We all know that most people with lumbar pain see their family doctors first. From there, they usually get referred directly to an orthopedic group or physical therapy. Many MDs don't even know DCs in their area. I have heard patients say, "My doctor said it was OK to go to a chiropractor, but when I asked whom I should see, they didn't have a name." That is the perfect time to reach out and also send them some patients.

It is our job to connect with these doctors and the best way is by sending them the patients we cannot help. Then follow up by calling the doctor and asking about the patient you sent. Many patients are unhappy with their family doctor. That is the perfect time to send them to one of your doctors. I do the same with family doctors. I also mention if they change to a doctor I recommend, it is much easier to get what we need such as diagnostic studies, medications, etc. Given capitated plans and other limitations, this can be vital in providing proper care. Also, in the event of an emergency, I can usually get to their doctor even if they cannot.

Call orthopedic groups in your area and ask if they have any primary care sports medicine doctors. If they do, call that doctor and ask if you can refer patients to them. Tell them you frequently get patients who need their care and are beyond our scope of practice at this time. Athletes and even the average patient benefit greatly from the combination of care. Cortisone injections, prolotherapy, PRP and other medical treatments are very effective and can greatly assist in a faster return to activity.

If timing is important, then both methods of care should be used. Even if the patient is not a highly paid athlete, timing can be as, or more, important. Professional athletes normally do not have pressing financial needs. A self-employed general contractor trying to feed his family, who does not get paid if he does not work, is even more pressed for time.

I always offer a holistic approach first. However, if a cortisone injection or other commonly used medical treatment, along with my care, will get someone back a month faster, then the patient should be aware and the treatment should at least be offered. Most patients will choose to forego aggressive medical care. That is why they are in your office in the first place, but all patients appreciate a definitive treatment plan with options open to their preference.

Heading for Home

After you calm patients' symptoms, you must recommend rehabilitation and strengthening exercises. Strengthening is vital to proper recovery. I tell all my patients that if they do the exercises we show them and get stronger, they will not need us. When they are released, one of three scenarios usually occurs: They do their exercises for a while, slack off, flare up and come back; they feel great, overtrain, get injured again, and return to you for treatment of another injury; or they do their exercises, feel great and refer everyone and their brother to your practice.

If you send a number of patients to a certain medical doctor and do not get referrals back, stop referring and start sending to another doctor. I have even called doctors and said it is a two-way street, and I need to see work coming from them as well. Continue to do this until you start to see regular referrals.

Other medical doctors who have become very valuable to my practice are pain-control specialists. Typically, they are either physiatrists or anesthesiologists. They are usually the last resort prior to surgery, or at least many patients think that is the case. In reality, many of their patients have been treated with standard medicine and physical therapy. Or they have only received chiropractic care without proper rehabilitation. Many of these patients do very well with the combination of care. It is basically impossible to have someone do their rehab elsewhere, due to time and financial constraints, so in-office therapeutic exercise is very valuable. The benefit of a chiropractic office is we can change treatment protocols daily if necessary. If a patient is in a lot of pain we'll do more passive modalities, active release, and less therapeutic exercise. I use this same basic approach with just about any type of doctor and have been able to develop relationships with some of the best doctors in the country, from the Hospital for Special Surgery to the Mayo Clinic.

Michael J. Tancredi is the team chiropractor for the Philadelphia Phillies, the Philadelphia Eagles and Villanova University's athletic department. He was the first chiropractor formally hired by a NFL team.