020- Safety of the Chiropractic Adjustment

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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. Today's episode is all about the safety of the chiropractic adjustment. So we have some great research to dive into as well as a few thoughts. But before we get started, let me 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. Nutritional New from Rock Tape is Rocksauce Chill powerfully cool pain relief topical and a convenient roll on with 6% menthol. It's stronger than the freeze competition. They are more than just a tape company, they are a movement company. Learn more and get access to your medical discount by visiting rocktape.com and it was last month that we had the medical director Dr. Capo on here and it's an awesome episode. So if you didn't check that out, please do. But today we are going to talk all about safety of the chiropractic adjustment and we're going to talk about it in the context of a spine journal article from 2007 that was titled safety of chiropractic manipulation of the cervical spine. So that's pretty straight up. The safety of the chiropractic manipulation of the cervical spine has been a contentious issue. I feel like not within chiropractic but between different disciplines in healthcare. And in the past, research took a back seat often to myth and conjecture. However, in the last few years, maybe the last 10 years, there have been a few really high quality prospective studies that have begun to separate fact from fiction. And the authors of this study found not a single instance of a quote unquote serious adverse event in over 50,000 cervical spine manipulations. Now, clinically, I believe it's important to point out that all patients referred to a chiropractor for neck pain or cervical spine pathology do not receive cervical manipulation. So as we know as chiropractors, there's a variety of techniques and tools out there for us in a thorough history, orthopedic and neurological exam and at times a film review as well are necessary to determine the appropriate treatment, the appropriate technique choice for every patient. But for patients who do receive cervical Spine manipulation. And when we say that, you know, we're typically talking about our hvla, the high velocity low amplitude adjustment. The risks are, as we know, low to very low, to say the least. So before we dive into some of the specifics on this piece of research, I always like to frame things a little bit. And really, in the context of a cervical spine adjustment, I really think there are two sides of the coin. One side is what we know and see and perform as chiropractors. So we know that a cervical spine adjustment, it's specific, that it can be done delicately and that it also can be very advantageous as far as opening up foraminal canals, stimulating the central nervous system. Everything that we want to deliver with that adjustment can be very effective doing a high velocity low amplitude adjustment and other techniques as well. But really, the other side of that coin is you have to imagine not only the medical doctors, but the patients who are very unfamiliar with what we do as chiropractors. Now, they might see a picture of a chiropractic cervical adjustment and it can look to them aggressive. Then if you put it in the context of them having a severe pain and limited range of motion in their neck, they're taking the image, and in their mind, that picture of a cervical spine adjustment, which looks, if you're not familiar with it, can look somewhat aggressive at first glance. And they're putting that together with the fact that they have a limited range of motion, they're in pain. So they almost can't imagine whether it's a patient or a medical doctor. Seeing these patients, it's difficult for them. They don't have the training that we do. So it's difficult for them to get beyond that mental picture of the fact that a nice tight high velocity low amplitude adjustment might be exactly what that patient needs. But for them, it can be a daunting task to get over that initial picture of the adjustment, so to speak, because they don't have the training that we do. Now, looking at the study that we started to talk about just a few moments ago, the study looked at almost 20,000 patients, and it looked at 20, almost 29,000 what they call treatment consultations and over 50,000 cervical spine adjustments or manipulations. And in that, they found 0,0 serious adverse events. So I'm going to take a few quotes from this study because I think again, they frame kind of what these researchers were looking at. It is the risk, quote, it is the risk, however, of serious adverse events following a cervical spine manipulation that is of most concern not only for patients and chiropractors, but also for general practitioners and hospital specialists considering referral for chiropractic treatment. So again, these people are a little bit referring doctors, that is, they can be a little bit skeptical. And it's their biggest concern with referral often is that adjustment. Now the researchers also found, we studied treatment outcomes obtained from 19,722 patients. There were no reports of serious adverse events. Great quote. Third, they found the serious adverse events estimated in this study can be categorized as low to very low. The patient reported side effects of cervical spine manipulation obtained in this study are lower than those previously reported. So this is a large study and they actually found any adverse event, even if it's just soreness, stiffness, post manipulation, post adjustment, they found it to be lower than in previous studies. Finally, they found the risk rates described in this study compared favorably to those linked to drugs routinely prescribed for muscular conditions in general practice. The risks reported here are also lower than those reported for acupuncture, which were described as a very safe intervention in the hands of a competent practitioner. So what they're saying here is that the risk rates described compared favorably to the drugs routinely prescribed for musculoskeletal conditions in general practice. So from a natural standpoint, I think, you know, while there might be the most common adverse events with chiropractic adjustment, continued cervical spine discomfort, maybe some muscle spasm there, really when they looked at the rates of when that occurs, it was no more than when a patient were to take any sort of, let's say over the counter medication. And consequently with a chiropractic adjustment, you also don't get those side effects. So that's really the key part there. While the risk of a non serious adverse event might be somewhat similar, there's nothing on the side effects side with a chiropractic adjustment that would seem to indicate that it is less safe or should be not considered in lieu of over the counter medications for any sort of cervical spine pain. So I really like looking at this study for a few reasons and one is that it was in spine journals. So really top tier publication, peer reviewed. What people really look for in terms of, of a journal is fine, there's no doubt about that. Consequently, this also has a very large patient population. So nearly 20,000 patients and over 50,000 performed adjustments or manipulations. So it's a really large pool that they're drawing from. And throughout that they saw zero serious adverse events. So again, this is not to say that there's never been a serious adverse event with a chiropractic adjustment. I think that would be foolhardy on the other end of the spectrum, but there's no doubt that a chiropractic cervical spine adjustment is an extremely an extremely safe and effective treatment option for those patients with cervical spine pain, cervical spine discomfort, or for those patients with some segmental issues in the cervical spine. Now at the Evidence Based Chiropractor we actually featured this article as one of our monthly research briefs in January of 2014. So if you are a current Evidence Based Chiropractic member and you would like to have this study, you can pick it up by going into the member's vault. So go into the Members vault and you'll see a list of all of our past research briefs and we highlighted this one in January of 2014. Now if you are not a member of the Evidence Based Chiropractor, I would highly encourage you to take a look at it. Especially if you've been following along with this podcast and you like a lot of the research that we bring to light at the Evidence Based Chiropractor. Our monthly program takes this research and puts it in an actionable format for you to build referral relationships with other providers. So if you go online go to www.theevidencebasedchiropractor.com. you'll see really throughout that first year we give a ton of bonuses as well. Every month you have your monthly research brief which is customized white labeled with all of your practice information. You'll also get a variety of other tools and bonuses throughout the year and we've literally helped hundreds of chiropractors across four continents humbled at what we've been able to accomplish with our chiropractors out there in the community. And I would welcome you to learn more if you are interested. But that is going to do it for this week. Also check the show notes. It always has a link to the research paper on PubMed. And have a great week in practice Doc. We will talk to you soon.

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