A podcast episode ("123 - Improving Spinal Stenosis with Chiropractic") by Dr. Jeff Langmaid focused on spinal stenosis: its prevalence (estimated ~20% of people worldwide), anatomy (spinal canal narrowing due to congenital small canals or acquired changes such as hypertrophic ligamentum flavum and posterior disc bulge), and hallmark symptoms (neurogenic claudication causing limited ambulation, numbness/tingling). Imaging grading is described using axial A–P canal measurements (roughly ~10 mm typical; ~6 mm or less indicates severe stenosis). Dr. Langmaid advocates conservative chiropractic options that emphasize flexion (flexion–distraction, decompression, mobilization) to open the canal and reduce symptoms, often avoiding surgery when red flags are absent. The episode also includes practice-facing promotion (a related Facebook video, RockTape product mention) and a call for listener ratings (over 9,000 listeners weekly).
Questions this episode answers
April 23, 2018
"Upwards of 20% of people worldwide" (verbal estimate in episode).
About 10 millimeters (A–P diameter on axial MRI cited as a reference).
Approximately 6 millimeters or less is described as severe.
Over 9,000 listeners weekly.
Welcome to the Evidence Based Chiropractor providing you with elegant and efficient research based content to help your practice prosper and succeed. Now get ready for a variety of dynamic communication tools designed for immediate growth courtesy of your host, Dr. Jeff Langmaid.
Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langme. This week is all about spinal stenosis. If you did not see it already, be sure to check out the Evidence Based Chiropractor Facebook page where a video regarding spinal stenosis was just put out. It's patient centric. It is for your patients and hundreds of docs I believe at this point have viewed it, shared it and all of that fun stuff. So be sure to check that out. In this episode of the podcast is a follow up for your practice relative to spinal stenosis and where chiropractic fits in and why chiropractic may be the best choice for patients or people suffering with spinal stenosis. But before we get started, I will say a few words about rock tape. Rock tape is revolutionizing the soft tissue world again with new rock blades Mohawk. Featuring three tools in one, a surgical stainless steel hand polished tool and two attachments, a silicon sleeve and an ABS comb roll Rockblade's Mohawk unlock never before seen treatment protocols to help reduce pain, improve mobility and address issues like nerve glide and neuropathy. They're 175 bucks and you can pick them up@rocktape.com Mohawk so today is all about spinal stenosis. Spinal stenosis affects, it's been estimated upwards of 20% of people worldwide. So we are in the hundreds of millions of category we with that statistic maybe even approaching a billion people. And there are two basic camps of spinal stenosis. One is congenital and the other is acquired. Let's talk through that a little bit. We'll talk through the anatomy as well. Then we'll dive into where chiropractic fits in. So congenital spinal stenosis, well let's break it down first. Stenosis as we all know is pinching, narrowing and or compression. So that is the stenosis word. The first word spinal tells us it is in the spinal canal. Therefore it's on the spinal cord or the thecal sac. The hallmark of this from a case management perspective or a symptomatology perspective is it results in what we call neurogenic claudication. The pipes are being shut off going into the person's legs. There's literally a pinch on the main conductor, the spinal cord. So what results is neurogenic claudication Neurogenic claudication, in turn, results in the decreased ability to ambulate. People are always looking for the next chair. So you're. If they stand up, it immediately starts their stopwatch internally before they're gonna have to ding, ding, ding, sit down again. So these people often are always looking for the next chair. It's very comfortable, AKA asymptomatic, to sit down. But as soon as they stand up, they. Things start hurting. Additionally, it can be numbness, tingling into the legs and feet as well. And typically, these are the people leaning on shopping carts in grocery stores I used to sit with. Well, I'd review probably 10 to 15 MRIs with patients every day in the last surgical group that I practiced with, and we saw more spinal stenosis than you could shake a stick at. And when I started telling people, how is your endurance? The answer every time was not good. They know if somebody has spinal stenosis and you say the word endurance, they know exactly what you mean because they feel like, again, they used to be able to walk around the store, then they could only make it to the end of the aisle. Now they're leaning on the cart, and pretty soon they're gonna be sitting in a cart, motorized, getting around. So spinal stenosis results in neurogenic claudication, and that impacts people's quality of life at a level that is practically unprecedented. When you can't get up, ambulate, and do the things that you want to do, it is a major impact on quality of life. So this is a big deal that hundreds of millions, bare minimum, people are dealing with worldwide. Now, as we talked about, there's really two big camps that it falls into. Congenital and acquired. Congenital just means, hey, that structure of their vertebra, right, their spinal canal, it's just smaller than the next guy or gal. So it's congenital. It's just the way they were born. It was tight to start. Secondarily, there's acquired. Acquired typically happens when ligamentum flavum on the inside of the canal becomes hypertrophic over time. Degenerative changes, aging, injury, you name it. It can contribute to the disc bulging posteriorly into that canal and. And ligamentum flavum also becoming larger, becoming hypertrophic over time. That causes a compression on or in the canal and resulting in the symptoms we discussed earlier. So if you look at an A to P shot on an mri, axial. Excuse me, an axial shot, I should say, on an MRI film. If you measure kind of the A to P diameter of that canal, it should be 10 millimeters in height, let's say now, when you start getting down into six or less, you're talking about severe spinal cord stenosis. So the grading system typically goes in order of light to heavy abutment. Means it's touching the sac but not compressing. Mild, mild, moderate, moderate, moderate, severe, and severe. So that is the grading system, and it's based upon the A to P dimension of that canal on an axial MRI sac slice. So that is how, when you get reports, or if you're looking, hopefully you're looking at those images yourself. That is how you can make the differentiation between the level of severity with that stenosis. So what happens now? We know people. It's affecting tons of people. It's slowing them down, and it's affecting their quality of life big time. Well, this is where, in my opinion, chiropractic care comes in huge. In especially techniques that emphasize that flexed posture, flexion, distraction is a fantastic example of that. When you bend into forward flexion, we talked about the grocery cart earlier. That's a naturally relieving position. It actually physically opens up the canal in extension, it literally physically closes the canal. So if the canal is compromised to start, if they only have 5 millimeters to start with, if they bend forward and they get up to seven, eight, or nine, they're gonna be feeling real good. If they're at five, let's say, and they bend backwards and that goes down to three or two, they are not feeling too good. So this is why many patients that come in, when there starts to be mobilization, manipulation, adjustments given to the low back, and it can emphasize that flexed positioning, it provides a dramatic amount of relief for these individuals. Now, it doesn't necessarily change the structure of ligamentum flavum after one adjustment. That is not what I'm saying. But the reduced symptomatology can make a world of difference in these individual lives. And many people, if you can reduce their symptoms, as long as they're not having red flags, a cauda equina, et cetera, they can even be in the moderate severe to severe category and receive, let's say, flexion distraction. For the sake of this talk, if their symptoms go down and they're living a high quality of life, there is no need for those individuals, in the absence of red flags, to have any surgical intervention. Now, here is the interesting part. Many of these individuals, if they don't come into a chiropractic office, they might go the road of medications orally. That's just not gonna work. They have a mechanical problem, then what happens? Well, they get, what do you think? An injection. The injection might get them up and moving for a little while, but again they have a mechanical problem so they end up down the route of surgery. This is very often when a Coflex device could be used, when a laminar decompression could be done, or even in some cases a fusion recommended if it's multi level and severe. So having the availability for a conservative care option such as chiropractic is life changing to these individuals. It's why with the evidence based chiropractor, we've focused on this in multiple research briefs throughout the years, bridging that gap, getting the word out to the PCPs, the primary care docs in your community. It is absolutely essential because millions of people are suffering and I'll tell you, hundreds of thousands, if not a million plus are having surgery for this each and every year. And in my opinion, again, I believe that all of these individuals should exhaust conservative measures, including chiropractic care, including chiropractic care, before entertaining the idea of surgery. In the absence of red flags, when you have a patient in a prone position, face down on the table and you can do a decompressive type maneuver, let's say it could be spinal decompression itself or flexion distraction. When you're able to get light mobilization, manipulation adjustments into that lumbar spine, in the case of we're talking with right now, it can just provide again a world of relief for these individuals. It's a mechanical problem. So when you can accentuate that flexed position, when you can provide motion into that area, Many of these people are drastically fixated in the area of stenosis. The muscles are spasm protecting it. There are osteophytes, there are disc issues. Most of these individuals have the whole gamut of issues going on where that compression's occurring. So being able to work that disc a little bit, get motion in there, relax those muscles, decrease the overall inflammation and achieve better segmental range of motion. Just again, we're talking millimeters here. Millimeters can go a long way towards changing somebody. So please, if you have not checked out the spinal stenosis video we posted on the evidence based chiropractor Facebook page, be sure to do that right now. Share it to your practice page. Get the word out that you are very likely the best choice for many individuals suffering from spinal stenosis in your town. Additionally, if you have not gave us feedback or a rating for this podcast, please do so. There are over 9,000 thousand individuals listening each and every week, including you. Thank you. I am humbled by that. I will continue to do the best job I can. All I ask of you is please leave us a little bit of feedback that helps us reach more and more chiropractors each and every week. And of course, if you need help or desire bridging the gap and building relationships with other healthcare providers, check out our memberships@the evidencebasedchiropractor.com otherwise, have a fantastic week in practice and I will talk to you soon.
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