We all want success in treating our patients. We all want to be the "Hero," and provide that special treatment to our patient which sets us apart from the other doctors in our area. That may be what drives us, but what does it take for us to be that "Special Doctor" we all strive to be?
The answer to that question is, of course, complicated; but let me talk to you about one simple thought and action that could help you tremendously in your practice. First, it is important for you to realize that you must become a "Black Belt" in any technique or treatment you use. You must go beyond the casual knowledge of the treatment philosophy and techniques used to provide the anticipated results. Having said that, this article does not provide you with the depth of knowledge that you will need to have to be proficient in this technique that I am suggesting. Be sure to seek out more information, both through the written word, and at seminars.
The thought and action step I am recommending for you to consider is using the "McKenzie Protocols" for Cervical and Lumbar spinal conditions as an adjunct treatment system to your established treatment protocols.
The challenges of treating lumbar disc syndromes are many. The lumbar disc represents the toughest challenge a clinician has in his musculoskeletal practice. As I travel the country speaking to doctors in seminars about the treatment of these syndromes with axial decompression, flexion distraction, or standard manipulation, I am constantly pulled aside by attending doctors and asked one consistent query: "What is the #1 reason why a treatment plan fails to provide the results that I desire with the disc patient? What am I missing?"
The thing I see clinicians ignore, and the thing that causes patient’s treatment plans to fail most often, is a failure by the clinician to observe the "Centralization Phenomenon" in their patient’s progress, and the lack of establishing a treatment protocol that promotes centralization. Robin McKenzie first talked of this phenomenon in the early 1980’s and suggested that, by following this principle, his success rate improved dramatically with lumbar disc patients. I have found that to be true in my office as well. McKenzie defines this phenomenon as the situation in which pain that is arising from the spine and felt laterally from the midline or distally is reduced and transferred to a more central or near midline position when certain movements are performed.1 In summary, that means any movement that reduces the pain distally and centralizes the pain should be pursued. Today, because of the advancement of biotechnology, we can now use tools such as axial decompression to lower the intradiscal pressure of the lumbar disc and facilitate restoration of the disc; but it is still the failure to observe the centralization principle in each patient that most clinician’s ignore, or fail to follow, that causes the unsatisfactory results that their treatment protocols produce.
But there is one "Missing Link" in the centralization protocols that doctors seem to omit. They forget the second part of the centralization phenomenon, which is centralizing the pain but gaining an increase in their patient’s active range of motion. They use a protocol which helps the disc repair, such as axial decompression; but they fail to use a rehab and core stabilization program to restore core stability and maintain a lordotic curve in the lumbar spine. It is my experience in teaching and talking with doctors from all over the country that use any kind of decompression as a therapy tool, that they often get bogged down with only pain reduction and centralization of that pain. The successful doctors that pay attention to the missing link, which is centralization with a restoration of normal range of motion, are the doctors who have higher success rates. This is what active rehab in your office is all about. On the business side, these are the procedures that insurance companies are looking for you to use that will increase your ratio of successful outcomes. These are the active therapeutic activities that insurance companies are willing to pay for. For more information on billing and coding, go to www.flexionextension.com for a free 15-page report produced by billing and coding experts on the content of this article.
Look for Part II in the December issue.
Dr. Reed has 22 years of clinical experience as director of Reed Chiropractic Clinic in Solon, Ohio. Randy B. Reed, D.C. is a former member of the Cleveland Orthopedic and Spine Hospital at Lutheran Hospital, where he specialized in chiropractic rehabilitation. He has also developed and presents the clinical and scientifically based "Better Doctor Seminar Series." You can contact him at 1-888-330-3627 or visit www.betterdoctorseminars.net.