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Why Chronic Pain? 

 January 17, 2010

By  Dr. Tripp Stover, D.C.

Muscle and soft tissue injuries are notoriously hard to treat and assess.  As a result, patients are often frustrated and left with many lingering problems after injuries.  Often times chronic pain syndromes are the result of incomplete care.  It is frustrating for all health care practitioners involved.  Most of my fibromyalgia patients can recall THAT one injury they could not heal from, or that one event that lead to the collapse of their musculo-skeletal system.  Usually followed by years of struggle.

I was amazed to read the blog entry bellow from, a blog entry at www.chiro.org.  What follows is a complete copy of the entry.

Medical Training For Musculoskeletal Conditions is Inadequate

From Harvard Medical School in the U.S. to medical schools in Europe, medical education related to musculoskeletal conditions is inadequate. A 2009 survey tested physician’s knowledge related to simple low back pain management [1]. The average survey score of family practitioners was 69.7 and the average score of orthopedists was far less at 44.3. Orthopedists were less likely to make the proper radiological referral and appropriate pharmacological prescription based upon the literature.

Another 2009 study from the U.K. found that only 13% of the junior doctors felt they had adequate musculoskeletal medical training [2]. Research from the University of Washington found that less than 50% for the fourth-year student interns were competent in the area of musculoskeletal medicine. A 2007 study of Harvard medical students found that they were not confident in management of musculoskeletal cases and failed to demonstrate cognitive mastery. The study concluded that “These findings, which are consistent with those from other schools, suggest that medical students do not feel adequately prepared in musculoskeletal medicine and lack both clinical confidence and cognitive mastery in the field.”

The current failure of modern medicine worldwide to adequately train physicians and the continually growing problems like low back pain is just one more good reason to see a chiropractor when you have musculoskeletal complaints.

REFERENCES: Thanks to ChiroAccess!

1. Orthopaedists’ and family practitioners’ knowledge of simple low back pain management
Spine (Phila Pa 1976). 2009 Jul 1;34(15):1600-3

2. The inadequacy of musculoskeletal knowledge after foundation training in the United Kingdom
J Bone Joint Surg Br. 2009 Nov;91(11):1413-8

End Medical Mis-Management of Musculoskeletal Complaints

Q. — Are medical doctors well trained to diagnose or treat musculoskeletal complaints?

A. — Find the unsettling answer in the following series of articles

Educational Deficiencies in Musculoskeletal Medicine
Journal of Bone and Joint Surgery 2002 (Apr); 84–A (4): 604–608
According to the standard suggested by the program directors of internal medicine residency departments, a large majority of the examinees once again failed to demonstrate basic competency in musculoskeletal medicine on the examination. It is therefore reasonable to conclude that medical school preparation in musculoskeletal medicine is inadequate.

NOTE: This is a follow-up article to the study cited below, which demonstrated that medical students were inadequately trained to diagnose and treat musculoskeletal complaints. What would the headlines scream if, after 4 years, our profession had failed to improve it’s skills in musculoskeletal assessment and management? Ask your self, why should medicine be shown more slack than we are???


The Adequacy of Medical School Education in Musculoskeletal Medicine
Journal of Bone and Joint Surgery 1998 (Oct); 80-A (10): 1421–1427
This is the original article, which found that 82 per cent of medical school graduates failed a valid musculoskeletal competency examination. They concluded that “we therefore believe that medical school preparation in musculoskeletal medicine is inadequate” and that medical students were inadequately trained to diagnose and treat musculoskeletal complaints.

Educating Medical Students About Musculoskeletal Problems: Are Community Needs Reflected in the Curricula of Canadian Medical Schools?
Journal of Bone and Joint Surgery 2001 (Sept); 83-A (9): 1317–1320
Musculoskeletal problems are a common reason why patients present for medical treatment. The purpose of the present study was to review the curricula of Canadian medical schools to determine whether they prepare their students for the demands of practice with respect to musculoskeletal problems. The curriculum analysis revealed that, on the average, medical schools in Canada devoted 2.26% (range, 0.61% to 4.81%) of their curriculum time to musculoskeletal education. Our literature review and survey of local family physicians revealed that between 13.7% and 27.8% of North American patients presenting to a primary care physician have a chief symptom that is directly related to the musculoskeletal system. (So they conclude:) There is a marked discrepancy between the musculoskeletal knowledge and skill requirements of a primary care physician and the time devoted to musculoskeletal education in Canadian medical schools.

A Comparison of Chiropractic Student Knowledge Versus Medical Residents
Proceedings of the World Federation of Chiropractic Congress 2001 Pgs. 255
A previously published knowledge questionnaire designed by chief orthopedic residents was given to a Chiropractic student group for comparison to the results of the medical resident group. Based on the marking scale determined by the chief residents, the Chiropractic group (n = 51) showed statistically significant higher average grade than the orthopedic residents. Expressed in other terms, 70% of chiropractic students passed the knowledge questionnaire, compared to an 80% failure rate for the residents.

WE need to relect on the differences between these 2 groups. The medical students had already graduated from medical school, received their MDs, had done their hospital rotations, and finally had been admitted to an orthopedic residency program (the “pinnacle” of medical training?), while the chiropractic students were still completing their chiropractic studies. 70% passes vs. 80% failed. Who would YOU rather see?

Musculoskeletal Knowledge: How Do You Stack Up?
Physician and Sportsmedicine 2002; 30 (8) August
One of every 4 or 5 primary care visits is for a musculoskeletal problem. Yet undergraduate and graduate training for this burden of illness continues to constitute typically less than 3% of the medical curriculum. This is an area of clear concern, but also one in which sports medicine practitioners can assume leadership.

Musculoskeletal Curricula in Medical Education
Physician and Sportsmedicine 2004 (Nov); 32 (11)
It’s 8:00 pm on a Monday night. Just as you’re getting ready to put your 5-year-old son to bed, he falls from a chair, landing on his wrist. It quickly swells, requiring a visit to a nearby urgent care clinic. At the clinic, a pleasant young resident takes a history, performs a physical exam, and orders an x-ray to evaluate the injury. You are told that nothing is broken, and a wrist splint is placed. The following day, however, you receive a phone call from the clinic informing you that upon further review of the radiographs, a fracture was detected, and your son will need a cast for definitive treatment. This scenario, while fictitious, is not unusual. According to some studies, up to 10% of wrist fractures are missed at the initial evaluation.[ 1 ] While pediatric fractures are often difficult to detect, this example highlights a problem that continues to plague medical education: inadequate instruction in musculoskeletal medicine in both medical school and residency training.

Adequacy of Education in Musculoskeletal Medicine
J Bone Joint Surg Am 2005 (Feb);87 (2): 310–314
In this study, 334 medical students, residents and staff physicians, specializing in various fields of medicine, were asked to take a basic cognitive examination consisting of 25 short-answer questions – the same type of test administered in the original JBJS 1998 study. The average score among medical doctors, students and residents who took the exam in 2005 was 2.7 points lower than those who took the exam in 1998. Just over half of the staff physicians (52%) scored a passing grade or higher on the 2005 exam. Only 21% of the residents registered a passing grade, and only 3% of the medical students passed the exam. Overall, Seventy-nine percent of the participants failed the basic musculoskeletal cognitive examination.

More Evidence of Educational Inadequacies in Musculoskeletal Medicine
Clin Orthop Relat Res 2005 (Aug); (437): 251–259
A modified version of an exam used to assess the competency of incoming interns at the University of Pennsylvania was used to assess the competency of medical students during various stages of their training at the University of Washington. Despite generally improved levels of competency with each year at medical school, less than 50% of fourth-year students showed competency. These results suggested that the curricular approach toward teaching musculoskeletal medicine at this medical school was insufficient and that competency increased when learning was reinforced during the clinical years.

Why is the Bone and Joint Decade Important?
Welcome to the United States Bone and Joint Decade

The Bone and Joint Decade initiative is a global campaign to improve quality of life for people with musculoskeletal conditions and to advance understanding and treatment of these conditions through research, prevention, and education. [ 1 ] The Decade aims to raise the awareness of the increasing societal impact of musculoskeletal injuries and disorders; empower patients to participate in decisions about their care; increase funding for prevention activities and research; and promote cost-effective prevention and treatment of musculoskeletal injuries and disorders.

Dr. Tripp Stover, D.C.


Dr. Stover grew up in Richmond. He has been married to his wife Andrea since 2000 and they make their home in Mechanicsville with their children, Avery and Garnett.

Dr. Tripp Stover, D.C.

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