468- Integrating Chiropractic into Military Medical Care for 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, we are back with more brand new research. Of course we'll drop a link to the study down in the show notes. We'll talk about what the findings are, why it's important and how you can communicate this in your practice. All on today's episode. Before we get started, I want to say a few words about neck care. The best objective assessment of the cervical spine on the market. Hardware and software. It's awesome. If you have not checked it out. Neckcare.com reliable assessments and exercises for neuromuscular control, proprioception, range of motion and sensory motor integration. The tech is awesome.

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Links down below. But as I said at the top, today's episode, all about research. Brand new study that came out.

The title is Effect of Chiropractic Care on Low Back Pain for Active Duty Military Members. This is a good one for a variety of different reasons. I'll set the stage with my own experience, which is when I first started practicing in a multidisciplinary practice over 10, 15 years ago, the VA setting was a lot different for chiropractors than it is today. Today, meaning the opportunities were sparse, the funding was exceptionally limited, and it just wasn't what it is today. There were not, I don't even know.

Maybe hundreds of chiropractors now working within the VA system.

Definitely, definitely dozens, if not hundreds. Back in the day that was not the case. So we have seen as the guidelines have evolved and highlighted how chiropractic care, and specifically non pharmacological care is the best option for spinal issues. An array of different spinal issues, including neck pain, back pain, headaches, et cetera, we've really seen the VA evolve quite a bit. Now. How is that as a work environment? That's a conversation for a different day. However, those opportunities didn't exist before and they are opportunities that exist today. And that is progress unequivocally. The other really great thing is I live here in Tampa, Florida. We have MacDill Air Force Base just down the street from where I Live. So there's a lot of active duty military around where I'm at. And you know, the joke is always vitamin M, meaning Motrin, prescribed for everything. It's like you're either completely out or it's live with it and take vitamin M. Now, clearly Motrin's not a vitamin, but it highlights the fact of the progress. And when I say that, I mean as opposed to the old joke of vitamin M, many people being able to. Now, the VA is still dramatically understaffed in terms of demand and how many chiropractors are available. But the fact that it's growing is impactful and important because it shows that many members of our active duty military are finally receiving care other than surgery, injections and medications. And that is very, very. That's good news. That's not only good news for them, it's good news for their family, it's good news for our society, and it's good news for chiropractic as a profession as well. So a lot of leaps and bounds have been made. Still a long way to go. This study is highlighting how does the biopsychosocial model fit within this and specifically with chiropractic. So we know people who are in the military have an exceptionally high risk of musculoskeletal pain and it's one of the most common reasons for interactive interruption to combat duty. We also know that clinical practice guidelines, as I said a moment ago, have really changed, evolved, and got to the point where they should have been a long time ago. Highlighting non invasive and non pharmacological treatments as the best first line therapies for low back pain. And specifically using multimodal care with chiropractic as a key component of it. And why a lot of times that dives into the really extensive mechanisms of action with, with what we can do as a chiropractic adjustment. As we've discussed many times on this podcast, the local the biomechanical changes to biochemical markers in the brain, all of those things make a really, really big impact and they really leverage the power of what we do for the benefit of the patient, in this case active duty military members. So adding chiropractic care to usual medical care for these military individuals has been demonstrated in the past to, to provide significant improvements in pain and disability, in function, in sleep disturbance, fatigue, anxiety, depression and satisfaction in their social life. That's a lot of benefits right there. I mean, just listing those down and the fact that that's already been highlighted in previous studies, really, really Good news. Now, changes in pain are thought to be a result of a variety of different mechanisms of action, as we've discussed here many, many times. And that is part of the catch 22 about chiropractic research. The mechanisms of action are so wide and diverse, it can often be difficult. It's not just A plus B equals C. There's a lot of dynamics that go into what we do. That's awesome because that's how we see such a wide array of conditions and people benefit from what we do. But it makes it pretty challenging from a research aspect because research, research really is always trying to sharpen the pencil. You're always trying to get to that most direct answer. And chiropractic's not exclusive in this way. All of us are dynamic, all bodies are dynamic. And quite often, regardless of the control or the, you know, the experimental group, so to speak, whether the experimental group's an adjustment or something else, there's a lot of dynamics at play. But the mechanisms of action within a chiropractic or spinal adjustment really amplify that up. And the biopsychosocial model, they highlight the fact that that might help remove pain by identifying the physical, mental and social factors that are all contributing components to that pain. And the objective of this study specifically was taking a look at social factors, mental factors, physical factors, and really analyzing for individuals, active duty military that receive usual medical care versus usual medical care plus chiropractic. How does this play out over time? Now this study focused again on active duty military. There's a lot that can be learned from this study for non military individuals. This one specifically focused upon that. So with that, the participants of this study had to be active duty military, treated in a military medical center, which means chiropractic was available, big win there. Ages 18 to 50 and they had to have musculoskeletal low back pain. Now they eliminated people with recent fractures and surgery and ptsd. So there was some segmentation of the audience. But generally speaking, 18 to 50 and low back pain, this included six weeks of treatment and post treatment follow up at 12 weeks time. Again, these two groups, control group, usual medical care, the experimental group, usual medical care plus chiropractic. They highlight that chiropractic care is typically multimodal and contains a combination of variety, different things. Education, passive intervention interventions, active interventions and self management strategies. And that's really how this was approached. Now in terms of the reporting system, they used this PROMIS patient reported outcomes measurement information system. That was what they used within this study. And the average age just under 31 years old and just under 77% male. So those are the demographics there of the participants in this study. And what they found was the addition of chiropractic care to usual medical care did have clinically important and moderate effect on the extent to which pain interfered with daily life and on the intensity of the pain. Great news. A little over half of the effect of chiropractic care on pain interference appeared to occur through the effects of biopsychosocial factors. So biopsychosocial factors accounted for as they worked to highlight about half of the benefit. And the largest indirect effect estimates in individual models for pain interference were for effects occurring through physical function, social activity and fatigue. Now, a majority, 72% of the participants receiving chiropractic in this study received a combination of passive and active interventions. Important to note that and, and they also highlight what are the specific and distinct differences in the military population. It's important to note this as we extrapolate the results. Military population is distinct from the general population. A few definitely ways. One of them is that while low back pain affects ability to work regardless of if you're in the military or not, military personnel face the additional risk of losing their ability to work and potential discharge from the military due to loss of function associated with low back pain and ptsd. As they highlight here, the loss in ability is felt at both the individual level and in terms of broader military readiness. Hadn't really thought of that. And the training that the military members receive towards being physically and mentally resilient may contribute to the need. The current need to target emotional numbness and psychological avoidance to address the large burden of chronic pain and PTSD and integrative approaches are recommended to address these components. So this is an interesting aspect of the study. I'll touch on it briefly. I'm not an expert in this, but I'll kind of paraphrase what I read and what I took away from it that the training of physical and mental resilience that many military individuals go through can become encumbrances to their ability to recover. And highlighting a biopsycho and social model can really open things up and provide opportunities for them to maybe recover at a more complete rate, maybe recover at a faster rate. Difficult to say, depends on the individual, but. But it unlocks some things that maybe have been trained, they've been trained to avoid. So utilizing a biopsychosocial model, I think for most of us as chiropractors, we're utilizing a biopsychosocial model, whether we are cognizant of it or not, it's just kind of how we go about our practice, right? We're having conversations, putting our hands on people, and we are empowering them to make better decisions and encouraging them each and every step of the way. It's kind of part of our DNA as chiropractors. And to have a biopsychosocial model in a loose sense. Now, some of us might practice that more strictly, some of us might practice that more loosely, but that's a real advantage that we have because pain is not unidimensional. Pain is multidimensional. So anytime, in my opinion, you can help somebody overcome fear avoidance, you can help them feel better about getting better, which is a very real thing. When you can help people specifically in chronic pain, break the cycle without the medication, that is something that we offer that is not found in very many places. And that's a massive benefit we provide for our patients and the populations that we serve. They found in conclusion, quote. U.S. military members likely experience some improvement in low back pain interference and intensity when chiropractic care is added to usual medical care due to biopsychosocial mechanisms. Improvements in physical function and social activity appeared to be the largest contributors. Significant natural direct effects remained in both interference and intensity models, indicating that additional factors such as patient beliefs may be important mechanisms needing further evaluation. Really nice statement there. To conclude this, the person matters. The baggage or not baggage that they're coming in with, into your practice or any other healthcare provider practice, it matters. So if they have beliefs that are set one way or another, that's gonna impact your care one way or another. So being able to have great. This all comes down to expectations and agreements and communication upfront. Understanding is that patient there begrudgingly because their spouse is pushing them and they don't believe in chiropractic quote, unquote. And that's a different patient from a biopsychosocial standpoint than somebody who's coming in saying, I've tried everything or, and I want chiropractic, or I was taken care of as a chiropractor all growing up and never really saw a medical doctor. I knew I needed to be here. Those are two worlds of difference. And asking the right questions about, you know, how did you come into the practice today? You know, how'd you make the decision to come in and see us? What are your goals and expectations? Have you ever seen. Shocking that this is not asked. It should be asked. Every single patient have you ever seen.

A chiropractor before and what was your experience?

These are really critical questions to use to be able to unlock the truth of that patient's journey. And if you want to be their guide on their journey to better health, you need to understand where they're at in that journey. You need to understand how they're feeling physically, mentally, how they're moving functionally. And then you need to be able to put together an accurate action plan, not only technically, but also through your communication to help guide them towards receiving the best results possible in your practice. That's a big take home message for me. Again, I will drop this link down in the show Notes. If you have not left a rating or review for this podcast you've been tuning in. I'd love it if you do. So. If you're listening on your phone, you can scroll on down on Apple Podcasts, click How Many Stars? Leave me a line or two of feedback. That would be super awesome. If you have any questions, you can always hit me up jeff the evidencebasedchiropractor.com before we wrap up, I want to say a few words about turncloud Minimalist design without being sparse, practical yet elegant. Stripping away anything that's not essential and making everyday functions simpler. That is turncloud Turncloud ehr. This is an intuitive application where nobody needs a user manual and they have a special offer going on right now. No setup fee, less than a hundred bucks a month and it is simple, Streamlined and effective. Turncloud.com I'll drop that link down in the Show Notes. Other than that, I hope you have a fantastic week in practice and I will talk to you soon.

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