What to Expect
I had a new patient yesterday who was kind of pushed towards “alternative approaches” by a friend. Her main complaints were left sided neck and upper back pain, and headaches. She had seen her PCP 2 days prior who had given her muscle relaxers for pain.
After reviewing her paperwork we sat down for around 10-15 minutes and she told me all about what she had been dealing with the last few weeks. I asked some questions, she answered them- AKA we took a history of the chief complaints. (85% of a diagnosis comes from what you tell your doctor, just an FYI)
Next we left my office and I checked her vitals to rule out any red flags- this is done to make sure she was in the right office. If she reported anything that could have been a more serious problem, or a “sinister pathology,” I have to get her out of my office and to the right place. (Had a patient with a 104 fever and mid back pain- got him to the ER immediately- infection can be a big deal- he was in the wrong office).
She was in the right office.
After some orthopedic tests, range of motion assessment, and physical exam, I formulated a few differential diagnoses (what is probably going on) and explained them to her. The differentials included a herniated cervical disc and/or facet syndrome, and tension headache (both pretty classic presentations). Showed her some diagrams, explained why her shoulder and upper back hurt and why it was probably from her neck. Assured her I'd seen many cases like this before and had success. We talked about advanced imaging and how her current presentation didn’t warrant it (there are rules to follow before sending out for imaging, some clinicians follow them and don’t waste resources, some don’t). We agreed she didn’t need any.
Next we did a mechanical exam and figured out that there was a movement that improved her range of motion and reduced her symptoms. A movement she would be able to perform anywhere. If we can find this out, and it can “centralize” a person’s referred pain (for example neck pain that is referred to the shoulder, or low back pain that is referred to the leg), there is a 98% chance the person will get significantly better within two weeks. She fell into this category (hooray!).
After some more of that movement, she said to me “I feel like it just wants to pop.” 30 minutes prior to this she told me she was hesitant, and kind of nervous, about getting her neck “cracked,” “adjusted,” or “manipulated.” I asked her if she thought that it going pop would give her relief and she said yes. So I did one of the things I am highly trained to do, and manipulated that joint in her neck. She got off the table and moved her neck around and within 3 seconds reported significant improvement.
Then I used my Class IV Laser on the left side of her neck for a few minutes to help with any of the residual pain she still had. I gave her homework to do every 60-90 minutes or so and she will follow up in a few days.
She reported roughly 60% decrease in pain and had noticeably better range of motion in multiple directions, or planes, prior to leaving. This entire encounter was about 60 minutes long.
This is a common new patient encounter here. The entire time one on one. All questions were answered, no stone was left un-turned, and this person reported significant subjective (what she told me) improvements, and there were also significant objective (what I can see or test for) improvements.
This type of presentation, from what I have seen, usually resolves between 4-8 visits, over about 6 weeks. Some quicker than others. No need for 3 visits a week for 6 months. When she’s pain free and recovered full range of motion in her neck she’ll be discharged. This is evidence based practice. This is how things should happen- in my opinion.
I was done writing this… but, funny thing, this patient just called me. On the phone just now she said she felt a bit sore but feels roughly 80% better. Rock on. I'll give her an excellent prognosis.
Any of my colleagues reading this, keep fighting the good fight. Let’s dispel any of the negative connotations about Chiropractic Physicians and keep rocking cases.
Until next time,