https://www.listennotes.com/e/178c33f9e3064545b85972ba004d663a

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 gonna highlight a really cool paper that can help you get more people. Well, what do I mean by that? We're gonna talk about the contextual effects in musculoskeletal pain. Are we overlooking the essential factors? Massive amounts of clinical pearls and take home messages on today's episode. Before we get started, I wanna say a few words about Patient Pilot. If you have seen 500 or more human beings in your practice and you are not generating consistent patient reactivations, you're probably stressing out way too much on new patient acquisition. Your email list is one of the most valuable assets you have, but only if you use it. We have a money back guarantee and a lifetime satisfaction guarantee going on with Patient Pilot right now. You can check it all out at thesmartchiropractor.com, which has been relaunch. Check it all out@thesmartchiropractor.com but as I said at the top on today's episode, we're talking studies and research. This was a 2025 study, brand new, and it came out in Frontiers in Psychology. And this study makes a really compelling case that how you deliver care, the words you use, the tone of those words, the posture of those words, the empathy beliefs, environment, all of those factors can influence outcomes just as much as the treatment itself. That's a bold statement. And we're gonna highlight why I believe that is absolutely true and what this research paper says about it. So the study I'm gonna drop down in the show notes. Of course, you can check it out and give your own input, but it is about what they call contextual effects. Now, what are contextual effects? They refer to nonspecific yet thoroughly therapeutic elements of a treatment or visit encounter. Things like the patient, doctor relationship, verbal cues and body language, treatment setting and environment and expectations, both from the patient and from you as the doctor. Now, these are often confused with placebo effects, but contextual effects go beyond just placebo. They're active ingredients that are embedded in every encounter you have with every patient, including the real treatments themselves. So here's a quote from the study. Contextual effects are components of all therapeutic encounters, including patient, clinician, treatment, the patient, clinician relationship and encounter context. So these are really, really important aspects and it makes me think back of practice management back in the day as they'd say, cleaning, clean windows. In other words, what does your practice literally look like? Are your windows clean? Is your floor and carpet clean or dirty, stained or not all of these things really, really matter. How are you showing up literally and physically and figuratively? Right? Those communication tools that you're using, the words that you say, how you are empowering your patients or, or not throughout every engagement, every interaction, from how your phones are answered to when they show up at the visit, to when they are sitting down on the table, when they're lying down on the table, what are you saying as you go through your examination, your DNS, your sfma, whatever movement based assessment tools you're using, what are you saying during that and, and, and how are you saying it? And then the expectations as well. So how you say it really matters? For example, they highlight one spinal adjustment study where clinicians who strongly believed in the treatment increased patient pain relief likelihood by 68% compared to neutral clinicians. So I know a lot of times people hear the words like certainty and clarity and there's many what I'll call evidence based chiropractors that are like that's for the other chiropractors. Like that's, that's a sales tool. No, it's not. It's actually a clinical tool. And, and if you don't, if you're not on board with that currently, you should. Because if you're not, you're shortchanging your patients. So if you need to become more certain, if you need to have more clarity, do whatever you need to do in order to get that. Because transmitting that clarity, certainty and confidence to your patients invariably improves outcome. The confidence, empathy and expectations that you bring are actually contagious to the patient and clinically impactful. Not from a fluff or a sales perspective, but from a perspective of are you getting your patients as well as they can. Are you showing up confident, clear, and are you communicating that with expectations of results? Really, really important. I love this study because it drives home a lot of, I think what I've tried to highlight on this podcast, but this distills it into a single study. Additionally, let's talk about patient beliefs and driving outcomes. There's a neck pain study where there are patients who expected cervical adjustments to help but didn't receive it, had a lower chance of success. Now when patients expected it and receives it, their disability dropped significantly. So More improvement. What does this mean? Well, I think about this like stage speaking. Tell them you're gonna tell them. Tell them and then tell them you told them. And this is difficult, I want to say, for a lot of docs out there, because we're onto the next thing. We have such knowledge, deep knowledge of what we're doing. We move way too fast for patience. Slow down in your communication. Let people know, here's what we're going to do today. Okay, we're going to do this today. I'm so happy we were able to do that today. Now, this and that you insert for whatever you're doing there. But, but setting that expectation. I'll say it one more time, almost like stage speaking. Tell them you're gonna tell em. Tell em and then tell em you told them. Drive those beliefs from your patient home based upon outcomes by really ensuring that they have a clear understanding of what's gonna happen. It just sets the stage for success. When you have expectations in alignment, your outcomes will be optimized. That's just the fact that additionally, let's talk empathy. Empathy isn't just about being nice. It's actually neurobiological. So there was a study with chronic low back pain, and those patients treated by empathetic doctors had better pain relief, better function, better quality of life lasting up to 12 months or more. So this isn't something that's just a nice to do. It's not just nice to be empathetic. It literally can improve your outcomes. This is not just about the care you deliver. It's the setting you deliver it in the conversations you're having in and around that care and whether you're setting yourself and the patient up for success or not. So empathy actually activates positive contextual effects. And as I say in the study, no prescription needed. Right. So this really gives an opportunity for you to set the stage. And there's a couple areas where things fall off the rails, and let's address those because there's misunderstandings. One is terminology confusion. Talk about speaking into chiropractors right here. So you know, placebo, placebo response, contextual effects. These things are often used interchangeably, but they're totally different. Contextual effects are present in real treatments. This is not fake, it's not filler, it's not fluff. This should literally be part of the care you're delivering. Secondarily is clinical relevance of placebo. So even in placebo, placebo really works. It can reduce chronic back pain when paired with positive expectations. Now is what we do and what we provide as chiropractors, far beyond placebo, yes, we've seen that in studies, but placebo is not a bad word. It. It's something you should lean into. And when you take and when you move, I'm gonna say from placebo to contextual effect, from fake to enhancement, you're gonna get even better results. Belief systems also matter tremendously. The beliefs, preferences, and communications that you bring, you bring to the table shape your patient outcomes. Patients are not just passive participants and recipients. They. Their expectations can directly alter their pain perception, which is really, really important, and then also statistical complexity. Researchers really have struggled to isolate and measure contextual effects using traditional randomized control trials. And that's something, that's okay, but what it does mean is when we see studies and papers like this produced, we need to take it seriously. And to me, these are just so obvious but often overlooked. And you might be thinking, okay, this all sounds great, but how do I really implement this in my practice? There's a few different things you can do. And this could literally start today. Setting positive expectations early in care. Many of our patients feel relief within just a few visits. This technique we're going to do today helps your body move better and heal naturally. Simple statements, but you're setting the stage for success. What does success look like? Have you anchored where you're trying to go? Have you highlighted the road to success in clear and understandable language? And use your presence as a tool. Slow down on occasion, listen actively, make eye contact, connect with your patients. I know a lot of us do a really good job with this, but it never hurts to take a moment today and take stock of how you are showing up. And also just that alteration, right? Slowing down in certain parts. We really want people to lean in and pay attention. Being a little louder, a little bit more firm in areas, utilizing your voice and communication can actually drive better clinical improvements and aligning expectations. Maybe you're asking the question, what do you hope to get out of today's visit? Use your language and recommendations to reinforce the patient. Yes, you have your goals, but the patient's goals. What's the life effect? Life impact? Why are they there, there in your practice? It's highly unlikely. It's not due to pain. They've lived with pain forever. It's when they were unable to do something in their life that they wanted to do that. Finally they said, let me take care of this. So continually referencing that life effect, really, really important. And also just ensuring that your clinic's awesome. So, you know have great lighting, a great layout, great sounds, great smells. All of these things are clues that can influence outcomes. Patients will heal better in environments that are clean, that are confident looking right. Make sure that you are washing the clean windows, as they say. Ensure that your place is tidy. Ensure that your front desk is clean. Does it look modern? Does it look like a place where people get awesome results? Or does it look like a place that's somewhere in between? Make it awesome. Why not? You got one practice, maybe you got multiple locations, but you have one opportunity to do this right. So take a few moments, paint your walls if you need to, update your art in your office if you need to. Make sure the front desk is clean. Make sure that when the door is open to the break room, there's not stuff everywhere, that it looks sloppy. And patients can see that just those little tiny things make such a big difference. And they really can actually not only make a difference in just somebody referring or feeling good about your practice, but it actually, as this study highlights, can improve their results. So this, this is a really important thing, I think, for us as chiropractors, because it shows how you show up as a doctor. Your energy, your confidence, your empathy changes the outcomes that your patients have. This is really about connecting with people and ensuring that they get the best results possible. So some of this, again, contextual priming, as they say, telling a patient what to expect. These cues can trigger brain pathways that release opioid dopamine and just make somebody feel better. That means in your visit, a little pep talk can do just as much. For pain modulation, you could use phrases as a highlight here. You're gonna feel looser and more balanced after this. This adjustment can help your nervous system reduce stress on your nervous system. Many of our patients sleep better after an adjustment like this. Whatever the truth is for that individual is a really. It's just verbalize it. Often we skip over it, we don't think of it, we move too fast, or we're just not saying it in super plain, easy to understand language. And taking a moment to do that will not only help your communication, it'll actually help your results. You are more than just a technician. You're not sitting there just pounding down the high spots, cracking backs. You're facilitating healing. And the way you do that is by creating trust, setting the right expectations, and empowering your patience. And that is really one of the most important things I think all of us can take away from that. That it's as. And here's the quote from the study, empathy Expectation and belief are not soft skills. They are central mechanisms in musculoskeletal healing. I could not agree more. And some other things you can do. Some ideas. Maybe you create words that heal. A cheat sheet for you and your team. What are the words you want to say? What? What's the language you want in and around your practice? It doesn't mean it's a script, but you just have a list. 10, 20 words. What are the words we wanna hear around this healing facility? That's really, really impactful. And you can also practice aligning your treatment expectations by just building it into your report of findings. That's the easiest place to start. So letting people know. We've seen many people with exactly this type of challenge. You here's what, here's here's the results that they typically experience just setting those expectations. Why not set yourself up for success by using the right language from the get go? So as you can tell, I love this study. I'm going to drop a link to it down in the show notes below and before we wrap up, I'll say a few words about TurnCloud. TurnCloud awesome EHR intuitive application. Nobody needs a user manual. They've stripped away everything that's not essential and left exactly what you need. Connect with their team over@Turncloud.com I'll drop that link in the show notes, have a conversation, see if it's right for you. It might change your workflow, simplify your practice, save a few bucks and make your life and your team's life a lot easier. If you have not left a rating or review for this podcast, I would love it if you would take a moment and do so. That would be awesome. And you can always email me jeff the evidencebasedchiropractor.com Other than that, I hope you have a fantastic week in practice and I will talk to you soon.

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