RD & Dr.Sood

Dr. Ron and Dr. Sarveshwar Sood of India

In my last blog posting, I was heading to Dubai to give a presentation at the World Congress on Low Back and Pelvic Pain.  This conference is considered by many to be “the place” to hear the latest and greatest research from the world’s top spine and pelvic researchers. Attendees include clinicians (doctors, physical therapists, and chiropractors mostly) and researchers – both clinical and basic science. The Congress is held every three years in a different, and always attractive, city.  More than 1,000 attended this four-day conference from 58 countries. The conference venue was outstanding and Dubai a fascinating city.

I’m sure most considered the presentations to be excellent research, yet so many were in fact only lectures about myofascial and musculature anatomy and physiology of the spine and pelvis, but no clinical data. The rationale for these presentations?… these structures are essential to spine movement and stability, ergo, they must in some way be deficient in painful individuals and therefore in need of strengthening or stretching.  So many presenters offered no explanation for how pain is generated related to these structures and their deficiencies, nor did they present any data as to the beneficial impact when people perform exercises that theoretically address these alleged deficiencies. In other words, so what?  Interesting anatomy and physiology, but where’s the clinical relevance?

One positive and significant program feature for me was the final half-day that focused on the topic of subgrouping: why is it important, how to validate subgroups, and examples of subgrouping efforts.

The final talk of that final day by Hanne Albert, PT, PhD from Denmark, was especially well-received.  She is an excellent presenter who reviewed her research in identifying and validating a new, but very small, subgroup within the chronic low back pain population whose pain appears to be due to an infection within a disc that was previously herniated and now has Modic 1 changes in the adjacent vertebrae.  Her RCT reports that this small subgroup does quite well with antibiotic treatment vs. being treated with a placebo medication.

What is remarkable is that identifying and preliminarily validating this subgroup is being hailed as a major breakthrough by the spine care world, despite only one RCT.  Further, even if this is all true, it is still only about 1% of the LBP population.

Meanwhile, my presentation, described in some detail in my last posting, preceded Dr. Albert’s.  It focused on two cases of radiculopathy and how both became completely pain-free in just 30 min. and were able to avoid scheduled surgery.  They both then fully recovered within days, and remained pain-free when last checked two years later.  All this happened because of their mechanical (MDT) assessment followed by performing some simple, safe exercises without risk or side-effects.

But then I additionally presented a great deal of published evidence that these rapid recoveries are actually very common, occurring in 70-89% of acutes, 50% of chronics and radiculopathies, most axial neck and low back pain, as well as a good percentage of stenotics and spondys.

Of course, most researchers have never, or have rarely, seen a patient evaluated or treated, so they have no appreciation for the rapid and rather dramatic rate and ease of eliminating these patients’ severe pain, sensory loss, and tension signs, while simultaneously restoring normal movement and reducing the size of their disc herniations – all within their 30-minute first session!

Just one question was addressed to me during the subsequent discussion. I was asked how the status of a painful disc’s hydrostatic mechanism influences whether the pain can be centralized or not. I responded with the results of our study published in 1997 that compared the findings of the MDT evaluation in patients who promptly underwent discography that identified the status of the anulus and hydrostatic mechanism in centralizers, peripheralizers and those who had no change in pain with their MDT assessment.

Not surprisingly, conference participants without any MDT training were described by one as “spellbound” because, on one hand, these two patients’ presentations were very familiar to them, yet they had no idea that such severe disc pathology could be turned around so quickly and easily.  One U.S. physiatrist also noted that I was the only speaker to present so much data in my literature overview.

Nevertheless, my sense was that Dr. Albert’s presentation caused the greater buzz, by far.  So why was that?

On one hand, even if we assume that her Modic infection subgroup is validated, that still only represents a very small portion of non-specific chronic LBP patients.  Furthermore, treatment consists of 100 days of oral antibiotics that routinely creates GI side-effects, an occasional temporary blackening of teeth, and some treatment failures of course.  Pain relief doesn’t begin until weeks into the treatment and then often does not resolve completely.  Nevertheless, even this small validated subgroup is worthwhile identifying for those with this infection who otherwise would continue in pain.

On the other hand, the “reducible derangements” (dir. pref. and centralization) that I described account for 70-89% of acutes, 50% of chronics and sciaticas.  The treatment is simple, safe, routinely brings complete pain relief, usually in minutes, hours or a few days, and commonly leads to long-term freedom from pain for patients who perform very simple exercises on a regular basis and guard their posture a bit.

So how much ‘buzz” did my presentation create?  Only a handful came up to me at the gala dinner that night to comment.  So my sense is that it did not cause as much stir as Dr. Albert’s work. Was that because those dramatic recoveries I showed were viewed by some as too-good-to-be-true? Or perhaps these highly prevalent rapid recoveries were just too disruptive to clinicians’ rigid perception of back pain’s pattern of slow recovery.

Regardless, the evidence indicates that every patient with neck or low back pain should undergo an MDT assessment and every clinician should be obliged to provide such an assessment for their painful spine patients. The strong possibility of such rapid, simple, and safe recoveries should be made available to all.

As always, I welcome feedback and questions. Please be sure to click on “Like” if this was useful and enlightening, or “Leave a Comment” by clicking on “Comment” below. Have a wonderful week everyone.

The cartoon showed a doctor in his office talking with his patient, saying: “I’ve just consulted with my accountant and he says you need surgery.” Like most jokes, the humor here is tied to an element of truth. Surgeons are often recognized for their financial conflict-of-interest (shall we say “economic bias”?) as they decide whether or not to recommend surgery.

Read the rest of this entry »

Dr. John Wennberg, Founder and Director Emeritus of The Dartmouth Institute for Health Policy and Clinical Practice, has asked: “If operating on the wrong leg is considered a medical error, what do we call operating on someone who doesn’t need surgery?” Operating on the wrong leg is every surgeon’s (and patient’s) worst nightmare, but Wennberg infers that operating unnecessarily is of even greater concern. Read the rest of this entry »

While the term “McKenzie care” is very familiar to most physicians, it is a greatly misunderstood form of care. Because family physicians and internists play such an important role in initiating care for back and neck pain, it’s important for them in particular to understand just what McKenzie care is. So let me briefly cover ten things that all health care practitioners, but family docs in particular, should know about McKenzie spine care. Read the rest of this entry »

First, I’d like to wish everyone a very Merry Christmas and may 2012 be a year of prosperity: physically, spiritually, emotionally, and financially.

I have advocated the benefits of making a mechanical diagnosis in individuals with back and neck pain since I first learned about how this was done 30 years ago. It was so impressive to see Robin McKenzie use his spinal movement testing methods to identify what proved to me over subsequent years to be very common patterns of pain response. These patterns enabled the classification of most patients into mechanical subgroups for which there were distinct and predictably effective solutions. Read the rest of this entry »

In their excellent book about health care reform entitled “The Innovator’s Prescription”, Christiansen, et al provide some very practical insight into the challenge of diagnosing and treating low back and neck pain. The authors describe three sequential eras or phases of medicine: Intuitive, Empirical, and Precision medicine. Read the rest of this entry »

I just returned from a most enjoyable trip to Warsaw, Poland where I was an invited speaker at the First Polish Conference on Mechanical Diagnosis & Therapy (MDT).  Most of the nearly 500 attendees had had some MDT training and most of those had passed the MDT credentialing examination.

In a discipline dominated by physical therapists, it is remarkable that more than 50 physicians in Poland have completed the entire McKenzie Institute course curriculum and also passed that exam.  I believe that’s primarily because, in Poland, it was an orthopedic surgeon, Dr. Tomasz Stengert, who first recognized 15 years ago the clinical value and effectiveness of MDT and subsequently founded the Polish branch of the McKenzie Institute.  He has personally taught most of the MDT courses that have attracted many physicians as well as physical therapists.  By way of contrast, there are only a handful of MDT-Credentialed physicians in the entire U.S., but then there are no physician McKenzie Institute faculty members teaching the basic training courses.

Meanwhile, over the years, I’ve been a guest speaker at MDT conferences and taught MDT overview courses to physicians in more than a dozen countries.  It always amazes me what conscientious and patient-centric clinicians I meet.  I believe that’s because the MDT paradigm attracts clinicians with the right motives.  There is no great financial reward for investing in the learning of these methods of care as there is in learning most other clinical “procedures”. They are instead attracted to the opportunity to learn how to determine with considerable precision the nature of each patient’s underlying disorder, their “mechanical diagnosis”.  That in turn identifies for most a standardized and predictably effective treatment that directly addresses the underlying cause, and not just the symptom.  If you’ve accurately determined a patient’s mechanical diagnosis, the patient can usually rapidly, and often dramatically, correct it themselves without needing to know the precise anatomic diagnosis.  That’s very satisfying, but also very fortunate since we are unable to make an anatomic diagnosis for most LBP.  And even when we can, i.e. a herniated disc causing sciatica, that anatomic diagnosis is typically insufficient to inform standardized, predictably effective treatment.

I either attend and speak at a number of non-MDT spine conferences each year.  In my 30+ years experience, these are distinctly different from MDT conferences.  They are characterized instead more by a lack of uniformity in how attendees manage their patients.  The focus is often on “one-ups-man-ship”, nearly always regarding the best treatments or the best study of treatment efficacy, rather than learning how to make a more precise diagnosis that then helps identify a more effective treatment for each patient.  While these organizations and societies are portrayed as scientific forums, many or the leaders have significant financial conflicts-of-interest undermining their objectivity in determining what is best for patients.

That’s a big part of what makes these MDT conferences so special.  Most attendees are eager to learn how to better clinically evaluate and diagnosis their patients and the basic science behind why common patterns of pain response occur during their office evaluation.  Indeed, it is very common for invited speakers who have no prior exposure to MDT to comment how uniquely motivated these attendees are to learn and how full the room remains throughout the conference.

A few years ago, the late Alf Nachemson, one of the most famous and leading experts in spine care, was invited to speak at an MDT conference in Ottawa attended by 350-400 clinicians, mostly physical therapists, as I recall.  Over many prior years, he had made some unflattering public statements about Robin McKenzie and “his disciples” and so accepted the invitation with some trepidation.  At the outset of his first presentation that weekend, he facetiously announced to the audience that he had considered bringing some bodyguards with him.  But after spending the weekend interacting with these people, he began his final talk by stating that “I really don’t understand just what it is you people do, but it is clear that you are passionate about it and you have a great deal of fun doing it” (paraphrased).  Acknowledging all his diligent and dedicated work over his long career, when he retired about a year before he died, I told him that I had great regret that he had worked so hard for so very long, including more than 20 years of intermittent exposure to MDT, but he never allowed himself the opportunity to acquire a working understanding of it and to appreciate its immense potential for improving spine care around the world.

This past weekend in Warsaw, I met a lovely married couple, she a rehab physician and he an orthopedic spine surgeon.  He said he merely drove her to her first McKenzie Institute course a few years earlier and stayed to listen for a bit.  He was so intrigued by what he heard that he ended-up taking all four of the McKenzie Institute courses with his wife and now they are both MDT-Credentialed.  He gave two excellent presentations at the conference, one on how MDT methods helped him in selecting his surgical patients.  What is so intriguing is that, on his own, in his busy surgical practice in Poland, he had learned the same valuable things about the very helpful utility of MDT in surgical patient selection that a handful of spine surgeons here in the U.S. have learned.

Again, the consistent uniformity in thinking and clinical experience is fascinating.  Brainwashing?  That’s what some skeptics conclude.  But none of those skeptics have ever taken an MDT course, and some get very nervous around clinicians who are enthused about what they do.

Personally, no matter what country I’m in, these people are the same.  They are happy and eager to learn because there is great satisfaction in knowing how to directly and successfully treat most patient’s underlying pain-generator that then teaches them how to bring about their own rapid recoveries.  Such high-quality care is occurring more and more frequently within the U.S. and in literally dozens of countries around the world, thanks to this growing corps of dedicated clinicians.

Musculoskeletal (MS) conditions account for the majority of lost work and bed days due to health conditions. According to a report by the Bone & Joint Decade commission, they are the leading cause of disability and health care cost, as well as the most common health condition in the U.S.  The total U.S. cost of MS treatment and lost-wages in 2004 was estimated to be $849 Billion, or 7.7% of GDP.

In this large and very expensive MS arena, numerous studies show that many disorders can be resolved quite easily and quickly using some simple-yet-precise movements and positions of the painful joints that somehow actually correct the underlying problem and eliminate the pain.  The really good news is that, if you’re the one in pain, you can usually perform these movements and positions yourself.  But this requires your provider to first determine which movements, if any, will correct the problem and then teach you what to do.  This specific form of self-care, known as Mechanical Diagnosis & Therapy (MDT), empowers you to take control of, and eliminate, your own painful problem.

Unfortunately, these painful conditions are rarely treated in this way. Only a small percentage of individuals with MS conditions are provided the opportunity to be evaluated by a clinician with MDT training. Consequently, the painful conditions too often persist, even worsen, despite undergoing other extensive, expensive, sometimes even risky treatments. But most importantly, these treatments are all unnecessary for those who can recover using self-care first and MDT principles.

I wanted to advocate for this first type of MDT self-care across the spine care community in order to help individuals avoid these other ineffective and expensive treatments. I therefore founded Self-Care First in 2002. This blog is part of that effort. So whether your condition can be eliminated easily with MDT care or not, the best way to find out is to be evaluated by a practitioner trained in MDT.  In other words, first explore the potential and value of self-care.  Therefore…..self-care first.

Exploring self-care first is especially important in the many disorders that do recover, only to recur days, weeks, or months later. Low back and neck pain are common examples of conditions that frequently recur. Many treatments for these conditions are described as “passive”. That means your practitioner performs the treatment on your behalf, doing something TO you.  They may apply ice, heat, ultrasound, or diathermy to your painful area, or use their hands to massage, mobilize or manipulate your spine and other joints. But they are performing the treatment for you.  You are passive.

Even if effective in decreasing your pain, the pain usually returns again soon.  When it does, your experience tells you to return to get that same relief again for that same passive treatment from your practitioner.  So you seek that type of care again, and again, and again, that cycle repeating itself sometimes many times.  But you meanwhile learn nothing about how to treat yourself or how to prevent your own pain from returning.  You instead develop a dependence on your provider and this passive care while gaining no insight into why it keeps returning nor how to prevent it.  Some practitioners will deepen your dependency on them by recommending you return for treatment even after your pain has gone away in order to prevent your painful condition from returning.  But no data has ever shown that such treatment lowers the chance of having another episode.

Alternatively, if you had learned methods of self-care first that enabled you to eliminate your own pain, you would have also learned how to prevent your pain from returning, a necessary part of your recovery from your current episode as well as for preventing it over the weeks and months ahead.  And if or when your pain does return, you already know how to get rid of it by yourself, because what worked before usually works just as well now.  You have been empowered to be independent of your practitioner using the know-how learned earlier to quickly and effectively treat yourself.

There’s one other point that illustrates the importance of pursuing self-care first (MDT care).   In other blog postings, I described studies documenting that as many as 50% of individuals with back pain that had been considered disc surgery candidates, when finally provided this MDT evaluation, found out they had a rapidly and easily reversible problem all this time that would quickly resolve using self-care.  This enabled these individuals to avoid what would have been unnecessary surgery.

The overwhelming message for patients, clinicians, employers and health plans is to pursue MDT and self-care first.  To locate a practitioner near you that is trained to provide you with this form of care, click here.

Here are some books you may wish to read about MDT and self-care for low back, neck, and shoulder pain:

Treat Your Own Back, by Robin McKenzie

Treat Your Own Neck, by Robin McKenzie

Treat Your Own Shoulder, by  Robin McKenzie

Solving the Mystery: The Key to Rapid Recoveries from Most Back and Neck Pain, by Ronald Donelson

Rapidly Reversible Low Back Pain: An Evidence-Based Pathway to Widespread Recoveries and Savings, by Ronald Donelson

Dr. Ron

Ronald Donelson, MD, MS
President

SelfCare First, LLC
Blog: blog.selfcarefirst.com

In my book “Solving the Mystery: The Key to Rapid Recoveries from Most Back and Neck Pain”, I included the stories of two individuals, one with disabling neck pain and the other disabling back pain, both persisting for more than two years despite actively seeking care.

I was present when Peter was first examined for his chronic neck and arm pain.  It was a demonstration to attendees at an international spine conference of how the MDT evaluation identifies rapidly reversible conditions and then guides rapid recoveries.  References to “Figures” below pertain to illustrations in the book.

PETER’S HISTORY
Peter is a 38 year-old adventure guide and instructor who was on his honeymoon when the car he was driving was hit from behind while stopped. He passed out at the scene and was taken by ambulance to the hospital where no severe injuries were identified. He was discharged, given Tylenol, and told to see his doctor when he returned home.

Severe headaches soon started that kept him from sleeping at night as well as pain and numbness progressing down his left arm to his hand. His physician at home sent him to physical therapy that he continued for 18 months.

His pain forced him to stop working because he couldn’t rotate his head when kayaking nor look upward when leading rock-climbing groups.

A neck MRI showed bulging/prolapsed discs at his C5-6 and C6-7 levels that were pressing against his nerve causing the pain and tingling in his left arm.

He was referred to a neurosurgeon who offered him surgery to relieve the pressure on the nerve.  He was told there was a 50% chance of improvement, 40% chance of being the same, and a 10% chance of worsening as a result of the surgery. Because he didn’t like those odds, he decided against surgery.

PETER’S MDT EXAMINATION
He was finally given the opportunity to be examined by a physical therapist with extensive training in Mechanical Diagnosis & Therapy (MDT). At that time, he reported he had improved only 10% over his 18 months of physical therapy. He had pain, numbness and tingling into his left palm and fingers as well as tension and tightness in his neck and aching in his left arm. He did report some improvement in those symptoms four months earlier when he changed his job and stopped climbing and kayaking.

Attempts to bend his neck in any direction seemed to increase his neck and arm pain, including bending his head and neck backward. But a special variation of neck extension (bending the neck backward) noticeably decreased the arm and hand tingling that then didn’t return, which he stated was a “huge difference” from his last 18 months. With more neck extension movements, his hand and arm symptoms improved substantially and remained better, which greatly impressed Peter.

PETER’S MDT EDUCATION AND SELF-CARE INSTRUCTIONS
The therapist told Peter that something was pressing on the nerve and they were perhaps learning that that “something” might be able to be withdrawn from the nerve so his pain and tingling would go away.

He was instructed to perform 10-12 repetitions of the cervical extension exercises 5-6 times/day.  He was shown how to perform them standing, sitting and lying down. He was shown how his forward head position when sitting aggravated his condition and was given a lumbar roll to use behind his lower back, especially in the car, to enable him to sit more erectly with his head positioned much better to keep from aggravating his condition while sitting (Fig. 22.6).

FOLLOW-UP
Using this self-care strategy, the tingling in his arm and hand disappeared almost immediately despite having been present for 18 months.  His headache, neck and arm pain progressively decreased over the next four weeks to where he no longer had any pain. He reported three months later that he was pain-free as long as he did his exercises. He admitted to only doing them 1-2 times per day and if he stopped those exercises for more than two days, his headaches would return very slightly which reminded him to return to his exercises.

He was able to return to all of his work and had even taken up snowboarding as a new sport that he could now include in his work.

SUMMARY
In hindsight, Peter had an undiscovered rapidly reversible problem all this time. Like so many with motor vehicle whiplash injuries, his neck and arm pain didn’t begin until many days after his accident. He then underwent 18 months of useless physical therapy and almost accepted an unnecessary surgical procedure because neither he nor his physicians knew his underlying problem was actually rapidly reversible all this time. Fortunately, Peter finally found someone trained to evaluate and treat him using MDT principles of care.

Peter Is Not An Unusual Patient! There are published data indicating that half of chronic back and neck pain patients respond similarly. While not unusual, sudden and rapid recoveries like this are not widely known, which is why I have written my books and created this blog.  Unfortunately, and most importantly, such dramatic recoveries are also unfamiliar to most health care providers, payers and policy makers who do not provide their back and neck patients with this Mechanical Diagnosis & Therapy (MDT) form of evaluation.

From a cost perspective, every one of these patients who have an undiagnosed rapidly reversible condition costs tens, if not hundreds, of thousands of dollars in direct medical costs and lost productivity,……..all unnecessarily! It only requires a thorough MDT evaluation at the outset of their care to identify them early and guide their rapid recovery to avoid nearly all of that unnecessary expense.

Peter’s actual initial MDT evaluation at this conference can be viewed on DVD available at http://www.optp.com/A-Day-with-McKenzie-DVD_914DVD.aspx. The therapist on the DVD who assessed Peter is Robin McKenzie himself, who developed the MDT method of care.

Dr. Ron

Ronald Donelson, MD, MS
President

SelfCare First, LLC
Blog: blog.selfcarefirst.com

 

In my book “Solving the Mystery: The Key to Rapid Recoveries from Most Back and Neck Pain”, I included the stories of two individuals, one with neck pain and the other back pain, both disabled for more than two years despite actively seeking care.

I was present when Clare was first examined as a demonstration to attendees at an international spine conference of how the Mechanical Diagnosis & Therapy (MDT) evaluation identifies rapidly reversible conditions and then guides rapid recoveries. References to “Figures” below pertain to illustrations in the book.

CLARE’S MDT HISTORY
Clare was 52 years old when she developed a sore back after moving some furniture. When her pain worsened, she saw her family doctor who sent her to physical therapy, but that was not all that helpful. During treatment, her pain even began to spread down her left leg. Her doctor and therapist nevertheless felt she should continue physical therapy and was also given anti-inflammatory medications.

With more and more flare-ups, she was referred to an orthopedic specialist. An MRI was ordered but she was told it didn’t show very much. She was told to continue physical therapy even though it didn’t seem to be helping her.

She saw a second orthopedic specialist who also felt it would simply take more time and she needed to become more fit. Physical therapy was continued but now her left leg pain had become constant and so painful she was unable to continue working.

A second MRI higher up in her back showed some herniated discs in her thoracic (chest portion) spine but those were not considered responsible for her pain.

One of her orthopedic surgeons discussed the option of surgery and referred her to a neurosurgeon who found nothing to operate on and labeled her as having “chronic pain”.

She was sent to a pain specialist who told her she would have to learn how to live with her pain and manage it with drugs. She was evaluated by a “specialty team” consisting of an occupational medicine physician, physical therapist, and psychologist who developed a plan that would include an intense rehabilitation program.

She had now been in pain for two years. It had become constant with shooting pain down her left leg and she was too painful to work.

Through another contact, she was finally given the opportunity to see a physical therapist well-trained in Mechanical Diagnosis & Therapy (MDT).

She stated that prolonged sitting would consistently bring on or worsen her leg pain.

CLARE’S MDT EXAMINATION
The therapist observed that she sat very slouched. By having her sit very erectly, Clare reported that the intensity of her leg pain promptly decreased. When she repeatedly extended her lower back (bent backward), her leg pain decreased more and more until it disappeared. Slouched sitting would bring the pain back again but she found she could decrease and eliminate her leg pain with backward bending while standing or sitting but was especially effective when lying facedown performing a series of press-ups (Fig. 22.2).

CLARE’S INITIAL EDUCATION
The therapist explained that her pain had clearly “centralized” (come out of her leg) with low back extension test movements and this was a very good sign. She likely had a bulging disc that was irritating a nerve causing the pain, numbness, and tingling in her leg. The longer she sits slouched, the more it bulges and the pain increases. But extension (backbending) likely decreases that bulge by putting the displaced disc material back in its place that then takes the pressure off the nerve.

It was important to find out whether she would be able to stop her pain and keep it from returning using these extension exercises and very erect sitting posture. Could she now prevent the leg pain from returning and eliminate whatever low back pain was still present?

CLARE’S INSTRUCTIONS & TREATMENT
She was given a lumbar roll to place behind her lower back whenever sitting (Fig. 22.6) to help her avoid the slouch and she was to perform 10-12 press-ups (Fig. 22.2) 5-6 times per day for the next several days. She needed to be seen for another 2-3 visits to be sure that this was working.

With considerable hope that something useful had been found, Clare began to work diligently on her sitting posture and performed her exercises as instructed. By doing so, when she returned two days later, she reported she was able to stop her leg pain herself and even keep it from returning.

She was encouraged to keep up the same self-care efforts. She soon found herself pain-free and off all medications. She was also able to become much more active and soon was able to return to work with no pain.

SUMMARY
In hindsight, despite two years of worsening pain, seeing numerous physicians, therapists, and a psychologist, despite having had two MRIs, lots of medications, and nearly two years of physical therapy, it is clear that Clare had a rapidly reversible problem all that time that simply had never been evaluated adequately or discovered. Unfortunately, none of her physicians or physical therapists ever provided the MDT evaluation nor sent her to someone who could.

Clare had been unnecessarily doomed by all her care-givers to a life of “chronic pain” while her true problem, when finally fully evaluated using MDT principles, was actually a rapidly reversible derangement that she was able to easily correct herself and then able to maintain that correction and get back to work and her life.

Clair Is Not An Unusual Patient!
There are published data indicating that half of chronic back and neck pain patients may respond similarly.  While not unusual, sudden and rapid recoveries like these, after so long, are not widely known, which is why I have written my books and created this blog.  Unfortunately, and most importantly, such dramatic recoveries are also unfamiliar to most health care providers, payers and policy makers who do not provide their back and neck patients with this Mechanical Diagnosis & Therapy (MDT) form of evaluation.

From a cost perspective, every one of these patients who have an undiagnosed rapidly reversible condition costs tens, if not hundreds, of thousands of dollars in direct medical costs and lost productivity,……..all unnecessarily! It only requires a thorough MDT evaluation at the outset of their care to identify them early and guide their rapid recovery to avoid nearly all of that unnecessary expense.

Clare’s actual initial MDT evaluation at this conference can be viewed on DVD available at http://www.optp.com/A-Day-with-McKenzie-DVD_914DVD.aspx. The therapist on the DVD who assessed Clare is Robin McKenzie himself, who developed the MDT method of care.

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