Achieve Relief / ABC PT Physical Therapy / 3502 S. 12th Street, Suite B, Tacoma, Washington / 253.564.2220

The Innovative "Ford Philosophy of Care"

The Ford Philosophy of Care

The Ford Philosophy of Care takes a unique approach to resolving patient complaints by finding and focusing attention and treatment on the source and cause of pain father than simply treating the symptoms. Although this approach was initially developed to treat patients with low back pain, we now utilize it in the treatment of all musculoskeletal pain and dysfunction. This is why ABC PT offers a consistently higher success rate.

During my 11 years working as a physical therapist, I have found that the sacroiliac joint is involved or "out of alignment" in nearly every patient that has been referred or presented to me with the complaint of low back pain. Clinical evidence has repeatedly shown that the sacroiliac joint complex, which I consider the biggest piece of the low back pain puzzle, is often not considered when working with patients who are suffering from low back pain.

I continue to find sacroiliac joint dysfunctions in nearly all of my patients with low back pain. This is not to say that this is the only source of low back pain, but in most cases it is a major source for pain and to get total resolution it needs to be addressed and included in the treatment plan for low back pain. Lumbar facet dysfunctions are also highly prevalent issues. The relationship between low back pain and sacroiliac joint dysfunction is often considered to be of little importance or significance in the medical community, Often bulging disks found with MRI’s are thought to be a more valid consideration as a source for pain, but I have consistently found a direct cause-and-effect relationship between patient’s with low back pain symptoms/ complaints and sacroiliac joint mal-alignment/ dysfunction. I have also found that by correcting the alignment (ie. sacroiliac joint rotation or sacral torsion) of this sacroiliac joint complex we can resolve or reduce low back complaints immediately. We successful do this 20-30 times a day.

These two findings (1) the high prevalence of sacroiliac joint dysfunction with most all low back pain patients and (2) the direct cause and effect relationship between their symptoms and mal-alignment of their sacroiliac joint complex are what drove me to establish a clinic that specializes in treating patients with low back pain.

Our mission is to be the "first choice and only choice for patients those who suffer from acute or chronic low back pain.” We therefore encourage you to refer patients that are not responding well with the traditional therapy approach, chiropractic, or other medical interventions to Alternative Back Care Physical Therapy. I believe we can change the way we view and treat low back pain. I believe our approach can have a dramatic impact on the high cost of low back pain to the workforce and our health care system.

What We Do Different

Once I began to document the high prevalence of sacroiliac joint dysfunction in patients with low back pain and to observe the clinical evidence demonstrating the significant role the sacroiliac joint plays in their symptomology, I began to work diligently toward the development of a unique plan of care to resolve low back pain. By employing sound biomechanical and physical therapy principles, I have developed an effective treatment protocol, and a philosophy of care that rivals and refutes many of the traditional approach that are still being practiced. In order for this plan of care to work we explain the structure and function of the sacroiliac joint complex, the importance of sacroiliac joint positioning, and the biomechanics necessary to keep their sacroiliac joint in a stable position. We also teach our patients how to self-align this complex in order to maintain proper sacroiliac joint alignment throughout the day. Our experience shows that this either resolves or minimizes symptoms after successful alignment is attained. It has taken years to develop an effective set of techniques and systematic strategies clinically proven to resolve low back pain for good. I call this The Ford Philosophy of Care for low back pain.

Traditional philosophies...

Bulging disks (HNPs) offer a very popular explanation for low back pain complaints. MRI’s will detect even the slightest bulging. These bulges are thought to pinch one of the spinal nerves, causing patients to complain of pain. MRI’s will never identify a sacroiliac joint dysfunction- radiologists simply do not consider it.

Degenerative disk disease is diagnosed when the disk looks flattened on one side or is not uniform in shape. It is believed this narrows the foraminal opening where spinal nerves exit. Here a nerve may be pinched or the disk itself may cause some pain.

Arthritis causes low back pain. This pertains to the facet joints that show signs of wear and deformity on x-ray.

Scoliosis is diagnosed when an x-ray notes a lateral curvature of the spine (S-shaped) when none of the above diagnoses pertain.

Lumbar strain is diagnosed when the physician notes Para lumbar (Back) muscle spasm and pain. Muscle relaxers are nearly always prescribed.

General terms, such as, Lumbago, low back pain, myalgia or retractable low back pain are given when no clear distinct diagnosis can be given.

Sacroiliac joint dysfunction or sprain is rarely given as a diagnosis and not considered as a relevant cause of low back pain. As a physical therapist, current thought believes that only about 10-15% of patients suffering from low back pain will have a component that involves the sacroiliac joint complex. MD’s, Radiologists, Orthopedist and Neurosurgeons rarely consider the sacroiliac joint complex a factor, either. Some surgeons believe this joint doesn’t even move.

Treatment of Low Back Pain

Muscle Energy Technique

We assess the entire sacroiliac joint complex and lumbar facets and the correct alignment by using a muscle energy technique (MET) or modified versions of it, to include A/P mobs. Our goal is to achieve proper alignment which usually resolves or significantly reduces their symptoms immediately afterwards. When used skillfully, this technique is extremely accurate and can take pain away immediately. Even ¼ inch deviation with a sacral torsion will cause significant pain or symptoms. The next step is to fixate this joint complex wit an sacroiliac joint belt, which stabilizes from the compressive forces that it can create. See "Stabilization" below.

Education

In order for this plan of care to work, it is vital that the patient know what is wrong with their back and how it relates to their specific complaints or symptoms. When an sacroiliac joint dysfunction is identified, they have to understand how the sacroiliac joint can manifest their various and changing symptomology. They receive a thorough education on the structure and function of this joint complex, an understanding of positioning and the biomechanics necessary to keep their sacroiliac joint in a stable position to allow healing to occur. They also have to learn how to self-align this complex to allow them to maintain proper sacroiliac joint alignment throughout their day. This either resolves or minimizes symptoms after successful alignment is attained. It also keeps the joint in place so it can scar down and produce the proper stability needed at this joint complex. They need to understand the biomechanics of the sacroiliac joint complex and what type of forces will compromise stability and allow a return of an sacroiliac joint rotation or torsion. They also need realize that mal-aligned means return of pain. This will help the patient understand the entire "big picture" of this POC. Success occurs when the patient is on the same page with us, as their contribution is imperative to the success rate of the "Ford Philosophy of Care".

Self -Treatment/ Alignment of sacroiliac joint

Day one, the patient will learn to re-align or correct the sacroiliac joint rotation component of the problem. This will allow them the ability to decrease their pain when this joint rotates out of position, causes a return of their pain. They must understand, that early on, this joint will move back out of place after it has successfully been aligned. The sacroiliac joint has a tendency to easily return to its dysfunctional position. This is why I show them how to correct this at home or anywhere, as needed. They need to re-align this rotated joint as many times as needed to have this joint spend more time in the correct position than in the incorrect position. Eventually, this movement in and out of place stops. It also is a quick and effective way for them to reduce the pain from flare-ups. As time goes on, they become more proficient at self-alignment of the entire sacroiliac joint complex and learn that this is the ultimate pain relieving action that they have in their arsenal to control their symptoms of low back pain

Stabilization

Stabilization begins with issuance of an sacroiliac joint belt, which nearly every patient receives, day one. Again, the sacroiliac joint belt is devised to create compressive forces on the sacroiliac joint without restricting its normal rotatory motions involved in gait and transitional motions, such as bending, stooping, sit to stand and in to out the car to name a few. It acts like a cast and should be worn as tightly as possible.

SEAT CUSHION A wedged seat cushion with a sacral cut-out is issued to those who do a lot of sitting or driving during their day or have a lot of sacroiliac joint ligament laxity allowing the sacrum to move or torsion, creating pain. The function of this cushion is to keep weight off the sacrum to keep pressure off the sacroiliac joint complex. Both of these devices are employed to avoid or prevent the sacroiliac joint complex from subluxing to allow stability where the loose ligaments can begin to heal and scar down or tighten again.

POSITIONING is the first aspect of stabilization, it involves how to sit or lie without putting undue pressures on the sacroiliac joint or the sacrum itself. A towel roll, wrapped tightly, can be used for sitting at home, in the car and at work. It should be positioned behind the low back, at the crest of the iliac or top of pelvis. The function is to keep the patient from slumping while sitting. The towel roll forces the pelvis forward, creating a lumbar curve. This, with the seat cushion keeps direct pressure off the sacrum while they are sitting.

BIOMECHANICS can be the most difficult task to learn for some and for others they catch on rather quickly, but this is truly the most important factor involved to maintain sacroiliac joint stability. Mastering this philosophy will give a patient about a 90-95% chance of successfully maintaining sacroiliac joint alignment. This is because next to just sitting on your tailbone/ sacrum, poor biomechanics is an equally if not more responsible factor for inability to hold sacroiliac joint stability. The biomechanics training in this portion of our "Ford Philosophy of Care" (FPOC) is perhaps the most important task to master and is responsible for resolving low back pain by maintaining sacroiliac joint stability. This knowledge will give the patient the ability to lift, bend, stoop, squat, and perform activities of daily living or any other transitional movement specific to their own specific demands. Once this is mastered, this is the single most powerful acquisition that will not only resolve their current symptoms/ dysfunction; it will be the primary factor in preventing the return of low back pain for life.

EXERCISES There are many exercises that trainers, Physical Therapists, Chiropractors and other health care professionals will give patients with low back pain that are absolutely detrimental to the integrity and stability of the sacroiliac joint complex. In other words, these exercises will most likely cause an sacroiliac joint rotation or torsion every time they perform them. It is vital that all exercises be terminated and only the exercises recommended by the FPOC should be employed. The patient should also be educated in why they are detrimental and the biomechanics behind the recommendations.

HOME EXERCISE PROGRAM A home exercise program (HEP) is administered Day 2 and usually only 1-2 stretches are given. # 1 piriformis muscle stretch, shown with exact isolation of the muscle and with good positional stability, such as using a towel roll under the low back while performing this exercise. All stretches are 1 minute long and progressive, with a medium stretch intensity. # 2 is the hip flexor mm group stretch, performed prone on elbows. Pictures are always given for reference at home. Practicing biomechanic strategies begins day 1 and during each visit, until they have mastered all our criteria.

SUCCESS

Success is directly related to compliance, effort and believing in the FPOC. Those that are able to successfully embrace and follow the unique strategies, knowledge and biomechanic knowledge, have resolved their low back pain and are confident it will not return. Some people have a hard time believing the simplicity of this philosophy of care and believe it is something else causing their pain that surgery or medication should be able to fix.