Dr. Rappard coined the phrase "the four pillars for the treatment of chronic spinal pain." Early in our practice we became interested in developing an underlying practice philosophy that would lead to our patients receiving more efficient and effective care. In addition, we wanted to develop a philosophy of care that would avoid most of the pitfalls commonly associated with spinal care and would minimize unnecessary treatment failures. The key is that we listen to our patients so that we can prescribe the right treatments to begin with, thus maximizing a patient’s chance to succeed. We also utilize an escalating care model. We make sure you have been maximally treated at one step before progressing to another step in your treatment.
The first pillar: Choosing the right type of therapy
The first pillar in the treatment of chronic spinal pain is tailored therapy. Tailored therapy utilizes multiple treatment modalities to maximize the patient's outcomes. We believe that therapy is not one size fits all. We have found some patient's benefit more from core strengthening while others require a conditioning program. We have also witnessed that chiropractic care, including manipulation, results in high patient satisfaction rates and significant improvement. Lastly, we have seen many of our patients benefit from acupuncture. By working with the right therapeutic modalities patients can be successfully treated early on without requiring extensive medications or medical procedures.
The second pillar: Selecting newer and more effective medical therapy
The second pillar is appropriate medical management. Many new medications are now available that can provide good results without the side effects of older medications. For example, pain creams consist of prescription medications that are applied to the skin, avoiding side effects that are present when taken orally. Some medications are better for back pain, while others are better for sciatica. Medications can provide a patient who has not done well in therapy the ability to obtain relief without having medical procedures.
The third pillar: Injectional therapy that is more likely to work
When minor procedures are needed it’s important that the right ones are performed. That may seem obvious, but it’s actually rather common for patients to undergo multiple procedures, like epidural steroid injections, that either have no benefit or may not have been indicated to begin with. For example, an epidural injection will provide little benefit to patients suffering from whiplash, yet is the most commonly ordered procedure. We carefully choose our prescribed procedures and injections based on a careful evaluation. Dr. Rappard performs all of his injection procedures personally, so he knows what is likely to work best, and no one receives an injection without a prior intensive one-on-one with Dr. Rappard. When we prescribe an injection procedure we feel it is more likely to help because it has been carefully chosen. That way, patients are less likely to go on and need surgery.
The fourth pillar: When surgery is needed, choose surgery that will preserve your natural spine
Unfortunately, some patients will be in a lot of pain despite expert therapy, effective medications and the right type of injections. Some patients will choose to suffer in life long pain because they are concerned about the risks and recovery of spine surgery. By offering surgery that maximizes recovery and maximizes the normal motion and stability of the spine we can now provide a surgical option like never before-The fourth pillar in treating chronic spinal pain. Most surgery, even surgery that is referred to as minimally invasive, involves cutting through important “core” muscles, stabilizing ligaments and even removing important spinal joints. All of this can result in a prolonged recovery, post-operative pain and future problems. Our specialized surgical techniques can achieve the same results as conventional surgery without the collateral damage to important spinal structures. That means a fast recovery. The results are also outstanding. Our recently presented data reported a 94% success rate in treating back pain due to herniated disc.
