Sunday, October 31, 2010


When describing our treatment approach to patients, I often cite what I call, Three Dimensional Care:

Three Dimensional Care consists of three areas:

1. The Intervention.
2. The Behavior.
3. The Environment.

With each patient we address these three aspects to provide a comprehensive, multi-dimensional solution to a health issue that, in the vast majority of cases, is a multi-faceted problem.

The Intervention.
This is why people go to the doctor, or to any other service industry -- to GET SOMETHING. It could be a medicine, or a diagnostic test. In other health care fields -- chiropractic, massage therapy, PT -- it could be a stretch, and exercise, a joint/tissue mobilization (e.g. massage or adjustment).

This is what people (and insurance) is willing to pay for -- the something. It's perceivable and often tangible, and frequently provides results.

Unfortunately, those results are frequently temporary.

Why? Because these next two are frequently neglected:

The Behavior.
The the vast majority of pathologies, our own behavior -- either knowingly or unwittingly -- either causes or exacerbates the situation.

How we use our bodies -- in motion and at rest -- is ultimately the most important factor in our well-being. More often than not, an issue -- e.g. PAIN -- requires either a temporary or permanent change in how we treat our bodies.

The healthcare professional MUST address this, and help the patient determine if he/she is using their body -- sitting, standing, walking, lifting, reaching, lying, squatting, twisting -- in such a way that is preventing recovery.

The Environment.
Nearly as important as The Behavior is The Enviroment. What about a person's surroundings is causing, exacerbating or hindering recovery from PAIN? For an office worker with neck, back, or arm pain, it may be office ergonomics -- or how one's work station is set-up.

Take, for example, this case:

An office worker who commutes 30 minutes each day to work is involved in a rear-end condition. Prior to the accident, they "never had back pain"*; however, after the accident -- despite "clear" diagnostic testing (x-rays, MRI), they continue to have chronic and debilitating pain -- worst in the morning, gradually improving in the AM, then worsening again by work's end and bed time.

(*"Well, it's been sore on and off...for twenty years...")

They've tried pharmaceuticals (NSAIDs to prescription narcotics), physical therapy, chiropractic, massage, acupuncture -- with varying results -- but always TEMPORARY.

Must be something siniser, right? Maybe NOT.

More likely is this person is only receiving one-dimensional care -- the Intervention, only.

Upon further examination:

- The worker sits with a flexed posture for a significant portion of his/her day -- in the car, at work, then at home "relaxing" in the easy chair or on the computer (BEHAVIOR).

- The person's work station requires frequent twisting -- from computer to file cabinet -- that, after further discussion -- gradually exacerbates back pain as the day goes on (ENVIRONMENT).

After addressing BEHAVIOR and ENVIRONMENT, the person -- coupled with effective and individualized INTERVENTION (e.g. manual therapy to lumbar spine, self-stretching, core stabilization) improves significantly over 2-3 weeks until their once-chronic back pain is abolished.

A True Story

This exchange actually occured in my office a few weeks ago.

[Joe walks into office, en route to the locker room -- undoubtedly to change after running before work]

Medical Assistant: "Joe, do you know a good stretch for your upper back?" [points to area between shoulder blades] "It's been bothering me for a few weeks..."
Joe: "Sure, try this." [proceeds to demonstrate trapezius/rhomboid stretch] (INTERVENTION)

Joe: "You know, most upper back and shoulder blade pain come from the neck. Make sure to watch your posture while working; a forward head posture can stress the neck and cause that soreness." (BEHAVIOR)
Med Assistant: "It's really sore in the morning..."

Joe: "Your neck can also get stressed out at night time -- do you ever read or watch TV in bed?"
Med Assistant [reluctantly]: "Yes..."

Joe: "Do you look like THIS?" [lays on the floor - literally - and demonstrates posture]
Med Assistant [more reluctantly]: "Yes..."

Joe: "It's likely you're straining your neck in that position. I recommend you read on your side -- or lie flat and hold the book over your head instead! Or read in a chair, before going to bed" (ENVIRONMENT)

In this example, the Medical Assistant's "upper back pain" (read: NECK PAIN) subsided in a few days with Three Dimensional Care. Equipped only with an INTERVENTION (e.g. a stretch, or massage), she likely would've received only temporarily relief.

The next time you visit your healthcare professional, look for Three Dimensional Care. It applies to all health issues.


1. "Here's a blood pressure medication." (INTERVENTION).

But what about:

2. "Add a 20 minute walk to your day -- even a brisk walk at lunch can lower blood pressure levels." (BEHAVIOR)
3. "Have you considered replacing the salt shaker on your table with a low-sodium seasoning?" (ENVIRONMENT)

Because, without Three Dimensional Care, your relief from any health issue may be only temporary, or require chronic usage of the intervention -- medications, massage, chiropractic adjustment, or pain drugs.