Category: Strength

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Diagnosing pain.

Did you know that there is a diagnosis code for virtually every part of your body plus the word “pain.”

Low back pain M54.5
Pain in the Thoracic Spine M54.6
Pain in the left foot M76.672
Chronic Bladder Pain R39.82

There are also diagnosis codes for significantly more detailed problems. This is often the reason for the “pain” diagnosis. I can diagnose right facet joint arthritis, or cervical degeneration that causes radiculopathy. There is value in both forms of diagnosis.

When you, the patient, comes in, you usually tell me about how you’re feeling. This discussion revolves, most commonly, around your pain. I will dig around and ask some questions and let you tell me your story. At this point, I can easily diagnose you with your specific pain diagnosis. You come in with neck pain, and I can diagnose neck pain in about 3 minutes of meeting you.

In the next step, I get to dig around and find out if there is an even more specific diagnosis that explains the “pain” diagnosis. This is the part where I rule out the really serious diagnoses, like a broken bone or a torn ligament. It is the part that takes a lot longer, occasionally more than one visit sort of longer. This is the part where we will usually throw out the fancy words. “Hip Impingement” or “Arthritis.” (And occasionally these fancy words come with an even fancier test.)

Now here is the really tricky part. Getting rid of pain can be really easy. (Tylenol, Gabapentin, Codeine) But getting rid of the fancier word part, the actual cause… now that is a lot harder. Just like diagnosing it requires a deeper understanding by your doctor to name it, it also requires a deeper understanding by you, for you to heal it.

Notice I said “You” to heal it. I can help you get rid of the pain and understand what needs to be done to heal, but the longer term changes, that is going to take more than just coming to see me a few times and taking tylenol for a couple weeks. There is a good chance you’ll need to support your body with movement, nutrition, rest and time.

This is a process. I hope to teach you everything you need to learn to heal, but it takes time. It takes time for us to peel away the layers that got you into pain in the first place and it takes time to explain each new healing step as we reach it. It will take time for you to make the changes you need to stay out of pain.

As Always,
Keep Moving.

Dr Cate

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“We do that on everyone” – The Insurance Debate

The great insurance debate.

So I had a small medical concern that I wanted to get checked out. I went to see my favorite Nurse Practitioner (Rachel VanBree at The Women’s Birth and Wellness Center) and we had a chat. We started with the usual discussion of my symptoms and she didn’t rush me. I went in knowing what I wanted to bring up, the timeline of things, the things I had ruled out and the things I knew I wanted to rule out. We set up a plan. She wanted me to get a test done, she told me the best time to get it done, what the next steps would be if we didn’t see anything on this test and what we would do then.

A few weeks later I had my reminder call and my pretest instructions from the office. I also had the discussion with my awesome NP rolling through my mind. I had looked up the approximate cost of the test because I knew my insurance wouldn’t cover a penny of it until my deductible was met. I went to the front desk, checked in, and inquired if they knew close to the exact cost of the test. She rattled off the cost that it would be if it were cash, but that could be very different if it were billed through the insurance. But after she stated the price, 2 things happened. First, my mouth dropped because it was 3 times as much as it suggested online and second, I knew something was incorrect.

I asked her if the cost she quoted were the tests that were recommended on the referral form. The first test was what I was expecting, the second I was not. The front desk said that the referral said, “If it looks needed” in reference to the second test, which made sense to me. I also realized the front desk there couldn’t make any changes, so I figured I’d mention it to the tech.

I was taken to the next waiting room, where they promptly came to get me and I was whisked into the test room. I immediately asked about the second test to which the tech said, “We do that on everyone.” I asked if we could base the decision off the first test and she said again, “We do it on everyone unless you refuse to have it done…”

So I refused, the tech said, “No problem!” and we went about doing the first test…

So why do I feel compelled to share this story with you? So many reasons!!

First – If you hadn’t had the in depth conversation with your primary, you might not be 100% certain of the reasons for your test. I felt prepared to make the decision about MY healthcare and I felt  comfortable saying no.

Second – It might be completely covered by insurance and you wouldn’t blink an eye.

Third – If the second test is better at seeing what we were looking for, why wouldn’t they skip the first test, and go right to the second test!?

Fourth – Because it brings me back to this constant internal struggle that I have with my own patient centered business plan. To take insurance, or to not take insurance. As most of you know, I’m currently a “cash only” practice. Which means we do not file insurance for anyone (Except medicare patients.) About once per week I think, maybe I should take insurance and I always come back to the same reasons: I think a lot of patients would benefit from being able to use their insurance and it might be a good idea from a business perspective.

But in this patient transaction I saw exactly what scares me about insurance from a business perspective. “We do it on everyone.” as well as how easy it would be to simply go with the flow and allow others to make the health care decisions for you.

So for now – we shall continue to be a cash only practice until my patients urge me to do otherwise…

In the meantime, do you have any similar stories? We’d love to hear them!

As Always – Keep moving,

Dr Cate

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Your Treatment Goals

I get excited when new patients are coming into my office. I mean – legitimately excited. So excited that I often text my next door neighbor,Colleen at The Balance Point Acupuncture when I see a new patient on my schedule!

Why do I get so excited? Because I have the chance to meet someone new and I have a new puzzle!! But lets be honest, odds are, you aren’t as excited to be in my office as I am to have you. Why not? Because you’re in pain. Maybe you’re scared. Maybe you’ve been in chiropractic offices before and you didn’t get the results you expected.  Or maybe you’re afraid its going to cost more than it said on my website.

I’ve come to learn that those fears and concerns I’ve just described are actually one of the biggest pieces to the puzzle.  Without evaluating them, there is a good chance that neither of us are going to leave the appointments as satisfied as we would have liked. The biggest thing that I’m learning I need to ask my patients are, Why have you come to my office and what are your hopes for today’s visit? Do you have treatment goals?

Some people simply want their diagnosis and what I would suggest. These clients are often going to go home, think it through and decide whether or not they want to take my advice. Some patients are ready for me to fix them, starting right now! And some patients want to know if they can fix themselves, with limited help from me or anyone else.

Each of these attitudes is completely acceptable. I’m happy to tell you my diagnosis and my treatment plan for you. The tricky part is the being certain we are on the same page together. I need you to tell me how you’re feeling each and every time. I need you to let me know if we aren’t getting where you want to be. I need to know and I need you to know what you’re looking for from my office.

So what exactly are your treatment goals? What is the reason you’re seeking my care? Let me know and I’ll be happy to help you with whatever you decide!

As Always,
Keep Moving.

Dr Cate

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Shoulder Pain Explained

I’ve always been convinced the the shoulder is quite possibly the worst designed joint in the body. Which makes it one of the most interesting to treat!! Lets break down the shoulder and shoulder pain generators today:

The bones of the shoulder consist of the humerus, the scapula and the clavicle with the rib cage and neck serving as attachments for ligaments, tendons and muscles. I think the simplest way to look at how the shoulder works is to imagine a golf ball on a tee and then tip it on its side. The golf ball, would be the head of the humerus and the tee would be the glenoid fossa which is actually part of the scapula, or shoulder blade. Often times, the shoulder will be an area of chronic aching and occasional sharp shooting pain.

The list of muscles involved in shoulder movement is pretty extensive, but lets stick to two that are often problematic and can cause shoulder pain. The pectoralis minor and the serratus anterior, although they are often problematic for different reasons.

"Pectoralis minor muscle and shoulder blade"
“Pectoralis minor muscle and shoulder blade”

The Pectoralis Minor is a small but important muscle beneath the Pectoralis Major. It attaches from the front of a few ribs in the middle of your chest to the coracoid process of the scapula. It is difficult to say what the “Primary function” of the pec minor is because it can play so many different roles. It helps in downward rotation of the scapula, internal rotation of the humerus and protraction of the scapula. If you’re reading this on the computer, take note of your current body position. Odds are your shoulder girdle is doing all 3 of these motions. Considering the fact that you likely sit in this position for upwards of 8 hours a day, there is a good chance your pectoralis minor might be suffering! It frequently becomes a muscle that is overactive and tries to work for most of the other area muscles. It can become knotted, tight, full of adhesions and becomes a shoulder pain generator. (If you want a little more detail of the exact opposites to the pectoralis minor, check out this article!)

Serratus Anterior Muscle
The second muscle I mentioned is the serratus anterior. The way the serratus anterior attaches to the body is really best described by a picture. (See the rotating picture.) It spans anterior ribs and attaches to the medial border of the scapula. When the serratus is working properly, the fibers combine to keep the shoulder blade flat against the ribs. This allows you to fix the movement of your shoulder and therefore move your arms and neck with a stable base. There is a good chance that in order to reach your computer screen and type you might be allowing the serratus anterior to have some time off. As a result, your shoulder blade is not stable, your shoulders are dropping forward and the shoulder muscles in the front of your arm are getting even shorter and tighter. (Think pec minor…)If you want a little more info on what the serratus does, take a look at this article in Dooley Noted.

Here is the part that makes diagnosing a little more difficult. It is easy to assume that the tight muscle is the one that is causing your pain which means we stretch and release the muscle. But sometimes… Its the weak muscle that can cause the pain!

So I’ve just described about 1% of the muscles involved in movement of the shoulder, but I would bet that approximately 80% of those in the desk job population suffer from some dysfunction in these 2 muscles.

I can’t know for certain unless I get my hands on your shoulders and do some testing… but if you’re having shoulder issues, pain, aching, numbness, tingling into the arms and hands or neck tightness, then odds are you could benefit from an evaluation.

And as always,

Keep Moving!

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Core Strength

core strength

core strength

 

Core Strength

“I need to strengthen my core muscles” – I’ve heard it from about 93% of my patients at some point.

Let’s discuss your core muscles. It is a term that I think gets misused frequently or thrown around as some sort of buzz word. But if someone says, “You need to strengthen your core” your response should be, “Which muscle?”

Core Muscles

If you’ve been into my office, there is a chance that you’ve heard some variation of my “Your core is like a can of soup” analogy before I’ve ever prescribed core strength exercises.  If not, you need to, so here it goes. Your core muscles need to be like a can of soup. The top of the can is your diaphragm, the bottom of the can is your pelvic floor and the sides of the can are your transverse abdominal muscles, oblique muscles, your spine and your rectus abdominus muscles. Are you picturing it?

Now I want you to picture a soup can made out of different materials. Picture first a normal soup can with the entire can made out of stable material on all parts. Next, imagine the top and the bottom of the soup can are made out of the usual metal and instead of metal sides, they decided to just use the paper label.  Third, picture a soup can where the  the sides are made out of the normal steady material and the bottom (Or the top) of the soup can is made out of something like a plastic grocery bag material.

The first one is great for stacking, rolling, moving and generally works well in all situations. The second soup can might be able to hold up the soup can on its own and maybe contain the contents of the can, but if you attempt to stack anything on top of it, forget it! The whole thing will collapse. Now picture the third can. where the sides are solid, but the top or the bottom are not stable. you can probably sit the can upright without a problem, but you cant pick the can up and move it around very safely. (Imagine if the can was filled with liquid – for example your bladder, and you wanted to move this particular soup can! Uh Oh!)

Does this make sense? If the ENTIRE soup can isn’t stable, then there is no way you can do everything you need your can to do without some problem somewhere. Now here is the difficult part. How do we know what part truly needs work??

This is where myself and many other practitioners enter the picture. We need your history, your previous treatments, your surgeries(Including C-sections!) and scars, your daily routine, every detail about you to help you figure out where, when, how and what EXACTLY you need to be doing to “strengthen your core.” Then and ONLY then can I give you an adequate prescription.

As always, I hope you learned something and if you have any questions, let’s set up an appointment and we can see if we can help you!

Dr Cate