Question
Dr. G,
Concerning the three times per week - getting the same thing done:  I get an adjustment, either before or after the E-stim and massage.  When I come in, I'm asked where am I having the greatest pain which is either my lower back or between my shoulder blades.  I say where and that's where they place the E-stim and where I get a massage.  And that happens each time.  I assume that it is not enough because when I leave, my muscles get stiff and I have trouble sleeping.
Thank you for you thorough explanations.

Cheryl
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Followup To

Question -
I was recently in a car accident-rear-ended.  I initially went to a medical center, but all they did was prescribe pills after taking x-rays.  They didn't even go over my x-rays with me!  I decided to go to a chiropractor.  The first visit there I filled out the paperwork and spoke with the doctor.  He gave me an adjustment and then I got treated with a machine (I don't know what it is called) but things are placed on your back and make your muscles "jerk".  Afterwards, another person massaged my back.  I go three times a week and get the same three things done in about 20 minutes.  To me, that seems like such a short time to really work on my stiffness.  I'm a bit wary because I don't want to feel as I did at the medical center; "treatment" that is just masking the pain.  Please help me to understand, are visits supposed to be that short?  Like shuffling many people in and then back out again?

Cheryl

Answer -
Cheryl,

Let me preface this response by stating that a chiropractic "adjustment" can consist of anything from light-contact to your bones, wedges placed under your pelvis, percussive devices (e.g. an Activator Tool), parts of the table that pop up and drop down (with a loud clunk!), and, usually, hands-on manipulation applied to specific joints.  An "adjustment" to an entire spine is a process that can take as little as seconds (e.g. Activator), to as long as a few minutes.  Most DC's that use mainstream, hands-on joint manipulation, and do it to at least three spine regions, such as neck, middle back, and lower back, can perform it on a patient in about 3 to 5 minutes.  That's all it takes, really.  Some of my colleagues see 12-15 patients in an hour, only performing a fast set of "adjustments" to the spine, and not doing much else.  This works for some patients.  For many other DC's, 4-6 patients in an hour is more typical.  I am hard pressed to see more than four in an hour, but I am also doing much of the muscle/soft-tissue work and exercise training myself, by hand.  Applying electric stimulation to your muscles remains a main-stay for many DC's and PT's, since it does not require a doctor to apply.  Sadly, though, this unattended modality has little benefit beyond very temporary pain relief, and it often not indicated for patients that are beyond the acute stage of an injury.  If your 20 minutes of time includes the E-Stim, then you are not getting much of a massage.  E-stim (often applied with the patient laying on the belly, and with a hot pack or cold pack put on top) should be applied for at least 15 minutes.  There are some specialized soft tissue methods that are very focussed, targeting muscles, tendons, or ligaments within a single joint region, and which only require a few minutes to perform.  Massage, however, should last at least 7 minutes per region when it is combined with other modalities.  This is what the official coding book states.  Massage therapy, if it being billed to an insurance company, should be performed by a licensed provider, such as a licensed massage therapist, a physical therapist, or a doctor.  Specialized, targeted soft tissue therapy, such as Active Release Technique, Graston Technique, or NIMMO, should be applied by the doctor or a certified PT.  All doctors are running a business, and, sadly, the costs of running a healthcare business are great while the reimbursements are often less than satisfactory.  Doctors either have to find ways to see more people per hour, perform more procedures per hour, find ways to cut staff and overhead, or all of the above.   If I knew more of what was being done with you, I could comment on it more.  As for 3x/week getting the same thing done every time, that's another story. After about six visits or two weeks, the doctor should review your condition and determine if you're getting better or not.  Exercises and active forms of care should replace passive (e-stim, ice, heat) care.  Re-examination should occur periodically, more frequently in the beginning, and less frequently in the end.  If you're not getting better week to week, you have every right to speak up and get logical answers as to why.  Whiplash trauma can be complicated, and it can take many months to fully recover. Some people never get 100%.  Regardless of the statistics on recovery, if you feel that your progress is too slow, then speak up.  Maybe there are other providers that can help speed things along, such as PT's, physiatrists, or acupuncture providers.   

I hope this helps.

Dr. G

Answer
https://www.yeomanschiropracticeducation.com/PDF%20files/07ApplyingOM.pdf

Please go to the link (above) and provide this information to your chiropractor.  The bottom line is this: if you are making progress and you are happy with the care, then continue.  If you are not making progress and/or are not happy with the care, make a change.  Outcome assessment tools, as described and provided in the .pdf article highlighted above, allow a practitioner and patient to know if progress is being made.  These tools (questionnaires)generate numerical scores that can be tracked over the course of care.  For a whiplash case where there is tissue damage and a lot of pain, if a patient's score is 70 points at the beginning of care and only 40 points at the 4 week mark, it's hard to argue that there's no progress.  It keeps everyone honest.  Lastly, regarding the care you're receiving, it sounds like reasonable care for the first week or two, but after that point a more clinically appropriate program would include exercise training and not electric stimulation.    

'Good luck,

Dr. G