Years of research and clinical trials have yielded the DMR Method, an innovative technique for treating back pain.
Having treated chronic and acute back pain for 25 years, Peter L’Allier, DC, Hopkins Health and Wellness Center (HHWC) Clinic Director, believed an integrated, collaborative approach that combined physical therapy with chiropractic care and physical medicine could offer an effective nonsurgical treatment option. With the mission of creating a protocol that would enhance spine care, L’Allier set out in 2006 to make the idea a reality with his HHWC team and local spine specialists.
“Our goal was to create a regimented spine care protocol that offered patients an alternative to surgery, when appropriate, so we developed a standardized evaluation that we could use to craft treatment plans that allow us to measure progress and customize treatment for each patient,” L’Allier says. “Years of research produced the Diagnose, Manage and Rehabilitate (DMR) Method, which has proven itself an excellent alternative to surgery for back pain.”
The Three Goals and Phases of the DMR Method
To decrease symptoms and improve function, HHWC clinicians tailor care plans that guide patients through a three-phase progression of treatment. They individualize the process to meet the needs of each patient — those who do not need the full, 24-visit advanced protocol may benefit from a reduced, 6-visit plan.
DMR Method treatment progresses through three distinct phases — relief, repair and rehabilitation. The process was designed to achieve three primary goals: mobility, alignment and stability. In phase one — the relief phase — clinicians educate patients about appropriate self-care, including restrictions and proper body mechanics. In this phase, practitioners use a number of techniques to create symptomatic relief. Depending on the nature of their patients’ back pain, HHWC clinicians begin a collaborative progression of care that can include Integrated Progressive Manipulation (IPM), traction, cold laser, basic stretching, and multimodal pain and inflammation strategies to assuage painful symptoms.
Physical therapists developed Dynamic Muscle Technique as part of the DMR Method treatment process
“Our physical therapists have developed a manual therapy technique called Dynamic Muscle Technique (DMT), based on knowledge gained from DMR Method research,” says Kelie Davis, HHWC physical therapist. “DMT works from superficial to deep to address the supportive soft tissue components of a patient’s condition. Simultaneously, chiropractors work collaboratively with physical therapists, providing IPM to address joint mobility issues. We discovered early on in DMR Method research that the two techniques performed in concert enhance speed and extent of improvement.”
In phase two, clinicians build upon progress made in phase one by focusing on enhancing soft tissue repair, alignment and spinal posture. The DMR Method culminates in phase three, as clinicians deploy advanced rehabilitation techniques to ensure spinal stability.
“Through DMR Method research, we discovered that optimal recovery results from a progression of care that focuses on mobility first, alignment second and stability third,” L’Allier says. “Many spine rehab programs fail because they begin the strengthening component too early in the treatment process. Timing is everything.”
The Clinical Research behind the DMR Method
Pre- and post-treatment MRIs show complete reabsorption of large disc herniation.
In 2007, to demonstrate the DMR Method’s efficacy, L’Allier and the HHWC team designed the DMR1 trial, in which they enrolled patients with herniated discs. Using MRI imaging before and after treatment and evaluating patients’ self-reports with Oswestry Disability Index, the team tracked progress. After 12 weeks of nonsurgical DMR Method treatments, 96.4 percent of trial participants demonstrated at least a 50 percent reduction of symptoms and increased function, according to L’Allier.
“When compared to similar studies, the DMR Method treatment protocol produced similar or better results in far less time,” L’Allier says. “The findings exceeded our expectations and reinforced our belief that a multidisciplinary collaborative process of evaluation and treatment could produce excellent outcomes. Another striking observation was that 100 percent of disc herniations that were treated within eight weeks of occurrence showed reabsorption, underscoring the importance of early diagnosis and treatment. We’ve also been following up with the DMR1 trial participants for the past seven years, and long-term outcomes have been exceptional.”
The DMR Method can also benefit people with a number of spine conditions, such as chronic back or neck pain, herniated discs, numbness or pain in extremities, sciatica, spondylolisthesis, and stenosis. HHWC clinicians provide complementary consultations to determine if patients qualify for treatment using the DMR Method.
The DMR Method requires the expertise of a team of specialists, including William Mullin, MD, spine radiologist at the Center for Diagnostic Imaging.
“We collaborate on many clinical cases using MRI scans before and after treatments to evaluate results,” says Dr. Mullin, who works closely with L’Allier and the HHWC team to track patient progress. “I’m constantly impressed by our patients’ excellent outcomes.”
The collaborative approach deployed by HHWC’s board-certified physical therapists and chiropractors is a critical component of the DMR Method’s success. They work alongside referring physicians to facilitate the entire treatment process for patients.
“The DMR Method produces consistent results and is an effective alternative to spine surgery. Even when a patient has previously had spinal surgery, the DMR Method helps stabilize the spine and prevent recurrence of symptoms and additional surgery.”
— John Mullan, MD, Neurosurgical Associates Ltd.
Although the DMR Method is a nonsurgical alternative for resolving back pain, surgical insight sometimes plays a critical role in the treatment process.
“Orthopedic and neurosurgical spine specialists have provided invaluable insight for the development of the DMR Method,” L’Allier explains. “In part, what has improved outcomes is an evaluation process that helps us identify when surgical intervention or other medical management needs to be considered.”
“Their team approach with physical therapists and chiropractors collaborating with other medical specialists to get a patient well is commendable,” adds John Mullan, MD, of Neurosurgical Associates Ltd., who has worked with L’Allier and the HHWC team for eight years. “Although I am a surgeon, my first course of action with every patient is to consider all nonsurgical treatments. I appreciate how the DMR Method includes established protocols for identifying when a surgical consult might be helpful.”
The first patient who underwent treatment with the DMR Method remains pain-free after presenting with debilitating pain at initial consultation in 2007.
“The patient had an acute back condition and could barely ambulate on her own,” recalls L’Allier, who ordered an MRI that indicated a massive extruding herniation and immediately advised for a surgical consultation. “She refused surgery but agreed to begin treatment with the DMR Method on the condition that if there was no progression, she would see a surgeon.” (Please see images in left column.)
Eight weeks after beginning DMR treatment, a follow-up MRI confirmed the herniated disc was completely reabsorbed. An eight-year follow-up revealed continued symptom resolution.
Another patient referred by his physician suffered from pain radiating down his leg and foot drop – difficulty in lifting the foot.
“After evaluating my condition and determining the cause of my pain, the HHWC team designed a specific treatment plan and explained the exercises and self-care program that I needed to do on my own,” the patient says. “My pain began diminishing right away, and I was able to resume my normal activities.”
In Minnesota and Beyond
Although the HHWC team is based in the Minneapolis area, patients seeking a nonsurgical option for back pain come from all over the country to undergo DMR treatment.
A patient recently flew from Alaska, received an assessment and evaluation and met with a physical therapist before returning home. An HHWC clinician contacted the patient’s physical therapist and chiropractor in Alaska and shared the DMR protocol to begin her treatment process.
“Some of our patients have pain that was not resolved through physical therapy, chiropractic care, medical pain management or even surgery,” L’Allier says. “We explain that we may do some of the same treatments they have already received, but we are going to perform them in a specific combination and order, which is what can make all the difference. The goal of the DMR Method is to restore mobility, alignment and stability to the spine. It’s a research-based innovation designed and developed by a collaborative team of physical therapists, chiropractors and physicians.”
For more information on the DMR Method or HHWC, call 952-933-5085 or visit DMRMethod.com.