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Educated patients are compliant patients.

This blog will detail three proven concepts to generate life-long promoters of your chiropractic practice.

For thirty years, research has challenged the assumption that persistent pain reflects unhealthy bodily tissue.  To treat pain, many patients will visit a chiropractic office, get a massage, watch some YouTube videos, take medication, buy gadgets online, or rub expensive oil on themselves. 

Each therapy has varying degrees of legitimacy and efficacy.  

PROBLEM: 

When you only treat PAIN as a part of your in-office narrative, you now compete for patients with every other gadget, infomercial, and healer.  

SOLUTION: 

There is a better way to use your license. Educate your patients about WHY their specific habits, co-morbid diseases, or activities cause pain. This small shift will separate you from the competition.  

Here are three concepts that evidence-based providers use to create highly engaged patients for life.

1. Pain is Normal

Pain is not a signal that originates from bodily tissues (1); rather, it is a highly motivating perceptual experience generated by a perceived need to protect bodily tissue from harm (2).

This concept should dominate your communication during an evaluation of a new problem.  Pain is a good thing and indicative of a properly functioning nervous system.  Muscle spasms, joint restrictions, and movement compensations are secondary to the activities we repetitively engage in throughout the day. Long-standing pain presentations require a broader focus than merely structural and functional adaptations. Nearly all veteran secretaries have rock-hard upper traps.  Repeatedly stretching hypertonic muscles and manipulating adjacent joints may not be as impactful as changing workstation ergonomics.  Likewise, novice runners may need to learn proper training strategies instead of manual therapy for their shin splints. 

Pro Tip: Patients are typically better equipped to participate in treatment selection when they understand the proposed mechanistic contributors to their pain (3). Sometimes you are not going to be the expert on everything the patient needs.  That’s okay, build a network of experts in your community to cross-refer in the patient’s best interest.

2: Structural Problems Do Not Correlate Well with Pain

Pain is not a dependable indicator of tissue state. Nociception is subject to up and down-regulation at multiple points enroute to the brain. Perception of pain is a product of the nervous system’s plasticity, and these three points: the periphery, dorsal horn, and the brain (4).

Lumbar spondylosis, rotator cuff tears, and knee osteoarthritis all sound like painful conditions. They often are asymptomatic. These pathoanatomic changes are merely symptoms of long-standing dysfunction.  The patient’s treatment requires recognizing potential contributors to their diagnosis instead of the symptom.  For example, many painful MSK symptoms reduce with exercise.  Mechanoreception and activation of the descending inhibitory pathway are cheap, effective, and safe ways to decrease nociception.  

Pro Tip: Have your patients park in the back of every parking lot. Increasing steps and walking speed are excellent therapies for nearly every MSK diagnosis. Keep things simple and measurable.  

3: Big Toolboxes Lead to Better Outcomes

The nervous system’s plasticity depends on other bodily systems and functions: immune function, tissue injury, stress, obesity, exercise, etc.  The reversal of these sensitization environments represents a viable target of treatment. This concept is particularly important for the chiropractic profession as we are experts in using movement and patient education to modify these neural pathways.

Treatment of rotator cuff syndrome may include manual therapy, heat, joint manipulation, altering sleep posture, controlling blood sugar, reducing obesity, PRP injections, screening for yellow flags, improving posture, etc.  How many of these therapeutic interventions or conversations are you willing to engage in will determine your patient’s success. 

Pro Tip: There is no secret that healing potential decreases with age. Three-year old’s and 90-year old’s don’t share the same healing capacity.  Other factors slow down or even stop the healing process, including autoimmune diseases, diabetes, thyroid disease, medications, and obesity, to name a few.  Don’t be afraid to treat each patient as a case study of one and explain how each variable affects their prognosis. Chiropractors must explain their bio-psychosocially informed hypothesis about all possible contributors to the pain experienced (5).

Conclusion

Explaining that your patient’s pain is due to a misaligned joint is no longer good enough. 

Evidence-based chiropractors must recognize ALL the factors leading to pain and educate patients about these variables. 

And if I can boast for a second – when it comes to patient education, there is no other company that can compare to what we’re doing at ChiroUp. 

Our condition report builder lets you create condition-specific reports that are customizable to each patient in as little as 4 clicks. These reports are what all of us have dreamed about having as providers, but now it’s a reality

Stop what you’re doing and head over to our website to learn more.

References
  1. Wall P.D. & McMahon S.B., 1986, ‘The relationship of perceived pain to afferent nerve impulses’, Trends in Neurosciences 9(0), 254–255.
  2. Moseley G.L., 2007, ‘Reconceptualising pain according to modern pain science’, Physical Therapy Reviews 12(3), 169–178.
  3. Lorig K.R., Ritter P., Stewart A.L., Sobel D.S., Brown B.W., Bandura A. et al. , 2001, ‘Chronic disease self-management program: 2-year health status and health care utilization outcomes’, Medical Care 39(11), 1217–1223
  4. Woolf C.J., 2011, ‘Central sensitization: Implications for the diagnosis and treatment of pain’, Pain 152(3 Supplement), S2–S15. 
  5. Nijs J., Van Houdenhove B. & Oostendorp R.A., 2010, ‘Recognition of central sensitization in patients with musculoskeletal pain: Application of pain neurophysiology in manual therapy practice’, Manual Therapy 15(2), 135–141. 10.1016/j.math.2009.12.001
  6. Parker, R., & Madden, V. J. (2020). State of the art: What have the pain sciences brought to physiotherapy?. The South African journal of physiotherapy76(1), 1390. https://doi.org/10.4102/sajp.v76i1.1390

About the Author

Dr. Brandon Steele

Dr. Brandon Steele

DC, DACO

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 a Diplomate and Fellow of the Academy of Chiropractic Orthopedists (FACO). His mission in practice is to get people in and out of pain as fast as possible; then give each patient the education and rehabilitation to never see them again. Dr. Steele is also the co-founder of ChiroUp.com, a resource used around the world by practicing chiropractors and colleges.

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