MD Meetings – Primary Care
Chiropractic Vs. Physical Therapy Script
I want to start this Consultation by saying there is NO time in medical school where a MD is taught to send musculoskeletal patients to Physical Therapy…They do primarily for 2 reasons, the first being they have followed the directions of their attending physician during their Residency Program and the second being that they “assume” [incorrectly] that spine pain is caused by the muscle FIRST. If you can put the latter into perspective that makes a lot of sense and will help you to understand why the primary care MD will send for PT first…it is also the reason why most medical specialists will use chiropractic first, especially if they have consistent exposure to chiropractic results. The specialists that don’t use chiropractic care [Specialist = Interventional Pain Management, Orthopedic Surgeon and Neurosurgeon] generally OWN a PT clinic…so to paraphrase the dating scene – “It’s not YOU its THEM”!
Now that you have a basic understanding that MDs, especially primary care MDs have little training on musculoskeletal conditions, think that it’s the muscle and when they are confused they do what their attending physician always did we can see the problem. The problem is NOT PT, it is the fact that some physicians believe that spine problems are all muscular…if that was a truism then we would be seeing a historic decrease in the frequency of spine pain when in fact we are NOT! You don’t have to be a rocket scientist to see that chiropractic utilization has decreased [7.5%] while chronic spine pain has increased to epidemic proportions along with narcotic pain medication and addiction. So what do we TEACH the medical community?
We teach them that the structure of the spine is the foundation of the problem with the muscle system reflecting those abnormalities. We can see the muscular manifestation of the subluxation complex [which in MD terms is a biomechanical abnormality], so without that underlying change to the mechanics of the “system” all other treatments – i.e. massage therapy, injections, medications, exercise, modalities, crystals, chicken bones – you get my point J have little effect on the long term structure of the spinal system. What you need to teach them is that without a diagnosis treatment is a moot point….DIAGNOSIS FIRST, TREATMENT SECOND! One of my favorite things to ask a Primary MD [one that is giving me a hard time] that is hell bent on sending to PT is “So what is the most common diagnosis for patients that you refer to PT?” Their answer is generally “Muscle Strain” or “Disc Herniation” or “Facet Syndrome”. My response is generally “Are you sure?” or “What are YOUR outcomes associated with exercise therapy for disc herniation [insert any of the other diagnosis here]?” The most common response to that is “Not good”, my follow up is then “You can’t exercise away a biomechanical problem, that has to be identified and fixed BEFORE we send to therapy”…See how we lead up to the learning issue…now we have the MDs attention and can start the teaching process. That is why we diagnose FIRST, fix the biomechanical problem SECOND then exercise and strengthen THIRD.
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