104: Neck Adjustments: Research, Safety, and Efficacy

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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week it is all about the cervical spine or the neck. We're gonna look at research that showcased the benefits of chiropractic care for those individuals with cervical disc herniations. We're gonna look at safety, a research paper that looked at 50,000 plus chiropractic adjustments with no serious adverse events. We're gonna talk a little bit about chronic neck pain and and acute neck pain and how chiropractic fits into that puzzle and the research supporting it. So it's an exciting episode. I can't wait to dive in. But before we do, I'll say a few words as we do each and every week about ROC Tape. Roc Tape is revolutionizing the soft tissue world again with Rock Blades Mohawk. Featuring three tools in one, a surgical stainless steel hand polish tool and two attachments, a sleeve and an ABS comb, Mohawk unlocks never before seen treatment protocols to reduce pain, improve mobility and address issues like nerve glide and neuropath. It's 175 bucks and you can learn more and explore education courses featuring mohawk@rocktape.com mohawk so as we said at the top, this is a great episode because we're gonna touch on a variety of factors that kind of influence or play with the neck, the cervical spine. And let's hit it right off the bat with safety. Let's get that out of the way. Sometimes for prospects, people in our community or other physicians, there's a question of the saf safety of adjusting the neck. Well, we know that that should be a non factor but let's take a look at the literature. Spine journal in 2007 put out a research paper aptly titled Safety of Chiropractic manipulation of the Cervical spine. That's about as clean cut as a title can get. Safety of Chiropractic Manipulation of the Cervical Spine. It was by Spine Journal or should I say it was by Spine, which is a top Tier journal. In 2007 they analyzed nearly 20,000 patients and over 50,000 cervical spine manipulations or adjustments were given. And what they found throughout that was zero. Let me repeat that. Zero serious adverse events. So that is exciting. So they found again, we studied treatment outcomes obtained from 19,722 patients and there were no reports of serious adverse events. They also found, quote, it is the risk, however, of serious adverse events following the cervical spine manipulation that is of most concern, not only for patients and chiropractors, but also for general practitioners and hospital specialists considering referring patients for chiropractic treatment. So safety is a concern of the public, safety is a concern of other healthcare providers. But having research like this, 50,000 adjustments, 0 serious adverse events, is a long go, goes a long way towards showcasing just how fantastic and fantastically safe a chiropractic adjustment in the neck could be. So then we take it one step further. Let's say, okay, well, what's the evidence based guidelines? And we can look at a paper From JMPT in 2014, evidence based guidelines for the Chiropractic Treatment of Adults with Neck pain. And what they found, this was an award winning paper, by the way, and it examined 41 randomized controlled trials from 2004 to present. And what they found was strong recommendations were made for the treatment of chronic neck pain with manipulation, manual therapy and exercise in combination with other modalities. So the highest classification, which was a strong recommendation, was absolutely given to adjustments or manipulations. Matter of fact, when you look at moderate recommendation, it also included manipulation or adjustments. When we look at weak recommendations, it was exercise, no recommendations, tens, trigger point therapy and traction. So strong and moderate, the highest recommendations they could give included manipulation. Well, I'm going to break that down one step further. They gave a strong recommendation for the use of manipulation with chronic neck pain and a moderate recommendation for manipulation or adjustments of the cervical spine with acute pain. So again, now we're starting to get a picture, right? We can start to understand a little bit more about chronic versus acute. What does the research say? Hey, it supports both. So let's take one step further. Let's talk a little bit about, you know, what's out there, which is adjustments. People that have neck pain, right, they are looking for, probably gonna get some exercise, some physical therapy. Maybe they're looking at medications or maybe they're considering calling your office. So we can take a look at a paper from the Annals of internal medicine. In January 2012, it came out, it's titled Spinal Manipulation Medication or Home Exercise with Advice for Acute and Subacute Neck. A randomized trial. Okay, this is pretty interesting. Let's see what the researchers found. They found for pain, spinal manipulative therapy had a statistically significant advantage over medication after 8, 12, 26 and 52 weeks. So in the short, mid and long term, spinal Manipulative therapy had a statistically significant advantage over medication. That is cool. And when they're talking about medication, they are talking about NSAIDs. And the researchers also found for participants with acute and subacute neck pain, spinal manipulative therapy was more effective than medication in both the short and long term. So just further stating what we had touched on, and the number of participants were nearly 300 in that study. So that is another nice piece of the puzzle. We've talked a little bit about safety, how safe chiropractic care is. We've talked a little bit about the evidence based guidelines for the treatment of neck pain. And hey, adjustments and manipulation fall right at the top. Then we look at some of the common things that patients and people might be thinking about or recommended. They might be recommended exerc in a physical therapy capacity. They might be recommended NSAIDs or medication, or they might be considering a chiropractor. We just talked about that. And chiropractic adjustments absolutely take the day as far as that's concerned. Better outcome in the short term and the long term. So let's look at another angle. What about a patient with a big disc herniation? That can be intimidating sometimes. And you know how it goes. Many times patients, they might be seeing you and maybe they're seeing a primary care doctor as well. The primary care doc, after a week or two is like, why don't you go get an mri? I don't like the fact that you have some numbness and tingling in those fingers. Patient goes and gets an mri. What do you know? There's a disc pressing on the nerve. Foraminal stenosis. And what does that primary care doctor do? They're gonna say time for injections and you might be looking at surgery. And we're gonna talk about a study that looked at that and, and examines whether or not that is the correct healthcare recommendation. So this study was from JMPT in 2013. So all of these studies, in my opinion, are pretty much brand new. So they are exciting. This JMPT study was titled Outcomes from MRI Confirmed Symptomatic cervical disc Herniation. Patients treated with high velocity low amplitude spinal manipulative therapy. So what did they find? Let's take a look at a few quotes. The researchers found by two weeks after the first treatment, 55.3% of all patients reported that they were significantly improved and none reported being worse. That is powerful. Let's take a look at something else that they found. Quote, at three months after the first treatment, 76.2% of the subacute and chronic patients reported clinically relevant improvement, with no patients reporting that they were worse. And finally, the researchers found, quote, patients with symptomatic MRI confirmed cervical disc herniations treated with smt, AKA adjustments to the level of herniation, reported high levels of clinically relevant improvement at two weeks, one month and three months after the first treatment. This is powerful. You can start to see when we piece together safety, when we talk about efficacy, when we showcase the latest guidelines. This makes a very, very compelling case that all patients. Now, as a practitioner, as a chiropractor, you might be interested in more than just neck pain and back pain. That's fine. But the bottom line is this research showcases unequivocally that nearly every patient with neck pain with a cervical disc herniation, whether that neck pain is acute or chronic, should absolutely be visiting a chiropractor's office first. When we look at it, the safety is there. It's fantastic. When we look at the efficacy, chiropractic outperforms medications. And then when we look at even when there's a disc herniation causing radiculopathy that sometimes gets physicians, chiropractors and PCPs a little nervous, let's say, and starts to push people towards injections, not the case. You look at 50%, over 50% of people with that condition improving within a couple weeks and over 75% improving in just a couple months. And it is staggering. You combine that with previous research showcasing adjustments or manipulations, outperforming nerve root injections when go up, when put head to head, and again, this makes a very compelling case that everybody who experiences neck pain should definitely at least be considering to visit a chiropractor's office, your office, before doing anything else. So I love this research and actually I love this research so much that we took, you know, cervical spine, you know, neck, so to speak, and made it our topic of the month for the smart chiropractor. So the smart chiropractor, as you probably know it, is all about weekly handouts for patients, social media graphics for patients in reception area, slideshows for your patients and all supporting that online and off. So it's about utilizing the research to build your brand from a patient perspective, engaging them, entertaining them, showcasing the research and helping them share it. At the Smart Chiropractor, we always talk about sharing research that matters. The that is what it is all about. What matters to your patients, what matters to your practice, and how can you impact more people? As always, we showcase all of this through the Evidence Based Chiropractor. If you're interested in bridging the gap and building relationships with other healthcare providers, then check out the evidencebasedchiropractor.com if you're interested in using research to boost your own practice with prospects and your community members and with your patients, then visit thesmartchiropractor.com we have you covered both ways and we want to make sure that 2018 is your best year yet, so you can check that out. And as always, thank you a ton for listening. If you haven't ranked us or given us any feedback on itunes, I would greatly appreciate that that helps us get seen and heard, so to speak, by many more chiropractors each and every week. I hope you enjoyed this research and I hope you have a fantastic week in practice Doc. I will talk to you soon.

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