Body Works Clinic

04/01/2026

SPECIFIC CHIROPRACTIC ADJUSTMENTS VERSUS RANDOM MANUAL MOBILIZATION:WHY IT REALLY MATTERS

https://www.researchgate.net/publication/377361433_A_randomized_controlled_trial_comparing_different_sites_of_high-velocity_low_amplitude_thrust_on_sensorimotor_integration_parameters

Over the last 30 years of practice I have often found myself answering the same question many times over. 1 of those questions is why I seem to only be adjusting only one side and only one very specific spot, when patients may have had previous experiences with chiropractors or other manual therapist that showed a much broader contact, and adjusting multiple areas of the spine on both sides. With the addition of Dr. Steve as my esteemed colleague and associate, I realize I'm not the only one answering that question. Dr. Steve and I have very similar approaches and background in manual adjusting, (more specifically we both had most of our training in the Gonstead technique and system), which means that on occasion we will both bemoan the drift of our profession away from specific and systematic manual adjustments based on a system of analysis that aims at isolating the main segment(s) of spinal dysfunction that should be adjusted, while leaving the rest alone.

There are good scientific rationales behind that approach: the spine is a very dynamic system of action and reaction based in gravity. What happens in one area of the spine will often lead to broad compensations in a different area, and it takes some clinical investigation to make sure you address the root cause rather than waste your time (and your body's limited healing energy) on areas of compensation.

There is also good and pretty solid research to validate the specific approach. I was thrilled to come across this wonderful paper by our colleagues from down under in New Zealand (especially Dr. Heidi Haavik who has been a workhorse of basic science chiropractic research for well over a decade). The nuts and bolts of the study was to measure the brain-based motor response of an adjustment...
https://www.bwclinic.com/blog/2024/5/30/specific-chiropractic-adjustments-versus-random-manual-mobilization-why-it-really-matters?rq=specific

03/31/2026

CAUTION IN THE USE OF MELATONIN IN CHILDREN
I was glad to see this article because I feel that I have sometimes been the lone voice in raising concerns about the use of melatonin for routine sleep problems in children (and in adults as well).

Melatonin, while available over the counter, is not the benign supplement that some people think it is. It is an actual short chain hormone that has profound actions on the brain and is involved in multiple delicate feedback loops. There are relatively few studies on its long-term safety use in adult and virtually none in children outside of the moderate to severe neurodivergent population like autism, where the risk tolerance may be different.

Low dose short-term use of melatonin for special circumstances like acute situational stress or jet lag may be appropriate, but that's where I would personally draw the line. Beyond that, you run the risk of suppressing and altering feedback loops pertaining to hormone and neurotransmitter regulation in a rapidly developing pediatric brain.

This is not to say that sleep difficulties in children should be brushed off. They can be significantly impacting a child and their parents. It's just to say that different interventions will be more effective and safer in the long-term but will require a little more detective work than simply giving a melatonin lozenge at bedtime.

https://link.springer.com/article/10.1007/s12519-025-00896-5?utm_source=klaviyo&utm_medium=email&utm_campaign=%28Friday+Email+-+Chris+Kresser+General+News%29+Chris%27s+Friday+Favorites&utm_term=World+Journal+of+Pediatrics&utm_content=World+Journal+of+Pediatrics&_kx=ZpXBDTeEF9QJhwDqQXXrImrT_HpFsBz1ZlYMbsx_Vq0.my75y6

03/24/2026

Scheduling update for the weeks of March 23 through April 2nd. Dr. Demel will be out of the office from Friday, March 27th through Wednesday, April 1st. There will be reduced front desk presence during that timeframe but someone will be in every day to return emails and voicemails. Regular chiropractic hours resume on Thursday and Friday, April 2nd and 3rd. Regular massages will continue during those 2 weeks.

03/22/2026

CAN THE LOW BACK CAUSE ABDOMINAL PAIN ?

It's a question that has been posed to me on a couple of occasions. Obviously, abdominal pain can have many pain generating structures, and internal abdominal organs are going to be the primary source of pain. However, I have had many a case over my 30 years in practice where a patient came in with persistent vague lower abdominal discomfort that felt really deep, and had had a battery of tests from ultrasounds, endoscopies, colonoscopies, and a boatload of labs, without any explanation for the continued symptoms. In the process of working up the patient for some other symptoms (lower back with thoracic pain most commonly), the patient reports a substantial improvement in their long-standing abdominal pain when starting chiropractic care.

An older and wiser colleague who mentored me in my early career once said: "there is as much lumbar spine in the front as there is in the back". The point was that the posterior aspect of the lumbar spine gets the lion's share of attention, since the posterior structures such as the facet joints, and the posterior margin of the lumbar discs, have a higher density of fine discriminating pain sensors, and all the spinal nerves which exit posterior to the center of the vertebral body can basically only be compressed in the posterior half of the lumbar spine. However, this is not to say that anterior lumbar pain generating structures do not exist or that they are rare. Anterior lumbar disc herniations are clearly seen on MRIs. They do not often get the attention they deserve, since orthopedic and neurosurgical providers are more focused on spinal nerve compression. Anterior lumbar disc herniations and the pain they generate is going to be more vague, ....
https://www.bwclinic.com/blog/2024/6/20/can-the-low-back-cause-abdominal-pain-?rq=CAN%20THE%20LOW%20BACK

03/21/2026

EXERCISE INDUCED PAIN AND BOTANICAL SUPPORT

It has been a bit of a busy week at the office and not as much time to dive into my research update safari as I normally would. But this piece of research caught my eye. I had several patients that have been very committed to trying to make strength gains with new exercise routines, however feeling a little bit deflated by painful responses post exercise that make it difficult for them to stay on track.

Making muscle gains does involve some micro-tearing and stimulation of new muscle growth, and there's almost inevitably some degree of discomfort associated with it. It should be transient, and allow you to continue with you normal activities of daily living, and most importantly allow you to go back to another strength workout later in the week. If you're running into roadblocks achieving that, you may need to work with the seasoned trainer to try to 1st revisit the adequacy of your current workout routine: are you trying to do too much too fast, do not have proper pre-workout meal and hydration, do you have inadequate warm up and warm down recovery? Do you lack post exercise protein intake?

If everything tracks and you are still having difficulty recovering from your workout, you may need to introduce some supplemental botanical anti-inflammatory to speed up the post exercise muscle inflammation and its recovery. Curcumin (an extract of the spice turmeric but in much higher concentration than what found in the spice itself), has been the most studied substance to achieve that purpose. As this meta-analysis reveals, it's been a tried and true and very dependable agent to minimize post exercise muscular soreness. It has very little side effect 2. But there are some important details and how you use curcumin. You do need to have an adequate amount (about 2 g), and it's poorly absorbed unless combined with a fat-soluble base, and additionally enhanced ...
https://www.bwclinic.com/blog/2026/3/21/exercise-induced-pain-and-botanical-support.

03/15/2026

BAROMETRIC PRESSURE, PAIN AND MIGRAINE HEADACHES

( reposting from previous post, but oh so timely with the snow apocalypse of today)

I am almost seeing the light at the end of the tunnel on my weather app. We have literally been rolling in form 1 storm system into the next for 10 days now, and while I am quite exhausted by the amount of wet dog smells and residues that this has brought into my house, I realize this is a minor problem compared to what some of our patients have been experiencing in that timeframe.

Some patients have conditions that are significantly flared up by sudden severe or prolonged drop in barometric pressures that are associated with storm systems. It used to be considered an "old wives tales"that people could predict upcoming bad weather with the arthritic joints. Modern science has finally caught up with that erroneous assumption. We now know that some of the sensory receptors that are found in many of our joint capsules, whose job it is to send off positional signal to our balance centers, can be expressed in much higher numbers in previously damaged joints, and can have a lower firing threshold over time. This essentially can turn a body part into a mini barometer, and at times more accurate than the weatherman.

The 2 patient populations that seem to be most affected by these barometric pressure changes (there are actually several more but I do encounter them much less commonly), are patients with posttraumatic or osteoarthritis related joint hypersensitivity, as well as patients with migraine disorders.

The scenario often goes as follows: patient has had a serious trauma to the spine or an extremity joint like the knee or wrist, (trauma can be physical trauma or something like surgery), and noticed over time that the joint pain seems to flareup independent of any normally aggravating activities, but seem to coincide with a 12 – 36 hour window before a major storm event. For migraine patients, every other trigger being equal,....

https://www.bwclinic.com/blog/2024/6/20/barometric-pressure-pain-and-migraine-headaches?rq=barome

03/14/2026

NECK AND SHOULDER INJURIES FROM PLANKING

https://www.youtube.com/shorts/zGL8G0ZRHM0

Seeing 3 consecutive similar injuries in one week reminded me to blog about this and record a short instructional video. (Thanks to Louis for joining the effort.)

Planking is a great strength, stability and endurance exercise for both the shoulder girdle and the core. However it's also a demanding exercise with little margin for error without running the risk of injury. It does require excellent form, and since it's working multiple body areas at the same time, is more subject to fatigue. This particular video discusses the impact on the neck and shoulder from our plank gone wrong. When the shoulder girdle and torso muscles start to fatigue, the load is shifted to the anterior cervical spine especially. Your trunk and shoulder muscles are engineered and designed to be able to hold your body weight under certain circumstances during activities that humans engage in on a routine basis, but cervical muscles are not. They are primarily designed to hold the weight of your neck and head.

The collapse of the torso into the shoulder is associated with anterior cervical injuries, often affecting the anterior clavicle, and the brachial plexus. They can result in not only local neck and upper back pain but also headaches, anterior pain referring to the head and arm pain and weakness.

If you have not been practicing planking for a while, I strongly recommend you gradually work your way up to it: you can consider doing a countertop plank, then a partial plank from the knees up and onto elbows, before slowly working your way up to a full plank on your arms.

03/09/2026

GLP1 MEDICATIONS, MUSCLE AND BONE LOSS
Like any clinician working in 21st century American healthcare, over the last 12 months, I've come in contact with an explosion of patients taking GLP-1 semiglutide medications. While those medications were initially labeled for diabetic control, the vast majority of cases presenting in my office are for weight loss. And like many colleagues in the integrated space, balancing the facts about the benefits of a medication addressing severe persistent medically dangerous obesity with known and unknown side effects has been a fine balancing act.

Behind closed doors, when colleagues and I candidly discuss our experience with patients taking this new class of medication, we all wonder when the proverbial other shoe will fall off. There has been an unbridled enthusiasm about the potential for those medication to help curb the scourge of chronic population obesity, but probably a bit of a vacuum when it comes to discussing all of the pros and cons of the prolonged use of a class of medication that historically had been reserved for the patient with poorly controlled diabetes. After 30 years in practice, you acquire a little bit of healthy cynicism when it comes to new treatments of any sort, knowing that some downfalls are not readily available during the "honeymoon" period of a launch that can take months to years to unfold.

There may be a bit of the proverbial shoe starting to drop based on the most recent article published in Lancet (1 of the top dogs of straightforward published medical research). The speed at which patients can lose weight, it turns out, is not all about tissue that you would want to shed. A whopping 3rd of the weight loss comes from lean muscle tissue. This is in contrast to nonmedically induced weight loss from calorie restriction and physical activity, which has a much better track record at preserving lean muscle mass. The latter is quite important for long-term weight maintenance, since muscle tissue .....
https://www.bwclinic.com/blog/2024/11/4/glp-1-semiglutide-medications-muscle-and-bone-loss?rq=glp

03/08/2026

SHOULDER IMPINGEMENT SYNDROME

Shoulder pain and dysfunction can have a variety of root causes. Chiropractors will directly or indirectly address shoulder problems since a large percentage are related to poor function and alignment of the cervical spine and upper thoracic spine preventing normal alignment of the shoulder girdle. However in this particular blog I want to talk about the more intrinsic presentation of shoulder pain and dysfunction, called shoulder impingement syndrome.

Shoulder impingement syndrome is actually a bit of a broader umbrella itself. In a nutshell, it describes a problem whereby the space above the ball of the head of the humerus and the bony bridge of the a acromioclavicular joint is narrowed, causing a pinching of the structures located in between, mostly some of the rotator cuff tendons and the bursa.

Shoulder impingement syndrome can fall into 2 categories, which sometimes overlap:

– static impingement syndrome describes a more or less permanent narrowing that is not affected by the movement and position of the arm. This happens when there is for example....
https://www.bwclinic.com/blog/2025/9/27/shoulder-imppingement-syndrome

03/08/2026

SHOULDER IMPINGEMENT SYNDROME

Shoulder pain and dysfunction can have a variety of root causes. Chiropractors will directly or indirectly address shoulder problems since a large percentage are related to poor function and alignment of the cervical spine and upper thoracic spine preventing normal alignment of the shoulder girdle. However in this particular blog I want to talk about the more intrinsic presentation of shoulder pain and dysfunction, called shoulder impingement syndrome.

Shoulder impingement syndrome is actually a bit of a broader umbrella itself. In a nutshell, it describes a problem whereby the space above the ball of the head of the humerus and the bony bridge of the a acromioclavicular joint is narrowed, causing a pinching of the structures located in between, mostly some of the rotator cuff tendons and the bursa.

Shoulder impingement syndrome can fall into 2 categories, which sometimes overlap:

– static impingement syndrome describes a more or less permanent narrowing that is not affected by the movement and position of the arm. This happens when there is for example....

Shoulder pain and dysfunction can have a variety of root causes. Chiropractors will directly or indirectly address shoulder problems since a large percentage are related to poor function and alignment of the cervical spine and upper thoracic spine preventing normal alignment of the shoulder girdle.

03/02/2026

WHAT ARE MODIC TYPE 1 AND TYPE 2 CHANGES ON MRI ?
Recently I've been looking at a lot of MRIs with patients, trying to go through each line of the report and make sense of the medical jargon. One term that seems to be completely foreign to most patients is the mention of Modic type I and Modic type II changes.

Modic changes refer to some abnormal signal on the bone marrow of the vertebrae adjacent to a spinal disc. They look like abnormal coloring on the top and bottom of the vertebrae. They represent some changes in the normal bone and bone marrow with some infiltration of inflammatory cells, edema. Modic changes are the reflection of the severity and active nature of degenerative changes of the vertebral segment, where the disc degeneration starts to progress to the point of involving the adjacent bone. Modic type I changes are acute, fresh, active, and almost always correlated with active bone pain, whereas Modic type II changes are more of the chronic, potentially non-symptomatic scar tissue of a previous acute episode. The importance of noting those on an MRI is that they tend to be much more correlated with active pain than certain disc changes, especially disc bulges, which can be found at a high prevalence level in the general population but can be completely asymptomatic.

You have to remember that MRI images are extraordinary at giving you a lot of information, including pretty much everything that's ever happened to you but doesn't help you differentiate what's relevant to your particular current complaint. The presence of Modic changes, especially type I Modic changes, can help you differentiate between background degenerative findings versus an active problem. How you treat Modic one changes is more complicated than the intent of this short blog, but does need to get to the root of the mechanical stress to the affected segment and sometimes involve oral supplemental anti-inflammatory control, whether pharmacological or botanical.