Guest guest Posted March 9, 2006 Report Share Posted March 9, 2006 For those of you keeping track, the 2nd installment of the NPR radio series exploring back pain was this AM. Although I, like you, are curious to see how they frame DCs in the back pain milieu, today's piece, coupled with a recent case, pointed out what I see as a need for a reframe or our position. First, they highlighted a physical therapist today who succeeded in helping a woman's unresponsive LBP (2 years of PT visits), by doing a functional analysis (read Steve Yeoman's book for more info) and targeting specific core stabilization exercises to address the woman's condition. They also highlighted another psychologist, I think, who was using PMR feedback to address sress/muscle tension aspect of the pain. My point is that these are things that many of us were also trained to do, and actually use in practice on a day to day basis. However, the public continues to view us as " adjustors " of the spine (when kind). It's nice to see the lights come on in referring physician's eyes and in patient's when they realize that you have deep knowledge of not only manipulation, but also specific exercise, functional analysis, flexion-distraction, myofascial release, level of evidence on transforaminal steroid injections/laminectomies/spinal fusion etc. I recently got my first referral from a DPT at Kaiser. He recommended SMT for the patient because in WA, he cannot perform SMT d/t the chiro lobby there, recommended my services, and did this despite the objections of the patient's PCP, who was a PA. Patient said the PA recommended against the DC referral, using the " Q " word and " quasireligious " in his opinion. Patient improved with myofascial release, SMT and specific exercises based on results of lumbar functional capacity evaluation. Patient is mid 20s, and mentioned during the course of care that he occasionally had AM lumbosacral pain when he bent his head forward while sitting. He had that sx on this particular day, and deeper questioning revealed that his mother has " arthritis " he had failed to mention in intake. Further Qs sounded like inflammatory variety. Myofascial release improved the condition that day. But in a letter back to the PA after the 5th of 6 alloted visits, I suggested HLA B27, RF, ESR and ANA blood work to be safe. Much to my surprise, the PA ran the tests, and patient was diagnosed with early AS. Take home, using evidence based methods, opened doors for referral, improved patient care and resulted in (I hope) the changing of a gate keepers mind about what we do day in and out. Time will tell if his behavior changes. My opinion, we will all benefit greatly by positioning ourselves as the go-to experts on managing the spine conservatively for prevention, acute, subacute, chronic, rehab, and appropriate referral. Take care. Note new address! W. Snell, D.C. 3942 SE Hawthorne Blvd. Portland, OR 97214 Ph. 503-235-5484 Fax 503-235-3956 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 9, 2006 Report Share Posted March 9, 2006 For those of you that listened to the piece this morning (I was still half asleep), did the PT actually say that part of their analysis included "pushing down on the shoulders until the spine buckles in order to see if there is an instability"?!! Yow! If someone did that to me and my abused lower back I'd be unable to walk upright for a week. Can you imagine if a quiet spondy walked in and had that done? Rod , DC NPR segment For those of you keeping track, the 2nd installment of the NPR radio series exploring back pain was this AM. Although I, like you, are curious to see how they frame DCs in the back pain milieu, today's piece, coupled with a recent case, pointed out what I see as a need for a reframe or our position. First, they highlighted a physical therapist today who succeeded in helping a woman's unresponsive LBP (2 years of PT visits), by doing a functional analysis (read Steve Yeoman's book for more info) and targeting specific core stabilization exercises to address the woman's condition. They also highlighted another psychologist, I think, who was using PMR feedback to address sress/muscle tension aspect of the pain.My point is that these are things that many of us were also trained to do, and actually use in practice on a day to day basis. However, the public continues to view us as "adjustors" of the spine (when kind). It's nice to see the lights come on in referring physician's eyes and in patient's when they realize that you have deep knowledge of not only manipulation, but also specific exercise, functional analysis, flexion-distraction, myofascial release, level of evidence on transforaminal steroid injections/laminectomies/spinal fusion etc.I recently got my first referral from a DPT at Kaiser. He recommended SMT for the patient because in WA, he cannot perform SMT d/t the chiro lobby there, recommended my services, and did this despite the objections of the patient's PCP, who was a PA. Patient said the PA recommended against the DC referral, using the "Q" word and "quasireligious" in his opinion. Patient improved with myofascial release, SMT and specific exercises based on results of lumbar functional capacity evaluation.Patient is mid 20s, and mentioned during the course of care that he occasionally had AM lumbosacral pain when he bent his head forward while sitting. He had that sx on this particular day, and deeper questioning revealed that his mother has "arthritis" he had failed to mention in intake. Further Qs sounded like inflammatory variety. Myofascial release improved the condition that day. But in a letter back to the PA after the 5th of 6 alloted visits, I suggested HLA B27, RF, ESR and ANA blood work to be safe. Much to my surprise, the PA ran the tests, and patient was diagnosed with early AS.Take home, using evidence based methods, opened doors for referral, improved patient care and resulted in (I hope) the changing of a gate keepers mind about what we do day in and out. Time will tell if his behavior changes. My opinion, we will all benefit greatly by positioning ourselves as the go-to experts on managing the spine conservatively for prevention, acute, subacute, chronic, rehab, and appropriate referral. Take care.Note new address! W. Snell, D.C.3942 SE Hawthorne Blvd.Portland, OR 97214Ph. 503-235-5484Fax 503-235-3956 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 10, 2006 Report Share Posted March 10, 2006 Hey Rod, That test was unfamiliar to me as well. As I understood it, the PT loaded the shoulders while watching the spine, looking for the area of " give " in the spine. McGill describes a prone instability evaluation test that has been shown to be both valid and reliable, and might not be so provocative. The evaluation for instability in these more difficult cases is important as it is often overlooked, and will be less responsive to CMT. The instability hypothesis gained a better foothold in 1996 when one of McGil'ls grad students caught a videoflouroscopic image of a power lifter's spine buckling injury during a heavy deadlift. Also interesting in the NPR piece was the mention of the transversis abdominus as a specific target muscle for stabilization exercises. We were taught as much in school via " abdominal hollowing " exercises. Again, McGill showed the fallacy of this method recently, and demonstrates a better way to train the whole ab group without increasing the compressisve forces on the discs beyond acceptable levels. Note new address! W. Snell, D.C. 3942 SE Hawthorne Blvd. Portland, OR 97214 Ph. 503-235-5484 Fax 503-235-3956 >From: " Rod " <rjacksondc@...> >< >, " Snell " <drpsnell@...> >Subject: Re: NPR segment >Date: Thu, 9 Mar 2006 09:47:23 -0800 > >For those of you that listened to the piece this morning (I was still half >asleep), did the PT actually say that part of their analysis included > " pushing down on the shoulders until the spine buckles in order to see if >there is an instability " ?!! Yow! If someone did that to me and my abused >lower back I'd be unable to walk upright for a week. Can you imagine if a >quiet spondy walked in and had that done? > >Rod , DC > NPR segment > > > For those of you keeping track, the 2nd installment of the NPR radio >series > exploring back pain was this AM. Although I, like you, are curious to >see > how they frame DCs in the back pain milieu, today's piece, coupled with >a > recent case, pointed out what I see as a need for a reframe or our > position. First, they highlighted a physical therapist today who >succeeded > in helping a woman's unresponsive LBP (2 years of PT visits), by doing a > functional analysis (read Steve Yeoman's book for more info) and >targeting > specific core stabilization exercises to address the woman's condition. > They also highlighted another psychologist, I think, who was using PMR > feedback to address sress/muscle tension aspect of the pain. > > My point is that these are things that many of us were also trained to >do, > and actually use in practice on a day to day basis. However, the public > continues to view us as " adjustors " of the spine (when kind). It's nice >to > see the lights come on in referring physician's eyes and in patient's >when > they realize that you have deep knowledge of not only manipulation, but >also > specific exercise, functional analysis, flexion-distraction, myofascial > release, level of evidence on transforaminal steroid > injections/laminectomies/spinal fusion etc. > > I recently got my first referral from a DPT at Kaiser. He recommended >SMT > for the patient because in WA, he cannot perform SMT d/t the chiro lobby > there, recommended my services, and did this despite the objections of >the > patient's PCP, who was a PA. Patient said the PA recommended against >the DC > referral, using the " Q " word and " quasireligious " in his opinion. >Patient > improved with myofascial release, SMT and specific exercises based on > results of lumbar functional capacity evaluation. > > Patient is mid 20s, and mentioned during the course of care that he > occasionally had AM lumbosacral pain when he bent his head forward while > sitting. He had that sx on this particular day, and deeper questioning > revealed that his mother has " arthritis " he had failed to mention in >intake. > Further Qs sounded like inflammatory variety. Myofascial release >improved > the condition that day. But in a letter back to the PA after the 5th of >6 > alloted visits, I suggested HLA B27, RF, ESR and ANA blood work to be >safe. > Much to my surprise, the PA ran the tests, and patient was diagnosed >with > early AS. > > Take home, using evidence based methods, opened doors for referral, >improved > patient care and resulted in (I hope) the changing of a gate keepers >mind > about what we do day in and out. Time will tell if his behavior >changes. > My opinion, we will all benefit greatly by positioning ourselves as the > go-to experts on managing the spine conservatively for prevention, >acute, > subacute, chronic, rehab, and appropriate referral. Take care. > > Note new address! > W. Snell, D.C. > 3942 SE Hawthorne Blvd. > Portland, OR 97214 > Ph. 503-235-5484 > Fax 503-235-3956 > > > > > OregonDCs rules: > 1. Keep correspondence professional; the purpose of the listserve is to >foster communication and collegiality. No personal attacks on listserve >members will be tolerated. > 2. Always sign your e-mails with your first and last name. > 3. The listserve is not secure; your e-mail could end up anywhere. >However, it is against the rules of the listserve to copy, print, forward, >or otherwise distribute correspondence written by another member without >his or her consent, unless all personal identifiers have been removed. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 10, 2006 Report Share Posted March 10, 2006 Thanks for the reply, - Where did you find the info on McGill's prone instability test and where can I find Steve Yeoman's book? I actually had a young female in yesterday with long standing low back pain from getting kicked in the back. When she extended, there was a visible "buckle" at the point of pain. Sent her for flex/ext films, seeing her again today. Funny how things come up! BTW - Are you in Bruce Chaser's old building? What a great area to have your practice in! Rod , DC NPR segment>>> For those of you keeping track, the 2nd installment of the NPR radio >series> exploring back pain was this AM. Although I, like you, are curious to >see> how they frame DCs in the back pain milieu, today's piece, coupled with >a> recent case, pointed out what I see as a need for a reframe or our> position. First, they highlighted a physical therapist today who >succeeded> in helping a woman's unresponsive LBP (2 years of PT visits), by doing a> functional analysis (read Steve Yeoman's book for more info) and >targeting> specific core stabilization exercises to address the woman's condition.> They also highlighted another psychologist, I think, who was using PMR> feedback to address sress/muscle tension aspect of the pain.>> My point is that these are things that many of us were also trained to >do,> and actually use in practice on a day to day basis. However, the public> continues to view us as "adjustors" of the spine (when kind). It's nice >to> see the lights come on in referring physician's eyes and in patient's >when> they realize that you have deep knowledge of not only manipulation, but >also> specific exercise, functional analysis, flexion-distraction, myofascial> release, level of evidence on transforaminal steroid> injections/laminectomies/spinal fusion etc.>> I recently got my first referral from a DPT at Kaiser. He recommended >SMT> for the patient because in WA, he cannot perform SMT d/t the chiro lobby> there, recommended my services, and did this despite the objections of >the> patient's PCP, who was a PA. Patient said the PA recommended against >the DC> referral, using the "Q" word and "quasireligious" in his opinion. >Patient> improved with myofascial release, SMT and specific exercises based on> results of lumbar functional capacity evaluation.>> Patient is mid 20s, and mentioned during the course of care that he> occasionally had AM lumbosacral pain when he bent his head forward while> sitting. He had that sx on this particular day, and deeper questioning> revealed that his mother has "arthritis" he had failed to mention in >intake.> Further Qs sounded like inflammatory variety. Myofascial release >improved> the condition that day. But in a letter back to the PA after the 5th of >6> alloted visits, I suggested HLA B27, RF, ESR and ANA blood work to be >safe.> Much to my surprise, the PA ran the tests, and patient was diagnosed >with> early AS.>> Take home, using evidence based methods, opened doors for referral, >improved> patient care and resulted in (I hope) the changing of a gate keepers >mind> about what we do day in and out. Time will tell if his behavior >changes.> My opinion, we will all benefit greatly by positioning ourselves as the> go-to experts on managing the spine conservatively for prevention, >acute,> subacute, chronic, rehab, and appropriate referral. Take care.>> Note new address!> W. Snell, D.C.> 3942 SE Hawthorne Blvd.> Portland, OR 97214> Ph. 503-235-5484> Fax 503-235-3956>>>>> OregonDCs rules:> 1. Keep correspondence professional; the purpose of the listserve is to >foster communication and collegiality. No personal attacks on listserve >members will be tolerated.> 2. Always sign your e-mails with your first and last name.> 3. The listserve is not secure; your e-mail could end up anywhere. >However, it is against the rules of the listserve to copy, print, forward, >or otherwise distribute correspondence written by another member without >his or her consent, unless all personal identifiers have been removed.>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 10, 2006 Report Share Posted March 10, 2006 Dennis, Last Wed I had the opportunity to give a short 30 min lecture to all the Kaiser Rheumatology MD, Nursing and some support staff. They wanted information on chiropractic. THe lecture was received better than I could've imagined. They had never heard of low velocity or light force adjusting technique. Altho my lecture covered both high velocity and low velocity adjustive techniques, all of them were aware of 'hard force' or high velocity adjusting techniques. They were amazed to learn that we have MANY ways to adjust a skeleton based on patient profile. Interestingly, one of the very first questions they asked was, " What is your profession doing about evidence based outcomes and clinical justification?" That was the exact wording from one of the doctors. I was able to tell them about the EMEBC (educational manual for evidence based outcomes) and the clinical justification rule as examples of our profession's work in that direction. What seemed to be an adversarial question line, became a great conversation. I ended up staying for about 3 hours and had lunch with them. I sat with about 6-7 MDs and by the end of lunch and much anatomy discussion and treatment protocol discussion they were asking for my card to schedule an appointment. They also asked , "how many DCs know how to use low velocity adjusting procedues?" I told them that most know how to use lighter force when the situation calls for it. That we are very aware of contraindications. I was also able to put a plug in for getting x-rays with the referrals so that we can see calcified longitudinal ligs, bone spurs, DJD, lesthesis etc before adjusting. In addition, I let them know that even with calcific bone bridging, a rheumatological patient may choose to have high velocity adjusting and put up with some pain in order to prevent continued fusion and regain ROM. They were very excited about referring to DCs by the end of the lecture. Minga Guerrero DC In a message dated 3/9/2006 8:40:42 A.M. Pacific Standard Time, drpsnell@... writes: For those of you keeping track, the 2nd installment of the NPR radio series exploring back pain was this AM. Although I, like you, are curious to see how they frame DCs in the back pain milieu, today's piece, coupled with a recent case, pointed out what I see as a need for a reframe or our position. First, they highlighted a physical therapist today who succeeded in helping a woman's unresponsive LBP (2 years of PT visits), by doing a functional analysis (read Steve Yeoman's book for more info) and targeting specific core stabilization exercises to address the woman's condition. They also highlighted another psychologist, I think, who was using PMR feedback to address sress/muscle tension aspect of the pain.My point is that these are things that many of us were also trained to do, and actually use in practice on a day to day basis. However, the public continues to view us as "adjustors" of the spine (when kind). It's nice to see the lights come on in referring physician's eyes and in patient's when they realize that you have deep knowledge of not only manipulation, but also specific exercise, functional analysis, flexion-distraction, myofascial release, level of evidence on transforaminal steroid injections/laminectomies/spinal fusion etc.I recently got my first referral from a DPT at Kaiser. He recommended SMT for the patient because in WA, he cannot perform SMT d/t the chiro lobby there, recommended my services, and did this despite the objections of the patient's PCP, who was a PA. Patient said the PA recommended against the DC referral, using the "Q" word and "quasireligious" in his opinion. Patient improved with myofascial release, SMT and specific exercises based on results of lumbar functional capacity evaluation.Patient is mid 20s, and mentioned during the course of care that he occasionally had AM lumbosacral pain when he bent his head forward while sitting. He had that sx on this particular day, and deeper questioning revealed that his mother has "arthritis" he had failed to mention in intake. Further Qs sounded like inflammatory variety. Myofascial release improved the condition that day. But in a letter back to the PA after the 5th of 6 alloted visits, I suggested HLA B27, RF, ESR and ANA blood work to be safe. Much to my surprise, the PA ran the tests, and patient was diagnosed with early AS.Take home, using evidence based methods, opened doors for referral, improved patient care and resulted in (I hope) the changing of a gate keepers mind about what we do day in and out. Time will tell if his behavior changes. My opinion, we will all benefit greatly by positioning ourselves as the go-to experts on managing the spine conservatively for prevention, acute, subacute, chronic, rehab, and appropriate referral. Take care.Note new address! W. Snell, D.C.3942 SE Hawthorne Blvd.Portland, OR 97214Ph. 503-235-5484Fax 503-235-3956OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 10, 2006 Report Share Posted March 10, 2006 Very cool.... Vern Saboe Re: NPR segment Dennis, Last Wed I had the opportunity to give a short 30 min lecture to all the Kaiser Rheumatology MD, Nursing and some support staff. They wanted information on chiropractic. THe lecture was received better than I could've imagined. They had never heard of low velocity or light force adjusting technique. Altho my lecture covered both high velocity and low velocity adjustive techniques, all of them were aware of 'hard force' or high velocity adjusting techniques. They were amazed to learn that we have MANY ways to adjust a skeleton based on patient profile. Interestingly, one of the very first questions they asked was, " What is your profession doing about evidence based outcomes and clinical justification?" That was the exact wording from one of the doctors. I was able to tell them about the EMEBC (educational manual for evidence based outcomes) and the clinical justification rule as examples of our profession's work in that direction. What seemed to be an adversarial question line, became a great conversation. I ended up staying for about 3 hours and had lunch with them. I sat with about 6-7 MDs and by the end of lunch and much anatomy discussion and treatment protocol discussion they were asking for my card to schedule an appointment. They also asked , "how many DCs know how to use low velocity adjusting procedues?" I told them that most know how to use lighter force when the situation calls for it. That we are very aware of contraindications. I was also able to put a plug in for getting x-rays with the referrals so that we can see calcified longitudinal ligs, bone spurs, DJD, lesthesis etc before adjusting. In addition, I let them know that even with calcific bone bridging, a rheumatological patient may choose to have high velocity adjusting and put up with some pain in order to prevent continued fusion and regain ROM. They were very excited about referring to DCs by the end of the lecture. Minga Guerrero DC In a message dated 3/9/2006 8:40:42 A.M. Pacific Standard Time, drpsnell@... writes: For those of you keeping track, the 2nd installment of the NPR radio series exploring back pain was this AM. Although I, like you, are curious to see how they frame DCs in the back pain milieu, today's piece, coupled with a recent case, pointed out what I see as a need for a reframe or our position. First, they highlighted a physical therapist today who succeeded in helping a woman's unresponsive LBP (2 years of PT visits), by doing a functional analysis (read Steve Yeoman's book for more info) and targeting specific core stabilization exercises to address the woman's condition. They also highlighted another psychologist, I think, who was using PMR feedback to address sress/muscle tension aspect of the pain.My point is that these are things that many of us were also trained to do, and actually use in practice on a day to day basis. However, the public continues to view us as "adjustors" of the spine (when kind). It's nice to see the lights come on in referring physician's eyes and in patient's when they realize that you have deep knowledge of not only manipulation, but also specific exercise, functional analysis, flexion-distraction, myofascial release, level of evidence on transforaminal steroid injections/laminectomies/spinal fusion etc.I recently got my first referral from a DPT at Kaiser. He recommended SMT for the patient because in WA, he cannot perform SMT d/t the chiro lobby there, recommended my services, and did this despite the objections of the patient's PCP, who was a PA. Patient said the PA recommended against the DC referral, using the "Q" word and "quasireligious" in his opinion. Patient improved with myofascial release, SMT and specific exercises based on results of lumbar functional capacity evaluation.Patient is mid 20s, and mentioned during the course of care that he occasionally had AM lumbosacral pain when he bent his head forward while sitting. He had that sx on this particular day, and deeper questioning revealed that his mother has "arthritis" he had failed to mention in intake. Further Qs sounded like inflammatory variety. Myofascial release improved the condition that day. But in a letter back to the PA after the 5th of 6 alloted visits, I suggested HLA B27, RF, ESR and ANA blood work to be safe. Much to my surprise, the PA ran the tests, and patient was diagnosed with early AS.Take home, using evidence based methods, opened doors for referral, improved patient care and resulted in (I hope) the changing of a gate keepers mind about what we do day in and out. Time will tell if his behavior changes. My opinion, we will all benefit greatly by positioning ourselves as the go-to experts on managing the spine conservatively for prevention, acute, subacute, chronic, rehab, and appropriate referral. Take care.Note new address! W. Snell, D.C.3942 SE Hawthorne Blvd.Portland, OR 97214Ph. 503-235-5484Fax 503-235-3956OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 11, 2006 Report Share Posted March 11, 2006 Hey , Although this guy does give some evidence to the old saying " He knows just enough to get himself into trouble " , my hat's off to him for shelving his predjudice and responding to the information presented in a language he can understand. To be even-handed, when I was in school, we had one of the whole family illness events. After the wife and son improved, I got nailed by a nasty chest cold that seemed to be consolidating. I saw a very nice, knowledgable PA at Kaiser, who looked at the X-rays with me (we were studying radiographic studies of pneumonia at the time) and he revealed that if he had it all to do over, he would have gone to chiro school. He had worked under a DO for 15 years, and had been taught manipulation skills. When he moved to Kaiser, he said the other docs on the floor treated him like he " walked on water " when he could help an acute LBP patient. His biggest disgruntlement was the look on patients' faces when he corrected them for calling him doctor, and always being considered " less than " . Note new address! W. Snell, D.C. 3942 SE Hawthorne Blvd. Portland, OR 97214 Ph. 503-235-5484 Fax 503-235-3956 >From: " hillcrestchiro " <hillcrestchiro@...> > " Snell " <drpsnell@...> >Subject: Re: NPR segment >Date: Fri, 10 Mar 2006 22:13:52 -0000 > >PAs are the absolute worst! A little education and a whole lot of >latitude equals a " quasi-MD " . > > , DC > > > > > > > > For those of you keeping track, the 2nd installment of the NPR >radio series > > exploring back pain was this AM. Although I, like you, are >curious to see > > how they frame DCs in the back pain milieu, today's piece, coupled >with a > > recent case, pointed out what I see as a need for a reframe or >our > > position. First, they highlighted a physical therapist today who >succeeded > > in helping a woman's unresponsive LBP (2 years of PT visits), by >doing a > > functional analysis (read Steve Yeoman's book for more info) and >targeting > > specific core stabilization exercises to address the woman's >condition. > > They also highlighted another psychologist, I think, who was using >PMR > > feedback to address sress/muscle tension aspect of the pain. > > > > My point is that these are things that many of us were also >trained to do, > > and actually use in practice on a day to day basis. However, the >public > > continues to view us as " adjustors " of the spine (when kind). >It's nice to > > see the lights come on in referring physician's eyes and in >patient's when > > they realize that you have deep knowledge of not only >manipulation, but also > > specific exercise, functional analysis, flexion-distraction, >myofascial > > release, level of evidence on transforaminal steroid > > injections/laminectomies/spinal fusion etc. > > > > I recently got my first referral from a DPT at Kaiser. He >recommended SMT > > for the patient because in WA, he cannot perform SMT d/t the chiro >lobby > > there, recommended my services, and did this despite the >objections of the > > patient's PCP, who was a PA. Patient said the PA recommended >against the DC > > referral, using the " Q " word and " quasireligious " in his opinion. >Patient > > improved with myofascial release, SMT and specific exercises based >on > > results of lumbar functional capacity evaluation. > > > > Patient is mid 20s, and mentioned during the course of care that >he > > occasionally had AM lumbosacral pain when he bent his head forward >while > > sitting. He had that sx on this particular day, and deeper >questioning > > revealed that his mother has " arthritis " he had failed to mention >in intake. > > Further Qs sounded like inflammatory variety. Myofascial >release improved > > the condition that day. But in a letter back to the PA after the >5th of 6 > > alloted visits, I suggested HLA B27, RF, ESR and ANA blood work to >be safe. > > Much to my surprise, the PA ran the tests, and patient was >diagnosed with > > early AS. > > > > Take home, using evidence based methods, opened doors for >referral, improved > > patient care and resulted in (I hope) the changing of a gate >keepers mind > > about what we do day in and out. Time will tell if his behavior >changes. > > My opinion, we will all benefit greatly by positioning ourselves >as the > > go-to experts on managing the spine conservatively for prevention, >acute, > > subacute, chronic, rehab, and appropriate referral. Take care. > > > > Note new address! > > W. Snell, D.C. > > 3942 SE Hawthorne Blvd. > > Portland, OR 97214 > > Ph. 503-235-5484 > > Fax 503-235-3956 > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 11, 2006 Report Share Posted March 11, 2006 Hey Dan, I don't have the text of the artticle as I am at home for the moment. As to what the researchers were viewing, it was exactly a subluxation as defined by any medical dictionary as a partial dislocation. As to his understanding of proprioceptive malfunction in the genesis of LBP, most of his most recent book is dedicated to exactly that. How to assess, and address that proprioceptive deficit in the treatment of back pain. His work is informed by chiropractors, Craig Leibenson is a presenter at his instructional modules if i'm not mistaken. As to your mention of the " S " word, as it historically pertains to chiropractic, this topic just came up on another listserve, and someone posted this reference. After seeing a subluxation PSA [public service announcement] 5% [of viewers] were very interested in consulting a DC. 15% somewhat interested and 75% not at all From: J. Chiropractic Business, July/Autumn 2000 Snell, DC >From: " D Beebe, D.C. " <res0btan@...> > " Snell " <drpsnell@...> >Subject: Re: NPR segment >Date: Fri, 10 Mar 2006 09:52:19 -0800 > > > >McGill was so wrapped up in his evaluation that he didn't even realize he >was seeing an acute subluxation, and, if my memory is correct never >mentioned the " S " word in his research. > >He did not undestand that the proprioceptive error from an assymptomatic >subluxation lead to the motor control error causing an acute subluxation. > >His research further defined that in an acute situation such a this, >reduction of pain and increased function would not occur for 3 months. > >Probably wise to take this research into consideration in developing those > " evidenced based guidelines " but to look at the research through a >Chiropractic view vs an academacian's. > >Wished I would have received all the wasted monies on those proper lifting >schools. > >Regards, > >Danno > NPR segment >>> >>> >>> For those of you keeping track, the 2nd installment of the NPR radio >>>series >>> exploring back pain was this AM. Although I, like you, are curious to >>>see >>> how they frame DCs in the back pain milieu, today's piece, coupled >>>with >>>a >>> recent case, pointed out what I see as a need for a reframe or our >>> position. First, they highlighted a physical therapist today who >>>succeeded >>> in helping a woman's unresponsive LBP (2 years of PT visits), by doing >>>a >>> functional analysis (read Steve Yeoman's book for more info) and >>>targeting >>> specific core stabilization exercises to address the woman's >>>condition. >>> They also highlighted another psychologist, I think, who was using PMR >>> feedback to address sress/muscle tension aspect of the pain. >>> >>> My point is that these are things that many of us were also trained to >>>do, >>> and actually use in practice on a day to day basis. However, the >>>public >>> continues to view us as " adjustors " of the spine (when kind). It's >>>nice >>>to >>> see the lights come on in referring physician's eyes and in patient's >>>when >>> they realize that you have deep knowledge of not only manipulation, >>>but >>>also >>> specific exercise, functional analysis, flexion-distraction, >>>myofascial >>> release, level of evidence on transforaminal steroid >>> injections/laminectomies/spinal fusion etc. >>> >>> I recently got my first referral from a DPT at Kaiser. He recommended >>>SMT >>> for the patient because in WA, he cannot perform SMT d/t the chiro >>>lobby >>> there, recommended my services, and did this despite the objections of >>>the >>> patient's PCP, who was a PA. Patient said the PA recommended against >>>the DC >>> referral, using the " Q " word and " quasireligious " in his opinion. >>>Patient >>> improved with myofascial release, SMT and specific exercises based on >>> results of lumbar functional capacity evaluation. >>> >>> Patient is mid 20s, and mentioned during the course of care that he >>> occasionally had AM lumbosacral pain when he bent his head forward >>>while >>> sitting. He had that sx on this particular day, and deeper >>>questioning >>> revealed that his mother has " arthritis " he had failed to mention in >>>intake. >>> Further Qs sounded like inflammatory variety. Myofascial release >>>improved >>> the condition that day. But in a letter back to the PA after the 5th >>>of >>>6 >>> alloted visits, I suggested HLA B27, RF, ESR and ANA blood work to be >>>safe. >>> Much to my surprise, the PA ran the tests, and patient was diagnosed >>>with >>> early AS. >>> >>> Take home, using evidence based methods, opened doors for referral, >>>improved >>> patient care and resulted in (I hope) the changing of a gate keepers >>>mind >>> about what we do day in and out. Time will tell if his behavior >>>changes. >>> My opinion, we will all benefit greatly by positioning ourselves as >>>the >>> go-to experts on managing the spine conservatively for prevention, >>>acute, >>> subacute, chronic, rehab, and appropriate referral. Take care. >>> >>> Note new address! >>> W. Snell, D.C. >>> 3942 SE Hawthorne Blvd. >>> Portland, OR 97214 >>> Ph. 503-235-5484 >>> Fax 503-235-3956 >>> >>> >>> >>> >>> OregonDCs rules: >>> 1. Keep correspondence professional; the purpose of the listserve is >>>to >>>foster communication and collegiality. No personal attacks on listserve >>>members will be tolerated. >>> 2. Always sign your e-mails with your first and last name. >>> 3. The listserve is not secure; your e-mail could end up anywhere. >>>However, it is against the rules of the listserve to copy, print, >>>forward, >>>or otherwise distribute correspondence written by another member without >>>his or her consent, unless all personal identifiers have been removed. >>> >>> >>> >>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 13, 2006 Report Share Posted March 13, 2006 Good Work Minga!! Dr. ph Medlin D.C.Spine Tree Chiropractic1627 NE Alberta St. #6Portland, OR 97211Ph: 503-788-6800c: 503-889-6204 Re: NPR segment Dennis, Last Wed I had the opportunity to give a short 30 min lecture to all the Kaiser Rheumatology MD, Nursing and some support staff. They wanted information on chiropractic. THe lecture was received better than I could've imagined. They had never heard of low velocity or light force adjusting technique. Altho my lecture covered both high velocity and low velocity adjustive techniques, all of them were aware of 'hard force' or high velocity adjusting techniques. They were amazed to learn that we have MANY ways to adjust a skeleton based on patient profile. Interestingly, one of the very first questions they asked was, " What is your profession doing about evidence based outcomes and clinical justification?" That was the exact wording from one of the doctors. I was able to tell them about the EMEBC (educational manual for evidence based outcomes) and the clinical justification rule as examples of our profession's work in that direction. What seemed to be an adversarial question line, became a great conversation. I ended up staying for about 3 hours and had lunch with them. I sat with about 6-7 MDs and by the end of lunch and much anatomy discussion and treatment protocol discussion they were asking for my card to schedule an appointment. They also asked , "how many DCs know how to use low velocity adjusting procedues?" I told them that most know how to use lighter force when the situation calls for it. That we are very aware of contraindications. I was also able to put a plug in for getting x-rays with the referrals so that we can see calcified longitudinal ligs, bone spurs, DJD, lesthesis etc before adjusting. In addition, I let them know that even with calcific bone bridging, a rheumatological patient may choose to have high velocity adjusting and put up with some pain in order to prevent continued fusion and regain ROM. They were very excited about referring to DCs by the end of the lecture. Minga Guerrero DC In a message dated 3/9/2006 8:40:42 A.M. Pacific Standard Time, drpsnell@... writes: For those of you keeping track, the 2nd installment of the NPR radio series exploring back pain was this AM. Although I, like you, are curious to see how they frame DCs in the back pain milieu, today's piece, coupled with a recent case, pointed out what I see as a need for a reframe or our position. First, they highlighted a physical therapist today who succeeded in helping a woman's unresponsive LBP (2 years of PT visits), by doing a functional analysis (read Steve Yeoman's book for more info) and targeting specific core stabilization exercises to address the woman's condition. They also highlighted another psychologist, I think, who was using PMR feedback to address sress/muscle tension aspect of the pain.My point is that these are things that many of us were also trained to do, and actually use in practice on a day to day basis. However, the public continues to view us as "adjustors" of the spine (when kind). It's nice to see the lights come on in referring physician's eyes and in patient's when they realize that you have deep knowledge of not only manipulation, but also specific exercise, functional analysis, flexion-distraction, myofascial release, level of evidence on transforaminal steroid injections/laminectomies/spinal fusion etc.I recently got my first referral from a DPT at Kaiser. He recommended SMT for the patient because in WA, he cannot perform SMT d/t the chiro lobby there, recommended my services, and did this despite the objections of the patient's PCP, who was a PA. Patient said the PA recommended against the DC referral, using the "Q" word and "quasireligious" in his opinion. Patient improved with myofascial release, SMT and specific exercises based on results of lumbar functional capacity evaluation.Patient is mid 20s, and mentioned during the course of care that he occasionally had AM lumbosacral pain when he bent his head forward while sitting. He had that sx on this particular day, and deeper questioning revealed that his mother has "arthritis" he had failed to mention in intake. Further Qs sounded like inflammatory variety. Myofascial release improved the condition that day. But in a letter back to the PA after the 5th of 6 alloted visits, I suggested HLA B27, RF, ESR and ANA blood work to be safe. Much to my surprise, the PA ran the tests, and patient was diagnosed with early AS.Take home, using evidence based methods, opened doors for referral, improved patient care and resulted in (I hope) the changing of a gate keepers mind about what we do day in and out. Time will tell if his behavior changes. My opinion, we will all benefit greatly by positioning ourselves as the go-to experts on managing the spine conservatively for prevention, acute, subacute, chronic, rehab, and appropriate referral. Take care.Note new address! W. Snell, D.C.3942 SE Hawthorne Blvd.Portland, OR 97214Ph. 503-235-5484Fax 503-235-3956OregonDCs rules:1. Keep correspondence professional; the purpose of the listserve is to foster communication and collegiality. No personal attacks on listserve members will be tolerated.2. Always sign your e-mails with your first and last name.3. The listserve is not secure; your e-mail could end up anywhere. However, it is against the rules of the listserve to copy, print, forward, or otherwise distribute correspondence written by another member without his or her consent, unless all personal identifiers have been removed. Quote Link to comment Share on other sites More sharing options...
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