064- Updated ACP Low Back Guidelines

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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are back with research and we are going to be talking about a brand new clinical guideline that was released by the acp, which is the American College of Physicians in regards to back pain and it touches on spinal manipulation, AKA the hallmark of chiropractic care. So I'm super excited to dive into the research this week. It's, it's brand new. It was released on Valentine's Day, February 2017. So just last week as we are recording this, before we get started, I will say a few words as I do each and every week about Rock Tape. Rock Tape, 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 radio roll ons and 32 ounce clinical pump tops. Give long lasting pain relief to your patients. Learn more@rocktape.com topicals that is rocktape.com topicals rocktape. You probably see them all over the place in chiropractic conferences and I also had their medical director Dr. Steve on the Evidence Based Chiropractor podcast a few times over the last year and a half and he knows his stuff. So if you haven't checked out those episodes, I implore you to do so. He is a wealth of research, a wealth of so be sure to check that out a couple other bits of housekeeping before we dive in. Thank you for listening. We have over 2,000, over 2,200 chiropractors listening each and every week. And if you have been listening, I ask you one huge favor. Go to itunes. You can actually access this from the app on your phone as soon as you get to the office today. And stop driving if you're listening to this while driving and you can give us feedback that helps greatly. Obviously the podcast is free. We give you research and the time it takes to get to your office each and every week. And I want to make sure we are reaching more and more chiropractors. The best way to help me do that is to give us some honest feedback, give us a rating or a review on itunes. It helps more and more chiropractors find us also in that vein. Another thing I will touch on is this past week I put out a piece research, or excuse me, not research, an article, a blog on theevidencebasedchiropractor.com and it was all about the chiropractors that you need to be following on social media. If you are listening to this podcast on your telephone right now on your iPhone or Samsung device, you probably use that device also for social media. Facebook, LinkedIn, Twitter, you know, all the usual culprits. It's great to keep up with friends, great to keep up with family, but it's even better when you can get some value added to your day. And I highlighted, I'm not sure exactly how many, probably about a dozen chiropractors that are huge influencers, making waves happen and putting out awesome content every day to help you and your practice. Much in the vein of what we aspire to do at the evidence based Chiropractor. So if you haven't checked that out, I know there's been, I think probably over a couple thousand chiropractors have visited that site and checked it out, but please do so. It's the top chiropractors to follow on social media. You will be glad you did and there'll be a ton of information that they'll be able to give you in bite size increments that's actually actionable, which is the whole key to everything. I'll also put that link in the show notes. But for today, we are talking about the American College of Physicians. They released new clinical guidelines. Again, they were released on Valentine's Day just last week. So this is hot off the press. And the title of the paper ultimately is Non Invasive Treatments for Acute, Subacute and Chronic Low Back Pain. A Clinical Practice Guideline from the American College of Physicians, again, that is titled Non Invasive Treatments for Acute, Subacute and Chronic Low Back Pain. A Clinical Practice Guideline from the American College of Physicians. So the description, ultimately the goal of this paper. The American College of Physicians developed this guideline to present the evidence and provide clinical recommendations on non invasive treatment of low back pain. So they put out a similar piece in 2007. So they're updating this a decade in and there have been some changes, but most importantly, those changes took place in terms of medications. Medications for back pain keep falling, and rightfully so, keep falling farther and farther down the list of what's prudent and ultimately what's in any patient's best interest when being taken care of for musculoskeletal Complaints in particular back pain in this instance. So what they looked at, and really what I want to get to the heart of is that there's unequivocal support in this paper for the use of spinal manipulation. Spinal manipulation will take it ultimately. Ultimately that's the hallmark. It's a chiropractic adjustment. It's the hallmark of what we do as chiropractors. There's nobody that does it better. There's some professions and some people which perform spinal manipulation, quote unquote, that are not chiropractors. Of course there are, but there's nobody that does it better than us. There is no question, there is absolutely no question about that. Our training dictates that and its use in our practice daily dictates that we are the most highly skilled in that. Now, with that being said, there is unequivocal support for spinal manipulation in this paper, which is very important because again, if you have been listening, if you are new and you haven't been listening, then I'm happy to touch on it. But everything we do about the evidence based chiropractor is about highlighting the chiropractic adjustment and highlighting how you can use research to build your practice, specifically through other providers in your community and gaining additional incoming referrals. We've helped hundreds of chiropractors, we've gained thousands and thousands of inc referrals to chiropractors offices throughout the world over the past five years, believe it or not, at this point in time. And there's a very systematic way to do it that we go through in the evidence based chiropractor. But this paper is further support that these primary care doctors, these internal medicine physicians, which we recommend as the primary target of your outreach. Ultimately due to co management and due to the fact that 25 to 35% of their practices each and every day have to do with musculoskeletal issues with their patients. These guidelines further reinforce and further give knowledge on the value of spinal manipulation and ultimately of chiropractic care. Now if we nitpick these a little bit, one of the things that I don't love or absolutely jump up and down about in this is that they do reference the fact that spinal manipulation has low quality evidence. I starkly disagree with that. Of course it is all in the eye of the beholder. Depending upon which papers they looked at, depending upon which papers we look at, you might be able to find low level evidence, you might be able to find moderate quality or strong quality evidence. In my opinion, the breadth and Depth of spinal manipulation is undoubtedly in the strong evidence category. They place it in the low quality. But still there is quality there. It is not negative and it is not neutral. And from a building block perspective, while I don't love the fact that they're referring to spinal manipulation or chiropractic care as low quality, regarding the evidence, I will take it in terms of the fact that low quality is better than zero or no quality. And from that perspective, that's a lot where medication begins to fall with this. So again, opioids are almost old hat at this point in time. It's absolutely crazy that some patients are still recognizing recommended opioids for acute and or chronic pain. These clinical guidelines firmly go against that. They also really place an emphasis on the fact that non pharmacological treatment should be sought before any medication is introduced. Now this is where things get interesting because we know, and I teach at the evidence based chiropractor, because it's the truth. When you go in and ask a primary care physician, well, what do you typically do for patients? What's your current treatment protocol? They're going to say one of three things. 99% of the time, refer to physical therapy, referral to another md, or do and or treat in house, which means ultimately the prescription of NSAIDs. And this paper very, very firmly states guidelines from their own internal documentation. The American College of Physicians ultimately states before even NSAIDs are prescribed, patients should be offered some non medication based treatment options. In other words, spinal manipulation, exercise, multidisciplinary rehabilitation, acupuncture, active care, et cetera, which that is my big takeaway from this paper is ultimately previous to NSAIDs being prescribed to patients walking into primary care doctors offices, walk in offices, walk in clinics, whatever the case may be, before they are prescribed NSAIDs, which is typically the first line of attack for many of these PCPs, again, it's because they don't have the tools. So they just go to what they think might be best, which is an nsaid. But this paper really is a big first step in the right direction to say before you sign that script, before you write that script for the nsaid, you should consider, and internally they're recommending that is not what you do. First, you should consider spinal manipulation, you should consider multidisciplinary rehabilitation, you should consider active care exercise. So that is a huge step in the right direction. And I love the fact that spinal manipulation is considered in that grouping of treatment options that should be explored prior to NSAIDs. Again, while there are some aspects of these guidelines that I don't love in terms of them calling spinal manipulation low quality evidence supporting it. I firmly disagree with that. But I think we can all come together and firmly agree that prior to patients taking NSAIDs they should explore chiropractic care and or spinal manipulation as it's put in this paper. And that by itself is a huge step in the right direction and a huge tool in our toolbox to better inform and educate other providers in our community. So members of the Evidence Based Chiropractor will be hearing a lot more about this paper. It is hot off the presses. We're going to make sure that we get it in an actionable format to our members. If you are not currently a member of the Evidence Based Chiropractor, check out what we have going on@the evidencebasedchiropractor.com as I've touched on multiple times, we help chiropractors build better practices by building better relationships. We've done it longer than anybody else, we have more experience than anybody else and we have been there and done it. So I hope you guys have a great week in practice. I thank you for tuning in and we will be back next week with another piece of hard hitting research. I hope you have a great, fantastic week in practice. Doc and I will talk to you soon.

We appreciate you joining us for this episode of the Evidence Based Chiropractor. Learn more tips for explosive practice development@the evidencebasedchiropractor.com youm can also join the Premier MD monthly membership, enabling you to use what you just heard to maximize results in your office. We look forward to providing you with more dynamic communication tools for immediate growth right here on the Evidence Based Chiropractor.

Sam.