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Back Care 101: Dick Cheney Are You Listening?

Wheelchair
Back pain is a real problem in the United States.  Many people have it and many people end up suffering needlessly with chronic low back pain.  I say needlessly because most back pain is easily remedied, most, in fact, gets better on its own.  But, most people recieve over-agressive care in the form of drugs, surgery, and expensive imaging.  This helps contribute to a widespread misunderstanding about low back pain and creates an environment which enables disability from low back pain.

People who know their back care will tell you that the single most important thing you can do when your back begins to hurt is to keep moving.  Keep to your normal routine and most certainly do not do the bed rest routine.  Odds are heavily in your favor that the back pain will improve.

Things you should not do include: deciding to use a wheelchair when your back hurts.  Yet this is exactly what Dick Cheney's physician has prescibed for tomorrow's inauguration ceremony.  Several serious heart issues while in office were not enough to keep him off his feet, but a pulled back muscle has grounded the controversial, war-mongering Vice President.  Perhaps he will show up in the wheelchair pictured here?

This is the last thing people with back pain need to see.

ERIC
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Another Reason to Wait on That MRI

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So, we already know that MRI's are routinely over-prescribed, especially in the case of low back pain.  Last year, 1 in 10 people in the U.S. recieved an MRI scan of something.  That's a bunch!  However, we might not be aware that the rate of injuries and incidents involving MRI scans are skyrocketing, beyond that which would be accounted for by increases in volume.

In 2005, the New York Times reported on an increase in accidents.  Since that time, the injury rate is up almost 175%!  The stats are hidden away in this database.  This website contains a collection of images from MRI events, with a surprising culprit, the floor buffer.

The FDA and Joint Commission seem to lack teeth to establish site specific standards for safety in the MRI suite.  Though, they seem to be trying.

Interested parties may wish to check out the MRI Metal Detector blog.  Make sure you really know why you're being sent for an MRI.  Understand that still pictures are hints of function, nothing more.  Sure, MRI's are a great tool, but not for 30,000,000 people a year!

ERIC
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2009 Healthcare Trends: Are PT's Behind the Times?

Twitter_com_EricRobertson 

From CNN Health we are given this list of upcoming trends in healthcare for 2009:

  1. Online House Calls
  2. Virtual Clinics
  3. Ask-a-doc websites
  4. Getting your test results online
  5. Twittering Doctors

I'm going to go way out on a limb here and suggest that 99% of physical therapists don't know what Twitter is, and just about the same percentage are prepared for the other items on this list.  Perhaps it's our love affair with third-party reimbursement, perhaps it's something else that causes physical therapists to be slow adopters of technology.  Afterall, most of these trends also include directly charging patients for things not covered by insurance.  The bottom line is that patient-provider relationships are evolving and physical therapists will need to evolve with them.
Get ready!
ERIC

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Fixing Back Pain: There's Work To Do

Curing-back-pain

The other day the LA Times had a feature piece by Amber Dance on low back pain.  Quite a few physical therapists I know got excited about the article, as it showed the profession in a positive fashion.  Go click here and read the article.  How many times did you see any mention of physical therapists?  Twice?  In passing?  

Go ahead, click on the supplement feature.   That's right! You get to learn all about chiropractic care for low back pain.  

The article interviewed an 2 orthopaedic surgeons, a chiropractor, a pain guy, and an internist.  No physical therapists.

This article gets my goat in a couple of ways.  First, the tag of the article really get's you wondering about what steps other than surgery one should take, but most of page 2 was spent describing different surgical options.  The author just couldn't resist!  Further, Dance pushed the most helpful and best scientific content of the article way down on the 2nd page, when Richard Deyo was quoted,

"When you do magnetic resonance imaging or computerized tomography scans of the spine, you sometimes see horrible things in normal people," Deyo says. One-fourth of people under 60 have a herniated disc, he says, and half have a bulging or degenerated disc. "And yet these are people who have no back pain."

The other goat grabbing portion of this option had to do with the lack of focus on physical therapists. Physical therapists are a key cog in the arena of low back pain care, yet were underrepresented in the article.  There are litterally thousands upon thousands of orthopaedic physical therapists, and far and away, the most common diagnosis we see is for low back pain.  It drives the profession in many ways.  We have a lot of work to do to be recognized by the general public for the work we do with back pain.

Even thought the intent of this article was strong and the message mostly consistent, it's still not screaming the right message.  What's the right message?

Back pain gets better, usually on its own.  Keep moving.  We usually don't know the cause of it, so imaging isn't so critical for most people.  Keep surgery as a last resort.  

Let's make friends with Amber Dance.  She's on the right track.  But, we have a lot of work to do.   

ERIC

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Google Reader for Beginners

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I get a lot of follow-up questions about using Google Reader from audience members when I present on using feeds to enhance evidence gathering for clinical practice.  The official Google Reader Blog has made some new videos which may prove a helpful resource.  Check them out!

ERIC

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Patient-centered Marketing Beats Fringe

Hippotherapy

I have a Google News search feed (you can copy and paste this url into your reader, fyi) for "Physical Therapy" set up in my reader program to help me keep up with what's going on.  Sometimes there's some interesting items, sometimes not so much.  But sometimes, the thing that captures my interest lies not so much in the individual news items, but in the patterns of groups of news items.  

This was the case today as I scrolled through the various entries.  There were a few job postings, one or two clinic opening announcements, and a whole lot of articles devoted to Wiihab, hippotherapy, and physical therapy for pets.

Not once in any of the hundred or so entries that I read did I discover news about physical therapists doing anything related to the core of the profession: enabling function, reducing pain.  Sure, those things are briefly implied in the fringe type articles, but why doesn't good old fashioned physical therapist practice garner news headlines?

Perhaps because it's boring.  From a news perspective, there's nothing too exciting about going to physical therapy and getting a good treatment.  Just like it's boring to hear about someone going to a primary care doctor and getting a new prescription for pain relievers.  We don't see news items about that either.

News headlines are about things that touch our humanity.  Things that are new and different.  Human stories.  Perhaps the stories of our patients need to play a larger role in the profession's marketing efforts.  Perhaps then the story might be more about what we can do to help, what good physical therapy is, and less about the random fringe-type aspects of physical therapy.  I'm routinely fascinated by the stories of my patients and the efforts they put forth to improve their lives.  Now that's good news!

I propose Patient-centered Marketing, which by the way, will be ripe for social media efforts as well.

ERIC

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Hands are Human, Use Them!

Hands

I'm an advocate of most things technology, and certainly appreciative of the Health 2.0 concept, whereby web tools are changing the way healthcare is delivered.  I'm also a fan of hands-on techniques and thorough physical examinations.  I was inspired by a couple blog posts to make sure that as much as we can talk about technology, the key, perhaps the most healing part of treating patients, is the human interaction.  

Larry at EIM discussed the effects that using laptops in the clinic had on patient satisfaction, and the Healthcare Blog discusses the humanizing role of the physical examination.  

One of my favorite things about physical therapy is the personal, one-on-one relationships that develop during treatment.  We spend time with patients.  We use manual techniques.  It's probably good to remember that as technology pushes us, and provokes change, the reason we're here is to get some healing done. And, for that purpose I have found no better tool than my hands.

ERIC

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Happy 2009 from NPA Think Tank!

LondonFireworks

Greetings loyal NPA Think Tank readers.  It's that time of year to offer my thanks for reading this wandering blog and offer my best wishes for your new year.  As a "gift," I present to you three links:

1.  New York Times Year in Pics.  Excellent photos and richly packed with events.

2.  Festive Medical Myths.  BMJ takes a look at those testy poinsettias and others sources of holiday stress.

3.  Some polka-dotted egg nog.  Shouldn't every year end with a solid swig of nog before the champagne is popped?!  Of course, I opt for the less health version of this delectable treat.

Best Wishes,
ERIC

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Lee Trevino Would Like to Sell You a Surgery

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Lee Trevino would like you to know that if you get struck by lightning and then happen to fall down into a sand bunker, his surgeon can help!

Trevino, famous for back pain and some decent golf, is now an advocate for low back pain, giving interviews to raise the awareness of low back pain..with his physician.  I'm not sure Trevino is really as much concerned with awareness of back pain, as much as his surgeon is an advocate of surgery for spinal stenosis.  Are these interviews thinly vield propaganda for this fellow's X-Stop Spacer?

I'm not into debating about how this device works or doesn't work for spinal stenosis, but I do have issue with yet another public statement of: low back pain = surgical repair, not to mention Trevino's guise of acting like a good guy.

Is Trevino looking to raise awareness for back pain or simply fullfilling his role as the spokesperson for the X-Stop?

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The Bionic PT

Bionic-Woman 

Most in physical therapy profession are a bit slow on the uptake of technology.  Most…but surely not all!  Some of my colleagues are really doing some interesting things with bionics.  As practitioners with expertise in prosthetics, it's a natural progression to this new generation of prosthetic technology.  

The first "real" bionic woman was Claudia Mitchell, who was part of the bionic? program at the Rehabilitation Institute of Chicago. 

Silicon valley is also getting into the mix, with the new PowerKnee by Tibion.  This device seems like an external brace vs. what is pictured above.  Physical Therapist Nancy Byl, Chair of the Physical Therapy Department at UCSF, was interviewed about a patient using this new device.  Key to progressing this technology is mastering user interfaces with the machine components.

Those really interested in the topic might find this New Yorker article (pdf) on the new generation of bionic prosthetics a good read.

ERIC