Originally I was going to write one blog a week, but after the great response to Friday's blog post, I couldn't wait to write again! Following is a response to a question asked on last week's post.

Q:  When should a patient decide they need more help (i.e. physical therapy, other) when they are seeing a chiropractor. What is a reasonable expecation?

A:  I think this is a common question that many patients have, and are maybe afraid to ask. Don't be! If you are seeing a chiropractor, and you don't feel you are improving, tell him or her! Most chiropractors have a preferred treatment, but also a back-up, or two, or three, method of adjusting. 

Different people respond better to different methods. Also, your chiropractor SHOULD BE teaching you what to do on your own at home, in order to "hold" your adjustment longer and get out of pain. Most of the time, this will come in the form of therapeutic exercise prescription. If you are uncomfortable with your progress, or are seeing a doctor that refuses to change your treatment, please find someone who will work with you and that you DO feel comfortable talking to.

  In my opinion, if you are spending less than 5 minutes per visit with the doctor, and have had no adjunctive therapies performed or prescribed you, find a new doctor.

It is difficult to put an exact time frame or to say that a treatment plan is reasonable or unreasonable. As I have said quite a few times in last week's post and comments, everyone responds differently to adjustments and adjunctive therapies. It is for that reason that I don't write extended treatment plans. It is my philosophy that each patient should be evaluated for improvement at each visit, and the next couple of treatments scheduled accordingly. I like to go by percent of improvement, subjectively (through the patient's eyes). 

For example, let's say "Jane" was in Friday for her initial exam, consultation and adjustment. We go through the treatment, schedule her for an appointment today (Monday). I tell her what to do over the weekend as far as taking care of her injury, and that she can call me at anytime if she has any questions/concerns or problems. 

The weekend passes and Jane comes in the office today for her appointment. I may ask her "Have we seen some improvement?" Now, in asking her that question I am not just talking about pain. I am also talking about function. If she can bend over farther with decreased pain, or sit longer without getting uncomfortable, then we have an improvement.

If someone is not in that much pain to begin with, but can now stand, walk or run longer without their pain increasing, that's improvement. So Jane say says "yes, I feel much better." I will ask her what percent better. She may respond with "my pain has decreased by at least 50%", or, "I have pain less 75% less frequently than I did last Friday".

She has improved. It is at this point that I decrease her adjustment frequency. We just saw her three days ago, so I will adjust her today and set her next appointment up for 5 or 6 days from now. 

If she says, "oh, it's only about 25% better," then I know we need to see her probably two more times this week, for a total of three times a week. On each visit, I ask her this percentage question. This way, the patient is working with me on the treatment plan and are much more involved than me telling them how they do or should feel.

I will say that I don't like to just stop seeing a patient. Know this...when you are out of pain (which may take one visit, or may take 5, or may take 10 visits), that doesn't mean the problem has gone away. Your chiropractor should evaluate you for function and you should always be working together toward the goal of preventing another injury.

Finally, the best advice I can give you is to use your own judgment. If you are currently seeing a chiropractor and don't feel you are seeing any improvement, tell the doctor. There may be something more serious going on, where you would need to be referred to another medical professional. 

Ask if there is something else you can be doing to help yourself recover from your injury or decrease your pain. Is it unreasonable to get adjusted for a particular problem for 6-8 weeks? No.

Is it unreasonable to be on a treatment plan that involves 3x/week visits for 12 weeks. In my opinion, yes. 

And you don't have to be seeing only one professional for your injury. There is nothing wrong with seeing a physical therapist in conjuncton with a chiropractor. Be careful here though, find a physical therapist and chiropractor who are willing to work with each other (and not downgrade the other's profession) in order to give you, the patient, the best possible outcome with your treatment. 

I hope I have answered your question. It is kind of a tricky subject, as there is just no "cookie cutter" answer to how long or how often someone should receive chiropractic care.