368- North American Spine Society's Thoughts on Chiropractic

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're talking research. We're going to look at a NAST Contemporary Concepts in Spine Care article that's all around spinal manipulation therapy for acute low back pain. This article came out a few years back. I'll drop the link down below. But it's important because North American Spine Society is a big deal. And when they release a paper in the Spine Journal that highlights who we are and what we do within chiropractic and with spinal manipulation, it's something to revisit, it's something to talk about. And there's a lot of great information here that holds true to today. But before we get started, I wanna say a few words about Patient Pilot. Now is the time to automate your patient communication. Automated email marketing is what we do. We work with over 300 practices around the world. We send over a million emails per 1.1 million emails per month. And our average doc is getting 26 clicks to their online scheduler from their email list. The money is in your list. Yes, you got holes in your bucket if you don't have automated email throughout new patient retention and reactivation systems in your practice. We can install all of it in a personalized and automated way with Patient Pilot. Head on over schedule a demo. That's how you'll get best pricing and we'd love to work with you. This is the year to make things happen. This is a foundational element. This is not email. Automated email marketing is not a nice to have. It is a need to have. It helps everything else in your practice run and work better. But as I said at the top of today's episode, we're talking research. And the study is titled NAS Contemporary Concepts in Spine Care Spinal Manipulation Therapy for Acute Low Back Pain. Again, I'll drop the link to the article down below if you want to go check it out. Why is this a big deal? Well, we'll start with the fact that we talk about many times low back pain is like the most common and debilitating condition on planet earth. So cumulative one year incidence of low back pain is 20% or more. So that can be scary. But the good news is a survey of people 35 to 45 years old found that low back pain Usually resolves quickly, but about 40% of people develop persistent low back pain. So here's the good and the bad side of that. Right? 60% don't, which is good. But 40% develop persistent low back pain. Now, why is that the case? I don't think you have to jump too far to say, well, a lot of it is gravity, time on earth, bad habits and lifestyle choices. These are the things that we see and deal with every single day in our practice. So it's no surprise. And this is why, in many cases, this is more about management than cure. Because people typically don't come into your practice with an incident of low back pain and then wildly change their lifestyle. People do pick up good habits, and your job is to help, educate and inspire them to do so. But specifically, if they're sitting at a desk like all day for 10 hours a day, most people won't dramatically change their entire career once they have back pain. And time can be difficult. So that's where exercise, it's important to emphasize the importance. But we know probably a good portion of people don't overhaul their lifestyle. So what does that mean? That means more management than cure. Because a lot of this is what they do outside the four walls of your practice, and inside is kind of crisis management, movement assessments, et cetera. But outside is where they're living their life all those other hours of the day. So it's so, so important, and it's important as well to head this off quickly, which is where we come in and why we're so important in this. Because patients with acute low back pain who don't improve quickly often seek additional and advanced interventions. And, and that is a big challenge, as we've identified the last few weeks on this podcast, specifically with the overuse of surgical intervention, It's a big deal for us as chiropractors to be able to enter the CARE algorithm as early as possible. It literally changes the entire dynamic. Opioid use down 50%. Surgical use probably down 40, 50% or more. And that is a big deal. So one of the things that people can seek out and do seek out is what we do as chiropractors with spinal manipulation. This study highlights the fact that that some form of spinal manipulative therapy to treat low back pain has been used for thousands of years. I think we've all probably seen the old hieroglyphics showcasing that even in ancient Egypt, what appeared to be people drawing other individuals utilizing adjustments or spinal manipulation from way, way back in the day. So it's Been around a while. So what are the indications when we're talking acute low back pain? Let's set some brackets here. Acute low back pain is defined as a minimum duration from one to four weeks and a maximum duration of three to weeks. So that in all the studies in this paper were less than 12 weeks, because 12 weeks is really where you tickle over to that chronic pain type situation. So this one's focused again exclusively on acute pain. So there was some discussion. What's the discussion around improvements in pain and function? This again, this is from the North American Spine Society in the Spine Journal. This is real deal stuff. And I love where they kicked this paragraph off. They basically say, I'll read it exactly as I do say it. Spinal manipulation therapy appears to be effective for pain reduction in the short, immediate and long term. Only one to two weeks after initiating care with SMT, pain reduction was substantial, 62%. So let's dig into that a little bit. This can be a criticism sometimes it's a false criticism, as we know now. But, well, chiropractic works because you're there, because somebody has their hands on, well, you know, because you want to get better. Placebo is real, it works. Hands on care is important. Human touch is really, really important. Don't underestimate that. But this is something that works in the short, immediate and long term. And within one to two weeks, pain reduction was substantial, 62%. That is a big deal. Almost no, nothing else can touch that. That is, you know, that really needs to be emphasized. They go on to say that pain reduction tended to peak within three to four weeks of beginning spinal manipulative therapy or chiropractic, 80% and tapered slightly after two to three months, down to 67%. Six months, 65% but remained higher, you know, higher than that achieved after one to two weeks. So one to two weeks, substantial pain reduction. Then you get into the meat of it, right? Pain reduction peaking three to four weeks. This is also something I think it's important to keep in mind and every patient's different and how you approach clinic. So this isn't about trying to coax anybody to take care of somebody longer or shorter. I just think it's important to acknowledge the fact that here they're saying pain reduction reaches peak within three to four weeks. It takes a little time. Now, some people might have pain reduction sooner or later, but as we all know, pain is the last thing to come and first thing to go. So it is important to understand biomechanics. And I've Said it before and I'll say it again, don't get people out of your practice too soon. Just because they're feeling a little bit better that day doesn't necessarily mean that they've made any lifestyle changes. It doesn't mean that they've made any psychological shifts and that they're feeling actually that much more confident. And it doesn't mean that they're biomechanics through your movement assessments, whether using DNS, sfma, whatever it might be. It doesn't mean that there's been substantial change there. It takes time to make change and people come in to feel better. But you should also hold them accountable. And accountability takes time. Accountability doesn't happen in two visits. Accountability takes time as you start to see what their patterns are, understand and be their guide. And to me that's one of the most important things we can do as chiropractors. And there's been a subset of chiropractors and probably people listening to this podcast on the evidence based world that have swung the pendulum in my opinion, far too much the other direction. Where they don't want to, they're making their decisions what they don't want to do instead of actually looking at the facts, actually looking at the stats and just look at how the body works and being able to make informed decisions about patient care and treatment. So pain reduction, tying back to this research, pain reduction continued to taper after one year, 51% in two years, 67%. So this is also pretty insane. Think about this again, I'll take a step back and look at what this is saying. People will undergo care and literally that's how powerful what we do can be. That six months later, three months later, one year later, two years later, they're still having benefit from it, despite the fact that their habits probably didn't change, despite the fact that they're older, despite the fact that they might have had injuries, despite the fact that gravity continues to wear on the musculoskeletal system. These are really, really big deals that I think often we overlook because we see people get well every sing single day. We see people come in in abject pain and walk out feeling great. And we almost become numb to the fact that nearly no other healthcare provider sees that happen day in and day out in their practice. Which is one of the reasons why I'm so passionate about who we are and what we do now. Additionally, when they looked at research in this study, they said no studies, this is so important. No studies reported that spinal manipulative Therapy was inferior to other treatments in providing pain reduction at any point in time. So they literally could not dig up a study where spinal manipulation performed worse than anything else. So at the baseline, it was as good as anything, if not better. And then you look at it in the short term, the midterm, and the long term, that is absolutely incredible and something that all of us should celebrate. So results from additional studies indicated that spinal manipulation was again, superior or equivalent to many commonly used interventions, including physical modalities, education, exercise, medication. And this suggests, as they say, that a patient with acute low back pain can reasonably choose between the most appealing options for them based upon availability, preference and expectation of improvement. Factors basically beyond just does it work or not. I'm going to have a little bit of a bone to pick with the research saying that, with that statement, because if we're looking at this from the standpoint, and patient preference matters, don't get me wrong. But if we're looking at this from the standpoint of do no harm, harm, you know, now education probably doesn't have too many harms and exercise has practically no harms, but medication should be lopped off this list real quick because just choosing medication, that's silly. You need to have context to be able to make a great decision. Exercise and education to me are complementary, not competitive. So it's not one, it's not a. A or conversation. It's an. And conversation and other physical modalities as well. So I kind of disagree with the fact that they're saying, hey, a patient should be able to just choose what now a patient can. We have autonomy with our healthcare decision, so you get to make whatever decision, but leaving it up as if all things are equal. I generally disagree with that because all things are not equal. Some things have more harms than others. Some things take longer than others. And guiding and directing is why people come to a doctor. Our bodies are ultimately doing much of the healing, and they're going to a doctor to understand what to do for themselves. And in the best, when we're at our best, we're empowering patients. Yeah, we're getting in there and adjusting the spine or extremities, because that's one of the most powerful modalities out there. But we're also helping them understand more about their body and coaching them along the way. So they point out that 94% of spinal manipulation is administered by DCs. That number might have gone down over the last maybe decade or so. I think, as other professions are realizing just how powerful it Is, but the bottom line is we're the experts in it, bar none, you know, we're providing say a majority of that care, an over overwhelming majority of that care. In the harms realm, spinal manipulation appears to be relatively safe. No harms were attributed to spinal manipulation in the five studies that did report harms data. I'll have a slight bone to pick here. Relatively safe. I mean it's difficult for anybody to ever give hard data on what the actual harms would be besides just, you know, some delayed soreness. When we look at medications, surgery as we did a few weeks ago, every two days, somebody passing away perioperatively to a surgical intervention, specifically a posterior lumbar fusion. When we look at 130 something plus people dying due to opioids, a majority of them starting opioids due to chronic pain and spinal being one of the number one issues there. This relatively safe is. It was a little, a little bit of an understatement, let's put it that way in my opinion, especially compared to what else is going on out there. So their conclusions were quote unquote, based on the RCTs reviewed. Spinal manipulation appears to be an effective for pain reduction. Appears to be effective for pain reduction in the short, immediate and long term. One third of studies included in this, in this study demonstrated more pain reduction with SMT than for control groups at one or more point in times where 2/3 showed no difference between SMT and the control groups, which were other modalities. No study showed SMT to be inferior to other treatments in regard to pain reduction at any time. And there's no evidence to suggest that a higher number of treatment sessions with SMT was superior to the commonly used five to 10 treatment sessions. So that's kind of what they were highlighting towards the end. There is, they're saying they didn't see a ton of abject benefit when he got into, you know, 25, 35, 45 visits or whatever it might be. They said 5 to 10 is really where you're maximizing things, almost like an MMI maximum medical improvement. But in my opinion, I look at this and I say we're talking management, not cure. Understanding what, what's the person's health goals and what are you seeing on your exam and ev that should dictate what your care plan is. And many people, you know, as a professor of mine used to say that I'll say getting a crunch every now and again is not a bad idea and I couldn't agree more with that. And helping inspire people to move. Holding them accountable to health habits is a great thing to do. People are happy to pay for it and they're better off for it. So great study. This came out a few years back. Again, it's a little bit dated, but I don't think I'd highlighted it yet on this show, so I wanted to make sure we did so. And before we wrap up, let me say a couple things. Things. Number one, powerstep Orthotics they support this podcast. Please support them. And when I say support, they're going to give you a free sample pair. There's no reason not to do this. Pro.powerstep.com sample pro.powerstep.com sample use the code EBC evidence based chiropractor. They'll hook you up to what I use, what my dad uses. Can't recommend that company enough. Additionally, World Spine Care everybody should have access to evidence based chiropractic. There's a billion people worldwide that experience low back and neck pain and many of them do not have access to World Spinecare does an incredible job. 50 chiropractors volunteering and international clinics. This is where it's at. Make a tax deductible charital donation today. WorldSpineCare.org EBCPodcast whether it's a buck, 5 bucks, 10 bucks. They are doing incredible work. I know the team over there. It's great to support organizations that support chiropractic worldwide. Especially in so many of these really, really. I mean underserved many of these locations. Some of them don't have forget about Internet. I mean it's like clean water and electricity are luxuries and access to high quality care is just so, so needed. So anything that you can do worldspinecare.org ebcpodcast they will graciously accept. I will graciously say thank you. I'll also say thank you for being a chiropractor. Thank you for tuning into this podcast. If you have any questions, as always, or you think there should be some research highlighted on here, hit me up. Jeff the evidencebasedchiropractor.com if you have not left a rating or review for this podcast that helps more and more docs find out about this podcast. So I would greatly, greatly appreciate it. If you're listening on your iPhone you can just swipe or scroll right on down, tap the number of stars. If you want to leave a sentence or two, that would be awesome as well. Otherwise, have an awesome week in practice and I will talk to you soon.

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