According to some estimates, over 90 percent of chiropractors incorporate some form of therapeutic exercise into their practices. While I think that figure is an optimistic one, there is a growing trend in the profession to include active care as a routine part of patient care.
I tend to encounter three types of doctors. The first group includes many successful practitioners, who have invested heavily in the latest high tech exercise equipment. Unfortunately, may of these doctors awaken only to find themselves saddled with huge overheads and facing tough competition from big budget fitness facilities. In their rush to have the latest and greatest equipment, they fail to effectively differentiate themselves in the marketplace as anything more than just another gym.
The second group includes doctors on tighter budgets who, out of necessity, resist investing in the latest high tech rehab fads, but aren’t sure they can afford to get started with active care.
The last group consists of doctors who shy away from rehab simply because they have had little training in rehabilitation and lack a clear understanding of how it should be done. Unfortunately, failing to include rehab within the professional office often means doctors end up doing little more than occasionally prescribing a generic series of take home exercises for their patients.
If you find yourself in either of these last two categories, I would like to share a simple approach to active care which has worked well for thousands of doctors.
The first thing you should know is that simple, low tech rehab procedures have been shown to work just as well or better than top of the line, high tech equipment.1 You don’t have to compromise quality of care just because you are starting on a shoestring. And, if you are new to rehab and looking for a simple, effective, way to get started, I suggest you consider approaching therapeutic exercise from a postural perspective. Basically, it works like this:
1. The patient’s posture is analyzed in both the frontal and sagittal planes.
2. Significant postural imbalances are noted, and…
3. The patient is instructed to exercise into the "reverse" or "opposite" posture(s).
Pretty complicated eh? Here’s how it works in real life.
I generally recommend patients perform postural exercise on a "10-10-10" basis until I start to see significant correction of the posture. That’s ten repetitions of ten seconds each to be done ten times daily. Holding the "reverse" position for a full ten seconds helps to tone and activate slow twitch fibers so important in maintaining balanced upright posture. We may also include other exercises if we observe a specific weakness, but reverse posture exercise is definitely at the core of what we do. In our office, we will typically observe and coach patients as they exercise during their initial period of regular visits and then try to transition them to home care as soon as they are symptomatically stable and proficient in performing their home care regimen. We also provide the patient with a take home exercise device, basically identical to what they have become accustomed to using in our office. This helps to insure compliance and then it’s simply a matter of following up and re-coaching as necessary to help keep the patient on track.
There now…. Wasn’t that easy? And painless, too!
One of the great things about approaching spinal correction from a postural perspective is that, no matter what your philosophy is or which technique you use, almost all chiropractors can agree that it’s generally a good thing for the spine to be straight in the frontal plane and to have healthy curves in the sagittal plane. Doctors who are willing to look at a posture-based approach to therapeutic exercise will find that reverse posture exercise is a great tool in helping you make real and substantial structural corrections on your patients, and will integrate well with essentially all styles of practice. No…it’s not the only way to approach rehab, but it is conceptually simple to learn and effective in producing results. Combine your reverse posture maneuvers with some general strengthening exercises for the spine, and I think you will be very pleased with your outcomes.
Maybe the best part is that posture-based rehab can be implemented very effectively for about a hundred dollars or so per station. All you need is a small dedicated space for your patients to exercise in, and a few simple pieces of basic equipment. Ten years ago, I was struggling to find affordable ways to implement rehab into our clinic, improve our treatment outcomes, AND keep the practice profitable. The solutions we came up with are affordable by every doctor and don’t require you to change a thing about your adjusting technique. If we did it, you can, too.
Dr. Mark R. Payne is the president of Matlin Mfg., a manufacturer and distributor of postural rehab products since 1988. For more information, call Dr. Payne at 1-334-448-1210 for his free report entitled Guerilla Rehab—Survival Strategies for the Chiropractic Jungle, to find out how to get started without breaking your bank account. To download a full and unabridged version of this article, link to www.MatlinMfg.com.
1.Evans, R., Bronfort, G., et al. Two-Year follow-up of a Randomized Clinical Trial of Spinal Manipulation and Two Types of exercise for Patients with Chronic Neck Pain. Spine 27 (21): 2383-2389, 2002. Lippincott Williams & Wilkins.