ORIGINALLY Published on Sunday, 21 October 2012
I want to take this blog to speak to a confusion that I firmly believe both doctors and patients share. That is, the concept of wellness or maintenance care. Often, in my first visit with a patient, they will share with me their concern of having to see me 'forever'. Or, I will hear in passing the reason patients choose not to see me is they have a concern that I will try to keep them coming. Or, patients will ask me after I have helped them resolve a complaint, "What is the maintenance schedule?"
This perception about wellness or maintenance care stems from a poor understanding of what is trying to be achieved. And as a practitioner, I could argue that doctors across our field are philosophically spread on this topic. So, without delving into the array of opinions - I want to provide a clear description of my reasoning for care that goes beyond resolution of a patient's complaint.
My primary objective when a patient presents with a complaint that can be positively impacted through the methods I practice, is to get to the end point as elegantly as possible. I try to identify the most direct reason that pain is being produced, and provide positive stimuli to reduce or completely alleviate the pain. On a more complex level, most complaints that present to our office are a function of poor force absorption. To understand this concept in detail, please see http://www.pittsfordperformancecare.com/services/in-balance.html.
I would argue that poor force absorption is the common denominator in most neuro-musculoskeletal injuries / pain presentations (from carpal tunnel to a torn ACL). And as a result, when working to alleviate pain in a patient, I am specifically targeting neural deficits that are responsible for permitting unwanted force to get in the body. This is the premise that guides my recognition, evaluation and treatment of injuries.
An example for clarification:
Chronic or acute lower back pain means undue force is consistently reaching the lumbar spine during any force production (which can be as simple as walking through the mall or being seated at 90 degrees in a chair). Everything that we do creates force. And when force is not absorbed with a rapid, accurate response by the muscles, it will penetrate the body and travel the path of least resistance to a stress point. An extraordinarily common stress point is the lower back, due to its anatomical position. It is important to understand that the body's ability to absorb the force that it creates is dependent on the brain's control of our reaction time- or motor reflexes. If these reflexes are healthy and fast, the muscle system is capable of absorbing tremendous force. If the neural circuitry has been compromised, the motor reflexes become down-regulated and compensated movement arises.
Causes of this down-regulation or compensation can include any negative neural stimulation. Examples: poor biomechanics, tissue sprains / strains, concussive injury, emotional stress, and chronic pain syndromes (not exhaustive).
Once I feel confident with the one or multiple triggers causing neural compensation - treatment begins. In-Balance treatment involves a receptor-based activation process that stimulates deficient neural pathways with directed positive afferentation . I know it sounds complex, but I assure you that my patients would say it's actually pretty simple. The process from evaluation to repairing neural integrity takes just a few visits. Remaining care is dependent on how much strength work is required to support accurate movement.
Hopefully this has provided some clarity about our process and methods. And when the question of maintenance or wellness care is posed, I have 2 comments. If activities of daily living (which can include periods of exercise) cause a level of 2 or greater on the (1-10) pain scale, then it is expected that compensation will ensue and correction is recommended. In addition to care for injury, I also recommend the In-Balance procedure for optimization. Because this methodology directly impacts cortical (top of the food chain) neural function, whole body benefits can be achieved. These benefits include dynamic increases in strength and stability as mentioned earlier, but also autonomic stability (lower resting HR, lower blood pressure, more efficient energy utilization, and decreased pain sensitivity).
So, yes, I do recommend wellness care. I think my definition is different than most. Ultimately, I am trying to balance self-sufficiency with optimized neural health for my patients, relative to ongoing care. I hope this post has helped. Please email me if you have comments or questions @ firstname.lastname@example.org