Your visit to the office
Because so much of getting well and healthy, not just out of pain, requires work on part of both the doctor and the patient, a trust and willingness to put in the effort is necessary to achieve this goal. To make that determination, the doctor always wants to have a no charge consultation first so that you can meet the doctor and talk about your health and current complaint.
Almost exclusively, patients present with a pain complaint. The consultation allows for us to determine if this is a trauma induced injury or if the pain is just part of a larger issue.
Musculo-skeletal injury treatment requires a determination of just what area is injured, the degree and extent of injury, how acute or chronic the injury is and any co-factors that affect the injury. The consultation offers much of the history that is taken on the initial visit which will be followed by an examination that includes physical exam, neurological exam and orthopedic exam there is also an SOT examination that gives information specific for treatment. Following the examination, if determined necessary, x-rays and lab tests may be done if needed. From all this information a diagnosis is made and a treatment schedule is outlined.
Acute Care Phase
This is an active inflammatory phase of injury and not so much based on time but the presence of a hot, red, swollen and painful injury site. Frequently if an injury with swelling and apparent inflammatory changes that is more than several months old may be considered to be a chronic injury. It is important to remember that NO HEALING will take place while there is active inflammation present. Therapies are done that specifically address reducing the inflammation and inflammatory process. Light gentle mobilization within the normal range of motion and the use of physical therapy modalities such as ultra sound, interferential, joint support with tape or orthopedic supports ice and of course rest the injury.
Healing Care Phase
This phase is the most important, as proper healing defines the outcome and corrected function of the injury. I tell patients all the time how you can take a broken bone in your arm or leg and simple put it on the table or recliner and do not move it for 3-4 weeks and it will heal. The bones may not be properly aligned and the arm or leg may have a bend in the healed state but it will heal. The problem then arises with correct function from the healed limb which has been compromised. This compromised function will elicit the body to compensate in some way which will eventually produce a different pain in a different area.
During this phase a more aggressive treatment protocol is employed. Mobilization to insure full range of motion is preserved with physical therapy modalities that now promote circulation and healing as well as breaking down any adhesions that may form. These modalities are things such as ultra sound, hot moist heat, massage and of course supplementing with vitamins and minerals, the building blocks for cellular rebuilding. We have found the laser to be very useful during this phase of treatment. Certain exercises can now be employed but need to be closely monitored as the injury is very vulnerable at this time.
This is the final finishing of injury healing and a return to normal. I have found the more chronic the injury the more important this final work is needed. A simple slip, fall, twist or bad lift that causes instant pain and injury if taken care of properly right from the start, will frequently heal and return to injured are to normal within 6-12 weeks. As for injuries that were not attended to properly years ago a more extended program will need to be employed. For these people months and even years may be necessary to achieve optimum health. For these longer more chronic issues, frequently the back half of the care will be largely home work and less in office treatment by the doctor.
Getting Started: What to expect
The treatment program that you will require will be determined by you and your doctor. The no charge consultation offers a good opportunity to see just how serious, or not, your situation is. It is said in diagnosis classes that 80-90% of the diagnosis is made from a complete and accurate history.
Following the history, we will do a complete physical exam, orthopedic exam and neurological exam (assuming you have more of a problem than a jammed and dislocated finger). From the information determined from these exams we then have an idea of any additional exams or tests, such as x-rays or lab tests, that may need to be done.
Once we have a working knowledge of what is going on we will begin treatment and offer the appropriate home care to help advance the treatment efficacy for the best result.
In IMPORTANT NOTE… This is a physical “medicine” and as such there are multiple visits needed to correct the problem (going out for one run does not get you in shape for a marathon race). In the world of “medicine” it is important to remember, the office visit is a treatment but then taking medication twice a day is 2 treatments a day. SO coming in 2 or 3 times a week for 2 to 4 weeks just makes sense. Once out of the acute phase which takes the 2 to 3 weeks to accomplish, we will do a re-examination of those things that were found to be a problem and if possible give more homework while we see you only once a week. This is a normal progression of the typical acute injury treatment protocol.