508- Chiropractic’s Role in Cervical Radiculopathy Management

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 fantastic research in a brand new study. This one all about cervical radiculopathy. We're gonna dive into what the study says, take home messages, next steps and more. But before I get started, special shout out to Leander Tables. They support this podcast and I'm gonna ask you to support them. And how is that? They're hooking you up with a massive deal. $1,000 off the their series 950 tables. I'll drop a link down in the show notes or you can visit them online, connect with your team, let them know you're a listener and you will get hooked up with $1,000 off. I think that's pretty awesome. But on today's episode we are talking all about research. The title of the study, drop a link down below of course, Cervical radiculopathy Management with physical, chiropractic and acupuncture therapy. Factors associated with different things, therapy utilization patterns. Now, how does this show up in your practice? Quite literally, it shows up. You probably have had patients walk into your practice with really classic cervical radiculopathy. Arm pain, numbness, tingling, and you've wondered to yourself, why the heck didn't they come to you first? And here's the crazy part. This is one of the largest studies ever done on cervical radiculopathy. Yet less than 20% of patients in this study received any, yes, you heard me right, any Conservative care within 90 days of diagnosis. Despite being a textbook, literal, textbook first line approach, most patients did not see a pt, didn't see a chiropractor, didn't try acupuncture. So today we're going to dive into this massive study, almost 800,000 patients in this study to see who's getting care, who isn't getting care and what this means for your practice. Now, this study was produced and came out of Yale School of Medicine and it was published in the North American Spine Society Journal just this year in 2025. The team of researchers really wanted to understand how people with newly diagnosed cervical radiculopathy with were being managed across the United States. So they tapped into a database which holds like 165 million patient records and they polled almost 800,000 people that had a new diagnosis of cervical radiculopathy between 2015 and 2022. Then they tracked how many went to physical therapy, how many went to chiropractic, how many went to acupuncture within the first 90 days. And they also looked at factors like age, insurance, regionality and comorbidities to see who was more likely to choose what. And the big picture question was, are patients actually getting the conservative care that we talk about? And if so, what type? This study is massive. I look at that right off the bat and I say 800,000 people were pulled over a seven year period. The that's a fractional percentage of the amount of people that of course have cervical radiculopathy. These were just the qualifiers, the people who qualified for this study. But it goes to show the massive opportunity out there right now in your community. There are people struggling with this. So I always like to ask this question, cause I think it's one of the most important questions. What are you doing to ensure that they know you are the best choice? Are you getting out there with blogs, are you, are you utilizing reactivation emails, patient pilot plug? Are you getting out there Maryland connection plug? Building referrals with other healthcare providers? All of these things are critical. Nobody knows to choose you until they do. So until you're taking the action steps necessary to get the results you desire, it's never gonna feel like it's getting through. But when you start taking the action steps with consistency, we say results follow actions. Got to take those actions to get the results. So in this study, again, nearly 800,000 individuals, 16.8% went to physical therapy. Drumroll please. Four cry over here. 4.4% went to chiropractors and 0.2% went to acupuncture within the first 90 days. So in total, less than a quarter of the patients with a brand new diagnosis of cervical radiculopathy actually got any conservative care in that critical first three month window. Well, guess what happens at three months. Things go from acute to chronic. Now there's no guidelines, right? Our body doesn't know acute to chronic. Our body knows the progression of something. But that's the window that is when acute pain has become chronic pain. Now for the ones that did seek care, chiropractic patients averaged about eight visits per pt, averaged about seven visits and acupuncture averaged about six visits. So they were all right in the same ballpark in terms of utilization. And another detail that's really important to mention is the choice of care was not Just about, I guess you'd say, clinical need factors like age, insurance, and location. Regionality played a huge role. Younger patients and those with fewer health problems and those with commercial insurance were much more likely in this study to see a chiropractor or acupuncturist compared to PT regionally. Interesting note, chiropractors regionally. Chiropractic was stronger in the South, Northeast, and Midwest, and acupuncture interestingly dominated the west and the Northeast. So if we look to unpack some of these data points a little bit more. Physical therapy, of course, was the most common choice. About 130,000 individuals went that route. But when you showcase that or Highlight that against 800,000 total cases, it's still a very small slice of the pie. Chiropractic had 34,000 patients. Now, interestingly, chiropractors held the highest per patient visit frequency. Again, remember, 8 instead of 7 visits instead of 6 compared to PT and acupuncture, respectively. So that's consistent probably with what most of us see. Patients in pain need multiple visits over a few weeks to stabilize, to start getting functional improvement and to reduce the risk of things coming back on. Right. Pain is always the first thing to go and the last thing to come. The dysfunction is there, and then the pain shows up. The pain goes away, but the functional improvement often is not complete. Now, acupuncture, very rare in 800,000 people. In this study, under 2,000 patients went to go see an acupuncturist. And although there actually are systematic reviews highlighting how acupuncture can help people with radiculopathy, it just hasn't gained as much mainstream attention. So let's dive into a few of these compounding factors. Age. Younger patients were far more likely to see a chiropractor or acupuncturist compared to pt. That's interesting, right? Insurance, commercial insurance. Patients way more likely to get chiropractic or acupuncture. Medicaid, we're 70% less likely. So why is that? Well, you just look and say what's covered. Right. So, and then geography again. If you're in the south or the Northeast, you're more likely to see chiropractic use go up in the west and Northeast. Acupuncture also jumps up compared to PT comparatively. So let's talk about multimodal care for a moment. A majority of the PT patients in this study stuck with PT alone. Yet chiropractic and acupuncture patients were more likely to mix approaches combining with PT or even all three, and younger and healthier people were most likely to go the multimodal route. So this suggests that people looking for faster or more complete relief often stack conservative care options. Probably you see this all day, every day when you're asking, what have you done? What are you doing? Oh, I'm going here, I'm going there. I was going there, I'm gonna go here. And older inpatient people that are older people with more comorbidities tended to stick with just one. Another factor. I'm gonna make a little bit of a leap. It does not say this in the study, but when people are sticking in PT and PT alone, it's because the PT is not making outbound referrals. Let's just be honest about that. The doctor is making the referral. And if the doctor owns the PT clinic, that's where the patient's going to. That's. It's very clear. There is absolutely no ambiguity. If the physician is going to make money and needs to fill the PT slots, the patient is going to pt. And that physical therapist, it's their last day on the job, the day that they start referring people out for other modalities. So unlike a chiropractor, us, who are very much more likely to say, hey, you might need this, let's do this. Or even an acupuncturist, who I'm going to say is more of a free agent, being able to co refer. Pts are just. By and large, there are exceptions, of course, but by and large are gonna be taking the order from the doctor and executing that order rather than making those independent clinical decisions. Now, PTs in more concierge medicine, or PTs that own their own private practice, hey, they're way more likely to be able to work with other healthcare providers. PTs and what I'll call PT Mills, you know the names. And also PTs that are in, I'm gonna say clinics owned by, let's say a local orthopedic group are gonna be far less likely to make outbound referrals, if ever. So why does this matter for all of us? Well, first, it's important to continually highlight the fact that there's a huge gap between what the guidelines say and the reality of actual practice. I wanna close this gap. I'm doing everything I can. I hope you're doing everything you can out there to close this gap. But there seems to be very little teeth for people that are not following the guidelines. Cervical radiculopathy is one of the conditions when conservative care is supposed to be first line, no Questions asked. Yet three out of four patients never got pt, chiro, or acupuncture within the first three months. That means millions, millions of people are slipping through the cracks. They're bouncing between things that probably are not serving them very well. Medications, injections, even early surgical consults, instead of getting the safe and effective conservative care that they deserve. And I say deserve very explicitly, because the goal of every doctor, every physician, every health care provider should be the Hippocratic oath of do no harm. And advancing people to medications and injections and surgery too fast is completely counterintuitive to that. And again, I'll say at some point there needs to be a responsibility held, so to speak. So also there's nonclinical drivers, right? We discussed insurance, age, geography. This tells us it's not just about outcomes, it's also about culture and access. The younger patients who had commercial insurance with fewer comorbidities were far more likely to end up in a chiropractic practice than a Medicare Medicaid heavy population. And third, when patients do choose chiropractic, they stick with it, right? Higher visit frequency. Now it's only one more visit, eight on average, compared to seven in PT, compared to six for acupuncture. But it showcases the fact that there's trust and engagement and perceived value in that care. And to me, that's a really, really important component. So communicating this is your patients. You can do this all over the place. So if we pull out a few patient friendly talking points, I think it's again, simple language reinforcement. Cervical radiculopathy, armpit, numbness, tingling, often responds really well to conservative care. But studies show most people never even try it. Let people know that that's the truth. Let people know when people choose chiropractic, they tend to stick with it. And also that conservative care is the first and safest first step before drugs, injections or surgery are even on the table. Using just like really short, clear and powerful statements, whether it's knee to knee, heart to heart with a patient, whether it's across your social channels, whatever might be helps you get the message out there. So putting this to work in your practice, I think in a report of findings. These are great talking points to highlight in your report of findings, again in your marketing and education, using stats in your newsletters and social posts, in your reactivation campaigns, this is absolute gold. And also, again, collaborating with other physicians in your community. So out of the 800,000 people wrapping up with cervical radiculopathy, most did not get any conservative care. 8 Even though it's a first line recommendation, PT was the most highly used chiropractic, lagged super far behind. That is an opportunity. It's an opportunity for you to get out there to educate people about their health, to advocate for their health and for your business and to position yourself as that front door for safe and effective care before people spiral down into drugs and surgery. So I thought this study was absolutely fantastic. Again, I will drop a link down in the show notes so you can check it out before before we wrap up, I also want to give a shout out to Neckcare, the best cervical assessment tool. Talking cervical radiculopathy. Head over to neccare.com as a listener. You're getting just stacked value all over the place. They're gonna give you 10% off as you get started with necare neccare.com you can purchase online, connect with their team, ask questions. In my opinion, you've probably heard me say it before, it is the best cervical assessment tool. It's objective. The hardware and software combo is awesome. They are doing a fantastic job, doing fantastic work and it can help you in your practice if you've seen anybody with cervical spine issues by having better specificity. And the tests are just awesome. Anyway, check it all out@neckcare.com I want to thank you for tuning into this podcast. Whether it is your 500 and whatever episode, whether it's your first episode. Thank you so much for tuning in. Thank you so much for being a chiropractor. Thank you. Have a fantastic week in practice and I will talk to you soon.

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