15% of patients seen each day by GPs have back pain: more needs to be done!

Stephen Small with BMI team at GP event in Coventry

Stephen Small with BMI team at GP event in Coventry

Two weeks ago I got some interesting feedback from GPs during an IDD Therapy CPD event about the actual incidence of back pain in their daily surgeries.

Whilst 99% of back pain presentations I have heard begin with the usual “back pain is the second most common reason for GP visits” etc, etc, I was interested to know how that translated into a percentage of their daily appointments.

I was quite surprised.

The general consensus amongst the group of GPs was that back pain represented approximately 15% of their daily case load,  i.e. about one in seven patients.

Given the hundreds of different conditions people might come to a GP with, I had expected the percentage to be lower.

GPs are up against it here because patients with chronic back pain clog up the system.  GPs really have limited options and often the patient is dissatisfied.  Help please!

Given the pressure on budgets within the NHS and the costs to society as a whole, surely it makes sense to make back pain resolution and prevention a top priority?

This is particularly important when we consider that societal lifestyles are appalling for disc health and spinal function and in addition, we are all living longer!

As far as the IDD Therapy programme was concerned, there was universal interest from the GPs:  some were extremely positive whilst one said “Listen, if we have a chance to help some patients, then there’s very little to lose and everything to gain.”

Exactly.

Author: Stephen Small
Director Steadfast Clinics Ltd
www.SteadfastClinics.co.uk

Hamstring Injury Treatment – Doing more with new Thermedic FAR Infrared Therapy

Having had my share of hamstring injuries, I know that the biggest pain is not the physical pain, but the pain of not being able to play your sport.

The risk of injury recurrence with any injury is very strong because for the competitive sports man or woman the desire to play can lead to an overwhelming temptation to play again too soon.

This is particularly the case with hamstring injuries and is especially aggravating because good hamstrings are so essential for running (fast!).  Incomplete healing, scar tissue, inflexibility and muscle imbalance with the quads mean that recurrent hamstring problems are a common (and expensive) problem.

So, can clinicians do more to help their patients with hamstring injury treatment?

Following the acute injury phase, it goes without saying that good blood flow to the injured site is essential to carry oxygen, nutrients and repair cells for efficient healing.  Stretching during the re-modelling phase of healing is essential to ensure that new collagen fibres are laid down neatly. 

Evidence shows that applying heat increases the extensibility of hamstrings1 and improves myofascial relaxation2 , thus applying heat before stretching muscles is beneficial.  Heat causes vasodilation: a widening of the blood vessels which in turn leads to more blood going through the injured area.

The problem to date has been in finding a comfortable and effective heat application for the hamstrings to help with healing and to help with the return to sport.

pw150_2%20close%20upThe new Thermedic Thigh is the ideal treatment tool for hamstring injuries.  It includes a cold pack to limit bleeding in the injured site whilst the support provides compression during the acute phase.

But the main benefit for athletes is a unique carbon-fabric FAR infrared heat element which delivers resonant energy into the tissues.

Mains powered, Thermedic has three temperatures and has been show to increase blood flow in tissues and joints; by 204% in the knee and 49% in the abdomen3.  The exact amount of increased blood flow in the hamstring hasn’t been measured but we might reasonably assume that the amount be somewhere in between.

At the same time FAR infrared has been shown to increase fibroblast proliferation and collagen regeneration, which are key components of healing4 .

Thigh ThighAnother significant benefit of Thermedic FAR infrared over standard heat products is that skin temperatures do not reach burning levels.  Thus, it is possible to apply FAR infrared for longer periods meaning that there is a sustained increased flow of blood through the injured site.

So, rather than 5-10 minutes of superficial warmth, with Thermedic it is possible to increase the blood flow for longer periods for a greater therapeutic effect.  This may have interesting implications for angiogenesis in the injured tissues but that question is for a phd student somewhere!

The key thing is to try the Thermedic Thigh on your hamstring and feel the difference compared to ANY other heat application.  When you feel this difference yourself, you can appreciate why Thermedic is becoming so popular for hamstring injury rehabilitation and many other painful conditions and injuries.

To order a Thermedic Thigh visit www.Thermedic.co.uk

Author Stephen Small
Director Steadfast Clinics Ltd
www.SteadfastClinics.co.uk

1 D. Funk, A. M. Swank, D. Treolo, K. J. Adams.  Efficacy of Moist Heat Pack Application Over Static Stretching on Hamstring Flexibility.  Journal of Strength and Conditioning Research, 2001, 15(1), 123–126

2 T. Muraoka, K. Omuro, T. Wakahara, T. Fukunaga, T. Fukunaga, K. Kanosue, Passive mechanical properties of the human muscle-tendon complex at different temperatures.  Journal of BiomechanicsVolume 39, Supplement 1 , Pages S197-S198, 2006

3 B.Y. Liau, A. Yang, T.K. Leung, M.C Ou, C.K. Ho and Y.S. Lin.  Inhibiting Effects of FAR-Infrared Ray-Emitting Belts on Primary Dysmenorrhea.  International Journal of Photoenergy, Volume 2012, Article ID 238468

4 Toyokawa H, Matsui Y, Uhara J, Tsuchiya H, Teshima S, Nakanishi H, Kwon AH, Azuma Y, Nagaoka T, Ogawa T, Kamiyama Y. Promotive effects of far-infrared ray on full-thickness skin wound healing in rats.   Exp Biol Med (Maywood). 2003 Jun;228(6):724-9.

Google search results for Physiotherapist vs Osteopath vs Chiropractor in the battle for the hearts and minds of back pain sufferers.

What does Google tell us about back pain and the different professions?

Google back painWhen people are in pain, they go online.  Working with Google Adwords, I decided to look at the search volume and see whether the search patterns revealed anything interesting about what people are looking for.

I began by taking the three main professions which treat musculoskeletal conditions: physiotherapists, osteopaths and chiropractors and then I looked at the search volume for specific conditions.

Google displays results in two columns, the first, for the world and the second, local to where you are – in this case the UK.  Here are the results:

Keyword

Global

UK

physiotherapist

1,500,000

368,000

physiotherapy clinic

60,500

18,100

chiropractor

2,740,000

165,000

chiropractic clinic

74,000

14,800

osteopath

1,220,000

135,000

osteopathy clinic

9,900

4,400

back pain

2,740,000

368,000

low back pain

673,000

90,500

herniated disc

368,000

27,100

slipped disc

165,000

22,200

sciatica

1,000,000

135,000

neck pain

550,000

74,000

shoulder pain

550,000

90,500

shoulder injury

74,000

9,900

knee pain

673,000

90,500

knee injury

246,000

33,100

sports injury

135,000

40,500
arthritis

4,090,000

450,000

Of course there are thousands of keyword permutations but these are the broad searches.

When people look for a clinician they do so because they have a condition.  Each profession has specialities but back pain is the number one reason that people visit a clinic.

Based on conversations with clinicians over the years, I would put forward the following general percentages as back pain-related patient visits for each profession globally:

Physiotherapy: 40-50%
Osteopathy: 60-70%
Chiropractic: 70-80%

The profession-related search reveals three interesting things for me. 

1/ When people need help, they are looking broadly for a profession.  The type of treatment is a commodity ie I just need a physiotherapist, chiropractor or osteopath.

2/ People are looking for information about back pain and they are looking for private treatment in very large numbers (you don’t need to search if you just go to your GP to get treatment/ referral)

3/ Clinics need to plant the name of their clinic in the minds of future patients so that when they do get pain, they won’t search generically, they will search for their clinic!

There are up to 10 times as many physiotherapists in the UK as osteopaths and chiropractors, but large numbers of patients are looking for osteopaths and chiropractors over physiotherapists.

If we take it that a search for a clinician is in essence a search for treatment for a condition, then applying some percentages we can see more dramatically that osteopaths and chiropractors are getting a disproportionate amount of search traffic for back pain for the number of clinicians in those professions compared to physiotherapists.

Keyword

UK Search

            % of Patients with Back Pain  

physiotherapist

368,000

50%

184,000

  

chiropractor

165,000

70%

115,500

  

osteopath

135,000

60%

81,000

196,500

This is search for broad terms only and the numbers may not be entirely accurate but they do give a ball park figure.  Combining the chiropractic and osteopaths (although I know the two professions are very different!) their combined search number of 196,500 is greater than the search for physiotherapist, 184,000.

What can we infer from this?

Quite a number of things but two things for me.

1/ The numbers show that in broad search terms for the professions, osteopathy and chiropractic are winning the day in the hearts and minds of back pain sufferers.

2/ With an ageing population, clinics can do worse than be the best for back pain … and arthritis.

Stephen Small
Director Steadfast Clinics

Steadfast Clinics is a dynamic medical company which helps clinicians do more for back pain sufferers and helps to grow clinics with the IDD Therapy spinal decompression programme.

For details request an information pack using the form below or visit www.SteadfastClinics.co.uk to read clinician testimonials and more.

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The Number 1 Mistake Clinicians Make When Seeking To Establish Relationships With GPs

For most clinicians getting GPs, or indeed any other clinician, to refer to them seems highly desirable.  However I consistently hear the age-old complaint from clinicians that ‘GPs just aren’t interested in them’.  Why is that?

The answer is not that GPs are interested per se, rather the fundamental problem is that most clinicians simply fail to establish relationships with their local GPs.

In this post I will tell you the Number One mistake clinicians make when seeking to establish relationships with GPs and outline 3 steps which MAY create the relationships you seek (and in turn get you referrals).

So if you want to engage GPs there are two important questions –

1/ Why should they be engaged by you? 
2/ How are you going to get your message to connect with them?

To begin with I’ll assume you have a compelling reason for GPs to be interested in you, but if you don’t, you can still establish a connection as the first choice treatment provider in your field.

Whatever your engagement means, the number one mistake clinicians make is to give up on establishing a relationship too soon.  

So many clinicians have the unrealistic expectation of getting an instant response or, for one or two letters (or other communication means)  to lead to the establishment of a meaningful relationship with their GPs.   Relationships don’t work like that.

The three pillars of any relationship are well documented – Know, Like, Trust. 

My brother-in-law is a GP and so are some of my old school friends.  They are snowed under with paper work, sales messages, drug company reps, government initiatives and of course patients!

If you want to engage GPs, you have to let them get familiar with you over time.

Here are 3 simple ways for you to engage GPs:

1/ Case History – If you successfully treat a patient, write to their GP with a brief case history. You should have their GP name in your notes, but if you don’t then make sure you get it! This will really set you apart from your competitors and the GP will remember your name and respect you.

Include a business card since whilst we tend to throw away mail, if we like the essence of a letter we will keep a business card.  Include an open invitation for them to visit the clinic at any time (they may need treatment themselves!).  So start by producing one patient case study a month and build from there.

Add the contacts to your database of “influencers” and send them a Christmas Card or Happy New Year card.  They get hundreds of Christmas cards so why not be different – send a Happy New Year card as in all liklihood yours will be the only positive message in the new year mail … be different!

2/ Newsletters – A 2 sided A4 newsletter sent quarterly should not be too much to ask of any clinic to produce.  All your contact details will be there and over time you will create familiarity if you have some interesting content.

3.a/ GP Talks – GPs need CPD and regularly get together.  If you have a compelling service, programme or something you are particularly good at, they will be interested in a short presentation (offer to bring lunch, they expect this!).  The talk is a great way to engage GPs but if what you offer is not discernibly different to what anyone else is offering, then you will probably get knocked back or more likely – ignored!

3.b/ Consistent marketing – If you can’t do talks, remember that GPs are residents of your community.  Whatever marketing you do in your community will be seen by the resident GPs.   Plus, patients go along to their GPs with information from the internet or newspaper so put interesting content out there consistently and people will notice you and talk about you.  That includes your community of GPs and healthcare providers.

Need a database of your local GPs, go to www.nhschoices.uk enter your postcode and you will get a list of all your GPs.

Some clinics will do better focusing on patients but if you do have something special to offer, then you have a good chance of being heard if you apply these principles.  PLUS, there will be very few, if any, of your competitors doing anything to engage with GPs.  

It’s an open field for you and yours will be the only voice heard!

Author: Stephen Small, ‘Mr IDD’ – Director, Steadfast Clinics Ltd
International distributor of IDD Therapy Spinal Decompression for herniated discs and sciatica plus Thermedic FAR infrared therapy systems for joint pain relief and soft tissue rehabilitation.
www.SteadfastClinics.co.uk

Back Pain Treatment – how to improve exercise compliance post ‘treatment’ with personal trainers.

The other day I received a newsletter/ email from Robin Sharma where he talked about his personal trainer getting him to perform more push ups than in his mind he felt capable of.

Since the beginning of February I have been attending exercise classes at my local gym – Body Attack Extreme and Boxercise.

I may have found an ‘ab’ finally and I echo what Robin says.

The encouragement of the class teacher Shaun and dare I say the desire not to lose face enable me to do more than I ever could when I ‘push myself’ in exercise.

It reinforced the idea in my mind that for patients with acute and chronic back pain, having a structured exercise programme is a MUST!

Many clinics provide treatment and at the end of treatment will instruct and usually detail a series of exercises for their patient to perform.

I have written about using exercise diaries to improve compliance, but really, most people will REALLY benefit from ideally some one to one training, but if not, and depending on the condition at least a one month plan which includes attendance at certain exercise groups.

For clinics which don’t already have them, I suggest you form a strategic alliance with a personal trainer to bolt on 3 or 4 training sessions to the end of the treatment programme to help patients post ‘treatment’.

Since compliance is such a problem and exercise is a crucial part of long term rehab, it seems crazy to me that more clinics don’t do this.

NOTE: Weight and obesity are all over the television and newspapers these days and magazines are full of diets.  If we could sort our weight issues out by ourselves, there would be no pandemic.

How many joint pain conditions are not helped by the extra pounds being carried.  The personal trainer will help get the ball rolling and hopefully get your patient on to a virtuous circle of progress.

Re Robin Sharma, he is new to me but so far I like what I am getting, get his free report at http://www.robinsharma.com/

Author: Stephen Small
www.SteadfastClinics.co.uk