ON Chiropractic
a component of muscle building and will
ultimately lead to restructuring, greater
strength and function,” said Dr. Takes.
Charting the Best Course with a
Patient
D
r. Takes is the first to admit
that finding the right sequence
of therapies for each patient
can be challenging. The place to start is
with an open dialogue with the patient.
Identification of the patient’s goals is step
one. Then you will be able to develop a
treatment plan that gets at the root cause of
the patient’s symptoms and dysfunction.
When you identify that an exercise
therapy component can help a patient
achieve their goals, the process of building
an exercise program begins. The foundation
for that building process is likely to be the
three bedrocks of exercises focussing on
lengthening, stabilizing and strengthening
tissues. There is no tried and true approach,
though, and it does take practice to develop
a clear sense of how individual patients may
respond to exercise therapies.
Dr. Takes believes that working with
patients in the early stages of their exercise
programs is essential. “Supervised exercise
is always going to trump unsupervised
exercise,” he believes. This is especially true
when working through the early stages
of recovery from a dysfunction or injury.
Given that a loss of proprioception often
accompanies or contributes to dysfunction
it is very challenging for patients to perform
exercises correctly, with proper alignment
and posture, when they are not being
supervised by a trained health care provider.
Dr. Takes explains with an example:
“Patients can’t always see what we see. That
their traps are firing too much and their
shoulder blades are elevating as they retract,
putting pressure on the cervical spine.” After
demonstrating a proficiency in completing
a certain subset of supervised exercise, the
patient can then self-supervise. But until it
is clear that the patient will not exacerbate
their symptoms, supervision should remain
in place whenever possible. “The last thing
we want is for a patient to waste six weeks
in a self-supervised exercise program by
working the wrong muscles and potentially
making matters worse.”
This is supported in research literature
as well. The Spine Journal published the
results of a clinical study in 2011 that
examined the relative impact of supervised
trunk exercises, chiropractic spinal
manipulative therapy and home exercises
on patients with mechanical low back pain.
The study found that all of the interventions
yielded similar results, but that those who
received supervised trunk exercise were the
most satisfied with care and experienced the
greatest gains.D
Spine published an article in 2012
with similarly telling results. This study,
conducted at the Wolfe-Harris Center for
Clinical Studies at Northwestern Health
Sciences University, compared the benefits
of high dose supervised strengthening
exercise with spinal manipulative therapy,
high dose strengthening exercise alone
and home exercise combined with patient
education for the treatment of chronic neck
pain. Supervised strengthening exercise
with and without spinal manipulation
outperformed home exercise.w
These studies reinforce what Dr. Takes
believes, that the combination of patient
education, manual therapy and supervised
exercise therapy can be of tremendous
benefit to patients. “Exercise therapy has
to be one of the tool ́ݔ