Chiropractic and Posture Exercise
Posture exercise is a natural for chiropractic for a number of reasons, aside from the obvious economic benefit that charging for such services generates. It is the missing link to stabilizing many of the procedures that chiropractors employ, including manipulation, passive modalities, myofascial techniques and others. Like others, I have had many experiences with patients who have come to me from other chiropractors’ offices only to discover upon intake that these patients have often been treated for years without once having been instructed in any form of exercise, much less postural activities. At the same time, there has been a long-standing lamentation by chiropractors about patients who “don’t hold their adjustments”. Posture exercise provides fertile ground for an optimum response to manipulation, in my experience, and I always am surprised to see when its great benefit has been omitted.
This same postural exercise has much greater significance in the context of our aging population and the increasing need for such instruction in this, with a goal of maintaining or even increasing stamina while minimizing pain in a society that shows an increasing reluctance in surrendering its accustomed activities, compared to past generations. Other potential benefits include maintaining or increasing range of motion and even cosmetic gains, such as preventing or reducing undesired hyper kyphosis and other postural alterations common to the latter decades. The obsession of our patients with advancing loss of height, when put into postural terms by chiropractors, can be addressed when it is explained that not only will adjustments assist with back pain relief and other expected outcomes, when coupled with postural exercise it may be demonstrated that loss of height may be attenuated or possibly reversed.
Patient Independence and Self Care
From a cultural authority perspective, this also makes a great deal of sense. A trend for many years that has unfortunately been unrecognized by many chiropractors, in my opinion, is to build as much patient independence as possible. Unfortunately, a number in our profession have historically clung to its physician reliance dogma rather unyieldingly, and a number of well-known treatment systems are representative of this concept. Corresponding advice is provided along the lines of “It looks as though you’re better / worse today (but I’m not going to inquire as to how you think you are doing), so here’s the plan I have for you (me).” Not only does this approach lead to well-documented physician dependency difficulties, it also speaks to other issues that have shaded our profession. This includes accusations of hard-sell and a sense by outsiders that the profession may not be in step with the rest of health care, which has moved toward an outcomes-based perspective. Whereas a provider-oriented approach may grant some short-lived benefits to physicians, clinging to this type of concept has been shown to be unsustainable in contemporary health care and even other settings. With the right nudge from the best chiropractic specialist around, it is a great idea to have patients help themselves with as much education, instruction, and exercise as they can be taught and encouraged to do.
Chiropractic Manipulation and Treatments
I already stated that I believe that supporting chiropractic manipulation and other methods used in the profession with postural exercise instruction helps build better doctors. However, I strongly feel that it also helps build better patients. Those who seek our care come to understand that when providers are earnestly doling out logical advice for them to improve their health, more trust is engendered. It may mean that patients actually do improve more rapidly and may “flee the coop” sooner. However, I have noted that those patients also frequently return for subsequent care and or advice more readily because patients have a higher trust level, based on past observations of the interest that the doctor has shown in them by arming patients with as much information as possible to achieve as successful a resolution as is achievable. When this pattern of active treatment coupled with logical and patient oriented postural exercise and other instruction is conveyed to other health care providers by patients and others, more trust in and referrals to our profession is a logical progression, as our place in the health care system is likely to be better understood in a contemporary independence building and outcomes based orientation.
About the Author
Eugene A. Lewis, D.C., M.P.H. is a chiropractor at Duke Health. He has been in practice in Greensboro, North Carolina since 1979, after obtaining his chiropractic degree at Logan College of Chiropractic. Dr. Lewis has a master’s degree in public health and a bachelor’s degree in medical x-ray technology / radiation health physics. He has been president of the North Carolina Chiropractic Association, was a member of the North Carolina State Board of Chiropractic Examiners and is Past Chairman of the Council on Chiropractic Guidelines and Practice Parameters. He is certified in acupuncture and uses flexion-distraction, diversified and activator techniques and practices in a multidisciplinary setting. Dr. Lewis is a Fellow of the International College of Chiropractors and has taught postgraduate courses on diagnostic topics for chiropractic colleges for over 20 years. He is presently serving his fourth term as a member of the North Carolina State Radiation Protection Commission and has been an advisor to the North Carolina State Health Planning Commission. Dr. Lewis is an advisor to Canadian Memorial Chiropractic College.
