Body Works Clinic

03/09/2026

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

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

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

03/08/2026

SHOULDER IMPINGEMENT SYNDROME

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

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

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

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

03/08/2026

SHOULDER IMPINGEMENT SYNDROME

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

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

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

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

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

03/02/2026

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

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

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

03/02/2026

UNDERSTANDING THE BENEFITS AND LIMITATIONS OF FUNCTIONAL GI MICROBIOME TESTING
Testing functional GI markers, as many of our patients have found out, can be really enlightening when patients are dealing with unresolved chronic health and digestive issues. However this interesting recent article in the scientific journal Nature decided to take an in-depth look at what's “underneath the hood” of much of the microbiome portion of the testing. There is an enormous amount of scientific data about the importance of a balanced GI ecology, for its role in health and disease, but that has not always translated into very clear guidelines about on the ground consumer testing , about what's valid and what's still undetermined.

Direct Consumer Testing (the ability of a patient to directly order health tests from a company rather than through their physician) , has further added complication to an already shifting picture. Many of these companies are freelancing by experimenting with methods that have not been fully validated, and developing interpretation tools that are still very much in their infancy.



This is not to say that there is no merit in doing stool functional testing. We do it routinely and have found it in many instances to be the key to turning around somebody's health by getting the right data set to make new clinical decisions. But this is a word of caution about two different aspects of this sort of testing: the first one is that DCT options will put more power in the hands of patients, however it also may make them more vulnerable to being sold substandard testing products from a strictly clinical perspective. As the article pointed out, several labs fared quite poorly in the reproducibility of their own testing using the same sample. The second aspect is more nuanced. We have a lot of scientific data about the benefits of a balanced microbiome, however we're still rapidly evolving in our understanding of what's healthy and optimal, and we need to understand that when we are looking at raw data to not excessively extrapolate conclusions that are not supported by our current scientific understanding.

https://www.nature.com/articles/s42003-025-09301-3

02/17/2026

Dr. Demel will be out of the office on Friday, February 21st and Monday, February 24th. Normal chiropractic hours will resume on Tuesday, February 25th. Staff will be in on Friday and Monday for a few hours to take care of administrative tasks and return phone and email messages. Massage hours will continue on a normal schedule.

02/15/2026

NECK PAIN, ANTERIOR NECK POSTURE AND MOUTH BREATHING
I've had a few cases recently of pediatric and adult straight neck with persistent neck pain that didn't seem to respond to the traditional neuromusculoskeletal interventions and I thought it would be a good time to bring up a lesser known contributing Problem to chronic postural neck pain.

A loss of cervical normal anterior curvature and a so-called straight neck can be the result of many factors, including flexion trauma, chronic anterior cervical strain associated with use of technology, and some vestibular cerebellar functional disorders. The interventions supporting the chiropractic treatments can be as varied as the causes themselves, including postural awareness and reset, cervical lordotic home device etcetera.

One lesser known contributing factor to chronic anterior cervical malposition is chronic mouth breathing. Normal resting breathing should be through the nose, since this is the most appropriate airway path to warm up air entering the lungs and filter for debris and pathogens. A person will switch from normal nasal breathing to mouth breathing if there is compromise of the nasal airways, in the form of chronic narrow airways ( narrow hard palate in children especially), chronic congestion from allergies or infections, chronic enlarged tonsils and adenoids, and chronic structural issues with the airways such as severe deviated septum. Positioning the head slightly anterior will actually increase the diameter of the oral airway, and becomes an adaptative posture in many patients with upper airway compromise. In patients with strained anterior cervical spine from mouth breathing, the patient will often notice increase neck pain during during cardiovascular endurance activities ( which will further strain the airways and accentuate the adaptative anterior neck posture)as well as during static sitting and laying flat on their back. Mouth breathing is surprisingly common and often completely below ...
https://www.bwclinic.com/blog/2024/9/28/neck-pain-anterior-neck-posture-and-mouth-breathing?rq=mouth%20brething

02/14/2026

OSTEOARTHRITIS AND MYOFASCIAL PAIN SYNDROME

An increasing percentage of our population is living above 65, and often for another 2 or 3 decades. This bit of good news if you're approaching that milestone (I am!), Is that you have 2 or 3 more decades to experience and hopefully enjoy life. The bit of bad news is that you will get to live out those 3 decades in a body facing increasing wear and tear.

Osteoarthritis refers to the process by which articular cartilage starts to deteriorate, leading to loss of joint space, and a constellation of associated structural findings and symptoms: instability, spurring, loss of normal motion, chronic pain and inflammation. It should be noted that osteoarthritis is not a linear finding correlating with simply aging. Some patients are more predisposed to osteoarthritis than others because of additional mechanical factors causing accelerated wear and tear on joints of the spine and extremities (which is why chiropractic research has shown some modulation of progressive osteoarthritis in many patient receiving care, reducing unnecessary mechanical stress). Other patients experience worse osteoarthritis because of metabolic factors that have to do with our poor nutrition, lack of blood flow from inadequate physical activity, and other complications from health issues such as medications, medical treatments etc.

One aspect of the constellation of osteoarthritis related findings and symptoms that is often missed or poorly understood is the secondary chronic myofascial pain syndrome and widespread trigger points. ..
https://www.bwclinic.com/blog/2025/4/13/osteoarthritis-and-myofascial-pain-syndromehttpspubmedncbinlmnihgov36943163

02/02/2026

CHIROPRACTIC ADJUSTMENT AND ANTIOXIDANT MARKERS

I recently had a little more time traveling, which has given me the opportunity to catch up on some of my chiropractic research podcasts.

One of the remarkable development of chiropractic research over the last 25 years has been in the basic science department among other places. In particular, while empirically chiropractors and their patients have known for a long time that the manual adjustment is associated with many changes in body chemistry well beyond neuromusculoskeletal markers such as pain reduction and range of motion, trying to document and quantify that has been comparatively lagging behind.

Some of the non-neuromusculoskeletal changes reported by patients often include feeling more energy, sleeping better, feeling less inflamed overall, improved mood and digestion and cognition. While some of those changes are thought to be associated with changes in neurological feedback loops between the brain and the body, this most recent piece of research seems to suggest that there is potentially an additional core biochemical change associated with the chiropractic adjustment, namely the modulation of local free radicals as well as the up regulation of the body's own antioxidant pathways. The research project was unfortunately interrupted by the arrival of the covid pandemic, which did reduce the total sample size of patients, making some of the statistical data a little tough to analyze, however this paper is still a very exciting first step in further investigating how chiropractic care can improve the overall long-term well-being of our patients.

https://pubmed.ncbi.nlm.nih.gov/39966844/

https://pubmed.ncbi.nlm.nih.gov/35760595/

02/01/2026

WHAT CAN GO WRONG WHEN YOU FALL ON YOUR ARM ?
https://www.youtube.com/shorts/kKP5KtWSxVw

We've seen so many of these injuries this week that I decided to record a short video with the help of my staff to review all the things that can go wrong when you fall on your arm. I thought it was an important educational material to have available since so many people fall and develop problems that they do not connect to the original incident. Especially since the area of symptoms may be far away from the point of impact on their hand and wrist.

Where the injury exactly will occur along the kinetic chain from the hand to the neck depends on a variety of factors, some of it having to do with the angle, and the speed of reaction and trying to break the fall. I've seen some patients develop along acute cervical disc herniations from the side to side during when they're caught off guard during the fall and the neck experiences a form of lateral whiplash. Probably more common are the areas along the shoulder girdle. I especially find that the sternal clavicular joint, at the end of the anterior kinetic chain, can be a source of continued misery and destabilization along the anterior neck and chest, often overlooked and even more often undertreated.

01/25/2026

WHAT IS WRONG WITH STOMACH SLEEPING ?

A colleague and I were reflecting recently on the patient conversations we find ourselves repeating over and over again like a broken record. One such conversation pertains to sleeping position, and in particular stomach sleeping.

As a reformed stomach sleeper, I can appreciate how unpleasant of a conversation it is to have with your healthcare provider when you're told that your problem is not going to improve much or beyond a certain recovery point without changing sleeping position. But it's a necessary conversation because of what you do for 8 hours a day, or about 1/3 of your life, can have a profound impact in unraveling what we do in the office for 15 minutes much less what a patient may be doing with home exercises at home for 20 minutes a day.

In this brief video Steve and I demonstrate 3 areas of major mechanical stress associated with stomach sleeping, namely the mid to lower next, the lumbosacral spine, and the shoulder. The 4th slightly less common area of stress as the jaw, which is going to be asymmetrically chronically pushed to one side with the pressure of the mattress and pillow on the chin.

Some patients have tried to mitigate the impact of their stomach sleeping position with a few retrofits such as chest pillows with a forward face slot, and other retrofit pillows that take the rotation out of the neck, but ultimately the only long-term sustainable solution is to switch to side or back sleeping. It's a transition that will take anywhere from 3 to 4 weeks and requires some sleep interruptions. My recommendation has been for the patient to secure a fairly long pillows such as a king size pillow or a site sleeper pillow to wrap the upper arm and leg into three-quarter prone position, with a good site sleeper pillow, so that the patient may not roll all the way onto the stomach in their sleep. The patient will often wake up as they attempt to do so, and have the opportunity to reposition themselves. Over time, the body will break the automatic reflex to roll over during your sleep. It's an uncomfortable process but worthwhile in the long term.

https://www.youtube.com/watch?v=yC0Piw8vwf0

01/24/2026

NEW LOW BACK AND HIP PAIN AFTER A JOINT REPLACEMENT: THE " LONG LEG EFFECT"

Several of our patients are opting in for planned joint replacements of hips and knees at this season, with the assumption that their work on their rehab and be ready to hit the ground for the season of outdoor gardening vacationing and general fun summer activities with some new and well-functioning hardware. This reminded me of a long-awaited blog as I've seen several cases last year.

I've been in practice 32 years and 1 of the most stunning improvement I've seen that affect my patients in my practice has clearly been the advancement in joint replacement. Minimally invasive, robotics, short recovery, they sometimes come with some challenges that need to be addressed so that the patient has the optimal recovery they're looking for by going under the knife. One such challenge is sudden changes in leg differential that can happen even when surgical intervention has been optimal.

The process of osteoarthritis and articular cartilage joint loss is a slow process that happens over years. The thickness of an intact joint versus that of a fully deteriorated joint can be over 1/2 an inch in difference. (Maybe closer to three quarters of an inch at the knee because of the presence of the meniscus). As a result, the leg affected could be easily an inch shorter from its original status, a process that the body will be able to mostly absorb over time due to its ability to slowly compensate at several levels including the sacroiliac, the lumbar spine, and the ankle.

A joint replacement will overnight reestablish the distance of a joint to its original state, and that can paradoxically be a real big problem. While the body can adjust to half an inch of difference in leg differential that gradually manifests over 2 decades, it doesn't have the ability to adapt to three quarters of an inch overnight. As a side note I should mention that our fine orthopedic surgeons have done an increasingly better job at trying to assess the leg differential and compensate for that during the surgery. But ...

https://www.bwclinic.com/blog/2026/1/1/new-low-back-pain-after-a-knee-or-hip-replacement-the-long-leg