Barry Coulter
One of the country’s most renowned back doctors and the creator of a revolutionary, yet simple, approach to treating back pain was in Cranbrook recently, giving a series of workshops to health practitioners from around the Kootenays.
CBI Health Centre Cranbrook brought in Dr. Hamilton Hall at the Prestige Rocky Mountain Resort to conduct workshops on the treatment and management of back pain. In 1974 Dr. Hall founded the Canadian Back Institute (CBI Health Group), now the largest rehabilitation company in Canada. Dr. Hall continues to serve as its Medical Director. CBI Health Centres have locations in Cranbrook and Kimberley.
Dr. Hall has also written several groundbreaking books on backpain, and the approach he pioneered has been adopted by jurisdictions like the provinces of Saskatchewan and Ontario.
Dr. Hamilton Hall
“When you think about it, what the spine does is amazing,” Dr. Hall said, in an interview with the Townsman following the workshops on Oct. 22. “We take it for granted that it does everything it does. It’s an amazing structure, but the concepts are simple.
“There’s been talk for years how we were designed to run on four legs, and we get back pain because we stand on our hind legs. It’s not true. Animals have back pain — dogs are notorious for having back pain. Our spine is perfectly built for what we do. The problem now becomes, the spine was built for an active animal, running on its hind legs, climbing trees, picking fruit … now we’ve taken that active spine and stuck it in a chair all day long, never letting it move, taking all the accompanying muscle control which is necessary to balance it, and louse it up with too much food.
“The spine is putting up with an enormous amount of misuse when we could be treating it better.”
But back pain is more than common — it’s normal.
“Back pain is not a disease, it is a human condition,” Dr. Hall said. “In the course of a lifetime, in Canada, better than 80 per cent of us will experience back pain. It’s the 20 per cent that never have it that are the weird people. So why are we turning it into an illness? It’s natural.
“And so the approach to it should be just as positive, just as natural, and simple. And that is what this whole approach does.”
The system CBI Health Group uses rests on a premise that the best person to treat the problem is the patient. Dr. Hall said that over the past 40 years what this approach has done is recognize that all back pain sufferers are not alike, that back pain is not a specific complaint. Some people’s back pain is very different from others, and so treating them in the same way doesn’t work. And recognizing that the exact source of the pain, is surprisingly not important, “unless you are prepared to have an operation, which is necessary in less than five per cent of everybody with back pain.”
Dr. Hall’s approach classifies back pain here into four basic categories:
One is which your pain is worse when you bend forward or sit. One in which your pain is actually better when you bend forward or sit. And then there are two other patterns in which your leg pain is actually worse than your back pain.
“So those four categories with approporiate subdivisions and specificity, is what we teach,” Dr. Hall said. “So if I recognize your pattern, I have a list of things I can try for that particular pattern, and I don’t have to worry about taking an MRI or an X-ray, because those aren’t going to change anything. What’s going to change is how do you respond to my treatment.
“So in an ideal world, I recognize your pattern. I give you an appropriate set of activities and exercises, you respond positively, you get rid of your pain, and we both go home happy. If you don’t respond, if I recognize a pattern and my treatment doesn’t work the way it should, they are the people who need to be assessed
The approach thus takes the “vast majority who respond quite predictably and says ‘okay, they’re done.’ And they’re not cluttering up the system. And the few who have not responded, they are the ones who warrant further investigation.”
In spite of its simplicity, there considerable resistance to thesystem over the years, Dr. Hall said.
“There’s pushback from people who want it to be complex, who believe it’s complex, and can’t honestly accept that for all these years the answers have been sitting right in front of us. That’s a hard thing to take.
“The second issue is that there’s an inherent fear of missing something awful — what if the patient had cancer? — which is a reasonable concern. But the way this system is devised, the way questions are built and the whole approach is taken, that focus is on those issues, so that in fact using the system properly eliminates the risk of missing something. The patients who don’t respond as predicted immediately become a source of concern.
“The third area, sadly, is just turf. That’s just human nature. I’m taking it away from people who offer you cures through manipulation, cures through magic chairs, cures with in-soles — sorry, none of those things have a place.
“I’m not proposing an alternative sort of magic, I’m just saying look, understand, you’re the patient, you should understand what’s going on, you should make the call. I’m offering something easy, do-it-yourself, or you can go next door and have an expensive therapy which is not guaranteed to do anything.”
“We were about 40 years ahead of our time,” Dr. Hall said. “At the time, the concept of treating the symptom was not accepted in the medical profession. MRI and CT were fairly new. Now, 40 years later, it’s obvious MRCT has not solved the problem. Now other groups are saying let’s go back to treating the patient, and we were already here.”
At the same time, there has been widespread interest in the concept in the medical community at large, as evidenced by the attendance at the two workshops, Friday and Saturday, Oct. 21 and 22. “The group was very interested, very interactive,” Dr. Hall said. “I was pleased with the response we got, because its a message that can either be well accepted by the family doctors or it can be rejected because it’s on the surface a little too simplistic. Everyone thinks backs are complicated. Everybody wants it to be challenging, which in many ways it is. But the approach is remarkably straightforward. If the family physicians use it, it changes the way they deal with their patients, which is the whole purpose.
“I thought the response I got was excellent. They were very interested and seemed quite willing to change the way they do things.”
Floyde Spencer, who operates CBI Health Centre in Cranbrook and who helped organized the workshops, said of the two groups, Friday was geared towards physicians, and Saturday provided more of a more of a multidisciplinary education, to physicians, physiotherapists, chiropractors, and kinesiologists. “We had some instruction from Worksafe BC on factors that get you back to work,” Spencer said. “Returning to work is good medicine.
“We serve this whole region,” Spencer said of CBI Heath Centre. “Injured workers from the whole region come through our centre, and we’re the final stage in their recovery. “We’re preparing them to go back to the workforce.”
The Canadian Back Institute started as a patient education program in 1974. Dr. Hall said that as it became apparent that patients needed mentors and monitors, the treatment program developed alongside the education program. “We are still very focused on getting patients to understand their problem, giving them advice, giving them the treatment they need, but making sure they are active participants.”
Dr. Hall has written four books and back pain, its management and treatment. “All were written for the public,” Dr. Hall said. “Professionals read them, but they’re written for the layperson. There’s nothing here that you can’t understand.”
CBI Health Centre is located at 28-11 Avenue South in Cranbrook, and 260-4 Avenue in Kimberley. For more information, go to www.cbi.ca.