480- Lumbar Disc Herniation Risk Factors and Management Strategies

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 Langman.

Hello and welcome to the Evidence Based Chiropractor. I am your host, Dr. Jeff Langmaid. And on today's episode, we are back with more brand new research. This one from the European Spine Journal. It's a systematic review on lumbar disc herniations with radiculopathy. It is a great study with a lot of clinical pearls and take home messages that you can start using today in practice. Now, before we get started, I want to say a few words about neck care. If you want the best objective assessments of the cervical spine and anywhere neck care is where it's at, reliable assessments and exercises for neuromuscular control, proprioception, range of motion and sensory motor integration, you can check it out and connect with their team@neckcare.com I'll drop that link down in the show notes. But on today's episode we're talking lumbar disc herniations. And if you're listening to this podcast, you are already aware of how big of an issue disc herniations can be, causing significant pain, disability, and even leading to surgical intervention, which is both risky, dangerous, often elective, and maybe not the best option. Now, what this study does is it sheds some new light on the incidence and risk factors for lumbar disc herniations and provides some really important and key takeaways that can help both you and I educate and take care of our patients and more effectively. So the foundation for this is what you've heard a million times, but is always important to reiterate. And that's the simple fact that low back pain is the leading cause of disability around the world. As a matter of fact, lumbar disc herniations with radiculopathy is one of the most common, severe and costly forms of back pain ever. And this study really analyzed two really critical questions. One, how common is lumbar disc herniation with radiculopathy? And then two, what are the biggest risk factors? Now, this has been studied many times before and it's important to keep studying as we continue to get the depth of knowledge. So they looked systematically at over 87 previous studies to really solidify the most comprehensive insights that we have today. And one of the biggest takeaways from this study is that the incidence of lumbar disc herniation varies widely based upon the population and this is a really important one, how cases are diagnosed. So let's talk surgical cases to dive right in. These are typically severe lumbar disc herniations requiring surgery. This affects one third to about three people per 1,000 each year. So about a third of a person to three people out of every thousand each year. Severe lumbar disc herniation requiring surgery. We'll come back around to that in a moment. Now let's talk requiring interventions but not surgery. That's about half a person to 1.5 people out of 1000 each and every year. And then when we look at clinically diagnosed cases, present basically people presenting with radiculopathy or radicular symptoms in primary care, it's up to up to 300 per 1000 people per year. So the big takeaway there is lumbar disc herniations are way more common than many people might think, especially when looking beyond the surgical cases alone. Now, a couple important things to keep in mind. We're probably in tune with that a little bit more as chiropractors because this is our bread and butter. It's likely what you see every single day, multiple times per day. But we are seeing a subset of the population and it's important to recognize when we expand beyond the four walls of our practice and we really say what's going on in the general population, this is a really big deal. So I say this because this may be something depending upon who you are, that's a really good idea to lean into with your messaging. We have seen whether it's spinal decompression practices do really well, whether it's rehab fix, online help, so to speak, and exercise, and guidance regarding specifically lumbar disc. I mean, you can literally build a seven figure practice out of taking care of only lumbar disc herniation patients. And that's not novel. It's literally happened tens of thousands of times. I'm not saying that's what you need to do, but what I am saying is this is a massive, massive opportunity. This, the market is probably the biggest that there is out there. And if you have any passion for this and you do like taking care of people that are coming in with radiculopathy, helping them avoid drugs and surgery, really refining your messaging on your website, through the conversations you're having, any of the in person talks and lectures, if you're shooting social media videos, really ensuring that it is super clear that you are a good answer to that problem would be very beneficial. And if you water it down too much People just aren't going to put one and one together to make two. So ensure, if you are interested in taking care of this population, it's massive, it's a growing opportunity, it's not going away anytime soon. But take a look at all of your marketing assets, all of your collateral, and ensure that you're being super, super specific. Because often the slippery slope is, well, let me just put this other thing on there. And I don't want to be so myopic. I'm going to take care of one or two more other things other than. And that is a slippery slope towards nobody being able to make a buying decision. A buying decision meaning scheduling a visit in your practice. So tying it back to lumbar disc herniation, and specifically this study, they identified a few what they call high risk groups. This was, this is a wide group here, adults, 30 to 50 years old. So that's just the most common ages that this takes place. The second was heavy laborers, so construction workers, machine operators. And interestingly the other side of that coin was also a high risk group, sedentary workers, office workers and professional drivers. One study found that people using, you know, kind of dump trucks, so to speak, earth moving machines in Italy had a lumbar disc herniation of over 215 per 1,000 people that year. So again, I think this is something we've probably all heard, but has been, I'll admit for myself, sometimes a little bit confusing in the literature. Is it heavy lifting, that cost that can be correlative to disc herniations or is it sitting around all day? And the answer is both. This is a bell shaped curve and if you're at the extreme on either end, you're putting yourself in a high risk category. Now then if you double stack on top of that, you're between 30 to 50 years old now you've really stepped up the, the likelihood that you may experience a disc herniation. So this is where you want to be, in the middle of the bell shaped curve, not on the extremes. This study also identified some top risk factors for developing lumbar disc herniations. Age and gender right up there at the top. Again, Most cases between 30 to 50 years old. 95% of disc herniations, as you are probably well aware, happen at either L4, L5 or L5 S1. And men are slightly, slightly more at risk than women. But women with cardiovascular issues have a higher likelihood of developing lumbar disc herniation. So interesting there lifestyle and health factors. This is a good one because this is an area again that you and I can make an impact through education, through inspiration, through education, all of those things. So smoking increases the risk by nearly one and a half times, particularly in women. That's a big, big deal. Higher bmi. Obesity is strongly linked to disc herniation. And then cardiovascular conditions, things like high cholesterol, diabetes, hypertension also increase the risk. So let's hit these back one more time. 95% of disc herniation is lower lumbar spine. When we add into that, it makes total sense when obesity is strongly linked because that's a lot of load on literally the most loaded area of the spine. The foundation, smoking, 1.5 times increase of risk, and then those cardiovascular conditions as well. Now, when we look towards occupational hazards, a lot of this ties back to what we described in those high risk groups. Jobs involving frequent bending, lifting, twisting, increased lumbar disc herniation risk. Nearly 4x sedentary jobs, long hours sitting also increased the risk due to sustained spinal compression. And there was one study that showed a much higher incidence in nurses, machine operators and public officers, interestingly, than the general population for lumbar disc. So this is one of those cases again, bell shaped curve. Both too much movement and too little movement can contribute to lumbar disc herniation risk. So immediately my gears start turning on this. In terms of office ergonomics, are you getting in there and having these conversations with office workers in your community about the necessity to have good ergonomics at their desk, to get up and move every 20 minutes, all of those items, to drink enough water to ensure that you're moving when you get out of the office so that you're able to keep that BMI down in state fit. All of those things really, really important. On the other end, many of, let's say the construction workers in your community, the linemen, all of those things, those are also great population. Hey, good ergonomics. As you're getting up and down, as you're moving around, as you're lifting things, as you're moving and then ensuring that they're also taking the time necessary to rest so their body is not overly taxed day in and day out. As again, days become weeks, become months, become years, you're probably not gonna change either trajectory of work. In other words, the sedentary worker, the office worker is probably gonna be an office worker. The person that's out there moving their body physically, maybe construction, et cetera, they're probably gonna stick with that for a long period of time. It's not about changing jobs, it's about doing the things while you're at your job to minimize risk. And then when you are away from your job, doing the right things to again minimize risk and ensure that you have that balance. I always think about this, the balance of strength and flexibility. That's always what we're looking for. Now where does chiropractic fit in? This is just the heartbeat of what we do. In my opinion, this study reinforces the need for proactive non invasive care way before anybody's entertaining advanced interventions so we can play a massively key role in educating patients about the lifestyle modifications. Of course, if somebody is struggling with radiculopathy or a confirmed disc herniation or it's back pain that maybe is not have a radicular component yet, yes, you can take care of that. But let's peel it back one layer before they even get to that point. Weight management education to reduce overall stress on the musculoskeletal system. Important. Smoking cessation to prevent disc degenerate degenerative changes of the disc. Important. Ergonomic improvements for workers in high risk occupations. Important. All of these are opportunities for you to create content, to create programs, to create educational material for your community, which does a couple great things. One, it positions you as an expert and you become the logical choice. If, if and when they deal with that issue, you're the logical choice, bar none. If you've put enough education out in the community. Two, is that for anybody? Hopefully you just help avoid people avoid this. Sony. I guess number one is, is if they struggle with the challenge, you're gonna be the logical choice. And two, many will not struggle with the challenge as a result of the education you provided. But they're gonna refer their friends, they're gonna refer their partners, they're gonna refer the other people. Why? Because you've built that trust by doing the work. Now, many cases of disc herniations are under reported and many people just don't recognize the early signs or symptoms before things become really bad. And that is where the proactive education as far as ergonomics, weight management, et cetera, all are just so powerful. This study continues to highlight that many cases resolve without surgery when managed appropriately. Couple key words there. Resolve without surgery. A few other key words when managed appropriately. So the spinal adjustments that you're delivering, the movement based care can improve biomechanics and reduce the nerve compression. Of course you stack onto that. Your exercises, your core strengthening, postural training. This can all be not only therapeutic, but Also preventative. So getting out there in your community, telling that story and ensuring again, I'll say this time and time again, sometimes back pain can seem a little bit boring as we see it as providers all day, every day. And we have such fantastic results when people come in with these challenges and we help them really completely reclaim their quality of life. But don't become bored, don't become blinded to it because literally every individual struggling with this is a new opportunity for you to build your practice and for you to impact a life. So there's a couple key takeaways that I think are important to recap before we close today's episode one. Lumbar disc herniation is way more common than probably you even thought and particularly when we involve these non surgical cases. Age, smoking, bmi, cardiovascular health and occupation are all major risk factors. Some of those you can influence, some of you can't, some of you can't, but you can educate around all of them. Conservative care, movement based care should always be the first line of defense in the absence of red flags. And you as a chiropractor are well positioned to provide it. And educating your patients on prevention and early intervention can reduce the need for surgery and long term disability while ultimately helping people live a better life and building and growing your practice. So the annual incidence of lumbar disc herniation in some high risk professions is over 200 out of 1,000 people. And that means you have have a massive opportunity to serve these patient populations with the care that you provide and the education that you can give. So hopefully this inspired you to get out there, continue to tell your story and understand there's a bell shaped curve when we're talking about lumbar discs. Too much motion can be a risk factor, too little motion can be a risk factor. And then you can throw on some of those lifestyle effects as well. So ensuring that your community is as knowledgeable as possible to avoid these challenges is great. Ensuring that that you are the number one choice if and when they encounter the challenge is great for business and great for the health of your community. And this study continues to position us as those leaders. Now, before we wrap up, I want to say a few words about TurnCloud. TurnCloud's design was really to make the most efficient path in the day of your office. They've stripped away everything that's not essential, made everyday function simpler, and created an intuitive EHR application where no one needs a user manual. Yes, it is that simple to use, which is a massive benefit in many practices. You can learn more, connect with your team, have a conversation@TurnCloud.com I'll drop that link down in the show, notes TurnCloud.com Other than that, I hope you have a fantastic week in practice and I will talk to you soon.

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