June 2003

Getting patients used to orthotics

by Dr. Mark Charrette

Most new care programs require a period of adjustment, in which the body adapts to an improved condition. Whenever I present a care 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 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.

Custom‑made orthotics combined with chiropractic adjustments will often 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 tips to minimize patient discomfort and help you reassure them throughout care.

Let the buyer wear

It is understood that, following any purchase, the purchaser must be reassured that his/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 is key. Your confidence in your program of care will be the number‑one aid to getting them through their "buying blues."

"You brake 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 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 all right to wear them, but it is also crucial that they do so.

Smoothing the adaptation process

Break‑in time for orthotics 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 steps to help your patients through the adaptation process:

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.

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

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

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

5. Most importantly, schedule additional visits during the first two‑three 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.

Focus on improvement

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.

Fortunately for us, chiropractic care is nothing like wearing braces ‑‑ chiropractic feels great! Because we are "selling" health performance, we are faced with many of the same challenges any retailer is. 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 ‑‑ 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!

(Dr. Mark N. Charrette is a 1980 summa cum laude graduate of Palmer College of Chiropractic. Over the past 15 years he has lectured extensively on spinal and extremity adjusting throughout the U.S., Europe, the Far East, and Australia. He received a Bachelor's degree from Illinois State University (summa cum laude) in 1976, where he was an NCAA All‑American in 1974. Dr. Charrette is a featured speaker in Foot Levelers' 2003 Spring Seminar Series )