Using Tension to Communicate?

As a modern, informed, intelligent DC, do you find it hard to communicate with patients and not choke on your own dumb-downed words?  Maybe, you catch yourself talking about a patient’s condition in your language and then notice the thousand-yard stare you created with all those big words?  Communicating with patients is a skillset all onto itself.  For decades, the almighty REPORT OF FINDINGS (ROF from here on) has been an important topic in schools, practice management groups, and online forums.  Being the evidence-informed, modern DC, you are, you probably find the classic ROF to be cumbersome, too heavy, or too dumbed down. The way you were taught in school was to layout your findings, explain them thoroughly, either with a hose and bowling ball or a dry erase board and books or cool print outs and programs.  I’m not here to judge or to criticize any ROF methods that are out there. I actually like some of the programs and digital explanations and, at some point in time, have used most of the methods you’ve been taught…minus the hose and bowling ball…it’s just not my thing.  😊 We all have enough tension in our lives right now (thank you, 2020), so why would we use such an ominous word to explain our findings or what we’re trying to accomplish with care? I have found that using tension to communicate our exam findings or what we’re doing with care is very effective because: 1) patients get it. They understand tension and its many meanings, and 2) it allows you to effectively communicate difficult concepts to patients in an easy to understand way without feeling like you need a shower afterward. So how does it work?

Over the years, I have tried many different methods of communication with patients after the initial exam.  I have found that explaining the control triad to patients is an effective way to explain things that no one has had answers to before. This is NOT meant that you explain the intricacies and nerdy things that Manohar Panjabi talks about in his Panjabi Subsystem Control Triad. Keeping this system in mind will help you explain the difficult things to patients in a comfortable, yet accurate, and articulate way. If you are not familiar with the control triad, let’s review it here quickly.

The stability model initially described by Manohar Panjabi is a theoretical model of how our joints (namely the spine in his work) are stabilized. He describes 3 subsystems, the passive system, which is made up of the ligaments, discs, and joints/ joint capsules; the active system, which is the muscular system, and the neural subsystem, which is the CNS.  If you think about it, these 3 systems encompass everything the modern DC works with.  You can also name any adjusting technique, rehab model, soft tissue technique, and nerve technique (i.e., neurodynamics, BPS, and DNS). You would be able to draw an arrow where this technique is affecting to gain access to this system. The diagram below makes this easier to visualize.

You can see how the various techniques we learn are just gaining access to the same system in different places. Once you understand this concept, explaining to patients what you found and what your plan is moving forward becomes much easier. For example, a recent patient asked me, “Why is this muscle always so tight (levator scapula), and why doesn’t anything I do to it last?”

Me: “Mr. Jones, the only way your brain can protect or affect a dysfunctional or painful tissue (passive system) is through the muscle system. It’s the only vehicle it has outside of the chemical system, and you are past the acute inflammation stage. 

Mr. J: “So why doesn’t massage therapy and PT help?”

Me: “Your brain is holding TENSION in this muscle for some reason. My job is to find out why, and then we will make a plan based on that.

Mr. J: “But the muscle doesn’t spasm. It’s just tight, and now I’m getting headaches and pain higher up in my neck.”

Me: “Think of holding a 1 pound weight.  It is not a lot of weight, but I want you to hold it every day, most of the day, for 3 months. You can see how maybe your bicep starts to get tired and sore, then maybe your shoulder, then your elbow, then your wrist or neck.  Your brain is holding this tension because you have an unstable shoulder blade, and this area of your spine (touch the area of restriction) is not sharing the movement load.  No matter what we do to this muscle, it is not going to change the reason your brain is holding TENSION in this muscle. We need to get the soil right in the garden first, which is the joint motion, and then we need to plant the unstable areas with exercise and correct breathing.  When we do that, your brain will start to re-pattern its muscle strategy.  Right now, however, your brain doesn’t even know you have a restricted joint group here (touch the area…in this case, it was the CT junction), and it doesn’t know or even have access to the right muscles.  Once we get the soil right, then we can start to access the right muscles through specific exercises, which will change this tension patten and unload this muscle and this area. This will take X number of visits over X number of weeks.  We will check things along the way to make sure we are (important to say WE…this makes you a team now) doing the right things. If we aren’t, then we can change gears and go in a different direction.” 

This simple explanation was met with “That’s the first time anyone has explained this to me.”  This typically means you have already made an impact, and the patient healing process has started.

This simple yet accurate way of explaining things is concise, simple, and understood well by most.  It also reinforces for you, the evidence-informed DC, that manual care and chiropractic really is a process that takes time if you do it correctly. This isn’t to say that you are treating people every week to change respiration. Still, it forces you to hear your words as well, and hopefully, under-treating (which is a big problem with newer docs) becomes less prevalent, and you can ethically grow your practice. 

Of course, you should communicate in a way that is comfortable (but not too comfortable…stretch that comfort zone) for you and still allows your personality to show through. As always, be honest, transparent, real, and compassionate as well, and people will not just hear you but really listen.

Corey Campbell, DC, MPI Board.