228- Best Practice Recommendations for Neck Pain

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. On today's episode, we are breaking down the latest bill best practice recommendations for chiropractic management of patients with neck pain. This is more relevant than ever right now. We're gonna talk about how you can utilize this research to impact your practice and much, much more. Before we get started, I'll say a few words about Rocktape. Rocktape is proud to be a sponsor of the Evidence Based Chiropractor and they are doing awesome online classes through Zoom right now. Head over to rocktape.com check out the classes. Pick up Mohawk while you're over there. That's my favorite tool. Rocktape.com Mohawk or. But be sure to get your clinical skills up to par while you have maybe a little bit of extra time. Right now, you can learn all about their courses@rocktape.com As I said at the top, today we are talking best practice recommendations for the chiropractic management of patients with neck pain. This came out in JMPT in 2019 and it basically was one of those papers where the researchers looked back at a variety of what had been published and, and tried to bracket some things, tried to essentially say, hey, what are the recommendations that we can provide for chiropractors to manage patients with neck pain? Sounds pretty obvious, but that really was the goal. And the goal of developing best practice recommendations is to improve patient outcomes ultimately by assessing the current evidence and combining it with the practical applications of care. When you look at best practices, it's not only looked at, you know, sort of in a, you know, isolated. Right. It's about, okay, what's out there in terms of the research, what's the current evidence? And then how are docs currently applying this to their care? That really the combination of that is where best practices are founded. And the goal of that, as we said, is to create better outcomes for the patients. So that's really the standpoint by which they were looking at this. We actually pushed this through just this month in April for all members of the evidence based chiropractor. So if you're a member of the evidence based chiropractor, as of a couple days ago, you received the research brief for the month of April that tied into the best Practice recommendations for the chiropractic management of patients with neck pain. And the question might be, well, why? Why is this so timely right now? And a lot of this has to do with COVID right? There are millions of people right now working from home in ergonomically compromised positions. And it's pretty likely that more people than ever are dealing with new or recurrent neck pain. When we look at poor ergonomic conditions, when we look at a decrease in exercise, when we look at a shout out to David Seaman here, we look at chronic inflammation, systemic inflammation based upon diet choices, and we look at ultimately just different lifestyles, right? People are in. There are people that are quarantining, There are people that are not getting exercise. This leads to the fact that there's a lot of people dealing with spinal issues right now. And that is an important hole that you can fill and should be filling in your community. So this set of best practices found that in the absence of red flags, chiropractic should be considered a frontline approach for patients with uncomplicated neck pain. Uncomplicated neck pain includes radiculopathy. It includes everything but red flag type issues. So the bottom line is getting out there and letting your community know and other physicians in your community to know that you're there for their patients that are looking to find relief. Conservatively is super, super important. Elective surgeries for many places still canceled across the board and or greatly reduced. Those unable. There's a ton of patients out there that don't want to go to a pain management practice right now. They probably shouldn't be there even when times were quote, unquote normal. But bottom line is they. There's a lot of people out there that don't. They're heightened to it, right? They don't want to take the drugs, they don't want to take the medications. They're leery of going into a physician's office and getting injections. This is prime time for you to get out there with your message of conservative care. Now, if you're closed, right, most docs are practicing part time by what I can gather. But if you're closed, perfect opportunity to do assessments, do movement assessments with telehealth, recommend at home care at home stretches and exercises with a platform like web exercises, which we recently included in the Smart Chiropractor, there's ample opportunity for you to get out there. And there are more people hurting than ever right now. There also is an appetite for natural and conservative measures that won't negatively impact Immune function. There's been a lot of press out there and a lot of back and forth. Right. Do NSAIDs compromise the immune system? Do they not? Clearly people don't and should not be in going to the ER for complaints that are musculoskeletal unless it's an extreme case. So there's really an opportunity for you to compete, so to speak, at a higher level with these individuals in the marketplace. So let's take a look at a few quotes from these researchers. I think this is really impactful and frames what they found. They found most people with neck pain are likely to continue to have neck pain with a clinically variable course in pain intensity and disability. Very, very important. Right there we see that neck pain, musculoskeletal issues by and large neck pain, mid back pain, low back pain. These have a variable course, meaning it's not for most people. You have pain one time, it gets taken care of and you're done for life. It's just not the way it works. There's a variable course. Pain intensity might go up. Pain intensity ideally stays down. Disability ideally stays down, sometimes might go up depending upon pain and functional ability. But the bottom line is most people now are coming to understand that these are episodic and chronic, meaning there's a chronic nature to having a musculoskeletal complaint. It doesn't mean that it's chronic in terms of that you're gonna end up on medications or that you need surgeries. But hey, it might pop its head up from it's episodic by nature and chronic, meaning it's gonna pop its head up from time to time depending upon quite often your lifestyle choices. Are you working in an ergonomically compromised position as we just talked about earlier on this podcast, did you lift a poor, poor posture or non ideal posture and now you have a sprain strain injury? These things can and do often rear their heads from time to time, the researchers also found. Which is gonna be important for what we talk about next. The researchers also found, quote, patients often benefit from one to two visits per month to providers of non pharmacologic conservative care who use spinal manipulation and to be re evaluated every six to 12 visits. Very, very interesting and important right there. Right? We just. That's they're saying it. Patients often benefit from one to two visits per month of non pharmacologic conservative care, including those who use spinal manipulation. Ding ding ding, chiropractic and should be reevaluated every six to 12 visits. So those people who do respond well to an initial trial course of care to those individuals that do have some chronicity to their complaints, which is a vast overwhelming majority of people. And hey, getting an adjustment every now and again probably isn't a good idea. Or probably is a good idea. Getting guided exercise, staying with your rehab program, these are probably good ideas. Maintaining a healthy diet that's non inflammatory by nature is probably a good idea. Guess who can guide on that? We can. It doesn't always have to be, I think a lot of docs out there, maybe even you listening to this as the title of this podcast, the evidence based chiropractor really are like, oh, I don't like the idea of my patient having to come see me forever. I'm with you right there. But where I'm gonna kind of play devil's advocate is I am with you. I am with the thought that you should be that patient's lifetime care partner, meaning they should be able to choose you. You shouldn't fear tactic them into anything. But the bottom line is getting an adjustment every now and again is not a bad idea. Getting nutritional advice consistently not a bad idea. Having guided rehab and exercise for life is not a bad idea. And guess who as a profession is really perfectly tuned to do those things and more chiropractors. So don't sell your patient short with the care by taking so much pride in a PVA of 3. Great. You get people out of pain, but if you're ditching them back to the same reality that they came in with, you're not doing them the best service you can because they're going to come back. The same issues that led them in are gonna bring them back. And that doesn't mean you force anybody, but it means you should, in my opinion, proactively offer them the opportunity. Hey, you know, I think we can get you out of pain if it's true, right? Hey, we can get you out of pain really quickly. Let's do just a couple visits, see if we can get you back to where you are functional and where you are happy. But for our patients that receive best results, we also do X and insert X, whatever that means to you. If you have a gym or offer it. Josh Shatterly does a great job with Clinic chip hybrid. If it's nutritional counseling, great. Keep in touch with them. You know, that's not a once. Okay, let me lay out the plan and never talk to you again. That needs consistent reinforcement. And I don't think it's a bad idea to get an adjustment every now and Again as well. And finally, the researchers found, quote, for uncomplicated neck pain, including neck pain with headache or radicular symptoms, chiropractic manipulation and multimodal care are recommended. So there you have it right there. The researchers really break down what are the best practices. The best practices are don't see your patient twice and leave them now. If they achieve their result and they want to come back later on, that's fine, but don't, I would say I think we have a tendency to maybe end care too soon based upon some sort of pushback against what's been done in the past within chiropractic. And I'd offer to you just to think about that as you make those decisions. I think there's a lot to think about in terms of how you offer care, number one, but also in terms of how you ultimately go about treating a patient over the course of their lifetime. And if a patient chooses you once, it's a really important thing, in my opinion, that you make it easy for them to choose you again in the future. And that is by giving your best recommendations, whatever that means to you and to me. A lot of times that comes down to having an ongoing relationship. Now let's take a look at when we talk about the differences between chronic between acute. What did the researchers say? Well, here's that initial treatment frequency for neck pain associated disorders. The patient comes in and they are acute or subacute and it's episodic by nature. They recommend an initial trial of six to 12 visits over the course of the first two to four weeks and then additional visits as needed with demonstration of improvement. So again, they're recommending right off the bat, hey, six to 12 visits. I think a lot of times there are evidence based, quote, unquote, chiropractors out there that say, let's do one visit and see what happens. Give them a chance, get those biomechanics right, dive into some strengthening and some stretching. Give them an opportunity to not only get well, but hopefully to stay well. Next, chronic episodic. So if they have had now a history of chronic episodes in the past, they say two to six visits over one to four weeks. So two to six visits over the first one to four weeks if they're chronic episodic. And if they're chronic ongoing, it could be one to two per month for up to six to 12 months and reevaluate every six to 12 visits. So again with all of this, it's with having a patient centered mind, you know, in your forefront Right. What are the patient's goals? What are you seeing on your examination? How can you help them? What service offerings do you have in your practice to be able to help them? All super, super important. And right now, people struggling with neck pain and low back pain, again, their options are somewhat limited. This gives you a huge leg up when we talk about getting out there in front of them in your community. I'm gonna recommend. If you haven't checked it out yet, Visit us@thesmartchiropractor.com We just do exactly that. Automated social content that B to C, right? Business to consumer. It is all public facing social media content, email content, all automated video scripts, ongoing coaching and training, you name it. That's part of the smart Chiropractor. Now, if you want to bridge the gap and build relationships with other healthcare providers in your community, B2B marketing, right? Totally different skillset. B2B marketing, business to business, then visit us at the Evidence Based Chiropractor. A majority of the members of one of the services utilize both because it really takes a hold of their entire marketing, right? They have their B2B locked up with the evidence based chiropractor getting those referrals coming in. We have docs generating 30 referrals plus per month, which is awesome. And on the other side of the token, we have the smart chiropractor with all of the B2C marketing. Not a single tool overlaps. They are totally different in how you go about them, but each one is super important. And in Smart Chiropractor, we have people activating five patients every single week based upon just the email component alone. So check them out. If you're looking for help or assistance, check out this paper. I'm gonna leave it down in the show notes. If you're listening to this on an iPhone, then I would love it if you give us some feedback. You can scroll right down, hit how many stars you think we deserve. That helps more chiropractors. Find this podcast. Make it a fantastic week. If I can help you in any way whatsoever, shoot me an email. Jeff the evidencebasedchiropractor.com I hope you have a great day in practice and I'll talk to you soon.

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