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A low back pain case study

By far and away the biggest reason people go to the chiropractor is for back pain. In the USA in the year 2016, we spend $380 billion dollars treating back pain. Back pain is a huge part of our medical expenditures. How can we reduce that expenditure? If we reduce the costs of any part of our medical bills it will have a positive effect on all of us. Naturally, we would benefit from reduced time and or amount of pain we would experience. We also would benefit in at least our insurance premiums not rising as fast if we don’t use the insurance as often.

Prevention is a huge part of reducing medical care. This is a topic for another day. Today, I want to focus on accuracy and efficiency of medical intervention in back pain. We have all heard about that person that has gone to a myriad of different doctors for a back problem. Each doctor makes their own diagnosis and tries their own form of treatment. The problem is, if the patient still has that pain, then the money and the time has not been used efficiently.

One of the ways to be efficient as a doctor is to truly make use of all that is presented to you by the patient and then by starting your own exploration of the problem from there. Recently, I had a patient, let’s call him Mr. Jones who presented to my office with low back pain on his right side at about the belt level. He had been to his family doctor, a physical therapist, and an orthopedic surgeon. He had x rays taken and MRIs taken. He had been prescribed anti-inflammatories, pain killers, and muscle relaxers. He had been diagnosed with slipped disc, lumbago, myalgia, and a lumbar sprain strain.

The thing is none of the diagnoses could be right because none of the treatments worked. This means that I should not use those diagnoses or those treatments. In my office, I operate an evidence-based practice. An evidence-based practice means that I follow a specific diagnostic sequence of thinking, use only the latest and most sensitive and effective orthopedic diagnostic tests, and all of these tools are all scientifically researched and supported. This helps me with my accuracy in diagnosing. When I am more accurate with my diagnosis, I am more effective with my treatment because I am treating what is the true source of the problem and not treating symptoms.

In Mr. Jones case, I knew the diagnostic tests for discs and sore muscles in the low back would not be positive and they were not. He still had the pain though. I tested for a problem in a different area of the spine that causes pain in the area of his chief complaint and that test was positive!

I treated Mr. Jones for four weeks at two visits per week. His pain was gone after the second visit. I also treated Mr. Jones by working in the office and having him work at home with exercises and stretches to stabilize the area we found in the spine that was causing his problem. Mr. Jones was thrilled with his progress and has agreed to continue with a maintenance care program. He explained it to me that he wasted so much time and money on his back before getting to my office, he was never going to let that happen again.

I do not want you to think that I am bragging as I write this blog. I would rather you remember to find a physician, chiropractor or otherwise, that takes the time to listen to your presentation when you are at his office. I would rather you find a doctor that is willing to do the digging to find the cause rather than just assign you the diagnosis that simply fits your symptom presentations when you describe them to him. Working that way, we all can save a lot of everybody’s time and money.

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