061- Chiropractic for Post-Surgical Patients

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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. My guest today is the host of the Back Doctors podcast, Dr. Michael Johnson. The Back Doctors Podcast is weekly conversations with doctors from all around the world sharing patient stories as they inform, educate and offer hope for the millions of people who have back pain. Dr. Johnson practices in Richmond, Indiana. He's a 1998 graduate of Palmer College and has been a Cox Technique certified doctor for over 20 years. So this is a special episode because Dr. Johnson and I go deep on some research and I had a great time chatting with him. So stay tuned. It's a great episode this week and I just came off a weekend with the Professional Baseball Chiropractic Society. I was honored to be able to speak, interact and really get to know their organization and it is pretty awesome. Definitely check that out if you get the opportunity. Before we get started, I'll say a few words about Rock Tape. Rocktape, makers of the world's best kinesiology tape are proud to introduce completely redesigned Rocksauce and Rocksauce Chill. Powerful topical muscle and joint pain relief now available in 3 ounce roll ons and 32 ounce clinical pump tops. Give long lasting pain relief to your patients. Learn more@rocktape.com topicals rocktape.com topicals all right.

So as we talked about at the top this week we have a great episode with Dr. Michael Johnson. He is a Cox certified chiropractor. He knows a lot about research and he actually reached out to me with a paper that I thought I absolutely had to share with all of you. So welcome. Mike, thanks for being on and I really appreciate you taking the time.

Well, thank you Dr. Langmay and thank you for this opportunity to share this relevant paper with your audience.

Yeah, my pleasure. So let's dive into it. Tell me a little bit more about what the researchers found. Tell me a little bit about the paper and let me know what got you excited and then in turn what got me excited.

Okay, well this paper that we're going to talk about is chiropractic care for the post surgical continued pain patient. To get us into that paper, I wanted to share, just briefly another paper that was published in the surgical neurology by Berger542 and this was 1000 case study of worker compensation patients who had had back surgery. So 600 of these patients were single operations and they were re evaluated 54 months after surgery. The second group was 400 had multiple back surgeries evaluated on an average of 38 months post operatively. The evaluations were actual physical exams and they were done by independent neurosurgical and orthopedic experts. So it's an impartial opinion. So this is the results of that study. Just briefly, 71% of the single operation group had not returned to work at four years after operation and 95% of those who had more than one back surgery did not return to work after four years. Now here's the kicker. In none of these cases was there a neurological deficit that precluded gainful employment. The failure to return to work was being blamed on chronic post operative pain. The conclusion of this study said, although motivational, I.e. psychosocial factors undoubtedly play a role in failure to return to work, the role of chronic pain cannot be ignored. So we know that 50% at a minimum, and according to this paper, up to 95% of these patients post operatively can continue to have pain. So that's why this paper for our profession, I think is so exciting.

Yeah, and I want to break in before you dive into the paper we're about to dive into because I think the numbers that you just brought up are so powerful. You know, every day, chiropractors out there, you, myself and everybody listening, we see patients that are post operative. And certainly I think we've all had patients that had, had previous surgery and maybe been told, oh, I don't know if you should go see a chiropractor. You know, I don't know if you should do that after you've had that procedure. And I think, you know, the paper that we're about to dive into really gives a lot of evidence, a lot of credence and can give a lot of confidence to all the practitioners out there. So I'll let you kind of take it away with really where we're going today and certainly where chiropractic comes into play.

All right, so this paper came out this year in the Journal of Chiropractic medicine, June of 2016. The title of the paper is Chiropractic Distraction Spinal Manipulation on Post Surgical Continued Low Back and Radicular Pain Patients, A Retrospective Case Series. Now, the lead author of this was Dr. Ram Gutavalli. And I know that you're familiar with Dr. Gutavalli. I know on your podcast website on the evidence based chiropractor. You can download the 10 most important chiropractic articles and one of those is the lead author again is Dr. Gutavalli. So I know you're familiar with him. The other authors are Curt Olding, George Yocum and James Cox. On this study, it was 15 doctors who collected data from records from six months of 2012 actually of their post surgical continued pain patients. So they had ended up with 69 patients. So after applying Cox flexion distraction technique to these patients who'd had back surgery continue to have pain at an average of 11 visits or 49 days of treatment, 81% had at least a minimum of 50% relief of their pain. So 81% had 50% relief of pain following Cox chiropractic flexion distraction, spinal manipulation. I think that's unbelievable.

Yeah, it's really staggering because if we make a counterpoint, you know, 90%, you know, up to 90% of people that have a procedure might not be returned to work after years. And patients in this study that are getting chiropractic care, that are getting Cox technique specifically, they're getting 50% reduction. I mean, that takes you from on a VAS scale, severe to mild, moderate. And I think the other thing that's interesting about it, concurrently, this is kind of a sidebar, but there's a lot of patients that have procedures done and they don't realize that from a surgeon's perspective, pain relief might be second or third in the chain, not the number one reason that they're having the surgery performed. So post surgical pain, I think can be very important, number one. Certainly it can be due to error in an extreme case or something like that. But often that can be almost an expectation post surgically with a lot of guessing games and a lot of meds being thrown around. So the fact that chiropractic care specifically in this study showcases a 50% reduction is really wild. And tell me a little bit about the research, your experience, how does it work, what are the mechanism of action and how does this work so well?

Well, on these post surgical cases, particularly if they have fusions, you're probably looking at the area above or below the fusion site. It accelerates the degeneration of the disc above or below. I guess, hopefully when I see patients, I'm hoping that's what happened so that I can work on that disc. And by doing the cos flexion distraction technique, we're open, opening up the facet joints, we're increasing the intervertebral foramen by 28%, we're decreasing the intradiscal pressure, we're getting circulation back into that disc, restoring range of motion to that motor segment above or below where the surgery site is. So in those fusion cases, that's what you hope. I've had those patients. I've had one patient who had a five segment fusion and I hated to tell him, but I just couldn't help him. But those that usually have two, three fusions, it's either above or below. You're in good shape to help these people. Of course, if it's within that fusion, then there's not much you can do. But it can certainly help those even though fusion patients.

Yep, absolutely. And regarding that, some of decreasing intradiscal pressure and gapping the facet joints and things like that, there's a lot of commonality in terms of multiple technique sets. Where do you feel like the big advantages are with flexion distraction, with COX technique? How do you feel like this might overlay to other techniques? What's been your feel, your experience, what are your thoughts on that?

Well, to do a high velocity, low amplitude adjustment on these post surgical patients, particularly with effusion or they're stenotic, they have a lot to disc degeneration, they have radicular symptoms. I'm just not comfortable doing that. You know, I will say that in the past I have it manually adjusted with high velocity adjustment on some patients who have had back surgery, but not those that are, they know that are stenotic and have the degenerative disc and you know, you just can't, you can't do that kind of technique. And you know, with the COX work, you know, you're always just going to tolerance. You know, it's low amplitude or low velocity variable amplitude techniques so that you really have control of what's happening. You know, it's just not that one thrust and you're, you know, you're just hoping and praying, you know, you really have control and you're just going to patient tolerance and they really respond nicely and the treatment's comfortable for them. You're not, you know, you know, you're not going to hurt them. So you know, I just, I love doing it that way and you know, I'm not afraid to see these patients.

I love it. And I think you touched on a really important thing. You know, some is patient, you know, patient safety is job one. But really patient comfort plays a huge role, as you said. I mean, COX technique is ubiquitous. It's used by certainly over half the profession at least. And I think it's important. Sometimes I talk about other physicians confusing the practice of chiropractic with the profession. Meaning that, you know, it's important for us to be able to tell other physicians, hey, we have a variety of tools in our tool belt. It's not all that diversified adjustment or that gonstead or that high velocity adjustment. But there's multiple techniques under that set and Cox obviously is one of the number one proven and certainly one of the number one research techniques. And kind of going in that vein how? I mean we talk a ton about research, we talk a ton about relationships, we talk a ton about using research for marketing and really chiropractors doing that and interfacing with other physicians, MDs, DOs in their community. How have you found, how does research like this work with you? How do you find that chiropractors can best use this to kind of promote their practices and get awareness and showcase the safety and the efficacy. What are your thoughts and what's your experience?

Well, I think kind of like you said, most have that idea that confusing the technique with the profession and the technique that they have in mind is the high velocity, low amplitude thrust. And you know, of course the surgeon is going to say you don't ever have a chiropractor do that to you. So you need to let the other medical professionals in your community know that that's not what you're going to do. You know that you have this, you can do Cox flexion distraction technique. It's a very gentle technique that it's safe. And now you have this paper that you know, you can present and say, this is what happens, this is what my colleagues are doing and this is what I do. And you know, I really feel that I can help these post surgical spine patients that you have because what else are they going to put them on more opioids? You know, their hands are kind of tied too. So I think this paper certainly can benefit marketing to other medical professionals in your community. Yep.

Yeah, the options stink. I mean a lot of the patients just, we see it every day. The patients end up on long term. We'll go to pain management and it really ends up being a dumping ground in a situation that changes a patient's life not for the better quite often. So I agree with you. I think it's a super important paper. I will absolutely link to the PubMed citation in the show notes. I really appreciate you taking the time, Mike, and coming on. I know other chiropractors after today are going to want to connect with you. You have an awesome podcast as well. So how can they connect with you? Tell us a little bit about your podcast as we wrap here. And really, I appreciate you taking the time well.

Thank you again, Dr. Jeff. My podcast is called the Back Doctors Podcast and my purpose of doing the podcast is that for people who are podcast listeners, they put in back pain or sciatica, cervical disc, anything like that. Our podcast will come up and the podcast is designed to. To speak to the patient. And I'm interviewing doctors from around the world who are Cox certified practitioners. And they tell patient stories and they tell how the patient responded. And it's just another way for us to get the word out that we are the spine doctors, that we are the spine specialists, that we own this. And we just want. I want everybody to know it. And if you're a chiropractor and you're listening to the podcast and you want to be on my podcast, I would love to have you on. Of course, there's no cost to do this and we're just trying to get the word out about how great our profession is. You can contact me through thebackdoctorspodcast.com my contact information is there.

Awesome.

Thank you.

Thank you, Dr. Mike. I really appreciate it. All the thousands of chiropractors are gonna catch this and listen to this right now. And certainly check out the Back Doctors podcast. Get in touch with Dr. Michael Johnson. He'd obviously love to have you as a guest. If it works out, continue to showcase and highlight the chiropractic adjustment. Thank you for your time today, Mike, and we'll definitely be in touch soon.

Thank you so much.

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