387- Adding Chiropractic Adjustments to Exercise for Thoracic Pain

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 research. A brand new study and a good one. It's all around the effects of spinal manipulation added to exercise on pain and quality of life in patients with thoracic pain. And this is an rct, a randomized controlled trial. We're going to get into this study. A lot of great take home messages, a lot of clinical pearls. It's a great study. We'll talk about it momentarily. But before we get started I want to highlight Chiro Spring. If you have been frustrated with your current ehr, Kairo Spring will hook you up with a hundred dollar Amazon gift card for a demo. If you've been listening to the podcast a few weeks back we had their founder on they're using AI, they're using really, really interesting and advanced tools to help make your life a lot easier. They want to showcase that to you. Kyrospring.com offer kirospring.com offer Take a few moments out of your day, enjoy a $100Amazon gift card on them and and have the opportunity to improve your practice. I'm gonna drop that link down below but they support this podcast. You should support them and especially if you have been frustrated with your current tools, head on over, schedule a demo. They'll hook you up with the gift card, see if it is a great fit for your practice. I have a feeling it will be. But as I said at the top on today's episode, we're talking research. This is a study that came out in 2023 so it is a brand new one and it is titled, as I said at the top, the effects of spinal manipulation added to exercise on pain and quality of life in patients with Thoracic pain. A randomized controlled trial. I'm going to drop a link to this study down in the show notes so if you want to check it out, please feel free to do so. We all know spinal pain is considered the leading cause of disability in individuals worldwide. Practically say that every single week on this podcast. And I believe many of us as chiropractors, quite frankly we've heard that so often it's become white noise in the background and but really take that to heart, there is no shortage of people not even close that need your help. So if your schedule is not literally overflowing and full, that means you have a communication issue. There's no question about it. Why? Because there are people suffering. It is the leading cause. This isn't like some esoteric complaint that maybe we can help with. Literally, it is the number one leading cause of disability worldwide. Yet too many of us, our practices are not full consistently because of communication. And in my opinion, specifically tying to what I see every day with patient pilot lack of retention and reactivation systems. There is just way too much churn ghosting people instead of consistently communicating the benefits of value of what you do. Because when people feel better in your practice, I can tell you, nine times out of 10, they go back to doing the same things that brought them there in the first place. That's okay, people should enjoy their life. But they also have to do the things necessary to continue that enjoyment. And part of that might be seeing you every now and again. So being able to communicate that message critically, critically important. Why is this such a big deal with thoracic pain? Well. Or what causes it? Well, there's a number of risk factors. Could include things such as repetitive tasks, prolonged static posture, spinal pathologies, of course, and psychological stress. Important one there. These factors can result in altered biomechanics of the discs and of the soft tissues and chiropractic adjustments, spinal adjustments, however you want to define that. A high velocity, low amplitude thrust has been shown to be clinically effective throughout a numerous amount of research studies in areas cervical spine, lumbar spine, shoulder. This was taking a look at the thoracic spine and specifically when added to exercise. So how does manual therapy change things? Well, predominantly you can think about it in terms of two major camps. One is biomechanical, the other is neurophysiological. And that was an interesting line in this study for me to read because it really helped me frame it. There's a lot of stuff that goes on when a chiropractic adjustment is performed. There's a lot of impact, but it basically comes down to two big buckets. One bucket is biomechanical, the other bucket is neurophysiological. That's a great way to frame it. And it's something I'll probably talk about and use more on this podcast. So the neurophysiological effects can do things like stimulate the sympathetic nervous system. This can increase skin conductance, respiratory rate and heart rate, suggesting a sympathetic excitatory effect, as they say. It also produces hypoalgesia, pain relief of course by affecting pain processing centers, endocrine responses and increasing pressure pain thresholds. All important stuff. I think we've gone probably highlighted different portions of that throughout the years on this podcast, but all important to know and understand. And as you can see just with that short list, there's still a lot of stuff going on. So understanding the mechanism of action, incredibly important. But understanding the benefits and the outcomes may be just as important from a clinical perspective. So in, in the healthcare community at large, pain is a really challenging problem. It's super complex, it's pathophysiological, and it has a ridiculously big impact on social and psychological well being of somebody experiencing pain. Persistent spinal pain also can cause things like absenteeism from work, increased treatment cost. There is just a cascade, never mind unnecessary surgery, drug abuse, and ultimately impairment of life. If you look at people who live on, unfortunately, I hate to say it, but who live on pain medication, they're quite often not living their best life. And if they're moving towards ear, you know, surgeries that you can't come back from, occasionally a surgery does provide a dramatic relief, in my opinion. This is not founded in any study. In my opinion, about 20% of the spine surgeries being performed today should be being performed. I think about 80% of them, quite frankly, shouldn't, because quite often I say this as somebody who's practiced in multiple orthopedic groups, so people are checking the box in order to advance somebody down a clinical pathway. And MRIs are used continually, day in and day out as rationale and reason for surgical intervention. It's wrong and it happens every single day. What's gonna change? Well, the change is gonna happen by people like you listening to this podcast, getting out there, telling your story and communicating at a higher level so people don't go through that journey. They don't know any different. They are trying to make the best decision. And the medical field has done a great job highlighting that surgery can fix the problem when that's just frankly not true most of the time. But our job is to get out there and tell the story, talk about movement based healthcare, highlight the fact that movement based assessments are critical and that pain is a continuum. It's not on and off, it's lifestyle factors, it's stressors, it's how we move. All of these things play a role and the beautiful part of it is us as chiropractors. Tying back to the beginning of this podcast can make an impact in nearly every aspect of that, most cases, most of the time. And with Everybody dealing with these issues, there's no shortage of people that you can help in your community. So it has been hypothesized that spinal manipulation with thoracic spinal exercises is more effective than thoracic exercise alone in pain and quality of life in patients that have thoracic issues. So in this study, they took 127 subjects between the ages of 16 and 60 years old that were having nonspecific thoracic spine pain between T1 and T12. The participants in this study, they got two treatment sessions per week, so to speak, for four weeks for a total of eight sessions. And measurements for pain, they were taken at the baseline, after the first session, four weeks and after the eighth session. The SF36 quality life measurements were taken at baseline after the eighth session, and patients were followed up at the twelfth week after randomization to see what went on what they call long term at the 12th week. So not super long term, but long enough to see did things hold, so to speak, or did people slip back to their own old pain patterns. What they found was a statistically significant change with each group. Those that got exercise and adjustments and those who just received exercise for VAS scores and all domains of SF36. So that's great. Now let's take a look one level deeper. And by analyzing the results, they found that there's a significant change within the difference between groups for reduction of pain and improvement of quality life. Leading up. We're leading up to the big reveal here. So the group that was given thoracic spinal manipulation or adjustments showed improvement at the end of the eighth session on the VAS scale. And this, they say, was concomitant with other studies showcasing hypoalgesia effect for manual therapy by sympathetic nervous system activation. And additionally, scores on the pain scale, they went down immediately and after the eighth session, which they highlight, is similar to other studies highlighting how spinal adjustments and manipulation can really make a big impact in pain levels now in quality of life. There are also some big changes. Significant improvements in spinal manipulation compared to the exercise group. Improvement in the spinal manipulation group, they say, maybe due to a effective decrease in pain after only one session. So initial adjustment, people were feeling better, which is awesome. The results also persisted for longer as measured after 12 weeks when treatment was discontinued. Now, both the physical and mental components of the SF36 showed improvement with both groups, which is awesome. But between group comparisons, spinal manipulation took the prize. It was more effective in improving health related quality of life immediately after treatment. So they kind of highlight, I think, what we know as chiropractors. But what needs to be known more out there, treating a patient with holistic and patient centered approach is required. And just acknowledging the fact that spinal pain is multifaceted, psychological, environmental, nutritional, emotional factors, all of these can play a really big role in somebody's experience of spinal pain. So the conclusion was, quote, spinal manipulation in addition to thoracic exercise was more effective than thoracic exercise alone for improving thoracic pain and quality of life. At the end of the eighth session of care, the advantage of including spinal manipulation was not found, however, at the 12 week follow up. Now why is that the case? Well, there could be a couple different things. They did not highlight exactly why in this study, because it ended right then. But there's a couple of things that come to mind based upon reviewing hundreds if not thousands of articles here. One is there could be a just decrease in the effectiveness over time. That's a possibility. There also could be, which is a very realistic possibility here. People went back to doing the same stuff they did before, which is what everybody on planet earth does, which makes sense. You get back to your life once you're feeling better, back to those activities of daily living, back to those habits, habits for good and for bad and everything in between. So people getting back to it. Long term follow up. We've seen interesting long term follow up in the cervical and the lumbar spine where benefits are extended out a super long time. Especially if you don't look at the benefit of pain relief, but the risk of advanced intervention. Here's what I mean by that. We've seen multiple studies where if somebody experiences chiropractic care early, the chances or likelihood that they go through an advanced intervention surgery, injections down the road gets chopped or you know, drug use in half. Right. Dramatic decrease. But they might still deal with some pain. Right. So those are two different things. In this case they were just looking at the pain and the quality of life. I think the quality of life maintained, but the pain level snuck back up a little bit. But there's another thing there. Maybe the people just needed a little bit more care to get over that hump. I don't know. But these are the things that come to mind for me. And maintenance and wellness care is a really good thing. If people go back to the same situations that got them there in the first place. Understanding that getting things moved every once in a while is not a bad idea. I like to get adjusted once a month. I think that that's a really good thing for Most people most of the time, and quite frankly for most people most of the time with really bad habits, they probably should get adjusted more often than that. Checking biomechanics, establishing a movement assessment, being able to coach and encourage them on nutrition and healthy habits. How does that ever get old? This is a lifelong process. As we experience life, as we experience aging and gravity, and as we just go through what we like to do, which sometimes can be counterproductive to our physical health. Whether it's you like skateboarding, whether you like surfing, whether you know there's impact related with these things, or repetitive motion sitting in a chair all day, which might be the most challenging, challenging of all. So great study, lot of take home messages here. Don't forget, don't hesitate. I don't think anybody is, but don't hesitate to get in there on that thoracic spine and get adjusting and add in the exercise as well. But know that when you add in the thrust adjustment, when you add in the spinal manipulation or the chiropractic adjustment, you are going to achieve better results than without it. So don't hesitate to get in there and also let people know that that's the case. And maybe this is a good opportunity tying the conclusion of this study to let people know up front, hey, you know, taking care of thoracic spine, I anticipate we're gonna get you feeling better really quick. But please understand, when you go back to those things that brought you here in the first place and every day you get older and every day you're under gravity, you might need some care every now and again after we get you feeling better, to keep you feeling better long term. A lot of different ways to phrase that, but keep that in mind when you go through and have these conversations with people in your community. Now before we wrap up, I want to say a few words about Patient Pilot by the smart chiropractor. The money is in your list. If you are not utilizing your email list, you are just missing out. It's the most valuable asset you have in your practice. It is a way to generate consistent reactivations through automation. That is what we do at Patient pilot. For every 100 put this in perspective. For every 100 email list subscribers that you have, we see two plus reactivations. Click to call, click to schedule reactivations each and every month. That's what we average with our members, if you would like that. And here's the bottom line. When your new patients plus reactivations exceed your inactivations, you have an infinitely sustainable practice, but you have to have systems and processes. It's not gonna happen on its own. The automations that we do with Patient Pilot help you get there. You can check that all out@thesmartchiropractor.com again thesmartchiropractor.com I'll drop that link down below. And finally, I want to say a few words about Powerstep Orthotics. As you've heard me say, they're what I use, they're what my father uses. I have seen a tremendous improvement in just my own movement pattern, so to speak. I run five days a week, six days a week, and utilizing these has been a real game changer for me and certainly for my father as well. They support this podcast. You should support them. They will also hook you up with a free sample pay. You can't go wrong with that. Pro.powerstep.com sample use the code EBC for evidence based Chiropractor. They'll hook you up with a free sample pair. Try it out yourself. There's no reason not to do that. They were designed by a podiatrist over 30 years ago. Awesome company, great people, really good product. Pro.powerstep.com sample use the code EBC I will drop that link down below. If you have not left us a rating or review for this podcast, I would love it if you took a moment and did so. That helps more and more docs find out about this podcast. I hope you have an awesome week in practice and I will talk to you soon.

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