18 I Summer 2018 www.anjc.info Legislative Update Legal Ease Chiro Assist TECHNIQUE Council REHABILITATION Council Legal Q&A S C H O L ARSHIP WI N N E R S By Dr. Jeffrey Tucker The ‘One Hour’ New Patient Visit The history taking: After more than 35 years in practice I still think it’s fun, exciting, intense and often challenging to meet and engage new patients. During the history I’m looking for messages… we talk for however long the patient needs to talk, sometimes it’s short and others it’s quite a while. I’m trying to size up there current chief complaints, past and present health and physical condition, previous injuries, medical history, family precondition, mental status and toughness, athletic background, nutrition, sleep habits, etc. While we are sitting I use this time to talk about proper sitting ergonomics and getting up for micro-breaks. When that is over we proceed to a standing posture evaluation, then gait observations. I am on a time schedule but I let the patient set the pace. I hope they leave room for the examination, an initial treatment and allow me to teach an exercise or two if that is being offered on day one. It’s a lot to take place and educate in an hour. I don’t like feeling rushed but I often do feel that way. It’s usually my own curiosity during the movement examination and assessments that get me off my time frame. If time permits, I start doing precise – or the word I find myself using lately is ‘detailed’ – muscle therapy and precision manipulation, if there is such a thing. All that in about an hour, surely my pulse rate goes up but that’s probably why I like it so much after all these years. Along the way or on follow up visits, we talk about eating healthy foods. I educate them on low carb, whole foods, lots of fresh produce and veggies so they can understand and implement an anti-inflammatory diet. I encourage that inner chef. I may have them schedule a consultation with my office nutritionist if I think a loss of 5-10 percent or more body fat is indicated. For the past year we are focusing on the ketogenic diet. Our average fat loss for females is 2 pounds per week; men lose 2.5 pounds of fat per week. It definitely helps decrease chronic inflammation and ease joint pain. I get them to eat a healthy diet but not a deprived diet. Come on, I still enjoy a glass of wine or cocktail from time to time. The examination: I integrate the exam- ination with standard orthopedic tests and functional movement tests. My plan is to figure out how to make it obvious to them that they need flexibility work and/or strength/stability training. It has become easy to demonstrate both using standard range of motion and isometric ‘holds’ in various plank poses. Then I guide them into what they can do at the gym or at home. I explain that our body can do the following movements and I want them to demonstrate these to me: • Squat • Lift from the ground (hip hinge) • Push overhead (vertical press) • Push away from the body (horizontal press) •  Pull a band or weight from overhead (vertical pull) •  Pull a band or weight towards the body (horizontal pull) •  Step (lunges or step-ups) •  Twist (rotational drills) I feel like I did a good examination if I can translate and transition the findings into floor exercises and bodyweight exercises that improve posture and pain. I like to demonstrate movements, watch them do it, correct obvious mistakes and help them download proper technique until it’s imprinted in their muscle memory. For some patients my exercises are a complete workout, and for others it is part of the warm up. Either way, we start out easy, then gain in intensity from week to week, incorporating sessions of bodyweight, CLX bands, free weights or kettlebells and cardio (power walking), none longer than 40-45 minutes (unless they personally chose to extend the cardio). I have patients who run marathons, do Tris, and crazy other high-level athletics. I really enjoy seeing them feel the progress from week to week. Squats, dead lifts, lunges, presses and rows are frequently trained with CLX bands. I just want to see patients as excited as I get about regaining lost range of motion, fitness and health. I often hear my self say to patients “Once we regain lost range of motion (or lose weight) I never want you to lose it again!” Compliance: I keep patients engaged in exercise because I have the ability to vary the workout types, from body weight to light weights and lots of reps and sets, to heavier weight and less reps, to new combinations of exercises, all mixed in with cardio variations. The goal is slow steady gains in flexibility if that is needed, or stability/strength if that is needed, or whatever form or another is needed. I do require that patients provide a detailed workout log and/or a food diary. When people know that they will be weighed in and have a body composition analysis on a weekly basis, it increases accountability and keeps them motivated to complete the agreed week’s program. My goal is