Consider the following complaints: “I want to run a race this weekend, what do you think?”
“I’ve been pretty depressed lately due to this chronic pain I’ve been in for years.”
“I feel great after treatment, but a few days later, the pain just seems to keep coming back.”
Get prepared, new doctor, because you will hear these statements over and over throughout your career. The efficacy of your treatments and the speed at which they take effect will be a crucial factor in the success of your practice.
People want to be feeling better yesterday, not after you’ve had to see them three times a week for six weeks. And especially now, with so many clinics fully transitioning to cash-based practices, you will have few patients coming to your office if it takes weeks of treatment for them to see improvement.
So do you improve the efficacy of your treatments? You chose this profession because you care. Doctors of chiropractic are not trying to simply get rid of their patients’ pain. We want to help them achieve a better quality of life. We want to help them move.
A different approach
We are classically trained as mechanics and are educated to look at the human body in a linear fashion. In other words, “If you lack A, do B, then you achieve C.” But this is arguably not the way to work. Coming out as a first-year chiropractor, I wanted protocols. If my patient presented with plantar fasciitis, I wanted a reliable protocol to use to get them better. I quickly found out the efficacy of my treatments was going to be hugely unsuccessful if I continued this way of thinking.
Enter the neurophysiological approach to chiropractic care. Through pain science and the bio-psychosocial approach, we are seeing new ways to assess, treat and connect with patients.
There are countless options to continue your education. In fact, the list of options can be downright overwhelming. Ultimately, focus on your weaknesses; do not use continuing education to solidify your strengths— particularly right out of school. Try to disprove your biases, and look at movement, assessment and treatment through a different lens.
Don’t “think outside of the box”—try to make your box bigger. Throughout the years I have taken countless courses in spinal adjustments, corrective exercise and specialized assessments; most of these courses left me wanting more. It seemed the instructors were ignoring half of the person in every one of these courses. The half I am referring to is the central nervous system.
It was easy to think about a joint, a movement pattern or neurology by itself. What was lacking was the idea that these separate systems are connected to the person and their brain.
How can you tap into this idea that treating each person requires a multimodal approach that may require constant tweaking and adjustment throughout the course of their rehab? No one has time to perform or follow these cookie-cutter approaches to exercise and manual interventions.
Educating yourself and your patients about pain through such courses as offered from the Neuro Orthopaedic Institute (NOI) and learning from such experts as David S. Butler, EdD, and Lorimer Moseley, PhD, will significantly help you and your patients manage pain. If we understand pain, and are able to communicate that to our patients, we can go a long way to returning people to the things they love while eliminating fear-avoidance and guarding behaviors.
More winning approaches
What about this idea of “releasing” tissue, or “smashing” adhesions, or [insert aggressive mechanical-based model of thinking here]? Is there a rationale to continue thinking this way? Perhaps, for the right patient in the right moment, but what we are finding is that this model of thinking is also fading. This is especially so among those like Robert Schleip, PhD, who are debunking the idea of mechanical deformation with studies showing that close to 2,000 pounds of pressure per square inch are needed to distort tissue by 1 percent.
Touch is important for patient care, but we should re-think what exactly we are touching. IASTM courses that speak about treating fascia and de-sensitizing the brain and removing the perception of threat have been a much welcomed relief—not only to DCs’ hands but to their patients as well. You can get the same if not better results by merely shifting your focus away from the mechanical and into the neurological realm.
When it comes to the problem of how to make a treatment stick, few additions to practice are better than kinesiology taping to improve movement awareness and maintain pain relief long after treatments have ended. Kinesthetic guidance provided by taping can be converted into movement behavior hundreds of times faster than visual guidance and thousands of times faster than verbal cueing.
For those patients in chronic pain who require not only movement correction but lifestyle adaptation as well, taping serves as a constant reminder to place them in a position, avoid a position or simply be utilized as a pain control method. This helps them avoid the doctor visits, pills and injections that are overprescribed throughout the country.
So if you are a new chiropractor, challenge yourself to step outside your comfort zone and consider some alternative ways of thinking. By viewing your patients as human and not as diagnoses, you will improve the efficacy of their treatments and the quality of their lives.
Courtney Conley, DC, graduated from the National University of Health Sciences in 2003. She also holds a BS in kinesiology and exercise science from the University of Maryland. Conley currently owns and operates Total Health Solutions in Golden, Colorado, where she has put together a team of skilled professionals to treat patients ranging from the weekend warrior to the ultra-distance athlete. She can be contacted through rocktape.com.
