Our Professional Service Charter

At Pinnacle Spine and Sports we appreciate the necessity of a GP-centric model to our patient’s health. We also understand the challenges of undertaking any new professional relationship. As such, we implement a collaborative treatment strategy, and provide communication that is prompt, pertinent and clear.

Since our establishment in 2006, Pinnacle Spine & Sports has endeavoured to forge a reputation of evidence-based practice. We enjoy good relationships with our medical colleagues, centered around sound clinical reasoning and a core scientific base. We understand the trust you place in us when referring one of your patients. Therefore, you, and your patient will receive a thorough diagnosis, concise explanations, and personalised care.

Musculoskeletal disorders are complex and diverse, and the related research literature is developing at the same pace as any other field of medical science. That is why we maintain a tight focus of expertise in musculoskeletal diagnostics and pain. We also recognise the value of collaborative care, and maintain good relationships with local physicians and orthopaedic surgeons.

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FAQs

Do we have an over-reliance on passive physical therapy?

Treatment dependency is a challenge that faces all manual therapy practitioners. At Pinnacle Spine & Sports we employ a multi-modal active model of care, and view physical movement and exercise as the mainstay of recovery.

We emphasise a real-world, functional method for exercise – combined with a comprehensive education program. Patients need to understand the reason for their pain, so that they can develop a sense of control. This is the philosophy of all of our practitioners, whether they be chiropractors, physiotherapists or massage therapists.

Is cervical manipulation dangerous?

Manipulation of the cervical spine has historically been a controversial topic in the medical world. Current evidence, viewed impartially, shows a different trend towards this mode of therapy.

Indiscriminate application of any therapeutic intervention has the potential to cause harm, of this there is no doubt. Cervical manipulation is no different. Our chiropractors employ a conservative approach, and carefully screen patients to ensure they are an appropriate candidate for spinal manipulative therapy.

Chiropractic care has become synonymous with the term ‘manipulation’. In reality, chiropractors employ a wide array of manual techniques. Manipulation itself is only one component of a variety of joint mobilisation therapies. Manipulation is not a ‘standard’ therapy applied uniformly. Rather, it is a carefully measured approach, tailored to the tolerance of the individual patient. When performing manipulations, our considerations are not limited to the articular structures involved, but also towards other connective and vascular tissues.

It is also important for us to point out that our physios and massage therapists do not perform spinal manipulation. Rather, they employ other methods to gain the changes they see necessary whilst leaving manipulative therapy to our chiros who have undergone 5 years of university level training to perform this safely and effectively when clinically indicated.

Are all patients x-rayed?

No.

Given the known risks of over-exposure to ionising radiation, we lean heavily towards a conservative approach to imaging. Diagnostic imaging is only utilised when more information is required to achieve a comprehensive and point-specific diagnosis than our clinical examination can provide.

In most clinical scenarios, a comprehensive history and examination is adequate to ensure a thorough diagnosis of a patient’s condition. There are some occasions where diagnostic imaging is required to safely commence care.

Take the example of a disc herniation with obvious radicular symptoms. Whilst a clinical workup is usually precise enough to determine the amount of sensory/motor deficit, and identify the level of lesion, it cannot provide adequate information regarding:

• Shape and size of the lesion (which directly influences the patient’s prognosis)
• The grade of neural compression (which will determine the likelihood of surgery)
• Composition of the extruded substance (affecting the level of long-term resorption)
• Fluid concentration and modic changes (which may hinder the efficacy of conservative care)

To gain information on the above to aid our diagnosis, we would normally lean towards MRI as our imaging of choice given its absence of ionising radiation and its clarity of image production. MRI is also superior in its ability to detect fluid concentrations, which is a useful tool in determining joint effusion as well as identifying the target for injections should they be deemed necessary.

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One of our treatment techniques – Flexion Distraction

Flexion-Distraction (FD) is a rhythmic traction therapy applied to the lumbar motion segments. FD is a gradual manual traction and mobilisation, as opposed to a traditional high velocity low amplitude manipulation techniques. It is widely regarded in the current literature to be a clinically effective treatment protocol for Lumbar Disc Disease, Lumbar Spine Stenosis and Facet Joint Arthropathies.

The physiological mechanics flexion distraction produces on the lumbar disc include:

• Elevation of the Intervertebral Disc
• Prevents distortion of the tip of the annulus fibrosus (which is pain sensitive)
• Reduces internal pressure on the disc. This reduced pressure gradient migrates vertebral pulp back towards the centre of the disc. The reduction of inflammatory mediators back into the disc structure also minimises chemical irritation of the surrounding nerve root
• Reduction of flaval ligamentous stenosis of the spinal canal

Amelioration of displacement of the facet joint maintains a normal range of segmental spinal motion, and decreases facet-mediated pain. The flossing and gliding of the lumbar nerve roots also restores normal neuro-elasticity of the sciatic nerves, reducing neural insult.

References:

Effects of flexion-distraction manipulation therapy on pain and disability in patients with lumbar spinal stenosis. Jioun Choi MS, Sangyong Lee, Chunbae Jeon. J. Phys. Ther. Sci. 27: 1937–1939, 2015

A randomized clinical trial and subgroupanalysis to compare flexion–distraction with active exercise for chronic low back pain. Maruti Ram Gudavalli, Jerrilyn A. Cambron, Marion McGregor, James Jedlicka, Michael Keenum, Alexander J. Ghanayem, Avinash G. Patwardhan. Eur Spine J (2006) 15: 1070–1082

Spinal reflex excitability changes after lumbar spine passive flexion mobilization. Bulbulian R, Burke J, Dishman JD. J Manipulative Physiol Ther,2002, 25: 526–532.

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