The Neck Bone's Connected to the...Leg Bone???

As a Chiropractor, I love it when making an adjustment to one area allows changes to occur elsewhere in the body. This is especially true when adjusting the Atlas with the Atlas Orthogonal Technique, because upper cervical misalignments can have such a profound impact on the overall function of the spine. This requires the doctor to treat the whole patient, instead of only focusing on the area of complaint. This difference in philosophy is what makes chiropractic unique in today's health care climate.


Let us first take a look at the philosophy of "traditional" medicine. In most cases, aside from the rogue medical practitioner who thinks outside the medicine cabinet, medical practitioners utilize a Mechanistic approach to health care. Mechanism is defined as "the belief that living things are like machines or artifacts, composed of parts lacking any intrinsic relationship to each other, and with their order imposed from without." In practice, they listen to the patient's laundry list of complaints, check the areas that are statistically most likely to produce those complaints, and treat those specific areas from without (with drugs or surgery) in the hopes that the condition will improve. If the condition does not improve, they simply remove the part and replace it (if possible), with little regard for the consequences of those additions or deletions. This approach is similar to what a mechanic does with a car. If the brakes squeak, change the brakes. If the engine knocks, you take it apart and overhaul it.


For instance, a patient could come in with a complaint of left knee pain, right arm numbness, and headaches. A "traditional" medical practitioner would immediately think: "What's wrong with that patient's knee, arm, and head?" They would ask the patient some questions, visually inspect those areas, maybe do some blood work, and then take some specific imaging of the symptomatic areas. If the x-rays, MRIs, or CTs of the knee, arm, and head come back negative, they treat the condition "conservatively" with pain medications, anti-inflammatories, and maybe some Xanax. (Of course, I would argue that anything with a long list of side effects should never be considered "conservative," but I digress). If the imaging comes back positive, the patient gets referred to a surgeon. You get the idea.


Any Doctor of Chiropractic worth his or her salt employs a philosophy of Vitalism when treating their patients. Simply put, vitalism describes a philosophy stating that we as human beings are more than the mere sum of our parts. Every aspect of a living thing is interconnected to the other in a multitude of different ways, with each organ, system, and tissue working together to maintain homeostasis. What happens in one area affects another, so great care must be taken when attempting to make changes to one's anatomy. What that means in practice is that we do not focus solely on the area of complaint. We understand that everything is connected and every facet of our well being plays in to our health care challenges.


When someone has a complaint of wrist pain, I don't put blinders on and only check the wrist. I move up the chain and check the elbow, shoulder, upper back, and neck. I talk to the patient about their job and about ergonomics. I ask the patient about leisure activities and hobbies. The patient may have to perform certain exercises and stretches to reverse some postural stress. I may have to refer them out for some soft tissue work. The point is, any doctor employing a vitalistic approach looks at the whole patient, trying to get down to what is really CAUSING the problem, instead of just treating a symptom because that's what the insurance company allows.


The confusing thing about this is that both mechanistic and vitalistic philosophies work, depending on the situation. For instance, if I fall off my mountain bike and impale myself on a sharp stick (it could happen) I wouldn't be knocking on a fellow DC's door hoping to get an Atlas Adjustment. I would go to the ER and have someone remove the foreign substance and stitch me up. I may even need some antibiotics to ward off infection. I certainly wouldn't be concerned about a hidden cause of my problem, because a stick protruding from my abdomen should be obvious. So yes, in acute life-threatening situations especially, a mechanistic approach works wonderfully. And thankfully, we live in a country where good acute medical care is available. My mother suffered a brain aneurysm last winter and her life was saved by modern medicine (and a fantastic surgeon). Where mechanistic philosophy falls short, however, is in chronic conditions, where many different stresses and imbalances build up over time to cause the symptom. This is where vitalism shines, because the doctor(s) will look at the whole person to find that imbalance and treat it from multiple angles, considering diet, lifestyle, physical imbalance, stress, and other potential contributors of the problem.


Where am I going with this? The reason I bring this all up is that I see this philosophical difference play out in my office all the time. A recent example is a patient with a complaint of lower leg pain and numbness. In addition to self diagnosing and medicating via Dr. Google, she had seen her primary doctor, a therapist, and another chiropractor for this problem over the course of 4 months. Each one employed different treatments including pain meds, supplements, stretches, exercises, and adjustments, all focusing on her leg (and in the case of the PT and DC, her lower back). However, that is where their focus stayed; only on the leg and lower back, and that is why they failed.


Upon consultation with this patient, I found out that she had been involved in a rear-end collision about a year prior. I asked her if she had any neck pain and she said "sometimes, but I think that's because of how I sleep. It could be stress." No doubt, this sound advice came from Dr. Google himself! I could have easily ignored her neck and focused on her lower back, but I investigated. She had obvious tenderness and diminished range of motion in her cervical spine on examination. She also admitted that her neck "clicks" a lot when she moves it just right, which she kindly demonstrated for me. Stress doesn't cause that! I evaluated her leg and lower back as well and found pain and problems with motion, as well. So the lower back condition that her PT and previous DC were treating was definitely there. However, it wasn't until I adjusted this patient's Atlas that she started to respond, with her leg pain completely gone after a couple of weeks and her numbness disappearing shortly after. I will not go into a lengthy explanation as to how an upper cervical misalignment can affect the lower spine and legs (although this might help) but suffice to say that the neck bone is indeed connected to the leg bone, despite what the popular children's song says. Those who understand vitalism realize that every bone is connected, eventually.