023- Adjustment Outperform Injections

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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. Today we have another awesome piece of research which is very actionable and basically it's a piece that looks at chiropractic adjustments or image guided lumbar nerve root injections for MRI confirmed lumbar disc herniations. So patients that have had a MRI confirmed lumbar disc herniation were segmented either to chiropractic care, I.e. adjustments or, or epidural steroid injections, essentially image guided lumbar nerve root injections and they took a look at that. So this is going to be a great episode as far as the research is concerned. I'm psyched to dive in. Before we do, let me say a few words about Rock Tape. Roc Tape is proud to be a sponsor of the evidence based chiropractor. Rock Tape offers the world's best kinesiology tape, pain relief topicals, mobility tools and functional fitness accessories. 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But today we are going to talk about the research study released in May of 2013 from JMPT and it is a long title, so bear with me. Symptomatic MRI confirmed lumbar disc herniation patients. A comparative effectiveness Prospective observational study of two age and sex matched cohorts treated with either high velocity low amplitude spinal manipulative therapy or image guided lumbar nerve root injections. So if we break that down in the most simple terms, patients had symptomatology that indicated a lumbar disc herniation. They they had an mri. It was confirmed via that MRI that that was the pathology that was likely causing their pain. They were matched on age and sex and then randomized ultimately to an injection or to chiropractic care. So as we know, estimates reveal up to about 5% of our population are currently experiencing a symptomatic lumbar disc herniation. Majority of these patients are between 30 and 50 years old by and large. And that's what I see in my practice. As we know, only a small percentage of those patients will end undergo surgical interventions for this condition. And we also know based on other research which we've highlighted, microdiscectomy versus chiropractic care for lumbar disc herniation and chiropractic is equal to if not better than microdiscectomy in many cases. But ultimately research continues to strong continue to show strong efficacy and safety for spinal manipulation for lumbar disc herniation. In this study, the number of patients significantly improved by adjustments was higher than those treated with the nerve root injections. The patients classified as worse after one month was greater in the nerve root injection group than the spinal manipulative therapy or adjustments group. So let's dissect that piece of research a little bit there. They found again, this is both sides of this coin are very important. Number one is that the number of patients who reported significant improvement was higher in the chiropractic or the adjustment group than in the injection group. Consequently, or in addition to that, the number of patients that were worse after one month were actually greater in the nerve root injection group. So patients that got chiropractic care not only were more likely to be significantly better, but inevitably they were also less likely to be worse and the opposite for the injection group. So let's take a look at a few quotes from this study because I think they really hammer it home. Quote A systematic review of the literature done the next year concluded that spinal manipulation is a very safe and cost effective option to treat lumbar disc herniation. So the literature supports it. Number two, they found both the treatment groups had significant decreases in their NRS scores at one month with a 60% reduction for the spinal manipulative therapy cohort. And a 53% reduction for the nerve root injection group. So with that quote, of course they found that more or a greater percentage of patients had significant decreases or a greater decrease, should I say, with chiropractic care adjustments versus the nerve root injection group. They also found lumbar nerve root injections are a commonly used and accepted treatment option for these patients, whereas lumbar spinal manipulation as a treatment for disc herniation remains controversial among some healthcare professionals. This is really where the opportunity lies, of course, and this is where I really get excited with the evidence based chiropractor. Showcasing this type of research to practitioners and other healthcare providers that may feel chiropractic or adjustments may be controversial is important because there are some healthcare professionals who still believe that to be true, even though the preponderance of evidence research and otherwise show the complete opposite. So really taking this upon ourselves, to be able to communicate effectively with other healthcare providers is absolutely imperative from a practitioner to practitioner standpoint. And believe me, you can do it. Just listening to the podcast over the last few weeks, or if you're just listening for the first time today, we hit this research each and every week, literally every Monday morning in the time it takes to get to your office. And all of these nuggets are things that you can certainly, and I would, I think it behooves you to use them daily in your practice when you're speaking with patients, use them in your clinical decision making as you're guiding patients. And of course please use this information as you go through and speak with other providers in your community. That is what it's here for. And if you need extra help, you know the evidence based chiropractor is here to help and support you. And you can visit the Evidence based chiropractor to learn more about that. And if you've been following Jason with Amplified and Guy Riechman with Amplified, you probably saw some emails come through regarding the evidence based chiropractor. I've been working with Amplified for a while. We've done some great co branded content and to be honest with you, some it's been some of the most popular content that they've put out. The amount of shares and likes and the visibility for chiropractic across the Amplified platform is awesome. And the evidence based chiropractor content has helped them also reach a new level. And with that we've kind of continued that. And Jason was nice enough to take and support the evidence based chiropractor out to his audience and make sure everybody knows the work that we're doing here. So kind of get off on a tangent there. But if we dive back into the research, the last quote that I want to touch on is quote the fact that 53% of the chronic patients in the SMT cohort reported improvement is important to note because these patient symptoms have exceeded the timeframe for improvement due to the natural history. This is one of my favorite quotes in research in a very, very top article for me. So let's dive into that. 53% of the chronic patients in the SMT cohort reported improvement is important to note because these patients had exceeded the timeframe for natural history. So I love this because sometimes I have still heard, well, chiropractic, it kind of helped somebody along in the natural process of the healing time anyhow. And again, this sort of research really frames it and says, hey, these patients were beyond the natural history. Therefore you really need to look at the intervention itself as the precipitating factor to health or the healing at that point in time. So again, I think this is a great study. JMPT 2013 I'm going to have the direct link in the show notes@the evidencebasedchiropractor.com podcast, so if you're interested in looking at this specific study, please go ahead and take a look at it. We focused and of course highlighted this with our monthly membership program with the Evidence Based Chiropractor. So if you want this highlighted in hard copy format and really want the tools to build relationships based on this type of research, don't hesitate to reach out to us@the evidencebasedchiropractor.com Also for any of our UK docs, I will be over at the AECC speaking. I'm doing a two day event over there in June so please be sure to check that out. Sign up I am pumped. We're going to be touching on a variety of topics. It's going to be a special event so if you're over in the UK I will be at the AECC in late June. Finally, I'll tease this here a little bit. I am going to have a column in Chiropractic Economics. I got my first few copies so I thank Daniel at Chiropractic Economics. I am absolutely pumped and psyched for the opportunity. So keep your eyes out in Cairo Echo. I'm sure everybody gets that and have a great week in practice Doc. I will talk to you soon.

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