My philosophy has always been to begin with the least invasive, most organic option that reasonably fits the problem and move toward more invasive options when they are truly necessary.
That does not mean I am against injections, medication or surgery. I am not. There are situations where those are exactly the right tools, and responsible conservative care includes recognizing when a patient needs something I do not provide.
But there is also value in asking what we can accomplish before escalating care.
Can we reduce mechanical irritation? Can we improve movement? Can we change the way the body is loading an area? Can we decrease guarding and give the nervous system a better environment? Can we teach the patient something that helps outside the treatment room?
Those are worthwhile questions because the body is not passive. It is constantly adapting to the environment we give it. Sometimes a relatively small improvement in motion or reduction in irritation creates the opening for the next improvement. That is what I call healing momentum.
Conservative care is not about proving that one profession is superior to another. It is about sequencing care intelligently. Use the right tool at the right time, and do not use a bigger hammer simply because a smaller, more specific tool has not yet been tried.
If you are considering more invasive treatment but want to know whether there are reasonable conservative options left to explore, I am happy to evaluate the situation and tell you what I think—even if the answer is that you need a different kind of care.
–Marc Bonacci, DC, PMMTP
