236- Disc Height, Pain, and Spinal Decompression

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. This week we are back with the research. We're talking non surgical spinal decompression. I'm gonna look at a study that was released by BMC Musculoskeletal Disorders not too long ago. And there is some really, they come up with some really, really interesting findings about decreasing discogenic low back pain and possibly restoring disc height as well, all through non surgical spinal decompression. Some interesting tidbits here. A lot to be explored, but that's what we're gonna break down on today's episode. And before I dive in, I have two big calls to action for you. Thank you for listening. And if you are listening, then I would love rating or feedback on itunes. If you're listening to this on your iPhone, you can just kind of scroll down, tap the number of stars, give some feedback. I love hearing about people who are listening to the podcast. What do you like? What can we improve upon? Let me know. Shoot me feedback. I absolutely love to hear it. Thank you. The second piece is we are talking marketing each and every day in the Smart Chiropractor marketing Facebook group. There are a lot of awesome Facebook groups out there. We think ours is pretty cool as well. I'm gonna drop a link to the Smart Chiropractor Facebook group in the show notes. So if you are not dialed in and tuned in, I've been posting there daily about mostly about marketing, a little bit of research as well. So be sure to check it out. I think we have almost a thousand docs. I'd love to push it over a thousand docs. And it's just a great group where we kind of jam on chiropractic stuff each and every day. But as I said at the top, we are talking about a study released by BMC Musculoskeletal Disorders and it is titled restoration of disc height through non surgical spinal decompression is associated with decreased discogenic low back pain. And this is a retrospective cohort study. So let's break this down from the top and then we'll get into the specifics of this study. I know there are a lot of docs. I think it's between 25 to 50% of chiropractors who utilize spine Spinal decompression in their practice. One thing of note is that I worked in a couple different surgical centers, ASCs, hospital based groups, and when you say spinal decompression, they automatically think laminotomy, laminectomy. So be sure as you're having conversations with surgeons, with pain management docs, with physiatrists that you're saying non surgical spinal decompression. I would typically always just say spinal decompression and they're looking at you sideways like what you're doing surgery. That doesn't make any sense. And that is the truth. You want to focus on non surgical spinal decompression because they think about decompression surgically as soon as you say that. The other piece of the puzzle with this study specifically is they're looking at discogenic low back pain, right? So there can be pain caused by the disc itself is discogenic in nature. What is the primary test that's ordered to confirm discogenic low back pain? I'll give you a moment. It is a discogram, right? Discogram is one of the only provocative studies. So this is something, thankfully, as chiropractors don't think we order very much and quite frankly, most docs don't order it because it's a painful test. A discogram is you take a needle, you inject fluid to increase intradiscal pressure. If the pain increases during and immediately after the injection, that's during the discogram itself, then that is a positive sign that the pain is discogenic in nature. Thankfully, most of the time I think what we work with within the chiropractic space and discogenic pain is less frequent than what I'll call facet mediated pain than, you know, foraminal encroachment, lateral recess stenosis, central stenosis, those things tend to happen, quote, unquote. Mechanical back pain tends to happen more frequently in my opinion, than discogenic pain. That's just my antidotal observation. But this study looked at discogenic pain. They looked at non surgical spinal decompression and they found some really, really interesting things. So number one is they cite that two of the most common diseases involving chronic low back pain are discogenic, responsible for about 39% of cases in disc herniation, accounting for about 30%. So according to the research, you know, my observational, you know, antidote, it might be a little bit off, right? I you look what you see, you got the hammer, you know, you're going to find a nail kind of thing. They're saying 39% of chronic low back pain is probably discogenic. They're saying about 30% is related to disc herniation. And of course, as you know, non surgical spinal decompression motorized unit, right? Technique designed to lessen the pressure on the discs, to vertically expand the intervertebral space and to ultimately restore disc height. Question is, does it or does it not? Right? So they found a statistically significant correlation between the increase in disc height and a reduction in pain, with a 1 millimeter increase in disc height being associated with a reduction of nearly two points on a verbal pain rating scale. This gets really, really interesting, right? A millimeter in height increase, which is no small task. You know, when you think about the central canal itself, where the spinal cord goes through, being 10 millimeters is perfect and six and a half, seven millimeters is basically severely stenotic. One millimeter changes do make a big difference. And if you're able to gain back a millimeter of height in the disc, what they're saying is, hey, every millimeter, we're seeing about a 20%, almost a 2 point decrease on that pain scale. So they found an average reduction in pain in this study. Most of the people that came in with an average of about 6 out of 10 pain, they went down to about 2 out of 10 pain after the non surgical spinal decompression. And they were able to show that increases in disc height did correlate with an increase in pain relief. Really, really, really interesting. So this relief of stress, they think, you know, simultaneously promotes regeneration of disease and compressed discs and increases lumbar disc height, with the latter reducing the load on the facet joints. That also makes sense, right? If the disc is. Has better height, is more plump, so to speak, you know, that is going to decrease the amount of load on the facet joints as that disc collapses. As the disc space collapses down, inevitably the posterior elements are also sliding, quote, unquote, you know, inferiorly. And therefore it is going to, by definition place increased stress on the facet joints. So it stands to reason that, hey, if you're able to plump that disc back up a little bit, that there is an opportunity to decrease the amount of stress and pressure on those facet joints. We also, also keep in mind, we've talked about this a couple times on this podcast, that as you age, the instantaneous axis of rotation migrates posteriorly. So when you are young, it's kind of like right in the middle of your disc and as you age, where you rotate from that instantaneous axis of rotation migrates posteriorly that is what also is thought to contribute to increased load on the facet joints, degenerative changes to the discs, and ultimately the whole entire cascade that goes down from there. So again, as we talked about in this analysis, they found each millimeter of increase in disc height was associated with a pain relief of roughly two points on the scale. And they found that. Here we go. Drumroll, please. A clinically important difference. I see a lot of chatter online in a lot of different groups. You know, people talking about research is. And then, you know, you find people coming out of the woodwork. Well, that's not clinically. There's a place for clinical relevance, there's a place for establishing precedent. There's a place for it all. But in this study, my point being is that they come up with those keywords that this has the potential to, to be clinically important and clinically meaningful. So it's not just, you know, it's not just like, you know, working out for the good looking muscles. Right. You know, this is, this is something. It's not just aesthetics. Like, we got the disc a little bit better, but the person's still in absolute and abject pain. They're saying, no. When you're able to increase that disc height a millimeter, when you're able to drop that pain 20%, let's say that is clinically meaningful. And that makes sense right now. They found the conclusion was quote, in this study of non surgical spinal decompression for chronic discogenic low back pain, we were able to demonstrate an association between the restoration of disc height and pain relief. This is the first time that I have seen this right now, non surgical spinal decompression. I'm gonna take a little bit of an aside here. You know, is, is it a great technique? Has it gotten a bad rap? It probably depends upon your experience with it. Right? I think we all have heard sort of, you know, the horror stories of lawsuits and challenges in the non surgical spinal decompression world, which I think occurred in the 90s, if I'm not mistaken. But there was, you know, there was sort of false claims. And with all of this, again, this is why it's important you take the research, you apply it in the best way possible. But you always want to be, you know, on the side of caution. You want to be easy. You never want to guarantee results. You can't guarantee results no matter what. Right. Every individual person is unique. Pain dysfunction is complex by nature. There's just a lot of factors that go into whether somebody finds great relief in your practice or not, but I think non surgical spinal decompression sort of got. Again, I don't know if I want to call it a bad rap or whether it was well deserved, but for most docs that utilize this, it's a cash service, right? And they're recommending, let's say 10 to 20 visits on sort of this cash plan. So based upon the conversations that you're having with your patients, it's definitely fraught with patient unhappiness at the end if they're out the money and they didn't get the result that they desired, especially if they feel like you were over promising and under delivering. I think there's a lot to be said for non surgical spinal decompression. I also still think there's a lot to learn, right. When we look at the mechanics and the computerized nature of it. I'm far from an expert in it, but I know that with the computerized nature of it, the goal of the non surgical spinal decompression over a flexion distraction technique is that the computer's doing the work, right? It's registering how much resistance there is and then it's providing stretch or resistance based upon real time feedback and the computer algorithm itself. Questions that come to mind for me, and I don't know the answers to them, are how often are those algorithms updated? How often have they been updated? Are there more successful and less successful algorithms? All really, really important points when we start to look at how can we make non surgical spinal decompression as effective as possible. Also, this study did not answer those questions of hey, were these people, you know, did they have 1 millimeter of disc height left? Were they 5 millimeters? Like, how far is too far, you know, and how little is too little? Those are interesting things. You know, I've been doing a lot of research into non surgical spinal decompression because it's been a huge area of interest within the evidence based chiropractor for a specialty series. I keep getting requests from members of the evidence based chiropractor that are out there bridging the gap and building relationships with other healthcare providers, like, can we get a specialty series of research briefs? And the ones that come up time and time again are can we get a series of research briefs on spinal decompression? Can we get a series of research briefs on related to personal injury care? And can we get a series of specialty research briefs devoted towards pregnancy and pediatric care? I'm working on all three of those right now. And I'm thinking about offering it even beyond the scope of just evidence based chiropractor members as items and tools that you can utilize to kind of bridge the gap and get out there. Obviously, if you're listening to this and you're a member of the evidence based chiropractor, there will be preferred kind of pricing for anybody who's an active member of the evidence based chiropractor. But research is the way to get out there. It's the way to get out there consistently. Right? When I talk about research, it is the marketing piece of our program. It is your opportunity to guarantee you stay top of mind that you continue the conversation. You want to send those case notes, but those are going to ebb and flow with who walks in your front door. You want to take those meetings. Meetings are difficult to come by right now. Maybe zoom meetings are the better option as we've been talking about within the evidence based chiropractor. But you can't take a meeting every each and every month in that missing piece. If you're going months and months without connecting to those other health care providers in your community, you are just crushing your ability to build referral relationships. We want to restore that ability by doing the right thing with case notes and meetings. But filling in that gap with marketing, which is the research. And I'm going to say nobody does it better than what we do at the Evidence based Chiropractor because we've been doing it longer than everybody else and we have a system that works. It's not an afterthought. It, it is literally what we do. So hopefully this was a good, you know, sort of start into the non surgical spinal decompression world. If you have any questions about this paper, feel free to drop them down below. Shoot me an email Jeff at the Evidence Based Chiropractor. Be sure to hit up the smart chiropractor Facebook group where we're talking marketing. And if you so inclined, I would love for ratings or feedback to continue to pour in across itunes. It helps more docs Find out about this podcast and have a fantastic week in practice and I'll talk to you soon.

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