Helping Patients Adapt to Orthotics

Treatment programs often require an initial period of adjustment, during which the body adapts to an improved condition. Whenever I present a treatment plan to a new patient, I compare it to what an orthodontist might do. Most patients can relate to the changes associated with moving teeth. However, everyone realizes that a temporary discomfort leads to a healthier bite and an improved smile. If the orthodontic appliances were removed at the first instance of discomfort, patients would never achieve lasting benefits. In a similar fashion, chiropractic care makes significant structural changes, and adapting to them sometimes requires patience.

Flexible, custom-made orthotics combined with chiropractic adjustments often will improve the adaptation period, but nothing will eliminate this natural process. Because supporting the feet affects the whole body, it is not uncommon for some patients to experience mild but temporary discomfort as the knees, hips, pelvis and spine adjust to the improvements. Here are some ideas I've found useful in my practice to minimize patient discomfort and help you reassure them throughout care.

Overcoming Buyer's Blues

It is understood that, following any purchase, the purchaser must be reassured that his or her decision was wise and valuable. "Post-buyer depression" may manifest as anything from apprehension to unrealistic expectations. Be aware of this fact so you don't overreact to patients' concerns; reassurance and education are key. Your confidence in your program of care will be the number-one aid to getting them through their "buying blues."

"You break it, you buy it!" and "You scuff it, you own it!" are familiar policies for our patients. In our office, we let patients know that after a care session, if they want to return that same day to be re-examined, or even adjusted, we will do it at no charge. A follow-up is reasonable, because no matter how well we adjust, we occasionally may occasionally need a second opportunity. When it comes to custom-made orthotics, patients must understand that during the adaptation period, it is not only OK to wear them, but also crucial that they do so.

Five Helpful Steps

Orthotic break-in time varies from patient to patient. Some patients accept them immediately, while others need up to four weeks to get used to the feel of their orthotics. Instruct the latter group to perform the "golf ball" exercise. Sit on a chair and place a golf ball on the floor. Put one foot over the ball and rotate it for about five minutes with a firm, comfortable pressure. Repeat with the other foot. This exercise should be performed in the mornings and evenings until the fixations in the foot are broken up, and adaptation to the orthotic is complete. Follow these five simple steps to help your patients through the adaptation process:

Step 1. Have patients bring the shoes they will wear with their orthotics. It is important to see the kinds of footwear they have. You can quickly spot properly fitting versus worn-out shoes.

Step 2. Instruct patients about (and demonstrate) the proper orthotic/shoe combination. They should understand orthotics are designed specifically to work only in certain shoes for maximum support and performance.

Step 3. Physically remove factory inserts from the shoes, so the patient knows the orthotic is designed to sit on a flat surface.

Step 4. Many patients can tolerate full-time use of their orthotics immediately. However, most patients should limit their use to 1-2 hours the first day, and then add an additional hour each day.

Step 5. Most importantly, schedule additional visits during the first 2-3 weeks while you help your patients adapt to their orthotics. Chiropractic adjustments improve the transition and help muscles, ligaments and joints adjust to more healthy positions. Nothing will help more than having you and your staff offer reassurance that improved health, performance and quality of life are just a few steps away.

Functional Improvement Over Pain

When your patients are focused on pain during any portion of your care, redirect their attention to functional improvement. Muscle testing is an effective way to get immediate, objective feedback from your patients. It is based on the fact that joints, ligaments and tendons have mechanoreceptors, which are constantly modulating neuromuscular tonus and reactivity. This allows the practitioner to supply a stimulus and measure the body's response. Using general muscle tests will allow you to go beyond pain and reassure yourself and your patient that performance is improving.

Here are a few examples. Before performing a lumbar adjustment, muscle test the psoas muscle bilaterally for relative strength and the ability to "lock in" resistance to the examiner's pressure. Make your adjustment and immediately retest the muscle. When joints are misaligned or ligaments are stretched, mechanoreceptors fire and inhibit muscle activity. Adjustments restore joints and supporting soft tissues, and reset mechanoreceptors. Your patients will feel the difference, even though they may still have low back pain! Similar procedures can demonstrate improved proprioception and coordination using orthotics versus going without.

Because we are "selling" health performance, we are faced with many of the same challenges any retailer faces. Understanding patients' needs for reassurance about their health care purchases should influence every interaction with our patients. This is especially important for our new patients, or for established patients changing some aspect of their care, such as converting from acute care to maintenance care, beginning a nutrition program, or starting custom orthotic therapy. Your ability to demonstrate improvement will overcome the natural resistance to change, even when it's for the better!

Mark N. Charrette, DC
Las Vegas, Nevada