Can Chiropractic Adjustments Predict Relief for Thoracic Pain? | Podcast Ep. 331

Foreign hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. On today's episode we're diving deep into the research. The study that we're going to take a look at is titled Factors associated with clinical Responses to Spinal Manipulation in Patients with Non Specific Thoracic Back Pain. This is a prospective cohort study that that was released just this year, January 2022 and there are some great clinical pearls that we'll cover on today's episode. Before we get started, I'll say a few words about the smart chiropractor. The smart chiropractor can power your patient journey to provide you with more qualified leads, more new patients, better retention and more consistent reactivations without spending any money on advertising. We believe that when you teach and invite consistently you, you do not have to rely on low quality deep discount advertising. But you can get out there, tell your story and attract more of your ideal new patients. We have the automations and the content campaigns to do that for you. Head over to the smart chiropractor.com again that is thesmartchiropractor.com but as I said at the top on today's episode, we're talking research. This was released in Frontiers in Pain Research and it is a study that took a look at the factors associated with the response to an adjustment in non specific thoracic pain. So let's set the stage then we can dive into some findings here. We know about back pain, we talk about it so often on this podcast. But let's take a step back from that 30,000 foot view. What's going on with musculoskeletal disorders? Well, as back pain has continued to rise, so has musculoskeletal disorders. There's a 30% increase in musculoskeletal related disability since 1990, so it's not too far ago and a 30% increase is substantial. So are there any shortage of people out there that need your help? Absolutely not. It's all about communication tying back to the smart chiropractor there. But when we talk about musculoskeletal disorders, spinal pain syndromes are classified as the most disabling low back pain alone being the leading cause of disability in 14 of the 21 regions of the world. And low back pain related years lived with disability has increased by over 50% in the past decade. So I know it sometimes can sound same as Y or it can sound boring. Shall I say talking about the challenges with back pain, talking about that such Big issue. But the bottom line is there's like 50,000 active practicing chiropractors for what, 6 billion, 7 billion people on planet Earth. So the fact that we're having difficulty with patient acquisition, patient retention or reactivation is just wild. It's a communication issue, it's a marketing issue, it's not an advertising issue. This is a communication issue at its heart. Because there are a ton of people out there in your community literally right now struggling, for which you are their best choice unequivocally. And you just have to be out there front and center and be top of mind enough. And hopefully podcasts like this enable you to tell that story. And services like the smart chiropractor, services like the evidence based chiropractor, everything help you get out there, communicate that message and expose more people to who you are and what you do. Because there's no shortage of those people. It's just a matter of connecting the dots. So when we take a look at thoracic pain, the annual prevalence of thoracic spine pain is up to 35% in the adult population and the one year prevalence can reach up to 55% in the working population. So we talk about low back pain so much a lot of times secondarily to that, we talk about neck pain and headache. But man, thoracic pain is a real thing, and it's a real thing affecting a real amount of people. 35% of the people in your community are going to have thoracic pain this year in the working population in your community, over 55% are going to have thoracic pain. So this is a big issue. And when we take a look at the demographic on here, women are two and a half times more likely to, to suffer from thoracic pain compared to men. So this is a big deal. It affects millions of people, probably thousands, if not hundreds of thousands depending upon the size of your community and us getting out there and communicating, connecting with these individuals, as I like to say, by proactively answering the questions they have about their health, it's a great way to go about it. So this study was a seven day single group, prospective cohort study and it had about 100 patients involved. All of them were over 18. All of them had nonspecific thoracic pain with chronicity of greater than three months or recurrent complaint with a pain score, NRS score above 3. Those that were excluded. So people that were excluded from this were signs of osteoporosis, fractures, disc herniations, symptoms of non Musculoskeletal disorder, tumor infection, neurological diseases, fractures, that sort of thing. So if you had any of that, you were excluded. So they really wanted to focus on nonspecific thoracic spine pain in the study. And I think they did a great job doing so. And again, around 100 patients enrolled. So what did they find? Well, they found that about 40%, 37.8 technically percent, were classified as responders based upon improvement after the procedure. Procedure being an adjustment of spinal manipulation. 49 patients, or 66% at follow up. So right after the care, about 40% were classified as responders. As time went on and there was Follow up, over 66% were classified as responders. So is that a good number? Is that a bad number? I think it's pretty darn good. And I'll elaborate on that in just a moment. When they took a look at the totality of responders, they had 94 people with a complete data set. So just shy of 100 people with a complete data set. And about 45% were classified as responders based upon improvement of their disability level. So there's pain levels here and there's disability levels, and they were looking at improvement in the disability level. And it was nearly 45% of the individual. So is that a good number? Is that a bad number? You might think at a surface value and say 45%, gosh, I think it should be 90%. 90% would be nice. But I will tell you this is not based upon research, but this is based upon offhanded comment. And I've had this conversation with many surgeons that I've worked with at the multidisciplinary clinics that I was in years ago. And they came to me and said, hey, we shoot about 33%, 33% of our patients get better, 33% get worse, and 33% stay about the same. So, and that's with surgical intervention, which many people believe fixes. I'm using air quotes here. The problem, very rarely, if it's an elective spine surgery, is a problem. Fixed pain might be abated for a short period of time, 33% of the time, but it's not a fix. And I also just wanna give a shout out, sort of a wake up call maybe to anybody listening. I know the title of this PODC is the Evidence Based Chiropractor, but it's. Sometimes I find chiropractors get so dug in to, I guess, a point of view, there's almost a reverence for medicine. Hey, I respect every healthcare provider out there. But we need to take a look at realistically what's going on. And realistically what's going on is movement based care for most musculoskeletal conditions, barring red flags is what should be happening. Elective spine surgeries to the tune of over a million a year. Epidural steroid injections to the tune of 25 million a year. Plus these have been proven time and time again to not be very good. I mean when we look at epidural steroid injections, outside of really, really high acute pain, they're essentially worthless. And when we look at spinal surgery and elective surgery and we see the challenges that happen biomechanically, we see a 33. 33, 33 in terms of percentages of getting better, getting worse or staying the same. And we compare that against the benefits, the lack of risks and harms. Right? Hippocratic oath, do no harm and we see what's going on. We should stand tall, we should stand proud and we should get out there. It's not to the diminishment of anybody else, but it doesn't need to be in reverence necessarily to some things that quite frankly aren't working. And we just need to be realistic about that. Because quite often I find docs that count themselves as evidence based chiropractors tend to almost have this reverence or almost, you know, and I see this sometimes, you know, where chiropractors almost hating on other chiropractors consistently and that's sort of their gig. And it's just soul crushing to me because it's number one unnecessary and number two, it's not really. If they took a look really at what's going on, you'd see that not only are we recommended chiropractic spinal manipulation, specifically adjustments recommended as a first line care and treatment option, but if you expand that a little bit and say movement based care, it's where it's at and it's what needs to be done. And quite frankly, many times this is not the. There are exceptions to this rule, many exceptions to the rule. But I always think about it like physical therapy focuses on strength and conditioning quite often. Not necessarily there are exceptions to this rule, not necessarily segmental biomechanics, but you have to start at the segmental level. I love to think about it, segmental, regional, whole body movement. And you have to dial in and improve to the best that you can. The segmental biomechanics then move on to your regional, then move on to your whole body. That's how you build a strong foundation of strength and flexibility, and in my opinion, how you get the best results with care. And when you're going in there and cutting things out, when you're going in there and fusing segments, that leads to challenges at adjacent levels. You're fighting an uphill battle. And when you're using medications for structural issues, quite often the body's gonna be sensitized, and quite often you're not gonna get the results that you desire. So not to go off on a tangent there, but I think it's really important to frame this. When we look at the percentages and we say, hey, about 50% of people were classified as responders based upon their improvement in disability level. That's a really strong number, and that's a great thing to know, and I think it's important to have the context for as well. So the researchers here found, quote, results of the present study show that patients were more likely to have meaningful decrease in pain intensity when expectations of disability improvement were greater at baseline. So important to keep in mind. We'll come back around to that in a second. They also found that although this study did not highlight any association between smt, force, time profile, and treatment, it seems to suggest that perceived comfort may be associated with clinical outcomes. So a couple things that are important there. Number one is this speaks to your initial report of findings, your initial examination. Are you helping people see that they are resilient? Are you inspiring them that they can improve? I don't care whether it's chiropractic, whether it's medic. I don't care what the treatment is, what the modality is. If the patient believes that they are more likely than not to get well, well, guess what? It's more likely than not to happen. So are you inspiring confidence? Are you communicating clearly and at their level? Say that one more time. Are you communicating clearly and at their level? Because otherwise you're not going to stand a chance in terms of really being able to connect and inspire. And. And it's critically important that we all do. Second part about that is perceived comfort. So I like a get in there adjustment as much as anybody. But this isn't to say to go light with your hands. It isn't to say to go heavy with your hands. Everybody has their own technique, but perceived comfort is important, and that can extend to not only the force that's being delivered, but the table, the conversation. I'm gonna say, even plays a role in ultimate comfort. Do they understand? Does your patient understand what's happening? Do they understand what's going on? Because that is going to play into perceived comfort. Then there's the physical nature of comfort. Right? Is your table comfortable or uncomfortable? How is your adjusting technique and skill? Are you super as specific as you can be with your hands? Are you fast? Are you doing those things to have a very high skill level with your adjustment? Because if you are, there's probably going to be a higher perceived comfort level and that again, is going to tie in directly to the clinical results that you get in your practice. So all great things to keep in mind. I think some of this extends even beyond the thoracic spine. When we talk about communication, when we talk about perceived comfort, this extends to nearly any reason why somebody's coming into your practice. But in this study, they're tying it to the thoracic spine care delivered there. So hopefully there are some really great clinical pearls that you can take away, I guess. As a final conclusion, these researchers found, quote, no specific dosage of SMT is associated with short term clinical responses to treatment. However, expectations of improvement as well as patient's comfort with SMT and pain change at post intervention were associated with a positive response to treatment. So that sort of just wraps it up, puts a bow on it. Dial in your communication, ensure that people are comfortable, accurately communicate what's going on at their level in a way people can understand and inspire them that there is a better day ahead. Inspire them that with change there can be. We always say in smart chiropractor, results follow actions. The actions that they take today, the guidance that you provide can provide the results that they desire in the future. So I love this study. I think it was a great one. Cool new study. If you have feedback on it, hit me up. Jeff, the evidencebasedchiropractor.com and if you have a moment, please, if you're definitely. If you're listening on a Apple device, scroll on down, tap some stars, leave some feedback, let me know you're out there. I love to see the feedback for docs that are listening each and every week to this podcast. And thank you so much for tuning in. Before we wrap up, I want to say a few words about Powerstep Power Step orthotics. They're just awesome. My father used them. He's used orthotics for years. These are the best orthotics that he has ever utilized. He's had consistent neuropathy issues, lumbar spine issues, and these have really, really helped him. And I love the product. So if you want to grab a free pair for yourself and see what's up. Pro.powerstep.com sample pro.powerstep.com sample I love being able to connect with companies that provide supreme value for everybody listening. But also it's nice when it provides value for me and my family personally. So in this case, my dad uses these orthotics day in and day out. He loves them. I've seen the results. I've seen the orthotics themselves. Super high quality. Check it out. Get yourself a free sample pair. Pro.powerstep.com sample also, drop that link down in the show notes. Have a fantastic week in practice and I will talk to you soon.

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