Implement the three Rs to crystallize the proactive chiropractic paradigm resulting in better care for your patients

Imagine a practice organized around the principles of chiropractic that developed efficient patient flow. Now, imagine this practice inspired its patients to choose ongoing wellness care and provided the necessary information and services to support this process. The uniqueness of the chiropractic message allows each practitioner to meet the needs of patients by supporting overall health and healing with individualized services and products. The key to this ideal setting is to create an organized and efficient template that can be adapted to each patient.

Adjusting and Balancing
The foundation for all chiropractic care is the adjustment—this distinctive procedure not only highlights our message and style of care from other health disciplines, it also allows the patients to see beyond their symptoms. All efficient procedures can be based on the delivery of the adjustment and the ancillary services that support the changes associated with this process. Each procedure, service, or product needs to be congruent with the philosophy of care within the office.

The chiropractic model is based on the understanding of natural healing and restoration of function. Chiropractic uses the structural balance of the spine and its components to reset the tone of the entire nervous system. Evaluating and rebuilding the structural alignments alter the tension at a neurological level. The importance of maintaining this natural balance is paramount in the success of long-term postural and tonal retraining.

In the alignment of community health services, chiropractors are viewed as the natural alternative to the medical model. As doctors, we operate under vis medacatrix naturae. Typically, these wellness-based services range from exercise protocols and hygienic nutrition to postural support devices.

There is a shift in the realization that medical services are not designed to support performance and well being. Medical management and insurance companies are primarily directed to address and treat disease states. Tissue pathology is the end stage of the adaptation and dis-ease process. People are making wellness choices outside of insurance coverage. Given access and opportunity, the public has demonstrated that they will shift toward making healthier choices.

The importance of the adjustment within the office can never be diminished. Releasing subluxations is the starting point to feeling alive and being well. Subluxations represent a persistent disturbance along the central neuraxis, which interferes with the interpretation and response to environmental challenges. This maladaptive process impedes the free-flowing, organizing impulses known as innate intelligence. The adjustments “arouse innate,” while other procedures support the healing process. The challenge for the chiropractic team then, is to be clear of their mission and to have a system that allows a timely application of congruent services.

Orthotic usage has long been an adjunctive procedure in practice. The goal is to use these devices to assist in the alteration of postural control. Better dynamic balance, beginning at the foot and ankle level, reduces the noxious stress into the structure and the nervous system. The purpose of the adjustment is to arouse the inner wisdom and control of the bodily systems, while helping to restore better tone to the structure and nervous system. The goal of orthotic placement is to supplement this chiropractic approach and enlist a passive device that challenges the structure and nervous system to hold a healthier pattern.

To many doctors and patients, orthotics are used in a reactive manner. If patients begin to exhibit foot or back pain symptoms, there is a need to examine the foot and ankle posture. However, the chiropractic paradigm is a proactive one. When posture is viewed from a tonal perspective, orthotic placement is a part of the hygienic regimen in addressing forces that can affect and damage the integrity of neural input and outflow. If adjustments arouse and reset the tone of the spine and nervous system, then orthotics support and challenge this process, making them a value-added service.

A Path Less Traveled
Patient care plans are traditionally based on a spinal rehabilitation model. After assessment and diagnosis, a three-step protocol is advised. This transits patients from acute to corrective care, after which maintenance check-ups are recommended. This style of patient treatment is ultimately short-sighted, as it focuses on the management of symptoms and the restoration of function. A missing dimension is the lifelong exploration of potential and well being. These stages of living far exceed the parameters of the spinal rehabilitation model.

A natural method of guiding and leading the patient is known as the Path to Wellness© [Fletcher owns the copyright]. This patient care and scheduling continuum can be used in any style of practice with any technique. Instead of a rehabilitative, three-step model, this is a wellness orientation for the chiropractic team and the practice member.

This wellness method follows three stages: release, rebuild, and revitalize. The stages represent a seamless flow that supports the release of persistent subluxations by rebuilding newer lifestyle habits. Finally, it offers the opportunity to choose chiropractic care with the goal constantly revitalizing the natural flow of innate intelligence.

On the practical side, this method is an orderly method of delivering watchful and progressive care. Strategies for managing each stage of care can be discussed with the patient. Display a roadmap that clearly defines when other services beyond the adjustment are applied.

For instance, the rebuilding stage is an ideal time to provide restorative exercises and to explore the use of orthotics to enhance stability and motion. Structural integrity and balance are an integral component in this stage of care. This phase is a time to create more flexible and stable support in the spinal system. It also enhances the effectiveness of adjustments and empowers patients toward more personal control of their health. This time in care is typically longer in duration than the release stage. It provides a focus for the patient to address long-standing health and postural habits.

Conversely, the early release stage has different goals, as it represents the initial unwinding of the subluxation process. Here, the practitioner may choose to use simple movement strategies rather than rehabilitative exercises to begin the process. Progressive strategies can easily be introduced as healing evolves.

By dividing care into different stages, the chiropractic team and patients can focus on immediate needs, while continuing to look toward the future. The intent of the chiropractic paradigm is imbedded in the communication and the procedures every step of the way. Wherever the patient is along this continuum, the central theme of adjusting the subluxation and supporting the process is never diminished.

The basis of the chiropractic paradigm is that structure and function are interrelated. The three natural arches of the foot may be compromised by ligamentous laxity, which will result in a serial misalignment syndrome affecting the foot/ankle complex, knees, hips, pelvis, and spine. Malalignment of any joint in the body will cause excessive mechanoreceptor firing that results in less than optimal muscular performance. Orthotics help support patients in a better positionof biomechanical function. Recent peer-reviewed literature has shown that custom-made, flexible orthotics help improve structural alignment,^1,2 dynamic function,^3,4 and athletic performance.⁵

Imagine a thoroughly trained team that focuses on providing watchful and progressive wellness care for each patient and their family in the community. Now, imagine how you can be this practitioner.

David S. Fletcher, DC, FCCSS (C), a Fellow of the College of Chiropractic Sport Sciences (Canada), has been in private practice for 22 years at The Fletcher Clinic, Pickering, Toronto, Canada. He is recognized internationally for blending traditional chiropractic principles with contemporary technologies and strategies. Fletcher can be reached at 905-831-9696 or via email: fletch5@rogers.com.

References
1. Radebold A, Cholewicki J, Polzhofer GK, Greene HS. Impaired postural control of the lumbar spine is associated with elayed muscle response times in patients with chronic idiopathic low back pain. Spine. 2001;26:724–30.
2. Palmer DD, Palmer BJ. The Science of Chiropractic. Davenport, Iowa: Palmer School of Chiropractic; 1906.
3. Stephenson RW. Chiropractic Textbook. Davenport, Iowa: Palmer School of Chiropractic; 1927.
4. Murphy DJ. Neurogenic Posture. American Journal of Clinical Chiropractic. 1995;5(1):16.
5. Whatmore GB, Kholi DR. Dysponesis: a neurophysiological factor in functional disorders. Behavioral Science. 1968;13:102.