Rehab made easy
By Michael Perusich, DC

Patient rehabilitation — rehab— is a function many doctors are incorporating into their practices. They find that rehab profits their patients, their outcomes, and their practice's bottom line.

In short, rehab adds value to chiropractic care. It teaches patients how to manage their bodies, improve outcomes, actively involve them in their care, and treat their functionality. Rehab is a natural way to improve joint endurance and stability, reduce muscle atrophy, decrease scar tissue formation, and restore function.

Pain relief is not the primary goal of rehab. Its goals are functional restoration and prevention of recurrences by establishing motor control of spinal, pelvic, and scapular stabilizers. Rehab also improves the speed of muscle contraction, inter-muscle coordination, endurance, and strength.

If you have not yet incorporated rehab into your practice, but are encouraged by its benefits, you will find that it is not difficult to implement. In most states, you do not have to acquire certification or undergo additional training to offer this service, nor do you have to increase the time you spend with your patients. (Always check your state licensing laws, however.)

Rehab does not use much space or expensive equipment. All you need to get started is a 10-foot by 10-foot room, resistive bands, free weights, stability balls, wobble boards, and floor mats.

REHAB IN 3 PHASES

Before you start patients on a rehab program, first adjust them to improve joint junction, then have them stretch to loosen tight muscles. Finally, involve them in a three-phase rehab program: Kinesthetic awareness, spinal stabilization, and endurance.

• Phase 1: Kinesthetic awareness. Phase one is kinesthetic awareness, or motor control. Begin with a functional assessment to identify weak muscles or muscle groups. Then, using spinal stabilization exercises such as proprioception training on unbalanced surfaces (stability trainers or balls), begin reconditioning the primary spinal stabilizing muscles.

Be sure to incorporate some cardiovascular training (treadmill, stepper, or cycle) as well, since the muscles require aerobic-based activity to function properly.

• Phase 2: Spinal stabilization. During phase two, incorporate the stability ball as the spinal stabilization protocol for a more liable surface and for challenging exercises. At this time also begin using resistance-band exercises for specific muscle groups the functional assessment identified as being weak or inhibited.

When the patient successfully completes the second phase of rehabilitation, perform a follow-up functional capacity assessment. If the patient shows adequate improvement, move to the last phase of rehabilitation. The general estimate is two to three weeks to accomplish the goals of the first two clinical phases, and four weeks to accomplish the third clinical phase.

• Phase 3: Endurance. Phase three is endurance and strength development. During this phase, implement a series of progressive resistance protocols with resistance bands or workout equipment.

Your patients will be more active at this phase and will perform much of the exercises at home. However, before you release them to exercise at home, review with them all exercises to make sure they do them correctly and in compliance with your treatment plan.

Treatment protocol for an average case is 18 to 24 visits for wellness, starting with four to eight visits of daily passive care, followed by six to 12 visits of semi-active care (two to three times per week), followed by four to six visits of active care (weekly).

LONG-TERM RECOVERY

Spinal instability is caused by muscle spasms, imbalance, disc degeneration, bulges, protrusions, joint fixation, anomalies, and fusions. Subluxation is the product of an unstable spine.

A demuscled spine can collapse (buckle) under as little as 20 pounds of pressure. The spine depends on the proper functions of the intrinsic muscles to provide stability, stiffness, and mobility. Failure of the intrinsic spinal stabilizing muscles to maintain proper positional alignment between segments leads to eventual segmental failure.

Rehab strengthens the muscles and creates spinal stabilization, which improves outcomes, overcomes pain, decreases the load to the spine, and helps to limit recurring problems.

The benefits of rehab to the patient are obvious, as are the benefits to your practice.

SIDEBARS:
More reasons to incorporate rehab into your practice
Home rehab made easy

Michael Perusich, DC, has advanced training in the chiropractic management of spine and joint rehabilitation, operates The Back Bone of Health Wellness Center, and was featured as a Success Profile in Vol. 51, Issue 14, of Chiropractic Economics. He can be reached at backboneofhealth@charterinternet.com.