Schedules of care for children

by Dr. Ogi Ressel

I just returned from lecturing in San Francisco and many doctors in the audience were very concerned about schedules of care for children in light of the Masters Circle class action lawsuit.

Let’s see if we can shed some light on the issue of corrective and wellness care for kids:

First of all, I’d like to emphatically state that children do need chiropractic care -- it is not a luxury; it is a necessity.

Let’s look at this from a clinical perspective.

In the child, neuromuscular and functional adaptive reflex development represents a critical period of time when the young developing nervous system assimilates, differentiates, and adapts to external and internal stimuli.  By means of these processes, the nervous system learns proprioceptive patterns and acquires future neural habits and reactions by responding to repetitive stimuli. 

However, such a developing nervous system is not always able to distinguish between proper and improper stimuli; therefore it responds to both.  This is the conundrum. The response is neither “good” nor “bad,” but rather adaptive to the presented stimulus.  These adaptive responses are remembered and patterned, habits are formed, and the young nervous system is conditioned for future response. This is the key!

This process of neurological “learning” or “programming” of the central nervous system with respect to locomotion, posture, proprioception, function, and body kinetics begins within a few months after birth.

Health issues such as scoliosis, colitis, colic, “growing pains,” bowel and bladder problems, asthma, infertility, etc. (just to name a few) are clear examples of such faulty neural programming in children. Many, if not most of the problems seen in children are the result of an adaptive neurologic response to some sort of a stimulus.

For example, scoliosis is often the result of an error in pelvic function. Infertility caused by decreased peristalsis of the Fallopian tubes, is another, etc.

Let’s look at this more closely for a moment: If you consider the pelvis for instance, you’ll see that the main function of the pelvic musculature is not to generate motion but rather to stabilize the pelvic mechanism for effective load transduction, the process of transfer of both elastic and gravitational forces between pelvic components in kinetic motion.

Thus, sacroiliac articulations can be assumed to be large mechanoreceptors located in the centre of considerable force streams being transferred by the pelvis from the upper body to the lower limbs. Further, these articulations are essentially ground into shape according to impulsive loading and learned kinetics and their ligamentous apparatus shows adaptations to strong long-time stresses.

Looking at this learning process from an adaptive perspective, it is not difficult to understand why a child would develop scoliosis, or “growing pains,” or colitis, or any number of other health issues.

As chiropractors, our main course should be concerned with chronic “low-grade” efferents from the autonomic nervous system that result from -- and thereby not only disturb -- normal neurological “learning” but also initiate “learned” and adaptive reflex kinesiopathophysiology. It is then of paramount importance to eliminate any faulty programming as soon as possible.

Your mission -- the reason you became a chiropractor -- is to initiate specific corrective procedures designed to correct vertebral subluxations, alter and change errors in learned and adaptive kinesiopathophysiological patterns, restore normal articular function, reduce disc stress, and optimize neurologic integrity.

In light of the above, do you think it is reasonable to expect that the above can be accomplished in just a short few office visits?

The Masters Circle lawsuit, it seems, was borne out of thinking that there is no need for corrective and wellness care for children -- that it is a misnomer designed specifically for the sole purpose of extracting money from unsuspecting parents. That such care, if rendered, would represent “unnecessary chiropractic treatment” (whatever that means).

Nothing could be further from the truth.

And here lies the crux of the matter: Medicine looks at what we do as some sort of a “treatment” or “therapy.” Physicians are unable to understand the reality of a wellness approach. From their perspective, their thinking makes perfect sense. Why would you continue to see a therapist for life? The basic tenet of therapy, after all, is that it has a beginning and an end; so does medical care. It has a start and at some point in time, it's over.

Not so with Chiropractic. There is no “end” -- a difficult concept for medically oriented people to grasp.

Let’s examine the concepts which Medicine uses as a political sword in order to attempt to invalidate chiropractic in the public eye. I would also like to add that these same concepts are often used by regulatory boards. Chiropractors who are thus singled out are often faced with the gargantuan task of explaining their rationale for care, with little research to reinforce their reason -- until now:

A.  Unnecessary care and Over-Treatment

The doctrine that patients can be “over-treated” and its subsequent implications, has been a political sword for many regulatory groups and associations within and outside the profession.

I feel there is no such commodity as chiropractic “over-treatment” and here are my reasons for departure from this commonly held view:

1. The words “unnecessary” and “over-treatment” have been borrowed from Medicine and other allied health care professions whose paradigm is the treatment of varied conditions and diseases of the human body. Because the basic tenet underlying this concept is vastly different from chiropractic, I feel it should have no place in chiropractic lexicon. In other words, one cannot compare and scrutinize chiropractic care with a medical microscope.

2. “Over-treatment” implies that chiropractic is based on “treating” some condition. This is totally incongruent with chiropractic philosophy of subluxation correction.

3. Chiropractic care is not predicated on a framework of allopathic thought. Ergo, concepts and ideology which are upheld by other health care delivery professions should not necessarily apply and dilute the chiropractic principle.

4. There is no rational manner with which one could impose the concept that a patient has been “over-treated.” To assign a numerical figure would be blindly self-limiting. If normal and accepted care of a certain patient necessitates, for example, 50 adjustments, and the patient receives 51, that would constitute “over-treatment” by definition. If however, a patient receives 49, that would necessarily mean that she/he was not cared for adequately by that same definition. Absurd.

5. The other discrepancy is that within the profession, different groups, associations, etc., have varied definitions of what they consider “over-treatment” to be. I contend that if there is such an entity as “over-treatment,” then that definition should be uniform throughout the profession. That regulatory bodies of Georgia, Nevada, Ontario, Florida, Alberta and such, should have the same understanding. That is not the case. This reality can lead to dangerous conclusions. A doctor could be accused of “over-treatment” in Florida, but be found to be practicing within accepted standards in Texas, or Nevada or Ohio. This inconsistency of philosophy and understanding can be devastating, as it has never been set down in writing in any professional standard. Most often it is only a "perceived” or “reasonable” standard that doctors are asked to abide by -- whatever that means.

6. The other aspect of this quandary I take issue with is its very reality: members of our profession taking care of their own families. Many chiropractors check and adjust their children and families 1-2 times per week. You probably do as well. That, in itself, translates into 52-104 adjustments in the course of a given year for each family member. Many would consider that figure and frequency as “excessive” if it applied to an actual paying patient. “Unnecessary” comes to mind. Yet when it applies to a family member, it seems to be totally permissible, reasonable, and utterly accepted.  We seem to have two sets of values within the profession when it comes to the issue of “over-treatment” -- one which is real, and one which is politically convenient. This is a contradiction, according to Dr. Patrick Gentempo.

B.  Frequency of Care

The second “doctrine” which has hampered care of patients and patient recovery has been the issue of frequency of care. It is nowhere written, yet every chiropractor seems to be familiar with the recipe of seeing a patient on a schedule of care, which would initially start with a frequency of  three times per week. This would be eventually reduced to twice a week, once a week, etc. At some point, patients are placed on wellness care.

I would not be out of line to stating that the majority of chiropractors approach patient care in a somewhat similar manner. To venture outside this accepted formula is to leave yourself open for possible repercussions from insurance and governing organizations.

I contend that the above view may be considerably limiting and even detrimental to the health of the public.

I would like to point out that when I was in practice, many children patients of our center were often placed on long-term care schedules whose primary goal was to alter and cause a change in existing neural programming, physiology, and pattern habituation. Many were seen on daily visits initially, in order to cause a change in their learned kinesiopathophysiology and break their subluxation patterning.

Patient care should be dictated by patient needs and not be limited by some unquestioned yet ambiguous standard. I believe that whatever needs to be done to help a patient regain their health, should be done. Sometimes that necessitates very frequent patient contact; sometimes not. The decision should rest entirely on the attending practitioner. At the same time, such a chiropractor should not feel pressured into providing sub-standard patient care.

I have seen, as you have also, that many times patients are simply not seen frequently enough to enact a change in the pattern of their subluxation. This can have serious consequences. It may not enable the chiropractor to correct the problem the patient has consulted him with. This in itself can have devastating implications not only for the patient, but also for the doctor and the reputation of the profession. In the most serious circumstances, it can be perceived as providing care which can be seen as fraudulent -- it is provided under false pretenses.

Doctors often do not see the results they should, as they do not see a patient on a schedule of care that is conducive to actual correction of a subluxation. To correct a subluxation habit, one that has become deeply learned, often an aggressive approach seems to work best -- even in babies and infants.

Long-term schedules of corrective care, with very frequent initial contact -- often daily -- seem to yield amazing results. Such an approach tends to change neural programming and learned patterning much faster and more completely than any other approach. This strategy provides excellent results, is cost effective for the patient in the long-term, and provides the doctor with a base-line approach that is built on certainty and data rather than dogma and rote.

The regimen of care should not be rushed, and patient care should not be based on symptomatology. Recovery should be measured by objective findings. It is essential that regular progress examination be performed to determine patient recovery and measure your correction.

(Dr. Ogi Ressel, author, researcher and an x-ray and pediatric specialist, teaches The Practice Evolution Program, the “fastest-growing coaching program on the planet.” Visit online at www.practiceevolution.com and take the Practice Health Mini-Checkup. Dr. Ressel may be contacted by e-mail at drogi@practiceevolution.com or by calling 800-353-3082.)