Tulsa Spine and Rehab

When you begin therapy, the question’s in the back of your mind, “How long do I have to do this?” One of the hallmarks of Tulsa Spine and Rehab is that we have a graduation focus. We want to not see you anymore. We want to get you to healing. But that’s not always possible, and to explain what maintenance care is and when it’s necessary, Dr. Riley is with us.

Hey, Charlie.

Dr. Riley, I’ve heard you many times talk about the fact that there should be a set number of sessions for you to accomplish a goal, and yet I know that there are times that you have to have a patient in maintenance mode. When do you know that has to happen?

e do things differently here, Charlie. I sold my X-ray unit years ago. I treat on the first visit. I wanted to try to provide some form of relief on the first visit. I am very, I don’t know, passionate, but I’m serious when it comes to treatment plans. I cannot stand open-ended treatment plans and I think related to chiropractic, that’s one of the things that a lot of my new patients say, “Hey, I read this on the website that you recommend four to six visits.” I’m going to give you home exercises and get you back to moving as quickly as we possibly can as opposed to, “I want to see you three times a week for 10 weeks.” My biggest complaint or argument is, how do you know it’s going to take 30 visits? It could take six.

We are very goal-driven here, outcome-driven, Charlie, meaning we want to have a start and a stop to care. Proper diagnosis, what’s the issue, and then what are the appropriate treatment recommendations? I think that’s also what’s different is that we have options here. We have multiple tools in the toolbox. Chiropractic, physical therapy, massage therapy, laser, cryo. If we can do all of those things under one visit and get that patient back to feeling better as quickly as we can, that’s what they want.

I know their time is just as important as mine, so I’ve gotten away from that model of just multiple treatments week in and week out. I’m sure many practice management folks might look down or frown upon my model, like well, what about all those other visits you’re leaving on the table? My argument would be, Charlie, what about all those patients that they’re going to send me? If I can get them feeling better quicker and sustain them, I think that’s a pretty good referral source. What do you think?

Well, I think that that’s exactly what I’d be looking for when I’m coming for therapy. I’m not looking to make this a lifestyle, I’m looking for you to solve a problem for me.

Sure. There’s always going to be a very specific treatment plan in the clinic, and like I mentioned, a start and a stop. Commonly I might recommend, depending on the case, two to four visits to see how the patient responds. Fourth visit, if everything’s responding appropriately, I’m going to start to give them homework, get them doing more things on their own. Because my goal there too is I don’t want to provide transient or temporary relief. I want it to be sustainable.

When do you wind up in maintenance? I know that there are times when you wind up with a patient who’s coming to you on a maintenance basis. How do you determine that?

Yeah, it’s a good question. Back on the patient I treat two to four times, they’re tracking, they’re responding appropriately, I get them doing more on their own. The sixth visit rolls around, or fifth, whatever the case may be, they’ve hit their metrics. Range of motion’s improved, they’re essentially pain free with bending, they have diminished pain while sitting, whatever. We want to know what makes you hurt when you come in, and ultimately get you to a point that you’re able to do things without discomfort or dysfunction or interference.

So I release the patient, the patient says, “Dr. Riley, I sit at my desk all day long. I notice that I kind of develop ongoing mid thoracic pain late in the day. Do you have any recommendations for me?” Well, the first recommendation I’m going to make is ergonomics, home exercise, modifying activity without a doubt. Those are the most important things. But in some cases, it’s reasonable to have some form of maintenance care. What that means, Charlie, is that every four weeks, every six weeks, every eight weeks, depending on the patient and their activity level, their diagnosis, they might come back in for some maintenance type care.

Essentially what we’re trying to do is manage their current condition, hopefully we’ve got them to a point where they’re able to do more, so we’re helping them maintain that active, athletic lifestyle. We’re maintaining pain free at work, sitting, whatever the case may be, through manipulation, soft tissue massage. I have some patients that come in every four to six weeks and just want to run through some exercises with me. “Hey, Dr. Riley, am I doing this correctly? Do you have any other recommendations for me?”

From there, we’re just trying to manage, and then also stay out in front of things. Some patients just, they have a very challenging time just being accountable. What I mean by that is, Charlie, I’m going to have you do three things, I want you to do it four, five times a week. “Hey, Dr. Riley, do you mind if I follow up with you in three to four weeks? I want to make sure I’m doing this right. I might not be doing it enough. I just kind of need a bit of a safety blanket because I want to make sure that I don’t end up back in this office with that significant low back pain, or neck pain, or whatever the case may be.”

It could also be a matter of them maybe getting off course, and maybe they’ve done that for a while and they need to do something different.

You’re exactly right, and sometimes the complaint changes a little bit. It might start out as a neck problem and then it kind of works down into the right shoulder. “I was thinking about you the other day and then I happened to see that I was scheduled. That’s great. Could you take a peek at this shoulder?” Many of those patients were just trying to maintain and manage and stay out in front of it.

It’s possible as you go down the road it’s going to be a good idea, whether it’s for accountability, or for tweaking what you’re working on, to schedule some maintenance appointments with Dr. Riley. Dr. Riley, thank you for your time today.

Yeah, you got it, Charlie.

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