Patients can remain in alignment and stay in motion
Our goal is to teach patients how to remain in alignment and stay in motion. This mindset alone requires a higher level of engagement from everyone and a gateway to build a proactive health partnership with patients.
When it comes to holding adjustments, we have found the most common issues to be addressed are anterior head carriage, pelvic tilting and excessive foot pronation. Spinal and extremity adjustments go a long way to break up these common patterns and reset the system to be more aware and responsive to movement. Rather than look outside our offices or even the chiropractic profession for physical rehabilitation, we zero in on spine-related functions that reinforce new movement patterns, help prevent recurrence and contribute immediately to improved quality of life.
Part 1 of this article (in Issue 17 of Chiropractic Economics) began by uncovering some hidden value offered by the No Surprises Act. Although the good faith estimate is primarily a vehicle for financial disclosure, we made the case that it offered the opportunity to provide a new standard in patient communications.
Part 2 of this article illustrates how to build a proactive health partnership with your patients and demonstrates the importance of supporting corrective adjustments with lifestyle changes and taking a direct approach to corrective care.
Support corrective adjustments with lifestyle changes
Although breathing is a subtle form of movement, it may be the pound-for-pound champion given how essential this spine-related function is. Proper respiration is highly susceptible to proper posture and breathing technique. Our patients find this fascinating and appreciate learning the right way to breathe, sometimes for the first time in their lives. We teach a simple four-step breathing technique that supports spinal awareness and can be used for calming and advanced exercise. The implications of posture on breathing will echo more deeply as we move on to balance.
Compared to breath control, balance is more complex when you consider the wide variety of whole-body movements we need for normal activities of daily living, let alone dynamic exercise and sport. Healthy movement hinges on balance. One of the most popular strategies for supporting adjustments and achieving better symmetry is the use of custom orthotics. Among the many benefits, while patients get used to being adjusted and experience greater awareness of their bodies, orthotics can protect them against further posture damage and help automate the process.
Posture muscles are often the initiators of movement, serving as a safety check prior to fully engaging the muscles that create dynamic movement. Movement deficiency or limited range of motion and the presence of guarding can further underscore imbalances from muscles connecting to the spine. The psoas muscle, a powerful hip flexor necessary for walking, climbing, running and pretty much every step you take is a great example. The primary functions are compromised when the muscle is recruited for balance as other structures fail. One of the more common results is sacroiliac ligament sprain and the sequelae of pelvic misalignment; loss of stability; muscle guarding and compensations throughout the spine (all the way up to TMJ). The sacroiliac joint may be the source of primary injury or it could be part of a kinetic chain reaction working its way up from another compromised complex, such as the foot. In the case of foot overpronation, there are similar muscle patterns.
Take a direct approach to corrective care
Balancing each and every one of these muscles is not a job for the chiropractor hands-on, but if we don’t identify the work that needs to be done when will it happen? When we lean on the effectiveness of adjusting without telling the full story of correction we may be missing an opportunity to lead a more fit and resilient population. We can have this conversation with patients at the beginning of care so they can have a clear path forward.
When patients are educated on common realities, such as overpronation and the chain reaction of muscle changes in the legs, they can begin to see body connections like we do. They can better understand how tight muscles meant to create movement and balance the spine, like quads and hamstrings, suddenly become a part of the problem that needs correction. Muscles like psoas literally attach to the front of the spine, having the potential to affect disc function. Further, in this part of the spine, the psoas muscle overlaps attachments of the diaphragm, where subluxation can potentially lead to movement deficiency of respiration.
Share something nobody else can: your perspective
It is likely patients can’t comprehend all the minutiae we posture nerds have an appetite for, but we can give them a clear starting point and a vision for the potential they can reach. One example from our office comes up immediately with regard to adjusting and orthotic wear: We make it clear that we recommend patients wear orthotics to optimize weight-bearing symmetry and that they should remain in adjustment regularly for best results. The foot is the closed part of our kinetic chain and a logical place to start home care, emphasis on movement-driven care at home. There are online videos available for foot rehab as well as other posture-based conditioning. Over time, patients can progress through a posture-building program with breath control and the right orthotics.
The spine demands our attention first, but sooner or later we’ll confront issues in the lower extremities both in the office and at home. It is unrealistic to expect people to get up out of their chairs and start moving the right way without additional direction. With a consistent effort, we can undo the damage from sitting and overuse of devices that all compete with posture-building. In the spirit of leaving no surprises, we can lay out all the possibilities for corrective care as well as options for performance.
ANISH BAJAJ, DC, is a 2000 graduate of Life University in Atlanta, Georgia. He is the owner of Bajaj Chiropractic in New York City. Bajaj serves on the executive board of the New York Chiropractic Council and was the recipient of their Chiropractor of the Year Award in 2022. As a member of the Foot Levelers Speakers Bureau, he travels extensively, sharing his chiropractic knowledge and expertise with audiences around the country. He can be reached at email@example.com.