All chiropractors have a choice as they emerge from college and launch into their first days in practice.
All chiropractors have a choice as they emerge from college and launch into their first days in practice.Will they be pain-and-symptom based or vitalistic? If you choose pain and symptoms, then the road forward is clear: Use the orthopedic tests you learned in school. When the test is positive, there is pain, and when it’s negative, there’s not. In this model, your patients stop care once their pain resolves.
I had a different experience of chiropractic. I was interested in the longer-term effects of chiropractic care and wanted to bring my patients on that journey. In the early days, this was difficult. All they had was my word that chiropractic was important even when they weren’t in pain.
Time has passed since then. Research is starting to show some of the longer-term effects of chiropractic. Still, the fundamental choice between vitalism or pain-and-symptom-based care remains. If you want to practice a more vitalistic model, then you need tools to help your patients understand why they would want to stay under care longer. The orthopedic tests won’t serve you well here, as they’re from a different model.
Your patients need something other than your word to trust in. So what do you do? You need to measure something beyond pain.
Objective measurements
You may have heard it said that chiropractors don’t treat pain. Realistically, they can’t—it’s a symptom. If your house was on fire and I just fixed the fire alarm, you’d be mad. Your house is burning down and I only stopped the beeping.
The problem with orthopedic tests is they check for the presence of the beeping fire alarm. They can check for the presence of pain, but they can’t objectively measure it.
What many people fail to understand is that you can objectively measure function.
Those who have studied and experienced chiropractic know its potential. But your patients sometimes don’t—especially new ones. They need something to help them understand and engage with you as you move them from the pathological model of care they’re familiar with to a vitalistic model that is likely new for them.
This is where neurological tests come in. They give you something you can measure and work toward. When I started to work this way, it made goal-setting and care-planning easier because it gave my patients something they could clearly see.
Gone were the days when I’d say, “Your back pain is resolved but come back and we can help you stay healthy.” I could show them their ability to balance was poor, or that their heart rate variability needed improvement. I had something they could look at and say “Wow! I need this investment in my health.”
You have a range of neurological tests to use in practice. For example, using neurological assessment tools, such as bilateral scales, balancing with eyes closed, heel-toe walks, standing on one leg, the turn 180 test, postural tension test, Romberg’s test, heart rate variability, ribcage expansion, and blood oxygen levels. You also have imaging tools such as thermography, sEMG and X-ray.
These offer objective findings that can be retested over time.
First the evidence, then the progress
The first patient visit is normally the evidence collection point that shows you where to start. A thorough history and examination is essential to patient management, and it’s vital to communicate your findings in a way the patient understands.
Objective findings aren’t recording pain; they involve balance and function. That way, when you perform a re-evaluation and take measurements again, you can keep the conversation where it needs to be—about optimal function, not pain. This is the way a vitalistic chiropractor should work. Use objective tests so patients can see where their starting point is.
Don MacDonald, DC, owner of South Side Chiropractic in Edmonton, Alberta, Canada, runs a high-volume, wellness-based practice and operates Personal Chiropractic Coaching. He can be reached at drdon@shaw.ca or through drdonmacdonald.com.
