Disc Issues and Chiropractic - role of multifidus muscle

Ask the Chiropractor- Dr Hulsebus reviews the newest research on multifidus muscle and the role in lower back issue.  https://pubmed.ncbi.nlm.nih.gov/37267391/  Should disc be the main focus on a MRI study?  This paper helps educate us what else we should be focused on.  #healthy815 #icachiropractor #palmerproud

www.rockforddc.com

Transcript

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- Hello, I'm Dr. Brant Hulsebus. Welcome to another edition of Ask the Chiropractor. Ask the Chiropractor's my little podcast that I do for people who have questions about chiropractic or chiropractic care. I always feel like you should ask a chiropractor. All too often people will check with their family provider or maybe check with a healthcare physician who's not a chiropractor about going to a chiropractor first and often we're also warned,"Don't go to a chiropractor until you talk to your healthcare provider first." And I started this podcast because that's really bad advice. Why is that really bad advice? Because your primary healthcare provider has no education on what chiropractors do or don't do. So they're a really bad source to ask,"Should I go see a chiropractor?" Because they don't know what we do. So how could they answer the question, yes or no, when they have no knowledge of what we do? So if you want to go see a chiropractor you should always ask a chiropractor a question. Just like if you have a question about your teeth you should always check with your dentist first. I had little fun with this the other day. I went onto ChatGPT and I said,"Can chiropractors help lower back pain?" And the answer was, yes, chiropractors can help with lower back pain but check with your healthcare provider first. The next question to follow up with that, I asked ChatGPT, "Does your healthcare provider educated on chiropractic and study chiropractic?" And the answer was no, they do not study chiropractic. So then I said, "Then why would we check with our healthcare provider first?" And the answer came back that one, they can help make sure there's an underlying conditions. Two, they can help with referral systems to get you other doctors if you need to be. And three, they can discuss different underlying pathologies that might be mimicking this. So then I asked ChatGPT,"If a chiropractor's educated on answering all three of these topics?" And ChatGPT said, absolutely. So I followed up with then, "Why bother asking?" At that point, ChatGPT apologized to me for having our disagreement. So at that point I gave up. But my point I'm trying to make is that everyone will tell you to check with somebody other than a chiropractor if you should go to a chiropractor. And I'm here to tell you that chiropractors are pretty knowledgeable about chiropractic. It's just a matter of finding a reputable chiropractor. Just like it's the same as finding a reputable healthcare provider or dentist or podiatrist or anybody else you would see. Myself, I am the proud chiropractor of the Rockford Icehogs. So I have been doing that since 2004. And I'm also a proud graduate of Palmer College of Chiropractic. I am on the International Chiropractic Association. I am the Illinois representative for our state. And I'm also a board member of the Illinois Prairie State Chiropractic Association. And I've had many other job titles over the years and worked with different various forms of colleges and educating the next generation of chiropractors. So today another question came up about chronic lower back pain. What is it that chiropractors look at differently than medical doctors do when it comes to chronic lower back pain? Well, if you go back a couple episodes on this podcast you'll see where I talked about stabilization muscles and how important stabilization muscles are. And I think it's really cool that PubMed just released another article. Now, what's PubMed again real quick? PubMed is one of the best sources to get medical information. So if you're ever searching for something on the internet and you want to get some raw science that no healthcare provider or chiropractor, dentist or anybody argues with you go to PubMed. So recently published article on PubMed just came out June 2nd of 2023. The article is titled,"Lumbar multifidus muscle morphology is associated with lower back pain related pain duration disability and leg pain." It's a cross-sectional study in secondary care. The lead authors Jeffrey R. Cooley. So what does the article talk about? The article talks about the fact that they found multiple people with lower back pain and then they had MRIs. Now usually whenever a doctor does an MRI, you get this report, "Well we did an MRI and it turns out you have a disc bulge.""Well we did an MRI and it turns out there's a disc issue.""Well we did an MRI and it's a disc thing going on." Or if you're really lucky you get both. There's a disc issue and a pinched nerve. Well you don't have a pinched nerve. If you had a pinched nerve the only way you'd know is 'cause the body part would quit working. If you walk in, you have foot drop and you can't lift your toes up because your lower back, the disc is hurting, the disc is actually pinching the nerves so you can't actually lift the muscles then that's a true pinched nerve. But if you just have a little bit of joint pain or ache or pain going on your arm, that's not a pinched nerve. A pinched nerve no longer functions. It's a bad diagnosis and we should stop using it because it's incorrect. Also, as we're getting more and more into this we're also finding out that disc is not the problem. That disc is a result of a problem. Now maybe you've heard me talk in the past about the fact that on the spinous bone itself, you have a body in the front, behind there's a spinal cord and behind that is a little round ring that goes around there and part of that's the spinous process, the bump you feel when you rub someone's back. The other part is another joint called the facet joint. F-A-C-E-T, a facet joint. Often the facet joint gets bent and twisted, turned the wrong way and it gets inflamed. When it gets inflamed, you lean away from it. When you lean away from it, you can press one side of the disc, causing the other side of the disc to bulge out just like a balloon. If I squeeze the balloon, the balloon will bulge on the other side. Is the bulge on the balloon the problem, or the fact that I'm squeezing it the problem? It's never the balloon, it's always the fact that I'm squeezing it. The disc might be bulging, but the origination of the back problem rarely ever comes from the disc and usually comes from the facet joint being irritated. Now this study shows us another dynamic of this whole process because when that's irritated, the nerve coming out doesn't fire as well. And the nerves innervate not only down your arms, down your legs or other body parts, but also the spinal erectile muscles, otherwise known as the paraspinal muscles. These are the muscles you've heard me discuss in previous podcasts. The fact that these are reflexatory muscles. These are not like prime movers. What I mean by that is in your arms or your legs, your muscles have a thing called golgi tendon organs, we call them GTOs. Golgi tendon organs, GTOs. Your brain can consciously control where a GTO is in space. So you can move your arm around, you can move your leg around. Your spinal muscles lack this ability. This is why I have a job. If you could move your fifth cervical without me, you wouldn't need me and I wouldn't have a job. But because you can't, it's the chiropractor's job to move that. And so we find that when these muscles, that their job is to hold your spine up and erect and maintain this position and posture, when these muscles over time, either from trauma, either from poor nerve innervation from the spine having the trauma from the facet joints, or various different reasons, the chicken or the egg here, we find that these multifidi muscles can change as far as atrophy or weaken can go away, where the opposite side will actually strengthen and get bigger, making the other side more susceptible to chronic injury, chronic reocurrence. So, "I went to the chiropractor, I got adjusted. Man, I felt better. But like 3, 4 weeks later, the lower back pain came back again." Or, "I went to the medical doctor, he gave me some prednisone. I did a 6, 5, 4, 3, 2, 1. I felt better. But a couple months later the pain came back." Or, "I went to the physical therapist, they exercised me, stretched me out and I felt better. But after a couple weeks the pain came back." Or, "I went to the pain guy and he gave me a shot in the spine, and then the pain went away. But then it came back." So what's going on here? Why is it coming back? Well, when we talked about the episode before about the stability muscles and the fact their job is to hold the spine in place. And then there was a number of people who had spinal surgery and after spinal surgery, those who did not improve on their stabilization muscles, those who had the physical therapist who doesn't understand this concept, or a doctor that ignored this concept, their back pain was just as bad before surgery as it was after surgery, okay? And then they ever given the stabilization muscles exercises and then the pain went away. You could question the validation of the surgery all you want, but those were the facts in that research paper. If you go back a couple of episodes, you'll see I discussed that and I cite that research paper. But right now we're talking about a different research paper that more or less validates this whole thing. Because in this research paper what they're saying is that these people with these chronic issues, these reoccurring issues, the multifidi muscle, which is a muscle that goes from lumbar to lumbar vertebrae keeps them stable, keeps them strong, they're saying one side gets dramatically weaker, the other side stays stronger. This is what allows it to misalign, create the stress, and that stress then causes inflammation and inflammation then causes the bones to move. It causes the bones to move, pinches the disc, makes the disc bulge and creates a stress response at that joint which hits that nerve and causes the pain radiating down your leg and lower back pain, everything else. So was it the distent problem? No. Was it the so-called pinched nerve, the problem? Those are issues, but they're not where it all created. That's like saying if I hit my thumb with a hammer over and over and over again, you're like, well your thumb's inflamed. We have a situation here. No, the situation isn't my thumb's inflamed. It is inflamed, but the situation is I keep hitting it with a hammer. So what's the hammer in this situation? What's the one that causes all this? Well over long term we're seeing that there's instability inside the side comparison of the musculature. And how do we find that out? How do we know this is true? Well, we do MRIs at people. Now I have read, in 21 years, hundreds and hundreds of MRI reports and not one report have I ever seen the multifidi comparison side to side, or the musculature comparison side to side. All they're looking at is the hole where the nerve comes out to see if it's encroached and the disc. That's the majority of all we ever get in our reports. So we get a report of how bad the symptoms actually are but we get no report on a possible cause of the symptom. So we need to start looking at this lower back stuff differently. This is what chiropractors are trying, have been screaming for years, that there's an underlying cause, a bigger issue. We need to work on rebuilding the spine, getting the spine straight and making it strong and keeping it there. And this is another report that continues to prove the stuff I have in a 1919 textbook by Stevenson about chiropractic. Continues to hold up in today's world. I always tease, you know, this textbook, chiropractic textbook, written in 1919 by Stevenson. How much of this information in this book today is still true? But they couldn't validate it in 1919 because I mean they barely had x-ray machines, right? They had no way to prove what they were saying. They just said if they do this, this happens. This is logically why? Well now as we get more and more technology, that book is like, amazing how much stuff they knew. And I'd often say compared to a book on dentistry from 1919 or how about a 1919 book on medicine, right? With leeches and stuff like that? It's amazing how much we haven't changed and how much of the things that we said back then just based on seeing the results we get when someone received chiropractic care, seeing the results that we got from that versus what they were doing in other fields of healthcare. And this is why I get so upset when they always say check with another healthcare provider before you go to a chiropractor, is because we know what we're saying, we know what we're doing. We have all the science and data to back it up and we're getting more and more of that every single day to back up what we're talking about. So I'm gonna put a link to this on the YouTube channel, Facebook channel, wherever I can post it. If you wanna actually see the actual article. Again, it's published with PLOS One, 2023, June 2nd, volume 18."Lumbar multifidi muscle morphology is associated with lower back related pain duration, disability and leg pain across sectional study and secondary care." You can look it up on PubMed too. Just type all that in and type in PubMed afterwards and the article will pop up. Take a look for yourself. See what I'm telling you. This is not stuff that I'm making up. This is not stuff that I want to be true. I'm actually signed in to PubMed Research so you can get a copy of it yourself. Again, I'm Dr. Brant Hulsebus, chiropractor. This has been another episode of Ask the Chiropractor. If you ever have questions about chiropractic or chiropractic care, always ask a chiropractor. If you'd like to ask me a question, or ask me to explain something, or do a deeper dive into a different topic, I'd love to. Go to my website, rockforddc.com. Rockforddc.com. When you're there just hit the blog, you'll see all the podcasts I've done. There's a search bar, you can search for them. You've heard me reference some previous episodes, feel free to go there and take a look at those. Other than that, have a great day. And today, the day this is being released, is July 4th. So if you listen to the day it comes out, happy July 4th to my fellow Americans, and everybody else, I hope you're staying safe. And again, if you have a question about chiropractic, always ask a chiropractor. Thanks everybody.