Live Lecture: Dr. Karen Derr, “The Chiropractic Connection”

Olivia: Good evening and welcome to Florida Orthopaedic Institute’s Physician Lecture Series. Thank you for joining us. My name is Olivia, and I am the physician liaison here at FOI. Tonight, I am proud to present our new chiropractor, Dr. Karen Derr. She will be talking about the functions, symptoms, and treatments of the nervous system. She earned a bachelor’s degree in biology at Bloomfield College and earned her Doctor of Chiropractic degree from the prestigious New York Chiropractic College in Seneca Falls, New York. Dr. Derr may be new here at FOI, but she has been in practice for 26 years.

Before we get started, just a few quick notes. We will be sending everyone a link to this webinar. You can comment or ask questions directly on Zoom, which I will be monitoring. You can also send questions on Instagram or Twitter @FL_Ortho. At the end of the presentation, we’ll get to as many of those questions as possible. Lastly, if at any time you don’t see your slides moving or are having trouble with the audio, try refreshing your browser. Now I am pleased to turn it over to our speaker today, Dr. Karen Derr.

Dr. Karen Derr: I’m so happy to be here to discuss the chiropractic connection, symptoms, and treatment of the nervous system. Your nervous system deals with every level of human performance. There’s not one thing that we do during the day or day-to-day that doesn’t involve the control of our nervous system, such as remembering the words to a song, feelings and thoughts, emotions like being sleepy or being hungry, feeling sad, and feeling happy.

Increasing heart and lung function as we perform during sports activities or exercise. Then the reverse. Calming those things down so we can rest and relax. Playing the piano with speed, coordination, dexterity, precision, and even digestion. Make sure you have the right digestive juices in the stomach to digest your last meal. You don’t want to have too little, and you don’t want to have too much. Of course, regenerative tissues, after injuries, you want to make sure that your body can do its very best to recover from those things. This all depends on a healthy nervous system. I’m very excited to share this information with you.

The primary function as a chiropractor is to make people perform better. The connections we’re going to talk about have to do with the joints as well as in between the nerves. How well you’re connected is directly related to your health, as well as your healing capacity and potential. The spine is a key player to this. It’s probably a good idea to be in great spinal health and that’s the job of chiropractic.

When we discuss the nervous system, what we’ll be discussing is the anatomy. The structures involved as well as the physiology and how it functions. We’ll be talking about what symptoms you experience when the nervous system is injured or damaged, what common conditions are related to the nervous system malfunctioning, as well as treatments and the role of the chiropractor.

What is the nervous system? The nervous system is made up of two main networks that work in harmony. You have the central nervous system, which is a continuous structure of the brain and the spinal cord. Then you have the peripheral nervous system, which is everything outside the middle, starting at the spinal nerves and connecting to all the tissues. A fun fact, embryologically during development, when two cells became four and then eight and then 16 and 32, the first tissues to form was our nervous system.

This tissue flattened out, the bottom became the spinal cord, and the top enlarged to become the brain. Off the spinal cord, just like branches of a tree, developed tissues. Like leaves and fruit, it gives life to our organs like our eyes, tongue, heart, stomach, muscle, liver, and bones. There’s not one part of us that’s not connected. The nervous system is truly the wiring to every cell, tissue, and organ. The brain will coordinate its function in everything that we do.

When we talk about the functions of the brain, the brain is responsible for all of our reasoning and our thoughts. It helps us recognize things that we see, things that we hear, things that we taste. It helps us with muscle coordination, balance, and posture. It’ll help us with temperature. If we’re cold, we’ll shiver to create friction and heat to warm us up. If we’re too warm, the body will know to perspire to allow us to cool down. That’s all regulated by the brain. Sleep, respiration, blood pressure, digestion, heart, and blood vessel function, all this occurs every day under the guidance of our brain.

The brain would be useless if we didn’t have a way to connect to the tissues. That’s why we have the spinal cord. The spinal cord is a direct link between the brain and the tissues. It’s a collection of nerve tracks known as a communication highway, and like all great communication, there should be two-way signals sending and receiving information.

There are three main parts or regions of the spinal cord. Cervical, which means in the neck, thoracic for the middle back, and then lumbar in the lower back region. The nervous system’s function can be explained easily by three basic steps, sensory input, integration, and motor output. In this example, we have someone touching the prickly surface of a cactus. There are sensory receptors that activate electrical impulses in the finger, along the nerve that go to the spinal cord. Then they go northbound on our communication highway to the brain.

The brain then decides, what is this and what am I going to do about it? The brain will process it, recognize there’s a sharp surface, and, “I’ve seen this before, I felt it before. It’s probably not a good idea to put pressure on there as it could cause harm.” Response to this stimulus is the motor output. The brain will then activate electrical impulses southbound through our communication highway off the proper exit to get to the muscles of the arm and move the hand away from harm. This is known as a reflex arc. Most reactions in the body are reflexes just like this. Immediate reactions that don’t cause or require any type of consciousness. Happens very fast.

How does our body send electrical impulses? There’s nerve tissue or nerve cells called neurons, about 86 billion of them in our body. There are some that are short. There are some that are long connections, and these nerves produce electricity, just like a small battery. They are the longest-lived cells in our body. That’s probably a good thing because most of them are irreplaceable or very slow to heal.

The nerves will function like wires and send electrical impulses to the tissue. Just like you are walking into a room and flipping the light switch. There’s electricity that runs through the walls to get to the outlet or the light fixture that turns on the light. Same thing with your body. Like the wires in the walls, there’s even insulation called the myelin sheath. This helps the transmission of electrical impulses to get to the tissue fast. The fastest recorded was 258 miles an hour. That’s pretty fast.

The nervous system has the ability to send and receive these signals at that speed as long as there’s no interference. Interference could be nerve compression. It could be a chemical irritation with infection or inflammation. It can also be overstretching of the nerves that can also slow down the transmission of electrical impulses and cause the nerve reflex not to work as well as it should. Doctors can order a nerve conduction velocity test. This is a test that will quantify the speed of the nerve transmission to see how slow or fast it is. It’s also a great diagnostic tool to help us find the sight of impingement of that nerve throughout the arms or the legs.

Nerve impulses can speed up so they can become excitatory. It can cause a muscle to tighten and stay that way, so it guards and protects the area of injury. Or it can slow down and even stop, causing malfunction to whatever tissues on the end of that nerve. Similar to a child’s toy, if the battery isn’t full strength, the light might come on or the sound might be distorted. It’s just not going to work as well. Or your Wi-Fi signal on your cell phone. If you don’t have all the bars, your phone will still work, just a little bit slower than usual. It’ll work, but not as normal as we want it to.

The symptoms that you’ll feel can be pain and tingling along the path of that nerve into your arms or legs or up towards your head, you can have numbness in the patch of skin that that nerve supplies or weakness in the muscle that that nerve supplies. It’s important to know that lack of motion can also decrease the sensory and mechanical input to the brain. This is going to become a little bit more important later on when we talk about the spine.

Hopefully, by now, you’ll agree with me that you can’t discount the importance of the nervous system. When you have something this valuable, the right thing to do is protect it. That’s what the body does with the skeletal system. Our brain is protected by bone in the skull and the spinal cord, and its nerve roots are protected by the vertebral column or spinal column when there is proper alignment, as well as the curves.

Looking at someone’s alignment from the front or the back, the bone should stack up pretty straight. This will allow for even spaces between the bones where the disc or cartilage is. It also allows for the hole, the height of the hole for the nerve to come out and feed the tissues to be as open as atomically possible. The curves of the spine, when you look at somebody from the side, if appropriate, that curve in the neck can help balance the head evenly and properly on the neck and shoulders, as well as the curves in the back that distribute the weight of our torso on our pelvis, hips, knees, and ankles. The spine is very strong, but with its flexibility, there’s vulnerability at the joints.

There’re so many different joints in the body. For our purposes tonight, we’ll be talking about the synovial joints. A joint is where the two bones connect. At a synovial joint, the two bones have articular cartilage, which is the buffer zone so the bones don’t get close or start to touch each other. Then there are ligaments that surround the two bones to provide strength and stability.

The space in between the bones is known as the joint cavity and this joint cavity is filled with fluid known as synovial fluid, which lubricates the joint, allows less friction, and perfect slide in glide during movement. Movement occurs when you tighten a muscle that’s attached to two bones, and it brings those bones closer. The pivot point or the part that moves should slide and glide effortlessly, that’s healthy movement.

Risk factors to synovial joints could be osteoarthritis. Due to the aging process or overuse or injury that has healed improperly, this can cause the joint capsule, as well as the cartilage to degrade unevenly. There are also conditions where rheumatoid arthritis and diabetes, these all can affect the joint capsule.

In the spine, there are facet joints that are synovial joints in the neck as well as the back. These are the connections between the bones, and they allow us to bend, twist, and turn comfortably. The facet alignment allows muscles to push or pull properly, reducing strain, and this is the part that chiropractors focus on. Because the spine protects the nerves, it’s important for alignment that keeps the holes as open as possible and allows less strain, wear and tear on the joint as well as the muscles. The issues that are often caused or caught by chiropractors are misalignments involving the spinal facets. This can affect that reflex arc that we talked about with the nerves and the muscle tissue.

How do we get misalignments or joint restrictions? There could be deformities or defects. You can have your bone developed incorrectly or just differently or an injury that has not healed up correctly, that can leave an imbalance. There can be scoliosis, a deformity of the spine where there’s asymmetry and abalance, an abnormal curvature. The accidents, falls, whiplash, injuries, and sports, that’s easy to recognize that forces from the outside can create imbalances in the body as well as poor posture over time.

There’s a lot of advertising for devices, braces, pillows, and mattresses that claim to support curves and proper joint mobility and flexibility, and they all work. Under the guidance of your healthcare professional when you have the right diagnosis and treatment, very often, these things are recommended for home care and will help you recover from your injuries better.

The aging process can also start the joints and cartilage to wear and tear unevenly. When this happens, there’s muscle imbalance, the nerves become irritated and start to interfere with that reflex arc. Chain reactions affecting more facets and nerves, muscles, and soft tissues occur. This forces our facet joints and muscles to work differently than originally designed, which can lead to early degenerative change. Again, the lack of joint movement causes reduced sensory and mechanical input. This is important because if the brain doesn’t get stimulation, then it can’t in return give it the attention it needs to start the healing process.

The common conditions that chiropractors treat are often the result of structural irritation like we talked about in the muscle tension of your neck, shoulders, and back. Chiropractic treatment allows for the improved nerve flow and blood flow that activate the healing process, and restoring joint mobility allows better connections and reflexes and improves overall outcomes for the patients.

Let’s look at some common conditions. The first one is known as a cervicogenic headache. 60 million Americans wake up every single day with this type of headache. It’s head pain or headache, even though it originates in the neck. Most of the time, it’s those facet joints that get jammed up, the capsule swells and irritates the nerves and causes referred pain to travel from the neck to the head. It’s often described as achy or dull. There’s muscle tension involved.

The muscles that connect are head, neck, and shoulder can become imbalanced or tight. When that occurs, referred pain can shoot up the back of the neck, around the ear toward the eye in that question mark pattern, which is very classic. It often affects one side of the head and face. This responds very well to chiropractic care because it is an issue with the facet joints and nerve reflexes.

The next one is neck pain or cervical radiculopathy. Neck pain, local neck pain without headache can come from the facet joints like we just talked about. It usually stays right in the neck area and doesn’t move around. Whereas cervical radiculopathy is nerve root compression that can cause paying the travel wherever that nerve goes, usually into the shoulder, down along the arm, the hand, the fingers, and depending on which fingers are involved can help the doctor properly diagnose which level of your spine that nerve interference is coming from.

You can have pressure on the nerve root, by disc material, bone spurs, or swelling, the tingling or numbness into the arms and legs we talked about, or weakness in the muscles. It’s often described as sharp and shock-like or burning pain, and in the neck, it’s usually caused by wear and tear changes or degenerative changes in the spine.

A common condition chiropractors treat is whiplash injuries. Many times, patients come to the chiropractor first because of these types of injuries, because it’s well known that we can support the tissues very effectively. Whiplash doesn’t only occur in a car accident. It can occur in a crowd if you’re pushed, it can occur in sports injuries where you’ve been tackled or a roller coaster ride. It’s really defined as any forceful, rapid back-and-forth movement of the neck. It’ll overstretch muscles and discs and nerves and tendons, and this responds very well to chiropractic because we’re addressing all the structures involved with this injury.

There’s shoulder pain and shoulder blade pain and burning. This can be caused from the spinal nerve roots being pinched or irritated either in the lower part of the neck or the upper part of the upper back. The nerve pain can radiate towards either shoulder blade or shoulder. You can have tingling into the hand. Many people say that their hand keeps falling asleep. That’s a common symptom. You can even have decreased sensation in the skin where that nerve supplies. There’s often muscle tension between the shoulder blades. Again, responding very well and effective to chiropractic care.

Then there’s low back pain or lumbar radiculopathy. Low back pain is very common. 8 out of 10 Americans will suffer with lower back pain sometime in their life. It’s so common it ranks second to the common cold for missed days at work and visits to your primary care doctor. You can see how common it is. Low back pain can be local, meaning staying in the lower back area due to the facet joints being jammed, nerve irritation, and responds very well to chiropractic. Or it can be radiating along the nerves, going down into the leg if it’s pinched at the spinal nerve root. This can cause numbness, tingling, weakness of the muscles. It could be in the front back or side of your leg, depending on which aspect of the leg hurts. This can also help doctors determine the right diagnosis.

Then there’s stenosis, which is narrowing of the hole where the nerve comes out. This can be by disc material, by swelling, by bone spurs. All this can be handled with conservative care. Sciatica is probably the most common example of lumbar radiculopathy. It’s nerve root irritation from the lower back that goes into the legs. It could be one or both and a treatment that I’ve had great success with this is nonsurgical spinal decompression, where not only do we help increase the hole where the nerve is trying to come out to feed the muscles of the legs, but it also mobilizes the facet joints and stretches the tight muscles of the lower back and hips.

Osteoarthritis or spinal degeneration can occur in the neck and back as well as the example here in your knee. It often starts with the joint malfunctioning or misaligning. The soft tissue damage or scar tissue can happen with the tendons and the muscles. The disc space can narrow unevenly and when the body senses instability, it will try to minimize that instability and lay down calcium to shim it in there and support it, which calcium over time turns into a bone spur. When you develop a bone spur in the joint, it changes its shape. It changes its function and unfortunately the bone can’t move, or joint can’t move as normally as it should decreasing the reflexes as we spoke about earlier. Then the worst-case scenario is when those bone spurs touch and then we have complete bone fusion, which we want to try to avoid.

Intervertebral disc conditions can be bulging discs, herniating discs, desiccated, which means less hydration to the disc, or degenerative. These discs keep the space between the bones. When the space is between the bones, that hole is maintained for the nerve to exit left side and right side and go down your legs, but when it’s narrow, it can’t perform its job of shock absorption. What happens is then the bone has to take up that responsibility and it can do for a while, but it really wasn’t designed for that aspect or that feature. Your facet joints in the back can become jammed, just like a jammed knuckle during sports. It can cause pain in the joint capsule as well as tightness of the muscles because they can’t stretch.

The treatment that we provide as chiropractors relieve the pain and physical tension of the neck, back, and shoulders. Its hands-on treatment that focuses on the joints, muscles, and of the spine, and treatment combines mobilizing the joints as well as stretching muscles for better body balance. There are many different types of chiropractic techniques. They’re all very powerful and painless.

The main goal and objection are always to have better nerve function, better performance, and increase that reflex arc so all the wonderful things can happen in our body. It’s designed to relieve pressure off the joints and our treatment improves both joint and nerve connections. Once the nerve function is restored, then proper performance can take over. Your body can make the right quantity and quality of healthy tissue and exercise is usually prescribed to brace it and stabilize it for the future.

The chiropractic connection is always for improved performance. The sole objective is to allow the human body to perform better. Our goal is to improve sensory, motor, and reflex connections to enhance patient outcomes during physical therapy and pre-imposed procedures. The moment a chiropractic treatment is delivered, or a joint restriction is corrected, literally 100s of functions, activities, and reflexes are restored so you’re better connected. This improved flow of nerve impulses can begin to renew and restore the balance of the body properly. Better function, and better healing for each person, not that you’ll be healthier than anybody else, but that you’ll be as healthy as you can possibly be. I hope you enjoyed the content of this presentation. My hope is that it will inspire you to see and find out how much chiropractic can help you.

Olivia: What a great presentation, Dr. Derr. Thank you for sharing that important information and the role that chiropractic care offers everyone. Now we have some time for a few questions that have been submitted. The first one today is, is chiropractic care safe if you’ve had back surgery?

Dr. Derr: Yes. Although we may not be able to treat the area where the surgery was, the areas above and below that spinal surgery are just as important to rehab and keep mobile. This way, nothing interferes with the healing of the surgery site. The different techniques are very gentle, low force as to not cause any harm at all.

Olivia: Great answer. What type of training did you have to go through?

Dr. Derr: With my education, I have a bachelor’s degree in science and anatomy, and then I transferred to chiropractic school where I got my doctorate and my Doctor of Chiropractic degree.

Olivia: Nice. Last one. Do I need chiropractic care if I’m on pain medication?

Dr. Derr: Very often pain medicine is very effective. The hope is that after the medicine is done or the chemicals wear off that if you receive chiropractic care, then structurally you’re better off when the chemicals wear off than you were before. I’m all for people being comfortable during the workday or getting a good night’s sleep, but medication used wisely when you get chiropractic care would be to have a better structural outcome and hopefully get off the need for medicine to help you feel better when your body can recover.

Olivia: That’s all the questions we have time for today. Thanks for joining us for our webinar. We hope you enjoyed this conversation. It will be posted on FOI’s YouTube channel within the next few days. Goodnight, everyone.