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‘Pain is not the only problem’: Game Day Plan

The Game Day approach evolved from the performance-based determination of athletes to get results in a competitive platform. It also evolved from my inspiration to create an alternative platform for the current health care ‘system’ that does not provide an efficient nor effective conservative treatment plan for clinically common LBP. If winning at the game of satisfactory LBP outcomes is the ‘play’ clinicians are running, patients will never become champions. The rules have to change.

‘Clinically meaningful results’ imply a treatment plan that provides biomechanically improved outcomes and patient satisfaction reflected through patient values and expectations. ‘Clinically meaningful’ is similar to ‘strategically meaningful.’ Team coaches do not get superior performance from the team unless there is a Game Plan that the entire team understands, supports and implements. Team coaches use ‘plays’ that work, and discard ‘plays’ that do not work since points are in jeopardy. When clinicians use LBP ‘plays’ that do not work, patients are being pointed in the wrong direction and can’t win.

It is useless to provide a surgical intervention on a disc herniation simply because it is seen on MRI if there is no surgeon’s promise for full recovery and return to premium performance; removal of the observed herniation is not the expectation of the athlete… hastened RTP is the expectation to be achieved. Surgery will always delay RTP, and is never at low cost.
Common LBP medical approaches are intended to manage ‘observed’ anatomical contributors, without ever considering FMP, spinal stability (proven), performance deficiencies, accuracy in motor commands, active range of motion, nor sports specificity (including ADLs.) The HORRER!

Conservative Care is intended to manage LBP firstly by treating the symptoms of the extremities then by, centralization; (1) identifying the FMP, (2) reducing and eliminating limb radiation, (3) reducing extremity sensitization, (4) producing negative extremity orthopedic exams, (5) finding palliative extremity positions, (6) improving joint play and stiffness, (7) restoring limb function integration to the whole-body system. This extensive list can be performed in first-encounter visit at low cost.
Next, Conservative Care is intended to manage LBP by (1) identifying the non-extremity causes and symptoms, (2) reducing the number of spinal levels involved, (3) reducing spinal symptoms, (4) producing negative pathological reflexes (5) finding a palliative LBP position, (6) improving joint play and joint stiffness, (7) restoring spinal function. This extensive list can be performed in the same first-encounter visit at low cost.

Game Day is about clinical conservatism. There are (9) conservative approaches:
(1) Primum non nocere: never do harm; zero side effects, no risk, 100% provider promise.
(2) Minimum intervention: provide comprehensive patient education and accountability.
(3) Reduce patient risk: self-evaluation to change lifestyle choices and behaviors to get results.
(4) Least side effects (medical model = 668 deaths/day, conservative = 0 deaths/day.)
(5) Patient explains self-identified contributions (problems/set-backs), these become therapy pointers.
(6) Least invasive interventions to minimize scarring, risks, impediments, and death.
(7) Individualized care to address a patient/athlete-specific case-management.
(8) Patient accountability to comply and participate as the primary care-giver.
(9) Lowest possible cost, treating in the least amount of time.

Game Day is about patient/athlete performance excellence. There are (9) excellence approaches:

(1) Do no harm to your teammates or to team values.
(2) Discover winning plays early.
(3) Reduce negativity and distraction: embody a victorious lifestyle.
(4) Least lost time due to injury and set-backs.
(5) Teammates support each other, coaches provide training and wisdom.
(6) Train for best performance with least risk to team values.
(7) Teammates recognize individual athlete values to be exploited for team gains.
(8) Athletes own their value to the team
(9) Least set-backs, least injury, most gains.

One Standard of Care (OSC) for LBP assumes that the symptom generator is not assumed to be IVF nerve impingement, disc herniation (classifications), piriformis syndrome, SIJ syndrome, or canal stenosis simply because it can be ‘seen/discovered’ on advanced imaging… there MUST be progressive neural deficits of 911 nature, and efferent deficits.

Conservative Care begins with evaluation: numbness, tingling, electric pain in LE, bowel and bladder changes (may signify a 911 surgical intervention.) Determine dullness v. localized. Determine distal v. local (toes v. hip.) Determine tenderness location (palpate everything, both LE.) Determine afferent deficiencies (both LE.) Determine a/pROM w/wo pain both LE. This extensive list can be performed in the same first-encounter visit at low cost.

Then, assess pointers to ADL changes: how has the patient chosen to modify ADLs? What are the provocative positions? What are the palliative positions? What are the pointers to inflammatory contributions… diet, auto-immune, acquired, exacerbation, non-healing?

Then, what are the pointers to sympathetic lifestyle: haste, emergency, distraction, productivity, etc.?
Then, what are the pointers to phasic healing: overlapping phases of unresolved tissue repair?
Then, provide parasympathetic lifestyle changes, and anti-inflammatory diet.

The first-encounter evaluation can be completed in less than 20 minutes.

Does your Course of Care provide functional confidence + systemic adaptability + patient satisfaction, or does it get you paid… since ‘pain is not the only problem’ and since medicine is never business as usual.

LBP Blog General information

Series Description

These articles intend to (1) re-evaluate the prevailing clinical practices thought to manage low back ‘pain’, (2) submit and debate novel low back ‘pain’ contributors and mechanisms, (3) meet patient expectations & satisfaction and clinically meaningful results, (4) recommend a conservative non-surgical course of care to over-ride ‘pain’ instantly, and (5) restore ADLs and patient confidence on the first visit at low cost. This article has a companion podcast.

Dr. Dean Bio

Forester Dean is a chiropractic and physiotherapy sports medicine doctor practicing in Los Angeles, California. Dr. Dean is a lifetime athlete, and currently teaches tennis, track, boxing, yoga. The Core X System™ Campus flagship location was opened by Dr. Dean in 2020.

© Copyright 2021 SpineSync, Forester Dean, DC
Duplication with permission only

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