Think Upstream!

Thinking Upstream

At a recent seminar, Dr. Michael Nelson, DC reported the case of a patient with patellar tracking dysfunction. After imaging, he successfully eliminated the problem.  How did he do this?  By thinking “upstream.” “There was no problem at the knee” Dr. Nelson pointed out, “just consequences.” He achieved success by treating the hip joint and gluteals.

 This is a typical situation among female athletes. It’s not “weak knees” or patellar tracking that is the problem.  It has to do with the relative difference in pelvic angle (from males) that makes it particularly vulnerable. These common issues may find resolution by examining the relationship from the problem area to the upstream structures. For example, a man who had experienced some success with laser therapy for diabetic neuropathy in his feet, asked his podiatrist if laser could help his “uncurable” gastroparesis. He was referred to Virginia based chiropractor Dr. Sherron Marquina. Within 12 laser treatments he states that the symptoms of constant nausea and abdominal pain disappeared. Pain that had been there for years. Pain his other practitioners had ruled as incurable.  And what were Dr. Marquina’s treatment targets? The nerve roots of the thoracic spine and vagus nerve.  Astonished, he asked if the relief was permanent. The doctor assured him, “If you want the symptoms to return, just maintain your current diet and lifestyle.”  Meaning that despite restoring neural function, other upstream lifestyle factors (like diet, sleep, stress the patient had reported earlier) were certain to recreate the neuropathy if not addressed.

Just Keep Swimming

Both physicians recognized that the symptoms were a voice, not the source, of the problem. “Going upstream” with a patient means looking at the potential of more proximal or distal structures or mechanisms that might be creating the symptoms. Patients question “How do I treat my XYZ?” often wondering “How long?” and ” How many treatments?” Physicians are schooled to respond to symptoms for effective resolution, especially when treating acute presentations. However, chronic, recurrent or persistent conditions require a different strategy, not necessarily a specific protocol. 

So, what’s the “protocol” for a chronic condition?  First, check the patient for possible “upstream” factors. This is especially important when a chronic condition has been minimally responsive to previous treatments. Upstream joints and associated structures, as well as nerve roots, are typically the first “suspects” in all chronic conditions. Also, consider the metabolic function. It is often deranged due to chronic inflammation and that will tend towards dysregulating the microbiome and/or medulla. Finally, establishing a change in lifestyle that supports healthy metabolic functioning will be crucial in maintaining effective resolution.

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