This is the 500th episode of the Evidence Based Chiropractor podcast, hosted by Dr. Jeff Langmaid (recorded July 14, 2025). The episode (a celebratory special) reviews a recent multi-arm randomized open-label trial in Frontiers in Medicine comparing four non-pharmacological treatments for confirmed lumbar disc herniation: acupuncture + spinal manipulation (combo), acupuncture alone, spinal adjustments alone, and traction. The trial randomized ~240 patients (about 60 per group), treated them three times per week for three weeks, and measured pain (VAS) and function (Japanese Orthopedic Association score) with follow-ups at 1 week, 3 weeks, 1 month, and 3 months. Results reported: the combination (acupuncture plus manipulation) performed best — ~63% reduction in VAS pain and ~55% improvement in JOA function at three weeks; acupuncture-alone and adjustment-alone groups were each about 10% less effective than the combo, and traction about 20% less; improvements persisted to three months. The host emphasizes clinical and marketing implications: combine modalities when possible, educate patients, consider co-management with acupuncturists, and use the trial to position practices as conservative alternatives to surgery/medication. The episode also includes a listener giveaway (screen-grab reviews) and sponsor offers from Leander Tables and Neckcare.
Pain via VAS (Visual Analog Scale) and function via JOA (Japanese Orthopedic Association) score
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 Langme. That is the 500th time that I have said that. Welcome to the 500th episode of the Evidence Based Chiropractor. This is going to be a special one. We still have some research that we're going to dive into, but I want to hit a few things off the top. Whether this is your first episode you've ever listened to or you've been following along for the nearly 10 years of weekly episodes, thank you so much. Thank you deeply for listening, for paying attention, and for contributing to my life in a massively meaningful way. I hope that this podcast has done just a little bit of that for your life. And as a massive thank you for somebody who has listened, I am going to have a massive giveaway for today's episode. What is that giveaway? All you have to do is leave a bit of feedback, a comment on this podcast, on Apple, Podcasts, on Spotify, wherever you can see it typed out. Why see it typed out? Because if you screen grab your comment and email it to me, Jeff, the evidencebasechiropractor.com I am going to hook every single doc, every person listening who screen grabs a comment, their comment obviously, and sends it to me. I'm going to hook you up with a goodie bag. So screen grab the comment, email me your address and I will hook you up with a goodie bag. Just as a little thank you for saying, thank you for listening, thank you for tuning in, and thank you for helping this podcast be, I'm gonna say one of the defining pillars of what I've been able to do in my career. We're at 500. I don't think we're slowing down anytime soon. So thank you so much for tuning in and if you would take a moment of your time to leave a bit of feedback on this podcast screen, grab it to tell me your address. I will make sure we get something special shipped out the door to you. But as I said at the top, today's episode is going to be more research. Today's study is a game changer for anybody taking care of patients with lumbar disc herniations, which is pretty much every single person that's listening to this podcast right now. This is a multi arm randomized open label trial published in Frontiers in Medicine just a few months ago. And what does it do? Well, we're gonna be comparing four different non pharmacological approaches. Head to head, spinal adjustments, acupuncture, traction and a combination of adjustments plus acupuncture. And again, this is for people that have disc herniations. We all know disc herniations is one of the most common spinal conditions and complaints, especially in that 30 to 60 year old age range. It's a leading cause of back pain, radiculopathy and disability. And while elective surgical intervention is an option for some, it should be an option for fewer. The vast majority of people, upwards of 80 to 90%, are treated from front to back, conservatively, non operatively. Now, this trial asked a really important question. Among the most popular conservative options, what works best? Well, here's a study design and what they started to find. They had over 240 patients with a confirmed lumbar disc herniation that were randomized 60 people per group into four groups. Group number one was acupuncture and spinal adjustments. Group number two was acupuncture alone. Group number three, adjustments alone. Group number four, traction. Treatments lasted three weeks, three times per week. And the outcomes were measured using two key tools, VAS Visual Analog Scale for Pain and what they call the joa, the Japanese Orthopedic Association Score for Function. Kind of like a functional disability rating kind of thing. Follow ups occurred at one week, three weeks, one month and three months. And let's dive into the results. The results, the combo group spinal adjustments plus acupuncture came out on top, hands down. And we're going to dive into the specifics of that. And of course, as I said, I'll drop a link to this study down in the show notes. But before we go farther, I just want to highlight a couple things that we already, I would say sort of skimmed across. One, there is massive opportunity for you to continue to tell the story about how you can help people with disc herniations. And as boring and mundane and obvious as that might sound to you, I know for a fact today in your community there are people scheduling elective surgeries for disc herniations that do not need to be doing so, that have never experienced chiropractic that would get well with the care you deliver and are scheduling elective surgery because they don't know you can help. That is happening in your town right now. So while disc herniations, while back pain are not the most exciting thing, they're not sports performance. They're not cortical, you know, increases in strength. They're not the sexiest things ever. What it is is the major problems that are affecting hundreds of millions of people and you being able to get out there in your community, changing one more life, changing two more lives, changing five more lives by helping people understand that your practice is where they should be. Because if they're not choosing your practice, they're either scared, they don't know better, they've got bad advice. So your job is to overcome those items. That's actually the job. The care that you deliver, I would say the care that you deliver is sort of the benefit of being a chiropractor. You get to have fun in the four walls of your practice. The job of being an entrepreneur, being a business owner, being a chiropractor is getting out there and telling the story so you can have the fun of being able to help people achieve their own goals with the care that you deliver. The hard work is not what happens in the four walls of your practice. The hard work is getting out there and ensuring enough people know who you are, what you do, and that you can help in a super clear and direct way so that they can experience the fun, experience the benefits. Now obviously nobody's having fun if they're in abject pain. But my point of that is for us as clinicians, getting in there, taking care of people and they are going to have fun once they start seeing the benefits that they receive. And chances are, you know, the stat 85 to 90% of these individuals that come into your practice are going to have significant benefits, if not life changing benefits. And that's when care starts to get real fun. But in order to have that fun, they need to choose you the first time. So getting out there and telling that story critically important. So again, the combo group in this study showed the best results. At three weeks, VAS scores dropped over 63%. In the combo group, those joa, those functional scores improved by over 55%. Now with acupuncture alone it was about 10% less. With adjustments alone, about 10% less. With traction alone about 20% less. And even better, these improvements held strong at the three month mark, showing that what you do today has long lasting benefits without like a rebound effect. Now this gets down to also remember they were taking care of people three times a week for three weeks. So again, ensuring that the care is long enough, ensuring that there is an opportunity for people to take what they have done and what you have given and run with it. And a Lot of that comes down to lifestyle. So here's a direct quote from the study. This study demonstrates that acupuncture combined with spinal manipulation significantly reduces pain and improves lumbar function in lumbar disc herniation patients compared to other tested interventions. Here's another power line. The symptom relief rate was significantly higher in the acupuncture plus manipulation group compared to the acupuncture manipulation interaction groups alone. So if you don't have acupuncture in your practice, that's okay. What you're doing is massively impactful. But if you do, ensuring that your lumbar disc program, quote unquote, has manipulation and acupuncture adjustments and acupuncture as a foundational component of it is a really, really good idea. And why does this matter for your practice? That the synergy between the care options is very, very real. This research confirms probably what you see in your practice, that the adjustments you deliver when combined with other things, when combined with exercise, when combined with traction, when combined with acupuncture, can really complement each other and improve patient outcomes. Now we've also seen just last week in cervicogenic headaches and in tons of other studies that we've highlighted over 500 episodes. And the core essence of this is the adjustment. That's the power move. But when you have other techniques, other modalities, other things you can implement with that, you can really, really accelerate that progress and really, really facilitate the best healing possible. The other thing to keep in mind is that you are in the right lane. You know, non pharmacological conservative care isn't just effective, it's superior. And that's important for all of us to keep in mind. This is, you know, and it's almost like alternative care. I know this has been said and it's almost cliche, but it's like we're not the alternative. It's like we really shouldn't be. And we're not in the eyes of the research yet. We're still considered alternative healthcare in terms of how people position us, how people think about it, and our utilization, if we're just honest about it. So anything we can do to continue to break through that obscurity. And your practice, let me be specific, your practice, breaking through obscurity locally, and you might say, hey, I have a healthy practice, we're seeing hundreds of people a week, it probably could be thousands now. Doesn't mean you need to take care of thousands. But what it does mean is there's always opportunity for More people to know about what you are, who you are and what you do. And part of this is because what we do is about more than pain relief alone. The combo group in this study not only had reduced pain quickly, but also showed significant improvements in functional activities. Walking, bending, sitting, activities of daily living all improved with the patients in this study. The other thing to keep in mind is there's a lot of people in your community that are really concerned about the side effects of medications, that are really concerned about the risks of surgery. So having options where you have built the trust, where you have positioned yourself as that ideal choice, by driving referrals from your patients, by driving reactivations from your patient list, by doing the things you know you can and should be doing each and every day, week and month, can really help continue to position your practice as what it should be, which is the leader in your community specifically. Just absolute slam dunk for people that have lumbar disc herniations. So if you don't have acupuncture in your practice, maybe start collaborating with an acupuncturist. This research is a great way to bridge that gap and start those conversations. If you do offer both services in your practice, awesome. Make sure you're educating your patients about the enhanced results of combining both approaches. Often patients don't know. So if they think it's just, you're just kind of loading stuff on, that doesn't feel good. So make sure you're taking a moment in time and letting them know, hey, the reason why we're doing this, and this is because of research that highlights this is going to help you get better results faster, and those results are going to last a longer amount of time. Now I'm a patient that's that easy. I'm like, okay, you know what you're doing, let's go. But without that being said, you can't assume that they know. And if you are not providing acupuncture and don't have anybody you're gonna refer to locally, that's okay too. If you're providing spinal adjustments, this study still proves it's massively effective. And it continues again to open the door for you to co manage, maybe expand service offerings. So this is what I consider to be a massively high quality prospective randomized trial that gives you and I, gives all of us more than antidotal evidence that the data we see here are things that we can act on. If you're taking care of people with lumbar disc herniations. Again, I said this last week with cervical genic headaches, like every single day in your practice, you probably are. Keep doing what you're doing. This study should give you more confidence, more clarity, more credibility for who you are and what you do. I'm going to drop a link to the study down in the show notes. But lumbar disc herniations, taking care of those individuals, utilizing spinal adjustments and then adding on those additional modalities is a fantastic way to reduce pain, reduce disability, improve functional ability, and help people see the results that they desire without having to go the route of dangerous medications, risky surgeries, et cetera. Now, before we wrap up today's episode, I'll say a few moments. Take a few moments to mention Leander Tables. Speaking of lumbar disc herniations, flexion distraction table. Do you have one? If you don't leave, Leander Tables will give you $1,000 off their awesome series. 950 by being a listener to this podcast. When you connect with them, mention it. I'll drop a link down in the show notes. Additionally, Neckcare, the best cervical spine assessment tool out there. Beautiful hardware and software package. They're gonna hook you up with a month for free if you let them know you're a listener to this podcast. Talk about hooking you up right month for free of neckcare neckcare.com, i'll drop that link down in the show notes. So again, from the bottom of my heart, 500 episodes in. Thank you so much for taking time to listen and if you would like to leave some feedback, leave a review screen, grab it. Send me an email jeffevidencebasedchiropractor.com, let me know your address. I will send a care package your way. Thank you so much for being a chiropractor. Thank you for listening to this podcast. I hope you have a fantastic week in practice and I will talk to you soon.
Thank you for joining us on this episode of the Evidence Based Chiropractic. If you want to grow your practice, come back for next week's episode. If you want to grow faster, visit theevidencebasedchiropractor.com and join our MD Marketing membership today.
