How Long Does a Chiropractic Treatment Take?

For many people, face time is equivalent with value.  Doctors are always trying to balance the number of patients they see with quality of care they can provide.  If you have too many patients on your schedule, you’re not going to be able to spend the quality time needed to meet everyone’s needs.  But if you see too few patients then you can’t afford to continue.

Doctors will try to balance this by improving how traffic flows through their clinic so that they can spend as much time as possible with patients.  Time checking on results, running back and forth between rooms, and waiting for a room so it can be used for the next patient are all examples of patient flow that can be managed and improved.

Another thing doctors will do is manage data collection by having a staff member such as an assistant or a nurse get your vital information such as your weight or blood pressure.  The forms you fill out also allow collection of this info without wasting the face time you have with the doctor.  These kind of tools give the doctor a few more minutes to spend in actual patient care. 

I recently had some patients of other chiropractors complain that their chiropractor did not take time with them.  They lamented that the doctor only spent a few minutes with them, and that they had to come back often, paying so much for so little time with the doctor.  What it seemed to me that they were really concerned about was value.  Their chiropractor may be providing proper treatment, but failed to help them truly understand how his plan of care for them would work.  Or, he really was not providing adequate time to fulfill what he had promised in his explanation.

Providers follow guidelines.  Medical doctors have guidelines on how many and how often to give pills. People respond differently and dosages have to be adjusted.  I set plans following research as a guideline for how often and how long to see a patient but modify for individual need.  In my office my average new patient face time is 25 min, and for patients established in a treatment plan I average about 12 min.  I see a patient about 12 times for an single complaint.  Some less and some more.  A patient’s time in the office does not always correlate to the amount of face time with me.  A visit may be from 10-60 min depending on what other therapies are prescribed for their treatment.  The important thing to me is that patients feel like our goals were achieved in their time in my office.

When thinking about value and face time keep in mind some treatments take longer than others.  For example: massage can take 15-50 min,  electric stimulation 12 min, chiropractic adjustments take about 5 min with everything.  Getting immunizations takes 3-5 mins, and you don’t even see the doctor.  Taking a pill only takes a few seconds between your medicine cabinet and your mouth, and think about the cost of those pills compared to the face time you got.

Fevers

Image: Ambro / FreeDigitalPhotos.net

Mom, almost instinctively, checks your forehead for a fever to see if she should keep you home from school.  That’s a good plan.  If your body is ill, one of the proper responses is for it to develop a fever.  The fever is not the problem however; it is part of your body’s solution. 

A recent question by a parent of a child with an ear infection brought this up.  Most parents get scared when their child gets sick and this is perfectly normal.  They should.  This information may help to calm you down.  Our bodies were masterfully designed to be able to combat illness on their own.  Sometimes they need a little help, but often are capable if we just provide the right environment for health.

When it comes to temperature normal is not 98.6° F (37° C).  That is a number for the text books, but anything from 97° F to 99° F may be normal for you.  A normal fever (in a person greater than 3 years old) is between 102.2° F and 104.5° F (39° C and 40° C). This temperature is not bad and should be considered beneficial; it is being regulated by the body and is still under control.  It’s ok.

A fever above 104.5° F (40° C) is not going to cause damage, but does indicate more seriousness and you should see a doctor if you have a fever that gets to this level or a low grade fever for more than 5 days.  Damage to the body or brain is not going to occur until temperatures of 108° F (42° C) or higher.  So don’t panic.

Over the counter fever reducing drugs are not even recommended by the American Academy of Pediatrics.  In the case of home medication for children with fevers they suggest and I agree that treatment should be provided to ”improve the child’s overall comfort rather than focus on the normalization of body temperature.”  If a child can’t sleep due to pain then they will have more difficulty getting well.  Care should focus on proper fluid intake and comfortable rest and not on reducing the fever.  For additional information please see this article by Claudia Anrig, DC.

Scientific Studies Interpreted

Journal of Manipulative and Physiological Therapeutics

Since the dawn of modern science answers to life’s questions have been sought through studies.  I highly recommend research and physicians using research to the advantage of their patients.  I encourage patients to stay informed through reading research.  In life, online, and even the media you hear things like, “oh it’s true, they’ve done studies.”  I’m not sure who “they” are and whatever study is being referred to probably didn’t mean what you thought it did.

American Chiropractic Association

Chiropractic, for good or bad, has been forced into research by the well-meaning movement of evidence based medicine.  This movement, as with most things, falls short when strictly applied to every scenario.  There are always too many exceptions.  One of the most well-known, and a great read, is a farcical review article discussing, “parachute use to prevent death and major trauma related to gravitational challenge.”  This article was actually published in the British Medical Journal in 2003.  It inferred that because there was no research studies to show the efficacy of parachute use that their use should be discontinued as a preventative health care measure.

Index to Chiropractic Literature

The truth is that most studies are either to vague or to specific or too something to be applied directly in real life situations.  They all have flaws and weaknesses.  Even the gold standard Double Blind Randomized Controlled Trial is not perfect.  Most of the good studies admit and disclose their bias so that readers can take that into consideration when determining usefulness.  If you don’t understand research bias don’t worry there are entire college courses dedicated to the topic, if you want to learn more you can begin here  Google results: research bias.

To make things simple for you, there is no perfect study because people are not perfect.   This principle becomes utterly clear in online debates that usually end in name calling and any truth lost to both parties.

The Chiropractic Resource Organization

I often cite research on my blog, and sometimes people agree and sometimes they disagree with the research.  You are welcome to do so.  I highly recommend reading research for truth.  The best RCT can be useless and the anectdotal single case study may hold the answer to the problem you face.  Don’t discount evidence of any kind.  Read it for truth and accept the research for what it is, one possible view of a whole situation.

Is Popping Your Knuckles/Back/Joints Bad For You (Part II)?

My prior post on this topic had so many comments that it had become bloated and difficult to follow. I will attempt here to summarize the answers to those comments and also add new insights that I have gained in the years since that prior post.

Joint motion is good.  Here is an excellent summary quote from The Mayfield Clinic for Brain and Spine: “Good joint motion is essential for the health and nutrition of the discs and joints because it permits the exchange of nutrients, fluids, and waste. Good motion helps reduce pain, muscle spasms or imbalance, and improves nervous system function and overall health. Without movement, discs and joints may degenerate more quickly than normal. Motion also reduces the formation of scar tissue, which can lead to stiffness and degeneration.”

The issue is simple sometimes our joints make noise when they move.  Noises are OK.  The old wives tale that popping your knuckles will give you arthritis is just that, a tale.  With that said, knuckle cracking is not a good habit.  There are 4 major noises that joints make and the general rule for all of those noises is, that if it doesn’t hurt, it is probably fine.  Here they are…

The Break – This one hurts and is therefore bad. When bones break they make a noise.

The Thunk – This one can go either way. The best example I can come up with is a dislocated shoulder. It thunks going out and then thunks coming back in, but one hurts and one makes it feel better.

The Twang – It’s like strumming a guitar string. You’ve seen people with their ankles or wrists popping over and over. It doesn’t hurt, but the ligaments or tendons are being strummed or popped over a bump or restriction of some sort.

The Pop – This is the one that the most people refer to with chiropractors. The popping is not perfectly understood.  The current thinking is that it is a cavitation. The pressure increases in the joint space causing the nitrogen or other gases to be “popped” from the liquid to gaseous form. It takes a refractory period before this can happen again. That’s why you can’t pop your knuckles immediately after doing it, but have to wait for a time before they will pop again

Popping your knuckles or any joint is not bad for you – Anything to excess is bad. You should not be popping any joint, all the time. I’ve seen people who every 30 minutes or so will take their head and twist it “crackle”. Every time you take your joints that far it puts stress on the joint capsule.  Stress by its self is not bad as with exercise it can lead to improvement, but if it is over done you can hurt yourself.

Let me address popping your own joints as a form of treatment.  A Chiropractor will assess specific joints, find restrictions and adjust them sometimes getting a pop.  If you try to adjust yourself you will likely end up getting some popping sounds somewhere, but you will probably only get temporary relief, if any at all.  You can also make things worse by producing a hypermobility around the area that is stuck.  

I encourage you to stretch and take your body through all of the ranges of motion that you can.  That will often solve your problem.  If stretching does help, that is great. If range of motion exercise does not solve your problem then seek chiropractic help.

Here are some of the most common questions asked in the past and their answers.

Q: How much is too much popping.

A: There is no answer for everyone.  If you think you do it too much, you probably do.  Track your symptoms. Make a little list of each that you are concerned with.  Write down what the symptoms are, when/how often they happen and anything that you do on your own that makes them feel better or worse.  You might find the cause and be able to make a change that resolves the symptoms on your own or you might be the best informed patient your doctor has seen in weeks.

Q: What should I do if I pop my knuckles/back/joints too much?

A: First see a chiropractor to see if there is something wrong that you should address physically.  If you can remove the cause then you won’t have to worry about popping.

If this popping has become habitual or obsessive for you and is not due to some underlying condition then you can try behavior modification.  Habits are always easier to break with support, and professional help may be useful to you.

Q: Can you tell me what’s wrong with my popping knuckles?

A: It’s very difficult and illegal to diagnose over the internet and without an examination.  I provide this information as educational.  It should not be a substitute for seeing your chiropractor.

UPDATE: Scientific American presents an interesting article reviews some of the research on the topic of knuckle cracking.

Menier’s Disease: New Research

Patients doing their own research on conditions occationally bring me something that they find interesting to get my opinion.  This recently happened with an article on MÉNIÈRE’S DISEASE AND JOINT INJURY.  The full title is “The Potential Role of Joint Injury and Eustachian Tube Dysfunction in the Genesis of Secondary Ménière’s Disease” I thought I’d just share that review with you.

Meniere’s Disease is a disorder of the inner ear causing many different symptoms from vertigo to ringing in the ears to hearing loss.  The article really seems to be just an idea that the authors have been pondering and sought to find evidence to back up their idea.  Not very scientific in my opinion.  What they’ve really done is see if there is any validity to their hypothesis so that they can do further studies.

The ear has 3 sections, inner, middle, and outer.  The inner ear is sealed off and in your skull and is what does all of the work you might associate with the ear, hearing and balance.  The middle ear is simply a cavity with facilities to allow the outer ear to “talk” to the inner ear and is drained by the eustachian tube into the back of your throat.  The middle ear is usually where ear “infections” occur.  The eustation tube becomes blocked and can’t drain the middle ear so fluid builds up or an infection may grow.  If this occurs frequently, medical doctors sometimes, (instead of fixing the tube that your body has) insert additional tubes that drain to your outer ear.

The bones in your neck join the skull right behind your ear.  If you put your finger right there you feel a soft spot between the bump of your skull your jaw and your ear.  Those are the joints that the article talks about, the upper cervical spine and the TMJ.  The close proximity has always caused people to justify a relationship between those joints and the ear. Neurologically there has been no direct connection found that I’m aware of. These authors are proposing an indirect nerve connection in order to explain why TMJ or neck injuries can lead to Menier’s disease. 

From a chiropractic perspective their hypothesis also implies the reverse, that patients with Menier’s Disease might benefit from chiropractic management.  To be determined…