Archive for February, 2013

Do Something Different

Thursday, February 21st, 2013

It’s time to talk about my “Life Rule” Number 3.

Hang on just a minute I can hear you think: You haven’t told us about Rule Number 1 and 2 yet?

Well to summarise; Rule Number 1 is “Breathe”. Doesn’t sound too difficult as it is one of the most basic life reflexes, and after sitting by the bedside of a dying person I can tell you just how innate and strong that reflex is. My kid’s got sick of me teaching this Rule at a very young age – Every time they had a fall or fright, and as a parent you watch that “hold” of the breath, and sense that rising of the anxiety and panic in their physiology, I would place a reassuring hand on their shoulder and firmly say “Breathe!” Breath control is a key to controlling our internal homeostasis but it’s not what I want to highlight today.

Rule number 2 is “Keep Moving” or as it was chanted in Finding Nemo “Just Keep Swimming”. Some of my practice members look a little bemused when they present in an acute inflamed state and ask – “should I rest?” And my standard response is “you need to keep moving, but gently!” Perhaps they are secretly craving a few days flat on their back in bed, with a small bell to ring to beckon their spouse to bring more fluids? Rule number 2 is a critical ingredient to any endeavor in life but it is not today’s topic.

So that gets us up to Life Rule Number 3: “Do Something Different” – I think I also learned this principle as a young parent. As your children begin to explore and attempt new milestones but at times reach a point of frustration when trying to do something new, by repeating the same unsuccessful steps. As a “mentor” it would be quick and simple to step in and show your “student” the correct way to do it – but a better life application lesson will come if they discover the solution – so instead we can summarise the best possible advice as “Do Something Different”. This doesn’t mean we turn a blind eye and leave them to figure it out, it would be better for us to make an alternative single suggestion, “reach your hand over a little further this way”, “why not try turning that block over on its side instead?”

Let’s jump for a moment into practice life and hear the Life Rule again – “Do Something Different”. Think of the practice member that appears to be responding poorly or too slowly to your care plan: This is a simple one – “Do Something Different”. Change the technique, change the schedule, change the home advice – makes obvious sense? The worst cases of over-servicing that we hear of in our profession are nearly always a case of a person with a complex health concern who is signed up for a long program of care, and then subjected to the same recipe book visit regardless of the course of their concerns. Having said that I do not believe that over-servicing is a widespread problem in our “culture”. Actually I strongly believe that under-servicing is the most serious negligence which exists at epidemic proportions in our society – there are very few people in our world that are suffering from too many adjustments – but there are far too many suffering from too few!

But this essay is not quite as simple as this – what about the person who is a loyal customer that might potentially see you on an ongoing basis for years to come? “Do Something Different!” Now I may ruffle some chiropractic feathers at this point. But the warning is to avoid the “if it ain’t broke then don’t fix it” philosophy. We supposedly reject this philosophy on the basis that prevention is better than a cure. When someone is out of pain we beseech them to continue with care, but if that care is the same neurological encounter on each and every visit from that point forwards then is that really any different – You see Maintenance is not Wellness?

Look at this from a few points of view:

1) The nervous system adapts and evolves based on its perception and response to every stimulus: So if the stimulus that you provide each week/fortnight/month is the same again and again then what evolution is going to occur as a result of your input? Let me simplify it this way – does your “technique” allow you to perform a live analysis of someone’s state right there and then so that you can provide an adjustment that is responsive to their neurological needs on that given day? Sorry to say but too few techniques truly offer this.

2) If the body is a self-healing organism, then why are you still correcting the same Subluxations that you chose on the first visit? I hear the arguments about scar tissue and degeneration, and “patterns” – but if your adjustment is initiating change, and healing and progression, then surely something has to change therapeutically at some point? In Torque Release Technique we argue that this should be occurring on every visit…

3) Chiropractic is about maximizing human potential: Doesn’t this mean that a person who is in their fifth year of care will probably need more advanced care than someone in the first? As an elite masters’ athlete, my training program develops in intensity and complexity within a short term and long term time-frame. I made my comeback to competitive athletics in 2008, and training methods have changed somewhat since my former aths career in the 80s. Even though I am approaching the 50 milestone, the training that I am doing in 2013 is more advanced than the training I was doing in 2008. And the training that I am doing in February 2013 is higher quality and more technical than the training I was doing in December 2012, as I approach my peak for state and national championships. This is contemporary sports science: But, I’m not convinced that this has pervaded contemporary chiropractic science.

Let me illustrate this with a scenario that I know we have all seen in practice: A person comes in to see you and they are in a bad way. You perform whatever analysis you do, go to work with your healing hands and send them home with some tips to keep them occupied till they next see you. They come back next time and praise you for your majestic healing powers and share their testimonial of retracing and insight. Now you have a quandary – you want to give them the same amazing experience each and every visit – so you rush back to your notes to try and discern what it was exactly that you did last time? And you attempt to reproduce that exact same adjustment. You eagerly await their next visit only to find that it just was not quite as dramatic, or worse they actually took two steps back after the last visit. What happened? You forgot Rule Number 3 – You adjusted them based on your analysis from days before, and not on the day that they presented: You didn’t “Do Something Different”!

Or you may have observed in the past that when a practice member saw your locum or perhaps visited another practitioner, all of a sudden they got a positive shift in their healing progress that had seemingly halted under your regular care. Was it that the other practitioner was better or more gifted, or smarter than you? No, they just did “Something Different”. Now I know you are thinking that you have seen the opposite scenario whereby a locum or alternative practitioner has done more damage than good – if you are thinking this then make sure you read the postscript below…

So how does Life Rule Number 3 change practice? If you want to maximize the physiological response to each and every adjustment follow these simple steps:

1) Find a technique that gives you certainty that you can discern exactly where and how to adjust on any given visit: If you don’t possess this certainty then please join us at a Torque Release Technique program to share what is perhaps the most consistent educational outcome – confidence in your competence. An adjusting technique that progresses in pace with the person’s response is pivotal to successfully implementing Life Rule Number 3 as a principled Chiropractor.

2) Build into each practice member’s care plan variety, change and progression – make every visit a new experience – not random unpredictable and hence stressful – but evolutionary and intelligent (like their nervous system).

3) Never stop learning new tricks: If you left college and have avoided attending any PD unless coerced to find the cheapest and quickest shortcut program to maintain your registration then shame on you. Commit your time, energy and money to developing yourself – for your patients’ sake if not for your own longevity in practice.

4) Incorporate objective functional assessments into your progress examinations – if you rely on how your practice members are feeling to determine their progress in care then you are at the mercy of anything from the weather, to the economy, even perhaps to astrology. People are going to feel good sometimes and be sick, and feel crook at times but be healthy. But the only thing that improves function is a management plan that works.

5) Cooperatively develop a micro plan and macro plan for your practice members: What do you both want to achieve from the next 6-12 adjustments. What will be the benefits to them if they follow your plan for the next 6-12 years? Conduct regular progress exams and celebrate the small and big steps.

6) If you are feeling somewhat fatigued or jaded in practice then remember Rule Number 3 one more time: “Do Something Different”!

P.S. If  you are now pondering how this can really play out in your consulting rooms then there are some tips I have learned from elite athletics training that I find apply to “Doing Something Different” in practice:

A) Don’t try to do everything in one visit: You can’t get fit in one training session, and as much as you may want to be a miracle healer, you won’t fix most people in one visit. So keep some tricks in your bag for subsequent sessions so that variety is easy to achieve – whoever made the rule that every chiropractic consultation should consist of the same experience – but in general it does? Dr Jay Holder teaches a key TRT principle of “Less Is More” – and this can be a hard but life changing principle to implement in the real world, especially when that 50 year old male walks in the room with extreme antalgia and demands for you to crack his back into alignment.

B) Have a plan for a series of sessions versus a plan for each single session. When I start coaching a new athlete, I have a fairly standard progression of drills and activities over a series of sessions that then has to fit and adapt with the athlete’s level of response and completion. Think through a progression of care that you would like to be given yourself if you were just starting out under your own program. I remember hearing of some old-timer therapists in Perth who had a three visit progression: On the first visit you had a hot-pack placed along your spine for a few minutes. On the second visit you had the hot pack, plus a tennis ball was then rolled up and down your paraspinal muscles. On the third visit you received the hot pack and the tennis ball care, and then had your spine manipulated so severely that the noises could be heard in the next suburb. And that was it – you were done! Hopefully you can come up with a more contemporary version of a more ongoing wellness based program?

C) Make each change a gradual progression from the last: In training my rule is only change one variable at a time – up the intensity or up the quantity or up the complexity, but don’t vary any combination of the above. This is a little hard to apply directly to chiropractic care but with some thought you should get what I mean? Let’s go back to the example I mentioned before of the practice member that sees your locum or another practitioner and suffers a significant setback – I guarantee that the other practitioner has either erred on point A (they did too much and tried to fix the person in one go in an attempt to prove how inferior you are and how superior they are) or this point C (the care they provided was too large a jump from what you were doing and the person’s body suffered a shock response).

I have a simplistic point of view to practice design and management: I try my very hardest to design a practice environment, policies and procedures that I would be highly impressed and compliant to pay good money for myself… Would you be happy to visit your own practice on a regular basis, and wait for however long you make people wait, and receive the care that you supply, and pay whatever fee you expect your own customers to pay? If not then it is definitely time to apply Life Rule Number 3 and “Do Something Different”…

To find out more about Torque Release Technique Training and access a big saving go to www.torquerelease.com.au/Torque-Release-Discount.htm

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