May 25, 2022
3:47 pm
There are many published journal articles and books pertaining to the topic of “Soft Tissue Injury and Repair.” My favorites include:
Phases of Healing
The article I have seen referenced (and personally used in numerous contexts) most often was published in 1986 in the journal Medicine and Science in Sports and Exercise by Australian physician John Kellett, MD, and titled (6):
Acute soft tissue injuries–a review of the literature
In this article, Dr. Kellett describes the pathological processes of soft tissue healing as following three distinct phases:
The phases of soft tissue injury repair are:
Phase 1: The Acute Inflammatory or Reaction Phase
This phase of healing lasts up to about 72 hours. It is characterized by vasodilation, immune system activation of phagocytosis to remove debris, the release of prostaglandins and inflammation.
The prostaglandins play a prominent part in pain production and increased capillary permeability (swelling).
The wound is hypoxic because the blood vessels have been disrupted, but immune system macrophages perform their phagocytosis duties anaerobically.
Phase 2: The Repair or Regeneration Phase
This phase begins at about 48 hours and continues for about 6 weeks. This phase is characterized by the synthesis and deposition of collagen, which literally glues the margins of the healing breach together.
The collagen that is deposited in this phase is not fully oriented in the direction of tensile strength. Rather, is laid down in an irregular, non-physiological pattern. Dr. Kellett states:
This phase is “largely one of increasing the quantity of the collagen” but this collagen is not laid down in the direction of stress.
Phase 3: The Remodeling Phase
This phase may last up to “12 months or more.” Dr. Kellett stresses that the remodeling phase of healing is critical for establishing the ultimate quality and functional capabilities of the healed tissues. He states:
“The collagen is remodeled to increase the functional capabilities of the tendon or ligament to withstand the stresses imposed upon it.”
“It appears that the tensile strength of the collagen is quite specific to the forces imposed on it during the remodeling phase: i.e. the maximum strength will be in the direction of the forces imposed on the ligament.” [This could argue for the need for specific line-of-drive joint adjustments.]
This phase is largely “an improvement of the quality” (orientation and tensile strength) of the collagen.
In support of the healing steps detailed by Dr. John Kellett, Physician Kevin Hildebrand, MD, and colleagues, from the University of Calgary, Alberta, Canada published a study in the journal Sports Medicine Arthroscopic Review, in 2005 titled (14):
The Basics of Soft Tissue Healing and General Factors that Influence Such Healing
Dr. Hildebrand and colleagues point out that wound healing following overt injury to a tissue follows general ‘‘rules’’ irrespective of the tissue involved. These “rules” are similar but somewhat more detailed than those outlined by Dr. Kellett. They include:
Phase 1: The Inflammatory
Following an acute injury, there is bleeding into the area of injury and pain. “Hemostasis is restored by the formation of a fibrin clot, which prevents further bleeding and serves as a provisional matrix for migrating cells.” This clotting cascade results in the release of inflammatory molecules and inflammatory cytokines from cells such as platelets. There is an influx of fibroblasts, which sets the stage for the second phase of the repair process.
Phase 2: The Matrix Deposition Phase
The fibroblasts produce collagen proteins that bridge the damaged area with the residual endogenous ligament tissue. “The tissue deposited early after injury appears to be an attempt to bridge the damaged area without regard to what was present before injury.”
Phase 3: The Remodeling Phase
“The remodeling phase is a slow process and is accompanied by alterations not only in matrix remodeling, but also gene expression, cellularity, vascularity, and innervation.” The scar tissue in a ligament “undergoes a protracted process where the initially deposited material seems to be turning over and the organization of collagen fibrils becomes more oriented along the long axis of the ligament.” “Because the remodeling phase occurs slowly, and may take months (i.e., skin) or years (i.e., tendon and ligament).” [Important]
Last year (2012), Robert Schleip, PhD, (Division of Neurophysiology, Ulm University, Germany) and colleagues, published an excellent and very detailed book on soft tissues, titled (16):
Fascia: The Tensional Network of the Human Body
The Scientific and Clinical Applications in Manual and Movement Therapy
In this book, they add to the details of the principles of soft tissue injury and repair. Specifically, they state: “Wound healing is divided into three or four phases:”
Phase 1A: The Vascular Inflammatory Phase
This phase begins immediately after injury and last 0 – 2 days. It is characterized by bleeding into the tissue.
Phase 1B: The Cellular Inflammatory Phase
Fibroblasts migrate into the injury area. This phase lasts 2 – 5 days.
Phase 2:The Proliferation Phase
This phase begins on the fifth day and lasts about 21 – 28 days. “The proliferation phase in poorly perfused tissue such as tendon, ligament, meniscus, or intervertebral disc can last up to 6 weeks.”
In this phase, wound closure occurs with a network of collagen fibers. “For this collagen network to attain an almost identical construction of the original tissue, the tissue in this phase of wound healing must be confronted with its normal physiological stress.”
Phase 3: The Consolidation Reconstruction Phase
This phase begins between days 21 – 28, and continues to about day sixty.
Phase 4: The Remodeling / Maturation Reconstruction Phase
This phase begins at about day 60 and continues for about a year. “Stress on the tissue should now be slowly increased to push ahead the reconstruction of unstable type III collagen to stable type I collagen and return the tissue to its original stability.”
Improvements in Timing and Quality of Healing
There are a number of variables that influence the timing and quality of healing.
Dr. Kellett notes (6): “Cryotherapy (crushed ice) for 10 to 20 min, 2 to 4 times/day for the first 2 to 3 days is helpful in promoting early return to full activity.” “Numerous studies have shown the effectiveness of ice therapy in reducing the pain and period of disability to soft tissue injuries.” In contrast, “early heat treatment leads to an increase in the blood flow to the injured area with an exaggerated acute inflammatory response.”
“The advantages of cryotherapy in treating soft tissue injuries have been well documented.” Ice within 48 hours of injury reduces disability of ankle sprains from 15 days to 10 days.
“Early mobilization, guided by the pain response, promotes a more rapid return to full activity.”
“Early mobilization, guided by the pain response, promotes a more rapid return to full functional recovery.”
“Progressive resistance exercises (isotonic, isokinetic, and isometric) are essential to restore full muscle and joint function.”
Following this acute inflammatory phase and largely guided by the pain response of the patient, early mobilization is commenced, based upon the premise that the stress of movement on repairing collagen is largely responsible for the orientation and tensile strength of the tendons and ligaments.
The goal of stressing repairing tissues with controlled motion is to induce the adaptive response of functionally stronger connective tissues. However, excessive stressing of the repairing tissues may result in further damage. Consequently, any sign or symptom which suggests a worsening of the injury (severe pain) is a clear indication to reduce the motion stress on the tissues.
The strength of repaired ligaments is proportional to the mobility of the ligament, resulting in larger diameter collagen fiber bundles and more total collagen. “Collagen fiber growth and realignment can be stimulated by early tensile loading of muscle, tendon, and ligament.”
In 1998, Drs. Hildebrand and Frank note (11): “Motion in stable joints improves the biomechanical properties of healing ligaments compared with immobilization of joints.” “The mechanism presumably involves the application of controlled forces; too little or too much force is detrimental.”
In 2005, Dr. Hildebrand and colleagues note (14): “The large scar tissue mass gradually remodels, likely under the influence of the mechanical environment.”
“Maturation of the scar tissue requires mechanical loading to continue the remodeling phase of healing.”
“Normal connective tissues that function in a mechanically active environment (actually most tissues) subscribe to the ‘‘use it or lose it’’ paradigm of tissue integrity.” “Increased loading leads to adaptation, whereas decreased loading below a threshold leads to atrophy.” “The same principle likely also holds for scar tissue and immobilization beyond the initial phases of healing could have a detrimental impact on outcome.”
“Mechanobiology is likely important in the healing outcome in tissues such as ligaments, tendons, and related tissues. That is, depriving healing ligaments of mechanical loading likely has a detrimental impact on healing outcome.”
Dr. Schleip and colleagues note (16): “For this collagen network to attain an almost identical construction of the original tissue, the tissue in this phase of would healing must be confronted with its normal physiological stress.”
“Stress on the tissue should now be slowly increased to push ahead the reconstruction of unstable type III collagen to stable type I collagen and return the tissue to its original stability.”
“Because connective tissue consists predominantly of proteins, the take-up of protein through nutrition is very important.”
“Matrix and cells are found in a continuous dialogue and are dependent on each other. The forces on the network of collagen and elastic fibers and ground substance are transferred to the cell membranes via link proteins. The cell is informed by these signals and is stimulated to keep synthesizing new matrix components. This rebalances the physiological breakdown of the matrix and the tissue retains its stability and mobility. A reduction in the load stimulus leads as a result to reduced synthesis activity of the cells and thus to a loss of matrix components.”
“This produces a lower level of stability and limited mobility because of the formation of pathological cross links. An important task for the therapist is to apply gradually increasing levels of force without causing pain, in order to promote the healing and regeneration processes and in this way restore mobility and stability.”
Problems and Residual Characteristics
Most healed soft tissue injuries are asymptomatic. However, it is universally accepted that the healed tissue is weaker than the pre-injured tissue. Consequently, acute flare-ups of pain or exacerbations of pain and/or spasm often occur as a consequence of increased use or stress of the once injured but now healed tissues. Good early treatment improves the quality and timing of soft tissue injury. The best early treatment appears to include ice and early controlled motion that does not move the tissues into pain.
The chronic tissue residuals following trauma and healing are histologically provable. Common terminology to describe them includes “scar, fibrosis, fibrosis of repair, adhesions,” etc. A collection of these principles follows:
Dr. Kellett notes (6): “The micropathology of acute soft tissue trauma has been investigated. Healing of ligaments and soft tissue injuries in general has been shown to occur by fibrous repair (scar tissue) and not by regeneration of the damaged tissue.”
“Normal ligaments are composed of type I collagen, whereas damaged (and healed) ligaments contain a large proportion of immature type III collagen which is deficient in the number of cross-linkages between and within the tropocollagen subunits.”
The remodeled scar is deficient in both content and quality 40 weeks after injury, as there is a plateau in scar collagen concentration at about 70% of normal.
In 1998, Drs. Hildebrand ad Frank note (11): “Injuries to ligaments induce a healing response that is characterized by the formation of a scar.” This “scar tissue is weaker.”
“Ligament healing is characterized by the formation and remodeling of scar tissue that is weaker than normal ligament owing to alterations in biochemical composition and structural organization.” “The scars have a greater amount of inferior strength tissue compared with that of normal” ligaments.
“The structural strength and stiffness, stress and tissue quality continue to improve up to 12 months after injury, but after that time only relatively small increases are made. However, the material properties of the ligament scar do not return to normal even after 2 years.”
Residual scar tissue behaves with “abnormal biomechanical, biochemical and ultrastructural properties.”
“The return of joint function after injury does not mean that the ligament has healed.”
“Ligament healing in what may be considered to be the best case scenario is characterized by a scar material with inferior tissue quality, with changes in biochemical and histologic properties, that does not regenerate a normal ligament even after 2 years of healing.”
The ligament scar affects the associated joint function.
In 2005, Dr. Hildebrand and colleagues note (14): “Whereas wound healing generally leads to a repair of the injured site, it does not lead to tissue regeneration. This difference between repair and regeneration has influence on tissues such as ligaments and tendons that function in a mechanically active environment.”
The repair process can lead to a loss of function, primarily from scar tissue, and this can occur in both musculoskeletal and visceral tissue (heart, lung, kidney, liver).
“The remodeling phase is a slow process and is accompanied by alterations not only in matrix remodeling, but also gene expression, cellularity, vascularity, and innervation.” “Because the remodeling phase occurs slowly, and may take months (i.e., skin) or years (i.e., tendon and ligament).”
“Even after protracted time post-injury, the mechanical properties of a scar tissue in a ligament … is still compromised compared with normal.”
“The scar tissue may be functional for most activities even though it is not ‘normal’.” [Fails during high demand activities]
The scar cells in the healing ligament are different from normal cells and therefore the scar is intrinsically different.
‘‘Scar-like’’ tissue is “functionally ineffective.”
“Some tendon and ligament injuries lead to formation of scar tissue that is partially functional, but to regain as much function as possible requires physiotherapy to ‘facilitate’ the return to function after the scar tissue has formed.”
The inflammatory response associated with overt injury or surgery can lead to the formation of adhesions, where “the ligament/tendon scar tissue is ‘‘bonded’’ to the surrounding tissue and thus, such restrictions compromise function in situations where movement is required.”
“The size of the wound and the resulting scar tissue has a dramatic impact on the biomechanical outcome.”
“It is readily apparent that wound healing in the adult under the most optimal conditions should be considered tissue repair not regeneration.” “For tissues like a ligament or tendon, the mechanical outcome may be less than ideal, depending on the expectations of tissue use post-injury and the occurrence of side-effects such as adhesions.”
Additionally, Dr. Hildebrand and colleagues discuss factors that impair soft tissue healing. These factors cause some patients to heal slowly or incompletely with more functional residuals. These factors include:
Dr. William Walsh and colleagues note (15): “Musculoskeletal soft tissues tend to heal through formation of relatively weak, disorganized scar tissue. Severe ligament sprains can be particularly problematic; even in the best case, there is a fibrotic repair response that remodels over several years, causing scar tissue that is structurally and biomechanically inferior to the normal tissue. For most soft tissues, the fibrotic repair process is thought to interfere with the possibility of regeneration.” “Soft tissues typically heal by fibrosis, potentially impairing regeneration.”
“Ligaments take longer to heal than other connective soft tissues, and the repaired ligament tissue is scarlike and inferior to normal ligament tissue both biologically and biomechanically. Furthermore, some ligament-deficient joints subsequently become unstable and can lead to lifelong disability with osteoarthritis.”
“Ligament wounds, even over 2 yr after injury, contain mainly a homogenous population of small-collagen fibrils as commonly observed in scar tissue, with a few patches of normal larger fibrils being observed. These ligaments never obtain their original biomechanical properties.”
These concepts on ligament repair have important applications for chiropractors that treat spinal trauma patients:
Soft tissue healing occurs over a period of 12 months or more. Controlled motion, including chiropractic adjustment, is the best approach to enhance the quality of ligament healing, especially in the remodeling phase.
Ligaments and tendons heal with scar tissue (repair) as a rule, and not with normal pre-injury tissue (regeneration). This scar tissue causes permanent loss of function. Even healed ligament injuries have residual weakness.
Scar tissue is mechanically functionally inferior to normal tissue. Its inherent weakness makes the tissue prone to failure at previously normal load levels, and subsequent new trauma to scarred tissue will result in greater injury.
Scar tissue (fibrosis) is linked to the intensity of the initial inflammatory response. Consequently, early inflammation control (ice) could improve the timing and quality of healing. Scar tissue, to varying degrees, is remodelable with the application of controlled motion, which I believe includes and even requires chiropractic adjustments.
Lack of symptoms is not synonymous with full healing and functional recovery. A flare-up or exacerbation of pain after the healing process will most likely require another few quick visits to the chiropractor.
SUMMARY:
This review reminds us that it is well-established that:
The Chiropractic Impact Report™ is a monthly publication by myself, Dan Murphy, DC. I am a 1978 graduate of Western States Chiropractic College in Portland, OR. I have managed about 10,000 whiplash-injury cases. In the past 32 years, I have taught more than 500 12-hour post graduate continuing education classes pertaining to whiplash and spinal trauma, including 21 years of coordinating a year-long certification program in spine trauma, certified through the International Chiropractic Association. Additionally, I am board certified in chiropractic orthopedics (DABCO), and I am on the faculty at Life Chiropractic College West in Hayward, CA (28 years).
The purpose of The Chiropractic Impact Report™ is to keep you updated as to relevant academic concepts pertaining to whiplash-injured patients. The hope is that the information is useful in terms of enhanced understanding, as well as helping the personal injury attorney deal with insurance claim adjusters and adverse medical experts.
The chiropractor sending you this Report is well versed and trained in these concepts, and can be a valuable asset in personal injury cases in terms of both academics and treatment. Additionally, these expert chiropractors have access to a monthly phone consultation with me to discuss any pertinent issues that they may be facing on a particular case. I hope that you find this Report and the referring chiropractor a valuable resource.
Sincerely,
Daniel J. Murphy DC, DABCO
References:
“Authored by Dan Murphy, D.C.. Published by Altadonna Communications, Inc. – This publication is not meant to offer treatment advice or protocols. Cited material is not necessarily the opinion of the author or publisher.”
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Over the last 15 years or more, I have experienced insomnia, acid reflux, mood swings and weight gain. I have tried to address these symptoms with the help of traditional medical practioners including general physicians, a sleep clinic, gastroenterologist, several medications, honestly, I’ve lost count. A couple of years ago, a friend of mine shared her experiences with Alcat testing. The nutritional recommendations she was given changed her life and she lost 40 pounds as a result. I felt ready to undergo testing and follow the recommended diet so I researched local medical practioners, including nutritionists, chiropractors, obgyns etc. I spoke with a couple but when I left a message for Dr. Caroline Fluegge, she returned the call herself. She asked various questions to discern my reason for requesting the Alcat. She was interested in the other issues I was dealing with besides weight gain. I immediately felt that she meant to dig below the surface. She asked me to complete several questionnaires that addressed general health far beyond weight. I did not expect her to address all the issues because no one ever had done so. I met with her and found her approach to be so holistic, touching on the physical, emotional, and perceptual issues affecting my health and wellbeing. It’s an approach I’ve never seen anyone take with my medical history. I honestly did not expect her to have answers for this broad assessment but sure enough, she had a plan. I am receiving brain function therapy for my insomnia. I am adjusted through chiropractic medicine each week. After blood tests showed imbalances, I was given a detox/supplement regimen to stabilize levels of numerous indicators which could lead to life altering health conditions. Many MDs would not have been concerned with these levels until they reached detrimental levels but I did not want that to happen. I wanted to prevent those situations without prescription drugs. My sleeping has improved, my weight loss has accelerated and my hope for a more fulfilling second half of life has returned. I’m not there yet but Dr. C has promised to stay the course until I become the best version of me possible. I refer everyone I meet who is dealing with health issues to her. She has opened my eyes to the benefits of functional medicine. I think people are searching for health experts who will look at the big picture of their lives rather than one piece of their life apiece which results in the patient having lots of tiny pieces of information which they may not know how to make sense of alone. Dr. C took that burden off of me and made sense of it for me.
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I have suffered from back pain and acute scoliosis my whole life, and it finally got to the point where I could no longer ignore the pain. Honestly, I had been skeptical about chiropractic work, but decided to give it a try. I did my research, decided to visit Doctor Caroline, and never looked back! This is SO much more than just a “quick fix” – I loved the fact that Dr. Caroline took x-rays to find the root cause of the pain before she did any adjusting and really explained to me where things needed help. Her holistic perspective is something that I really appreciate, as well. With regular adjustments, my back pain is almost completely gone, and I feel so much more aligned. I am so thankful I decided to visit Balance Atlanta when I did, Dr. Caroline’s dedication of getting to know each patient on such a personal level is something that I am so glad to have in my life!
I am new to Chiropractic care because I’ve never met a chiropractor like Dr. Caroline! She was very thorough in her explanation of what I was experiencing with my hips. She asked me what my goals were and made sure that I felt heard. Dr. C is focused on solving my problems which is a new experience for me, and is succeeding in helping me achieve my athletic goals. I look forward to my abilities as I continue under her care.
We just wanted to say thank you for your assistance and support with Janna’s health over the last 4 months. She just told us a week or so ago, that she is happier personally and physically and feels better than she has in years. We celebrated her 22nd birthday yesterday and she is doing great. Janna first came to see you four in February of 2013 for assistance in managing tension along with joint pain that we and she believed were associated with Rheumatoid Arthritis and fibromyalgia. This was because she had been diagnosed by other Doctors with Rheumatoid Arthritis as well as Fibromyalgia. Her treatments basically were through prescription medication for RA, fibro, sleep assistance, anxiety and depression. She was taking 8 prescription medications, with 4 of those having warnings of very dangerous and serious side effects. This has always been concerning for us with Janna being only 21 years old and having to take so much medication. You took time unlike all of her other doctors to spend time and effort in understanding and diagnosing what Janna’s problems really were vs the traditional doctors plan of prescribing medicines. Through your sessions with her, you assisted her in how she looked at things and how she should manage her health. Everything from what she put in her body, to exercise and her outlook on life. This change assisted her in reaching the conclusion that she did not want to be on all these medications as it was impossible to tell if one was helping or not. We are so happy to now have her off of all these prescribed medications and that she is healthier and happier than she had been in years. She no longer is suffering from symptoms of RA or fibro and is living the life that a 21 year old should be living. Thank you for your help in assisting her through your chiropractic care, brain core assessment, and wellness management. Thank you for taking time, unlike most any other doctor to dig into finding out what is really the issue vs a medical plan that is through prescription medication.
Balance Atlanta is great! Happy with my progress, easy to schedule, and always enjoy coming in.
Well good morning Dr. C! It’s Tom. I just wanted to speak on behalf of our family. We’ve been coming to you for almost 10 years. When I say almost, our dogs, our kids, and of course my wife, Julie. Our son Anthony, who is 16, our daughter Annalise is 12, she started coming here when she was 3, and of course our 4-year-old dog Connor. He’s been coming for a couple of years and you have helped him with his hips. You have also helped with my father in law’s dog who is 13, Ella. She just came last week. Thank you for everything you have done! God bless you!
I have been going to Dr. C for around 8 months now. I started when I was in my last trimester of pregnancy when my back was in its peak stiffness and ached all the time. I also had really bad sciatic nerve pain. I started going to Dr. C pretty frequently in the beginning, and I would limp in and skip out whistling! One day I had a very severe migraine with aura and couldn’t see anything. My husband drove me to see Dr. C and helped me into the building. After a couple of quick neck adjustments my vision was back to normal and the headache was almost gone! I even went to work 20 minutes after the adjustment! So now that my baby is 5 months old and my back doesn’t have another human to tug on it, I find myself still wanting to go see Dr. C all the time. I carry my stress in my shoulders, neck and of course my back, too. Every time I leave her office I feel like I’m prepared to take on whatever the world throws at me. My mind can focus better on what’s important versus the pains in my neck, shoulders, and back. I’ll never underestimate my tiredness and soreness because sometimes it’s just telling me that I need to go see Dr. C!
Dr. Caroline is an amazingly gifted chiropractor. She does not limit herself when it comes to your healing. She wants to get to know the real you and help you achieve all that you desire for your health and well-being. She has an affinity for kids of all ages especially teens and young adults. If you and/or your child are looking for a place to be welcomed with open arms, a place to feel safe, a place where true healing of the body, mind and spirit takes place, then call Dr. Caroline today.
Dr Caroline and Staff are amazing! My kids and I moved from chicago last year and it took us a minute to find the right chiropractor out here. When we met Dr Caroline we felt her warmth and dedication to treating us (not just adjusting us) and felt right at home! Highly recommend for MORE than just an amazing adjustment experience!
I’ve been seeing Dr. C for weekly maintenance since 2004. When I was in a car accident a few years ago I had to see an orthopedic spine specialist for insurance purposes. After he reviewed my xray he was literally amazed at how healthy my spine was. He said people in their 50s usually have a lot of degeneration, but I don’t. The specialist recommended physically therapy, which I coupled with increased adjustments from Dr. C. Within three months my neck pain was gone. Thanks Dr. C!
I originally came to Balance Atlanta in 2002 because I had been told that my hip was out of alignment. Dr. C acknowledged that, but also found that my back and shoulders needed adjustment even more because of the amount of time I spent hunched over my desk. I have been seeing Dr. C for 13 years now and find the adjustments just as valuable now as I did then. Each week I sit at my desk and try to keep good posture, but by the end of a seven hour day period, my neck and shoulders hurt. After an adjustment the aches and pains in my neck and shoulder go away. I wish I had met Dr. C while I was pregnant. I had sciatica with both pregnancies, and I think her adjustments would have relieved some of that pressure. I bring my children in as often as possible. The backpack my daughter carries in middle school is half her weight! Dr. C has seen my children grow from toddlers to teenagers. She’s more like Aunt Caroline than a doctor. If you are looking for a family chiropractor, Dr. C will treat your family like her own
I was very pleased with the care I received at Balance Atlanta. Dr. Caroline is very friendly and she makes it a point to get to know her patients as actual people, not merely manilla case folders and insurance files. I could tell the atmosphere in her office caters to families – very warm and inviting. I used to have excruciating migraines years ago and chiropractic helped tremendously. Now that I live in Buckhead, I wanted to go to a chiropractor who offers wellness plans and where I have the flexibility to call up spur of the moment to make an appointment. The adjustments are gentle and specific, I feel great, and I appreciate how committed Dr. Caroline is to chiropractic and her patients’ health. Great choice!
I was very pleased with the care I received at Balance Atlanta. Dr. Caroline is very friendly and she makes it a point to get to know her patients as actual people, not merely manilla case folders and insurance files. I could tell the atmosphere in her office caters to families – very warm and inviting. I used to have excruciating migraines years ago and chiropractic helped tremendously. Now that I live in Buckhead, I wanted to go to a chiropractor who offers wellness plans and where I have the flexibility to call up spur of the moment to make an appointment. The adjustments are gentle and specific, I feel great, and I appreciate how committed Dr. Caroline is to chiropractic and her patients’ health. Great choice!
I initially made the appointment for functional medicine because I was having some gut health issues. Dr. Caroline was able to educate me and really dig into what was going on with my body. She was able to help me with the stomach pains, bloating, fatigue and a number of other issues. I also decided to get chiropractic services and this was life changing! I literally have had headaches for years stemming from sitting at the computer for so long. I would wake up with a headache about 5 days a week. By the 3rd week of going to Dr. C I started to notice the headaches were a bit less intense and frequent. Now after being put on a plan and sticking to it, I honestly can say I rarely wake up with a headache. This makes me want to get up and conquer the world!!
Balance Atlanta Chiropractic is fantastic, When I came in to the office I was welcomed with open arms and really felt like I belonged in that office. Dr. Caroline really took the time to explain and go over everything that what was going on with me, and for being a chiropractic kid my entire life she did a great job of going into detail with things and made sure I understood the type of care I was going to be under. She really changed my life and helped me a ton. I would recommend anyone to go to her, because she is that fabulous and will turn your power on!
I have seen many chiropractors through the last decade and in more than one country. I’ve been working with Dr. Caroline for a couple months and am very pleased with her work and with her as a caring person. I value that she will not do piecemeal work with her patients but rather insists on a realistic treatment plan. I have experienced real and continued relief with her treatments. She knows the field very well and is a gifted practitioner who is continually improving her practice. If you value yourself, it is worth sticking to the plan with Dr. Caroline and following her guidance and advice.
I am a patient at Balance Atlanta. I‘ve been a patient here for about a year. I’ve been having neurofeedback and I finally sleep better. I also had debilitating headaches and they’re gone too! I found out about BrainCore Therapy through coming here to Dr. Caroline’s office at Balance Atlanta for Chiropractic. I was also in the Brain Injury Support group and Dr. Caroline came and talked about BrainCore Therapy and talked a little bit about the musculoskeletal system and everything. I was very intrigued. So my mom and I then perused a patient relationship with Dr. Caroline. I was in a really bad car accident. My friend, Chris was killed instantly and I suffered a severe brain injury. I was in a coma for several months and in several different rehab programs for the better part of a year. I was having debilitating headaches. I had neck problem because I broke my neck. I was in a lot of pain. I held my neck pretty crooked. My skeleton was all messed up. Dr. Caroline’s work has been able to give me some motion in my neck and also my spine seems straighter. Basically, I would get like two or three hours of sleep a night, and I couldn’t sleep. Now I get 8-10 hours of sleep! With a brain injury you need more sleep than a regular person. Since BrainCore Therapy I am able to get sleep, my headaches are gone, and everything is just going wonderfully! I got a job! I am very excited about all of this! I would absolutely recommend BrainCore Therapy to other people! Other people with disabilities or any kind of brain trauma or whatever BrainCore seems to really really help! It seems to be the answer to all my problems! Well, maybe not all my problems, but close!
Stacey is part of the Balance Atlanta family. As an actress, she has appeared in numerous Hollywood films, including Mother’s Day most recently. Stacey is a wife, a mother of two and a casting agent for a modeling company specializing in infants and children. Mind-body fitness is essential for her career and busy lifestyle.
I could not be in better hands, Dr. Caroline you are not only highly trained and prepared as a chiropractor but the way you give to your patients goes beyond anything I’ve ever seen. Thank you for all your love!
Here’s a picture of my husband and little girl. A couple of years ago I was backed into the C-Section by my OB/GYN because my daughter was presenting as breech just weeks before my due date. Unwilling to accept it as the only viable option, I conducted some independent research. I found all kinds of ideas from sitting up-side-down to manual turning; not for me. Finally, I discovered Balance Atlanta whose website described using the Webster Technique to encourage the baby to turn on her own. Apprehensively, I made an appointment. Dr. C was very kind and laid out a treatment plan that included 2-3 visits a week for 3 weeks. I was stunned- mostly because I resided 45 minutes away. After I finished sharing all of my excuses for why the plan would not work, Dr. C explained to me that treatment was a commitment on the part of both parties for the benefit of the client. She flat out told me that if I was unable to commit to the treatment plan that she was unable to guarantee it’s success and, in turn her preference was not to even start. I thought about it and decided to go with the good doctor. BEST decision I’ve ever made for my health and the health of my family! After the second visit, my daughter turned as I lay in bed. I continued to see her and experienced other benefits like no swollen feet or ankles, no back pain, increased energy and faster postpartum recovery. I also began bringing the rest of my family in for adjustments. The adjustments resulted in overall decrease in pain and inflammation in joints, increased metabolism, more productive decision making and the gaining a true friend and supporter in wellness. Dr. C is much more than just someone we visit when in pain. She is like family. She is always warm and connected when we see each other. I love her and Balance Atlanta for what they have done for my family. If you are looking for more than a quick fix, if you want a Chiropractor who is committed to your physical wellbeing, Balance Atlanta is where you want to be.
I have been coming to Balance Atlanta regularly. I would recommend services here. Real friendly. Also, I want to see how to be healthy and how to handle weight the problems sooner, as well as pains. I am happy about the people who work here. They are passionate about their work. They improve their services constantly. I highly recommend coming here!
Hi, my name is Shanolla Franklin. I am here at my chiropractor, Dr. Caroline, and I’ve been coming here for about 35 visits. When I first came here, I had a lot of problems with my back. I couldn’t sit comfortably and I would always feel very nauseous. Today, speaking with Dr. Caroline, I noticed that for the last 3 months, I was able to sit properly, I don’t feel nauseous at all and I’m super excited. So, if you guys are looking for a great chiropractor, come to Balance Atlanta. She is AWESOME!
First visit with Dr. Caroline, and I already feel like I have a brand new back. Thoughtful and experienced care combined to deliver life changing results in just a few minutes. It was noticeable before I even left the office that several years of athletics and weight lifting damage had been treated, as a fair amount of persistent and lingering pain had been lifted. I would absolutely recommend Dr. Caroline and Balance Atlanta to anyone, whether for maintenance, or general treatment. Quite simply, the best!
Doctor Caroline is someone who genuinely cares about her patients and is truly passionate about what she is doing. She sees the bigger picture, and genuinely wants to help people as much as she possibly can whether it be in the form of a mentor, doctor, or even advice-giving friend. To ensure timely improvement, she holds not only the patient (whether it be an at home exercise or stretch) but also herself accountable to make sure the patient is feeling better. She is one of those people who really sees how everything fits together, can easily pinpoint what needs to affect what or what changes should be employed to make the whole system running better, whether it be a change in diet, posture, habits, or attitude. The day is yet to come before I meet somebody who knows this much about a healthy body and lifestyle. I have been seeing her for several months now for corrective care and will continue to do so, because with each appointment I feel better.
I’ve really enjoyed working with Dr. Caroline. I had frequent back pain that would last 1-2 weeks at a time and could not find a long-term solution. I went to Dr. Caroline, and she started with a comprehensive physical assessment. I had weekly adjustments, and she consistently provided additional information on stretches, exercises, and other holistic health pointers, all of which were extremely valuable. I have now been pain-free for almost a year.
I’ve been bringing my 4 year old daughter to Balance Atlanta for several months now. What I love about Dr. C is her personalized attention to each client. She took so much time with me to discuss a holistic approach for my daughter beyond just chiropractic care, including nutrition. Dr. C is so dedicated and committed to the health and wellness of her patients, and it shows during each visit. Holly is also amazing and so friendly, as well. It’s a wonderful clinic and so great for the whole family. I highly recommend it!
I’m so happy to have met Dr. Caroline! She’s one of the most trustworthy chiropractors I’ve ever met and I’ve met a lot of them. Not only is she exceptionally knowledgeable, she also has a heart of gold. She’s not afraid to tell if like it is, especially when it comes to her patients’ health. I’ve recommended others to see her and I endorse her wholeheartedly for anyone looking for the highest level of chiropractic care. Thank you, Dr. Caroline!
I’m so happy to have met Dr. Caroline! She’s one of the most trustworthy chiropractors I’ve ever met and I’ve met a lot of them. Not only is she exceptionally knowledgeable, she also has a heart of gold. She’s not afraid to tell if like it is, especially when it comes to her patients’ health. I’ve recommended others to see her and I endorse her wholeheartedly for anyone looking for the highest level of chiropractic care. Thank you, Dr. Caroline!
Dr. Caroline is awesome! She has positively changed the way I feel and move, I wish I had gone to her much sooner.
I want to tell you this amazing story about Dr. Caroline. She is wonderful! I came in about a couple months ago. I had my pelvic totally misaligned. But over time, slowly, I am back aligned again! I am so grateful and so very happy! She’s the most amazing person and the most amazing Doctor EVER! I love the sweet surprises. You never know if you’re going to walk out with a pocket full of candies or just a big hug. Overall, the mental and physical treatment here is amazing. You are going to love it! I received her wonderful card with all the wonderful words. You know, she is the one who deserves the admiration. I think she set a new high standard for doctors. Dr. C took such good care of me in Atlanta. I am continuing with treatments here in Michigan under Dr. ED. I can’t even tell you the gains that has been made. I will have to WALK into Dr. C’s office for her to see. Did you get the WALKING part? Yes at times l can walk without a cane!!!
I have only been seeing Dr. Caroline von Fluegge-Chen for a month and she is not only dedicated to helping my fix my back issues but opened my mind up to so much. It is obvious she is extremely dedicated to create true balance in a persons life and lives up to their brand name. People go their entire life without finding a doctor that truly cares about your entire wellbeing. I am one of the luck few that found one. If I could give Balance more than 5-stars I would! You won’t retreat going.
