What causes acute low back pain (LBP) to become chronic? This is the question explored in a new study [Stevans JM, et al. JAMA Netw Open, 2021;4(2):e2037371] from a research group centered at the University of Pittsburgh looking to identify the relevant risk factors, and the answer suggests acute LBP patients shouldn't be going to medical doctors.
The study evaluated the care provided to 5,233 patients with acute LBP in 77 primary care practices. Among the potential factors leading to chronicity, the authors considered "nonconcordant" care, or care not consistent with established guidelines. Surprisingly, almost half (48%) of patients received at least one form of nonconcordant care.
Nonconcordant care was divided into three categories: pharmacologic, diagnostic and medical subspecialty referral. Almost 50% of patients received at least one form of nonconcordant care within the first 21 days – many for non-guideline-recommended medications such as opioids.
The authors note that "nonconcordant care can lead to direct and indirect harm, given that it has been linked with medicalization and unnecessary health care utilization."
Patients were stratified into three levels based upon their likelihood of transitioning to chronic LBP: low, medium or high risk. Overall, about a third (32% unadjusted) transitioned from acute to chronic: approximately one fifth of low-risk patients, a third of medium-risk patients and almost half of high-risk patients.
A patient whose medical PCP provided two or more forms of nonconcordant care was more likely to transition to chronic than a patient stratified in the medium-risk category. The nonconcordant actions of the MD effectively moved the patient from low risk (one in five chance of becoming chronic) to med-ium risk (one in three chance) or almost high risk (even chance). Overall, exposure to one, two or three forms of nonconcordant care increased the odds of transitioning to chronicity incrementally (adjusted odds ratios: 1.39, 1.88 and 2.16, respectively, for one, two or three forms of nonconcordant care).
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?
