The language that clinicians use for back pain – Confusing for patient

In a recent study published in BMC Musculoskeletal Disorders 1 researchers looked at the language health care professionals use when communicating back pain to patients.

In this study, professional’s (Chiropractors, General Practitioners, Osteopaths and Physiotherapists) conversations were recorded and analyzed word-by-word.

Here is some of what they found, although you can read it directly from the horse’s mouth if you read here.

  1. Non-specific low back pain (participants had not heard of that term before and thought it perhaps meant: “non-existent“, “that spells referral to me“, “you would feel it all over really“)
  2. Acute (participants were not familiar with this term)
  3. Chronic (most thought this was a terminal condition-no way out)
  4. Muscle Weakness  (participants were unfamiliar in the context of low back pain)
  5. Instability (participants were unfamiliar with this term)
  6. Neurological involvement (One participant thought this term meant “Something’s going wrong in your head.”)
  7. Trapped nerve (this was very common but not understood well)
  8. Wear and Tear (also very commonly used by professionals and participants interpreted as the back “wearing out” or “being worn out” by age, work or sport)
  9. Arthritis (participants thought It’ll get worse…you’re diagnosed with that as you get older it’s going to get worse and more painful … There’s not a lot of treatment for it that works.)
  10. Exercise and activity (many participants were also a little confused about what this meant specifically)

The results of this study peel back the underlying reason why there are focused groups, like PainScience, in the drive to improve the language health care professionals use in the talk of back and neck pain.

Doctor-patient communication is only as good as the language used by the doctor in clinical settings. Unfortunately, most of the terms used in this study were misunderstood and had negative emotional overtones.

This is at the crux of WHY at Dynamic Disc Designs we have worked hard to help the clinician minimize the unintentional perception of these misunderstood words. We have lessened the need to use excessive back pain words and have empowered the doctor and patient with realistic models to improve communication of back pain in a dynamic and realistic way. Why risk saying the wrong thing when you can just show the patient where and why it hurts and what you plan on doing about it. Simple tools so you don’t have to search for the words….and risk unintentional negative emotional responses from those you are trying to communicate with about solutions.

language, back pain, patient education

Communicating with accurate models can help reduce the potential for misunderstood language.

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Migration of Nucleus Pulposus

Treatment strategies related to intervertebral disc displacement often involves extension. Robin McKenzie’s work on centralization of symptoms in the case of disc herniation has been used by many.  Most of the research on migration nucleus pulposus has been previously investigated in the lumbar spine. In a recent study published in PM&R 1 , researchers looked at the cervical spine and wondered if this was a similar case. They hypothesized that cervical extension would centralize and shift the nucleus anterior–away from the associated disc herniation.

They looked at 10 healthy young males with mean age of 22 yrs old and compared neutral to extension position of the cervical discs using MRI. They carefully mapped out the nucleus pulposus and found that in extension the migration nucleus pulposus was anterior and away from the posterior disc margin.

They concluded that moving the cervical spine into extension could be clinically valuable in the case of cervical disc problems.

At Dynamic Disc Designs, we have seen what these researchers have seen! When our handcrafted models (with an annulus and nucleus) are moved into extension, the nucleus can been seen to move anterior. In our lumbar models, the clear L4 vertebra of our Professional LxH Model allows full migration visibility of the nucleus pulposus. This is helpful in the clinical explanation of treatment targets for patients with intervertebral disc problems.

migration nucleus pulposus, lumbar model

Posterior nucleus migration in flexion.

  1.  Kim YH, Kim SI, Park S, Hong SH, Chung SG Effects of Cervical Extension on Deformation of Intervertebral Disk and Migration of Nucleus Pulposus. PM R. 2016 Sep 6. pii: S1934-1482(16)30905-4. doi: 10.1016/j.pmrj.2016.08.027. [Epub ahead of print

Plain Talk about a Lumbar Herniated Disc

Plain Talk about a Lumbar Herniated Disc

The term “herniated disc” is a fairly common one. Most people have heard it used in conversations about friends or family members suffering from back pain, but do they really know what it is we’re referring to when mentioning this term.?Probably not.

The fact remains, however, that a fair percentage of individuals will suffer from a lumbar herniated disc sometime in their lifetime, and that problem may just bring them to you, the spine specialist.

So what will you tell them? Perhaps something like this:

  • A disc herniation might occur for a number of reasons or seemingly for no reason at all. It may be the result of heavy lifting or perhaps twists and turns of the lower back – anything that puts extra stress on your discs.
  • Herniated discs are a very common problem and most often occur in those between the ages of 35 and 50, generally because of the kind of activities practiced by that age group.
  • A lumbar herniated disc occurs when stress is placed on the spine and the tough outer ring of the disc cracks, tears, or bulges. In the lumbar area, the protrusion of the disc can push against the spinal nerve root that’s located nearby or the root may become irritated. As a result, the patient will likely experience shooting pains that travel into the buttock and down the leg.

There we are! Sounds pretty simple, right? Well, perhaps #1 and 2 are easy to understand but it’s likely that when you start talking about the spine, discs, nerves, and perhaps the nucleus pulposus, you will have lost your patient’s attention. Around that time, he or she may develop a befuddled look that will let you know they really don’t understand what it is you’re trying to explain. There’s got to be a better way!

There is! Many individuals learn better with some sort of visual aid, and the best kind of visual aid you can provide for explaining a lumbar herniated disc is a fully-dynamic 3D model that can be twisted and turned and can help you illustrate disc problems in a way that the patient can truly VISUALIZE.

When Dr. Jerome Fryer crafted his first spine models and created Dynamic Disc Designs (DDD), this is exactly what he had in mind. Fryer recognized that his patients really didn’t understand his verbal explanations of spine problems nor did a flat, uninteresting drawing help teach these concepts. So he came up with a model of the spine that is so accurate that it’s the only one many of today’s spine professionals will use.

With the help of DDD’s lumbar models, chiropractors, surgeons, physiotherapists, pain management specialists, and other professionals can get their point across and prompt that “aha moment” that will have patients nodding their head in understanding, and patients with a solid understanding of their lumbar herniated disc issue will likely take advantage of the treatment you recommend and do what’s necessary to feel better.

Read what ChiroHub has to say about DDD’s models:

We have never seen, and we have definitely looked, a more detailed and accurate model of the lumbar vertebrae and disc complex. These units are extremely well thought out, and represent the latest in our understanding of the anatomy of lumbar discs, facet joints, nerves, and vertebrae. The user can easily identify the cauda equina, dorsal root ganglia, nerve roots, nucleus pulposus, annular fissures, and more. During our two months of clinical testing with real patients, we never had an instance where we desired to showcase an anatomical structure and were unable to do so.

Demonstrating the Advantages of Lumbar Adjustment to New Patients

Lumbar Adjustment

If you’ve studied chiropractic, you certainly understand the advantages of a lumbar adjustment. Indeed, spine adjustments have been helping pain sufferers for decades, and chiropractic continues to be popular all over the world, with individuals embracing non-invasive ways to feel better when their lower back hurts.

There are a lot of reasons for patients to enjoy the benefits of lumbar adjustment. In 2003, the British Medical Journal published the results of a study that examined 183 individuals with neck and lower back pain. The year-long study sent one-third of the participants to a chiropractor, another third to a physiotherapist, and the last 61 individuals saw their general practitioner for treatment, agreeing to a combination of counseling and drugs when it came to controlling their lumbar pain.

The results are probably not surprising to those to know the true value of chiropractic. The statistics showed that chiropractor-treated patients recovered more quickly than the other two groups and, as an added perk, the cost of chiropractic added up to only about a third of the costs involved with being treated by a physical therapist or general practitioner. That’s a win-win for the chiropractic field!

So, when conferring with new patients considering regular chiropractic care, this is a great study to cite. Patients will be enticed by both the lower cost and the quicker recovery. However, it’s also a good idea to give new patients a perfunctory lesson on the spine in general, including how the spine moves and what a lumbar adjustment can do to help them.

To accomplish that task, an accurate spine model is a necessity. That’s why so many chiropractors are already using the finely-detailed models manufactured by Dynamic Disc Designs. These models are ideal for educating new (and existing) patients about whatever it is that’s ailing them. Furthermore, it’s a tool you can return to again and again as the patient begins and continues to improve.

“This is what was happening to your spine, and this is what chiropractic adjustment has done to help your spine,” is a line you’ll love saying to your patients as they progress through their treatment.

When Dr. Jerome Fryer established Dynamic Disc Designs (DDD) and crafted his first model, he was determined to help his patients better understand the advantages of chiropractic. With his models, patients can hold the spine in their own hands while the chiropractor points out different parts and demonstrates movement.

They’ll leave the office knowing that it’s possible for their pain to disappear and with a determination to make it happen. That’s the best you – the chiropractor – can hope for, right?

I previously used the standard spinal model sold on the market, but my patients seemed disinterested, but when I switched to the DDD model not only was it educational for adults, but has sparked children in our practice to ask great questions as well! They are amazed at the details on the DDD model and really enjoy learning about their spine now!”
– Jen Chen, DC

Patients Have Lots to Learn about the Lumbar Area

Lumbar area problems

To most people who aren’t involved in medicine, anatomy is a mystery. Perhaps there are some individuals who took an anatomy class in high school or college, fascinated with the make-up of the human body, but that’s as far as it went. Or maybe some had one of those skeleton models when they were a kid, the one that looked kind of creepy but at least gave you a rudimentary knowledge of the human body. Those have been popular with kids for decades and maybe some of those jangling bones inspired a boy or girl to eventually enter the medical field.

However, the average person can only identify perhaps a dozen bones in their body, but if faced with questions about the spine region, most will be perplexed. Mention the lumbar area and probably only a small percentage will know that the word “lumbar” refers to the lower back. So, imagine the potential confusion a patient could face if you start talking about their lumbar region and all the details about the problem that’s causing their pain.

Vertebrae. Facet joints. Flexion. Stenosis. Spondylitis. Osteoporosis. You might find yourself throwing out any of these terms – and more – in hopes of explaining your patient’s lumbar area issues, but chances are that those words won’t lead to a great understanding of the problem your client is facing …and the solution needed to solve that problem. Most doctors agree that patients need something more than a verbal dissertation to understand what’s happening to their body.

When a patient feels well-informed about their medical condition, what happens? They:

  • Feel relieved that they have a knowledge of their issue(s)
  • Have more confidence in you as a medical professional
  • Trust that the solutions you offer are viable ones
  • Will more than likely take your advice for treatment
  • Will follow up on their treatment and become a regular client
  • Will recommend others to your practice

Confidence earning isn’t always easy. You’ll need the correct tools with which to educate your patients about the problems of the lumbar area. So, will it be your favorite textbook, one of those static skeleton models, or that old poster you have hanging on your wall? Will any of those really accomplish your goals? Probably not.

More and more spine professionals, instead, are discovering the amazingly-detailed patient education models manufactured by Dynamic Disc Designs (DDD). Made by a chiropractor FOR chiropractors and other spine doctors, the lumbar models offered by DDD are the most detailed on the market. They bend, twist, and turn like a real spine and are ideal for teaching patients about any number of lumbar area problems.

The company’s Professional Lumbar Package is especially enticing for the spine specialist. It includes three of DDD’s most popular products: Professional LxH with LF, Lumbar Stenosis, and Spondylolisthesis models. This bundle is offered at a significantly lower price than what the models would cost if purchased individually. They represent a good start to your DDD model collection and will no doubt help educate your patients about the lumbar area.

My clinic relies heavily on the patient education process, as I believe all clinics should. I have not come across any anatomical model that depicts spinal mechanics as well as this one does. It saves me time, makes detailed explanation easy, increases patient compliance and ultimately, produces better results. I recommend it highly to any clinician who works with the spine.”
– Dan Kelly, physiotherapist

How Do You Clinically Execute Back Pain Education?

back pain education

Studies and research papers each provide us with plenty of information. Put them all together, however, and you might make even more discoveries about the subject that interests you.

Recently, a study in the European Journal of Pain consisted of results from a systemic review of all current research regarding the treatment of lower back pain. This study took into account some 2,500 different research articles. In the end, it was discovered that many of the articles came to the same conclusion: education is one of the most important factors in the management of low back pain.

Researchers wrote:

Most high-quality guidelines target the noninvasive management of nonspecific low back pain and recommend education, staying active/exercise, manual therapy, and paracetamol or NSAIDs as first-line treatments.”

Indeed, systemic reviews help us look at the big picture. Literally, we can compile facts and opinions from all ends of the earth from professionals that are doing the same things we do. This helps keep us on the right track. This most recent European Journal of Pain study, for example, aids us in understanding that patient education – no matter where the patient is located – is of the greatest importance where low back pain is concerned.

In addition, given the fact that the World Health Organization has declared low back pain to be one of the most disabling conditions the world over, we – as spine specialists – must do our best to alleviate the problem and help patients get back into the workforce and continue the activities they love.

So, how do you approach back pain education with your patients? It’s likely you sit down for a chat, point to the parts of the spine on your favorite drawing or 2D model, and attempt to help your patient understand why their back pain is literally crimping their style. But there’s a better way to tackle back pain education.

Nearly a decade ago, Dr. Jerome Fryer, a chiropractor in Nanaimo, British Columbia, Canada, recognized that tools for spine education were lacking. Eager to fill the gap, he took his knowledge of the spine to his workroom and developed the first Dynamic Disc Designs (DDD) model, intent on using it for his own patients to help them better understand chiropractor, its advantages, and their role in keeping their spine healthy.

Others in the field soon became aware of these fully-dynamic, amazingly-accurate models and Fryer found himself creating more and different models suitable for a variety of back pain education applications. Now, spine specialists around the world turn to DDD’s models as the best education tool available for their practice. With these models, they can show the patient what will occur before treatment, what happens during treatment, and how their spine should/will respond when treatment is complete.

Knowledge helps a patient to relax, and a relaxed, confident patient is one that will continue patronizing your practice for years to come. All it takes to achieve that are DDD’s tools for back pain education, lots of compassion, and a sincere interest in your clients.

I would like to thank you and your company Dynamic Disc Designs Corp. for creating a realistic product that can be considered worthy of being in a health care office.  This product makes it so much easier to show a 3D reference while explaining MRI’s and X-rays results to the patients.  I actually did not really use 3D models before because of their lack of realism.  Please keep on developing your models and I would highly recommend you to everyone.”
– Brent C. Bluekens, DC

Explaining Annoying Spine Neck Pain

Stand for models, Spine Neck Pain

Spine neck pain can be one of the most annoying types of pain a person will experience in their lifetime…and the pain is especially frustrating when it lingers, keeping the sufferer from doing everyday tasks and from enjoying the activities they love most. Just like back pain, neck pain can be very debilitating and is often the reason a patient seeks help from a chiropractor.

Someone with spine neck pain finds it quite difficult to do anything comfortably, and sleep is especially difficult to come by when you’re literally suffering from a pain in the neck. The result is a tired, irritated, pain-ridden individual who just wants to feel better.

Neck pain will need to be assessed, of course, to rule out any serious medical problems that will require immediate attention. Once those are ruled out, you’ll likely find that most acute spine neck pain is due to muscle or other soft tissue sprains. This can occur due to an accident or injury (such as whiplash) or might be caused by something as simple as sleeping the wrong way with your neck twisted in an awkward position or perhaps carrying something heavy.

For these minor spine neck pain problems, chiropractic manipulation is often a good solution and can result in an almost immediate reduction of pain. Many sufferers will see the pain go away altogether in just a few days to a week. There are some problems that may speak to an anatomical abnormality, of course, so those will need to be assessed further.

Once a diagnosis is made, the patient will need to be informed as to the problem AND the solution. Most patients don’t want to be kept in the proverbial dark about what’s ailing them but would, instead, prefer to be as educated as possible as to the reason they are suffering from spine neck pain. To accomplish this task, the chiropractor will need to demonstrate what’s gone wrong and how it will be fixed. He/she might also want to demonstrate some neck exercises the patient can do at home.

Custom Pro Package Deluxe

Using a spine model manufactured by Dynamic Disc Designs is the best way to educate patients about cervical/neck problems and disorders. The company’s Professional CxH cervical model includes a two-part intervertebral disc with six degrees of natural motion with a red post-lateral nuclear migration upon manual compression, posterior longitudinal ligament (PLL), anterior longitudinal ligament (ALL) and periosteal fascia (POL) (adjacent to the uncovertebral joint). Designer Dr. Jerome Fryer notes that this model is especially helpful in doctor-patient discussions of pain related to the uncovertebral joint, IVF narrowing, and dynamic disc changes related to the facets.

In simple words, it really helps the patient understand their neck pain and identify the reasons for it. It also aids them in understanding how to avoid a recurrence of this pain in the future and why treatment is so important. An educated patient is one that is more likely to return to your practice for other spine-related issues and is apt to refer you to their friends and family members as well.

I have been using the lumbar and cervical spine models for over 15 years and still use them almost daily. My aha moment-producing favorite is the disc model. Fun and amazing. Thank you for providing an excellent line of products.”
– Aron Enns, DC