Why Does My Back Still Hurt?
I get this question a lot from patients and practitioners. The majority of people that are asking say that they have already received a variety of care, but expectations were not being met. Back pain is the #1 neuro-musculoskeletal problem in the world for many reasons. And in way too many people, back pain can become chronic with recurring episodes.
In this newsletter series, I am going to describe numerous considerations regarding evaluation and treatment options. I am going to start with the basics. "Basics," may seem rudimentary for clinicians. But there are also patients reading this newsletter. It is important for those suffering to know what to expect when looking for help and the value of an integrative practitioner provides over any one-dimensional clinicians. During the exam and first treatment, I may do more than what will be discussed in these numerous newsletters. Other comprehensive variables are continually expanded in Performancepractic TV and Fitness Integration Technique (F.I.T.)® for the clinicians who always strive to learn more and desire to transfer their head knowledge to hands-on application. My goal is to keep each newsletter short and to the point, but not to sacrifice the quality of care or how you may integrate any information into your current methods.
The discussions I am going to provide are not personal injury or Medicare documentation specific. It is just important information to help any person (acute, chronic, healthy, or non-responsive to previous care at any age), who genuinely want to get better, with or without insurance. The case scenarios described are all applicable to chronic back pain and some modification may be necessary in those with acute episodes. Chronic pain is defined as any pain lasting more than 12 weeks.
The complete patient history and personal intake cannot be understated for importance. Think of this as a crystal ball. If you ask the right question, you will get the correct answer. And you have the answer sheet right in front of you…..the patient!
When beginning to work with a patient, who has been to numerous clinicians of different licensure as well as previous chiropractors, I do not want to perform what has already proven not to work. Be aware they had already filled out numerous intake forms of similar questions such as, when did your pain start, what makes it worse or better? Age, weight, any previous accidents, and knowing what medications (supplements) they are taking are all contributing factors to their outcome. The patient history can start "here we go again" in the patient's mind unless the clinician knows how to use the information and get more out of it.
Clinical Pearls When Taking a History:
Ask the patient "Is your back pain better or worse with movement?"
If pain is worse with movement, better with rest, it is highly likely there is an actual tissue injury such as significantly sprained ligaments and herniated discs, torn muscles, or any combination. Current daily activities and overall health of the organism has not allowed healing to occur if the pain is significant and not improving after 12 weeks or more. Especially if pain increases during movement. In many cases integrated physical, nutritional (chemical), and emotional factors are being missed in previous treatment regimens before you have seen this patient.
Using Low-Level Laser Therapy for pain (acute or chronic) is a significant integrated advantage. For low back pain 10 – 20 minutes of cellular enhancing mitochondrial laser love, symptom-specific, has been proven in Level 1A research study and granted an FDA Clearance using the FX635!!!! You may combine ice and laser at the same time.
If pain is worse with ALL movement this is one of the many advantages of FDA Cleared Low Level Laser Therapy. Place the patient in the most comfortable position possible. Refer to the FDA study protocols and press the start button. Modify if needed for what is best for the patient and your office procedures. Remember healing takes time but sometimes you may need to change protocols. The standard settings of 9, 16, 42, 53 (for the hand held lasers) are always appropriate for any acute or chronic condition. The current FX635/FX405 has a preprogrammed button specifically for the Low Back FDA Clearance and the FX635/FX405 Manual has 6 pulse settings per condition and provides the clinician with many additional options. That may be using different pulse settings on your laser: disc, neurogenic inflammation, chronic pain are all good options and clearly displayed in the A-Z Manual specific to your Erchonia Laser.
If pain is better with movement (and maybe even hurts worse while resting), that tells me there is NOT a severe connective tissue pathology. I can start by being a little more aggressive with all my treatment decisions (within reason, of course). This includes clinical exercise specific to the priority distortions(s) affecting the symptomatic area combined with chiropractic adjustments immediately.
No matter how you practice, unattended Low Level Laser therapy stations are a great asset to increase efficiency and clinical outcome. You just need to be prepared by having additional tables / stations so you keep adjusting patients and then delegate the best pre / post adjustment therapeutic laser session.
Low level laser (no heat) is very safe and can be left unattended in a separate room or the concept of unattended laser sessions works equally well in open room adjusting concepts and keeps the flow of the clinic while providing an increase in services. You can only adjust one person at a time but your patient history and clinical exam will identify areas that can benefit from 5 - 20 minute therapeutic dose Low Level Laser Therapy. So it is very easy to treat 3 or more patients at the same time when your office is set up with stations to compliment the adjustment you give. When you create treatment stations it opens up an entire different level of efficiency for services charged.
Click here to find out about some of my favorite tables to use for unattended therapy and why.
See Part 1 for the beginning of taking a good patient history.
While taking the patient history, another one of many vital questions is, “Have you had ANY surgeries? Do you have any scars?” This may seem like a redundant question. But you can have scars from a scrape or fall, and not require surgery. And maybe the scar is located distant from the symptom. But through biotensegrity and distorted cellular electromagnetics, the scar(s) have systemic adverse effects on tissue, muscles, and organs as well as cellular, neurological communication, local and systemic.
Patients commonly do not answer the surgery question accurately. And maybe not at all. This can be due to their (false) reality that the surgery or surgeries were years before the symptom flare-up; therefore, surgeries are unrelated and irrelevant. Your health, or lack thereof, is cumulative. Surgeries and old injuries come back to manifest locally or systemically. Dig deep, my clinical detectives. Past operations or accidents are a big one for ultimately setting up the treatment program backed by tangible causes.
Treating With The Laser
There is an entire “Scar” protocol on the Advanced Laser Video Volume #2 found only at Performancepractic TV. The detailed case study and interview is with a female patient who had lingering concussion effects. And I teach the step-by-step history, local correction, and progress through systemic involvement. The methods applied in this hands-on correction case study can be applied to scars anywhere on the body. Taking a comprehensive history is invaluable. Hands-on correction using a system separates the clinicians from the healers!
Watch Dr. Jerome Rerucha's Advanced Laser Volume 2 Video at watch.performancepractic.com
Treating With The Percussor
Using the Erchonia Percussor to break up scar tissue and integrating laser therapy is an effective combo to address the breaking up tissue adhesions manually as well as the cellular healing benefits that laser provide. The Percussor Basics - Advanced video series in PerformancePracticTV has hours and hours of find it and fix it, hands-on details covering all of the Percussion attachments and primary anatomical areas, toes to nose.
Scars always need to be treated at some point (laser and manual adhesion correction).
Watch Dr. Jerome Rerucha's Percussor Basics Video at watch.performancepractic.com
Identify Anatomical Short Leg
Take x-rays (for numerous reasons) at the time of the examination. Having proper x-rays brings life to your patient's intake and history.
X-rays can provide a fantastic correlation to the current symptom and how past injuries have caused degeneration, previously missed pars fractures, spondylosis, structural misalignments, etc. And the #1 reason I take the below standing pelvic x-ray on 100% of all new patients (pain or not, I still take my standard FIT X-ray series) is to identify and correct an anatomical short leg.
The anatomical short leg identified in the two examples above is common, but the severity and compensatory changes vary greatly. If the difference is relatively slight (3/8" or less), an internal lift works well. I do not like using a heel lift to correct femur head height in ideal neutral only. I apply a full-length lift, so the entire foot is elevated in a standard position when walking, running, etc. A greater than 3/8" difference from right to left is worth changing the shoe's sole. A cobbler or pedorthist (not a pediatrist) is my preferred local choice.
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The more athletic the person's needs are, the more significant the art of shoe correction. The patient education using the above x-rays is invaluable. It amazes me how prevalent the anatomical short leg is (day-to-day real life and research) and how many patients have never had it identified, explained, let alone a method of correction in a care program. The anatomical short leg should be identified on the first visit, and you become an instant difference-maker. You become a doctor hero of sorts through the patient's eyes is no small exaggeration when these commonly missed priorities are corrected.
It is quick and fast to improve additional healing benefits to the chiropractic patient by implementing the X-ray analysis to identify "IF" the patient has an anatomical short leg. This combined examination of identifying an anatomical short leg and testing for the need for a sacral belt (discussed in the near future) provide significant changes to the great work you are already providing.
Suppose you purchase the Fitness Integration Technique (F.I.T.)® Level 1 System. In that case, we teach you how to evaluate the stand 4 FIT® X-rays and make a 2-dimensional x-ray a three dimensional Brain/Body Map® for patient education and priority correction.
ADJUST! Adjust! Adjust! (physical pain and overall health benefits)
Following your patient intake, history and examination, it is time to provide correction(s). The chiropractic adjustment is one of the absolute most beneficial applications to promote natural healing. For pain and overall health and well-being. The two following publications did not increase the patient use of chiropractic nationally or globally, but the educational premise discussed offers unlimited excitement to create information marketing to promote the Chiropractic Triad. The adjustment and structural correction are the unique foundation of the chiropractic profession.
Dr. Jerome's Favorite Adjusting Table
The Pivotal ErgoStyle™ FX is the official adjusting table of Dr. Jerome's Brain/Body F.I.T.® Clinical Performance Center.
Dr. Jerome's Fitness Integration Technique (F.I.T.)® Certified Practitioners Get 5% Off Any Pivotal Table Purchase.
The chiropractic principles are proven in the above peer-reviewed medical journal which shows patients who received the chiropractic adjustments had the most improvement over drugs and acupuncture. In addition to pain resolution, the study concluded that chiropractic adjustments were effective for overall health benefits, and free of side effects as well.
The second paper, “Mechanobiology and the diseases of mechanotransduction,” describes that structural health directly affects cellular function and disease development. Yet, the adjustment is underutilized (more than 90% of the U.S. population does not receive chiropractic care).
I constantly enjoy learning from practitioners and expanded adjustments that are not “technique specific.”But when I was a patient (prior to becoming a chiropractor) it was terrific being under the care of a great hands-on chiropractor. There are hundreds and hundreds of unique adjustments I have seen others do. I cannot do all of them at a ninja level, but I enjoy passing on adjustment skills and details that have shaped how I can help patients as well as pass on to young chiropractors and seasoned experts alike. There are 206 bones in the body, and I strive to have many options for each spinal level and extremities and cranial adjustments. The adjustment has its own channel in Performancepractic TV to provide a growing library of hands-on teaching.
Performancepractic TV online instructional library (adjusting technique, nutrition, laser, soft tissue, vibration therapy, and more) is available to all clinicians. And Brain/Body FIT® hands-on seminars teach the art of elite-level adjusting skills and how to provide priority support and correction (soft tissue, nutrition, neurology, clinical exercise, and much more) in a comprehensive system that can only be taught by your personal attendance (staff is encouraged to attend!!!)
You and the entire profession have done so many positives to educate the population, but this needs to advance continually, and it will take all of us. At Performancepractic.com we have released Digital Marketing Slides to promote natural health care education using the latest education sources for the integrative chiropractor.
Digital Marketing Slides help your existing patients, staff and potential new patients understand the benefits of the chiropractic adjustment. As well as common nutritional support and why, validation of Erchonia FDA Cleared Low Level Laser Therapy and call to action slides to grow your business.
All of these patient education material are personalized with your clinic information and used on social media, for community health classes, in your clinics, and in your own advertising or used for patient education.
Sacral belts are primarily thought of to help those with low back conditions. You do not have to have a “pelvis first philosophy” to apply sacral belts as a standard (exam and correction) in your practice. I know many upper cervical or brain-based clinics that have implemented the use of sacral belts into their specialty with rave reviews and additional treatment success. I have been aware of sacral belt benefits as a young chiropractic patient (for myself at age 8 or so due to a significant axial compression impact injury of my low back/pelvis).
I am not a one-dimensional pelvis specialist, but I am a pelvic expert. In my late teens and 20’s I learned to build world-class strength and flexible pelvises as a strength coach and competitive strength athlete. And then, I became a chiropractor, which provided additional exam and treatment skills. No matter the great work you do, the teachings I provide in Performancepractic TV (adjustments, laser, soft tissue, nutrition etc) and FIT® System have proven to help the most advanced practitioners to the next level with their understanding of pelvic function, examination, correction and outcome.
Symptoms are the tip of the iceberg. A strength coach understands that "the most power comes from the pelvis!" This is true whether you are throwing a ball or throwing a punch, as well as if you are a wrestler or a track athlete, etc. The concept of power comes from the pelvis (do not misinterpret from the "above down, inside out philosophy") is also true if you are just trying to have a good quality of life and getting groceries pain-free. Which requires a lower physical capacity necessary vs. what it takes to be a novice weekend warrior athlete, let alone a moderate - elite athlete of any kind but requires a level of function fitting to the activity, which many patients do not possess.
Dr. Jerome is pleased to be an authorized distributor of Serola Sacroiliac Belts. Bulk pricing is available!
You can use sacral belts based upon patient symptoms and history. But by performing a simple muscle test referred to as "The Standing Stress Test" (Created by Jerry Hochman D.C.) has a tremendous educational impact on the patient and can further tell the examining clinician if it is the right or left sacral ligament that is the injured. Check out the Standing Stress Test video and purchase your sacral belts from Performancepractic.com.
For the full impact of pelvic testing involvement to common shoulder, low back, knee pain, plantar fasciitis, headaches, TMJ brain imbalances, etc, subscribe to Performancepractic TV.
Inflammation and Pain - The Omega 3 Lab Test and Fish Oil Correction
The Omega 3 blood spot test is a great test for low back patients (and much more). Would you rather adjust a patient with an improper inflammation ratio or KNOW that the person has a healthy or optimum ratio? Traditional and natural healthcare professionals agree that inflammation is a common denominator to all diseases, acute and chronic. This includes joints, the entire brain, and the nervous system, as well as visceral disease. The ability to perform a simple blood spot lab analysis to get the patient’s inflammation ratio (Arachidonic Acid and Eicosapentaenoic Acid ratio. Commonly abbreviated as AA/EPA.) This test and ratio will provide an exact answer specific to that patient. I then provide a treatment program for 3 - 4 months and retest. The essential fatty acid ratio is an incredible advantage to everyone who offers it to their patients and requires a simple blood spot analysis.
Many people and doctors already take fish oil to decrease inflammation and want to receive all the benefits, including building a healthy brain, joints, heart, hormones, immune system, etc. Taking fish oil (or any supplement) without a scoring method has shown to be very inefficient. An optimum AA/EPA ratio is 1.5 and extends to 4 as a “healthy ratio.” AA = Arachidonic Acid (inflammatory) / (EPA = Eicosapentaenoic Acid (anti-inflammatory).
Over the past three years, I began providing a complimentary test after my seminars (from LipidLab.com 888.630.6634) to doctors who attend. Over 97%+ claimed to be regular fish oil supplement takers and have taken numerous seminars that promoted the health benefits of maintaining a proper AA/EPA ratio and the importance of performing the lab test. Despite this, I rarely see a doctor score below a ratio of 15:1. YIKES! In fact, out of 250 tests on clinicians, only five have passed the test with a score of 4 or below! If we use a score of 3, that means the person is 5X too inflamed if the score is 15:1
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In my personal clinic, this test is performed on 100% of my chiropractic patients. I am happy if the patient initially scores a ratio of 22 (although if maintained, they are doomed from a health perspective). The reason I am happy with 22 to start a health restoration program is that 40+:1 is very common. A high ratio has a very negative effect on the mid-term and long-term health of the nervous system and overall cellular health. So far, the record in my clinic is 69 (and yes, we changed their life epically and saved them a trip to the mayo clinic). As a natural health care expert, I feel it is my job to educate and provide this life-changing test and supplement correction integrated (not just sell supplements) and enhance the chiropractic adjustment.
Below (Test #1 = 42 AA : 1 EPA) is a common test result we receive. Based on experience (not a set formula) with supplement dose, patient weight, digestion, etc., we create a protocol and retest 3-4 months later.
Below (Test #2 taken 3 months later = 2.1 AA : 1 EPA) is the same person as Test #1 above. Life changing improvement! We now want the patient to maintain this healthy ratio for life. And we are there to coach, provide supplementation and retest them to do so. Once a healthy ratio is achieved, retest frequency can vary (but for sure one time per year for the next couple years minimum), and we will maintain a supplementation schedule.
Since we can test the exact ratio in the clinic, we can find it, fix it, and re-evaluate how the patient has progressed. We provide other specific lab testing and provide correction synergistically (Vit D, selenium, zinc, magnesium, to name a few). Some nutrients are not cost-effective or possible to lab test, and we provide supplementation due to other evaluation methods.
We are very serious about our chiropractic adjustment and our supportive integrative natural care. We are also passionate about providing clinical pearls to grow your practice and providing the communication that gets patients to understand and commit to care. Purchase our Digital Marketing Slides that are personalized with your office information to educate existing and non-existing patients to pay for the elite services you provide; laser therapy, the chiropractic adjustment, and nutritional examination and correction.