100- Maintenance Chiropractic Care and Research

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Hello and welcome to the Evidence Based Chiropractor. I am your host Dr. Jeff Langmaid. Maintenance Chiropractic Care do you advocate for it? Do you discourage it? Or have you been waiting your whole life for this podcast to talk about the research that examined it? Well if you are in the third category you are in luck because this week we are going to look at a paper that examined maintenance chiropractic care and its potential value. So that is a cliffhanger if I have ever heard one. But as you know, before we get started we will say a few words about Roc Tape. Roc Tape is revolutionizing soft tissue world again with the new Rock Blades Mohawk. Featuring three tools in one, a surgical stainless steel hand polished tool and two attachments silicon sleeve and an ABS comb. Rock Blades Mohawk unlocks never before seen treatment protocols to reduce pain, improve mobility and address issues like nerve glide and neuropathy. It's a 175 bucks and you can learn more and also check out where their awesome education courses are going to be featuring mohawk@rocktape.com mohawk also if you are maybe you just started following us here at the Evidence Based Chiropractor. I did a live unboxing on Facebook and I believe that's also up on YouTube. So if you want to check out the tool you can there. But today we are talking about research and we're going to talk about a paper as I spoke of at the top, it's about maintenance chiropractic care and more interestingly perhaps it is published in Spine Journal. So a non chiropractic focused journal. Spine, one of the most prestigious peer reviewed journals in all of spine care in 2011 put out a paper titled does maintained spinal manipulation therapy for chronic non specific Low back pain result in better long term outcome? And they ended it with a question mark. I'll repeat that one more time. The title of this paper which you can find linked in the show notes Spinal Manipulation Therapy for chronic non specific Low Back pain Result in better long Term outcome. So again this gets a little bit controversial which I think is really really interesting. Maintained Care, Maintenance care, Wellness care. There's a certain percentage of the chiropractic population, their office thrives on it. Their office wouldn't exist without it. And there's certain other chiropractors that really, it's pain relief and nobody's in there for a PVA of maybe more than six to eight visits. And that's a matter of personal preference, in my opinion. We're gonna look at the research behind that. And when I say personal preference, I also mean this. I don't believe that any patient, and this is just me, I don't believe that any patient should be prescribed, so to speak, 24, 36, 100 visits on visit one. You just don't know them well enough yet. Always. In my opinion, you should start with that initial trial course of care, six visits, 12 visits, whatever it may be for you to see if you're reaching the goals and expectations that you set forth. And in my opinion, that doesn't matter how you practice. I don't care about your technique, I don't care about your philosophical bend. In my opinion, patients should be experiencing improvement, whether subjective, objective, or both, and whether that's by their thought or whether that's by your as a chiropractor, examination and following that patient. So really, this paper takes an interesting look at it because again, this is a non chiropractic journal looking at what maintenance chiropractic care. And we all know that non specific low back pain affects 80% of the population. And ultimately, we also know limited success has been found with treatments, traditional medical treatments such as medication and rest. And to me, well, let me just say it straight up, this study from Spine indicates that not only does spinal manipulation therapy significantly decrease both pain and disability scores in the short term, but it may help in the prevention of future episodes. So that is exceptionally powerful. And what I'd like to do, I'm gonna dive into three quotes that I think really, really frame what the researchers found in this study directly from the paper itself. Researchers found, quote, nonspecific low back represents about 85% of low back pain patients seen in primary care. About 10% will go on to develop chronic disabling low back pain. So 10% of people will become chronic. 85% of the low back pain in primary care is non specific low back pain, meaning there's not a direct correlation. There's nonspecific low back pain. It's not just very clearly a radiculopathy at L4, L5 because of a disc, because they're a football player that got tackled a funny way or something, something like that. Non specific low back pain, 85%. Now, if we take a little bit, I'm going to veer off a little bit because I also want you to understand and really be able to appreciate the fact that 30% of primary care doctors daily visits involve musculoskeletal or spine related symptoms. I also want you to know that the research and we've highlighted this on the Evidence Based Chiropractor podcast. In the past, 85% of primary care physicians have reported that patients ask them about chiropractic care, yet only 11% initiate a formal referral to a chiropractor. Let's say that one more time. 85% of primary care doctors have been asked about chiropractic care, yet only 11% have formally made a chiropractic referral. To me, that is opportunity number one. That's sad if we get that right off the top because chiropractic is by far the most effective and safe treatment option for these patients, bar none. And that's low hanging fruit. We're talking about low back pain. Chiropractic can do much, much more than that. But there's a great divide between 85 being asked and 11% making a referral. And ultimately that's what we do, of course, at the Evidence Based Chiropractor. If you check out the evidencebasedchiropractor.com that's exactly what we do with our monthly membership. And really our team is really the support systems, tools and everything you need to bridge that gap. 85% to 11% is kind of the smell of opportunity there, that is for sure. But you need to do it the right way. You need to position yourself the correct way to be able to bridge that gap. So here's a couple other quotes from the researchers. They found the postulated modes of action of spinal manipulation therapy include disruption of articular adhesions, improvement of trunk mobility, relaxation of hypertonic muscle by sudden stretching, release of entrapped synovial folds, attenuation of alpha motor neuron activity, enhancement of proprioceptive behavior and the release of beta endorphins. So really that's the nutshell, right? That is the toolbox by which a chiropractic adjustment works. And there's a lot to it. There is a lot to there's central nervous system effect, there is muscular effect, there is mechanical synovial fold effect and much, much more. And endorphin release. So these are great setups. Now the researchers also found, quote, this study confirms previous reports showing that spinal manipulation is an effective modality in chronic non specific low back pain, especially for short term effects. Nothing world beating there, but it's nice reinforcement and finally, the researchers found here's kind of the one that takes it home. The researchers found, quote, as patients did benefit from the maintenance treatments believe that periodic patient visits permit proper evaluation, detection and early treatment of an emerging problem, thus preventing future episodes of low back pain. So there you have it. That is a very, very powerful study. Spine Journal 2011, taking on the interesting turf maintenance care and chiropractic and actually standing behind it saying, hey, patients did get benefit from the treatments and, and additionally those periodic patient visits, they permit evaluation, detection and early treatment of an emerging problem. Now don't get me wrong, the difference between what this paper says and what an insurance company will allow may be great and wide as unit, as you may know, but in terms of support of some ongoing care, it doesn't say see the patient five times a week for the next 170 years. But it does say we stand behind maintenance, chiropractic and ultimately we stand behind periodic patient visits to a chiropractor because the benefit far outweighs the harm. And again at the evidence based chiropractor, as you can imagine, we featured this study previously for all of our members as part of their monthly brief because it's a powerful one. And it doesn't say that you, it's not mutually exclusive. It doesn't say, well, we don't do an initial trial course of care. Everybody gets maintenance care and everybody gets 700 visits on visit number one. Of course not. But this does start to open their eyes. It does start to showcase that there may be more to chiropractic than just simply that relief care. If you're all into the relief care, go for it and good for you. There is a need for it. That is for sure. With 90% of people having pain related to their spine, yet only 5%, 7% visiting a chiropractor. We still have a lot of work to do there. But furthermore, papers like this supporting what we do long term are exceptionally important in us building trust. And the second component to that, in my opinion is the fact that I'll tell you, working in a multidisciplinary clinic, with neurosurgeons, with orthopedic surgeons, with physiatrists day in and day out and kind of being a director level in that system in this company, one thing I will tell you is those docs are more open than you can possibly imagine and more respectful than ever to the fact of people are deconditioned. And it's not just three visits, it's not just five visits. It's not just one surgery that's gonna magically change lives. These are ongoing degenerative processes in many, many people that require a multifaceted plan of attack and also require maintenance. They require the ability to continue the work. So in my opinion, this study is a fantastic one. It's one that we all should be showcasing to other healthcare providers. Of course, with the caveats, that doesn't mean that every patient gets that on visit one. But in terms of showcasing the positive research from a journal like Spine, an esteemed journal like Spine, I just don't you can go wrong. So if you'd love to learn more about what we're doing over at the Evidence Based Chiropractor and how we utilize papers like this to build relationships and get more patients into chiropractors offices just like yours, check us out@the evidencebasedchiropractor.com secondarily if you've been checking out the podcast. Thank you a ton. I have one ask of you. As soon as we finish up this episode momentarily, hop in. You can do it right from your iPhone. If you have the new operating system, you can hop right in and give feedback and a rating or right now right there. And then it helps us reach more and more chiropractors every week, talking about research, talking about marketing, and hopefully having a little fun along the way. So I hope you have a fantastic week in practice Doc and I will talk to you very, very soon.

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