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Length of Treatment
One of
the most frequent asked questions is "How long will this
take?" This question is important for both psychological and
financial reasons. Because each case is so unique in its
particular circumstances, it is obvious that there will be no
specific answers for your specific problem in this discussion. But
let me explain some general guidelines that may be of some
help.
Sooner is
Better
In general, the quicker you
seek help, the quicker you will end the problem. Seemingly
little problems can result in large problems, if neglected. It
is natural to want to use a few days of rest and home remedies
before seeking professional care. Patients who are seen within
the first week of onset with mild to moderate symptoms will often
have their problems resolved within a few treatments. Often we
see patients who have waited 2 or 3 months before seeking
help. It is more typical in those cases that treatment needs
to be extended over a 3 - 6 week period.
Traumatic Sprain/Strain
Injury
Traumatic strain/sprain problems
typical of auto accident usually take longer periods of treatment
because of the degree of injury associated with the high velocity
sheer within the muscles and ligaments of the spine. In these
cases, 2 weeks of treatment is usually minimal and 4 - 8 weeks more
the average with some cases where injury was accompanied by
pre-existing degenerative problems requiring as much as 3 to 6
months. In some cases unfortunately, treatment may conclude
with some issues still unresolved.
In
the acute phase, immediately after the trauma, treatment is often
scheduled on a daily basis for a few days, until the patient can at
least be somewhat comfortable at rest. Every other day
treatment is then scheduled. As range of motion returns and
the patient is able to move somewhat comfortably, treatment is
reduced to twice per week or weekly.
It is important
for the patient to understand that in such traumatic injuries there
is a window of healing for 6 to 8 weeks where the body is in high
healing mode. Damaged tissue is replaced during this time with
collagenous scar tissue. Scar tissue is much different from
the original muscle or ligamentous tissue it replaces. Scar
tissue lacks suppleness. It is dense and resists stretch and
must be molded as it is being laid down in order to function
properly. If treatment is postponed beyond the window of high
mode healing, there may be some irreversible residuals that
will result in chronic stiffness and episodes of soreness.
When under treatment and the patient is faithful to perform certain
procedures, the scar tissue is laid down in an orderly fashion and
molded allowing for a full return of motion range that is free of
pain and stiffness. Without treatment, the scar
tissue may be laid down often in a disorganized fashion
and not molded properly. This will sometimes result in
impaired function. Therefore, it is important to get treatment
after high velocity injuries early on and stick with the
program.
Chronic Pain
Syndromes
What kind of timetable should one
expect with this type of problem? Obviously, chronic pain
syndromes like osteo-arthritis, fibromyalgia, disk degeneration,
spinal stenosis, migraine to name a few, are not going to respond
very quickly. If these
conditions are severe, there may not be any response. Our goal
with these problems is to help the patient better manage with the
problem by reducing the severity and frequency of the pain.
How long then should a patient continue with treatment?
Outcome provides the answer. We usually
recommend a patient treat for 2 to 3 weeks, twice to three
time a week as a trial period. If there is not even the
slightest improvement, treatment is discontinued as the outcome of
the trial was poor. However, if the patient can definitely
feel some real improvement occurring, then treatment is continued
until a plateau of improvement occurs. At that point, we begin
spacing out treatment by one, two, three and four weeks to see what
treatment frequency is required to keep the patient at that level of
improvement. Some patients prefer to simply monitor their
condition and make appointments on their own as they feel the
need.
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