The Ford Philosophy of Care

Traditional Philosophies of Care
How we treat low back pain

During my 12 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 MRIs 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 patients with low back pain symptoms/ complaints and sacroiliac joint mal-alignment/ dysfunction. I have also found that by correcting the alignment (i.e. sacroiliac joint rotation or sacral torsion) of this sacroiliac joint complex, we can resolve or reduce low back complaints immediately. 

The high prevalence of sacroiliac joint dysfunction with most low back pain patients and the direct cause and effect relationship between their symptoms and mal-alignment of their sacroiliac joint complex are what led me to establish a clinic that specializes in treating patients with low back pain.

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

Traditional Philosophies of Care

Bulging disks (HNPs) offer a very popular explanation for low back pain complaints. MRIs will detect even the slightest bulging. These bulges are thought to pinch one of the spinal nerves, causing patients to complain of pain. MRIs 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. Most physical therapists, believe that only 10-15% of patients suffering from low back pain will have a component that involves the sacroiliac joint complex. MD’s, Radiologists, Orthopedists and Neurosurgeons rarely consider the sacroiliac joint complex a factor. Some surgeons believe this joint doesn’t even move. Return to top

How We Treat Low Back Pain

Muscle Energy Technique
We assess the entire sacroiliac joint complex and the lumbar facets and then we correct alignment by using a muscle energy technique (MET) or modified versions of it, to include A/P modalities. Even ¼ inch deviation with a sacral torsion will cause significant pain or symptoms. Our goal is to achieve proper alignment which resolves or significantly reduces symptoms immediately. The next step is to fixate this joint complex with a sacroiliac joint belt, which stabilizes the sacroiliac joint from the compressive forces that it creates. See "Stabilization" below.

Education
In order for this plan of care to work, it is vital that patients understand what is wrong with their back and how it relates to their specific complaints or symptoms. When a 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 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 a sacroiliac joint rotation or torsion. They also need realize that mal-aligned means return of pain. This will help the patient understand the "big picture" of this philosophy of care. Success occurs when the patient fully understands and is diligent with the strategies and techniques within this program.

Self -Treatment/ Alignment of Sacroiliac Joint
Day one, patients will learn self-alignment techniques. This will allow them the ability to decrease their pain when this joint rotates out of position. They must understand that early on, this joint will move back out of place as the sacroiliac joint has a tendency to easily return to its dysfunctional position. This is why I show them how to self-correct this at home, or anywhere, as needed. They learn to re-align this rotated joint as many times as needed to keep the joint in the correct position. Eventually, as the joint scars down, this movement in and out of place stops. The self-alignment is a quick and effective way to reduce pain from flare-ups. As time goes on, they become more proficient at self-alignment of the sacroiliac joint complex and learn that this is the best pain relieving tool that they have to control their symptoms of low back pain

Stabilization Compression Belt
Stabilization begins with a sacroiliac joint belt, which nearly every patient receives on day one. The sacroiliac joint belt is devised to create compressive forces on the sacroiliac joint without restricting its normal rotator motions involved in gait and transitional motions, such as bending, stooping, sit-to-stand and in and out of the car. 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 patients 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. The function of this cushion is to keep weight off the sacrum thus keeping pressure off the sacroiliac joint complex. Both of these devices are employed to prevent the sacroiliac joint complex from subluxing thus allowing stability so the loose ligaments can begin to heal and scar down or tighten again.

Positioning
Positioning involves ways to sit or lie down 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 keeps 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
Biomechanics can be the most difficult task to learn for some, while others catch on rather quickly, but it is truly the most important factor in maintaining sacroiliac joint stability. Mastering this philosophy will give the patient a 90-95% chance of successfully maintaining sacroiliac joint alignment. Next to sitting on your tailbone/ sacrum, poor biomechanics is equally, if not more, responsible for the 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. Once this is mastered, it will be the primary factor in preventing the return of low back pain for life.

Exercises
Often there are 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 sacroiliac joint rotation or torsion every time they perform them. It is vital that all previously taught exercises be terminated and only the exercises recommended by the FPOC should be employed. The patient will be educated in why they are detrimental and about 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 biomechanical strategies begins on day one and during each following visit, until they have mastered our philosophy of care. Return to top

"I would recommend the President to come here. The staff and therapy are very good."

John F. Hall Sr.
Patient

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