097- Open the Canal: Spinal Stenosis and Chiropractic Care

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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week our research paper is one that you do not want to miss. It is about lumbar spinal stenosis and how chiropractic care, conservative care, can help people live a higher quality of life with more function and better overall health and wellness. But before I get started, I'll say a few words as I do each and every week about Rock Tape. Rock Tape is revolutionizing soft tissue world again with the new Rock Blades Mohawk. Featuring three tools in one, a surgical stainless steel hand polish tool and two attachments, a silicon sleeve and an ABS comb. Rockblades Mohawk unlocks never before seen treatment protocols to reduce pain, improve mobility and address issues like nerve glide, excuse me. And neuropathy. Starting at 175 grams. These things are a steal. Learn more and explore educational courses featuring mohawk@rocktape.com mohawk but as I said at the top this week we are all about the research. There are people coming into your practice today that have spinal stenosis. The prevalence of it's just high. It's stuff we see every day in and out and a lot of these individuals explore injections and potential surgical solutions for their stenosis. But this paper that we're gonna touch on today showcases why chiropractic care should be at the top of that list. And the paper is titled A Non Surgical Approach to the Management of Lumbar Spinal Stenosis. A Prospective Observational Cohort Study. This was done in 2006 by BMC Musculoskeletal Disorders and I will have a link to this paper in the the show notes which if you've updated your iPhone are actually right there. If you scroll down just a little bit. I am a huge fan of the update to the podcast application in the new operating system on the iPhone. But anyhow, lumbar spinal stenosis, the incidence rate is 10% or more of the general population. Basically, if you live long enough you're probably gonna have stenosis of some kind. Ultimately, as we know that's encroachment on the central canal. That encroachment can take place through one of tissues, disc, bone or ligament. Pretty simple. Often if we read a report it might say triangulation of the canal and that means that all Three tissues are involved. Ligamentum flavum on the posterior aspect of the canal can kind of push things up or in so to speak, that can become thick or hypertrophic, taking up valuable real estate in the central canal. And the disc on the other side can push back or down. And that causes compressive pathology. If you look at an axial cut of an MRI, we like that central canal to be 10 millimeters or more in A to P diameter. As that goes down from there, it becomes a different and separate degree of stenosis abutment. You know, the tissue is touching the thecal sac, but no compression. Mild, mild, moderate, moderate, moderate, severe. And 6 centimeters or below, excuse me, 6 millimeters or below is where you get into the territory of severe stenosis. And we all know what people look like with stenosis. They come in with that forward leaning posture. It's not the antalgic. They're not leaning one side or the other. They're leaning flexed forward. They love to have the grocery cart. If they go to the store, if they take the car away and they need to stand up or just walk, they're always sitting down. And the time between chairs keeps getting. And most often these individuals, when they sit down, they say, I feel great if I sit down, I just stay in my la Z boy all day long. Which we know further exacerbates the issue at hand. So this study shows chiropractic low velocity lumbar flexion distraction to be very promising non surgical treatment option for these patients. The hallmark of that lumbar spinal stenosis is the neurogenic claudication. The pipes are being shut off and that enables people to not walk very far and really takes a huge, huge impact on these individuals quality of life. So the flexion distraction technique, what it does is it provides direct manual decompression of the spinal motion segments and it mobilizes the segments and decompresses the nerve roots. Bottom line is we just said it. Hey, people love to flex forward when they have lumbar spinal stenosis. They squat sometimes halfway. If they're walking from the grocery store to the parking lot, they have to squat down for a minute, then keep going. So when you're able to do, for instance, flexion distraction, get somebody in prone position, contact that spinous process, and then get some decompression as well as that flexion, flexion distraction, in the truest essence of the words, that provides unbelievable relief for these individuals. Now let's take a look at what the researchers specifically in this paper found regarding flexion distraction. The Researchers found. I'm gonna read four specific quotes from them. Quote, non surgical management should be the first line of approach in patients with lumbar spinal stenosis. Nothing to disagree about with that. Also, the researchers found lumbar spinal stenosis can lead to low back and leg pain, most typically via encroachment on the central canal, lateral recess or lateral canal. The source of the encroachment is typically vertebral body osteophytes, hypertrophy of the ligamentum flavum or Z joint, or a combination of all of these. The development of these degenerative changes is often accompanied by restrictions, restriction of the segmental mobility, end quote. Kind of like we just touched on. The researchers also found a non surgical approach that attempts to target the unique pathophysiology of lumbar spinal stenosis may be best able to rapidly improve pain and function in these patients. Rapidly improve pain and function in these patients. And finally, the researchers found clinically meaningful improvement in disability was seen in over two thirds of the patients. That is substantial. Researchers found 65.1% was the patient rated improvement for those that had flexion distraction technique. So people were improving by over 65%. Imagine that. My mathematics aren't gonna be perfect here, but that would be like taking somebody from a 10 out of 10 pain and disability down to a 4 out of 10, from a 6 out of 10 down to maybe a 1, 1 and a half. These are substantial improvements. And it makes sense right when you have somebody in that prone position and they have triangulation of the canal. Central stenosis, it is just pinching, pinching, pinching, and gravity's taking its toll. And the person's trying to get up and moving and they can't get around. And you get them again in that prone position, you're able to provide flexion, which opens the canal naturally and, and distraction, which also again, further decompresses that nerve root, decreases the intradiscal pressure, and ultimately provides mobility to a segment that's probably not moving the way that they would like it to move in an ideal world. These are things that make a huge, huge difference in the quality of life for patients that are suffering with lumbar spinal stenosis. So this is an absolutely great thing to be able to coordinate all your language with other healthcare providers in your community. Whether it's somebody who focuses, a doc that focuses on geriatrics, whether it's a doc that focuses on sports medicine, whether it's a primary care internal medicine doc, you pretty much name it, you're gonna see lumbar spinal stenosis across the gamut of ages, sexes, et cetera. So the ability to showcase to other physicians, I mean, this result is substantial. 65% patient rated improvement. I'm gonna go out on a limb and say that's probably at least as good as many surgeons expect when they surgically decompress the canal. And this study showcases how flexion, distraction, a low force chiropractic technique, can provide that much improvement for people suffering with lumbar stenosis. So in my opinion, it is a fantastic paper to share with your local community. Share not only with patients. Imagine the patients that are coming in that might be 40 years old. What are their parents that are 80 years old or 70 years old and probably a major majority of them are suffering from some form or some severity of lumbar stenosis. This is a great opportunity to share this information with them. It's also a great opportunity to showcase this with other healthcare providers. Of course, as you can imagine here at the Evidence Based Chiropractor, we released this as a research brief for our members because it is all about building relationships with other healthcare providers in your community. I don't care do Maryland midwife doula, whatever that person's specialty focus, papers like this provide education and provide enlightenment and hopefully a little bit of entertainment regarding how exciting the research behind chiropractic care is becoming. So I would encourage you to check out this paper. It'll be linked in the show Notes. If you have an opportunity, leave us some ratings or feedback on itunes. If you're using your iPhone and you've updated that app, slide down a little bit and you can leave it from right there. Any opportunity you have to give us feedback, welcome. It helps us reach more and more chiropractors each and every week and I want to continue to get the word out as much as I can. Thank you for listening. I hope you have an awesome week in practice and I will talk to you soon.

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