The endpoint of treatment is that a patient can return to full activity, doing the activities that they desire, symptom free. If we can trigger the healing system (which we can ultimately do in around 95% of people), and assuming that there are no other major sources of symptoms (which, even in our very broad and varied patient population, is very rare), then we can generally accomplish this. The endpoint of treatment for any given structure is that it becomes ‘load-bearing’, or ceases stretching abnormally under typical body loads. Therefore, the nerve fibers that had been chronically damaged heal, and cease to produce either tenderness or symptoms. Usually many structures are treated in a given patient. Some of these structures finish healing before others, so toward the end of the treatment course it is not uncommon for the treatment size to contract a bit. How do we know what to treat, and what we do not need to treat, at a given visit? We treat only tender structures. Those that have become non-tender can be left alone. We simply continue until we are finished, and this does not comply with any arbitrary ‘schedule’ or patient expectation. Healing systems produce widely varying amounts of collagen with stimulation—some large amounts leading to quick responses, others smaller amounts, leading to progress that can be ‘moderate’, ‘slow’, or ‘very slow’. If the pace of healing is not optimal, we will usually explore options to stimulate the system more strongly, and perhaps look at the healing system per se more carefully.
We track progress with several questions on the patient follow-up form, and with a follow-up pain and symptom diagram. These are extremely helpful in caring for you, for decision making that allows us to render the best care possible. We would greatly appreciate it if you would take these questions seriously and give the best answer you can. Symptoms fluctuate, we understand…but your ‘guesstimate’ answers are surprisingly helpful to us. The fundamental question at each visit is, ‘more of same’, or ‘change course in some way’.
The issue that is most disconcerting to patients during treatment courses is the occasional ‘bad’ day or week that occurs just when the patient ‘thought they were getting better’. We spend A LOT of time discussing whether or not the treatment is ‘working’ in light of these symptom variations. The issue is not that WE do not know the answer to that question…the problem is that what the patient is ‘feeling’ does not match what they ‘expect’ to feel if the treatment is ‘working’. If a person understands the concept of ‘load bearing’ and ‘non-loadbearing’ structures, and realizes that, at any point, if enough force is applied to any of these structures to ‘trip the strain gauge’ (stretch the structure to the point that damaged nerve fibers are yanked, or further damaged), then symptoms MAY WELL be as ‘bad’ as they have ever felt, even though they are very close to being completely healed. If patients ‘get this’ concept, and understand that this is normal and, frankly, expected as patients become more active as they are feeling ‘better’, then much anxiety can be avoided. A more detailed discussion of symptoms during treatment will follow in a few paragraphs.
Some people have a large array of painful and symptomatic structures. One reason that people from all over the country seek us out is that we get excellent results with ‘larger’ issues. Our treatments are more precise, and can therefore cover more geography (we do not treat structures that do NOT need to be treated, as opposed to many practitioners ‘template’ approach—where they treat the same set of structures in every back, neck, shoulder, etc.), and we have developed ways to get patients through treatments that are ‘larger volume’ treatments, so that we can cumulatively treat a multitude of structures successfully in a finite amount of time. If you have this kind of problem, the discussion about overall treatment strategy will be quite detailed and take into account physical, logistical, and financial issues.
Whether we are treating half the body, or ongoing pain in a single structure, we can give patients a general idea of the length of the process, particularly after seeing the ‘trajectory’ of healing after a few treatments. But pace of healing and magnitude of injury are unique in each patient, and this process simply requires that our patients have patience.