By D. Gordon Hasick, D.C.
Vol. 5, No. 1, March 1991
Patient education and communication is a wonderful challenge and is essential for excellent care. The word “education” comes from a Latin word meaning to “draw out of”. The word doctor refers to a teacher. One of the responsibilities of a doctor is to teach, educate, or in other words, draw out of the patient their inherent abilities to be well.
We are not born with the information to properly care for ourselves and exemplify a well-balanced lifestyle. We must learn how to live a balanced life in all areas. How does one obtain this information other than from the experiences of distinction; finding out what does not work, and seeking to find what does. Patients consult our offices for various reasons, but mostly for assistance and education.
The role of the doctor is not to tell patients what to do all the time but most importantly, to remind the patients of their responsibilities in caring for themselves. Then the doctor should provide the tools or information to accomplish this task. It is important that the patient and the doctor clearly understand their respective roles and their responsibilities.
The doctor teaches, and in a National Upper Cervical Chiropractic Association (NUCCA) practice, corrects the subluxation. The patient’s role in his care is equally important for the success of the treatment. No longer can a doctor be perceived as a mechanic to fix the body when the patient chronically abuses his health. Healing comes from the patient and not from the doctor.
The nature of this article is to provide some information relative to patient management in a NUCCA practice. The primary purpose of the NUCCA practice is to correct the Atlas Subluxation Complex Syndrome (ASC Syndrome), and monitor the changes as the patient improves in bio mechanical and neurological symmetry and balance.
The correction of the subluxation is the essence of the chiropractic practice. The patients contacting your office are doing so for various reasons and to obtain information and care on how to improve their current state of health and wellness. Patients cannot be managed and told what to do; however they can be educated, encouraged and supported in their pursuit of health and wellness.
The objective of a doctor is to provide technical excellence in spinal care along with education, encouragement and support as the patient moves from a state of illness to wellness. This includes referring the patient to another health care provider for services and care that may help solve the complex puzzles of health and wellness.
Pain is a common part of our life experience. Understanding what is causing the pain is an essential challenge for the NUCCA doctor of chiropractic. The cause of the patient’s condition may be linked with the ASC Syndrome. Health and wellness is not the result of only one factor but the accumulation of many factors involved in the patient’s life experience. Lifestyle in combination with the subluxation complex will combine and cause distress on the body. The result is the patient’s present state of health and wellness. The lifestyle and history of experiences of the patient help in the creation and the correction of their condition.
The doctor should take a proper case history on the first visit. The necessity of a proper case history is to more fully understand the nature of the patient and the condition he presents. From a medical perspective it is important to understand the nature of the signs and symptoms, the date in which the condition was established, long term effects, the exacerbations and remissions of the symptoms, the location, the nature of the pain, and pertinent information relative to whether or not the condition presented by the patient is that of a life-threatening condition.
The proper taking of a history is a most challenging opportunity. To relate, from a chiropractic perspective, the importance of the history relative to the patient symptoms and past trauma, the doctor must know the extent of the injury and how and when the subluxation complex was produced. The length of time since the onset is an important factor in the recovery time.
Often patients do not consider the seemingly minor incidents and accidents throughout their lifetime important enough to produce any injury. There may not have been an apparent injury to the patient at the time of the accident. Consequently, the majority of the injuries incurred at that time may not become symptomatic for up to two or three years following the injury and at times, seven to ten years following an initial trauma.
The NUCCA organization has set out to establish and research the vertebral subluxation complex and its specific correction. Through its years of research, NUCCA has established a system in which the patient may be assessed and treated most effectively for a condition that has very far reaching neurological effects. This condition is the ASC Syndrome. The ASC Syndrome is seen in patients with a subluxated C1 vertebrae, leading to an over innervation of the motor neurons of the spinal cord and is well researched and documented by NUCCA. This leads to a neuro-muscular imbalance with postural asymmetry leading to leg length disparity. This biomechanical asymmetry is a major stressor to the human body and is a positive factor in creating a variety of conditions, signs and symptoms.
It is a primary goal of a NUCCA practitioner to examine, assess and correct the ASC Syndrome. It is then important to monitor the changes the body will go through in the ensuing months as restoration of the human frame to a normal biomechanical symmetry and position is reestablished.
The long term health maintenance of a patient’s spine is a priority. It is important to educate the patient on the importance of how seemingly minor trauma, and the implications they may have in the production of the subluxation complex, ultimately affect the neurological balance of the human body. A very small percentage of the nerves in the human body are responsible for carrying pain messages, therefore, a subluxation complex can exist creating neurological distress and no pain or symptoms may be experienced at that time. It is not until further structural and neurological changes occur that the patient experiences symptoms relative to the initial trauma. Educating the patients on this and further preventative steps is a primary responsibility of the doctor.
Once the history is taken and a correlation with the history of trauma (which can relate back to birth) has been established, the patient may have a clearer understanding as to the types of trauma that will injure and re-injure the spine. The patient should be educated regarding the intricacy of the human spinal column and its relationship to the nervous system and all other systems of the body. If patients do not recall episodes of trauma or injury, they may check with relatives, parents, etc., if they should desire to fully understand the nature of their injury.
The causative factor relating to the symptoms may be a moot point, as the original traumatic injury cannot be changed. It is only out of interest that the patient may wish to know and, if possible, the correlation should be made. However, the state of the spine must be assessed as it presently exists and is presented to the office. The spinal examination on the initial visit should include assessment of postural symmetry, pelvic distortion and leg length disparity. These are the physical manifestations of the ASC Syndrome. If it is concluded that the patient presents with the findings of an ASC Syndrome then the pre x-ray examination is performed to determine the specific nature of the subluxation complex. Once the pre x-ray examination is completed and the patient’s subluxation complex is properly assessed, the patient can then be adjusted.
Prior to the initial correction, the patient’s review of findings should be aimed at having him understand, in simple terms, the mechanics of the subluxation and how it produces the tractionization of the nerves. This should be demonstrated by showing the patient his pre x-rays and using a spinal model to reproduce all the structures requiring correction. A correlation should be made relating the subluxation to the vertical axis and the correction that needs to take place. The relationship of the subluxation to the physical findings, including leg length disparity, pelvic distortion and postural asymmetry is then correlated. This establishes a purpose for the adjustment in the patient’s mind.
Management of the different types is exceedingly important in that a normal pattern Type 1, 2, or 3 may respond and stabilize in a relatively short period of time whereas a Type 4, an abnormal pattern, may require additional time to establish stability and balance as it returns to the vertical axis.
The initial adjustment is provided. Following the initial adjustment, the post x-ray assessment will provide information relative to the extent of the correction. This is valuable in that the progress of the patient and the response to the treatment is directly related to the correction provided in the subluxation complex. In general terms, the better the correction, the better the response.
The complexities of the nervous system provide a variety of responses to an adjustment and every patient responds in a different manner. It has been shown through study, post-surgically, that patients respond to a treatment in a cyclic fashion in a twenty-eight day period, thus the establishment of the 28 day healing cycle (see Figure 1). The patients, following initial treatment, respond and may experience more changes symptomatically on the third, seventh, fourteenth, twenty-first and twenty-eighth days.
It is important that patients understand that symptoms indicate a change is going on, and provided the post x-rays assessment reveals an accurate and proper biomechanical correction, the symptoms that the patient would experience would be of a positive nature as the body recovers and heals. As with all conditions and problems in the human body, there is a time factor involved in the healing process. Healing is not an immediate response and the adjustment is not designed to alleviate the symptoms immediately.
The adjustment is designed to restore the spine to its normal biomechanical balance and bring all the structures back to the vertical axis. Since that is the primary goal and purpose of the adjustment, the patient’s symptomatic response should be monitored but not considered singularly in the decision to adjust or not adjust the patient.
As patients respond in the initial twenty-eight day period, a variety of signs and symptoms may present themselves. However, the objective findings, such as leg check and Anatometer or pelvic measurements, provide an objective assessment of the patient’s response. Many times patients will respond and present with a variety of symptoms; however, no adjustment may be necessary. This may continue for three to four weeks before the patient responds in a symptomatic way that is seen and felt as positive. This provides the NUCCA practitioner an easy task; to monitor the progress of his patients by staying with the objective findings and not placing a great emphasis on the subjective findings, such as symptomatic changes. Symptoms are not ignored but not emphasized in the care.
Some of the factors that determine the response to the adjustment are the length of time a patient’s condition has existed, the age of the patient, the severity of the subluxation complex and the extent of nerve damage. It is through extensive clinical experience in handling a variety of cases that the doctor will be better able to provide a more accurate prognosis for the patient’s condition.
The effects of the adjustment on the nervous system are rather profound and include an effect on the sensory as well as the motor control of the nervous system. This is exhibited by change in the postural muscle of the spinal column and the change in the leg length disparity.
There is often a change in the sensory activity of the nervous system following an adjustment and this is demonstrated by an increased activity of the sensory system. This can be seen by an increase in symptoms and signs in various parts of the body. Old injuries may become symptomatic again and present symptoms may become more accentuated.
Once again to properly assess and evaluate the patient’s progress and manage the case properly, it is important to rely on the objective findings such as post x-ray, leg check, postural distortion and thermographic findings. This enables the doctor to assess whether the patient does or does not require an adjustment. It is just as important to know when not to make the adjustment as to know when to make the adjustment!
D.D. Palmer and other technique developers established the same protocol in case management. The subluxation is to be determined and once determined and found, corrected and left alone. It is leaving the subluxation and the body alone and not interfering with the healing process that provides the best long-term effects. It is not uncommon for patients under NUCCA care to experience tremendous changes in the first twenty-eight days and maintain or hold their first correction for a period of months.
The symptomatic results depend on the correction to normal of the misalignments and detractionization of the nerves. Stability is required for a time period long enough for nerves to be restored to normal diameter, necessary to their conduction of normal impulses.
Maintaining or holding a correction means that the normal balance is maintained in a state of equilibrium. This enables the healing process to take place and allows for correction of the nerve imbalance. It is important to always maintain a state of balance to ensure optimal function and expression. It cannot be considered a failure if it takes some time for a patient to hold an adjustment for extended periods of time.
As we further research the subluxation complex, we will (perhaps) understand what we can do to provide more long term benefits for all our patients. The tendency is that once an ASC Syndrome has been corrected and has been left alone to recover on its own, the long term effects provided for the patient have proven to be most beneficial. There are inherent recuperative abilities in the human body controlled through the nervous system that must be respected and worked with.
There is current research in a relatively new area of human physiology known as psycho-neuro immunology. This is the area that studies the link between the brain, the thought process, the nervous system and the immune system and the effects that these have on our body’s ability to resist, to fight and to heal ourselves. These studies have shown the link between these systems is much more complex and intricate than once believed. This research is now confirming many of the thoughts and beliefs that chiropractic has spoken of for many years. The human nervous system requires a great deal of respect, not only in its treatment but in its preventative steps.
The primary challenge of the NUCCA chiropractor is the assessment, correction and management of the ASC Syndrome. It is a system of health care that deals in an exceedingly scientific and specific manner with health and wellness and is able to provide management from an extremely objective point of view. The case management of all patients can become very straightforward and will provide many patients relief from conditions for which they previously have been unable to obtain help.
Following the healing cycle, after the initial adjustment, the patient should be examined on the third, seventh, fourteenth, twenty-first, and twenty-eighth days to ensure that the patient is maintaining or holding his spinal correction. During that time the patient may experience a variety of symptoms, however, the objective tests will provide the information as to whether an adjustment is necessary or not.
Following the initial twenty-eight day period, the patient’s spinal condition will continue to change and remodel over a number of months. The number of months depends on the extent of injury, the type of biomechanical problem the patient presented, and the patient’s participation and adherence to the recommendations. It is a recommended procedure, in my clinic, to assess these patients on a six to eight week interval for ten to twelve months, following the initial twenty-eight day period.
Our quality of health and wellness can be improved dramatically by taking some very simple steps in the preventative and restorative care of the human body. It should be the desire of all doctors to provide direction for the patient’s wellbeing. NUCCA is a health care system which consistently provides quality health care through the correction of the ASC Syndrome and also follow-up care ensuring an optimal state of wellness. As a NUCCA doctor you can provide the care and the direction to assist and support the patient in his pursuit of wellness. “Salus Aergroti Suprema Lex” – “The welfare of the sick is the supreme law.”