Speaker 1:

Welcome to The SIBO Doctor podcast, hosted by Dr. Nirala Jacobi. Medical experts join us to discuss functional digestive disorders, clinical practice, and research as it relates to SIBO and associated conditions. This podcast is intended for SIBO-treating practitioners and aims to help educate how we may best serve our SIBO patients. Head over to thesibodoctor.com and sign up to the SIBO Mastery program and take your SIBO knowledge to expert level. If you're a patient, you can sign up to the SIBO Success Plan and beat SIBO for good.

Speaker 1:

Please note this podcast series is not intended to diagnose or treat medical conditions. Ask your doctor before initiating any new treatments. Now, over to Dr. Jacobi and the latest episode of The SIBO Doctor Podcast.

Nirala Jacobi:

Welcome to another episode of The SIBO Doctor podcast. I'm your host, Dr. Nirala Jacob, and with me today is local chiropractor, Dr. Maree Chilton, who I've been seeing for some time now, and I thought it would be great to have a conversation with her about some of the topics that we haven't really covered on The SIBO Doctor podcast and a lot of the physicality and patterns in the body that we recognize, and Dr. Chilton has a lot of extensive experience with chiropractic medicine, but also she's collected a lot of different modalities along the way, but she is specializing in pain and symptom management, and rehabilitation and health and wellness optimization, but really focusing on treating the underlying cause to an issue, and she's had this massive career with which she had a lot of other experience as well, like I said, gathering different types of modalities that we'll also talk about here today, so just a really warm welcome to you, Maree.

Maree Chilton:

Hello, Nirala. Thank you for letting me be on the podcast.

Nirala Jacobi:

So nice to have you here, and it's like we've tried this now three times, and when I'm in your office, we always get on this passionate conversation about what we're seeing in our patients and how people are holding different patterns in their body, and not only stress related, but previous injuries and how this can really affect the function of the body. We'll get into that a little bit later in the podcast, but before we begin, just sort of by way of just getting to know you a little bit more, but how did you get into this field?

Maree Chilton:

I got injured when I was six, and my dad was a chiropractic patient, and he took me to the chiropractor. My mom didn't like chiropractors, but my dad did. Fortunately, I had a really good result. It was a sporting injury at the time, and it set me on a journey of having a great relationship with my local chiropractor, and by the time I was 12, I was actually working in a chiropractic office doing massage. It's very hard to believe now that I would've let me do that at such a young age, but it was exciting and interesting, and I've just been interested in how the body works.

Maree Chilton:

I wasn't a competitive local athlete where I live, so keeping optimal function at the time was really important. When you're doing repetitive activities, it's really easy to be injured, and I always thought I would go onto sports chiropractic or something in the sporting field, but as it happened, I had a head injury when I was 17 and fell off trampoline and hit the cement really hard and fractured my neck. Fortunately, I was really fit and healthy that I wasn't paralyzed, and that sent me down a different journey on rehabilitating myself. I grew up in a small community and I didn't always have a lot of professionals around me, so I've had to sort of find my way along the way to help get myself better, and I've just been very dedicated to feeling good because when you have a head injury, you often feel crappy and it's hard to know what symptoms are which.

Nirala Jacobi:

Definitely. With chiropractic medicine in essence, a lot of people just think that anytime you have a neck problem, you go to the chiropractor, but really, the essence, as I understand it, is that you really work with a nervous system, that you're focusing on reestablishing function through the nervous system and the nervous system and the vagal tone and all of that has sort of experienced the Renaissance, in a way, because everybody talks about vagal toning and I think chiropractors are uniquely positioned in terms of understanding the function of different organ systems through the nervous system. Correct me if I'm wrong, but that's always been my understanding of the focus of chiropractic medicine.

Maree Chilton:

That's right. I think the sad part for chiropractic is that gets a very bad rap and the fact that the nervous system, brain and spinal cord, and that's the central nervous system and the peripheral nervous system is in the rest of the body, and the autonomic nervous system is like an automatic nervous system, it sits within the skeleton and the cranium, and we use, in a lot of cases, the bony structures to adjust and have access to the nervous system, but sadly, most people and a lot of medical professionals think chiropractic is about cracking backs, and it's so far away from that. I think that's, for me, the joy of 30 years in practice, is it was. You have to learn how to do that well, but over time, you learn about the nuances of how the nervous system expresses itself within the body structures.

Nirala Jacobi:

That was one of the reasons why I wanted to also talk to you because you're like actually the very first chiropractor I've ever gone to who hasn't really adjusted me, and we really focused on ... I knew that I had a lot of issues around breathing and couldn't really expand my ribcage and had neck and shoulder pain, the usual when you're sitting, but I also have had injuries in my life and I've shared on this podcast before having had a lot of burn injuries. One of the things that I really appreciated is how you really took all of that into consideration and realized that part of my body was just really twisted and I couldn't really unwind certain parts of my body, and that really got me thinking of, "How many times do people think something is happening to them?," and it's actually an old pattern that's really stuck and just by adjusting it, it just doesn't solve the issue, and so through this process, I thought about also, where my diaphragm is really tied with this whole issue of not really breathing with my ribcage and got me thinking to, "How many people have these old patterns stuck in their body that they think it's their digestive symptoms?," for example. A lot of people have tight diaphragms that can't really breathe properly because of a tight diaphragm possibly due to an old injury that then consequently develop digestive issues because the diaphragm is not really moving up and down and massaging the transverse colon as just an example, and I just was so fascinated by that. How many times do you see somebody coming in for some acute issue or something that they've had for a long time and you're just seeing that this is just an old pattern that's stuck in the body, if that makes sense, my question?

Maree Chilton:

Yeah. Look all the time. In practice, I often talk to other professionals about this, 30 years ago, it wasn't so stuck in people's bodies. I remember in the first, say five or 10 years in practice, the practitioners that had been in practice for 30 or 40 years used to say, "I could do one thing and get a miracle," and so 30 years ago, like I was sort of seeing that, but it's still used to take a few visits, and it's getting harder and harder, and I think the challenge is the diaphragm is not just a structural muscle. It's not just a breathing muscle.

Maree Chilton:

It's a functional movement muscle, meaning, it's part of holding our spinal structure together so that we can walk and we can stand, and we can breathe, and we can talk, and our blood pumps, and the air moves, and we can think about all of that thing at the same time or not think about that. We live in a world now where there's so many of these things where ... When you say about patterns, nearly every person, even babies and children, everyone is stuck somewhere, and that makes it really complex. It makes it complex to unravel it to go, "What have we got?," but I think structurally, we really have to look at the diaphragm and the hip flexor, the iliopsoas muscle is the connector between ... Like the solar plexus, we often say between the body and earth.

Maree Chilton:

It's between our structure and our function because that's what holds us ... onto. The planet allows us to move, and it's that connector between heaven and earth is the, I was trying to say when I was saying that. It's the conscious part of the body.

Nirala Jacobi:

Yeah.

Maree Chilton:

We've got to ... Diaphragm has the aorta that runs through it, the esophagus goes through it to the stomach, the vena cava, so all the blood vessels from our internal organs and our legs have to go up through there and be able to go back and have flexibility to allow the fluids to keep moving and the food to go down and keep our structures working, so I mean, that's pretty damn complex.

Nirala Jacobi:

Yeah. Also, I learned this from, well, Dr. Steven Sandberg-Lewis, who's a frequent guest on this podcast, but he reminded me that the diaphragm actually makes up part of the lower esophageal sphincter. If you look at the actual structure of how the esophagus passes through the diaphragm, that part of all of that dynamic is it's not just the diaphragm is a separate thing, so I keep coming back to the diaphragm because it's such an easy access point for people who have a lot of stress, have a lot of tension in their body, and continue to have digestive issues and just breathing, for example, breathing exercises isn't enough. It wasn't enough for me, so I want to kind of ... We'll circle back to how people can kind of start to work with this, but what other types of modalities do you practice?

Nirala Jacobi:

Like you talked about this, I think it was the Sacro Occipital Technique or the ... What is it? The craniosacral therapy, so what other types of modalities are you using and how are you implementing them, and how do they work?

Maree Chilton:

I use a chiropractic technique called Sacro Occipital Technique, which means the sacrum, which is in the pelvis, and the occipital, which is the back of the skull. It's about how they work together, so we need to be able to walk around and be able to have a control system that sits in the center of our head, where the brain is that can actually allow it to work, and so my main methodology of being able to assess the body is using Sacro Occipital Technique. Then, I also use more specific cranial techniques, which allows to be able to look at the way the fluid circulates around the brain and spinal cord and looks at the nerves, the cranial nerves that come out that control, so the vagus nerve is one of the cranial nerves. I'm also interested in jaw function because our jaw is on the front of our face. It's also connected to our head.

Maree Chilton:

Then, there's a lot of muscle connection and fascial connections that attach our jaw and our face to our neck and our chest that are like tents that allow the really important wind pipe and the esophagus to be able to run down through the front of our throat in front of the spine and between the spine and basically the front of our skin, and we need to be able to hold enough space for those smooth muscles to allow them to go then into the chest cavity, so the fascia is really important and understanding those fascial connections. I'm really also interested in the way the tongue works because the tongue is part of the front fascial line that actually connects down from the tongue. The tongue is the only end that's free-moving, and then it goes down the back of the throat, and then connects into the tent of the front of the fascial structures of the front of the neck, down into the chest and down through the middle of the chest, then attaches heart, lung to the diaphragm. Then, on the other side of that is the stomach and down into the other organ systems and the mesentery. Then, that line attaches from the diaphragm down the hip flexor to the pelvis, to the pelvic floor, to the adductors, which are the medial thigh muscles, to the knee, to the back of the calf, to the feet and to the foot, so I'm interested in foot function. I'm interested in leg function.

Maree Chilton:

I'm interested in leg stability. I'm interested in diaphragm function and hip flexor function. I'm interested in how we breathe. I'm interested in the airway of the throat. I'm interested in the development of the face, and I'm also interested in how the teeth develop because the tongue then sits in the mouth, and the roof of the mouth is the floor of the nose, and it sits within the center of the skull and holds the skull up, so there's a lot of parts to that that are structural and functional that can in themselves be their own modalities like the ear, nose and throat is like a, it's a specialty in itself, and then you've got digestion, and then you've got heart and lung function.

Maree Chilton:

Then, you've got knees, and then you've got feet, so there's so many parts of this that all have to work together that create patterning that can become problematic. The older you get, the more injuries, accidents and illnesses you have, the more likely you are to upset the adaptive capacity of the body and create problems that can create patterns that can stop the body from being able to find its own balance point.

Nirala Jacobi:

That's a lot there that I actually would like to expand on. Let me just go back for one moment. Can you explain to the listener what the fascia is?

Maree Chilton:

The fascia is the connective tissue that holds ... Look, the fascia is in every single part ... Every tissue in our body has fascia around it. It's like a glove around it, so the heart has its own fascia. The lung has its own fascia.

Maree Chilton:

The connection between the diaphragm and the muscles of the ribcage, they have their own fascia. You have superficial layers of it and you have deep structures, and so it's all the connections. It's like, think of it like a glove, and it needs to be flexible and fluid and able to move to allow all the bits of our body ... The bits that need to expand, they need to be able to expand. The bits that need to be able to move across so when you're bending, they say if you bend forward, it's not only you're bending at your hips and your spine is moving, but your ribcage is moving inside your ribcage, your heart and your lungs are moving, and they have to be able to move on themselves.

Maree Chilton:

They have to be able to move within the muscles that make them do that. They have to be able to move within the bony structures that are able to do that as well, and so it makes for lubricating surfaces, but it also gives a tautness and attention to the system to allow some of these structures, think of a blood vessel, so it doesn't collapse on itself, or your heart. We would be in trouble if our heart or lung collapsed on itself, yeah, to go to the gut. The stomach is not ... It empties, and so it collapses down, but then, when it has food go into it, it needs to fill back up again, but if every time it was empty, the walls stuck together, would be in trouble.

Nirala Jacobi:

It is super complex in terms of it's then the innovation and you have superficial innovation, you have deep innovation, you have all this feedback. Kind of switching gears for a second there, what kind of ... Because I'm just thinking of the listener saying, "Oh, how does this relate to me who has chronic digestive issues or I happen to also have a lot of stress in my life?" What have you observed ... I know that you see a lot of different patterns, but have you seen any kind of recurring pattern, for example, people that have a lot of stress in their life? How does it affect the physical structure?

Maree Chilton:

Okay. That's possibly one of the easiest ones, and it's the effect on breathing, really. When we get stressed, we often lose the awareness of our breath, and as we lose that awareness, our body breathes us. Life breathes us, and often, the more stressed we are, the more tight our muscles are. If our diaphragm is our major breathing muscle and it's not working properly and it starts to constrict, you start to lose space in the body for allowing safe food to come into, down through the esophagus, down through the diaphragm.

Maree Chilton:

If the diaphragm constricts and the esophagus gets constricted and the sphincter gets constricted, it's harder to get food through that sphincter across into the stomach, and then if the diaphragm is contracting and not being able to move through its full range, there's not the space for food to fill up into the stomach and to allow that process of food to move through the stomach, then into the small bowel, into the large bowel, and then out the other side. Probably the big thing is we stop using the diaphragm the longer stress goes on, and we start using accessory breathing muscles, which often are neck muscles, back muscles, shoulder muscles. They're not designed to do that. We breathe about 20,000 times a day, so if you're breathing even more than that, then those muscles get pretty tired. Then, as you start to use neck and back muscles and hip flexor muscles to be able to do that breathing, eventually those systems break down and we can end up with back pain, back pain, neck pain, hip pain, shoulder pain, because some of our accessory breathing muscles go up to the shoulder and can limit shoulder movement, and if you get stressed and your neck muscles get tight and you start to have a little bit more forward head carriage, the diaphragm tightens, the front of the chest tightens, then the shoulder girdle starts to move forward on the ribcage, and that then limits the ability of the arm to lift, so then as we age, we can, with repetitive strain, end up with shoulder injuries.

Maree Chilton:

Now, that gets complex because a lot of the gut reflexes actually reflex back to the shoulder, so the stomach can reflex back into the left shoulder. The gallbladder and liver and the ileocecal valve can reflex back into the right shoulder, so ...

Nirala Jacobi:

That's actually a really good point to interject. A lot of people that keep thinking they have shoulder pain and they work on their shoulder, they have those issues in their body, like a gallbladder issue or an ileocecal valve that's either stuck open or stuck closed, and it's referring to the shoulder, so that's really the patterns that I think are really important to address, that it's not always a shoulder problem, like you say.

Maree Chilton:

That's right, and it's being able to differentiate those. If you treat the shoulder and it doesn't go away, then you might have a smoldering gut issue. As chiropractors, a lot of the time what we're treating and naturopaths, we're treating a lot of functional issues, so the pathology stuff is really obvious. You've got gallstones. It's obvious.

Maree Chilton:

You can do a scan and you can go, "I can see gallstones," but if you've got a liver that's not functioning properly because the diaphragm's restricted on top of it or you've got a twist in your ribcage, and that diaphragm locks the liver down, and in the phase when the body needs to be detoxifying and you're pumping blood through the liver, and it can't drain and it fills up like a sponge, and then it won't drain into the gallbladder into the small bowel, then you might start getting a firing off of some of the viscerosomatic, meaning the reflexes of the organs like the gallbladder, back to the body, complaining that something's not right, but it might not also be pathological. That's what we're trying to look at and differentiate is, "What is it telling us? Have I hurt my shoulder, or have I got a gallbladder that's not so happy?"

Nirala Jacobi:

Obviously, I see a lot of people that have chronic digestive issues, and I always ... Whenever somebody ... For me, a red flag is if they have a recurring pain, really pinpoint somewhere in the body, and everything has been scanned, checks out, it's all fine, but that always seems to me that there is some other structural problem that hasn't really been identified, and on scans and things like that, you can't really see very well those kinds of patterns or functional issues. It just rules out any kind of gross pathology, but it doesn't really help us understand how something is twisted or there's blood supply being cut off functionally. Do you know what I mean?

Nirala Jacobi:

Usually, just for the listener, because I've had patients that miraculously had relief with visceral manipulation or somebody who released their diaphragm, or I know we keep going back to that because it's such a important topic in digestive health, but it can be really, really powerful when you find a practitioner that understands these kinds of connections like you do, that then can really be very targeted in their release, and it's not about relieving the shoulder, it's about relieving the ileocecal valve, for example, you know? That's why I wanted to talk to you and bring up this topic, that don't always think the problem is where the pain is. It can be in a different part of your body and you need to find a skilled practitioner to help you with that.

Maree Chilton:

That's right. That just reminded me of ... Also, when we're working with the body and we constantly have the same problem keep coming back, particularly in the gut, if you're doing visceral work and a gallbladder symptom, there's no pathology and a reflex keeps showing up, it also can be the body, the spinovisceral reflexes or somatovisceral reflexes can be the problem where the feedback loop coming from how the brain is integrating that back to the body, that reflex loop has not been cleared because we have a spinal reflex that goes from the spine to the body and the body to the spine, so we get information. Does that make sense?

Nirala Jacobi:

Yeah, so this is ... Are you talking the afferent and efferent nerves?

Maree Chilton:

Yes. I'm talking the afferent and efferent.

Nirala Jacobi:

Yeah. Yeah. Yeah, so just for the layperson, your central nervous system, your brain is communicating with your body through these different nerves that are sending messages back to the brain through the spinal cord. Is that what you're talking about?

Maree Chilton:

That's right.

Nirala Jacobi:

Yeah.

Maree Chilton:

Yes, that's what we're talking about. If you're rubbing a spot on the gut, for instance, or treating a digestive symptom and it's not going away, then sometimes we have to look at going, "Has the body actually identified that there is a link between them?," because sometimes we're just there rubbing. I suppose this is where massage, where we can go, "Yeah, I've got a pain somewhere and I'm just going to keep rubbing that," like we were talking about the shoulder reflex, but if the body can't identify that it needs to defend something, then it doesn't matter how much you rub that. It's not going to change it. I think this is where sometimes we have to go back to the control system, and this is where I like the chiropractic philosophy, is because we come back to that point of view of it's a self-regulating system, so what is getting in the way from stopping the brain and the body talking to each other effectively, and if the body is twisted and there is pressure on nerves or there's a twist in the pelvis and that causes a twist up through the diaphragm, the hip flexor, the ribcage and we don't change that reflex, then we might just keep that reflex going in the gut, so we have to go back and treat it through the spine.

Maree Chilton:

I think that's where sometimes that's something that's sometimes missed, I think, and we need to try to clear that. It's easy to rub, so if you're a person that has those symptoms, it's easy to do your own visceral relaxation. You can easily massage a part of the body with a little bit of guidance to that, but the harder part, and I know myself as a chiropractor, I can't adjust my own spine. If I was trying to look for someone to help me to sort something out, I can do some of the visceral work. I can do vagal toning.

Maree Chilton:

I can do breathing to help that, but if the coordinating system is not working, then it's really hard to change some of that. You're going to have to do a lot of vagal toning for a really long time in order to change the tone of that, the vagus nerve, if it's squashed coming out from the skull down into the neck, down into the body.