Many chiropractors and patients think that if they hear a "pop" sound when they are adjusted that something useful has been done. I have been re-evaluating my patients immediately following treatment and a sound means very little. Whatever criteria was used to find the problem originally, should be immediately repeated to see if you did what you thought you did. My patients respond faster because I'm sure I performed a treatment. Then I instruct them in home care and self help.
I started my Chiropractic career as an associate. After being offered positions across the state I selected a doctor in Grand Junction who said he could teach me the things that I wasn't taught in chiropractic school. Any new doctor is unsure if he knows enough. So I jumped at the chance. It turns out he didn't want to teach me about better patient care, he was talking about practice building. His practice hired a consultant who advocated maximizing patient visits by telling patients they needed to be seen a lot of times. These are called treatment schedules. Every patient gets the same treatment schedule of 3 times a week for a month, 3 times a week for a month and once a week for a month. It didn't matter if you were a truck driver, athlete or child, everyone was told they needed 24 visits.
Of course, Chiropractic colleges don't teach these systems because care should be based on the needs of the patient, not how much money you can make. The senior doctor did all the report of findings, until I could memorize the script. I treated my patients as best as I knew how and progressed them from 3 times a week to 2 time and once as quickly as I could. I shortening the treatment schedule to what the patients needed. I found even the worse injuries could get better in one quarter to one fifth of the 24 visits recommended. My employer thought that I was getting my patients well too fast. He even brought in his consultant who tried to convince me that I was doing it wrong.
When I started my own practice a year later, I continued to strive to get my patients well as soon as possible. I soon discovered that treatment 3 times a week didn't allow enough time for healing between treatments, so I eliminated the 3 times a week. I also discovered that I could get the patient through the inflammatory phase at 2 times a week in about a week or 10 days. Once the inflammation was settled I could monitor and facilitate the healing process at once a week until the abnormal tests were negative. Once the tests were negative the normal healing abilities of the body were in full swing and I wasn't needed unless the patient experienced a set back. Now I had shrunk 24 visits to four or five.
At the same time that I was perfecting my skills and lessening the necessary treatment, the practice building crowd was listening to David Singer, 3 times a week for 6 weeks, 3 times a week for 6 weeks and once a week for 6 weeks for a total of 36 visits. Then the surface EMG (electromyography) people can along. This is a tool that measures the electrical activity on the skin as a measure of injury or problems. This sounds like a great tool except that it was marketed as a way to substantiate excessive care to the insurance companies. The recommendation was to use the Surface EMG every 12 visits and everyone got four tests for 48 visits. As if this wasn't enough, next came the pre-paid 65 to 72 visit practice builders (don't try to get your money back from this one). Each of these money making systems claims to be providing a "spinal correction". So I guess you can tell the practice consultant by how long it takes to do a "spinal correction". It's up to you whether you want a 24, 36, 48 or 65 visit correction. The problem being that your number of visits was set before you walked in the door and the only criteria for completion of the "spinal correction" is the number of visits.
I have heard patient say that they feel better while they are being treated every week. The definition of recovery is feeling good without on going treatment. It's not surprising that after a lot of treatments and a lot of money that these patients get smarter. It may seem amazing, but these patients still respond to good care in a few treatments. I'm still surprised when a patient gives up after 30 visits somewhere else and then gets better in 2-3 treatments. Don't think that I'm the only one, there are other fine chiropractors in town. Just don't let them schedule for a "wallet emptying" instead of patient care. I wouldn't know any of this if I hadn't been through it myself.
I guess if you are going to see a patient 50 times, what's the incentive to learn what's needed to get them better today. In my practice there are procedures I don't use anymore, because they just didn't work fast enough. There are other procedures I have discovered. I once had a discussion with a doctor who saw 100 patients 30 times, while I saw 1000 patients 3 times. His response was "what?"
Some problems can't get 100% well and need ongoing care. Some jobs create recurrent strains to the spine and need periodic attention. These are not what I am talking about and shouldn't be used as an excuse for prolonged treatment of everyone.
Does this mean I'm a better doctor? I don't know, I don't know what the other guys are doing. When I say I'm "Putting the pieces together" I don't mean the pieces of your spine, I mean the piece of your treatment plan so it is successful. Treatment must include improving all the aspects of your problem. That includes stretching, exercises, nutrition, postural changes, acupuncture as well as manipulation to correct mechanical problems of the spine.