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The Law of Order

"What exercises can I do?"  This question comes up a lot in my practice as I start relieving a new patient.  Don't get me wrong.  I am glad people are willing to do stability exercises, but their ambition is a bit misguided.  For some reason, people with dysfunctional spines believe that performing specific strengthening exercise with those tight, irritated muscles and joints is a good thing.  Exercise IS crucial to the well being of each patient, but like most things in life, timing is everything.  You would not want to do bicep curls in order to strengthen a newly broken arm, would you?  Of course not.  Why?  Because the bone must heal before you can even think about strengthening the soft tissue.  This same line of thinking can be applied to a chiropractic care plan.  There is a natural order of things, in regards to healing.  We understand this concept and apply it to the treatment plans of our patients in order to get the best results.

When patients consult our chiropractic office for care, they are often in pain.  Whether the pain is acute, chronic, or a sub-acute flare up of a chronic condition, the joints are inflamed to a certain degree.  For this reason, the patient usually states that when they do too much (yard work, lifting, gardening, snow shoveling, etc.)  the pain increases.  Why?  Because using irritated joints will cause inflammation, which leads to more pain.  That is your brain's way of saying "You injured this joint!  Don't use it!"  For this reason, strengthening exercise is avoided in the early stages of a chiropractic care plan.  It only causes more inflammation, which slows down the healing process and causes further agony.  The first step in any care plan is to get the joints functioning properly while managing inflammation with things like ice and rest.  Exercise is a crucial component to long term spinal health, but only after we "stop the bleeding."

While putting together a plan of care for our patients, there are different phases the patient must go through in the proper order.  The first stage is what we call the "Corrective Phase."  This phase is the most intensive and requires more treatment frequency than the others.  The reason for this is muscle memory.  When we are trying to literally "straighten" a dysfunctional spine, the body will fight us initially.  The muscles, ligaments, and tendons are used to the old position.  When we try to make changes, even with the best intentions, the soft tissue will often resist, which is why adjustments often do not hold very long in the initial phases of a treatment plan.  People always ask "Why do I have to come in ____ times per week?"  The reason is quite simple.  Before any long term benefit can be achieved, we must first undo the months (usually YEARS) of dysfunction that has existed.  If patients actually got their spines checked immediately after a problem started (or better yet, maintained their spinal health regardless of symptoms, much like the way they treat their teeth), this phase would not need to be nearly as long in duration or as intensive.  The longer the patient has had the problem, the longer it will take to undo.

After the corrective phase, the patient will start to hold their adjustments better.  On given appointments, certain areas of the spine will not need treatment.  This is a great sign that a patient is responding to care and changes are being made.  We love it when a patient's Atlas or pelvis holds for several appointments in a row as this means that the soft tissue is accepting the new position and true healing can begin.  Consequently, this next stage in a patient's care is called the "Healing Phase."  Because the treatments are lasting longer, we can scale back the frequency of visits.  The patient will often notice significant changes in range of motion or pain levels at this time.  In most cases, we will have performed a re-examination of the patient prior to the beginning of this phase, which will often affirm this progression if positive changes are noted.

Once the healing stage is completed, we start the "Rehabilitative Phase."  This is when we include certain exercises designed to help strengthen the muscles and joints of the spine and improve range of motion, as well as correct postural abnormalities.  Again, the treatment frequency is decreased during this stage, even though this phase is just as important as the "Corrective Phase."  While the frequency of treatments decreases, the patient's workload increases as most exercise programs are to be done a minimum of three times per week, if not every day.  The patient checks in just often enough to keep things in place while the rehab does its thing.  These exercises are the "glue" that will help patients hold their adjustments longer, thus maximizing the long term benefit of their chiropractic program.

In our chiropractic clinic, we do not have the patient perform their rehabilitation on site.  Some offices do provide space and equipment for the patients to complete their rehab (for a fee, of course), but we feel that if a patient is going to make a long term commitment to exercise, why not make the exercises easy and "low-tech" enough so they can do them at home?  Once the patient completes the rehab phase of their care plan, these exercises are designed to be done on a long term basis as a part of good "spinal hygiene."  Performing the proper exercises help patients make the most of their care and help decrease the possibility of re-occurence.  This, in addition to good preventative spinal maintenance check-ups at regular intervals gives the patient the best chance of achieving lifelong spinal health.  Having a specific treatment plan with specific steps, goals, and milestones is much better than just doing the "let's wait and see" approach.

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