551- Chiropractic’s Expanding Role in Strengthening Rehab and Integration Across Health Systems

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'm your host, Dr. Jeff Langmaid. On today's episode, we're going to talk all about chiropractic's role in strengthening rehabilitation in health systems. Brand new study, a fantastic one. We're going to dive into takeaways, application in your practice, and much more. Before we get started, big shout out to Shockwave Centers of America. $500 off any of their shockwave units and a free cart by being a listener. Let them know you're a listener. As well as the NovoPulse OA Recovery Program. If you have people in your community struggling with osteoarthritis and you do not have a recovery program to specifically help them, you're missing out. NovoPulse makes it super easy. Hardware, software, patient attraction, all built into one. You can check that out down at the link in the show notes as well. But today's episode, all about strengthening rehab in health systems, utilizing chiropractic. So the question that we kind of begin with here is, What if one of the biggest opportunities for chiropractic over the next decade was not being seen as the quote-unquote spine profession, but potentially being recognized as a core and integral part of the rehab workforce? That's kind of the big idea behind this study. And sometimes you hear the word rehab and you think of like bands, balance boards, foam rollers, etc. But we're going to talk about rehab in a bigger sense regarding this article. We're talking about helping people restore functional ability, helping them overcome the life effect and life impact of what's driving them into your practice so they can participate really in life to the fullest again. And ultimately helping people move better, recover better, return to work, return to sport, avoid unnecessary escalations of care, and really stay active throughout every season of their life. So kind of the punchline of the whole thing is you're probably already doing a ton of that work. Really? This sounds like I'm doing it every day, all day. Well, the problem is, in many health systems, chiropractic and the individual chiropractic practices are pretty underrecognized. They're underintegrated and they're often pretty misunderstood. So this study came out in Chiropractic and Manual Therapies, and it makes a pretty strong case that chiropractic has a really important role in strengthening rehabilitation within larger health systems. And I think it's a pretty big deal because when we talk about the future of chiropractic, Often we can get stuck in conversations that probably sound pretty familiar to you. Are we evidence-based enough? You know, are we accepted by medicine? Are we primary spine care providers or musculoskeletal experts? And the truth is, this paper gives us a really useful way to frame that future conversation. Us as chiropractors, we're all trained to assess, to diagnose, to manage, to educate, to refer, to co-manage. And help people improve function. So that's not a small lane. That's a massive opportunity within the scope that we already have, unequivocally. So today we're going to walk through the article again, unpack some of the big takeaways and kind of, you know, go from there. So what is this paper? This is not a randomized controlled trial comparing one treatment to another. It's really a commentary article. And it matters because the goal of the paper is not a single test intervention. The goal of this paper is to make a larger professional and health system related argument. So the authors are really looking at chiropractic's role in rehab and asking the question, can chiropractors help strengthen rehab in health systems? And to answer that, they built on the World Federation of Chiropractic's Chiropractic Rehab Competency Framework and connected it to a broader global rehab priority study, so to speak, or, or position paper. And the big context there was the WHO's Rehab2030 initiative. So that initiative was created because rehab is bluntly in need of enormous world, it's in need of change, it is enormous, and it is growing when I speak about rehab. So the paper notes that in 2019, an estimated 2.4 billion, that's with a B, 2.4 billion people were living with a condition where they could benefit benefit from some form of rehab. And that number is not expected to go down. It's expected to grow as people continue to live longer, uh, and as more people live with chronic disease and as disability becomes an even larger public health issue. So rehab is not a, a niche service line. It's not something that happens just after surgery or only for athletes. This is really designed, you know, to optimize function and reduce disability across the entire human population. So when you look at chiropractic through that lens, I think our role can become much clearer. We're not simply deliver— delivering isolated interventions. We're not defined by the adjustment and the adjustment alone. We are healthcare providers and we manage neuromusculoskeletal conditions. And those affect things like function, activity levels, participation in life, quality of life. And all of those items are the language of rehab. So the paper highlights the International Classification of Functioning, Disability, and Health, often called the ICF framework. So if that sounds academic, you know, kind of, let's break it down a little bit more. So the ICF framework is basically a way to look beyond the symptoms and diagnosis alone. Instead of saying, where does it hurt? Or what structure involved? You're really getting down to, I love this, life effect. How is this condition affecting the person's ability to live their life? Can they sleep, play with their kids, participate in the community? Which I think is a far deeper and more a more accurate conversation to why people make healthcare decisions to begin with. Very rarely are they making healthcare decisions due to pain. People live with pain for days, weeks, months, and years. It's really only when that pain overtakes their ability to do something that they love that they search out anything related to a solution. And this is a conversation, as you probably have heard me say, I believe chiropractors should be leading this conversation. Because in real, you know, in practice, people don't come in because they have L4-L5 disc issues. They come in because they can't sit through work, they can't pick up their kid, they can't swing a golf club, they can't train, they can't live the way that they want. So what this paper is saying is that what you do as a chiropractor fits beautifully within a modern rehab model, but we as a profession should and likely need to position ourselves a little more clearly, collaborate a little more effectively, and align our language with health systems. This does not mean ditching who we are and what we do.. It means being able to communicate effectively, and those two things are not mutually exclusive. So let's dig into some of the numbers and major points that I think will get your attention. First, the global rehab need— massive. As I said, nearly 2.5 billion people were estimated to be living with a condition that could benefit from rehab. So it's a global health priority bar none, and neuromusculoskeletal conditions were a major part of that. They note low back pain alone, the basics of what we can do. We can do so much more than that, but that is hundreds of millions of people worldwide. Some estimates to be over half a billion people right there. And that's the world we already practice in each and every day. Things like back pain, neck pain, headaches, sports injuries, functional limitations, chronic pain. These are not fringe issues. They're some of the most common reasons people walk through our front doors or should be walking through our front doors if we're positioning ourselves and promoting ourselves effectively. The second part that they bring up was that chiropractic utilization remains really low. There was a global scoping review of 328 studies, and it found that the 12-month utilization of chiropractic services was less than 10% of the population, with no meaningful increase over a 35-year period from, from 1980 to 2020— from 1980 to, to 2015. So about 10%. And I've harped on this for a long time. I've seen chiropractic studies say, "We're at 12%, 15%." Well, they're nitpicking certain things, and that still is pathetically low, by the way. 10% with no growth over 35 years is how thousands of students can graduate each and every year, yet the number of chiropractors basically has not only not been going up, it's been going down. So musculoskeletal problems are increasing. You know, disability related to those problems are increasing. The need for function-focused care is increasing. Yet chiropractic utilization has not meaningfully increased over decades. And that tells us something really important. It's not enough to be only clinically valuable. We need to have better integration, communication, and positioning, and better referral relationships as well. To really get where we need to be, which in my opinion should not be 10%, it should be over 50%, a majority, by definition over 50%, a majority of people should see a chiropractor over a 12-month period at least one time. The fact that we are still, you know, 20% of that puts us in a position, I'm gonna say here's the great news of this, every challenge is an opportunity, the great news is, man, talk about opportunity to grow. The bad news is what's currently being done is not working and has not worked in a quarter century. So it's time to think about things differently. It's time to do more. It's time to be more. And, and that's really a big take-home message. So this paper also highlights some very interesting examples of chiropractic being used in rehab settings, which is great. Uh, one example involves adults with ongoing lumbar radiculopathy, uh, at least one year after lumbar discectomy. There was a retrospective cohort study, and the people who received spinal adjustments had a lower reoperation rate— 7% compared to 13%, cut it in half. And that persisted over a 2-year follow-up. So it's association, not causation, but clinically it's massively meaningful because it shows that, you know, conservative care, including what we do, can have an important supporting role and potentially even reduce direct escalation in post-surgical populations. And that's massively powerful. Sports injury The data, also really good. The article notes that sports injuries can have serious long-term effects. No surprise there. And between 14 to 32% of competitive athletes could be forced to retire because of a career-end injury. That's a big, big deal. Think about the, you know, the kids, the parents, the athletes, the student athletes, wherever they might be on their continuum, who are investing literally their entire life. I mean, time, effort, energy, money, into traveling all over, playing all over, hoping. And you look at this, you're like, man, a quarter of these individuals are going to retire at some point because of a career-ending injury. Being able to reduce that, that is massive. So, you know, we can often think of sports injuries as like temporary setbacks. Well, these people in good shape, they're, you know, they'll get back to it. But for competitive athletes, an injury can totally change the course of their life. Um, and this paper notes the fact, rightfully so, that chiropractic is already used in sports environments. At the 2017 World Games, 16% of all athletes received chiropractic treatment. That's a big bump up from, you know, from 9% of general people over a 12-month period. Two-thirds of Canadian national athletes reported using chiropractic care. And you, you already know when we talk about the NHL, the NBA, the NFL, all of the North American, US, United States-based sports here, traditionally all of— nearly every single team has a team chiropractor as well. So, um, you know, do athletes use chiropractic? Yes, but not just athletes. You know, chiropractors can really be part of that broader team focused focused on recovery, performance, and often in the athlete world, I love this, it's very rare that the chiropractor is really directly addressing pain. The medical aspect, or the medical team is typically addressing that. The chiropractor, ironically, lives in the performance realm. I say ironically because you think of the sports team as being very rigid, right? Well, they might not be looking for something new. Well, they're always looking for an edge. So that's always the irony to me is that there are a lot of sports chiropractors out there that are in their practice focused really on pain and treating as short-term as possible. Yet the real sports chiropractors doing the work on teams are often doing it in a performance maintenance and proactive way. And I think there's a massive opportunity to continue to bridge those conversations in your community. Um, its article also discusses, again, chiropractic in neuro rehab. And, uh, you know, the conversation gets really interesting, but it's really early. So there was an observational study in a neuro rehab hospital where chiropractors co-managed patients with a variety of different injuries, traumatic brain injuries, uh, you know, hemorrhages, ankylosing spondylitis. And chiropractic included things in that study like myofascial therapy, percussion, muscle stretching, and adjustments, of course. And it really showcased that we can be part of that team. So the authors organize their commentary around several major themes. The first is the role of chiropractic in rehab, and they argue that chiropractors are really well positioned, which is awesome, uh, because of our training in neuromusculoskeletal assessment, neurological orthopedic exams, spinal manipulation, mobilization, exercise, patient education. And I think this really pulls us out of a narrow box without expanding scope. Too often we can get reduced down to one tool. Now, the hallmark of what we do of course, is the chiropractic adjustment. I love it. Adjustment's the most powerful thing we could probably do, probably the best time for money aspect of what we can do as well. But the value that we provide goes far beyond that. Evaluating the patients, understanding those functional limitations, providing education, monitoring progress, that's a much bigger clinical identity. It's not just taking an order, it's making a decision and, you know, it's being the doctor doctor, right? And that's really, really important because that can be applied, as they highlight here, in a post-operative type setting, in a sports injury type setting, in a neuro rehab type setting, and probably some others as well. So utilizing things like graded exercise, mobility work, all of the things that we have deep understanding of, including and maybe sometimes with and sometimes without the direct adjustment, is a really, really massive aspect of what we can bring to the table. These are specialized spaces. But the paper makes the case that chiropractors can support functional outcomes in all of these patient populations. And that integration is really what's, what's key. So they note that chiropractors are integrated in public health systems in countries like Norway, Sweden, Denmark, and are conditionally available in countries like Australia, New Zealand, United States, and Canada. They also highlight the big changes that have happened in the United States veteran system where chiropractic has increased significantly as access and infrastructure has continued to improve since legislation that really got things going in 2023 about that. So, you know, bottom line is when chiropractic is available, structured, and integrated, more patients can access it. People get better results, and you can become part of a bigger healthcare system. So I know sometimes that can feel like a lot or maybe not even relevant to what you're doing. If you're like, well, I kind of got my own practice, I'm kind of in my community, I'm getting out there. It doesn't mean you need to sell your practice and join a large group. What it does mean is getting out there and starting conversations, building referral relationships. Evidence-Based Chiropractor, we have MD Connection, the best program in the world to help do that. And just getting out there and looking at ways you can position yourself appropriately to take care of more people. I want chiropractors taking care of many people as possible, and I want you feeling comfortable and confident that you can get out there and take care of as many people as possible. A lot of that comes down to communication, and that also is informed by your positioning. So this showcases we have every opportunity to get there. It's just a matter of doing the work to do so. So I love this study. I'll drop a link down in the show notes if you want to check it out. Before we wrap up, uh, RehabFix Hybrid Program, partner of mine, RehabFix Hybrid Program. If you're looking to increase your revenue and bring in an online component without abandoning your brick and mortar, the RehabFix Hybrid Program has been adding a lot of cash to a lot of Doctors based on the service that they're providing, which is getting out there and helping more people. You can link up with Dr. Grant. I'll drop that link down in the show notes as well as you're looking for a new chiropractic table, Leander Tables, $750 off their Series 950 using the code EBC2026. And final big shout out, if you tuned in last week, CarePlan Pro, it is out there, careplanpro.ai. We are getting feedback. Docs are selling care plans. In a way that the software does the work for them in a way that feels comfortable, ethical, straightforward. So check that out at careplanpro.ai. Love to have you on board for that. Have a fantastic week in practice and I will talk to you soon.

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