Not all patients are the same, and how they respond to the same treatments can differ tremendously.
After examining a patient, putting together a treatment plan, and beginning care, some patients do not respond well initially. When your patient’s condition is not improving, you may need a different approach.
Experienced chiropractors know that a combination of thorough research, a quality treatment plan, and a willingness to try new methods helps treat a variety of illnesses more effectively.
“If I don’t see an improvement in one or two visits, then I start switching up my game plan,” said Erik Korzen, DC of Dynamic Physical Health in Mokena, Illinois.
Korzen looks for signs of improving symptoms and pain. Initially, new patients are asked about their pain levels. Acute pain is treated very carefully with gentle adjustments, while Korzen watches for evidence of healing.
If adjustments are contraindicated for other reasons or the patient wishes to avoid certain adjustments altogether, Korzen seeks out other treatment methods by reviewing recent publications and conducting online research to find more suitable techniques for the patient.
“Through PubMed, I actually have certain search criteria that I have,” Korzen said. “I get weekly updates from PubMed [regarding] research articles that come out.”
Other resources for searching chiropractic literature are readily available. The Index to Chiropractic Literature, Google Scholar, and The Directory of Open-Access Journals are all either free or mostly-free resources for chiropractors to search scholarly articles and read the latest research on chiropractic care.
Find other ways to adjust patients
Modifying a technique may make it more suitable for the patient. If your patient is suffering from substantial pain, making the adjustment more gentle and gradual may be enough to offer the technique without harming the patient.
“An adjustment is considered a grade 5 mobilization on the scale that we use, so I will take that down to a grade 1 to 4 depending on how much the patient can tolerate,” Korzen said.
“The choice of technique would depend on the patient’s response to the adjustment which may change [the] plan of care,” said Stacy-Ann Smith, DC of Abundant Chiropractic in Loxahatchee, Florida.
Smith looks for other ways to make adjustments easier on the patient. “If hand adjustments are not are not well tolerated by the patient, I would change to another technique which I feel would be better tolerated,” Smith said. Instrument adjusting is a great alternative.
Implement new techniques, and refer if needed
To a certain extent, trial and error are part of every chiropractic clinic. Alternative treatments, tools, instruments, positioning, and table height are just a few of the methods available in the chiropractor’s arsenal. Sometimes, attacking a stubborn condition requires changing your plans.
Smith recommends that doctors carefully consider whether or not new techniques would benefit their patients. Any new technique should be studied carefully and certainly should not be applied without careful consideration of the patient’s circumstances.
For Korzen, trying something new may even require stepping outside of adjustments and instruments. Also trained as an acupuncturist, he is willing to turn to acupuncture techniques or even refer the patient for outside care if needed.
For example, if patients need nutrition advice, Korzen has them complete a food diary and provides basic nutrition education to patients at his clinic. He chooses to focus his care on addressing patient pain and physical health, while other conditions and concerns may get a referral to another specialist.
“If a patient is looking for more in-depth supplementation and [nutrition] modifications beyond that, I typically refer that out,” Korzen said.
Keep looking and trying
Using resources such as Chiropractic Economics, scholarly journals, and even asking other chiropractors can help you develop the treatment plan that is right for your patient.
Be willing to use the resources at your disposal, and you will offer better care for more patients.