SPINEgroup: the “Centre of Excellence” for Back Pain and Spinal Related DisordersBy: Dr. Connie D’Astolfo, DC, PhD (c) Scan with your smart

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Care Program

Treatment of Back Pain and Spine Related DisordersThe first line of therapy for spine pain is re-habilitation. For most cases of spine pain, surgery can be averted with a comprehen-sive rehabilitation approach. A variety of providers have traditionally been involved in the treatment of back pain and spine related disorders. This in-cludes family physicians, chiropractors, physiotherapists, massage therapists, phys-iatrists, orthopaedic surgeons, neurosur-geons, kinesiologists, acupuncturists and even personal trainers. This has resulted in what some have termed a “supermarket ap-proach” where the patient or “consumer of healthcare” is left to sort out which of these approaches is best for his or her particular spinal or spinal related condition. Unfortu-nately, a patient’s selection will be based on salesmanship rather than on science, cost effectiveness and clinical benefit. Chiropractors are generally perceived by the public as back pain experts. The fal-lacy is that although all chiropractors treat back pain not all chiropractors are experts at managing specific back pain condi-tions. In other words, some chiropractors may not treat a disc herniation or spinal stenosis (which involves damage to spinal joints, nerve tissue, disc tissue, reaction of muscle tone, change in posture, loss of strength and conditioning, change in nerve conduction and alteration in brain, psycho-logical and behavioral response) but may only manage one aspect of the pain. This is because some chiropractors only focus on removing what is termed spinal “sub-luxations” which is essentially areas of the spine that are fixed or immobile causing pain and stiffness. In spite of the fact that delivery of a spinal adjustment can help restore spinal joint movement which can reduce some level of pain, this may not be adequate in fully managing your spinal condition or injury. The same is true about a massage therapist delivering massage to a tense muscle tissue or a physiotherapist prescribing only strengthening exercise or only using ultrasound therapy or a family physician only prescribing pain relieving and anti-inflammatory drugs. Rehab clin-ics that offer multiple therapies ‘under one roof’ may not mean you will be receiving coordinated and comprehensive spine care that is targeted to your condition.

The Challenge with Back PainBack pain conditions have features that differentiate them from other health con-ditions. For example, diagnosis is chal-lenging in many causes of back pain par-ticularly when there is no lesion or injury detected by MRI , x-ray imaging or special tests. In many cases a lesion or injury like a disc herniation for example may not even be the cause of back pain. Additionally, most cases of back pain are multi-facto-rial, meaning back pain may involve many factors including psychological, social and neuropsychological factors. Management of back pain thus requires a high level of expertise that can respond to these multiple challenges. This high level

of expertise necessitates an experienced spine care provider who can offer a clear diagnosis for your condition and provide a treatment strategy to directly address your condition. For instance for many back conditions, i.e. disc herniations and spinal stenosis, it is not enough for a health care provider to provide one intervention re-peatedly like acupuncture, spinal manipu-lation or massage therapy. These interven-tions will only address a small component of the problem and therefore only offer temporary pain relief. Your condition may require a thought out plan that includes ses-sions of varying interventions or interven-tions from multiple experts for a particular period of time.

SPINEgroup: The Centre of Excellence for Spine CareAt SPINEgroup, we set extremely high standards and we strive to be the “Centre of Excellence” for spine care. Our clinicians are fully qualified and licensed to perform rehabilitation by their appropriate provin-cial licensing authorities. In addition all SPINEgroup clinicians receive training in our specific spine rehabilitation processes and procedures that are unique in our in-dustry. SPINEgroup is the only clinic in Ontario to bring together a team of clinical experts trained in spine and spine related conditions targeted at diagnosing and man-aging these disorders directly with a mini-malist approach through coordinated pro-grams of care. This means the treatment is aimed at getting you better faster with the lowest cost. The group encompasses skills to maximize value in the management of spine related disorders. The program of care is delivered by our clinical team of experts including our chiropractor, physio-therapist, massage therapist, psychologist, psychotherapist and case managed by our registered nurse. SPINEgroup’s clinical process for the management of spine pain disorders paral-lels none in Canada.

A Spine Pain Centre Must Have the Following Expertise: • Skills in diagnosis of spinal pain conditions• Skills in the management of different patient populations • Wide range understanding of complex nature of spinal pain with psychological factors with the ability to detect and manage psychological factors • Appreciation in minimalism of treatment in spine care • An understanding of the methods, techniques and indications of medical and surgical procedures • A unique understanding of work related spinal disorders • A unique understanding of motor vehicle accident related spinal disorders and injuries • Public health perspective and co-morbidity relationship with diabetes, hypertension, obesity, dementia and depression • The ability to coordinate the efforts of a variety of providers; case management • The ability to follow patients over the long term to monitor and treat re-occurrence and educate patients in self-management • The ability to performance manage and assess outcome measures• Ongoing research in the detection and management of spine pain disorders

SPINEgroup’s unique treatment approach ensures that you will get better faster at the least cost. I will give you a real case ex-ample of one of our recent patients, who for confidentially reasons, we will refer to as “Ms. Jones”. Ms. Jones a 52 year old female, presented to our clinic with severe bilateral leg pain, weakness, instability and numbness/tin-gling. The patient was unable to work due to the pain and had been off work for over 5 months. She had attempted moths of reg-ular chiropractic and physiotherapy treat-ments with little benefit. After a thorough history, orthopedic evaluation and review of her x-rays and MRI, we diagnosed the patient with a L4-L5 disc bulge and L5-S1 central spinal stenosis (a degenerative con-dition where disc tissue and osteophytes cause a narrowing of the spinal canal which houses the spinal cord and may lead to neurological impairment of the lower extremities.)The disc herniation had been irritating her right nerve root causing severe, sharp radi-ating pain down her right leg. The spinal stenosis was making both her legs weak, unstable with the numbness and tingling

sensation. As a consequence of her pain and disability, the patient had also become depressed and anxious. Her history and exam also revealed high blood pressure and significant weight gain since the on-set of her disability. Along with her pain condition and depression, the patient was at high risk for heart disease.After the course of his 6 week treatment plan, Ms. Jone’s pain was reduced from 9/10 to a rate of 1/10. She lost 15 pounds, her blood pressure had normalized. With the help of the psychological counseling, the patient had learned to reduce her anxi-ety and depression. Ms. Jones was finally able to resume her normal daily activities and return to work. The full cost of his treatment was less than half the cost of typical rehab care with quick and positive outcomes.Our program is unique in the rehab indus-try. Patients regularly travel from outside of the GTA and province to access our services. The Spine Care program has an extremely high success rate for some of the most complex spinal injuries and con-ditions including herniated discs, moder-ate to severe degeneration, spinal stenosis, based on our evidence based, team mod-elled, self-management approach.Currently our success rate for the program is an average of 85-98% for pain reduction and functional improvement and we have scored high for continued improvement

post discharge. The research is clear that some cases of back pain tend to reoccur and persist if a comprehensive solution is not delivered by expert in spine care. Due to its complex nature, a comprehensive approach is recommended to effectively manage back pain including emphasis on pain manage-ment; patient education, regeneration and repair; lifestyle modification, psychologi-cal factors and functional rehabilitation. This approach ensures long lasting restor-ative effects with fewer treatment visits and less overall costs. The program length is 16 sessions over 8 weeks, followed by a con-sult at one month and at three months post discharge. Patients thereafter will receive complimentary assessments (in person or through teleconference) every year to ensure continued compliance, motivation and clin-ical outcomes. Dr. Connie D’Astolfo, DC, PhD (c) is a chiropractor and the director of SPINEgroup® an integrated medical rehab clinic located in Vaughan. Dr. D’Astolfo is currently pursuing a PhD at York Universi-ty. She has several published peer reviewed articles and is a chapter author for several medical texts. Her interests include chronic disease prevention and management, spinal disorders and rehabilitation. You can visit our website at www.spinegroup.ca or con-tact our client care representative at 905-850-7746 for more information on our clin-ical programs including our popular Spine Care Program.