Seasoned clinicians recognize that beliefs and habits are difficult to retrain – at best. Even with concrete evidence to support your claims, it is sometimes not advisable to attempt to change a patient’s long-held perceptions in one visit, week, or month. It takes trust between the patient and doctor before you can begin remolding their beliefs.
Read on to download our newest patient infographic that helps you educate patients and change misconceptions about “Arthritis”.
Evidence-based chiropractors must explain the disconnect between symptoms and imaging findings.
Recently, Daimon K et al. (2018) published a landmark study for EVERY evidence-based chiropractor. It highlights the notion that degenerative changes are merely age-related and do not necessarily correlate with symptoms. This study assimilates two decades of sequential imaging to prove that there little association between degeneration and clinical symptoms:
“results of our statistical analysis and the different rates of disc degeneration versus clinical symptoms reported here and elsewhere, the degenerative findings on cervical MRI do not appear to be generally associated with the development of clinical symptoms.” (1)
Chiropractors must retrain patient beliefs associating degenerative changes (simple arthritis, disc pathology, and stenosis) with acute pain. Structural findings take months or years to progress. Acute symptoms usually occur within moments to days after a trauma, or change in activity, movement, hobby, or habit. Structural abnormalities can complicate tissue failure, but are not directly correlated with symptoms. It is essential that we focus on what is correctable and what is not. There is no treatment to eliminate the degenerative changes in the spine; however evidence-based chiropractic care can effectively and efficiently resolve symptoms.
Arthritic and degenerative changes are a fact of life. It is important not to focus on what shows up on imaging but rather focus on what we can do with the cards that were dealt.
“the rate of degenerative progression at one intervertebral disc level on MRI over the 20-year period was 95.3%, whereas the rate of the development of clinical symptoms was 66.9%. Statistical analysis of the relationship between the progression of the 5 degenerative findings in the cervical spine and the occurrence of clinical symptoms only detected a significant association between foraminal stenosis and upper limb pain.”
When a patient presents with a one-week onset of neck pain; is it from their stenosis? NO! The cervical narrowing has been there for years.
Is it a complicating factor? YES. However, treat the patient’s symptoms by focusing on the functional reasons the pain started. Once the pain is gone, the stenosis will still be there. Use this as a teaching point. Educate the patient to not blame their arthritis for every malady affecting their life. Focus on their habits, hobbies, and postures to eliminate the stressors on their body that are exacerbating their spinal condition. This same paradigm works for disc pathology, or chronic meniscus injuries, or SLAP lesions, or…(name your chronic structural lesion)
“A study of clinical symptoms and cervical MRI findings by Siivola et al. showed that neck and shoulder pain in young adults was not associated with disc degeneration, an annular tear, or disc protrusion on MRI.”(2)
Evidence-based practitioners must surpass the highest standard: THE PERCEPTION OF OUR PATIENTS!”
Before patients ever challenge their own beliefs, they must perceive that you are a source of valuable information and your treatments will be effective.
Humility is not typically a clinicians top personality trait. Tread lightly with patients holding different assumptions about the etiology of their symptoms. They have years of experience, mis-information from other healthcare professionals, and most importantly, the reassuring counsel of Dr. Google. Surely a simple chiropractor cannot be smarter than all those sources. Provide a credible report of findings, clear handouts, and most importantly, a solution to their problem.
Check out our newest infographic that helps you explain the dis-relationship between chronic DJD and acute symptoms.
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- Daimon K, et al. A 20-Year Prospective Longitudinal Study of Degeneration of the Cervical Spine in a Volunteer Cohort Assessed Using MRI. Follow-up of a Cross-Sectional Study. J Bone Joint Surg Am. 2018;100:843-9
- Siivola SM, Levoska S, Tervonen O, Ilkko E, Vanharanta H, Kein¨anen-Kiukaanniemi S.MRI changes of cervical spine in asymptomatic and symptomatic young adults. Eur Spine J. 2002 Aug;11(4):358-63. Epub 2002 Feb 9.
About the Author
Dr. Brandon Steele
DC, DACODr. Steele began his career at The Central Institute for Human Performance. Dr. Steele has trained with experts including Pavel Kolar, Stuart McGill, Brett Winchester, and Clayton Skaggs. He has been certified in Motion Palpation, DNS, ART, and McKenzie Therapy. Dr. Steele lectures extensively on clinical excellence and evidence-based musculoskeletal management. He currently practices in Swansea, IL and serves on the executive board of the ICS.