Chiropractic vs. Nerve Root Injections for Disc Herniations | Podcast Ep. 227

Foreign. Hello and welcome to the Evidence Based Chiropractor. I am your host, Dr. Jeff Langmaid. And as we know, with all of the crazy changes that have happened in the healthcare space over the past few weeks, hundreds of thousands, if not millions of elective surgeries have been canceled. And I'm going to look at a paper that, that ties some of this back to what we do as chiropractors in our practice for those big cervical discs that are causing radiculopathy. Patients are unable to get those elective surgeries, are probably making decisions right now on what else can I do to find relief. We're gonna look at a paper that had chiropractic care and or injections. We're gonna look at the results and I think you're gonna be very, very happy with what these researchers found. We're gonna talk about nerve root injections versus spinal manipulation versus adjustments. What happens. This study is titled Symptomatic MRI confirmed Cervical Disc Herniation Patients. It's a comparative effectiveness prospective observational study with cohorts treated with either image guided indirect cervical nerve root injections or spinal manipulation therapy. This came out in JMPT, I believe it was 2016. So it's pretty new, just a couple years old. And they were looking at individuals who had radiculopathy, right? They have pain, pain going down their arm, big cervical disc. They see it on the mri, super clear. It is a disc pinching on a nerve causing symptomatology. They basically took two different cohorts, they age and sexed, match the people, and then they either got a nerve injection or a spinal manipulative therapy treatment. So what did they find? Ultimately, these researchers found subacute and chronic pain patients treated with spinal manipulation were significantly more likely to report relevant improvements, improvement compared to nerve root patients. So let's break that down, right? So we know cervical nerve root compression, radiculopathy, it could be really disabling. And it's typically caused by either a disc herniation, right? Pressing into the foraminal canal, pinching on the nerve in the neuroframinal canal, or by degenerative changes of the disc, right? The disc decreases in height, the roof of the building collapses down, so to speak. The superior aspect of the foraminal canal crushes down on the nerve and onto the inferior aspect as the disc decreases in height due to degenerative changes over time. So it can either be a big disc pressing out the backside or degenerative changes. Now, one thing that the researchers note that I found interesting was they say the most common level to be affected is C6, C7. I've seen it more in 5, 6, but just interesting nonetheless. So typical, you know, clinical signs and symptoms. We know this, right? Pain in the distribution of that nerve root, paresthesias in the dermatomal pattern, weakness of the muscles and, and, or a decrease in the reflex. It'd be a combination of all of those items. So pretty interesting as far as that's concerned. Previous research has showcased more than three fourths. More than 75% of patients with subacute and chronic symptoms had clinically relevant improvement at three months after the start of treatment. So this paper was really looking and saying, okay, cool, that's great. But what happens when we go comparative? If we put it against a nerve written injection, what happens? Researchers also note the fact that, hey, safety shouldn't be too big of a concern. It doesn't mean we take things for granted. It means that we be as clinically sound and relevant in our patient and treatment selection as possible. But they're estimating one in every 200,000 to one in every several million patients might experience a severe challenge after an adjustment. And as they say, it's hard to even estimate because it happens so infrequently. So take that for what you will on the safety side of things. So from a chiropractor perspective, the treatments were repeated three to five times per week for either two to four weeks and then one to three times per week after that as needed. So this was multiple treatments. It was over 100 patients in this study and 35% of them were female and 65% were male, and the average age was about 45 years old. So when they looked at all of the patients in both treatment groups, right, nerve root injection and chiropractic adjustments, they 86.5% of the spinal manipulation patients reported clinically relevant improvement at three months, and that was compared to less than 50% of the nerve root patients. So nearly 90% of people who received chiropractic after three months had clinically medical improvement. And less than 50% of those individuals that received a nerve root injection had similar improvement. That's super, super impactful and important when evaluating the subacute and chronic patients. Only about 80% of the spinal manipulation patients had clinically relevant improvement in less than 38% of the nerve root injection patients. So very, very, very interesting. Now also what was interesting that I didn't know about was a recently published systematic review on the effectiveness of nerve root injections states that the minimal Standard of a successful outcome is at least 50% relief of the pain, and it has to last at least four weeks after the injection. So the researchers actually know, hey, the quality and quantity of research showcasing that nerve root injections do this is pretty low and or non existent. But yet we talk about the fact that nerve root injections are done so many millions upon millions of times each and every year. This paper is perfect positioning, in my opinion. If individuals had big disc herniations pressing on the nerve, they have radiculopathy. There are hundreds of thousands, literally of individuals that had elective surgeries, laminotomies, laminectomies, forex, laminotomies, microdiscectomies to take care and infusions for that matter, to take care of these issues over the last four to six weeks and definitely over the next four to six weeks, if you add up all of these appointments, there is no question that this is totaling hundreds of thousands of individuals. They are going to be looking for alternative options. If they're unable to get those elective surgeries performed, the question is then gonna be, well, the pain's probably not gonna magically go away, so what treatment options are they gonna look for? And the two things that they're probably gonna look for, to be 100% honest with you, are injections or chiropractic. And they might look for injections first. But if you get out there and let people know the actual truth of what's going on in the research, the benefits that your care can provide, that can go a long way. And this goes consumer facing and referral source facing. So I think this is a great paper to showcase to other healthcare professionals in your community, especially those primary care doctors right now. Maybe they have a great relationship with these orthopedic guys and g. And you were just unable to get referrals from them in the past. Well, right now is a great time to bridge that gap because if they literally can't refer to their orthopedic surgeon friend, they're gonna have to do something with these patients. And I got a feeling, no matter where you live, if you're listening to this, there are people in your community that are falling into this boat that had elective surgeries or that might go in over the course of the next few weeks that the doctor, the primary care physician might have recommended a surgical consultant, but now can't do. So that is a massive opportunity for you to start new relationships, solidify existing relationships in a way that's meaningful and impactful and ultimately showcase the truth of what's going on, which is the fact that nearly 90% of individuals who receive your care with the cervical disc herniation are going to have clinically relevant improvement, and less than 50% of those that get nerve root injections are going to have clinically relevant improvement. That is really, really stark. We're not talking about differences of 5%. I would say 5% would be a big differ. Five people out of 100 is real meaningful. We're talking about like a 40% practically swing. And it's nearly a double the rate of improvement. When we look at somebody being 45, 46% effective of the people having clinically relevant outcome with a nerve root injection and nearly 90% with chiropractic, it's nearly double the success rate is one way of looking at it. That's exceptionally impactful. The other way to think about this is from the consumer perspective. Right? So we just talked about physician relations. But the consumer aspect of this is just as important. Getting this information out to those people in your community, having them understand, hey, you might be thinking about getting an injection. You might even have an injection book. But did you know about this recent research that showcased how beneficial chiropractic care can be for those individuals who have a disc herniation pinching a nerve? Right. So I'm not gonna use words like degenerative changes causing interforaminal compression. It's not consumer facing language. That's the way I'm going to talk to physicians. When I talk to consumers. I'm going to talk about, do you have a big disc herniation pressing on a nerve that's causing pain down your arm and neck? You know, these are the types of things that researchers have found very, very successful when those ailments are treated and taken care of with what we do in our office with chiropractic. As a matter of fact, if you've been told or been exploring injections as an option, we see that chiropractic care has success with these individuals. 90% of the time in an injection, it's less than 50% of the time. Right. Just phrasing it in a way that's meaningful to those people, that's impactful. Because when you start telling this story, even if the person listening, if you do a Facebook Live video, for instance, the person watching your video might not have that challenge at that moment, but they might know somebody, a spouse, a friend, a colleague, a child, you know, a sibling that is experiencing that, that's thinking about doing something else. And that they can refer into your practice. And to me right now, this is the time when we need to be leading with these conversations, especially in light of this type of research. When we see what historically people might have thought from a primary care perspective, oh, there's a huge disc herniation on an MRI that's too far gone for chiropractic or therapy. We gotta get that off to the surgeon. It is just frankly untrue. We've seen it time and time again and now we pull that back one more layer with this research and say not only is that not time for the surgeon, if there's not a red flag, quite frankly, the nerve root injection is not a very great option. It's not very viable, it's not particularly effective. The research supporting it is exceptionally low and it's pretty darn invasive and it doesn't take care of the issue. That's the other aspect of this that this paper doesn't get into. But it's so important for you and I as chiropractors when we're able to decompress an area, when we're able to get people on active rehab, you can literally see changes in things that go beyond the natural history of recovery. Right? They're taking an active role. You're adjusting the area, you're strengthening the area, you're doing decompression in the area, whatever it might be. These things actually have structural and functional improvements over time as opposed to let's dump a whole bunch of steroids in it and hope for the best. Yes, Steroids to a certain extent stimulate some form of healing while at the same time ultimately deconditioning and destroying the joint spaces itself. But the gist of it is is there's no active component to the medication, meaning the medication is not going to magically he. The goal of the medication is to decrease symptomatology. It's not necessarily there to heal the area, which is also a big deal for these individuals. Even people that find relief, they probably are going to have an episode in the future. But if they take proactive steps, they dramatically decrease that opportunity. That's one of the other big differentiating factors between getting the injection and coming into your practice and getting the darn thing taken care of. So hopefully this was impactful to you. Feel free to shoot me an email if you have any questions. Jeff, the evidence based chiropractor. I'll drop a link to this paper in the show notes and also if you're listening on your iPhone, we love feedback, so please feel free to scroll down, give us feedback. If you think we deserve five stars, that'd be awesome. That helps more chiropractors find this podcast. Have a great week in practice and I'll talk to you soon.

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