207- Adjustments or Medications: The Ultimate Research Study

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 Langmay.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langme. Today I am doing a throwback to a research study that came out a couple of years back. It's not too old, 2013 in my opinion. One of the most important studies that's ever been produced. It looked at spinal high velocity low amplitude manipulation in acute non specific low back pain and it pitted what we do, adjustments, manipulations, against one of the most commonly prescribed NSAIDs ever, as well as placebo. It's double blinded, it's placebo controlled. This is a study you want to know about and you want to talk about. We'll break it down and also give you those talking points on today's episode. And it is if you're in the United States, I don't know if this is a US thing only, but it is Cyber Monday if you are in the US or maybe if you're around the world. And right now I would highly encourage you to head over to rocktape.com they have 40% off all product. Yes, you heard that correctly. 40% off all product. Head over to rocktape.com right now. You can check out the pods, you can check out Mohawk, which I love and I talk about every single week on this podcast. You can see the tape, all of their products, 40% off. Also, if you are looking to pick up a trigger point device, a foam roller, vibrating foam roller, et cetera, you can check out trigger point and skills material for 20% off@shop.rocktape.com but rock tape product, 40% off. Yes, you heard that correctly. Please head over there and I will drop a link in the show notes as well. Treat yourself. Get ready for 2020. Build that clinical tool set and have the literal tools to do it. Check out rocktape.com so as I said at the top, this is one of my favorite studies of all time. This study came out in April 2013 and it came out in Spine, which is probably the most popular prestigious spinal journal in the world. And it was titled Spinal High Velocity Low Amplitude Manipulation in Acute Non Specific Low Back Pain. As I said at the top, this is a, this was a randomized double blinded placebo controlled parallel trial with three arms. Wow, that is a mouthful. Basically what that says is this is legitimately the top Echelon of research, it's randomized, it's double blinded, it's placebo controlled, and it has multiple arms. That's pretty much what you're looking for if you are running a very, very complete study. And in my opinion, this is a landmark study in spinal manipulation in chiropractic in adjustments, because they tested commonly prescribed NSAID diclofenac against spinal manipulation and placebo. Now, of specific note, in this study, sometimes we get this question is, well, was the adjustments, were the manipulations performed by a chiropractor? In this study? It was not. So these were basically like long axis type osteopathic moves, which to me, if we want to criticize this study at all, is actually a design flaw. And there still was unbelievable advantage for those who received high velocity, low amplitude manipulation or, or adjustments as we know them. And let me break that down a little bit before we talk about the results of this study. So I am of the belief that there are great adjusters in chiropractic. There are not so great adjusters in chiropractic, and there are, let's say, physical therapists who happen to do manipulation and they're very talented at the skill and others who are not. But by and large, with the amount of time, focus and energy that we as chiropractors spend on adjusting and on manipulation, I'm going to blanketly say that we are the best at it. I don't think that's a far stretch to say by any stretch of the imagination. Ultimately, individuals can be better or worse than their next counterparts. But as a whole, chiropractors, bar none, are the best. We're the only people who really adjust, and we are some of the most technically skilled at manipulating, depending upon which way you want to look at that. So when I see a study that showcases, you know, let's say, osteopaths doing long axis maneuvers, I tend to believe that that's a design flaw, meaning if a chiropractor was doing the adjustment or the manipulation, I tend to believe that on the whole we have a higher skillset and therefore that has the potential to impact the outcome of the study in a positive way. And in this study, even with that flaw, those who received spinal manipulation showed clearly advantageous outcomes. The results were just as little as seven to nine days after starting care. And let's take a look at some of the key points in this study. The researchers found this is the first time that spinal manipulation was investigated in a double blinded, randomized, controlled design, showing clear superiority compared with placebo and nsaid. I'll read that one more time. It's super powerful to keep in mind. Researchers found, quote, this is the first time that spinal manipulation was investigated in a double blinded, randomized, controlled design showing clear superiority compared with placebo and nsaid. Very important to keep in mind because I know all of us have heard whether it was from, you know, unknowing other physicians, whether it was people in your family, whether it was somebody on the street, oh, yeah, chiropractic, that's not any better than placebo. Wrong. We've talked about it on this podcast before and this is the exact study that says that is false. It is not even close. There is clear superiority compared to placebo and that is a double blinded, randomized, controlled design. Now let's tackle NSAIDs. Same story. So diclofenac. This is something I heard from patients all day long when I was at the surgical groups. What medications are you on? Diclofenac. Diclofenac. It's a commonly prescribed nsaid. So it is a very commonly prescribed first line treatment for those dealing with musculoskeletal complaints from a primary care physician. And what we see here, again is that spinal manipulation in a double blinded, randomized, controlled design showed clear superiority compared with nsaid. So that is just so, so powerful to keep in mind as you have conversations with other people in your community, as you have conversations with your patients. These researchers also found, quote, high velocity low amplitude manipulation can be recommended for the therapy of acute non specific low back pain. So they are saying this is spine, your spine coming out and saying, hey, we believe manipulation can be recommended for the care of acute nonspecific low back pain. And again, they found, quote, final evaluation. So manipulation being significantly better than NSAID and clinically superior to placebo. I'll repeat that line one more time because this is another one of those lines that you want to know. Final evaluation showed manipulation being significantly better than NSAID and clinically superior to placebo. So the arguments as far as pharmacological treatment, starting with NSAIDs, we know that they were drastically flawed, but this is really the study that ties it all together. That's why I wanted to hop on, revisit this study from April 2013. Additionally, clinically superior to placebo. I can tell you quite frankly, there's a lot of other care and treatment that goes on in the musculoskeletal realm, not by chiropractors, and that is not clinically superior to placebo or barely beats placebo we are clinically superior to placebo. And when we see some of these numbers break down, I want to break down a couple of the numbers on these groups between manipulation and diclofenac because I wish I could show you the graph here, but I'll break down the numbers because I think it's incredibly powerful. So when we look at the individuals who received manipulation and either improved or had complete relief, and it was 29 individuals. When we looked at those who either improved or had complete relief in diclofenac, it was only 21 individuals. When we looked at the individuals in the manipulation group who deteriorated throughout the course of their care, it was zero. And when we looked at the amount that deteriorated in the diclofenac group, it was seven. So legitimately, and I'll say this again one more time in a little bit of a different way, 19 individuals in the manipulation group had complete relief, zero deteriorated. Eight in the diclofenac group had complete relief, seven deteriorated. So it's just as likely as you'd find relief with diclofenac as you deteriorate. Basically, ah, it's a crapshoot. Good luck. Maybe it's better than placebo, maybe it's not better than placebo, but it's not really doing anything for correcting the issues at hand. People were middling at best in their results. Whereas when we looked at manipulation, the data was clear in terms of a vast overwhelming majority of individuals had complete relief or improved. And literally, I mean vast, overwhelming, zero deteriorated. So it is dramatically overwhelming. And then we looked at the Roland Morris scores as well. Diclofenac. Over the first couple of weeks, both manipulation and diclofenac, those Roland Morris pain scores, they drop a little bit. Natural course, natural history with pain, you know, comes and goes. But then diclofenac flatlines, meaning no real abject improvement. Whereas manipulation continues to trend downward ultimately towards a less than one, you know, less than one figure there. So very, very powerful study. I'm going to link it in the show notes down below. So if you want to head over to PubMed, download it, check it out in more detail, you can feel free to do so, but, but important to keep in mind. Spine journal in 2013. This stuff has been around for a while. This did not come out last week. Spinal high velocity low amplitude manipulation in acute non specific low back pain. This was that first study that was double blinded, randomized, controlled that showcased manipulation adjustments have clear superiority compared to placebo and nsaid. This is one for the ages. We got this out for all of our members, the Evidence based chiropractor in April 2013. I'm actually thinking about bringing it back around. I think it's that important. So if you're looking to reach out to other healthcare providers in your community and you want to make it easy to do so, you want the results associated with that, then I'd encourage you to become a member@the evidencebasedchiropractor.com if 2020 is your year for automation, if automation rings true, as I'm saying this right now, you want to automate your marketing systems, you want to automate your email, you want to automate your social posts, Please visit us atthe smart chiropractor.com so those are the two main projects I have going on right now. Evidence Based Chiropractor is for all of your referral needs. This smart Chiropractor is for all of your social email marketing needs. If you have any interest in those whatsoever. If you want to step up your results in 2020 then I'd encourage you to head over, check those out and be sure on Cyber Monday as you are listening to this, head over to rocktape.com and get free 40% off all product. That definitely does not happen every day, so take advantage of it. Make sure you are set up for 2020. Have a fantastic week in practice and I will talk to you soon.

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Sam.