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Primary Spine Practitioner

 Primary Care Physicians also referred to PSP, Spine Care Clinician or Spine Care Specialist are health care provider who is specifically trained in the differential diagnosis and, the management of musculoskeletal complaints. They and are likely to be the best provider to diagnose and treat spine-related disorders (SRD). 


Runners Taking Off

History of Primary Spine Practitioner

Neurologist Scott Haldeman first presented the concept of a spine care clinician or practitioner in an editorial in The Spine Journal in 2001.[5] The PSP role includes all clinical specialties that treat patients with spinal disease. The American Back Society Annual Convention in San Francisco emphasized this concept in November 2005.[6] At that time, none of the current clinical disciplines were adequately trained. They didn't have the skill to care for people with spinal disorders and offer treatment consistent with current evidence-based guidelines. The role of a Primary Spine Care Specialist is to function as a primary contact provider for patients with Spinal related disorders (SRD). PSP is responsible for identifying the minority of patients who do require further diagnostic evaluation such as (x-ray, MRI, CT, and EMGs) or specialized intervention such as injections or surgery and appropriately referring these patients out to the best provider in the community.


Based on Dr. Haldeman's research, over 200 treatment approaches are available for patients with spine-related disorders. No clinicians have the knowledge, time skills, or ability to guide patients through these complex treatment options. Similar findings were presented in the  British Medical Journal by Hartvigsen et al. He indicated that the general medical practitioner is not adequately equipped to deal with the complexities of musculoskeletal disorders and suggested that the solution to this problem would be the development of a primary musculoskeletal specialist.[8] Hartvigsen et al. suggested that chiropractorsphysical therapists, or osteopathic physicians could serve this purpose with specific changes in education, clinical practice, and licensure of these professions.

The PSP has the training necessary to provide differential diagnosis, rule out serious pathology (such as infection, fracture, cancer, inflammatory joint disease), and provide evidence-based management for most patients with spinal disease.

 Evidence-based treatment methods include spinal manipulation and manual therapy, rehabilitative exercises, patient education, motivational techniques, and the application of psychological principles, particularly cognitive-behavioral therapy and acceptance and commitment therapy.[2][3] In addition, the PSP can recognize the few patients who may require special tests (radiographyMRI, laboratory workup) and other invasive procedures (injections, surgery) and serve as the center of care to provide counseling for the patient, coordination of care, and long term follow up.[1][2] An essential aspect of this role is educating the patient on the risks, benefits, and research evidence of all treatments for spinal pain so that, through a shared decision-making process,[4]  appropriate choices are provided as to what is the best treatment for the patient.

In addition, the PSP helps patients navigating the often complex health care systems, particularly for patients whose spinal disorders arose from a work-related incident or personal injury.

Primary Spine Care (physician, chiropractor, nurse practitioner, physical therapist) is responsible for the followings:

 initial diagnosis


prioritizing people for treatment accordingly

February2020,Dr.Gilak has completed 120 hours of instruction and obtained the certification from the University of Pittsburgh. she became the first certified Primary Spine Provider (PSP) in Orange County, California. 

This training has only enhanced our already excellent form of hands-on musculoskeletal care and benefits patients in the following ways: 

  • To Provide targeted evidence-based care which focuses on educating the patient about preventative measures. 

  • If necessary, we refer the patient to an appropriate provider. This care will maximize outcomes and lead to faster recovery. 

  • Educating patients to remain active will lead to increased productivity. "You don't get better to go back to work. You go back to work to get better!"

  • , early detection and intervention to make the appropriate referral, In case of psychosocial factors.

  • Educating, motivating, and empowering patients via cost-effective active care plans result in high patient satisfaction 

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