CCGI Best Practice Collaborators
CCGI Best Practice Collaborators
CCGI Best Practice Collaborators
In April 2016, CCGI Opinion Leaders were joined by a new team of CCGI Best Practice Collaborators. These are influential evidence-informed clinicians recently nominated by their colleagues in a nationwide survey. They are assisting Opinion Leaders in their area with reaching out to other chiropractors and teaching them about critical thinking, proper interpretation of evidence-informed clinical practice guidelines, and evidence-informed practice in general.
CCGI is delighted to have them on board and looks forward to collaborating with them to take the best practices forward in Canada.
Roles and Activities of CCGI Best Practice Collaborators
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understanding how clinical practice guidelines are developed;
-
discussing best practices and guidelines with colleagues;
-
having a presence on social media to raise awareness of resources on evidence-informed practice;
-
encouraging clinicians and patients to use the CCGI website and resources;
-
making presentations on evidence-informed practice at continuing education events and conferences in collaboration with their local opinion leaders team.
In April 2016, CCGI Opinion Leaders were joined by a new team of CCGI Best Practice Collaborators. These are influential evidence-informed clinicians recently nominated by their colleagues in a nationwide survey. They are assisting Opinion Leaders in their area with reaching out to other chiropractors and teaching them about critical thinking, proper interpretation of evidence-informed clinical practice guidelines, and evidence-informed practice in general.
CCGI is delighted to have them on board and looks forward to collaborating with them to take the best practices forward in Canada.
Roles and Activities of CCGI Best Practice Collaborators
-
understanding how clinical practice guidelines are developed;
-
discussing best practices and guidelines with colleagues;
-
having a presence on social media to raise awareness of resources on evidence-informed practice;
-
encouraging clinicians and patients to use the CCGI website and resources;
-
making presentations on evidence-informed practice at continuing education events and conferences in collaboration with their local opinion leaders team.
In April 2016, CCGI Opinion Leaders were joined by a new team of CCGI Best Practice Collaborators. These are influential evidence-informed clinicians recently nominated by their colleagues in a nationwide survey. They are assisting Opinion Leaders in their area with reaching out to other chiropractors and teaching them about critical thinking, proper interpretation of evidence-informed clinical practice guidelines, and evidence-informed practice in general.
CCGI is delighted to have them on board and looks forward to collaborating with them to take the best practices forward in Canada.
Roles and Activities of CCGI Best Practice Collaborators
-
understanding how clinical practice guidelines are developed;
-
discussing best practices and guidelines with colleagues;
-
having a presence on social media to raise awareness of resources on evidence-informed practice;
-
encouraging clinicians and patients to use the CCGI website and resources;
-
making presentations on evidence-informed practice at continuing education events and conferences in collaboration with their local opinion leaders team.
Are you interested in getting involved with CCGI?
We are always looking to get people involved in our projects. No experience necessary - we provide training!
Contact us today!
Are you interested in getting involved with CCGI?
We are always looking to get people involved in our projects. No experience necessary - we provide training!
Contact us today!
Low Back Pain Care Pathway
Date of last update: November, 2024
9. Treatment Considerations for LBP Amenable to Conservative Care
Applicable to common LBP, LBP with radicular pain/radiculopathy from disc pathology, deep gluteal pain.
Report of Findings (ROF) and Informed Consent
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During the ROF, clearly explain the diagnosis, prognosis, and treatment plan using accessible language.
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Refer to the detailed informed consent process in [Section 2] to ensure comprehensive patient understanding and agreement.
Additional Considerations regarding Interventions Supported by Guidelines
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Additional consideration to the patient’s health history/health status/comorbid conditions may be needed on a case-by-case basis.
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Treatments should integrate clinician experience, patient preferences, and individual needs.
Manual Therapy Considerations
Contraindications to spinal manipulation therapy include:
Absolute Contraindications
Relative Contraindications
Region-specific Contraindications
- Acute fracture
- Spinal cord tumor
- Acute infection (osteomyelitis, septic discitis, tuberculosis of the spine)
- Meningeal tumor
- Hematomas (spinal cord or intracanalicular)
- Malignancy of the spine
- Frank disc herniation with progressive neurological deficit
- Dislocation of a vertebra
- Aggressive benign tumors (aneurismal bone cyst, giant cell tumor, osteoblastoma, osteoid osteoma)
- Internal fixation/stabilization devices
- Neoplastic disease of muscle or soft tissue
- Positive Kernig’s or L’hermitte’s signs
- Congenital generalized hypermobility
- Signs or patterns of instability
- Syringomyelia
- Hydrocephalus of unknown etiology
- Diastematomyelia
- Cauda equina syndrome
- Articular hypermobility and uncertain joint stability
- Postsurgical joints or segments with no evidence of instability
- Acute injuries of joints and soft tissues
- Traumatic events requiring careful examination for excessive motion
- Bone weakened by metabolic disorders
- Demineralization of bone (osteoporosis, long-term steroid therapy)
- Benign bone tumors with risk of pathological fractures
- Tumor-like and dysplastic bone lesions
- Malignancies, including malignant bone tumors
- Infection of bone and joint
- Severe or painful disc pathology (discitis, disc herniations)
- Circulatory and hematological disorders
- Neurological disorders
- Aneurysm involving a major blood vessel
- Bleeding disorders (anticoagulant therapy, blood dyscrasias)
Interventions Not Consistently Supported by Guidelines:
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Needling therapies, topical cayenne pepper, electrotherapies (e.g., TENS, IFC), and traction, have limited or mixed evidence for benefit or harm.
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These interventions may be considered as adjuncts through shared decision-making with patients.
Case Examples for Applying Interventions
Example 1: Common Chronic LBP (Mechanical or Non-Specific LBP)
Patient Presentation: A patient presents with chronic LBP persisting for more than 12 weeks, localized below the costal margin and above the inferior gluteal folds, with occasional referred pain to the legs. The pain is sharp and dull, aggravated by prolonged sitting and standing.
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Education and Reassurance:
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Frequency: Initial visit and reinforced in follow-up visits.
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Protocol: Provide a clear explanation of the condition, expected course with treatment (may be 6-12 weeks), and encourage the patient to stay active. Use visual aids or pamphlets for better understanding.
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Maintain Activities of Daily Living:
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Frequency: Daily.
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Protocol: Encourage the patient to continue with normal activities as much as possible, avoiding prolonged bed rest. Provide specific instructions on safe movements and ergonomics.
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Self-Care Practices:
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Frequency: Daily.
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Protocol: Recommend a home exercise program focused on stretching and strengthening exercises tailored to the patient's abilities and pain levels. Advise on proper nutrition, adequate sleep, and stress management techniques.
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Address Yellow Flags (Psychosocial Factors):
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Frequency: Regularly, integrated into each visit.
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Protocol: Identify and address psychosocial factors such as fear of movement, depression, or anxiety. Use cognitive-behavioral strategies to modify negative beliefs about pain.
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Manual Therapy:
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Frequency: 2-3 times per week for 6-8 weeks.
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Protocol: Spinal manipulation/mobilization and soft tissue techniques to relieve pain and improve mobility. Adjust techniques based on the patient's response.
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Exercise Therapy:
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Frequency: 2-3 times per week for 6-8 weeks.
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Protocol: Include a combination of aerobic exercises (e.g., walking), and strengthening exercises. Sessions are supervised initially and then transitioned to a home-based program.
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Electromodalities (e.g., TENS, IFC, low-level laser):
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Frequency: 2-3 times per week.
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Dose: Utilize Transcutaneous Electrical Nerve Stimulation (TENS), Interferential Current Therapy (IFC), or low-level laser therapy to provide temporary pain relief and comfort. Use in conjunction with other interventions.
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Medications:
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Frequency: As needed.
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Protocol: Over-the-counter NSAIDs or acetaminophen for pain relief, used judiciously and in combination with other treatments. Consider muscle relaxants if indicated.
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Psychological Support:
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Frequency: Weekly or as needed.
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Protocol: Cognitive-behavioral therapy (CBT), mindfulness-based stress reduction, and other techniques to manage chronic pain and improve mental health.
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Follow-Up:
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Regular follow-up at each visit, and every 2-4 weeks to reassess pain levels, functional status, goal achievement and adjust the treatment plan as necessary.
Example 2: LBP with Radiculopathy (Disc Protrusion/Herniation)
Patient Presentation: A patient presents with LBP radiating down the leg, often to the foot, following a specific dermatomal pattern. The pain is sharp and shooting, exacerbated by sitting and bending forward.
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Education and Reassurance:
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Frequency: Initial visit and reinforced in follow-up visits.
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Protocol: Explain the nature of radiculopathy, expected course (may be 4-12 weeks), and encourage active participation in the treatment plan. Use visual aids (e.g., diagrams, models, digital resources) to illustrate the condition.
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Maintain Activities of Daily Living:
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Frequency: Daily.
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Protocol: Encourage modified activities to avoid exacerbating the symptoms while staying active. Provide guidance on ergonomics and safe movement strategies.
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Self-Care Practices:
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Frequency: Daily.
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Protocol: Tailored home exercise program focusing on nerve mobilization exercises, gentle stretching, and strengthening. Include lifestyle advice on proper posture, nutrition, and sleep.
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Address Yellow Flags (Psychosocial Factors):
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Frequency: At each visit.
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Protocol: Identify and address factors such as fear of movement, poor recovery expectations, depression, anxiety, work-related or family issues, litigation or compensation claims, and maladaptive coping mechanisms. Provide appropriate reassurance, counseling, or referrals to mental health professionals as needed.
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Manual Therapy:
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Frequency: 2-3 times per week for 4-6 weeks.
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Protocol: Spinal mobilization techniques to alleviate pain and improve function. Techniques should be adjusted based on patient response and pain levels.
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Exercise Therapy:
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Frequency: 2-3 times per week for 4-6 weeks.
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Protocol: Include specific exercises to relieve nerve tension (e.g., directional exercises), core stabilization, and aerobic conditioning. Begin with supervised sessions and transition to the home program.
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Electromodalities (e.g., TENS, IFC, low-level laser):
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Frequency: 2-3 times per week.
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Protocol: Utilize TENS, IFC or low-level laser therapy to provide temporary pain relief and comfort. Use as an adjunct to other therapies.
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Medications:
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Frequency: As needed.
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Protocol: NSAIDs or acetaminophen for pain management, possibly combined with muscle relaxants for short-term relief of acute symptoms.
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Psychological Support:
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Frequency: Weekly or as needed.
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Protocol: Cognitive-behavioral therapy (CBT), mindfulness-based stress reduction, and other techniques to manage chronic pain and improve mental health.
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Follow-Up:
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Regular follow-up every visit and every 2-4 weeks to monitor symptom progression, functional improvement, goal achievement, and make necessary adjustments to the treatment plan.