Have You Been Saddled with a Garbage Can Diagnosis? Part II

This is the second part in a series that focuses on “garbage can diagnoses” (see Part I for a more detailed description of what constitutes a GCD.)

TMJ: (properly known as temporomandibular joint disorder) “My doctor/dentist says I have TMJ.” Gawd, I wish I had a dollar (nickel adjusted for inflation) for every time I’ve heard this one. Of course, they never follow up this statement with how it’s being treated, because most practitioners don’t know what to do with this condition besides give you a mouth guard. Great, now I can play hockey without losing my teeth, but my jaw still hurts. This GCD could include everything from jaw clicking, locking, joint pain, and nighttime clenching and grinding.

The importance of the jaw in overall health can’t be overstated. Because of the intense concentration of nerve receptors in the jaw that monitor proprioception–the body’s ability to sense where it is in space–proper alignment of the jaw is essential in maintaining balance and a decent center of gravity.

More importantly, the TMJ is one of the linchpins of the skeletal system (along with the sternum and pubic joint), meaning that if it’s out of alignment it can easily take out your whole skeleton. This can cause chronic muscle and joint conditions to flare up, inner ear problems, chronic headaches, sensitive teeth, ringing in the ears, and make you more prone to injury because of compromised balance. What causes the TMJ to be out of alignment? Intense dental work, serious injuries such as car accidents, giving birth, and gum or tooth infections are some of the most common causes.

Chronic pelvic pain: I could build a practice based on this GCD alone. I’ve listed this right after TMJ because the pubic joint and the jaw joint are inextricably linked. When the TMJ is not aligned properly, then the pubic joint also misaligns itself in order to balance the skeleton out as much as possible, and keep the body upright in space. And, the reverse is also true–if the pubic joint is misaligned, the TMJ follows suit. I’ve seen this relationship to be true 100% of the time.

A misaligned pubic joint can result from many factors, but a few common ones are: pregnancy and childbirth, acute injury such as car accident, abdominal or pelvic surgery, bladder or reproductive system infection or inflammation, dental work, and bodice-ripping sex.

A chronically misaligned pubic joint can cause a whole host of problems, such as: migrating pelvic pain involving the hips, tailbone (sacrum), genitals, and sometimes the groin or front of the hips; chronic urinary system infections; chronic vaginal or prostate infections; frequent groin muscle strains; and knee joint instability.

Do you see a chiropractor, physical therapist, or osteopath, but he/she just can’t seem to get your pelvis and hips to hold their adjustments? Quite likely they either don’t know how to recognize a misaligned pubic joint or they don’t know how to adjust it. If your pubic joint is misaligned and your therapist adjusts your hips or sacrum without adjusting the pubic joint first, then any other adjustments will not hold for very long. The third possibility, of course, is that your therapist simply doesn’t want to go there. At one clinic where I worked I was known as “the pubic joint guy,” which was something of a dubious distinction. But hey, everyone needs a niche, right? And this is one that badly needed to be filled.

If you take anything away from this series, it would be the critical importance of the jaw and pubic joint in both musculoskeletal and systemic health. It’s frequently missed because it’s rarely a consideration in the medical model, and it was also given scant emphasis in my chiropractic education.

Leg Length Inequality: This is more commonly known has having a short leg. The two most blatant symptoms are talking like a pirate and involuntarily walking in circles.

There are two types of short leg, anatomical or functional. An anatomical short leg means that the bones of one leg, either the femur or tibia, are literally shorter than the other side. A functional short leg is caused by structural imbalance in the pelvis, which results in one leg appearing to be shorter because of dysfunctional muscle patterns that are attempting to right things.

In 12 years of practice I can count on one hand the number of people I encountered with an anatomical short leg. It is extremely rare. Generally, it’s either due to a congenital condition such as a malformed hip joint on one side, or a nasty hip/leg fracture that healed in a less than ideal manner. Functional short legs, however, are more common than dirt. Just from your personal history you’d likely know if you had such a congenital condition and certainly would’ve remembered a bad fracture that didn’t heal properly.

I can’t say this more emphatically: If you don’t have an anatomical short leg and your therapist wants to prescribe a heel lift for you then they simply do not know how to adjust your pelvis to even out your legs, in which case you need a new practitioner, or they need to prove the need for a heel lift by virtue of full skeleton x-rays. If you’re given a heel lift for the “short” leg only and you don’t have an anatomical short leg, it can screw you up for life. If the therapist tries to convince you that a heel lift is not a big deal, then run, don’t walk, out of that office.

Because a functional short leg is a compensation for an imbalance in the pelvis, using a heel lift does nothing to correct this imbalance and in fact encourages one’s body to accept this imbalance as normal. This will create even more layers of muscular dysfunction over time, and can even cause secondary problems in the neck, upper back, and shoulders.

Carpal Tunnel Syndrome: This is the GCD for which I’ve encountered the most failed surgeries simply because it is so easy to misdiagnose. The actual carpal tunnel is a bony trough in the wrist that is bordered by two of the carpal bones. A variety of tendons, nerves, and blood vessels pass through this area. Generally, you have to really beat the crap out of your hands for a very long time in very repetitive ways for the actual carpal tunnel to be the source of the symptoms of numbness, tingling, pain, muscle weakness, and muscle wasting.

More often than not, however, the symptoms leading to this diagnosis do not originate in the carpal tunnel. Hence, the number of unnecessary and unsuccessful CTS surgeries. More commonly the symptoms originate from the upper back, neck, shoulder joint, collarbone, elbow, and the muscles, nerves, and disks in these areas. Even inflammation of muscles in the forearms can mimic CTS. A major problem with being diagnosed with CTS is that if you don’t improve with conservative treatment such as rest, splinting, and stretching, then you’re likely on a track for surgery.

It goes without saying that you need a second or even third opinion if you receive a CTS diagnosis, before you go down the road of a treatment plan designed around it.



Have You Been Saddled with a Garbage Can Diagnosis?

Have You Been Saddled With a Garbage Can Diagnosis? Part I

As a chiropractor I was often the last resort for someone whose experience with previous health care practitioners was less than satisfying. Kinda goes with the territory when working in a fringe profession. So, neither one of us had anything to lose. I would either be the latest source of that person’s dashed hopes or I’d be able to bring a fresh set of eyes and find something the doctors missed.

One of the shortcomings of the medical model is its reliance on diagnosis. A doctor often lives or dies with it, and so will the patient. This jump to identify and label can actually impede a healing process because it can severely restrict the condition’s freedom to reveal itself. Instead of witnessing what’s going on in front of us, we impose a diagnosis that is generated by the intellect and its relentless obsession to categorize, explain, and rationalize.

The establishment of a diagnosis is treated as a victory of sorts, as if to say, “now we know what we’re dealing with.” When our intellect feels like it has reached a resolution of sorts, then it will often abort all further investigation and fall into the default protocol associated with that particular diagnosis. All it does is relieve our poor assaulted psyches of the anxiety of uncertainty. Well, certainty is often our worst enemy.

Also, the next step after diagnosis is to suppress whatever has just been named. So, say goodbye to finding root causes if the goal is simply to push everything back below the surface and turn off the body’s distress signals. In the rush to identify and suppress, the clues to the condition’s source are trampled.

This is especially true of a so-called “garbage can diagnosis.” It’s a label that is slapped onto a symptom or group of symptoms because the practitioner doesn’t feel that the principle of do no harm extends to a willingness to say “I don’t know.” As health care practitioners, we sometimes trick ourselves into thinking that we have someone’s best interests in mind when all we’re doing is covering our ass as a professional.

GCD’s are superficial umbrella terms used to classify symptoms that can have a wide variety of possible origins. A GCD is a prime example of using language to obscure rather than clarify, something American culture has elevated to an art form in more arenas than we can count. For example, the diagnosis of sciatica might be applied to a condition whose root cause might be any of the following: muscle spasm, lumbar disk bulge or herniation, infection, fibula misalignment, or repressed grief.

GCD’s also worm their way into everyday language, which accentuates their superficial nature. The words “TMJ,” “impingement syndrome,” “chronic fatigue syndrome,” “fibromyalgia,” “tendonitis,” and “bursitis,” glibly trip off our tongue like we’re talking about the latest hijinks of some Hollywood beefcake.

A good indication that you’ve been slipped a GCD is that you don’t significantly improve with the treatment protocol that accompanies the diagnosis. The condition ends up being managed rather than resolved because the diagnosis is a cop-out in the first place, and thus can leave a person in health care purgatory for years. It can cause even more pain and stress for the patient just because someone thought they needed to give a name to something.

I’m only going to cover some of the most common ones I’ve encountered, and I’ll be making generalizations that are based on my own experience.

Fibromyalgia: This is the mother of all GCD’s. There was surely dancing in the streets in the medical community when this diagnosis finally hit the streets. No longer did GP’s have to wince at seeing these folks in the waiting room, and have the joy of telling them after a 30-minute phantom evaluation that “it’s all in your head.”

Conditions like these of global pain or chronic fatigue often remain mysteries because their origin is precisely in that area that most practitioners and patients don’t want to go–repressed emotions. This doesn’t mean that the physical pain is not real; it most certainly is as real as the pain from an acute ankle sprain. The difference, though, is that the pain is being generated by the body to inform the person that unless these emotions get some expression, the pain will persist.

One of the dangers of this diagnosis is that if the person is resolved to remain in the dark about their repressed emotions, now they’re free to use the diagnosis as official confirmation that there’s something wrong with them. So, the diagnosis becomes ammunition for behaviors and beliefs that further alienate the person from her/his true feelings. This is a GCD that can perpetuate a particularly brutal cycle of suppression, particularly if extended use of antidepressants is also part of the treatment protocol.

Pneumonitis, costochondritis, angina, thoracic outlet syndrome, dyspnea: I’ve lumped these together because I’ve seen them all applied to what turned out to be rib misalignments, which are quite common. This is sad, because rib misalignments are one of the simplest corrections to make, and generally provide a quick resolution to the problem. When ribs aren’t properly aligned, it can cause intense, knife-like pain, particularly with deep breaths and particular movements, such as twisting of the upper body. Other possible symptoms are numbness and tingling in the arm and hand, or poor circulation to the arm.

Ribs can be misaligned both in the front where they join the sternum, producing a pain which can mimic heart-related symptoms, or in the back where they join the spine. The cause is generally an acute injury, such as a fall or car accident, repetitive stress, or a period of intense coughing and/or sneezing.

Stay tuned! Part II of this blog post will include old favorites like TMJ, carpal tunnel syndrome, leg length inequality, plantar fasciitis, scoliosis, tension headaches, and chronic low back pain.


Who Says It’s a Symptom?

by James Rolwing, DC

Here’s what I found in an online dictionary as the definition of the word “symptom”:  that which falls together with something, any phenomenon or circumstance accompanying something and serving as evidence of it.

Wow, nothing about health, sickness, or disease! Sometimes looking up a word in the dictionary is a profound revelation. The original meaning can be so right on, and so different from its common usage and understanding.

Let’s break down our typical response to a “symptom” in slow motion.
1) First, a sensation or feeling arises in our awareness. This is instantaneously followed by our mind’s judgment of the sensation as pleasant, uncomfortable, painful, or neutral.

2) Based on our judgment of the sensation, a plan of action or a reaction ensues. If it’s judged as pleasant, the plan might be, “Hell, let’s do this some more!” If it’s labelled as uncomfortable we’ll look for the nearest exit. And if we decide that it’s painful, our response may be anything from, “I want this to go away, now!” to “Oh shit, I’m gonna die!” Finally, a sensation judged as neutral will be ignored entirely.

3) Next, if the pain is physical, all that remains is finding a way to suppress it. If the pain is perceived as emotional, the mind will look for a target or a justification (“I’m angry at X,” I’m sad about X”), and then look for a way to suppress it or express it in a way that’s hurtful to oneself or some unsuspecting poor slob.

4) If we’re unable to manage sufficient suppression of the pain on our own, then, by golly, let’s enlist someone’s assistance in this search for the Holy Grail of suppressive agents. Now we’re greasing the slippery slope to a diagnosis, or at least a professional-sounding description of the symptoms.

I’m stopping way short of the extended version of this chain of events because whatever happens thereafter is just a further reflection of what occurred in step 1: an immediate separation from ourselves. The initial sensation or feeling is quickly replaced by the intellectualization of it. The feeling or sensation continues, but it’s been judged so profoundly by the conscious mind that even as we’re aware of it we hold ourselves separate from it. It’s like looking at our face in a mirror while we repeatedly say, “That’s not me, that’s not me.”

All of this occurs in a split-second, and it’s the most critical moment in our opportunity to heal that we trample over again and again. We cannot stop the mind’s judgment of the sensation; we can only shift our attention to watching our mind’s judgments while we also allow ourselves to feel the sensation.

If we can feel the sensation as well as acknowledge the label we’ve given it, give equal time to feeling and thinking, then we can ride that in-between state where the sensation is allowed to do whatever it’s going to do, and allow healing and movement to occur. If we react to the label we give it then movement stops, we’re no longer grounded, and being with the sensation is replaced by a strategy of the rational, fixing mind.

Our conditioning encourages us to regard any and all phenomena relating to our body with the utmost suspicion and fear. It’s a mental trap we’re taught early in life, to erroneously regard a symptom as a noxious outside influence trying to harm us, rather than an invitation to widen our capacity for feeling and functionality.

Self-Mutilation or Preventive Health Care?

Sometimes the clearest demonstrations of human nature are played out in seemingly throwaway, tabloid-type stories. Like it or not, this is where America often hides its gold. Recently, Angelina Jolie revealed that she’d undergone a double mastectomy because she possessed a gene that has been identified as a carrier of breast cancer and wanted to give herself the best chance possible to beat the odds.

We make choices every day about our health and well-being with little or no effect on public perception. However, if I’m a well-respected, high-profile celebrity who elects to go public about my choices it pushes the discussion into a larger forum. Jolie is currently portrayed in the media as a compassionate humanitarian and consummate mom. Essentially, she is beyond reproach in an entertainment culture that usually eats celebrities for breakfast.

This perception of Jolie is important because it lends tacit legitimacy to her decisions and actions. Can you imagine what the public response would’ve been if the subject had been Pamela Anderson or Nikki Minaj, for instance? So, if I’m a teenage girl who idolizes Jolie, I could easily get the message that it’s okay to hate my body and totally disregard what it has to tell me about myself. Once again, we’re unable to view disease as anything but the enemy and not as a part of us that’s attempting to make itself heard. We don’t heal by making ourselves less whole, we heal by becoming more whole.

Whatever intelligence is driving a hereditary health pattern will find a way to express itself, even if in our arrogance we attempt to avoid its expression by divesting ourselves of a body part that hasn’t even shown any evidence of disease. We’re simply not in control here, folks.

Thankfully, Melissa Etheridge had the stones to publicly question whether this was a decision that Jolie made out of fear rather than courage. Considering the present atmosphere in this country, this statement couldn’t have come from a man. There have been so many instances of male conservative politicians making asinine, ignorant statements about women lately that the backlash would’ve been too intense to examine whether he actually had anything legitimate to say. The rush to Jolie’s defense would’ve been immediate, as the issue would’ve been polarized into a male vs. female context, and the subtler implications of the story would’ve been lost.

Rather, it took a woman like Etheridge who has healed from her own breast cancer and is not shy about discussing how it taught her a lot about herself to offer an alternative perspective. What about the courage it takes to actually communicate and participate with one’s body? How about the courage required to trust a process that our culture and health care system judges as a betrayal by the body? Etheridge’s story of recovery is the kind of experience that actually informs us about our humanity rather than reinforces an illusion of immortality and invincibility.

If you know you may have a predisposition toward a particular disease, then you’re in a unique and empowered position to watch whether your mind will manifest the disease or not, because in the end it’s our beliefs that determine our health. We blithely talk about “living in the present,” but this is one instance that genuinely requires it. But it is regarded as a curse and not a gift. And, by the way, all of us have a predisposition toward a terminal condition, and it’s called death.

A person cannot simply come out and say, “I’m going to have my breasts surgically removed because I’m afraid to die.” No, it has to be framed as a noble choice that requires “courage.” This story is all about our collective fear of death, but we shape the narrative in any other way possible, because any real discussion of death is too taboo. We’re trained early on in life to both fear death and to feel ashamed of acknowledging that fear. This leaves us no recourse but to talk around death in some manner that makes a pretense of confronting our mortality, but in reality goes only so far as to skirt any uncomfortable feelings. We all instinctively know where those boundaries lie. It’s a careful tightrope act that we perform around death and it goes largely unnoticed.

How much evidence do we need that one of the prices of inhabiting a physical body is witnessing its dissolution? Does this thrill me? Of course not, because I’ve been taught to fear death just as much as the next person. But it is a simple fact of life that presents itself on a daily basis. And, if we could begin to acknowledge the inevitability and practical reality of death on a culture-wide basis, it would profoundly transform our idea of health and our health care system.

James Rolwing, DC