by Jeffrey D. Olsen, DC

With any new treatment or therapy, there is an adjustment period while the body adapts to the improvements being made. Whenever I present a treatment plan to a new patient, I like to use an orthodontic analogy. Most patients can relate to the always-uncomfortable changes associated with moving teeth. However, everyone realizes that the temporary discomfort results in a healthier bite and improved smile. If the orthodontist were to remove the appliances at the first hint of pain, patients would never achieve these benefits. Similarly, Chiropractic treatments make significant structural changes, and the patient must have patience.

Combining custom-made orthotics with Chiropractic treatment will often shorten the adaptation period, but nothing will eliminate this natural process. I frequently remind my patients about the changes they might experience. Because supporting the feet affects the whole body, it is not uncommon to experience mild but temporary discomfort as the knees, hips, pelvis, and spine adjust to the improvements. This article will provide some tips to minimize the discomfort your patients feel and help you reassure them throughout care.

First, let me share an observation I have made about Chiropractic care in general and with supportive products specifically. People seem to believe that custom-made products must also be indestructible. By their nature, custom-made products actually might not be as durable as mass-produced products because the attention in their design is on “customization.”

An example might help make my point. A good friend was not happy with the standard 15-inch tires that came on his sports car, so he purchased customized, 16-inch tires to tweak the performance. Unlike production tires, each custom tire was unidirectional and could only be used at one corner of the car and, therefore, could not be rotated. The car gripped the road like nothing I have ever seen, but the tires, which cost five times a normal tire, lasted only 20,000 miles.

I like to remind my patients about performance enhancement whenever I hear concerns about price, number of visits, or the fact that “adjustments don’t last.”

The first hurdle we must overcome is common to every purchase. It is well understood that following any purchase (adjustments, orthotics, or tires), the purchaser must be reassured that the purchase was wise and valuable. This period of “post-buyer depression” could manifest as anything from apprehension to unrealistic expectations. Simply be aware of this fact so that you don’t overreact to patients’ concerns—reassurance and education are key. Your confidence in your treatment will be the number-one help to getting them through their “buying blues.”

“You break it, you buy it!” and “you scuff it, you own it!” are common policies our patients are familiar with. However, in our office, we let our patients know that after a treatment, 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 need a second chance, occasionally. When it comes to orthotics and custom-made shoes and sandals, patients must understand that, during the adaptation period, it is not only acceptable to wear their shoes and get them dirty, but it is also critical that they do so!

The normal adaptation period could last from two to four weeks, or longer with patients in special circumstances. It is only after the proper break-in period that the patient will feel how truly wonderful these prescription products are. And if, during the warranty period, the product requires any “tailoring,” Foot Levelers is happy to do it, regardless of any normal wear and tear.

Follow these steps to help your patients through the adaptation process:

1. Have the patient 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 the patient about and demonstrate the proper orthotic/shoe combination. They should understand that orthotics are specifically designed to work in only certain shoes for maximum support and performance.
3. Physically remove the factory insert so the patient knows the orthotic is designed to sit on a flat surface. The factory insert can also be used as a template. Foot Levelers intentionally sends its full-length orthotics with extra material beyond the toes. This allows the doctor to trim the orthotic to match the factory insert, which eliminates movement of the prescription while in the shoe.
4. If the patient has opted for a custom shoe or sandal, have them tear the tags off and try them on right there. Sandals require additional attention to the straps. Patients’ heels should rest firmly toward the rear with the forefoot secured by the straps. Properly securing the straps ensures the prescription is properly located. Verify with subjective muscle testing-more later.
5. Many patients can tolerate full-time use of their orthotics immediately. However, most patients should limit their use to 1 to 2 hours the first day and then add an additional hour each day.
6. Most importantly, schedule additional visits during the first 2 to 3 weeks while you help your patients adapt to their new supports. Chiropractic adjustments improve the transition and help muscles, ligaments, and joints adjust to their healthier positions. Nothing will help more than having you and your staff offer genuine empathy and reassurance that improved health, performance, and quality of life are just a few steps away.

When your patients are focused on pain during any portion of your care, redirect their attention to functional improvement using muscle testing. If you are unfamiliar with or unsure about doing muscle testing, ask Foot Levelers for their free educational materials on the subject (e.g., “Enhanced structure and muscle function”). Muscle testing is an effective way to get immediate, objective feedback from your patients. Muscle testing 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. 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.

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 healthcare 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 confidently demonstrate improvement will help your patients overcome their natural resistance to change, even when it’s for the better!

About the Author
Dr. Jeffrey D. Olsen is a 1996 Presidential Scholar and summa cum laude graduate of Palmer College of Chiropractic. He has been in private practice with his two brothers/partners since 1997, in Roanoke, Virginia. In addition to his practice, Dr. Olsen has instructed as an adjunct faculty member at the College of Health Sciences in Roanoke, teaching Anatomy and Physiology in the Physician Assistant department.