When it comes to treating pain, chiropractors have a variety of methods at their fingertips. In fact, many treatment plans involve more than one technique, with chiropractors combining traditional subluxation, active-release stretching techniques, and postisometric relaxation techniques with other methods, including ultrasound, iontophoresis, icing, or even the Graston technique.

Martin Geoffreys, DC, CCSP, who maintains a private practice in Dana Point, Calif, learned the effectiveness of chiropractic pain management firsthand after suffering injuries in a car accident. "The chiropractor was the only one who helped me," he says. "I came out feeling better, and I thought, ‘There's got to be something about this.' "

This positive experience led Geoffreys to pursue a career in chiropractic. Today, using a combination of techniques, he helps patients of all ages and walks of life find the pain relief they need.

Pain Relief Starts with Education

At Geoffreys' coastal Southern California practice, he sees many athletes of all types, such as professional soccer players and marathon runners, as well as active adolescents and very young sports enthusiasts. The weekend warrior is also a familiar face. But no matter the athlete's age or experience level, the first step in pain treatment is education about how injuries develop and how to prevent them. "Patient education is key," Geoffreys says, "because then they know how to avoid these injuries. They know when these injuries are occurring."

This is especially important when working with children and teens, who may not know proper stretching techniques. Forming good habits early can prolong kids' activity in sports without risking scar-tissue buildup or other injuries from overuse and strain. It is also imperative to teach these young players how to train properly, as well as to watch for early warning signs of strain or injury.

Geoffreys sees many young patients who injure themselves playing soccer or high-school football. These young players are susceptible to the same types of injuries that their professional counterparts develop, such as shin splints and chronic back pain.

For example, one of Geoffreys' patients, a high-school quarterback, sustained a back injury in the latter part of the season that is affecting his ability to play basketball. "It's recurring his injury when he jumps," Geoffreys says. "He had scar tissue in his back from the previous injury where he was playing football. That's pretty much what you would see with adults, too."

Often, Geoffreys will ask a young patient about the team's stretching regimens and other warm-up habits. He will also recommend that the patient tell his or her coach about a certain stretch (for example, one that focuses on the iliotibial bands) that could help the rest of the team avoid the same injury. "You can actually see some of their programs and trainings change all because of the information you're giving through your patients," Geoffreys says.

Recognizing the early signs of injury and learning how to manage them help prolong many athletic careers. For example, one of Geoffreys' patients is a 60-year-old triathlete and Olympian medalist in marathoning. "When he's getting an injury, he knows what to do," Geoffreys says. "He knows to take a break, focus on something else, and get treatment for the injury right away to get it to heal."

Geoffreys finds the Internet is a helpful resource for patients, who are usually unfamiliar with the types of injuries they have. As he explains the nature of an injury during an appointment, he will write down the keywords that patients can search online to learn more about their conditions. "There's a lot of good information on the Internet," he says. "Especially with injuries, there's not a lot of misinformation."

Looking up their injuries online also gives patients a chance to absorb the information at their own pace, which Geoffreys finds reinforces what he tells them in the appointment. "Then it all kind of clicks for them because it confirms what I've been telling them," he says.

À La Carte Treatment Planning

The Empi Hybresis System combines the power of a conventional iontophoresis treatment with the convenience of a patch.

While most injuries are addressed in six to eight visits, the timing varies depending on the nature of a patient's condition. Geoffreys tailors each treatment plan to the patient, using techniques that address that patient's specific needs. "With any patient, I try to start very noninvasively—manipulation, maybe some stretching," Geoffreys says. "If that's not being effective with their condition, I'll start more aggressive tissue or manipulation techniques."

Effectively managing pain usually requires a combination of techniques. For example, Geoffreys notes that working the tissues sometimes will create additional irritation and swelling, which can be addressed with the use of ultrasound.

Geoffreys also has found Kinesio Tape to be very effective when used in tandem with other treatment methods. The Ace-bandage-like tape moves the skin over the injured area to help decrease inflammation. "This works really well on athletes after you do all of the soft-tissue mobilization techniques," he says. "It treats the circulation in the muscle, which aids in the healing."

When determining a treatment plan, it is important to consider the patient's age. Patients under age 12 generally are not candidates for ultrasound or electric muscle stimulation, for example. "You don't want to damage their growth plates," Geoffreys says.

Adults, however, may benefit from these techniques.

Products as Part of the Plan

Recently, Geoffreys has begun using Ibunex, a topical supplement from Core Pro­ducts, Osceola, Wis, that includes ibuprofen. By a process called phonophoresis, the ultrasound unit uses sound waves to push the active ingredients of the cream to the affected area, which means reducing the long-term effects of having ibuprofen and acetaminophen filtered through the whole body. Although he has only been using the product for a short time, he has been seeing some positive results in his patients with arthritis. "It gives them some good relief," he says. "So, I've been increasing my use of it because of positive feedback."

Geoffreys also employs iontophoresis, a technique that he believes has tremendous implications for the future of chiropractic. The EMPI iontophoresis unit that Geoffreys uses allows him to drive a drug or a supplement into the affected area of the body through a direct current. For patients with chronic conditions, such as bulging disks, iontophoresis offers a way to direct the ions of strong medications, such as cortisone-based dexamethasone or morphine, to a targeted area without injecting the entire molecule into the body. "You get the ions, so you get _1/100th of the dose," Geoffreys says. "Getting just those ions as opposed to the whole molecule is way safer to the patient."

In older patients, scar tissue often develops calcific bursitis or calcific tendinitis from calcium that has been drawn to the area. To address this, Geoffreys applies apple-cider vinegar, which contains 10% acetic acid, to the area via iontophoresis. "Acetic acid binds to the calcium and draws it out of the area," he says. "So, I've been pushing apple-cider vinegar into chronic injured areas. For elderly patients, this is great."

This technique proved particularly effective for a professional motocross rider, who was forced to retire after he broke his tibia and fibula. Plates were placed in his leg during a surgery that used bone from the back of his pelvis to rebuild his leg. When the patient came to Geoffreys later, his leg was doing fine, but his back pain was so great, he could no longer sit on his motorcycle.

After determining that the pain was a result of scar tissue that built up where the bone had been removed from above the pelvis, Geoffreys used iontophoresis to drive acetic acid and vinegar to the affected area. He also used a combination of Graston techniques, active-release techniques, and chiropractic manipulation. "In five visits, he was fine," Geoffreys says. "He was back riding his motorcycle, and it didn't hurt anymore."

The Future of Pain Treatment

Find out more about pain-treatment methods by visiting our October 2007 issue.

The future of chiropractic will be in continuing to seek ways to reduce scar tissue to restore restricted joint movement, according to Geoffreys.

While the field of chiropractic continues to explore new ways to relieve pain, Geoffreys believes it is just as important to keep abreast of breakthroughs in other areas of medicine, such as the use of physical rhizotomies and even radiofrequency identification technology. He also recommends developing a referral system with neurosurgeons who perform arthroscopic surgeries on disks. "It's so much less invasive, and the patients do very well because there is less trauma to the area that's already injured," Geoffreys says.

By staying on top of trends both in chiropractic and in other areas of medicine, Geoffreys believes patients benefit. "If you can keep up as much as you can on what's being done on the other side, you have other places to send your patients that can help them further if you can't help them," he says.

Ann H. Carlson is a contributing writer for Chiropractic Products. For more information, contact .