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September, 2011

Stabilize Your Practice With Structural Supports

By Jerry Porter, DC

When Marianne came in as a new patient with back pain I examined and adjusted her. She immediately felt better and I gave her instructions to get another couple of adjustments in the next few days to get her out of the acute stage. She didn't return. When my CA called her a week later Marianne reported that her low back hurt again by the time she had gotten home, and so decided that she needed an MD instead of a chiropractor!

What a way to lose a patient. I knew her adjustment had been highly effective; she left the office functioning and feeling better. So what happened? She must have done something to mess her body up herself sometime between getting adjusted and getting home. The fact is that I had given the right treatment that got the patient better. Then, she did something to make her body worse and I got the blame for it because "the adjustment didn't work."

How many patients have you lost simply because the patient didn't see the value of chiropractic care after one or two adjustments, as happened with Marianne? Unfortunately, all patients aren't created equal; "good patients" become good patients over time. Our first emphasis then should be on giving them what they want… pain relief, so that you have the extra time you need to make them into good patients. Along with your adjustment there are a few aids you can use to support your adjustment and assist with pain relief.

What Can Cause Problems After An Adjustment?

There aren't that many things patients can do to mess up their body so quickly. It's your job to understand what they are, then prevent them from happening. The problem is that it doesn't seem like these patients did anything wrong by simply driving home. But they did. They actually did two things that nearly everyone does which makes their body worse; they 'walked' out of the office, and then they 'sat' in their car.

Similar scenarios played out many times over the next several years of my practice. Trying to fix the damage after the fact seemed to me pretty much like treating the symptom but not the cause. Obviously this isn't the only reason patients drop out of care. It is however, one that happens all too often, costing us patients so unnecessarily when we could easily prevent it by paying attention to the cause.

I am going to urge you to spend a little time initially with your patients to explain a few simple things that will help them support their adjustment. If they don't do these things then there is a good possibility that they will feel worse than they otherwise could. You may not get a second chance with them.


I never made the connection that this was what was happening with my patients until one day, when a painful knee (that was putting a damper on my vacation) got me going to a chiropractor in Los Angeles. He worked me all up and down and when he was done I felt great. I was standing straight, I could breathe easier, and my knee pain was gone. I started to put on my sandals to leave when he stopped me. He took the sandals and threw them in the trash. These were $200 Italian sandals and he got my attention.

I pulled my sandals out of the trash. He showed me how much worse my body became – immediately – when I put them on. I took them back off and threw them in the trash myself! Making my way back to my hotel in the midday heat of August, as I was hopping around, dodging melted gum on Los Angeles sidewalks, I had plenty of opportunity to reflect on my newly acquired knowledge on how shoes might mess up the body and make a person feel worse. (This chiropractor I visited in Los Angeles was Jesse Jutkowitz, D.C.)

Simple Tests

Unfortunately, we were not taught all that we need to know in school to do the best job we can on this. The big idea here is for patients to be supported into a more upright position. This is consistent with being more upright after their adjustment.

Get an image in your mind of someone who is leaning forward, their breathing is shallow, and their face shows pain. If you have your patients who are in pain simply breathe in and out and let their body slump, this is what you will see if they have a structural problem.

Now get an image of someone who is upright, their breathing is easy and full, and their face is relaxed. This is how your patients look when you have improved their structure.

This simple test above and its resulting indicators of posture, breathing and pain, may be used to gauge the effectiveness of support aids and any other structural modifications you may make. You'll quickly see if they are helping improve your patients' bodies– or making them even worse. The two activities – sitting and walking – when done incorrectly, have a dramatic and immediate effect on how patients feel after their first adjustment. Their first visit therefore is the critical time to check them both, and if need be, correct them.

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