Please Note! Due to the high volume of irritating spam and slow-down of participation here, we are no longer accepting new comments, questions, or subjects on this Forum. We are keeping all the subjects and comments for review as there is a lot of good stuff here relating to practice-building subjects. So, dig deep! Thanks to everyone who participated here but it is time to move on to bigger projects educating the public about acupuncture! Matt Bauer
23-Apr-2013 01:35 PM
Sparking and Riding Momentum
A major part of the treatment protocol I promote is learning how to squeeze the most benefit for your patients with the fewest treatments. While the best way to do this involves many aspects such as preventing backsliding, teaching patients elements of self-care, and several others, perhaps the most important skill of all is learning how to space the treatments to “spark and ride momentum.” The following is an excerpt from my “Making Acupuncture Pay” book, from Chapter 12 “Spacing Treatments to Get the Most From the Least’. I hope those who have not read my book will learn something from this and those who have already read this may pick-up something you missed.
I tell my patients that the treatment takes place in three sections—beginning, middle, and end. The beginning is where you make something good start to happen, the middle where you build on this and take the progress as far as possible, and the end where you make sure whatever progress you have gotten will be as stable as possible.
There is a momentum to the treatment process that often builds during the middle stage. Spacing your treatments so you can spark this momentum and then ride it with the fewest number of treatments is another critical element to squeezing the most from the least. Schedule twice-weekly treatments to get the first bit of improvement started and continue at that pace to push that momentum in the first part of the middle stage. Once you have this momentum, you can reduce the treatments to once a week for the remainder of the middle stage, riding the momentum until nearing the maximum therapeutic benefit. How do you know if you are reaching the maximum therapeutic benefit? In some cases this will happen when the symptoms completely disappear. In others there may be an aspect of the problem that is beyond the body’s resources so some of the problem will remain. To know if you are at the ending stage you should stretch the last 2-3 treatments out to every 2 or even 3 weeks. If the symptoms begin to return when you stretch this way, you had not yet reached the ending stage and you need to do a few more treatments at once a week. If the progress reached up to this point holds, you can release the patient from your care.
You will also find some cases where the symptoms could be made to completely resolve but it is impractical to keep treating until this happens. These are cases where the momentum of progress has slowed but is still taking place a little at a time. In these cases when you reduce treatment to once every 2-3 weeks, there is still gradual improvement. That is a good sign and you can stop treatment and let your patient know that they should continue to see gradual improvement for several weeks afterward even though treatment has been stopped. This happens because some problems take a very long time before reaching the maximum therapeutic benefit but don’t need continual treatment to reach this due to momentum.
As I emphasized earlier, understanding that acupuncture sparks the body’s internal resources helps explain virtually every aspect of how acupuncture works. This includes the phenomena of momentum in self-healing. When one is beginning to spark these resources with the first treatments, the improvement this brings is often limited and short lived because the body has fallen into some bad habits in how it utilizes those resources. The qi flow has become restricted and/or diverted to some errant pathways. The longer the qi has been affected this way, the more it gets worn into that errant flow. Like water, qi follows the path of least resistance and so tends to flow in a “follow-the-leader” habit. Effective acupuncture helps shift the flow back into the proper pathways, but until those proper pathways become as well-worn as the errant pathways, the qi will keep following the wrong path. Once the proper pathways become well-worn and less restrictive than the errant pathways, the qi will naturally follow this course without the need for continual pushes from the treatment. Experienced acupuncturists can actually sense this unfolding during the treatment process although no one can exactly predict this all the time.
Everything in nature is a creature of habit because qi is a creature of habit. It takes time for bad qi flow habits to form and it takes time for good habits to be restored. Fortunately, the deck is usually stacked in our favor as nature is inclined to have normalcy. If we can just give the right kind of push often enough to help restore this normal flow, things should take care of themselves. That is what is so beautiful about facilitating self-healing. Being able to do this with acupuncture is a valuable skill. Being able to do this with the least number of treatments and the least out-of-pocket costs adds layers of complexity to this skill but is critical to private practice success. Spacing the treatments as described above should help you accomplish this.
As a rough rule of thumb, I have found that there is a basic ratio in how to space treatments to get the most out of the least by understanding how to take advantage of momentum. As a general rule, the number of weeks you treat at once a week should be about double of those weeks you treated at twice a week. If it takes treating a patient twice a week for three weeks to get momentum started, then treating them once a week for six weeks should get them through the middle stage to maximum therapeutic benefit. If treating twice a week for two weeks gets the momentum started then once a week for four weeks should be about right for the next stage. For those difficult cases that might need twice a week for five weeks to get the momentum started they will probably require once a week for ten weeks to near the maximum therapeutic benefit. This is why you need to see how the patient responds in the first stage to have an idea of how many treatments it may take after that. And as the number of treatments it takes in the end tends to be proportional to how many treatments it took to get the momentum started in the beginning it is important to do all you can to get that momentum rolling with the least number of treatments in the beginning stage.