Articles by Dr. Erdman are for informational purposes, and are not to be taken as specific medical advice.
A few weeks ago an article by Daniel DeNoon of the Harvard
Health Blog ran in our local paper. It was titled, “Back pain overdiagnosed, overtreated.”
He quotes Dr. Bruce E Landon, a professor at Harvard Medical School, saying,
“Most routine back pain will improve on its own WITH conservative therapy in
three months, often shorter than that. Even more importantly, when we do more
aggressive things – such as injections, [high tech] imaging, and surgery- the
long term outcomes don’t change at all. These things have very little impact on
what is going on, and they have the potential to make things worse.”
Wow! What a complete indictment of how most people are
treated when they present to their medical doctors for back pain. There is so
much new evidence coming in every year that shows conservative care for back
pain is the first treatment of choice for the best results.
Medical doctors own research and guidelines tell them, based
on scientific evidence, to refer to conservative care providers such as
physical therapists and chiropractors prior to sending a person for advanced
orthopedic referrals. Have they heeded the science? According to Landon and his
colleagues, from 1999 to 2010 referrals to medical specialists rose from 6.8%
of visits to 14% of visits. Their referrals to conservative physical therapy
remained low at 20%. Their referrals for higher imaging rose from 7.3% to 11.3%
of visits. These are the exact opposite course of action evidence based care
should be producing. The guidelines are
being ignored.
Medical doctors’ biggest complaint about chiropractors is
that we aren't “evidence based.” Not true! We have more evidence every year
piling up showing chiropractic specifically, and conservative care generally,
are the best course of care for back pain. According to this study of care by
the medical establishment, they do not follow evidence based care! I can tell
you that in my 20 plus years of practice, I can count on one hand the number of
patients who came to me via a referral from their medical doctor. What a shame.
Are our professions not to have the best interest of the patient as our main
priority? Then why do doctors shun the evidence right before their eyes?
Chiropractic’s own studies show less than 7 to 10% of the
population ever goes to a chiropractor. A few more have tried physical therapy,
and are referred there more readily. Why? Because a PT generally needs a
prescription from the medical doctor to treat that patient, and the doctor
still has control over that patient. Chiropractors are primary portal of entry
doctors, and do not need a referral to treat, so we somehow pose a threat to
their pocketbooks. It is not good for our patients. This feud goes all the way
back to the fifties and sixties when the medical associations could still put a
chiropractor in jail for “practicing medicine without a license.”
Are all doctors like this? No, but this study shows they
still do not value conservative care which is completely based in science. Some
still cling to the “chiropractors are quacks and aren't real doctors.”
I have full knowledge that I am not a medical doctor, nor do
I pretend to be one. I don’t need to be the one handing out the drugs; we have
enough of that. I take a completely different approach and treat your back pain
in a far more conservative way based on science before seeking further invasive
care outlets when necessary. If you give me 12 weeks, I’ll be able to tell you
if conservative care will be of help to you. Will you be cured? Probably not, but
most back pain isn’t cured, it is managed. Using adjustments, therapies and
exercises, you can return to daily life and control your back pain, instead of
it controlling you.