22 I Spring 2018 www.anjc.info TECHNIQUE Council Low back pain treatment guidelines don’t usually make headlines, but the 2017 release of new recommendations by the American College of Physicians (ACP) was big in mainstream media, with implications reverberating throughout healthcare. It’s historic news when the ACP, the world’s largest medical-specialty society, advises against drugs for “non-radicular low back pain” because research shows it’s better to handle back pain naturally. It’s a seismic change in back pain management. One example: A local hospital I visited the following week had multiple table signs in the physicians’ lounge of a Medscape article describing the new guidelines that said: “For chronic low back pain, consider non-drug therapy, such as exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyog- raphy biofeedback, low-level laser therapy, operant therapy, cognitive- behavioral therapy, or spinal manipula- tion (low-quality evidence).”(1) For DCs, the ACP’s advice to its 148,000 members opens the wider door for collaborations with evidence- aligned MDs and DOs because they’re being told to avoid prescribing drugs for low back pain patients, and instead to recommend alternatives including spinal manipulation and motor control exercise (aka MCE). This is a huge opportunity for the profession… and especially for those chiropractors who also incorporate individualized MCE rehab protocols into their care plans. All motor control exercise is not the same MCEs are not just any exercise, or traditional rehab, and they’re way more than just muscle isolation or just “using good form.” MCEs are about systematic and precise isolation of motor control, with stabilization, with accuracy, tailored to the individual’s body and functional ability. The new guidelines focus on MCEs put the motion issues often at the root of back pain (and other NMS symptoms) in a whole new light. Our bodies move dynamically, and the muscular and neurologic patterns we use to stabilize begin with the patterns of our static posture. Posture has been an unrecognized general health issue that’s suddenly getting attention. Focusing on the subtleties of postural motor control is a relatively new arena, and aligns with the new evidence showing how retraining subtle motor control is significantly better than stretching (2) as well as other exercise. (3) Designing the posture practice… and profession New injuries and old habits result in functional postural compensation as the body shifts to maintain global balance - standing, sitting and moving. Over time, structural changes occur: muscle atrophy, nerve inhibition and other more permanent adaptations. Chiropractors restore joint motion and neurologic function. DCs should also integrate postural MCE therapy to retrain motion patterns. The StrongPosture® motor control exercise protocols use MUST vs TRY cueing to target specific weak links in short duration sessions. Each exercise has appropriate clinical rationales for integration into a care plan and to fulfill coding requirements for third party reimbursement. Plus, Strong- Posture® rehab and therapy sessions are designed to be combined with basic bio-mechanic education to guide patients towards intelligent postural life habits. DC’s observe and address subtleties of spine and joint function with palpation and adjustments. If we also observe, communicate and then rehab subtle motions, we can earn new respect as the posture specialists. Steven Weiniger, DC, is creator of the StrongPosture® motor control exercise protocols. He wrote Stand Taller Live Longer – An Anti-Aging Strategy and has trained thousands of professionals to first rehab and then keep people moving well. As managing partner of BodyZone.com Dr. Weiniger developed PostureZone® , the free assessment app promoting posture awareness and health. He also spearheads PostureMonth.org, the global public health project educating people about the impact of posture on health. 1  Qaseem, Amir, Timothy J Wilt, Robert M McLean, Mary Ann Forciea, and Clinical Guidelines Committee of the American College of Physicians. “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice GuidelineFrom the American College of Physicians.” Annals of internal medicine (2017)doi:10.7326/M16-2367 2 http://www.medscape.com/viewarticle/875737_ 3  Effects of Motor Control Exercise Vs Muscle Stretching Exercise on Reducing Compensatory Lumbopelvic Motions and Low Back Pain: A Randomized Trial.” Park, Kyue-Nam, Oh-Yun Kwon, Chung-Hwi Yi, Heon-Seock Cynn, Jong-Hyuck Weon, Tae-Ho Kim, and Houng-Sik Choi. Journal of manipulative and physiological therapeutics 39, no. 8 (2016): doi:10.1016/j.jmpt.2016.07.006 4  Biswas, Aviroop, Paul I Oh, Guy E Faulkner, Ravi R Bajaj, Michael A Silver, Marc S Mitchell, and David A Alter. “Sedentary Time and Its Association with Risk for Disease Incidence, Mortality, and Hospitalization in Adults: A Systematic Review and Meta-analysis.” Annals of internal medicine 162, no. 2 (2015): doi:10.7326/M14-1651. SMT, Massage and Motor Control Exercise are IN – Opioids, NSAIDS and Tylenol are OUT By Dr. Steven Weiniger Pro-Chiropractic Changes in Low Back Pain Care Guidelines