When a DC analyzes muscle dysfunction along with joint dysfunction, the results are extraordinary

In the minds of many chiropractors, the term “rehabilitation” has negative connotations. They often misunderstand it as a concept that undermines a chiropractor’s philosophical foundation. In this article, I will discuss the opportunities that rehabilitation brings to a chiropractor’s office, how to transition rehabilitation into your practice, and how to properly bill for rehabilitation-related services. My goal for this article is to reveal how rehabilitation can complement your current philosophy and can serve as a tremendous opportunity to strengthen your practice.

When I first started practice, my sole concentration was pain relief for my patients. The problem with this paradigm was that my patients continued to come back time and time again with the same problems, hoping that I would again be able to give them some type of relief. I started to focus on not just ridding my patient of pain, but trying to determine what I could do to improve my patients’ well-being. I found that the subluxation complex was much more than just adjusting a bone out of place. In fact, the missing component of the subluxation complex within our practice was that the function of the neuromuscular system was to produce proper motion and to maintain stability. Recognizing this role, our practice transitioned into providing two types of care with each patient: pain relief and preventive management. Pain relief is where the chiropractic adjustment thrives.

Analyzing Joint and Muscular Dysfunction
Preventive management is where rehabilitation thrives. Rehabilitation of the motor system is concerned with restoration of function, not merely relief of pain. The ultimate goal of care is to improve a patient’s physical performance capacity so that he can handle the demands of daily living and career. Rehabilitation, however, is not merely giving handouts of exercises for the patient to do at home or telling him to join a fitness center. Rehabilitation is a process that begins with an evaluation for muscle imbalances and then continues with a customized program of care that encompasses both the joint dysfunction and muscle dysfunction to optimize the neuromuscular system. If a DC gives stretching or strengthening exercises to a patient without performing a detailed examination of the muscles and the joints, it may only perpetuate the joint and muscle dysfunctions.

Chiropractors are skilled at analyzing joint dysfunction, but they too often overlook or minimize the role of muscle dysfunction. When a chiropractor analyzes joint dysfunction and muscle dysfunction, the results are extraordinary. Bringing long-lasting changes to a person’s overall well-being is why we address the joint and muscle dysfunctions. Patients have a better understanding of how to care for themselves and are not solely dependent on the chiropractic adjustment. Instead, they enter into a paradigm of true wellness care.

Rehabilitation does not replace the need for chiropractic adjustments. In many cases, muscle dysfunction is frequently secondary to joint dysfunction. Therefore it is crucial to begin any rehabilitation program by first adjusting the spinal fixation that is causing the inhibited or facilitated muscle imbalance. In our practice, I meet patients almost every day who have undergone physical therapy or chiropractic care in other facilities and have gotten poor or ineffective results. But when the two disciplines are brought together under the same roof, as within our practice, the patient gets well and stays well.

Rehabilitation has brought many opportunities to my office. Rehabilitation adds value to the prescription of care. It has made people take notice of the care that they can receive in our facility. It further allows us to truly treat a patient functionally and wholly to see life-changing results. Opportunities have further presented to treat postsurgical cases that we did not have the means to treat effectively prior to having rehabilitation. We get referrals from medical practitioners that at one point were nonexistent in our practice. In many medical offices, a prescription of rehabilitation is written for a patient, but chiropractic is not even considered. Now, we can offer those rehabilitative services in addition to educating the patient and referring physician on the benefits of chiropractic and multidiscipline care. Rehabilitation has also put me in a position to help employers make their employees more productive and less prone to injury by keeping them at work and helping them understand how injuries can be prevented. Third-party payors want to see patients taking more of an active role in their care, and this has given my office the opportunity to educate patients and case managers alike on how patients can care for themselves. This, in turn, helps to reduce health care costs. I feel that the referrals a practice receives are an indication of the results that it has achieved. Skilled rehabilitation teamed with excellent chiropractic care is the reason our patients continue to refer our facility.

Adding rehabilitation to your practice is not as difficult as some may think. It is a common misconception by chiropractors that a big investment is necessary to implement rehabilitation into their offices. The investment does not have to be large to run a very successful rehabilitation department in your office. Simple resistive band equipment, Stability Ball activity, and guided home exercise programs instructed and performed in a 10- x 10-foot room is a step toward effective rehabilitation.

Empower the Patients
An office that uses rehabilitation should understand the continuum of care that needs to be incorporated. As a patient’s condition is evaluated, a conservative approach needs to begin with passive care and transition to semiactive care, then finally to active care. In our office, the system of care empowers patients to direct their wellness through education and cooperation. A simplified model of our care is as follows:

Empower the patients with their own wellness. This includes education in chiropractic care, rehabilitation, the patient’s specific joint and muscle dysfunctions, and correction and prevention through proper posture and body mechanics with daily activity.

Care for the cause, not for the symptoms. We take steps toward alleviation of pain and dysfunction through passive activities that include chiropractic adjustments, range-of-motion and movement training, physical agents and modalities, and manual therapies. It is crucial, though, that neither the clinician nor the patients believe that no pain means “no problems.”

While our hands and skills benefit the patients’ overall wellness, it is ultimately their own responsibility to achieve wellness and stay well. We progress through a series of semiactive care through assisted movements and activity, and finally to an active-care model of advanced and independent rehabilitation and care. This prepares the patients through increased muscle endurance and balance, and trains them to succeed in continued prevention of injury or exacerbation.

Throughout this article, we have explored the possibilities that rehabilitation adds to our practice.

Whether you are at the forefront of wellness care, or are newly starting, I hope you recognize the complementary benefits of rehabilitative care in your practice. CP

Nathan Unruh, DC, practices in Sioux Falls, SD. Contact him at thedoctor@downtown-chiropractic.com