034- Evidence-Based Guidelines for Neck Pain

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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are on location in Cincinnati, Ohio. If you are a doc and you are practicing or living in and around Cincinnati, I will be here until Friday so please don't hesitate to shoot me an email. Jeffevidencebasedchiropractor.com I'd love to take an opportunity to meet up and chat again. I will be in Cincinnati until this coming Friday, so don't hesitate to shoot me an email and I'd be happy again to get together and chat. Jeffevidencebasedchiropractor.com this week we have some exciting research that we're going to dive into, but first I'll say a few words about Rocktape. Rocktape 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. New from Rocktape 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. Learn more and get access to your medical discount@rocktape.com I also am proud to say that Dr. Steve Dr. Capo will be back on the Evidence Based Chiropractor podcast. I am recording with him Tuesday of this week and we're going to talk about Rock Blade, some of their new soft tissue tools. I also know Rocktape is out at the CrossFit Games which is a large event that I actually just happened to catch on television. I believe it was on espn. So that's a large event that Rocktape's taking part in. So that's always exciting. But to get down to today's business or this week's business, I should say this week we're going to look at a JMPT article that was released in January of 2014. It's titled evidence Based Guidelines for the Chiropractic Treatment of Adults with Neck Pain. So this was an award winning paper with the WFC in 2013 and it looked at 41 randomized control trials from 2004 up until the present date. At that time, evidence based recommendations for the treatment of mechanical neck pain were developed from their research. So they looked at 41 randomized controlled trials, basically spanning about a decade before this paper was released. Neck pain, acute or chronic, is one of the primary reasons why patients visit chiropractic offices. Number one, lumbar pain, number two, cervical pain or neck pain. The implementation of evidence based care guidelines is absolutely imperative to efficiently and safely deliver care to these patients. And I say that not only from a chiropractic perspective, but also from a primary care perspective. So there are many primary care physicians out there who are potentially recommending treatments which may not be, you know, if you look at the research, the top tier options for their patients. So of course, as you well know, listening to this podcast, extending and building relationships based on research is what the evidence based Chiropractor is about. Our goal, our passion, our why, is increasing chiropractic utilization. And the way that we do that here at the evidence based Chiropractor is of course, by providing our members with monthly research to bridge that gap and to build those relationships. So in practice, clinical signs, diagnostic results and case histories will also play an important role in developing the best plan of care for each individual. Guidelines such as these provide a framework to assist in clinical decision making. And most importantly, the research further emphasizes that interventions commonly used in chiropractic care can produce significant benefit for patients with acute or chronic mechanical neck pain. And that's relative to this specific research study. So let's take a look at a few quotes that the researchers came out with due to or during this important paper. And I'll repeat the title of the paper one more time. Evidence Based Guidelines for the Chiropractic Treatment of Adults with neck pain. JMPT January 2014 in our show notes you will find a direct link to this paper on PubMed. So don't hesitate to visit the evidencebasedchiropractor.com and there you will see all the show notes and have a direct citation to this paper. The researchers found 27% of patients seeking chiropractic treatment report neck or cervical problems. So over a quarter of the patients, one in four patients that we see have some sort of neck complaint, thus treatment. Excuse me, I'll dive back into the quote. Thus, treatment of neck pain is an integral part of chiropractic practice. We all know that as practicing chiropractors each and every day. Secondly, they found only RCTs. That means randomized controlled trials were selected as the evidence base for these guidelines, consistent with current standards for interpreting clinical Findings. So what they're saying with that is we talked about at the top, they looked at 41 RCTs, randomized controlled trials, which are the top tier, the top echelon of all research. So this is very high quality data that they were obtaining their information from. Third, they found there was no serious adverse events reported in any of the citations. Neck pain, stroke, cervical adjustments, these are things that have long since been fodder for myth and conjecture amongst the public, other professions at times. So it's really nice when we look at the Highest quality research, 41 of the highest quality RCTs available, and there is no serious adverse events reported in any of them. That's an extremely important part of this entire process. And fourth, they found strong recommendations were made for the treatment of chronic neck pain with manipulation, manual therapy and exercise in combination with additional modalities. So let's dive into a little bit about what that means. This paper basically broke things off into four recommendation, strong recommendation, moderate recommendation, weak recommendation or no recommendation. In the no recommendation camp was tens for chronic pain, laser for chronic pain, traction for chronic pain or trigger point therapy for acute pain. In the weak recommendations based upon the research that they looked at, exercise for acute pain was a very weak recommendation. Now we're getting into moderate and strong recommendations which are much more where the evidence based guidelines come from. Moderate recommendation, manipulation plus other modalities for acute crime for acute neck pain, excuse me, mobilization. This is in moderate recommendation, mobilization plus others for acute and or chronic pain and massage and others for chronic pain. Now let's go into the highest category which was the strong recommendation and at the top of that list, manipulation and other modalities for chronic neck pain. Manual therapy and other modalities for chronic neck pain. Exercise and other modalities for chronic neck pain. Stretching for chronic neck pain. So there is only one item that is in the strong recommendation and moderate recommendation category for acute and chronic neck pain and that is manipulation plus ancillary modalities. Now, in my practice personally, I've never been a large user of ancillary modalities. However, this research certainly supports the use of them based upon looking at the other papers available, which were those high quality RCTs. So we released this in May of 2015. So just about a year after its initial release, we had released this as a monthly member research brief to all of our members of the evidence based chiropractor. I think it's extremely powerful because it really pits things against each other and is a true RCT review which those are hard to come by when we look at a lot of papers. There's a variety of data out there and there's a variety of data, whether it's prospective, whether it's retrospective, etc. Looking at quality treatment. But when we can see and find a paper that's an award winning paper that's looked at 41 RCTs for the last decade and made manipulation aka chiropractic adjustment integral part of the strong and moderate recommendation categories, it's extremely hard hitting and being able to place this in the fashion to other physicians in your community, which is going to place it in a fashion that makes them think about chiropractic, makes them think about your office when they encounter a patient with chronic or acute neck pain is extremely important. So great paper. I love the data behind this. Don't hesitate to check out the direct citation in our show notes. And again, if you are in the Cincinnati area, I will be here all week. So do please do not hesitate. I have not been here in over 10 years so I'm happy to be here. Please shoot me a message at jeff the evidencebasedchiropractor.com and I would be happy to meet up. Also, if you've been following the Facebook page, you probably saw that I was on ABC News talking a bit about gluteal fatigue or dormant butt syndrome. This last week I had some behind the scene pictures on our Facebook page. I'll also have a direct link to that to that segment. And I thank ABC News and I thank all their affiliates for having me on and being able to talk a little bit about what we would do in terms of exercise, stretch and conservative care for people who may be spending a long time sitting at their desks. And as always, I will say please, if you've been listening to this podcast, go on itunes, give us a rating, give us a review. It helps keep us up in the charts and help expose us to other chiropractors. There's been about a thousand chiropractors listening in each and every week, so thank you for taking the time to listen. We will continue to give you research and the time it takes to get to your office every Monday morning. And also in case you had missed it, we recently launched chiropractic office coverage. Chirofficecoverage.com Please do not let your patients suffer. Do not lose revenue. If you are seeing more than 5, 6, 7 patient visits per day and you are closing your office even for a half a day, you are doing yourself as a business owner and your patients a great disservice, you can be profitable and you can maintain those visits and those opportunities with new patients as well as existing patients by using chiro office coverage when you need to be out of the office, even if it's for as little as four hours. So I hope you have a fantastic week in practice, Doc. We will talk to you next week. Have a great week and I'll talk to you soon.

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