Did It Go?
Where? Where do you want it to go? Those are always the first two thoughts that go through most evidence-based chiropractor’s mind after a patient asks, “Did it go?” Many patients equate joint cavitation with successful treatment. Historically, chiropractic patient education has focused on this one element to measure our clinical effectiveness. There is certainly a need for evidence-based chiropractors to discuss all the in’s and out’s of cavitation.
Explaining the mechanism of joint cavitation takes time, but is an important element of patient education; particularly, explaining that joints do not routinely go in and out of place. Patient ignorance regarding the mechanics and benefits of joint manipulation is OUR FAULT. We must adequately reeducate our patients on what is happening, why the joint is restricted, and how manipulation is the treatment of choice for their problem.
Check out this week’s video blog to see how Dr. Steele educates patients about why joints cavitate and the importance of this phenomenon… in less than one minute.
Joint manipulation improves range of motion across individual and multiple vertebral segments. A recent paper by Anderstt et al. (2018) confirmed that cervical manipulation results in facet gaping. This force also improves regional motion across multiple spinal levels during and post-manipulation.
“This study is the first to measure facet gapping during cervical manipulation on live humans. The results demonstrate that target and adjacent motion segments undergo facet joint gapping during manipulation and that intervertebral range of motion is increased in all three planes of motion after manipulation. The results suggest that clinical and functional improvement after manipulation may occur as a result of small increases in intervertebral ROM across multiple motion segments.” (1)
“In 2006 I began designing and building dynamic disc models (which I named Dynamic Disc Designs…a bit of a play on acronyms: DDD) when years later as I was increasing the detail of the synovial joint when a ‘crack’ occurred spontaneously. It happened after polishing the simulated hyaline cartilage and sculpting an elastomeric synovial fold. It generated a cracking sound when it pulled off the shiny surface. I developed a model from that moment and called it “The Audible Release Dynamic Disc Model”.
This basic observation led to the paper conducted in 2015 at The University of Alberta, using myself as the lone subject. It was our PLOS Study that Greg Kawchuk lead and I co-authored that challenged Unsworth’s collapsing cavity hypothesis. You have likely seen the video of the Greg pulling my finger. It was after this study that I decided to re-introduce fluid into the Audible Release Model which led to a 2017 publication in JCCA.
In the meantime, I am happy to have developed a model we can use to show our patients how manipulation (with audible release) generates facet space and likely disc height gains. Often patients are nervous about the physical event. With a dynamic disc model, a practitioner can now quite easily show the patient what this looks like and how side posture manipulation rotates a motion segment to allow separation of the facet joint to occur. Having been a chiropractor for 18 years, I understand those questions that come up or those questions that patients are afraid to ask. These models bridge and strengthen the bonds between chiropractors and patients. The current language is “therapeutic alliance.” They enhance the clinical setting because they are engagingly dynamic and can show the problems as well as the proposed mechanical solutions. They are perfect to show what we intend to do to help patients with back and neck pain.”
Our flagship clinic has purchased and used models by Dynamic Disc Designs for several years. The quality is unmatched, and the patient education possibilities are endless. The models provide transformative moments for when patients ask the dreaded question “did it go?” Instead of a canned 5-minute explanation of joint manipulation, I simply take out the model and show the patient how a joint cavitates through facet joint gapping. That’s usually the end of the discussion. No physics or follow up questions. Just, “Oh, now I see.” This model saves time and provides a visual representation for a sometimes difficult concept.
ChiroUp pushes out evidence-based content, ideas, and strategies on a weekly basis to make your practice run smoothly. Saving seconds per patient can significantly increase your revenue. Investing in staff, training, programs, education, and products is a reality of doing business. ChiroUp has no monetary affiliation with Dynamic Disc Designs. We simply appreciate the product and enjoy conversations with the owner, Dr. Fryer.
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- Anderst WJ, Gale T, LeVasseur C, Raj S, Gongaware K, Schneider M Intervertebral Kinematics of the Cervical Spine Before, During and After High Velocity Low Amplitude Manipulation. Spine J. 2018 Aug 21. pii: S1529-9430(18)31085-4. doi: 10.1016/j.spinee.2018.07.026.
Special thanks to Dr. Jerome Fryer CEO, Dynamic Disc Designs Corp.
About the Author
Dr. Brandon Steele
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