February 20, 2024 • 42 mins
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.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Robert A. Kayal, MD, FAAO (00:00):
Hello and welcome to another edition
of the Kale Ortho Podcast.
Today is February 20th, 2024.
And today our special guest isDr David St.
Dr David St is the ChiefChiropractor and Clinical
Director of two of the KaleOrthopedic Centers Chiropractic
Facilities one in Montvale andone in Stony Point, new York.
(00:22):
Welcome to the podcast.
Thank you so much, dr Kale.
So happy to have you, dr St.
So today we're going to speakwith Dr St about the field of
chiropractics in general, someof the latest advancements in
the field of chiropractics andhow we can use that specialty to
assist us in taking care of ourpatients suffering from
(00:43):
musculoskeletal injuries.
So, dr St, first and foremost,why don't you just take this
opportunity to teach our viewingand listening audience a little
bit about yourself?
Tell us you know where you grewup and how you got into the
field of medicine in general.
David Saint, DC (00:57):
Well, thank you .
Well, thank you, dr Kale.
I grew up in Rivervale, newJersey, attended Don Bosco Prep,
went on to play football atLafayette College and got my
Doctor of Chiropractic at LifeUniversity in Atlanta, georgia.
I've been fortunate to bearound chiropractic my whole
life because my father, who'sstill in a chiropractor at 83
(01:18):
years young, and for myself itwas an eye-opening experience on
there.
Forget one day when I was nineyears old and I opened the front
door and this gentleman wasstanding there holding his
X-rays.
His name was George Martin andhe was a defensive end for the
New York Giants and his careerhad been considered completely
over and he was referred to myfather.
We had a home office and hesaid could I see your father?
(01:42):
And I said, absolutely so, Iget that.
This gentleman's at the frontdoor.
Well, six weeks later Mr Martinwas back on the football field
and from there his careercontinued to thrive.
He became MVP of Super Bowlagainst the Denver Broncos.
So I got to see my fatherworking and literally
transforming people's livesthrough his career, and I knew
(02:02):
it.
I wanted to help people and Itold my father when I was at
Lafayette.
I said I want to become achiropractor, and here I am now
going on a 27 years in practice.
Well, what an inspiration.
Robert A. Kayal, MD, FAA (02:12):
That's a great story.
So when we talk about the fieldof chiropractics in general, Dr
St, what are some commonmisconceptions people have about
chiropractic care in generaland how do you address them in
your practice.
David Saint, DC (02:26):
Well, one of the things I hear all the time
is that, well, if I go to achiropractor once, I have to go
to the chiropractor for the restof my life.
And my answer to that is well,you should have your spine
checked for the rest of yourlife.
We brush our teeth on a regularbasis, we continue to floss and
do dental hygiene and go seeour dentist, sometimes every six
months or once a year.
Most people don't even knowwhat to do for their spine.
(02:49):
They say, well, I just do somestretching, I drink some water.
But what we've now found out isit's about keeping the body in
alignment, it's keeping ourmuscles strong, our core muscles
, and most patients have to beeducated.
They don't know necessarilywhat to do, and I find that part
of the visit is not just takingcare of the patient, but it's
also educating the patientsRight.
Robert A. Kayal, MD, FAAOS (03:10):
Well , on that note, can you just
sort of describe the generalprinciples of chiropractic care
and how they contribute to one'swell-being.
David Saint, DC (03:19):
Sure Well, chiropractic is premised off
that the central nervous systemcontrols everything in the body.
Most people are unaware thatonce a sperm and egg come
together, the first thing thatis formed is actually the spinal
cord and the brain.
And spinal cord controls everysingle function Around.
The spinal cord is the hardestthing that we have, and that's
(03:39):
bone to protect it, and betweenthose bones are nerves that exit
and they go to every tissue,organ, cell, and the goal of
chiropractic is to increasenerve flow.
We want to make sure that thebody is in balance, that proper
nerve flow is happening, so thatnot only to muscles but as well
as to organs.
So we look at the alignment ofthe spine and we look for areas
(04:00):
of the spine that are lackingmotion and we put motion back
into the body Great and what aresome of the common conditions
that a chiropractor willtypically see and treat on a
daily basis?
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 canhappen in the neck headaches.
(04:21):
There can also be symptoms thatgo down into the arms and the
legs.
People have heard of the termsciatica, which is leg pain.
We've also had pain thatradiates down the arms and those
are typically severe irritationto the nerve roots.
Robert A. Kayal, MD, FAAOS, (04:34):
How do you individualize a
treatment plan for patientsbased on their specific needs?
David Saint, DC (04:40):
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'reexperiencing.
From that history we go into anexamination.
We're actually palpating andtouching the patient, putting
the patient through some rangeof motions, do some orthopedic
tests as well.
(05:00):
We also test on neurologicalpackages, which are parts of the
skin, to see how the patient isfeeling, are they sensitive and
can they actually have goodstrength.
From there we go in and we alsotake x-rays.
Diagnostic films and diagnostictests are so important.
First of all, looking at anx-ray, we just want to see the
healthiness of the bones, or isthere any type of degeneration?
(05:23):
Are the bones healthy?
Are there possibly even thesigns of even osteoporosis,
starting to begin From thex-rays we also look at alignment
, looking at one joint versusthe other.
From the x-ray, many timeswe'll be ordering MRIs, because
x-ray shows bone, mri shows softtissue and by marrying those
two tests together we many timeswill get a clear indication of
(05:46):
what's happening to the entirespine itself.
Robert A. Kayal, MD, FAAOS (05:50):
Does chiropractic play a role in
preventative health care?
David Saint, DC (05:54):
Yes, First and foremost is that if the spine is
not in the correct alignedposition, 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 willcontract and the body will just
be vulnerable, many timesvulnerable to an injury, to a
(06:15):
twist, a turn.
Quite common I mean literallyevery day I have a patient come
in and says Dr St, I don't knowwhat I did, I just turned a
certain way, I just went downand tied my shoe and I couldn't
get up.
And by the time that motion orthat 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
(06:39):
beforehand.
Robert A. Kayal, MD, FAAOS, (06:41):
How can chiropractic be utilized to
complement other wellnessservices?
David Saint, DC (06:47):
Well, one of the biggest things that I love
in our practice and what weoffer is acupuncture.
Acupuncture is just known tohelp with inflammation, help
with pain, and what we find isthat when patients come into our
practice Dr Kale, patients comein with two problems we're
having a chemical problem andwe're having a mechanical and
(07:08):
patients come in I ask them painscale one to 10, how are you
feeling?
10 being the worst pain?
And that basically tells usthat there's inflammation going
on.
So something like acupuncturehelps bring inflammation down
naturally and that's just one ofthe tools that we use, along
with our medical side ofmedically managing that
patient's problem.
Robert A. Kayal, MD, FAAOS, (07:29):
Are there other specific exercises
or lifestyle modifications thatyou also employ to ensure that
patients benefit the most fromyour chiropractic services?
David Saint, DC (07:40):
Absolutely.
One of the things that we talkabout during our case of review
with a patient is finding outwhat they do occupationally and
unfortunately we're dealing withpatients, now more than ever,
working from home.
I'm finding, specificallyduring the pandemic, patients
did not have the properworkstations.
We're working on their laptop.
I would ask them where are youusing the laptop?
Oh, I'm sitting on the couch,so we called it.
(08:02):
You know computeritis, wherethe head be forward, changing
posture, and what happens isthat people's core muscles, you
know repetitively they're notbeing worked on and when you
have muscle fatigue, all themuscles control and support the
spine.
So it's just turned into awhole effect of looking at about
how the body is workingcollectively.
Robert A. Kayal, MD, FAAOS (08:23):
What are some of the recent
advancements and technologiesthat you've experienced recently
in the field of chiropractics,and how have you employed them
and how have they benefited yourpatients?
David Saint, DC (08:35):
Absolutely so there are so many chiropractic
techniques I mean I believethere are over 70 of them.
For myself, I use about 18different techniques themselves,
but two of the techniques thatwe use in our clinic.
One is what I call hands freeinstrumentation, adjusting.
It's dynamic there whenpatients are seen.
Many times patients areconcerned about quote unquote
(08:58):
getting cracked, hearing sometype of audible noises, and we
use instrumentation where thereis no noise whatsoever.
It's light force and mostpatients when they get off the
table they go wow, they were.
They couldn't believe theexperience of having something
like that.
Another wonderful techniquethat we use in our Montville
location is spinal decompressiontherapy.
(09:19):
It's a light force, non audiblestretching mechanism of
decompressing the spine to getmotion into the joint space, and
it's just a wonderful tool thatis able to help patients who
are suffering from back issues,facet injuries, bulging,
herniated discs and it's anotheralternative that we use when
(09:40):
necessary.
Robert A. Kayal, MD, FAAOS, (09:41):
And with respect to maintaining
current in your field and thetechnological advancements that
we've discussed.
How important is ongoingeducation and training in the
field of chiropractic to ensurethat you deliver the latest and
greatest techniques to ourpatients Well, first, and
foremost, not only ourprofession but our state.
David Saint, DC (10:01):
It's mandated that we do continuing education
within the state of New Jerseyand also state of New York and,
a matter of fact, every state inthe country, and it's a
wonderful tool because it allowsus to hear also not only the
research but also learn newthings that are happening out in
the field on a continuing basis.
So we do a minimum of 30 hoursevery two years here in New
(10:22):
Jersey.
Robert A. Kayal, MD, FAA (10:23):
That's great.
That's great to know.
Well, as you know, I'm anallopathic physician, orthopedic
surgeon, and you as achiropractic physician.
We have different approaches topatient care.
Many allopathic physicians haveconsidered the field of
(10:45):
chiropractic in general to besomewhat taboo.
As you know, I, at the KaleOrthopedic Center, have embraced
the field for over 25 years now.
To me, it is exceptionallyimportant to collaborate with
others as we continue to carefor our patients.
Each one of us brings our ownskill set to the table in caring
(11:08):
for the patients.
How can you discuss for ourviewing and listening audience
how we have collaborated withone another, not only in the
field of orthopedics but at KaleOrthopedic Center in general,
with other specialties likepodiatry and rheumatology and
interventional pain management,and even our board-certified
(11:29):
fellowship trainedmusculoskeletal radiologists and
neuroradiologists?
David Saint, DC (11:34):
So often when I see patients now over the years
coming in and happened just theother day.
A patient comes in with chroniclower back pain and first and
foremost obviously do anexamination and taking updated
x-rays, but not only looking atthe back but looking at the
entire person, and I startedasking questions about their
feet and brought us some, youknow, questions about what they
(11:58):
are feeling, what they can do,what they can't do, and turns
out there was some irritationdown there that led me to some
type of examination of the footat that moment and that patient
is going to see our podiatryteam because I'm concerned with
the alignment of the feet thatare the foundation for the spine
, along with it finding out thepatient is having chronic pain
(12:19):
for years and we're going to getthat patient over to our
rheumatology department becauseof there's inflammation.
We want to see what thoseinflammation markers are.
The goal that I want to do isnot just bring chiropractic of
the spine to the patient, but Iwant to make sure that and we
rule things out and that is theimportance of not just our
diagnostic test but also usingour medical team and that's why
(12:43):
it works hand in hand and thepatients that I see all see our
medical team and we see thepatient as a whole person.
Robert A. Kayal, MD, FAAOS, (12:49):
And , as you know, oftentimes the
chiropractors are thegatekeepers into the healthcare
system.
Patients trust theirchiropractors.
They see their chiropractorsfirst, often before even seeing
their primary care physicians.
They go to their chiropractorsfor headaches and jaw pain and
(13:10):
arm pain and hip pain and legpain.
As the gatekeeper of patientcare, oftentimes that
chiropractor can be incrediblyinstrumental and influential in
making that patient better andgetting that patient in the
right hands.
How do you first assess apatient and make those
(13:32):
determinations in the office, drSt Well, again, the clinical
history, speaking with thepatient finding out.
David Saint, DC (13:40):
I always ask the patients when was your most
recent accident or injury?
And patients look at me firstand I said you know, have you
had a car accident in the lastthree months, six months, even
about back to two years?
And how often patients thinkthat the injuries that they've
had have been a small thing.
And those injuries have nowcomplicated and they've been
(14:01):
basically a snowball that's justgetting bigger and bigger.
So, again, working with ourteam and ruling things out is so
important.
And back to the diagnostic testthat we use in the Kale model
here, the fact that we can notonly take x-rays on site
digitally, we see themimmediately.
Number one, number two we canget another opinion of reading
(14:24):
those x-rays right away.
How many times I'm looking atx-ray?
Can I get another opinion?
Get right on the phone to oneof our orthopedias.
Can you do me favor, can youlook at this?
What do you see?
I see this here and that justgives me comfort and just knows
that the patient is also gettingthe best care.
Then, of course, what we doin-house with our MRIs and using
CAT scans and our bone densitytesting that we're able to do
(14:47):
these things literallyimmediately, and this is unheard
of in today's world ofinsurance.
Robert A. Kayal, MD, FAAOS (14:53):
Yeah , I think, just going back to
what I was talking about, abouthow a lot of doctors consider
the field of chiropractic to besomewhat taboo.
I think it's not necessarilybecause of the field of
chiropractic in general or whatyou do for our patients.
It's the reputation,unfortunately, in the community
(15:14):
that has been formed over theyears, where there's essentially
the thought process that a lotof the chiropractors just hold
on to their patients.
Sometimes things get missed andsometimes those things are bad
things like tumors, cancers etc.
Like that, not having thewisdom or the discernment
sometimes to refer the patientout of the practice.
A lot of the chiropractors ingeneral have developed a
(15:37):
reputation that they tend tohold on to their patients.
They'll often see their patientsthree times a week for years
just for what they callmaintenance, and all of us have
seen patients over the yearslike that, that have seen
chiropractors for years andunfortunately some bad things
(15:58):
have been missed.
So, speaking of that, speak tothe benefits of being in an
organization where you haveaccess to medical doctors of all
different musculoskeletalspecialties and advanced
cross-sectional medical imagingat your beck and call, at your
fingertips, to ensure thatnothing gets missed.
(16:22):
It's not the field ofchiropractics necessarily that
most MDs have an issue with.
It's the concern that manychiropractors unfortunately did
not have, or do not have, thewisdom or discernment as to when
they should refer patients outto an MD to get further
evaluation and treatment.
(16:43):
I think the thought process isthat some of these chiropractors
are just treating patientsbased on X-ray analysis alone,
without having an MD assess thepatient, do a physical exam,
take a history, get some bloodwork and maybe some high
resolution cross-sectionalimaging in addition to that
(17:03):
management and treatment.
Can you speak to that, dr St?
David Saint, DC (17:06):
Yeah, well, the first thing is how the dynamics
of what we have is the teamapproach and again being able to
work hand in hand specificallywith our spine orthopedist, that
we have Dr Paul Boggi, drMichael D'Anezzo, I mean it's
just absolutely wonderful andthey understand what we do as
chiropractors and the benefit ofwhat we have.
(17:28):
I am not a surgeon, I'm notgoing to go in and fix things
and they are wonderful doingthat.
But what can we do on anon-invasive type of care?
And chiropractic has its role.
Chiropractic also has itslimitations and we work and
collaboratively with physicaltherapists.
Chiropractic on our side of thein the Kailh Method, works on
(17:49):
the alignment motion of thespine.
We allow the physical therapistto work on strengthening
because many chiropractors willdo that in their own clinics
when they are just working solo.
But the fact of working togetherand having another set of eyes
is so important.
Myself personally, I've been soeducated by our orthopedic team
(18:10):
on what's going on with thecondition known as a labral tear
of the hip and how oftenthere's an underlying soft
tissue component that'sliterally not even evaluated and
not seen.
It's seen on MRI image but thisgets made time of a patient who
has a chronic back or hip issuewhere there's actually another
component that's going on thathas to be looked at, and it's
(18:32):
something that has been a realeye-opener since I've joined the
Kailh team here.
Robert A. Kayal, MD, (18:36):
Absolutely , dr St.
You referenced before a littlebit about how you work hand in
hand with our physical therapist.
Can you elaborate on that alittle bit more?
What patients get seen bychiropractors, which patients
get seen by physical therapists,and how does each specialty
contribute to the overallwellness and well-being of our
patients?
David Saint, DC (18:57):
Well, the dynamic that we have in our
practice is that the fact thatwe are in the same location
together and, of course, ourphysical therapists are experts
when it comes to extremities,they're working hand in hand
with the orthopedist.
However, very often anextremity problem is causing
another spine problem that'sunderlying, and the fact of, for
(19:18):
instance, when patients come inhere with whether it's foot,
knee, hip issues, that they'rehaving an underlying gait issue
that's affecting their lowerback.
So working collaboratively withthem is so important because I
can address the alignment side.
They're going to handle themuscle end and then what we do
is work together with atreatment plan of what they do
(19:39):
best and what I do best, andreally marrying them together.
I love it.
Robert A. Kayal, MD, FAAOS, (19:45):
If we refer a patient to you for
chiropractic evaluation and thatpatient is somewhat hesitant,
what advice would you give thatpatient who is considering
chiropractic care and whatshould he or she look for in a
qualified physician?
David Saint, DC (20:00):
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, reviewyour case and maybe put a set of
eyes on it from a differentangle.
And Quite often I would getpatients to say, yes, I'm not
saying we're gonna startchiropractic care, but I like to
discuss more about what I coulddo, possibly, or how I would do
(20:21):
things differently or inadjunct to what care you're
having right now.
In regards to Types ofchiropractors, there are
numerous types of techniquesbased on the school that you go
to.
I'm a big believer that there'snot necessarily one technique
that's better than another, butat that, one technique many
times will work Better with oneindividual than another.
(20:42):
Again, the dynamics that wehave within the kale model is
that we have I don't know howmany 1213 chiropractors or even
more, and there's differentchiropractors within our
organization that offerdifferent types of techniques.
Robert A. Kayal, MD, FAAOS (20:56):
Yeah , I agree with you
wholeheartedly.
I mean it's it's a wonderfulRelationship that we share as we
all assist one another incaring for our patients.
You mentioned before a littlebit about the chemical component
of patients symptoms andinflammation.
How do you employ the usage ofsome Pharmacological agents in
(21:19):
the management of your patientsymptoms?
David Saint, DC (21:22):
Well, again, part of our team is we have an
interventional pain managementteam.
That's wonderful and so manytimes I've had patients that
come into our practice andthey've already been through
medical management.
They've been prescribed ananti-inflammatory, they've been
prescribed a muscle relaxer.
Things may not be reallyworking Well.
They may have started some typeof care, maybe trying things,
(21:42):
you know, doing things on theirown with going to the gym.
Now, with our team here,specifically our interventional
team, it's getting to see wherethe irritation is happening at
the spine.
I'm a big fan of medicationmanagement orally for short-term
basis.
I've, dr Kale, been a patientmyself.
That's why I think I became apretty good doctor.
I've had five knee operations,I've torn my bicep tendon, so
(22:05):
I've had to be not only apatient, have had been on
medical management.
I've had to go through arehabilitative process.
But when it comes to ourinterventional pain management,
what I love about it is thatit's putting medication around
the problem.
It's putting it around thenerve root, around the disc, to
bring inflammation down, whichthen makes my life easier as a
chiropractor, because then it'seasier for me to get motion into
(22:27):
the spine when inflammation isdown by reversing the
inflammation.
Robert A. Kayal, MD, FAAOS, (22:31):
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 inand they're inflamed and we'll
give them a cortisone injectionof some sort.
And the patients are like Well,are you just, you know, masking
the problem?
Well, but in reality we'retreating the problem.
We're treating the inflammationand allowing them to Go to
(22:54):
physical therapy or chiropracticand undergo some treatments to
actually reverse the condition.
So that's just one way that wecan really collaborate with one
another and caring for thesepatients Cortisone injections
locally, oralanti-inflammatories can decrease
inflammation, topical SAVs, butwe're all trying to get Rid of
the inflammation which seems tobe the common culprit in so many
(23:17):
musculoskeletal and and medicalconditions in general.
Dr St, with respect to employingsuch Such technological
advancements that we'vereferenced before, what
modalities do you use in theoffice to help our patients?
I know you spoke a little bitabout the distraction methods.
(23:40):
What other pieces of equipmentdo you use in our different
offices and how do we, each oneof those modalities,
theoretically work to reversepain and inflammation or correct
alignment?
David Saint, DC (23:55):
Well, again, there's different chiropractic
techniques that we talked about.
We actually use differenttables that our goals to do
something a little bit differentwith each of them.
We also use modalities verysimilar that physical therapy
uses.
We use electrical stimulation,which helps with pain as well as
inflammation, but we use a lotof manual, manual, hands-on
(24:15):
techniques and it's importantwith not only working the
muscles, stretching, we'redealing with contraction.
That's happening when you know,many times when I'm looking at
the spine, I'll see a patientand they'll even have a head
tilt to one side.
Well, it's because muscles arecontracted on one side and
elongated on the other, and thegoal that you know with a
chiropractic is to put the bodyback into balance.
(24:38):
And you know these soft tissueTechniques that we use.
Again, many times, patientscome in here and they were
expecting to be twisted like apretzel and there are certain
techniques that we do in orderto align.
But we can do very soft andgentle techniques that are
wonderful.
I Even take care of women thatare pregnant, literally up to
(24:59):
the time of delivery, and peoplesay, geez, how would you do
that?
Well, I have a special tablethat does it takes the pressure
off their belly.
They lay there.
I have patients that say allthe time, can I just stay, like
this doctor say, for a half hour?
I'm so comfortable.
But again, there are so manydifferent things that we can do
and I think it's more importantthat we have to get in front of
(25:20):
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 theright care plan together.
Robert A. Kayal, MD, FAAOS (25:30):
Yeah , and what on that?
No, what should patients expectwhen they see you?
Should they expect immediaterelief?
Is it a gradual improvement?
Is it Typically a short-termcourse of care, a long-term
program that you set up?
What, what?
How can you set theirexpectations?
David Saint, DC (25:47):
Well, first of all, that is individualized for
each patient, of course.
Age of the patient, what we'reseeing with bone structure, is
the bones healthy?
Is there some type of genegeneration?
It's just an alignment issueversus it, or is it a
Discomponent?
Was there a bulging disc orherniated disc?
I will tell patients this If Iwas going to go to the gym and
(26:07):
put on 10 pounds of muscle ortake away 10 pounds of weight,
it takes time, effort andrepetiveness and, on a minimum,
I'm seeing the patient quitefrequently Anywhere between two
to three times a week for thefirst four weeks to get to an
evaluation where we can seewhere we were at that time and
also where we started, and thenseeing okay, what other things
(26:29):
do we need to incorporate intotheir care plan?
So it's a that's a verydifficult question out there.
Robert A. Kayal, MD, FAAOS, F (26:35):
I have had patients I've only had
to see a few times, and thenthere's patients in my clinic
for literally six months andthen there's patients that you
will see once and Immediatelyrefer the patient out to someone
like our spine surgeon, thatfor an emergency spine surgery
to.
I mean, that's that's what we'retalking about where our
chiropractors have the wisdomand discernment To, to recognize
(26:59):
their limitations and to knowwhen something is an outlier,
when we're dealing with apatient that is not
appropriately managed inchiropractic care, and and
that's where we only Employeechiropractors that have that
experience, wisdom, knowledgeand expertise to know when he or
(27:20):
she Needs to refer that patientout to an expert for emergency
care.
And so that's that's what we'retalking about, about
collaborating with one another,getting imaging at the
appropriate time, havingsurgeons and specialists at
their beck and call, at theirfingertips, where they can just
immediately schedule thatpatient for an orthopedic
(27:43):
specialty console that same dayfor emergent care, and so that
that's very important, I think,to have that access and to not
misguide that patient thatpotentially can do further harm
by holding on to that patientand allowing them to suffer from
God forbid permanent nervedamage or Miss a tumor or things
(28:06):
like that.
So I think you know, to me thatis the whole comprehensive
package that we offer ourpatients at the Kale Orthopedic
Center I that is so important toemphasize and to replicate.
On that note, dr Singh, can youspeak to chiropractors out
(28:26):
there that may be consideringjoining a facility such as ours
where we deliver that wholepackage, that comprehensive pair
?
How has your alliance with KaleOrthopedic Center joining
forces?
How has that benefited youpersonally, how has it benefited
you professionally and, mostimportantly, how has it
(28:49):
benefited our patients?
David Saint, DC (28:51):
Well, let me just go back a little bit in
history, and I said before thatI've been a patient myself and
unfortunately, tearing my ACLthree times it is possible and
having to be under physicaltherapy care for all those years
.
I wanted to create myself aprofessional office that had
chiropractic and physicaltherapy, so I did that for many
years and then I incorporatedmedical into my team and for
(29:14):
this past year, dr Kale, Ijoined your team because not
only what you have, but you haveso much all these different
services and being able to worktogether and being able to get
things done immediately.
That is one of the dynamics ofwhat we have seeing patients
same day and if it's not sameday, it's the next day, and
we're dealing with a worldthat's so difficult to navigate
(29:37):
around insurance, around theirprotocols, and each insurance
many times has their ownpolicies and procedures.
However, we do the best for thepatient and that's always been
your model Give the best patientcare that we can give, and it's
the dynamic of working with theKale model.
It's just absolutely wonderfuland I was so for years.
(29:58):
I was doing things alone in thepractice and you can go so far
with that and you need to havesupport, and the support
structure that we have here withall these different departments
is just absolutely wonderfuland it's something that makes us
unique.
Some practices have maybe adoctor in their group that can
(30:20):
handle certain things.
We have specialists across theboard and it's just a phenomenal
team that you put together.
Robert A. Kayal, MD, FAAO (30:27):
Thank you, thank you, and we're
honored to have you as part ofthat, dr St.
For sure, are there any thingsthat you'd like to demonstrate
to our patients with respect tosome models, some of the
techniques that you employ, someof the basic anatomy that you
typically deal with on a dailybasis?
Absolutely so, dr St.
What are we?
David Saint, DC (30:46):
looking at here .
So this is the lumbar spine.
We have five lumbar vertebrae.
In between each of thevertebrae we have a cushion
known as a spinal disc.
So that's the lower back.
This is the lower back.
This model is showing righthere that we have a red
herniated disc that's actuallycompressing and coming out and
hitting the spinal nerve.
Robert A. Kayal, MD, FAAO (31:05):
Right .
So if we look at this modelfrom the side we're looking at,
this is the sacrum where thetailbone would be down.
Here we have the vertebralbodies l5, l4, l3, l2, l1.
And between the vertebralbodies we have what's called the
intervertebral discs.
And in this particular place,at this disc level, it appears
(31:28):
that there's a disc that is whatwe call herniated.
It's pushed out and it'sputting pressure on that nerve
and that's what we call a discherniation.
And when it puts pressure onthat nerve, that patient will
feel pain and discomfort,numbness and tingling and
potentially weakness along thecourse of that nerve root.
(31:49):
Wherever that nerve root goes,typically down into the buttocks
and down the leg somewhere.
So how are you going to treatthat in chiropractic?
David Saint, DC (31:58):
Dr St Well, with chiropractic, there are
different techniques that we usein the office that are using
our hands free instrumentationas long as our hands adjusting.
However, we also use somethingcalled spinal decompression
therapy, and this is actuallysomething that was designed by
the medical profession, actuallya way of elongating, getting
motion into the spine, and itdoes so by causing negative
(32:21):
pressure.
We use a harness system andliterally we cause a stretching,
pumping mechanism, just likeI'm doing Now.
For this to occur, the patientis actually laying down on their
back.
They're very comfortable.
A session goes for anywherebetween 15 to 20 minutes.
There's a harness system aroundthe stomach as well as a
harness system around the uppertorso, and again, we're causing
(32:44):
this type of motion and veryslowly, very gently, we're
changing the pressure in thatdisc and the goal is for that
disc to literally get suckedback into its normal position,
because it's actually stuck andthe body doesn't want to be
stuck.
The body wants to constantly gothrough a natural healing
ability.
(33:04):
If I cut my skin, I will startto bleed, I'll start to get a
scab.
The body will go through awhole course on getting new skin
.
The same thing wants to happenhere.
Unfortunately, if it can'thappen.
Welcome to the team at Kailor's, the pediatrics that can go in
surgically and repair that, buton a non-invasive, non-surgical
way.
There's a high likelihood thatwe can actually help these
(33:26):
patients as well, All right.
Robert A. Kayal, MD, FAAOS, (33:28):
So the concept is to create a
negative pressure to reduce thatdisc herniation.
By performing that distractiontechnique You're also taking
pressure off the nerve rootsthat are exiting, that are being
compressed in that spinalforamen.
That little hole on the sidebelow every pedicle, right here
there's a nerve root that'sexiting and by causing that
(33:49):
distraction it's opening up thatspinal foramen and
decompressing that nerve.
So hopefully that wouldalleviate the patient's symptoms
.
Is this akin to the DRX9000machine that people use?
David Saint, DC (34:03):
Absolutely.
Now, along with what we do onthe mechanical side, as we
discussed earlier, there's achemical portion to this and I
have found that using ourinterventional pain management
doctors to help you bringinflammation down almost like a
spark plug to an engine startsthe engine that when it dies
it's so inflamed.
(34:23):
If we can get in there and putmedication around that nerve
root, around that facet joint,it just brings it down and then
the body is so much easier toexpand and first to stretch it.
Robert A. Kayal, MD, FAAOS, (34:36):
So we're.
It's a multimodal approach.
We're hitting it from manydifferent angles physical
therapy, chiropractic, oral,anti-inflammatories,
interventional pain managementprocedures.
So it's a multimodal approachto patient care to give the
patient everything we have inour armamentarium to make that
patient better, right?
David Saint, DC (34:54):
Yes, and and I find, doc, which is the best
here is that there's many timesthat I say this a nice way We'll
throw the kitchen sink at thepatient, because the patients
come to us They've already beeneither self-medicating or been
on medications for a longerperiod of time and we'll have to
get more aggressive.
The great news is the majorityof our patients that come in we
can start with a veryconservative approach.
(35:16):
We can start and we can addalong the way if we're not
getting to the certainbenchmarks that we need.
So not every patient needs tocome 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 wecan pivot and that is the
biggest thing that I love aboutworking with a Kail model being
(35:37):
able to pivot, get a test, makea decision, collaborate with
another doctor, and that way thepatient gets the care that they
need immediately, not threemonths down the road.
Robert A. Kayal, MD (35:49):
Beautifully articulated, Dr St.
David Saint, DC (35:51):
Thank you so much so this is the cervical
spine, so this is the back ofour head, this is the skull
right here.
Okay, and we have our cervicalspine, our neck, which is
composed of seven vertebra,along with a cushion in between
each vertebra that allows thespinal nerve to exit as well.
And the model of the neck is soimportant because, due to
(36:12):
injuries, specifically whiplashinjuries and we always assume a
whiplash being an automobileinjury where the head gets
thrown forward and back, but itcan be contact sports, it can be
just slipping down or missing astare or two and, unfortunately
, this curvature of our neck canmany times go straight or
actually go the opposite way.
Robert A. Kayal, MD, FAAOS, (36:33):
So we're normally supposed to be
in that lordotic posture, right,what we call that lordotic
posture, correct.
David Saint, DC (36:39):
Correct and unfortunately, you know, most of
us are on our phones all daylong with the head positioned
down, again working on laptops,the curvature in the neck is
lost.
So we see this on an x-ray, okay, and then also, when necessary,
on an MRI, we can actually seethe spinal cord being affected.
We can see the disc beinginvolved, whether it's a bulge
(36:59):
or herniation, and, of course,the nerve root showing
irritation and inflammation.
So one of the tools that I usein my practice is I use
instrumentation adjusting, whichthis is called the impulse
adjuster, right here, okay, andit has actually a dual function,
it has the dual tip here.
And what we're able to do, doc,is what?
Literally, with the patientgoing face down, we can take
(37:21):
this instrument and it'sactually works very light and it
actually works on speed and wecan literally drive the neck and
bring that neck back into it.
It's normal posture and weliterally, after the adjustment,
what's done?
By palpating the patient.
Beforehand and afterwards,patients can literally feel the
(37:42):
difference of muscles that arerelaxed and many times the range
of motion has actually comeback.
Robert A. Kayal, MD, FAAOS, (37:48):
So what's the mechanism of action
with that impulse adjuster?
David Saint, DC (37:52):
Well, it's life force okay, and by actually
pressing in and giving theimpulses it works on speed, and
by giving speed it's causing thevertebra to jump back and forth
.
So again, what's great aboutthis?
Ligaments and tendons are notbeing really touched at all.
It takes away any type ofcrepitus feeling, so patients
(38:13):
are not going to hear any typeof noise.
Quite often after theadjustment I had patients say to
me that's it.
I said that's it, but you willbe feeling some sortness.
The next day and again, theseare great things and how we can
treat a patient without havingto use our hands.
So it's just wonderful whenpatients have degeneration, some
patients who have even havesome, you know, beginnings of
(38:34):
osteoporosis, because this isagain, it's a very light force
technique.
Robert A. Kayal, MD, FAA (38:38):
That's beautiful.
Thank you for thatdemonstration.
And just to clarify when yousay light force, you're talking
about force that is gentle,correct?
We're not talking about lightas an ultraviolet rays light
force correct, correct, allright.
So we're talking about gentleforce, because I know you meant
you mentioned light forcethroughout this podcast and I
(39:01):
just wanted to clarify for ourlistening and viewing audience.
Speaking of light, I do knowthat some of our providers
employ light energy as well.
One particular example is theMLS laser, the robotic laser
machine that we have in ouroffices, where essentially, it
(39:23):
utilizes two differentwavelengths of light energy.
One of those wavelengths is todecrease pain and one of the
other wavelengths is to decreaseinflammation.
So by decreasing inflammationand increasing blood flow to the
region, in addition to workingon the nerve fibers that sense
(39:44):
pain, we're also able toalleviate some pain and
discomfort, as well asinflammation, and promote
healing by increasing blood flowwith the usage of the MLS laser
light energy techniques.
So that's just something elsethat we perform at our
facilities as well.
So any closing words that you'dlike to leave this podcast with
(40:11):
Dr Singh.
David Saint, DC (40:12):
Well.
Again, thank you so much forhaving me, and if patients have
specific questions the one thatthey can always reach out I
would love to sit down anddiscuss things with them and
understand that chiropracticcould be a great benefit to
their care and to their entirewell-being.
But again, it has to beassessed properly and seen what
(40:34):
they have.
If I can even possibly help,them Well.
Robert A. Kayal, MD, FAAO (40:37):
Thank you so much, dr Singh.
It's really been such a pleasureworking with you and having you
as part of the Kale OrthopedicCenter.
Your patients just adore you.
You've been so helpful incaring for our patients and, as
far as I'm concerned, it's abeautiful compliment to our
practice, adding thechiropractic services but not
(40:59):
only chiropractic all the otherservices that Dr Singh mentioned
, the acupuncture, the physicaltherapy, and the holistic
approach we have to patient careas well.
Conservative management issomething that we definitely
hope for for our patients and tomanage their symptoms entirely
(41:21):
with, but unfortunately,sometimes they will require
something more invasive, and wehave that as well.
Our main goal is to take careof the patient and just get them
better as fast as possible, asquickly as possible, so that
they can enjoy the quality oflife that they all deserve, and
so thank you so much forspending some time with me this
morning, and I hope that ourviewing and listening audience
(41:44):
has found this to be helpful andthat they will entrust our
chiropractors to help deliverthe best musculoskeletal care to
aid in their recovery.
Hello and welcome to another edition
of the Kale Ortho Podcast.
Today is February 20th, 2024.
And today our special guest isDr David St.
Dr David St is the ChiefChiropractor and Clinical
Director of two of the KaleOrthopedic Centers Chiropractic
Facilities one in Montvale andone in Stony Point, new York.
(00:22):
Welcome to the podcast.
Thank you so much, dr Kale.
So happy to have you, dr St.
So today we're going to speakwith Dr St about the field of
chiropractics in general, someof the latest advancements in
the field of chiropractics andhow we can use that specialty to
assist us in taking care of ourpatients suffering from
(00:43):
musculoskeletal injuries.
So, dr St, first and foremost,why don't you just take this
opportunity to teach our viewingand listening audience a little
bit about yourself?
Tell us you know where you grewup and how you got into the
field of medicine in general.
David Saint, DC (00:57):
Well, thank you .
Well, thank you, dr Kale.
I grew up in Rivervale, newJersey, attended Don Bosco Prep,
went on to play football atLafayette College and got my
Doctor of Chiropractic at LifeUniversity in Atlanta, georgia.
I've been fortunate to bearound chiropractic my whole
life because my father, who'sstill in a chiropractor at 83
(01:18):
years young, and for myself itwas an eye-opening experience on
there.
Forget one day when I was nineyears old and I opened the front
door and this gentleman wasstanding there holding his
X-rays.
His name was George Martin andhe was a defensive end for the
New York Giants and his careerhad been considered completely
over and he was referred to myfather.
We had a home office and hesaid could I see your father?
(01:42):
And I said, absolutely so, Iget that.
This gentleman's at the frontdoor.
Well, six weeks later Mr Martinwas back on the football field
and from there his careercontinued to thrive.
He became MVP of Super Bowlagainst the Denver Broncos.
So I got to see my fatherworking and literally
transforming people's livesthrough his career, and I knew
(02:02):
it.
I wanted to help people and Itold my father when I was at
Lafayette.
I said I want to become achiropractor, and here I am now
going on a 27 years in practice.
Well, what an inspiration.
Robert A. Kayal, MD, FAA (02:12):
That's a great story.
So when we talk about the fieldof chiropractics in general, Dr
St, what are some commonmisconceptions people have about
chiropractic care in generaland how do you address them in
your practice.
David Saint, DC (02:26):
Well, one of the things I hear all the time
is that, well, if I go to achiropractor once, I have to go
to the chiropractor for the restof my life.
And my answer to that is well,you should have your spine
checked for the rest of yourlife.
We brush our teeth on a regularbasis, we continue to floss and
do dental hygiene and go seeour dentist, sometimes every six
months or once a year.
Most people don't even knowwhat to do for their spine.
(02:49):
They say, well, I just do somestretching, I drink some water.
But what we've now found out isit's about keeping the body in
alignment, it's keeping ourmuscles strong, our core muscles
, and most patients have to beeducated.
They don't know necessarilywhat to do, and I find that part
of the visit is not just takingcare of the patient, but it's
also educating the patientsRight.
Robert A. Kayal, MD, FAAOS (03:10):
Well , on that note, can you just
sort of describe the generalprinciples of chiropractic care
and how they contribute to one'swell-being.
David Saint, DC (03:19):
Sure Well, chiropractic is premised off
that the central nervous systemcontrols everything in the body.
Most people are unaware thatonce a sperm and egg come
together, the first thing thatis formed is actually the spinal
cord and the brain.
And spinal cord controls everysingle function Around.
The spinal cord is the hardestthing that we have, and that's
(03:39):
bone to protect it, and betweenthose bones are nerves that exit
and they go to every tissue,organ, cell, and the goal of
chiropractic is to increasenerve flow.
We want to make sure that thebody is in balance, that proper
nerve flow is happening, so thatnot only to muscles but as well
as to organs.
So we look at the alignment ofthe spine and we look for areas
(04:00):
of the spine that are lackingmotion and we put motion back
into the body Great and what aresome of the common conditions
that a chiropractor willtypically see and treat on a
daily basis?
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 canhappen in the neck headaches.
(04:21):
There can also be symptoms thatgo down into the arms and the
legs.
People have heard of the termsciatica, which is leg pain.
We've also had pain thatradiates down the arms and those
are typically severe irritationto the nerve roots.
Robert A. Kayal, MD, FAAOS, (04:34):
How do you individualize a
treatment plan for patientsbased on their specific needs?
David Saint, DC (04:40):
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'reexperiencing.
From that history we go into anexamination.
We're actually palpating andtouching the patient, putting
the patient through some rangeof motions, do some orthopedic
tests as well.
(05:00):
We also test on neurologicalpackages, which are parts of the
skin, to see how the patient isfeeling, are they sensitive and
can they actually have goodstrength.
From there we go in and we alsotake x-rays.
Diagnostic films and diagnostictests are so important.
First of all, looking at anx-ray, we just want to see the
healthiness of the bones, or isthere any type of degeneration?
(05:23):
Are the bones healthy?
Are there possibly even thesigns of even osteoporosis,
starting to begin From thex-rays we also look at alignment
, looking at one joint versusthe other.
From the x-ray, many timeswe'll be ordering MRIs, because
x-ray shows bone, mri shows softtissue and by marrying those
two tests together we many timeswill get a clear indication of
(05:46):
what's happening to the entirespine itself.
Robert A. Kayal, MD, FAAOS (05:50):
Does chiropractic play a role in
preventative health care?
David Saint, DC (05:54):
Yes, First and foremost is that if the spine is
not in the correct alignedposition, 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 willcontract and the body will just
be vulnerable, many timesvulnerable to an injury, to a
(06:15):
twist, a turn.
Quite common I mean literallyevery day I have a patient come
in and says Dr St, I don't knowwhat I did, I just turned a
certain way, I just went downand tied my shoe and I couldn't
get up.
And by the time that motion orthat 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
(06:39):
beforehand.
Robert A. Kayal, MD, FAAOS, (06:41):
How can chiropractic be utilized to
complement other wellnessservices?
David Saint, DC (06:47):
Well, one of the biggest things that I love
in our practice and what weoffer is acupuncture.
Acupuncture is just known tohelp with inflammation, help
with pain, and what we find isthat when patients come into our
practice Dr Kale, patients comein with two problems we're
having a chemical problem andwe're having a mechanical and
(07:08):
patients come in I ask them painscale one to 10, how are you
feeling?
10 being the worst pain?
And that basically tells usthat there's inflammation going
on.
So something like acupuncturehelps bring inflammation down
naturally and that's just one ofthe tools that we use, along
with our medical side ofmedically managing that
patient's problem.
Robert A. Kayal, MD, FAAOS, (07:29):
Are there other specific exercises
or lifestyle modifications thatyou also employ to ensure that
patients benefit the most fromyour chiropractic services?
David Saint, DC (07:40):
Absolutely.
One of the things that we talkabout during our case of review
with a patient is finding outwhat they do occupationally and
unfortunately we're dealing withpatients, now more than ever,
working from home.
I'm finding, specificallyduring the pandemic, patients
did not have the properworkstations.
We're working on their laptop.
I would ask them where are youusing the laptop?
Oh, I'm sitting on the couch,so we called it.
(08:02):
You know computeritis, wherethe head be forward, changing
posture, and what happens isthat people's core muscles, you
know repetitively they're notbeing worked on and when you
have muscle fatigue, all themuscles control and support the
spine.
So it's just turned into awhole effect of looking at about
how the body is workingcollectively.
Robert A. Kayal, MD, FAAOS (08:23):
What are some of the recent
advancements and technologiesthat you've experienced recently
in the field of chiropractics,and how have you employed them
and how have they benefited yourpatients?
David Saint, DC (08:35):
Absolutely so there are so many chiropractic
techniques I mean I believethere are over 70 of them.
For myself, I use about 18different techniques themselves,
but two of the techniques thatwe use in our clinic.
One is what I call hands freeinstrumentation, adjusting.
It's dynamic there whenpatients are seen.
Many times patients areconcerned about quote unquote
(08:58):
getting cracked, hearing sometype of audible noises, and we
use instrumentation where thereis no noise whatsoever.
It's light force and mostpatients when they get off the
table they go wow, they were.
They couldn't believe theexperience of having something
like that.
Another wonderful techniquethat we use in our Montville
location is spinal decompressiontherapy.
(09:19):
It's a light force, non audiblestretching mechanism of
decompressing the spine to getmotion into the joint space, and
it's just a wonderful tool thatis able to help patients who
are suffering from back issues,facet injuries, bulging,
herniated discs and it's anotheralternative that we use when
(09:40):
necessary.
Robert A. Kayal, MD, FAAOS, (09:41):
And with respect to maintaining
current in your field and thetechnological advancements that
we've discussed.
How important is ongoingeducation and training in the
field of chiropractic to ensurethat you deliver the latest and
greatest techniques to ourpatients Well, first, and
foremost, not only ourprofession but our state.
David Saint, DC (10:01):
It's mandated that we do continuing education
within the state of New Jerseyand also state of New York and,
a matter of fact, every state inthe country, and it's a
wonderful tool because it allowsus to hear also not only the
research but also learn newthings that are happening out in
the field on a continuing basis.
So we do a minimum of 30 hoursevery two years here in New
(10:22):
Jersey.
Robert A. Kayal, MD, FAA (10:23):
That's great.
That's great to know.
Well, as you know, I'm anallopathic physician, orthopedic
surgeon, and you as achiropractic physician.
We have different approaches topatient care.
Many allopathic physicians haveconsidered the field of
(10:45):
chiropractic in general to besomewhat taboo.
As you know, I, at the KaleOrthopedic Center, have embraced
the field for over 25 years now.
To me, it is exceptionallyimportant to collaborate with
others as we continue to carefor our patients.
Each one of us brings our ownskill set to the table in caring
(11:08):
for the patients.
How can you discuss for ourviewing and listening audience
how we have collaborated withone another, not only in the
field of orthopedics but at KaleOrthopedic Center in general,
with other specialties likepodiatry and rheumatology and
interventional pain management,and even our board-certified
(11:29):
fellowship trainedmusculoskeletal radiologists and
neuroradiologists?
David Saint, DC (11:34):
So often when I see patients now over the years
coming in and happened just theother day.
A patient comes in with chroniclower back pain and first and
foremost obviously do anexamination and taking updated
x-rays, but not only looking atthe back but looking at the
entire person, and I startedasking questions about their
feet and brought us some, youknow, questions about what they
(11:58):
are feeling, what they can do,what they can't do, and turns
out there was some irritationdown there that led me to some
type of examination of the footat that moment and that patient
is going to see our podiatryteam because I'm concerned with
the alignment of the feet thatare the foundation for the spine
, along with it finding out thepatient is having chronic pain
(12:19):
for years and we're going to getthat patient over to our
rheumatology department becauseof there's inflammation.
We want to see what thoseinflammation markers are.
The goal that I want to do isnot just bring chiropractic of
the spine to the patient, but Iwant to make sure that and we
rule things out and that is theimportance of not just our
diagnostic test but also usingour medical team and that's why
(12:43):
it works hand in hand and thepatients that I see all see our
medical team and we see thepatient as a whole person.
Robert A. Kayal, MD, FAAOS, (12:49):
And , as you know, oftentimes the
chiropractors are thegatekeepers into the healthcare
system.
Patients trust theirchiropractors.
They see their chiropractorsfirst, often before even seeing
their primary care physicians.
They go to their chiropractorsfor headaches and jaw pain and
(13:10):
arm pain and hip pain and legpain.
As the gatekeeper of patientcare, oftentimes that
chiropractor can be incrediblyinstrumental and influential in
making that patient better andgetting that patient in the
right hands.
How do you first assess apatient and make those
(13:32):
determinations in the office, drSt Well, again, the clinical
history, speaking with thepatient finding out.
David Saint, DC (13:40):
I always ask the patients when was your most
recent accident or injury?
And patients look at me firstand I said you know, have you
had a car accident in the lastthree months, six months, even
about back to two years?
And how often patients thinkthat the injuries that they've
had have been a small thing.
And those injuries have nowcomplicated and they've been
(14:01):
basically a snowball that's justgetting bigger and bigger.
So, again, working with ourteam and ruling things out is so
important.
And back to the diagnostic testthat we use in the Kale model
here, the fact that we can notonly take x-rays on site
digitally, we see themimmediately.
Number one, number two we canget another opinion of reading
(14:24):
those x-rays right away.
How many times I'm looking atx-ray?
Can I get another opinion?
Get right on the phone to oneof our orthopedias.
Can you do me favor, can youlook at this?
What do you see?
I see this here and that justgives me comfort and just knows
that the patient is also gettingthe best care.
Then, of course, what we doin-house with our MRIs and using
CAT scans and our bone densitytesting that we're able to do
(14:47):
these things literallyimmediately, and this is unheard
of in today's world ofinsurance.
Robert A. Kayal, MD, FAAOS (14:53):
Yeah , I think, just going back to
what I was talking about, abouthow a lot of doctors consider
the field of chiropractic to besomewhat taboo.
I think it's not necessarilybecause of the field of
chiropractic in general or whatyou do for our patients.
It's the reputation,unfortunately, in the community
(15:14):
that has been formed over theyears, where there's essentially
the thought process that a lotof the chiropractors just hold
on to their patients.
Sometimes things get missed andsometimes those things are bad
things like tumors, cancers etc.
Like that, not having thewisdom or the discernment
sometimes to refer the patientout of the practice.
A lot of the chiropractors ingeneral have developed a
(15:37):
reputation that they tend tohold on to their patients.
They'll often see their patientsthree times a week for years
just for what they callmaintenance, and all of us have
seen patients over the yearslike that, that have seen
chiropractors for years andunfortunately some bad things
(15:58):
have been missed.
So, speaking of that, speak tothe benefits of being in an
organization where you haveaccess to medical doctors of all
different musculoskeletalspecialties and advanced
cross-sectional medical imagingat your beck and call, at your
fingertips, to ensure thatnothing gets missed.
(16:22):
It's not the field ofchiropractics necessarily that
most MDs have an issue with.
It's the concern that manychiropractors unfortunately did
not have, or do not have, thewisdom or discernment as to when
they should refer patients outto an MD to get further
evaluation and treatment.
(16:43):
I think the thought process isthat some of these chiropractors
are just treating patientsbased on X-ray analysis alone,
without having an MD assess thepatient, do a physical exam,
take a history, get some bloodwork and maybe some high
resolution cross-sectionalimaging in addition to that
(17:03):
management and treatment.
Can you speak to that, dr St?
David Saint, DC (17:06):
Yeah, well, the first thing is how the dynamics
of what we have is the teamapproach and again being able to
work hand in hand specificallywith our spine orthopedist, that
we have Dr Paul Boggi, drMichael D'Anezzo, I mean it's
just absolutely wonderful andthey understand what we do as
chiropractors and the benefit ofwhat we have.
(17:28):
I am not a surgeon, I'm notgoing to go in and fix things
and they are wonderful doingthat.
But what can we do on anon-invasive type of care?
And chiropractic has its role.
Chiropractic also has itslimitations and we work and
collaboratively with physicaltherapists.
Chiropractic on our side of thein the Kailh Method, works on
(17:49):
the alignment motion of thespine.
We allow the physical therapistto work on strengthening
because many chiropractors willdo that in their own clinics
when they are just working solo.
But the fact of working togetherand having another set of eyes
is so important.
Myself personally, I've been soeducated by our orthopedic team
(18:10):
on what's going on with thecondition known as a labral tear
of the hip and how oftenthere's an underlying soft
tissue component that'sliterally not even evaluated and
not seen.
It's seen on MRI image but thisgets made time of a patient who
has a chronic back or hip issuewhere there's actually another
component that's going on thathas to be looked at, and it's
(18:32):
something that has been a realeye-opener since I've joined the
Kailh team here.
Robert A. Kayal, MD, (18:36):
Absolutely , dr St.
You referenced before a littlebit about how you work hand in
hand with our physical therapist.
Can you elaborate on that alittle bit more?
What patients get seen bychiropractors, which patients
get seen by physical therapists,and how does each specialty
contribute to the overallwellness and well-being of our
patients?
David Saint, DC (18:57):
Well, the dynamic that we have in our
practice is that the fact thatwe are in the same location
together and, of course, ourphysical therapists are experts
when it comes to extremities,they're working hand in hand
with the orthopedist.
However, very often anextremity problem is causing
another spine problem that'sunderlying, and the fact of, for
(19:18):
instance, when patients come inhere with whether it's foot,
knee, hip issues, that they'rehaving an underlying gait issue
that's affecting their lowerback.
So working collaboratively withthem is so important because I
can address the alignment side.
They're going to handle themuscle end and then what we do
is work together with atreatment plan of what they do
(19:39):
best and what I do best, andreally marrying them together.
I love it.
Robert A. Kayal, MD, FAAOS, (19:45):
If we refer a patient to you for
chiropractic evaluation and thatpatient is somewhat hesitant,
what advice would you give thatpatient who is considering
chiropractic care and whatshould he or she look for in a
qualified physician?
David Saint, DC (20:00):
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, reviewyour case and maybe put a set of
eyes on it from a differentangle.
And Quite often I would getpatients to say, yes, I'm not
saying we're gonna startchiropractic care, but I like to
discuss more about what I coulddo, possibly, or how I would do
(20:21):
things differently or inadjunct to what care you're
having right now.
In regards to Types ofchiropractors, there are
numerous types of techniquesbased on the school that you go
to.
I'm a big believer that there'snot necessarily one technique
that's better than another, butat that, one technique many
times will work Better with oneindividual than another.
(20:42):
Again, the dynamics that wehave within the kale model is
that we have I don't know howmany 1213 chiropractors or even
more, and there's differentchiropractors within our
organization that offerdifferent types of techniques.
Robert A. Kayal, MD, FAAOS (20:56):
Yeah , I agree with you
wholeheartedly.
I mean it's it's a wonderfulRelationship that we share as we
all assist one another incaring for our patients.
You mentioned before a littlebit about the chemical component
of patients symptoms andinflammation.
How do you employ the usage ofsome Pharmacological agents in
(21:19):
the management of your patientsymptoms?
David Saint, DC (21:22):
Well, again, part of our team is we have an
interventional pain managementteam.
That's wonderful and so manytimes I've had patients that
come into our practice andthey've already been through
medical management.
They've been prescribed ananti-inflammatory, they've been
prescribed a muscle relaxer.
Things may not be reallyworking Well.
They may have started some typeof care, maybe trying things,
(21:42):
you know, doing things on theirown with going to the gym.
Now, with our team here,specifically our interventional
team, it's getting to see wherethe irritation is happening at
the spine.
I'm a big fan of medicationmanagement orally for short-term
basis.
I've, dr Kale, been a patientmyself.
That's why I think I became apretty good doctor.
I've had five knee operations,I've torn my bicep tendon, so
(22:05):
I've had to be not only apatient, have had been on
medical management.
I've had to go through arehabilitative process.
But when it comes to ourinterventional pain management,
what I love about it is thatit's putting medication around
the problem.
It's putting it around thenerve root, around the disc, to
bring inflammation down, whichthen makes my life easier as a
chiropractor, because then it'seasier for me to get motion into
(22:27):
the spine when inflammation isdown by reversing the
inflammation.
Robert A. Kayal, MD, FAAOS, (22:31):
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 inand they're inflamed and we'll
give them a cortisone injectionof some sort.
And the patients are like Well,are you just, you know, masking
the problem?
Well, but in reality we'retreating the problem.
We're treating the inflammationand allowing them to Go to
(22:54):
physical therapy or chiropracticand undergo some treatments to
actually reverse the condition.
So that's just one way that wecan really collaborate with one
another and caring for thesepatients Cortisone injections
locally, oralanti-inflammatories can decrease
inflammation, topical SAVs, butwe're all trying to get Rid of
the inflammation which seems tobe the common culprit in so many
(23:17):
musculoskeletal and and medicalconditions in general.
Dr St, with respect to employingsuch Such technological
advancements that we'vereferenced before, what
modalities do you use in theoffice to help our patients?
I know you spoke a little bitabout the distraction methods.
(23:40):
What other pieces of equipmentdo you use in our different
offices and how do we, each oneof those modalities,
theoretically work to reversepain and inflammation or correct
alignment?
David Saint, DC (23:55):
Well, again, there's different chiropractic
techniques that we talked about.
We actually use differenttables that our goals to do
something a little bit differentwith each of them.
We also use modalities verysimilar that physical therapy
uses.
We use electrical stimulation,which helps with pain as well as
inflammation, but we use a lotof manual, manual, hands-on
(24:15):
techniques and it's importantwith not only working the
muscles, stretching, we'redealing with contraction.
That's happening when you know,many times when I'm looking at
the spine, I'll see a patientand they'll even have a head
tilt to one side.
Well, it's because muscles arecontracted on one side and
elongated on the other, and thegoal that you know with a
chiropractic is to put the bodyback into balance.
(24:38):
And you know these soft tissueTechniques that we use.
Again, many times, patientscome in here and they were
expecting to be twisted like apretzel and there are certain
techniques that we do in orderto align.
But we can do very soft andgentle techniques that are
wonderful.
I Even take care of women thatare pregnant, literally up to
(24:59):
the time of delivery, and peoplesay, geez, how would you do
that?
Well, I have a special tablethat does it takes the pressure
off their belly.
They lay there.
I have patients that say allthe time, can I just stay, like
this doctor say, for a half hour?
I'm so comfortable.
But again, there are so manydifferent things that we can do
and I think it's more importantthat we have to get in front of
(25:20):
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 theright care plan together.
Robert A. Kayal, MD, FAAOS (25:30):
Yeah , and what on that?
No, what should patients expectwhen they see you?
Should they expect immediaterelief?
Is it a gradual improvement?
Is it Typically a short-termcourse of care, a long-term
program that you set up?
What, what?
How can you set theirexpectations?
David Saint, DC (25:47):
Well, first of all, that is individualized for
each patient, of course.
Age of the patient, what we'reseeing with bone structure, is
the bones healthy?
Is there some type of genegeneration?
It's just an alignment issueversus it, or is it a
Discomponent?
Was there a bulging disc orherniated disc?
I will tell patients this If Iwas going to go to the gym and
(26:07):
put on 10 pounds of muscle ortake away 10 pounds of weight,
it takes time, effort andrepetiveness and, on a minimum,
I'm seeing the patient quitefrequently Anywhere between two
to three times a week for thefirst four weeks to get to an
evaluation where we can seewhere we were at that time and
also where we started, and thenseeing okay, what other things
(26:29):
do we need to incorporate intotheir care plan?
So it's a that's a verydifficult question out there.
Robert A. Kayal, MD, FAAOS, F (26:35):
I have had patients I've only had
to see a few times, and thenthere's patients in my clinic
for literally six months andthen there's patients that you
will see once and Immediatelyrefer the patient out to someone
like our spine surgeon, thatfor an emergency spine surgery
to.
I mean, that's that's what we'retalking about where our
chiropractors have the wisdomand discernment To, to recognize
(26:59):
their limitations and to knowwhen something is an outlier,
when we're dealing with apatient that is not
appropriately managed inchiropractic care, and and
that's where we only Employeechiropractors that have that
experience, wisdom, knowledgeand expertise to know when he or
(27:20):
she Needs to refer that patientout to an expert for emergency
care.
And so that's that's what we'retalking about, about
collaborating with one another,getting imaging at the
appropriate time, havingsurgeons and specialists at
their beck and call, at theirfingertips, where they can just
immediately schedule thatpatient for an orthopedic
(27:43):
specialty console that same dayfor emergent care, and so that
that's very important, I think,to have that access and to not
misguide that patient thatpotentially can do further harm
by holding on to that patientand allowing them to suffer from
God forbid permanent nervedamage or Miss a tumor or things
(28:06):
like that.
So I think you know, to me thatis the whole comprehensive
package that we offer ourpatients at the Kale Orthopedic
Center I that is so important toemphasize and to replicate.
On that note, dr Singh, can youspeak to chiropractors out
(28:26):
there that may be consideringjoining a facility such as ours
where we deliver that wholepackage, that comprehensive pair
?
How has your alliance with KaleOrthopedic Center joining
forces?
How has that benefited youpersonally, how has it benefited
you professionally and, mostimportantly, how has it
(28:49):
benefited our patients?
David Saint, DC (28:51):
Well, let me just go back a little bit in
history, and I said before thatI've been a patient myself and
unfortunately, tearing my ACLthree times it is possible and
having to be under physicaltherapy care for all those years
.
I wanted to create myself aprofessional office that had
chiropractic and physicaltherapy, so I did that for many
years and then I incorporatedmedical into my team and for
(29:14):
this past year, dr Kale, Ijoined your team because not
only what you have, but you haveso much all these different
services and being able to worktogether and being able to get
things done immediately.
That is one of the dynamics ofwhat we have seeing patients
same day and if it's not sameday, it's the next day, and
we're dealing with a worldthat's so difficult to navigate
(29:37):
around insurance, around theirprotocols, and each insurance
many times has their ownpolicies and procedures.
However, we do the best for thepatient and that's always been
your model Give the best patientcare that we can give, and it's
the dynamic of working with theKale model.
It's just absolutely wonderfuland I was so for years.
(29:58):
I was doing things alone in thepractice and you can go so far
with that and you need to havesupport, and the support
structure that we have here withall these different departments
is just absolutely wonderfuland it's something that makes us
unique.
Some practices have maybe adoctor in their group that can
(30:20):
handle certain things.
We have specialists across theboard and it's just a phenomenal
team that you put together.
Robert A. Kayal, MD, FAAO (30:27):
Thank you, thank you, and we're
honored to have you as part ofthat, dr St.
For sure, are there any thingsthat you'd like to demonstrate
to our patients with respect tosome models, some of the
techniques that you employ, someof the basic anatomy that you
typically deal with on a dailybasis?
Absolutely so, dr St.
What are we?
David Saint, DC (30:46):
looking at here .
So this is the lumbar spine.
We have five lumbar vertebrae.
In between each of thevertebrae we have a cushion
known as a spinal disc.
So that's the lower back.
This is the lower back.
This model is showing righthere that we have a red
herniated disc that's actuallycompressing and coming out and
hitting the spinal nerve.
Robert A. Kayal, MD, FAAO (31:05):
Right .
So if we look at this modelfrom the side we're looking at,
this is the sacrum where thetailbone would be down.
Here we have the vertebralbodies l5, l4, l3, l2, l1.
And between the vertebralbodies we have what's called the
intervertebral discs.
And in this particular place,at this disc level, it appears
(31:28):
that there's a disc that is whatwe call herniated.
It's pushed out and it'sputting pressure on that nerve
and that's what we call a discherniation.
And when it puts pressure onthat nerve, that patient will
feel pain and discomfort,numbness and tingling and
potentially weakness along thecourse of that nerve root.
(31:49):
Wherever that nerve root goes,typically down into the buttocks
and down the leg somewhere.
So how are you going to treatthat in chiropractic?
David Saint, DC (31:58):
Dr St Well, with chiropractic, there are
different techniques that we usein the office that are using
our hands free instrumentationas long as our hands adjusting.
However, we also use somethingcalled spinal decompression
therapy, and this is actuallysomething that was designed by
the medical profession, actuallya way of elongating, getting
motion into the spine, and itdoes so by causing negative
(32:21):
pressure.
We use a harness system andliterally we cause a stretching,
pumping mechanism, just likeI'm doing Now.
For this to occur, the patientis actually laying down on their
back.
They're very comfortable.
A session goes for anywherebetween 15 to 20 minutes.
There's a harness system aroundthe stomach as well as a
harness system around the uppertorso, and again, we're causing
(32:44):
this type of motion and veryslowly, very gently, we're
changing the pressure in thatdisc and the goal is for that
disc to literally get suckedback into its normal position,
because it's actually stuck andthe body doesn't want to be
stuck.
The body wants to constantly gothrough a natural healing
ability.
(33:04):
If I cut my skin, I will startto bleed, I'll start to get a
scab.
The body will go through awhole course on getting new skin
.
The same thing wants to happenhere.
Unfortunately, if it can'thappen.
Welcome to the team at Kailor's, the pediatrics that can go in
surgically and repair that, buton a non-invasive, non-surgical
way.
There's a high likelihood thatwe can actually help these
(33:26):
patients as well, All right.
Robert A. Kayal, MD, FAAOS, (33:28):
So the concept is to create a
negative pressure to reduce thatdisc herniation.
By performing that distractiontechnique You're also taking
pressure off the nerve rootsthat are exiting, that are being
compressed in that spinalforamen.
That little hole on the sidebelow every pedicle, right here
there's a nerve root that'sexiting and by causing that
(33:49):
distraction it's opening up thatspinal foramen and
decompressing that nerve.
So hopefully that wouldalleviate the patient's symptoms
.
Is this akin to the DRX9000machine that people use?
David Saint, DC (34:03):
Absolutely.
Now, along with what we do onthe mechanical side, as we
discussed earlier, there's achemical portion to this and I
have found that using ourinterventional pain management
doctors to help you bringinflammation down almost like a
spark plug to an engine startsthe engine that when it dies
it's so inflamed.
(34:23):
If we can get in there and putmedication around that nerve
root, around that facet joint,it just brings it down and then
the body is so much easier toexpand and first to stretch it.
Robert A. Kayal, MD, FAAOS, (34:36):
So we're.
It's a multimodal approach.
We're hitting it from manydifferent angles physical
therapy, chiropractic, oral,anti-inflammatories,
interventional pain managementprocedures.
So it's a multimodal approachto patient care to give the
patient everything we have inour armamentarium to make that
patient better, right?
David Saint, DC (34:54):
Yes, and and I find, doc, which is the best
here is that there's many timesthat I say this a nice way We'll
throw the kitchen sink at thepatient, because the patients
come to us They've already beeneither self-medicating or been
on medications for a longerperiod of time and we'll have to
get more aggressive.
The great news is the majorityof our patients that come in we
can start with a veryconservative approach.
(35:16):
We can start and we can addalong the way if we're not
getting to the certainbenchmarks that we need.
So not every patient needs tocome 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 wecan pivot and that is the
biggest thing that I love aboutworking with a Kail model being
(35:37):
able to pivot, get a test, makea decision, collaborate with
another doctor, and that way thepatient gets the care that they
need immediately, not threemonths down the road.
Robert A. Kayal, MD (35:49):
Beautifully articulated, Dr St.
David Saint, DC (35:51):
Thank you so much so this is the cervical
spine, so this is the back ofour head, this is the skull
right here.
Okay, and we have our cervicalspine, our neck, which is
composed of seven vertebra,along with a cushion in between
each vertebra that allows thespinal nerve to exit as well.
And the model of the neck is soimportant because, due to
(36:12):
injuries, specifically whiplashinjuries and we always assume a
whiplash being an automobileinjury where the head gets
thrown forward and back, but itcan be contact sports, it can be
just slipping down or missing astare or two and, unfortunately
, this curvature of our neck canmany times go straight or
actually go the opposite way.
Robert A. Kayal, MD, FAAOS, (36:33):
So we're normally supposed to be
in that lordotic posture, right,what we call that lordotic
posture, correct.
David Saint, DC (36:39):
Correct and unfortunately, you know, most of
us are on our phones all daylong with the head positioned
down, again working on laptops,the curvature in the neck is
lost.
So we see this on an x-ray, okay, and then also, when necessary,
on an MRI, we can actually seethe spinal cord being affected.
We can see the disc beinginvolved, whether it's a bulge
(36:59):
or herniation, and, of course,the nerve root showing
irritation and inflammation.
So one of the tools that I usein my practice is I use
instrumentation adjusting, whichthis is called the impulse
adjuster, right here, okay, andit has actually a dual function,
it has the dual tip here.
And what we're able to do, doc,is what?
Literally, with the patientgoing face down, we can take
(37:21):
this instrument and it'sactually works very light and it
actually works on speed and wecan literally drive the neck and
bring that neck back into it.
It's normal posture and weliterally, after the adjustment,
what's done?
By palpating the patient.
Beforehand and afterwards,patients can literally feel the
(37:42):
difference of muscles that arerelaxed and many times the range
of motion has actually comeback.
Robert A. Kayal, MD, FAAOS, (37:48):
So what's the mechanism of action
with that impulse adjuster?
David Saint, DC (37:52):
Well, it's life force okay, and by actually
pressing in and giving theimpulses it works on speed, and
by giving speed it's causing thevertebra to jump back and forth
.
So again, what's great aboutthis?
Ligaments and tendons are notbeing really touched at all.
It takes away any type ofcrepitus feeling, so patients
(38:13):
are not going to hear any typeof noise.
Quite often after theadjustment I had patients say to
me that's it.
I said that's it, but you willbe feeling some sortness.
The next day and again, theseare great things and how we can
treat a patient without havingto use our hands.
So it's just wonderful whenpatients have degeneration, some
patients who have even havesome, you know, beginnings of
(38:34):
osteoporosis, because this isagain, it's a very light force
technique.
Robert A. Kayal, MD, FAA (38:38):
That's beautiful.
Thank you for thatdemonstration.
And just to clarify when yousay light force, you're talking
about force that is gentle,correct?
We're not talking about lightas an ultraviolet rays light
force correct, correct, allright.
So we're talking about gentleforce, because I know you meant
you mentioned light forcethroughout this podcast and I
(39:01):
just wanted to clarify for ourlistening and viewing audience.
Speaking of light, I do knowthat some of our providers
employ light energy as well.
One particular example is theMLS laser, the robotic laser
machine that we have in ouroffices, where essentially, it
(39:23):
utilizes two differentwavelengths of light energy.
One of those wavelengths is todecrease pain and one of the
other wavelengths is to decreaseinflammation.
So by decreasing inflammationand increasing blood flow to the
region, in addition to workingon the nerve fibers that sense
(39:44):
pain, we're also able toalleviate some pain and
discomfort, as well asinflammation, and promote
healing by increasing blood flowwith the usage of the MLS laser
light energy techniques.
So that's just something elsethat we perform at our
facilities as well.
So any closing words that you'dlike to leave this podcast with
(40:11):
Dr Singh.
David Saint, DC (40:12):
Well.
Again, thank you so much forhaving me, and if patients have
specific questions the one thatthey can always reach out I
would love to sit down anddiscuss things with them and
understand that chiropracticcould be a great benefit to
their care and to their entirewell-being.
But again, it has to beassessed properly and seen what
(40:34):
they have.
If I can even possibly help,them Well.
Robert A. Kayal, MD, FAAO (40:37):
Thank you so much, dr Singh.
It's really been such a pleasureworking with you and having you
as part of the Kale OrthopedicCenter.
Your patients just adore you.
You've been so helpful incaring for our patients and, as
far as I'm concerned, it's abeautiful compliment to our
practice, adding thechiropractic services but not
(40:59):
only chiropractic all the otherservices that Dr Singh mentioned
, the acupuncture, the physicaltherapy, and the holistic
approach we have to patient careas well.
Conservative management issomething that we definitely
hope for for our patients and tomanage their symptoms entirely
(41:21):
with, but unfortunately,sometimes they will require
something more invasive, and wehave that as well.
Our main goal is to take careof the patient and just get them
better as fast as possible, asquickly as possible, so that
they can enjoy the quality oflife that they all deserve, and
so thank you so much forspending some time with me this
morning, and I hope that ourviewing and listening audience
(41:44):
has found this to be helpful andthat they will entrust our
chiropractors to help deliverthe best musculoskeletal care to
aid in their recovery.
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