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Thursday, June 20, 2013

Should I have to Keep Going to My Chiropractor to Get Adjusted?

We recently were asked a very common chiropractic question: "If I have been to the chiropractor to get my hip put back in place, after a few visits should it keep coming back out?"

Have you ever felt that way? No matter how much you visit your chiropractor, whatever the problem is KEEPS COMING BACK!

Here is Dr. Matt's response to that question:

That's a tough question that depends greatly upon the details of a given
patient's case.  
First, the general answer is no.  I don't expect to be adjusting the same
joint over and over every day for weeks on end.  However, there may be
muscle imbalances or repetitive activities that are contributing to the
problem; if that is the case, those underlying issues need to be addressed.
That's one reason that we tend to add some kind of home exercise to stretch
and/or stabilize the joints in the end of a plan of care.  We may also
address sleep posture, computer posture, job activities or other things that
could be causing the joint problems.  
Second, it is important to distinguish between stuck joints and symptoms.
Motion can be restored to a joint, but there can still be symptoms due
related soft tissue issues which may or may not be correctable with
chiropractic, exercises, ice, massage, medicine or any other number of
treatments.  These symptoms could come and go with activities that cause the
joints to become inflamed.  At the same time, it is entirely possible for a
joint to be stuck for a while without causing any symptoms at all.
Ultimately, I may have a pretty good idea of what I normally feel like when
I have joint restriction, but even as a chiropractor I can't say with
certainty that I have a stuck joint unless I have someone else check it for
Thirdly, if a joint has been stuck for a while it isn't uncommon for it to
become fixated again shortly after it has been adjusted.  That's why most of
our patients come in 2-5 times for that first condition that we manage.  The
second visit is almost always a day or two after the first visit.  The idea
is that if the joint does get "stuck" again we simply get it moving before
the muscles and ligaments become accustomed to it being stuck again so that
the soft tissues can heal and recover.  From there we spread the visits out
more and more until the soft tissues get a chance to accommodate for the
restored joint motion and maintain the benefits of the adjustment on their
own.  Even then, there can be recurrent activities or chronic issues that
come into play and can cause the joint to become stuck again.  In those
situations, a maintenance plan of checking that joint for restriction
periodically may benefit a patient by allowing us to detect the fixation
before the joint becomes symptomatic. Patients on maintenance plans also
find that over time we adjust fewer segments because they are reaping the
benefits of a prolonged plan of care that extends beyond what insurance
typically covers. 
I guess the all-inclusive, yet vague, answer is that if you know someone
like that I'd advise them to see a chiropractor for evaluation.  If the
patient follows up and is compliant with the instructions (i.e. ice,
exercises, keeping follow-up visits, etc.) it may be time to either see
another chiropractor or explore other options for managing the symptoms.
Some chiropractors advise patients to get checked every day for a couple of
weeks upon starting care, but our clinical protocols tell us that if we move
the same joint a few times over a period of a couple of weeks without seeing
functional improvement, it might be time to let another chiropractor look at
the joint to see if we are missing something.  For us, that means that I
will see Liz's patients for a visit or two or she will see mine for a visit
or two. If the other doc gets better results, we may see them some more
until the findings resolve or the symptoms and functional restrictions
plateau; however, if we aren't seeing any long-term improvement a few weeks
into a plan of care even with the patient doing the home activities we will
probably refer that case out for medical evaluation, massage, physical
therapy or some other type of alternative treatments.

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