Chiropractic Treatment Plans

Mar 30

Reading time: 4 minutes

Your clinical treatment plan should be just that—A clinical decision, not a business one.

For most diagnoses treated within a chiropractic office, three things must happen.

Chiropractors need to get things moving
Patients need to keep things moving
Allowing tissue time to heal

Today’s blog will focus on the third point—giving tissue time to heal. Your patient must understand the healing process as well as you do and why their injury may take weeks to resolve. Patients don't comply with their treatment plan because they don't understand why they have to. Patient education is the key!

For simplicity, I will use the example of a tendon injury. One size fits all treatment plans don't make clinical sense when patients may injure different types of tissue with varying degrees of severity. Furthermore, the time it takes for a tendon to heal can vary depending on the individual's overall health.

Check out this infographic I use daily explaining tendon injury and recovery to patients. Patients can look to see where they are in the chart, signifying how long it will take to recover from their condition. It will also correlate symptoms, treatments, and the expected recovery time. Your treatment plan will now be scientific versus a guess.

Minor ligament injuries, such as sprains or strains, may heal within a few weeks with rest, ice, compression, and elevation (RICE) therapy. However, more severe ligament injuries, such as complete tears or ruptures, may require surgical intervention and a longer healing time.

The healing process of a ligament typically involves three stages: the inflammatory phase, the proliferative phase, and the remodeling phase. The inflammatory phase, which occurs immediately after the injury, involves releasing chemicals that cause swelling and pain. The proliferative phase, which can last several weeks, involves the production of new cells and collagen fibers to replace the damaged tissue. The remodeling phase, which can last several months, involves the realignment of the collagen fibers to restore the strength and flexibility of the ligament.

Do Tendons Heal?

The Inflammatory Phase

Minor ligament injuries like sprains or strains may heal within a few weeks. Acute injuries may require rest, ice, compression, and elevation (RICE) therapy for the first few days if pain limits the normal range of motion. However, less severe injuries typically respond better to (MEAT) therapy, including movement, exercise, analgesics, and manual treatment.

RICE is typically recommended for acute injuries or flare-ups of chronic injuries and focuses on reducing inflammation and pain. Rest involves avoiding activities aggravating the injury, while ice, compression, and elevation help reduce swelling and pain.

On the other hand, MEAT focuses on promoting healing and recovery through movement, exercise, and pain management. This approach is often used for chronic injuries or after the initial inflammatory phase of an acute injury has subsided. Movement and exercise can help improve blood flow and promote tissue repair, while analgesics (pain medications) can help manage pain and allow for increased activity.

How Long Does It Take For a Tendon To Heal?

The Proliferative Phase of Healing

Generally, tendon injuries can take several weeks to months to heal completely. Following the recommended treatment plan, including rest and selective rehabilitation, is essential.

Factors affecting the healing response of a patient include:

Increasing age
Smoking
Hypercholesterolemia
Biological sex (variable by tendon)
Diabetes mellitus
Excessive load post fatigue damage

After an injury, the average healing rate of the tendon is approximately 1% per day and reduces if the patient continues to load their injured tissue excessively. Think about your patients with lumbar disc injuries who continue to flex forward and touch their toes every morning because they think it is helping. (1)

If your patient understands their condition, just as well as you do, they will begin to understand the hobbies, habits, and daily postures, that may be contributing to their diagnosis or failure to recover from their injury.

Here is a past blog on the Top 5 Tips For Resolving Patellar Tendinopathy. If you are looking for the exact steps to manage tendon injuries in your office, this is the playbook!

How Do I Strengthen A Tendon?

The Remodeling Phase of Rehab

Don't use corticosteroids during this phase. Corticosteroids limit the inflammatory process vital to remodeling tissue. Furthermore, patients who received a corticosteroid injection reported worse outcomes in the long run compared to those who only did the progressive loading rehabilitation. (2)
Gradual resistance training alleviates symptoms immediately and over a more extended period. (2)
Avoid being too concerned with imaging. Acute and chronic tendon repair does not go hand in hand with the appearance of the affected tendon during imaging. Tendon morphology may remain altered possibly forever. Focus on function and reducing symptoms during rehab—not the MRI findings. (3)

Here's an example of a progressive loading program for Achilles tendinopathy. Using ChiroUp, you can provide the most evidence-based manual therapy treatments for this diagnosis and then deliver essential rehabilitation exercises to help your patients recover.

In less than 4 clicks, ChiroUp subscribers can share fully customizable condition reports just like the one above with their patients. If you're ready to transform your patient education and improve outcomes for your practice, start your 14-day free trial with ChiroUp today.

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1. Griffith KM, Hammer LC, Iannuzzi NP, Takatani KC, Hsu JE, Cotton JD, Gee AO, Gardner RJ, Lack WD. Review of human supraspinatus tendon mechanics part II: Tendon healing response and characterization of tendon health. Journal of Shoulder and Elbow Surgery. 2022 Jul 5. Link
2. Couppé C, Døssing S, Bülow PM, Siersma VD, Zilmer CK, Bang CW, Høffner R, Kracht M, Hogg P, Edström G, Kjaer M. Effects of Heavy Slow Resistance Training Combined With Corticosteroid Injections or Tendon Needling in Patients With Lateral Elbow Tendinopathy: A 3-Arm Randomized Double-Blinded Placebo-Controlled Study. The American Journal of Sports Medicine. 2022 Jul 22:03635465221110214. Link
3. Maffulli N, Nilsson Helander K, Migliorini F. Tendon appearance at imaging may be altered, but it may not indicate pathology. Knee Surgery, Sports Traumatology, Arthroscopy. 2023 Feb 17:1-4. Link

Brandon Steele

Dr. Steele is currently in private practice at Premier Rehab in the greater St. Louis area. He began his career with a post-graduate residency at The Central Institute for Human Performance. During this unique opportunity, he was able to create and implement rehabilitation programs for members of the St. Louis Cardinals, Rams, and Blues. Dr. Steele currently lectures extensively on evidence-based treatment of musculoskeletal disorders for the University of Bridgeport’s diplomate in orthopedics program. He serves on the executive board of the Illinois Chiropractic Society. He is also a Diplomate and Fellow of the Academy of Chiropractic Orthopedists (FACO).