Phase 1: Passive Modalities and Adjustments

We use passive and active modalities to help you through three phases of care as quickly as possible. The first phase is pain control; the second is increasing motion and the last is increasing strength in order to maintain long term relief and help you manage your injury long term.

Chiropractic adjustments, spinal manipulation or “cracking” your back (all the same thing and neck) is an incredibly effective modality when indicated. Also it really isn’t painful, but can look that way. If done the right way at the right time there is usually no pain at all. In the early stages there may be some simply because tight muscles become sore and we have to push on those areas. The most common reaction is mild pain if at all. We grade pain on a scale of 1 – 10; and any pain from an adjustment is about a 1 or 2 on that scale with 10 being the worst pain a patient can imagine. That pain is also very short lived lasting only about 20-30 seconds. It can increase motion and decrease pain immediately and speed up most recovery times. While you may need some repetition in the first week or two, we quickly proceed to strengthening exercises so you can manage your condition on your own. An adjustment gets motion back in a joint faster than any other modality and exercise can keep it that way; providing long term relief. For a more detailed and scientific explanation of what really happens when you hear something “crack” see “The Physiology of Manipulation” power point in the “Active Release Tech” section of our website.

The use of passive modalities such as heat, ice, electrical muscle stimulation, ultrasound, iontophoresis, phonophoresis, traction, massage and active release technique can be extremely helpful in many ways when treating musculo-skeletal injuries, in particular back pain. In the early stages of injury management they can be used for pain control, muscle spasm reduction and to decrease inflammation. When a body part gets injured it swells up and muscles go into spasm surrounding the painful area. While this is a protective mechanism, it can frequently impede the speed of recovery. Many patients simply have too much spasm to adjust or manipulate properly. Russian electrical muscle stimulation works very well at reducing spasm so we can then perform a much more successful and manipulation or adjustment with less discomfort (if there is any at all). If we can decrease inflammation and tightness, it makes the adjustment much more tolerable. It also makes the results last longer.

The passive modalities can also decrease pain by increasing your body’s production of its natural pain killers (endogenous opiates) and actually blocking pain signals from reaching the area of your brain that perceives pain (substantia gelatinosa). The effects of these modalities may only be short lived, but they can be incredibly important when someone is in pain. They increase circulation to the injury site and this provides more nutrients to the area and carries more metabolic waste products away, all helping provide a better environment for healing to occur.

Individually each modality may not be very effective; however; using the right modality at the right time, for the right timeframe can frequently cut recovery times in half. We also instruct our patient on how to help themselves at home. At most, we can only see a patient for a couple of hours a week; so home care is vital. The proper use of heat, ice, over the counter medications, stretching, and even self administered manual therapy (pressure point therapy) all contribute to a much faster and comfortable rehabilitation process.

Phase 2 – Therapeutic Exercise

Therapeutic exercise is the exercise program we’ll teach you; in order to maintain the relief provided by chiropractic care, active release technique, and passive modalities.. I t is truly the best way to stay “out” of our office. It is a specific program designed based on your injury, body type, activity level, response to care and general lifestyle goals. No two programs are alike; they are developed in order to prevent your pain from returning. If it does return, it will also give you a method to try managing your life and still function at your best. Unfortunately, once you’ve suffered from spinal problems, you are much more likely to have them return at some point in the future. However; if you do what we teach, chances are your symptoms will be less severe and less frequent.

In the perfect world we should all exercise at least three times a week, and do all of the exercises we teach you, to prevent the return of your symptoms. However; with tight schedules, jobs, families, etc; that can be very difficult to achieve. We must also tell you that the specific exercise program designed to prevent the return of your pain, probably won’t be very exciting! So patients frequently do their program a lot; in the beginning, and then slack off.

If you do “slack off” and your symptoms flare up; first try to resume your exercises, stop any impact activities such as running, use ice and/or heat, and try some over the counter medications. If that doesn’t relieve your symptoms in about a week or so; you should probably come back in for a quick adjustment. If you get treated within the first two weeks of a flare up (provided the flare up isn’t severe) one adjustment may do the trick. If your pain persists much longer than 10-14 days; try to get is ASAP. If we can treat you in that time frame, usually one treatment will get you back on track, and we may not need to see you for years (if you exercise).

Typically if you wait past the two week time frame for treatment of a flare up; many patients end up needing much more care (3x/wk for a week or two, sometimes more) in order to calm your pain.

Please realize your program is just that – YOUR PROGRAM. We are VERY different in our instruction and exercise selection; which is based on the patient as a whole, not just the worst problem, mainly because many of us have more than one musculo-skeletal issue. Initially patients think the program isn’t very difficult or very long. However; by the time we are finished; you’ll have a complete program for your entire body consisting of strengthening, cardiovascular conditioning and lastly flexibility.

We emphasize getting stronger with specific strengthening exercises over flexibility; especially for anyone not competing at a high level. Research is very questionable regarding how to stretch, when to stretch, and what type of stretching to do. Most rehabilitation programs consist mainly of stretching your hamstrings and then strengthening your abdominals. There is very little if any good research that correlates tight hamstrings with an increased incidence of back pain. However; most physical therapy programs are based on just that concept. With so much concentration on hamstring flexibility, many neglect strengthening the correct body parts. They almost all work on strengthening your abdominals, and forget about strengthening your back muscles. The single most effective way to stay pain free is to get your back muscles stronger. Abdominal strength is important, but not at the cost of having weak lumbar and spinal erector muscles.

The most effective way to get stronger is to lift weights and perform strengthening exercises that are similar to real life. Squats; which so many of our patients have been told to “never to do”, are probably the single most effective full body strengthening exercise. It is jut like many other exercises, in that they just need to be done correctly. When done properly; you will gain strength incredibly fast and rarely need to come back into our office.

One of the other problems with constantly stretching your hamstrings is that they require you to lean forewords. When you do that; spinal discs (our spines shock absorbers) get pushed directly into the nerve roots and spinal cord. That is something that we should all try to avoid. For example; Dr. Tancredi has had 4 knee surgeries and low back surgery, and he still incorporates straight bar squats into his program. The key is to do them properly, just like anything else.

Our approach has been shown to be incredibly successful; but very different. It is the main reason why very few of our patients require regular care.

Phase 3: Maintenance

At Tancredi Chiropractic, we really don’t even like the term maintenance care or regular adjustments. As mentioned earlier, you may need future care; but no one can tell you a set schedule or accurately predict your future needs. What we do know is that everyone needs exercise, but regularly scheduled ongoing chiropractic past phase two is unnecessary. You may be able to go years without needing any care; or you could flare up next week, we simply don’t know. However; if you do what we tell you and you do flare up, your symptoms usually resolve quickly and on their own. Most exacerbations do not require much; if any, care in our office. One we release you; we really don’t want to see you again. If you are a professional athlete or serious competitor, you may wan to get a periodic “tune-up adjustment”;, but we still don’t know how often that may be. If you are training regularly, and need an adjustment, you’ll know when you need it. No doctor can predict your future needs.

We pride ourselves in paying attention to every detail, so you are sure to understand your problem, and then be able to manage it in the future.


Tancredi Chiropractic & Rehab
940 E. Haverford Rd., Suite LL-3
Bryn Mawr, PA 19010
(610) 353-9400