In distinguishing my practice from the “average” chiropractic practice which claims to do rehabilitation, it's important that you do not view my comments as criticism of the “old-school” approach. For 124 years chiropractic has helped untold millions of patients to recover their health without reliance on drugs or surgery. I am proud of my profession's track record.
However, less than 400 chiropractors in this country have taken the same 3-year program in rehabilitation which I completed. There is only one practicing DACRB office (Diplomate of Chiropractic Rehabilitation) within a 10—mile radius of my office.
That makes this office totally unique within the La Grange area.
There is a huge difference between taking one weekend class from a manufacturer of exercise equipment versus taking 36 different
12–hour classes, spread out over a 3&–month period, supervised by the most skilled physical medicine trainers in the world.
More than half of those class-hours were spent developing hands-on training in assessment and treatment. The curricula was developed by chiropractic's foremost rehabilitation specialist, Craig Liebenson, D.C.
Some background on Injury Behaviors
If you have ever sprained your ankle, you know you had to modify how you walked, to reduce the pain. It's called limping. Modified behavior. We all do it. However, some percentage of people maintain these “modified” behaviors long after the initial injury heals. A large portion of our training is focused on identifying these behaviours, because they frequently involve unnecessary recruitment of accessory (or helper) muscles to assist the prime movers of a joint complex. This often leads to an over-use syndrome in that region.
A typical example is “shoulder hiking”. This may develop after a neck injury. The muscles across the top of the shoulders (the trapezius and levator scapula muscles) increase in tension. They get sore towards the end of the day, or during or following stressful events, or following prolonged use of the computer, or after driving for long periods. None of those activities would normally cause pain. It's the over-activity of those muscles that is the problem. Our treatment plan is aimed at locating and eliminating these types of behaviors, through a combination of patient training and various forms of active soft-tissue rehab.
What Is the Difference?
The essential difference with the rehab specialist is not just their knowledge. The treatment end-goal of the rehabilitation specialist is different than the average chiropractor. All too often, the average chiropractor's goal is to foster care-dependency, to create a life-time patient. This is not meant as a criticism of wellness-based care. The difference is all about resolving your original health complaint. Once it's resolved, the patient always has the option of periodic wellness checkups.
Our training also includes “active-learning” about how to apply advanced diagnostic, soft tissue, and other treatment techniques. We learn the appropriate staging for cardio-training, proprioceptive, muscle, facilitation, flexibility, strength, power, and speed rehabilitative templates and treatment. Simply put, Dr. Painter is considerably more knowledgeable and skilled in the rehabilitation arena.
The properly-trained rehab specialist's goal is:
find and correct the true underlying cause(s) of the patient complaint;
empower the patient with self-care regimens and self-confidence;
release them from care when they have stabilized
The Active Care Pathway
Just as with wound healing, there are definite phases of progress with active care:
1.) The Inflammatory Phase: The most common sign of inflammation is PAIN. Spinal facet joints become tender, and may exhibit swelling (edema) and often display increased localized muscle tension. The chiropractic adjustment is amazing at reducing inflammation (especially when supported by home icing). A sure sign that you are being adjusted in the correct place is that you should experience significant (50%) pain reduction by the end of the first week's care.
2.) The Repair Phase: Once inflammation reduces, the body continues to rebuild damaged tissue. Care during this phase involves spinal adjusting and light stretching to help those tissues to remodel. This helps to increase tissue elasticity, and to avoid the formation of adhesions. During this phase, increasing the time-period between office visits is the best measure of clinical success in the care program. The repair phase usually lasts about 6 weeks.
3.) The Stabilizing Phase: Soft tissues continue to remodel for 6 months to a year after an injury. The object of stabilizing care is similar to the approach of an Orthodontist. To get significant remodeling, re-alignment and improved function of bony and ligamentous tissue, there needs to be a consistent program of controlled stressors on those tissues (like adjusting the braces). That's the aim of a rehabilitation program.
Treatment in our office may include passive care therapies such as manipulation, mobilization, a variety of soft tissue techniques, or infrequently acupuncture; this is especially true in the acute phase of care, but the our focus is always on reactivating the patient as soon as possible.
Another difference is that our choice of treatment methods is evidence-based and progressive.
Treatment is also progressive
This means that the care plan changes as the patient improves. Treatment is based on the phase of care: inflammatory, repair/remodelling and stabilizing phase. As the patient improves, their treatment changes accordingly. As has been shown in research trials, active care is especially important for chronic pain patients.
Treatment is also based on the needs and goals of the patient. A fifty five year old sedentary office worker will not have the same rehab treatment plan as a 25 year old delivery person whose job requires constant lifting 20–50 lb boxes. The end-goal of a treatment plan should be based on the demands of the patient's activities of daily living (ADLs) along with the patient’s personal goals (such as playing 18 holes of golf pain-free, lifting their 30 lb grandchild, or taking a kickboxing class).
In most traditional chiropractic offices, the same patient will receive the same treatment for their entire program of care — every patient receives the same full spine adjustment, every time. There is no progression; there is no addressing of posture, joint function, movement patterns, fitness or deconditioning issues. The patient is dependant on the chiropractor to fix them. Great for the doc, not so great for the patient.
That is the REAL difference between my office and the average chiropractic practice.
Patient Involvement with Their Care Plan
The biggest difference in the Active Care approach is that the patient is included in their treatment— giving patient’s control over their own healing process is especially important with chronic pain patients.
By addressing underlying causative issues like poor posture while sitting at a computer or driving, poor patterns of lifting and bending, in-coordination in movement, muscle weakness, poor cardio-vascular fitness, poor balance and general deconditioning — the patient has an opportunity to get better and to maintain a home program that keeps them better. It is empowering to the patient and it is very cost-effective.
If your neck or low back is “going out” more often than you are,
you will definitely benefit from meeting “The Doc on The Block”