007- Comparing 2 Types of Chiropractic Care

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Happy New Year and welcome to the Evidence Based Chiropractor. I am your host, Dr. Jeff Langmaid. I hope you had an opportunity to recharge your batteries and get excited for 2016. Certainly here at the Evidence Based Chiropractor we are absolutely looking forward to 2016. We're going to put out some great content and we're going to continue to be your weekly resource for research and marketing as far as chiropractic practice is concerned. Today we're going to touch on a wonderful study that was produced by JMPT in June of 2009. It is titled A randomized controlled trial comparing two types of spinal Manipulation and Minimal Conservative Medical care for adults 55 years and older with Subacute or Chronic Low Back Pain. One thing that really strikes me about this journal article is that it is a true randomized controlled trial. So that's the top tier of research. That's the gold standard and what everybody is looking for in terms of again the gold standard of research. Additionally, they look at two types of spinal manipulation so they're going to look at high velocity and low velocity chiropractic care and or spinal manipulation. So it breaks that down in a little bit more detail and pits both of them against conservative medical care. So this study has a lot of action going on and it's something that every chiropractor certainly should know about to be able to use for patient education, for confidence building and for communication in their practice. But before we go too far, I'd like to say a few words about Rocktape. Rocktape is proud to be a sponsor of the evidence based Chiropractor. Rocktape offers the world's best kinesiology tape, pain relief topicals, mobility tools and functional fitness accessories. New from Rocktape is Rocksauce Chill. It's a powerfully cool pain relief topical in a convenient roll on and with 6% menthol, it's stronger than any of the quote unquote freeze competition. Rock Tape is more than just a tape company, they are a movement company. Learn more and get access to your medical discount by visiting rocktape.com on an aside, I had the opportunity in 2015 to speak at a few events where there some of Rocktape's chiropractic medical personnel were also speaking. And I'll tell you what, they put on an absolute fantastic program. I'm looking forward to doing more with them in 2016. And if you're a chiropractor out there, I'm sure that they'll be visiting York local continuing education programs. So keep an eye out for when you see them on the schedule. It's always going to be an event that's packed and it's going to be an event that really gives a lot of good, high quality content. So without further ado, let's dive right into the research again. This was a piece that was released by JMPT in June of 2009. I'll repeat the title again. A randomized controlled trial comparing two types of spinal manipulation and minimal conservative medical care for adults 55 years and older with subacute or chronic low back pain here in the United States and certainly really when you look worldwide, there's truly an aging population going on. And with an aging population, there's a lot of health challenges that that come with that. And certainly I don't think there's too much that creates higher economic costs or disability than any sort of low back pain. Here at the evidence based chiropractor, we're always looking towards interdisciplinary care. And in my opinion, the care, interdisciplinary care of these patients, meaning the aging population, seniors, is absolutely paramount to reducing the economic burden and also improving the quality of life, improving the functional capacity of really all of us as we continue to age. The study that we're talking about today is again, it's unique. It examines both high velocity and low velocity manipulative techniques or chiropractic techniques. It compares them to each other and then to standard medical care. Surprisingly, there was little difference in the functional outcomes between the chiropractic techniques, but both yielded superior outcomes to standard medical care. I'll repeat that again. There was very little difference in the functional outcomes. Again, notice I'm not saying reduction in pain, I'm saying improved function functional outcomes. Very little difference between the high velocity chiropractic group and the low velocity chiropractic group. Although both of the chiropractic groups or manipulation groups yielded superior outcomes to the standard medical care. Let's take a look at a few direct quotes from this study. The researchers found participants who received either form of spinal manipulation were approximately 30 to 40% better on the average in functional status than those who received minimal conservative medical care. They also found both manipulative procedures were associated with clinically important changes in functional status by the end of treatment. Finally, they found spinal manipulation had improvements on average in functional status ranging from 1 to 2.2 over those who received minimal conservative medical care. So let's dive into that a little bit more. One of the functional outcomes or certainly one of the main criteria they were looking at is a Roland Morris disability scale. And they really looked at patients from zero week, when treatment began, three weeks, six week, 12 week and 24 weeks. So they were looking up to about six months after the initial start of care. So that's a little bit. It certainly is not a study that just took place over the course of one to two weeks. This was following patients for up to six months. And with that at the conclusion, again, they found clinically important changes in functional status. I'll repeat that again, they found clinically important changes in functional status. So that actually means in a clinical setting, the results of the patients that received chiropractic care, AKA spinal manipulation, whether it was high velocity or of low velocity, had clinically important changes at that six month marker. And again, one of the quotes that I brought up when we first started talking was participants who received either form of chiropractic or spinal manipulation were approximately 30, 30 to 40% better on average in functional status than those who received minimal conservative medical care. So 30 to 40% better is to me extremely significant. Especially when patients are coming in hurting, they're coming in in pain, they're coming in with functional deficits. And to improve that 30 to 40% more than if they hadn't come into your office is a big time game changer in terms of that patient in that person's life and their ability to have quality of life, have happiness and be able to do the things that they want to do. The other thing that this study I think is very unique in is again, it looked at high velocity and low velocity chiropractic care or chiropractic manipulation. There's a lot of debate within chiropractic as far as technique, and often some technique gurus will say their technique has better outcomes than this technique. Certainly I think having well rounded technique choices is important. One of the things that I speak with to the members of the air and space chiropractor is promoting the fact that you have more than one thing on your palate. If you do, if you have the availability and you have the knowledge and you do perform high velocity and low velocity techniques, it's extremely important when you're speaking with other care providers to let them know that you have a spattering or an array of technique options that's important because many times what we have found is that other providers can confuse the practice in art of chiropractic kind of with the profession. So they automatically assess, assume that chiropractic care means high velocity adjustment. And often it can be, you know, high velocity adjustment is a part of what we do, but it may not be the only thing you offer in your office. So it's a really important thing to be able to bring up and discuss with other care providers in your community. I think it sets them at ease. The bottom line is when other providers see patients with restricted range of motion in acute pain, they just can't imagine a high velocity adjustment relieving that. Pat Certainly as chiropractors we know that high velocity adjusting can be extremely beneficial for patients of all types. But many other providers just don't have that knowledge base. So it's important to bring up to them. The other thing with this study I think is it puts to rest the one technique versus another or maybe doesn't put it to rest, but at least gives us a good foundation in terms of, hey, you can do a high velocity adjustment or you can do a low velocity adjustment. And the research supports the fact that you can get functionally based outcome improvement over the course of 4, 6, 12, 24 weeks. And finally, this study looks at subacute or chronic low back pain. So these are patients that are typically very difficult to treat, chronic low back pain patients, especially older, practically senior chronic low back pain patients. This is an extremely challenging demographic to be able to take care of and give improvements to. And this research clearly supports chiropractic care or spinal manipulation, regardless of technique choice in the ability to give these patients improvement. So this is a great study to look at in 2016. We highlighted it earlier for all of our members as part of a monthly research brief. And I think it's a really imperative study to be able to actively use in your practice and discuss not only with your patients but with other providers in your community. So we'll wrap up today's episode and I'll continue to ask. Please rate, review and or comment when you subscribe to this podcast. It helps us get recognized and it helps bring our message to more and more people, whether chiropractors or lay public around the globe. The other thing that I'll let you know about, I'm very excited is that in the first few weeks here, Marketing Chiropractic to Medical Doctors, the book I released on itunes worldwide last year will have a print version. I'm extremely excited about that you'll certainly be hearing more of that as we get down to it, but I hope everything's gearing up for a great 2016 for you, Doc. Have a great week and we will see you next week on the Evidence Based Chiropractor.

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Sam.