kayalortho Podcast
I would like to take this opportunity to welcome you to another episode of the kayalortho Podcast. My name is Dr. Robert A. Kayal, and I am a board-certified Orthopaedic Surgeon and Founder, President & CEO of the Kayal Orthopaedic Center. We are a large multi-specialty and multi-disciplinary musculoskeletal medical center in Northern NJ and NY, specializing in orthopaedic surgery, interventional pain management, rheumatology, podiatry, chiropractics, physical therapy, massage therapy, acupuncture and high-resolution, cross-sectional medical imaging. For additional information or to schedule an appointment with one of our health care providers, you can contact us at 844-777-0910 or at kayalortho.com.
kayalortho Podcast
Chiropractic Healing Unveiled: Dr. David Saint on Spinal Health, Collaborative Care, and Innovative Therapies
Unlock the secrets of chiropractic medicine with Dr. David Saint, Chief Chiropractor and Clinical Director at the Montvale and Stony Point locations of Kayal Orthopaedic Center. Dr. Saint brings a legacy of healing to our latest episode. His narrative begins with a New York Giants player's astonishing recovery, setting the stage for a deep dive into the transformative power of chiropractic care. We expose the myths and highlight the critical importance of spinal health, much like we prioritize dental hygiene, to our overall well-being. Dr. Saint takes us through a fascinating look at how chiropractic principles prioritize the central nervous system and the wide range of conditions they can address, from persistent back pain to the radiating discomfort of sciatica.
This episode isn't just about the individual; it's about the power of team. We explore the immense benefits of multidisciplinary collaboration in patient care, illustrating how chiropractors serve as primary contact providers, pivotal in detecting serious health concerns. Hear how Dr. Saint shares his experiences at Kayal Orthopaedic Center, where the confluence of expertise from orthopaedic surgeons, podiatrists, and other healthcare specialists enriches patient outcomes and elevates practice dynamics. We shed light on the multimodal treatment strategies that are reshaping the future of chiropractic interventions, such as spinal decompression therapy, and discuss how these non-invasive options work synergistically with other treatments to enhance recovery.
Our final thoughts in this episode center around the personalized approach chiropractic care brings to the table. Dr. Saint voices his appreciation for the bespoke assessments that form the cornerstone of effective treatment. As your host, I reflect on the dual commitment to conservative management and the seamless integration of more invasive procedures when necessary. We've woven a tapestry of insights that not only showcase the broad capabilities of chiropractic practitioners but also affirm their vital role in musculoskeletal health and patient recovery experiences. Join us for a session that promises to deepen your understanding and confidence in this field of medicine.
Hello and welcome to another edition of the Kale Ortho Podcast. Today is February 20th, 2024. And today our special guest is Dr David St. Dr David St is the Chief Chiropractor and Clinical Director of two of the Kale Orthopedic Centers Chiropractic Facilities one in Montvale and one in Stony Point, new York. Welcome to the podcast. Thank you so much, dr Kale. So happy to have you, dr St. So today we're going to speak with Dr St about the field of chiropractics in general, some of the latest advancements in the field of chiropractics and how we can use that specialty to assist us in taking care of our patients suffering from musculoskeletal injuries. So, dr St, first and foremost, why don't you just take this opportunity to teach our viewing and listening audience a little bit about yourself? Tell us you know where you grew up and how you got into the field of medicine in general.
David Saint, DC:Well, thank you. Well, thank you, dr Kale. I grew up in Rivervale, new Jersey, attended Don Bosco Prep, went on to play football at Lafayette College and got my Doctor of Chiropractic at Life University in Atlanta, georgia. I've been fortunate to be around chiropractic my whole life because my father, who's still in a chiropractor at 83 years young, and for myself it was an eye-opening experience on there.
David Saint, DC:Forget one day when I was nine years old and I opened the front door and this gentleman was standing there holding his X-rays. His name was George Martin and he was a defensive end for the New York Giants and his career had been considered completely over and he was referred to my father. We had a home office and he said could I see your father? And I said, absolutely so, I get that. This gentleman's at the front door. Well, six weeks later Mr Martin was back on the football field and from there his career continued to thrive. He became MVP of Super Bowl against the Denver Broncos. So I got to see my father working and literally transforming people's lives through his career, and I knew it. I wanted to help people and I told my father when I was at Lafayette. I said I want to become a chiropractor, and here I am now going on a 27 years in practice. Well, what an inspiration.
Robert A. Kayal, MD, FAAOS, FAAHKS:That's a great story. So when we talk about the field of chiropractics in general, Dr St, what are some common misconceptions people have about chiropractic care in general and how do you address them in your practice.
David Saint, DC:Well, one of the things I hear all the time is that, well, if I go to a chiropractor once, I have to go to the chiropractor for the rest of my life. And my answer to that is well, you should have your spine checked for the rest of your life. We brush our teeth on a regular basis, we continue to floss and do dental hygiene and go see our dentist, sometimes every six months or once a year. Most people don't even know what to do for their spine. They say, well, I just do some stretching, I drink some water. But what we've now found out is it's about keeping the body in alignment, it's keeping our muscles strong, our core muscles, and most patients have to be educated. They don't know necessarily what to do, and I find that part of the visit is not just taking care of the patient, but it's also educating the patients Right.
Robert A. Kayal, MD, FAAOS, FAAHKS:Well, on that note, can you just sort of describe the general principles of chiropractic care and how they contribute to one's well-being.
David Saint, DC:Sure Well, chiropractic is premised off that the central nervous system controls everything in the body. Most people are unaware that once a sperm and egg come together, the first thing that is formed is actually the spinal cord and the brain. And spinal cord controls every single function Around. The spinal cord is the hardest thing that we have, and that's bone to protect it, and between those bones are nerves that exit and they go to every tissue, organ, cell, and the goal of chiropractic is to increase nerve flow. We want to make sure that the body is in balance, that proper nerve flow is happening, so that not only to muscles but as well as to organs. So we look at the alignment of the spine and we look for areas of the spine that are lacking motion and we put motion back into the body Great and what are some of the common conditions that a chiropractor will typically see and treat on a daily basis?
David Saint, DC:Well, typically, the most common, of course, are lower back pain and neck pain, but, however, there are other symptoms that can happen. There are symptoms that can happen in the neck headaches. There can also be symptoms that go down into the arms and the legs. People have heard of the term sciatica, which is leg pain. We've also had pain that radiates down the arms and those are typically severe irritation to the nerve roots.
Robert A. Kayal, MD, FAAOS, FAAHKS:How do you individualize a treatment plan for patients based on their specific needs?
David Saint, DC:Well, the first thing when I see a patient is number one having a discussion. A history is so important, understanding what the patient has done, what they're experiencing. From that history we go into an examination. We're actually palpating and touching the patient, putting the patient through some range of motions, do some orthopedic tests as well. We also test on neurological packages, which are parts of the skin, to see how the patient is feeling, are they sensitive and can they actually have good strength. From there we go in and we also take x-rays.
David Saint, DC:Diagnostic films and diagnostic tests are so important. First of all, looking at an x-ray, we just want to see the healthiness of the bones, or is there any type of degeneration? Are the bones healthy? Are there possibly even the signs of even osteoporosis, starting to begin From the x-rays we also look at alignment, looking at one joint versus the other. From the x-ray, many times we'll be ordering MRIs, because x-ray shows bone, mri shows soft tissue and by marrying those two tests together we many times will get a clear indication of what's happening to the entire spine itself.
Robert A. Kayal, MD, FAAOS, FAAHKS:Does chiropractic play a role in preventative health care?
David Saint, DC:Yes, First and foremost is that if the spine is not in the correct aligned position, the range of motion of the spine, the motion itself, will be limited. And when there's limitations, muscles will start to guard and of course those muscles will contract and the body will just be vulnerable, many times vulnerable to an injury, to a twist, a turn. Quite common I mean literally every day I have a patient come in and says Dr St, I don't know what I did, I just turned a certain way, I just went down and tied my shoe and I couldn't get up. And by the time that motion or that incident happened, it was because of accumulation of time, of things happening to that spine, for whether it was days, weeks or even months or years beforehand.
Robert A. Kayal, MD, FAAOS, FAAHKS:How can chiropractic be utilized to complement other wellness services?
David Saint, DC:Well, one of the biggest things that I love in our practice and what we offer is acupuncture. Acupuncture is just known to help with inflammation, help with pain, and what we find is that when patients come into our practice Dr Kale, patients come in with two problems we're having a chemical problem and we're having a mechanical and patients come in I ask them pain scale one to 10, how are you feeling? 10 being the worst pain? And that basically tells us that there's inflammation going on. So something like acupuncture helps bring inflammation down naturally and that's just one of the tools that we use, along with our medical side of medically managing that patient's problem.
Robert A. Kayal, MD, FAAOS, FAAHKS:Are there other specific exercises or lifestyle modifications that you also employ to ensure that patients benefit the most from your chiropractic services?
David Saint, DC:Absolutely. One of the things that we talk about during our case of review with a patient is finding out what they do occupationally and unfortunately we're dealing with patients, now more than ever, working from home. I'm finding, specifically during the pandemic, patients did not have the proper workstations. We're working on their laptop. I would ask them where are you using the laptop? Oh, I'm sitting on the couch, so we called it. You know computeritis, where the head be forward, changing posture, and what happens is that people's core muscles, you know repetitively they're not being worked on and when you have muscle fatigue, all the muscles control and support the spine. So it's just turned into a whole effect of looking at about how the body is working collectively.
Robert A. Kayal, MD, FAAOS, FAAHKS:What are some of the recent advancements and technologies that you've experienced recently in the field of chiropractics, and how have you employed them and how have they benefited your patients?
David Saint, DC:Absolutely so there are so many chiropractic techniques I mean I believe there are over 70 of them. For myself, I use about 18 different techniques themselves, but two of the techniques that we use in our clinic. One is what I call hands free instrumentation, adjusting. It's dynamic there when patients are seen. Many times patients are concerned about quote unquote getting cracked, hearing some type of audible noises, and we use instrumentation where there is no noise whatsoever. It's light force and most patients when they get off the table they go wow, they were. They couldn't believe the experience of having something like that. Another wonderful technique that we use in our Montville location is spinal decompression therapy. It's a light force, non audible stretching mechanism of decompressing the spine to get motion into the joint space, and it's just a wonderful tool that is able to help patients who are suffering from back issues, facet injuries, bulging, herniated discs and it's another alternative that we use when necessary.
Robert A. Kayal, MD, FAAOS, FAAHKS:And with respect to maintaining current in your field and the technological advancements that we've discussed. How important is ongoing education and training in the field of chiropractic to ensure that you deliver the latest and greatest techniques to our patients Well, first, and foremost, not only our profession but our state.
David Saint, DC:It's mandated that we do continuing education within the state of New Jersey and also state of New York and, a matter of fact, every state in the country, and it's a wonderful tool because it allows us to hear also not only the research but also learn new things that are happening out in the field on a continuing basis. So we do a minimum of 30 hours every two years here in New Jersey.
Robert A. Kayal, MD, FAAOS, FAAHKS:That's great. That's great to know. Well, as you know, I'm an allopathic physician, orthopedic surgeon, and you as a chiropractic physician. We have different approaches to patient care. Many allopathic physicians have considered the field of chiropractic in general to be somewhat taboo. As you know, I, at the Kale Orthopedic Center, have embraced the field for over 25 years now. To me, it is exceptionally important to collaborate with others as we continue to care for our patients. Each one of us brings our own skill set to the table in caring for the patients. How can you discuss for our viewing and listening audience how we have collaborated with one another, not only in the field of orthopedics but at Kale Orthopedic Center in general, with other specialties like podiatry and rheumatology and interventional pain management, and even our board-certified fellowship trained musculoskeletal radiologists and neuroradiologists?
David Saint, DC:So often when I see patients now over the years coming in and happened just the other day.
David Saint, DC:A patient comes in with chronic lower back pain and first and foremost obviously do an examination and taking updated x-rays, but not only looking at the back but looking at the entire person, and I started asking questions about their feet and brought us some, you know, questions about what they are feeling, what they can do, what they can't do, and turns out there was some irritation down there that led me to some type of examination of the foot at that moment and that patient is going to see our podiatry team because I'm concerned with the alignment of the feet that are the foundation for the spine, along with it finding out the patient is having chronic pain for years and we're going to get that patient over to our rheumatology department because of there's inflammation.
David Saint, DC:We want to see what those inflammation markers are. The goal that I want to do is not just bring chiropractic of the spine to the patient, but I want to make sure that and we rule things out and that is the importance of not just our diagnostic test but also using our medical team and that's why it works hand in hand and the patients that I see all see our medical team and we see the patient as a whole person.
Robert A. Kayal, MD, FAAOS, FAAHKS:And, as you know, oftentimes the chiropractors are the gatekeepers into the healthcare system. Patients trust their chiropractors. They see their chiropractors first, often before even seeing their primary care physicians. They go to their chiropractors for headaches and jaw pain and arm pain and hip pain and leg pain. As the gatekeeper of patient care, oftentimes that chiropractor can be incredibly instrumental and influential in making that patient better and getting that patient in the right hands. How do you first assess a patient and make those determinations in the office, dr St Well, again, the clinical history, speaking with the patient finding out.
David Saint, DC:I always ask the patients when was your most recent accident or injury? And patients look at me first and I said you know, have you had a car accident in the last three months, six months, even about back to two years? And how often patients think that the injuries that they've had have been a small thing. And those injuries have now complicated and they've been basically a snowball that's just getting bigger and bigger. So, again, working with our team and ruling things out is so important.
David Saint, DC:And back to the diagnostic test that we use in the Kale model here, the fact that we can not only take x-rays on site digitally, we see them immediately. Number one, number two we can get another opinion of reading those x-rays right away. How many times I'm looking at x-ray? Can I get another opinion? Get right on the phone to one of our orthopedias. Can you do me favor, can you look at this? What do you see? I see this here and that just gives me comfort and just knows that the patient is also getting the best care. Then, of course, what we do in-house with our MRIs and using CAT scans and our bone density testing that we're able to do these things literally immediately, and this is unheard of in today's world of insurance.
Robert A. Kayal, MD, FAAOS, FAAHKS:Yeah, I think, just going back to what I was talking about, about how a lot of doctors consider the field of chiropractic to be somewhat taboo. I think it's not necessarily because of the field of chiropractic in general or what you do for our patients. It's the reputation, unfortunately, in the community that has been formed over the years, where there's essentially the thought process that a lot of the chiropractors just hold on to their patients. Sometimes things get missed and sometimes those things are bad things like tumors, cancers etc. Like that, not having the wisdom or the discernment sometimes to refer the patient out of the practice.
Robert A. Kayal, MD, FAAOS, FAAHKS:A lot of the chiropractors in general have developed a reputation that they tend to hold on to their patients.
Robert A. Kayal, MD, FAAOS, FAAHKS:They'll often see their patients three times a week for years just for what they call maintenance, and all of us have seen patients over the years like that, that have seen chiropractors for years and unfortunately some bad things have been missed. So, speaking of that, speak to the benefits of being in an organization where you have access to medical doctors of all different musculoskeletal specialties and advanced cross-sectional medical imaging at your beck and call, at your fingertips, to ensure that nothing gets missed. It's not the field of chiropractics necessarily that most MDs have an issue with. It's the concern that many chiropractors unfortunately did not have, or do not have, the wisdom or discernment as to when they should refer patients out to an MD to get further evaluation and treatment. I think the thought process is that some of these chiropractors are just treating patients based on X-ray analysis alone, without having an MD assess the patient, do a physical exam, take a history, get some blood work and maybe some high resolution cross-sectional imaging in addition to that management and treatment. Can you speak to that, dr St?
David Saint, DC:Yeah, well, the first thing is how the dynamics of what we have is the team approach and again being able to work hand in hand specifically with our spine orthopedist, that we have Dr Paul Boggi, dr Michael D'Anezzo, I mean it's just absolutely wonderful and they understand what we do as chiropractors and the benefit of what we have. I am not a surgeon, I'm not going to go in and fix things and they are wonderful doing that. But what can we do on a non-invasive type of care? And chiropractic has its role. Chiropractic also has its limitations and we work and collaboratively with physical therapists. Chiropractic on our side of the in the Kailh Method, works on the alignment motion of the spine. We allow the physical therapist to work on strengthening because many chiropractors will do that in their own clinics when they are just working solo.
David Saint, DC:But the fact of working together and having another set of eyes is so important. Myself personally, I've been so educated by our orthopedic team on what's going on with the condition known as a labral tear of the hip and how often there's an underlying soft tissue component that's literally not even evaluated and not seen. It's seen on MRI image but this gets made time of a patient who has a chronic back or hip issue where there's actually another component that's going on that has to be looked at, and it's something that has been a real eye-opener since I've joined the Kailh team here.
Robert A. Kayal, MD, FAAOS, FAAHKS:Absolutely, dr St. You referenced before a little bit about how you work hand in hand with our physical therapist. Can you elaborate on that a little bit more? What patients get seen by chiropractors, which patients get seen by physical therapists, and how does each specialty contribute to the overall wellness and well-being of our patients?
David Saint, DC:Well, the dynamic that we have in our practice is that the fact that we are in the same location together and, of course, our physical therapists are experts when it comes to extremities, they're working hand in hand with the orthopedist. However, very often an extremity problem is causing another spine problem that's underlying, and the fact of, for instance, when patients come in here with whether it's foot, knee, hip issues, that they're having an underlying gait issue that's affecting their lower back. So working collaboratively with them is so important because I can address the alignment side. They're going to handle the muscle end and then what we do is work together with a treatment plan of what they do best and what I do best, and really marrying them together. I love it.
Robert A. Kayal, MD, FAAOS, FAAHKS:If we refer a patient to you for chiropractic evaluation and that patient is somewhat hesitant, what advice would you give that patient who is considering chiropractic care and what should he or she look for in a qualified physician?
David Saint, DC:Well, first of all, I always tell a patient come have a consultation. Consultations, we are talking, it's merely a discussion, and I would like to, you know, review your case and maybe put a set of eyes on it from a different angle. And Quite often I would get patients to say, yes, I'm not saying we're gonna start chiropractic care, but I like to discuss more about what I could do, possibly, or how I would do things differently or in adjunct to what care you're having right now. In regards to Types of chiropractors, there are numerous types of techniques based on the school that you go to. I'm a big believer that there's not necessarily one technique that's better than another, but at that, one technique many times will work Better with one individual than another. Again, the dynamics that we have within the kale model is that we have I don't know how many 1213 chiropractors or even more, and there's different chiropractors within our organization that offer different types of techniques.
Robert A. Kayal, MD, FAAOS, FAAHKS:Yeah, I agree with you wholeheartedly. I mean it's it's a wonderful Relationship that we share as we all assist one another in caring for our patients. You mentioned before a little bit about the chemical component of patients symptoms and inflammation. How do you employ the usage of some Pharmacological agents in the management of your patient symptoms?
David Saint, DC:Well, again, part of our team is we have an interventional pain management team. That's wonderful and so many times I've had patients that come into our practice and they've already been through medical management. They've been prescribed an anti-inflammatory, they've been prescribed a muscle relaxer. Things may not be really working Well. They may have started some type of care, maybe trying things, you know, doing things on their own with going to the gym. Now, with our team here, specifically our interventional team, it's getting to see where the irritation is happening at the spine.
David Saint, DC:I'm a big fan of medication management orally for short-term basis. I've, dr Kale, been a patient myself. That's why I think I became a pretty good doctor. I've had five knee operations, I've torn my bicep tendon, so I've had to be not only a patient, have had been on medical management. I've had to go through a rehabilitative process. But when it comes to our interventional pain management, what I love about it is that it's putting medication around the problem. It's putting it around the nerve root, around the disc, to bring inflammation down, which then makes my life easier as a chiropractor, because then it's easier for me to get motion into the spine when inflammation is down by reversing the inflammation.
Robert A. Kayal, MD, FAAOS, FAAHKS:We always speak about decreasing pain, redness, warmth, swelling, allowing the therapist to do what they need to do. A Lot of times patients come in and they're inflamed and we'll give them a cortisone injection of some sort. And the patients are like Well, are you just, you know, masking the problem? Well, but in reality we're treating the problem. We're treating the inflammation and allowing them to Go to physical therapy or chiropractic and undergo some treatments to actually reverse the condition. So that's just one way that we can really collaborate with one another and caring for these patients Cortisone injections locally, oral anti-inflammatories can decrease inflammation, topical SAVs, but we're all trying to get Rid of the inflammation which seems to be the common culprit in so many musculoskeletal and and medical conditions in general.
Robert A. Kayal, MD, FAAOS, FAAHKS:Dr St, with respect to employing such Such technological advancements that we've referenced before, what modalities do you use in the office to help our patients? I know you spoke a little bit about the distraction methods. What other pieces of equipment do you use in our different offices and how do we, each one of those modalities, theoretically work to reverse pain and inflammation or correct alignment?
David Saint, DC:Well, again, there's different chiropractic techniques that we talked about. We actually use different tables that our goals to do something a little bit different with each of them. We also use modalities very similar that physical therapy uses. We use electrical stimulation, which helps with pain as well as inflammation, but we use a lot of manual, manual, hands-on techniques and it's important with not only working the muscles, stretching, we're dealing with contraction. That's happening when you know, many times when I'm looking at the spine, I'll see a patient and they'll even have a head tilt to one side. Well, it's because muscles are contracted on one side and elongated on the other, and the goal that you know with a chiropractic is to put the body back into balance. And you know these soft tissue Techniques that we use. Again, many times, patients come in here and they were expecting to be twisted like a pretzel and there are certain techniques that we do in order to align. But we can do very soft and gentle techniques that are wonderful.
David Saint, DC:I Even take care of women that are pregnant, literally up to the time of delivery, and people say, geez, how would you do that? Well, I have a special table that does it takes the pressure off their belly. They lay there. I have patients that say all the time, can I just stay, like this doctor say, for a half hour? I'm so comfortable. But again, there are so many different things that we can do and I think it's more important that we have to get in front of the Patient and talk to them. And talk to them what they're, how they're presenting and also how they're feeling and really, you know, put the proper assessment and then put the right care plan together.
Robert A. Kayal, MD, FAAOS, FAAHKS:Yeah, and what on that? No, what should patients expect when they see you? Should they expect immediate relief? Is it a gradual improvement? Is it Typically a short-term course of care, a long-term program that you set up? What, what? How can you set their expectations?
David Saint, DC:Well, first of all, that is individualized for each patient, of course. Age of the patient, what we're seeing with bone structure, is the bones healthy? Is there some type of gene generation? It's just an alignment issue versus it, or is it a Discomponent? Was there a bulging disc or herniated disc? I will tell patients this If I was going to go to the gym and put on 10 pounds of muscle or take away 10 pounds of weight, it takes time, effort and repetiveness and, on a minimum, I'm seeing the patient quite frequently Anywhere between two to three times a week for the first four weeks to get to an evaluation where we can see where we were at that time and also where we started, and then seeing okay, what other things do we need to incorporate into their care plan? So it's a that's a very difficult question out there.
Robert A. Kayal, MD, FAAOS, FAAHKS:I have had patients I've only had to see a few times, and then there's patients in my clinic for literally six months and then there's patients that you will see once and Immediately refer the patient out to someone like our spine surgeon, that for an emergency spine surgery to.
Robert A. Kayal, MD, FAAOS, FAAHKS:I mean, that's that's what we're talking about where our chiropractors have the wisdom and discernment To, to recognize their limitations and to know when something is an outlier, when we're dealing with a patient that is not appropriately managed in chiropractic care, and and that's where we only Employee chiropractors that have that experience, wisdom, knowledge and expertise to know when he or she Needs to refer that patient out to an expert for emergency care.
Robert A. Kayal, MD, FAAOS, FAAHKS:And so that's that's what we're talking about, about collaborating with one another, getting imaging at the appropriate time, having surgeons and specialists at their beck and call, at their fingertips, where they can just immediately schedule that patient for an orthopedic specialty console that same day for emergent care, and so that that's very important, I think, to have that access and to not misguide that patient that potentially can do further harm by holding on to that patient and allowing them to suffer from God forbid permanent nerve damage or Miss a tumor or things like that. So I think you know, to me that is the whole comprehensive package that we offer our patients at the Kale Orthopedic Center I that is so important to emphasize and to replicate. On that note, dr Singh, can you speak to chiropractors out there that may be considering joining a facility such as ours where we deliver that whole package, that comprehensive pair? How has your alliance with Kale Orthopedic Center joining forces? How has that benefited you personally, how has it benefited you professionally and, most importantly, how has it benefited our patients?
David Saint, DC:Well, let me just go back a little bit in history, and I said before that I've been a patient myself and unfortunately, tearing my ACL three times it is possible and having to be under physical therapy care for all those years. I wanted to create myself a professional office that had chiropractic and physical therapy, so I did that for many years and then I incorporated medical into my team and for this past year, dr Kale, I joined your team because not only what you have, but you have so much all these different services and being able to work together and being able to get things done immediately. That is one of the dynamics of what we have seeing patients same day and if it's not same day, it's the next day, and we're dealing with a world that's so difficult to navigate around insurance, around their protocols, and each insurance many times has their own policies and procedures. However, we do the best for the patient and that's always been your model Give the best patient care that we can give, and it's the dynamic of working with the Kale model.
David Saint, DC:It's just absolutely wonderful and I was so for years. I was doing things alone in the practice and you can go so far with that and you need to have support, and the support structure that we have here with all these different departments is just absolutely wonderful and it's something that makes us unique. Some practices have maybe a doctor in their group that can handle certain things. We have specialists across the board and it's just a phenomenal team that you put together.
Robert A. Kayal, MD, FAAOS, FAAHKS:Thank you, thank you, and we're honored to have you as part of that, dr St. For sure, are there any things that you'd like to demonstrate to our patients with respect to some models, some of the techniques that you employ, some of the basic anatomy that you typically deal with on a daily basis? Absolutely so, dr St. What are we?
David Saint, DC:looking at here. So this is the lumbar spine. We have five lumbar vertebrae. In between each of the vertebrae we have a cushion known as a spinal disc. So that's the lower back. This is the lower back. This model is showing right here that we have a red herniated disc that's actually compressing and coming out and hitting the spinal nerve.
Robert A. Kayal, MD, FAAOS, FAAHKS:Right. So if we look at this model from the side we're looking at, this is the sacrum where the tailbone would be down. Here we have the vertebral bodies l5, l4, l3, l2, l1. And between the vertebral bodies we have what's called the intervertebral discs. And in this particular place, at this disc level, it appears that there's a disc that is what we call herniated. It's pushed out and it's putting pressure on that nerve and that's what we call a disc herniation. And when it puts pressure on that nerve, that patient will feel pain and discomfort, numbness and tingling and potentially weakness along the course of that nerve root. Wherever that nerve root goes, typically down into the buttocks and down the leg somewhere. So how are you going to treat that in chiropractic?
David Saint, DC:Dr St Well, with chiropractic, there are different techniques that we use in the office that are using our hands free instrumentation as long as our hands adjusting. However, we also use something called spinal decompression therapy, and this is actually something that was designed by the medical profession, actually a way of elongating, getting motion into the spine, and it does so by causing negative pressure. We use a harness system and literally we cause a stretching, pumping mechanism, just like I'm doing Now. For this to occur, the patient is actually laying down on their back. They're very comfortable. A session goes for anywhere between 15 to 20 minutes. There's a harness system around the stomach as well as a harness system around the upper torso, and again, we're causing this type of motion and very slowly, very gently, we're changing the pressure in that disc and the goal is for that disc to literally get sucked back into its normal position, because it's actually stuck and the body doesn't want to be stuck.
David Saint, DC:The body wants to constantly go through a natural healing ability. If I cut my skin, I will start to bleed, I'll start to get a scab. The body will go through a whole course on getting new skin. The same thing wants to happen here. Unfortunately, if it can't happen. Welcome to the team at Kailor's, the pediatrics that can go in surgically and repair that, but on a non-invasive, non-surgical way. There's a high likelihood that we can actually help these patients as well, All right.
Robert A. Kayal, MD, FAAOS, FAAHKS:So the concept is to create a negative pressure to reduce that disc herniation. By performing that distraction technique You're also taking pressure off the nerve roots that are exiting, that are being compressed in that spinal foramen. That little hole on the side below every pedicle, right here there's a nerve root that's exiting and by causing that distraction it's opening up that spinal foramen and decompressing that nerve. So hopefully that would alleviate the patient's symptoms. Is this akin to the DRX9000 machine that people use?
David Saint, DC:Absolutely. Now, along with what we do on the mechanical side, as we discussed earlier, there's a chemical portion to this and I have found that using our interventional pain management doctors to help you bring inflammation down almost like a spark plug to an engine starts the engine that when it dies it's so inflamed. If we can get in there and put medication around that nerve root, around that facet joint, it just brings it down and then the body is so much easier to expand and first to stretch it.
Robert A. Kayal, MD, FAAOS, FAAHKS:So we're. It's a multimodal approach. We're hitting it from many different angles physical therapy, chiropractic, oral, anti-inflammatories, interventional pain management procedures. So it's a multimodal approach to patient care to give the patient everything we have in our armamentarium to make that patient better, right?
David Saint, DC:Yes, and and I find, doc, which is the best here is that there's many times that I say this a nice way We'll throw the kitchen sink at the patient, because the patients come to us They've already been either self-medicating or been on medications for a longer period of time and we'll have to get more aggressive. The great news is the majority of our patients that come in we can start with a very conservative approach. We can start and we can add along the way if we're not getting to the certain benchmarks that we need. So not every patient needs to come in here and get pain management injections right away. We can start with, say, acupuncture and maybe some oral medication. But the great news is that we can pivot and that is the biggest thing that I love about working with a Kail model being able to pivot, get a test, make a decision, collaborate with another doctor, and that way the patient gets the care that they need immediately, not three months down the road.
Robert A. Kayal, MD, FAAOS, FAAHKS:Beautifully articulated, Dr St.
David Saint, DC:Thank you so much so this is the cervical spine, so this is the back of our head, this is the skull right here. Okay, and we have our cervical spine, our neck, which is composed of seven vertebra, along with a cushion in between each vertebra that allows the spinal nerve to exit as well. And the model of the neck is so important because, due to injuries, specifically whiplash injuries and we always assume a whiplash being an automobile injury where the head gets thrown forward and back, but it can be contact sports, it can be just slipping down or missing a stare or two and, unfortunately, this curvature of our neck can many times go straight or actually go the opposite way.
Robert A. Kayal, MD, FAAOS, FAAHKS:So we're normally supposed to be in that lordotic posture, right, what we call that lordotic posture, correct.
David Saint, DC:Correct and unfortunately, you know, most of us are on our phones all day long with the head positioned down, again working on laptops, the curvature in the neck is lost.
David Saint, DC:So we see this on an x-ray, okay, and then also, when necessary, on an MRI, we can actually see the spinal cord being affected. We can see the disc being involved, whether it's a bulge or herniation, and, of course, the nerve root showing irritation and inflammation. So one of the tools that I use in my practice is I use instrumentation adjusting, which this is called the impulse adjuster, right here, okay, and it has actually a dual function, it has the dual tip here. And what we're able to do, doc, is what? Literally, with the patient going face down, we can take this instrument and it's actually works very light and it actually works on speed and we can literally drive the neck and bring that neck back into it. It's normal posture and we literally, after the adjustment, what's done? By palpating the patient. Beforehand and afterwards, patients can literally feel the difference of muscles that are relaxed and many times the range of motion has actually come back.
Robert A. Kayal, MD, FAAOS, FAAHKS:So what's the mechanism of action with that impulse adjuster?
David Saint, DC:Well, it's life force okay, and by actually pressing in and giving the impulses it works on speed, and by giving speed it's causing the vertebra to jump back and forth. So again, what's great about this? Ligaments and tendons are not being really touched at all. It takes away any type of crepitus feeling, so patients are not going to hear any type of noise. Quite often after the adjustment I had patients say to me that's it. I said that's it, but you will be feeling some sortness.
David Saint, DC:The next day and again, these are great things and how we can treat a patient without having to use our hands. So it's just wonderful when patients have degeneration, some patients who have even have some, you know, beginnings of osteoporosis, because this is again, it's a very light force technique.
Robert A. Kayal, MD, FAAOS, FAAHKS:That's beautiful. Thank you for that demonstration. And just to clarify when you say light force, you're talking about force that is gentle, correct? We're not talking about light as an ultraviolet rays light force correct, correct, all right. So we're talking about gentle force, because I know you meant you mentioned light force throughout this podcast and I just wanted to clarify for our listening and viewing audience.
Robert A. Kayal, MD, FAAOS, FAAHKS:Speaking of light, I do know that some of our providers employ light energy as well. One particular example is the MLS laser, the robotic laser machine that we have in our offices, where essentially, it utilizes two different wavelengths of light energy. One of those wavelengths is to decrease pain and one of the other wavelengths is to decrease inflammation. So by decreasing inflammation and increasing blood flow to the region, in addition to working on the nerve fibers that sense pain, we're also able to alleviate some pain and discomfort, as well as inflammation, and promote healing by increasing blood flow with the usage of the MLS laser light energy techniques. So that's just something else that we perform at our facilities as well. So any closing words that you'd like to leave this podcast with Dr Singh.
David Saint, DC:Well. Again, thank you so much for having me, and if patients have specific questions the one that they can always reach out I would love to sit down and discuss things with them and understand that chiropractic could be a great benefit to their care and to their entire well-being. But again, it has to be assessed properly and seen what they have. If I can even possibly help, them Well.
Robert A. Kayal, MD, FAAOS, FAAHKS:Thank you so much, dr Singh.
Robert A. Kayal, MD, FAAOS, FAAHKS:It's really been such a pleasure working with you and having you as part of the Kale Orthopedic Center. Your patients just adore you. You've been so helpful in caring for our patients and, as far as I'm concerned, it's a beautiful compliment to our practice, adding the chiropractic services but not only chiropractic all the other services that Dr Singh mentioned, the acupuncture, the physical therapy, and the holistic approach we have to patient care as well. Conservative management is something that we definitely hope for for our patients and to manage their symptoms entirely with, but unfortunately, sometimes they will require something more invasive, and we have that as well. Our main goal is to take care of the patient and just get them better as fast as possible, as quickly as possible, so that they can enjoy the quality of life that they all deserve, and so thank you so much for spending some time with me this morning, and I hope that our viewing and listening audience has found this to be helpful and that they will entrust our chiropractors to help deliver the best musculoskeletal care to aid in their recovery.
