Welcome to all my neuro-mechanically minded colleagues, but before we get in it, a warm welcome to the new members on this list from the British Chiropractic Association (BCA).
On Wednesday night, I shared a romantic night in with over 400 members of the BCA whilst we canoodled in front of zoom and I whispered sweet nothings into their ears about vitamin D…..and they say romance is dead!
Whenever I lecture I always say the same thing at the start, we all have two things in common.
Ultimately we should be interested in results not theory.
This pairs up nicely with last weeks newsletter when I asked if you are a clinician or a therapist (new BCA sign ups should deffo read that one, it’s a cracker)
This week I am going back to a topic from last year which pulls together all of that into one key principle that any Chiropractor, Osteopath or Physiotherapist should have.
If you look at the history of any healing profession, you will see outright hostility from others to protect their territory.
Chiropractors were put in jail, and yet we survived and indeed thrived.
The reason we survived, in my opinion, is because of one thing…..results.
You can sell a theory, but at some point, you have to deliver and people want results.
That is what Chiropractic was known for, BJ Palmer did it one in visit!!
How is that for results.
It also gives you something tangible, something real, integrity.
And that my friends is something I believe we as professions (and maybe as a nation) have lost.
Last year, before the world went bonkers, I lectured for the Lions of Chiropractic and truth be told I didn’t read the stuff they sent properly and I thought I had longer than I actually did…..
So when it turned out I only had 20 mins I had to revise my original plan to talk about vitamin D.
Instead, I did a concept talk and out of my brain came something that has been brewing for some time, a discussion about the loss of integrity in my profession, Chiropractic but I suspect this is a theme that runs through all neuro-mechanical professions.
Once upon a time, we were all about results, today it seems we are all about patient visit averages (PVA’s) and selling the theory of Chiropractic.
Now there is nothing wrong with theory.
Theories are the vehicles to get us to results, but the vehicle has to arrive at the promised destination, or else what are we selling?
My feeling is we are being lead astray by slick salesmen, many of whom are no longer in practice selling us a theory to sell a theory.
If they are in practice, they often work in countries and locations that have so few other Chiropractors they have no competition and then go crazy with the high volume to make their money before the locals realise there are no results being delivered.
We also have to be aware that researchers at academic institutions (many of whom are not clinicians or if they were at some point have not seen a patient in decades) create an equally difficult path to walk, especially in newer graduates.
They have a very clear agenda to achieve acceptance from the medical community and results on an individual level are not part of that.
Research is a map, but the map is not the territory.
Research can never truly represent the complex, nuance of a one to one clinical encounter.
But without any research (map) you can get lost, so we need both (I will write a full article on that another time……)
Now I am all in favour of aiming for cultural authority via the model of being a spine care specialist.
But when I speak to new graduates that use trigger point therapy, dry needling & ultrasound as their main treatment (possibly some vague manipulation in the area of pain if they are feeling frisky) and refer the patient after 3-4 visits if they are not “better”, I feel they have also been lead down the wrong path, albeit with different intentions.
The great irony of the latter issue is it leaves new graduates like lambs to slaughter with the slick sales men, whom are all too happy to indoctrinate them.
My message to the Lions was to reclaim their integrity.
We talk a lot about function but don’t really measure it as much as we should.
Repetitively looking at leg length while laying on a bench is not a functional measure nor is checking reflex points.
You can still use these (and I do) but they by definition should translate into something functional changing, right?
I believe we should test something meaningful – a range of motion (all ROM’s but especially the motion that is provocative) measuring both quantity and quality, muscle strength and pain during those two things.
The apply an intervention – an adjustment, fascia release, nerve release, taping, whatever you want.
The re-test – immediately, not in 6-12 visits, immediately.
If you really are changing the function of the neuro-mechanical system we should see a change in one or all three of the markers.
If not, that tells you something too, it is simply data, it is feedback on how effective your care was.
Then you repeat.
This could be done once or many times in one session, depending on the patient’s issues.
But when they leave you should have at least one of the following, ideally all of them: increased range of motion or improved quality, more strength and less pain.
At the next visit, the first thing is to re-check those markers and see if we retained some changes.
If you lost 100% then either you simply jangled a few mechanoreceptors for a short term override which probably lasted a few hours (a bit like foam rolling or general exercise) or potentially the patient did something very inappropriate.
The repeat again and again and again.
Do I get all my patients fully restored to full ROM with zero pain?
There are some truly messed up people out there, some are beyond full restoration.
Also, some cannot or will not commit to the actions necessary to facilitate true healing.
But I have my principles, I know what a good outcome looks like, and I will aim for it.
How far they get depends on how bad the issues/damage is & how committed they are.
Some of my more long-standing patients are 100% uninterested in any lifestyle changes, or supplements and seem almost to enjoy getting another prescribed medication from the GP.
The care I deliver is palliative in nature for pain relief, we both know it and that is OK. Those are actually very easy sessions to deliver, they are the same every time.
But if those were all I did, I think I would have to find a new career.
I enjoy a clinical challenge.
For the first 5-10 years, I honestly don’t think I would have been brave enough to measure something meaningful.
I would not have liked the results, it would have burst my little Chiropractic bubble – cognitive dissonance.
I talked about function, but actually don’t measure it and didn’t deliver it consistently.
Being honest with these markers is very humbling and as the brilliant Ryan Holiday says “ego is the enemy”.
By the way, it is the really chronic patients that sort the masters from the apprentices.
Acute pain creates very limited ROM and pain by its nature.
That is always self-limiting, there is a natural history to it.
I used to think about those patients improving to reassure myself about my skills (confirmation bias), but in reality, if they never saw you and took NSAID’s most of them in a few months would have a significant decrease in pain and increase ROM.
You might be very pleased with your acute disc patients straight leg raise (SLR) coming up over 1-2 months of care, but try measuring SLR in a chronic patient with a goniometer and see how smug you feel then.
So be your true authentic self and ignore salesmen selling you a theory about selling a theory.
Reclaim your integrity, in Chiropractic (and life) with results.
Life is short, there is no point pretending to be something you are not.
These newsletters would be a lot easier to write if I trotted out some basic information about nutrition.
But I want to give more than that and really make an impact.
So I give you me, the actual real, authentic me.
It is how I think and talk.
If the message or delivery in these weekly newsletters isn’t for you, so be it.
ACTIONS TO TAKE:
– Measure something meaningful just to be sure you are not fooling yourself or your patient, but also recognise that not everyone is able to fully restore their function or committed enough to make it happen.
– Buy Ego is the Enemy by Ryan Holiday (and read it).