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Recently, The Journal of Physiotherapy (2019) published a paper finding that patients have a desire for a specific diagnosis. From which, they want “clear, consistent and personalized information on prognosis, treatment options and self-management strategies, related to healthcare and occupational issues.” (1)

How practical is it for an evidence-based provider to create a personalized treatment plan for every patient? Extremely!

Patients want to get out of pain quickly. This week’s blog is going to break down the strategies that I use in my clinic to alleviate my patients’ pain quickly and allow them to heal faster. Check out the video below for a demonstration of these strategies.

Developing personalized treatment strategies will help you and your patients understand each condition thoroughly. Patient participation is critical to their overall success. Most patients are looking for you to alleviate pain fast; but they are also wanting to understand their condition better and are looking for self-management strategies to reduce disability. Here are three of my favorite ways to reduce pain levels and decrease the reoccurrence of pain syndromes.

Build Tissue Capacity

Share Load: Joints bear the load, move, and perform optimally while at the same time, avoiding injury. Joint stability requires two essential components: the strength of the supporting musculature and the precise dynamic coordination of these muscles through the central nervous system. A deficiency, injury, or weakness in one joint stabilizer requires compensatory recruitment of other muscles altering global movement patterns. Compensatory muscle activation may lead to muscular strain, overuse injuries, and ongoing “learned” movements or postures. Longstanding joint dysfunction may also lead to physical changes in the supporting muscles or bony architecture. Muscular weakness, morphologic change, and learned neuromuscular dysfunction lower an individual’s capacity to do work. (2)

Strengthen Tissue: Rehabilitation programs should be implemented early and often with progressive restorative loading. The use of isometric and eccentric exercise places tensile stress across injured or degenerated tissue. Muscles, ligaments, and tendons remold to accommodate physical stressors. When performed correctly, and often, tissue can increase strength and resiliency to prevent injury in the future. (3)

Movement Retraining: Repetitive movement and postural stresses apply force to specific tissues. Evidence-based providers must recognize these injured tissues through orthopedic testing. However, they must also identify the activity resulting in pain. For example, lateral hip pain, IT Band Syndrome, Greater Trochanteric Bursitis, and Gluteal Tendinosis are all orthopedic diagnoses reflecting the exact site of tissue injury. Chiropractors must then identify the movements or postures resulting in tissue failure.  For example, if running is the repetitive stress resulting in a hip injury, be sure to access gait mechanics before releasing the patient.

Some runners may benefit from a 3-inch gap between their feet during the stance phase in gait. Increased step width will slow foot pronation, tibial/ femoral internal rotation, and improve knee mechanics. Most runners begin by running on a flat surface with a line. (side of a road or track) each step should land on opposite sides of the line, ensuring the 3-inch gap in stride width. Changing habits and patient behavior is a tough task. Start with running short distances as this will be a tremendous challenge to the glutes. Slowly increase range by ten percent per week to avoid injury. 

Increase Pain Threshold 

Increase pain threshold: Patients who continually challenge themselves physically and mentally are often our most healthy patients. Teaching every patient to move well and move often is a common motto in physical medicine offices and for a good reason. Daily non-specific exercise is proven to increase descending pain inhibitory control. Performing global exercises, or to a specific region, will decrease pain intensity and allow patients to recover more quickly. (4)

Individuals exposed to trauma, especially (i.e., posttraumatic stress disorder), are at a higher risk of suffering from chronic pain due to altered pain perception and modulation. (5)

Treatment: Select treatment methods to increase pain pressure thresholds. Ancillary therapies, like deep needle manipulation may reduce mechanical pressure sensitivity. (5) Consider adding one or two services directly aimed to reduce pain. Spinal manipulation in both asymptomatic (6) and symptomatic patients (7) is the most common treatment to reduce symptoms in chiropractic offcies. However, there are a multitude of treatment methods proven to decrease pain, depending on the tissue injured. Refer to ChiroUp’s Condition Reference section for an exhaustive list of treatments.

Screen For Psychological Overlay: Many factors affect an individual’s pain pressure threshold. Pain catastrophization, depression, and pain-related fear have significant negative associations that decrease an individual’s pain thresholds. (8) Evidence-based chiropractors should screen patients for high fear-avoidance beliefs with validated disability indices. Results may affect your prognosis and possible referral to an outside specialist.

Allow Tissue Healing

Stop The Offending Activity: Early rehab must minimize positions, activities, and exercises that involve sustained or repetitive compressive loading to injured tissue. Performing tasks that compress injured tissue or load painful joints are counterintuitive. For example, gluteal strengthening is imperative for many knee conditions; however, co-morbid knee osteoarthritis reduces the types of exercises you can prescribe. Choosing a clam exercise may achieve similar results to a standing lunge without aggravating a joint.

Gluteal strengthening with Knee Osteoarthritis

Sleep: Adequate sleep is imperative for proper immune function. (9) Sleep position may also impede the healing process. Sleeping places stress on particular regions of the body, dependent on position. For example, rotator cuff tendinosis healing requires blood flow. Resting on the affected shoulder inhibits the healing process through compression of the tissue. Ischemia to injured tissue further slows the healing process and resultant pain.

Metabolic considerations:  Injuries happen. Luckily we are all self-healing organisms. Although, some of us heal faster than others due to the overall capacity to heal. For example, people with Type 2 diabetes have a reduced ability to heal. High glucose levels lead to poor blood circulation and nerve damage. Others have metabolic conditions limiting their ability to control inflammatory reactions—sustained inflammation results in chronically irritated tissue. Multiple inflammatory molecules unique to discs are involved in early degeneration. (10) Luckily, patients can increase their healing potential through a healthy diet and exercise. Supplementation may be a viable option to speed up healing time. Vitamin C plays an essential role in collagen synthesis, fibroblast proliferation, capillary formation, and neutrophil activity. Omega-3 fatty acids may also enhance T-cell and natural killer cell activity and reduce systemic inflammation. (9) Nutrition can be a detriment to healing or exploited to do the opposite. 

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Consider using simple infographics to educate your patients on the benefits of nutrition.

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Okay so hopefully now you can see that YES, it is practical for an evidence-based provider to create a personalized treatment plan for every patient.

But now I want to take it a step further and introduce you to the ChiroUp feature that will generate a patient condition/exercise report in SECONDS. If this sounds like something you want to learn more about, click here.

And if you like what you see, you can build your own reports for FREE through our 14 day trial. No credit card required so you can see for yourself, with no pressure of commitment, if this will work for you.

As always, I’m here to take your questions. You can email me at Brandon@chiroup.com.

References
  1. Lim YZ, Chou L, Au RT, Seneviwickrama KM, Cicuttini FM, Briggs AM, Sullivan K, Urquhart DM, Wluka AE. People with low back pain want clear, consistent and personalised information on prognosis, treatment options and self-management strategies: a systematic review. Journal of physiotherapy. 2019 Jul 1;65(3):124-35. Link
  2. Bertelsman TB, Steele BS Spinal Instability. ChiroUP.com accessed 3/5/2020 https://appsv2.chiroup.com/treatment/conditions/104
  3. Bertelsman TB, Steele BS Gluteal Tendinopathy ChiroUP.com accessed 3/5/2020 https://appsv2.chiroup.com/treatment/conditions/3567
  4. Hansen S, Vaegter HB, Petersen KK. Pretreatment Exercise-induced Hypoalgesia is Associated With Change in Pain and Function After Standardized Exercise Therapy in Painful Knee Osteoarthritis. The Clinical Journal of Pain. 2020 Jan 9;36(1):16-24. Link
  5. Wang-Price S, Zafereo J, Couch Z, Brizzolara K, Heins T, Smith L. Short-term effects of two deep dry needling techniques on pressure pain thresholds and electromyographic amplitude of the lumbosacral multifidus in patients with low back pain-a randomized clinical trial. Journal of Manual & Manipulative Therapy. 2020 Jan 18:1-2.
  6. Honoré M, Leboeuf-Yde C, Gagey O. The regional effect of spinal manipulation on the pressure pain threshold in asymptomatic subjects: a systematic literature review. Chiropractic & manual therapies. 2018 Dec 1;26(1):11. Link
  7. Srbely JZ, Vernon H, Lee D, Polgar M. Immediate effects of spinal manipulative therapy on regional antinociceptive effects in myofascial tissues in healthy young adults. Journal of manipulative and physiological therapeutics. 2013 Jul 1;36(6):333-41. Link
  8. Othman R, Dassanayake S, Jayakaran P, Tumilty S, Swain N, Mani R. Relationships Between Psychological, Social, Physical Activity, and Sleep Measures and Somatosensory Function in Individuals With Spinal Pain: A Systematic Review and Meta-analysis. The Clinical journal of pain. 2020 Feb 14;36(2):124-34. Link
  9. Smith TJ, Wilson M, Karl JP, Orr J, Smith C, Cooper A, Heaton K, Young AJ, Montain SJ. Impact of sleep restriction on local immune response and skin barrier restoration with and without "multinutrient" nutrition intervention. Journal of Applied Physiology. 2018 Jan 1;124(1):190-200. Link
  10. Rajasekaran S, Tangavel C, KS SV, Soundararajan DC, Nayagam SM, Matchado MS, Raveendran M, Shetty AP, Kanna RM, Dharmalingam K. Inflammaging determines health and disease in lumbar discs—evidence from differing proteomic signatures of healthy, aging, and degenerating discs. The Spine Journal. 2020 Jan 1;20(1):48-59. Link

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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