Rode Chiropractic Center
Darcy A. Rode, DC, CCST * 2010 W. 120th Ave #106 * Westminster, CO 80234
THANK YOU FOR CHOOSING RODE CHIROPRACTIC CENTER
Restoring function is as important as relieving pain
The following has been shamelessly ripped off from a Malik Slosberg, DC, MS article printed earlier
Improving function is the key to long term pain relief, NOT pain medications or anti-inflammatory. In the presidential address to the North American Spine Society, Saal, MD stated, “We must adopt the principle of improving patient function as our new paradigm. Improving patient function must be the credo of care.”Failure to restore function means any pain relief will be temporary and reinforces chronic pain.” This functional orientation is, unfortunately, not the focus of the traditional medical model and explains some of the deficiencies in an approach that evaluates and treats only pathology as opposed to functional compromise
The most basic goals of chiropractic are; 1) PAIN RELIEF; 2) TISSUE REPAIR; 3) RESTORATION of FUNCTION.
A MODEL FOR THE RECURRENT NATURE OF BACK PROBLEMS
Gordon Waddell, MD, in his 1998 book he presents a simple and concise paradigm that examines the relationship between tissue repair, function, and symptoms. Pain may arise as a result of tissue damage or dysfunction and that with the onset of significant pain, TWO RESPONSES OCCUR. One is involuntary muscle spasm as spinal reflexes react to guard an injured area. Second is a fear avoidance behavior. Both responses contribute to immobilization and disuse; muscles will undergo disuse atrophy and weaken. Soft tissues become progressively stiffer and inflexible as fibrotic infiltration ensues. Also, cardiopulmonary function declines because of reduced activity. These factors contribute to progressive chronic musculoskeletal dysfunction, which may persist long after the healing process is completed and therefore, contribute to CHRONIC PAIN. Dysfunction may become self-perpetuating. If dysfunction is the problem then symptoms can persist for as long as dysfunction continues.
REGAINING A SENSE OF CONTROL
The treating physician must identify losses of function and correct them by both treatment and an active rehabilitation program. It is essential in musculoskeletal conditions that the patient participate in such a program.
RECOVERY OF FUNCTION NOT CHRONIC DISABILITY
If tissues are allowed to heal without functional restoration, chronic disability can occur. Mayer, MD, in 1999 states: “The majority of injuries to the low back…have a relatively brief healing period. When healing is temporarily complete, but BIOMECHANICALLY IMPERFECT, leading to permanent impairment of the supporting elements, chronic disability may follow.
If we are not evaluating and quantifying our patients functional impairment, we are not adequately representing the severity and nature of their health problems, and are missing, perhaps, the most important characteristic of their case, their disability.
Ameis, MD explains: “As time passes, the rehabilitative program should become progressively more active. It should also be stressed that
What it comes down to is this: Pain relief is NOT enough; tissue healing is NOT enough.
It is important for patients to understand these goals and the time required to achieve each of them, so that they appreciate the process and endpoints of care. DYSFUNCTION MAY BE SELF-SUSTAINING, SO SYMPTOMS MAY PERSIST INDEFINITELY. This unfortunate cycle may doom a person to lifelong problems of recurrences and chronicity. PATIENTS MUST UNDERSTAND THAT THEY ARE NOT PASSIVE VICTIMS OF MUSCULOSKELETAL PROBLEMS. Treatment and rehabilitation will improve strength, flexibility, endurance, and patterns of muscle coactivation and recruitment.Patients therefore must, understand the importance of, and participate in, a functional recovery program. ”recovery of function is the primary goal. We must minimize pain and maximize function. From the Report of the International Paris Task Force on Back Pain, published in 2000 states: Individuals who have back pain reduce their activity. The longer they reduce activity, the greater the risk of the condition becoming chronic. A return to normal activities is considered to be more important goal than pain relief. Ultimately, it is the loss of function that impairs the ability to perform daily activities and gainful employment that sabotages the quality of life. It is restoration of function, as a result of a cooperative, active and successful partnership between chiropractor and patient that results in functional recovery, improved quality of life, and patient satisfaction.
Haldeman, DC, MD, PhD in a literature review from 2000 states: “There has been no evidence that a change in the relation of adjacent vertebrae of the type commonly described in the chiropractic literature can result in nerve root or spinal cord compression.” Bogduk, in a 1999 paper states that neuropathic lesions such as nerve root compression causing radicular pain are uncommon in the spine. There is however one very brief statement which captures the essence of the chiropractic treatment goal, “minimize pain and maximize function”
It is essential that you the patient know not only the goals of the care but also the time frame necessary to achieve them. Chiropractic is a reasonable, natural, effective, and functional alternative to a medical system that has become overwhelmingly drug based and symptom oriented.
NEUROMUSCULOSKELETAL SYSTEM STRESSED EVERY DAY
A basic premise, which must be understood and passed on, is the fact that the neuro musculoskeletal (NMS) system is under daily bombardment as a result of repetitive strains and stresses of daily work and recreational activities. Such stressors constantly challenge the integrity and stability of the system. Once NMS has sustained a significant injury, it is critical that the care provided not only achieve pain relief and tissue healing, but also that it help restore good function in order for the NMS to regain and maintain the strength, endurance, and flexibility necessary to tolerate the repetitive tasks of everyday living.
Waddell, MD underscores the importance of function in his statement:
The traditional medical approach makes a reasonable assumption, which is, as we now know incorrect- when tissues have healed, pain should be gone and function restored. Tissue healing should signify the end of medically necessary care. However, the relationship between (1) tissue healing, (2) pain relief and (3) restoration of function is considerably more complex. These three things are INTERRELATED but are NOT INTERCHANGEABLE.
Back pain and disability frequently persist beyond the period off tissue repair. Wahlgren, MD states: “…pain related effects such as functional deficits & distress may extend beyond healing of tissue damage.”
Philips, PhD and Grant conclude: “The recovery process was found to be considerably longer than was expected and than would be predicted from the course of physical healing of soft tissue damage.
From Waddell, MD comes a list of RESIDUAL DYSFUNCTIONS that can persist long after tissue has healed; 1) Abnormalities of joint Movement, 2) Acute joint locking, 3) Muscle fatigue, weakness, tension 4) Reflex muscle spasm, 5) Connective tissue adhesions, scarring, trigger points, fibrositis 6) Neuromuscular Incoordination,
7) Muscle imbalance, 8) Abnormal patterns of movement, 9)Altered PROPRIOCEPTOR and NOCICEPTOR input.
Herring, MD, concludes, after injury: “The signs and symptoms of injury abate but these functional deficits persist. The rehabilitation process is not over when the symptoms disappear. Rehabilitation must not be solely based on symptom relief.
DIFFERENT RESPONSES, SIMILAR GOALS
Not only do patients’ presentations differ, but also their response to care differs. The treating physician must personalize the treatment plan, evaluate progress and customize one’s care to the unique needs of each patient.