I have found that following the below treatment model greatly opens up my ability to make lasting change in my patient’s lives. The traditional approach is like cleaning a patient’s teeth at the dentist but not teaching them how to brush and floss between appointments. Movement patterns, posture, and correct movement patterns all add to the lasting effect of improved health, lack of pain and overall wellbeing.
The following is Dr Craig Liebenson’s description of functional healthcare from Rehabilitation of the Spine, 2nd ed:
“Most patients seeking healthcare for back problems either have severe pain, are getting worse or simply not improving. Patients want to know:
- What is causing my pain
- How long will it last
- What can you do for me
- What do I have to do
The modern approach to managing spine problems involves reassurance and reactivation. Most spine problems are simple, uncomplicated mechanical disorders. Once triage has been performed to rule out pathology such as fracture or tumor (<1%) or mechanical problems such as nerve root compression (<10%), the patient should be reassured that they likely have a simple mechanical problem and that their prognosis for speedy recovery is excellent (90%). With proper care, they should be 80% better in just two weeks.
The four stages of care are:
- Palliative
- Spine Sparing
- Spine Stabilizing
- Functional Training
Steps to take in an office visit include:
- History: Identify the patient’s activity or occupational goals or intolerances.
- Exam: Identify the patient’s capabilities or impairments
- Identify the self-care methods which enhance the patient’s functional abilities and tolerances
- Remove intolerances or activities associated with pain.
- Means: Restore function by enhancing capabilities or reducing impairments – in particular, teaching the patient self-care treatments to achieve this.
It is imperative to find out what activities are limiting due to the patient’s pain
Then, we perform tests which reproduce the patient’s characteristic symptoms. This provides an outcome-based, bullet-proof way to efficiently audit the results of treatment.
Finally, it is crucial to place the determination of self-treatment strategies as the #1 priority in patient care, such as supervised exercise training, post-isometric relaxation. Chiropractic adjustments or other passive modalities are thus seen as catalysts to a self-treatment program rather as ends in themselves.
Active interventions such as ergonomic advice, stabilization or functional exercises can all be used through a McKenzie prism of pre and post treatment audits of the patient’s mechanical sensitivity.
The most unique feature of a self-management approach is that care is framed so that the patient attributes their success to self-care rather than practitioner care. And thus the patient gains confidence and self-efficacy that their symptoms are truly under control.
Many patients are insufficiently motivated to make self-care a priority. In such cases, it is wise to focus on tissue-sparing strategies rather than tissue stabilizing ones (such as proper bending, sitting, squatting, sit to stand movements). However, the beauty of the outcome-based strategy is that the movements or positions that reproduce the patient’s pain are always found first and used as an audit to prove to the patient the value of the self-care prescription.
Behavioral modification research indicates that a few simple steps significantly enhance patient compliance.
- An explanation of the risk to the individual of NOT performing the self-treatments.
- A one-on-one demonstration of simple self-care strategies.
- An explicit commitment to problem solving any unique barriers to success. “