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

A very common complaint patients with back or neck pain have is that their doctor doesn’t provide them with a clear diagnosis or explanation of their pain.23,79

That complaint is quite understandable because the conventional examination used by most doctors, along with the best imaging procedures available, are unable to identify the precise cause of most back and neck pain. That does not mean there isn’t a cause; it just can’t be found in most cases using those methods of evaluation.

Nevertheless, back and neck pain often go away on their own in a few days or weeks, regardless of what treatment you pursue.21,59,81,82 Therefore, the underlying problem, whatever it is, is somehow often able to recover, even without formal treatment.

Unfortunately, even though it goes away, it often returns a few weeks or months later.21,59,81,82 Each time it returns, it is referred to as a new “episode”. Each episode ends when the pain goes away again for a few more weeks, months, or maybe even years. Unfortunately, it is all too common for back pain to return several times each year and continue to do so for many years.

Many report that, when their pain returns, it’s even worse than before.30,83,84 Perhaps you have had a few episodes.  Is your pain now more intense, more disabling, lasting longer than in your early episodes? Has it now spread into your arm or leg and require more care than in the past? Often, after many episodes, your pain finally just doesn’t recover again. When it persists for three months or more, it is usually referred to as “chronic”. Once symptoms become chronic, the underlying problem is often much more difficult to solve.

Sometimes back or neck pain become so severe that it prevents you from doing things you want and need to do: you can’t work, take care of your home and family, or participate in the fun things in life. If you are just not improving, your doctor may offer a referral to another doctor for spinal injections or to a spine surgeon to consider an operation.

Besides being no fun, these procedures are risky. They are not always successful, may make your pain worse, cause new symptoms, and also limit future treatment choices. In most circumstances, these risks are unlikely, but they are certainly possible. Unfortunately, it is not unusual to end up with long-term, even permanent, disabling pain.

But these procedures can also be helpful for many. But who are they? There is no way to figure that out ahead of time. And unfortunately, even those who improve are often still unable to return to their former level of activity or work.

So are there any better solutions? Yes, thankfully, for most there are.

The above is a chapter excerpted from my book entitled “Solving The Mystery: The Key to Rapid Recoveries for Most Low Back and Neck Pain.”  This book, my first book (“Rapidly Reversible Low Back Pain“), the SelfCare First website, and many posts on this blog are all devoted to spreading the message:  yes, thankfully, there are better solutions.  In fact, most back and neck pain is rapidly reversible using simple-but-specific exercises and posture modifications. Keep reading these resources. (Numbered references in this excerpt cite specific scientific articles listed in this book.)

Dr. Ron

Ronald Donelson, MD, MS
President

SelfCare First, LLC
Blog: blog.selfcarefirst.com

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