Generally, if you analyze and correct your patients' shoes, and then take the time to make sure that they are sitting properly in their car and in their home and work places, you are well on your way to making them into a good patient. Remember, at this point in their care, your goal with supports and modifications is simply to support them enough so they won't get worse and blame it on you. You can always go into more detail later with other aspects of these as needed.

Test Which Supports Your Patients Need

I like to have the patient notice things for themselves. If I do it for them then they really don't get it. I start with their shoes. After their adjustment I simply have them stand there while barefoot or in socks. I have them take in a deep breath and slump, and then observe if their breathing is easier or fuller than before the adjustment. I then have them notice if they are more upright, straighter, taller, stronger, and more stable (not swaying). They can feel this or even see it in a mirror. Essentially, we're checking the indicators described above. Once they see how the adjustment made them better than before, I have them put their shoes on. I don't bother having them fasten the shoes because they may have to take them on and off a few times. Once their shoes are on I have them take stock of the same indicators as before while helping them to observe any changes. If I see a difference but they don't yet, we repeat the process until they can tell. The next step is to fix their shoes as best I can with heel lifts, insoles, or whatever they need so that their indicators will be better while they are wearing them.

There are many things that could be wrong with shoes. Some you can change and some you can't. This will be a trial and error process as you gain experience, but there are a few guidelines for immediate success. With nearly every patient at this point, the changes made to their shoes will need to be done bilaterally. You can see this for yourself by testing the indicators such as breathing and slumping when you make changes to just one shoe or both.

Some things to consider and possibly change with shoes: reducing arch support height, adjusting heel height, and removing or replacing the insoles. Some shoes fix easily with only one change, while others may require more than one change; some shoes, no matter what you do to them, will just never work (like my cherished Italian sandals). Now it's time to take a look at sitting. In order to sit and not cause undue stress to the body, a person's hips must be higher than their knees.

I have personally looked at over 1000 car seats and never found one that puts bodies in the correct sitting posture with good indicators. Regardless all the possible position adjustments and fancy designs they may have, they are still basically shaped like bucket seats with the back part lower than the front, putting the hips lower than the knees.

The way to deal with this is to sit on a wedge-shaped seat cushion. This raises the hips up a bit while balancing and strengthening the upper body.

I don't ask others to take my word about the body mechanics involved or the supports needed to help. In fact it was Dr. Jutkowitz who figured these things out, not me. I encourage you to test these ideas for yourself. Once you see the changes you can make with patients simply by fixing what their shoes and seats are doing to the rest of their body, you will have more control of their care. You will also gain their respect and gratitude as you empower them to accept some responsibility for their own improvement.

As you gain experience doing this with your patients you will gain appreciation for just how important supports are in keeping patients aligned in the first place, and then in helping to maintain their correction in ongoing care. The additional benefit is that needing new supports from time to time will ensure that your patients stay in touch with you.

You will also be able to determine if your patients are in pain due to an injury (new or old), or if they are just continuing to mess themselves up with poor shoes and seats. This will provide ample opportunities to discuss their use of support products, and any need for temporarily increasing the frequency of their care.

I believe you will be thrilled with the enhanced results for your patients, and find deep satisfaction in improving your skills, which will make you better known in your community and field.

Patients are still going to drop out of care at times but, you can minimize this by "plugging the holes in the bucket". How patients feel in the beginning of care is important enough to them that they use it as their own indicator as to whether to stay with you or not. Realize that patients often get worse from what they do and it isn't necessarily a problem with your adjustment "not holding". Understanding and using these concepts will give you the confidence and tools to build a stronger practice.

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Dr. Jerry Porter, a 1981 graduate of Palmer West College of Chiropractic, has been in private practice for 30 years in Spokane. He assisted with the development of Chiropractic Biophysics™ and became a certified instructor. In 1998 he learned Advanced BioStructural Correction™ and has taught standing, sitting, and sleeping technology at many ABC™ seminars. For additional information contact Dr. Porter via his website, www.ezpostureproducts.com.