On the other side of “The Wall,” taxis waited.  I picked one out of a clump and haggled over the fare. (“It’s fucking hard here man” my driver said, as he demanded an exorbitant price. I bargained it down, all the while assuring him that I could see it was “fucking hard” here). He drove me to my hotel, the Paradise.

“Separation”, “apartheid”, “security”—The Wall has many names depending on which side of it you are on. Whatever one calls it, most would agree on its physical impressiveness: twenty-five feet high, watch towers regularly placed with armed soldiers, and rows of lights to illuminate potential nocturnal “terrorists.” On the Israeli side, the surface appears clean and smooth–like the walls of San Quentin or Folsom prisons. On the Palestinian side, at the edge of the ancient city of Bethlehem, it is covered with political graffiti, testimonial posters, and revolutionary art. In Israel, The Wall speaks of power; in Palestine, of resistance.

After I settled in, my taxi driver took me the few blocks from the hotel into the Deheisheh refugee camp. I saw a group of eight teenage boys with rocks in their hands.   A Palestinian Authority policeman was talking to them. The scent of gunpowder was in the air.  I looked up and saw a burned-out guard tower.  My driver explained that a Palestinian boy had been shot with rubber bullets a few days before by an Israeli Defense Force (IDF) soldier and was now in the hospital. In response, some Palestinians had fire-bombed the tower above. The boys were looking for a place along the wall from which they could safely throw rocks at the Israeli soldiers.  This cat and mouse game had been going on for many hours, the lingering gun smoke its residue.

A few days before I had been strolling on a Tel Aviv beach.  It was a perfect sunset. Golden clouds hung gently over the Mediterranean. Joggers, baby strolling parents, and lovers of every persuasion were savoring the warm winter breeze. Earlier that afternoon I’d walked through the city, enjoying the city’s cafes and Bauhaus architecture, and the beautiful faces of khaki-clad Israeli soldiers; young men and women carrying Uzis in the thick of  bustling rush hour crowds.

From Tel Aviv I took a 45 minute taxi ride to Jerusalem where  I wandered the ancient winding streets.  I went to the Western Wall and watched bar mitzvah after bar mitzvah; young men in full temple regalia, led by marching bands, followed by proud mothers and fathers, all joyously singing the praises of the “One and Only Lord Our God” and celebrating their return to the “promised land.”  Nearby, Muslim prayers blasted from minarets overlooking Al Aksa, the Dome of the Rock, while kneeling pilgrims in the Church of the Holy Sepulchre wept at the Station of the Cross where Jesus was crucified and Roman soldiers gambled for his clothing.

On the West Bank I traveled to places I’d read about in Hebrew school–and in today’s newspapers. I walked through desert canyons to 5th century monasteries built into cliffs where monks still live in tiny cells and pray in silence. In Ramallah I visited Arafat’s tomb. And in Hebron I passed by pimply-faced IDF soldiers guarding the Tomb of the Patriarchs—the biblical burial site of Abraham, Sarah, Isaac, and Leah–and through the cobblestone alleyways of the Muslim quarter, where a thick wire roofing had to be installed to catch the garbage thrown down by Jewish settlers living above the markets where Arab shopkeepers sold freshly butchered meat and olive oil soap.  I saw barriers erected to separate the walking areas of Israelis and Palestinians and a wall spray painted with the words “Gas the Arabs!”

Israel is a sad and beautiful place.  From the lush fields of Galilee to the fig palm groves of the Jordan Valley–and the desert where both Jesus and Moses spoke with God–the magnificence of creation calls out.  At the same time, driving on roads through the occupied territories, I passed bright red signs that warned of the mortal danger facing Israelis who enter Palestinian areas.  I was rarely out of sight of The Wall.  Like a raised scar snaking through the Holy Land, it cast an ominous shadow.

My travel agent in Bethlehem had arranged a visit to one of the settlements that had sprouted in the West Bank since the 1967 war. I wanted to understand why these fellow Jews had come, at great risk, to live in this internationally contested area.

Ardie, the settlement representative, met me and Ayat, my Palestinian guide, outside the compound gates and drove us through the guarded entrance. I was a little nervous, having heard and read so much about these outposts, home to “extremist” settlers. We entered what appeared to be a lovely suburban community, complete with a recreation center, a shopping mall, and a synagogue. There were rows of Mediterranean homes with perfectly manicured lawns and views of Jerusalem in the distance.

We sat in Ardie’s living room. He was an affable, familiar figure; someone I might have grown up with back in Queens. He had come to Israel from Chicago to make aliya, the traditional “ascent” to the Jewish homeland, in 1982, and had lived in this settlement since 1985. He had grown up a secular Jew but had become orthodox over time and was happy to be living in this troubled, but sacred landscape.

As we sipped tea, I watched Ayat squirm while Ardie described Palestinians as foreigners in the West Bank; how they needed to submit to the “fair’ laws of a democratic Israel; how lucky they were to be living in the only democracy in the region. Ardie referred to the West Bank territories as “Samaria and Judea”, the Biblical names for the land; never as Palestine. He claimed he wanted to live peacefully, but separately, from his Arab neighbors.

But it seemed to me that every word he spoke just inflamed old open wounds. I thought about the pain of dispossession that Ayat must have felt; and about the barbed wire and armed soldier we had passed to get into the settlement. I imagined the hate and the fear and the suffering of those living in and outside of those fences. I wondered if this place was a fortress or a prison; and if healing was possible in a world of such separation.

Dr. Ricky Fishman has been a San Francisco based Chiropractor since 1986.  In addition he has led educational tours to many parts of the world since 1989. He will be taking a group to Israel and Palestine in January, 2014.  The trip will be an exploration of both sides of The Wall, with the group moving between Israel and the West Bank.  If interested please email him at ricky@rickyfishman.com for more information

Copyright 2013 Ricky Fishman

MusiCares offers support for musicians in need.  Among other benefits, it helps them pay their rent, subsidizes the cost of medical services, and provides free support groups for musicians who are dealing with staying clean and sober.   

As a bass player I go to NAMM to check out the latest gear.  I especially love playing with the beautiful handcrafted basses, guitars, and boutique amplifiers.  As a chiropractic ergonomist, I enjoy observing the equipment modifications made over the past year to minimize the physical wear and tear on musicians bodies.

Finally, as a doctor I volunteer in the MusiCares booth so I can answer the questions of musicians who are dealing with pain.  I advise them about proper exercises and stretches.  I recommend appropriate treatment modalities to address their complaints.  And I provide reassurance that there is a lot they can do to heal themselves.  MusiCares, essentially, lets musicians know that they are not alone; that such healing is possible.

This year, like last, I anticipated writing an article about the industry’s latest ergonomic innovations.  I saw wonderful light weight guitars, amps, and drum hardware.  I saw improved gig bags with chest and waist supports.  I saw core stabilizing piano benches.  There were many advances that excited my attention.  But on this visit, to my surprise, it was the MusiCares story itself that drew me in.

During my hours in the MusiCares booth, I spent a good deal of time talking to older players: mostly rockers in their 50’s and 60’s.  These were players who have been on the road for decades. Some have gone from playing in dive bars to filling stadiums; from traveling in vans and living on Cheetos to cruising in luxury tour buses and sleeping in five star hotels. Some of them are now back in the dives and the vans—but all remain dedicated to their music.

And all feel the cumulative physical and emotional effects of the rock and roll life.  I spoke to the lead singer of one well known punk band who told me how he had collapsed on stage during a set, a fully blown (herniated) lumbar disc leaving him without feeling in his legs, his back in fiery pain.  Emergency surgery in a Hamburg hospital followed. His health insurance “provider” in the US (to which he had been paying premiums for fifteen years) denied payment of the 6000 Euros (about $9000 US at the time) as the surgery was performed without prior authorization.

I spoke to another player who’d recently turned fifty.  The previous year he’d been playing an arena show when, in the middle of a thrashing windmill chord (a la Pete Townsend), he felt a sharp twinge in his neck; then a bolt of electricity shot into his right arm.  He powered through the set, but the next morning he couldn’t get out of bed.  Somehow he made it through the tour, but afterward he hobbled home–unable to work for months.  He had no health insurance.

I also talked to young players; guys in their twenties; the “invincible” ones.  From gig to gig, fueled by burgers, chips, adderall, and beer, they madly pound drum kits and crowd surf.  They haul their own gear onstage and off.  Sleep is an afterthought.  The early signs of wear are already showing on these young warriors: constant low grade pain, an occasional spasm.  But they accept these tweaks as “normal”: obligatory battle scars on the long crusade to fame and fortune.

Others just came by to sit and talk, and to thank MusiCares for the help it has given to them or their friends; for the money to get the customized hearing protection, for the psychologist referral, or for just being there when no one else was.

I realized then and there that NAMM is far more than a trade show. NAMM is a gathering of kindred spirits.  It’s an annual meeting of the tribe; a place where we can all come together after another year spent pursuing the holy musical grails of rock and roll, country, jazz, and classical.

Staffing that MusiCares booth with my fellow musician/healers–social workers, addiction specialists, administrative support staff–I felt like part of an ancient shamanic priesthood, serving the needs of our troubadour family.

Musicians are called to make music because of the joy it brings to them and those around them. But few of those players recognize the toll that this path can take.  When more dreams have been lost than have been fulfilled; when the adoration of the crowds has waned; or when the sheer physical duress of the working musicians life fully demands attention, there is a need to heal. And from the alchemical blend of music, open listening, therapeutic wisdom, communion and love, such healing arises.

NAMM provides the meeting ground for this process; MusiCares, the healing space.

Dr. Ricky Fishman, the Director of Musicians Chiropractic Project, has been a San Francisco based chiropractor and performing electric bass layer for over twenty-five years.  His goal is to help maximize potential by minimizing pain and dysfunction.  He believes that music is a fundamental part of the human experience and musicians should be valued and supported for providing this to us all.

Copyright 2013 Ricky Fishman

But what exactly is mindfulness?

According to Jon Kabat-Zinn, a well known expert in the field, “mindfulness means paying attention in a particular way; on purpose, in the present moment, and nonjudgmentally.” In this mental state, one can release one’s mind from the weight of past actions and thoughts as well as from worries about the future. Each person can experience  life fully and deeply, right now.

Historical Origins

Twenty five hundred years ago, an Indian Prince named Siddhartha Gautama left the protected confines of his palace, seeking answers to his most profound questions about life.  Why do we get sick and die? What is the nature of joy and happiness, of sorrow and pain? Who are we? How should we live?

At his moment of enlightenment, Siddhartha realized that life itself was suffering, and that this suffering had a cause. The cause, he saw, was rooted in our attachment to transient things.  But he also realized suffering could be eased by following what he called the “middle path.”  This was a way of living between the extremes of excessive self-indulgence (hedonism) and excessive self-denial (asceticism).

These were the Four Noble Truths and became the foundation of the religion known as Buddhism (after the Sanskrit word buddha, or “enlightened one”).

One method used to achieve this detachment is meditation. By focusing upon one’s breath, a ritual phrase (called a mantra), or musical notes, a person can release him or herself from the ego attachments that keep us trapped in the ongoing state of suffering that Buddha described. With practice, the relentless chatter in our heads–“monkey mind”– begins to slow down.  One can breathe into the silent spaces between words, achieving a state of peaceful calm.

But Buddhism is more than just the resolution of suffering through meditative contemplation.  Buddhism is also a religion, replete with gods, dogma and a doctrine reincarnation; a religion where people spin prayer wheels, carry mallas of prayer beads, and worship relics believed to be the hair and teeth of the historical Buddha.

As the religion moved through space and time, it absorbed the characteristics of the tribes and countries it entered.  The teachings of Siddhartha, also known as the Buddha, eventually spread south and east to Burma, Thailand, Sri Lanka, Cambodia, and Laos.  Carried by itinerant teachers, it took root in Tibet, China, Korea, and Japan.

Along with focusing on Siddhartha himself, many Buddhist centers began to include worship of bodhisatvas: enlightened beings (often considered saints) who refuse release from the cycle of birth, death and re-birth, choosing instead to be reborn again and again until all sentient beings are liberated from suffering.  The fundamental tenets of the Buddha’s original teachings, however, always remained at the center of these variations.

During the 1950s and 1960s, Buddhism washed ashore in America. The ancient religion found fertile ground in a country receptive to fresh ideas. Material prosperity and stifling conventionality pushed many in the young generation to search for new sources of meaning in a world where the good life was defined by material success. At the same time, the Vietnam War raged on, further undermining faith in western modes of thought and action. Restless, youthful eyes were turned eastward.

And from the far east came waves of smiling Buddhist monks, ancient texts in hand. They opened up institutes, meditation centers, and printing presses to spread the word.

The Science Buddha

Among them was the affable Dalai Lama.  Fascinated by science, he presented Tibetan Buddhism as a belief system that could provide spiritual satisfaction, while it satisfied scientific rationality.

The Dalai Lama and his cadre of monks and nuns calmly submitted to a battery of evaluative tests.  These included electroencephalograms (EEGs), fMRI’s, and blood draws to monitor their serotonin and dopamine levels as they moved from ordinary consciousness into deep meditative states.

The possible health benefits of these practices for the general population were duly noted:  lowered blood pressure, improved sleep, and the relief of anxiety. In combination with proper diet and exercise, heart disease could be slowed down and even reversed.

The marriage of science and Buddhism provided the legitimacy needed to allow an ancient religion to become fully modern.  Buddhism was embraced by spiritual seekers and scientific alike.  It was this evolution that gave rise to the mindfulness movement.

Bait and/or Switch?

Though one cannot be a Buddhist without practicing mindfulness, one can certainly practice mindfulness without being Buddhist. But there has been a subtle merging of the two under the new heading of “Buddhist Psychology”.

Western psychologists have naturally taken the lead in this field. They teach classes with titles such as “The Hungry Ghost: Mindfulness for Addiction Recovery”, “What the Buddha Felt”, and “Nyngma Psychology”. Classes commonly begin with the Indian greeting “namaste”, sometimes include group chanting of “om”, and often end with the ringing of a Tibetan bell or bowl.  Buddhist philosophy and ritual mingle seamlessly with the science of psychology.  It becomes difficult to tell where one ends and the other begins–or if there is really any difference between them at all.

In his seminal book “Orientalism”, Edward Said described a process in which westerners travel to the “Orient”, return, and describe the world they have seen.  But the Orient of their telling is a projection of their own romantic fantasies, rather than an accurate description of the thing itself.  Eastern thoughts and practices came to fit the shape of their container: western desires.

According to Said, this was part of a colonial project, grounded in a powerful narrative. The Orient was seen as a mysterious land of riches (territory and treasure) and superstitious beliefs (Hinduism, Buddhism, Islam).  It was all but calling out to be conquered by the advanced (scientific) and compassionate (Christian) west—conquerors who would protect its cultural and material wealth and civilize its heathen population. The West would even save their oriental souls (with conversion). As Rudyard Kipling, the great British poet and colonialist said, such was the “white man’s burden”.

We in the west have embraced Buddhism. It’s rich history has left the world beautiful gold-adorned temples and a legion of monks and nuns who walk the earth peacefully, offering an alternative to the hustle and bustle we have come to call normal.

But there are aspects of this religion that don’t really make sense to our western minds.  They offend our rational, scientific view of the world. With the help of western trained psychologists, though, we have been able to “cleanse” Buddhism of its superstitions, extract its scientific core, and replace it with an improved, modernized version: mindfulness.

One cannot deny the health benefits of mindfulness.  However, we should not confuse mindfulness with the ancient spiritual traditions from which it arose.  Buddhism—and the Vedic teachings that inspired it–is a complex mix of ritual and belief, a culture–based path to enlightenment. Mindfulness is a single piece of that path, a thread pulled from a complex tapestry.

On its long journey from the Himalayan foothills to the conference halls of Silicon Valley, Buddhism has been recast in a purely scientific, psychological and neurological light. Psychologists, with the stamp of professional legitimacy, now stand behind lecterns and presume to be expanding the teachings of Siddhartha Gauthama.  Listeners beware.  While we can embrace mindfulness, it’s important to remember what it is—and what it is not.

Dr. Ricky Fishman has been a San Francisco based Chiropractor since 1986.  In addition to the treatment and prevention of back pain and other musculoskeletal injuries, he works as a consultant in the field of health and wellness with companies dedicated to the re-visioning of health care for the 21st century.

Copyright 2013 Ricky Fishman

Our five senses–hearing, touch, smell, taste, and sight–are directed primarily outward.  They help us to navigate the material world, to survive so we may pass our DNA on to future generations.

This Darwinian narrative has framed many of our modern ideas about health and healing. We’ve come to see our bodies as biochemical capsules moving through space and time.  As a result, modern medicine has developed a reductionistic, physico-chemical model to describe, diagnose, and treat disease.

We now have laser-tipped endoscopic tools that can snip off cancerous colonic lesions, nano-engineered, pharmaceuticals tailored to bond only with diseased cells, and fMRIs that allow us to study brain activity during meditation, sleep, and sex.

Yet the deeper we probe, the further away we move from knowing other levels of our being.  We simply re-enforce the model that has been in place for the past 100 years.

A Parallel Journey

Western medicine, at the end of the 19th century, recognized the role of mind in health and healing.  Sigmund Freud, a Viennese medical doctor, systematized psychotherapy while treating the neuroses of his (mostly female) upper class patients.  The field grew rapidly. From the collective unconscious of Carl Jung to the somatic psychology of Wilhelm Reich, these early pioneers built upon (and challenged) the foundation Freud established, expanding our understanding of mind.

But compared to other western medical disciplines, psychiatry (and its non-medical offshoot psychology) is considered a junior partner to fields such as cardiology, orthopedics, and nephrology.  These latter specialties are deeply rooted in classical mechanics, a physics that has long been viewed as the most accurate way to explain the world. The more snugly stories fit into this Newtonian framework, the more  “real” they are. The study of mind has not lent itself to the same sorts of mechanical analyses. Yet the recognition that our minds and bodies are connected and can be treated as one has opened a doorway to understanding other more subtle levels of our beings.

Even if mind emerges from brain biochemistry—still a subject of passionate debate—it expresses itself through our nervous and endocrine systems. Stimulation from the outside world sets off a cascade of electrical impulses and hormonal surges.  Muscles contract, blood pressure and respiratory rates rise and fall, serotonin and dopamine are released.  Our thoughts trigger chemical releases that give rise to fear, love, anger, and trust.  Quickly the line between inside/out and outside/in becomes blurred and confused. Where does mind begin? Where does it end? Where exactly is it located?

As we go deeper into the matter (stuff) of which we are made, we enter the microcosmic world of molecules, atoms, subatomic particles and quantum probability waves.   Here we are buzzing fields of energy.  The bounded selves we experience through our five senses vanish; the duality of I/it dissolves into one great energetic dance.

And as the understanding of our bodies expands beyond the sensed, our notions of health and healing must also change.

We see that pulling on a single thread in this intricate web–the post traumatic stress of a violent encounter, a moldy basement, the break up of a relationship, a poorly designed work station, an unhealthy diet, the low grade despair of a life lived without meaning—will affect the whole of it.  Each experience, each event has its own energetic frequency that reverberates throughout our chemical, emotional, and physical bodies. We may be  thrown off balance. But our bodies automatically push back, innately seeking a center, seeking the sympathetic vibration of resonance. Because in resonance energy flows smoothly.  Blood flows smoothly. Neurons work in harmony, orchestrated by a brain focused on integration, moving its body agilely through the world.

Whether offered as a chiropractic adjustment to support joint movement, an acupuncture needle to assist the flow of chi, or a Peruvian medicine ceremony to help align ones life with ones purpose, the process of healing is the same. It is the creation of balance—physical, chemical, emotional, and energetic.  It is the creation of an “ease” which enables the body to function optimally.  It is in this space of ease that we are able to connect what is within us to what is beyond, and to allow the energies of the vast cosmic field through which we move to nourish and sustain us.

Dr. Ricky Fishman has been a San Francisco based Chiropractor since 1986. In additiion to the treatment and prevention of back pain and other musculoskeletal injuries, he works as a consultant in the field of health and wellness with companies dedicated to the re-visioning of health care for the 21st century.

Copyright 2012 Ricky Fishman

The bulk of my practice is devoted to the pain that develops slowly from postural strain, most often the strain of sitting.  As our work lives have shifted from manual labor to sedentary work, our bodies have become de-conditioned. Perky at 9 AM, our upright postures fueled by powerful espresso drinks, by 4 PM we are slumped into our ergonomically designed chairs, low backs rounded, heads pulled forward into our monitors.  Automatically activated to pull ourselves into balanced positions above our centers of gravity, our muscles tense, fighting the distortions work has forced upon us. These low level contractions produce the normal byproducts of muscular metabolism, a variety of biochemicals that, when combined with reduced oxygen due to sustained tension, cause localized irritation.

Under normal conditions, we consciously command our muscles to contract.  To lift an object, a message is sent from our brains to our upper extremity, muscles are contracted accordingly to complete the desired task, waste products are produced and deposited in the substance of the musculature. Upon completion, blood vessels dilate to allow the collection (flushing) of this biochemical “gunk”. However, the maintenance of distorted postures over long periods of time causes a continuous deposition of these substances without allowing for the regular clean-up of relaxed musculature by free flowing capillaries.  The result is a build up of  noxious substances and the irritation of pain sensitive nerve endings.  We become aware that there is a “problem”.  We are now symptomatic.

Compounding the pain of muscle irritation is the fact that these chronically tightened back muscles, which connect to the vertebral segments of our spines, cause a loss of motion in the spinal joints. When our joints move normally, they act (in addition to being mechanical pivots) as pumping mechanisms, pushing blood and lymphatic fluids through our joint spaces.  As the muscles tighten, these mechanisms become compromised, causing a congestion that puts pressure on the nerves traveling through the area, becoming yet another source of pain. And in addition to irritation of pain sensitive nerves, motor (motion inducing) fibers are stimulated, sending a barrage of impulses back to the already tightened muscles, causing further tension, adding to this cycle of mechanical stress, strain and pain.

A visit to the chiropractor will help address each part of this dysfunctional mechanism.  The muscles that are tightened will be loosened with a variety of bodywork techniques, and the fixated (subluxated) joints will have their motion restored with spinal manipulation. This will help relieve pain by releasing the pressure on the nerve endings at each point in this cycle. More fundamentally, the chiropractor should address the causes of the problem with a series of exercises and stretches and postural awareness training.

We are taught to rely on symptoms to tell us when we have a problem that needs treatment, whether it is a fever that sends us to the medical doctor or the back pain that sends us to the chiropractor.  And while it is true that a symptom is a reliable indicator of a problem, and its relief a sign of the problems abatement, the absence of a symptom does not mean the absence of a problem.  As in the classic case of the fifty-year old man who suddenly drops dead of a heart attack, symptoms are often absent until well into the pathological process. Plaque was building in his arteries and his blood pressure was rising.  Sadly, his first symptom was a spasmed heart and death. Similarly, as we sit hour after hour at the computer, our muscles slowly tighten, straining to maintain our sedentary upright postures, until a sudden movement—a sneeze or the lifting of a hair dryer—produces the sharp pain of back spasm.

When patients come into my office in pain, I am often asked, “What is wrong with my back?” Before I can answer, I conduct an examination, which consists of both a physical assessment—orthopedic testing, neuromuscular evaluation, and postural analysis—as well as a case history to find out about previous injuries, exercise habits, and the nature of the their work. I may be told by the patient that although they spend all day at the computer, that they have an excellent work station, and that they have been evaluated by an ergonomic expert sent by the Human Resources department of their company. So again, “What is wrong with my back?”

To this, I often respond, “The problem is not with your back, but rather with your (work) life.  Your body is simply responding normally to the mechanical stress that you are subjecting it to.  We are simply not designed to sit in front of computer screens all day, even when seated in the best ergonomic chair.” But given the demands of modern post-industrial life, this is how most people earn their livings and until our interfaces with computers are modified in such a way as to minimize the mechanical strains, we will suffer the pains of slow onset muscle and joint dysfunction.

To simply wait for the pain that will inevitably come from staring all day into our luminescent screens is to deny the reality of our modern work lives.  Steve Jobs and Bill Gates might have dictated how we will live, but it does not mean we must suffer passively. As the man with the clogged arteries must alter his diet and exercise, the sedentary computer worker must stretch, strengthen, and be sure that her joints are well mobilized—whether symptomatic or not!

We live in a society that defines health as the “absence of disease”.  But we understand that disease processes take time to develop and symptoms are often expressed far along in the process. And while symptoms provide valuable information about the state of our bodies, waiting for them often delays care, creating the need for increased treatment. The wellness model is rooted in prevention.  It is a proactive approach, focused on supporting the bodies systems with nutrition, exercise, mindful living, and modalities such as chiropractic, Traditional Chinese Medicine, and other non-invasive therapies. Symptoms are important indicators of compromised health, but treating our bodies holistically, before symptoms arise, will help to improve our quality of life, enhancing vitality while minimizing pain and dysfunction.

I first take a history. How long have they had the complaint? What makes the pain worse?  What relieves it? Have they had any car accidents or sports injuries?  What kind of work do they do?  Do they exercise? And so on.

Then I do a physical exam. I look at their posture.  How do they hold themselves in space?  Are their heads tipped forward?  Are their shoulders rounded? I have them stand on one foot, then the other to check their balance.  I instruct them to go through ranges of motion, to determine limitation and/or pain.  I check the tone and strength of their musculature.  I palpate the motion of their spinal joints, check their reflexes and blood pressure, and do orthopedic testing.  In some cases, when I think there might be a fracture in the event, say, of  a motor vehicle accident or fall, or if I suspect bone pathology, I will refer them to a lab for x-rays.

At this point, I’ll have a good idea about the cause of the patient’s complaint. But relief, ultimately, comes from two places: within, and without.

Treatment flows naturally from the exam.  If muscles are tight, I loosen them using a variety of soft tissue techniques. If they are weak, I prescribe exercises to strengthen them.  If joints are not moving, I restore motion with chiropractic adjustments.  And if their posture is distorted, I suggest ways to correct it.

The effect of these treatments is generally a reduction of symptoms.  But what is actually happening in the body?  Why is there pain?  How is the pain relieved? What are the physico-chemical processes at work?

When muscles tighten, pain-sensitive nerve endings embedded in the muscular tissue are stimulated, causing pain.

These tightened muscles in turn connect to joints and inhibit joint motion. Under normal conditions, blood and lymphatic fluid are pushed through these joint spaces—but when the pumping action of the joint is lost, a localized congestion is produced.  The build-up of fluid creates pressure which stimulates both sensory (pain) and motor nerve endings.  These motor nerves are responsible for normal muscular contraction; but when they’re irritated they fire increased signals to the musculature, creating even more tightness and pain. This becomes a viscous cycle—or a downward spiral.

The Chemical Contribution

Chemical processes also feed back into this spiral.

The metabolic bi-products of muscular contraction include hyaluronic, pyruvic, and lactic acids. Normally, after contraction, muscles relax.  When relaxation occurs, blood vessels in the muscular tissue are able to dilate (open up), and flush the tissue with blood.  This blood in turn moves the metabolic waste to the kidneys for filtration and excretion.

If the muscles are being over-used however–perhaps from continuous heavy lifting or by the non-stop clicking of a computer mouse—there is not enough muscular relaxation to allow for proper blood flow.  Acidic waste products build up in the tissue, creating focal points of irritation.  These chemicals stimulate pain sensitive nerves.  The body responds with inflammation, and produces scar tissue to fortify the damaged (burned) muscle.

But scar tissue is stiff, and tightens the muscle further. Some of us are familiar with these painful fibrotic areas.  We call them “knots” or “trigger points”.  And we instinctively know how to massage them.  Massage also helps to flush out the pooling waste, relieving pressure on nerves and easing pain.

This also explains why exercise is so important.  Cardiovascular exercise stimulates increased blood flow which removes inflammatory fluid and brings healing biochemicals to injured areas.

During the first phase of care, chiropractic treatment focuses on the causes of pain and dysfunction.  Tight and weak muscles are loosened and strengthened.  Hypomobile, or subluxated joints are mobilized.

A deeper level of care, though, supports patients in their self-healing process. They learn how to safely perform their work activities and to strengthen their cores; how to breathe and the importance of rest. They learn about good nutrition. This is about injury prevention; a strategy of proactivity rather than reactivity.

But there are other, more subtle levels of tissue/whole body irritation and healing at work.  These will be discussed in Part Two: “Levels of Healing: Psycho-Energetic Dimensions”.

Dr. Ricky Fishman has been a San Francisco based Chiropractor since 1986.  In addition to the treatment of back pain and other musculoskeletal injuries, he works as a consultant in the field of health and wellness with companies dedicated to re-visioning health care for the 21^st century.

Copyright 2012 Ricky Fishman

During the past 30 years there has been a steady shift from high quality insurance plans (with low deductibles, small co-pays, and broad coverage) to a managed care model of HMO’s with more limited coverage, culminating in the current crop of super high ($3,000-$5000) deductible policies. Consumer premiums have far outpaced the rate of inflation.  At the same time, payments to providers have been reduced, while insurance company profits have soared.  Meanwhile, millions remain without health insurance of any kind.

Yet pundits and politicians on the right keep pushing to maintain this status quo. They act as if Obama’s legislation is the latest edition of The Communist Manifesto.

The most controversial part of the ACA is the “individual mandate,” which requires everyone to purchase health insurance. This requirement will help fund new health care programs by distributing the costs throughout society. For many, this mandate strikes at the heart of the American ideal of individual choice—of even freedom itself.  Yet at the same time, the mandate resonates with the very Christian notion of caring for those less fortunate than ourselves.

This has created a quandary for the far right. While Fox News characterizes Obama as a godless socialist, it was a compassionate Obama, following Christian ideals, who  pushed the legislation through.  He recognized not only the economic unsustainability of our current system, but also the moral rot at its core.

In the end a values argument carries greater weight than a practical one.  People will vote against their economic self-interest if their vote reflects their ethical universe. I believe it was a moral argument that brought Chief Justice Roberts over to the side of the four liberal judges.

Affirmation of so-called Obamacare will ultimately be recognized as an historical landmark. Like Social Security and unemployment insurance, the ACA will have far-reaching real-world consequences.  Like those other acts, it will alter our national consciousness, our assumptions of what is real and true. There will be discussions of “radical” ideas like universal coverage and the right to health care.  There will be challenges to the traditional power of pharmaceutical and insurance companies.  Even the relationship between the health of an individual and of the society will be examined. Sacred cows will be tipped, creating space for a new worldview.

The increased role of the government in the messy business of health care is sure to create bureaucratic havoc.  It will most likely drive reimbursements down to Medicare levels, threatening the sustainability of some private practices and the livelihoods of some providers. But it will also guarantee insurance to large swaths of the previously uninsurable public–whether they are Democrat, Republican, Tea Party Conservative, Libertarian, Progressive, or Independent.

Dr. Ricky Fishman has been a San Francisco based Chiropractor since 1986.  In addition to the treatment of back pain and other musculoskeletal injuries, he works as a consultant in the field of health and wellness with companies dedicated to the re-visioning of health care for the 21st century.

Copyright 2012 Ricky Fishman

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The clinic was in a rickety second story flat a half block from Haight Street. The hardwood floors were worn, and the waiting room chairs a bit ragged.  But the bathrooms were clean, the walls well painted, and the care provided to the neighborhood excellent.

Last January I received an email notifying me that Susan Poff, one of the physician assistants I worked with, had died tragically.  The email also let me know there would be a memorial at the home of Joe Elson, the clinic’s medical director through most of the 1990s.

Though I hadn’t seen many of the people present at the memorial for years, I felt an immediate sense of connection.  In part it was the common bond to Susan. But there was something else, something I couldn’t quite put my finger on. Perhaps it was because we had all worked together on a grand project, grounded in the conviction that healthcare was a right and not a privilege.  We all believed in the result of that project–a viable health care alternative that was integrative and free of charge. No sliding scales, no health insurance accepted.

But as I stood, listening to the many testimonials for Susan, I remembered that the clinic had offered more than high quality care.  It had also provided a safe place where those down on their luck could get treatment without judgment, where people in the neighborhood could volunteer their time, and where students could do internships that would help them go on to become dedicated practitioners themselves.  The clinic was not only a health center.  It was a community center.  And in Joe’s living room, we were that community.

Our communal focus was part of a philosophy of health and healing that was broad and deep. It was a philosophy that connected individual wellness to planetary health, and went beyond the application of specific therapies to specific conditions. This philosophy stressed balance–of mind, body, spirit, nature, and society. It asserted that to heal one, we must work toward healing all.

Susan embodied this vision. She worked in the clinic and on the street. She ran needle exchange programs under the freeways, lanced boils on the sidewalks, and shaved the heads of the homeless to get rid of their lice.  If it was cold and rainy, she was out there because that was where her patients were.  And when there was an unwanted child in foster care, a child born into a profoundly broken world, she adopted that child.

That kind of selfless giving came from a deep well of love and compassion.  Susan had more than excellent clinical skills.  She had a fierce and passionate heart.

When I was at the clinic, we serviced 17,000 patient visits per year.  This was accomplished at a fraction of the cost incurred by most primary care centers.  But such success is a threat to the status quo—a bloated health care system controlled by an insurance industry dedicated not to health and well being but to profits. As a result, many of those in power have dismissed the free clinic model as a socialist fantasy and an economic failure. That such clinics could be an important part of the health care reform conversation is not seriously considered.

The Haight-Ashbury Free Medical Clinic may someday close its doors due to higher operating expenses and diminished public support.  But it will never die as an idea, as radical as that idea may seem.  And Susan, though she is gone from this world, will live on as an inspiration: a reminder of what healing truly means.

Dr. Ricky Fishman has been a San Francisco based Chiropractor since 1986.  In addition to the treatment and prevention of back pain and other musculoskeletal injuries, he works as a consultant in the field of health and wellness with companies dedicated to the re-visioning of health care for the 21st century.

Copyright 2012 Ricky Fishman

One of the simple, profound conclusions he reaches, is that we must stop thinking about cancer as a “thing” to be cut out or poisoned, but as a  pathological systemic process.  Cancer, he believes, should be seen as a verb.  We don’t just “have cancer.” Instead, we “cancer”.

Dr. Agus traces this flawed understanding of cancer to “germ theory,” one of the foundational theories of modern medicine.  According to this theory, sickness is caused by the invasion of external agents such as viruses or bacteria.  Treatment consists of killing the invaders.  This was validated by the development of antibiotics and vaccinations in the nineteenth and twentieth centuries, and the subsequent eradication of many infectious diseases.

Due to its historical success, germ theory has become deeply internalized, shaping medical perception.  The causes and treatment of most diseases are sought within its framework.  The search for chromosomal anomalies, and the development of nano-surgical procedures and increasingly sophisticated imaging studies are all modern manifestations of this worldview.

Yet many of the chronic diseases that plague us today, such as fibromyalgia, rheumatoid arthritis, diabetes, and cancer, do not have singular causes and are not easily located within the body.

If satisfactory answers elude us, we may be using the wrong model to frame the scientific research. This, Agus believes, is the reason for the failure of the “war on cancer”.

Chiropractic, in my view, has suffered a similar failure.

Founded in 1895 by D.D. Palmer, chiropractic theory asserts that the spinal joint fixation, or subluxation, lies at the root of many health problems.  The loss of motion in the subluxated joint generates compressive forces which irritate spinal nerves.  This irritation, in turn, alters nerve conduction to the various systems of the body, preventing the body from properly maintaining itself.  This can cause a variety of symptoms, ranging from back pain to gastrointestinal distress.

It is not coincidental that chiropractic theory developed as germ theory took hold of medical thinking. The subluxation, like the germ, was a reductionist explanation for the cause of disease.  Chiropractic treatment, however, was drugless. And it was an effective alternative to the many toxic remedies prescribed at the time by medical doctors. Treatment consisted of spinal manipulation to mobilize the joints and relieve nerve pressure, allowing the body to heal itself.

Like medical doctors, chiropractors have allowed this powerful but limited theory to restrict their vision. They take x-rays, draw lines on the films, and set up months of treatment.  The focus of care is on the elimination of the subluxation—just as medical treatment focuses on the elimination of offending bacteria and cancer cells.

Chiropractors need to see the subluxation not as a “thing” to be realigned or mobilized, but as an active response to forces at play in the body: as a verb and not a noun. We don’t just have subluxations.  Rather, we subluxate.

Dr. Agus has embraced an approach to medical diagnosis and treatment based upon the growing field of proteomics.  Using new technologies that can map the state of protein production within the body, one can see patterns of cellular activity. These patterns, which vary from person to person, indicate a body in or out of chemical balance.  They can reveal the early stages of disease development, which precede symptoms.

Treatment is highly individualized, focused on bringing protein production into balance.  The causes of the imbalance can be varied.  Therapies–whether pharmaceutical, nutritional, or life style modification–are aimed at restoring balance rather than the treatment of symptoms.  One thinks of traditional Chinese and Indian systems, which are focused on restoring harmony to the body.  When in balance, the body is better able to prevent the onset of disease, better able to resist bacterial or viral invaders, and less likely “to cancer”.

In chiropractic, some of us are shifting away from a “subluxation as primary cause” model.  It has become clear that there are dysfunctional patterns which manifest as increased tension in the musculoskeletal system. Over time, tightened soft tissues become painful, restricting the motion of their articular connections and causing further pain and dysfunction.  In this case, the subluxation is part of a chain of events embedded in a framework of systemic imbalance.

A broader chiropractic approach includes evaluation of the forces at play in a person’s life. How is their workstation set up? Are they exercising?  If so, how? Have they had sports injuries or motor vehicle accidents?  The answers to these and other questions will explain why the spinal joints have become subluxated.  Treatment will consist of soft tissue and spinal manipulation to address the structural effects of these imbalances, but more fundamentally treatment will focus on the underlying imbalances that often precede symptoms.

The scientific method is largely a reductive process.  We attempt to understand complex processes by reducing them to their most basic components.  This method has proven very effective for building bridges and skyscrapers, microchips and batteries.  But it has been less effective in understanding the body.  New discoveries in the physical sciences have taught us that complex systems are often emergent, defined by the higher level integration of their components. There are limits to reductionism.

Both chiropractors and medical doctors have been operating within a nineteenth century framework. For chiropractors, the world has been framed by the subluxation.  For medical doctors, it has been framed by germ theory.  Both antibiotics and  spinal adjustments can be powerful treatments–often the only treatments necessary for particular conditions.  But when the problem is nonlocal, emerging as the sum of multiple, deeply rooted causes, those modalities are often inadequate.

The body has a powerful capacity to heal itself.  Our role as healers is to support its ability to do so. Whether with pharmaceuticals, chiropractic adjustments, acupuncture needles, or ayurvedic herbal formulas, treatment will be most effective when we honor the body for what it is: a dynamic system in constant flux.

Dr. Ricky Fishman has been a San Francisco based chiropractor since 1986.  In addition to the treatment and prevention of back pain and other musculoskeletal injuries, he works as a consultant in the field of health and wellness.  He is dedicated to the re-visioning of health care for the twenty first century.

Copyright Ricky Fishman 2012

I was a guest of Musicares, a Grammy Foundation health care program that supports musicians who have fallen on hard times. As a chiropractor, my mission was to provide information about how to address common music world injuries: low back pain, shoulder strain, repetitive stress, etc.  But I was also there to check out the latest generation of equipment with my ergonomic eye.

Those of you who have read my previous “Rock and Roll Ergonomics” columns know that I’ve been on a crusade against the tube amp. Don’t get me wrong; there are certain sounds that can be created only in the mysterious circuitry of Marshall and SVT heads. But I believe that these holy grails of bottom and wail should be installed as altars in rehearsal and recording studios. They should be played, not moved. There are plenty of onstage options that can give you and your fans the sounds you want, without wrecking your body.

On the bass front, I got to play through some great sounding and lightweight amps.  Mark Bass and Phil Jones were most impressive, offering powerful solid state/tube pre-amp heads that weighed in at 6 lbs. Last year I got rid of my Aguilar 750 (45 lbs. of monster tube power) and picked up the Mark tube 800.  It fit into my backpack and powered my 6 x 10” Eden stack.  No problem.

Speaker cabinets remain a challenge, but with lighter woods and small, high quality speakers, choices are expanding. While I personally favor 10’s, I played some really nice 5’s and 6’s.  If you are playing small clubs, check them out. And you can always stack cabinets. The 2 x 10 cabinets are much easier to move in and out of a van than 4 x 10’s.  So mix and match to save your back.

I saw some sweet boutique guitar amps that were also easy on the back.  Risson Amplifiers caught my eye. Works of art, they are constructed with vintage electronics and low wattage tubes. Beautiful in bright blue and green pine cabs.  A pleasure to see, to hear…and to lift. As a bonus, I got to meet designer and builder Bob Rissi.  Bob began his career in Leo Fender’s factory in the early 60’s.  So I got to hear an awesome amp, as well as some awesome stories from one of the pioneers of the rock and roll sound.

I was also checking out adjunctive equipment.  When I do a show, I always go out with two basses.  This requires a double gig bag.  I have been unhappy with the one I’ve been using, and was on the lookout for a better model.  I found it at Mono Cases. Very nicely constructed, with a semi-hard shell.  This case will actually protect your instruments.  Add to this the wide, softly padded shoulder straps and chest clips (for weight distribution), and you’ve got some easy carrying.  With a few minor ergonomic design touch-ups, this could be the perfect gig bag.

I saw pedals with angled metal rests to minimize leg and ankle strain, foot switches that turn sheet music pages on an iPad, and drum thrones that support, strengthen and stabilize the abdominal core so that drummers can rock out and work out simultaneously.

Another inspiring sight at NAMM was a motley tribe of thousands, all brought together by our love of music.  Players, dealers, electronic techs and master luthiers, all sharing an understanding of the power of music to raise each of us up and to connect us to one another.

Exhausted and exhilarated after the weekend, I reflected on my own place in this mad and magical world. As a player and a doctor, I was pleased to see the ongoing pursuit of perfect sound coupled with an awareness of what musicians need as biomechanical beings.

But mostly, I was just glad to be in the mix.

Dr. Ricky Fishman is a San Francisco Chiropractor and has been a performing electric bass player for over thirty years.  He is the Director of the Musicians Chiropractic Project which specializes in the treatment of musicians injuries and offers special rates for uninsured players.

Copyright Ricky Fishman 2012

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