The Unsuccessful Patient: When Chiropractic Fails

chiropractor singapore, jesse cai, pain guru

It would be a lie if I told you everyone achieved full recovery with our treatment. However, it would be fairly accurate to say you have a 80+% chance of achieving their recovery goals with us in just 12 weeks.

Technically, over 90% of our clients achieve full recovery within seven visits – that is because a good 10% who will achieve full recovery in under 4 visits.

Enough of numbers. Today we want to discuss unsuccessful patients. Why do some patients get better while others don’t?

Just in the last month or so we had two new patients who booked in with us but decided not to come back anymore.

  • Patient A decided she would not come back because she was struggling to keep up with the exercises. She has decided to stick to her TCM treatment.
  • Patient B had to cancel her follow up appointment. She also struggle with “headache and neck pain” from her exercises. One of her last questions was, “How will the program help me to improve my situation?”

Why is Patient B not getting better?

1. Did not heed clinical advice

It is common for people to experience some pain, soreness, discomfort when you first start an exercise program for the first time. It’s no different from if you are lifting weights for the first time, running for the first time, or even yoga for the first time.

Clinical rehabilitation is no different. People do experience soreness, discomfort, or even pain. The difference is that we access for your risk of injury. Is this exercise more likely to make you injured? If not, you’re probably good to go ahead with it.

We follow up with our clients VERY closely.

We did our first follow up with Patient B over WhatsApp in less than 24 hours from her first visit with us. Upon knowing that one of the exercises (originally prescribed at 1x/hour) is starting to cause pain, we specifically advised that she cut down on the exercise to once every 3-4 hours.

When we followed up with the client again at day 5, the exercises are causing neck pain and affecting her sleep. She also added that the exercises are not helping her.

Upon further questioning on her exercise routine (i.e. how much and how often), she copied and pasted her original exercise program and she said, “as per your instructions”,

When we asked about the rest she is taking between each set, she mentioned 1-3 hours.

It is indeed true that we are unable to foresee how you would respond to our exercise programming – especially on the very first visit – this is why we follow up with our clients so closely.

Sometimes, additional discomfort is avoidable with little between-visit tweaks to the programming.

2. Poor collaborative relationship

There are a few things that would have already indicated that her recovery may be poor:

  • Within the space of a few minutes, she claimed that she did the exercises as prescribed (hourly) to every 1 to 3 hours. Providing inaccurate information is not going to allow us to make good clinical recommendations. This apply across all aspects of healthcare.
  • She did not take our previous advice to do the exercise every 3-4 hours.
  • Lastly, also less importantly, she did not take the initiative to inform us of her increased/worsening symptoms (i.e. no collaboration).

At the end of the day, it is important that you choose a chiropractor or physiotherapist whom you trust. Recovery involves both the clinician and the patients themselves working together!

3. Chose to request for more exercises than chose to reject earlier follow ups in spite of symptoms

During her first session with us, the patient specifically requested for more exercises. I did inform that it’s likely to cause discomfort but she insisted on going ahead. We ended up prescribing her with four exercises: 2 for the upper body and 2 for the lower body.

On Day #1, we offered to bring her appointment earlier. Twice. She turned the offer down.

On Day #6, she had to cancel her follow up appointment.

Moral of the story: More is NOT always better. 

We are definitely not at the stage where we can manage clients’ cases remotely. For most parts, the follow up visits are an opportunity for me to learn more about your progress (or lack of) and to tweak your program for the best results.

4. Fixed mindset?

On Day #12, patient B said she had stopped the program because of her “struggle with daily headache and neck pain.” She then proceeded to ask, “How will the program help me to improve my situation?”

There are at least four instances where we could have avoided the aggravation of her symptoms, and thus – potentially – improvised her pain experience:

  • Day 0: Be realistic with what she is able to do or unable to do. It doesn’t make sense to ask for more exercises – despite fair warning that it will likely aggravate her symptoms (without increasing risk of injury) – then later on complained about the pain. We believe in collaborative decision making. This means as long as your risk of injury is low, we are willing to increase the intensity of your program. The down side is the risk of symptom aggravation. In this case, it did occur as we predicted.
  • Day #1: Accepted our advice to reduce the frequency of the exercise.
  • Day #1: Accepted our offer of moving the appointment forward to Day #5 instead of Day #7.
  • Day #7: Commit to her follow up appointment.

It does not make sense to question the program. At the end of the day, the program is just a tool that we use.

Sure, she is doing her exercises.

No, what she was doing was inappropriate (quite honestly it was too much) to create meaningful change.

Did the exercise work? Sure, it did. It just didn’t work for her because the dosage was wrong!

Here are five reasons why the program did not help her situation:

  1. Unrealistic expectations on the patient’s capacity to cope
  2. My recommendation was rejected
  3. Poor collaboration between myself and the client
  4. Unable to accurately obtain useful clinician information from the patient
  5. Did not commit to scheduled appointment

Is Patient A getting better?

I do not know. I will follow up with the patient in 2-3 months for an update.

The difference between Patient A and Patient B is the ownership of their own recovery.

In the case of Patient A, she wasn’t doing enough for her to see meaningful change. She decided she will continue with a less-ideal treatment that does not yield long-term results for her. She acknowledged the shortcomings of both treatments and made an informed decision.

In the case of Patient B, she was physically doing too much for her to see meaningful change. Yet at the same time, she wasn’t doing enough to collaborative with us. She questioned the program instead of engaging in discussion on how we can optimise the program for her own unique pain experience.

Square One is not a one-size-fit-all chiropractor

It is true that our approach to long-term results doesn’t suit everyone.

Most Singaporeans are indeed more familiar with the traditional, authoritarian healthcare model where the patients are always told what to do.

We don’t subscribe to that model. We respect our patient’s prerogative at making their own health care decisions.

We empathise that this is challenging and we are constantly looking to engage our clients better.

Successful recovery is in the mindset

neck pain, chiropractor singapore, wellness singapore
One of our best clients to date. In her gratitude card, she didn’t thank us for making her pain-free or making her stronger. At Square One, we don’t sell our clients fish. We teach them how to fish for recovery so they don’t have to keep coming back.

Too often patients are too fixated on the outcomes (or the results) instead of the process.

We want to get better faster, we want it quick. In doing so, we jeopardise your own recovery.

When things go southward, what do you do?

  • Patient A chose to take matters in her own hand and go back to seeing her TCM practitioner. She knows that the results are short-term and that she has to go back every 2-4 weeks. However, she is able and she is willing to do that. At the same time, she had tried the exercise programming and she is fully aware that it is not the right treatment for her given her current circumstances.
  • Patient B chose to focus on her pain experience. She decided to stop the program because of her pain. She also questioned the efficacy of the program.

In my opinion this is the best example of a growth mindset vs. a fixed mindset.

It’s not about how much better you are right now or how much pain you are experiencing.

It’s about making the best possible decision you can given the uncertain circumstances. And taking actions, however small they may be, to progressively bring you to where you want to be.

p.s. Don’t forget to collaborate/talk to your clinician. We have no crystal ball to tell us what would 100% work for you. At the end of the day, long-term results only happen when there is a bilateral, dynamic working relationship.

p.p.s. There was concern that this is a shaming post. I assure you 100% this is not the case. I wanted to share this specific experience with you to highlight that at every stage of recovery, there are actions that could be taken to optimise recovery or to mitigate poor response to exercise.

Read more: