Every day we get asked, “What happens during my first visit with Urban Wellness?” and “What makes you different?” We break down that question here! The majority of patients come to us in pain from a traumatic injury like a fall or overuse injuries from sitting too many hours in the day. Our goal is not to see our patients 3x/week for 12 weeks like traditional rehabilitation but to give you the tools to empower yourself. Our patients use these “knowledge bombs” when they feel discomfort come on and are able to move better and smarter through their day.

We dive deep into a thorough history, not only every detail of the current injury, but every injury you can remember. All of that history plays a role in the person you have become when you walk through our door. Old ankle sprains can lead to headaches down the road, and an old appendicitis surgery can lead to core weakness causing knee pain when you are training for the NYC marathon. Everything is connected, which is why we want all the details.

The Tools From Our Toolbox

We rule out all the serious stuff like nerve pain, disc herniations, and stenosis (narrowing of the space around the nerves as they exit the spine and around the spinal cord) with orthopedic tests. We will order imaging if we feel it is necessary but we send out for this to East River Medical Imaging. They do the best readings and the most detailed reports. We are not a practice where every patients gets x-rays because we feel this is unnecessary radiation when the majority of conditions we see (including low back pain) get better without imaging.

Every patients is taken through a movement screen from head to toe. Even if someone comes in with low back pain, we want to see how their neck and shoulders are moving. We have seen patients where their low back pain was coming from “stuck” neck creating compensations below–leading to low back tightness and discomfort. But we would have never known this if we didn’t look up above. We use a screen from Selective Functional Movement Assessment (SFMA) created by a couple of the brightest minds including Gray Cook, a physical therapist and Greg Rose, a world renowned Chiropractic Doctor. We want to know where there is too much mobility, too much stability, and what is a motor control issue. What is a motor control issue you may ask? It’s when the body has forgotten how to get you to the place you want to go, usually limited in range but not painful. These are some of the easiest patterns to clean up and retrain.

Patients then take a step on our force plate, a device that measures where you are placing the majority of weight in your feet when you stand. The force plate creates a heat map to show the distribution of your weight. We’ve seen patients stand with the majority of their weight into their back right heel and then wonder why their right low back hurts. That poor low back was taking all the weight trying to help the body find center!

Most patients want to crawl onto our table to get worked on, but we want to make sure we know the WHY of their disc herniation, low back pain, or headache. We want to find the root cause and it’s usually not where the pain is coming from. We use a powerful tool, NeuroKinetic Therapy (NKT) founded by David Weinstock to help us find this root cause, a muscle testing technique used when one area of the body is compensating for another area. We find jaw pain over-working for a lack of core strength and plantar fasciitis caused by weak glutes from sitting all day. We start with testing the deep core muscles (transverse abdominus, multifidii, internal obliques, diaphragm, and pelvic floor) since they hold us together every time we move. This muscle testing peels away the layers, works through old injuries, and gives a clear picture of where pain is coming from.

As we get to the root cause of the pain, we use tests from Postural Restoration Institute (PRI) which helps us see if your body can find center. Once you find center, can you own stepping on your right leg and then on your left leg with all the areas of the body doing what they are suppose to do through that movement. PRI also helps us see how you are breathing, how your hips are sitting in your sockets, and if you have ligaments that are overstretched from trying to compensate for movement.

We are hunters and we love getting to the root cause

Time For Treatment: Our Integrative Approach

Based on what we find from the movement screen, muscle testing, and PRI tests, we “massage” the areas that are tight and overworking with the gold standard in soft tissue work, Active Release Technique (ART). Unlike a massage where you lay down and knock out, ART is quick and effective at releasing scar tissue and tight muscles with a couple passes while the patient moves a muscles from a shortened to a lengthened position. Also unlike a typical massage, we don’t release the muscles that tested weak because we don’t want to tell those muscle to “turn off” or “relax”, we want those muscles to activate and start to stabilize.  An pivotal moment in my learning was when Greg Rose DC said, “Don’t bring mobility to a stability issue, that’s an amateur move. Don’t be an amatuer.” Epic. We make sure to retest the compensation findings, to make sure the area we released made the “weak” or inhibited area stronger.

We firmly believe strength is the key to a lifetime of no pain. We start with basic physical rehabilitation exercises to get the muscles that were “turned off” to turn back on and eventually use weights like kettle bells to build strength. Some exercises come from Strong First, the highest standard in kettle bell training. It helps find energy leaks in the body and build tension to help protect the back while moving and lifting. Other exercises come from Original Strength and Dynamic Neuromuscular Stabilization (DNS) which retrains movement patterns from when we were babies in the order that we learned them as kids–like lifting our heads, rolling, crawling, kneeling on one knee, and then standing.

The sample homework will look something like this:

1. A breathing exercise to reposition the body back to its center
2. A stretch, foam roll, or release to tell the tight muscles to stop working so hard
3. A strength exercise to tell the weak muscles to turn back on
4. An integrative exercise to teach the body how to use this new found strength in a movement that is applicable to life like picking up your baby, going from sitting to standing, or bulletproofing your body for your marathon

We are obsessed with movement and always curious to learn more about how to get our patients better. We have so many tools in our toolbox but the most important is knowing when to use what tool because everyone does not respond to the same exercise. There is no one magic bullet but we have pretty effective tools with dedication and hard work from our patients.

I often get asked, “You are a chiropractor, are you going to adjust me?” We adjust when it’s needed. We know the power of an adjustment to bring motion to a stuck joint. We also know how to identify hyper-mobility and when an adjustment could be detrimental or create more pain. I’m a chiropractor by training but one who adjusts only when it’s indicated. That is the power of any health professional, knowing when to use what tools and when.

Patients Who Rocked 

The Pilates Rockstar with an Old Scar

A patient came in with chronic neck and jaw pain and occasional tension headaches after doing her weekly private pilates session. It was almost getting to the point where her neck hurt so badly that she couldn’t get through her entire pilates routine without needing to stretch her neck and continually stop her session. We found scar tissue around her C-section scar from 18 years prior was making her deep core weak. During her private pilates session, she couldn’t find her true intrinsic core strength and her neck would kick in to help  her core instability. We did some ART around her C-section scar, collaborative with her pilates teacher to help her find her true deep core with her breath, and then taught her how to find good posture while sitting at her job 14 hours a day. This last piece was a crucial since she was sitting slouched over and turning her abdominal muscles off for 12 hours a day. No amount of pilates was going to help those hours hunching at her computer.

We did a little feel good massage on her neck but it wasn’t the root cause. After almost two decades of neck pain with pilates, she was finally able to tap into her deep core and get stronger by dealing with the root cause of her pain.

The Jiu Jitsu Ankle Sprain

A patient came in with left groin pain and clicking in his hip with doing leg lifts at the gym. He had occasional giving way of his hip when he ran meeting to meeting throughout his day. His hip and groin were especially painful after jiu jitsu. Orthopedic tests pointed to a labral (the cartiladge) tear in his hip. We wanted to know WHY he had a tear in his hip–on top of the reasons of sitting all day in a mesh chair and getting into deep squats for jiu jitsu. Diving deeper into his history, he mentioned he sprained his ankle on that same side four years earlier and he had failed to fully rehab the left ankle. His “sloppy ankle” had worked its way up the kinetic chain and his hip was trying to find stability by compressing the hip to the point of shearing the cartilage.

We gave him ankle strength and stability exercises with a theraband and standing moves to decompress the hip, strengthen the gluts, and stabilize the ankle.  We retrained his gait, (i.e. how he walks), so that the joints from head to toe were moving at the right times.

The College Runner

One of the hardest things to learn was knowing when to not adjust a patient. We saw a runner with knee pain below the left knee cap. He had tried everything including tradition physical therapy strengthening his VMO (vastus medialis oblique), acupuncture, cortisone injection, and seeing an orthopedist. We found his passive knee extension to be more than normal range and his hamstrings were overly stretched out from years of yoga.

The hamstrings are what hold us up in the world and walk us. We gave him breathing exercises to help his body find center and create integrity in his hamstrings so they weren’t so over-stretched. We then sent him to Matt, our amazing trainer, to help him find posterior chain activation through deadlifts, thrusters, and eventually kettle bell swings.

Wondering Why?

So if you are wondering why we spend 60 minutes on an initial visit and 45 minutes on every follow up, this is why. We are hunters and we love getting to the root cause.  Our true nature is to be problem solvers so we are looking where others haven’t or may have missed. We don’t want to leave any old injury or past surgery unturned. We haven’t even talked about nutrition, sleep, and stress as other pieces of puzzle, but we assess those in future visits. If you want to look outside the box of only assessing the pain area, give us a call, 212-355-0445 or shoot us an email, emily@urbanwellnessclinic.com.

Best in health,

Dr Emily Kiberd