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Chiropractic and the Lost Art- Part 2

Chiropractic and the Lost Art- Part 2

In part 1 of this article we discussed the importance of becoming the "Big Kahuna" and predicting what was going on with our patients while making the "picture bigger" by simply touching our patients spine and using Touch, Tell, Ask and Teach (T.T.A.T.) If you did not get to read that article please feel free to go to my website and read part 1.

http://www.rosencoaching.com/information/a/chiropractic_and_the_lost_art-_part_1.php

In this article I want to discuss the different ways we can use T.T.A.T. In part 1 we discussed how to use T.T.A.T. during the examination. You will notice I said, "Is it tender there? Often times if people have subluxations in this area (T4) they will have gas, bloating, indigestion or heart burn, do you ever have any of those?" It is crucial that we spell it out for them versus asking them if they have gall bladder problems. If you ask them if they have gall bladder problems most likely they will say no they don't. But if you ask them if they have gas, bloating, indigestion or heartburn they will most often say yes. Same thing goes for sugar handling problems, etc. You must describe the symptoms for them in detail, don't think they know what each organ does and what symptoms might be if the organ is not functioning at its optimum.

Also during the examination we want to predict other positive tests that might show up. This adds to our "Big Kahuna" persona and also adds value for doing the tests. Such as, "Jill often times when people have subluxations in this area (C1) which is most likely causing those headaches and brain fog; they may also notice that their range of motion is decreased on one side compared to the other. Go ahead and turn your head to the left, now to the right. Wow, can you feel how your head goes so much farther to the right than the left. That sure makes a lot of sense. Kathy, (C.A.) please make sure you do an entire full spine range of motion study on Jill." This way Jill knows why Kathy is going to do the ROM study, I get the Big Kahuna points for predicting it and I don't have to spend all that time doing the entire study. Or, "Jill, often times if you have a subluxation at T-4 like you do and you have those gall bladder type symptoms we will also see one shoulder sitting higher than the other. Boy can you see how your right shoulder is two inches higher than the left. That sure makes a lot of sense; (show Jill on a spine why this makes sense.) "Kathy, please make sure you do a full postural evaluation on Jill I want to make sure we correlate all these findings." Again it creates value, adds to the knock their socks off Big Kahuna experience and it doesn't cost you more than a few seconds to a minute at best!

There are several things we can discuss with T.T.A.T. So far we have discussed the sensory and autonomic aspect of the spine and subluxations. "Is it tender right there? (Sensory) Often times people will experience gas... (Autonomic)" Recognize that in each area of the spine the subluxation may affect the sensory, motor or autonomic. So we may also ask them other questions such as motor weakness, radiation of pain, numbness, tingling etc. The point is we are trying to help them experience if they are in fact experiencing any symptoms of the affects of the subluxation.

We also may discuss the three subsystems as we palpate their spine. The three subsystems are active (muscles), passive (bones), and controlling or neural (leg checks.)

So while checking a patient I might point out how the muscles are tighter on one side than the other, or the right butt is contracted and higher than the left and the left side is really flaccid; or how it is so tight in the neck or between the shoulder blades (active system.) I may help them feel how locked or hard the bones feel in a particular area (passive system.) I may help them experience how the legs don't turn in on one side compared to the other, or how there is heel tension or adduction stress etc. (controlling or neural system.)

The reason I want them to experience the differences in their body is because after the adjustment I want them to feel how they were successful that visit and I also want them to experience all of the changes. Sometimes their symptoms don't go away, and what about when they come in and don't have any symptoms. This is a great way to use T.T.A.T. to help them experience how their body is changing due to the adjustment.

Another great way to use T.T.A.T. is to help them realize how their symptoms are caused by their subluxations, which are caused by mental/emotional, physical and chemical stress, which is caused by lifestyle stressors. If we are going to run more of a wellness practice than a symptom based practice we have to help our patients recognize how important their lifestyle is. Let me ask you a question. If a patient has mid back pain that is caused by their diet will you ever be able to clean up their mid back pain and subluxations if they don't change their diet? NO!! You and I both know you can bang away on their spine from now till eternity but if we don't get to the underlying cause of the subluxation our adjustments will not correct their problem.

This is where T.T.A.T. is so beautiful. Here is a sample dialogue. "Wow Jill, can you feel how tender it is in that mid back today?" (She says yes it is terrible.) "Let me ask you a question have you had any more sugar or carbs in the past few days?" (She says yes it was her friend's birthday and she had cake and ice cream.) "Well Jill that makes a lot of sense. We also noticed this connection about a week ago when you had a big weekend partying. Well let's see what we can do to help this area out today."

I don't want to tell her that she needs to change her diet. The fact is people do not like to be told what to do! (I go into great detail about this whole subject in my L.A.A.S.R. Course.) If I tell her what she "has to do" the odds are she won't do it and I will ruin our relationship.

I would much rather just point out the connection between her pain and her lifestyle a few times in a row. Usually within a few times they "get it" and will say that maybe they should not eat that way and often times ask for help and advice. Now they are ready to "hear" what I have to say.

If by chance it goes on several times in a row and she doesn't decide to make the change on her own, I may say something like, "You know Jill it has become clear that your mid back pain and your diet seem to be related. What do you think?" They almost always cop to it. You can then say, "I know that mid back pain is really bothering you, may I make a suggestion? Would you consider taking a few weeks off sugar and see if your back feels better?" Again, if we don't tell them what they "have to do" but we just help connect the dots for them you will be amazed how open to change they will be!

Another classic scenario is when Jill comes in and her spine feels very tense. "Jill, your spine feels very tense today, what is going on?" Jill says that she is very stressed, her and her husband are separating..." This is where T.T.A.T. is so brilliant, this is how we can really take such personal care of our patients vs. just doing the pop and pray thing. "Jill I am so sorry you are going through this type of stress. Your spine really shows the stress you are under. What are you doing to take extra special care of yourself right now?" If she doesn't know what to do you may want to give her some suggestions. Remember it is Touch, Tell, Ask and TEACH!

The more you can relate what is going on with your patients spine and the rest of their life, the more you can become the Big Kahuna and predict what is going on with them, the more you can help them experience the chiropractic story in their body the more your patients will value you, what you do and STAY, PAY AND REFER!!

If you have any questions about how to implement TTAT please feel free to give me a call and I will help you through it.

Russ Rosen, D.C. - Apr 26, 2005