Importance of Compliance

At Nashville Chiropractic we make it our goal to provide exceptional chiropractic care to the Nashville area. Most chiropractors are owners of their practice, therefore, offices operate at the owner’s discretion. Many chiropractic offices have various philosophies and perspectives on how to interact with patients and how to reach health goals. This will influence what techniques are used most often, if imaging is done in or out of the office, what the new patient exam protocols are, if they are in network with insurance or accept cash only, and how they present a treatment plan. 

The focus of this post is on treatment plans. Goals of a treatment plan can be separated into short term goals and long term goals. In general, short term goals often include decreasing intensity and frequency of discomfort, increasing pain free ranges of motion, and decreasing positive exam findings. Long term goals focus on increased functional mobility and how to decrease the likelihood of reoccurrence or new injury onset. Re-evaluations and patient feedback are documented to see if these goals are being reached.

The stage of the condition; and if it is defined as acute (new, recent, actively painful) or chronic (old, reoccurring, latent periods) will also influence treatment plan formats. An acute condition is actively in the stages of the body’s inflammation process. A chronic case needs to account for compensatory changes from long term failed healing conditions. 

This chart illustrates the phases of treatment and healing.  The first stage is relief care.  After this stage most patients are starting to feel better and be less symptomatic.  At time, some patients opt out of their treatment at this time.  These are the patients that are most likely to see relapses and re-occurrence of symptoms.  The goal of treatment should be to improve and restore function in the present as well as the future.  

This chart illustrates the phases of treatment and healing.  The first stage is relief care.  After this stage most patients are starting to feel better and be less symptomatic.  At time, some patients opt out of their treatment at this time.  These are the patients that are most likely to see relapses and re-occurrence of symptoms.  The goal of treatment should be to improve and restore function in the present as well as the future.  

The tissue that is injured will also influence the timeline of a treatment plan. Different tissues heal at different rates due to biological make up and external and internal stressors. For example, a ligamentous injury may take longer than a muscle injury because it has less blood flow and less nutrients available to it, at the same time a muscle is harder to rest, while a ligament can be more easily stabilized to decrease stress while healing.

The recommended treatment plan goals and visit frequency are based on researched ethical expectations that take into account stages of the condition and biology of injured tissue. Researchers, such as Perry Nickelson, author of Stop Chasing Pain, Gray Cook, physiotherapist, and Craig Liebenson,DC, have effectively defined reasonable times of the body’s healing process with conservative treatment. It can confidently be stated you should expect 80-90% of acute symptoms to be gone within 2-4 weeks of treatment, about 5-6 visits, when utilizing chiropractic care. The last 10-20% of treatment takes a bit more time, active effort, and compliance. 

Research also supports that combination care is more effective than the individual treatments alone. Chiropractic adjustments, muscle work, exercises, diet, and rest are more effective together than simply choosing one route. Long term goals, chronic pain conditions, and injury prevention are dependent on this combination. 

Of course the only way this is useful information and an effective treatment path for patients is if they are compliant. At Nashville Chiropractic we try to support easy compliance. At our office patients have the option to schedule out their appointments as far into the recommended plan as they wish. This allows for patients to consider their schedules and progress. Payment is collected at time of service to ease financial comfort for the patient and to hold our doctors accountable to the visit at hand. 

To summarize:

  • Treatment plans are designed to reach short and long term goals of being pain free and functional.
  • Stage of the condition and the specific injured tissues are two aspects that determine goals and duration of a treatment plan.
  • Research has shown what expectations a doctor and patient should have for the healing process and future injury prevention.
  • It is always the patient’s choice to comply with recommended treatment plans. Successful recovery is not guaranteed if a patient does not follow through with a credible, researched treatment plan. 

At Nashville Chiropractic, we vow to never recommend more treatment that what is reasonably and ethically necessary.  We hope to provide as much flexibility in scheduling and payment options to ensure that time and financial management are on the patient’s side to ease compliance to treatment.

Sitting is Bad for Children, Too

An article, posted by The New York Times in their Well section, described a study to check the health effects of prolonged sitting in children.  They found that, just like in adults, prolonged sitting leads to decreased vascular dilation which can raise blood pressure and lead to cardiovascular disease in the future.  

As iPads, video games, Netflix, and other attention-grabbers have become more prevalent, kids are sitting more and more.  One researcher in the article even said, "I was surprised by how easy it was to get the girls to stay still for three uninterrupted hours."  

The study concluded that we should avoid prolonged sitting.  Getting up every hour to walk around for a few minutes can help undo the damage done by sitting.  

For more information on this study you can read the article by The New York Times HERE.  

Rib Pain: What Causes It, and How Can I Get Rid of It?

Anyone that has had rib pain can tell you it is not fun at all.  Rib pain typically presents itself as pain just outside the spine on the back; although, it can extend to the front of the chest too.  Rib issues can make also it difficult and painful to breathe.  These issues are often a result of restrictions or improper seeding of the rib head joint with the thoracic spine.  


So what causes these rib issues?  Sometimes, it can often be as simple as a hard cough or sneeze.  Another common cause of rib head issues is improper form or too much of a pushing exercise such as bench press, pushups, or punching.  When you push your arms forward and your scapulae retracts, the ribs move as well.  This produces a lever action on the costovertebral joint (the joint the rib makes with the spine).  Too much of this action or too much force, combined with weakness of the posterior muscles, can cause the rib head to push back in the joint, or in severe cases dislocate.   When the rib head is affected the muscles surrounding it tend to tighten up a lot.  This can help protect that joint, but can cause a lot of discomfort at the same time.   

So what do I do about it?  At Nashville Chiropractic we see these rib issues almost daily.  It is a very common occurrence due to people working out and neglecting the back muscles, or the back muscles becoming weak from years of desk work and sitting.  Typically, we are able to resolve these problems with a few visits.  By adjusting the rib head and promoting proper thoracic extension, usually the pain is greatly reduced after a few adjustments.  BUT that's not the end.  Ribs tend to be recurrent, so we need to address the surrounding musculature to strengthen the area around the ribs and prevent future injuries.  

If you are having, or commonly get, rib pain give us a call at (615) 620-0904.  We can address the issue and get you back to feeling and moving better.  

What Causes Achilles Tendinitis, And What Can You Do About It?


Achilles tendinopathy is usually a gradual-onset injury most often caused by overuse.  It is a common injury for runners, soccer players, basketball players, and any other athlete that spends a lot of time in forward motion.  Overuse occurs when the Achilles tendon undergoes excessive stresses without enough time to adjust to those stress levels between occurrences.  Excessive stress can be the result of poor foot mechanics, increased conditioning sessions, improper playing or running surfaces, improper footwear, muscle weakness, inflexibility, or a combination of all of the above.  


Let's focus on poor foot mechanics and footwear.  Excessive pronation (leaning of your foot towards your big toe) when running increases stress to the Achilles tendon.  The Achilles tendon naturally has a spiral formation; thus, when the foot is pronated it adds extra stress and tightness to the tendon.  This, coupled with then tendon's poor blood supply, can lead to injury that can be a real "pain" to get over.  

So what can be done to treat Achilles tendinitis?  First and foremost, a gait analysis should be performed to see if the athlete is a pronator.  If so, proper footwear and taping techniques can help limit the amount of pronation while running and ultimately decrease the stress on the Achilles tendon.  Further, a qualified healthcare provider can provide myofascial release to help break up any adhesions found in the tendon.  Stretching of the whole leg region can help increase achilles flexibility, i.e. calves, hamstrings, hip flexors, and glutes.  Your healthcare provider can then prescribe exercises to help control and strengthen the area.  

It is best to seek help sooner rather than later regarding Achilles issues.  The longer one goes trying to fight it on their own without treatment or rest, the more likely more damage may occur.  If you or someone you know are having these issues then we would be happy to help you here at Nashville Chiropractic!