Smart Pain Relief | Functional Triage
Pain Relief and Why Healthcare Has Been Failing
It is not hard to poke holes in our nations healthcare. Instead of magnifying the issues with coverage and costs, we should be focusing on how we address pain relief. Over the years, the healthcare industry has been far too reliant on drugs and surgery which has resulted in an opioid epidemic and overuse of unnecessary procedures. Standard conservative measures, such as chiropractic, are effective for pain relief but the results are not always long lasting due to failure to treat the body as a system. Everybody in the healthcare game (MD, DC, DO, DPT...) has been guilty of being entirely too focused on short term pain relief instead of long term solutions. We are starting to see a renaissance of chiropractors, PT's, and the like who are starting to evaluate and treat the body in a different fashion. The concept of a "Functional Triage" approach involves collecting data and information via communication and assessment and then establishing a treatment plan and approach based on what the patient gives you, rather than what you've always done or what your bank account needs.
The Functional Triage Approach
At Elite Chiropractic and Performance, we use the functional triage as the foundation of our evaluation process. We call it a triage because it allows us the ability to funnel the patient into different assessments and categories based on their exam findings.
To better highlight the functional approach, let's outline a patient scenario. Mrs. Jones, who is a middle aged female that enjoys playing golf and doing CrossFit, walks into our clinic complaining of shoulder pain. Right away, a subjective history and conversation is initiated to learn the patient's previous injury history, family history, social history, etc. We can sometimes speculate what is going on just by having a conversation with the patient. Mrs. Jones states that she has pain when lifting overhead and also when she does push-ups. Occasionally, she has pain doing menial tasks such as grabbing her purse. Once any potential red flags are ruled out and the need for an immediate referral is not needed, the evaluation starts.
During the evaluation process, other systems may be examined, such as the heart and lungs, but Mrs. Jones has nothing indicating a need to do so. The functional approach combines several different examination types into one streamlined process. Each test and assessment is done in order to collect bits and pieces of the patient's overall status and function. Depending on the findings, the exam can funnel into different focuses. Essentially, we take what the patient gives us in order to deduce not only the diagnosis, but all of the contributing factors as well. For example, we assess Mrs. Jones' overall shoulder mobility in the standing position. We want to know how far she can raise her arms overhead and whether or not she "cheats" to do so. Very commonly, humans can get the job done but we may do so using the wrong strategies. Called dysfunctions, these faulty strategies can eventually lead to problems. In Mrs. Jones' case, she has to over extend her mid to low back in order to get her arms fully overhead. Without the over extending, her overhead range of motion decreases significantly. It is my belief that she should avoid overhead lifting until she improves her mechanics because she is sacrificing her shoulder joint and low back in order to get her arms overhead. Adding weights and barbells to the scenario further complicates things.
After a general movement assessment, we can start to evaluate with more detail. For the shoulder, we pay special attention to the neck (cervical spine), upper back (thoracic spine), shoulder blade (scapula), and the shoulder joint itself (glenohumeral joint). By the end of the evaluation, we want an accurate diagnosis of why Mrs. Jones has shoulder pain but most importantly, what involvement does the surrounding joints and muscles have on the shoulder.
He who treats the sign of pain is lost.
Karel Lewit, MD
pioneer of modern diagnostics and manual therapy
Functional Triage in Chesterfield
At Elite Chiropractic and Performance, we utilize several well known and effective techniques during our evaluation process. Things like Dynamic Neuromuscular Stabilization (DNS), Selective Functional Movement Assessment (SFMA) and Mechanical Diagnosis and Therapy (McKenzie Method) are gold standards in the industry for comprehensive assessments as well as treatment.
In a nutshell, a functional triage is meant to figure out the "Why" to the "What". The "What" is the patient's shoulder pain, the "Why" is all of the details that are gathered during the process. In addition, the process allows the clinician to figure out the right tools for the job.
Every treatment and rehab approach must be specifically tailored to the individual patient. What may work for one patient may not work for another. We like to say that if you aren't assessing, then you're guessing! Below is a diagram that simplifies the functional approach.
The Future of Pain Relief
We are seeing an evolution with how we assess and treat pain and function. Many chiropractors, physical therapists, and physicians are realizing that what they have been doing has not been good enough. Adjusting your low back repeatedly is a great way to reduce pain for the short term. However, we should incorporate stability and rehab not just for the low back, but above and below the chain as well. Physical therapists that mostly use corrective exercise are also selling you short. If you have major joint restriction and muscular tightness then you won't be able to perform many movements correctly. Muscle relaxers and other pain relievers have their place, but medical doctors are realizing that they are only addressing symptoms and not the cause. Not to mention that many prescriptions for pain are highly addictive.
It is time that the public demands more from their healthcare. The functional triage approach has the potential to impact the quality and efficiency of musculoskeletal based care. In addition, it requires that the provider is well versed in other techniques instead of being a one or two trick pony. With this mindset, we can not only help people feel better, but function and perform better as well.
Chesterfield's Pain Relief and Human Performance
Do you have chronic pain or recurring injuries and you're located in Chesterfield or its surrounding communities? Do you know someone that can't seem to find the right fix? Now is the time to take control of how you feel and function. Elite Chiropractic and Performance is a clinic for all things related to pain relief, fitness, and performance. We believe that it is a fundamental human privilege to be able to do the things that we love habitually and to function pain free.
Originally posted 04/12/2018