A “CORNERSTONE” OF NON-SURGICAL TREATMENT, NEW REPORT CONCLUDES

Middleburg, Virginia, July 3, 2009  – A new review article published in the Journal of the American Academy of Orthopaedic Surgeons should help convince many patients with low back pain to consider physical therapy as a first line of treatment for their condition, according to Richard Jackson, PT, OCS, of The Jackson Clinics. The review, published in February 2009, recommends that in most cases of symptomatic lumbar degenerative disc disease, a common cause of low back pain (LBP), the most effective treatment is physical therapy combined with anti-inflammatory medications. Approximately 75 to 85 percent of adults will be affected by low back pain during their lifetimes.

 Symptomatic lumbar degenerative disc disease develops when a disc weakens (often due to repetitive strain), is injured, or deteriorates from aging. As a result, the disc is unable to hold the vertebrae as it should and the lack of stability can cause back pain.

 The review details the different treatment methods for symptomatic lumbar degenerative disc disease, including physical therapy with the use of nonsteroidal anti-inflammatory drugs (NSAIDs), and concludes that, in most patients with low back pain, symptoms resolve without surgical intervention. The review also concludes that physical therapy and nonsteroidal anti-inflammatory drugs are the “cornerstones” of non-surgical treatment.

 Physical therapist intervention includes strengthening of core muscle groups, including the abdominal wall and lumbar musculature, which can have positive effects in patients with this condition. According to American Physical Therapy Association (APTA) spokesperson Julie Fritz, PT, PhD, ATC, clinical outcomes research scientist at Salt Lake City’s Intermountain Healthcare and associate professor at the University of Utah, physical therapists have several treatment options that can help patients with LBP whether due to degenerative disc disease or a variety of other causes.

Exercise and manual therapy including spinal manipulation, have been shown to benefit many patients.. In addition, patient education to remain active and use appropriate body mechanics is beneficial. Physical therapists are trained to identify which of these treatment strategies will be most effective for an individual patient, which further improves the effectiveness of care.

 In previous systematic reviews of the literature, it was found that exercise has been shown to improve function and decrease pain in adult patients with chronic LBP and that physical therapy was beneficial for the treatment of acute LBP.2,3 In another systematic review, NSAIDs were found to provide LBP patients with short-term symptomatic relief. 4

“Receiving care from a licensed physical therapist can further improve the odds that a patient can maintain their quality of life and avoid surgery,” said Fritz. In addition to building the core muscle groups, hands-on therapy to mobilize the spine has been shown to be particularly effective. 5,6 “Spinal manipulation can be an important component of physical therapist treatment for low back pain. Supplementing exercise with spinal manipulation is also beneficial for many patients.”

 Physical therapists can help patients develop a safe and effective exercise program that is tailored to an individual’s specific needs and goals. “Surgery should be the last option, but too often patients think of surgery as a cure all and are eager to embark on it,” said Luke Madigan, M.D., an attending physician at Knoxville Orthopaedic Clinic, Knoxville, TN, and the lead author of the literature review.

 The Jackson Clinics, LLC, offers skilled physical therapy in twelve (12) locations throughout Northern Virginia. Visit our website, www.thejacksonclinics.com for more information on the causes and treatments of low back pain.

 Physical therapists are highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility – in many cases without expensive surgery or the side effects of prescription medications. In most states, patients can make an appointment directly with a physical therapist, without a physician referral. To learn more about conditions physical therapists can treat and to find a Jackson Clinics location in your area go to www.thejacksonclinics.com.

Contact: Richard Jackson, PT, OCS
540-687-8181
rjackson@thejacksonclinics.com

2 Hayden JA, van Tulder MW, Malmivaara A, Koes BW: Exercise therapy for the treatment of non-specific low back pain. Cochrane Database Syst Rev. 2005;(3):CD000335.

 3 Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG: Spinal manipulative therapy for low back pain. Cochrane Database Syst Rev. 2004;(1):CD000447.

4 vanTulder MW, Scholten RJ, Koes BW, Deyo RA: Nonsteroidal anti-inflammatory drugs for low back pain: a systematic review within the framework of the Cochrane collaboration back review group Cochrane review. Spine 2000:25:2501-2513.

 5 Childs JD, Fritz JM, Flynn TW, Irrgang JJ, Johnson KK, Maikowski GR, Delitto A: A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study. Ann Intern Med. 2004; 141(12):920-928.

6 Chou R, Huffman LH: Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline.; American Pain Society; American College of Physicians; Ann Intern Med. 2007; 147(7):492-504.

Middleburg, Virginia, March 12, 2007 - The American Heart Association recommends doctors change their approach to prescribing pain relievers for patients with or at risk for heart disease. In a scientific statement published Feb. 27, 2007 in Circulation: Journal of the American Heart Association, the heart specialists instead prescribe physical therapy first.

“We believe that some physicians have been prescribing the new COX-2 inhibitors as the first line of treatment. We are turning that around and saying that, for chronic pain in patients with known heart disease or who are at risk for heart disease, these drugs should be the last line of treatment,” said Elliott M. Antman, M.D., FAHA, lead author of the American Heart Association scientific statement and professor of medicine at Harvard Medical School and Brigham and Women’s Hospital.

“We advise physicians to start with non-pharmacologic treatments such as physical therapy and exercise, weight loss to reduce stress on joints, and heat or cold therapy. If the non-pharmacologic approach does not provide enough pain relief or control of symptoms, we recommend a stepped-care approach when it comes to prescribing drugs.”

“This recommendation comes as no surprise to physical therapists,” said Richard Jackson, owner of The Jackson Clinics. “Research has repeatedly shown the value of early physical therapy for patients with musculoskeletal conditions. We are glad to see that the AHA’s recommendations of physical therapy as a safe and effective alternative to drugs are consistent with these findings. It only makes sense to see your physical therapist before trying drugs and surgery.”

To read the AHAs scientific statement online, go to: http://www.americanheart.org/presenter.jhtml?identifier=3045689. For more on the benefits of physical therapy, contact your nearest Jackson Clinics office or visit their website at www.thejacksonclinics.com

CONTACT: Richard Jackson, PT, OCS
rjackson@thejacksonclinics.com
Phone: 540-687-8181

Middleburg, Virginia, October 3, 2007 - The American College of Physicians and the American Pain Society recommend doctors prescribe physical therapy when managing patients with low back pain.

“There are many options for evaluation and treatment of low back pain,” said Amir Qaseem, MD, PhD, MHA, senior medical associate in the American College of Physicians Department of Clinical Programs and Quality of Care, and an author of the guidelines. “We wanted to review all the evidence and develop guidance for clinicians and to give our patients a realistic sense of what they can expect when they visit a clinician for low back pain. In particular, clinicians should consider the addition of non-pharmacological therapies with proven benefits.”

“This recommendation comes as no surprise to physical therapists,” said Richard Jackson, PT,OCS, owner of The Jackson Clinics, LLC “Research has consistently shown the value of particular physical therapy interventions for patients with low back pain. Specifically, spinal manipulation and exercise have repeatedly been shown to be effective in managing patients’ current pain and preventing future episodes. We are glad to see that the American College of Physicians and the American Pain Society recommend physical therapy as a safe and effective alternative to drugs for patients with back pain.” Physical Therapists can help patients with low back pain by performing thorough examinations and designing an evidence-based treatment program to meet their particular needs. These treatments can include hands-on therapies to mobilize the spine and exercises designed to alleviate low back pain.

For more on the benefits that physical therapists can provide in the management of low back pain, contact your nearest Jackson Clinics office or visit their website at www.thejacksonclinics.com.

CONTACT: Richard Jackson, PT, OCS
rjackson@thejacksonclinics.com
Phone: 540-687-8181

Middleburg, Virginia, February 8, 2007 - Spine fusion (surgery) is commonly viewed as a stabilizing treatment that may reduce the need for additional surgery. However, according to a recent study published in the medical journal, Spine, “the indications for fusion surgery in degenerative spine disorders remain controversial, and the effects of fusion on reoperation rates are unclear.”

The study, is titled “Reoperation rates following lumbar spine surgery and the influence of spinal fusion procedures”. According to the authors, BI Martin and associates from the Department of Medicine, University of Washington, Seattle, WA, the objective of the study was to “determine the cumulative incidence of reoperation following lumbar surgery for degenerative disease and, for specific diagnoses, to compare the frequency of reoperation following fusion with that following decompression alone.”

The study found a rate of nearly 20% reoperation following the first spinal surgery. “In other words,” said Richard Jackson, PT, OCS, owner of The Jackson Clinics, “one in five people who have their spines fused in surgery, must suffer through additional surgery because it failed the first time. That’s an alarming rate. In the vast majority of cases, patients would have benefited from physical therapy first.”

The conclusion from this study is clear, according to the American Academy of Orthopedic and Manual Physical Therapy (AAOMPT): Patients should be informed that the likelihood of re-operation following a lumbar spine operation is substantial. The group suggests considering alternatives to lumbar surgery proposed by the Association of Ethical Spine Surgeons, who understand that lumbar surgery rates in the U.S. are very much over-utilized. The number one alternative to lumbar surgery, according to the surgeons themselves, is to first visit a physical therapist.

“That is the mantra of The Jackson Clinics”, noted Mr. Jackson, “Go see your physical therapist first. We will not prescribe drugs or perform invasive procedures that may well cause more harm than good. We can alleviate the pain in your back, and show you how to prevent it from reoccurring.”

For more information about the benefits of physical therapy and how it can help you alleviate back pain, eliminate your use of prescription drugs, and prevent costly and painful surgery, go to: www.thejacksonclinics.com, or contact your local Jackson Clinics office.

CONTACT: Richard Jackson, PT, OCS
rjackson@thejacksonclinics.com
Phone: 540-687-8181

Spinal Manipulation, Exercise and Advice Offer Patients an Effective Alternative for Back Pain

Middleburg, Virginia, Feb. 14, 2008 – Health care expenditures for patients with spinal conditions are rising without an associated increase in health status, according to a February, 2008 research report appearing in the Journal of the American Medical Association. The study suggests Americans may be wasting their money for treatments as the overall proportion of people with impaired function increased from 1997-2005, despite a 65% increase in expenditures to treat spine conditions. Physical therapists offering spinal manipulation, exercise, and advice can provide an effective alternative for patients with back and neck problems, often at a lower cost.

“I think the truth is we have perhaps oversold what we have to offer,” said Richard A. Deyo, a physician at Oregon Health & Science University in Portland and a coauthor of the report. “All the imaging we do, all the drug treatments, all the injections, all the operations have some benefit for some patients. But I think in each of those situations we’ve begun using those tests or treatments more widely than science would really support.”

What science does support is the effectiveness of physical therapy for affecting outcomes in patients with spinal conditions. “Research has consistently shown the value of particular physical therapy interventions for patients with back and neck problems,” said Richard Jackson, PT, OCS of The Jackson Clinics. “Specifically, spinal manipulation and exercise have repeatedly been shown to be effective in managing patients’ current pain and preventing future episodes.”

Particularly discouraging in this recent report was an increase in pharmaceutical expenditures of 171% during the study period. This suggests that physicians are over-utilizing an ineffective treatment for spine pain.

“You have drugs, you have surgery, or you have us,” explained Jackson. “The reality is that very few treatments have shown the ability to truly affect patients with spine conditions. Physical therapists can do just that.”

These treatments include hands-on therapies to mobilize the spine and exercises designed to alleviate low back pain. Jackson suggests that patients should seek out physical therapists as a first-line treatment for these conditions.

A separate study in 2006 demonstrated that patients with back pain were experiencing an increase in the rates of imaging and injections, meanwhile realizing a significant under-utilization of physical therapy.

For more on the benefits physical therapists can provide in the management of back and neck problems, contact your nearest Jackson Clinics office. The Jackson Clinics has twelve offices in Northern Virginia promoting excellence in orthopaedic manual physical therapy practice, education and research.

CONTACT: Richard Jackson, PT, OCS
The Jackson Clinics, LLC
Phone: 540-687-8181
rjackson@thejacksonclinics.com
www.thejacksonclinics.com

###

Physical Therapy offers same outcomes for patients with sciatica 6 months after surgery.

Middleburg, Virginia, June 23, 2008 – A recent study published in the British Medical Journal1 reports that spinal surgery for patients with sciatica offers a short term benefit, but by 6 months that benefit disappears and no difference is seen between patients who had surgery and those receiving physical therapy. The study suggests that the benefits of surgery are only short-term and conservative treatments such as physical therapy may offer the same outcome.

Sciatica often resolves quickly, but in some patients it persists. Previous to this study, only limited evidence existed that could guide patients about when or if that resolution was going to occur. In this study, patients had the option of opting for early surgery, or prolonged conservative management under the guidance of a physical therapist. The surgical group showed improvement in symptoms for only a brief period following surgery. But, by 6 months, and up to 2 years following surgery, the difference between the groups having surgery and those that didn’t disappeared.

“The significance of this study is that patients may be able to avoid surgery if they realized they can expect a similar improvement in symptoms if they use other ways to manage the pain for 6 months,” said Richard Jackson, PT, OCS, owner of The Jackson Clinics.“ Patients should be aware that surgery is not the only option to reduce the symptoms of sciatica.”

The study’s authors conclude that since the early benefits of surgery are gone by 6 months, when deciding to have surgery for sciatica, well informed patients, and not physicians, should decide if and when they opt for surgery.

The results of this study, coupled with the findings of another study published earlier this year suggest expensive treatments for low back pain may not be the best approach. Less expensive conservative options like physical therapy may be the preferred choice for patients with low back pain.

“The best course of treatment for low back pain is to make sure it is addressed early and does not progress to leg pain, or become a chronic condition,” continued Jackson. “Research has shown that early movement and treatments like exercise and spinal manipulation offer strong benefits to this group of patients.”

These treatments include hands-on physical therapy to mobilize the spine and exercises designed to alleviate low back pain. Jackson suggests that patients seek out physical therapists as a first-line treatment for these conditions.

For more on the benefits physical therapists can provide in the management of back and neck problems, contact your nearest Jackson Clinics Office or visit their website at www.thejacksonclinics.com. The Jackson Clinics promotes excellence in orthopaedic manual physical therapy practice, education and research.

CONTACT: Richard Jackson, PT, OCS
The Jackson Clinics, LLC
Phone: 540-687-8181
rjackson@thejacksonclinics.com
www.thejacksonclinics.com

1Peul WC, et al. BMJ. 2008; 336(7657):1355-8.

###

More surgery, more drugs, and more injections are not what the doctor ordered.

Middleburg, Virginia, May 20, 2008 – When it comes to chronic back pain management patients should know that “less is more.” The American Pain Society at their annual meeting unveiled a current review on invasive procedures for the treatment of chronic low back. The scientific review concluded that most invasive interventions, including spinal joint injections, radiofrequency denervation, intradiscal electrothermal therapy demonstrated no evidence of effectiveness. Furthermore, surgical procedures for chronic low back pain demonstrated only small improvement in pain and disability but were accompanied by considerable risk.

“The expert panel reaffirms its previous recommendation that all low-back pain patients stay active and talk honestly with their physicians about self care and other interventions. “In general, non-invasive therapies supported by evidence showing benefits should be tried before considering interventional therapies or surgery,” said Chou.”

“The American Pain Society panel has acknowledged the central role of an active physical therapy program in managing low back pain patients,” noted Richard Jackson, PT,OCS, owner of The Jackson Clinics. “The key in chronic low back pain is avoiding too much medicine. There is no magic bullet but a combination of hands on care and an active exercise approach is the best solution.”

CONTACT: Richard Jackson, PT, OCS
The Jackson Clinics, LLC
Phone: 540-687-8181
rjackson@thejacksonclinics.com
www.thejacksonclinics.com

###

Middleburg, Virginia, April 26, 2007- Despite widespread use, the supplement chondroitin does not appear to help a majority of individuals with hip and knee pain caused by osteoarthritis.

According to the April 17, 2007 edition of Annals of Internal Medicine Stephan Reichenbach, MD and associates in Switzerland and Germany discovered that while previous meta-analyses described moderate to large benefits of chondroitin in patients with osteoarthritis, recent large-scale trials did not find evidence to support that theory.

“Fortunately,” according to Richard Jackson, PT, OCS, owner of The Jackson Clinics “there are alternatives.” Mr. Jackson said that by “using an innovative treatment approach consisting of manual physical therapy and specific exercise based on recent high quality research, patients with knee arthritis frequently report a 20-40% relief in their symptoms after only two or three sessions of manual physical therapy and exercise.” He added that “these improvements are usually maintained for up to one year.”

Similar results were observed in a recently published follow-on trial in patients with knee arthritis, Jackson said. “At one year, patient improvements were maintained and patients who received a combination of manual physical therapy and exercise were less likely to be taking medications for their arthritis.” “Evidence also suggests that patients with hip arthritis experience similar benefits from manual physical therapy and exercise,” he added.

“The research is clear. Individuals with hip and knee arthritis should see their physical therapist first, before trying dietary supplements, prescription drugs, or surgery,” suggested Mr. Jackson. “A physical therapist can help you alleviate the pain in your knees and hips and show you how to prevent that pain from coming back.”

To read a synopsis of the study in “Annals of Internal Medicine,” go to: www.annals.org and search for Vol. 146, No 8, 17 April 2007.

For more information about the benefits of physical therapy and how it can help you alleviate knee and back pain associated with osteoarthritis, eliminate your use of supplements or prescription drugs, and prevent costly and painful surgery, go to: www.thejacksonclinics.com, or contact your local Jackson Clinics office.

CONTACT: Richard Jackson, PT OCS
rjackson@thejacksonclinics.com
Phone: 540-687-8181

Middleburg, VA, January 26, 2009– Richard Deyo MD, the keynote speaker at the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) National Conference in October 2008, has again published data indicting the US approach to chronic back pain dramatically increases costs without improved outcomes. Deyo and colleagues reported in the January 2009 issue of the Journal of American Board of Family Practice the following staggering statistics:

• A 629% increase in Medicare expenditures for epidural steroid injections;
• A 423% increase in expenditures for opioids for back pain;
• A 307% increase in the number of lumbar magnetic resonance images among Medicare beneficiaries;
• A 220% increase in spinal fusion surgery rates.

The incidence of chronic and acute Low Back Pain, as documented by office visits, has not changed during the last 12 years. The application of these technologies is not without consequences Deyo et al noted, ‘Innovation has often outpaced clinical science, leaving uncertainty about the efficacy and safety of many common treatments. Complications and even deaths related to pain management are increasing.’ Indeed, the reoperation rates for low back pain have increased, not improved. The authors conclude that the ‘Prescribing yet more imaging, opioids, injections, and operations is not likely to improve outcomes for patients with chronic back pain.’ They note that these approaches often are applying an acute care model to chronic pain and not acknowledging the current evidence that chronic pain requires a different approach and that there are ‘no magic bullets.’ In a “chronic care model” chronic back pain, like diabetes or asthma, ‘is a condition we can treat but rarely cure.’ Deyo et al suggest the solution that ‘chronic back pain may benefit from sustained commitment from health care providers; involvement of patients as partners in their care; education in self-care strategies; coordination of care; and involvement of community resources to promote exercise, provide social support, and facilitate a return to work.’

Richard Jackson, PT, OCS, president of the The Jackson Clinics states, ‘The manual physical therapist is the health care provider uniquely trained to manage individuals with chronic low back pain. We utilize low risk, state-of-the-art care incorporating exercise, manual physical therapy, patient education and the application of the biopsychosocial model in managing this chronic condition. The Jackson Clinics is dedicated to the application of current models for chronic pain management.’

CONTACT: Richard Jackson, PT, OCS
President, The Jackson Clinics, LLC
Phone: (540) 687-8181
rjackson@thejacksonclinics.com
www.thejacksonclinics.com

######

Physical Therapy an Alternative to the High Risks of Methadone

Middleburg, Virginia, August 18, 2008 – A recent investigative report1 published in the New York Times highlights the alarming increase in methadone prescriptions for the treatment of chronic spinal pain. The result has been a shocking increase in methadone related deaths. Physical therapists can play a role in providing patients and physicians with an alternative to dangerous pain medications like oxycodone and methadone.

Methadone was once limited to use in addiction treatment centers to replace heroin, but today it is frequently given out by physicians to manage spine and joint pain. The Drug Enforcement Administration noted that from 1998 to 2006, the number of methadone prescriptions increased by 700 percent. “Many legitimate patients, following the direction of their doctor, have run into trouble with methadone, including death,” noted pain specialist Dr. Howard A. Heit from Georgetown University. Florida alone, which keeps detailed data, listed methadone as a cause in 785 deaths in 2007, up from 367 in 2003.

“These are senseless deaths,” said Richard Jackson, PT, OCS owner of The Jackson Clinics. “Patients should be aware that these medications are not the best option to reduce the symptoms of spinal pain. Research has shown that early movement and treatments like exercise and spinal manipulation offer strong benefits to spine pain and disability.” “The medical management of spinal pain in this country is a failure,” continued Jackson, “we too often initiate prescription drug therapy before choosing safe and effective alternatives.” Jackson suggests that patients seek out physical therapists as a first-line treatment for these conditions.

A February 2008 report published in the Journal of the American Medical Association reports that from 1997 to 2005, pharmaceutical expenditures for the management of low back pain increased by 171% while the rate of good outcomes fell. “All the imaging we do, all the drug treatments, all the injections, all the operations have some benefit for some patients,” said Richard A. Deyo, a physician at Oregon Health & Science University in Portland and a coauthor of the report. “But I think in each of those situations we’ve begun using those tests or treatments more widely than science would really support.”

For more on the benefits physical therapists can provide in the management of spinal pain, contact your nearest Jackson Clinics office or visit their website at www.thejacksonclinics.com.

CONTACT: Richard Jackson, PT, OCS
The Jackson Clinics, LLC
Phone: 540-687-8181
rjackson@thejacksonclinics.com
www.thejacksonclinics.com

1www.nytimes.com/2008/08/17/us/17methadone.html?ex=1376712000&en=857a1ef1d4e38769&ei=5124&partner=permalink&exprod=permalink.

#####