Exercise Compliance for Back Pain: Lessons from Selling Fitness Programmes on the Shopping Channel

The other morning, one of my daughters was watching the TV shopping channel where ‘Shaun T’ was selling the 60 day workout programme – INSANITY.

I had actually heard of Insanity because my gym instructor had lost 2 stone doing the programme and also, he had the classic “after shot” physique!  So I watched some of it and it got me thinking about back pain.

One of the bonuses Insanity gives is a 60 day wall chart calendar where people tick off their exercise days.

Why would Insanity offer that?

Sure, it’s a free bonus but they could give any kind of bonus.  The reason they choose the Wall Calendar is to help customers with self-discipline and thus help customers comply with the programme.

Such an approach is more likely to lead to a happy customer and therefore company is happy because they don’t have to honour the money back guarantee from people giving up!

You may have read my piece about using exercise diaries to plan when patients will do their exercises.  This is a way to help patients be more disciplined in planning and doing their exercises so they get the benefits (i.e. diaries help with compliance).

Why not go a stage further and get some A3 clinic-branded posters printed with a 60 day exercise planner?

Give one to each patient to put on their wall; they then tick off the days as they do their exercise.

For 2-5p, a (branded) wall calendar is something else to hold patients accountable to themselves.

It contributes to an overall professional patient approach and since you are giving it to your patient like a piece of homework, they may feel honour-bound to use it (and it just so happens to be good for them!).

Put it this way, which of these adjuncts is more likely to have a positive effect on exercise compliance?

1/ Use an exercise diary with a wall calender tracker        2/ Use nothing

You can choose to use nothing pending a clinical trial to categorically prove diaries and a wall calendar will help patients comply with their exercise programme, or you could just go for it!!!

By the way – If you want to transform your body this summer, you can see the Insanity workout programme here, over 600k Facebook likes can’t be far wrong! Not sure if my joints could take it but it does seem the Insanity programme achieves its goals http://www.beachbody.com/product/fitness_programs/insanity.do?e=5b

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

Steadfast Clinics is the international distributor of IDD Therapy spinal decompression, SDS SPINA, Accu SPINA devices, Thermedic FAR infrared therapy systems and HydroMassage machines.

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

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

Chronic Back Pain Treatment With IDD Therapy And The History of MRI Scan Usage

This article considers the role of the MRI scan when treating low back pain with IDD Therapy.

Herniated Disc TreatmentIt raises the possibility that early back pain studies conducted without MRI technology were in part flawed since without consideration of the underlying condition, how would it have been possible to create and direct an appropriate treatment regimen?

When back pain and neck pain remains unresolved, clinicians now use MRI scans to help diagnose or confirm the cause of someone’s pain.

As an example, IDD Therapy treatment providers take advantage of MRI scan technology for three reasons.

1/ Rule out contraindications to treatment
2/ Identify the underlying pathology
3/ Confirm the spinal level to be targeted for treatment 

IDD Therapy treatment uses a computer-controlled, cyclic pulling force to distract and mobilise targeted spinal segments in an axial plane.

sds spina treatment lrThe application of distraction forces is safe, however it is essential to ensure there are no contraindications, such as a vertebral fracture or metastasis (cancer).  (A full list is available by contacting Steadfast).

The scan helps to confirm whether IDD Therapy may be appropriate and the most common conditions treated include herniated discs and degenerative disc disease.  The MRI scan helps the clinician to select the level to be treated e.g L5S1 disc and to understand the severity of the condition.

IDD Therapy treatment protocols detail a set of angles which when applied, enable clinicians to distract targeted spinal segments.  Shealy & Bourmeyer 1997(1)  first observed that applying distraction forces at different angles enabled them to open the disc space 5mm-7mm.

Whilst dermatomes and clinical diagnosis help clinicians, without an MRI scan to confirm the diagnosis, it is very difficult for the clinician to be clear in the treatment plan.

Traditional traction had many flaws and the Cochrane Review confirms that traction as a single modality is not effective.  http://summaries.cochrane.org/CD003010/traction-for-low-back-pain

Common use of MRI scan technology developed long after use of traction was dismissed. Whilst traditional traction was never applied scientifically with measured angles, with sufficient force for sufficient time, significantly, traditional traction treatment was never applied with the knowledge of which level and what pathology was being treated.

If you are not aiming, how can you achieve your goal?   It would be like blindfolding an archer and pointing them in the general direction of the target.

So, with IDD Therapy it is, where possible, desirable to have an MRI to determine the condition being treated and then using the SPINA machine tool, to direct treatment to the targeted level.  Of course, if treatment is not responding adjustments can then be made.

The conclusion of the Cocchrane Review is interesting:

“A limitation of this review stems from the scarcity of high quality studies, especially those which distinguish between patients with different symptom patterns (with and without sciatica, with pain of different duration).”

Having spoken to hundreds of clinicians who used traditional traction, I am yet to meet a single one who used any kind of precise methodology in the application of the treatment (irrespective of the tool they were using).

Invariably it was, “we’d try a bit of traction and see what happened.”  Since they would not know the nature of the condition they were treating, how could they apply a method other than pull and hope?

This quite frankly is useless and we can ask it is any wonder that outcomes in clinics were so poor?!

The other benefit of the scan is to be able to see the size of a disc herniation or the degree of degeneration.  It is extremely difficult to structure a randomised controlled trial with a one-size fits all approach for back pain. 

IDD Therapy has a growing body of evidence to support it and more will be needed to help develop and refine treatment programmes.

Anecdotally, clinicians will confirm that larger disc herniations require more time for treatment than small bulges, whilst degenerative discs tend to require more treatments before improvements can be felt.

The use of the MRI scan is thus a key tool to enable clinicians to target and treat chronic low back pain more effectively.

For a summary of the differences between IDD Therapy Spinal Decompression and traditional traction, please use the form below.

(1) Shealy CN and Borgmeyer V. Decompression, Reduction, and Stabilization of the Lumbar Spine: A Cost-Effective Treatment for Lumbosacral Pain. American Journal of Pain Management. 1997. 7:63-65.

Author: Stephen Small
www.SteadfastClinics.co.uk

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How do herniated discs occur and what are the best treatment options?

“Ouch….I’ve slipped a disc!” 

Low back pain affects over 80% of the population at some point in their lives and it’s the second most popular reason for visiting the GP after the common cold. It comes in many guises but a herniated or ‘slipped’ disc is one of the easiest things to succumb to and is one of the most difficult types of back pain to relieve. 

This article examines the ways in which herniated discs can occur and explains the treatment options available to help patients get back to their usual daily activities.

Contrary to popular belief, slipped discs are not just common to people who do manual work involving heavy lifting: many office-based workers succumb to disc problems as a result of sitting in one position for too long, putting pressure on the disc walls so that they weaken over time.

The spine is made up of 24 individual bones called vertebrae which are stacked on top of each Herniated Disc MRI scan - Pre IDD Therapy. Discs are the protective circular pads of connective tissue in between – the ‘padding’ which acts as shock absorbers, protecting the spine when we run or jump.

We cause small weaknesses in our spine all day long with prolonged sitting or standing in certain positions, for example at workstations or hunched over the ironing board.

The intervertebral discs are unlike other parts of the body in the sense that they have a limited nerve supply.

Very often we are not aware of the discs being under strain until the accumulation of months or years of stress has reached a point where small tears form in the outer disc wall. These tears can result in several months of nagging discomfort.

As a defence-mechanism against further damage, the body will often react to this situation with muscle spasm or at the very least, ‘muscle guarding’ which is when the long muscles of the spine tighten up. This causes compression of the discs and a lack of mobility in the spine. 

If this situation prevails, the tears can very often become worse and allow the inner jelly like part of the disc – the nucleus – to herniate outwards. This is referred to as a herniated, bulging or ‘slipped’ disc.

Disc problems can also cause pain in other areas of the body, the most common of which is sciatica, a grinding pain which travels down the length of the leg.  Sciatica can be caused by the bulging part of the disc squashes the nerve root next to the disc or when chemicals from a prolapsed disc irritate the nerve endings.  

Neck pain, headaches or numbness in the foot can also be a sign of a damaged disc. So, what are your options for treatment?

Your first port of call should always be a good osteopath, physiotherapist or chiropractor who will have experience in treating disc-related problems. With this type of manual therapy in most cases you should see a marked improvement in your condition in 6-8 weeks.

At the same time, if you are in so much pain that you can’t sleep then your GP can prescribe you painkillers and/or anti-inflammatory medicines which can be taken alongside physical treatment.

If you see no real sign of improvement after eight weeks of manual therapy, it would be advisable to get an MRI scan of your spine to confirm the possible causes of your pain and the location (level) of the spine affected.

If a disc problem is identified, a programme of treatment including IDD Therapy non-surgical spinal decompression may be recommended.

IDD Therapy is a computer-controlled mechanical treatment used by clinicians to gently and safely relieve pressure on specific discs, alleviate muscle spasm and increase mobility in the spine.
 
decompression[1]As part of the IDD Therapy programme, patients undergo a course of core-strengthening exercise to help them maintain their healthy spine.

In a small number of cases, patients with severe disc damage/degeneration may require invasive treatments including injections and/or surgery. Also, in rare circumstances, the patient may require immediate surgery, for example, when the bowel and bladder function is affected.

There are different types of surgery for a herniated disc, the most common is the microdiscectomy where fragments of the disc may be cut away.

Another common type of spinal surgery is the lumbar fusion where the vertebrae surrounding a disc are fused together.

Thus, there are now several treatment options available to patients with herniated discs and indeed, a wider array of effective non-surgical options allowing more patients to avoid invasive procedures.

For information about treatment options at Spine Plus or any other IDD Therapy providers, please use the form below.

Robert Shanks BSc (Hons) Ost
Clinical Director
Spine Plus
www.SpinePlus.co.uk
Spine Plus is a group of multidisciplinary clinics in London and Essex.

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