With the ultimate chiropractic report of findings, orthotics, laser and other treatments follow only after thorough patient education
The chiropractic report of findings is the cumulative byproduct of many aspects of a chiropractor’s belief system, confidence, knowledge and compassion for the patient. It’s a culmination of everything, and the patient will know immediately if this is an office they feel good about or not.
A variety of objectives need to occur at the chiropractic report of findings, and if all of the critical objectives are met, the report will usually end up successful. The first goal is to educate the patient enough so they’ll more clearly understand their problem. So, the first step is always to remind them of Crooked Man (Fig. 1). You can tell them this is every human, that everyone’s imbalances originate in the feet, and that there is a domino-like effect going up the structure.
It begins with the feet
Humans are architectural structures influenced by gravity, aging and stresses. “So, let’s look at your feet.”
We then go to the monitor of our digital foot scanner and point out the optimal feet (Fig. 2) and explain that the red represents the weight-bearing portion of the foot (Fig. 3). In most cases, the patient’s feet have collapsed to some degree, and the response to them is, “We have to fix the feet if we’re hoping to fix your problem.” With the patient also looking at Crooked Man, this makes perfect sense to them.
To fix the feet, we use custom orthotics. When you put custom orthotics in your shoes, your imbalanced feet will now act like the optimal feet. “So, the feet are easy to fix.” We then move to the A-P L-S X-ray which was taken in the standing position with bare feet, with the central ray one inch below the umbilicus to reduce magnification. (Fig. 4)
The first reference point we use is femoral head height. With digital X-ray, we can be very accurate in any difference that may occur. We consider 2 millimeters and under as normal. However, even if the femoral heads are under 2 millimeters different in height, it doesn’t guarantee the feet are actually level. We’ve now learned that femoral head height when barefoot rarely equals femoral head height with custom orthotics in the shoes. So, we tell the patient that we know the femoral head heights generally change in some way, either for better or worse, once we put orthotics in their shoes. You can tell the patient, “If you decide to get the orthotics, when they come in we’ll put them in your shoes and re-take this X-ray to determine if a lift is needed in either shoe, as our goal is to fix your feet and level your femoral heads. If we can accomplish that, your life will be immeasurably better.”
This dialogue virtually guarantees the patient will accept your recommendations and elect to buy at least one pair of orthotics.
Balancing the feet
Once we’ve gone through the A-P L-S, we can then either go to the lateral L-S or the cervical spine X-rays, depending on where their injury is. We can compare their X-ray with normal, and if they have symptoms and if their X-ray doesn’t demonstrate normal biomechanics, we can teach them “Maggs’ Law”: When the loading of a tissue exceeds the capacity of that tissue, compensatory physiological changes occur.
This can easily cause muscle constriction with inflammation, nerve root compression with inflammation, joint capsule inflammation, tendonitis, bursitis, etc. In the end, abnormal loading produces compensatory changes and an acceleration of degeneration over a patient’s lifetime.
We can explain that once we balance the feet and level the femoral heads, we then want to work on healing the involved area. I recommend cold laser (Fig. 5), as this can be used for virtually every and any condition, from fractures to abrasions and contusions, to strains and sprains, pre-surgery and post-surgery, and most conditions that patients suffer. We can explain to patients that laser provides accelerated healing and reduces pain and inflammation faster than any therapy.
Patient response to recommendations
Over the years I’ve learned that blurting out recommendations I think are appropriate for a patient is a waste of time. We don’t know all the circumstances that make up a patient’s life, like their schedule, their goals, their financial situation, etc., so we can go through a series of questions with a patient to better match an appropriate set of recommendations to a patient’s life.
We can explain with the chiropractic report of findings to the patient that what we see on the exam, X-rays and digital foot scan is objective — it’s black and white. What they elect to do about it is subjective, and we want the patient to have a say in it as well. We first talk about the reason they have come in, which usually is some condition or injury that is affecting their life, and what it will take to improve that component of their case.
You can explain that it’s impossible to know how many visits or how long this aspect of care will take, but the less activity, work and exercise they do during this initial phase, the quicker their injury will heal. Everyone wants to continue a full exercise program while also wanting to heal at record pace. It can’t happen. In this case you can let them choose what they’d like to do, and then give them honest outcome potentials: “If your goal is to get better as quickly as possible and spend the least amount of money, you’ll want to take 2-4 weeks off from exercise.”
We can then explain we don’t know how long treatment will take, as everyone heals at a different rate, so let’s set up a fixed number of visits, and we’ll do our best to get improvement with those visits. We’ll re-evaluate at the end and set up our next phase at that time. If they are still suffering symptoms, we re-do the original plan. Once they get better, we then talk about the rest of their life. “Do you want to be the average American who only reacts to your symptoms, or do you want to be more proactive?”
A patient 81 years young
At the conclusion, I then tell them the story of my patient who has been coming to see me three times a week for 37 years. He’s 81, still works as an engineer full-time, runs three days per week, and goes to the gym three days per week. I kiddingly say I don’t know if there’s any correlation, but there might be, so maybe the patient should think about that. We both smile, and the patient has some good food for thought.
This outline for a report of findings allows the doctor to present with no stress, be willing to deal with whatever answer a patient gives, and offer a lifetime of great care if the patient so chooses.
TIM MAGGS, DC, has been in practice nearly 40 years, and is the developer of the Concerned Parents of Young Athletes (CPOYA) network, with the goal of offering every middle and high school athlete a biomechanical exam prior to each sports season. The network, in partnership with Foot Levelers, provides training, resources, networking opportunities and more for DCs interested in working with youth athletes. He can be contacted at firstname.lastname@example.org or through CPOYA.com.