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Telephone: +44(0)207-631-3067 Emergencies: +44(0)7710-901140
THE LUKLINSKI' SPINE CLINIC
Suite 17, Milford House - 7 Queen Ann St. (off Harley St.), London, W1G 9HN
Established 1969 - over 40 years experience in treating spinal disorders
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THE TREATMENT OF BACK PAIN
by Mr. B.M. Luklinski
MSc Medical Rehabilitation; MSc Physical Education; Dip Home Med.

Introduction   (Click on one of the back conditons on the menu for information on treating specific conditions)

The proper treatment of spinal problems requires a clinical knowledge and understanding which can only be gained after studying the vertebral column and conducting treatment over many years. I have been practising since 1969 and I specialise in dealing only with difficult and chronic cases of back pain that have not responded to osteopathic or chiropractic treatment.

Exercises and Back Care (consult your doctor before doing any exercises)

There are a few basic tips that I would like to pass on at this point which are generally applicable to all cases of back pain:
(i) Don't buy those ridiculous products that purport to stretch your back, turn you upside down, or which apply traction; appliances such as rollers which apply muscular pressure won't cure you, but at least they won't cause you any harm.
(ii) All exercises for the back should be carried out while lying down.
(iii) Contrary to popular wisdom, don't sit up straight but rather lean back in your chair at an angle with support (without slouching)
(iv) When lifting objects, bend your knees and keep your back straight and chin up, even if it looks comical. This will lock the vertebrae in your back to prevent them moving and will reduce the risk of strain.
(v) It is essential to keep the stomach muscles in trim to reduce pressure on the back, as the spine is mainly supported by muscles at the front and rear of the trunk. If the front stomach muscles are weak (as in a 'pot-belly'), even the best treatment in the world may not prevent a recurrence of spinal problems.

As for that dreaded word 'exercises', the temptation is naturally to reduce movement in the hope of avoiding pain, but if it is possible, try stretching like a cat every morning before getting out of bed. Arch your back gently up and down while on all-fours, particularly to elongate the back muscles while pulling your stomach in and stretch yourself in the way that Muslims pray.  And while you're on your hands and knees, why not gently move your trunk left and right? This will help to keep the spine flexible. One useful movement you can do on the floor, or while still lying in bed, is to lie on your side with legs slightly bent and rotate or gently 'rock' your trunk back and forth to apply a twisting motion to your spine. You don't need to take your head off the pillow. The rocking motion doesn't need to be to Olympic standards, just gently and slightly rock your trunk back and forth (without jerking, but rather in the way a baby's cradle is rocked)  and feel your spine loosening and stretching while your legs remain to one side. You can turn over onto your other side to repeat the 'exercise' and you can bend your legs further in stages by bringing them up closer to your chest (while lying on your side) to benefit the upper part of the spine. As for keeping your stomach muscles in trim (which is essential), simply lie on your back and bring your knees up with your legs bent towards your stomach and hold them or move them a little to tighten your stomach.  Try these simple movements (exercises!) regularly to see the results. It may save you from having to visit us for treatment if your back condition is from a minor cause. And of course these movements can be supplemented by using our Back-Rack, which we provide to all our patients.

Physical Therapy

For more protracted spinal problems, the success of any treatment depends on an accurate diagnosis being made of the patient's condition. This is where experience is crucial. Too often one hears of horror stories where the poor patient has been bashed about by a practitioner who is really groping in the dark. "Clunk-click-every-trip" is not the way to treat back problems.

Mobilisation of the spine however is a safe and gentle way of freeing trapped nerves and realigning vertebrae and discs that have become misaligned. Joints are normally moved when the body itself moves ('active mobility'), but joints can also be subjected to 'passive mobility' as in mobilisation, when the joints are moved by another person. The procedure takes many years to learn and is the correct method for freeing or re-aligning stiff joints. The patient cannot move his own joints any more than he can jump over his own knees, and that is why the service of a practitioner skilled in mobilisation is essential.

The branch of orthopaedic medicine that deals exclusively with the spine is known by the name of Maitland-Cyriax and text books written by these two professors are available in most medical reference libraries for those who wish to learn more about the spine.

The proper approach regarding treatment for most spinal conditions is to mobilise the affected joints to free them from constriction, and to increase the elasticity of those soft tissues which may be pressing on spinal nerves. When this is achieved after only a few sessions (or as many as 14-20 for really chronic and difficult cases), the patient will feel a significant improvement and the cause of the symptoms will be cured. The initial treatment however can produce soreness and discomfort, but this soon subsides  when the vertebrae are able to move more freely and the whole spine becomes less stiff. Specific floor exercises are given to prevent any recurrence of the problem and the patient is able to get on with their life with their spine (and wallet) intact and their quality of life restored.

Surgical Treatment

It is worth remembering that the spine is a completely mechanical yet wonderful structure of bone, muscle and tissue and the best way of treating back problems is therefore achieved using physical methods. If one thoroughly understands the mechanics of the spine, there should be no need to resort to surgery to remove or modify something that Nature has provided for a particular purpose.

I am not an advocate for spinal surgery except where the spine has suffered a traumatic injury which is life-threatening or which requires an immediate operation. There are 300,000 back operations performed in the USA every year, but I have yet to find in my 45 years of clinical experience just one person who can honestly say that their condition has improved as a result of surgery. There is nothing worse than operating on a person when better treatment methods are available, and when spinal surgery itself has such a track record of failures.

Drugs and pain-killers

Most people probably appreciate that pharmaceutical drugs as prescribed by a doctor or which are available over the counter may reduce pain but they will never be able to treat back problems when they are due to mechanical causes. Only physical treatment can safely free a trapped nerve - there simply isn't a drug on the market which can achieve that, and there never will be one available. Epidural injections only serve to anaesthetise nerves for a while and Cortisone (which is highly toxic and should not be administered more than twice per year) and other anti-inflammatory injections do not treat the causes of any spinal conditions.

COST OF TREATMENT
NOTES. Evey patient is rquired to read the notes before signing the Consent to Examination and Treatment Forms.

CONSULTATION

A consultation and examination normally lasts for one hour. This enables us to determine the cause of your spinal disorder, and to determine the correct treatment procedures. We rely primarily on precise physical tests rather than scans to arrive at a diagnosis.

INITIAL TREATMENT

If the patient decides to begin a course of treatment, a payment of an account is required to cover the initial cost of treatment. This initial period of treatment allows the patient to appraise the results without having to pay for a whole course of treatment in advance.

It may not be possible however to obtain an improvement during the initial treatment phase because in many chronic cases an increase in pain or discomfort is experienced following the mobilisation of spinal joints and the consequent irritation of nerve roots. If there is a strong reaction to treatment however, this is usually a good sign that the treatment is working. For example, in regard to cervical nerve root impingement affecting the arm and hand/fingers (radiculopathy), the treatment may initially exacerbate the symptoms. In many acute cases however, a significant reduction in symptoms can be achieved after only a few sessions.

1st REVIEW

A determination is made following the initial treatment period. The full cost of treatment with an estimate of the number of sessions required to successfully treat the disorder is then given. It is important to appreciate that although the cost for the whole course is determined at this review, the estimate for the number of sessions required to successfully treat the disorder may turn out to be inaccurate.

If the patient's disorder is satisfactorily resolved within the estimated number of sessions, the patient will be discharged, and no refund will be given for 'unused' sessions. If the patient however requires more sessions than was originally estimated, appropriate advice will be given and additional charges may apply.

It is important to appreciate that although our aim is to 'cure' a disorder, the most we can undertake is to reduce the patient's symptoms as much as possible by treating the cause of any diagnosed disorder. We can never guarantee to cure a patient because some factors are beyond our control, such as the patient's own lifestyle (the patient may enjoy skiing down mountains!) If we express an opinion that we can effect a cure, this must only be regarded as an opinion which can turn out to be wrong.

FINAL REVIEW

A course of treatment will be concluded and the patient discharged when the practitioner believes no further improvement can be gained, or that the disorder has been resolved as best as possible in the existing circumstances. There would be little point in continuing treatment if no improvement can be obtained in the patient's condition.

If a disorder has been resolved, so that for example no further pain or numbness is felt in a leg, the patient may still require additional treatment for another part of the spine and for other symptoms, such as pain or numbness in an arm.

This treatment cost will be quoted in the same way as described above and the same review structure will apply. Obviously if one set of symptoms have been satisfactorily resolved, the patient would have the necessary confidence to begin treatment on the second category of symptoms.

When patients are discharged we may ask the patient to provide a written confirmation that they feel as comfortable as possible with no symptoms. The patient is usually given a programme of specific floor-based movements to carry out to prevent any recurrence of the disorder and so we usually do not need to see the same patient twice.

PAYMENT

Any appointments for treatment not kept or cancelled will be charged £250, or if at least 24 hours notice of cancellation is given, a cancellaton fee of £100 will be retained or charged. The cost of treatment can be paid for in instalments. The patient may withdraw from treatment at any time although any money paid on account will not be refunded.

The practitioners are busy and like any other professional, time is chargeable and a missed appointment cannot always be filled by booking another patient.

Our fees are not calculated in terms of an hourly or session rate but according to the condition that needs to be treated and the degree of experience and skill that needs to be applied. In some cases for example a mobilisation, manipulation, distraction, or manual traction procedure may be required in the course of treatment which if it were not applied would never cure a condition. The procedure may only take a few seconds to apply and so if we were merely charging an hourly or session rate then our fee might not come to more than £5!

An hourly or "per session" rate is therefore not an appropriate basis on which to charge treatment fees, which are based upon the condition to be treated.

The Consent Forms that you will be required to sign before any examination or treatment is conducted are set out below. These consent forms are designed to enable a patient to give informed consent to being examined and treated and to provide legal support for the practice.


CONSENT TO EXAMINATION

I hereby consent to being examined by Mr B Luklinski [or other practitioner's name] for the purpose of diagnosing my spinal disorder. I understand this will involve physical contact and that Mr. Luklinski [or other practitioner's name] is not a medical doctor (MD) but that he is suitably qualified in the field of Medical Rehabilitation. I have read the website of the clinic www.back-pain.co.uk and agree to be treated in accordance with the principles of Orthopaedic Medicine which Mr Luklinski [or other practitioner's name] practices and which are described on the clinic's website.

I accept that Mr Luklinski [or other practitioner's name] has not represented to me that he is a medical doctor, nor that he can cure my condition and that the most Mr. Luklinski [or other practitioner's name] has undertaken to achieve is to improve my condition with no guarantee of success.

I agree to pay all agreed charges as and when they fall due and I have read the notes above that accompany this Consent Form. I understand that I may withdraw from treatment at any time without further liability, although no refunds will be given for fees already paid.

CONSENT TO TREATMENT

I AGREE TO BE TREATED BY [enter practitioner's name]. I HAVE READ THE NOTES ACCOMPANYING THE CONSENT TO EXAMINATION FORM.

I AGREE TO PAY THE INTITIAL PAYMENT REQUIRED OF £___________

SIGNED: ____________________________DATE:____________

PATIENT______________________________________________

THE 1ST REVIEW (AFTER 4 -8 SESSIONS)

1) I AGREE TO THE FULL COST OF TREATMENT £___________

2) I UNDERSTAND THAT THE ESTIMATED NUMBER OF SESSIONS REQUIRED TO SATISFACTORILY RESOLVE MY SPINAL DISORDER WILL BE___________

3) I AGREE TO PAY THE COST BY INSTALLMENTS AT INTERVALS TO BE AGREED UPON AND UNDERSTAND THAT I MAY WITHDRAW FROM TREATMENT AT ANY TIME ALTHOUGH NO REFUNDS WILL BE GIVEN FOR FEES PAID ON ACCOUNT.

SIGNED: ____________________________DATE:____________

PATIENT______________________________________________


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Questions and answers with Mr Luklinski:

Q. What is the average number of treatment sessions required and over what time period do these take place?

A. This depends on the availability and condition of the patient. Usually treatment for a herniated disc with no neurological symptoms takes three to four sessions per week, over 2-3 weeks.

Q. Where can I find evidence of the reputability of your clinic and effectiveness of your treatment methods?

A. It would be the easiest thing in the world to provide "endorsements" from former patients but what would this prove? Every patient is an individual with different degrees of conditions, and treatment that might work for one person may not work for another. In accordance with standard medical practice, we are unable to give any guarantees regarding the outcome of treatment. We have expressed our experience and knowledge of the spine in this website and it is up to the patient to decide whether we may be able to provide the necessary treatment to cure or alleviate their condition. Health professionals do not usually provide testimonials or guarantees because their qualifications and experience should be sufficient.

New patients can rely upon the information contained in this website and my qualifications in determining whether I may be able to provide proper treatment for spinal conditions.

My relevant qualifications are an MSc (Master of Science) in Medical Rehabilitation gained from Cracow University in Poland (my country of birth). I have specialised in spinal care for more than 30 years and I worked in the NHS before setting up my own private practice.

Please note that any treatment provided will necessitate physical contact and hence the patient's consent to treatment must also include an implied consent to physical contact. In accordance with established medical practice, no guarantee of a cure will ever be given, but if an opinion is expressed that a cure can be effected, this must only be regarded as my professional opinion, and cannot be relied upon in any way as a guarantee of a cure, or even as an assurance regarding any possible result of treatment.

I cannot for legal reasons recommend any other practitioners, although there are links to physiatrists and physical therapy associations in our links section who may be able to provide assistance if you cannot visit our clinic in London. Please note that for obvious reasons it is impossible to give a quote over the telephone in the absence of a physical examination. A herniated disc for example could be uncomplicated with no neurological deficit, but the contrary may also apply: there may be serious neurological complications that require additional treatment.

Please also note that I am not a medical doctor (MD). If you wish to see a doctor for treatment (for example to receive pharmaceutical medicine such as painkillers) you should visit your local General Practitioner or Health Advisor. Payment can be made under medical insurance policies provided the insurer agrees to pay our fees prior to treatment.

In conclusion, the difference between Orthopaedic Medicine (the service we offer) and surgical treatment is that our patients are left with their spines intact while facing a healthy future, whereas patients who have undergone surgical treatment are invariably disabled sooner or later as a direct consequence of the operation (rather than as a consequence of their original condition).