Rehabilitation


Building Your Practice on a Strong Foundation
Rehabilitation
Written by Mark R. Payne D.C.   
Friday, 24 September 2010 15:46

Building Your Practice on a Strong Foundation

by Dr. Mark R. Payne D.C.

 

In keeping with this month’s focus on practice management and coaching, I wanted to take a slightly different twist with this article.

While I make no pretense at being a practice manager or coach, I have started and operated two successful practices in my career plus a couple of other successful businesses, and there is one principle which should be carved in stone. You can never have any measure of long term success unless you actually deliver a real and valuable service/product to your patient or client. Oh, sure, there are plenty of folks in every line of business who talk a great game, but never actually deliver very much of what they promise. Such businesses generally start out great but fade in the stretch. Practices which are built on little more than hype and patient motivation generally start to implode after a few years when the community realizes the doctor "just keeps you coming back for the money." There’s just no staying power to any business that doesn’t honestly serve the best interests of its customers.

On the other hand, thousands of doctors all over the country are quietly doing their job, delivering what they promise, and serving the needs of their patients; and patients intuitively know who has their best interest at heart. With a bit of patient education, patients can understand the difference between short term relief and true correction. And, sometimes, with a little patience, they even come to understand the concept of prevention. But there’s one thing that patients always understand and that is objective results they can clearly see with their own eyes. There is nothing more powerful than when a patient sees and understands their problem at the beginning of care and then can clearly visualize their own improvement as care progresses.

It probably comes as no surprise that I believe a postural chiropractic paradigm has numerous advantages for both doctor and patient. At the same time, I realize and respect that many of you have a fundamentally different approach to practice. Where I might choose to concentrate on improving the biomechanical (structural) status of the patient, another doctor might focus on various parameters of patient function like range or quality of joint motion or enhanced ability to perform various activities of daily living.

Whenever we treat a patient, it is incumbent upon us to objectively document the results of our care. Obviously, some methods of documentation are apparent only to the doctor, such as improvement in palpated joint motion. Others, like X-Ray, or visual postural analysis, may be easily seen and understood by the patient as well. The degree to which patients can see and comprehend their problem and the results of your treatment will determine, in large part, the patient’s perceived value of your care and, consequently, the referral value of your services. It is here that a strong focus on posture rehabilitation can be a significant tool in building your practice.

 

 

Figure 1: The PRE treatment film here clearly shows the patient’s loss of the normal cervical lordosis (the red dotted line) as compared to a more normal or optimum lordosis (the black solid line). Patients understand such simple, concrete demonstrations of their problems.

 

 

 

Doctors who focus on biomechanical correction have no problem educating patients as to the nature of their postural problems. These are problems which don’t require a sophisticated or trained eye to see. Once patients understand what their spine should look like (shown here with the black solid line), they can easily understand why they need to perform various rehab activities like exercise, extension traction, or lifestyle modifications to help their posture return to normal. Likewise, the clinical advantages of a structural practice paradigm are numerous as well. Unlike the small, single segment subluxations you learned about in chiropractic college, large scale, multi segmental postural misalignments can be easily and objectively identified, accurately measured, and effectively treated in the majority of cases.

 

Figure 2: The POST treatment film here clearly shows the patient’s lordosis returning to a more normal or optimum position. Patients can clearly see and understand results like these.

 

Including postural care brings patient benefits that simply can’t be achieved in any other way, as well. Simple, low tech methods of postural rehab, such as extension traction and reverse posture exercise, as were used on the patient above, have been shown to produce long term structural improvements, far exceeding those of adjusting or functional based rehab alone. Such postural improvements are key to reducing long term pain and spinal degeneration. Obviously, that’s in the best interest of your patients in terms of their long term health. Hopefully, the above example will stir your thoughts as to how the simple, "common sense" paradigm of postural based chiropractic can be an effective tool for building the health of your practice as well.

Special thanks to our client Dr. Mark Berry of Vestavia Hills, AL, for sharing his pre and post care results. Congratulations, Dr. Berry, on a job well done.


Dr. Mark Payne is the president of Matlin Mfg., a manufacturer and distributor of postural rehab products since 1988. To learn more about implementing postural rehab into your practice, call 1-334-448-1210 or link to www.MatlinMfg.com to request our FREE REPORT, "The Best Corrections of Your Career."

 
Preventing Injuries Requires More Than a Strong Core
Rehabilitation
Written by Dr. Kirk A. Lee, D.C.   
Friday, 24 September 2010 13:33

Preventing Injuries Requires More Than a Strong Core

by Dr. Kirk A. Lee, D.C.

 

Whether we are confronted with developing an exercise rehab program for a male patient (who is sedentary, overweight, and experiencing low back pain) or developing a strengthening program to fine tune a professional athlete, some emphasis must be placed on the core musculature. With today’s marketing of the "infomercial," we have seen everything from machines that promise six-pack abs to cures for low back pain.

Before we start any patient on a rehabilitation program, we must consider several things. It must be designed to improve flexibility and increase strength but not create overload or stresses on the musculoskeletal system. Too much stress can prevent the body from continuing to heal and repair and, ultimately, lead to an exacerbation of the patient’s present injury or lead to a new injury.


 

One of the easiest means of addressing core strength is through the use of exercise balls. A patient who has balance problems can achieve help from just sitting on the ball. Sitting on the pliable-moveable ball causes the stimulation and recruitment of the core muscles to maintain stability. Most balls come with a booklet of choice exercises. It is your job, as the doctor, to determine what activities best suit your patients’ needs.

Keeping in mind the importance of a good core muscular strength, another area of consideration must be focused around the hip or pelvic musculature. When we consider the biomechanics of walking and running we know that, during the stance phase or weight-bearing phase of gait, we have a sub phase called "mid-stance." During this sub phase of weight bearing, all the body’s weight is placed on one leg at a time. It takes strong abductor muscles (gluteus minimus and medius) to maintain a level pelvis, while weakness in the muscles can allow a drop of the unsupported side. Weakness of these muscles could lead to repetitive stress and a familiar gait pattern called a "trendelenburg."


 

 

The importance of maintaining a strong hip and/or pelvic musculature is clearly pointed out in a research study completed at the University of Calgary in 2007 by Dr. Reed Ferber, a professor in Kinesiology. During a seven-month period, they assessed 284 patients who entered his running injury clinic at the University of Calgary. The study showed that 92 percent of the patients demonstrated weakness within the hip musculature. Of those 284 patients, 89 percent showed marked improvement in four to six weeks from performing specific exercises to strengthen the hip/pelvic musculature. The exercises included hip abduction, hip extension and flexion, and external rotation. These were performed in a sequence of:

1. Day one—1 set of 10

2. Day two—2 sets of 10

3. Day three—2 sets of 10

4. Day four and after—3 sets of 10


 

He recommended performing these exercises for four to six weeks and then continuing two times a week thereafter to maintain the strength that was gained.

 

HIP ABDUCTOR—STANDING

1. Place foot not attached to the exercise band behind the leg that is attached to the band.

2. Move leg attached to the band outward, keeping the knee straight.

3. Count two seconds going out and four seconds coming in, controlling the
motion throughout.

HIP FLEXOR—STANDING

1. Place foot not attached to the exercise band beside the leg that is attached to the band.

2. Move leg attached to the band forward, keeping knee straight.

3. Count two seconds going out and four seconds coming in, controlling the
motion throughout.

 

HIP EXTERNAL ROTATION—SEATED

1. Move leg attached to the exercise band outward, then return to starting position.

2. Keep knees together throughout the motion.

3. Count two seconds going out and four seconds coming in, controlling the
motion throughout.

 

In his study, Dr. Ferber recommended using a two-second count while taking the leg out as well as bringing it in. I like adding the four-second count to allow an eccentric unloading of the muscle as you return the leg to the starting point.

As you assess your patients’ rehabilitation needs, remember to emphasize not only the core musculature but the hip and pelvic musculature as well for additional stabilization.

A 1980 graduate of Palmer College of Chiropractic, Dr. Kirk Lee is a member of the Palmer College of Chiropractic Post Graduate Faculty and Parker College of Chiropractic Post Graduate Faculty. He has lectured nationwide on sports injuries and the adolescent athlete, and currently practices in Albion, Michigan. Dr. Lee can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

 
The Crossroads of Rehab and Technique
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Rehabilitation
Written by Mark R. Payne D.C.   
Friday, 24 September 2010 10:34

The Crossroads of Rehab and Technique

by Mark R. Payne D.C.

 

Adjusting technique and spinal rehabilitation have always been viewed as two completely separate subjects. Chiropractic’s rich history is replete with innovative ways of adjusting misaligned or dysfunctional spinal segments. Most such chiropractic techniques would be classed as "passive care" in that the patient is a non active recipient of care administered by the doctor.

 
Importance of Foot Function in the Gait Cycle
Rehabilitation
Written by Dr. Kirk A. Lee, D.C.   
Thursday, 23 September 2010 17:26

Importance of Foot Function in the Gait Cycle

by Dr. Kirk A. Lee, D.C.

 

An essential part of our chiropractic examination should include evaluation of the gaitcycle, with special consideration toward the patientwho has chronic musculoskeletal-related pain.

 
Depression Era Marketing for Today
Rehabilitation
Written by Mark R. Payne D.C.   
Thursday, 23 September 2010 17:23

Depression Era Marketing for Today

by Mark R. Payne D.C.

 

O   kay…so, I said it. The dreaded "D" word. The pundits may debate whether our economy is in recession or a true depression but, if you’re out there trying to survive this economic mess, I suspect that technical distinctions don’t matter much. Fact: If chiropractors can’t figure out a way to serve their patients and survive this financial downturn, a whole bunch of us won’t be here a year from now. That sounds like a depression to me.

I talk to lots of doctors and things are tough all over. But don’t lose sight of the fact that times are tough on your patients right now, too. The fact that they are losing their jobs doesn’t change one thing about whether or not they need your care. Regardless of their economic circumstances, people still need your help. They’re still in pain, still sick, and still depending on you.

With that in mind, I want to relate something from my first quarter in chiropractic college—something that stuck with me and is just as relevant now as ever. Fall of 1976, the college was all abuzz about a famous doctor from Wisconsin who was visiting the campus. As a dumb freshman, the name didn’t mean anything to me, but everyone else seemed impressed, so I went to listen. For about an hour, the older gentleman shared his insight on treating patients and how he managed to grow a thriving practice during the throes of the great depression. The doctor was Clarence Gonstead.

It was 1929, and a terrible flu epidemic was in full swing. In some towns, as much as thirty percent of the population was sick at any given time. More than 50,000 people died in the winter of 1928-29 from flu and related pneumonia…more deaths than in the entire Vietnam War. Dr. Gonstead worked his Mt. Horeb clinic six and a half days a week from early morning until late evening. Very sick patients were often seen multiple times daily. Mrs. Gonstead would often bring lunch so he could treat patients straight through the day. On Fridays and Saturdays, he would close the office, go home for a quick supper and be back to open the doors at 10:00 PM for folks who were exiting the "picture show" and wanted to stop by for an adjustment while they were in town.

There was no such thing as health insurance and no one but the patients to pick up the bill. But, still, they came. Unemployment was approaching twenty percent, but patients still referred their friends and relatives. In a rapidly deflating economy, dollars were in very short supply and, yet, they still valued the service enough to part with much needed cash.

And Dr. Gonstead wasn’t the only chiropractor to survive and flourish during the depression. There were nearly eighty chiropractic colleges operating by 1930 and many doctors did quite well, considering the bleak economy. But, of course, success was measured by a different set of standards then. There were no such things as a BMW or Lexus, no dreams of a new mansion in a gated community, no expectations of working three days a week and retiring at fifty. Doctors were quite happy with a dependable Ford, a modest home in a decent part of town, and enough money at the end of a long week to support their families. Hard work was the order of the day and Dr. Gonstead was as good an example as this profession ever had.

Were there other factors responsible for pushing the Gonstead clinic and chiropractic to uncommon success during tough times? Perhaps. For one thing, professional fees had to be affordable for the patients. For another, chiropractic promoted a simple, understandable model of health care…a simple bone out of place pinching a nerve. True, that old single bone model of subluxation is now outdated, but the old acronym of K.I.S.S. (Keep It Simple, Stupid) is just as relevant as ever. That’s one of the things I love most about practicing around a "posture paradigm." It allows me to communicate with patients in factual, yet very simplistic, language. Patients can see and understand postural imbalance when they view it in a mirror or on an X-ray.

Chiropractic was founded around the "unique selling proposition" (little bit of marketing lingo there) of the relationship between spinal structure and bodily function. That simple, understandable concept played a central role in the rapid growth of the profession. Things are quite different now. Most chiropractors can’t explain succinctly what they do; the doctor-patient relationship has been complicated by third party pay plans, and most new doctors can’t imagine working twelve hour days, or making a house call for a sick child. They work nine to five, take a three hour lunch, and keep their home phone numbers unlisted.

Are you struggling to survive in today’s economy? I would submit that, in some respects, building your practice today isn’t really all that different than in the Great Depression. It still makes sense to communicate with patients in simple terms they can understand. Hard work and frugality are still at the heart of success. Finally, making your services affordable and becoming an example of service-based leadership within your community will do more to build your reputation than any marketing gimmick or management seminar. As it turns out, even in the midst of a depression, patients can still spot a doctor who really has their best interests at heart.

 

Mark R PayneDr. Mark Payne is the president of Matlin Mfg., a manufacturer and distributor of postural rehab products since 1988. To request more information on managing the scoliotic patient with postural chiropractic methods, call 1-334-448-1210 or link to
www.MatlinMfg.com

 
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