Sciatica Research Today is a free monthly online journal that collates and summarizes the latest research about Sciatica, including details on treatment, prevention, medication. | ||||||||
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Is Your Client's Back Pain "Rapidly Reversible"? Improving Low Back Care at Its Foundation.Donelson R Ronald Donelson, MD, MS, DipMDT, is a board-certified orthopedic surgeon who specialized in nonoperative spine care for 20 years in both private practice and at The Institute for Spine Care at the State University of New York in Syracuse. His numerous research publications and frequent presentations around the world focus on the assessment, classification, and nonoperative treatment of neck and low back pain. His recently published book, Rapidly Reversible Low Back Pain, can be accessed at www.amazon.com or www.optp.com. He is an Advisory Editor with the journal Spine, member of the International Society for the Study of the Lumbar Spine, the North American Spine Society, active with the International Forum for Primary Care Research in Low Back Pain, and is the current vice president of the American Back Society. PURPOSE/OBJECTIVES: To convey a valuable and greatly misunderstood paradigm for evaluating and treating low back pain (LBP) and its extensive scientific evidence. PRIMARY PRACTICE SETTING(S): Low back pain is a highly prevalent and very expensive health dilemma. But by using a paradigm called Mechanical Diagnosis and Therapy (a.k.a. McKenzie methods), it is now possible to identify a very large LBP subgroup whose pain is rapidly reversible, meaning that it can often be eliminated quickly, with return to full function using a single, patient-specific direction of simple, yet precise, end-range low back exercises and some posture modifications. This interesting subgroup includes patients with both acute and chronic LBP as well as both LBP-only and sciatica with neural deficits. FINDINGS/CONCLUSIONS: This special form of clinical assessment can detect which patients are in this large, rapidly reversible subgroup and which ones are not. Of the numerous studies targeting Mechanical Diagnosis and Therapy (MDT), three have focused on patients whose persisting pain had led to recommendations of disc surgery where 50% were then found to still have a rapidly reversible disc problem with high rates of nonsurgical rapid recovery. If patients are never assessed in this way, this reversibility remains undiscovered and these patients commonly undergo potentially unnecessary surgery. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Armed with knowledge of this subgroup, how to identify it, the considerable supportive scientific evidence and strongly beneficial implications of utilizing this MDT paradigm, case managers are positioned to have an immensely positive impact on the care of LBP. Tremendous cost savings and greatly improved clinical outcomes are available by utilizing this form of evidence-based MDT care. Published 17 March 2008 in Prof Case Manag, 13(2): 87-96.
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