029- Comparing Adjustment Types and NSAID's for Low Back Pain

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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. Thanks for tuning in. I hope you had a fantastic Father's Day yesterday and were able to get some rest and relaxation and certainly some time with loved ones. I have a couple business items to get out of the way before we dive into the research this week. Number one would be a huge thank you to Lily and everybody at Florida Chiropractic Conferences. I was out there speaking last weekend, fantastic event here in Tampa and they put on absolutely first class events and with that, probably something I shouldn't speak of too soon, but I think there might be an opportunity for me to come up to Life University in the not too distant future and that would be something that would really certainly invigorate me. I'd be greatly looking forward to that and have a lot of gratitude even at the potential opportunity to get up to life and speak. I know they have some fantastic events up there and certainly a lot of chiropractors look to them for their continuing education and professional education as far as that goes. Secondly, at that event I saw a master trainer from rockteam. As you know, Rocktape is one of our sponsors and I just can't say enough good things about them.

The products and services they offer are first class and again certainly the training backs that up. 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 Rocktape is Rocksauce Chill, a powerfully cool pain relief topical and 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. Learn more and get access to your medical discount by visiting rocktape.com also. I have teased it out a few times but I got finally back in touch with Dr. Capo, the medical director at Rock Tape and he will be on here soon to talk in depth about Rock Blades, their new soft tissue tools. I got an advanced set and they're fantastic. I'm sure you've seen them online. If you haven't checked them out in person, I would encourage you to do so. So for this week, let's dive into why you are listening and that is for chiropractic research in a actionable way. And today we're going to look at a paper From Spine Journal, February 2015. This is FRESH research. It is titled Comparison of Spinal Manipulation Methods and Usual Medical Care for Acute and Subacute Low Back Pain. I know I tend to say this more often than not, but this is another one of my favorite pieces of research. We highlighted this for our members in April 2015. So literally, I guess two months after it came out, we were going to print as far as highlighting how this is actionable for chiropractors to build relationships with other providers in their community. And again title Comparison of Spinal Manipulation Methods and Usual Medical Care for Acute and Subacute Low Back Pain so this article from Spine compared the effectiveness of manual thrust manipulation against mechanical assisted manipulation and usual medical care.

Patients selected to participate reported non radicular, acute or subacute low back pain. So no radicular complaints and they could be subacute or acute, no chronic pain. Additionally, the patients all reported at least a minimum pain rating score of 3 on that 0 to 10 VAS scale. So 0. No pain at all 10. These patients are ready to literally drive to the ER. They had to be a 33 or above a minimum of 3. The results emphasized earlier research in which spinal manipulative therapy displayed superior outcomes when compared to usual medical care, while nsaids described as the usual medical care in the study. As we well know, NSAIDs are typically and appropriate or inappropriately prescribed for acute or subacute musculoskeletal conditions, certainly low back pain in the United States. And so while nsaids, again usual medical care in this study have long been prescribed for back pain, they do not, as we know as chiropractors, provide any tactile stimulation. They don't provide any muscle spindle, stretch response or any physiological advantages typically associated with spinal adjusting. There's no hands on component. It's strictly pharmacological. That sounds foolish to say and very obvious, but there's an extremely important component to that that often many practitioners don't understand number or really think about. Not that they don't understand it, they just don't really think about it. And certainly the lay public, when you have the lay public that are going to their primary care providers for musculoskeletal complaints for performance and endurance issues instead of a chiropractor, it certainly shows a disconnect in the education of the public on what we are able to do as chiropractors so again, when somebody takes in that nsaid, they're not getting any.

Tactile stimulation, they're not getting any hands on, they're certainly not getting any stretch response on muscle spindle fibers as far as muscle spasm concurrently is going to be concerned. And also they are not going to have any physiological advantages that we would typically associate with a chiropractic adjustment or manipulation.

While manipulation provided statistically significant and clinical meaningful outcomes in this study, as you well know, I still believe that the co management of these patients could create even better results in a sharply acute. Again, remember, this included subacute and acute patients. If a patient is in that sharply acute state, they might not be ready for a chiropractic adjustment at that point in time. So this is where there can be certainly advantages as far as co management of these patients for their benefit and ultimately for better outcomes. But it's something that should be explored in terms of who has the best tool at that available moment. And in my opinion, chiropractors working together with primary care providers, as long as the understanding is there, provides certainly a superior opportunity for the patient to have the best possible outcome. Let's take a look at a few quotes from this study. Quote the researchers found participants who achieved at least 30 or 50% decreases in an outcome were considered to be responders with moderate or substantial improvement, respectively. Let me repeat that. Participants who achieved at least 30 or 50% decreases in an outcome were considered to be responders with moderate or substantial improvement, respectively. So if you received 30% improvement or 50% improvement, the researchers would deem that moderate or substantial improvement. Quote Our primary analysis shows that manual thrust manipulation group achieved a statistically significant short term reduction in disability compared with the usual medical care group. I'll repeat that again one more time. The researchers found our primary analysis shows that the manual therapy group achieved a statistically significant short term reduction and disability compared to the usual medical group. And it's important because there's a couple words here that are important. Number one is statistically significant. So that's a good opportunity to showcase what we do as chiropractors in a statistically significant fashion. The results favored chiropractic. Secondarily, it was a result in, or excuse me, a reduction in disability. Disability is not the same as function, but they go hand in hand. So I like that even better than a reduction in pain. It's truly all about function. Pain relief certainly is one thing, but ultimately function is what we need to focus on, not only from a documentation standpoint, as Dr. John de Villa would speak of, but also from the standpoint in wellness in getting a patient where they are improved quality of life. It starts with pain, but it has to include and continue with functional gains. Finally, the researchers found significantly more patients in the manual thrust manipulation group ACHIE achieved moderate greater than 30% or substantial greater than 50% reductions in self reported disability and pain scores at four weeks. So here's where they hit both aspects. Again, significantly more patients in the manual thrust manipulation group achieved moderate or substantial reductions in disability and pain scores at four weeks. So this was not just a placebo effect on one adjustment or a nice conversation with a chiropractor. This is looking forward to four weeks ultimately probably at the point of a reevaluation where they were seeing that these patients still had statistically significant advantages in the reduction of pain and also in the reduction of disability. So I love this study. Again, it was released in February 2015 and it compared spinal manipulation methods and usual medical care for acute and subacute low back pain. And if I didn't say it, it was produced by Spine Journal Volume 44. So in the Show Notes I will have the direct link to this study. So please visit the evidencebasedchiropractor.com podcast or certainly on itunes. You should be able to see the Show Notes there as well so you'll be able to directly access this study on PubMed. Again, we focused on this in April 2015 with our membership. If you are not a member, I would strongly encourage you to at least consider becoming a member of the Evidence Based Chiropract long term contracts. And we are all about we are the leader in chiropractic worldwide as far as building referral relationships and we focus that on research, we focus that on highlighting the chiropractic adjustment and we focus it by empowering chiropractors with the knowledge to practice at a higher level with their current patients and with the future patients. And if you are a member, One of the other things I'd like to.

Touch on as we get finished up.

With this episode is the Evidence Based Chiropractor Mastermind Group. It is for members only. If you have not already joined, join the group please@facebook.com it is a resource, an additional resource. Aside from the members vault and all the bonuses, it's an additional resource for members of the Evidence Based Chiropractor to mastermind to take time out, to strategize and to make sure that all of us are doing our best to not only improve our practices, but improve the profession as a whole. So I hope you have a fantastic week in practice Doc. I will be back next week on this podcast, the Evidence Based Chiropractor. I'll talk to you soon.

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Sam.