Chiropractic Care Plans for Common Low Back Conditions
SOURCE: Chiropractic Technique 1993 (Aug); 5 (3): 119-125
by Robert D. Mootz, D.C. and V. Thomas Waldorf, D.C.
Our thanks to Robert D. Mootz, D.C. and to Dana Lawrence, D.C., the editor of Chiropractic Technique, for permission to reprint this FULL-TEXT article article, and its extensive collection of Care Plans, exclusively at Chiro.Org
A detailed description of chiropractic care parameters used at a large occupational medicine center is presented. The algorithms were derived from clinical needs of the facility, expert opinion, and reviews of several contemporary written protocols. Twelve of the most common industrially related low back conditions are included. The algorithms are grouped according to nondiscogenic and discogenic conditions. The guidelines are consistent with many third party chiropractic review policies, as well as the recently published Chiropractic Quality Assurance Guidelines and Practice Parameters. The first algorithm is based on uncomplicated joint dysfunction, and is considered the base algorithm. Other, more complicated conditions follow, and a preface is included for each describing specific issues relevant to each condition. The purpose of these algorithms was to help standardize care in the clinic, to foster interdisciplinary communication, and to provide consistency in administration for research purposes.
Occupational Low back injuries make up a major component of industrial expenditures in the United States.  A number of retrospective studies have suggested that conservative chiropractic management may be more cost effective than other approaches. [2-3] Although a number of general practice guidelines have been developed [4-6], none have (yet) provided “condition specific” guidelines.
A condition specific description of chiropractic care parameters used at a large multidisciplinary occupational medicine facility is presented. These guidelines address 12 of the most common industrially related low back conditions that presented during 1991 at the Advantage Occupational and Sports Medicine Center in San Leandro, California.
They represent experience of the practitioners on approximately 150 acute low back injuries, based on clinical needs of the facility. In addition, expert opinion and reviews of several contemporary written protocols served as resource information [5-13]. These guidelines best fit the classification of “seed algorithms”, that serve as the basis for further investigation and lend themselves to further development through standard consensus process. 
Actual preparation of the guidelines involved first characterizing the types of low back conditions (diagnoses) that had presented to the facility during 1991. A series of seed proposals were drafted and reviewed by the two authors. These initial proposals were based on a qualitative chart review of frequencies and duration of care for the conditions identified. These were then distributed to other physicians and therapists at the facility for input and appropriate modification. Future reports will analyze comparative effectiveness of active and passive approaches in this facility.
The guidelines presented here are categorized generally as nondiscogenic and discogenic conditions (See Table 1). The purpose of these protocols was to help standardize care in the clinic in order to foster good interdisciplinary communication, as well as provide consistency in administration of care for research purposes.
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