348- Chiropractic After Surgery, Does it Help?

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 we are going to touch on a brand new study that recently came out in Medical Science Monitor. It is titled Effectiveness of Multimodal Chiropractic Care featuring spinal manipulation for persistent spinal pain syndrome following lumbar spine surgery. Great new study and it highlights what goes on when somebody who has previously had surgery that visits a chiropractic practice. A lot of clinical pearls here and this is something all of us, in my opinion, should be really familiar with. We probably all see patients all the time that have previously had surgery and there's many people in our communities that have had surgery that haven't come in yet. So being able to confidently explore this topic and know the data and the research, so important to communicating the message of who you are and what you do is. And as this study will show, kind of spoiler alert, we can really help people. Even those that have had biomechanical permanent changes anatomically via surgery can still really be helped. And it speaks to the power of who we are and what we do. But we need to be aware of how to communicate that in the best way possible. Before we get started, I wanna say thank you to everybody who has picked up a copy of the Payday Practice. It is the step by Step guide. It's my new book, it's available on Amazon right now and it's a step by step guide to, to show you how to generate monthly recurring revenue in your practice. We have literally seen copies be shipped all around the world, which is awesome. And if you've listened to this podcast for a while and you've appreciated the information, I'll ask you a favor, head over to Amazon, pick up a single copy of the paperback. It does wonders. As a new author, every single one counts. So if you have a few moments today and you head over to Amazon, I would really appreciate it if you picked up a copy of the Payday Practice. And I'll nearly guarantee you you get a shift, a transformation in how you think about your practice and hopefully you can really start building recurring revenue. That's what it's all about. We show you it step by step. But as I said at the top on today's show, we're talking about this study. It just came out and again the title will drop it down below in the show notes. But its effectiveness of multimodal chiropractic care featuring spinal manipulation for persistent spinal pain syndrome act after lumbar spine surgery. So persistent spinal pain syndrome. I had not heard that term before this study. Why? Well, because it's a new term proposed by the International association for the study of pain to define chronic or recurrent pain. And it replaces the old term of failed back surgery. Now that's ever convenient if I've ever heard of it. We don't wanna call it failed back surgery because it's very clear that a lot of people fail back surgery. So we're gonna call it persistent spinal pain synd. Wow. May wonders never cease in the medical world. This is failed back surgery. No matter how much they try to spruce it up, this is failed back surgery. And it happens a lot. How often? 20 to 40% of patients who have had spine surgery. This ties back to one of the best neurosurgeons that I ever worked with, which this sounds almost like a paradox or like. I'm kidding when I say best neurosurgeon. And they said 33, 33, 33, 33. 33% of their patients get better, 33% stay about the same, 33% get worse. We see here failed back surgery, 20 to 40%, well, guess what falls right in that range. 33%. So this is a really big deal. And it ties to a deeper underlying current here, which is people who believe that in non emergent cases that spinal surgery and advanced intervention is going to, quote, unquote, fix their problem. This has been an area I've kind of rallied harder against, I would say, over the last year than I have in previous. And it's because the data is just so overwhelming. There's way too many people getting elective spine surgery and there's way too many people walking around, you know, I say a lot lighter in their wallet, meaning $80,000, $100,000 surgery. And they're ending up in worse situations than they were before. And they're not only in more pain, but even if the pain is equal, they've changed the anatomy and biomechanics in a way that makes healing harder. They've impeded their ability, and that's a really big deal. And it's something that all of us really need to introspectively look at. And are we doing everything we can to reach out to the people in our community, B2C Marketing. And are we doing everything we can? And that doesn't just mean running discount ads, Are you really doing what's necessary to get out there in your community? And the second part of that is, are you doing what's necessary to bridge the gap with other healthcare providers? Because if you're not, there's just too many people in your community right now that are getting bad advice from people. Now you might not be able to change everybody's treatment algorithm, but even if you build a relationship with 1, 2, 3, 4 people in your community, you're going to be if you start thinking about those referrals coming in 5, 10 referrals per month coming into your practice, those are lives changed. And there's a certain percentage of those that would have ended up with injections and surgery. So I'll get off the soapbox here and get back to the study. But that's why this is so important, why I'm so passionate about it. So in this study they cite right at the top. Spinal manipulation is an evidence based therapy and recommended by several practice guidelines. Again, 10 years ago you were not seeing that as de facto fact. Yet much of the public still thinks it's exploratory, it's risky, it could cause injury. It's what they should be doing. Movement based care. So newer research suggests that pain relief relies or relates to the biomechanical and neurological changes that happen during an adjustment or manipulation. They say manipulation may improve intervertebral motion in areas where motion is reduced or inhibit nociceptive signaling. All of which I think we've seen proven throughout the literature. And it's important stuff to continue to re emphasize as time goes on. Now the individuals in this study received chiropractic care two times per week. So they received chiropractic care again two times per week. And patients, well, in this case all of the patients had surgery at least three months previously. And this is an important piece right here. Post surgical clearance, somebody has surgery, they're in pain directly after. I know sometimes I see in chiropractic groups the question how soon to treat? Usually the answer is my recommendation would be you really want surgical release, meaning you want to get with the surgeon or the surgeon's team and get their release or their sort of signing off on the ability to receive care. And that's just as a really a CYA type thing. Depending upon your technique, you could certainly get in there earlier. However, you don't want to be held liable for anything like that, especially when you're trying to help people that have had a bad surgery. You don't need to be on the negative end of that, get a release from that surgeon or you know, that three month time marker is a really, it's kind of a standard one. If they haven't had crazy complications and specifically if it was non instrumented, let's say they had a laminotomy, a laminectomy, a foraminotomy, those sort of things. Three months is really an easy to remember type thing. But I'd also follow up with that surgical team. So patients often in this study, many of them had lower extremity symptoms including pain, numbness, weakness, cramping, 90%. So they still had ridicular complaints after the surgery. There's no question about that. The mean duration of the symptoms was about 4 years and patients pain scores were about 6.6. So kind of fell. That mean was about 6.6 out of 10 on the pain level. So they were in moderate to severe. I mean they were at the high end of moderate in terms of pain. The interval between lumbar spine surgery and chiropractic evaluation in this case was over three years. And so you know, the minimum, when you say three months, that's sort of those minimums you can get in there sooner as long as you have the surgeon's okay, but three months. But most of these people had been in pain for years. And that's just too bad. I mean you're having ridicular symptoms years after having a surgery that was in theory provided to correct that issue. It's just challenging and it speaks to why we need to be able to communicate who we are and what we do and the benefits of the care that we provide specifically to these post surgical people who many of them end up on that treadmill. Chronic pain crisis is the opioid crisis. Right. So really understanding that these are people at a real high risk for going down the road in medications. You can only operate on something so many times and surgeons only want to go back so many times. So there's a cut point there. And when somebody doesn't know where else to go, it quite often ends up in the bottle and it ends up with drugs and medications. And we see this played out over the last 20 years. Now the most common surgery for the individuals in this study and were laminectomies. Over 80% had laminectomies, about 13% had dissectomies and only 6% had fusions. So it's a good thing, but that's sort of the breakdown as far as that goes. And after the chiropractic care so okay, two times a week they were saw a couple times a week. None of them had any serious adverse events. Let me repeat that. None of them had any serious adverse events. So is it safe? This was not a safety per se study, but I think we can all say yes, it is very safe when things are done clinically appropriate, when you do a great exam and if somebody's having post surgical pain, the risk is so low. Hippocratic oath rule number one, do no harm. We certainly live that to A T. So 55% of the patients report get this stat. 55% reported post treatment pain and disability scores of 0 indicating no pain or low back related disability. 55% of the individuals in this study had zeros after the care that they received. That is powerful, that is important and that is a story that needs to be told. Now is that stat hold if over 10,000, over 100,000 cases? We don't know. This was a smaller study. It was about 30 some odd people I believe. So we can't extrapolate it everywhere but man, that's a good start. These are people that had fusion. 6% had fusion and they still over half of them had no pain, no radicular symptoms and no disability rating after they went through this care. That speaks to the power of what we can do with our hands, what the power of movement based care is and how it can impact a body that's compromised. By definition. These people are coming in post surgically. Their anatomy's been changed, their biomechanics have been changed. Who knows what else is going on on the inside. And with the care delivered, they were able to achieve relief long term. Follow UP analysis at one year identified that 48% of patients maintain the improvements that they attained during care. That's great too. Like, you know, oh, oh, they felt good at the time, right? You know, skepticism. They felt good at the time, but they probably went right back. Well, no, about half of these people one year later maintained the benefit. You want to know probably what all of them should be doing is receiving maintenance care as time goes on. Because they probably didn't go all of a sudden dramatically change their life. They have biomechanical compromise. That's not changing. The surgery is done, that's not changing. Their habits might be improved. Hopefully they are, but many of them are not. So being able to have maintained care over a period of time depend how frequent. Well, it depends on the person. What are the health goals, what are their habits? These things matter. It's important to drill deep as well. Because the last thing you want to have is somebody to come in, feel a little bit better. They have a surgery and they go through all of that. They then make the decision, which is not everybody, to go see a chiropractor. And they're probably getting flack from people that they know, yeah, you shouldn't do that. They're going to mess up the surgery. The patient is in pain as a result of the surgery and they're being, you know, this is just what happens. It's crazy, but it's what happens. They come in and see you, they find they get relief and then four or five weeks later, because of the way they came in and their daily habits, things come back and it's quote, unquote, chiropractic didn't work. That's not the case whatsoever. This is about setting expectations and letting people know the real truth. Their anatomy has been changed forever. Their biomechanics have been altered. And really, unless they're willing to make truly significant changes in their work, in their daily habits and what they eat, how they move, they're going to need some ongoing care. But the beauty is, is that when they receive benefit and they're like, I'm feeling great. Well, let's keep you feeling that way because that is a great sign that a little bit of maintenance will go a long way. And it's really important to clearly describe that to patients so they don't get this false sense of they actually felt better and then they weren't told the truth and now things crept back in and they're like, I don't know. Did it work? Did it not work? I was hoping it'd be a permanent fix. Most of the, most of the time that's not going to be the case. But unless you tell your patients that super clearly, their expectation is probably going to be that. And if there's missed expectations, they might end up going back under the knife again or looking towards medications, which is what we're trying to avoid. So all that to say, communication, critically important. So with several sessions of manipulation, all patients, all patients showed improvements in pain and odi that's disability. Further analysis showed younger patients and those with shorter duration of symptoms and higher baseline pain were more likely to respond positively, which makes sense. The younger, their bodies are a little bit more dynamic. Shorter duration of symptoms, it hasn't been as chronic, it hasn't set in, the sensitization is not as deep. Neuro from a neuro perspective. And higher baseline pain. Well, if they can with, you know, if they're able to, if they're coming in in a lot of pain, really chopping that away is a good thing. And it's been shown that when somebody has really high pain, when you're able to chop away 20%, these are really meaningful. Now, in this case, over half the patients had zero pain and everybody had relief, which is powerful. But man, even taking somebody from an eight to a six, a seven to a four and a half out of ten, these are changes that really change people's lives. You don't. It's nice when people get to a 0 or 1 out of 10, but even just taking a chunk out of that 20 to 30% reduction in most cases is meaningful in a, in the context of lifestyle and important to remember that as well. Not everybody's going to get to 0 or 1 out of 10 pain and also being able to let people know that's okay. But when you can move, live and do the things you want without having to feel like you're ready to take a medication without having to feel like you need another surgery to fix the problem. Cause it didn't happen the first time, that's important. And it's super, super important for us to communicate that at a super clear level. So the conclusions on this study were, quote, we found that adult patients with persistent pain syndrome, failed back surgery showed improvement with multimodal chiropractic care featuring manipulative therapy, which was more effective in patients who are younger, had a shorter duration of symptom and or had a higher level of pain or disability before treatment. So big takeaway here is, you know, who are the people most likely to respond? Well, if they're in a lot of pain, they're pretty young and they had surgery not too terribly long ago. And it's a failed surgery. That's going to be somebody who is very likely to respond to the care that you deliver. Somebody that's older, somebody that has lower pain and has been having the symptoms for a super long period of time. Those are more difficult, difficult nut to crack. So I don't think there's anything there that surprises us. But it's important to see in the literature because it sets the stage for what can eventually happen in clinical guidelines. So I love this study. Thank you, everybody involved for putting it out. And I hope that you listening, got some clinical pearls out of this, some communication that you can have with your patients to better set expectations. Because not everybody's going to get 100% relief in this study. A lot of people did, but not everybody's going to get 100% relief and letting people know that that's okay. Setting the stage for what is expected and appropriate. So, so important. Can't be overstated enough. Now, before we wrap up today's episode, I want to say a few words about Powerstep. Powerstep Orthotics are what I use myself and my dad has found tremendous relief using as well. They were designed by a podiatrist over 30 years ago and Powerstep is hooking you up as a listener of the Evidence Based Chiropractor podcast. They want to give you a free sample pair. 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It's gonna be super frustrating and you're probably gonna end up with a employee retention problem because you didn't go through a process. You went on gut. You threw up an ad and somebody came in with a license. It's about matching people. That's why it's termed Chiro Matchmaker. So if you're looking to hire this year, have a conversation with us. Just have a conversation, see if we can help you with that process. Save you a bunch of time, energy and, and frustration in the process. You can click over to Chiromatchmakers.com schedule with our team. They'll be happy to chat with you. Otherwise, thank you for being a chiropractor. Thank you for listening to this podcast. Have an awesome week 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 the evidencebasedchiropractor.com and join our MD Marketing membership today. Sam.