In Parts I and II of this series, we took a little journey into the world of low back pain. As you look at the signs along the road, you come to realize that the low back pain paradox is reflective of the greater woes of the health care system as a whole. As I mentioned in Part I - as goes low back pain, so goes health care.
Solutions, however, oftentimes look more like a quilt of short-term patches more so than real systemic and cultural change. A little of this, a little of that, but no guiding foundational principles.
With that in mind, let's begin with one of the most important principles: the patient must be at the center of the equation. Solutions lie in the phrase "patient-centered care", not in political agendas or turf wars. If we then use science-based clinical guidelines as a framework for the low back pain paradox, then we stand to create a culture of patient-centered solutions. So what does this framework look like?
March Madness. Survive and advance. One play at a time. Protect the basketball. Defend and rebound.
These are more than just over-used phrases that make an annual appearance in March. They truly epitomize the "in the moment, right here, right now" mentality that pervades the NCAA men's basketball tournament.
March Madness is more than just excitement, upsets, and drama. It is about college athletes, their passion for the sport of basketball, and the opportunity to play on the big stage. And it is definitely a spectacle to behold, a microcosm of life itself.
After a weekend's worth of hoops - including a couple of days at the Frank Erwin Center in Austin watching second and third round games - I was reminded yet again of how special this month really is.
I can remember a time not so long ago when only the crazy, hard-core runners would do a marathon. In that same fleeting memory, I can remember a time when only the crazy, hard-core triathletes would do an Ironman. Neither of these was something a sedentary person would even consider, much less put on their bucket list.
Oh, how times have changed. Here we are now in 2013, living in a world in which you can't throw a stone without hitting a marathon or Ironman finisher. In the same breath, however, the incidence of obesity is rising. Somehow there seems to be a growing chasm between the two.
What is going on here?
In Part I of this series, I discussed a few of the reasons that make low back pain such a paradox in health care. The scientific research clearly indicates a disconnect in the health care world - a disconnect between commonly-held beliefs about low back pain, and the evidence that refutes them.
When 97% of low back pain patients present with "mechanical low back pain" - with the majority of those having no specific patho-anatomical diagnosis - we are forced to re-consider the context in which we view the problem itself. This is the only way that we will find solutions and not just stop-gap measures to satisfy the status quo.
So with solutions as our goal, let's take the next step in understanding the paradox. We'll carry on from patient access, head into assessment, and end up with the utilization of services once the patient has access to care.
March 15 is a day to rejoice and revel in the beauty of great music. Why today? Because March 15 is the birthday of one of the greatest slide guitar players the world has known - and one of the musicians who has had a great impact on my personal world.
His name is Ry Cooder. For many, that will prompt the next question: who?
Sure, I will admit, it might come across as just another obscure musical reference. That wouldn't surprise me.
But here's a little-known fact: Cooder was rated the #8 guitarist of all time by Rolling Stone magazine. He resides in the top 10 with Jimi Hendrix, Duane Allman, B.B. King, Eric Clapton, Robert Johnson, Chuck Berry, Stevie Ray Vaughan, Jimmy Page, and Keith Richards. That's some impressive company.
Ry Cooder brought slide guitar front and certain in my world. He exposed me to a rich and eclectic mix of musical genres. Perhaps most importantly, he reminded me of the incredible capacity of one note to bring a person to tears, to joy, and all points in between.
Spring break. In Canada, it was better known as "Reading Week" and it wasn't in March - it was in February. I don't remember there being a mad rush to Florida or South Padre Island. You were probably spending that week shoveling snow and longing for spring time.
I don't ever remember that week being anything like Spring Break week in Austin - otherwise known as SXSW. What started as 4 days of music from unsigned bands back in the late '80s and early '90s has become a 10 day multimedia extravaganza for music, film, and social media celebrities. As much as I appreciate SXSW, it's just not like it used to be. Austin ends up looking a lot less weird, or, perhaps more appropriately, a lot more manufactured, trendy, pretentious weird.
In an attempt to inject some "weird" back into our world this week, I bring you the the latest episode of the Rhubarb Report. Where else can you find politics, mathematics and physics, and economics all in the same 500 words? You are in the right place. Onwards with Episode 062!
It was once noted that "every problem contains within itself the seeds of its own solution". With that astute quote in mind, I present to you low back pain: the poster child of all of the health care system's woes and harsh realities.
A total of 31 million Americans experience low back pain at any given point in time. Low back pain affects about 80% of the population at one time or another. If you had those odds in Las Vegas, you would be making a lot of money. Quickly, I might add.
Low back pain also represents the #5 reason for all physician visits, and the second most common symptomatic reason (1,3). The scope and magnitude of the problem is significant. The estimated cost of back pain in the US exceeds $170 billion annually. Yes, billion. That puts it in the same category fiscally as hypertension and diabetes.
It doesn't take the crew of Apollo 13 to establish that yes, Houston, we do have a problem here. It is a problem that is reflective of the woes of the health care system. As goes low back pain, so goes health care costs.
Low back pain is a paradox that contains within itself the seeds of its own solution. But we need to learn from the lessons of 20+ years of spine research – and we need to do so as soon as possible. Let’s start with what may sound like the most basic of questions for patients, clinicians, and legislators: what is low back pain?
Up to 60% of runners will sustain an injury within any given year. Poor running mechanics, in conjunction with poor, ineffective and outdated training methods, can pose a significant injury risk. "RunSmart" was written to address these issues in the running community.
"Running Injuries: Etiology And Recovery- Based Treatment" (co-author Bridget Clark, PT) appears in the third edition and fourth editions of "Clinical Orthopaedic Rehabilitation: A Team Approach" by Charles Giangarra, MD and Robert C. Manske, PT.
Allan Besselink, PT, DPT, Ph.D., Dip.MDT has a unique voice in the world of sports, education, and health care. Read more about Allan here.
Top 5 finalist in three categories: "Best Overall Blog", "Best PT Blog" and "Best Advocacy Blog".
PO Box 26161
Austin, TX 78755
512-222-6263
