Flexibility and Chiropractic Care

Hi All -

I have a strange question. Does anybody have any tips on improving flexibility while having chiropractic adjustments?

It's a bit of a long story. Year and a half ago I busted my neck and slipped some discs... those have healed and I have doc approval to continue training. But as a result of seeing a chiropractor FOR my neck problems, I am having some complications when it comes to my flexibility. I have great flexibility in my hamstrings (can kick above head height with an axe kick, for example) but my hips are really tight... They have always been tight, but not anywhere close to how tight they are now. Anyways, ever since I started seeing a chiropractor, any gains I seem to make via stretching are lost the second I get adjusted. I have asked my chiropractor about it... he said it was my sartoris muscle and that it was literally pulling my back out of alignment if I stretched it too hard. He suggested that "my flexibility may never be the way it was before"... which to me... well... it doesn't mean I'm not going to try.

Is this a case where I should more on crazy strengthening my core and lower back rather than stretching? I do the "exercises" they suggest almost every day... sometimes I miss because of a brain fart or whatnot, but yeah. It's not like I'm slacking on those and I don't understand why this keeps happening. I need to figure out some way to improve things - my instructor has gently said I need to get my hips to loosen up or I may not be able to get my black belt as scheduled.

Suggestions? Ideas? Let me know... and thanks!

~ a rather odd little ducky

 

generally stretching works best if accompanied with strength training, so if you get medical approval for it i'd suggest some heavy full squatting (ideally high-bar back squats, but if your neck can't take it you could go for front squats instead) in addition to your usual stretching. even if it doesn't help with that specific issue, squatting heavy and deep is generally good for the body, and it'll help you with other stuff in MA, so might as well.

 

also check this for other exercises you could use: http://www.exrx.net/Lists/ExList/HipsWt.html

(the sartorius is listed under hip flexors, but is also an external rotator and an abductor as well as a knee flexor, so that's something to keep in mind)

 

''Anyways, ever since I started seeing a chiropractor, any gains I seem to make via stretching are lost the second I get adjusted. I have asked my chiropractor about it... he said it was my sartoris muscle and that it was literally pulling my back out of alignment if I stretched it too hard. He suggested that "my flexibility may never be the way it was before"... which to me... well... it doesn't mean I'm not going to try.''

It is a bit odd that you are being told that there is an association with your sartorius muscle ''tightening'' and pulling your back out of alignment when you are being adjusted for your neck complaints. Perhaps you could clarify what you are having adjusted and how? It isn't really clear whether you are being told that there is no relationship between the adjustments and the tightening (even though that is what you perceive)

One concern, and it may be way off, is that after having had the injury (at least as you are describing it) you may have been left with some neurological hypersensitivity. When you get adjusted it might be setting off protective reflexes that are causing your hip muscles to tighten up. It is possible that when an area has been injured the reflexes from the nerves passing through that area may become hyper-reflexic. Have you been cleared of any long term neurological problems from the doctors that dealt with your initial neck injury? You do see this sort of thing in people who have had neck trauma although it is more common to see the hamstrings over-firing than say some of the other hip musculature.

Perhaps you should ask your chiropractor why he or she thinks that a muscle so far away from the initial injury is being affected by the adjustments? Just saying that the sartorius is at fault is a bit confusing as this muscle is innervated by branches of the femoral nerve which comes off the spinal cord quite a distance down the spine. I would also wonder why this muscle and not any of the other related muscles aren't tightening up as well if that were the case.

There are some chiropractors who are members of MAP and one of them might be better to explain what is happening from a chiropractic point of view. They might even be able to suggest what would be best to ask your chiropractor. I am not a chiropractor but my gut feeling would be not to have anything done that appeared to routinely disturb my flexibility. I would be concerned if the adjustments were quite far away and negatively affecting your hip flexibility. Perhaps you might also ask your chiropractor if there is a different form of adjustment that might not set off this tightening. Some chiropractors swear by activator technique or use low force non-thrust techniques to treat patients that don't do well with more traditional adjustments.

Hope this helps,

LFD

 

Alright, let me back up... it seems I didn't explain things appropriately.

First off, my injury was to my neck, but when I started getting chiropractic care they started adjusting my entire back. Apparently my lower back was not in ideal alignment, though it honestly had never troubled me at all. Since getting these adjustments, my vertebrae as a whole seem to move easier. When I started getting these adjustments, my flexibility seemed to freeze. Any non-gentle hip stretching just seemed to pull my back out instead of stretching my muscles. It wasn't that my flexibility suddenly got worse... it's that it froze. I said my flexibility was worse than it used to be because... well... I've been doing martial arts off and on now for years. 3-4 yrs ago my hip flexibility was better than it is now... when i started training again two years ago I was starting to work on increasing my flexibility and then I injured my neck and things just sort of stopped right where they were... neither getting better nor worse. But like I've said, now that I'm back training seriously I am trying to get my flexibility issues resolved, but every time I stretch with this in mind it seems to do no good... any "gains" I seem to make seem to be mostl because of my lower back vertebrae moving. It's been pretty frustrating as a few years ago I was getting things to loosen up slowly, but now I seem to not be able to make any progress. I have not had an examination of any possible longer-term neurological damage... I guess that is possible... but like I said, my hip flexibility was never great... just a bit better than it is now... and it just seems really improbable i'd have hip nerve damage when the neck disc issues involved my deltoids (c5) and my ulnar nerve (C7).

My chiropractor said my sartorius was the culprit because after an adjustment (where I had complained about this problem) he moved my legs around and said my sartorius (which connects the lower back vertebrae and goes on down to the outside of the knee) was so tight that when I stretched it aggressively, it was pulling my back out. So obviously I have to strengthen my lower back and my core, and that's in the process of being done... I was just wondering if anyone else had any suggestions. Maybe my chiropractor is right and I'll never even be able to have the slightly better flexibility I had a few years ago... but I want to try.

I hope that explains things a little better.

I'll try those exercises, Fish of Doom... thank you.

~me

 

You rang?

The sartorius muscle does not attach to the spine. It attaches from the pelvis (technically, the anterior superior iliac spine) and goes to the inside of the knee right about where your knee bends, but on the "medial" part - the part where your knees would touch if you pushed your legs together toward the midline. It is innervated by the femoral nerve, which normally originates from the L2 and L3 spinal levels.

All that is to say that a cervical adjustment should have little to no impact on the performance of your sartorius muscle.

There are some chiropractors who seem to think that EVERYTHING should be treated with cervical adjustments. I am not one of them. If you consider the anatomy of the spinal cord, you will see that the outer layers are the ones that exit closer to the brain and the inner layers are the ones that exit lower along the spine, thus the L2-L3 nerve bundles are pretty close to the middle of the spinal cord width-wise since they are close to the end of the spinal cord length-wise. Pressure in the cervical spine would be far more likely to impinge on something toward the outside of the spinal cord, thus something much higher up than a lumbar nerve. This, of course, is not accounting for possible lesions in the cord itself, but I would strongly suspect that your chiropractor would have spotted something like that on an xray and should refer that out as a potential surgical case.

All of this is to say that there really should not be much impact from the adjustment on your sartorius muscle.

Now, about stretching it...
The sartorius muscle performs three actions simultaneously:

1. Hip Flexion - it draws the upper leg and knee toward the chest.
2. Hip abduction - it draws the upper leg and knee "outward", away from the midline.
3. Lateral rotation of the knee - turning the knee outward and also bending it somewhat.

Thus, to stretch this muscle you want to place it into the opposite position - extension, adduction, medial rotation. This is a somewhat awkward position to maintain while seated or standing, and is best done when prone (lying face down).

A powerful stretching technique is Proprioceptive Neuromuscular Facilitation (PNF). The concept behind PNF is that you are overriding, in a controlled manner, the normal stretch reflex that makes your muscles contract when the tendon is hit with a reflex hammer.

Once you have the muscle in a stretched position, you will need a partner to help hold the stretch for a few seconds while you contract the muscle as hard as you can. The person holding the stretch is to provide resistance but NOT overpower your effort. The person providing resistance has the goal of keeping you from moving, NOT overpowering you and pulling your leg further into a stretch WHILE YOU ARE CONTRACTING THE MUSCLE.

Hold the contraction/resistance for about 10 seconds and then relax the muscle while your partner moves the limb gently further into the stretch. When you reach the new point where you cannot comfortably stretch further, repeat the resistance exercise as described above. A set of five repetitions is good followed by a minute or two of rest. This can be quite tiring for both people, but you should find that it works quite well for obtaining a good stretch in a much shorter period of time than more traditional techniques.

Please, as always, consult your physician before beginning any exercise regimen. I am a physician, but I am not YOUR physician. This information is provided for educational purposes only and does not constitute establishing a doctor-patient relationship, etc. Use at your own risk.

 

Hi,

I see you've already got an answer from a chiropractor - thanks querist, by the way - but I've had chiropractic treatment in the past, and some flexibility problems. So what I found was that when you have a lot of chiropractic adjustments close together the structures that were holding your spine in place in an unhealthy way get broken down, so you have to build new, healthy ones. That's how it seems to me, and I seem to recall my chiropractor telling me something similar. Say you're stretching your hips out, well, in the past, tight, spasmed muscles kept your low back immobile. Now the muslces have loosened up, your lower back is too mobile to stretch the way you used to til it gets stronger. I found I had to quit stretching for a while. I think it helps to do stretches that have a strength element to them, in general but especially in this situation. When I stopped doing any flexibility exercises at all for ages I didn't really lose all that much flexibility. Some people advocate using weightlifting - especially good mornings, front squats and the like -as a form of 'loaded stretching,' to which list I would add pullups and back bridges, which are a pretty good hip stretch that teach you to stabilise your back at the same time.

Some chiropractors (this is second hand and anecdotal, from aquaintances who had chiropractic) believe that they need to treat the spine as a whole to deal with problems like compensatory scoliosis - where your whole spine kinks out of shape to accomadate a problem in one spot and keep functioning. So that might be why your guy is treating the low back for a bad neck. When I saw my chiropractor I would get pretty much everything adjusted including some soft tissue release, cervical, thoracic and lumbar manipulation by thrusts and rotation and what-all else, and getting shot with the Weird Chiro Gun (TM).

 

I'm going to dabble in a bit of necromancy here, and potentially get myself into a hate-storm as well. But isn't chiropractic-ism just quackery? If I understand correctly it's just an alternative therapy that has only been proven to reduce back pain, yet makes claims to treat pretty much anything. I'm a bit surprised that no one's jumped on this already.

My advice, if you're still looking/needing it, is to go to a proper physician and get it looked at by someone trained in the area. What may have happened is that your chiropractor may have caused the problem that you are currently facing, and he's putting the blame on your past injury to cover his buttocks. Maybe it's a bit out there, and it probably is, but if I were you I'd get it looked at by someone that knows what they're doing and that can give you proper care. Worse case scenario you have two opposing opinions.

 

And not even that according to some people.
Chiropractic is riddled with quakery.

 

I've heard martial artists make claims that their training can heal, bring enlightenment, teach to kill with a touch, or fight off multiple armed attackers with ease. I don't think that makes all martial arts a scam.
According to professional medical associations over prescribing drugs, and not enough doctor patient communication is a problem (at least in the US).
So how are chiropractors any different? Sure, some of them are not good at what they do and make outrageous claims as to their benefits. I don't see how this makes them all "quacks".

 

Well, scientific research has been conducted on the techniques as well as the central hypothesis of chiropractics, and both have been demonstrated to be faulty. This means that even "good" chiropractics aren't actually doing anything beneficial. So the chiropractors rake in the cash while the patient's are given false hope that their ailment is cured/treated and a few 100/1,000 $ poorer.
The false hope being especially important since patients may be told that their chiropractic setting has treated their problem, and they may never go to a real doctor for a second opinion ending up doing serious damage to themselves.
Also just because some doctors are incompetent doesn´t mean you should sack the whole medical system, they are still backed by way more research and facts.

 

Chiropractic is founded on the idea of "innate intelligence" and that pretty much ALL illness is a result of misplaced vertebrae.
If you ascribe to that then you are a quack be definition because that isn't how the human body or medicine works.

Bad backs are a prime area for quackery because they are very complex systems, conventional medicine isn't that good at treating them and they often come and go naturally.

 

My chiropractor also happens to be a good friend of mine as well as an athletic trainer. He will be the first to tell you if he can't help with something and where to go to address it. He has helped me through numerous injuries and ailments as well as telling me where to get help when he couldn't fix something.

In short there are some that make the field look bad but in general I think they provide a good service to those who need it.

 

My point exactly.

 

But being bad or incompetant isn't a reflection on the underlying scientific implausibility of the treatment.
You can have "bad" homeopaths and "good" homeopaths (in terms of patient care, bedside manner, good intentions, compassion etc).
But both are still peddling nonsense because the system of homeopathy is flawed from the ground up.

Chiropractic is founded on similary shakey ground but has evolved into being a more evidence based physical therapy. It's not something I'd go for (I'd go to a physio) but there's more variety of quality in chiropractic than homeopathy because all homeopaths are selling homeopathy.

 

This is one of the reasons I don't often admit that I'm a chiropractor. It seems that the bad ones are the ones who are noticed the most. There are some out there who truly think they can cure anything and everything with a chiropractic adjustment. I am not one of them. Chiropractic treatment, with the scope of practice I have in South Carolina, can treat a wide variety of MUSCULOSKELETAL conditions. In other words, we're really good with muscle and bone injuries and some neurological stuff resulting from muscle and bone injuries. We are also taught to diagnose many internal conditions and other things that could present themselves as problems that would require chiropractic attention. For example, the kidneys refer pain to the lower back. We need to be able to tell the difference between low back pain due to a kidney infection and low back pain due to a strained muscle.

And there has been considerable peer-reviewed, double-blind, clinically controlled research on Chiropractic treatment for things other than low back pain. I was personally involved in a few studies, including one for migraine headaches which demonstrated that chiropractic care was effective for managing migraines under certain circumstances.

There is much more to chiropractic than low back pain, but it has limitations as well. I would personally (and keep in mind that I no longer practice full-time) recommend seeing a chiropractor for sports injuries, work injuries, etc. A good chiropractor will tell you if what you have is outside of his or her scope of practice and will refer you elsewhere when appropriate.

Unfortunately, a large number of chiropractors won't do that.

 

I would like to see this research, because there is plenty of research that shows chiropractic care is effective for certain musculoskeletal conditions as well as a few others that would not be immediately obvious to non-chiropractors such as migraine headaches and muscle tension headaches.

I will admit there are problems in the chiropractic community as well as in the medical community.

 

There is a lot of research, so long as you look outside the Chiropractic "journals". To be honest if I was looking at the effectiveness of phrenology as a diagnostic tool I would look at proper medical journals, and would probably discount anything from a "journal of phrenology".

A good example of the research in the more scientifically accepted journals is:

although there are plenty more out there. I could probably list journal articles from respected organisations all day, if I had the time to do it. The "science" behind chiropracty has been pretty soundly debunked, positive outcomes are on a par with other placebo treatments, and the possible negative outcomes (such as a stroke) are substantial though admittedly rare.

 

Another issue with alternative medicine, especially chiropractics, is that it take insurance money away from the hospitals. This may sound arbitrary, but many of the larger hospitals now-er-days also support/conduct a lot of research. I'd rather have that money be spent on a new real-time PCR machine for the Carcinorgenesis Department, then buying chiropractor Bob a new Porsche. This affects me personally since I'm training to become a bio-medical researcher, and the job market for fundamental research is fairly dismal right now.

 

Oh, so the mainstream medical community has a vested interest in proving chiropractic care does not work. It means more money for them.