Once a patient has had subluxation for more than a few weeks, they always get weakening of the spine, and often shortening of ligaments leading to permanent deformity if nothing is done. Left long enough, this even leads to remodelling of the vertebrae and so irreversible bony deformity.
It is a terrible progressive loss of function and vitality that can be so easily avoided with quality chiropractic care.
While spinal adjustments are an essential part of the correction of a misaligned spine, if the postural muscles are weak and the ligaments shortened, no number of adjustments will make them right again. That takes effort on the part of the patient to do specific strengthening and corrective exercises known as ‘Rehab’.
We all know this, but it is often seen as difficult and time-consuming and is often met with resistance from patients giving us even more reason not to do it. In truth though, if we don’t hold strong for our patients and make it easy for them to do their rehab, they simply won’t get great long-lasting results.
When I was a student in my final year, I remember asking my clinic supervisor, “Dr X, what exercises should I give this patient?” His reply? “Don’t waste your time – patients never do exercises anyway.” If you don’t put enough energy on the importance of the exercises and make it easy for your patients, he’s right. But with the right approach, we have reached over 90% compliance.
Exercise Options
You have essentially two ways you can get your patients to do their exercises. At home, or in-office.
Done in-office you can be sure the exercises get done and get done right… but to do this, you need a space for it, and someone to supervise – a doctor or a personal trainer. These are two big expenses making this solution not very attractive for most offices.
The other way is to have patients do their exercises at home. To ensure your patients do their exercises and do them right, the secret is … as always … your systems. For example, it doesn’t matter how good a job you do teaching exercises if you don’t follow them up – your patients just won’t do them.
Today I want to go cover the key elements of a rehab exercise system that will give you 90% compliance with 90% success in patients doing their exercises right.
Key Elements of the Rehab Exercise System
Preframe
You need to tell your patients that they will be getting rehab exercises because everyone who has been subluxated for more than a few weeks needs them. Put energy on their importance up front. If you do this well you should be having your patients asking you to teach them their exercises instead of you asking them to do them!
Nothing will make your patients value their rehab more than you and your team placing high value on it first.
Teach from Templates
Make a template for each exercise you teach so it is an easy and reproducible experience. You may just have a document that shows in pictures and describes in words how the exercise is done. Have copies and give one to the patient writing their name and date on the document.
Better still, with computers, you can keep all your document templates on your server and just print out what the patient needs. This way, if you update any document, the very next patient gets the updated one instead of having to use up pre-printed stock.
Better yet again… if you use Spinalogic you can not only merge the patient’s name and DOB, you can also insert their faulty x-ray into the very same doc so they can see each time they do the exercise, just exactly why they are doing it. Our compliance literally doubled when we started doing this.
Whichever template you use, remember you should keep a copy in the patient’s file too so you have a record of exactly what they were taught.
You’ll probably need about 10 general strengthening exercises and then a set of more specific corrective exercises too. If you are using Spinalogic, you get some 50 exercises pre-installed which are all that most offices need. You can change or add to them at any time.
Teach them WHY
As you teach the exercises, anchor why you are teaching them this particular exercise and why it is so important for them. This gives them intrinsic motivation which lasts much better than extrinsic. At the same time, still tell them that you expect (or the doctor expects) they do their exercises. You want to get all the leverage you can lined up here!
Record Progress
Have an exercise completion record sheet for the patient to fill out each time they do their exercise. This makes it very easy to see at a glance how the patient is doing – both for themselves and for you. Not all patients will use the sheet – that’s OK – but many do and for them it is very helpful.
Review Technique
It’s no good if the patient is doing their exercise every day if they are doing it wrong! They could even make matters worse. So make certain you schedule a check 3-5 days after you teach them to make sure they’ve got it right. You can also have them bring in their record sheet at that time.
This makes a huge difference to compliance. Make sure you tell the patient when you first teach them their exercises that you will check to see they’ve got them right in (say) 5 days’ time and that you’ll want to see their exercise record sheet then too. And make sure you do what you say! This really makes it clear to the patient that you are serious about their rehab.
Review Completion
At the end of each cycle of care – 3, 4, 6 or 12 weeks – check the patient’s progress again. Get them to show you (or your trained CA) their exercises. You want to know: how often they are doing each exercise, how much intensity they are putting in, and how correctly they are doing them. You need to record all three in your notes as the patient’s compliance here will influence the final step…
Update the Program
Don’t just give the same exercises to the patient for ever. They are rehab exercises so they should change as the patient rehabs! Updating the patient’s exercise program will ensure they stay committed.
How many exercises should you give? I recommend 2 to 4. More than 4 and your compliance drops right off. It’s much better that a patient does 2 critical exercises well than 4 less important ones irregularly. Keep it simple.
Time to let the Rubber hit the Road
No plan takes effect until you take action. If you don’t have good systems around your rehab, maybe now is the time to make the change. For Spinalogic users, we have a training video on how to implement these steps using the cool tools in Spinalogic. You can see it in the support portal. Just search for ‘experts’.
If you don’t have Spinalogic yet, maybe it’s time to get it so you can get better results for your patients while spending less of your and your CA’s time. If you do have Spinalogic, start getting these steps in place if you don’t already. Just contact support if you ever get stuck.
As always, I look forward to your comments. Just post them right below here.
Yours in Chiropractic,
Dr Richard Sawyer.