019- Manipulation vs. NSAID's: the Landmark Study

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Hello welcome to the Evidence Based Chiropractor. I am your host, Dr. Jeff Langmaid. I hope everyone had a great Easter weekend and got some rest and relaxation. In today we're going to talk about another piece of my favorite chiropractic focused research. Before we dive in, let me say a few words about Rock Tape. As I do every week, 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 and a convenient roll on with 6% menthol. It's stronger than the Freeze competition and they are more than a tape company, they are a movement company. Learn more and get access to your medical discount by visiting rocktape.com so this week we have another piece of research which is one of my all time favorite chiropractic focused pieces. This comes from Spine Journal in April of 2013. So a pretty fresh piece of research here and it is titled Spinal High Velocity Low Amplitude Manipulation in Acute Non Specific Low Back Pain. So I love this for a few different reasons. Number one is that it's a randomized double blind placebo controlled parallel trial focusing on spinal manipulation. So I love that and in my opinion it's is already considered, if not to be considered a landmark in chiropractic or spinal manipulative research. They basically tested prescribed NSAID diclofenac against spinal manipulation and then against placebo. Of note in this study is that the manipulations performed were an antiquated technique by physicians without specific training. So while I say this is one of my favorite pieces of chiropractic focused research, please understand that the practitioners giving the manipulation or in this case not truly an adjustment as not a chiropractor was performing it. I feel as though the results could have been even better if a chiropractor were performing a specific chiropractic adjustment. So even with that said, even with this inherent design flaw, the group which received the spinal manipulation showed clear outcome advantages. We're going to dive into those advantages again. Let's look at the title Spinal High Velocity Low Amplitude Manipulation and Acute Non Specific Low Back Pain. Acute Non Specific Low Back pain. So back pain less than 90 days duration of non specific trigger. So with that, that makes up a majority of people who come into chiropractic practices, whether referred by other physicians in town or whether calling in off the online or finding out your website or by referral, whatever the case may be, acute, non specific, low back pain is a great deal of the patients that as chiropractors we see and treat every day in practice. Consequently, it also is what many primary care doctors are seeing and what many physical therapists are seeing in their practices. So it is a very common patient type or a very common symptom from a person who may be coming into our office. Consequently, they also looked at high velocity low amplitude manipulation. So hvla. So we can compare that most equivalently probably to just a general diversified adjustment. So when we take a look closer at the research, I kind of touched on it at the top, but they looked at diclofenac, common NSAID versus manipulation versus placebo. Again, what I love about this study is diclofenac is something, quite frankly, I don't know the percentage, but I could probably guesstimate 10, 20, 30% of many of our practices. Many of the patients coming in have already been prescribed diclofenac. So this is a very real world situation. And then they are getting in this case manipulation. So what I will equate to hopefully in the next study, perhaps a chiropractic adjustment. So the researchers found, here's where things get real interesting. The researchers found, quote, this is the first time that that spinal manipulation was investigated in a double blinded, randomized controlled design showing clear superiority compared with placebo and nsaid. I'm going to dive into that in a moment, but let's look at two other quotes. HVLA manipulation can be recommended for the therapy for acute nonspecific low back pain. And finally, quote, final evaluation showed manipulation being significantly better than NSAID and clinically superior to placebo. So these three quotes are three of the big reasons why I just love this study. So let's go one by one. First, they said this is the first time that spinate manipulation was investigated in a double blind randomized control design. So that's important. Those are the top tier research and it showed clear superiority compared with placebo and nsaid. Clear superiority compared with placebo and nsaid. Great starting point. Second, they found HVLA manipulation can be recommended for the therapy for acute nonspecific low back pain. I might like that sentence to be stated in a slightly different fashion. But overall, for Spine Journal to come out and basically support the biggest treatment option or modality associated with chiropractic care is something that I find striking. Third, final evaluation showed manipulation being significantly better than NSAID and clinically superior to placebo. So this really hits on two items there. Number one is that they are finding at the duration that the study took place that manipulation was significantly better than NSAID. Great starting point. None of the risks associated with NSAIDs. We'll do a podcast upcoming on just the risks of NSAIDs, but they are wide and vast. And secondly, found that manipulation was clinically superior to placebo. So I often hear, or not often anymore, but I do hear from time to time chiropractors who have reached out and essentially they feel like the conversation with a medical doctor with another care provider goes towards a chiropractic adjustment being hands on and really the adjustment itself doing no function. Essentially it's placebo. Maybe the patient feels better because you have the hands on them and they listen. We know that's completely false, but it's nice when a study from spine in a randomized controlled study can show clear superiority compared to placebo. So those are a few reasons why I really love this study. I'm going to take a quick break from the research right now and just say again for anybody that's been listening, you've heard me talk about it, but I think it's important and I'm extremely proud of it. My book, Marketing Chiropractic to Medical Doctors has been on Amazon. It has been at the top of the chiropractic charts on Amazon since it came out in late January. Everybody that's picked that up, I greatly appreciate it. I worked hard on it. Certainly. I think there will be another edition coming down the pipe and I'll clean up some of the things that I can do better. But as far as a guide to interdisciplinary communication for building referral relationships, I just don't think there's anything better out there. So if you have an extra coffee, you know that you don't get and you pick up the book, I think you'd be well served to do so. It's on Ibooks World, but it's also available on Amazon worldwide. It's called Marketing Chiropractic to Medical Doctors and I greatly appreciate everybody that has picked it up and if you haven't, please do so. Second to that, I'll say one more thing. If you've been enjoying listening to the podcast, I would implore you, please give me feedback online rate the podcast leave a comment that helps keep us up at the top as well. So if you've been enjoying what we've been going through and we have a lot more to come, believe me, then please give me feedback online. I would greatly appreciate. Appreciate. It helps us share the message with other chiropractors and get visibility. So getting back into this study and the research we're talking about today. Spine Journal Spinal High velocity low amplitude manipulation in acute non specific low back pain. This is what I almost refer to as the NSAID versus manipulation study because again, they looked at diclofenac and they looked at manipulation. So I wanna dive into one more piece of this. Now. The chart on this is very easy to read. It might get a little heady going through this verbally, but I think it's. They looked at four criteria for manipulation and diclofenac complete relief, improvement, no change, and deterioration. So if we look at that, I'm just gonna touch on a few of those 19 people, which is the high, you know, the most people in the manipulation group had complete relief. So 19 had complete relief. In the manipulation group, 10 were improved, 6 had no change and 0 deteriorated. Let me say that one more time. In the manipulation group, 19 of the patients had complete relief, 10 improved, 6 had no change and 0 deteriorated. In the diclofenic or NSAID group, 8 had complete relief, 13 improved, 9 had no change and 7 deteriorated. So manipulation group, 0 people deteriorated. In the NSAID group, 7 in the highest bracket of complete relief, 19 people that had manipulation had complete relief. In the diclofenac group, 8 manipulation, no change, 6 diclofenac, 9 improvement, 10 in the manipulation group. Okay, 13 in the diclofenac group. But when we really look at this laid out, there's about 30 some odd participants in each group. And in the chiropractic or the manipulation group, nearly 30, I guess almost 40. Nearly 30 out of those 40 people had improvement or complete relief. And it just is completely the other end on the diclofen or the NSAID group. So again, this is not a study. I certainly wouldn't go in guns blazing to a practitioner that I'm trying to build a relationship with and harp on the fact of how much better manipulation is than NSAIDs. I think it's well proven in literature, to be honest with you. But I think this is a great starting point to opening eyes as far as what a manipulation or what a chiropractic adjustment may be able to do. And for many providers who are completely unfamiliar with chiropractic care and manipulation. This is a great starting point because it gives them grade A top tier research number one. Number two is it pits something that they're very familiar with against something new, against what we do as chiropractors, manipulation or chiropractic adjustments, by and large. And in my opinion, it gives the ability to start a conversation, it gives some common ground, it gives an educational positioning of your practice when you're able to discuss research such as this with other providers. This is what we do at the Evidence Based Chiropractor. We guide hundreds of chiropractors to build referral relationships in their community. If you haven't checked that out, please do at the evidencebasedchiropractor. Com. But until next week, I hope you have a fantastic week in practice. We'll be back with another piece of awesome research next week and we will talk to you soon.

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