A well-known expression in approaches to patient care is “if all you have is a hammer, all you see is a nail”. Surely this is also prevalent in other fields as well and basically means that often times a practitioner will have the patient fit into their scope of knowledge rather than objectively looking at a patient and deciding what the best course of care may be. Mostly this is done without any kind of malice, but there is an inherent bias that exists based on the training and specific skill set of the health care professional.
A patient with low back pain may present to the family doctor and simply be prescribed pain medications and told to come back in a couple weeks if it doesn’t resolve. This is not necessarily bad advice but simply how the doctor treats low back pain according to their skill set. Conversely an acupuncturist may see this as a problem that acupuncture can effectively treat. The same goes for a surgeon, physical therapy and yes of course a doctor of Chiropractic. And all these practitioners are likely correct to a degree. The pain may eventually get better and if it doesn’t the patient will likely seek an alternative practitioner to find some help. This exists with all types of injuries and illnesses. The problem is that patients often end up suffering for longer periods because they were not initially diagnosed correctly and proper treatment was delayed.
The goal of the health care practitioner from the initial assessment has to focus on diagnosing the problem correctly. This is often the most difficult thing to do because inherently we see things from a certain perspective and want to help our patients as best as we can. I believe that one of the strongest traits that a healthcare practitioner can have is knowing when to refer and having a strong network of other healthcare providers who can provide a different perspective. The patient has nothing to lose and everything to gain in this model.
Employing this approach, we were very happy to open Momentum Health in downtown Kelowna last month. We are proud to be able to offer chiropractic, registered massage therapy, Active Release Techniques and rehabilitation to our patients under one roof. We also look forward to adding other health disciplines in the coming months. It is an exciting time for us and we could not be more proud of the beautiful facility that we get to work out of each day and providing the best health services possible for our patients. All the practitioners at Momentum Health have many years of experience and our patients are already seeing the benefits of our collaborative approach.
We are located at 103-1664 Richter Street and our website is http://www.momentumkelowna.com . We look forward to connecting with you!
Among the most common complaints that are treated in Chiropractic practice are acute low back and neck pain. These are often idiopathic (which means no specific cause) and in the short term can be disabling and painful.
When this pain hits it will greatly reduce mobility and make the simplest tasks such as shoulder checking or putting on socks incredibly difficult. The management of these acute episodes of pain has greatly changed over the last 10-15 years. Gone (hopefully) are the days of recommending bed rest, immobility and ice as the only interventions. It has been shown that this sort of advice will delay recovery and increase pain and dysfunction.
When suffering with acute pain there are several things that a person can do to help manage the pain in order to get through the day:
1. Stay relatively active: This is particularly true with low back pain. The longer you lay around in bed or on couch, the longer the pain will typically persist. If there are no clinical contraindications, I advise my patients to stay active through walking or swimming etc. While this may be a little painful to start, generally as the body warms up, you will regain some mobility and associated pain relief.
2. Avoid static positions: I’m talking to you salespeople and desk workers. Sitting down for a four hour drive or logging a full day in front of the computer is a recipe for disaster. I always recommend frequent micro-breaks in order to prevent long term immobility.
3. Heat instead of Ice: Without any specific mechanism of injury such as a lifting, twisting movement or a whiplash situation there is no reason to ice. And even with those, most of the time people tend to do better by applying short bouts of a heat pack or hot shower to help maintain movement and control pain.
4. Choice of anti-inflammatories: Many people are intolerant to products such as acetaminophen or ibuprofen due to abdominal or liver problems. There are alternatives that have been shown to very effective for pain control and act in an anti-inflammatory way. Tumeric and Bromelain (which are often combined) are very safe to take, affordable and in some studies rate more highly in effectiveness and patient satisfaction when compared to ibuprofen.
When to get checked
If the pain and disability has not substantially improved after 2-3 days it is a good idea to get checked by a qualified Chiropractor. Chiropractors are able to very accurately assess, diagnose and provide treatment options to patients which can safely and quickly relieve pain. Through a consultation, a Chiropractor will also be able to help you discover what sort of movements you should be doing more of and what ones are best to be avoided in the short term. Most importantly, with a thorough clinical exam, Chiropractors are able to identify red flags that reveal a complaint of pain if something more than strained muscles or a stuck joint.
Communication is an often overlooked, but very important aspect of either doctor-patient or therapist-patient interaction. When patients refer friends and family to certain practitioners, it is because they obviously believe that practitioner is skilled in their field, but also they must have had some level of positive interaction as well. People don’t tend to refer their friends to jerks. Having a good rapport with patients is critical for doctors in order to establish trust so that patients are more likely to follow your recommendations. And as an obvious benefit for the doctor (especially one in private practice), those patients will return if and when future problems arise.
Over the last couple of weeks there have been a couple of very interesting blog posts written about the use of certain language used by doctors or therapists can that negatively influence patient perceptions and expectations (one of them written by a chiropractor is here). As an example I often review x-ray and CT scan reports with my patients in order to give a clear understanding of what they mean. Patients often are alarmed by the language contained in these reports because out of necessity in the radiology field, most reports contain wording that leads a patient to believe their ailment is more serious than it actually is. Phrases such as “degenerative changes” or “disk space narrowing” or “reversal of the cervical curve” give the impression to the patient that something is really wrong. And while this phrasing is technically appropriate and is required for clarity in report interpretation, how it is relayed to the patient is problematic. Patients hear these words and understandably get concerned. The problem is that most of the time these are changes that have been happening for years and are likely not related to the patient’s current complaints and are mostly normal for their age bracket. Most patients arrive in my office with acute musculoskeletal pain, which affects their function, yet doctors are quick to attribute their symptoms to structural changes (through imaging), which were present long before the new complaint.
In most instances (and especially with younger patients) imaging in the form of x-rays or a CT scan is not required and should NOT be used for dealing with musculoskeletal complaints. They should be used if Red Flags appear as part of the physical and orthopaedic exam that should be performed on a first visit. I have written previously on the use of both X-Rays and MRI in previous articles, which can be found here and here.
The job of both therapists and doctors in a clinical setting is to focus on enabling our patients; not to create fear and dependence. Patients have to be encouraged to move and to keep their levels of function and mobility high. I always try to encourage my patients to think about activities that they can be doing rather than what they shouldn’t. It is well know that regular activity is a much better treatment approach for aches and pains than rest and inactivity.
Sadly, some practitioners use x-rays to create that exact fear to set the stage for what is likely to be a long treatment regimen based on their ability to sell whatever treatment they use to “cure” what is likely not a major problem to begin with.
In my daily Chiropractic practice when helping patients with low back pain, one of the first movements I assess is the patient’s ability to squat properly. This may seem like a cruel thing to do to a person with back pain, but is actually clinically very revealing about why that patient may be in pain in the first place. Someone with poor squatting movement is much more likely to put undo stress on their lower back and more likely to re-injure themselves frequently throughout their lives.
In fact, a well known medical screening test known as the Sit to Stand test has shown that a person who has a poor ability to move from a sitting to standing position (essentially returning upright from a squatted position) has a 2 to 5 times higher mortality rate. The article regarding this test and the authors’ findings can be accessed here: Sit to Stand
The overhead squat is also one of the movements screens used in the popular assessment method known as Selective Functional Movement Assessment (SFMA). It assesses a person’s ability to squat fully to the floor with the heels down while holding a dowel overhead. It is actually a quite difficult task for a lot of people (myself included) and provides the therapist or doctor information about flexibility, mobility and trunk strength.
Being able to squat is an inherent human ability that we develop very young. Watch a 3-year-old squat and you are amazed by their ability to stay in that position, feet flat on the ground for long periods of time and be perfectly comfortable. As we get a little older and spend 12 years or much more behind a desk, we lose these inherent qualities such as ankle and hip mobility to be able to easily squat.
So now you can’t squat, but you still need to be able to complete low-level activities. So what do you do? You start bending at the waist, over and over again, throw in some rotation occasionally and in no time at all, you have a perfect recipe for low back pain. And by doing all that bending at the waist and avoiding squatting, you are further weakening your legs and glutes thereby impairing the likelihood that you will be able to achieve a squat or sit to stand movement in your later years.
What is the solution to this spiral? Squat and squat often. If you are unsure how to squat properly contact a knowledgeable health care provider who can teach you the proper technique. Learn how to squat properly and do it all your life. Chances are your life will be longer and you will have a significantly higher quality of life.
Read more Back to Basics articles
- Is the 'W' sit bad for kids? Oct 9
- Strength & Conditioning Conference Jul 17
- Fixing your shoulder Jun 26
- The truth about Spinal Discs May 1
- Roll to better golf Apr 3
- What is your passion? Mar 20
- Why rolling over is important Mar 6
- Chiropractic & sciatica symptoms Jan 23
- Is Paleo right for you? Jan 9
- Supplements for pain management Nov 28
- Core exercises you are better off without Nov 14
- Why your back hurts Oct 31
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