At a laser therapy seminar, Dr Michael Nelson, DC reported the case of a patient with patellar tracking dysfunction. After imaging, he successfully eliminated the problem –by treating the hip joint and gluteals. “There was no ‘problem’ at the knee, just consequences,” he explained. He achieved success by thinking “upstream.”

This patient was typical among female athletes. It’s not “weak knees” or patellar tracking that is the cause of the problem. The relative difference in the pelvic or Q angle (relatively different from males) promotes the vulnerability that may manifesting symptoms elsewhere.

Another patient, a gentleman who had had some success with laser therapy by his podiatrist for diabetic neuropathy in his feet, asked him if laser could also help his “incurable” gastroparesis. He was referred to Dr. Sherron Marquina,DC. Within 12 laser treatments the symptoms of constant nausea and abdominal pain that he had experienced for years had disappeared. Described as incurable by his gastroenterologist, the visceral neuropathy responded to laser therapy. What were the treatment targets? Spinal nerve roots of the thoracicspine and the vagus nerve.

Astonished by the results the patient asked if the relief was permanent. Dr. Marquina’s advice: “If you want the symptoms to return, just maintain your current diet and lifestyle.” Despite restored neural function, other “upstream” lifestyle factors (poor diet, poor sleep, excessive stress reported by the patient) were likely to recreate the neuropathy if not addressed.

Both of these physicians recognized that the symptoms were signals, not the source of the problem. Going “upstream” might be considering distal or proximal structures or systemic mechanisms that create or contribute to the symptoms.

“How do I treat XYZ? How long, how many treatments, what settings?” As physicians we can often respond just to symptoms and obtain effective resolution, especially for acute presentations. But chronic, recurrent or persistent conditions mayrequire a different strategy, not necessarily a specific protocol, whether we are treating with spinal adjustments, PEMF, e-stim, laser or combinations of treatments.

So, what’s the “protocol” for a chronic condition? First, check the patient for possible “upstream” factors. This is especially important when chronic symptoms have been minimally responsive to previous treatments. Upstream joints and associated structures and spinal nerve roots are the first “suspects” in chronic conditions. Also consider metabolic function. Chronic pain and inflammation can derange and dysregulate the microbiome, the medulla, and other “upstream” factors.