top of page

An Introduction to Primary Spine Care

Do you know how much money is spent every single year for spine care (primarily back and neck pain)? In 2008, the Bone and Joint Decade released a study that estimated that the United States spends $102 billion dollars per year for “direct costs” of care. Direct costs are the cost to provide a service related to spine care. That service could be spinal manipulation, advanced imaging, injections or a consultation with an orthopedic surgeon. The indirect costs of are projected to be at least $102 billion dollars per year as well, and those tend to reflect costs such as lost wages [1]. Another study in 2008 estimated that the total cost of low back pain care in the United States is projected to be $600 billion dollars a year [2]. We, as a healthcare system, aren’t getting any better at treating back pain either. Between 1994 and 2004, Medicare expenses for epidural steroid injections rose 629%. There was a 423% increase in prescription pain killers, 307% increase in the ordering of MRIs, and a 220% increase in lumbar spinal fusion [3].

Something needs to change. There is a grass roots / ground floor movement right now in spine care that originated from the idea of Dr. Scott Haldeman, MD, DC. The goal of the movement is to train existing providers to fulfill the role of a Primary Spine Practitioner in their local communities. The idea of the Primary Spine Practitioner (PSP) is similar to that of the General Dentist. Someone suffering from tooth pain won’t run to their Primary Care Physician (PCP) for help. They know, instinctively, to go to a dentist for appropriate care. If the issue is something that is outside of the dentist’s specialty, he or she will refer the patient to an oral surgeon or orthodontist. With the new training being provided to chiropractors, physical therapists, and some medical doctors, there will soon be a growing number of providers ready to take on a similar role as it pertains to spine-related disorders and musculoskeletal pain.

Let us briefly give an official definition to the The Primary Spine Practitioner (PSP). He or she is a professional who is specially trained to provide front-line management for patients with Spine Related Disorders (SRDs). The PSP has the skills necessary to provide differential diagnosis and management for the majority of patients with SRDs without the need for referral. In addition, this practitioner has the ability to recognize those relatively few patients who require special tests (radiography, MRI, laboratory workup) and invasive procedures (injections, surgery) and to serve as “Captain of the Spine Team” for the purpose of providing counseling for the patient, coordination of care and long term follow up [4]. The majority of PSPs in the field will originate from one of the two following healthcare fields: Doctors of Chiropractic (DC) or Doctors of Physical Therapy (DPT, PT, or MSPT). Both are well versed in some, but not all aspects of spine care.

It is my opinion that most evidence-informed chiropractors are traditionally well trained to recognize and refer patients who require urgent medical care and identify and subsequently treat some (but not all) of the pain generators of spinal pain. We, however, are not traditionally trained to identify factors that lead to the development of or the persistence of the symptoms. These things include motor control instability and how to speak to patients about pain science.

In my experience, as a non-PT/non-DPT, most physical therapists are well trained to identify and subsequently treat some (but not all) of the pain generators of spinal pain. They are also well versed in how to address motor control and instability issues and tend to be receiving up-to-date education about pain science. Although this is changing with recent laws allowing patients direct access to physical therapy, most PTs traditionally did not have to worry about ruling out conditions requiring urgent medical care because they tend to work based on referrals from local medical doctors who had already evaluated the patient. The overall message is that both professions require a little extra training in certain areas to be able to fulfill the PSP role in their respective communities.

“Be the change you wish to see in the world.” ~ Mahatma Ghandi

Join the movement. Primary Spine Care is a growing movement with the goal of changing how we deliver spine care services to patients in the United States. Partner with a Primary Spine Practitioner today for your spine care needs!

Hans W. Bottesch II, D.C., completed his clinical training as an evidence-informed Chiropractor in the Veterans’ Affairs Medical Centers (VAMCs) of upstate New York. He has been trained as a Primary Spine Practitioner and has published articles in the lay press community. He currently practices out of Bloomsburg Spine & Sport. You can contact him at


1) US Bone and Joint Decade. The Burden of Musculoskeletal Diseases in the Unted States. Rosemont, IL. AAOS; 2008.

2) Dageneis. Caro. Haldeman. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J. 2008 Jan-Feb;8(1):8-20. doi: 10.1016/j.spinee.2007.10.005.

3) Deyo. Overtreating chronic back pain: time to back off? J Am Board Fam Med 2009; 22(1):62-8.


Featured Posts
Recent Posts
Search By Tags
Follow Us
  • Facebook Basic Square
  • Twitter Basic Square
  • Google+ Basic Square
bottom of page