At Cole Pain Therapy Group, we have many treatment tools at our disposal: chiropractic manipulation, manual therapy, rehabilitative exercises, e-stim w/ therapeutic ultrasound, and nutritional recommendations (to name a few). Yet, a problem arises when some patients assume that the treatment tool is actually a treatment system. They may shop for a health professional with a specific treatment tool. If home construction were the same way, that would be like looking for a builder that specializes in the “hammer system”, because you’ve heard that nails are the best for building a strong house. When in fact, you want a well-equipped professional to explain what it’s going to take to help you reach your goals.
“In order to help someone towards their health goals, we need to apply the right combination of tools, in the right way, at the right time, for the right diagnosis.”
And what about treatment timing? The diagram to the left represents a logical progression of treatments that would get the most sustainable improvements in both pain and function over the shortest amount of time. Let’s look at a specific example to see how this progression would work.
Jane (not a real name) came to Cole Pain Therapy Group with 3 weeks of low back pain that occasionally radiated to the right lower leg. She explained that the pain was worse while stooping over to care for her infant son. She had been stretching her hamstrings, which felt tight, to no lasting benefit. Her goal was to get out of pain and be able to function through the busy day. Eventually she hoped to get back to boot camp style training for weight loss, but feared her back would never be strong enough.
After our discussion, the examination revealed that several different treatment tools would move her from pain to performance. The pictures below illustrate her specific progression of treatment.
1st session. Instruction about how to move in a way that doesn’t hurt. Jane was squatting/stooping better within 5 minutes, feeling more confident since it didn’t make her back hurt like before.
More at 1st session. She was instructed on McKenzie extension exercises to be performed 10x/ day for the next 2 weeks. She also received spinal manipulation to improve spine function and ultrasound with e-stim for pain control.
Sessions 7- 10. She was instructed and performed a variety of stabilization exercises. The focus of these customized movements was to train stability at the core (her God-given back brace) in the context of motion at the hips and shoulders. It is not a matter of strength, but of control (more on this concept). I also applied spine manipulation to improve mid-back mobility and applied kinesiotape to support a related shoulder blade tracking problem.
More at sessions 7-10. When normal movement was no longer painful, she went through a series of functional movement screens to uncover dysfunctional movements that were not necessarily painful. The above corrective exercise was prescribed in order to correct a predisposing factor to the original low back pain episode. So the purpose of global correction is to address movement problems remote from the site of pain. It’s these silent dysfunctions that derail fitness goals.
After the last session, she returned to this office every 4-6 weeks per her goals to address minor pains or movement issues and to discuss the application of her customized stability principles in the context of her boot camp training.
This post is an excerpt from The Art and Science of Treatment Selection, originally published at DrBradCole.com.