Business Innovators Radio - Instability Insights

Episode Date: October 6, 2023

Ligament Instability is a buzz term in the healthcare field that patients are bringing to our office in search of answers. Ligaments hold bones to bones in your body and as you can imagine – instability would be an issue and can result in a wide range of symptoms from achy muscles to migraines to vertigo. But are these symptoms inevitable? And is ligament instability the only culprit?Many patients are being referred to our office by other healthcare providers because our motion x-ray technology is the gold standard for identifying ligament instability in the neck. But it also shows when it isn’t instability – but immobility that is causing the problem.In this episode, Dr. Dan and Angela share what ligament instability is and what can cause it (especially in developing spines), what a lack of spinal motion means for health and how resolving one problem can impact the other. When there isn’t a clear cut reason for chronic symptoms, finding the true cause is the only way to find real relief.To learn more about this and other hot health topics, follow us on social media and subscribe to our WTH podcast. If you have a specific health question or would like to find out if we can help you with a personal health challenge, check out our office page or contact us at 412-369-0400/ [e-mail] always, our mission is to help you Get Healthy and Stay Healthy for a Lifetime!What the Health?!https://businessinnovatorsradio.com/what-the-health/Source: https://businessinnovatorsradio.com/instability-insights

Welcome to What the Health, where anything health is fair game as we tackle the trends and bust the myths about health and wellness. Here are your hosts, Dr. Dan and Angela Toro. And welcome to another episode of What the Health I am. Dr. Dan here with my co-host. Angela, welcome back, everyone. As you know, get this out of the way. We are here for informational purposes only in no way offering individualized medical advice. always talk to your trusted health care provider before making changes to your life or routine. So with that being said, I know this is a big one for you. This has been, this is something that's been. I'm seeing it more and more often. So we're going to talk about instability inquiries or more

in relationship to ligament instability. And a lot of it, it's a big buzzword that's coming out in the healthcare field. I would say maybe probably over the last decade. or more, but we're seeing... Yeah, and even just recently, I mean, I just noticed more people coming in and using that word, which is not... Yeah, like they know about it. Yeah, like, which is not something that, yeah, I noticed as much earlier on when I started with you guys. Yeah, so if you just, you know, do a search on, you know, ligament instability, you'll see a lot of...

You'll probably see videos of motion x-rays come up, which is a good thing, because that is the gold standard for analyzing, you know, spinal motion. But I think what the challenge becomes, you're looking for instability. Really what happens is ligaments as your spine goes through a development, it hits that spinal maturity, which happens at about the age of 24, 25 years old. Women are usually a little bit sooner than men, but it's somewhere in that early 20 range that your spine hits maturity and really your whole skeletal system hits maturity so meaning that all the the growth centers of the bones have closed up you were done growing yes yeah you're done growing yeah so bones have stopped

growing and then the ligaments have reached a healthy tension hopefully a healthy tension around for those who don't know the ligaments are what connect the bone to the bones they they help hold everything, like your skeleton would, without all the ligaments and tendons and muscle and everything. Yeah, it would just fall apart, right? Yeah. You think about Halloween skeleton. We had Halloween coming up. Like how they're all like, wee. Yeah, yeah, yeah. There's a big, there's a big dinosaur, a Tiranosaurus Rex skeleton in the Pittsburgh airport. Yes. And you're going, you know, going up, going down. But again, it's all held together by wires. Yeah. The bones can't just stay at place. Yeah. So you would just be a big, you know, flop on the floor. Yes. You didn't have.

ligaments holding the bones together. And then you have tendons which connect muscle to bone. That's what allows the lever action of the movement of your body, left, side, side, you know, twisting, lifting left, right. So, so quick anatomy lesson for those since we're going to be sitting here talking about them. I don't want people sitting there going the whole time. Like, what the heck is a ligament? Or my life? I don't know.

Do I have one? Do I have a ligament? Do I need to be concerned about it. Yes. You all have ligaments. Everyone has ligaments. So, yeah, so there's this big buzzword. You know, and some of it, I think, is related around there's a, there's a syndrome called Ehrlich's Danlos syndrome.

And that, it used to be, you know, there was a, you know, when I was learning it in school a little over a decade ago, talked a lot about like there was a genetic component to it. But more and more that Ehrlich Danlos has been, you know, discussed over the last several years, that more is becoming a syndrome that doesn't necessarily. It can have a genetic component, but just like with a lot of these other disorders where they don't really truly understand the mechanisms behind it. There can be genetic markers, but there's some cases that there's no genetic marker, but you have all the symptoms of the syndrome. Kind of like fibromyalgia, right? I mean, there's like literally fibromyalgia is such a broad-based term.

It's like we know something's wrong. We know something's wrong. We don't really know what's wrong. As the drug commercials say, you have hyperactive nerves and it causes you pain. So we're going to call it by my outside. Yes, we acknowledge you that you're in pain, but we don't know why. We don't know what. Exactly.

So, so, you know, we are starting to see more and more, you know, patients that are referred to us from other doctors who work with chronic pain patients that, you know, maybe don't necessarily have a specific solution or they're trying to look at multiple aspects. So I think that's where I really, you know, started coming across this over the last several years is that we started getting referrals. Yeah. Yeah. because of the specific motion x-ray technology we have.

You know, it's called video fluoroscopy or, you know, dynamic motion x-ray, digital motion x-ray. You know, so if you are having chronic pain and you don't know why, you know, if your regular traditional medical doctor, you know, doesn't necessarily know, a great place to start, you know, is looking at these motion x-rays. The challenge is a lot of patients are coming in and they believe or, you know, they have been told from the, you know, the primary care provider or another practitioner that they have this instability or at least they want to rule out this instability. And really what happens is, you know, your ligaments were kind of hyperstretched. And in an unstable or in unstable ligament, hypermobile ligament, what happens is it was just stretched too far. If you think about it. it in terms of a t-shirt or a piece of a cloth you know imagine uh let's say you know i have my younger sister here and she was she's trying to run away from me as a young kid and i just grab her

t-shirt and then like you know rip her back uh so that she's sure that never happened i'm sure he's not pulling from an actual memory here so so you know and i rip her back and um you know and now her t-shirt you have this little bit of a wave in the t-shirt right because you you you know you hyper stretched all the fibers in that t-shirt. And so now the the normal tension on the t-shirt has been changed. And so now you have like this waviness in it because it's been hyper-stretched. That's what happens to ligaments that have been hyper-stretched. So example that comes to mind for me then is like when I dislocated my shoulder. So I sat in the ER with it dislocated for four hours. So for four hours, those, basically my shoulder was only being held in place by all those ligaments because the bone was not where it was supposed to be. And it was, they were getting stretched. So once it was put back in place, I was told, you know, there's a very high chance that this could happen again, especially early on. They said, if you can make it three months, great, six months even better. If you can make it a year without it dislocating again.

That's a good sign. Yeah, that's a really good sign, which I did because I followed PT and I followed everything. But, But I remember, I mean, I'd be walking around and in those early months, even just like, you know, taking a shower, washing my hair and it just felt unstable. Yeah, like it just didn't feel. It wasn't going to stay there. You'd listen to it anymore. Yeah. And so that's, you know, that's what I always think of. So then when, so people are, is that essentially what that would kind of feel like then?

If you did have that in the ligaments surrounding the spine, you would almost feel this like slipping. Well, yes. And so, yeah, the short answer is yes. We have patients that have that, you know, feeling of like, you know, if they just turn a certain way, it's going to catch or it's just going to, you know, their neck or their upper, you know, because a lot of times they're looking at instability with the upper cervical area. And so, like, in that upper cervical area, you know, you have your oxiput, which is the base of the skull. That's where your spinal cord leaves from the brain and goes, you know, down through the spinal column. But you have your oxiput, which sits on C1. that's the first bone, also called your Atlas, and then C1 sits on C2.

I'll never forget my anatomy teacher. I'll never forget my anatomy teacher, you know, telling us that you have to know all 24 names of every bone in the spine, you know, whenever she first introduced, you know, the spinal anatomy that we were doing. And she's like, okay, so get it out because this is going to be on the test. C1 through C7. those are the bones of the neck T1 through T12 Those are the bones of the thoracic L1 through L5

Those are the bones of the lbar The low back Okay great, got it, thank you So yeah So you have C1, C2 And then your head sits on top of C1 C2 So when we're looking at instability

Because of the very close intimate relationship Of that, you know, massive highway Of brainstem turning into the spinal cord happens right through that area. If you have excessive motion in that area, you can have a lot of chronic weird symptoms that are associated with that. You could get headaches, migraines. You could get, you know, paresthesia, esthesia where you're having like this hypersensitivity in the skin, you know, like the tingling and numbness in the face or the hair, you know, back of the neck. Dizziness vertigo can come from instabilities up there.

I just mentioned headaches and chronic migraines. Tension in the musculature where you feel like your muscles are just cramping down on you. I'm assuming because they're overcompensating for the ligaments not doing. So the ligaments aren't working. So now you're getting this excessive motion. Your muscles are trying to keep you in place. Motion is detected by. You know, by joints and muscles, there's things called Golgi Tendent Organs, which those are sensor receptors in the tendons of the muscle.

And then there's also muscle spindles, which are in the belly of the muscle. So those receptors are constantly, the tension on those receptors are in a constant feedback loop with the brain. So if there's too much or too little tension on those muscles, then there's feedback loops to. either say, hey, take some tension off or maybe you need to add more tension. So if you have ligaments that are unstable and essentially hypermobile and you have too much motion in one area, well, then there's going to be more motion in the musculature to the point where the muscles may start stretching too much. And so that feedback loop will then go up to the brain. And then the brain will say, hey, we need to tighten up those muscles. And so now you'll get muscle tension

in and around the neck and the upper back if that's the area that you have instability in. And again, instability going to like where in the region it happens. Well, because of our heads being a pretty heavy structure on a small neck, you know, you have a large head on a small neck, especially when you're developing. We talked a lot about this. We just had a seminar. We were talking about this. You know, doctors came from all over the country.

We had about $15. doctors and, you know, a couple from out west, couple from down south. I mean, from all over the country. And again, we look at this stuff and we study this stuff. And, you know, when we look at, you know, the developing spine, you know, as you, when you're very young, you know, infant toddler stage, you know, you have a very heavy head on a very small neck because, again, your spine is still developing. The ligaments are growing. The bones are developing. The muscle tension is developing, but that head is very heavy on top of the neck. And so now, you know, let's say, for an example, you have a young hockey player who's learning how to skate. Well, they have to wear helmets.

And so now you have this heavy helmet. You have this extra weight on this big head on this small neck. And so we were actually looking at cases where we could see either instabilities or changes and bone growth in that upper cervical area that very well could have been an excess of biomechanical stress or weight stress and strain on the developing spine from a very young age. So these are all things that we can see. And so then you add in things like, you know, contact sports when you're young and developing. Again, that spine doesn't hit full maturation until about 20 to 24 years of age. So if you're doing a contact sport, you know, such as, you know, the headers and soccer, Ethan hit the Ethan finally. I just noticed the other day he had his first game in a new league.

They're up, you know, up another age group and they were doing, you know, a couple kids were doing headers. I'm like, oh, I guess they're allowed to do that now because they weren't allowed to do it a year before. So, you know, again, you know, something like that. Football, you know, they're playing football. They still hit, even though they're trying to teach them better ways of tackling. it's still you're hitting that head into someone else or into the ball. So it's a lot. You already have a large head on top of a small developing neck and you add, you know,

another structure like a helmet or, again, a fast, you know, start stop motion in a sport. That can significantly impact the structure of the developing spine. So, so again, when we're looking at these things like instability, you know, we will see there's different patterns in the motions that we see that show excessive motion. And that could have a significant impact on, you know, just some of the symptoms like I mentioned. So, you know, how it develops, again, I think there's still a lot of unknowns in the literature currently. we're starting to, I think a lot of chiropractors who are very biomechanically and scientifically sound, they're looking at it more and more.

And it's funny because a lot of what the chiropractors are seeing or have been seeing the last several decades who look at this stuff, they're starting to correlate with a lot of what we see in like neurosurgery journals and stuff like that. So there's a lot of cross-referencing in terms of the biomechanics, what the ideal spine should look like versus what is actually doing? Versus what it's actually doing. So you really don't know if you have instability. Again, if you have a chronic health condition, you know, chronic pain or just, you know, weird symptoms,

a lot of times it'll show up after an injury. Maybe immediately, maybe years after. I know we had a couple patients that were in, you know, pretty severe head injuries. And they have not been the same. since those injuries. You know, one of them was a hit to the top of the head. Another one was a fall off of a forklift and smacked his head on the cement first and then is, you know, back and, you know, back and butt followed. But so, yeah, I mean, a lot of times, you know, if you have an

injury like that and you are just not the same, you know, after that injury, that is a case where you should absolutely look at a motion x-ray assessment to see if there's any, you know, instability there. You know, but there's some people that, you know, they just have these chronic conditions, you know, like a fibromyalgia or just a muscle tension or a headache that just cannot, you know, it doesn't respond to traditional, you know, medications, you know, their traditional medical doctor can't figure it out. There's a lot of chronic pain clinics. and all they want to do are, you know, cortisone injections or, you know, something that just

traditional medicine is not helping with. It would be very beneficial to look at how the spine is moving because we can see if there are these instabilities that are leading to, you know, that are leading to some of the subjective, some of the chronic health conditions that you're experiencing. But one of the things, so again, the advantage that I have from, you know, from, you know, the subjective, some of the chronic health conditions that you're experiencing. the chiropractic perspective is, you know, chiropractors are looking at structure and motion from the other end of the spectrum from the restrictive end. So the spine can be moving too much, hypermobility, that would be the ligament instability, or it could not be moving enough. And that's where we call it intervertebral between two segments of the spine, intervertebral restriction,

or the term we utilize commonly is subluxation, vertebral subluxation complex. So if the spine is not moving enough, then that is something that if it's locked up in one area, you change the tension of the entire system. So I always, you know, I talk to my patients when I walk in. You know, someone comes in with low back pain. Like, you know, just started like a new patient the other day. You know, he has low back pain. Well, guess what?

I'm going to look at the lower back, but I'm also going to look at the neck because the spine works as a system. And if you have a lock or a tension, a subluxation in the neck, that changes the entire structure, the kinetics, the motion of the spine from top the bottom and bottom up. Think of it like this. If you've got, what's that cradle thing call? I always forget. Where the balls on the end? Oh, yeah, the metal balls. Yeah, the Newton's cradle?

The Newton's cradle? I don't know. Anyway, yeah, you got the metal balls and you got like five of them. So there's three in the middle. And then you pick the one metal ball up and you let it go and it hits the three in the middle and then it sends the other one up. And then it comes back. And once you get it in motion, it will continue to do that forever until you add a force or change the tension of there. So if I go and grab the middle ball, okay, in that system, that's going to change the tension, the kinetics on there.

It's not going to let it transfer. It's not going to let it transfer through. And so now it will eventually slow down and stop. So imagine that for the spine. The spine is... The subluxation is like somebody grabbing that. Exactly. That's exactly right.

The subluxation is like grabbing that middle ball. So you're changing the tension. So now you could have a lock in one area, but it's changing the tension on the ligaments and the musculature in a different area of the spine. Well, you know, if then you go and, you know, try and lift something up or, you know, you're trying to do some sort of activity, you know,

like a soccer ball kick. You're playing with your kids and you're trying to kick a soccer ball and you know, you're twisting the lower spine and that's been locked up for years and you haven't noticed it because maybe you injured it when you were young and you recovered quickly and, you know, no pain associated with it. But now the low back locks up because you were being a weekend warrior trying to do too much and oh crap, I can't get out of bed. I can't get off my couch. You know, we all know those situations. Either we've had them ourselves or we know someone, a husband or wife or, you know, a friend who was in that situation. So, If the neck was locked up, changing the tension, okay, of where the motion can move in the spine, so now you can see how you can have an increased stress on, you know, the musculature and the ligament soft tissue structure around the spine in a different area. And so that's where the pain can show up. Well, even though the pain is down below, it could be there because your body was not able to process the motion from top down or from bottom up. And so now all of a sudden you have an acute injury or an acute pain in one area, but the lock, okay, the tension is coming from another area.

It's the concept of the barking dog. I always use this example. You know, if you step on a dog's tail, okay, and he starts to bark, okay? Well, is the problem that he's barking? You can muzzle him or is the problem that your foot's on his tail, okay? So muzzling the dog would be like taking a medication, doing an injection, trying to muzzle the area where it hurts. you know, where you're in pain. Or you can take the pressure off of the area that's locked up or off of the dog's tail and he'll probably

stop barking. Now, that's the idea that we see all the time is that if you take the pressure off the area under the most tension, then you will start to see the barking, the pains, the chronic, you know, whether it's acute or chronic pain, you'll start to see those subside. Sometimes it happens immediately. Sometimes it takes time. especially if it's been there for a long period of time. You know, it can take, you know, months or years to fully resolve.

But, you know, again, it has everything to do with how long it's been there. So I think having that eye for someone who's looking at both the hypermobility of the spine where it's moving too much versus hypomobility, okay, restriction, the sublixation, if we're looking at both of those in combination, what we can do, then to impact there is, you know, we can adjust, we can add motion to the segment that's restricted at the subluxation. That's what the chiropractor does. And many times, if there are instabilities, even if they're, you know, if they're minimal or moderate, we'll see improvements on those instabilities when we unlock the area of tension. Because we think about an area of

if it's hypermobile, if it's moving too much, but it's right next to an area that's locked up. Does it make sense that the spine is trying to make up motion where it's been lost? Yeah. So the segments above and below that are going to try and make up for that motion. So they'll look like they're moving too much. The ligaments are under more stress. The muscles are under more stress. So if you unlock the area of tension, then those ligament instabilities will start to resolve on their own

because now the spine is moving more fluidly through the system. You take the pressure off the ball like in that cradle. example. And that's why the motion x-ray is so important, because that's the only way you would see that. I mean, you can take a still x-ray, which has, I mean, we do both because that seeing the structure has so much value as well. Absolutely. I mean, we've seen people that have a nice looking curve in their neck. And then as soon as they could move, you're like, oh, that's just not moving in it at all. So it's really important to have both because that can really, that, that shows the full picture then. You know, what does it look like structurally? But all that's not.

Also, how is it moving? Because that's how we've been able to help so many people that have been to so many other medical professionals and chiropractors and just not getting the relief. And I mean, I still think about the, you know, the woman that jumped off the table one adjustment and was like, my pain's gone. That was still. She was a sister. I still believe there might have been a little bit of other. Spiritual. Spiritual advantage.

But, I mean, that was, I mean, she had been to, I mean, she was at the point of meeting with surgeons. I mean, it was, yeah. So because, again, just being able to do that, do those x-rays and see. Yeah. And it's about, again, it's about looking at things from a different perspective, more in-depth perspective. Unfortunately, you know, something like a medication, it's a very shotgun approach, right? I'm just going to, you know, take my shotgun and I'm just going to blast, you know, all the way across and just, you know, take 10 shots or whatever. chances are I may hit my target.

Yeah, great. But what damage have I done in the process? Whereas, I think we take much more of a sniper approach. You know, I'm looking, I've got a laser focus on exactly where the instability or really where the vertebral subluxation, the restriction in the spine is located. And now let me go and target that and do the adjustment. And that's where you just have this massive people who have been to other chiroin factors who have another healthcare professionals and are just not getting resolution in their pain,

not getting resolution in their headaches, not getting resolution from an old injury. They start to see that their body gets stronger. Again, sometimes it's very quick. Sometimes it's over time. But they're seeing a result that they have not seen before because it's a much more targeted sniper approach, not the shotgun approach that medication has. again, medication has a time and a place. You know, if you've got like a massive presentation and you've got to function, you know, I get it.

But again, it's not going to resolve the issue. Pain medication is merely masking, you know, an injury of what's going on. The body signal, you know, pain is there for a reason. You put your hand on a hot stove. You better have pain. Otherwise, you're going to have damage to your flesh because you're not going to take your hand away quickly enough before it burns. So pain is there for a hot stove. Pain is there for a reason.

You know, our goal is not to cover it up. Our goal is to get to the underlying reason why it's there. And, you know, the motion x-ray assessment does such a, it's the gold standard. It's just, you know, once you train doctors on how to use or how to analyze a motion x-ray, the reliability, it's something called in, you know, in research or something called inter-examiner reliability and intra-examiner reliability and intra-examiner reliability. meaning that inter-examiner reliability means if you take a test and five different doctors do that test, they're going to come to the same conclusion with that test. That's a very high inter-examiner reliability. If five different doctors do the same test and they come up with five different solutions, five different answers, that's a very poor inter-examiner reliability. So the higher agreeableness you have doing a test between different doctors, you know, then the higher, again, the higher energy examiner reliability, the better the test is. So once you train doctors into how to look for these restrictions and hypermobilities,

then the agreement between these doctors gets in excess of 90 to 95 percent, you know, the agreeableness. So again, then you're looking at a test that's much more valid to be able to correct, adjust, and correct the area that is under most tension in the spine, which that, again, not only do you start to see people feel better, but you start to see other functions improve, such as better mental clarity, they start breathing better, because all of these, you know, all these pathways of nerves that are causing pain, these pathways up and down the spinal cord are also carrying messages for internal organ function. So that's why you can adjust someone. And not only do they feel better, but oh my gosh, my sinuses just opened up. How many times, especially this time of year,

we're going into fall season and seeing the spring season. You know, you're just someone, it's like, oh my gosh, my sinuses just opened up or oh, I just started to drain. My ears opened up. I can breathe better, you know, they go home and they can poop better because they're constipated. And, you know, all these different internal organ functions improve because we are taking tension off of a system and normalizing tension through that spine. And because it's so intimately related with the spinal cord, which is merely an extension of the brain, carrying messages for all types of body functions throughout,

once you start to normalize that function, the body starts to heal the way it's designed to. So that's why that test is so significantly important. So whether you've had an injury in the past and you just don't seem like it's resolving, or whether you have a young child who is in some type of sport and you think that, oh, you know, maybe I better have them assessed because I want to make sure their spine is as strong as possible. Because why wouldn't you want to make sure that their spine is developing under a normal healthy tension rather than an abnormal tension, the subluxation? Because once your body matures with that subluxation in it, then it starts accepting that as normal. And it's not that it can't be corrected, it can be, but it just takes a heck of a lot longer once the body has established the abnormal as its new normal.

Okay. Boy, I just used that old term that we hate. But anyway, so, I mean, that's the advantage of looking at, you know, an instability. So if you've been diagnosed or told that you might have an instability, the best way to assess it is looking at this motion x-ray assessment. And, you know, again, we're one of the few offices. in our region that has it and assesses it in this way in combination, looking at too much motion or too little motion, and trying to get you, you know, coordinating the best results through adjustments

and other, you know, techniques that may be other health care providers use and being able to coordinate care for the best solution of your health and well-being. So with that being said, I think I can get off my soapbox now. Every now and again, they let me get up and, you know, then they got to ring me back in. But I hope that was helpful. If any of this resonated with you, if you yourself are seeking help or, you know, seeking help for a family member, especially a child who you think may be developing some sort of abnormal, you know, challenge because of an injury or because of a sport or, you know, some sort of activity that they're doing, strongly encouraged that you give our office a call or check out our website. And if you're out of the area and, you know, still looking for that professional that could do that test, that motion assessment. in your area, don't hesitate to reach out because we know what to look for and hopefully find

someone closer to you. Or you can fly in and see us. We got people do that too. So, you know, Pittsburgh is a nice place to visit. Just not in January. Yeah. So come now. Come now. Yeah. We're entering the most beautiful time of year around here. Book your appointments. Absolutely love it. So with that being said, I am Dr. Dan. Thanks for interjecting. I'm Angela guys. And thanks for listening. And we will see you next time. See you the next one. You've been listening to What the Health with Dr. Dan and Angela Toro, brought to you by Toro family chiropractic. To learn more about the resources mentioned on today's show or listen to past episodes, visit www.org.com.