330- The Effectiveness and Efficacy of Chiropractic Adjustments

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. Today's episode, we're talking research. This was published just a few months back and the study is titled Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain. Lot of clinical pearls to come out of this and it's a pretty darn good review. So this is gonna be a episode packed with stats all around what we do, which is chiropractic adjustments, chiropractic spinal manipulation, and this is a look at again, the effectiveness and efficacy. Before we get started, I will say a few words about the smart chiropractor. The smart chiropractor powers your patient journey to provide you with more qualified leads, more new patients, better retention, and more consistent reactivations without any money spent on advertising. We do that through the pillars of email, of social and in office patient education. You can learn more, schedule a demo. Check it all out@the smartchiropractor.com Again, that is the smartchiropractor.com. but as I said at the top on today's episode, we're talking research. This was published in Frontiers in pain research in October 2021. And again the title is Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain. You can check out a link in the show notes if you want to see the paper. And the researchers started this one off hot. They came out swinging and they said spine pain is a highly prevalent condition affecting over 11% of the world's population. It's the single leading cause of activity limitation and ranks fourth in years lost to disability globally. So is this a big deal? Yes, and we talk about that each and every week. And it's for good reason, because it is a big deal. And sometimes we can become, I think as chiropractors, people who see this all day, every day. We're sort of desensitized to the fact that almost everybody's dealing with it, that it's the number one cause of disability, and that millions of people are struggling to live their lives appropriately because of, in many cases, chronic non specific low back pain. And when you add in neck pain, when you add in thoracic pain, it starts to become a big challenge. And I'll reference again what I refer to as the journey of Professional indifference. If they don't come to see you, they're gonna go down that journey. And that journey's not a good one. It often is. Medications, we see opioids still being prescribed and over prescribed and essentially should not be prescribed for spine related conditions. We still see NSAIDS, 100,000 hospitalizations per year. With those, we see millions of epidural steroid injections when pretty much most, aside from really acute settings, most of the time that they're unnecessary and they don't provide real relief. And we see surgical intervention, elective surgical intervention, often being performed to the tune of over a million a year as well. And we've seen the data on harms there. So is this an important conversation? Yes. Are we going to continue to talk about it? Absolutely. And why is this a big deal in terms of growing population and this is a growing part of your business? The prevalence has been increasing over the past decade. Probably no surprise there, particularly they say among working age females in high income countries. So I know as chiropractors, I believe in many of our practices it slants a little bit more female in terms of patient demographic and this reinforces why. Likewise, pain affecting the spine affects more than 50% of people with chronic pain. So if people have chronic pain, the chances are more likely than not they have a spinal component to it. A few, I guess it was a year ago, so maybe a little bit longer. The Lancet had a series of, of papers about low back pain and they highlighted that there's just an overbearing reliance on imaging, on opioids, on spinal injections, on surgery, and that quite often people should be looking towards what we do. Quite often movement based care and adjustment manipulation is part of that. But movement based care is really the key. Movement is the foundation of healing. Movement is the foundation of then staying well as well. What an irony. And it's a core component of what we do with our exercise instruction and certainly with the care that we give with our hands or instruments segmentally. So the researchers in this study cite the fact that chiropractic is a healthcare profession concerned with the management of neuromusculoskeletal conditions. I like that. I think it encompasses really what we do in a very simple phrase. And. And they also highlight the fact that adjustments provided by chiropractors for spine pain have been demonstrated to be a cost effective option and are rarely inappropriate. And that's a good thing. That means for an overwhelming majority of people, I'll flip that coin the other direction and say, hey, for an Overwhelming majority of individuals with spinal issues, chiropractic care and adjustments are something they should be looking towards. So this is not for a minority, this is for a majority of those struggling with spinal issues. And recent research showcases that chiropractic care may be evolving from a field of complementary and alternative medicine towards becoming a mainstream option for spine pain. That one's, I wouldn't say a tough pill for me to swallow, but I think it is an interesting observation. If we look back 20 years, we had very limited space in the VA system here, veterans Administration, a system in the United States. We had very limited opportunities in many professional sports. We had very limited opportunities in interdisciplinary care. Now we look forward to today and where we're going tomorrow. And there's no question that those have opened up dramatically. We have Dozens if not 100 plus docs working within the VA system. Probably close to a thousand, I would estimate, working in multidisciplinary clinics, orthopedic clinics, whatever it might be. And that certainly is pro sports. It's ubiquitous across all professional sports chiropractors. There's no question the opportunities have gone up. But when I look at the lag in terms of the common person in your community, how much penetration does chiropractic have in your community? It certainly hasn't jumped from 10% to 80% in most populations. Right. So we've meandered along utilization, 10, 15%. Now, one way we can look at that and say, well, first comes these high level items, then that's going to trickle down and we will see that push in the next five to 10 years. Even places like the joint, you know, these, these, you know, additional places to receive care quickly and easily have opened up opportunity, but we just haven't seen it in utilization. So I think that utilization is going to be a lagging indicator, but it's something to keep an eye on as well. So non specific neck pain, they take a look at neck pain first. As we remember, they highlighted spinal pain. So we're going to look at low back, we're going to look at neck, et cetera. Regarding neck pain, they defined it as pain between the skull and the first thoracic vertebra. In the absence of specific pathology or neurological sign. In at least 10% of people, nonspecific symptoms persist beyond three months and can become chronic. So that is a big deal because we see the evolution of chronic pain. How the chronic pain epidemic is the opioid epidemic by and large, in being able to steer people before they get beyond that three month 90 day marker from acute to chronic transition is incredibly important and impactful. And movement has a lot to do with that. And of course, the last thing people want to do when they're in pain is move. Yet that is quite often the healing mechanism. And they cite the fact that results from previous studies suggest that spinal manipulation is more effective than medication, but not necessarily more effective. It's about equal to home exercise. So is medication the answer? I think time and time again we continue to get this response that, no, it's not. Yet we see hundreds of millions, if not billions of pills being taken for chronic and acute spine pain each and every year. So movement is key, right? Home exercise, key. I always view that as regional or whole body. And then I view what we do with our hands as segmental. And there's some overlap and play between those two. But all are critically important. All forms of movement are important. And when we take the low back into example, the low back presenting to primary primary care is predominantly considered nonspecific, again meaning there's no specific source of nociception or a specific pathology. And we know that about 30% of primary care visits each and every day, give and take a bit, are related to spinal issues. And many of those primary care doctors are super ill equipped to make great decisions. They are doing one of three things. We talk about this every day within the evidence based chiropractor and our referral relationship program is many of these primary care doctors are really doing three items. They're prescribing medication, referring to physical therapy or referring to a specialist. And I believe there's huge opportunity for us as chiropractors to get in there and to build relationships one on one and to become that primary option. The research shows that's what should be being done. However, it's not typically being done in many offices, day in and day out, that gap is your opportunity. So standard medical care based on medication is more frequently used during the early stages of low back pain. This is an opportunity, right? While interventions based on exercise are more commonly prescribed for chronic primary low back pain. So is that an opportunity for you? Absolutely. Because when these primary care physicians are doling out the oh, you have back pain. Let's start with a course of NSAIDs. Well, number one, there's gonna be people that can't take those NSAIDs. They have clotting issues, they have heart issues, they have whatever the contraindications might be. Well, that's a great opportunity to get your foot in the door, hey, I can take care of Those individuals that aren't able to do what you'd like to do. And as you do that, you're positioning yourself. And this is key because as we have seen, the guidelines change and alter as doctors start to wean off medication as that first line treatment, they're going to look to their existing relationships first. And you can be that existing relationship, but you have to take action to get there. So when spinal manipulation was directly compared to usual medical care, patients receiving adjustments reported significantly greater reductions in pain and disability at the four week follow up. Why is that important? Four weeks is before 90 days, right? So this is breaking people out of that acute to chronic transition. Hugely, hugely important, hugely, hugely impactful to all of those people. And hey, it's great for your practice too, because you're able to see more people, you're able to help more people, and that only helps generate more positive momentum for your clinic and your practice. So you can continue to do all of your reviews, your outreach, your referrals within your patient base, but don't forget about these other healthcare providers. So this study comes to a conclusion, saying, and I disagree with this, to be honest with you, they say this probably suggests, quote, the quality of evidence and efficacy and effectiveness of spinal manipulation remains insufficient. I staunchly disagree with that. Now, I'm not a professional researcher. I take what I see and try to interpret it in the best manner possible. But how much more literature can you have? It blows my mind where these questions remain. Yet there's a gold standard of care within the medical paradigm that still allows opioids, that still allows NSAIDs, that still allows elective surgery and injections. Yet with the overwhelming amount of literature over the last five plus years, we've highlighted it week in and week out on this podcast. There's still statements like this from researchers. It's just confusing to me. Then they go on less than a paragraph later to say, the United Kingdom's National Institute for Health and Care Excellence guidelines make it imperative that spinal manipulation be offered alongside exercise therapy. And they also go on to say, the American College of Physicians guidelines endorse spinal manipulative therapy as a frontline non invasive intervention. So it's kind of dichotomous in my mind in terms of how they're playing that out, but it is what it is. And finally they state, quote, recently a decision aid developed for managing chronic back pain by Canadian colleges of family physicians endorsed exercise and spinal manipulation as the only interventions for which benefits likely exceeded harms. I'll say that one more time. There's a Canadian Colleges of Family Physicians endorse exercise and adjustments spinal manipulation as the only interventions for which benefits likely exceeded harms. My understanding is when all of us, regardless of the letters after our name, so regardless whether we are md, do, dc, arnp, pa, Hippocratic oath is do no harm. So why aren't more doctors looking at that, taking that as seriously as they should, especially with the preponderance of low back pain being tying it back to beginning the number one cause of disability. This is what everybody is seeing day in and day out in their practice. And I think it's high time that we not only hold people accountable for their clinical decisions, but I'll say this in a positive way. Us as chiropractors continue to reach out, continue to tell the story of who we are and what we do and help people understand. Because quite often on the physician side of things, it's a lack of understanding. They're not trained in who we are and what we do. They don't know what happens within your four walls and it's left to myth and conjecture. And if you're not getting in there and proactively having conversations. The other thing is breaking referral patterns is tough, make no bones about it. So you have to have consistency with your messaging. These are all the things that we focused on with the evidence based chiropractor program and why it's been so successful, generating hundreds of thousands of referrals for thousands of chiropractors is because we focus on those core tenets, what's actually happening in the real world, and then supply you the tools to bridge that gap and make that break so you're able to, to really gain those referral relationships. And once you build that, here's the beauty, it might take a little longer to build a relationship, but you can have it for your entire career. And that's such a powerful thing in the, you know, in, in the time of advertising, paid advertising, specifically to have a referral relationship that continues to produce for years and decades to come is one of the best things you can do. So what do I like about the study we highlighted today? I love the fact that they showcase what's going on in the world of spine pain. I love the fact that they're pulling from other research and highlighting just how effective we can be as chiropractors. And if I had a criticism of it, it would be just that end where they're still questioning whether or not spinal manipulation is effective and whether or not the efficacy is there when they've spent the whole rest of the paper highlighting the fact that it is so. Again, these are what research is for. I think research gives the opportunity to plant a flag and ask more question. So I love the fact that this came out. I love the fact that we have the opportunity to break it down on this podcast and there will be more to come I am sure in this vein. So that is the topic on today's podcast episode. If you have not left us a rating or review, I'm gonna ask you please please please do so. It helps more and more docs find out about this podcast. You can scroll on down, tap how many stars, leave a few words of encouragement. Greatly, greatly appreciate it. If you have anything you'd like to see us highlight in the future, you can always hit me up. Jeff the evidence basedchiropractor.com and tying into our previous episode on Orthotics, I want to remind you powerstep is offering a free sample pair for all listeners of the Evidence Based Chiropractor podcast. Get on it. You can click the episode show Notes or head over to pro.powerstep.com sample pro.powerstep.com sample and pick up your own free pair. These are orthotics that my dad has seen tremendous success with, so I have a personal testimony there pro.powerstep.com sample Otherwise, I hope you have a fantastic week in practice and I will talk to you soon.

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Sam.