109- High Velocity vs Low Velocity Techniques

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Hello and welcome to the Evidence Based Chiropractor. I am your host Dr. Jeff Langmaid. This week we have an exciting piece of research. A randomized controlled trial looking at two different types of chiropractic adjustment or spinal manipulation. High velocity versus low velocity versus medical care. What does the research say? The that is what we are going to talk about today. So this is one you do not want to miss. But before we get started, I'll say a few words about ROC Tape. Roc Tape is revolutionizing the soft tissue world again with new Rockblades Mohawk. Featuring three tools in one, a surgical stainless steel hand polish tool and two attachments silicon sleeve and an ABS comb. Rockblades Mohawk unlock never before seen treatment protocols to reduce pain, improve mobility and and address issues like nerve glide and neuropathy. 175 bucks. You can find them and educational courses@rocktape.com Mohawk but for our research this week I'm gonna read you the title of that paper and article. You can also find it in the show Notes. A randomized controlled trial comparing two types of spinal manipulation and minimal conservative medical care for adults 55 years and older with subacute or chronic low back pain. And this was in JMPT in June of 2009. I'll repeat that title for you one more time. It says it all. A randomized controlled trial comparing two types of spinal manipulation and minimal conservative medical care for adults 55 years and older with subacute or chronic low back pain. So this study is pretty interesting and pretty cool in my opinion because it's one of the first ones that analyzed high velocity adjustments versus low velocity adjustments versus that minimal medical care. Excuse me. So it was interesting to see what the results were going to be because it really pits a few different things that have real world applications. Many chiropractors have both high velocity and low velocity techniques available in their practice. Some of us lean more one way or the other or maybe do more of one than the other. And there are certainly some offices that really hyper focus on a technique, kind of a technique driven office. But for a majority of chiropractors we kind of sit in the middle, myself included where I have some high velocity techniques that I know and love. I probably lean a little bit more that way. But I'm not hesitant to use an activator or use flexion distraction, things like that. That could be a little bit more comfortable for the patient. Or maybe there's contraindications to the high velocity techniques. And then you comp that, of course, to medical care, which many people, we know it, with subacute or chronic low back pain, especially Medicare population, basically people 55 and older, many people are seeking concurrent care, meaning they probably went to see their medical doctor and their chiropractor if they're suffering from a bout of low back pain. So what did the research find that really is the crux of today's talk, right? What? When these two things were pitted against each other, or three things were pitted against each other, who came out on top? Well, let's dive right into it. And I'm gonna read three important quotes from this paper. The researchers found, quote, spinal manipulation had improvements on average in functional status ranging from 1 to 2.2 over those who received minimal conservative medical care. All right, so that's a good start. I love that because we're talking about function, right? Which is real world. I mean, there's the geeked out research stuff that's about, you know, the content, but how do you put it in the proper context that it matters to your patient? And function and functional status are things that matter to patients. How are they able to do their activities of daily living? How are they able to function day to day? So the first quote we find spinal manipulation, either one outperformed medical care. Good start. But let's go a little bit deeper. The researchers also found both manipulative procedures were associated with clinically important changes in functional status by the end of treatment. So again, reinforcing a little bit of what we just talked about. Both techniques, high velocity and low velocity, were associated with clinically important changes in functional status. That's a good step in the right direction. And let me take a sidebar right now to talk a little bit about the technique specifically addressed in this paper. So when they talk about low velocity technique in this paper, they were talking basically about a flexion distraction type technique. So that's what they were referring to with the low velocity in this paper. Additionally, the high velocity technique was more of a traditional side posture lumbar adjustment, so to speak. So those were kind of the two technique choices if we get into the weeds on them a little bit. The researchers also found the third quote here is the most powerful, and it's the one that really we can hang our hat on. The researchers found participants who received either form of spinal manipulation were approximately 30% to 40% better on the average in functional status than those who received minimal conservative medical care. Let me read that one more time. The researchers found, quote, participants who received either form of spinal manipulation were approximately 30 to 40% better on the average in functional status than those who received minimal conservative medical care. So that is what drives the point home, ultimately, these two techniques. So I kind of jokingly at the top said we're gonna have kind of technique wars here and which one's gonna come out on top. This paper showed both techniques resulted in significant and clinically meaningful improvement in function for the patients who underwent either chiropractic technique. And the only people in this case who were left in the dust were those who received conservative medical care, which was basically medications as dictated in this paper. And we know, right, anybody who's a member of the evidence based chiropractor, and certainly those, I've talked about it on the podcast before, we know that 30 to 40% of a primary care's daily volume in their practice is related to spine or musculoskeletal. We also know 90%, yes, 90% of PCPs have stated they have been asked about chiropractic care. The other side of that equation, only 11% have initiated a formal referral. That gap to me is the opportunity for us to bridge the gap and build that relationship. And with this, a paper like this, we absolutely can see hands down that regardless of what you do as a chiropractor, regardless of the technique, now I think if you go drill down farther and farther, you're gonna find some differences in technique. And that's about selecting the right patient for the right technique, etc. But with acute and chronic low back pain, there is no doubt that regardless of what technique is chosen, that it is going to outperform medical care. That's not a hit on those doctors necessarily. It's really gonna outperform not medical care. It's gonna outperform the treatment that these medical providers are giving. Which one out of three times is going to be medications. It is going to be medications. The other two things that those primary cares typically are doing are referring to physical thera or another specialist. But that is why it is so important to reach out to speak to these providers, to set up meetings and to find your value add, find out what they're doing, find out how you make things easier or better for them and their practice, and then follow up consistently. That is exactly what we teach all of the members of the evidence based chiropractor. And each and every month from the get go, they have the tools, the systems, the resources to be able to bridge that gap, to be able to know what questions to ask, to creatively go about how they find their value add. And to me the best part is it doesn't matter if you're introverted or you're extroverted or really again even what technique you have in your practice. It is about finding the value add for the other party, for the other provider, and showcasing how you can be an improvement and make things easier and better for them. So it is fantastic when then you have the research such as this, supporting the care that we do, because now that conversation can be had with integrity. That conversation can be had much more naturally and quite frankly, you're not out there hawking junk. We have seen time and time again the research supporting chiropractic care keeps getting wider, it keeps getting deeper. And I for one am truly excited about everything that is emerging in the research world as well. So there you have it. Technique wars on the evidence based chiropractor this week maybe weren't so much of a war as we thought. After all, both high velocity and low velocity chiropractic care outperformed minimal conservative medical care in a Senior ish population 55 and older a senior ish population. So that is it for today. I hope you have a fantastic week in practice. I hope everybody, everybody is warming up. I know it's been freezing everywhere, including here in Tampa, Florida. So I hope everything warms up. I hope your practice is off to a great start in 2018. As always, if we can be of assistance, please don't hesitate to shoot me an email. Jeffeevidencebasedchiropractor.com I would love to help you and your practice however I can. And jumping on the tail end of last week's podcast as well. I want to have a total research and marketing immersion event in 2018. And I'm not talking about theory, I'm talking about practice. I want to be able to review research and more importantly I want to do live website breakdowns. I want to build stuff with chiropractors that can help them from that day forward. And I am looking forward to doing an event in 2018. I had quite a few emails come in from last week saying hey, I would be interested. I'm going to throw it out there one more time. No dates yet or anything like that, but I just want to get a feel for how many people are interested. I'm not holding you to it. But if you would be interested in growing your practice, building your practice, and hanging out with a small group of awesome chiropractors, shoot me an email. Jeffeevidencebasedchiropractor.com I would love to hear from you. I hope you have a great week in practice and I will talk to you soon.

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Sam.