San Francisco Chiropractor Moving October 1st

After many years at 230 California Street, Suite 600 in downtown San Francisco, we are moving down one block to 311 California Street, Suite 300.  Our new clinic will feature five private treatment rooms, and a more modern look and feel.

Like before, we will feature same-day appointment chiropractic services.  If you haven’t been to our clinic, San Francisco Chiropractic, our practice emphasizes quick relief of pain and discomfort using state of the art physiotherapies combined with multiple-approach manual therapy techniques, such as spinal manipulation, instrument adjusting, and joint mobilization/stretching.  Basically, we aim to make you feel better, and move better, upon your departure from our office.  We try to fix the problem within 6-8 treatments.   We know you are busy and want to get back to work, without being encumbered by a nagging neck, shoulder, back, or wrist pain.  Sometimes the problem can’t be fixed in one session, but other times, it can.

In addition, we offer active release technique, courtesy of Leland Thunes, L.M.T.  Active release technique is a participative form of massage therapy that gets results quicker than traditional deep tissue massage.  It’s a great method to re-energize muscles, strip away old adhesions from previous injuries, and get oxygen to tired and sore muscles and joints.

Lastly, acupuncture is offered by Emily Mooney, L.Ac.  Emily specializes in pain modulation using electro-acupuncture.  She is also a Traditional Chinese Medicine herbalist.  Emily has had great success treating people suffering from chronic pain.

Our Mission:  Serve as downtown San Francisco’s all-in-one center for the non-surgical, non-drug treatment of acute and chronic spinal, nerve, muscle, and joint pain.  We will use modern equipment and techniques to help alleviate, cure, and rehabilitate common musculoskeletal conditions, and we’ll do it in a compressed timeframe in mind.

Dr. Dan

San Francisco Chiropractor

Neck Alignment and Neck Pain

San Francisco Chiropractor

Many people have been to a chiropractor.  If you are one of them, and you came in for a neck and/or shoulder problem; or headache, you may have been advised by the chiropractor to take a lateral (side-view) cervical (neck) x-ray.  The reason for doing so was to determine if the seven vertebrae that comprise the neck are in proper alignment relative to one another.  The chiropractor may have gone on to say that if the neck is not aligned, it recruits the neck muscle to balance the weight of the head in an inefficient manner, causing neck strain and possible headaches.  Also, abnormal alignment may lead to increased pressure in the discs and facet (rear) joints of the vertebrae resulting in arthritis, and possible nerve encroachment (pinching).

So, the question is, is this true?  I believe the analysis has merit.  It basically transfers engineering principles to the human body.

Most chiropractors will explain to their patients that the neck, when viewed to the side (x-ray) must form a gentle arc, with the convexity in the front of the neck.  When the alignment is reversed (convexity at the back of the neck), or if the neck is like a straight line (no curvature), it causes problems in the joints, which can lead to things like a stiff neck, headaches, and even arm symptoms (pain, numbness, tingling).

Consider the arc.  Even centuries ago, ancient civil engineers knew that an arc imparts strength to a structure.  Ancient roman aqueducts had arched ceilings to prevent them from caving in.  If you look at a bridge, you will notice that it has an upward arc to support the traffic that crosses it each day.

The head weighs about 8-10 pounds, and is supported by the neck.  If the neck has an arc, the arc acts like a spring, balancing the weight of the head so that minimal neck muscle contraction is required.  But flatten out the curve, and more neck muscle contraction is needed to hold up the head.  Reverse the curvature, and the demands increase.  And, pressure increases in the discs and facet joints, causing them to wear out faster.

It’s believed that the curvature of the neck is formed during infancy.  When an infant lies on its stomach and raises its head, it forces the neck into an arc.  This starts the process of shaping the neck into the gentle, forward-convexity arc.

The things that cause the arc to flatten include poor posture, prolonged or repeated forward bending of the neck, such as when sitting at a desk looking down, or at a computer monitor; and accidents like whiplash and sports injuries to the neck.

So, if you are experiencing neck pain and/or headaches, or symptoms like tingling in your arms/hands, go see a chiropractor and have your neck x-rayed.  The information will be useful in diagnosing the problem, and deciding on a proper treatment plan.

Dr. Dan

San Francisco chiropractor

San Francisco Chiropractor

Every once in awhile, you might feel like your back hurts.  For many people, low back pain can be a major burden:  the pain interferes with your concentration.  You can’t lift your kids up and play with them.  The gym is out of the question.  Running is out of the question.  Social activities are limited.  Basically, it cuts your productivity by over 50%.

So what do you do if you have low back pain?  If you live in San Francisco, try visiting a San Francisco Chiropractor.  If you back hurts, it is most likely undergoing some degree of muscle spasm and inflammation.  Vertebrae may not be moving fluidly.  And the nerves that control muscle and vertebral movement are under constant tone.  In severe cases, a disc may be bulging.

What you should first do is apply ice to your low back for 20 minutes, every two waking hours.  Do this by placing an icepack on the floor, then a thin cloth, and lie down on it so your lower back is on top of the icepack (no clothes in the way).  For comfort, place a pillow under your knees, and a small rolled up towel under your neck.  Close your eyes and relax.

San Francisco Chiropractors will typically treat low back pain with ice for the first few days, and will introduce movement to the low back by light spinal manipulation and/or passive stretching and joint mobilization.  Modalities like muscle stim (electric current to relax muscle spasms) may be used, as well as phototherapy (therapeutic light, to enhance tissue repair).  Usually, 6-8 treatments can clear up most typical low back pain cases.

To sit up from bed when you have low back pain, first roll to one side while lying down, then let both legs slide over the edge while you push up with your shoulder.  Wait for a minute, then stand up.

When the pain goes away, make sure to avoid heavy lifting for at least another week, to give your back muscles time to return to their normal function.

The Family Doctor offers some good tips  to help reduce the chances of getting low back pain.

The San Francisco Chiropractor

Disc Herniations: Part II

Previously, I wrote about how the diagnosis of “disc herniation” may not be all that bad.  The term is frequently overused by some orthopedic specialists and chiropractors.  A small degree of disc “bulging” is normal, as the discs ARE supposed to flatten somewhat when placed in a weight-bearing position (standing or sitting),  much like how pressing down on a ball of dough causes it to “bulge” outwards.

But of course, a diagnosis of disc herniation can also be the “real deal.”  Especially if the onset was from a single-incident trauma, like lifting a heavy crate over one’s head.  If the inner material of the disc (nucleus) “pops through” the onion-like collagen rings of the disc periphery it will most definitely generate deep, intense pain.  Pain that pretty much prevents bending certain positions and lifting heavy objects.  If the bulge hits a spinal nerve root, it can cause radicular, or radiating pain (the term “radicular” actually is derived from the latin word for “root”) down the leg.

Treatment for such disc protrusions can be either surgical or non-surgical.  The two surgical methods available are discectomy and percutaneous discectomy.   Discectomy involves accessing the disc through the back, oftentimes removing a portion of the vertebrae called the lamina (called a laminectomy), and removing the material that is pressing against the nerve root (which may be bone as well as disc).  Microdiscectomy is the same approach, but uses a special microscope to visualize the disc material.  Microdiscectomy allows for a smaller incision, which reduces the probability of chronicity.

Percutaneous means “through the skin” and involves using special tools to reduce the disc herniation.  This procedure allows for even smaller incisions.  In percutaneous discectomy, a special scope is used to guide the instruments to the disc.  Then, the surgeon my shave off a portion of the disc or evaporate it with a laser, causing a vacuum which draws in the disc protrusion.  Percutaneous discectomy is know to be not as effective as traditional discectomy.

Non-surgical treatment for disc protrusions involve physical therapy, exercises, rest/ work restrictions, and cortisone (antiinflammatory) injections.  A more recent procedure that has come on the scene in recent years is non-surgical spinal decompression, which uses a special table to gently separate the lumbar vertebrae in a cyclical pattern.  In non-surgical spinal decompression the patient is secured to a sectional table, and a harness is attached to the patient’s pelvis.  The harness is connected to a programmable unit that exerts a subtle pull, holds for a set time, releases and rests for a set time, and repeats the pattern.  The idea is to “pump” the disc, increasing fluid exchange and creating an environment that promotes faster healing.

Results vary by individual, but generally speaking, the cases where the disc has room to regenerate will get the best results.

My clinic in downtown San Francisco offers non-surgical spinal decompression.  We offer complimentary initial consultations.  An online pre-qualification questionnaire is available for those interested.

Dan Perez, DC

San Francisco Chiropractor
(415) 627-9077 x1

Disc Herniations: Reason to be scared?

MRI of lumbar spine

When a patient comes into my clinic and starts using the words “L5-S1 disc, stenosis, laminectomy…”  I know right then he/she has had a consultation with an orthopedic surgeon.  These are the typical words that signal disc problems in the lumbar spine– one of the more serious causes of low back pain.

If you have back pain that doesn’t respond to therapy and are told you have a “disc herniation”, don’t be too alarmed right off the bat.  Get more specific information.  You see, the term “disc herniation” is sometimes abused by doctors, including chiropractors, just like the term “scoliosis.” 

A spinal disc is actually a very tough, fibrous ligament that holds the bones (vertebrae) of your spine together.  The discs also enable smooth movements, and absorb forces to the spine.  At the center is the nucleus, a jelly-like material that acts like a ball bearing.  When you are standing, your weight naturally causes the discs to “bulge” outwards, like squishing a ball of dough.  So don’t panic (yet) when you are told you have a “disc herniation.”  Many people walking on the street will show these “disc herniations” on MRI, and they feel perfectly fine.

What matters is the size of the herniation, and whether or not it is contained within the outer fibrous strands of the disc.  The term disc protrusion is typically used for disc bulges exceeding 5mm past the edge of the vertebra.  The term disc prolapse is used to describe a situation where the nucleus gravitates past the outer strands of the disc.  It is obviously a more serious condition and can trigger an immune response (inflammation).  A sequestered disc is when the nucleus pushes out of the disc periphery, and a part of it detaches, leaving a floating piece in the spine.  Since the spinal cord and nerve roots are contained inside the spine, disc bulges can push against them causing radiating pain.  A worse case scenario is if the disc bulge presses against the nerves that control the kidneys.  This is a medical emergency that most likely will require emergency surgery.

Next week, I’ll talk about treatment options that are out there for people suffering from disc herniations.

Dan Perez, DC
San Francisco Chiropractor

Neck Pain and Chiropractic Care

We’ve all used the phrase “a pain in the neck” to describe something or someone who causes great inconvenience.  Perhaps your boss, or paying taxes.   And what a fitting term.  Having neck pain is no fun, if you’ve ever had it.

The neck, or cervical spine is comprised of seven (7) vertebrae and is considered the top part of your spine.  What distinguishes the neck from the rest of your spine is its versatile flexibility.   Of equal importance is its proximity to the head and brain.  In short, the neck plays a crucial role in balancing your head and moving your head so that you can see all around you.

Unfortunately, the neck is more susceptible to getting injured or “mechanically defective” because of its unique flexibility.  And when this happens, some very noticeable things happen:  headaches, neck stiffness, dizziness, and even numbness and tingling in the hands and arms.

Here’s a neck x-ray that illustrates hypolordosis, or flattening of the normal curvature.  In this case, it is due to congenitally fused vertebrae (5th, 6th and 7th neck bones).   Fused vertebrae move together as one unit, resulting in significant loss of range of motion.

If the neck is too straight (also called a military neck) it loses some of its ability to “cushion” the weight of the head.  A gentle curvature is needed to act like a shock absorber, as the head acts like a 10 pound weight on top of the spine.

Things that can cause your neck to lose its curvature, or cause one or two vertebrae to misalign include car accidents, falls, sports injuries (football tackle), and craning your neck over a desk for many years.  Depending on the structures involved, it can cause chronic neck stiffness, and in worse cases, neurological deficits like numbness and tingling in the face, neck and/or arms, and chronic headaches.

Chiropractic can help by repositioning the vertebrae back into normal position.  This is accomplished by adjustments (a gentle thrust to reposition the vertebrae), traction (a device that bends the neck and stretches shortened ligaments) and specific exercises.

Chiropractic is very safe when done correctly.  If you are experiencing neck pain, neck stiffness, inexplicable headaches, numbness and tingling in the hands, call our San Francisco office and ask for a consultation.  We’ll diagnose the condition and let you know if it is something that can respond to chiropractic treatment.

Dan Perez, DC
San Francisco Chiropractor
230 California St. Ste. 600
San Francisco, CA 94111
(415) 627-9077 x1

Dealing With Tendonitis, Wrist, Shoulder and Neck Pain

carpal tunnel and tendonitis

I’ve seen a lot of patients over the years who suffer from RSIs, or Repetitive Strain Injuries.  RSI is the blanket term for overuse injuries, usually affecting the upper extremities and often the neck and shoulder.  The common forms of RSIs are tendonitis or tendinitis; carpal tunnel syndrome, epicondylitis (golfers elbow/ tennis elbow), stenosing tenosynovitis, trigger finger, and frozen shoulder/adhesive capsulitis.    The condition affects people who use their hands frequently, or in the same manner, repetitiously.  For example:

-anyone whose job requires typing and mousing
-waitresses who have to carry heavy plates
-construction workers using vibrational tools
-sports participants whose sport requires the same movement; i.e. golf swing, tennis swing, baseball pitching, bowling

Medically speaking, the pain from RSIs is mostly from inflammation. Microscopic strands of tendon, ligament, muscle, and bursae (friction-free joint padding) snap under repetitive conditions, which initiates localized inflammation. The inflammation irritates nerve endings and increases the internal pressure in the wrist and arm, generating pain. As the tissues heal, they contract (shorten) resulting in weakness and further strain. The cycle is known to be chronic (permanent and reoccurring) in some unfortunate individuals.

The first thing to remember is that RSIs can be very painful and can take a long time to heal. So if you fall into any of the categories above and begin to experience pain in your upper extermities, take careful note and change your routine. This is where most people make mistakes– they assume the early symptoms are merely from fatigue, and keep their routine going, allowing the RSI to progress until it is firmly rooted. This is the stage where the RSI patient first contacts her/his doctor.

If you start to develop pain, numbness, tingling, fatigue, and/or weakness in your hands, wrists, and/or elbows do this:

Rest your hands and arms more frequently. If you type, take 15 second pauses every minute and stretch out your wrists and hands. If your office can accomodate job rotation, choose one that doesn’t involve typing. If you play sports, lay off for a while.

Try to determine if you are using the wrong technique, and make modifications as necessary. For example, many people who type bend their wrists upwards (should be kept in a straight line).

Strengthen your upper back and neck muscles. This will improve your posture and allow you to use your hands better.

If you are already experiencing pain, try icing the painful areas. Apply an ice pack for 10-15 minutes. Then, progress to contrast baths: fill your sink with hot water (just hot enough that it won’t scald your skin). Place your hands and arms in the hot water for a few minutes, then place them in an adjacent sink filled with ice water. Repeat 2-3 times. This forces circulation to the area and helps pump out inflammation.

Some people resort to anti-inflammatory medications like Tylenol and Motrin; these drugs usually don’t do well with RSIs for some reason.

If the pain persists, try chiropractic. Spinal adjustments to the neck and upper back can release muscle tension and improve range of motion. Adjustments to the wrist and elbows can do the same. At my clinic, we do a special type of massage called Active Release technique, which helps reduce scar tissue formation and bring the tendons to their original condition. Lastly, we employ therapeutic light to help injured cells regenerate faster.

Bottom Line: Take RSIs seriously from the start. To borrow from the sports world, the best defense is a good offense. Take active, protective measures to keep the disorder at bay.

Dan Perez, DC
San Francisco Chiropractor

Chiropractic and Car Accidents

whiplash victim

If you’ve ever been in a low-impact auto accident, you probably know that it can cause a pretty bad case of neck pain and stiffness.  And, depending on the angles of the accident, it can hurt your lower back as well.

 Low impact car collisions, or those occurring at less than 20 mph are a major contributor to neck pain cases across the country.  This includes chronic (long-standing) neck pain.

When two cars collide, even at low speeds, a tremendous amount of kinetic energy is released.  Kinetic energy is equal to mass times acceleration.  The large mass of the cars are what enable the violent impact forces to develop.

 In a low speed collision, sometimes the cars do not dent very much.  This can actually be worse than if they had dented, because denting absorbs some of this energy.  If the bumper is sturdy, the forces travel through the car frame and into the passenger.  As the car goes from, let’s say, 20 mph to zero mph (collision point) in less than a second, the head and spine go through a very short but violent contortion, resulting in torn muscle fibers and ligaments.  Swelling follows, maximizing at 72 hours after the accident (that’s why your neck feels more stiff the next day or two, not immediately afterwards) which limits your ability to bend your neck and back.

 If you are involved in a low-speed car accident, here are some tips:

 First of all, the obvious– if you are seriously hurt and do not feel safe to drive, call an ambulance.  If you are shaken up, but have your faculties intact, do the following:

 1.  Determine who was at fault (some insurance companies will advise you not to admit fault, even though you think it was your fault– it’s your choice).

2.  Exchange IDs– make sure you get the number of the other party’s auto insurance, and his/her phone number.

 3.  Call the police and ask for a report (in some jurisdictions, police will not arrive unless it was a serious accident and/or the car was totaled).

 4.  Report the accident to your auto insurance company, even if you don’t feel pain.  The insurer will ask if you were injured and need medical care (they ask this to see if your Med Pay benefits, should you have them, will need to cover your expenses).  If you don’t feel pain immediately, it’s advisable to not tell the adjustor you do not need medical care, because sometimes in these scenarios, pain arises several hours later, due to the slow process of swelling.

 5.  If your car needs towing, call a towing company.  Do not attempt to drive it if it looks like the frame, engine, steering column, or wheels have been damaged.

 6.  Many low-impact car accident victims experience headaches, dizziness, and neck pain and stiffness; and sometimes jaw pain and knee and wrist pain after the accident.  If you experience this, take it easy for the rest of the day.  It would be wise to check into the local ER and get checked.  Have a friend drive you.  Also, take the rest of the day off.

 7.  Ice your neck and low back to reduce muscle inflammation.  Do it every two waking hours, 20 minutes each time.

 8.  Contact a chiropractor.  Chiropractors are highly trained in spinal biomechanics and can detect if your neck, spine and extremity joints have been affected.  Choose a chiropractor who is experienced in treating auto accident soft tissue injuries.  These conditions require a specific protocol:  pain reduction, functional restoration, and strengthening.

Dan Perez, DC

San Francisco Chiropractor

(415) 627-9077 x1 

Chiropractic in the 21st Century

The purpose of this blog is to provide chiropractic information to the public.

Chiropractic has been around since 1895, yet it is still a bit of a mystery to many people.  The main consensus is that chiropractors treat back pain using manual (hand-delivered), as opposed to invasive (drugs, surgery), procedures.  Those who are more familiar with this discipline know that chiropractors can also treat extremity joint problems (shoulder, elbow, wrist, hip, knee, anke, foot).  Still others have an understanding that you can receive chiropractic treatment from a “wellness” standpoint.

One of the main reasons the public has different impressions of chiropractic is that there are multiple specialties within the field.  Some chiropractors use solely their hands; others use hand held adjusting intruments that impart a light, quick impulse; some use modalities such as ice, heat, laser, and electric stimulation to help reduce pain and encourage soft tissue healing; and others rely heavily on nutrition and nutritional supplements.

Then there are the differences in treatment approach:  let’s say you come in for acute low back pain.  Go to a chiropractor who emphasizes pain relief, and you’ll most likely get ice, muscle stim, passive back stretches, light massage, and a low back adjustment (spinal manipulation).  You may be told to come in 3x a week for 1-2 weeks, or even daily for one week.  After the pain is gone, the chiropractor may recommend optional maintenance visits at up to 1x/month.  Go to a chiropractor who emphasizes posture correction, and you may get recommended a more comprehensive treatment approach.  If your spine deviates from normal posture (hunched back, straight neck, head tilt, sidebending spine) you may be recommended a treatment approach that attempts to restore normal alignment to your spine.  This can be up to 50 treatments over six months and will require you to do home exercises.  Go to a holistic chiropractor and you will have a different experience entirely.  The holistic chiropractor will try to help you get out of pain, but during the process will inquire about other health deficits you may have, such as frequent colds, allergies, stomach/ digestive issues, and so on.  Then, he/she will tell you that your body functions better if your nervous system is unobstructed, and that spinal dysfunction (misaligned and/or improperly moving bones) are the major cause of nervous system dysfunction.   You may be recommended an “annual” wellness program consisting of weekly visits.

Now, how does one go about finding a good chiropractor?  First of all, be aware of the three main types of chiropractors mentioned above.  Ask the potential chiropractor what he/she emphasizes in his/her practice.  Many chiropractors give complimentary consultations; take advantage of them.  Don’t feel pressured to commit to care; the purpose is to visit the clinic, meet the chiropractor, get info on the type of care offered, and perhaps, discuss finances.  Then, if all checks out, go for it.

I will address more topics of this nature in the future.

Dan Perez, DC

San Francisco Chiropractor
230 California St., Ste 600
San Francisco, CA
(415) 627-9077 x1