Rethinking Orthopedics: Recent Episodes
Mary J. Rogel, Ph.D., L.Ac.
I would like to shift our understanding and practice of orthopedic medicine away from the prevailing model of the body as a machine with replaceable parts toward an understanding of the body as a dynamic, adaptable structure with potentially reversible problems. If we shift our view of the body from the insides of the joints to the outsides of the joints, we get a different understanding of how they function. In this show, we will explore that adaptability and its consequences for structural alignment. My hope is to encourage health care practitioners to see new possibilities for, and to improve upon, their treatment methods so that their patients can derive more benefit from therapy, and to help people understand their orthopedic issues better so they can prevent problems, recover faster from ones they have, and work more effectively with their physicians and therapists.
Throughout this series we have been investigating the dynamic, adaptable nature of the human frame. The alignment of any given joint is not static or fixed. Joints normally operate through a range of alignment possibilities. This is true not only for the pelvis and lower and upper extremities, but also for the entire spine and the head. In this episode we will follow the pathway of adaptability up the spine to the “end of the line” in the head. We will examine how the pelvis affects the diaphragm and the various conduits that pass through it, as well as the rib cage, thoracic and cervical spines, skull, jaw, and even the teeth. Among other things, we will see how orthopedic and musculoskeletal issues can be at the root of some internal medicine problems, what might be the cause of some people’s migraines or tinnitus, and why some people’s teeth move back where they were when their braces are removed.
Chiropractors have been practicing in this country for well over 150 years, but people tend to think of chiropractors in terms of spinal adjustment and not much else. My guest, Elaine J. Wagner, D.C., will help us understand the broad range of what chiropractors do, how they differ from other health care professionals, and how to choose a chiropractor. Some people are afraid of spinal adjustments, so we will talk about spinal adjustments and how they are done, as well as why it is important to approach health problems in layers and with multiple approaches. Dr. Wagner will talk about some of the many techniques she uses and how she combines them to help her patients achieve better health.
In Oriental Medicine we have a saying – “as above, so below.” When it comes to orthopedics and musculoskeletal issues, I believe it is more accurate to say, “as below, so above.” The pelvis is the foundation on which the upper body is built. Problems in the pelvis and lower extremities are reflected in and counterbalanced by the upper extremities, torso, neck, and head. In this episode of Rethinking Orthopedics, we will examine the structure and function of the upper extremities. We will look at the shoulder girdle and arms as an integrated, dynamic whole that responds to what is happening in the lower body. Our focus will be more on the connections between the joints than on the joints themselves. We will examine the similarities and differences between the upper and lower extremities, and the implications for what kinds of problems we experience in our shoulders, arms, and hands.
Pain and injury are part of the experience of sporting activities. My guests, Clinical Psychologists James Bruce, Jr., Ph.D., and Anne-Marie Nicolas, Psy.D., will talk about how competitive athletes deal with pain and avoid injury. The principles of sports psychology can be used by recreational athletes, non-athletes, and people with chronic pain to reduce the experience of pain. We will also talk about how careful planning and realistic goal-setting can help us avoid injuries during sports activities and physical workouts.
If the pelvis is the foundation on which the upper body is built, then the lower extremities are the pylons on which the foundation rests. In this episode of Rethinking Orthopedics, we will examine the structure and function of the lower extremities, but in a different way from usual. Most of the time we view the body as though it were a machine made up of replaceable parts. Instead of looking at the legs joint by joint, today we are going to look at the connections between the joints. We will see the leg as an integrated, dynamic whole that changes its shape and its motion in response to changing pressures from above (from the pelvis) and from below (the feet and ankles). Find out how knees and feet respond when pelvic motions are restricted by an injured sacroiliac joint or hip. Hear some uncommon explanations for common foot problems such as bunions, hammertoes, and plantar fasciitis. Once you see how the joints are connected, you will wonder why you never saw it before.
Western Medicine treatments for chronic pain frequently include medications to manage or mask the pain. These medications are not without effects. My guest, clinical psychologist Anne-Marie Nicolas, Psy.D., explains the differences among the various types of unintended effects various common pain medications can have, including side effects, rebound, withdrawal, and addiction. We discuss the role psychologists can play in helping people control or diminish their pain, reduce their dependence on pain medications, and manage the unintended effects of pain medication. We also discuss the difference between Complementary and Alternative Medicine, and the importance of addressing the body-mind-spirit connection.
Humans are not the only species to experience orthopedic problems. All living beings with joints experience similar problems and respond to those problems in much the same way, whether they walk on two legs or four. My guest today, licensed Clinical Massage Therapist Rachel Purpura, treats structural alignment problems in both humans and their small and large companion animals. We will talk about the similarities and differences that come from walking on two legs vs four, special considerations for doing massage therapy and structural realignment on animals (especially 2000 lb horses), why we need to treat our companion animals, how the structural alignment problems of equestrians can create alignment problems for the horses they ride, and what can be done about it.
Foot pain can be more than just achy feet! One in four U.S. women suffers from debilitating foot pain, which can affect the function of other body parts, from knees and hips to the pelvis and spine. But the solution may be as easy as some simple changes and gentle exercises. My guest, biomechanical scientist Katy Bowman, M.S., will talk to us about how the foot is designed to work, what shoes we should and should not be wearing at different stages in our lives, and how to reduce or prevent foot pain and halt the cascade of damage throughout the rest of the body. Find out how something you do every day without giving it much thought, i.e., wearing your shoes, can disrupt or negate all the good things you are so careful to do for yourself. Learn how something as simple as the heels of your shoes can have an impact not only on the health of your feet but also on conditions as diverse as the strength of your pelvic floor and the density of your bones.
The pelvis is one of those mysterious, hidden body parts. It is hard to imagine what it looks like, and even harder to imagine what it does and how it moves. In this episode of Rethinking Orthopedics, we will examine the structure and function of the pelvis.
In many ways, our bodies are like tall buildings. The pelvis is the foundation on which the upper body is built. The lower extremities are like pylons on which the foundation rests. What makes it all so interesting is that the foundation is articulated, and it participates in moving us through space. It also makes a nice container for holding some of our softer parts.
We will talk about the pelvic bones, how they move, male-female differences, differences in men's and women's orthopedic problems, how the pelvis participates in walking, how the pelvis is related to the hips, and why the pelvis is so involved in back pain, sciatica, almost every orthopedic problem, and many internal medicine problems.
Though acupuncturists are generally not first responders in emergencies involving broken bones, we treat many patients as they recover from broken bones, including surgical repairs, stress fractures, and fractures that cannot be set. Our approach, as practitioners of Eastern Medicine, is quite different from the approach taken by practitioners of Western Medicine. Combining the methods of both medicines can speed the healing process, reduce pain and swelling, and improve outcomes. In this episode, three acupuncturists discuss the many options they use to help themselves and their patients recover from broken bones.
Why do we need to rethink orthopedics? Dr. Dane Shepherd and I will explore this question, as well as the broader need to rethink medicine in general. There are other ways to practice medicine besides what has become the norm in Western countries, particularly the U.S., where physicians rely on laboratory tests to tell them about their patients. As an Osteopathic Physician, Dr. Shepherd relies primarily on what he feels with his hands to diagnose and treat his patients. We will talk about the differences among various types of medicine, including osteopathic, allopathic, homeopathic, chiropractic, and Oriental Medicine; and Dr. Shepherd will tell us his ideas about how to shape the direction that medicine is evolving. Imagine what might become possible if we think together in a different way about our dynamic and adaptable bodies!
Alignment has an impact on all aspects of health. My guest for this show is Anna York, who has lived with multiple sclerosis for 50 years. At age 37 she was largely paralyzed from the neck down and spent several weeks in a hospital and nursing home. The turning point came when two of her sons introduced her to Tai Qi. At a Tai Qi class in 1996, the instructor realigned her hip in 20 minutes, changing her life forever. The nerves on her paralyzed and atrophied left side started turning back on, leading us to ask whether the symptoms of MS were due to the documented lesions in her brain or to the misalignment of her hip. Today Anna York is active and vibrant, and without a wheelchair. She leads a full life as an author and teacher, and she has produced two instructional Tai Qi - Qi Gong DVDs, specially designed for seniors and people with serious conditions like MS, Parkinson's, stroke, fibromyalgia, and arthritis. We will talk about the role of alignment in her recovery, as well as related issues regarding diagnosing and treating serious disease, interacting with one's physician about alternative diagnoses, and empowering oneself to change one's life.
Rethinking Orthopedics challenges the prevailing notion that the body is a machine with replaceable parts. In this first episode, host Mary J. Rogel, Ph.D., L.Ac., will explain how our joints are constantly adapting. Rather than seeing chronic wear and tear as a design fault, she sees it as evidence of an ingenious mechanism that allows us to continue functioning after injury. This shift in thinking, from mechanistic to plastic, explains why some people have such poor treatment outcomes, and it totally changed her methods of diagnosis and treatment. So many of our current diagnostic and treatment strategies attribute the cause of orthopedic problems to things that are actually unrelated, and many treatments attack the symptom of the problem instead of the problem itself. With the knowledge of how joints adapt, patients can work with their health care providers to find treatments that preserve our body’s greatest gift to us, its ability to function with misaligned and damaged joints.