062- Why Some Patient's Respond Better to Care Than Others

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. This week we have a great piece of research that looks at why some people respond to chiropractic care and why others may not respond to chiropractic care. So before we dive into this episode, one thing I will touch on is earlier this week I released a chiropractic marketing and growth hacks cheat sheet. Hundreds upon hundreds of chiropractors have downloaded it. The response has been unique, unbelievably tremendous. So if you haven't checked that out, go to the evidencebasedchiropractor.com it's a free download. I'm leaving it up for a limited amount of time. It really touches on everything you need to know to market your practice in 2017 and beyond. I spent a few months building it out, so I'd appreciate it if you went there and checked it out. But for today, we are looking at a study from Spine Journal. You know Spine Journal? Absolutely. Top Tier Research Journal. It was released in 2015 and this article was titled do participate Participants with low back pain who respond to spinal manipulative therapy differ biomechanically from non responders, untreated controls, or asymptomatic controls. I'll repeat that title one more time. It's a little bit wordy. Do participants with low back pain who respond to spinal manipulative therapy differ biomechanically from non responders, untreated controls, or asymptomatic controls? So as we know, spinal manipulative therapy, AKA a chiropractic adjustment, is the hallmark of chiropractic care in a common treatment for patients with a variety of conditions and or those looking to just get an edge function and performance wise in life. Research has continued to showcase the efficacy and safety of the chiropractic adjustment. However, little has been done to understand really why some people respond so favorably, while others may not be able to notice too much of a change. So this study aimed to determine whether patients who responded favorably to chiropractic adjustments differed from those who didn't respond as much. They found that responders had. There were differences, they found. The researchers found that responders had an immediate and sustained decrease in spinal stiffness. So flexibility is unbelievably important for spinal Hygiene, so to speak. And people who responded to chiropractic care, they had an immediate and a sustained decrease in spinal stiffness. Additionally, they had an increase in their multifidus thickness Multifidus, a deep spinal stabilizing muscle. A lot of people out there working core, they often work multifidus work multifidus. It is a key stabilizer in our spine in patients. People who responded very well to chiropractic care had a multifidus thickness ratio which was higher than those who did not. So this study has very important clinical implications. But by decreasing stiffness and increasing multifidus thickness spinal manipulation, chiropractic adjustments may be beneficial prior to active care and there might be clinical advantages that can lead to improved outcomes when mirrored or co managed with other providers or practitioners. So here are a few key quotes that I really loved from this study. The researchers found quote after the first SMT adjustment, SMT responders displayed statistically significant decreases in spinal stiffness and increases in multifidus thickness ratio sustained for more than seven days. These findings were not observed in other groups. So again, the researchers found people who responded very well to a chiropractic adjustment, they tended to have an immediate decrease in spinal stiffness and an increase in the multifidus, the deep spinal stabilizing muscle multifidus, an increase in multifidus thickness. The researchers also found responders to spinal manipulative therapy for low back pain are characterized by an immediate and sustainable decrease in spinal stiffness and an increase in lumbar multifidus thickness ratio. Same thing said a little bit of a different way. Patients that had a great response to a chiropractic adjustment, they saw a decrease in spinal stiffness that also lasted. It was not a decrease for one minute. It was observed up to seven days post adjustment. And that multifidus thickness ratio also was better. So they found, quote in other words, the biomechanical changes in SMT responders were clinically relevant. Again, they found, in other words, quote unquote from the researchers quote in other words, the biomechanical changes in SMT responders were clinically relevant. So I love this paper because I think it touches on often as a chiropractor we might find, hey, why do some patients tend to respond absolutely wonderfully while some may be slow to come around? And this touches on two key components to that equation that we've already talked about. One is a stiffness decrease. So patients who notice they have increased flexibility AKA decreased spinal stiffness, those aren't mutually exclusive, but there's A lot of overlap, decreased spinal stiffness that was sustained, and very quick onset of decrease in spinal stiffness. Those patients tended to get a vastly better or more significant benefit from a chiropractic adjustment than those who did not. Secondly, the researchers found multifidus. I've just talked about this. I spoke. Actually, I had the wonderful privilege to speak at the Professional Baseball Chiropractic Society annual event. We were reading a lot of, and we were doing a lot of MRI and a lot of perioperative care. But most importantly, one of the things that I touched on on those axial slices of an MRI were the multifidus muscle and where you can see that there's a lot of fatty infiltration on some patients and where other patients had great, fantastic muscle tone. So this paper also touches upon that which I find very interesting. They touch upon the fact that that multifidus muscle, the thickness ratio of that multifidus muscle is exquisitely important in getting a good benefit, which makes sense if you're multifidus. If you're stabilizing muscles, your core muscles, the tone stinks, the ratio stinks, and you have more fat than actual muscle in the area. It's gonna be an uphill battle to get a great response. However, for patients that do have great muscle tone, you should be able to expect a better response. And I think this comes full circle. One of the things that we touched on during that talk was the fact of if you notice, if you happen to have an MRI available, everybody looks at MRI for disc pathology, for nerve root compression. Take a look at that multifidus muscle. If you notice that there decrease in muscle tone and there's a ton of fat in that multifidus, you need to set your patient's expectations a little bit differently. So it's going to take longer for them to get gains because they don't have the exact. Exactly as we're talking about with this paper. The response may be slower. Again, they don't have the core stability, they don't have multifidus tone. They are going to be a tougher patient to come around the bend to get that result with because they're deconditioned ultimately. So keep that in mind when you look at those MRI slices is bring up your T2 axials and take a look at the multifidus muscle. It's right in the gutters of where that lamina reside and see if it looks darker or whiter. Whiter means there's a lot of fatty infiltration. Darker means it's a healthy muscle. Tone. This gives you the ability to better communicate with your patients, better set expectations. And for many of the patients that come in that are a little bit older, you can actually clinically and relevantly tell them it's gonna take a little bit longer with your care because and here's the picture why, and that is unbelievably powerful when you marry those two things in clinical practice. So again, today's paper that we talked about, this week's paper was a spine journal paper, volume 40, number 17 from 2015. This is brand new. Do participants with low back pain who respond to spinal manipulative therapy differ biomechanically from non responders, untreated controls, or asymptom controls? And it comes down to two huge spinal stiffness and multifidus thickness ratio as we touched on at the top. One other thing I'd be remiss if I didn't say before so if you're watching this right now live on Facebook, give me a like if you're listening to this tomorrow or today when you listen to it in your car on the ride to the office, there's a few thousand kairos that listen to the weekly podcast. This is a live recording of it that we have live on Facebook right now. If you listen in every week, I'd really appreciate it. Send me some feedback. Jeffevidencebasedchiropractor.com or you can just go on itunes. Make sure you give an honest feedback. It helps more chiropractors find what we're doing, which helps us spread the message, which helps us raise the tide, which raises all the boats with it. So we put these out each and every week for free to make sure that chiropractors have the best available information. So little things like that go a long way towards helping expand our reach and expand who we can talk to, which helps all of us as time goes on. One other bit of housekeeping I touched on at the top of this video as well. Chiropractic growth hacks. Chiropractic marketing growth hacks. I took a few months. I looked at Neil Patel Sumome, a ton of six, seven, eight figure businesses, distilled it down to what I think is relevant for a modern chiropractic practice to grow. I put it together as a cheat sheet, an article@the evidencebasedchiropractor.com I will in the Facebook comments here. I'll be sure to put it in below. And if you're listening to this on itunes, it will be on the show notes at the evidence based chiropractor. Hundreds, probably over a thousand chiropractors have downloaded it to date. It's been out less than a week. The response has been awesome. I'm gonna leave it up for a limited amount of time, so be sure to check that out when you get a moment. You will not be disappointed. 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