Bye-Bye Back Pain

Anuj Arenja, managing director & CEO, QI Spine Clinic, on how the group is redefining back pain management through targeted non-surgical treatment

QI Spine Clinic, Anuj Arenja, Arenja Holdings, Nithiij Arenja, DSA

QI Spine Clinic is one of the ventures of Arenja Holdings, an investment house that specialises in the promotion and incubation of greenfield healthcare ventures.  QI Spine Clinic, established in 2011 to provide advanced back pain diagnosis and treatment, has 22 clinics across four cities in India and is looking at fortifying its presence to 80 centres in the next five years.

What were the initial thoughts behind starting QI Spine Clinic in 2011? Did you think of having a chain of clinics, right at the inception?
We started working with patients with back pain in 2011 from a clinic at Churchgate in Mumbai. We did not have the branding of ‘QI Spine Clinic’ then.  Many of our patients at that centre had been advised spinal surgery for severe back pain and had come to us for a second opinion. This was exactly the plight that my brother, Nithiij,  who is the chairman and co-founder of QI Spine Clinic, had experienced when he was struggling with severe back pain and obesity. He travelled to many countries exploring a non-surgical option, and in collaboration with medical practitioners and technology innovators in Europe, he came up with a treatment that worked for his condition.
Around 80% of back pain can be treated non-surgically but there is no non-surgical consultant for back pain patients. So, after the success of our first centre in Mumbai, Nithiij and I decided to open India’s first chain of medical centres that would focus on accurate diagnosis and non- surgical treatment of back and neck pain, whether severe, moderate, acute or chronic.

How the group has evolved, over the years?
We opened our first centre in 2011 in Mumbai. Now, we have a chain of 22 centres in the cities of Mumbai, Pune, Bengaluru and Delhi. We have invested Rs 50 crore so far in clinics and on developing proprietary technologies, protocols, research institute and a training academy to ensure that we have the infrastructure needed to expand our network across India and globally. Because of our data-driven approach and our team of trained spine specialists, we are now able to scale up our business model faster.

Most of your clinics are standalone ones…
Yes, but we are exploring the option of collaborating with hospitals to start and manage spine clinics with the hospital as a partner in the venture. We have received encouraging response from hospitals and might announce ventures with a few of them.

What’s the prevalence of back pain in India and how the treatment has evolved?
More than 85% of the world’s population experiences back pain at some time during their lifetime. In India, 50 – 80% of us suffer at least one episode of back pain in our lifetime. Around 85% of back pain is caused due to mechanical issues in the spine.
The global point prevalence of low back pain (LBP) is 9.4%. and it has emerged as the biggest cause of global disability in a study based on data of ill health and disability arising from all health conditions. Yet, the diagnosis and treatment of back pain is under developed..

When we had started the first clinic, treatment of back pain and spine was non-specific and is still not being treated in a holistic way. According to a report published in 2017 by QI Spine Clinic, back or neck pain patients neglect their pain or try other approaches that give temporary relief and the pain usually returns. The rate of negligence at 45% is quite high. Most patients pop pain killers to get temporary relief from back pain but the pain returns as the root cause of the pain is not addressed. There is a growing global consensus among the world’s most respected spine institutes such as Harvard Medical School, Stanford Medicine that less than 5 % of severe back pain cases actually need surgery. But surgery unfortunately is still recommended in many cases where conservative treatment would have worked.

Global medical guidelines recommend a physiotherapist’s consent is required before a patient undergoes spine surgery. In India, such protocols are yet to be laid out and followed. A few patients try physiotherapy but the pain keeps returning and they discontinue it eventually.

The latest clinical guidelines set out by European and American medical associations recommend spine rehabilitation as an effective treatment method for chronic back and  neck problems. The concept of diagnosing the root cause and making the patient go through spine rehabilitation programme is not prevalent in India.

What has been the contribution of QI  Spine Clinic in back and neck pain management?
  We have collaborated with leading orthopaedic surgeons and institutions in India and globally to validate that non-surgical treatment through accurate diagnosis, pain management, targeted mechanical and medical treatment of the affected area and functional recovery is the right approach in 95% of spine-related illnesses.

Medicos have now accepted that the cure to back and neck pain lies in muscular recovery and regeneration. Every spine specialist at QI can access ring-fenced, impersonal insights from over 1,00,000, varied and challenging back pain cases treated by the team.
The QI Spine programme is a proprietary, technology enabled spine rehabilitation programme that employs a data driven approach combining custom built software, predictive analytics, devices and services to deliver superior patient outcomes and patient efficiency.
Our medical team of spine specialists undergo a one-year fellowship in orthopaedics and rehabilitation to recognise and treat over 100 different types of back pain. The course is devised by a senior team of doctors including orthopaedic surgeons. QI Spine Clinic today has a success record of 91% in treating even the most severe conditions. Our Net Promoter Score is above 80%, and that is much higher than the industry standards.

Where surgery is indicated, we collaborate with leading surgeons for surgical treatment and for post surgical rehabilitation.
Also, I would like to add that QI Spine Clinic was the first chain of medical centres in India to introduce a motion analysis based functional diagnostic test (DSA) that clearly identifies weak muscles in the spine. And our new Isolation Technology gives the doctor live bio-feedback, so that the diagnosis is precise and hence the treatment can be targeted.

How different is the treatment of back and neck pain in ‘QI Spine Clinic’ from what is being offered in the market?
While most specialists focus on the structure of the spine for back pain patients, we look at the structure and the function of the spine. As stated earlier, we focus on the non-surgical treatment through accurate diagnosis, pain management, targeted treatment of the affected area and functional recovery through muscular regeneration. The patient usually takes two to three weeks to a few months to fully recover, depending on the severity of the pain.

The successful treatment outcomes we have achieved over the last eight years, is thanks to accurate diagnosis of the root cause of back and neck pain. QI Spine Clinic’s medical treatment protocols have ensured non-surgical recovery in 95% of back pain cases.

Please elaborate on your approach to back and neck pain treatment.
We adopt a four-step approach. The first step is pain management using cell repair technology, or frequency specific microcurrent (FSM), that uses extremely low frequency of electric current to treat the root cause of pain by aiding tissue repair at a cellular level. FSM therapy has been proven to enhance the healing process in damaged soft tissue and  reduces inflammation. It is a safer, more effective way to reduce pain and has no long-term side effects compared to most painkillers.

Step two is accurate diagnosis through Digital Spine Analysis (DSA). Before back and neck pain can be treated, it needs to be diagnosed correctly. Identifying and isolating the root cause of the pain is essential to restoring the mobility and function.
A DSA test is used to measure spine function in the same way that a cardiac stress test is used to diagnose cardiac function. Unlike an MRI or X-ray test that can only provide a visual static snapshot image, the DSA test determines the ability of the muscle tissue to support the spine during various movements.

Step three is targeted treatment through isolation technology. The isolation technology is able to isolate the weak area and precisely target weak tissues. This results in focused treatment and hence the regeneration of muscle tissue is faster. With conventional physiotherapy, the spine is forced to carry our entire body weight even when it may be too weak.
We believe that one session of isolation treatment is more effective than three sessions of conventional physiotherapy.
And step four is recurrence management. Back pain can reoccur in patients even after successful treatment if proper prevention plan isn’t followed. It is therefore important to prevent the pain from returning after restoring spine function. QI Spine Recurrence Management programme is designed to help patients take care of their spine in the future and manage any bouts of pain with success.

What is the business model for new centres?
We invest around Rs one crore per centre, which includes investment in technology, infrastructure as well as manpower. Our clinics spans approximately 1,500 feet. We have our own research institute and training academy for imparting training to spine specialists.

How do you see treatment of back pain evolve a few years down the line?
With awareness and right treatment, people with back and neck pain should be able to lead a normal life and continue doing all physical activities that they pursued before the pain disrupted these activities. The insurance companies should back and encourage non-surgical treatment of back and neck pain, as the surgical options runs into lakhs but do not address the root cause.

What is the road ahead for the group?
We plan to expand to 80-90 clinics in the next five years within India. We are also keen on making our prescence in other countries. We will start in the US soon. We are looking at foraying into the Middle East as well.
Through Arenja Holdings, we have made investments in healthcare ventures which varies from clinics,  fitnesss services & Metabolic Health (Melt.Health), health and fitness equipment (Trinity Healthtech), and  specialised care for chronic diseases.  We will focus on strengthening our presence in all these ventures.

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