by Alan Ruskin
Los Angeles DC helps patients assume control of their own rehabilitation.
More than 20 years ago, Jeff Tucker, DC, DACRB, left the practice he had shared with two other chiropractors for one reason: “I really wanted to do rehab,” he says. His colleagues didn’t share his singular enthusiasm, so he moved on and eventually established a multidisciplinary practice in Los Angeles with two medical doctors—one a specialist in pain management and the other a general practitioner with a background in acupuncture. “I found both doctors through the rehab community,” Tucker says with satisfaction.
While pain relief is the initial focus of Tucker’s practice, he also guides his patients toward optimum health by helping them assume control of their own rehabilitation. This includes teaching his patients how to use various exercises and therapeutic tools to achieve this goal.
Kicking Off with a Comprehensive Analysis
Tucker uses a variety of approaches, beginning with his own powers of observation. “My eyes are my best tool,” he says. “My examination begins as soon as I see the patient. I note their posture, watch their movement patterns.” From the patient’s health history and assessment forms, Tucker builds the foundation of his structural analysis. “The visual and postural analysis helps to evaluate the quality of their movements, more so than traditional tests that just evaluate strength.”
Next, Tucker performs an array of body-composition analyses, such as body mass index (BMI), intracellular and extracellular water, and basal metabolic rate. He uses the Biodynamics bio-impedance analyzer to help devise the kind of strength or weight-loss program that is right for the patient, and considers this phase crucial because “losing body fat and increasing muscle mass is a big part of the rehab process.”
Putting Out the Pain
Before implementing any BMI-changing program, however, Tucker must first ensure that the patient is out of pain. Calling upon his years of experience, he determines which modality will help the patient meet this goal. This may include one or more modalities, such as the recently developed technology known as Sound Assisted Soft-Tissue Mobilization (SASTM).
SASTM uses specialized instruments made from ceramic polymer, which resonate to create sound waves that are magnified as they pass through the instrument, detecting irregularities as the tool is pressed against tissue. (A lotion is used so the instrument can glide smoothly over the body.) Once the instrument has located adhesions and fascial restrictions, the doctor can treat the affected area with the pressure he applies to the instrument, which induces micro trauma to the affected area, producing a controlled inflammatory response. This in turn causes the reabsorption of fibrosis and scar tissue to facilitate healing.
SASTM is based on the ancient Chinese healing tradition of Gua Sha, which involves palpation and cutaneous stimulation to remove blood stagnation and promote normal circulation and metabolic processes. SASTM was introduced in the early 2000s by David Graston, a pioneer in the instrument-assisted soft tissue mobilization industry. The procedure is designed to reduce pain and restore function to many soft tissue injuries. “It breaks down myofascial restriction and scar tissue,” Tucker says, “allowing me to follow up with stretching and strengthening exercises. Graston developed it to aid in his recovery from carpal tunnel and a serious water-skiing injury to his knee.” Tucker believes this treatment is highly effective, and it is one of his first choices for injury and pain.
Another therapy that Tucker uses on roughly half of his patients is a Class IV High Power Warm Laser. The laser, Tucker says, stimulates cell growth and metabolism; accelerates wound healing; and results in a dramatic reduction of inflammation, fibrous scar tissue formation, and pain. “The high-power laser is more effective than its predecessor—the low level, or cold, laser—because it delivers considerably more healing photonic energy at a much greater depth of penetration, thus accelerating the healing process,” Tucker says. “Another interesting note is, because of the warmth, the patient can actually feel the laser’s healing properties at work, which contributes to greater effectiveness. The idea is to get the person out of pain as quickly as possible, and the high-power laser’s ability to alleviate pain makes it a valuable tool in my rehab armament.”
Tucker also uses standard modalities such as the Chattanooga ultrasound and Dynatron interferential electrotherapy, both of which are widely used adjuncts to mobilization and manipulation treatments. Additionally, Tucker’s use of specialty tables plays a significant role in his patients’ treatment. He believes that his Leander flexion-distraction table is invaluable in providing gentle traction and repetitive motion, and that his Repex tables for extension are particularly effective for disk patients.
Building Bodies Through Fitness and Rehab
Rounding out Tucker’s therapeutic collection are foam rolls, the Swiss Ball (aka the Gym Ball or the Big Ball), free weights, and most especially, the relatively new Gymstick (www.GymstickLA.com).
A simple, dense foam roll, 3 feet long and 6 inches wide, that clients lie on with their own body weight, is an important component of achieving and maintaining healthy, full range of motion around the joints. “By putting pressure on tender areas along the muscle tissue, the golgi tendon organs help trigger the relaxation of the muscle spindles, which helps to dissipate adhesions, increase blood flow and enhance overall movement,” Tucker says. “When used in self-massage the roll can have a positive effect on cellular viscosity, changing the fluid properties of tissues to help prevent the drying out and stiffness that are typical symptoms of aging. “It’s a wonderful modality,” continues Tucker, who teaches his patients how to use the rolls for maximum benefit.
Free weight and Kettlebell programs are also high on the list, along with the Swiss Ball. Tucker prefers free weights over stationary machines because, “Where in real life do you sit down and push weights other than in the gym?” He recommends their regular use for building strength and stamina. He also makes use of the Swiss (Big) Ball, which is excellent for developing balance and core strength.
But the real star of Tucker’s rehab program is the up-and-coming Gymstick, which he believes “is going to be one of the best home exercise devices for rehabilitation or small group exercise classes.” Developed in Finland, the Gymstick is regarded as a total body fitness tool that produces speedy results in cardiovascular, muscular, and endurance training.
The Gymstick uses an exercise stick and resistance bands. The bands are attached to each end of the stick, with loops on the other end of the bands that go under the feet. There are hundreds of exercises working out every aspect of strength, flexibility and balance, including replicating free weight exercises such as squats, curls, and presses. The device comes in five strength levels and colors, to suit any user, regardless of age or fitness level. Resistance can also be raised or lowered within each level. The Gymstick provides resistance training for both Type I (slow-twitch) and Type II (fast-twitch) muscle fibers, and it is very efficient in reducing body fat (at a rate of up to 700 calories per hour!).
An Ideal Approach
Tucker’s ultimate rehab and fitness regimen encompasses the use of SASTM and other modalities such as warm laser and ultrasound for pain relief, low-load body exercises such as bridges and quadruped maneuvers, and then whole-body stabilization exercises, including squats and lunges. Once this is accomplished, Tucker moves on to free weights and the Gymstick which, along with diet and nutritional counseling, puts the patient on the road to optimal, self-sustaining strength, flexibility, and cardiovascular health and endurance.
As Tucker puts it, “Many of my patients want to know, ‘What am I going to be like 20 years from now?’ ” It’s a good question, and Tucker’s goal is to provide a good answer.
Alan Ruskin is staff writer for Chiropractic Products. For more information, please contact linkEmail(‘aruskin’);firstname.lastname@example.org.