By: Monte H. Greenawalt, DC, DABCO
Doctor, it is your ATTITUDE that will take you to whatever ALTITUDE you want. Think about the fact that your patient is a person who acts and reacts in much the same manner as you react.
Your patient has come to you for help. Their problem is of sufficient importance to cause them to seek your services. Realizing this fact, imagine yourself in the same place you find your patient. If you had a problem, you would seek the services of the finest, most knowledgeable and caring doctor you could find. This is the very kind of doctor your patients are seeking.
This patient has made an appointment with you. The patient feels he/she is going to receive top-quality care. How you conduct yourself can make or break this initial bond.
Demonstrate to your patient that you care by encouraging the patient to talk and express his/her concerns. When your patients look into the mirror, they see the most important person in the world. Demonstrate your caring and desire to help restore their health.
People respond and do what they do for four reasons: They want to be LIKED, be WANTED, BELONG, and be RECOGNIZED.
So, how do you catch the GOLDEN RING OF SUCCESS?
When things are simple, easy, and uncomplicated, it is hard to believe the “little things” can make a big difference; but they can and do make a big difference. Taking the time to talk with your patient is important. In fact, your initial meeting for consultation and examination will strengthen the patient-doctor bond. It is during this period that patients will recognize that they are liked and wanted, if you take time for a good history and examination. Your report of findings can assure patients that they have come to the right doctor and belong in your care.
Doctor, your patient is made up of a group of integrated and interrelated components that are not separable. Your patient’s history will no doubt reveal the fact that he/she has been under the care of other doctors and failed to find help and relief. Patients who are satisfied with their doctors do not seek help from another doctor. Take care of your patients in such a manner that they will not want to seek care from another doctor.
To be successful is easy; just be a little better than average. It’s easy because the average is so low. Dare to be different. Show your patient you care by performing an examination that is different than what he/she has experienced in the past.
Manual Muscle Testing
Proprioceptive evaluation of the patient in the standing, sitting, and reclining posture is a very effective communicator. Conduct this test in the same manner you would test muscle strength for disability evaluation.
Explain to the patient: “I want you to think of your body as a pile of bones, tied together with ligaments and muscles to move the bones. If the muscles are stronger on one side of the body than on the other you’ll develop distortion. I’m going to test the strength of your muscles on each side of your body to determine if you have any muscle imbalance. I’ll test you in the standing posture first. The reason I’m testing in the standing posture first is due to the fact you spend so much of your time on your feet. The position of the bones of the feet can have an effect on the knees, hips, and spine—all the way up to the neck.”
Testing in the Standing Posture
“Let’s make this test: Hold your hand close to your side with the palm open. I’m going to try to pull your hand away from your side, but don’t let your hand leave your side. I’m going to pull, so push your hand against your hip and keep pushing as I pull. Now, let’s test the other side in the same manner.”
If you find one side weaker than the other, explain: “This side is weaker than the other side and muscle imbalance can cause distortion. It must be corrected. Your feet can be a causative factor.
“We’ll repeat the test, with one difference. Roll your foot to the outer edge, not on the side, just the outer edge. This will take the weight from the inner arch of your foot. We’ll retest the weak arm with your foot resting on the outer edge. Hold your hand tight to your side, and I’ll try to pull it away as we did before.”
If the arm tests stronger state: “We must examine your feet to determine what must be done to help maintain better muscle balance when standing, walking or running.”
Examine the feet at this time by moving the foot in various directions to determine the range of motion. Note any calluses, which are evidence of excess friction caused by foot dysfunction or poorly fitting shoes.
The vast majority of patients will demonstrate muscle weakness on the same side the inner longitudinal arch demonstrates the greatest weakness or pronation. Patients demonstrating a leg length deficiency on X-ray will generally have greater pronation on the side of deficiency. Heel lifts are not advised when correcting a functional leg deficiency. Restoring balance to pronated feet has results in a 5–7 mm leg deficiency correction on X-ray.
When your patient leaves the office after your examination, ask: “Would you like to take your foot examination report home to show the family?” If he/she wants to take the examination card home, state: “Please bring your examination card when you return for your next appointment; it is an important part of your file.”
Return Visit Evaluation
When the patient returns:
- Be certain to ask for the examination card.
- Repeat the proprioceptive test in the standing position.
- Repeat the test with the foot rolled laterally.
- If you have athletic tape, place a figure ”8” tape strapping on the foot with the greatest pronation – the weak muscle side.
- Repeat the proprioceptive test: The weak muscle will now test strong.
- Remove the tape and retest. The muscle will test weak.
Ask your patient: “Do you understand why it is necessary for us to restore balance to your feet?” If your patient fails to understand the need to have his/her feet balanced, repeat the proprioceptive tests. If the patient still fails to want their feet balanced, state: “Help me to help you understand the importance of balancing your feet to help your adjustments hold. You must have some questions; let me answer them for you.”
- Show the X-ray and explain the leg deficiency due to foot pronation.
- Show the navicular drop test results.
- Place patient’s finger on greater trochanter and instruct him/her to raise and lower the arch. The trochanter rotates back and forth.
- Explain the proprioceptive test and the neurology involved.
Most patients will then want you to cast/scan them and order Foot Levelers orthotics.
Testing in the Sitting Posture
Instruct the patient to sit in an armless chair. The patient is to assume his/her normal sitting posture. Make the proprioceptive evaluation in the following manner:
Instruct the patient to extend one arm straight in front at shoulder level with hand open. Place your hand on the patient’s wrist, and instruct the patient to push up toward the ceiling as you push downward. Repeat with the opposite arm.
Next, place your hand on the patient’s knee and instruct him/her to raise the knee upward toward the ceiling as you push downward. Repeat with the opposite knee. Generally, you will find one side weaker than the other.
Instruct your patient to sit up straight with the spine over the sacral-base. Re-test the strength of the weak arm and leg. Your patient will experience a positive proprioceptive response.
Maintaining this posture will do much to relieve the stress between the shoulders and neck. Make this statement to your patient: “You can experience the benefits of the proper sitting posture. Failure to do so will produce negative results.
“Let me demonstrate the use of a ‘towel’ for support.” [Materials: 1 bath towel and 5 large rubber bands.] Fold the towel into thirds and roll into a cylindrical shape. Maintain the shape with rubber bands. Position the towel at the base of the sacrum and fifth lumbar; test the proprioceptive response.
If the test is negative, check towel position; if the position is correct, reduce size of towel roll until a positive proprioceptive response is demonstrated.
“Do you understand why we must help you maintain a good postural attitude while sitting? Remember, I want you to use this postural assist anytime you are going to be sitting for five minutes or longer. We want to do everything possible to help your adjustments hold longer.”
- “We want to do everything possible to restore wellness!!
- “Our goal is to maintain your wellness!”
- “It’s easier to maintain wellness than restore wellness!”
- “Staying well is much better than coming to me to get well!”
It’s the little things you do for your patients—testing, evaluating, communicating—that will help you reach that GOLDEN RING OF SUCCESS. Implement the ideas I’ve mentioned in this article, and you’ll see a positive improvement in both your patients and your practice.