COLUMN BUSINESS TALK Research to referrals F Newest journal article offers tools to educate others or spinal manipulation.” Since these “nonpharmacologic interventions (were) shown to be effective for improv-ing pain and function in patients with acute and sub-acute low-back pain.” What speaks volumes is what the clinical practice guideline did not rec-ommend: low quality evidence showed exercise had no benefit for acute low-back pain; evidence was insufficient to determine the effectiveness of the fol-lowing non-recommended treatments for acute and sub-acute low-back pain: • physiotherapy; • all modalities and therapies largely associated with physiotherapy as presented by the authors: TENS, electrical muscle stimulation, infer-ential therapy, traction, core-stabiliz-ing exercises, and multidisciplinary rehabilitation, ultrasound and tap-ing. Qaseem clarified that physiotherapy was defined according to how it was defined in the journal article being reviewed. For instance Cochrane de-fined physiotherapy as, “activity advice, mobilization, hydrotherapy, disc load-ing and unloading exercise.” Regardless, all of the above spinal manipulation was included as a recom-mendation after a systemic review of the best available research. This is significant. Chiropractors are the world’s spinal manipulation spe-cialists as they make up over 95 per cent of those who practice spinal ma-nipulation. In the US and Canada, pain medica-tion and opioid use are at an all-time high, since over 25 per cent of people experience at least one day of low-back pain in the last three months. Qaseem also points out that total costs BY ANTHONY LOMBARDI or the most part, whenever chiropractic makes the news it is typically associated with something negative about the profession. The moments when what chiropractors do are dis-played in a positive light are few and far between. Although that is the reality for many alternative services, it will get better if chiropractors learn how to take advantage of golden opportunities like this one. In the Feb. 14, 2017 issue of Annals of Internal Medicine the American College of Physicians published a clinical prac-tice guideline for non-invasive forms of treatment for acute, sub-acute, and chronic low-back pain. I connected with one of the authors of the guideline, Dr. Amir Qaseem, to ac-quire further information about this new document. In the guideline, Qaseem and his co-authors state that for those patients with acute or sub-acute low-back pain, physicians should recommend: heat, massage, spinal manipulation and acu-puncture first, before recommending medication. For chronic low-back pain patients, physicians should recommend: exercise, stretching, yoga, and acupunc-ture. Only if the above remedies don’t work should the recommendation for chronic low-back pain be medication. The authors evaluated roughly 61 spinal manipulation trials, some in a systematic review. The details regarding evidence rating and quality assessment can be found in the evidence review published along with the guideline. Qaseem and his co-authors con-cluded, “Clinicians and patients should select nonpharmacologic treatment with superficial heat, massage, acupuncture, DR. ANTHONY LOMBARDI, DC, is consultant to athletes in the NFL, CFL and NHL, and founder of the Hamilton Back Clinic in Hamilton, Ont. He teaches his fundamental EXSTORE Assessment System and conducts practice-building workshops to health professionals. Visit exstore.ca for information. 14 Canadian Chiropractor April 2017 attributed to low-back pain are esti-mated at over $100 billion per year, two-thirds of which are lost wages and productivity. These guidelines now encourage and educate the public and primary physi-cians that there are other options rec-ommended to be utilized before turn-ing to prescription drugs. Back in 2015, I had the privilege of interviewing renowned chiropractor and president emeritus of Parker Uni-versity, Dr. Fabrizio Mancini. I asked him about the importance of chiro-practors becoming ambassadors for the profession through the media. Mancini said, “I learned many years ago that if we do not control our mes-sage to the public, someone else will control it for us. It seems like the main-stream media only talks about the negative in our profession. That is only because we do not ‘pitch’ them our evidence and success stories. “The public is ready for us, but they need to hear from us. It is up to us to make it happen by sharing the many good things we do for our patients.” This journal article about the effec-tiveness of spinal manipulation after an extensive review of the evidence must be shared with mainstream media. I have already contacted two newspapers and one television station and we are currently arranging interviews to dis-cuss the significance of this article to the public. I encourage every chiropractor to do the same. Pitch this story to your local newspaper, newsletter, university or mainstream radio station, and public and community television stations. The profession must use opportunities like this to become ambassadors of our brand so the public can see that main-stream health professionals are recom-mending spinal manipulation for acute and sub-acute low-back pain. www.canadianchiropractor.ca
Chiropractic + Naturopathic Doctor April 2017: Page 14
