018- Chiropractic Care for MRI Confirmed Disc Hernations

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Hello, welcome to the Evanstonspace Chiropractor. I am your host, Dr. Jeff langmaid. Today we have another great episode packed with chiropractic research. Specifically today we're going to look at MRI confirmed lumbar disc herniation and how high velocity low amplitude chiropractic adjustments stack up. And I gotta say, it is good. So we will dive into that in a few moments. But first, as always, I'll say a few words about Roc Tape. 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 Rock Tape is Rocksauce Chill, a powerfully cool pain relief topical in a convenient roll on with 6% menthol, it's stronger than the freeze competition. They are more than a tape company, they are a movement company. Learn more and get access to your medical discount by visiting Rocktape. I got a few emails this week asking if I was going to be out speaking at Cal Jam. Unfortunately I was not. But if you were there, I hope you had an awesome time. And Billy, if you're listening, I am definitely interested in coming out there. Looks like an awesome event. I saw one of my chiropractic friends and colleagues, Josh Hand, who practices in New York City posting a variety of pictures and it looked like an awesome time. Hopefully I'll get out there next year. Everybody that followed up asking if I was going to be there, I appreciate it and I hope to get out there soon, dive into some research. So I'm going to be looking at a study that was released in 2014. So it's pretty new. And it was from OR in jmpt, the Journal of Manipulative and Physiological Therapeutics. Great study. Here they looked at the title outcomes of acute and chronic patients with MRI confirmed symptomatic lumbar disc herniations receiving high velocity low amplitude spinal manipulative therapy or a prospective observational cohort study with one year follow up. That's a mouthful. So they looked at two things. One, they looked at acute and chronic patients. So both ends of the spectrum there that is good. That covers things secondarily. All of the patients, whether acute or chronic, had MRI confirmed symptomatic lumbar disc herniation. So both from a symptomatic point of view, they had symptomatology, of course, but second to that on the mri, there also was a confirmed disc herniation. And they looked or provided these patients with high velocity, low amplitude chiropractic smt, chiropractic adjustments, as we would like to say. So as we know, lumbar disc herniations with radiculopathy often result in significant disability, societal cost and missed work. Studies are far and wide showing lumbar disc herniation with radiculopathy is expensive to treat. And we just touched on a study literally last week on this podcast that looked at microdiscectomy versus chiropractic care. And chiropractic care equaled the results. So if you haven't checked that one out, it's one of my favorite pieces of research out there. But this also today is a great piece. So previous research has proven, of course, that chiropractic care produces outcomes equal to microdiscectomy, as we just said, and in my opinion, certainly better than epidural steroid injections for lumbar discs. So in this study, all patients exhibited an abnormal physical exam with radiculopathy. Their diagnosis was confirmed, of course, by the mri. And this research is very encouraging because both acute and chronic patients exhibited improvement with chiropractic care. So some of the times I see that being sometimes a pigeonhole criteria. So many times people will say, or at least cursory, they will say, well, chiropractic is great. It's only good during the acute, is it? You know, was the natural history going to take care of it anyway, et cetera, et cetera. This study looks at both acute and chronic and patients exhibited improvement in both groups. So we know for long term improvement there has to be an active care component or relapse is very likely. So patients need to take responsibility, they need to take action. Chiropractic care is going to improve the function. It's going to have stimulation to the central nervous system. It's going to give them the best opportunity for full function. But moving forward from any acute incident, there's some patients that have to many patients, almost all of us really should include an active care component. So let's look at a few quotes from the study. Researchers found at two weeks after the start of treatment, a large proportion of patients reported substantial improvement, with the percentage reporting improvement increasing at one and three months by 80 and 90%, respectively. So that's pretty impressive. Secondarily, they found chronic Patients continued to report higher percentages of improvement at both 6 months, 88% and 1 year, 89%. Finally, they found there were no adverse events reported due to SMT applied to the patients with MRI confirmed symptomatic lumbar disc herniation. So let's dive into those three statements a little bit. Number one, what we just touched on was there were no adverse effects. That's great. Good chiropractic safety is very high. We all know that. This study further emphasizes that fact. Let's look at the other two. For the chronic patients, there is higher percentage of improvement at both six months and one year, 88% and 89% respectively. So nearly 90% of patients reported improvement at six months and one year. That is also extremely impressive. Now let's take a look at that first statement. At two weeks after the start of the treatment, a large proportion of patients reported substantial improvement, with the percentage reporting improvement increasing at one and three months and one in three months, 79% and 90%. So almost everybody in this study is significantly improving. And if we go full circle with it, what we find is 90.5% of patients reported being much better or better at three months. So, you know, coming full circle with this, again, these are patients and people more importantly, that have significant sciatic like complaints, ridicular complaints. They have a large disc herniation, essentially occluding what we can assume based on their symptomatology, occluding a foraminal canal causing nerve root compression, whether in the foraminal canal or lateral recess, they don't specify. But these patients, that's like raw wire. And when the disc is getting back in there, whether it's compressive directly or whether there's a chemical component, if it has some sort of tear and extruded component, this seems to specify herniation. But the bottom line is that's raw Y. These are patients that are in tough shape symptomatically, and the improvement that chiropractic care gave them in this study is absolutely impressive to say the least. If we combine this with what we've learned and looked at over the last few weeks, specifically last week, about microdiscectomy versus chiropractic care or smt, and chiropractic care performing equally as good as a microdiscectomy, this becomes again, substantial research when put and framed appropriately, which is in the case of clinical care and in the case of what we can offer as chiropractors for patients that are coming into our office. Not only that, but also Being able to, as I always talk about with the evidence based chiropractor, we reach across the aisle, bridge the gap between providers, inform other providers of what we can accomplish and what we do as chiropractors. By highlighting the chiropractic adjustment, it provides a great deal of breadth and depth of knowledge for other healthcare providers in our communities that they can then, if they're taking into account the evidence, then they're going to be able to make significantly better clinical decisions for their patients. And, and quite honestly, as the chiropractor presenting this information, it's compelling and it certainly is something that should help bolster your practice because the evidence supports the safety, efficacy and ultimately the cost effectiveness of chiropractic care across the spectrum of research. But today I just like it. I mean, I can look here again. We look at baseline, two weeks, one month, three months, six months, one year, Oswestri NRS leg, NRS back. So the ratings of pain and disability just all starkly go down throughout time. It doesn't spike up after one month, it doesn't spike up after three months. But these patients get well and stay well. And if as chiropractors out there, we are taking a full look at the totality of what our patient is going through and offering them the best tools and solutions to move forward after these acute incidents and instances, excuse me, then we really have a potent combination and not only bridge the gap to other providers, but also get the word out in our community through great work and through the positioning of your practice as really the centerpiece of healthcare. So don't be in a silo out there. Make sure that you're reaching out to other docs in your community. If you have questions about that, email me. Jeff the evidencebasedchiropractor.com and if you've been listening and you like what you hear, go on itunes, give us a rating, give some feedback. It helps keep us at the top. Have an awesome week in practice. We'll be back next week with another fantastic piece of research. We'll talk to you soon.

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