001- Research in Support of Maintained Chiropractic Care

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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. Every week we're going to touch on the latest in chiropractic research as well as marketing tips to help grow and develop your practice. All of this in the time it takes to get to your office on our first episode today we're going to look at an extremely important and sometimes controversial piece of research that was released by spine journal in 2011. It's titled Does Maintained Spinal Manipulative Therapy for Chronic Non Specific Low Back Pain Result in Better Long Term Outcomes? Essentially, they were looking at maintenance chiropractic care and whether it provides benefit for those patients. As we know, chronic non specific low back pain is a condition which affects over 80% of the population. Unfortunately, limited success has been found with traditional treatments such as medication and rest. We see patients in our practices each and every day who have gone through the wringer as far as NSAIDs and various medications and not yielded the outcomes that they're looking for. This esteemed study from Spine indicates that not only does chiropractic adjustments significantly decrease both pain and disability scores in the short term, but it may help in the prevention of future episodes. This is extremely important research. In it, there's they found non specific low back pain represents 85% of low back pain patients seen in primary care. About 10% will go on to develop chronic disabling low back pain. Again, 85% of low back pain seen in primary care is nonspecific low back pain. The research fully supports chiropractic care for these patients. They're also finding that roughly 10% will go on to develop chronic disabling low back pain. We all know that chronic low back pain and pain in general is much more difficult to reduce than acute or subacute pain. The researchers also found the postulated modes of action of spinal manipulative therapy, AKA adjustments include disruption of articular adhesions, improvement of trunk mobility, relaxation of hypertonic muscles by sudden stretching, release of entrapped synovial folds or plica, attenuation of the alpha motor neuron activity and enhancement of proprioceptive behavior as well as release of beta endorphins. In short, they're talking about the gapping of the facet joints during a chiropractic adjustment. The fact that increased range of motion is gained the activity with the central and peripheral nervous system in terms of the release of endorphins as well as the stretch response including the alpha motor neuron activity, these researchers also found. This study confirms previous reports showing spinal manipulation is an effective modality in chronic non specific low back pain, especially for the short term effects. Most importantly, they found as patients did benefit from the maintenance treatments, we believe that periodic patient visits permit proper evaluation, detection and early treatment of any emerging problem, thus preventing future episodes of low back pain. That last statement is perhaps the most important part of this research. In it Spine Journal is fully supporting the evaluation and periodic visits of patients to chiropractors and they do find that chiropractors are able to evaluate and treat and perhaps even proactively prevent future episodes of low back pain. While us as chiropractors certainly have more to offer than simply the treatment of spine related complaints, this is an important first step in terms of highest quality peer reviewed research supporting what we do over the long term. Of course this is not going to change or affect what an insurance company reimburses for that care, but certainly it gives credence to the fact that we are able to help patients in a long term capacity if they follow a care plan which is appropriate for themselves. Additionally, when speaking with primary care providers or other spine specialists, this piece of research is something that we can refer to, it's something we can look back on and it's something that certainly we can give to and inform our referral providers in our local areas. It's not to say that every individual person is going to necessarily have a long term treatment plan, but after that acute or subacute phase, it certainly gives again credence for the fact that long term care or at least periodic visits to a chiropractor provide significant value for patients across the board. As a matter of fact, here at the Evidence Based Chiropractor, we actually used this piece of research as our October 2013 MD research brief. If you've been following the evidence based chiropractor, you probably are familiar with what I always refer to as the three big hindrances to chiropractic referrals. When I speak of that, I mean referrals from primary care or internal medicine physicians predominantly. One of those three big hindrances in my opinion is the fear of long term treatment plans or never ending care plans from providers who don't understand how we do things or consequently why we make the recommendations that we do. In my opinion. Again, a referred patient that comes over from a primary care provider, I believe it's extremely important to treat that patient in the best capacity possible and make sure that you set short term goals and that you additionally set long term goals. During that process. You may have and should have reevaluation checkpoints, but moving forward from there, research such as this provides the foundation for periodic visits over time, especially when we think of patients that have all already progressed to a long term chronic complaint. These patients, certainly we see them every day in our practices, benefit from a chiropractic adjustment, there is no doubt about that. May they ever get back to 100% function? Perhaps not, but we see that the wellness Care, AKA maintenance care, provides them with the ability to move forward and stay consistent with their activities of daily living. Most physicians, almost every physician, truly does understand the importance of it, but this piece of research frames it in a way which is actionable and certainly again, when coming from Spine Journal, it truly gives a backbone for the how and the why we do what we do for the documentation needs of patients regardless of whether they're acute, sub acute or maintenance wellness patients. I would strongly recommend looking into the work of John de Villa at Custom Cairo Solutions. I saw him at a continuing education event just a week or two ago and it was absolutely fantastic. The content that he has and the knowledge he has regarding documentation is unsurpassed in chiropractic. Additionally, I would encourage you please download the chiropractic forms we have@the evidencebasedchiropractor.com ChiropracticOfficeForms this used to be product that was a few hundred dollars. I'm now offering it for free with an implementation guide. I talked to way too many chiropractors who have had too many billing issues, too many issues regarding getting paid for their work and it's all about documentation. John de Villa is absolutely the cream of the crop regarding chiropractic documentation. But here at the Evidence Based Chiropractor we've created a form set which is based on the AAOS guidelines as far as evaluation and management is concerned that is available for free at the evidencebasedchiropractor.com chiropracticofficeforms in closing on our first episode for the Evidence Based Chiropractor podcast, I'd like to thank you for taking the time to listen. Please comment like share our podcast with your colleagues each and every week. We'll be back providing you with actionable content to grow and develop your practice. It's an exciting time to be a chiropractor. We're excited to be involved. We touch chiropractors on four continents all around the world and 2016 is going to be a fantastic year for chiropractic. Thank you and I'll talk to you next week.

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