Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 1161
Infrastructure 246 I

From the Desk of Dr. Mark Studin
Academy of Chiropractic

Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006

"Managing Cases that linger"


Guest Dr: so, case management question. I feel like we all have patients, that have been in a car accident regardless of how much damage there is, then it was all based off of the injury to the patient, what I find is many cases I'll treat somebody for a reasonable amount of time, four or five, six months, yet that patient seems to not be progressing in a manner that they should be, at least from the symptoms that they write down every single time, I'll do a follow up, examination on them. They are improving on examination, and I'll have a discussion with the patient, and saying to them, when you're putting your subjective complaints, you're putting the same numbers every time.

Dr Studin: They're not progressing.

Guest Dr: they're not progressing. It seems like. so this just happened with me though, a patient. She said, well, I am progressing. I'm feeling so much better yet whenever I am doing something. For example, like I love to boat and so it's boating season. Every weekend I'm getting worse because I go boating and then I come back into your office. What do I do at that point with that patient?

Dr Studin: So the patient's not progressing, but the patient is, but then they go back into there lifestyles. So, and being a boater, I understand, but whether it's a boater or a bowler or golfer or whatever it is, the patient could do that prior to the accident that they can't do it now. So you're going to have to do two things. One, you're going to have to modify what the patient does on a boat. So if they're pulling the lines and pulling the boat in to get a tied up. If it's a sailboat and they're doing rigging and all that stuff, you're going to tell them they're going to have to modify their lifestyle. Number two, you might have to really work on doing some work hardening, exercise rehab to strengthen the muscles that hold the correction. Number three, you might not be treating or adjusting the primary lesion. So you need to get that patient full spine digitized and that's critical. They've got to be full spine digitized because you might be adjusting compensation and not the primary lesion and you don't know where that is

Guest Dr: Well it seems that sure cause that was my next question. Do you said that you guys were working on the ability to do that. Is that finished yet or is it only for AOMs Psi.

Dr Studin: If I would say by the time someone listens to this, it should be ready for prime time. And I know that working on this in earnest, cause very least you can get the Beta version, which is almost perfect and it's still good enough that I would hang my hat on it and as updates come and the updates really are measuring tools and annotation tools, but the basics are already there.

Guest Dr: So that brings my final question about, I'm thinking of this patient specifically, her low back is her primary complaint, should I perform fluxion extension films, which I never did on her lumbar spine?

Dr Studin: 100%. And the other thing, you have physical therapy in your office?

Guest Dr: I do.

Dr Studin: Well send them over to the physical therapists to do some strengthening of the core, And here's what can physical therapy really works for the best we should see them first. You make this by the biomechanical corrections and stabilize them and then send them over the PT for course stabilization to help that adjustment hold. That's the ideal. And that's how the treatment plan should be written.

Guest Dr: Real quick question, can I charge for doing a report with a Symetra?

Dr Studin: Yes. If someone else does it. No, if you do it, yes. 

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