Adjusting Protocol for Patients with Orthotics

By: Dale Heil, DC

Doctors of Chiropractic have always strived for a delineated adjusting protocol that makes sense to both the patient and themselves. When using functional orthotics in combination with an appropriate adjusting technique, the doctor can intelligently demonstrate the need for continuing corrective care and establish an effective maintenance program.

Patients and doctors alike have never been able to make much sense of adjustment schedules that are inflexible and arbitrary. Patients like their care to be personalized and do not adhere well to “cookie cutter” styles of healthcare. When a patient is told, “You need to be seen three times a week for six weeks, and then twice a week for…..” they question the premise that such a schedule is based upon. They have to wonder, “How does the doctor know, in advance, how much care I will need?”

Keeping Patients Informed

Let’s explore another way of handling the relatively long treatment times that conservative Chiropractic care mandates. Pedal imbalance affects postural health; fortunately, orthotics are excellent for supporting the three arches of the foot. The patient should be informed that, after she is fit for orthotics, it will take—depending on method of ordering and geographic location—approximately one to two weeks for them to arrive. The patient should be seen three times a week until she actually puts the orthotics into her shoes. It is explained that this is to prepare her spine for the major postural changes that will occur with orthotic use.

This is usually easily understood by patients. They are probably in pain at this stage and can fathom the fact that something is seriously wrong and needs to be corrected. After patients begin wearing their new orthotics, they should continue to be seen three times a week. This is to assure that feet, knees, femoral heads, and spine all respond positively to the introduction of the orthotics.

Subluxations by the Numbers

When a patient is first seen in your office, an appropriate subluxation evaluation technique will usually reveal a large number of subluxations throughout the spine. During the one-to-two-week period that the patient is being treated while waiting for her orthotics to arrive, the number of subluxations will reduce significantly. In some cases, after a day or two following the introduction of the orthotics into the patient’s shoes, the number of subluxations may increase, due to the postural changes initiated by orthotic use. In essence, you are starting the treatment program over, and the patient should be seen three times per week during this phase of care.

However, it usually only takes approximately three to eight post-orthotic visits until all corrections have been made. The spinal adjusting that took place prior to placing the orthotics in the patient’s shoes has prepared the spine to readily accept postural changes. It is a smooth and seamless transition from poor postural structure to improved postural health.

Don’t reinvent the wheel with each new patient. Put a system in place that works well for both you and your patients, and it will serve as a template for the care of all future patients. In addition to following the instructions found in the “Foot Owner’s Guide” that comes with the functional orthotics, it is a good idea to have your patients use their thumb to gently push the bones in the foot cephalward two or three times per day while stabilizing the forefoot. By having the patient perform this technique at home—along with the golf ball and towel scrunch exercises—you greatly reduce potential discomfort when initiating orthotic use.

Everything should be geared toward making our lives as efficient and uncomplicated as possible. When patients benefit from our efficiency, it results in another win-win situation. Naturally, the patient cannot do the entire job and needs to be seen in your office often until the acclimation process is complete. There is a great advantage to completing the acclimation process as quickly and effortlessly as possible.

Essential Techniques

If you have not yet taken Dr. Mark Charrette’s extremity adjusting course, you are really missing some great techniques for this type of work. When you adjust the lower extremity as Dr. Charrette teaches, with a sufficient volume of adjustments in a short amount of time, the number of complaints from patients during the acclimation process becomes almost nonexistent.

If you use an adjusting technique that allows you to quantify the number of subluxations present, it makes the development of your treatment plan very easy. Palpation alone does not offer sufficient information to accurately establish the exact number of subluxations present. There are many techniques such as DNFT, Activator, Applied Kinesiology, etc. that exhibit greater validity and repeatability of findings than palpation alone offers.

This is important as you want to be as accurate as possible when counting the number of subluxations present at any given time during the treatment program. Patients can easily understand an extended treatment plan that is based upon the number of subluxations. It makes sense to them, and it gives us a criterion to base the visitation schedule on. When our confidence in what we are doing rises, so do the number of referrals from the patient.

Making the Case for Optimal Care

At this point, a maintenance program is appropriate to maintain joint motion throughout the life of the patient—assuming that they want to benefit from the preventative healthcare aspects of Chiropractic care. Orthotics and regular Chiropractic adjustments have been shown to improve the proprioceptive ability of the body.1,2

This is a significant point when making the case for maintenance care, as poor knee proprioception has been associated with increased disability in patients with osteoarthritis.3

As preventative healthcare professionals, offering such effective services to our patients is a very satisfying and humanitarian way to practice.

References

1. Riegler HF. Orthotic devices for the foot. Ortho Rev 1987; (5):293-303.

2. Bates BT et al. Foot orthotic devices to modify selected lower extremity mechanics. Am J Sprts Med 1979; 7.

3. Birmingham TB, Kramer JF, Kirkley A et al. Association among neuromuscular and anatomic measures for patients with knee osteoarthritis. Arch Phys Med Rehabil 2001;82:1115-1118.