Spine care in the US has been mired in a crisis of rapidly rising costs with rapidly declining outcomes for patients. Disability related to spine-related diseases (SRDs) is on the rise, costs of medical care for SRDs have skyrocketed in recent years, and despite rising costs there is no evidence of improvement in the quality of care. Across the medical community, many believe that one of the key solutions is for the health care system to have a group of practitioners who are trained to function as primary care practitioners for the spine. To this end, The University of Pittsburg’s Physical Therapy Department has created a trailblazing Primary Spine Practitioner (PSP) program, for which our very own Dr. Shireesh is an adjunct Professor (virtually!). What exactly is a Primary Spine Practitioner, and how does it differ from a Physical Therapist or Chiropractor? Let’s ask our man on the inside!

Question: What is a Primary Spine Practitioner?

Dr. Shireesh: The Primary Spine Practitioner Certification through the University of Pittsburg PT school better positions chiropractors and physical therapists to work in integrative healthcare settings acting as a spine specialist. The only people in the program are all PTs, Chiros, D.O.s (Osteopaths) and M.D.s with minimum requirements for clinical experience and experience with advanced rehabilitation of the spine. This is a 64-hour post-grad hybrid (thanks to COVID) training program. I teach Evidence-Based Practice as an adjust faculty member.

So, what is the point? A PSP will be positioned to achieve the goals of the Triple Aim of Healthcare: improved patient health, improved patient experience, and decreased per capita costs.

Question: How does a PSP differ from a Chiropractor, Physician, or Physical Therapist?

Dr. Shireesh: Chiropractors don’t necessarily specialize in the spine, they need advanced training to manage complicated spinal situations. And there’s a need globally to reduce spinal disorder prevalence. A PSP will know when to order imaging and special tests, how to perform orthopedic evaluations, and understand the current best-available clinical care guidelines and how to implement them. Primary Spine Practitioners are able to accurately diagnose and classify patients with spine-related symptoms. In the U. Pitt program, they’re learning treatment-based classification: once diagnosed, patients are classified according to what treatment they’d respond best to.

Question: What kinds of treatment might a PSP provide?

Dr. Shireesh: There are different classifications for treatment such as Symptom Modulation, which is used in the early phase of injury or acute conditions; Movement Control, which is one of the most common treatments along with Symptom Modulation. A Primary Spine Practitioner will refer the patients as necessary, and appropriately. In the PSP program there’s an emphasis on directional preference, mobilization, and manipulation.

Question: Who would benefit from having a Primary Spine Practitioner?

Dr. Shireesh: The biggest benefit of the PSP program is that it’s creating collaborative bridge between different professions, getting on the same page, getting the same training. So we’re broadening the network globally to produce better outcomes for patients. There’s a need in healthcare because Primary Medical Care admits they don’t know what to do with these kinds of patients. We need specialists, rather than pain meds or generic physical therapy.