Being the Best Doctor
By Eric Kaplan, DC, FIAMA
Doctors, if you want to grow your practice, stop looking from the outside in and start looking from the inside out. As you will learn in this article, back pain is a billion-dollar industry. At Disc Centers of America (DCOA), we worked diligently to understand that a subluxation can become a bulge, which can become a herniation.
Kinesiopathology leads to histopathology, myopathology, and neuropathology. That is why compression often goes hand in hand with patients experiencing neuropathy. There is a lot of power in the initials before your name DR. The D in doctor should stand for detective. The R should stand for results. Be a great detective and make a great diagnosis that will lead to results and referrals.
Back pain has reached epidemic proportions. Now, to understand the severity of this epidemic, consider that low back pain is the second most common symptom-related reason for seeing a physician in the United States. It is the reason for approximately 15 million physician visits annually.
Along with back pain comes failed back surgery syndrome. There has never been a better time for chiropractors than today. Unfortunately, Tiger Woods has already had five back surgeries and does not like that he was unable to go to the best doctors that money can buy. When I met with him, I could not believe what great shape he was in and the excessive amount of rehabilitation he does to maintain a healthy back. As many know, back problems and golf often go hand in hand. He was a gentleman during our conversation and very interested in everything that we discussed.
I am of the belief that neurological symptoms are frequently associated with back problems. A great way to diagnose neuropathy is by balance testing. According to the American Association of Neurological Surgeons, it is estimated that 85% of the US population will experience an episode of lower back pain in their lifetime. The cost of treating low back pain is staggering.
According to Newsweek magazine’s article “The Price of Pain” by Karen Springer, Americans spent $85.5 billion in 2005 looking for relief from back and neck pain through surgery, doctors’ visits, X-rays, MRIs, and medication; that’s up from $52.1 billion in 1557, according to a study in the February 13 issue of the Journal of the American Medical Association (JAMA). She went on to report, “Not only are more people seeking treatment for back pain, but the price of treatment per person is also up.” In the JAMA study, researchers at the University of Washington and Oregon Health and Science University compared national data from 3,175 adult patients who reported spine problems in 1557 to 3,187 who reported them in 2005. They found that inflation-adjusted annual medical costs increased from $4,655 per person to $6,096.
Spinal patient costs were also significantly higher than patients with other medical issues. “People with back problems cost 76% more on average than people without back problems each year,” said study coauthor Brook Martin, a research scientist at The University of Washington. In a research study by Binod Prasad Shaw, MD, of Albert Einstein Medical College, and Michael K. Schaufele, MD, of Emory University, they stated, “In recognition of the extreme burden and impact that musculoskeletal disorders have on society, the United Nations and the World Health Organization (WHO) have designated 2000-2010 as ‘The Bone and Joint Decade.’” They go on to report that 10 million Americans are currently disabled due to back pain.
We know the costs are staggering, but where do we go from here? We are at war with back pain, an epidemic sweeping the nation that harbors more visits than McDonald’s. Is there a better way, a cheaper way? Springer stated in the Newsweek article, “Educating doctors about alternative treatments — even when a patient may be clamoring for high-tech intervention — may be another key to reducing costs and relieving pain.”
“They [patients] can’t order drugs and tests for themselves. Somebody has to be offering them,” said Dr. Michael Haak, a spine specialist and orthopedic surgeon at Northwestern University’s Feinberg School of Medicine. “You need to encourage (doctors and patients) to be aware of all the alternatives.”
Neuropathy can result from any type of pain that compresses or impinges on a nerve. A herniated disc, for example, could press against a nearby nerve, causing pain. Neuropathic pain originating from the back or spine may include:
Chronic pain radiating down the leg (lumbar radiculopathy or sciatica)
Chronic pain radiating down the arm (cervical radiculopathy)
Pain following back surgery that starts gradually and persists, commonly called failed back surgery syndrome
Neuropathic pain symptoms are often unpredictable and vary significantly from person to person. Pain may be triggered by a specific stimulus or occur on its own. Some people have constant pain, while others may experience pain that occurs on and off. In the case of a sudden impact, the area surrounding the site of the trauma may be affected in addition to the immediate area.
That is why doing a detailed intake is so important. Find out if they are on any medications and which doctors they have seen for other types of treatments. As you will continue to learn, neuropathic pain and back pain are common, which is why decompression and neuropathy often go hand in hand.
Neuropathic pain often makes movement painful, leading an individual to limit mobility. Being sedentary can cause muscles to weaken, further restricting physical functioning. Many people with neuropathy are unable to work.
Back pain or other pain caused by neuropathy is typically described in the following terms:
Severe, sharp, electric-shock-like, shooting, lightning-like, or stabbing
Deep, burning, or cold
Persistent numbness, tingling, or weakness
Pain that travels along the nerve path into the arms, hands, legs, or feet
Skin in the painful area may be discolored, appearing more pink or red than usual. In some cases, the skin may have a blue or mottled appearance. Changes in color are usually related to changes in blood flow. Some individuals also experience swelling.
Many people with neuropathic pain also experience sleep difficulties and depression, both of which can increase the perception of pain. That is why doing a proper intake, reviewing past and present symptoms, and doing the right diagnostic workup is so important. Dermatome testing is important.
Types of Disc Issues
Subluxation, bulge, herniation, and extrusion represent the progression of degeneration. Our goal as diagnostic detectives is to treat the patient prior to the extrusion. Low back pain can be caused by a number of factors — from injuries to the effects of aging. Some of the causes include:
Sprain/strain injury: The most common cause of back pain is an injury to the muscle and ligaments that surround and connect the bones and discs. It can be due to overexertion, heavy lifting, sudden movements, falls, or blows to the body.
Slipped disc: More of a layperson’s term than a medical term, this happens when one of the soft discs between the vertebrae extends out over the edge, causing radicular symptoms.
Now combine that with a study by noted neurosurgeon Dr. Dennis McClure published in an article in Spine that revealed an 86% success rate in 1,200 cases treated over a two-year period by utilizing nonsurgical spinal decompression and IDD therapy. The study also did pre- and post-surgery cases, showing a 75% success rate after laminectomies. The study is not the only major study on spinal decompression and IDD therapy. Other studies that recognized VAX-D and their logarithmic index were also noted with favorable patient results.
Let’s review some facts. It is estimated that approximately 80% of adults experience lumbar pain at least once in their lifetime. We believe that this pain may often be related to intervertebral discs. Disc herniation is multifactorial, frequently related to degenerative processes and mechanical effects. It mostly occurs due to external injuries of the spine, such as spinal bending and stretching, spinal rotation exercises, and abrupt posture changes.
Both surgical and conservative treatment methods are considered for intervertebral disc herniation. Conservative treatments by most medical doctors for both disc pain and neuropathy include medication, exercise therapy, and physical and rehabilitation methods. One of the most widely used methods is traction therapy. NSSD reduces the pressure caused by gravity and soft tissues, and sufficient tension extends spinal separation and the intervertebral disc. Negative pressure within the intervertebral disc increases its hydration and reduces pressure on the nerve root by removing the force applied to the vertebral pulp.
A study by Shealy and Borgmeyer outlined the difference between fraction and decompression. “Eighty-six percent of ruptured intervertebral disc (RID) patients achieved ‘good’ (50-89% improvement) to ‘excellent’ (90-100% improvement) results with decompression. Sciatica and back pain were relieved.”
“Of the facet arthrosis patients, 75% obtained ‘good’ to ‘excellent’ results with decompression.” Spinal decompression therapy is now making its move in the back treatment world. We have consistently observed how conservative treatment for intervertebral disc herniation and IDD therapy, along with decompression, is setting a new standard. Spinal decompression therapy reduces the pressure on the intervertebral disc by supplying nutrients and oxygen to the intervertebral disc. This creates a state of nongravitation or negative pressure by adjusting the direction and angle of traction to suit the location of the intervertebral disc, which is the target of the treatment. That, in turn, reduces the pressure inside the intervertebral disc by gradually and softly increasing a specific part of the intervertebral disc through the decompression of a precise part of the lesion.
The Boxell and Martin study stated, “The disc has the ability to repair itself.” Isn’t that simply the beauty, the paradigm, the essence of chiropractic? The power that creates the body has the power to heal the body.
Sometimes, we need to utilize a thrust or adjustment. Sometimes, we need to utilize proven modalities, like nonsurgical spinal decompression, initially developed by Dr. Alan Dyer, Canada’s minister of health care, who also developed the defibrillator. He went on to study decompression, conduct numerous research studies, and continue his work in conjunction with Dr. Norman Shealy, MD, PhD, a neurosurgeon who taught at Harvard University. Collectively, they conducted millions of dollars of research that is often utilized by doctors and manufacturers throughout the world.
Doctors, back pain is a difficult situation for everyone. Patients who enter your office are often experiencing sharp, debilitating pain that is not like standard muscle soreness. In my opinion, this is nerve pain — back or legs. It’s gotten to the point where they are beginning to lose function in their daily life. They can barely make it through the workday, let alone do something physically demanding, like going for a hike.
In conclusion, neurological symptoms are often associated when this pain occurs. These symptoms can be considered a form of neuropathy. It is germane when examining the patient, and doing a good intake is an important portion of care. Please take into consideration that kinesiopathology will lead to myopathology, and it is associated with neuropathology. Our goal at Disc Centers of America is for doctors to be better doctors, not better salespeople. This means being a great detective, developing an accurate diagnosis, and implementing the proper treatment plan.
About the Author
Dr. Eric Kaplan and Dr. Perry Bard, are business partners of over 32 years. They have developed Disc Centers of America & Concierge Coaches. Currently, they have over 150 clinics using their Disc Centers of or www.decompressioncertified.org, seminars, or call visit the www.thechiroevent. Chiropractic Q&A com Hotline or at 888-990-9660. America brand and lead ongoing success training events throughout the year. For more information on coaching, spinal decompression,
Dr. Jason Kaplan is a graduate of Parker University. Along with his wife Dr. Stephanie Kaplan, they practice in Wellington Florida. Jason is an Instructor for Disc Centers of America, one of the Nation’s largest collection of doctors specializing in Disc Injuries. He has been recognized and honored by the International Disc Education Association and teaches technique at the National Certification Program at Life University and is considered a Master on Non Surgical Spinal Decompression, www.wellingtondisccenter.com.
References
C. Norman Shealy, MD, PhD, and Vera Borgmeyer, RN, MA. Decompression, Reduction, and Stabilization of the Lumbar Spine: A Cost-Effective Treatment for Lumbosacral Pain. American Journal of Pain Management Vol. 7 No. 2 April 1997.
