The Day Chiropractic Adjustments Stopped Working

working.jpg“I don’t think you got it doc,” the patient said rolling his right shoulder.

“Your atlas moved really well, maybe better than previous visits,” replied the chiropractor.

“Yeah, but something still doesn’t feel right.”

“I understand. Let’s see how you go after an hour or so, and if you still think there’s work to be done, give Barbara a call and we’ll get you back in and give it another look, okay?

It happens. But what made this particular incident so unusual is that on that crisp January morning, thousands of similar conversations were being repeated in chiropractic practices around the world. It was the day chiropractic adjustments stopped working!

Preposterous? It all depends upon how you define the word “working.” It’s an essential distinction. Your definition will either give you extraordinary levels of confidence and certainty, or curse you with doubt and frustration, burdened by constantly having to wonder about each patient’s commitment to your recommendations.

In other words, what is the purpose of your adjustments? What is the intent of your adjustments? What is the expectation of your adjustments?

Amazingly, the answers to these questions vary depending upon whom you ask. And it is a root cause of why so many chiropractors, especially those in underperforming practices, are struggling as insurance deductibles rise, reimbursement declines, and patients seem to have less financial margin to finance their unplanned back pain.

In the hopes of stimulating a potentially vigorous conversation, here is my take on these three key terms, providing an underpinning to the meaning of the word “work:”

Purpose: The purpose of the chiropractic adjustment is to add a specific energy, at opportune times and places along the spine, to help restore motion to hypomobile joints and reestablish neurological integrity between the brain and body, in the hopes of reviving each patient’s inborn ability to self heal.

Intent: The intent of the chiropractic adjustment is to add a constructive force to the body in such a way that the body can use it to help “right itself.”

Expectation: The expectation of the chiropractic adjustment is… the problem. This is where the convergence between the differing expectations of the chiropractor, the patient and the insurance company create so much tension. Each party has a different expectation!

The Patient's Expectations

The patient expects your “prescription” of three-visits-a-week to “fix” their pinched nerve, whether it’s a headache, neck pain or back pain. They expect your “dosage” of adjustments will treat their symptoms and reduce the discomfort that prompted them to begin care. Oh, and they expect their insurance will cover all the care they’ll need. And make it snappy.

The Insurance Carrier's Expectations

Since insurance companies aren’t interested in the health and well being of their policyholders, and frankly see you as a reducible expense, their expectation is objective proof that your intervention is producing functional improvements. (By the way, if the shoe were on the other foot, you’d want that assurance too.)

The Chiropractor's Expectations

This is the messy part. While based on your experience you might have the expectation that your adjustments will produce symptomatic improvement (the practice of medicine), you have little or no control over if or when such improvement will manifest. Patients are free to sabotage the potential results by what they do (or don’t do), what they think, and even what they eat. The physical, chemical or emotional stressor may still be present in their lives. They may run out of patience before their body can invoke a healing response. The list is endless, all pointing to the conclusion that your expectations should be modest at best.

However, in light of this intricate dance of differing expectations, there is one expectation you would want to control. And that is to manage everyone else’s expectations! You could start by explaining this ménage à trois at the beginning of your relationship, perhaps at your pre-care consultation or report of findings.

No, chiropractic adjustments are still working. They may take longer to “work” today than they did a generation or two ago. But it all depends upon how you define the word “work.” Seems like you’d at least want patients to embrace the same meaning you do.

(Originally posted January 27, 2013)