An Open Letter to our Medical friends.

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In the past year, many trusted medical establishments including the FDA (1), CDC (2), Joint Commission (3,4), JAMA (5), and The American College of Physicians/ Annals of Internal Medicine (6) have encouraged medical providers to prescribe spinal manipulation as a first line treatment for acute, subacute, and chronic low back pain.

Most recently, The Lancet echoed that endorsement, and provided a unique perspective:

The reduced emphasis on pharmacological care recommends nonpharmacological care as the first treatment option and reserves pharmacological care for patients for whom nonpharmacological care has not worked. These guidelines endorse the use of exercise and a range of other non- pharmacological therapies, including massage, spinal manipulation, and acupuncture.

Gaps between evidence and practice exist, with limited use of recommended first- line treatments and inappropriately high use of imaging, rest, opioids, spinal injections, and surgery. Doing more of the same will not reduce back-related disability or its long-term consequences. The advances with the greatest potential are arguably those that align practice with the evidence. (7)

Unfortunately, personal experience skews our perception of each other’s merit, i.e., we primarily see each other’s failures since the successes don’t need to seek additional care. Regardless of our professional degree, we all have failed cases mixed into our many clinical successes. We must not lose sight of the evidence supporting each other’s overwhelming proven value for a given diagnosis. If we judge each other by our successes rather than our failures, we will work toward an integrated model where the patient wins. Together, we will help more patients than either working alone.

We are honored for the opportunity to co-manage your patients.

 

References
1. FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain. May 2017. Accessed on May 12, 2017
2. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain- United States, 2016. MMWR Recomm Rep 2016;65(No. RR-1):1–49.
3. The Official Newsletter of The Joint Commission. Joint Commission Enhances Pain Assessment and Management Requirements for Accredited Hospitals. July 2017 Volume 37 Number 7. Ahead of print in
2018 Comprehensive Accreditation Manual for Hospitals.
4. Joint Commission Online. Revision to Pain Management Standards. http://www.jointcommission.org/assets/1/23/jconline_november_12_14.pdf
5. Paige NM, Miake-Lye IM, Booth MS, et al. Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain; Systematic Review and Meta-analysis. JAMA. 2017;317(14):1451-1460.
6. Qaseem A, et al. for the Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514-530.
7. Foster, Nadine EBuchbinder, Rachelle et al. Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet, Published Online March 21, 2018 http://dx.doi.org/10.1016/ S0140-6736(18)30489-6

Trigger points and headaches

Trigger points are contracted knots of muscle tissue that form in any muscle as a result of overload stress. Trigger points cause pain, referred pain, stiffness and weakness. Trigger points that form in the muscles of the neck and head often refer pain into the head and face. This is one of the most common causes of headache pain. Trigger point massage is an effective way to treat trigger points.

Myofascial pain syndrome.

Myofascial pain syndrome is a chronic pain disorder. In this condition, pressure on sensitive points in your muscles (trigger points) causes pain in the muscle and sometimes can cause pain spread to other  parts of your body. This is called referred pain. Trigger points can also cause stiffness and weakness. This syndrome typically occurs after a muscle has been contracted repetitively. This can be caused by repetitive motions used in jobs or hobbies or by stress-related muscle tension. While nearly everyone has experienced muscle tension pain, the discomfort associated with myofascial pain syndrome persists or worsens. Treatment options include massage therapy, dry needling, and physical therapy. relaxation techniques such as meditation also can help.

Got a stiff neck??

One of the most common causes of a stiff neck are trigger points in the levator scapulae muscle. This muscle runs up the side of the neck from the top of the shoulder blade. It helps to shrug the shoulders and move and stabilize the neck. When trigger points form in this muscle they will produce pain and stiffness in the neck. Deep tissue trigger point massage applied to these knots is an effective treatment method.

Trigger points in the abdominal muscles.

Myofascial trigger points in the abdominal muscles are very common. These muscles are responsible for trunk movement and stability, and are engaged in some way during most activities. As a result trigger points will easily form. These knots will often refer pain into the lower or mid back in a horizontal strip. Trigger points in the abdominal muscles are often overlooked as a source of back pain. Once developed, a trigger point won’t release on its own. A therapeutic modality such as trigger point massage is needed to release the tissue.

Trigger point pain

Myofascial trigger points are contracted knots that form in muscle tissue. They form from overload stress placed on the muscle. Both chronic stress such as poor posture and acute stress such as an injury will cause trigger points to form. Once there a trigger point will produce pain, referred pain, weakness and stiffness. Trigger points don’t go away with rest or with time, some form of intervention such as trigger point massage is needed to treat the injured muscles. Trigger points can form in any muscle in the body and are one of the most common causes of pain.

Trigger points in the hamstrings.

With all the sitting going on these days, tight hamstrings are becoming increasingly common. When your hamstrings are tight they almost certainly have trigger points. These contracted knots in the muscle are a common cause of pain felt in the back of the leg, knee and lower buttocks. Trigger points don’t go away with rest or stretching, they need a therapeutic intervention such as massage to be released.