American College of Physicians Issues Guideline for Treating Nonradicular Low Back Pain

American College of Physicians Issues Guideline for Treating Nonradicular Low Back Pain

As my avid blog followers are already aware I am a Baltimore Chiropractor that spends the majority of my clinic time treating Baltimore area residents with chiropractic care for headaches, neck pain, and back pain. If you read my last blog entry you’ll remember that we recently just opened our second clinic in Northwest Baltimore, on Park Heights Avenue. We are now offering the same great service that you’ve come to know and trust to the communities in northwest Baltimore, including Baltimore City, Pikesville, Mount Washington and Owings Mills.

Even though my time is spread thin with more attention being placed on the new northwest Baltimore clinic, I still take time to read about chiropractic and back pain in the news in order to share any pertinent information with my fans.

I recently came across a recommendation from the American College of Physician’s with regards to treatment of nonradicular low back pain. You can see their position on the matter by clicking this link here. Anecdotally, I suspect that about 50 percent of the patients that present to my two Baltimore chiropractic clinics are patients who present with nonradicular low back pain. To be nonradicular means that the back pain is local and does not involve nerve root irritation. To say it another way, this means that patients feel their lower back pain ONLY in their lower back and they do not have any associated numbness, tingling, or weakness down into their grown, thighs, buttocks, lower legs, or feet. Given how often my Chiropractic associates and I come across this physical presentation I wanted to know what the American College of Physician’s thought would be “best practice” to help reduce or eliminate back pain.

Their official policy was that patients with acute (less than 4 weeks duration) or subacute low back pain (4 to 12 weeks duration) should treat their conditions with “superficial heat, massage, acupuncture, or spinal manipulation.” While they do not come right out and recommend chiropractic care, they do state “physicians should remind their patients that any of the recommended physical therapies should be administered by providers with appropriate training.” Chiropractors are exactly the types of professionals that are trained in administering these remedies appropriately for low back pain patients.

For patients that have chronic lower back pain (greater than 12 weeks duration) or who have had inadequate response to non-drug therapy, patients should first consider NSAIDs as a first line of medicine to combat the pain, followed by tramadol. They then go on to state that “physicians should only consider opioids as an option in patients who have failed the aforementioned treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients.”

For our patients and our providers this is wonderful news that the American College of Physicians guideline for treating low back pain is in line with what the majority of chiropractors across the country already knew and already perform. I suspect that this news will help to open the eyes of more physicians across Baltimore and the rest of the country to the benefits of chiropractic care for acute back pain episodes.

If you, or someone you know, has acute or subacute low back pain and you’ve been curious about trying chiropractic care for low back pain, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

Daylight Savings – Time to Review Your Auto Insurance PIP Coverage

As a Baltimore Chiropractor I spend the majority of my clinic time treating injured patients in Baltimore with headaches, neck pain, and back pain. In about half of the instances these patients were injured in Baltimore auto accident car crashes. In the other half these are regular people such as you and me who woke up with a stiff neck or back and wanted some relief of their symptoms. I came across a scenario last week in my clinic that I thought warranted a further discussion so I figured I would make a blog entry about it here today. The issue involved a component of auto accident insurance in Maryland, called PIP.

As you may know, PIP stands for Personal Injury Protection. It is a form of no-fault insurance in Baltimore and the entire state of Maryland that pays for your medical care and lost wages following an auto accident, regardless of fault. So to be clear, if you hit a patch of ice and hit a wall or tree, your PIP coverage would pay for medical care and lost wages related to this injury. Likewise, if you were at a red light and got rear-ended and developed whiplash, headaches, and neck pain, the PIP coverage would pay for your care as well.

PIP is written in amounts of either $2,500, $5,000 or $10,000. All of this sounds great but there’s a catch. Under current Maryland law anyone who elects to purchase insurance must be offered PIP coverage, but can waive it entirely, and not pay for it. Typically those who waive PIP don’t even realize it until after they’ve had an accident and need the coverage. So what I am recommending is that my blog readers take 15 minutes and review their coverage now, before they are injured and before they ever need it.

When I was growing up, we used daylight savings time as “built in reminders” to change the batteries in our smoke alarms. As I got older I further used it as a reminder to ask my credit card companies for credit line increases every six months. Now that I am a professional chiropractor with two clinics in Baltimore (both southeast Baltimore in Fells Point and northwest Baltimore in Upper Park Heights) I see daylight savings as a “wake up call” to review auto insurance coverage. Rates change and benefits change all the time and there are tons of property and casualty insurance professionals who would be happy to review your auto policy and let you know what your levels of coverage are.

The thing I like best about PIP is how cheap it is to buy.  I carry the maximum amount of PIP at $10,000. I pay a total of 78 dollars a year(!) ($6.50 per month) for this invaluable coverage. I know I am paying hundreds of dollars of premium a month for health insurance that I barely use but given the population of Baltimore and the number of bad drivers out there I think spending $6.50 a month on 10,000 worth of coverage is well worth every penny. Heck, most people spend about $8 a month insuring a $300-400 dollar iPhone with Apple!

In spite of this, most people sadly still don’t know what PIP is, or if they carry it. The number one complaint I get from patients who have been involved in Baltimore auto accidents is they wish they had purchased more PIP before they had their accident.

My friend and auto accident personal injury attorney Ross Albers wrote a blog post about PIP and how it is important not to waive it for many of the same reasons I touch on.

So do yourselves a favor. Don’t be another patient that wishes they had taken 15 minutes to review their policies now. You’d be surprised how inexpensive it would be to purchase PIP or add on to a higher level of coverage. Those that have been involved in Baltimore auto accidents and know the financial ramifications of these crashes will attest that it is something they wished they would have done sooner.

If you, or someone you know, has been injured in a Baltimore auto accident with or without PIP coverage, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We now have two locations to better serve your needs.

Dr. Gulitz

Ice Missiles Causing Baltimore Auto Accidents

As my avid blog followers are already aware I am a Baltimore chiropractor with two clinics in Baltimore City that spends the majority of my time treating Baltimore auto accident injury patients. Typically the injuries we see present as headaches, neck pain, and back pain. In some instances we see upper and lower extremity pain as well as vehicle occupants suffer contusions and extremity sprains and strains due to striking their body within the vehicle during the impact.

Just today we had several new auto accident patients who all had one thing in common – their injuries were due to ice missiles! Prior to today I had never heard of the term ice missile so I wanted to learn a bit more about it and share it on my blog.

I have been a chiropractor for almost nine years and I had not heard of ice missiles until today. An ice missile is when a sheet of ice or snow flies off another vehicle or truck and then causes either bodily injury and/or property damage to another car. Although we had a relatively mild winter with only one really substantial snow storm, there are still many people driving around on the roads who have not taken the time to brush their vehicle’s roof of from snow and ice. So what happens when they drive is that sheet of snow or ice takes off and becomes an “ice missile” that can go anywhere and cause havoc on the roads to other motorists.

Interestingly, Maryland does not have any laws on the books that require the removal of snow and ice from a vehicle before operating it. According to AAA, Maryland State Troopers are legally allowed to give tickets to motorists for driving with accumulated snow and ice on the surface of their vehicles, but the state of Maryland does not have law that specifically require that motorists do so before driving their vehicles. The same holds true for Washington D.C. and Virginia. Commercial trucks and vehicles are required to remove snow and ice debris, but sedans and SUVs do not have the same law on the books. That sounds a little confusing to me. Surrounding states such as Pennsylvania do require motor vehicles to remove their snow and ice, however. So even though the law does not require it, it is considered a common courtesy and good general practice to clear the debris from your car prior to operating it.

Here are some tips to help you clear the snow and ice off of your vehicle. And yes, you guessed it, they are pretty common sense.

1. Use de-icer spray on the windshield of your vehicle prior to a substantial snow fall if you can.
2. Pull your windshield wiper blades off of the your windshield prior to the snow storm. It will make your windshield easier to clean and will prevent your blades from sticking.
3. Use a telescoping snow brush to reach the hard to reach areas such as the roof of your car to knock snow or ice off.
4. Work from the top down – Always start with the top of your vehicle and pull the snow towards you. That will prevent you from having to do double duty and re-clearing the hood of your car a second time.
5. For tall vehicles such as trucks and SUVs, get a step stool or step ladder to reach the top
6. Park your car facing the morning sun (east) – Even a few degrees of warmth may be enough to help loosen the snow and ice from your vehicle. You can aid in the melting of the ice and snow by turning on your vehicles front and rear defrosters by taking advantage of morning sunlight.
7. Always make sure your tailpipe is clear of snow to avoid the accumulation of toxic carbon monoxide

Even though we all want to stay in bed as long as possible and avoid having to go to work the morning following a snow storm, its important to spend the extra time to carefully remove snow and ice from your vehicle. Although it technically is not a law in Maryland, it is common courtesy. We all share the roads and we owe it to each other to make the commute as safe as possible.

If you, or someone you know, has been injured as a result of an ice missile, please contact Mid-Atlantic Spinal Rehab & Chiropractic. We now have two locations in Baltimore (Southeast- Fells Point, and Northwest, Upper Park Heights) to better serve your injury treatment needs.

Dr. Gulitz

Autonomous Uber Car Involved In Roll Over Crash

As a Baltimore Chiropractor, I spend the majority of my day while in my two Baltimore chiropractic clinics treating patients that have headaches, neck pain, and back pain. About half of our patients have been involved in Baltimore auto accidents and have suffered from whiplash. The other half of our patients are athletes, couch potatoes, and weekend warriors who sprain and strain their spine and are just looking for short term relief care so they can resume their lives quickly and pain free. We are happy to provide whatever level of care that our patients need.

One of the subjects that I like to follow in current events is the technology surrounding autonomous vehicles. I do forsee a day and probably within my working lifetime that there will be fewer (if any) human drivers on the road and that all non-commercial motor vehicles will be controlled by on board computers. Right now most of the major technology companies such as google, tesla, uber, and apple are all trying to stake their claim to the autonomous driving world so I see it as a foregone conclusion. Technological advancement, however, is not without its draw backs and “growing pains.” Just this past week in Tempe, Arizona an autonomous driving uber was involved in an auto accident with a human driver and it rolled over following the impact.

It’s a pretty sensational headline because naturally you might think that the autonomous uber vehicle caused the crash, but that wasn’t the case. The uber vehicle reportedly had an operator behind the wheel but was in autonomous driving mode at the time of the crash. There were no passengers in the uber and there were no reported injuries at the scene. According to police the uber was a Volvo XC90 that was hit and rolled over when another vehicle failed to properly yield at an intersection.

As a result of the crash uber has temporarily suspended the operation of all autonomous vehicles in Arizona as they gather data. Uber also temporarily suspended self driving vehicles in Pittsburgh and San Francisco for the day and are considering doing so longer.

While I do only see this as a short blip on the radar for uber and other companies with autonomous driving vehicles, it does bring to light the complexity of driving, especially when there will undoubtedly be a mix of autonomous and human driving vehicles sharing the road. Humans sharing the road with other human drivers leads to hundreds of thousands of injuries a year in the United States and humans sharing the road with autonomous drivers is already leading to motor vehicle collisions. Until we can get to the time and place where ONLY autonomous drivers are operating cars on the road, I foresee there being many more collisions (but certainly at a rate that is less than when only humans operate vehicles.) I am not sure how engineers can account for all of the complexities of operating cars in real time to prevent all collisions and injuries.

I do not think that uber has a plan to release autonomous driving vehicles in Baltimore any time soon. But when they do my staff and I are happy to take care of any uber-induced Baltimore auto accident injuries.

If you, or someone you know, has been injured in a motor vehicle collision in Baltimore, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We now have two convenient and accessible locations to better serve your injury treatment needs.

Dr. Gulitz

What is Maximum Medical Improvement?

As my avid blog readers (and I know you are out there) are already aware, I am a Baltimore Chiropractor. I own two clinics in Baltimore, located in Southeast Baltimore (Fells Point) and Northwest Baltimore (Upper Park Heights). We focus on taking care of anyone with spinal pain. That includes athletes, students, couch potatoes and really anyone else. As the clinics grow we continue to see more Baltimore auto accident patients. I like to focus each of my blog posts about an issue dealing with Baltimore auto accidents since it is a subject that I find particularly interesting and it impacts me and my providers every day.

When someone gets injured in a Baltimore auto accident, they typically present with a series of symptoms that include but are not limited to, headaches, neck pain, back pain, numbness and tingling down an arm, numbness and tingling down a leg, shoulder pain, and concussions. Just about any body part, under the right circumstances, could become injured following a Baltimore auto accident injury. Our job as treating providers at Mid-Atlantic Spinal Rehab & Chiropractic is to figure out exactly what pain and injuries were caused by the crash and then to rehab the patient until those symptoms and pain resolve.

That brings me to the subject of the blog post, Maximum Medical Improvement, or MMI. The definition of MMI is having a patient’s subjective and objective complaints return to the level of pain that they were experiencing prior to their injury. It also means that if you can not do that, that you have exhausted all methods within the scope of your practice to do so. In the cases where there are permanent injuries, patients must be discharged/released from care once it is clear that their treating providers can not continue to heal or improve the patient.

I am going to offer up a few examples below to demonstrate what MMI is.

A) A patient was a normal healthy 21 year old college student. He got rear-ended and developed neck and back pain. He did a “routine” course of chiropractic care with physical therapy and modalities and after about eight weeks all of his symptoms resolved. He resumed all of his normal activities and he was discharged as being pain free with no residual symptoms. In this case, the patient reached MMI in 8 weeks. He had no pain or issues prior to the crash and was discharged once he again reached that level of discomfort (which was becoming pain-free again).

B) A patient has chronic back pain from a football injury in college. They usually get a low level of pain in their lower back (4/10) and they experience this pain about the half the week (3-4 days are good and then 3-4 days are bad). They already have medical providers such as pain doctors or orthopedists that they follow up with to manage their chronic pain.

This patient who is different from the example above gets involved in a Baltimore auto accident as in the example above. Now the definition for MMI is different for this patient. Our goal is to get this patient back to their PRE-EXISTING condition. For him, that is mild-to-moderate lower back pain about half the week. It is NOT getting them to zero pain, given that they presented with back pain. In this instance the Baltimore auto accident aggravated or “flared up” their condition and our obligation is to get their condition back to where it was before the crash. Once the patient’s condition is back to where it was, we release them at MMI.

C) In the example above let’s look at that patient again. What if we were never able to get that patient back to where they were prior to the crash? What if they were ejected from the vehicle and now have a surgical back condition that chiropractic care and physical therapy will not help? What if despite our help they now have daily constant back pain at a 9/10 and none of our treatment can help reduce the pain any further after a reasonable course of care? That has happened before. We would still release that patient at MMI in this example because they will have a condition that therapy in this office can not realistically get back to “pre-injury” status.

So the big question is why does any of this matter?

The answer is simple. When a patient is injured their insurance companies (either their first party PIP carriers or the adverse insurance driver who struck them and is responsible for paying for the injuries) have agreed to contractually ONLY pay for injuries that are related to an accident. That means that they will pay for the treatment of these patients only until they have reached MMI. They will discontinue payment for treatment once MMI has been reached. That is why providers such as medical doctors, orthopedists, chiropractors, and physical therapists need to concern ourselves with what MMI is when a patient has reached MMI with our care.

If you, or someone you know, has been injured in a Baltimore auto accident, please contact Mid-Atlantic Spinal Rehab & Chiropractic. We now have 2 convenient locations to better serve your injury needs.

Dr. Gulitz