Rehabilitation


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

 
Dirty Harry, Scoliosis And You
Rehabilitation
Written by Mark R. Payne D.C.   
Thursday, 23 September 2010 14:21

Dirty Harry, Scoliosis And You

by Dr. Mark R. Payne D.C.

 

A man has got to know his limitations." Clint Eastwood growls the famous line right after administering a lethal case of justice to some villain foolish enough to take on Inspector "Dirty" Harry Callahan. Just goes to show there are some things in life you shouldn’t ever try. Sometimes we have to learn that the hard way in practice and a good example is managing scoliotic patients. I speak with lots of doctors from a wide range of educational backgrounds and practice styles. Some don’t think scoliosis can be managed at all in the chiropractic office. Others are so overly optimistic of their abilities that they recommend extensive corrective care programs for every case only to find out down the road that there’s been little or no change. As is often the case, the truth appears to be somewhere in the middle. Let’s take a brief look at two cases which illustrate some of the factors which might affect your prognosis for a successful outcome.

 

Case # 1: An 8-year-old boy presented with mild neck and shoulder soreness following a motor vehicle accident. Both parents were under care for their injuries and I did a cursory examination of the child upon discovering he was involved in the accident as well. The child’s neck injuries were quite mild, but Adam’s test was positive and his posture was suggestive of scoliosis. I suggested we take films to see what was happening.

X-ray revealed a 12 degree Cobb angle with the apex at L-3. (See Fig.1) I noted what appeared to be a possible leg length deficiency which appeared to be contributing to the curvature and opted to take an A-P femur head view to more accurately measure the amount of leg length inequality. The right leg ultimately measured 5 mm shorter than the left and a 5 mm heel lift was provided. Over the next few weeks, the child was adjusted a few times and rehabbed with simple posture reversal exercises to address the worst aspects of his postural imbalance. On each visit, the parents were tutored on how to properly observe and monitor the child’s exercise at home.

Approximately 6 weeks later, a post care film was taken to see how things were progressing. The results were gratifying with the Cobb angle now reduced to zero degrees. (See Fig. 2) Parents were instructed to make sure the child continued to use the heel lift and exercise three times weekly. Twice annual follow ups were recommended until the child reached skeletal maturity.

 

Factors which contributed to such a successful outcome were:

• A fairly mild curvature ( Cobb angle less than 20 degrees)

• An easily remedied cause (leg length inequality)

• No vertebral wedging/deformity

• Parents who were disciplined about following home care recommendations.

• Early treatment…well before skeletal maturity.

 

Case # 2: 57-year-old female presents with chronic LBP and a prior diagnosis of scoliosis. X Rays revealed a 48° Cobb angle with apex at L-1. (See Fig. 3) Closer inspection revealed severe wedging of vertebrae at multiple levels plus pronounced disc degeneration. Patient was adjusted in our office on a symptomatic basis for 2-3 weeks and given home exercises to help strengthen the area and minimize asymmetrical loading of the spine. Symptomatic management was successful and she now returns as needed for relief of any exacerbations. Corrective care was not recommended, as it seemed highly unlikely to produce significant structural correction.

Factors here which would likely complicate a successful corrective outcome are:

• Large Cobb angle

• Patient well past the age of skeletal maturity

• Significant vertebral remodeling (wedging)

• Advanced disc degeneration

 

Incredibly, this patient had visited another chiropractor earlier who had recommended a year long program of adjustments to correct her problem. Fortunately, the patient had declined to accept the treatment plan which would have been highly unlikely to correct this advanced curvature.

Please don’t misconstrue this to mean I am opposed to corrective care programs. To the contrary; what I am opposed to is any doctor making promises he/she can’t reasonably hope to keep. If you recommend a corrective care program, you must have reasonable professional expectation of a successful outcome. The moral here is to be realistic as to what you can actually deliver before recommending programs of extensive corrective care. Scoliosis cases present with a unique set of variables which can either work in your favor or complicate things greatly. Like it or not, once the growth plates have closed, any vertebral wedging or deformity constitutes permanent change in the spinal architecture. All the adjustments in the world won’t change structural asymmetry which has literally become "set in stone." Yes, you can work wonders with some cases but, ultimately, Dirty Harry was right. We’ve all got to know our limitations.

 
A Runner with the Wrong Orthotics
Rehabilitation
Written by Dr. Kirk A. Lee, D.C.   
Thursday, 23 September 2010 12:00

A Runner with the Wrong Orthotics

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

 

Today the doctor of chiropractic has many choices when choosing the type of Spinal Pelvic Stabilizers, or custom-made orthotics, to use in his office. We must first and foremost use orthotics from a company that also supports our profession. Secondly, these orthotics must be custom made, semi-flexible and have high doctor-patient satisfaction.

 
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