045- Manipulation Proven More Effective than NSAID's

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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are gonna dive into one of my favorite pieces of research. We're gonna revisit it. We touched on this late last year, but I think it's important enough to touch on again. So there's been a lot of new action from listeners of the Evidence Based Chiropractor podcast. If you have been listening, if you are new, old or indifferent, somewhere in between, I ask you please, if you have the opportunity, give us a rating or a review on itunes. It helps other chiropractors find us. It really helps keep the positive momentum of the Evidence Based Chiropractor podcast. And as you know, we give you research in the time it takes to get to your office each and every Monday morning. We're coming at you. So this week we are gonna touch on a great piece of literature and and it really highlights chiropractic and NSAIDs. And it's titled Spinal High Velocity Low Amplitude Manipulation in Acute Non Specific Low Back Pain. This was released by Spine Journal in April of 2013. So when you hear Spine Journal, you know it's going to be a top tier research publication. Before we get started, I'll say a few words as I do each and every week about Rock Tape. Rock 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. 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. Or learn more and get access to your medical discount by visiting rocktape.com so as I touched on, I'm gonna repeat the title because it's very important and you'll also be able to find it in the show notes as well. Spinal High Velocity Low Amplitude manipulation in Acute Non Specific Low back pain. And this is a really pinnacle piece of research for me and for you listening as well because it highlights spinal manipulation, the hallmark of chiropractic care. And it pits it against diclofenac, a very commonly prescribed nsaid. And it really puts these Two treatment options, head to head and diclofenac is something that's being prescribed by the thousands, perhaps even hundreds of thousands, each and every day in primary care offices. If you've been following the evidence based chiropractor, you know that when you try to build a relationship with a medical doctor, there are likely three procedural treatment algorithms that they're using for their spine patients. And number one is treat in house, which means usually prescribing NSAIDs. And diclofenac is one of the most popular NSAIDs out there. So this piece of research is extraordinarily powerful. We released it as a research brief for our members in April of 2013, so just after it came out. And I'd love to touch on a few quotes that the researchers found in this study. They found this is the first time that spinal manipulation was investigated in a double blinded randomized control design showing clear superiority compared placebo and nsaid. So this was the first time again that they looked at a double blinded rct that is truly the highest level of research that exists today. And they pitted spinal manipulation again against placebo and nsaid, in this case diclofenac, and they found spinal manipulation showing a clear superiority. So that is a very powerful item that, that. I think there are too many chiropractors out there that are unfamiliar with this piece. And I touched on this with the Hillsborough County Chiropractic Society last week and there was a lot of excitement when I talked about this study because many chiropractors, it's been out a couple years, they didn't know that it existed. Here's a second quote from this piece. The researchers found HVLA high velocity low amplitude manipulation can be recommended for the therapy of acute non specific low back pain. So again, the researchers at Spine in a double blinded randomized control trial, they are strongly and again, they are recommending chiropractic care or manipulation for acute non specific low back pain. Now, of course we can take care of more than acute non specific low back pain, but you have to remember with research, the finer the tip of the pen, so to speak, the better and more accurate the research is. So it is great that they actually specify acute non specific low back pain because that is a very clear patient population. The researchers also found final evaluation showed manipulation being significantly better than NSAID and clinically superior to placebo. So another quote that really hits home, their final evaluation showed that manipulation is significantly better. And that's a clinical term. And there has to be a threshold to reach that so it is significantly better than nsaid, and additionally, it's clinically superior to placebo. So this, sometimes I think we hear this much less than before, but there are still some people out there that feel as though chiropractic, oh, well, you're actually getting hands on with the patient. There's a placebo effect to that care. Now, there has been a vast array of studies which show that to not be the case, but this further emphasizes that point and really hammers it home again. That last quote, final evaluation showed manipulation being significantly better than NSAID and clinically superior to placebo. So this research is again, top tier piece of research. Double blind, randomized control, three arms, there was NSAIDs, spinal manipulation, and of course, there is a placebo or a control group. Now, if you dive into this piece, there's one thing that I always like to bring up, and the truth of this study is, while it is fantastic, these manipulations or adjustments, so to speak, they were manipulations because they were not adjustments performed by a chiropractor. So to me, that actually further emphasizes the point of this research because there is, bar none, no other profession that has more skill, more experience, or more aptitude to provide a manipulation or an adjustment than a chiropractor. My expectations and where I would love to see this research go, would be to actually redo this research with a chiropractor performing the care. And I would almost guarantee you're going to see even better benefits than what was found on this initial piece. So let's talk about a few other things that they found. Now, this chart or this graph, I'm gonna put in the show notes as well. But when they looked at manipulation and diclofenac, they also broke it down into patients that had either complete relief, no change, they were improved, or they deteriorated. Or if I put that in a better order, they found patients that had either complete relief, patients that improved, patients that had no change, or patients that deteriorated throughout the course of care. And this is perhaps again the most insightful or shocking if you weren't expecting it. There was literally zero patients in this study that received manipulation that deteriorated throughout the time that they were in the study, and only six had no change. Whereas the patients that received diclofenac, seven patients deteriorated and nine had no change. So if we look at patients that improved or had complete relief, we take them off the table and we say there's a certain subset of patients that either had no change or got worse. In the chiropractic group that was 6 and in the Diclofenac group that was 16. So over double the amount of patients had either no change or got worse when they received simply an NSAID and not a high velocity low amplitude manipulation. Furthermore, when we looked at patients that had complete relief, 19 patients in the manipulation group had complete relief, yet only eight had complete relief in the diclofenac group. And if we touch on the final bit there about improved, 10 in the manipulation group improved and 13 in the diclofenac group improved. So if we take our same logic on the good side of the spectrum, as a matter of speaking, 29 people patients, participants in this study that received manipulation either had complete relief or improved whereas only 21 in the Diclofenac group. So on all criteria, on all fronts, this study fully supports the use of spinal manipulation and there is nobody as we know better than a chiropractor to perform that care. So if you have not looked at this research, I would really encourage you to search it out on PubMed. We've wrote about it a few times at the Evidence Based Chiropractor and I think it's one of the most important pieces of research that's ever been released that a vast majority of chiropractors out there are unaware of. And if we are unaware of, stands to reason that the medical doctors in our community are completely aloof to the fact that this research exists. So if you have the opportunity, search it out on PubMed. You can certainly find a citation in the show notes. And I also would encourage you if you have any inkling, any idea or any interest in building referral relationships which in my opinion is the heart of what we should be doing as chiropractors is that peer to peer building of relationship, building of a referral relationship because it's going to better help our patients in our community. If you have interest in that, please check out what we're doing at the Evidence Based Chiropractor. We've served hundreds of chiropractors around the world. I would absolutely love to have you on board and you can check out even our free tools to get started and get a feel for where we are and what we are about. But until that time I hope you have a fantastic week. Week in practice. Please go to itunes, leave us a rating or a review and I will talk to you soon.

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