Step 2: Treatment
Step 3: Elective care
In Practical Terms...
Step 1: Assessment and Diagnosis
- History is taken to determine whether the condition is treatable through chiropractic methods, or there is a need to refer the patient on
- The Chiropractor uses neuromuscular tests that are the same as in physicians’ practices
- The Chiropractor uses specialized chiropractic tests such as static and/or motion palpation and pelvic balance and compensation tests, to assess function, reproducing pain & uncover compensations
If there is a Chiropractic treatment for the patient, we move to step 2. There are national guidelines used to determine the appropriate course of treatment:
Step 2: Treatment
- No drugs or surgery is used, a referral is given when these are needed
- Manual techniques such as Soft Tissue Techniques for muscles, Joint mobilization, and/or Joint Manipulation (a.k.a. adjustments) may be used if needed to restore function
- Adjustments may be used (mobilization and/or manipulation) due to the greater effectiveness of these methods (see explanation of these methods further on)
- Patient education
- Patient Exercises may be given
Mobilization: a slow-speed technique in which the joint remains within the passive range of motion (ROM). Treatment can be monitored and resisted by the patient who therefore has final control.
Manipulation: a fast-speed technique that takes the joint beyond the passive ROM. Because of the speed, the patient does not have control and the potential for harm in UNSKILLED hands is greater.
NOTE: The importance of this distinction is underlined by a growing body of research showing that manipulation has superior results to mobilization in reducing back pain, neck pain, and in increasing ROM in a joint.
How do Adjustments Work?
- Increasing the ROM inhibits pain
- Joint and Muscle receptor stimulation causes realization of Paraspinal muscles which then break joint adhesions
- Releases trapped joint inclusions such as in a locked back or torticollis
- Stimulates the autonomic Nervous System
- Relieves chronic nerve compressing and irritation by abnormal body mechanics
Some patients will have a combination of stenosis and restricted joint motion. For many of them, joint manipulation will increase the range of motion, thereby relieving chronic intermittent nerve root compression and stretch, causing reflex effects that decrease pain and muscle dysfunction.
Objective Effects of an Adjustment:
- Sensory and Motor Function
- Increased range of motion of the joint in all 3 planes with decreased pain
- Increased skin pain tolerance level
- Increased Paraspinal muscle pressure pain tolerance
- Decreased muscle electrical activity and tension
When dealing with Acute Care (such as acute low back pain in Adults) there is a recommended initial course of four weeks. If there is objective improvement (such as described above), then treatment may continue.
Step 3 Elective care:
However long you choose to benefit from care at this office is up to you. The services we offer can fall into one of the following themes:
prn or “as needed” care. Next time symptoms start to bother you, we will be happy to reestablish relief. We will coach you in the orthopaedic signs relevant to you for the purpose of early detection of lurking trouble. Like the adage of “a stitch in time saves nine,” recovery can be quicker if don’t ignore those early signs before they turn into symptoms.
Elective care/treatment is at the option of the patient who wishes to maintain optimum function with preventive/maintenance care. Some patients, for example, wish to have functional pathology treated before pain and disability develop. Here the focus is on training for performance, like Michelle Stilwell and her Gold medal Olympic performances in Beijing and London.
Supportive care is therapeutically necessary care for patients who, despite rehabilitative exercises and other lifestyle modifications, fail to sustain therapeutic gains after treatment withdrawal. Reasons may include the ongoing stresses of work and other activities of daily living.