Dr. Jeff Langmaid reviews a 2013 study showing that chronic low back pain reduces pressure pain thresholds in muscles like the piriformis and quadratus lumborum. Spinal manipulation may increase these thresholds through proprioceptive input, and early pain reduction helps prevent chronic patterns from taking hold.
Welcome to the Evidence Based Chiropractor providing you with elegant and efficient research based content to help your practice prosper and succeed. Now get ready for a variety of dynamic communication tools designed for immediate growth courtesy of your host, Dr. Jeff Langmaid.
Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. Today we're going to talk about an interesting paper that was published by spine journal in 2013. It's titled Changes in Pressure Pain Threshold in Patients with Chronic Non Specific Low Back Pain. It is a good one and it is very relative to how we see and examine patients in practice every day as chiropractors. Before we dive in, I'll say a few words about Rock Tape. Rocktape is proud to be a sponsor of the Evidence Based Chiropractor. Chiropractor Rock Tape 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. 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This research from Spine indicates that low back pain can cause altered sensation and sensitization spinal tissues which can result of course in pain and dysfunction. Sensitization of tissues reduces the threshold of neurosensory input which is required for the perception of pain so they become sensitized. Of course research has of course proven as we know that chiropractic spinal manipulation provides stimulation to the Golgi tendon organ afferents stimulation of those proprioceptive fibers generates input to the cerebellum from the spinocerebellar tracts. We've seen this in previous research that we focused on here on the evidence based Chiropractor podcast. Reducing the pressure pain threshold through either manipulation or manual therapy would increase what I call the quote unquote buffer zone prior to the perception of pain. The decreased ability to withstand pressure and neurosensory input without causing pain may be one way in which the tissues become sensitized in acute and chronic pain conditions or acute conditions then become chronic. Excuse me. So it's imperative to reduce pain early to avoid chronic pain patterns is the gist of it. Meaning that as tissues are under a fence, so to speak, they become sensitized to input. It takes less stimulation for them to cause pain. So reducing pain early can avoid chronic pain patterns on the back end. Chiropractic care is considered to be safe and effective healthcare options for acute and chronic low back pain so exquisitely important to us. And let's take a look at a few quotes from this research and if you are looking for the direct citation, as always, it will be in the show notes or you can find it@the evidencebasedchiropractor.com podcast. So a few quotes are Quote Some conditions may stimulate nociceptive pathways and depending on the duration and intensity of the pain, they may expand the receptive fields in the dorsal horn of the spinal cord, stimulate specific related pain areas in the central nervous system and lower the pain threshold. So that's kind of how it works. They also found, quote in fact, MRI scans revealed interspinous ligament tears in patients with low back pain that could influence a neurosensory role in the mechanism of back pain. And finally, they found our results showed that individuals with chronic low back pain have lower pain pressure threshold values than healthy individuals in almost all assessed structures. Their assessed structures were piriformis quadratus, lumborum iliopsoas and glutemin. So again, they looked at chronic low back pain patients and healthy controls. They looked at painful side and contralateral sides and they looked at piriformis quadratus lumborum, iliopsoas and glute minimus. So what I'm getting at with this paper is that when you look at today in practice, when you go into practice and you're examining and evaluating your patients and you're doing your palpation, when you palpate piriformis quadratus lumborum iliopsoas and or glute men. It's a good thing to keep a keen eye out for because this paper clearly shows that for patients that are approaching perhaps chronic pain, those tissues are going to have a altered threshold to pain. So they're going to become sensitized again. Take a look at piriformis, quadratus, lumborum, iliopsoas and glute minimus today in practice for those patients. This is a nice piece of research, not necessarily because it dives into chiropractic adjustment, let's say, but it's a nice piece of research because it provides value and it provides value, hopefully here today by me talking about it with you. But secondarily for the members that were able to give this and hand this out to the physicians in their area or circle of practice by being a member of the evidence based chiropractor, having all the tools and everything necessary in order to build those referral relationships. This tool being just one small item, it is something that adds to that drip, it adds to that drop and it further positions your practice as somebody who's leading the way and somebody who is the expert locally in musculoskeletal care. When you're providing this research in a frank, in a concise, in an elegant and in a modern fashion to other providers in your area, it very well positions your practice extremely quickly in their eyes in terms of who the leader in not only chiropractic but really conservative care is in your area of town. So again, for me, this study, it's something that again doesn't highlight specifically chiropractic adjustment, but you have to put it into perspective. And I touched on that at the top a little bit and I touched on that. Regarding how the chiropractic adjustment works. If you didn't listen last week, and this is the first time you listened, take a listen to last week's episode. We dove into how the chiropractic adjustment works, but today we focused on the goli tendon organ and when that is stimulated through a chiropractic adjustment, again, that is one way that we can affect the relative threshold of that area through the central nervous system, of course, ultimately locally first and then through the cns. So the. That is important because patients, when we are able to get them in more of an acute state or a subacute state with our intervention chiropractic techniques, by and large, the research on them is pretty much conclusive across the board that they all work to the same degree. And there's some slight changes with that depending upon specific patient presentation. But the bottom line of what I'm trying to get at is when we have patients in an acute or subacute state, very often a preponderance of the time, we are able to get those patients back to a place where they are functional. So again, we focus today on pressure pain thresholds. But keep in mind it's all about function here. So when a patient comes in and the documentation should support that, pain is an easy way to get in trouble, not only with patient education, but also with patient's understanding ultimately of their conditions. But second to that, it's a good way to get in trouble, documentation wise. Really. Functional abilities are what the insurance companies are looking at from a third payer perspective. But secondarily, again, it's a nice common ground. When a patient's able to have functional improvements, pain should go by the wayside. But ultimately functional activity is where that third party payer is going. So I'm not an expert in necessarily billing and coding, but certainly our friend John De Villa is at Custom Chirosolutions. So if you have any questions. We actually featured a five part documentation series in our members vault featuring Dr. John. He travels literally the world talking about documentation, billing and coding from a chiropractic perspective. He's unabashed leader in that field. I'll leave that to him. But if you are a member of the Evanite space chiropractor, go into the members vault because you will find a great five part documentation series by Dr. John in there. But the bottom line is today, take a look at the piriformis, quadratus, lumborum, iliopsoas and glute minimus in your practice today. Have a great week in practice, doc. Bye.
We appreciate you joining us for this episode of the Evidence Based.
