Among the team members of the spinal surgery mission that was to depart for Croatia in February was ABS Executive Director Dr. Aubrey Swartz. Contributions in any amount may be made payable to the American Back Society Medical Relief Fund. Any funds donated will be used specifically for the purchase of needed medical and surgical supplies. Sonja Hagel, director of Operation Second Chance, will address the fall meeting of the ABS on the results of the mission. A special documentary on the experience will also be presented at this meeting.
A Survey of Referral Habits of ABS Symposium Attendees (Chiropractic Technique, Feb. 1994)
Drs. Robert Mootz and William Meeker distributed 500 surveys concerning referral habits to the attendees of a recent ABS symposium in San Francisco: 280 were completed and turned in by the attendees. In addition to providing demographic data, they were asked to state whether they referred to each of the other specialties "never," "sometimes," or "often." The respondents tended to be male, relatively young, in practice less than 10 years, and located in an urban area. In terms of practice environment, 38 percent reported they were in solo practice; 43 percent were in group practices (same discipline); and 19 percent practiced in multidisciplinary settings. Broken down by profession, there were 41 percent MDs, 25 percent each DCs and PTs, five percent DOs, and four percent in other miscellaneous professions.
Profession | % that never refers to DCs |
MD | 48% |
DC | 46% |
PT | 93% |
Although only seven percent of the respondents said they never referred to MDs, a whopping 62 percent reported never referring to chiropractors. The accompanying table indicates the percentage of each profession that never refers to chiropractors (except the DOs, whose sample size was too small to yield interpretable results). These numbers are worthy of some discussion.
Although I am used to hearing from my patients who are concurrently seeing PTs that had gravely warned against the evils and dangers of chiropractic care, I am still surprised by the near total extent (93 percent) to which these PTs never refer to chiropractors. It would be interesting to go back and ask them a few questions, starting with whether they really think manipulation is so dangerous (at least that's what they tend to tell my patients). If so, the next question would be why many of them apparently would like to incorporate manipulation into their practices. In the end, it's probably a garden-variety case of turf wars. In that context, it is relatively reassuring that only half of the medical respondents reported never referring to chiropractors. In the larger scheme of things, they are relatively supportive of chiropractic compared with some of the other more standoffish allied health professionals.
It is not obvious why almost half of the DCs never refer to other DCs, even though without exception all of the chiropractors said they refer at least sometimes to medical doctors. Barring a rather unpleasant interpretation of this curious phenomenon, one better left unsaid, it is tempting to read a certain megalomania into this pattern. It would go something like this: "I don't always get the results I would like with my patients, but that never reflects any personal failing in my diagnostic or therapeutic methods. Because this patient's problems are obviously beyond chiropractic, there would be no point in seeking a second opinion from another DC. I'll refer the patient to an MD." Sound a little far-fetched? I am reminded of occasions where my testimony has been solicited on behalf of chiropractors who had seen patients 100 or more times in a year with only modest results, where the payer had wanted the patient either dismissed or sent to a medical provider. I have always turned down such requests, unable to justify the DC not having sought at least a second chiropractic opinion, much less a medical referral, in what appears to have been a challenging case.
The Slipping Clutch Syndrome
In my last column I mentioned in passing that ABS member Dr. Thomas Dorman is a recognized authority in prolotherapy, which provokes hypertrophic change in ligamentous tissue through injection of hypertonic solution at a fibro-osseous junction. This has the function of stabilizing a hypermobile joint. In the fall 1993 ABS Newsletter, Dr. Dorman turns his attention to "a new syndrome ... in eight patients with back pain who experienced unexpected falling." All eight patients derived benefit from prolotherapy. The Slipping Clutch Syndrome follows trauma to the trunk, resulting in a mechanical dysfunction of the posterior ligamentous support of the sacroiliac joints.
According to Dr. Dorman, the function of the SI joint resembles that of a clutch, engaged on the stance load and disengaged on the swing leg during locomotion. "Bracing on stance and unlocking of the sacroiliac joint on the swing leg constitutes the normal mechanical function of the joint in humans." An episodic failure of self-bracing would be due to weakened posterior SI ligaments and would account for the poorly understood phenomena of sudden falling (tendency for one leg to buckle, or give way) during walking.
Spring '94 ABS Symposium in Montreal
The following description of the upcoming ABS spring meeting, to be presented with the support of McGill University and in association with the University of Montreal Faculty of Medicine, is taken from the fall 1993 ABS Newsletter. I would add that this will be an excellent opportunity to hear Pran Manga, PhD, discuss the now famous study on chiropractic that bears his name.
"We are excited about having faculty from these two outstanding medical schools for our Spring 1994 Symposium in Montreal. We have developed many new and different workshops for this meeting. The majority of our outstanding faculty has been gathered from Montreal and surrounding Quebec communities. Our educational events will include topics concerning the changes and reforms in the health care system, presentations on outcome studies, an update on the Quebec Task Force Report, workers' compensation issues, and presentations by spinal rehabilitation facilities offering the benefit of their experience in back care. Among the centers presenting will be the Western Occupational Rehabilitation Center in Calgary, Alberta, which has developed outcome and centralization studies; La Clinique de Mal de Dos in Sherbrooke, Quebec; Le Centre d'Evaluation et de Rehabilitation; the Sir Mortimer B. Davis Jewish General Hospital; and the Sacre Coeur Hospital. These presenters have many years of extensive clinical experience in the field of back care.
"We have several new topics to present: how to utilize upper limb testing in your examination; which are the most valid diagnostic screening tests for back pain; tissue origin of low back pain and sciatica; disc surgery under local anesthesia; how gait mechanics affect back pain; utilization of the progressive/resistive work circuit; pre-employment screening; and pelvic ring instability with sacroiliac pain.
"There will also be intensive workshops on manual techniques; pain management; psychiatric assessment; spinal anatomy and imaging; new approaches for physical therapy; and surgical presentations based on the most current, state-of-the-art approaches to back pain, including an all-day laser discectomy bioskills laboratory with certification available.
"In keeping with American Back Society tradition, there will be many presentations designed for an interdisciplinary audience. Attendees will have the opportunity to learn from the experience of back care professionals representing the various specialties and disciplines in the back care community."
Fall '94 ABS Symposium in Beverly Hills
The fall meeting of the ABS will take place November 30 - December 3, 1994, in Beverly Hills, California. Its theme will be "Back Pain in an Era of Health Care Reform." You may contact the American Back Society at 2647 E. 14th St., Suite 401, Oakland CA 94601, Tel. (510) 536-9929, Fax (510) 536-1812.
Robert Cooperstein, MA, DC
Oakland, California
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