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The Ultimate Back Pain Relief Tips Blog

Making Better Decisions Regarding How To Treat Your Back Pain and Sciatica; Lessons Learned From Harvard

Posted by Dr. Jeff Winternheimer D.C. on Fri, Jan 29, 2016 @ 04:52 PM

Dr_Jeff_Harvard_Outside1.jpgRecently I made a trip to the Harvard Business School, where I joined a group made up of 70 of the top minds in the Medical World to attend a series of lectures and meetings about the state of health care in America. The professor leading the group was Michael E. Porter, Ph.D., Bishop William Lawrence University Professor with Harvard Business School (HBS); he co-authored a book about value-based health care in 2006.

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The main objective of these lectures and small group meetings was to discuss how to better serve our patients through the publishing of patient outcomes. In our healthcare system it is very difficult for patients to identify what is the best course of action to take to treat their conditions, because providers don’t have to publish the outcomes of their treatments.

An outcome is the net result of your condition after the treatment is administered. When a procedure has been completed, or in our case therapy, how much better are you? This is what is considered outcome. For example:

  • Did you get better?
  • How much better are you?
  • And how does that compare to other therapies?

However, because providers don’t have to publish outcomes, there is no true way to identify who or what treatment is best for your condition. This is one of the main problems with healthcare today. The consumer (the patient) doesn’t know what the best treatments are for their condition.

One of the guest speakers for the event was Elizabeth Teisberg, Professor for both the Dartmouth Center for Health Care Delivery Science and the Geisel School of Medicine. She talked briefly in one of our sessions about an article written for Harvard titled, “Patient-Reported Data Can Help People Make Better Health Care Choices.”

The premise of her article is that the patients don’t have a thorough understanding of what types of treatments are available and what the different outcomes of these treatments might be. The solution, she said, is to help patients make informed health care decisions by giving them access to clear, relevant, meaningful information about treatments through published outcomes. A well-informed patient makes better decisions about how to treat their problem, which is beneficial for all involved.

This is my goal; to help patients make better decisions about what treatment is best for their condition. We currently have 3000 patient outcomes that we are going to publish on the internet. This will allow you to better understand our outcomes for the conditions we treat. We will be grouping our case studies by condition, age, severity of problem, and level of disability based on the Oswestry Disability Index (ODI).  

What this means is, all you will need to do to find the outcomes for a specific condition is identify the group of case studies that are similar to the condition, and look to see what the expected outcomes are for that group. As we continue to add these case studies it will be easier for you to identify your group, and we will add tools and emails to help you. In conjunction with publishing our outcomes, I will do my best to publish information about outcomes for other types of treatment for the same condition so that you can compare outcomes between those therapies and ours.

We have several case studies available online in different formats. We will be re-organizing these case studies so that their formats are all the same and easier for you to understand. Because this is new, we will be starting with outcome case study number one. I will walk you through this first case study now so that you know how to read them, and so that you know some of the important points in our cases. This first explanation will be the longest so that we can ensure that you understand how to read it. My goal is to publish the facts only for all the other outcome cases.

As we move forward, I will also create a video about how to read and understand these case studies, so that you can watch it and make sure you understand all the important points.

To begin, I will write out a case study and explain how to read it. It’s simple to do.


Outcome Case Study #1

  • 41 year old Female
  • Back Pain 5.5 years


Before seeing us, the patient:

  • Saw 4 different doctors for her back pains
  • Had MRI and X-Ray taken


Treatments she tried before seeing us included:

  • Physical therapy
  • Chiropractic
  • 3 cortisone shots
  • Narcotics
  • NSAIDs


Using a MRI, we diagnosed the patient with the following:

  • Spondylolisthesis
  • Degenerated Disc
  • Herniated Disc
  • Bulging Disc
  • Sciatica


When the patient started our Therapy:

  • Back pain and Sciatica was a 9
  • ODI was 42


End of our Therapy:

  • 30 Treatments
  • Back Pain and Sciatica was 0
  • ODI was a 16


Before our treatment

  • Surgical Candidate


Now I will walk you through the above template. It appears fairly straightforward, but I will just make sure there is clarity on what all the variables are.

A 41 year old female presented to our clinic suffering with back pain for 5 and a half years. Before she came in to see us she had seen 4 different specialists and had a MRI and X-Ray done to try and identify her problem. She also tried several different therapies, including: Physical Therapy, Chiropractic, 3 Cortisone Shots, Narcotics, and NAISDs (non-steroidal anti-inflammatory agents, an example would be Advil).

When she came into our office we had a new MRI taken and she was diagnosed with: Spondylolisthesis, Degenerated Discs, Herniated Disc, Bulging Disc and Sciatica.

When she started our therapy her pain was a 9 on a scale of 1-10 (with 10 being the worst), and on the Oswestry Disability Index she scored a 42. The Oswestry is considered the standard for back pain when determining outcomes, as it is considered the only tool to truly evaluate a patient’s progress with therapy. Because it is so important, I will elaborate further.

The ODI is an indicator of how well the patients can perform the activities of daily living. The score is used as a way to measure the effect your pain has on your ability to live your life. The higher the score is, the more your life is disabled by pain. Patients that have a score over 40 and pain that is considered chronic are considered candidates for spinal surgery.

Conversely, the lower your ODI score is after therapy, the better your outcome tends to be. The goal of therapy is to lower the ODI as much as possible. ODI is scored as follows:

0-20 - Minimal disability: This group can cope with most living activities. Usually no treatment is indicated, apart from advice on lifting, sitting posture, physical fitness, and diet.

20-40 - Moderate disability: This group experiences more pain and problems with sitting, lifting and standing, travel and social life are more difficult and they may well be off work. The back condition can usually be managed by conservative means.

40-60 - Severe Disability: Pain remains the main problem in this group of patients. These patients require detailed investigation.

60-80 - Crippled: Back pain impinges on all aspects of these patients' lives. Positive intervention is required.

80-100 - These patients are either bed-bound or exaggerating their symptoms.


After finishing our therapy the patient had a pain level of 0 and an Oswestry (ODI) score of 16. This would be considered a very good outcome for therapy considering all the other therapies failed to eliminate her symptoms. The very last line stated that the patient was a surgical candidate before our therapy. This is because her pain was persistent, she failed all other therapies, and had an ODI above 40. 

We will be organizing all 3000 of our existing case studies online, using this as a template and a tool to help you read them. The goal would be for you to have access to all of our case studies that are similar to your condition, thereby allowing you to make better decisions about how to treat your back pain and sciatica. I will also be publishing any literature available online to help you understand what other treatments outcomes are available. My goal is to help as many people as possible eliminate their back pain forever.


To read Case Study #2, Click Here!

To read Case Study #3, Click Here!


To access our growing list of Patient Outcomes, Click Here!


At The Illinois Back Institute we are dedicated to educating people, because we know that the more that you understand about your problem, the more likely you are to eliminate it. We specialize in Functional Disc Rehydration - a multi-disciplinary approach to making the back healthier without surgery, injections or medications

If you would like to schedule a Free Consultation, you can call us at 855-972-3368, or click here:

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Also, if you would like to learn more about your back pain, or would like to know more about what we do and how our treatment works, we regularly hold Free Educational Seminars at each one of our clinics! To find out when the next seminar is and reserve a seat, click here:

Upcoming Webinars at Illinois Back InstituteIn this case study, one of the causes of the woman's back pain was a Herniated Disc. If you would like to know more about Herniated Discs, we have a Free Email Series that is all about them! To sign up for the Free Series, Click Here: 

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Disclaimer: The content on this web site is for information purposes only and should never be used as the basis for diagnosis or treatment. We always recommend consulting a qualified professional before embarking on any form of self treatment or rehabilitation.

All content is protected by the usual copyright laws and cannot be used, stolen or reproduced for any purpose without Illinois Back Institute permission. Please feel free to call about anything although we are unable to give advice on any specific injuries or conditions over the phone.