Author: Dr. Travis White

Today’s blog post stems from a case that I had this week. If I would’ve adjusted this patient like I do others, I would’ve punctured his lung and caused a pneumothorax.

 No, chiropractors cannot fix a broken rib.

All too often chiropractors try to fix every condition that enters our office. Sometimes they try to adjust things they should not adjust or apply treatment modalities that are not necessary or in some cases even rub “snake oils” on the area with hopes that it would help.

 The best thing that a chiropractor can do for a broken rib is to NOT touch it. If the patient’s history provides evidence that a fracture could be probable, then why do chiropractors continue to get overly creative with the treatment? The treatment of broken ribs has relatively gone unchanged since the beginning of modern medicine. These ribs surround the organs of sustain life and typically do not want to be tampered with- especially when there’s evidence of pathology or fracture.

 This past week I had a young man enter my office after sustaining an injury in jujitsu. The injury happened about three weeks ago, and it was tender around the midaxillary line as most rib fractures are. There is a huge difference between “rib joint pain” (which chiropractic is helpful for) and “fracture pain”. There are a couple of orthopedic tests that you can do for a patient to determine how volatile the injury is. In this case, all of his tests were positive so we proceeded to shoot an x-ray. It is important to note that 50% of fractures will not be visible on a standard radiograph, as there is an overshadow from the lungs and other vessels in the area. So you really have to trust your gut with this one. Fortunately, there was a very evident small hairline fracture on the anterior left eighth rib of this patient. He was very surprised, because he felt like it was not a substantial hindrance in his life, but made sleeping uncomfortable. Chiropractors need to rely on their medical knowledge and their expensive education so that they cannot harm the patient. This is an oath we all swore after graduating from medical/chiropractic school. 

I sent the patient on his way with instructions to avoid contact activity and be careful not to fall on his left side. He will return in four weeks undoubtedly with a fully healed rib and be able to resume activity.

 I had the honor of being an expert witness on a case where a chiropractor adjusted a patient who had broken ribs. The saddest part about the case was the chiropractor even took x-rays, and upon my review of the x-rays, it was very clear that the patient had multiple broken ribs prior to being adjusted. The chiropractor ignored his education and the standard of care while proceeding forward with a high-velocity, thoracic maneuver. This ultimately put the patient in the hospital for 10 days fighting for his life because one lung collapsed and there was bleeding into his pleural cavity.

 It’s instances like this that give chiropractors a bad name. We are already fighting for the survival of our practice and profession in general. Blatant malpractice incidents like this, are just another thing that the medical community can hang their hat on.

 If you or a loved one has suffered a rib injury, and there is a suspect of a possible fracture please feel free to visit a chiropractor for a proper diagnosis. But please understand that a good chiropractor should not touch the area and only provide instruction on how to heal with time.

Do not let a chiropractor adjust a broken rib, no matter how confident they are. Chiropractors cannot fix broken ribs.

“Hard work always pays off” that’s a tribute to my parents. In my short career as a healthcare provider, I’ve gotten a chance to meet a lot of people from all walks of life. After developing a thorough history, and assessing the amount of effort that each person applies to their own life, I take that into consideration when prescribing treatment plans to avoid frustration for both myself and the patient. The success of your healing has a direct relationship to the amount of work you put into your treatment.

 Back pain is more likely to go away faster if you work at taking care of it.

 That seems like such a simple answer and probably won’t get great Google ratings, but when you get down to the simple facts, typically people who get results faster are the ones that work at it. After 11 years of practice, I found that patients that are ambitious in life tend to heal from their injuries faster than those who are more sedentary.

 A lot of psychological factors play into this. Is it because back pain is hindering their lifestyle and they’re less efficient? Is it their “Type A” personality and they don’t like to have things wrong with them? Most of the time it’s a combination.

 Blue-collar workers that spend time doing physical labor are some of my best patients. They need their bodies to function and be efficient and they are quick to adhere to any treatment programs I prescribe. Ironically, this typically leads to fewer visits to my office and more home therapy. The person that aspires to not do much have much or achieve much in life, tends to be my longer-lasting patient. This is purely based on anecdotal evidence, but after 11 years I feel like I have recognized a pattern.

 I think the saddest thing in life is that I’m noticing there are fewer ambitious patients each year- which is a reflection of our society lately. There’s a larger percentage of younger populations that I speak of that bewilder me with their life choices. A lot of my discussions with younger generations usually revolve around how little they want to work and how much money they want to make. 

These conversations typically emulate their perspective when addressing their injuries. A typical low back sprain/strain injury can take as little as 2 weeks to fully resolve with 15 minutes a day of self-care and management, but often I see patients for 4-6 weeks because they choose not to partake in their own active treatment. I even implemented an online based rehab program that allows me to see when they log in and do the exercises and stretches that I prescribe. Inevitably the patients that actively log in and do the work heal faster.  

So when patients ask how long will it take to heal their injuries I always tell them it will heal faster if they do the homework I prescribe and aren’t lazy.

Ambulance chaser. Ahh, the old term that encompassed so many people and professions. I remember adults when I was younger using this term for certain lawyers doctors chiropractors and so forth. But why? I mean aren’t patients that are injured in motor vehicle accidents entitled to treatment as well, and if they choose to seek compensation and treatment for their injuries is that so wrong?

Yes, if you were injured in an automobile accident you should see a chiropractor as long as your injuries are not life-threatening.

When discussing patient demographics amongst my colleagues all too often the question comes up what kind of people do you treat? For the last 11 years, I have considered myself a sports medicine chiropractor with an affinity for the general population as long as they are healthy and active. All too recently though over the last five years I’ve seen a huge uptick in the personal injury side of my practice.

It started about eight years ago when I was taking care of a lawyer friend of mine who worked with car accident victims. He had been injured in a pickup basketball game after somebody had checked him really hard. We started discussing the mechanisms of his injury and we both came to realize that a lot of sports injuries are impact-related; no different than car accidents except the impact usually happens between multi-ton vehicles.

Soft tissue injuries, like sprains and strains, and dislocations all respond fairly similarly despite the mechanism of injury or causation. The wide receiver that suffers a whiplash from a linebacker on the football field has very similar characteristics to the soccer mom who is struck from behind by a construction vehicle. I quickly realized that car accident patients deserve the same amount of attention as any other patient, and just because I treat these injuries does not make me a bad person.

Auto accident patients are usually caught between a rock and a hard spot in states that do not provide “no-fault coverage”. Everybody carries auto insurance. Well, we would like to think so but the truth is there are far more uninsured drivers than you would think. When you arrive at the hospital you are allowed to utilize your private medical insurance however in the background coverage is not so clean. Once your private insurance figures out that you were hit by another person they immediately deny bills and seek compensation from the at-fault insurance company. This leaves the patient with the inability to pay for their medical coverage despite its necessity.

Enter medical liens. If a practice is capable of doing so with good ethics and morals then you may find a chiropractor who is willing to hold your bill until the case settles. Sometimes this requires a lawyer to make sure that bills are properly paid by the insurance company. However, it is important to note that as long as the doctor is doing their job properly and within the confines of standard medical care your bills will be paid for. Do not avoid seeking medical care because of insurance concerns!

Since broadening my scope and opening my practice to car injury patients I have made it a devout effort and motto. “To treat these injuries according to science and not use them to provide a lavish lifestyle for me.”

In our practice, we see a variety of injuries caused by auto accidents. Sprains and strains broken bones dislocations concussions internal hemorrhaging all of it. All too often, patients present from the emergency room with a discharge paper stating soft tissue injuries. But where are they to go and what are they to do? Are they supposed to just heal on their own? If so are they going to be left with permanent problems and disabilities? This is where the disconnect happens.

Chiropractors go to school for eight years to learn how to diagnose and treat injuries appropriately. Our first six years of school are almost identical to medical school. We have the capability to diagnose any condition from a hangnail to cancer. A good chiropractor will be able to identify auto injuries that fall within their scope and treat them as such. A GREAT chiropractor will be able to identify injuries that fall outside of their scope and refer them to the appropriate provider. In Boise, Idaho our clinic has become one of the largest PI clinics for auto injuries because of our vast network of providers in the area.

Respectfully and with the utmost consideration many of the family practice doctors in the area are not equipped to handle these cases appropriately. Most of the time a simple prescription for muscle relaxers or pain medication and a referral to the physical therapist is all that is done leaving patients with lasting injuries and not healing correctly.

If you were a victim in a car accident you should see a chiropractor for your auto injuries.

The cost of healthcare is going up, the cost of insurance is going up, and the cost of doing business is going up. Insurance payments to chiropractors are not going up and in some cases, the reimbursement is going down. That is why some chiropractors do not take insurance.

Growing up in a small town in Idaho my parents always pushed “get a good job with good benefits so you don’t have to worry and can take care of your family”. Isn’t that the American dream I would think to myself. Be a productive member of society and you will be rewarded with a mediocre salary, medical coverage, a 401k match, and 3 weeks of paid vacation. I mean for most that sounds like a great way to start your working career.  

It was not until I became a healthcare provider that I realized most people’s dreams are not what their parents had hoped for them. Long hours at the office, still mediocre pay and those health benefits are not all they were cracked up to be….

I had a patient last week lose his mind on my staff as we tried to explain his benefits to him. You see “Greg” (this is not his name but what we will refer to him as.), works a decent job locally, and has decent medical benefits. He is allowed 18 chiropractic visits a year and he only has to pay for 20% of the bill while his insurance will take care of the other 80%. What Greg did not understand is he has a $4000 deductible that he must “hit” before his insurance company will contribute. 

Of course, Greg will never accumulate $4000 worth of care in our office so his entire bill was going to be the full amount out of pocket. This is usually the moment that patients walk away sheepishly because they have argued with our staff only to realize that their “benefits package” with their employer is not a valuable perk unless they need major medical intervention.  

Let’s flip sides to the value of insurance in the chiropractic office for the providers. It wasn’t until the 90’s that insurance companies started covering chiropractic care. It is speculated that the stronghold of the American Medical Association lobbyists on the insurance companies stopped coverage from ever being provided until the dawn of the internet. In the 90s, at the stroked of a key, patients were able to research treatment options and many chose chiropractic for their health care needs after learning about its benefits on the world wide web. Insurance companies answered the demand by raising premiums for their policyholders while minimizing payouts to the “in-network” providers. 

One of my partners graduated from chiropractic school in 1979. He reminds me that they charged $30 an adjustment back then. As of today 11/1/2022, most insurance companies will reimburse a chiropractor between $28-$40 for the same treatment. Because these reimbursement rates do not commiserate with the current cost of doing business many chiropractors have opted out of taking insurance and find more value in providing quality care without insurance oversite.

I would say no less than 30 times a week A new or existing patient will present to my office with upper back pain right between the shoulder blades usually on one side of their spine. The first question I always get: is there anything you can do to help with this knot in my shoulder? My wife keeps rubbing it and it’s not getting any better.

Yes, absolutely chiropractic can help with upper back pain.

The world is constantly changing around us, and there happens to be one constant that will probably be with us: our workplace is becoming more and more sedentary. In the early 1950s when the first computer was invented it was large enough to fit in the basement of most homes. There was never really a common use except for large computing but it was not applicable in everyday work environments. Fast forward 70 years and now we have computers in every aspect of our life, but mainly for work.

The bureau of labor statistics states that 99% of all occupations require computers. Whether it be for the smallest GPS coordinates for farmers to plant their crops more efficiently, or for software engineers and department of defense applications. The overall message is that everyone is using computers these days, and most people are sitting in front of them for at least eight hours a day.

The first thing I usually ask my patients who are experiencing upper back pain is what their work style and lifestyle are like. I turn to find out that the majority of people are sitting most of their days.

In comparison, I deal with a lot of auto injuries and whiplash-related trauma. One of the primary complaints for a whiplash patient is also a primary complaint for my patients who sit at desks all day. It’s because the pain in your upper back is likely coming from your neck, not your shoulders or upper back muscles.

What are the most overlooked nerves in all of musculoskeletal health care? The long thoracic nerve that travels from the base of the neck down between the spine and scapula on both sides of our body. It is one of those obnoxious nerves that, when irritated, usually is the contributing factor to the pain that patients are experiencing.

This constant pulling and tugging on the long thoracic nerve produces irritation and stress. The nerve typically fires abnormally causing a spasm of the muscles that are innervated fast, leading to the restless nights that we may experience if left untreated for long. When I’m looking at these injuries and pain, more often than not, I will find ribs that are not moving appropriately we start to address that area but also move up to the neck.

But the problem is much greater than just upper back pain that’s usually the symptom to drive patients to our office. However, the culprit is usually the lower neck. Patients who sit at their desk for long periods of time usually lose their posture, and their head starts to move forward. This relies on our upper trap and upper back muscles to hold our head upright is almost to prevent it from falling off of our cervical spine.

The most valuable orthopedic test that I can do on a patient is a test called a maximum cervical compression test. I would say the majority of the patients experiencing this type of pain will test positive when I perform this test. It’s a compression of that specific nerve as well as the disks in the lower cervical spine. When we identify the culprit, which is usually the neck, I’m able to educate the patient as to the source of their pain. A broader picture is then painted so that they understand the proper treatment protocols to address this. Because all too often they think it’s just a knot in their upper back.

Through proper postural training corrective exercises and adjustments, I’m able to eradicate the pain for these patients and ultimately provide long-lasting relief. I too suffered from this while entering my chiropractic education, and within a couple of short months, my pain was resolved by one of the school doctors. Remember I studied for 40 hours a week in school, and 40 hours a week outside of school. Since this incident, I have never suffered from this pain again. It’s all about proper education and treatment protocols. This specific problem does not require lengthy treatment programs that last months, but simply proper education. So I guess the long answer is yes, chiropractors can treat upper back pain.

It’s funny as we grow older and fall into our ways as adults, we begin to identify certain moments in time that truly generate wisdom. I recently had a patient come into my office that will change my life forever and generate wisdom that I never knew was coming. This young woman was hit by a train five years ago and has been confined to her wheelchair since then with no hope no answers and little to no conservative treatment after her initial trauma

The answer is YES chiropractors can treat people in wheelchairs. 

All too often there is an unspoken fear of Chiropractic for no reason at all except for old rumors and a history of quackery in the profession. I guess that’s a contradictory statement as we can only rely on our own experiences and all too often in the history of my profession quackery was strong and as society got smarter, they realized it for what it was. 

In the past few decades chiropractic care has taken a huge turn and continues to grow as a profession. More science has been thrown into practice than ever before substantiating our claims that have been present for the last hundred years. But nothing will reign stronger than the patient testimonial and anecdotal evidence. 

The young woman I mentioned above entered my office after seeing multiple chiropractors who truly did exhibit that old quackery. Nobody wanted to even touch her body after being bound to a wheelchair due to a traumatic brain injury. Her mother and father were with her, and both had tears in their eyes in hopes of some sort of relief for their daughter whose life will be changed forever. I don’t typically treat this population as my knowledge is limited and I don’t want to cause further harm, but when a person looks you in the eyes with nothing but pure hope that you can provide the relief it’s your duty as providers to do everything you can. We spent eight years in school and hundreds of thousands of dollars to learn how to treat the body and harness the innate intelligence for the healing practice. 

She suffered a severe brain injury that put her muscles into uncontrollable spasms on the left side of her body. It was simple to see that all she needed was someone to touch her, analyze her appropriately, and offer some insight as to what was going on. 

All too often chiropractors and other providers are too afraid or unknowledgeable about the body to even attempt something like this, but all you had to do was look in this patient’s eyes and realize she just needed someone to pay attention for even a brief moment to give her solace and understanding. 

That day was a day that I will remember forever. I got her on my table, and the second I did my daughter comes barging in from after school. We’re working on her manners and how to behave in a medical setting, but truthfully when this young woman’s parents saw my daughter their eyes lit up… Maybe it was because her usefulness reminded them of their daughter. Her innocence resonated throughout the room as they remember their daughter leaving that night from their house and they would never see her the same again. I looked at my daughter and took a look at the young lady laying on my table. I realized I have a responsibility to protect my patients just as I protect my daughter. To protect them from the world that’s too afraid of them. And casts them off as though they are lepers. So I did what was trained to do. I took a look. Reviewed her novel of medical records and applied the science. I applied a few small adjustments and showed her family a few small stretches and exercises to begin retraining her motor pathways this young woman started to cry on the table and then her parents started to cry. I would love to say that she stood up and walked out of my office but of course, that’s not the case. 

We stood her up and she reported far less pain standing than she had felt since leaving the hospital so many years ago. She will be coming back weekly for a little while as we continue to push her limits and encourage her positivity. And if that’s all we can do then it will be more than she has ever gotten. It’s moments like this that teach wisdom, it teaches us not to be afraid; to love our neighbor and our community, and more importantly, it teaches us that we have more power than we ever give ourselves credit for. 

Never has there ever been a sport that can be so frustrating and keep you coming back for more. Golf has blown up in the last 10 years to become one of the most highly sought-after athletic activities in America. Once a sport that I was made fun of for playing in high school is now a past time for all of my high school buddies. It’s a great place for camaraderie and sport in one place. Like all other sports injuries are likely to happen. The most common injury in golf is pain on the inside of the elbow commonly referred to as golfers elbow or medial epicondylitis.  

Yes, chiropractors can fix golfer’s elbow.

Medial epicondylitis is inflammation of the bony process on the inside of the elbow joint. It is where multiple tendons attach and with repetitious exercise like golfing or swinging a hammer or other repetitious movements there can be inflammation of those tendons that can progress into inflammation of the periosteum on the bone. This is a very painful condition and usually causes a loss of grip strength over time. It is nagging, relentless, and often unresponsive to conservative care or home treatments. Typically, these people will try and ride out the pain for as long as possible until seeking care. Physical therapists have long had the market cornered for this condition. Physical therapy is an amazing tool and approach to managing the condition, but often patients do not have an hour a day three times a week to go to a physical therapy office and seek treatment.

So what are you to do if you’re suffering from this condition and are not gaining with home therapy? Chiropractic offers a unique approach to soft tissue and hard tissue management of the area. The properly trained Chiropractor can provide relief within a visit or two with simple stretching soft tissue manipulation and sometimes adjusting or correcting the articulations within the elbow joint. Furthermore, an untrained chiropractor will not have success treating this condition as they only focus on the area of pain. All too often there are restrictions in the shoulder and wrist that have led to the condition. 

Our body is amazing at compensating and if we are not utilizing our wrist and shoulder properly we will start to over-utilize the elbow joint. As I said above, this is an overuse injury typically emanating from tendinitis on the inside of the elbow. The properly trained provider can identify these functional deficits in the other joints and start addressing the issue as a whole. Ice tends to be a successful remedy for the short term, but relieving the stress on the tendons must be the number one priority.

I have spent many hours studying golfers elbow as I’m an avid golfer and have dealt with it multiple times in my career. I recently went as far as getting additional certification from the Titleist Performance Institute (TPI). The Titleist Performance Institute is a training facility that provides specialized education for healthcare providers in addressing golf-specific injuries. This took hundreds of hours and multiple tests to attain. I’m able to look at swing characteristics patterns and compensation movements that lead to the injury and start providing therapeutic treatment and corrective drills and exercises to alleviate the condition.

What kind of treatment helps golfer’s elbow?

One of the most beneficial treatments that we offer in our office is extracorporeal shockwave therapy. This is old technology that has been re-developed and re-distributed to the sports world. We utilize low-frequency shockwaves to disrupt injured tissues and poorly circulated areas. The shockwaves promote neovascularization as well as eradicating afferent or pain fibers. Promoting new blood flow through the area drives out old inflammation in irritating toxins that are causing the pain. Golfers often report a significant reduction in pain after the first visit. The procedure is quick usually only lasting 10 to 20 minutes and does not require any anesthesia. 

Proper knowledge and education as well as training on the device is absolutely crucial when working on this area. I’m starting to see more and more providers buy these machines or low end alternatives that are not successful nor do they have the training to treat these areas and or sometimes cause further harm.

Finding a properly trained provider and equipment is essential if you want success in treating this condition.  There are too many quacks out there trying to make a quick buck off of you and know very little about what they’re doing. Our office has multiple reviews when it comes to treating golfer’s elbow and a success rate of about 95% reduction in pain. And by a reduction in pain, I mean at least 80% relief or improvement in functional abilities. 

So yes, properly trained chiropractors can treat golfers elbow and can do it very effectively.

The Cowboy Chiropractor

Am I a real true-blood cowboy? No, not at all, but I did grow up in western culture. Boise is a big city and that’s where I spent most of my childhood, but you can never escape the roots of a western state which constantly left me wondering why should doctors dress professionally!

Professional dress is the eye of the beholder. Doctors should dress according to their patient demographic and how they feel they represent themselves best amongst their patient populations.

As healthcare providers, we are often expected to look, act, and talk a certain way. Society has come to expect professionalism from the healthcare profession. But just like every other profession we are evolving and becoming more casual with respect to our bedside manner and mannerisms. Chiropractors are never been taken too seriously and are usually a more personable doctors when it comes to our patients. Many times we are not facing life-threatening diseases but typically just aches and pains both acute and chronic.

As I continue to mature both personally and professionally, I am coming to realize that staying true to myself instead of fulfilling an ideal is far more important and makes me happier.
Recently, I decided to change my dress attire at the office. Only a few patients were caught off guard not realizing that I spend most of my time in jeans and cowboy boots outside of the office. I was a little bit nervous initially wondering if I would scare them off or if they would think of me less professionally. It turns out that when you’re a chiropractor in Idaho people love you for who you are and your service does not reflect the way you look. Furthermore, a lot more of my patients supported the new feeling in the office of a laid-back, down to earth country boy. I still talk to my patients the way I always have, but now I feel my mannerisms fit my visual appearance. Some of the older ladies have even made sweet comments about nice it is to have somebody that acts and appears down to earth. They let their guard down and are not so nervous during our conversation.

A professor once told me if you out-dress your audience they may be so intimidated by you they will close off. I’ve never been a suit and tie kind of guy. Black slacks and dress shoes were just never who I was.

Some of my inspiration came from an old neurosurgeon in the valley, I divulge names. He wore a ponytail and always wore cowboy boots and jeans. I referred a lot of patients to him and some of my favorite stories were with patients that came back and felt like they had just committed to surgery with the neighbor next door. Their trust levels were much higher and their confidence in his skills greatly increased simply because he looked like them dressed like them and talked to them like people. I had a patient tell me one time that he walked in and was talking to them and halfway through the consultation he stood up and walked over to his door and put his white jacket on he said “I guess I am a doctor I should throw this thing on every once in a while”. The second he put the white jacket on they felt slightly intimidated. He picked up on their body language and said, “Hey I don’t know why I did that this isn’t me, and hung it back up on the door”. This is one of the most highly respected neurosurgeons in the Treasure Valley and he recognized long ago that being a relatable provider was much more valuable than matching the persona of what a healthcare provider should be.

One of my very good buddies is a very successful attorney in California who recently opened a practice in the Boise as well. I’ve always admired him because he has kept his office very casual and sits Knee-to-knee with his clients and reassures them that they are going to be OK. He very rarely wears a suit and tie and has created one of the most successful law practices in California just by being personable.

Google asks “Why does a doctor need to dress professionally?” My response is they need to look professional not wear a white jacket or fancy suit.  The need to look like a person with an enhanced knowledge of their field. In this day and age, people are smart enough to do their research and know which ones are good and bad and you don’t have to look the part as long as you are professional and respectful. Have a clean look and show people that you truly care about their problems and business will flood through the door. I will be forever grateful to my patients who have been with me for the last 10 years and referred to me hundreds if not thousands of other patients. I just recently realized it was never because I looked like a doctor, but that I acted like one.