warmest regards,

Peter

I’m not sure what to say about Liebenson’t text…I loved the classes, and use some of that material, but we do have some philosophical differences about the long-term benefits of the adjustment.

Although our research basis is growing slowly, there’s still a LOT to be funded. Perhaps you could consider tithing some money to FCER so that happens sooner. Our website donates half our income to support research, and have been doing that since 2001.

Please take a look at Ron Rupert’s article “Maintenance Care: Health Promotion Services Administered to US Chiropractic Patients Aged 65 and Older, Part II” as it reports on some interesting statistics:

• The cost of health care for patients receiving MC in this study was far less than that for patients of similar age in the general population despite the doubling of physician visits (medical plus chiropractic). The greatest difference in health care costs with patients receiving maintenance care was in the areas of nursing care and, especially, hospital care. This reduced need for hospital and nursing home services has recently been corroborated by the research of Coulter et al. [22]

• Chiropractic patients receiving maintenance care, when compared with US citizens of the same age, spent only 31% of the national average for health care services and reported a 50% reduction in medical provider visits. The health habits of patients receiving maintenance care were better overall than the general population, including decreased use of cigarettes and nonprescription drugs. Furthermore, 95.8% believed the care to be either “considerably” or “extremely” valuable.

The chapter in Liebenson’s book that addresses spinal stability talks only about exercise. In other areas where he talks about manipulation in conjunction with other methods like McKenzie he does not address frequency or duration. The book mentions that Shekelle “thinks” that 12 treatments over a one month period are sufficient for a therapeutic trial for specific conditions.

This does not address the idea chiropractors often present that it takes many treatments to achieve spinal stability (whatever that is) and I am still wondering whether there is any good evidence to show that treatments beyond the elimination of symptoms lead to increased stability and therefore better health and less recurrence.

What you are referring to is an acute facet, and yes, those will clear up quickly in a young person. What I am referring to is someone who has had recurrent experiences over years, and that’s most of what I see in this office.

If I *play* the way a managed care outfit wants, I would get them out of pain, then wait 3 or 6 months and then I’d get to see them again.

That’s why I am not on anybody’s managed care panel…I don’t want to do *patch care*. I want to correct people…and just like the orthodontist says, remodeling bony and ligamentous tissue takes time. NOT numbers of visits, but concerted care over a longer period of time.

I can’t speak for the decompression crowd. I practice McKenzie for disc derangement, and rarely see a disc person more than 9 times the first month. During month 2 it’s between 4-8 visits to resolution. And insurance companies have NO issue with paying for that type of care plan, whereas most of them will not pay for decompression.

I would refer you to Craig Liebenson, D.C.’s textbook Rehabilitation of the Spine for the numerous citations supporting stabilizing care.

I’m interested to know if you have any evidence to show that your spinal stability improves any further after say 20 visits than it does after 4 visits.

RESPONSE from Frank:

Sure, read “Newly Published Study Confirms That “Maintenance Care” Delivers!”

Anyone who says that “x-number of visits” is required for anything is lying, because none of us can predict the future.

However, pain relief (your 4 visits) is NOT spinal correction….it”s a bandaid. Look at the statistics from BMJ etc…that recurrance is common.

Care after the second week should move from pain management to stabilizing care. That can be justified to any carrier by closely monitoring other symptoms like stiffness, ROM, response to ADLs.

Mike I agree. People in general expect their insurance should pay for their sick-care. Insurance is the main reason our country is spending 2x more than anybody else is in the world and getting sicker by the minute

The first article says it all:

A new retrospective analysis of 70,274 member-months in a 7-year period within an IPA, comparing medical management to chiropractic management, demonstrated decreases of 60.2% in-hospital admissions, 59.0% hospital days, 62.0% outpatient surgeries and procedures, and 83% pharmaceutical costs when compared with conventional medicine IPA performance. This clearly demonstrates that chiropractic nonsurgical nonpharmaceutical approaches generates reductions in both clinical and cost utilization when compared with PCPs using conventional medicine alone.

However, those numbers do not count as evidence, in the strictest sense. But it’s sure hard to ignore, isn’t it?