Chiropractic Adjustments for Disc Herniations | Podcast Ep. 55

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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are back with a awesome research based study that I guarantee you if you're watching this video or listening to this on itunes, you are going to see patients that fall, fall into this bucket that we're gonna talk about today in practice. And we're gonna talk about patients that have herniated discs in their lumbar spine with radiculopathy traveling pain down that lower extremity in an acute setting. So these are tough patients to see in chiropractic practice. And the other great thing about this study is that it doesn't matter whether you're a chiropractor, whether you're a primary care doctor, an internal medicine doc, orthopod, neurosurgeon, anything in between. These are patients that everybody dealing with spine care sees every single day in practice. And this study specifically is gonna showcase the awesome results of chiropractic care with these patients. So sometimes that can be a criticism or question as far as, ooh, a patient in an acute state, should they or shouldn't they get a chiropractic adjustment? This paper is gonna lay the hammer down and say absolutely, yes, I'm going to touch on a paper about those acute herniated discs. The title of this paper is Chiropractic Manipulation in the Treatment of Acute Back Pain and Sciatica with Disc Protrusion. A randomized double blind clinical trial of active and simulated spinal manipulations. This was released by the spine journal in 2006. I'm going to say that title one more time. You could also find it in the show notes. Chiropractic Manipulation in the treatment of acute back pain and sciatica with diagnosis disc protrusion. A randomized double blind clinical trial of active and simulated spinal manipulations. So let's dive into the title a little bit. This was by the spine journal in 2006. This title hits it all. It is randomized. It is double blinded clinical trial, top tier research. It's from the spine journal in 2006, relatively recent, very esteemed journal. And they looked at chiropractic manipulation, the not spinal manipulation, not manipulation by a md, not manipulation by a do not manipulation by a pt. They looked at chiropractic manipulation in the treatment of acute sciatica as a result of a disc protrusion. So in order to Know that they took the mri. It's an MRI confirmed disc protrusion, disc herniation, and it is pressing in the foraminal canal on the exiting nerve root. Of course, we know that's how you get sciatic like complaints or radicular like complaints. So of course, when a disc protrudes, bulges, extrudes, however, we want to define the malplacement of that disc or the pathology of that disc when it enters into either the lateral recess or the foraminal canal, which is exquisitely clear to see on mri. At that point, it's going to often call for a cause, excuse me, for foraminal narrowing, ultimately the pinch, foraminal stenosis, the narrowing, pinching or compression of the exiting nerve root. Now, typically we associate those sciatic like complaints, Strictly a sciatic like complaint would be L5S1, but we sciatic like complaints, if we open up that criteria a little bit, we probably go L4, L5, L5 S1, and at times L3, L4, if that disc is in the lateral recession, hitting that L4 nerve root. So that's really the lay of the land of what we're looking at. And as we talked about at the top, this study is really looking at active chiropractic adjustment, chiropractic manipulation versus simulated, and they're going head to head with it. So it is a very clear study. It's double blinded and it's awesome. Now we know again, as we talked about at the top, all of us, regardless of our practice style, see these patients in our office. Even the most wellness focused clinic in the world is going to have patients that from time to time have exacerbations of previous complaints or new complaints. And often that results in sciatic like complaints. Now, from a primary care perspective, and really where this study's gonna be important is from a primary care perspective, they're often treated with meds, right? I mean, these patients are the definition of who goes in. And they get that steroid pack, they get that diclofenac, they get NSAIDs, they typically get a steroid pack to start. And what this is gonna showcase is, is another way those patients could be treated that is very likely more effective than the current path. The other thing I will say about this study is it provides unequivocal support for the use of chiropractic adjustments on these patients with acute pain, not only with decreasing radiating pain, but decreased local pain as well, up to six month follow up. Let me say that again. Not only did this study showcase that there's decreased radiating pain or radicular pain, and that there's decreased local pain. But those benefits have been checked, verified, and last at least six months from initial onset. So an unbelievably powerful piece of research we have here. I'm gonna read a few quotes from this research so you know exactly what we're getting into. One quote that the researchers found was, quote, the rationale for manipulation includes reduction of a bulging disc, correction of disc displacement, release of adhesive fibrosis surrounding the prolapse disc or facet joints and entrapped synovial folds or plicae, inhibition of nociceptive impulses, relaxation of hypertonic muscles and unbuckling displaced motion segments. That is a mouthful and a half. But it all gets back to what we know about chiropractic care. Basically, we are gapping the facets. We are creating negative pressure in the disc, reducing that bulge disc, thereby taking the pressure off the nerve. We are certainly making sure that any segmental dysfunction, any segmental challenges are being unbuckled, as they should put it, or relaxed. We're inhibiting nociceptive function by providing, of course, that sort of central nervous system component by making sure we're activating mechanoreceptors through that adjustment, thereby inhibiting nociception. So everything that we know, they put into a nice concise paragraph, even though it gets a little wordy. Research has also found that, quote, at first follow up, day 15, patients receiving manipulation had a low, lower mean VAS1 local pain score than patients given simulated manipulation. Let me repeat that one more time. At first follow up, which was day 15, patients receiving manipulation had a lower mean VAS1, which they were classifying as a local pain score than patients given simulated manipulation. So patients that received the active chiropractic adjustment were getting better, quicker, point blank. The researchers also found patients receiving active manipulations enjoyed significantly greater relief of local and radiating acute low back pain, spent fewer days with moderate to severe pain, and consumed fewer drugs for the control of pain. Now, this is the quote that everybody that's listening to this podcast has been waiting for and is going to get excited about. So I'm going to say it one more time. The researchers found, quote, patients receiving active manipulations enjoyed significantly greater relief of local and radiating acute lobe back pain, spent fewer days with moderate to severe pain, and consumed fewer drugs for the control of pain. So that gets really to the heart of what this paper is all about. And again, when we see patients, PCPs, any practitioner, any healthcare provider, we see Patients that have a disc that quote unquote went a disc that blew. Whatever the patient lingo wants to be regarding that. We see them and they're in tough shape. Often these patients are coming in exquisite pain, bent over, antalgic lean. They might need even assistance. These are the patients that kind of crawl into your office. And we've all seen it where those patients have literally walked out after crawling in the office or being wheeled in the office. But this paper actually puts that case study that millions of individual case studies, which don't have that much merit, and it puts it in to a double blinded randomized control trial that showcases an adjustment, a chiropractic manipulation, as they say, can make a world of difference in that patient's life, not only decreasing the local pain, but certainly decreasing the radiating pain. And by the way, the patient gets out of the moderately severe pain quicker. And of course they take fewer pharmaceuticals, less drugs as a result of that care. So this paper is an absolute home run. I'm gonna link all of the PubMed information in the note certainly. And I would definitely recommend going out and grabbing it. If you are a member of the Evidence based chiropractor then you received this in June of 2016. So we highlighted this specific paper for all of our members in June of 2016. If you're not actively a member, you are doing your community a disservice. So all of our members get research like this each and every month. White labeled with their practice information and they also get all the tools, support and everything needed to make sure that they are using this research to build referral relationships with their partners in their community. So this is all about the evidence based chiropractor each and every week with the podcast, the video, everything in between. But really the flagship, if you want to take it to the next level, is becoming a member of the Evidence based Chiropractor where you're going to get all the tools and support necessary, including monthly research updates. White labeled your practice information and everything you need to know how to use it to get more patients in your front door. That is what we are all about. And as we come to the close of this year, I hope you had an awesome year in practice. We will be back next week with a year end wrap. So it's going to be the highlights of we're over a year now on the podcast. We're going to wrap all news, marketing, research, all the highlights that we've had in Chiropractic from 2016 into next week's episode. So you absolutely do not want to miss that. And now is a great opportunity to leave feedback on itunes. Share with your chiropractic colleagues or shoot me an email jeffevidencebasedchiropractor.com, let me know how you're doing. Let me know how the Evidence Based Chiropractor can help you in 2017. I hope you have a fantastic week in practice Doc, and we'll talk to you soon.

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