You’ve no doubt heard the version of “The Golden Rule” that says: he who has the gold makes the rules.

Well, there’s often a lot of truth to that.  But unfortunately, that version of “the rule” doesn’t apply to you employers regarding your ability to control your rising costs, nor the quality, of your employees’ health care…….just because you are paying for it!!! Your costs keep increasing with little, if any, evidence you are getting any better quality for your money.  You have the gold but you have very little control over the rules.

Well, times are changing, at least in one big area of healthcare.  There’s some light at the end of this tunnel……and some very good news for your bottom line.  While the care of back and neck pain and other musculoskeletal conditions (including painful shoulder and arm conditions, as well as hip, knee, ankle and foot problems) keeps skyrocketing, you not only can stop that increase, but employers are starting to substantially lower their costs for care of these conditions. Learning about and then implementing some enormously valuable innovations in the care of these spine and musculoskeletal conditions is what will enable you to gain considerable control over your local health care marketplace, that will in turn greatly improve both your employees’ welfare and your bottom line.

To begin to take control of all this expensive care, I’d recommend doing four simple things:

1 – ask those who currently care for your employees to show you their data as to their short- and long-term outcomes/recoveries for treating these specific conditions. Unfortunately, most don’t even have this data. You see, most are too busy discovering new ways to deliver more care for your employees, to generate more income for themselves, without great concern about its quality.

2 – inquire about the same data for those using Mechanical Diagnosis & Therapy (MDT) methods of care for these same conditions. Much of these data can be found in some of these blogs or in my two books, both found at Unfortunately, many of those clinicians aren’t tracking their outcomes either, BUT, many are.  For example, in just their care of back and neck pain alone, one network of high-quality MDT clinics saved one payer millions by providing such good long-term results that back and neck pain recurrences were reduced by more than 80%, which reduced the need for MRIs by more than 70% and spine surgeries by 45%, all with patient satisfaction of 97%.  And we all know that satisfying employees with their health care these days is not easy. To do that, coupled with the huge cost savings, is an unbeatable combination for the employer.

3 – Consider spending a little more upfront to reward and therefore motivate clinicians to deliver and monitor excellent short and long-term recoveries that will then help you save lots of money in unneeded, expensive, additional care. That means transitioning away from paying and rewarding providers for simply prescribing more treatments, so often useless, called volume-based reimbursement, and instead pay a bit more upfront to reward and motivate the delivery of high quality outcomes, or value-based reimbursement.

4 – conduct a small pilot study to determine the extent to which this value-based reimbursement model and the utilization of high-quality MDT clinicians can bring you substantial long-term savings.

Through SelfCare First, I would by happy to help you review and implement these steps with the intent of significantly lowering your costs of caring for these very common and currently very expensive musculoskeletal problems. It is now possible to escape being at the mercy of so many well-meaning, but often ineffective and expensive, clinicians in your community from whom your workers are seeking care.

To learn more about this, “Leave a Comment” to me below and visit and follow the “Employers” pathway.

Dr. Ron

Ronald Donelson, MD, MS

SelfCare First, LLC

In a prior blog, I reported that most individuals struggling or disabled by low back or neck pain actually have a condition that is rapidly reversible. That means that, regardless of how long they’ve had their pain, if it’s rapidly reversible, and it usually is, it can still be turned around and corrected, providing the proper type of evaluation and treatment is undertaken.

This is very exciting news for two different very large groups. The first and obvious one is comprised of those who are personally experiencing pain in their back or neck and trying to endure all the day-to-day consequences of it. There are millions of you out there.

When you seek care, you are so often prescribed unproven and questionably effective treatments that are typically based on your clinician’s theories or favorite type of care. When your pain and impairment persist, some of you understandably turn to “alternative care” methods, most of which have even less scientific basis. With further failure to recover, you understandably seek spinal imaging (CT scans and MRIs), injections, and even surgery.  Some of you are even rushed to expensive, painful, even risky procedures within days of the onset of your symptoms, justified by the intensity of your pain, your high level of impairment, and the hope the surgeon offers of returning to normal quickly.

But there is a second group that also suffers, but in quite a different way.  Your suffering is primarily economic.  You are the employers who often tremble as you watch your employees with back or neck pain go off to consult with one of a wide assortment of clinicians in your community who prescribe an equally wide array of treatments. Some employees recover quickly, often on their own, but many do so very slowly and often only partially, while others simply do not recover. Most of you, along with your risk managers, see some clinicians be more effective and caring than others but usually with limited predictability of a successful recovery.  Some treatments may even stretch your sense of appropriateness.  Despite your best efforts to control them, your costs for these spine disorders have been steadily increasing, in fact skyrocketing, over the past 10 years with no evidence you are purchasing any better quality of care for all you’re spending.

There are two other prominent stakeholders that are also discussed at length in my book Rapidly Reversible Low Back Pain. They are the clinicians who care for these disorders and the spine researchers who investigate them. Neither of these groups directly suffer from either the physical or economic pain.  In fact, they both make their living on the existence and even persistence of back and neck pain.

So it is the patients and their employers who directly suffer and have most at stake in finding a solution.

However, the good news for members of all four groups who sincerely seek cost-effective solutions is that significant progress is being made. There is considerable data clearly showing that most LBP is rapidly reversible and that costs can be cut dramatically by identifying those individuals early in their care.  In a properly incentivized world, there should be widespread clamoring for this knowledge by all stakeholders.

So how do these various groups objectively determine who has and does not  have rapidly reversible back or neck pain? Concise and evidence-based answers are now available in the scientific literature and are the focus of my two books entitled “Rapidly Reversible LBPand “Solving the Mystery. Please take a few minutes to read the Foreword and well as a few published book reviews for RRLBP.

It remains my hope that these books will be catalysts for progress in bringing more understanding and know-how to our management of back and neck pain.

Dr. Ron

Ronald Donelson, MD, MS

SelfCare First, LLC
See the new patient education book: “Solving The Mystery: The Key to Rapid Recoveries for Back and Neck Pain” at

As I pointed out at the end of my Nov. 23 blog, as an employer, you are no doubt suffering badly from the very high costs of care for low back and neck pain, in fact from all musculoskeletal disorders.  In the health care marketplace, you are at such a disadvantage, with very little control over your costs, primarily because no one is telling you the truth about the current state of care for these disorders.

Today, I want to cover some very cost-relevant information: things you don’t know that are costing you money, and then some very encouraging news.


  1. The so-called natural history of recovery from low back or neck pain (recovery independent or regardless of any formal care) is simply not reliable in helping your employees recover.  I will discuss this very point in greater detail in an upcoming blog.  Many studies show that 60-70% still have pain a year later, or have one or more recurrences. Recurrences often progressively worsen until episodes no longer recover and pain then becomes chronic.  That means it no longer stops; no more pain-free intervals.
  2. Conventional office evaluations and our most advanced imaging techniques do not provide a confident diagnosis in most cases of low back and neck pain. Many who are having NO pain actually have herniated and/or degenerated discs if they undergo an MRI.  MRIs can therefore actually be misleading, causing inappropriate treatment, including surgery, based on the appearance of “abnormal” discs that are not even the cause of the pain.
  3. Consequently, most clinicians choose their treatment based on their training background and favorite treatment(s), NOT on what is causing your employee’s pain.
  4. Further, there is no standard treatment for low back or neck pain.  What treatment your employee receives is determined by what office (s)he walks into, not on what is actually causing the pain.
  5. Most treatments are therefore minimally effective. Some are even detrimental, especially if they take up valuable time (weeks, even months) when your employee could be recovering with care that targets their specific disorder.
  6. A separate but strongly related issue: the current system of paying clinicians rewards them for lots of care (high volume) and not for its quality. Naturally, many clinicians select treatments that either pay well or need to be repeated.
  7. Some insurance and workers compensation plans know this information but are so focused on their own needs and bottom line, they’re reluctant, or too busy with other matters, to bring this information to their employer-customers.


  1. Using new clinical examination methods, a far more precise diagnosis can now be made for your employee that guides treatment decisions that produce highly effective, predictable recoveries.
  2. Consequently, 80-90% of back and neck pain can now fully recover inexpensively, quickly, and easily by determining the most effective treatment for each individual.
  3. These same methods also teach your employees how to prevent the next episode.  Recurrences over the next year can be reduced from 60-70% to 10%!  And that’s so predictable that some clinicians who use these methods well are “guaranteeing” their results.
  4. Even for those employees who were never initially provided the opportunity to be evaluated, if they reach the point of having spine surgery recommended and if these same evaluation methods are then introduced, three studies report that at least 50% can still be rescued from undergoing surgery, most with a quick, often fairly easy, and complete recovery.  These patients commonly state: “Why hasn’t someone shown me this before?” or “I can’t believe it’s this easy.”
  5. Rather than financially rewarding clinicians for their volume of care, rewarding clinicians’ performance greatly motivates high quality care while substantially lowering the overall cost of care.
  6. Actively addressing all these factors has been shown to save employers 50% in both their direct medical and all indirect costs.

Please visit for more detailed information and the opportunity to sit in on a live webinar specifically for employers wanting to gain control of their spending on musculoskeletal care.  I’ll be talking more about this in future blogs as well.

Dr. Ron

Ronald Donelson, MD, MS

SelfCare First, LLC
See the new patient education book: “Solving The Mystery: The Key to Rapid Recoveries for Back and Neck Pain” at

In his book entitled “Innovator’s Prescription”, Clayton Christensen describes three eras of medicine: intuitive, empirical, and precision.

The intuitive era is characterized by highly trained, usually expensive, professionals who solve medical problems through intuitive experimentation.  They use and re-use treatments that just seem to work for them.

As medicine evolves, an empirical era emerges where data are amassed that show there are certain treatments that seem to work better when treating patients on average.  This era is often referred to as “evidence-based” using randomized clinical trials that determine what works best for the average patient suffering from a non-specific symptom.

In the precision era, each individual’s disease or disorder can be diagnosed with such precision that a predictably effective, standardized treatment can be identified that addresses the cause of that individual’s problem rather than just the symptom.

Christensen points out that the care of infections moved through all three of these eras. Once diagnosed intuitively as immorality or weakness of faith, and then empirically as a result of unsanitary conditions in a city, as technology progressed, microscopes and staining techniques enabled the identification of microorganisms, some harmless and some deadly.  Identifying the specific organism causing an infection provided clues about the aggressiveness and spread of the disease, a patient’s prognosis, and, over time, enabled the development of consistently effective therapies. Infections used to account for the majority of health care costs but that has declined to about 5% per year of what it was in 1940. They now comprise just a tiny part of the U.S. health care budget.

The treatment of non-specific low back is following this same path.  Care remains in the intuitive phase for those clinicians who choose their treatment based on their best theory as to what causes most low back pain, and then often prescribe their favorite treatment.  Thousands of randomized clinical trials over the past 25 years have defined our current evidence-based/empirical era that has, not surprisingly, failed to identify an effective treatment for the “average patient” with non-specific low back pain.  After all, are any care-seeking patients “average”?

When an anatomic diagnosis is confidently made of a herniated disc causing sciatica and a neural deficit, even that diagnosis lacks sufficient precision to guide predictably effective treatment or determine early whether or not recovery can occur without surgery.

Ironically and unfortunately, most academic spine clinicians, researchers, and policymakers are deeply committed to empirical care with little or no understanding or vision for the importance of moving toward precision medicine.  They incorrectly think that RCTs of a non-specific symptom will somehow identify a predictably effective treatment for most patients.

So how do we move toward a precision diagnosis for low back or neck pain?
When we take our car to a mechanic seeking help with a problem, he doesn’t start by taking pictures of the car or its engine.  He begins by asking details about how the car is misbehaving and then takes it for a test-drive to personally evaluate its behavior so he can determine what treatment it needs.

It is similarly valuable and informative to “test-drive” a painful low back or neck while monitoring for familiar patterns of symptom response.  Numerous studies show that this form of dynamic assessment, part of an approach to spine care known as Mechanical Diagnosis & Therapy, provides far more precise information about the pain source than does most physicians’ clinical examination and way more than is provided by spinal imaging. This assessment can also uniquely identify predictably effective treatment for the great majority with low back and neck pain.

Unfortunately, the extensive evidence that validates this MDT form of assessment continues to be ignored by most spine experts who remain deeply entrenched in the empirical phase of spine care.  Despite 25 years of minimal progress in identifying effective treatments for non-specific low back pain, most experts remain fixated on finding ways to improve studies that still focus on subjects with a non-specific symptom.

The MDT assessment research has strongly established that the underlying cause of most low back and neck pain can be corrected quite quickly and easily without having to make an anatomic diagnosis. Making a precise dynamic mechanical diagnosis is far more informative and cost-effective than making a mere anatomic diagnosis. I’ll write about this more in future blogs.

The MDT assessment and its extensive research support is ushering in a new decade of spine care focused on establishing a far more precise diagnosis.  This is good news for everyone, especially patients and employers.  Identifying a precise mechanical diagnosis early will not only bring about rapid and inexpensive recoveries, there will be much less need for expensive spinal imaging, prolonged non-surgical care, injections, medications, and surgery.

For more information on this and many other topics, go to

Dr. Ron

Ronald Donelson, MD, MS

SelfCare First, LLC
See the new patient education book: “Solving The Mystery: The Key to Rapid Recoveries for Back and Neck Pain” at

I founded SelfCare First a few years ago to help spread some very exciting and very important news about low back and neck pain.  I begin this new blog with the same intent: to help millions worldwide struggling with low back and neck pain recover, many of whom are frustrated by having tried numerous treatments without success.

So what is so exciting?

Most low back and neck pain is rapidly reversible. That means that the underlying painful disorder can be turned around and the pain turned off, fairly quickly, often as fast or faster than it turned on.  But for those with rapidly reversible pain, the means of reversing it differs from person to person.

And how common is rapidly reversible back or neck pain?  There are numerous studies documenting that 70-90% of acute low back pain and 50% of chronic low back pain can be rapidly reversed.  More people in pain need to know that!

So how do you know whether you have rapidly reversible back or neck pain?

To find out if your pain is rapidly reversible requires a special type of examination of your back or neck disorder. If your pain is reversible, that same assessment will also reveal the way you can reverse or recover from your own problem.  You need to be examined by someone with special training in this form of evaluation

So many are suffering unnecessarily.  If they only knew what many low back and neck pain sufferers have been fortunate to learn, what so many scientific studies have documented, and, unfortunately, what so many spine researchers, policy makers, and most doctors, even the experts, still do not appreciate.

You can read more about that examination process and rapidly reversible back and neck pain at and especially in my new book entitled: “Solving the Mystery: The Key to Rapidly Reversing Most Back and Neck Pain”.

This news will have tremendous impact on the costs of managing individuals who seek care for their back or neck pain.  In the U.S. alone, nearly $90 billion is spent each year on the problem of low back pain alone!  In future blog entries, I will be discussing the huge savings available to employers and health plans that are frustrated with paying for so much unnecessary and very expensive care.

Dr. Ron

Ronald Donelson, MD, MS

SelfCare First, LLC
See the new patient education book: “Solving The Mystery: The Key to Rapid Recoveries for Back and Neck Pain” at

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