201- Exercise or Adjustments for SI Joint Dysfunction

Welcome to the Evidence Based Chiropractor where each week we deliver the latest chiropractic research and marketing strategies, all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langmaid.

Hello and welcome to the Evidence Based Chiropractor. I am your host, Dr. Jeff Langmaid. We have gotten past the 200th episode. We are into 201 and we're gonna keep talking research. This week we are going to discuss a paper titled effectiveness of Exercise Therapy and manipulation on Sacroiliac Joint Dysfunction. A randomized control trial. You guys know RCTs are the highest mode of research. This one again looked at exercise therapy and manipulation on SI joint dysfunction. There are a couple surprising facts in this study that you are going to want to keep your ears out for and we're gonna have some fun in the process because we have some giveaways. Last week, 200th episode, I am giving away a set of chiropractic office posters. We're gonna announce the winner in just one moment. Before we get started, I'll say a few words about Rocktape. Rocktape has revolutionized the soft tissue world again with the new Rockblades Mohawk featuring three tools in one, a surgical stainless steel hand polish tool and two, attach attachment silicon sleeve and an ABS comb mohawk unlock. Never before seen treatment protocols. You can pick yours up today for 175 bucks@rocktape.com Mohawk also they have integrated with skills so check that out. If you are running a rehab facility, an exercise based facility, a mobility, a movement based facility, check out what they have going on. There's actually a sale as well. You can see some details at Rocktape or on the Evidence Based Chiropractor Facebook page. Also, I am just gotten through with an insane amount of travel. Four out of the last five weeks have been traveling. Kicked off with Rock Stock 2019 which was awesome. You can see the recap video on the evidence based chiropractor YouTube page. Tidied it up with Jersey just this past weekend. Awesome group packed house, 450 docs in the room, standing room only. Thank you to everybody in Jersey for coming out and Specific thanks to Dr. Kovacs and Dr. Graeber for having me up. And in the middle was forward 2019. That video, the behind the scenes video there has gone completely nuts. It's thousands of views online right now. So if you have not checked that out, there's some pretty sick drone footage you can check out. And additionally, I made a pit stop over in Dallas for Parker Seminars. So lot of travel, lot of teaching over the last few weeks. I got a great opportunity to meet a ton of you guys, people who listen to the podcast and or are members of the Smart Chiropractor or the Evidence Based Chiropractor. Thank you for coming up and saying hi. It is always greatly appreciated and it always is greatly appreciated to have the opportunity to come out talk about research, talk about marketing, talk about MD referrals. It's what I'm passionate about and it is a ton of fun in the process. But that doesn't make it any less tiring. So I'm happy to be home, happy to be recording this podcast, take a little bit of time, regroup, get some exciting things on the docket for for 2020 as we roll through quarter four here of 2019. So let's dive in first let's do our giveaway. I think that's an exciting part about it. So I was giving away last week for the 200th episode I said hop online, give ratinger reviews on iTunes and BrookeVTDC you are the winner. BrookeVTDC. Email me with your information, your mailing shipping information and I will get the those posters out to you. But there are a couple other so you're the grand prize winner Brooke. Let's give the round of applause for Brooke. And there's a couple other docs I want to give a shout out because some other docs left awesome reviews as well. So I'm going to give you a smaller than the entire poster set but I'm also going to send you a couple things from the evidence based Chiropractor. So if you are PT Hooser, if you are Dr. Swink DC if you are Jhauring, if you are DX Spaz, interesting one if you are Jake Croft or if you are Dr. John Curry, please email me as well with your information. I'll send you some evidence based chiropractor swag. But the grand prize winner was Brooke Vt DC be sure to send me your shipping address. So without further ado, a lot of housekeeping on the front end there but let's dive into the research. As I said at the top this was a article titled Effectiveness of Exercise Therapy and manipulation on Sacroiliac Joint dysfunction. A randomized controlled trial. Now this just came out. This was in pain Physician journal. Apparently it's a journal pain physician in 2019. First shocking fact SI joint dysfunction has been found to be the primary cause of lower back pain in 15 to 40% of patients. That's absolutely nuts. So be sure that you are checking those SI joints. We know low back pain is the number one reason why people come in to visit a chiropractor. We also know 90% of individuals plus will have low back pain at some point in their life. Potentially 15 to 40% of those actually have SI joint dysfunction. Beautiful part about that is there's probably nothing better than what we do as chiropractors. Getting in there, getting motion into the SI joint is one of the most effective things. Effective processes with healing injections, eh? The results on those are meh at best. Surgery man. I have seen SI joint fixations. They don't work out well. Compensations happen like crazy. I see a bunch of lumbar spine issues arise. It's a mess many times with surgical intervention. So the gist of it is that the researchers talk about how chiropractic adjustments manipulation have therapeutic effects such as stretching soft tissues around the joint, improving range of motion, reducing edema and muscle spasmodic, correcting joint defects and controlling pain. These are all the things that we've gone through over the last few years on this podcast. I could not agree more with their assessment of that. Now they also found adding exercise therapy to manipulation did not reduce the intensity of the pain. However, the exercise and manual therapy group produced better results than the manual therapy group in terms of Roland Morris score at 4 weeks and 12, ODI at weeks 4 and 24 and functional objective tests at weeks 12 and 24. Man, that was a lot to be said right there. The gist of it being is this, hey, adding exercise and adding rehab into your or in addition to the adjustment or the manipulation. Probably a good idea. And they cite a possible explanation for the more enduring results of the subjective test is that a rewarding experience with the test made the patients answer the questions favorably. High satisfaction mental component. We talk about the biopsychosocial model. Couldn't agree more. The psychological portion of this is big. Getting people on the right track, reinforcing their decision making and working through that with them, making sure that they're doing safe motions and activities so that their guard can come down, they can get back to their normal activities of daily living is oh so important. Researchers also found at week six manipulation therapy yielded better results than exercise therapy in terms of pain relief, showing the quicker positive effect of the former. This could be due to its analgesic effect either from structural or neurological processes. Another plausible explanation is the antispasmodic effect of manipulation as confirmed by oh boy, I'M going to butcher this name Akrifard. So gist of it being is this. That's a very interesting last name. The gist of it is this is they found at week six manipulation adjustments outperformed exercise therapy, better pain relief. And why? Well, they talk about because an adjustment has structural effects and neurological effects. That's important, right? This is research in Pain Physician that is talking about the fact that structure, function and neurological effects happen when a spinal manipulation is performed. That's very, very powerful. This is a huge leap from where we were maybe 15 or 20 years ago is where it was just, well, that doesn't really work. Or maybe the reason it actually works is just because you're putting your hands on somebody. No, putting your hands on somebody is part of it many times. But bottom line is there are structural, there are functional and there are neurological effects after an adjustment is given. That is super, super important. The researchers finally found, overall it can be concluded that manipulation can be an effective approach to reducing pain in the SI joint. So let's frame this in its totality, right? This is a brand new article just came out, pain physician 2019. They're saying exercise therapy, what typically would be a hallmark of physical therapy, manipulation, typically a hallmark of chiropractic. There is crossover, of course, and they're looking at it in terms of SI joint dysfunction. So let's kind of frame this again from the top. We know that a vast array, a vast majority, basically everybody on planet earth is going to have low back pain at some point in their life. We also know that based upon their research, 15 to 40% of those individuals actually have an SI joint issue. And now we know if we're looking for pain relief quicker, easier than manipulation therapy has outperformed an adjustment has outperformed exercise. This makes sense, right? When we talk about passive, passive, active to active care. This is what we discuss often I discuss with members of the evidence based chiropractor is they get out there and have conversations with medical doctors and let's say the medical doctor is like, well, I love physical therapy. Physical therapy is great. I think it's important to touch on the fact that, hey, I think active care is super important, but what we find is establishing proper biomechanics, AKA the adjustment before strengthening, AKA exercise, yields better outcomes. And that's what we're seeing in the research time and time again. And it makes sense in a very simplified fashion. If you're just strengthening areas that have biomechanical dysfunction, if you're strengthening the muscles around Joints that are dysfunctional, joints that have adhesions, joints that have limited range of motion and you're only focused on strengthening, quite frankly, that doesn't make a heck of a lot of sense in my mind. However, if your first step is to improve the range of motion of the joint, if your first step is to, through an adjustment or manipulation, decrease pain, decrease edema and inflammation, improve range of motion while having structural, functional and neurological effects, that sets yourself up really well for then the next step to be strengthening the areas around it to prevent or reduce the likelihood of further injury. However, if all you're focused on is the strengthening component, I think you're in a very, very big uphill battle to really get the results that you desire. So this is where in my opinion, whether you're talking to a medical doctor and if you wanna dive deep on that, become a member of the evidence based chiropractor. Nobody's done it longer, nobody's done it better. I sent out an email last week, we have a doc, you know, Dr. Anthony. He emailed me saying he got 18 referrals from medical doctors in a single month. And he thanked us for helping him. I told him, hey man, you're doing the hard work out there by making sure that you get your name out there. I'm happy just to supply you with some of the strategy, the tactics and the tools. But if you want the strategy, the tactics and the tool tools, become a member at the evidence based chiropractor because these conversations are so, so important. And if you haven't built referral relationships in your community, if you're only focused on Facebook advertising, if you're only focused on those sorts of things, your practice is gonna become very, very challenged over time. You're gonna continue to spend more money, continue to get less return. That's why I love relationship building as a core tenet and I love brand building on social media. That's why we have the evidence based chiropractor and the smart chiropractor. If you're looking for research based social for you getting it out, email, social, blogs, video, all done for you, then check out the smart chiropractor. If you are looking to build relationships with other healthcare providers in your community, then check out the evidence based chiropractor. But the bottom line is we all know based upon this research that a lot of people out there are suffering. And what we do continues, we talk about it nearly every week on this podcast. Continues to be proven as the, if not the best, one of the best ways to take care of it. We're effective, we are safe, we're pretty cost effective overall and we don't have to. People don't have to pay the piper. Meaning you have surgical intervention, not only is the effectiveness low, not only are the risks high, but then you deal with all the compensations around that. You fuse a level, you fuse an SI joint. Now you end up with problems 50% of the time within a few years. At adjacent levels, we don't deal with that. Medications, the risks are a little bit lower than surgery overall or injections. But the output, what's the effectiveness? The effectiveness has been proven time and time again to not be very good because it doesn't take care of the issue. It temporarily masks the symptoms and then it creates a perpetual downward spiral. What we do as chiropractors is so important, but more important is our ability to get out there and communicate that to the people in our community and to the other practicing docs in our town. So hopefully that got you a little fired up, ready to get into practice today on this Monday morning. If you're listening the day it's released and take care of some people, have some conversations, have some fun with it too, Don't. I think a lot of docs out there, we get so intertwined with the grind of our day in and day out. Have some conversations, open some eyes, do what you do if you and celebrate those wins that you have in practice. I hope you have a fantastic week out there and I will talk to you soon.

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