With the treatment of any new patient following initial consultation, evaluation and management we must make some decisions; or to meet our E&M requirements we have some “medical decision making” to do. How many Chiropractic Manipulative Therapies (CMT), do we schedule before our next progress exam or re-evaluation? Are we scheduling any type of conjunctive therapy like muscle stimulation, ultrasound, hot or cold packs, mechanical traction to help promote healing? Maybe we will include some soft tissue work like active release, Nimmo, Graston technique to assist in stabilizing the components of the vertebral subluxation complex. Finally, we may determine that rehabilitative exercises or neuromuscular reeducation is necessary to help further the patient’s progress and ultimate outcome.
All these procedures may or may not make up your patient’s chiropractic office visit; but when the patient is not in your office, what instructions have we provided to further allow them to develop the “chiropractic lifestyle” or “wellness lifestyle?” Have you discussed activities of daily living do’s and don’ts? Have we considered home use of hot or cold application and home instructions of rehabilitative exercises or just general fitness options? What about our patient, who is a salesperson or is leaving on vacation, are we addressing their rehabilitation and physical fitness needs?
Rehab-to-go
Let us take a look at this patient who may use the excuse that they are on vacation or have a busy daily schedule and are traveling for business all the time.
As our patients travel, whether it has to do with vacation or business, we want them to maintain the types of “wellness lifestyle” that we have incorporated as part of their care plan. If we have placed our patients on a home rehabilitation program, it is essential that they follow your recommendations—regardless of whether they have to go on vacation or a business meeting. Today hotels have developed state-of-the-art fitness centers to attract guests; some may even have a complete spa facility. But, what if our patients are on tight schedules, long days in the car, sitting in long meetings or standing while giving a presentation? When they finally get something to eat and go back to their rooms, going to the fitness room is probably the last thing on their minds. Maybe they did not bring any clothes for a work out?
Patients who are assigned at-home resistance exercise programs need to continue performing their exercises when they are traveling. Keep in mind that most types of resistance tubing come in a variety of strengths, This is usually demonstrated by color sequences, with red being the lightest, yellow or green mid-range and black being the most resistant. The main objective is to move a joint through a complete range of motion or specific movement, while stimulating the muscle or muscle groups by acting to the resistance—all for the purpose of reeducation, toning, or strengthening a muscle or muscle group. If you provide only one type of tubing strength for your patient (yellow), show them how to vary the length of the tubing to either decrease or increase the strength of resistance.
Make sure you have your patients loosen up their muscles a little before starting the resistance exercises. Have them do some general stretches or perform a couple of the recommended exercises without the tubing or resistance. It is very important that our patients perform the tubing exercises properly. Full ranges of motion and being able to pull the band through the complete movement pattern to end-point is essential. If end-point is not achievable then we are having them use too much resistance which can lead to “overloading the joint” and possibly creating an aggravation or re-aggravating a previously stable condition. Proper instruction on correct breathing patterns must also be included, such as exhaling during the resistance movement pattern and inhaling during the return to starting point.
Many of your larger hotel chains like Hilton, Westin, Marriott provide in-room resistance tubing kits upon request. Some even have in-house TV channels that allow you to follow along. During your wellness lectures is another great time to introduce the importance of maintaining some form of exercise program.
A 1980 graduate of Palmer College of Chiropractic, Dr. Kirk Lee is a member of the Palmer College of Chiropractic Post Graduate Faculty and Parker College of Chiropractic Post Graduate Faculty. He has lectured nationwide on sports injuries and the adolescent athlete, and currently practices in Albion, Michigan. He is very active with the Michigan Chiropractic Society serving on the legal and government affairs committees.