University of Pittsburgh Medical Center Says Chiropractic Before Spine Surgery

Posted by Miami Beach Chiropractor - Dr Todd Narson

Chiropractic Before Spine Surgery for Chronic LBP

University of Pittsburgh Medical Center Health Plan mandates conservative care before considering surgery for chronic LBP cases.

By Peter W. Crownfield, Executive Editor

The University of Pittsburgh Medical Center (UPMC) Health Plan, a health maintenance organization affiliated with the university's School of Medicine, has adopted landmark guidelines for the management of chronic low back pain. As of Jan. 1, 2012, candidates for spine surgery must receive "prior authorization to determine medical necessity," which includes verification that the patient has "tried and failed a 3-month course of conservative management that included physical therapy, chiropractic therapy, and medication." Surgery candidates also must be graduates of the plan's LBP health coaching program. The program features a Web-based decision-making tool designed to help plan members "understand the pros and cons of surgery and high-tech radiology." It is the first reported implementation of such a policy by a health care plan.

Putting a Clamp on the Soaring Rates of Spine Surgery

According to the December 2011 issue of the UPMC Health Plan Physician Partner Update, which informed participating providers of the new guidelines and the rationale for their implementation, "We feel strongly that this clinical initiative will improve the quality of care for members who are considering low back surgery, and that it will facilitate their involvement in the decision-making process." The update also noted, "Surgical procedures for low back surgery performed without prior authorization will not be reimbursed at either the specialist or the hospital level."

According to the December 2011 issue of the UPMC Health Plan Physician Partner Update, which informed participating providers of the new guidelines and the rationale for their implementation, "We feel strongly that this clinical initiative will improve the quality of care for members who are considering low back surgery, and that it will facilitate their involvement in the decision-making process." The update also noted, "Surgical procedures for low back surgery performed without prior authorization will not be reimbursed at either the specialist or the hospital level."

Headquartered in Pittsburgh, the UPMC Health Plan covers insureds in 15 counties in western Pennsylvania. The plan integrates 20 hospitals, 400 doctors' offices and outpatient sites.

Chiropractic Services: What the UPMC Health Plan Covers

"It is the policy of UPMC Health Plan to recognize chiropractic services and adjunctive procedures as appropriate and consistent with good medical practice and will provide coverage when the services are medically necessary and covered by the member's benefit plan for the specific indications detailed in this policy. Coverage is limited to medically necessary services provided by a licensed doctor of chiropractic, within the scope of his/her license."

"Covered chiropractic services include evaluation and management, manipulation, spinal X-rays, therapeutic exercise, and adjunctive procedures that are appropriate and medically necessary for neuromusculoskeletal conditions. ... Indications for Chiropractic Services: Indicated for primary, neuro-musculoskeletal symptoms involving the spine, para-spinal soft tissues, and extremities. Indications for Manipulation: Manipulation is appropriate to restore function that has been reduced or lost by illness or injury. Indications for Adjunctive Procedures: Adjunctive procedures are appropriate to restore function and prevent disability following injury. Indications for Therapeutic Exercise: Indicated for improvement or to restore functional status by building strength, endurance and flexibility of the affected region."

A Conservative Strategy for Managing Chronic LBP
• PCP discussion related to self-care consisting of rest, ice, compression and elevation (RICE)
• Screening for psychosocial factors or "yellow flags" and incorporate behavioral interventions as appropriate with other treatment interventions
• Education on self-management techniques – functional ability assessment and education on return to work / usual activity and function
• Enrollment and graduation from UPMC Health Plan Health Coach's Low Back Pain Program (mandatory) which may also include participation in other programs such as weight loss, physical activity, tobacco cessation, depression and/or stress
• Early referral to chiropractor or physical therapist, but before advanced imaging, for manipulation/mobilization; stabilization exercises; directional preference strategies – member and/or provider movements that abolish or cause centralization of pain (McKenzie self-treatment repeated movements that centralize pain)
• Detailed documentation of extent and response to conservative treatment including chiropractor/physical therapy documentation
SOURCE: UPMC Health Plan Policy and Procedure Manual, October 2011: Surgical Management of Low Back Pain (partial list of considerations prior to spine surgery to determine medical necessity). Complete policy available at:www.upmchealthplan.com/pdf/PandP/MP.043.pdf.

This article has been reposted from Dynamic Chiropractic: The original article can be found by clicking here

Dr. Narson is a 2-term past president of the Florida Chiropractic Association’s Council on Sports Injuries, Physical Fitness & Rehabilitation and was honored as the recipient of the coveted Chiropractic Sports Physician of the Year Award in 1999-2000. He practices in Miami Beach, Florida at the Miami Beach Family & Sports Chiropractic Center; A Facility for Natural Sports Medicine.

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High Fructose Corn Syrup - Making You Stupid???

by Miami Beach Chiropractor & Chiropractic Sports Medicine Specialist-Dr. Todd Narson

Over the past several years I've commented and written about the dangers of high fructose corn syrup (HFCS).   I've had other bloggers write to me telling me of their being strong armed into removing their posts about the evils of HFCS. On at least 2 occasions I've dedicated full blog articles on the topics, countering their TV ads to try to brainwash the public into thinking HFCS is anything close to being natural.


Somewhere along the way while on my never ending path to nutritional learning, I've realized that ALL sugar that is consumed in anything other than the natural fruit it came from it toxic to your body. That being said, I believe that HFCS is worse. New studies out of UCLA support the facts that HFCS is just not something that you should consume. Not only does it adversely affect your blood sugar and insulin resistance, but the studies out of UCLA basically state that it makes you stupid.


But, I'll let you decide for yourself.  Click here to read about the studies out of the University of California Los Angeles/UCLA and make your own decision. But just remember, if it's not in the form by which it grows in nature, if it's not plainly recognizable, if it has ingredients you don't easily understand then seriously consider not eating it.


Someone please tell me where in nature High Fructose Corn Syrup exists naturally as HFCS???


You can't because it doesn't.


No matter how they spin it, HFCS is not natural.


Nor is the corn they make it from.


'nuff said


Dr. T

Dr. Narson is a 2-term past president of the Florida Chiropractic Association’s Council on Sports Injuries, Physical Fitness & Rehabilitation and was honored as the recipient of the coveted Chiropractic Sports Physician of the Year Award in 1999-2000. He practices in Miami Beach, Florida at the Miami Beach Family & Sports Chiropractic Center; A Facility for Natural Sports Medicine.

#chiropractormiamibeach #MiamiBeachChiropractor #SportsInjuriesFixedHere #DrNarson #TriDoc #TriathlonDoc #ChiropracticSportsMedicine #ACASC #SportsMedicine #SportsChiropractor #MiamiBeachSportsMedicine #SportsMedicineMiami #MiamiSportsMedicine #MiamiChiropractor #Triathlon #Running #Ironman #IFixPeopleInPain #TrainWithoutPain #MiamiBeachChiropractor #GrastonTechnique #FAKTR #IASTM #Chiropractor #FootPain #Narson #NarsonBodyMechanic #NarsonTool #DACBSP #CCSP #ACBSP #BackPain #NeckPain #ShoulderPain #RotatorCuff #ITBandSyndrome #runnersKnee #PlantarFasciitis #Plantarfascitis #AchillesTendonitis #AchillesTendonosis #GettingAthletesBackInTheGame  #MiamiBeachChiropractor #MiamiSportsMedicine #MiamiBeachSportsMedicine #WeFixPeopleInPain #TrainWithoutPain #ChiropracticSportsMedicine #ACASC #ProSportChiropractic #FunctionalMedicineMiami #DrNarson #BackPainRelief #NeckPainRelief #SportsInjuriesFixedHere #LaserTherapy #RockTape #KinesioTape #KTTape #Nutrition #21DayPurificationProgram #DetoxProgram #PaleoDiet #PaleoDoc #FunctionalNutrition #Chirooractor #Chiropractic #ChiropracticPhysician #DoctorOfChiropractic

Conservative Care Beats Medication For Neck Pain

Posted by Miami Beach Chiropractor - Dr Todd Narson

A study published in the Jan. 3, 2012 issue of the Annals of Internal Medicine and widely reported by mainstream media suggests conservative care consisting of either spinal manipulation or home exercise is more effective than over-the-counter and prescription medication for relieving acute and subacute neck pain. Spinal manipulative therapy was more effective than medication in both the short and long term, as was home exercise in the form of self-mobilization of the neck and shoulder joints – a point media outlets were quick to emphasize in a classic attempt to downplay the value of the chiropractic intervention.

The study, conducted by Northwestern Health Sciences University under the direction of NHSU Vice President of Research, Dr. Gert Bronfort, and Dean of Research, Dr. Roni Evans, involved 272 adults ages 18-65 with nonspecific mechanical neck pain of two to 12 weeks' duration. Participants were recruited from a university research center and a pain management clinic in Minnesota. Other inclusion criteria included pain equivalent to grade I or grade II according to the Bone and Joint Decade's Task Force on Neck Pain and Its Associated Disorders; and neck pain score of 3 or greater on a 0-10 scale. Exclusion criteria included cervical spine instability, fracture, neck pain referred from peripheral joints or viscera, progressive neurologic deficits, diffuse idiopathic hyperostosis, inflammatory or destructive changes of the cervical spine, previous cervical spine surgery, and blood-clotting disorders, among other criteria.
Subjects were randomized at their second baseline appointment to one of three groups for 12 weeks:

• A spinal manipulative therapy group, which received "manipulation of areas of the spine with segmental hypomobility by using diversified techniques, including low-amplitude spinal adjustments ... and mobilization." According to the study, six chiropractors, each with at least five years' experience, provided treatment, with the specific spinal level to be treated and the number of treatments rendered left to the discretion of the individual chiropractor.
• A home exercise advice group, "with advice provided [by six therapists] in two 1-hour sessions one to two weeks apart. Recommended mobilization exercises included "neck retraction, extension, flexion, rotation, lateral bending motions, and scapular retraction, with no resistance." Participants received a booklet and laminated cards of prescribed exercises, and were advised to perform 5-10 repetitions of each exercise six to eight times daily.
• A medication group monitored by a licensed medical physician, with nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, or both serving as the first line of pharmacological therapy. With patients who did not respond to or could not tolerate these drugs, narcotic medications and muscle relaxants were prescribed. With each patient, the MD determined the type of medication administered and the number of patient visits.

Self-reported outcomes, including pain, were measured six times during the 12-week treatment period in all three groups: at both baseline appointments; two, four, eight and 12 weeks after randomization; and on two occasions post-treatment (weeks 26 and 52). Objective measures of cervical spine motion were measured at four and 12 weeks by seven trained examiners blinded to treatment assignment.
Of the 272 participants, essentially equally assigned to the three treatment groups (91 SMT, 91 home exercise and 90 medication), "improvement in participant-rated pain significantly differed with SMT compared with medication at 12 weeks ... and in longitudinal analyses that incorporated pain ratings every two weeks from baseline to 12 weeks. At 12 weeks, a significantly higher proportion of the SMT group experienced reductions of pain of at least 50% [compared to the medication group]. Differences in participant-related pain improvement between the SMT and [home exercise] groups were smaller and not statistically significant."

Specifically, at week 12, more than 82 percent of the SMT group reported a 50 percent or greater reduction in pain; 57 percent reported at least a 75 percent reduction and 32 percent reported a 100 percent reduction. By comparison, the home exercise group reported pain reductions of 77 percent, 48 percent and 30 percent, respectively, while the medication group reported reductions of only 69 percent, 33 percent and 13 percent.

In terms of long-term improvement, 75 percent of the SMT group reported at least a 50 percent reduction in pain after 26 weeks, while nearly 81 percent reported at least a 50 percent reduction at 52 weeks. At 26 and 52 weeks, 71 percent and 69 percent of the home exercise group, respectively, reported at least a 50 percent reduction in pain. In long-term follow-up, the medication group's improvement fluctuated from 59 percent reporting pain reduction of 50 percent or more at 26 weeks to 69 percent reporting the same reduction at 52 weeks.

"Spinal manipulation therapy and [home exercise advice] led to similar short- and long-term outcomes," stated the authors, "but participants who received medication seemed to fare worse, with a consistently higher use of pain medications for neck pain throughout the trial's observational period."

Source: This article was reprinted from Dynamic Chiropractic Vol 30 No. 4, by Peter W Crownfield. Bronfort G, Evans R Anderson AV, Svendsen KH, Bracha Y, Grimm RH. Spinal manipulation, medication or home exercise with advice for acute and subacute neck pain: a randomized trial. Ann Intern Med, Jan. 3, 2012;156(1 Pt 1):1-10

 In our office we offer a wide range of spinal manipulation options, physiotherapy and rehabilitation exercise programs for neck and back pain as well as for other areas such as shoulder/rotator cuff pain, tennis or golfer's elbow, swimmer's shoulder, I.T. band syndrome, ankle sprains, plantar fascitis, knee pain and more.  Combining all conservative approaches described above to help solve a multitude of problems is just our way of doing things...

'nuff said

Dr Narson


Dr. Narson is a 2-term past president of the Florida Chiropractic Association’s Council on Sports Injuries, Physical Fitness & Rehabilitation and was honored as the recipient of the coveted Chiropractic Sports Physician of the Year Award in 1999-2000. He practices in Miami Beach, Florida at the Miami Beach Family & Sports Chiropractic Center; A Facility for Natural Sports Medicine.

#chiropractormiamibeach #MiamiBeachChiropractor #SportsInjuriesFixedHere #DrNarson #TriDoc #TriathlonDoc #ChiropracticSportsMedicine #ACASC #SportsMedicine #SportsChiropractor #MiamiBeachSportsMedicine #SportsMedicineMiami #MiamiSportsMedicine #MiamiChiropractor #Triathlon #Running #Ironman #IFixPeopleInPain #TrainWithoutPain #MiamiBeachChiropractor #GrastonTechnique #FAKTR #IASTM #Chiropractor #FootPain #Narson #NarsonBodyMechanic #NarsonTool #DACBSP #CCSP #ACBSP #BackPain #NeckPain #ShoulderPain #RotatorCuff #ITBandSyndrome #runnersKnee #PlantarFasciitis #Plantarfascitis #AchillesTendonitis #AchillesTendonosis #GettingAthletesBackInTheGame  #MiamiBeachChiropractor #MiamiSportsMedicine #MiamiBeachSportsMedicine #WeFixPeopleInPain #TrainWithoutPain #ChiropracticSportsMedicine #ACASC #ProSportChiropractic #FunctionalMedicineMiami #DrNarson #BackPainRelief #NeckPainRelief #SportsInjuriesFixedHere #LaserTherapy #RockTape #KinesioTape #KTTape #Nutrition #21DayPurificationProgram #DetoxProgram #PaleoDiet #PaleoDoc #FunctionalNutrition #Chirooractor #Chiropractic #ChiropracticPhysician #DoctorOfChiropractic