As I sit in my office drinking coffee and listening to The Movement Fix podcast, it became evident that Physical Therapists (PTs) and Chiropractors (DCs) alike are in a strange position in our healthcare system.  We are both viewed by many as secondary providers focusing on the movement of joints and muscles which are relatively unimportant when compared to vital structures such as the heart or the lungs.  Additionally, our scope of practice (what we are legally allowed to perform under a license) varies greatly across the country which contributes to a convoluted image of our professions.  

Dr. Sahrmann plainly explains that physicians have become specialists in certain human systems:  you can see an endocrinologist, a neurologist, a cardiologist, an orthopedist, a pulmonologist and the list goes on.  All of these physicians have become "specialists" or "experts" in that anatomic and/or physiologic system.  The problem for PTs, as well as many DCs, is that we need to establish ourselves as specialists in the musculoskeletal system.  Actually the problem is not establishing ourselves as experts in that system, because many of us have.  The issue arises from the general public's perception of the musculoskeletal system as a non-essential and sometimes simply annoying aspect of health.  Most people feel as if they are low back pain is happening to them as opposed to having some form of input or control over the how and why the low back pain exists.

If you have talked with me about routine or follow-up care, you know that I frequently relate asymptomatic visits or well visits to the dental world.  If you are not in any pain or discomfort, have someone like myself, evaluate you on a periodic basis.  If you are in pain, that changes everything.  But just as you schedule 2 dental visits per year to get a check-up and cleaning, as a PREVENTATIVE, you should schedule 2 movement visits per year to get a check-up and lifestyle modifications.

My opinion is obviously just that. It has been influenced by many factors, both seen and unseen.  But I want every one of you to re-consider your daily movements.  Unless you are completely immobilized from head to toe, ALL of us move everyday.  These movements effect your bodily systems in a variety of ways and one of the most obvious is through altered biomechanics and eventually pain.  You don't even need to exercise regularly to realize how much movement impacts your life.  

You walk to the bathroom.  You bend forward to look into the refrigerator.  You stoop over the kitchen sink to wash dishes.  You turn to get into your car.  You walk up and down stairs.  You pick-up children.  You sit at a desk.  You walk around the office or your home.  You sit on the couch.  You run on the treadmill.  You perform a deadlift at the gym.  Many of these movements happen without our conscious awareness, until pain occurs.  Prior to that pain, we do not realize how much we must move.  Same situation occurs with regards to dental eat food everyday without consciously considering your dental hygiene (except for brushing, flossing, etc), until pain occurs.  Prior to that pain, we do not realize how much stress our oral health battles.  Hopefully this analogy lessens the muddiness of the water.


Included here are links to Dr. Sahrmann's profile, books, and The Movement Fix podcast.,Shirley,PT,PhD,FAPTA.aspx

Be blessed!
-Dr. K

Maintenance Care is a term frequently used in healthcare, but is especially prevalent in the chiropractic field.  This seems like a relatively neutral term, right?  Unfortunately it can initiate a rather "charged" conversation between 2 chiropractors and even more so between a chiropractor and a clinician from another discipline.  To be clear, maintenance care is sometimes referred to as supportive care or even preventative care by some.  Since some of you reading this are not clinicians and not directly aware of some of the internal struggles in chiropractic profession, let me fill-in the blanks.

Years ago chiropractors, in general, would recommend "maintenance care" to their patients to accomplish just that...maintenance of their health.  For the most part what I am referring to is receiving chiropractic manipulations, although other therapies are used as well.  As our knowledge of chiropractic through research increased and managed care organizations took over healthcare in the USA, "maintenance care" became a touchy subject.  There were some chiropractors supporting "maintenance care" and some chiropractors supporting "incident care" and some chiropractors confused on which direction to turn.  The problem for either camp is GENERALIZATION.  For clinicians to simply group ALL patients in their practice into 1 treatment plan results in low-quality care and a negative public image.  This is true for chiropractors, neurologists, pediatricians, surgeons, oncologists and the list goes on...because no 2 patients are the exact same.  Do you want your pediatrician prescribing the same medication for patients regardless of the infection?  The same concept applies to chiropractic care.  Now let's get into how this concept applies realistically.

To be honest, all clinicians see patterns in their patients. This is very different than generalizing treatment though.  Many patients with acute low back pain (LBP) experience some condition related to their intervertebral disc which responds well to extension-based movements and exercises.  However, not EVERY patient with acute low back pain will have an issue with their intervertebral disc, there is an entire list of other possibilities.  Meaning that extension-based movements and exercises may not be included in their treatment and could even be detrimental to their condition.  Patterns help both clinicians and patients attain a more realistic picture of the prognosis.  However, patterns can also negatively impact the patient's condition if the clinician fails to think beyond generalizations.

Here's my opinion on "maintenance care":
There are patients who may greatly benefit from continual, routine care.  There are patients who may have detrimental effects from continual, routine care.  I have this opinion for a few reasons.
1. Certain patients have chronic, degenerative or progressive conditions that cannot be "cured" OR they can ONLY be "cured" through extensive means like surgery.
2. Certain patients have acute conditions that required a minimal number of visits to return them to pre-injury status
3. Excessive and repetitive chiropractic manipulations of the same joints may lead to joints that are unstable (Yes, I said it and I know some of you will think this is blasphemous)
4. Repetitive chiropractic manipulations generates a doctor-centered treatment plan which allows the patient to become completely dependent and lack any accountability for their condition (again, this does not apply to every patient)
5. Maintenance care can create a lucrative business for chiropractors, an unethical aspect of healthcare.


CLINICAL INTUITION.  That is the term I have recently used to describe this approach to patient care.  A video recently posted on Facebook by a colleague of mine essentially describes this thought process.  He focused more on the terms 'research' and 'experience' which is clearly applicable to clinicians, as this is where we draw our decisions from.  He likened clinicians using concepts from both terms to a pendulum.  We must swing between research and experiences to provide the best possible care.  If clinicians pigeon-hole themselves into either extreme, we do a terrible dis-service to our patients.

I want to create patient-centered treatment plans.  I want patients to have accountability and independence.  I want patients to simply live healthy, happy lives.  If that means that you need maintenance care, then so be it.  If that means we can get you back to your life without constantly needing care, then let's do that.  Individualized, high-quality care, that's what healthcare should be about.  (Stepping down from my soap box now)

Be blessed!
-Dr. K

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    Erik Korzen DC is a chiropractic physician and educator.  He is passionate about re-defining the chiropractic profession and is somewhat of an "Anatomy Geek".


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