Comparing Chiropractic Adjustments and Advice for Spine Pain | Podcast Ep. 337

Foreign hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langme. Today's episode is all about the research. We are looking at a brand new study from chiropractic in manual therapies and it's titled Manual Therapy vs Advice to Stay active for non specific back and or neck pain. This is a cost effectiveness analysis and in my opinion this study is really gonna set the stage for future studies. It's sort of one of those plant the flag type studies. So if you are interested in effectiveness or cost effectiveness, then this episode of the podcast is going to be for you. Before we get started, I want to say a few words about the smart chiropractor. The smart chiropractor can power your patient journey to provide you with more qualified new leads, more new patients, better patient retention, more consistent reactivations without spending any money on advertising. How do we do it? We do it by helping you teach and invite consistently across all of the most popular channels and most impactful channels you have available to communicate through. That is email, social in office patient education, you name it. It is created and automated with the smart chiropractor. You can check it out at the smart chiropractor. But as I said at the top for today's episode we are talking research. Manual therapy versus advice to stay active for back or neck pain. Couple interesting pieces of information right off the top in this study. That was news to me. What's not news? That low back pain is one of the most common health problems and the lifetime prevalence is 84%. I've typically said 85 to 90, but that means 84% of people out there are gonna deal with low back pain at some point in their life. So just about everybody. Now here's the part I didn't know and I found interesting. Mainly striking women in those 40 to 80 years old. So I did not know that there was a slant of low back pain towards women or females 40 to 80. Makes sense. A lot of times we don't see a ton of back pain pre 40 years old unless there's an acute injury after 80 years old. A lot of bone has been a lot degenerative changes. Bone has been laid down. We see pain tend to subside after somebody has gotten that old. So not the age was not surprising. But slanting towards women certainly was for me. Also they brought up low back pain as affecting about 83 million people worldwide. 83 million people. And again, sometimes these numbers, they're so big it's hard to even quantify it just seems okay, yeah, everybody but. But that is opportunity and I don't think we should ever be numb to that. That's millions, tens of millions. Nearly. What is that, nine figures? Nearly 100 million people struggling and suffering neck pain. On the other side, very, very common and especially in women. One year prevalence of neck pain, 25% among women. That means 25% of women at any given point in time during a one year period going to have neck pain. Take 10 people off the street, 10 women off the street, 100 women off the street. If you take 10 women off the street, 2.5 of them, no matter what their age, no matter what their demographic, no matter what their socioeconomic class, whatever it might be, 25%, 2.5 out of those 10 are going to have neck pain within a 12 month period. Pull 100 women off the street, 25 of them are going to have neck pain over a one year period. That's a lot. And we see that come in at about 16% for men. And this peaks. Neck pain peaks 30 to 60. So a little bit younger. Interesting. I did not piece that together either. They're saying low back pain most common, 40 to 80 years old neck pain most common, 30 to 60 years old. A little bit more common in females than males. Couple clinical pearls for you there. Musculoskeletal disorders, they've been estimated, this was shocking to me. They would have been estimated to comprise 3,33% of total health insurance costs. So that is astounding. When you think about our health insurance system, when you think about the worldwide health insurance system, regardless of the country, that is a big deal. And yes, it might ebb and flow depending upon the country. That 33% might go up a little bit, might go down a little bit, but man, it is a big deal. There's a lot of money being spent and sometimes I showcase what's going on in the medical world on stage and I'm like, has all of this expense helped anybody? Certainly it's helped some individual people, but when we look at it aggregate numbers, no. Low back pain is more prevalent than ever. There's people getting higher interventions, more advanced interventions than ever. What the heck is going on? In my opinion, a lot of this stems from a lack of early exposure to movement based care, which is why so passionate about communicating that to other healthcare providers. So the evidence based chiropractor, or to your community with the smart chiropractor, critically important, huge opportunity to build and grow your practice. Of course, huge opportunity to impact your community. As well. So indirect costs for low back pain were substantially higher than direct costs, which is also fascinating. You think about often we think about cancer care as okay, it costs $50 for that visit to the chiropractor, $100, whatever it might be. It costs $2,000 for that injection. It cost $30,000 for that laminotomy. But they are citing the fact that at this point it's clear that the indirect costs are even higher than the direct costs. Now why does that matter? Well, more effective prevention of low back pain could lead to cost savings even if the treatment costs were higher. Now that is fascinating. We do not need to race to the bottom. So I think as chiropractors often and every healthcare profession deals with this, where you get squeezed by the assurers and the payers. And of course out of pocket expense is one thing as well. Everybody wants to be cognizant of how much they're spending on their healthcare. But paying the right price now, so to speak, can save you a ton of money down the road in indirect cost. Loss, productivity, inability to do things, advance interventions, transition from acute to chronic pain. Even if you spend a little bit more up front, it tends to work out in the end. And there's a Dutch study that found manual therapy for neck pain was more effective and less costly when compared to physiotherapy or care by a general practitioner in primary care. So there is a standard. This is not something where it's is manual therapy is getting in there with an adjustment, a spinal manipulation. Is it something that people have to live on? Is it something that is detrimental? Absolutely not. Number one, I think we see it time and time again our cost as chiropractors. Even probably the most expensive chiropractor out there. I'm sure there's an exception. But some of the most expensive chiropractors out there are still a heck of a lot cheaper than if you think about getting an injection that costs $2,000 bill charges for a single injection, which has limited utility and may provide a week or two of relief at best. In an extreme acute setting, that's an entire case. That is like an entire 12, 16, 24 visits in most chiropractic practices. Do I think a patient would get more out of it? I think just apples to apples. Absolutely. So and that's besides the fact that what we're going to do as chiropractors is movement based. It's actually stimulating how the body heals, not just covering up the symptomatology by dumping a bunch of steroid in an area. So it's a big deal. And I think sometimes again we get so myopic as movement based conservative healthcare providers and sometimes we can even. We see it online all the time. Right. You know, nitpicking at each other. When man, when we take a look outside of our scope, outside of what's going on within our industry, there's a massive amount of opportunity, number one. Number two, there's a massive amount of subpar care going on which is even more impactful and important. On why us, we, you, me, need to get out there, tell our story and take care of more people because it is only gonna help our businesses, but it is definitely gonna make a supreme impact on global healthcare if we can do it at a big enough scale, that's a big if. So this study looked at up 409 study participants. Average age was 47 years old and it skewed towards females, women. So 71% of those in this study were were women and they mainly suffered from neck pain. So 58% had neck pain. There was a little bit of crossover people that had neck pain and low back pain, but the remaining percentage were predominantly low back pain. So they were looking at a couple different things. Title pretty much says it all. They were looking at advice versus manual therapy, manual care and is this cost effective? What's going on with the outcomes in and they found in this study economic evaluation of treatments in a working population with nonspecific back and or neck pain. We found that the gains in quality of life and improvement in pain were slightly higher for manual therapy than advice and that both indirect and direct costs were lower for manual therapy. Then they also cite a previous randomized control trial that showed manual therapy was clinically and statistically significantly better. A lot of words there than advice. In regards to pain, physical function and perceived recovery for back or neck pain, both in the short and the long term. That sentence pretty much encapsulates it all. There's criticisms. Is it just short term relief? Is it long? It hit both. Is it just pain or is it function? Well, it's pain function and perceived recovery. Is it just neck or back? It's both and it's clinically and statistically better. So what's the best case scenario? Of course us as chiropractors, we're getting in there with manual therapy and advice, which I think is going to lead to even better results. But let's just think about this quickly from the standpoint of what's going on outside of your practice. Again, it's hard to envision this sometimes because we know what we do and we don't know what the what what everybody else is doing. And the same holds true, right? How many other healthcare providers in your community really know what you do? Probably not that many. Unless you've gone out and built that relationship or unless you are a content creator, a content machine, getting that message out there, whether you're doing it yourself or whether you're doing it with the help of the smart chiropractor. Here is the gist of it. When somebody goes into a primary care physician, I don't mean to pick on them, but quite often their tools and scope in terms of treating neuromusculoskeletal challenges is going to be super limited. They're going to do one of three things, right? We talk about this within the evidence based chiropractor all the time. They're going to refer for pt, they're going to refer for a specialist, or they're going to prescribe medication, probably in reverse order right there medication is going to be the first one. So they do not have a great tool set, they do not have a great toolkit and their knowledge is really subpar in terms of low back and neck. If it was above and beyond, if it was where it should be, they wouldn't be doing those things quite often, right? Maybe physical therapy, referral, but they certainly wouldn't be prescribing medications which are guideline discordant. They certainly wouldn't be doing early advanced imaging, mri, ct, and they certainly wouldn't be referring to a pain specialist before all, all, not one, all conservative options had been exhausted. So this is just a real life type thing. People are going into their primary care physicians, primary care physician, us as chiropractors. I have yet to meet a primary care physician that knows more about the spine than almost any chiropractor I've met. We live there, we know it, we breathe it, we do it each and every day. And the other individual's primary care physicians, specifically internal medicine, they just don't. So should they step up their game? Absolutely. But, but quite often it's gonna be medication or in this case, advice. Hey, you need to lose a little weight. Hey, you should move more. Now. The confounding thing about this is that seems like advice is pretty cheap to give yet because when we add the direct and indirect cost, it's actually more expensive. Why? Because people transition at a high rate from acute to chronic pain, they end up getting advanced interventions because they're not getting the relief they desire when which ties back to the clinically and statistically significant benefits of manual therapy in regards to pain, function and perceived recovery. So that is really the take home message. The conclusion that these researchers found is Quote Our results indicate that manual therapy is slightly less costly and more beneficial than advice for working age persons with nonspecific back and or neck pain. Together with clinical results from previously published studies on the same population, the results suggest that manual therapy may be as cost effective a treatment as evidence based advice for a physician for neck and back pain. So should manual therapy be recommended? In my opinion, absolutely. Does the research continue just to stack, stack, stack on top of itself, showcasing why who we are, what we do as our core modality is so critically important? Absolutely. Does it mean things are going to change tomorrow in your community? Absolutely not. That is why it is so, so important to take this information, share it with people. We're going to get this of course in the EV based Chiropractor Q for all of our evidence based chiropractor docs to use as marketing research briefs. So if you're interested in getting out there building referral relationships, nobody does it. Better head over to the evidence basedchiropractor.com but bare minimum, take the information on this podcast. Utilize it when speaking with your patients if they think they're going to get better care outside. There's exceptions to this, but if they think they're going to get better care outside of your practice, number one, patient preference matters. But number two, showcasing the fact that man, many people do not have any concept of that movement based care. Manual therapy is and continues to be the most highly recommended, most effective and potentially most cost effective solution to their neck and back pain. That is a critically important message that all of us should be getting out time and time again. Before we wrap up today's episode, I want to say a few words about powerstep. You've heard me talk about Power Step Orthotics before. They are offering a free sample to you. Yes, You a listener of the Evidence based chiropractor podcast? Pro.powerstep.com sample pro.powerstep.com sample I'll drop that link down in the show. Notes these insoles are fantastic. 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