460- The Benefits of Dry Needling and Spinal Manipulation for Chronic Low Back 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. On today's episode, if you're into dry needling and if you're into adjusting patients, this one is for you. It's gonna be all around the comparison of effects of dry needling and spinal manipulation versus spinal manipulation alone on functional disability and endurance with patients that have nonspecific chronic low back pain. Lot of clinical pearls. Take home messages as you would come to expect and I am happy to say we we have a new sponsor, Turncloud Minimalist design without being sparse, practical yet elegant. Turncloud's design was to find the most efficient path in the life of a chiropractic office and strip away anything that's non essential. They make things simpler and their real goal is with an ehr, to not need a user manual. I love that. So if you'd love to learn more, check out turncloud.com again that is turncloud.com can't recommend their product and service enough. I'll drop a link down in the show notes but as I said at the top on today's episode, it's all about the research. A new study that I will also drop in the show notes title is comparison of the effects of dry needling and spinal manipulative therapy versus spinal manipulative therapy alone on functional disability and endurance in patients with nonspecific chronic low back pain. So this study is really tackling a big topic, I'm going to say within the chiropractic space. I have seen this, the popularity of dry needling explode. I don't think even if you don't do it right now, it's probably something you've heard of. And this study starts to codify what we understand of when that's added to a spinal adjustment. So I love it. Let's dive in as we all know and talk about just about every single week. Low back pain affects people worldwide and for up to 90% of people with low back pain, there is no underlying pathology. There is, therefore it is deemed chronic, nonspecific, chronic if it's over three months, nonspecific if there's no underlying pathology, chronic again 12 weeks or more with no etiology. Low back pain affects almost the same amount up to 85, 90% of the global population where chronic low back pain affects up to 25% of the population. And here's the real kicker on this right, rendering up to 12% of people disabled. That is a big, big deal. Low back pain, global prevalence, 12%, one month prevalence, 23% and females are far more likely to experience it again, prevalence. Let's parse out this a little bit. Prevalence is the amount of people at any given time. So you walk into a room globally, the room of global humanity, and 12% of people at any given time have, have low back pain. That's really over a year. And at one month, 23%, that is super, super high. We also know that dry needling. Let's set the stage. Innovative method for taking care of people that are struggling with low back pain. It's a contemporary treatment. They use filiform needles made out of fine and stainless steel. And these are used to relieve pain in the muscle. And the goal here is to have the needle alleviate muscle tension by placing them on or in a trigger point and holding them firm for a few minutes in that position. So that is the basis of dry needling. Now, in this study, they were looking at individuals between 19 and 60 years of age who were previously diagnosed or actively diagnosed with chronic nonspecific low back pain and who had four points or more on the Roland Morris Disability Questionnaire with no physical therapy treatment for the last three months, who had at least one active trigger point that reproduced the symptoms in the quadratus lumborum, glute med and paraspinal muscle. Or paraspinal muscle, I guess I should say. So this is a lot of people. I mean, if you think about the individuals that you're seeing in your practice each and every day, I can practically guarantee, unless you have a super specific practice that doesn't take care of back pain, if you're in the majority of chiropractors out there, you got a lot of people that are coming in between bouts of chronic low back pain. You have people coming in with acute low back pain. You have people coming in with no direct etiology. Now, yes, as chiropractors, we tend to look at things in a great way. And if we have X rays, maybe we're taking a look at those facet joints. If we're going through our movement assessments, sfma, DNS, we are really analyzing the one thing I will say about chiropractors, I think we do a really great job determining or at least narrowing down the pain generators for individuals that are struggling with most musculoskeletal challenges and specifically low back pain. I don't think the non specific low back pain tag is applied in a chiropractic practice as often as a traditional medical practice. It seems as though if they don't have, you know, a super hot disc, it almost immediately fall or something painfully obvious, then it typically falls into this non specific category. Whereas with chiropractic we're looking at biomechanics, we're looking at science, segmental function, we're looking at what's going on with compression, we're looking at what's going on with disc height. If we have imaging, we're looking at what's going on with the movement of the facet joints and ultimately any compensations that are also happening as a result of just how somebody's built and when we take and their job and what they do for fun and all of those things are taken into account in a chiropractic practice. It's just what we do, it's just how we're trained. Yet those things are way overlooked and not even overlooked. They're not even on the radar in most practices that are not chiropractic practices. So this gives us an advantage to be able to, I'm going to say, better identify the pain generator through our movement assessments, through our orthopedic exams, through all of the tools we use to analyze what's going on with an individual that are far more robust, far more specific and far more reliable than happen in many other practices. So we need to also understand that when we look at the literature, when the literature lumps a lot of people in to these non specific etiologies. So during this experiment specifically or during this trial, they were looking at spinal adjustments and dry needling that was used in the experimental group. Just spinal manipulation or just spinal adjustments were in the control group. And the total number of interventions was 12. The intervention duration was eight weeks and it was an hourly session of two sessions per week until the fourth week and then one session per week for the remainder. So that's kind of how they set things up. There was a total of 128 participants enrolled and it was equal between males and females. And the average age was about 37 years old. So a little bit of a younger population here, specifically those, especially when we think about having chronic low back pain, 37 year old individuals. So this study compared spinal adjustments alone to spinal adjustments plus dry needling and they found that spinal adjustments combined with dry needling produced better results. Patients with chronic low back pain Historically treated with dry needling experience improvement in pain relief, functional disability and endurance. And the combination approach of both adjustments and dry needling appear to improve patient outcomes as they highlight by targeting both the musculoskeletal and neuromuscular components of pain. So that's an interesting statement in the research because we know that a chiropractic adjustment impacts biomechanically, it impacts structurally, it also impacts literally up to the brain with biomarkers in the brain, central nervous system, peripheral nervous system, et cetera. So there's a lot that happens, and this is some of the challenge I think we've seen in the literature when analyzing adjustments is a lot of stuff happens when you deliver a high velocity, low amplitude adjustment. There's a lot of effects of that. I was almost gonna say side effects, but these are not negative side effects. A lot of positive effects, primary and secondary, when an adjustment is delivered. Now, that doesn't mean that there can't be things like dry needling and other modalities that, that help ultimately improve the overall result for the patient, pending what's going on with the patient. Remember, these are chronic, nonspecific low back pain patients. So when I think about chronic non specific low back pain, there's a couple things that come to mind, just chronic low back pain in general. One is that it's not this patient's first rodeo. They've dealt with this before, so might they be earlier to compensate? Probably because they're not, maybe not as scared as acute back pain where you're like, oh my gosh, what's gonna happen if you've had it before, you've gotten over it, or it's continued on, you've lived your life through it, right? So being able to understand that a patient probably compensated earlier, understanding that, you know, fear avoidance is probably a factor, but maybe not as big of a factor as with acute. And this depends upon the person and of course, what's going on with the individual and their job and all of those things. But I think there are some generalities we can have here. And when you utilize something like dry needling, that goes into a trigger point that really affects the musculature and then you're able to deliver an adjustment in all of the benefits and impacts of that. I can see how a combination of approach could be beneficial. Just as we've seen when you combine a chiropractic adjustment with education, when you combine a chiropractic adjustment with exercise, when you combine a chiropractic adjustment with all these other modalities that beautifully live under the banner, you might not choose to do all of them, but they live under the banner of what we do as chiropractors is a really great thing because it means we can have a really comprehensive toolbox. And you can have as much of a comprehensive toolbox as you choose based upon what you want to incorporate in the care that you deliver. And that's a really, really wonderful thing because we are not limited to, well, I would prescribe this medication or that medication. That's my toolbox. That's a limited toolbox. When you think about us as movement based healthcare providers, it starts to really widen and open up what we're able to do, how we're able to work with our patients and ultimately help them get where they want to be, which is the goal. So according to previous meta analysis of RCTs randomized control trials, spinal adjustments had better effects on chronic low back pain than acupuncture and both had similar on functional improvement. So this is also those differences and there's a Great blog article Dr. Todd Sullivan help with this on dry needling versus acupuncture that is on the Smart Chiropractor blog. So if you need to parse those out at all, check out the Smart Chiropractor blog. So dry needling was found to be more effective than other treatments in reducing the intensity of low back pain. Really interesting and functional disability. But the significant effects of dry needling in combination with other treatments on pain intensity may be superior to dry needling alone post low back pain intervention. So what does that tell us? That tells us that dry needling also is one of these items that hey, by itself can it provide benefit? Of course it could. But when you that benefit can be amplified when it's utilized with other modalities. So spinal manipulation was one of several, as they say, moderately effective treatment choices for low back pain. Bizarrely, in the, in, in the literature, moderately effective actually is a pretty rousing endorsement. You know, it's just that's the way that science and literature goes. So when they say it's moderately effective, that's actually a really good thing. And in addition to reducing back pain, we know that tri needling and spinal adjustments can offer a variety of other benefits. As they highlight in this study, we're talking about things, let's highlight cervicogenic headaches, reducing headache intensity, frequency and disability. So hopefully this study will spur on studies just like this in other regions of the spine with other challenges because it'd be really great to be able to put that body of knowledge together. So their conclusion was quote. In conclusion, this study revealed that patients with chronic non specific low back pain show improvements in functional disability and endurance with treatments including dry needling in conjunction with spinal manipulation and the spinal manipulative therapy alone. Despite the fact that both approaches improved functional impairment, dry needling plus SMT was determined to be more significant than spinal adjustments alone. So, great study. I think it's really interesting for you docs out there that are doing dry needling. This is just great to have in your knowledge base and it provides further clarity, further, further your confidence in man. For people with chronic non specific low back pain, amongst obviously a host of other issues, adding dry needling in is a really, really good idea. So second thing is you're on the fence and you're thinking about taking an elective course or a weekend or something like that. You happen to see it on the calendar. Probably a good thing to add into your tool belt. Dry needling seems to be something that has gained a lot of popularity. So it's consumer friendly. And when I say that, I mean people search out the term dry needling. Individuals are interested in it. This is not something where you're going to have to be pushing rocks uphill. It's popular, especially in the sports community. It's exceptionally popular. So when you add something like this in, it's not something else that needs to be a difficult discussion with a patient more often than not. And specifically, if you skew younger and towards sports, this is gonna be something that they're gonna welcome and be excited about, not something that you need to deeply describe. And they're gonna have all these challenges with getting started. It's actually gonna be the complete opposite, which is really, really interesting. And with the amount of chronic low back pain people continuing to ever increase finding the set, I'm going to say the set of modalities that can really help people get where they want to be, I think is really, really critically important. The other nice thing about dry needling is it's not expensive. When I think about delivering care like dry needling in a practice, this doesn't require a machine that cost 50 grand. It doesn't require something that, you know, costs $30,000. It's really something that can be done really, really affordably. And it's something that, generally speaking, the public continues to increase their desire for. And when utilized with an adjustment, it can provide a superior effect than one or each alone. So for all of those reasons, I think it's a great study. I'm going to drop again a link down in the show notes and before we wrap up, I want to say a few words about neck care. Objective assessments of the cervical spine. You've heard me say it before. I'm going to say it again. It is the best objective assessment tool that I have ever seen of the cervical spine. It's reliable and it's an assessment for neuromuscular control, proprioception, range of motion and sensory motor integration. What more do you want? I put out a host of videos across my Instagram YouTube showcasing neckcare neckcare.com, super easy website to remember, head on over, have a conversation with their team. Fantastic tools to become more specific in terms of your ability to take care of people and the communicative aspect. Their reporting is awesome. It's user friendly, which I can't say about many things. Neckcare.com be sure to go over there and check it out. Other than that, I hope you have a fantastic week in practice and I will talk to you soon.

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