The patient told me that their first episode began three years ago and didn’t resolve after months of physical therapy and doing exercises at home. Two months ago he experienced the same symptoms in his left shoulder which did not improve much after therapy directed toward his neck and shoulder.
He said his friend recommended him to our office because we evaluated people holistically. Holistic simply means we are thorough and we evaluate the whole person, not just the symptomatic part. It doesn’t mean we stack rocks, light candles or spend all day doing yoga :).
He was surprised when I asked him about his knees, back, and other areas and we discussed chronic problems he was able to tolerate in his lower back. He didn’t see these occasional self-resolving pains as a health risk.
My evaluation had shown that his chronic lower back problems were causing upper back pain, something no other healthcare provider considered. The patient felt a marked improvement in not only his pain but his overall mobility after the initial visit.
The problem is our multi-specialty healthcare systems are bloated with inefficient bureaucracies.
We move as a unit, not as parts as I discussed in my book Cheating Mother Nature, what you need to know to beat chronic pain. The current healthcare system is based on multiple people managing even simpler cases. Years ago, a more robust primary care system would have your physician helping you stay out of the system. Today, they are the system and are just a doorway into it in most cases. Even then, medicine as a profession had and still has a huge blind spot; the musculoskeletal system.
The multi-specialist model most of us are used to is a terrific profit center for healthcare systems, but it makes care very expensive and inefficient. Even multi-specialty practices suggest that having one electronic health record system for their patients has little data to show that they save any money by making care more effective or efficient. You can put lipstick on a pig idea thrown around in political circles that fits this problem perfectly. Even the medicare alternative care models cannot show they save money by efficiently managing problems. ACO or MCO models have yet to show they do anything but keep physicians employed while placing them in a situation where they must talk about cases with each other.
Many patients we evaluated are surprised at the questions we ask them on a first visit. Neck and shoulder problems that occur in the absence of trauma often involve other parts of the body.
Many athletes have been told their problems are from overuse even though they practice as much as others who don’t have those problems. Why is this body part overused for some and not for others who are doing the same amount of activity?
One concept I have used to help patients understand this is the DNA spine idea. If you have imbalances from the ground up, it will affect the way you move and function. The fascial system, which is important for coordination of movement will tighten according to the forces we place upon it. If those forces are uneven, the fascial system will through more activity distort how you move and create pain and strain in different parts of the body. These compensations will result in pain in the neck, shoulders, arms, and elbows. Everything in the body is connected and we move as a unit, so why is it that most doctors ignore this and evaluate our parts instead of us? This is especially true for neck and shoulder pain which is often a global movement issue.
Most doctors overuse imaging such as MRIs since when they don’t know, they test. An MRI will often not tell you what is wrong but it can be a useful part of clinical data.
A better evaluation results in better diagnostics and fewer tests which are often more history of malfunction than an understanding of why you are in pain. From a chiropractor’s perspective, we keep it simple. Evaluate functionally, treat using methods such as manipulation, exercises, and soft tissue methods to improve how you move, and only test if treatment does not improve how you feel and function within a few weeks. The good news is that most people improve. For those who don’t and require a further workup, your chiropractor will recommend the appropriate medical specialist.
Ignoring this and only evaluating the painful area and then directing exercises and medicating it with anti-inflammatory medication is not evidence-based, and will make a patient’s problems more chronic over time as more research is beginning to show for problems such as lower back pain. Many of these patients can and will have damaged joints years later that were preventable with appropriate holistic care. A recent study shows how chiropractors, who are broadly underutilized in workers comp get the job done for less, with fewer tests and better outcomes.
Perhaps this is why so many patients are now visiting chiropractors first. Chiropractors improve how you move. Often, a simple shoe insert can level the pelvis and make a huge difference in how you feel and function.
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