The health care system problem of back pain is due to the epidemic costs of chronic disability. The chiropractic problem within the heath care system is that we are getting paid less but being asked to do more (documentation, rehabilitation, etc.). The learning objectives for this article are to discuss chiropractic as the benchmark profession for managing neuromusculoskeletal conditions; the biomechanics of soft-tissue injury; the biopsychosocial aspects of pain and disability; and how to integrate simple advice, manipulation and exercise into a goal-oriented clinical approach.
The Biopsychosocial Model
A major cost problem is that a small minority of patients who become chronically disabled cost the vast majority of dollars. A solution is to shift resources from chronic cases to the subacute ones. Here's a road map of how to accomplish this:
Various aspects of psychological deconditioning are:
The clinician has to identify the source of repetitive strain responsible for pain and injury, and seek a better understanding of the etiology of soft tissue injury and the components of the spinal stabilization system. Repetitive lifting, exposure to whole body vibration and sudden, unexpected movements or loads have been demonstrated to cause spinal problems.1
A common myth about back injury is that it results from a single, specific event, but it is the "straw that breaks the camel's back" syndrome. McGill states that back injury is usually a result of "a history of excessive loading which gradually but progressively reduces the tissue failure tolerance."2
Bogduk and Twomney add: "After prolonged strain, ligaments, capsules and IV discs of the lumbar spine may creep, and they may be liable to injury if sudden forces are unexpectedly applied during the vulnerable recovery phase."3
What exactly is the injury mechanism of the low back? Simply put, it is too much of any one thing; in particular, end range loading. Disc problems usually result from repetitive end-range flexion: facet problems of repetitive end range extension. Knowledge of the mechanism of injury can influence our management by focusing us on the importance of educating patients about how to maintain a "neutral spine" when performing tasks.
"Avoiding spine end-range of motion during activity can reduce the risk of several types of injury," McGill says.
Is there a spinal stabilization system? According to Panjabi, these subsystems work together to promote stability: central nervous subsystem (control); osteoligamentous subsystem (passive); and muscle subsystem (active).4 The stabilization system works by tensing the muscles, like rigging on a ship to make the sails taut, to support the spine and prevent it from buckling under strain. This system works surprisingly well when large forces are involved because the muscles automatically contract, but when light forces are involved, the muscles are often relaxed and the spine is not stiffened. A trivial trauma thus can surprise the patient and cause an unexpected low back injury.
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
