SpineCare Clinics Offer Post-Injury Relief

Back and spinal problems often seem hopelessly resistant to improvement, leaving patients to endure pain and discomfort with little prospect of relief.

But two SpineCare Clinics, operated by Froedtert & The Medical College of Wisconsin, are producing substantial improvements for patients with back and spinal pain, says Diane Braza, MD, Medical College of Wisconsin Associate Professor of Physical Medicine and Rehabilitation and Clinical Director of the clinics.

The SpineCare Clinics are showing a high rate of success for patients with musculoskeletal spine injuries, neck pain, scoliosis, backaches, degenerative disc disease, disc herniations and other spine-related disorders, Dr. Braza says.

For example, 97% of patients receiving rehabilitation care at SpineCare are able to return to their regular work duties with minimal modifications by the end of treatment.

Moreover, fewer than 5% of the SpineCare Clinic patients undergo surgery, compared to 12% of patients with comparable symptoms. "The reason our surgery rate is so low is that most SpineCare patients get better with conservative treatment alone," notes Dr. Braza.

Full Range of Treatments
Dr. Braza sees SpineCare's unique approach as responsible for its notable success rate. "We use a multi-disciplinary approach where we can provide different treatments concurrently, so that there is a synergistic effect from having the full range of treatments in one place at the same time," she explains. "For example, if a patient is undergoing pain that prevents them from doing therapy, we can provide them with an epidural injection that allows them to participate.

"From almost the first moment we begin seeing patients for an initial assessment, they are benefiting from our team approach. We're able to offer 'one-stop shopping' in a sense," she says, noting that patients do not have to schedule multiple visits with different providers at various locations.

Typically, SpineCare patients are people who continue to experience spinal pain or discomfort even after trying over-the-counter medications and visiting their primary care physicians, according to Dr. Braza. "We have many sub-acute patients who aren't responding to medications and find themselves functionally limited in terms of work or their usual activities likes sports or gardening.

"We also see patients with acute problems. We see many post-operative patients following a spinal fusion or other spinal surgery, helping them get weaned from their brace, managing their medications, and assisting them in getting back to work."

Dr. Braza notes that the focus of the SpineCare Clinics is generally on patients who experience an injury or undergo an operation that limits their ability to carry on their normal lives. "Basically, we are not a chronic pain program. Someone who has had chronic back pain, as opposed to injuring or twisting their back, is going to do better in a chronic pain management program," she advises.

SpineCare's approach allows a broad range of care that is individualized to each patient's needs, whether it is sophisticated diagnostic testing or working with patients to ease them back into work.

"Our occupational therapist will sometimes confer with management or will actually make an on-site assessment at a patient's workplace to see how the job might be done differently to place less stress on their spine," says Dr. Braza. "The majority of our patients become able to return to work with minimal modifications. The therapist also looks at bridging the physical demands of work with the right exercise at home."

Group Shares Common Vision
Moreover, treatment by both doctors and physical therapists adds additional insight into the patient's condition. "The therapists and doctors bring in different perspectives, and we learn from each other. We've had the same basic team for 11 years, the same core group that believes in the same vision of working together."

The team includes a physiatrist or neurologist, a chiropractic physician, a physical therapist, an occupational therapist, a nursing manager, and if indicated, a psychologist. The psychologist works with the depression that often co-exists with spinal problems and the resulting limitations on activity, and also with the challenges faced when a change in career is required by the spinal difficulty.

Another key element in SpineCare's approach is "the consistency of our message to our patients," says Dr. Braza. "We stress to our patients that they must be pro-active about their spine's condition. We explain that back pain tends to be a condition like asthma or diabetes that cannot be cured once and for all, so the question is, 'How do we manage it?'"

Another vital element in the SpineCare strategy is "communicating in real time among the staff," Dr. Braza states. "We truly are communicating all the time between doctors and therapists about patients, the progress of different treatment and different problems that come up. We have a consultative approach. We focus on 'What does the patient need?'"

Finally, SpineCare educates patients and the public on how to prevent spinal trauma. "People need an understanding of good posture and back care, because it crosses over to their entire lives," Dr. Braza says. "So we stress the importance of being fit, using good body mechanics, and eliminating tobacco from their lives. Tobacco has a significant negative effect on the spine in terms of degeneration and inhibiting healing after an injury.

"We emphasize providing patients with the tools to take control - teaching them about the right kinds of exercise, aerobics, icing to reduce pain, and other techniques," she says. "We treat the patient as intelligent and concerned, and help them feel more in control of their condition."

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.