232- Maintenance Care Updates

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 talking about a brand new study that came out in chiropractic and manual therapy's journal and it is titled the Nordic Maintenance Care Program. Maintenance care reduces the number of days with pain in acute episodes. I'm going to break down this paper, what the key points that I took away from it, maybe some things you can think about and how it relates to your practice. And I'll also of course link it via PubMed in the show notes so you can check it out there and make your own decisions. Before we get started, I'll say a few words about Rock Tape. Rock Tape is proud to be a sponsor of the Evidence Based Chiropractor and if you have not checked out all of their educational courses, you gotta do so they have a variety of online courses going on right now@rocktape.com and also you can head over and check out my favorite tool of theirs, mohawk@rocktape.com Mohawk. Also a little bit of housekeeping. You may have saw the big news in podcast land over the last week or so was Joe Rogan is moving his podcast from YouTube the to Spotify in what is reported to be a $100 million deal. Absolutely crazy. I sort of break down some of the numbers on that in a YouTube video that I recently did. So you can check out the evidence based chiropractor on YouTube if you want to see kind of behind the scenes at how the heck does a podcast generate $100 million in a licensing deal? I have some theories on that. You can check it out at the Evidence based chiropractor on YouTube. But as I said for today we are talking research, we are talking maintenance care. We've talked about this before. Probably gonna talk about it again in the future as well because it's a big topic. It's a big topic for a variety of reasons, not only from just clinical practice. How are you managing coaching? Guiding your patients in your practice is one key aspect of it. The other interesting aspect of this is the legacy and baggage within our own profession. Meaning there was a time in my opinion where an overwhelming amount of chiropractors were potentially over prescribing care and that has led to the pendulum Swinging back the other way, where now I see younger docs especially that really don't want anything to do with maintenance care or as it was called back in the day, wellness care. And they're doing, in my opinion, a dramatic disservice for their patients because of an aversion to some sort of historical baggage. So I love papers like this that we're going to break down because I think it really modernizes the context of the conversation and really analyzes where is this applicable, where is it not applicable, and how could it be used in an evidence informed way that's ultimately patient centric, which is what it is all about. So where do we start with all this? Well, we know low back pain is persistent, it's rough, recurrent, and it's been labeled as the largest cause of disability in the world. So that is a good reason. Right? We know that it is a persistent issue and it's a recurrent issue. Low back pain does not come on in one episode. And typically with one bout of care resolved for life, it comes back in episodes based upon the fact that we're dynamic beings, right? People go through injuries, people have poor ergonomics, ultimate stresses, injuries, you name it, it is likely to come back. And over the past decade, what we've seen and highlighted on this show time and time again, because chiropractic care has been shown to be extremely effective at taking care of low back pain, as well as a variety of other musculoskeletal conditions. And also in the last few years, the really exciting stuff has been that large healthcare organizations have begun recommending chiropractic as a primary first care option. So all of that is new, right? Historically, never. Nobody had that to lean into except for us here today. So this study examined the utility of maintenance care for the ongoing treatment of recurrent low back pain. And. And it found that chiropractic care is very effective at sort of flattening the curve around low back pain. Yes, I'm pulling one of those statements out there, which is the trajectory of low back pain. How does it impact before an episode, after an episode? And we see a big time flattening of the curve when maintenance care is utilized. Now, I want to be super clear. Maintenance care may not apply and probably doesn't apply to every single single patient. But for those individuals who have recurrent symptoms, who really responded well to their initial course of care, maintenance care can be a really powerful strategy at reducing pain level and contributing to an overall higher quality of life, which is really what it should be all about. So they found ultimately that the clinical course becomes more stable and the number of pain free weeks between episodes increases with maintenance care. That's very, very impactful. Again, if we come at this with the understanding of this is going to be a persistent and recurring condition, we come at it from the understanding of, let's carefully select these patients. You know, in those individuals that get a great response and have had recurrent issues, Gosh, when you can think about improving or increasing the number of pain free weeks between episodes and potentially even decreasing the severity of those episodes, that is super, super, super powerful. That's life changing for a lot of people in your community, not only in terms of their quality of life, but also in terms of the interventions that they choose. Right? If somebody comes in, let's just talk about this pragmatically. If somebody comes into your practice, they get a few adjustments, they feel great and they go on their way. And then whatever it might be, three weeks, six weeks, eight weeks, eight months later, they were under the understanding that you quote unquote, took care, fixed the problem, yet they go back to all of those wonderful things that they were doing before they came in that caused the initial bout. But they're thinking back now and saying, gosh, I thought he or she took care of the problem. I guess chiropractic didn't work. That is a travesty. And I get a feeling it's what a lot of really great docs out there, maybe even yourself, deal with time and time again. You might not even know it. And by exploring the conversation of maintenance care for those patients that it applies to, might be the difference between them saying chiropractic didn't work, then going down the route of medications, injections and or surgery down the road, or saying, oh, I think I feel something coming on, or let me go see Dr. Jeff because he took care of me last time. He told me that this might come back in the future. And that's a, okay, that's normal. But the sooner I get on this, the better my care and the better course and the better recovery. I'll have just some things to really, really keep in mind. So the patients that had received maintenance care, they had a flat trajectory as opposed to a big trajectory. So inevitably they were just better off. The maintenance care group had fewer days of bothersome low back pain than patients receiving control, which was not, and demonstrated, you know, who demonstrated more acute episodes. So those who did not receive maintenance care also had more acute episodes, maintenance care, more pain free weeks than the control group. In other words, the clinical course was stabilized by reducing the number of days with low back pain per week of each new episode and by increasing the total number of pain free weeks in this dysfunctional group. That is really, really important. So I'm gonna pull out a couple specific quotes here. Researchers found, quote, treatments performed by chiropractors have been found to be effective in reducing pain intensity and disability for patients with low back pain and are recommended in current practice guidelines set in the stage. I love stuff like that. Quote Number two, quote, there is now compelling evidence that stresses the importance of careful selection of patients for maintenance care to include those who have recurrent or persistent low back pain. Basically broke that down a few minutes ago. And finally they found, quote, chiropractic maintenance care reduces the number of days of bothersome pain within each new low back pain episode among patients classified as dysfunctional. Maintenance care stabilizes the clinical course and increases the number of pain free weeks between episodes. All of this to say, it is critically important that you think about this in terms of your practice. And when I say that, I mean in my opinion, maintenance care, you know, it shouldn't be used for everybody. But also in my opinion as a chiropractor, your skill set is wide enough where if you choose to do it, you have the opportunity to maintain a relationship with people throughout time and offer services that improve their quality of life in a way that's patient centric and ethical. So how am I toeing the line there and what do I mean by that? I mean it this way. There are some patients that might be very, it might be very applicable for them to have maintenance care. Now in terms of this study, I'm going to equate that maybe a little bit unfairly, but in terms of getting adjusted, right? So getting adjusted, as Dr. Seaman used to say, getting a crunch every once in a while is not a bad thing. Dr. Seaman was a teacher of mine and very much well known in the nutrition and anti inflammatory world. But he would say getting a crunch every now and again is not a bad idea. Right. Sort of interesting way to put it, but a funny way to put it and a true way to put it where, you know, getting mobilized, getting adjusted, getting manipulated every once in a while is probably a good idea. Now let's break it, let's bring it back to the research. Getting adjusted via maintenance care program. For those individuals who have had challenges in the past, have had persistent and recurrent back pain and have had a great result with their first, that should be a gimme, you need to have those conversations, especially with research like this, providing you the backing to feel real confident with it. Now, if the patient, let's say they responded, but they never. It's their first episode, they may have not had some recurrent back pain. They've never had recurrent back pain. You should really think about the services that you offer. And this isn't about convincing somebody to do anything that they don't want to do. It's actually the complete opposite. It's about offering the services and skills that you have to your patients that help them continue that journey. Most people, I think you would agree that pain is the last thing to come and the first thing to go. Now, that doesn't mean that then you craft a story around it. It means that you guide them along the truth, which is active care in rehab, in a practice can be a very important part of continuing that relationship, even if it's not maintenance, quote, unquote, chiropractic, in terms of getting adjusted every time. They should be staying fit with exercise, they should be going through active care and rehab. They might be interested as a person in terms of nutrition, in terms of supplementation, in terms of weight management. These are all things that, depending upon what type of practice you have, you can keep an ongoing relationship with patients based upon ultimately your findings and their goals. What are their health goals? Have a patient centric model. But also don't cut things short just to get people out. So you could report a low pva. The PVA should be something that, I think it's a legacy item. These docs with these, these incredibly high PVAs, well, that just matters how long you've been in practice and how long the patient's been alive and how long you've been doing the work. So don't get falsified with that. But on the same token, I would say I'd hedge against being super prideful of having this incredibly low pva, because if you're having an incredibly low pva, I'm gonna say you might be releasing patients too early. Now, pva, again, don't confuse this with just the act of the adjustment. I believe that you should be able to help guide a patient, especially those of you that have active care and rehab. If a patient starts feeling well, they get those adjustments, they get that initial care, and they're feeling well, Then they go back to insert globogym brand here and they're using poor ergonomics, poor lifting technique, their movement is terrible, their biomechanics are compromised, and they get hurt. Again, just to come in and get a few treatments and then go back to doing the same thing. I'm gonna say there's a better way. And that would be by guiding them in your rehab space, going through, showcasing to them how they can go about a fitness or an exercise routine in the best manner possible based upon your movement assessments. There's literally nobody better to do it, probably than you. And also that's something that you can and should be compensated for. It can and should be a part of your practice. So not to go off on a different tangent here, but I wanna bring it home that maintenance care that this paper really focused on, the modern context of that, and I wanted to take even one step back from that. After citing the paper and just opening your mind to the fact that having an ongoing relationship with your patients throughout time is the most important thing that you can do. It's gonna be on their schedule. It's gonna be based upon what you're finding during examination and evaluation, and it's gonna be based upon, number one, what are their goals and expectations as a member of your practice. So keep all of those things in mind. Have a fantastic week. If you have rating or a feedback this podcast on itunes, please do so. If you're listening on your iPhone, you can scroll down and smash how many stars you would like. I love five stars and I love getting feedback. But keep it honest, keep it real. That helps more chiropractors. Find out about this podcast. Have a great week in practice and I'll talk to you soon.

Thank you for joining us on this episode of the Evidence Based Chiropractic. If you want to grow your practice, come back for next week's episode. If you want to grow faster, visit the evidencebasedchiropractor.com and join our MD Marketing membership today.