Can Massage help Arthritis?

According to the Archives of Internal Medicine, in 2006 a study was conducted testing the benefits of massage on osteoarthritis (aka: degenerative joint disease).  Here is what they found.

The effects were gauged on five different outcome measures:

•    Range of Motion
•    Pain
•    Function
•    Stiffness
•    Patient subjective pain level (VAS scale)

Massage was found to help in all of theses areas!  It was found to be a safe and effective means of treatment for osteoarthritis.

I believe the next study should test the effects of muscle work, or even better Active Release Techniques®, on prevention of osteoarthritis.  I would assume if it is good for treatment then it would also be an effective means for prevention.

-Thanks for reading

Dr. Sebastian Gonzales DC, CSCS, CGFI-MP3
Elite ART® Provider
USA Track & Field Level 1 Coach

P3 Sports Care
18700 Main St.  Suite 206
Huntington Beach, CA 92648

Perlman, Adam. (2006). Massage therapy for osteoarthritis of the knee . Archives of Internal Medicine, 166(22), Retrieved from http://archinte.ama-assn.org/cgi/content/abstract/166/22/2533/a

There are many different theories on the benefits of receiving chiropractic manipulations; this is what I tell my patients.

Even if you don’t believe the traditional view of the chiropractic philosophy, most people will agree they do feel much “looser” after an adjustment.  I believe motion is critical, in some joints more than others.  But it is also important to realize this normal joint motion can be accomplished by addressing the joint and the surrounding soft tissues.  By soft tissues we are talking about muscle, ligaments and tendons.

I think everyone can believe in the benefits of joint motion and how it can benefit your training in team sports as well as endurance sports, like running and triathlon.

One of the fastest ways to recover motion in the soft tissue is with Active Release Technique® (ART®) and specific strengthening exercsies.  Many athletes attempt to regain this motion by foam rolling or using other forms of self-treatment but fail to attain the same results as a skilled professional.

P3 Sports Care can provide you with the increase joint range of motion you need with our unique style of evaluation and treatment.
 

Have a great week!
–
Dr. Sebastian Gonzales DC, CSCS, CGFI-MP3
Elite ART® Provider
USA Track & Field Level 1 Coach

P3 Sports Care
18700 Main St.  Suite 206
Huntington Beach, CA 92648
www.P3SportsCare.com
"Where the Athletes send their Families"
714-392-6482

Something you might not know about Pinched Nerves. – Huntington Beach CA

How does anyone really know if a nerve is being "pinched" or not?  Fact is, many patients "feel" they have a pinched nerve yet they really don’t have any idea about what it really is.  I asked a few of my new patients this week about why they think they have a nerve being pinched. 

"Well, because it is sharp and I can’t turn my neck." 

Another replied, "because my friend told me that was what it was."

Something you might not know is the feeling you are experiencing can also be a muscle in severe spasm!  Not everything sharp means nerve pain; sometimes the treatment is as simple as releasing the scar tissue and spasm from the offending muslce.  Next you have to figure out why it started in the first place.

Not everything is as it seems

If you have some type of pain and loss of motion in a joint it is in your best interest to go see a trained professional.  It is what we do!  Take my advise and don’t waste your time trying to search Youtube for stretches and self help solutions.  If you are training for a race or are on a time table, you will need a professional.

Dr. Sebastian Gonzales DC, CSCS, CGFI-MP3
Elite ART® Provider
USA Track & Field Level 1 Coach

P3 Sports Care
18700 Main St.  Suite 206
Huntington Beach, CA 92648
www.P3SportsCare.com
"Where the Athletes send their Families"
714-392-6482

As the weather gets nicer we have seen more runners out training for their respective races.  I love running just as much as the next guy but I think I experienced more injuries during running than in cycling or playing baseball combined.  Fact is, running produces more impact than other endurance sports and more overuse injuries will result.

One injury common to runners is Achilles tendonitis/ pain, calf tightness and shin splints.  Many times runners will come in with an injury on one side and not the other, which begs the question of why not the other ankle?  Many times the answers to this question can be found by movement analysis or video gait analysis.  One focuses on the strength and movement of the respective joint of the lower body and the other at how the body moves in during the sport.

There are three main power sources in the lower limb propelling you forward when running: the gluts, quads and the calf.  All three of the these major muscles groups share the act running propulsion (not swing phase of the leg), which consists of extension of the hip, knee and plantarflexion of the ankle.  Granted there is a little bit more to it than this but this makes it easier to understand why your calf or Achilles might have started acting up over the recent weeks.

If you have all of these three areas working in unison they all share the workload.  If one area is not doing its job then the others have to work harder causing overuse.  Lately I have been finding patients with Achilles tendonitis have had a lack of function of the gluteus maximus or lack of hip range of motion.  Many times looking at the video analysis of their gait you can see abnormally dominant vertical motion, from excessive work from the quads and calf.

Although Active Release Techniques® is the best at ridding the painful tissue of scar tissue, in my opinion, but fact of the matter is the problem will have a tendency of returning if the primary gait issue is not corrected as well.

If you are experiencing Achilles tendon issues I would strongly recommend seeking the care of an Active Release provider who is well trained in analyzing gait as well.
 

–
Dr. Sebastian Gonzales DC, CSCS, CGFI-MP3
Doctor of Chiropractic
Elite ART® Provider
USA Track & Field Level 1 Coach

P3 Sports Care
18700 Main St.  Suite 206
Huntington Beach, CA 92648
info@P3SportsCare.com
"Where the Athletes send their Families"
714-392-6482

___________________________________________________________________________________________________________

P3 Sports Care, previously Orange County Pain Management, has been serving Southern California for over 5 years. Although many of our patients live right in the city of Huntington Beach, many of them will come from a great distance to receive our Active Release Techniques®, Chiropractic Care, and Rehabilitation. Our customer service is second to none; our patients always come first.  Even patient who are afraid of going to a chiropractor love our style of care.

Serving the cities of Orange, Irvine, Villa Park, Mission Viejo, Fountain Valley, Santa Ana, Newport Beach, Anaheim, Placentia, Yorba Linda, Costa Mesa, Stanton, Westminster, Buena Park, Aliso Viejo, Rancho Santa Margarita, Lake Forest, Seal Beach, Long Beach, Sunset Beach, Fullerton, Brea, Laguna Hills, Tustin, and Huntington Beach.

Check out our other articles and information on Active Release Techniques® and Injury Prevention Assessments to see if it can help you or any of your loved ones get out of pain and prevent new injuries.

P3 Sports Care in Huntington Beach has been able to successfully treat and cure lower back pain in as quickly as 4 treatment using Active Release Techniques®.

Hi,

I have been treating patients with lower back pain for about 5 years now, which is not that long when compared to other chiropractors or physical therapist you might find, but I have been able to find great success in my style of treatment.  I have seen patients with “fresh” lower back pain and ones who have been dealing with it for years. Although each condition is different, majority of them have a common factor involved… hip involvement.  Asymmetry of hip flexibility and strength is a HUGE factor in the onset of lower back pain.

I treat largely a population of runners, trialtheles and golfers, all of which push their bodies to the limits in their respective sports; hip range of motion and stability is needed in all.

Many people have overlooked this factor in lower back pain patients but think about it.  If the area above or below the lower back is not moving how it should, it will cause the lower back to move more and become unstable.  This is how the body will compensate during activities.  For years the lower back/ abdominal region has been dubbed the “Core”, which is an area of relative stability.  How can the core function as a point of stability if it has become unstable?

Getting motion back in the hips and midback region will help set the stage for proper core strengthening and prevent recurrent lower back pain.
 

Thanks for reading,

–
Dr. Sebastian Gonzales DC, CSCS, CGFI-MP3
Doctor of Chiropractic
Elite ART® Provider
USA Track & Field Level 1 Coach

P3 Sports Care
18700 Main St.  Suite 206
Huntington Beach, CA 92648
info@P3SportsCare.com
"Where the Athletes send their Families"
714-392-6482

___________________________________________________________________________________________________________

P3 Sports Care, previously Orange County Pain Management, has been serving Southern California for over 5 years. Although many of our patients live right in the city of Huntington Beach, many of them will come from a great distance to receive our Active Release Techniques®, Chiropractic Care, and Rehabilitation. Our customer service is second to none; our patients always come first.  Even patient who are afraid of going to a chiropractor love our style of care.

Serving the cities of Orange, Irvine, Villa Park, Mission Viejo, Fountain Valley, Santa Ana, Newport Beach, Anaheim, Placentia, Yorba Linda, Costa Mesa, Stanton, Westminster, Buena Park, Aliso Viejo, Rancho Santa Margarita, Lake Forest, Seal Beach, Long Beach, Sunset Beach, Fullerton, Brea, Laguna Hills, Tustin, and Huntington Beach.

Check out our other articles and information on Active Release Techniques® and Injury Prevention Assessments to see if it can help you or any of your loved ones get out of pain and prevent new injuries.

P3 Sports Care in Huntington Beach has been able to successfully treat and cure arm numbness in as quickly as 4 treatment using Active Release Techniques®.

Over the past few weeks we have had a inflow of patients with arm numbness (also called "pinched nerves"), mostly down the back of the arm and forearm.  I have treated many people in the past with the same condition but it is surprising to hear patients talk about how they have tried so many different types of treatment and nothing has worked.  It is also surprising to hear how many friends and family they could name off the top of their heads who have the same problem!

Normally these types of conditions, traditionally diagnosed as carpal tunnel syndrome, thoracic outlet syndrome and radial nerve entrapments, can be resolved within 4 treatments, give or take a few treatments.  Active Release Techniques is the main focus of our treatment in these conditions in addition to chiropractic care and rehabilitation exercises if needed.

As stated, most of these people tried many treatments prior to coming in to P3 Sports Care in Huntington Beach.  When they come in and hear a rational solution to the problem they are so excited and some have even cried.  A few of these patients have been seeking answers for years!

Basically what it comes down to is what is the main cause of the arm numbness?  Where is the nerve being entrapped?  Which of the major nerves of the brachial plexus are the culprits?  Are there spots of multiple nerve entrapments?  All of these questions can be answered with a proper exam and can be corrected permanently with correct treatment.

If you have been dealing with arm pain/ numbness I would strongly suggest seeking the care of an Active Release Provider if you have been experiencing arm numbness or pain.  Normally if there are no positive effects to treatment of your condition with a short time spand you will be referred out for the proper medical care.

Thanks for reading,

–
Dr. Sebastian Gonzales DC, CSCS, CGFI-MP3
Doctor of Chiropractic
Elite ART® Provider
USA Track & Field Level 1 Coach

P3 Sports Care
18700 Main St.  Suite 206
Huntington Beach, CA 92648
info@P3SportsCare.com
"Where the Athletes send their Families"
714-392-6482

___________________________________________________________________________________________________________

P3 Sports Care, previously Orange County Pain Management, has been serving Southern California for over 5 years. Although many of our patients live right in the city of Huntington Beach, many of them will come from a great distance to receive our Active Release Techniques®, Chiropractic Care, and Rehabilitation. Our customer service is second to none; our patients always come first.  Even patient who are afraid of going to a chiropractor love our style of care.

Serving the cities of Orange, Irvine, Villa Park, Mission Viejo, Fountain Valley, Santa Ana, Newport Beach, Anaheim, Placentia, Yorba Linda, Costa Mesa, Stanton, Westminster, Buena Park, Aliso Viejo, Rancho Santa Margarita, Lake Forest, Seal Beach, Long Beach, Sunset Beach, Fullerton, Brea, Laguna Hills, Tustin, and Huntington Beach.

Check out our other articles and information on Active Release Techniques® and Injury Prevention Assessments to see if it can help you or any of your loved ones get out of pain and prevent new injuries.

Working the capsule with ART® (Active Release Technique) is great but if this will help I am all for it.

Hope you enjoy.

Phys Ther. 2006 Mar;86(3):355-68.

Comparison of high-grade and low-grade mobilization techniques in the management of adhesive capsulitis of the shoulder: randomized controlled trial.

Vermeulen HM, Rozing PM, Obermann WR, le Cessie S, Vliet Vlieland TP.

Department of Physical Therapy, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands. h.m.vermeulen@lumc.nl

PMID: 16506872 [PubMed - indexed for MEDLINE]

Access to this research on Pub Med can be accessed my clicking HERE

___________________________________________________________________________________________________________

P3 Sports Care, previously Orange County Pain Management, has been serving Southern California for over 5 years. Although many of our patients live right in the city of Huntington Beach, many of them will come from a great distance to receive our Active Release Techniques®, Chiropractic Care, and Rehabilitation. Our customer service is second to none; our patients always come first.  Even patient who are afraid of going to a chiropractor love our style of care.

Serving the cities of Orange, Irvine, Villa Park, Mission Viejo, Fountain Valley, Santa Ana, Newport Beach, Anaheim, Placentia, Yorba Linda, Costa Mesa, Stanton, Westminster, Buena Park, Aliso Viejo, Rancho Santa Margarita, Lake Forest, Seal Beach, Long Beach, Sunset Beach, Fullerton, Brea, Laguna Hills, Tustin, and Huntington Beach.

Check out our other articles and information on Active Release Techniques® and Injury Prevention Assessments to see if it can help you or any of your loved ones get out of pain and prevent new injuries.

Acute and overuse injuries correlated to hours of training in master running athletes.

Knobloch K, Yoon U, Vogt PM.

Hannover Medical School, Plastic, Hand and Reconstructive Surgery, Carl-Neuberg-Str. I, Hannover 30625, Germany. kknobi@yahoo.com

PMID: 18785416 [PubMed - indexed for MEDLINE]

More information can be found on Pubmed

___________________________________________________________________________________________________________

P3 Sports Care, previously Orange County Pain Management, has been serving Southern California for over 5 years. Although many of our patients live right in the city of Huntington Beach, many of them will come from a great distance to receive our Active Release Techniques®, Chiropractic Care, and Rehabilitation. Our customer service is second to none; our patients always come first.  Even patient who are afraid of going to a chiropractor love our style of care.

Serving the cities of Orange, Irvine, Villa Park, Mission Viejo, Fountain Valley, Santa Ana, Newport Beach, Anaheim, Placentia, Yorba Linda, Costa Mesa, Stanton, Westminster, Buena Park, Aliso Viejo, Rancho Santa Margarita, Lake Forest, Seal Beach, Long Beach, Sunset Beach, Fullerton, Brea, Laguna Hills, Tustin, and Huntington Beach.

Check out our other articles and information on Active Release Techniques® and Injury Prevention Assessments to see if it can help you or any of your loved ones get out of pain and prevent new injuries.

I think the main point I came away with was many Primary Care Doctors are not opposed to patients seeing chiropractors but they are not willing to tell a patient about a chiropractor they would specifically like them to see, as they would with a physical therapy center.

Take a look…. it is an interesting read and much of the discussion and reasoning is at the bottom.

If you would like to access more on the research please click HERE and contact Bio Med Central

Referral patterns and attitudes of Primary Care Physicians towards chiropractors

Abstract

Background

Despite the increasing usage and popularity of chiropractic care, there has been limited research conducted to examine the professional relationships between conventional trained primary care physicians (PCPs) and chiropractors (DCs). The objectives of our study were to contrast the intra-professional referral patterns among PCPs with referral patterns to DCs, and to identify predictors of PCP referral to DCs.

Methods

We mailed a survey instrument to all practicing PCPs in the state of Iowa. Descriptive statistics were used to summarize their responses. Multivariable logistic regression analyses were conducted to identify demographic factors associated with inter-professional referral behaviors.

Results

A total of 517 PCPs (33%) participated in the study. PCPs enjoyed strong intra-professional referral relationships with other PCPs. Although patients exhibited a great deal of interest in chiropractic care, PCPs were unlikely themselves to make formal referral relationships with DCs. PCPs in a private practice arrangement were more likely to exhibit positive referral attitudes towards DCs (p = 0.01).

Conclusion

PCPs enjoy very good professional relationships with other PCPs. However, the lack of direct formalized referral relationships between PCPs and chiropractors has implications for efficiency, continuity, quality, and patient safety in the health care delivery system. Future research must focus on identifying facilitators and barriers for developing positive relationships between PCPs and chiropractors.

Background

An increasing number of Americans are receiving health care from alternative care providers [1-3]. A study conducted by Eisenberg et al [1] demonstrated that more Americans are consulting alternate care providers than conventional allopathic trained physicians, and that 425 million visits were made to providers of unconventional therapy in 1990. This number far exceeded the estimated 388 million visits made to conventional primary-care physicians. A follow-up survey revealed that the number of visits to alternate practitioners increased from 425 million in 1990 to 629 million in 1997 [2]. Approximately 42% of Americans consulted at least 1 of 16 alternate care provider types. Chiropractic care was found to be one of the most frequently sought after alternative care, and evinced a high level of patient satisfaction and continuous utilization [4-6]. Despite evidence of increasing usage and popularity of chiropractic care in the United States, there is a dearth of research examining the professional relationships between chiropractors and conventional primary-care physicians (PCPs), namely medical doctors and osteopaths. To our knowledge very few studies have examined the professional relationships between physicians and alternate care providers [7,8]. The purpose of this study is to examine PCP referral patterns, intra-professional relationships among PCPs, inter-professional relationships between PCPs and chiropractors from the perspective of the PCP, and characteristics of PCPs that best predict referral behaviors towards chiropractors. Other study objectives were to examine the intra- and inter-professional relationships from the perspective of chiropractors; these reciprocal objectives, along with performance in focus groups on these topics will be published elsewhere.

Methods

Drawing from information obtained during initial pilot groups of PCPs and chiropractors, we developed a survey instrument to measure patterns of referrals/consults and bidirectional communication between chiropractors and PCPs in Iowa. Specifically, we examined two dimensions of cross-disciplinary activities between the two practitioner types: sharing of patients (referrals), and sharing of patient information (clinical records). We examined both formal referrals and consults, as well as informal processes such as lay referrals and curbside consultations. We considered lay referrals as those in which patients were advised to contact the other practitioner on their own. Curbside consultation was explicitly defined within the survey instrument as "an informal process whereby a provider (typically an MD) obtains information or advice from another provider (typically an MD) to assist in the management of a particular patient, but the consultant neither reviews the patient’s records nor examines the patient and does not document his/her recommendations" [9-13].

The survey instrument was pilot-tested on a convenience sample of PCP clinical faculty at University of Iowa – Carver College of Medicine, and their feedback was used to refine the instrument. The final survey instrument is appended as Appendix 1. The study was approved by The University of Iowa IRB.

We obtained the roster of MD and DO physicians from the database of the University of Iowa Office of Statewide Clinical Education Programs (OSCEP). OSCEP is an administrative unit within the College of Medicine. The OSCEP tracks all Iowa-licensed physicians, physician assistants, nurse practitioners, pharmacists, and dentists. The survey instrument was ground-mailed to all 1,561 MD’s and DO’s in the OSCEP list, with two follow-up mailed reminders to non-respondents.

We used chi-square tests and t-tests where appropriate to compare participants to non-participants. Simple descriptive statistics compare the responses of the 2 subgroups of PCPs: MD’s and DO’s. Chi-square tests were used to compare the referral patterns of PCPs to other PCPs and to Chiropractors.

Multivariable logistic regression models were used to identify variables that are most predictive of PCP relationships with chiropractors (DC). Separate logistic regression models were built to model each of six dichotomous outcome variables: 1) recommend patient see DC, 2) recommend patient contact DC, 3) make formal referral to DC, 4) receive referral from DC, 5) advise DC, and 6) receive advice from DC. The predictor variables used were sex (female is reference), MD degree (DO degree is reference), age, time since graduation, private practice (other practice set ups is reference, see table 1), internal medicine residency (family practice is reference), and metropolitan county (non-metropolitan is reference). The Hosmer and Lemeshow goodness-of-fit test was used to examine the adequacy of the multivariable models. A two-tailed p-value of less than 0.05 was deemed to be statistically significant for all the analyses. SAS version 9.1 (Cary, NC) and SPSS version 13.0 (Chicago, IL) were used for statistical analyses.

Results

Five hundred seventeen physicians responded to the survey. This is 33% of the entire universe of 1,561 primary care physicians in the state of Iowa. These rates are comparable to that obtained in similar surveys of physicians and other health professionals [14,15]. After excluding ineligible surveys (i.e. respondents no longer in active practice), 513 PCPs were included in the analysis. The study group then consisted of 404 medical doctors and 109 osteopaths.

A profile comparison revealed only small differences between study participants and non-participants (Table 1). Respondents were less likely to be osteopaths, less likely to have specialized in internal medicine, and more likely to have completed a family practice residency.

PCP intra-professional relationships

Table 2 summarizes the responses of medical doctors (MDs) and osteopaths (DOs) to questions that assessed their referral patterns to/from other PCPs. The results indicate that both DO’s and MD’s preferred to initiate formal referral to other PCPs (> 98%) rather than have the patient make the initial contact with the doctor. Over 70% of referring physicians sent a case report or clinical records "usually" or "always." Less than 10% of physicians "never" included a report with the referral. All physicians included an explanation for the referral at least "some of the time", and over 96% did so "routinely".

Seventy nine percent of DO’s and 82% of MD’s reported that they "always accepted" referrals from other PCPs (or peers), and only 4% of DO’s and 3% of MD’s "never" sent follow-up clinical information to referring physicians. PCPs did not accept referrals from physicians when they felt that caring for the referred patient was beyond their scope of expertise or were not covered by insurance.

Curbside consultation was common practice among both DO’s and MD’s. Physicians were about equally likely to receive or give a consultation. The referral patterns of both DO’s and MD’s were very similar.

Inter-professional relationships

The results of the responses of PCPs to questions assessing their referral patterns to/from chiropractors are summarized in Table 3. Eighty-one percent of DO’s and 87% of MD’s reported that their patients had asked them for information about chiropractic, and close to 75% of PCPs have patients who have requested a referral to a chiropractor. Approximately 65% of DO’s and MD’s had recommended that their patients consult a chiropractor. However, only 24% of DO’s and 29% of MD’s had themselves formally referred a patient to a chiropractor. The common reasons for referring a patient to a chiropractor were back or neck pains, unresponsive chronic pain, fibromyalgias, and musculoskeletal conditions. A vast majority of both DO’s and MD’s preferred that their patients contact chiropractors on their own rather than the physicians initiating a formal referral themselves.

While 82.5% of DO’s accepted referral from a chiropractor only 55.4% of MD’s accepted a referral from a chiropractor. The common reasons for not accepting a referral from chiropractors were the absence of a formal referral and health problems outside the PCP’s area of expertise. Eighteen percent of DO’s and 19% of MD’s indicated that chiropractors did not send them any clinical information about the referred patient.

Thirty-five percent of DOs mentioned that a chiropractor obtained curbside advice from them. Only 18% of MD’s mentioned that a chiropractor obtained curbside advice.

Univariate analysis

The combined responses of DO’s and MD’s to questions assessing their referral behaviors to other PCPs and chiropractors are summarized in Table 4. Approximately 99% of the PCPs responded that they would initiate a patient referral to other PCPs, whereas only 12% said that they would initiate a referral to a chiropractor (p < 0.001). Close to 95% sent a case report when referring a patient to another PCP, but only 73% sent a case report when referring a patient to a chiropractor (p < 0.001). PCPs were also more likely to send X-rays or X-ray report and other clinical records to another PCP than to a chiropractor (p < 0.001).

Eighty-one percent of PCPs had accepted a referral from another PCP but only 61% of PCPs had accepted a referral from a chiropractor (p < 0.001). PCPs were also not consistent in sending follow-up clinical information to referring chiropractors. Only 77% of PCPs who had accepted a referral from a chiropractor sent follow-up clinical information about the patient to the chiropractor, whereas 97% of PCPs who had accepted referral from another PCP sent follow-up clinical information to the referring physician (p < 0.001). Close to 95% of PCPs mentioned that other PCPs had obtained curbside clinical information or advice from them, whereas only 22% of PCPs mentioned that chiropractors had obtained curbside clinical advice from them (p < 0.001). PCPs were also more likely to obtain curbside clinical advice from other PCPs when compared to obtaining advice from chiropractors. Approximately 97% of PCPs mentioned that they had obtained curbside clinical advice from other PCPs, whereas only 8% of PCPs had obtained curbside clinical advice from chiropractors (p < 0.001).

Multivariable analysis

Results from the Multivariable logistic regression analyses, including odds ratios and 95% confidence intervals for each predictor variable, are summarized in Table 5. All 6 models had a good fit. The first model shows that the odds that PCPs in private practice would recommend that their patients see a chiropractor were twice that of PCPs in other practice arrangements, after adjusting for other model predictors (p = 0.012). The next 2 models revealed no strong predictors of referral or type of referral to chiropractors. The 4^th model identified several predictors of accepting referrals from chiropractors: The odds of accepting referrals were 67% higher for men than women (p = 0.032), 3.7 times higher for DOs than MDs (p < 0.001), and 83% higher for PCPs in private practice than for those in other practice arrangements (p = 0.031). In Model 5, we found that the odds that an MD was approached by a chiropractor for curbside advice was only 47% of the odds that a DO would be approached (p = 0.004).

Discussion

In our study, clearly a majority of PCPs were willing to recommend that patients consult a chiropractor, yet they were reluctant to actually make a formal referral themselves. Only 30% of PCPs in our study and 50% in previous studies [16-18] have ever made a formal referral to a chiropractor. An important finding from our study is that when PCPs recommend chiropractic care, close to 88% preferred that patients contact a chiropractor on their own. There are several possible explanations for their unwillingness to "formalize" their relationships with chiropractors. PCPs fear malpractice litigations [19]. A perception that alternative care providers could be a threat to their practices could also have been an influence. Some of the PCPs in our study mentioned that they do not know enough about chiropractic to have an opinion, or do not view chiropractic as a legitimate health profession.

The lack of direct formalized referral relationships between PCPs and chiropractors has implications for efficiency, quality, and patient safety in the health care delivery system. It has been documented that allowing patients to contact other physicians on their own is likely to break continuity of care [20,21]. Patients are caught directly in the middle of this uncertainty between provider types. More research needs to be directed at better understanding of those issues surrounding the coordination and the loss of care which results from the poor professional relationships between these two provider types. This should include an examination of educational interventions to improve the documentation and sharing of clinical information and thereby enhance cross-disciplinary standards of care. Coulter et al in their study examined the inter-referral patterns between primary care physicians and alternate medicine providers and described a network system that can potentially provide an administrative structure to facilitate changes in physician attitudes in terms of referrals for their patients [7].

It is evident that the patients demonstrated a strong interest in chiropractic care. This finding is consistent with other studies [22,23]. Patient interest in alternate care is a great driving force for the PCP to refer or recommend them to chiropractors [22,23]. Several studies have revealed that general practitioners refer to alternate care providers for back pain, musculoskeletal conditions, and neck problems [21,23]. This is consistent with our finding that the most frequent reason for referral to a chiropractor was chronic musculoskeletal pain that does not respond to conventional treatments.

We found that PCPs in private practice are more likely to show positive referral attitudes towards chiropractors. It is likely that physicians in a private practice are not subject to the peer review or pressure in large institutional settings. Several authors have shown that physicians in solo practice are more open to unorthodox methods of treatment [23,24]. Also, Easthope et al [25] demonstrated that general practitioners in smaller practices view complementary therapies more favorably than those in larger practices.

A few studies have shown that age and sex influence physicians’ perceptions of usefulness of alternate care therapies [26,27]. Sikand and Laken [26] have shown that younger physicians are more likely to exhibit positive attitudes towards complementary and alternative medicine. Glodsmitz et al[27] demonstrated that female general practitioners are more likely than their male counterparts to view complementary health care practices as useful. In contrast to these studies, sex and age were not significant predictors in our models, after adjusting for other model predictors. However, male physicians were more likely to have accepted referrals from chiropractors.

Our study adds precision to understanding the referral patterns of PCPs. A vast majority of PCPs seem to enjoy very good intra-professional relationships. However, it is clear that there is a major communication problem in inter-professional relationships with chiropractors. While chiropractic care has become popular with patients, PCPs in Iowa do not generally have a positive impression about chiropractic care and it is the case that MDs are very reluctant to make/receive referrals.

An issue to be considered is that our study assessed the views of primary care physicians in a predominantly rural state. It is quite possible that chiropractors play in different role in the primary care system of rural areas. Attitudes towards alternative care may differ between rural and urban physicians and between regions of the country. Hence, caution should be exercised in generalizing the study findings.

Finally, only 33% of the entire population of Iowa PCP physicians solicited to participate in this study responded to our survey and this raises questions about generalizability of our findings to all Iowa PCPs. While the information presented in Table 1 shows only minor differences between respondents and non-responders, there could still be some non-response bias attributable to unmeasured covariates. Previous studies requiring physician participation have encountered similar problems [28,29]. However, we should note that when compared to the general population, physicians constitute a relatively homogenous group. If our sample is representative, then the external validity of a study can still be achieved with relatively smaller sample sizes [29,30].

Conclusion

PCPs enjoy very good professional relationships with other PCPs. However, the lack of direct formalized referral relationships between PCPs and chiropractors has implications for efficiency, continuity, quality, and patient safety in the health care delivery system. Further research must focus on identifying facilitators and barriers of developing positive relationships between PCPs and chiropractors.

Competing interests

The author(s) declare that they have no competing interests.

Funding

This research was made possible by funding by NIH-NCCAM – Project #AT-01-001 – Analysis of DC MDPCP Interprofessional Relationships. This investigation was conducted in a facility constructed with support from Research Facilities Improvement Grant Number C06 RR15433 from the National Center for Research Resources, National Institute of Health.

P3 Sports Care was at the OC Marathon expo on Friday and Saturday, for the second straight year, giving short treatments of Active Release Technique (ART) to runners of all ages and skill levels.  After just one short session, most runners felt a significant difference in their body and injury.

In fact many of the runners who are treated in the days leading to the race have a personal record (PR) on race day.

Active Release Technique is considered as the "Gold Standard of Soft Tissue Care" and is the Official soft tissue treatment of IRONMAN®. 

If you didn’t get to give it a treat contact P3 Sports Care at Info@P3SportsCare.com

P3 Sports Care has an 80 – 90 % success rate with the following conditions:

___________________________________________________________________________________________________________

P3 Sports Care, previously Orange County Pain Management, has been serving Southern California for over 5 years. Although many of our patients live right in the city of Huntington Beach, many of them will come from a great distance to receive our Active Release Techniques®, Chiropractic Care, and Rehabilitation. Our customer service is second to none; our patients always come first.  Even patient who are afraid of going to a chiropractor love our style of care.

Serving the cities of Orange, Irvine, Villa Park, Mission Viejo, Fountain Valley, Santa Ana, Newport Beach, Anaheim, Placentia, Yorba Linda, Costa Mesa, Stanton, Westminster, Buena Park, Aliso Viejo, Rancho Santa Margarita, Lake Forest, Seal Beach, Long Beach, Sunset Beach, Fullerton, Brea, Laguna Hills, Tustin, and Huntington Beach.

Check out our other articles and information on Active Release Techniques® and Injury Prevention Assessments to see if it can help you or any of your loved ones get out of pain and prevent new injuries.

–