162- Disc Herniations and SI Hypomobility

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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we have an awesome piece of research that we are covering. It is brand new, it was released in chiropractic and manual therapies and it is titled Spinal Manipulation in the Treatment of Patients with MRI Confirmed Lumbar Disc Herniation and SI Joint Hypomobility. This is a really interesting one because we've talked a lot about lumbar disc herniations. This steps it up in one way because it's talking about an MRI confirmed lumbar disc herniation and secondarily and most importantly, or what gets me most excited is we're talking about SI joint hypomobility along with that, which is something we very rarely have seen in the literature. This is a great paper. I know you are gonna be very happy, let's say with the results that the researchers found. So stick around for that. A bit of housekeeping on the front end here. Today's episode is brought to you by Roc Tape. Roc Tape has revolutionized the soft tissue world again with new Rock blades Mohawk Featuring three tools in one, a surgical stainless steel hand polished tool, two attachments silicon sleeve and an ABS comb Mohawk unlock never before seen treatment protocols and you can get them right now for 175 bucks and see all the educational courses@rocktape.com Mohawk I am also super pumped to say not only am I going out to Berlin at EPIC 2019 to hang and shoot a bunch of video and great content with the speakers out there, but I am in fact now privileged to be one of the speakers out there. So if you have not picked up your tickets in March to head out to Epic in Berlin, if you do let me know. I will guarantee I will buy you a beer. Now the speakers outside of myself should be more than enough to get you there. But if you need a little extra incentive, I'm happy to pick up a German beer for you while I am out there. Shoot me a message if you are going to go. Also I put out probably one of the, you know, two of the most, you know, pieces of content that I'm the most excited about in a long time at the Evidence based Chiropractor this past week. So if check out the Evidence based Chiropractor blog if you haven't, because on it there's a piece that talks about blogging and driving massive free traffic to your website with SEO. Basically breaks down how I've done it with the Evidence Based Chiropractor. Be sure to check that out. In addition, I have finally a piece actually about marketing chiropractic to medical doctors in written form and there's a video there as well. So you could also check this out on the evidence based chiropractor YouTube channel or the blog, but two great pieces of content that can get you up and running in 2019. So with all that housekeeping out of the way, let's dive into this week's research. As I said at the top, we are talking spinal manipulation in the treatment of patients with MRI confirmed lumbar disc herniation and SI joint hypomobility. These two things, as we'll discover, go hand in hand. But quite frankly, the literature, the researchers just haven't looked at it in concert in the past. So with that being said, let's dive into some quick hitters of facts here that I think really set the stage. So they found that for lumbar disc herniation, 24% of cases of lumbar disc herniation are asymptomatic. Just an interesting fact to keep in mind. Additionally, they found approximately 95% of all instances of lumbar disc herniation occur at L4.5 or L5s1. So those bottom two levels, they're going to undergo the most stress and strain throughout time. There's the greatest angle there. So no surprise, particularly that 95% of all lumbar disc herniations happen at those two bottom levels. But perhaps even more interestingly, the research has found up to 30% of patients with lumbar disc herniation and sciatica have SI joint dysfunction. And a recent study reported the prevalence of SI joint dysfunction at 72% among patients with lumbar disc herniation. So this starts to become pretty compelling where it's showing to us, man. You know, SI joint hypomobility is something that's happening a lot with individuals who have a lumbar disc herniation, but but quite frankly hasn't been addressed very well. So these individuals in this study again received spinal manipulation. They had an MRI confirmed lumbar disc herniation and SI joint hypomobility. So let's just talk about and dive in a little bit to the results of this study. So this was 20 patients between the ages of 20 and 50 years old. Just to keep in mind. So what they found, the researchers found the NRS score for back pain showed statistically significant improvement at the fifth step, fifth session. Excuse me. And at one month follow up compared to baseline. So that's a good start. Pain scores, statistically significant improvement after the fifth session, which was within a two week time period, if I am not mistaken. And at one month follow up, they also found the ODI scores indicated statistically significant improvement at the fifth session and at one month follow up. Wow, that sounds vaguely similar to the NRS score. So we found statistically significant improvement at the fifth session and at one month follow up for both pain scores and, and those ODI scores. And they also found the findings also indicated 95% improvement in the results of the SI joint Hypomobility tests after SMT. We also observed a 20% improvement in the straight leg raise test results and a 15% improvement in the slump test in the fifth session and at one month follow up. So this is really, really interesting. That is a very, very high number regardless that you're talking about with research, 95%. So these findings, they showcased after five sessions of spinal manipulation to somebody who has hypomobility of the SI joint and lumbar disc herniation, which are also highly Concurrent, they found 95% of improvement in the results of the SI joint hypomobility test. So that tells me, by and large, we are as chiropractors using an adjustment of manipulation, we're getting those SI joints moving and that really can help people with overall mobility as we'll talk about how, how this really impacts the whole body in a moment. Now, as a side note, they also found, quote, our findings suggested that five sessions of lumbar and SI joint manipulation can lead to statistically significant improvement in pain and functional disability, which in turn may restore normal SI joint mobility in these patients. So that kind of wraps it up now when we talk about chiropractic care versus, you know, let's say surgery or injections or medications, I think we are in a hot competition, so to speak, with medications because millions of medications are being taken, millions of medications are being prescribed. There's no question that individuals who have hard surgical red flags, you know, they need to have surgery, right? But there's also no question that those that don't, that haven't exhausted conservative care should before they go on to surgery. But I think this, so I don't want to put it as a this versus that type situation, but I think it's important to frame this because these researchers also put in some very interesting things versus non steroidal anti inflammatory drugs, NSAIDs and surgery. And I'll just read it as a quote because it's so impactful. Quote. Compared to common treatments for lumbar disc herniation, spinal manipulation is reported to be 37,000 to 148,000 times safer than NSAIDS and 55,000 to 444,000 times safer than surgery. Wow. So that is absolutely compelling. Again, people who have surgery, we're comparing a little bit of apples to oranges when we're talking surgery, but for an nsaid, we're talking pretty close to apples to apples. And when we see people have that question all the time, oh, chiropractic. I don't know if it's safe. I'm not sure if it's effective. Well, the effectiveness argument has been proven out on this podcast and many others dozens and dozens of times. And we'll continue to do so until we have 99% utilization notwithstanding, we can see here compared to NSAIDs, spinal manipulation, what we do, adjustments 37,000 to 150,000 times safer than NSAIDs. That is dramatic. That is why also this is going to be featured as part of the Evidence Based Chiropractor Monthly Research Brief. We're going to cite this study and talk a little bit about lumbar discs and SI joint hypomobility as what we give all of our members this month for the Evidence Based chiropractor to get these messages out there to the other physicians and other healthcare providers in their community. This is an exquisitely important piece of research that many people are probably unaware of. I know I was unaware of it until it came across my radar. I looked at it. I doubt, oh my goodness, this is just so impactful. And to get that message out to the people in your community is absolutely crucial when bridging the gap with other healthcare providers. So I'd encourage you, if you building relationships with other healthcare providers is on your radar in 2019, join us and become a member at the Evidence Based Chiropractor. But at least at the bare minimum, take this knowledge and use it to have good conversations with your patients and good conversations with other healthcare providers in your community. So why does SI joint, you know, really play such a big role? We'll wrap up with that over the next minute or so. And the researchers here, I think they really rely on what we know as chirofractors. Right? We have quadratus lumborum, we have the piriformis and a lot in the lumbosacral complex. There's a lot of things that work together and SI joints are commonly mistaken for lumbar issues and vice versa. But when both are present and both are accounted for, getting in there and adjusting the lumbar spine and the SI joints can make a dramatic difference in the overall regional mobility of the lumbosacral spine, so to speak. But also all the compensation points that go off from that when you have better range of motion, when you're able to, you know, use those reflex tendon, so to speak, when you're able to get in there with an adjustment, you get that relaxation effect. You get better mobility both segmentally and regionally. It allows people to move better, it allows people to experience less disability. And certainly with pain gating and all of the effects of an adjustment through the central nervous system, you also have the opportunity to reduce some of that pain. So this was a great paper. I'm going to link it in the show notes if you want to check it out there. Also, again, one last reminder. If you are going out to EPIC in Berlin, I am going to be there hanging out, filming a ton of video and also super honored, super privileged to be speaking. So let me know if you're going to be there. Let's grab a beer together. Secondary component to that is head on over to the Evidence Based Chiropractor blog and we talk about chiropractic blogs and driving massive traffic via SEO. Blogging is so important for that. And also about marketing chiropractic to medical doctors in a pretty in depth article. Those are two brand new pieces on the blog or you can check out the videos of of them on our YouTube channel and you can hit that subscribe button while you're over there. So I hope you have a great week in practice and I will talk to you soon.

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