DMR Clinics: Groundbreaking Collaborative Spine Care
Years of research and clinical trials have yielded the Diagnose, Manage and Rehabilitate (DMR) Method, an innovative technique for treating back pain.
“Physical therapy, chiropractic, physical medicine and surgical intervention all have benefits,” says Pete L’Allier, DC, DMR Method founder and Clinic Director. “But together, implemented in a specific order, the modalities are better. Short- and long-term outcomes improve, the need for surgical intervention decreases and patients become more independent with self-care.”
In 2006, L’Allier and a team of experienced spine care specialists created the multimodal approach delivered via the DMR Method. Since then, the team has worked together to enhance the process, organizing clinical trials to refine the order and combination of the treatment to optimize effectiveness. To demonstrate the DMR Method’s efficacy, the team designed the DMR1 trial, in which they enrolled patients with herniated discs. The team tracked progress using pre- and post-treatment MRI scans in conjunction with self-reports utilizing the Oswestry Disability Index. After 12 weeks of nonsurgical DMR Method treatments, 96.4 percent of trial participants showed at least a 50 percent reduction of symptoms and increased function.
“The findings exceeded our expectations and reinforced our belief that a multidisciplinary collaborative process of evaluation and treatment could produce excellent outcomes,” L’Allier says. “Another striking observation was that 100 percent of disc herniations treated within eight weeks of occurrence showed reabsorption, underscoring the importance of early diagnosis and treatment. We’ve followed up with DMR1 trial participants for the past seven years, and long-term outcomes have been exceptional.”
“For many spinal conditions, I’ve found that the DMR Method produces consistent results and has an amazing ability to help patients avoid surgery,” adds John Mullan, MD, Neurosurgical Associates Ltd. “Even when a patient has previously had spinal surgery, the DMR Method can be valuable in helping that person stabilize his or her spine and prevent a recurrence of symptoms and additional surgery.”
In both the evaluation and treatment processes, DMR Method providers focus on inter provider communication and collaboration.
“The essence of collaborative care is knowing as much as possible about what other providers can contribute and turning that knowledge into treatment that improves efficiency, outcomes and patient satisfaction.”
— Brownie Williams, DC, Director of Williams Integracare in Sartell, Minnesota
Three-phase Progression Is Key
DMR Method clinicians tailor care plans that guide patients through a three-phase progression of treatment. The phases — relief, repair and rehabilitation — were designed to improve mobility, alignment and stability.
“The combination and order of treatment is critical,” L’Allier says. “A source of ongoing debate within the field of nonsurgical spine rehabilitation is that many practitioners start strengthening or implement superficial soft-tissue techniques and don’t address core structural joint mobility and alignment issues. That’s a recipe for recurrence. If you want the best outcomes, treatment must focus on joint mobility and alignment first. Strengthening should then be applied gradually for stability.“
In phase one, the relief phase, clinicians restore joint mobility through three DMR Method-specific techniques: integrated progressive manipulation and dynamic muscle technique, along with spinal traction and stretching. These techniques improve motion to stimulate healing and quickly bring symptoms under control.
Next, the team begins phase two — repair. During this phase, the focus is assisting soft-tissue healing and remodeling, as well as spinal alignment and posture.
The DMR Method culminates with the rehabilitation phase, during which clinicians deploy advanced rehabilitation techniques to ensure spinal stability.
“Collaboration is truly the most powerful medicine.”— Pete L’Allier, DC, Hopkins Health & Wellness Center (HHWC) and DMR Clinics Director
“One of the greatest gifts you can give patients is the power to take care of themselves,” says Megin John, DMR Method physical therapist. “We poured countless hours of work into developing simple, targeted exercise and stretching programs tailored to the individual needs of each patient. I had been to other places, and no one could figure out what was wrong with my back, and I was suffering. In one visit, the DMR physician figured out the cause of my pain and implemented a combination of treatments that quickly improved my back and leg pain. The therapists gave me some simple exercises to do on my own, and I haven’t had any problems since.”
— Patient Testimonial
Clinicians build personalized therapeutic plans using elements developed specifically for the DMR Method, including:
- Integrated Progressive Manipulation (IPM), a specialized progression of joint manipulation.
“This is a graduated form of manipulation based on the science of joint motion,” says Brody Peterson, DMR Method chiropractor. “We start most patients with very gentle level I manipulation and slowly progress to level III, manipulating the joint to full range. The benefit of this approach is it’s more gentle and gradually progresses with other therapies focused on joint mobility and alignment.”
- Dynamic Muscle Technique (DMT), a muscle massage and mobilization protocol. This three-phase soft-tissue mobilization technique was designed to work in concert with spinal manipulation.
“Like Integrative Progressive Manipulation, we discovered that following a three-phase progressive model that begins with myofascial released, then deep tissue work, and then finally, motion-assisted massage allows us to maximize effectiveness and comfort,” says Kelie Davis, DMR Method physical therapist.
- Progressive Traction, traction applied to the neck and back to reduce pressure on the intervertebral discs and improve spinal mobility and alignment. Using high-tech traction heads programmed to apply traction in three phases, including static, intermittent and oscillating modes, complements other DMR Method techniques to provide patients with rapid and optimal results.
The Power of Patient Education
In 2015, to help patients better understand, treat and recover from complicated spinal issues, DMR Method clinicians published a comprehensive, practical guidebook, titled The DMR Method: Advanced Nonsurgical Care for Neck and Back Pain.
“This book is specifically designed to educate patients about spine mechanics, spine conditions and the treatment process,” L’Allier says. “The book also provides self-care resources for patients to utilize once they’ve completed their DMR therapy.”
Relief to Wellness
“Our goal is to help patients effectively treat their back condition and transition to doing things on their own to enhance their personal health and wellness,” L’Allier says.
To help achieve this goal, the DMR Method team wrote another book, Wellness for Everyone, that they give patients as a gift upon their graduation from care.
“The short book is a concise, practical guide that helps patients discover simple things they can do to stay healthy on their own. By making small but intentional changes, patients will see a huge difference in their health and wellness, and, thus, their quality of life.”
Passing the Torch: DMR University
Clinicians well versed in the Diagnose, Manage, and Rehabilitate (DMR) Method are collaborating with other providers to enhance the level of available neuromusculoskeletal therapy.
In August 2016, DMR Clinics launched the first-ever collaborative care conference: DMR University (DMRU), a 20-hour training program consisting of a certification curriculum and corresponding practicum to instruct physical therapists, chiropractors and allied health professionals how to perform the DMR Method. The program also emphasized the importance of a collaborative approach to spine care and rehabilitation. The inaugural session began with a panel of 15 experts from across the country, including radiologists, neurosurgeons, orthopedic surgeons, physical therapists and chiropractors, and followed with hands-on training of DMR Method techniques, including Integrative Progressive Manipulation and Dynamic Muscle Technique and Progressive Traction.