. My goal is not to provide parenting advice here. It is simply to point out an obvious example of how your choices can be influencial on someone else. Whether you are influencing your children, your friends, your co-workers, or your patients and clients, believe me when I tell you, you are influencing someone.

So the next question is, what will the people you influence think of your choices? Unfortunately there is no way to know for sure. What you can know for sure however is that if you make decisions that you truly believe are moral, upstanding, positive, and representative of yourself, whether they agree with your choices or not, others will have no choice but to respect them. Some people will think you are correct, smart, and worth listening to. Others might tune you out. If you use the Barbara Walters principle (always act as if Barbara Walters is there with a camera crew and a microphone to record your every action), you will never have to recommend doing as you say and not as you do. Believe me when I tell you from experience, living this way will give your words merit, and it will help you sleep at night.

So the last thing to consider is how others will react to your choices, words, and actions. Well, it probably depends on who the word "others" represents. Hopefully if it represents your patients, they will follow your lead and live longer, healthier, more fulfilled lives. If the "others" are your friends, you might influence these people who are so important to you to make more health conscious decisions. Maybe the activities you take part in when you get together will shift from expensive dinners out to cost effective, health promoting hikes, sports, or dancing. Perhaps, in the case of your children, they will have a healthier role model which would lead them to live healthier lives.

I'll never forget the night that my father made a choice that influenced me to this day. I mentioned earlier that I have never been a parent, but for my entire life I've been a son. I was about ten years old I was at one of my father's softball games. The league was extremely competitive and the game was a playoff game. His team was losing, the bases were loaded, there were two outs in the last inning, and it was dad's turn to bat. All I could think of was "wow, he must be nervous because I sure would be." My father walked right over to me, looked me in the eyes, and told me it was "time to be a hero." He wasn't nervous at all. A few short moments later my father sent a ball over the left field fence to win the game. Dad was right, it was time to be a hero. He just didn't realize to who. My father is a chiropractor, I don't think it's a coincidence that I am too.

Friday, March 4, 2011

Socially Well, Physically Diseased.

Does your social status infringe on your ability to achieve wellness? It has been my observation that efforts to achieve wellness are no longer the norm in society but the outlier, the exception, the weirdo.

Think I'm wrong? Consider this, how would your co-workers look at you if you came into work with your breakfast; a salmon filet, some steamed broccoli, and a handful of walnuts? If that's not weird to most people at 8am, I don't know what is. Now compound that experience. Your office is carpeted right and it's pretty clean, so walking around barefoot would not be dangerous to your health. Kick your shoes off, relax, build proprioception in your feet, support your arches, create more stability and flexibility around your ankle, have less back pain. Oh wait, you can't kick your shoes off, because if you walk around your office with no shoes on you are a weirdo. It doesn't matter if your shoes produce endless back pain for you and you are extremely comfortabl when you get home and kick them off... you better keep those babies on at work, don't want to be weird.

So let's assume that you are your own boss and you do whatever you please in your office. In fact, you demand that your staff eats salmon, broccoli, and walnuts for breakfast every day! Your office is all based on telephone and internet conversations so no client is ever going to meet you or your staff anyway! What will your friends think when you tell them that you go to a chiropractor? Did you know that only 7% of the population is gutsy enough to skip the medications and seek healing through natural remedies? That means that most likely 93% of your friends will think you are weird for going to see your chiropractor, even though it is the only thing that has relieved your pains for the last 20 years! Once again, socially, you're a weirdo.

This concept even comes into play when you exercise. Of course everyone knows there is nothing weird abot going to the gym and getting your sweat on. What can be weird though is how you do it. Are you like everyone else in the gym? Do you go from machine to machine and move your body on a track that the machine dictates? Maybe not, maybe you are a big muscular guy who sticks to free weights and cables, you have read all of the fitness magazines out there and your workouts fit their recommendations to the letter. Still not weird. But what if you are me? I'm the guy in the gym that doesn't come to socialize, I don't meet my friends at the gym. I rarely touch a bench press and I haven't sat down to lift something in over 5 years. You will never jog next to me on a treadmill or glide next to me on an elliptical. I'd rather run outside in the freezing cold in my snow boots. I wouldn't even know how to operate many of the fancy machines in the gym anymore and I've been a certified personal trainer for 7 years! You can find me in the gym doing power cleans, pull ups, squats, dead lifts, push presses, plyometrics, and other functional exercises. That makes me weird. I don't fit in to the social environment at the gym.

I'm not unrealistic. I run a chiropractic practice and a personal training business that are growing in their successes and I know that if I really stick to my convictions of walking around with no shoes on it would scare clientele away. That's bad socially, bad economically, and when I can't afford to buy vegetables, bad physically and emotionally too. So I get it. You can't just be a total weirdo all the time unless if you are a complete genious. The point of this posting is not to get you walking around barefoot, eating salmon for breakfast, and ignoring your friends at the gym. The point of this posting is to get you thinking. Are you making the best choices? For me, wearing shoes to work is the best choice even though I know physically it is not. That's why I take them off when I'n not seeing patients. But you bet your ass I eat fish for breakfast regularly. And when I'm at the gym it's not to make friends, it's to make progress.

Is your social standard getting in the way of your health and wellness? It's easy to see, look down, can you see your toes? If you can it's a good start. Go to the bathroom mirror with your shirt off, like what you see? If you do then you are even more on your way. Ask yourself, if you are doing everything you can to make yourself as healthy and as well as you can (a pint of ben and jerry's from time to time not withstanding). If the answer is yes, either people think you are weird and you are cool with that (which is awesome), or you might be someone who could benefit from a little more education (which is fine as well).

Patrick Henry once said "give me liberty or give me death." Well, we have liberty. Why do we take life for granted?

Saturday, January 22, 2011

"Do you take my Insurance?" The Truth About Insurance

If you are a doctor of any kind you have heard this question. If you are not a doctor but have been to one, you have probably asked this question. But what does it really mean? What does the answer that follows it mean? These days the meaning is a lot different than it was about 20 years ago.

Take the average insurance plan that comes through my office on a daily basis. Patients either have high copays of over thirty dollars, or they have a super high deductible (usually between $1,500 and $3,000) before the insurance company will pick up any of the expense. Doctors must be making millions of dollars with figures like this right?! Not even close.

Let's not forget, insurance companies are a business. In the state of New York, insurance "covers" chiropractic care. Usually they set a cap for reimbursement for a patient visit. Speaking candidly that fee max averages at about $35. That's thirty five dollars, when you spell it out. If your copay is $30, the insurance company will send a check for the balance of $5. That's five dollars. Good thing you are covered huh? If you didn't spend $400 dollars or more in many cases a month your insurance company wouldn't pick up those extra $5 associated with each visit. You would have to get treatments at a rate of 80 times a month to reach your $400 monthly premium (which is on the low end by the way). This example of course is in the absence of deductibles.

Deductibles are the patient's responsibility (your responsibility) for out of pocket expense BEFORE the insurance company will start absorbing payment to your treating doctor. Let's use the average deductible of $2,000 for this example. If you have a $400 premium with a $2000 deductible, you are accepting that you will need almost $7000 worth of health care each year! Don't believe it? Add it up. $400 x 12 months = $4800. A $2000 deductible that you have to pay before the insurance company will take responsibility for chipping in plus the set $4800 is $6800 per year. Do you need that much health care? Without insurance a physical with your primary care can cost about $200. Expensive services like getting eye glasses made can cost as much as $500. An endoscopy and colonoscopy would run you about $800 to $1000. Of course there are situations like surgery where one visit would run your bill over the $10,000 mark, but if that is your concern you should be speaking with your insurance broker about catastrophic care and relying on yourself to pay other health care fees as they will be significantly less than your insurance costs annually in many cases.

This is not meant to be a sob story. I want you to understand how the insurance industry works. Patients struggle to find quality doctors who take their insurance. Doctors struggle to give you the care you deserve because they need patient volume to survive. It's a viscious cycle.

So what are the alternatives?

If you carry health insurance, of course it makes sense to ask if a doctor takes it before deciding whether to use the doctor's services or not. The doctor's answer however should not be the deciding factor in your decision. Consider your insurance first. Do you have a high deductible? Do you have a high copay? If you do it is likely that you will essentially be paying cash for your services regardless of the doctor you go to. When I have a patient come in with a $40 copay we know very well that the insurance company isnt sending us a penny to supplement the payment. The copay is really the entire pay. The insurance books and the insurance provider websites just become referral sources for doctors in many cases to recruit new cash patients. Are you a cash patient? If you have a high deductible or a high copay you probably are.

So the answer is simple. Find the best doctor and allow them to give you the best care available. A common rebuttle to this suggestion is "but Dr. Sean, your fees are a a little higher than my copay and I can't afford that." It's a fair statement. However, it is important to know what your payment is getting you. If one doctor is more expensive than another but he gets you well in half the time, over the course of treatment the fees might actually be less.

Health care has become a confusing game of finance. Fortunately common sense still prevails. Find the best doctor, and let them get you well regardless of what insurance plans they take or don't.

Tuesday, January 11, 2011

Is Chiropractic what you think it is?

I've been around chiropractic my entire life, and it wasn't until about a month ago that I really understood what exactly it is. With my father having started his practice 30 years ago (3 years before I was born), you would think that by now I would have a pretty firm grasp, but it's just not the case. Don't get me wrong, my patients were improving and my quality of care was high, it was the word "chiropractic" that I couldn't wrap my brain around. With so many doctors practicing so differently, what does it really mean? What does a chiropractor do?

I know what I do and I know what my father does, and I know what my friends from chiropractic school do. So I thought it was important to find out what people from different schools, who were taught different philosophies do. A friend of mine went to Life Chiropractic College West in California where the philosophy is heavily based on the nervous system controlling the entire body and mind. They are known for reducing "subluxation" through use of chiropractic adjustments and thus improving overall bodily function. My friend's patients get well.

I went to a school that is more medically modeled. Physiology and bio mechanics were important aspects of our education. We are commonly called "medipractors" by other chiropractors who do not learn from the same curriculum. I address joint dysfunction, soft tissue dysfunction, and nerve dysfunction to come up with the most appropriate and effective treatment for a given symptom set. Sometimes that treatment is a simple adjustment, sometimes it is more involved and can include soft tissue manipulation adjustments and exercises. it really depends on the patient presentation.

So, if my friend and I practice so differently, how could we possibly call ourselves the same thing? My friend called me last week and we discussed at length (2 hours) what we were doing to build our reputations, our practices, and our skill sets. We discussed what chiropractic is, and we came to a very clear conclusion. Chiropractic is the drug free administration of care at the best interests of the patient. It's very simple. While we both do it very differently, we give the patient exactly what they came in for; a side effect free, efficient, resolution to his or her ailment. Both my friend and I are after the same thing, what we believe is best for the patient. We both refer for nutritional consults with nutritionists or dieticians we trust, we both refer to medical doctors when patient complaints turn out to be outside of our scope, and we both get results.

When I spend time out in the public meeting perspective new patients, after listening to one of my talks, people typically come up with many questions about themselves. I answer the best I can and then let them know that if they come into the office I can be much more thorough with my answers. That's usually when they ask what type of doctor I am. When I tell people "I'm a chiropractor", they decide immediately if it's a chiropractor that they need to help them. My question to you is this: I've been around Chiropractic Care my entire life, and until about a month ago I couldn't identify what it really is. Are these people making decisions from an educated place? The answer is probably not. Their personal experiences in all of their years on earth led them to the moment that they make the decision to come in or not. The only thing that can alter the decision making process is experience and knowledge. People don't even know what we do. Now, you have a better idea. But in case you forgot I'll repeat myself.

Chiropractors provide patients with efficient, drug free, holistic, resolutions to their complaints. When done right it's a beautiful thing, we don't change symptoms, we change lives.

Before choosing a chiropractor you shouuld call the office, ask questions, make sure you are going to a doctor you believe can help you. Believing you are going to improve is half the battle.

Questions or comments? Let me know. Comment below.

Friday, January 7, 2011

How is that New Year's Resolution Going?

Do you find yourself struggling to accomplish your new year's resolutions? Don't worry, you're not alone, and there is a good reason for it.

Every year people like yourself make resolutions, promises to yourself that something about your life is going to change for the better in the new year. The problem is that you are not always being realistic about your goals. The first obstacle that many people face is lack of a time frame, and this is paramount.

January first. That's the first day of the "New and improved you." Right? You were supposed to join the gym, start eating right, get more sleep, make more money, have a better relationship with your spouse and with your kids. You were supposed to reduce your stress. Well, if you are anything like me, and most other people, just looking at a l ist like that is stressful and thus counter productive. It's easier to hide that list in a desk drawer than it is to actually put it into action. So despite our best intentions, that's exactly what many of us do. The fact is, this list is simply too much to accomplish in one day! Just because you didn't lose a pound on New Year's Day doesn't mean weight loss can't be accomplished in the new year. It's not you that is flawed - it's your approach. Let's try a new one.

It's good to have a long list of life changing goals, but they need to be measureable, and attainable. For example, don't say "I wasnt to get in better shape this year." You have to define what "better shape" means to you. WHat does that look like? How will you feel? How many inches do you want to lose? Do you want to be able to run a mile? Maybe you just want to lose 10 pounds and keep it off this ti me. Whatever they are, your goals have to be specific, measureable, and achievable. Start small, if you haven't run around the block in a few years, running a marathon can still be a goal, but you will need to set smaller, more achievable goals first. For example, try aiming to run around the block without getting winded, and progress from there once that goal is achieved.

Once you have made a list of real, attainable, measurable goals, it is important to write them down and store them somewhere important, or somewhere you will see them often. Maybe with your jewelry, after all, they are more important than your bracelet aren't they? Writing things down signifies commitment. It's easy to change your goals when things get difficult if you haven't written them down. Putting goals to paper will help keep you in check. Once you have your list written, you should prioritize it. Put the easiest goals first and the most difficult goals last. Accomplishing your easier goals will help you build self confidence and will make those large difficult goals seem much more attainable. This list that you are writing, while specific, also needs to be fluid. Simply put, if you achieve your goals, it doesn't mean you stop progressing. Continue to rewrite your list of goals with new ones as you accomplish the old ones. Save your old lists as reminders of where you came from.

You can accomplish all of your goals, it just takes the right approach. You would probably benefit from telling a friend your goals. When someone else knows, they will commonly ask you how you are doing with your progress, this acts as great external motivation to keep moving forward. Sometimes you will even find that your friend has the same goals you do. Your book club buddy could turn into your jogging buddy. Believe me you are less likely to miss that run if your friend already woke up early and is counting on you to be there.

There is no bad time to start changing your life for the better. It doesn't have to be a Monday, and you're not to late if you didn't start on the first of the year. Make a decision and start working towards your goals. Marathons are run one step at a time. Good luck to you on a happy, successful, and healthy new year.

There is no bad time to start changing your life for the better. It doesn't have to be a MOnday or the first of the year. Make a decision and start working towards your goals. Marathons are run one step at a time. Good luck to you on a happy, successful, and healthy new year.

Wednesday, October 20, 2010

Department of Parks and Recreation(al) Exercise

For many people walking through the doors of a gym on a regular basis is just not going to happen. In fact, gyms count on this. When a gym establishes its capacity, it does so accounting for a given percentage of its paying membership not coming! You don't have to spend your money on a gym membership that you know you will never use. There are other ways to get your exercise.

When I was in school for Chiropractic, I already had years of personal training experience. Some of my friends at school had similar experiences. We designed the ultimate out door workout. In fact, it was so intense, that we could only do it once a week. We started this workout in a group of 4 guys and it turned into an unofficial group fitness routine that weekly saw up to as many as 25 people come down to participate! Why? Because it was fun. For you, what I was doing might not be fun, or even possible. We were flipping 500 pound tractor tires, dragging over 100 pounds of kettle bells, swinging sledgehammers, doing pull ups in trees, and running sprints across the two acre yard. There are modifications for all skill levels. You can exercise outside, have fun, and challenge yourself at the same time.

The easiest exercise we can all do outside is going for a walk, or a run. The biggest hurdle people encounter when going for a walk or a run is lack of progression. Put simply, most people just don't push themselves hard enough to garner the results they want. For these types of people, fartlek runs can be extremely effective. I know, "fartlek" sounds silly, but it's a real word. An example of a fartlek run goes as follows; when you go outside, pay attention to the telephone poles on the block. Walk from the first one to the second one. Jog from the second pole to the third pole, and sprint from the third pole to the fourth. From the fifth pole to the sixth pole, the pattern resets, and you walk. Fartlek runs are runs in which there is a set interval dictated by a given time or distance.

Maybe the most fun way to exercise is to go to a park. Don't think playing in the swings is a workout? Think again. Sure, if you just sit there and allow momentum to do its thing, you aren't getting much of a calorie burn, but do some work and you are looking at a core strengthening, calorie burning fun time. Each time you kick your feet out in front of you, the quadriceps (leg muscles) and abdominal muscles contract. Bringing your feet in for the back swings works the hamstrings and the muscles of the lower back. Do you bring your kids to the park and watch them play tag? Why not play with them? It is great aerobics, and it is a fun, free way to bond with your child. If you walk or jog to the park, it just adds some bonus time to your enjoyable workout.

For the challenge seeker, parks can be a great place for exercise too. Monkey bars are pull up bars, and pushups on swinging plank bridges are much harder than pushups on solid ground. Running to the park is of course always an option as well.