https://www.listennotes.com/e/61b4796505384a8a9001e24f2b9a0d0b

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 AM your host, Dr. Jeff Langme. This week we are back with more research. It is all about therapy after lumbar disc herniation surgery. This is a massive study. 55 randomized controlled trials were put together into this one. We'll drop a link down in the show notes. Of course, this has massive implications and they dive into spinal adjustments as well. So if you have taken care of anybody with lumbar disc herniation that's been considering surgery, maybe they've had surgery. If you plan on doing it or if you're just in practice, this is gonna come your way. Lots of relevant information on today's episode. Before we get started, I wanna say a few words about patient pilot. Patient pilot helps reactivate your patients on autopilot. If you have a patient list of hundreds of people, maybe thousands, that are inactive and you're not communicating with them, you are leaving money on the table and spending way too much acquiring new patients. So if you think that your patients had a great experience and that you're a pretty good chiropractor, patient pilot will deliver results unquestionably for your practice. We have a money back guarantee going on right now along with a lifetime satisfaction guarantee. So there is literally nothing to lose. Check it out@thesmartchiropractor.com but as I said at the top, today we're diving into one of the largest and most comprehensive reviews ever published on a very hot topic. What's the role of physical therapy after lumbar disc herniation surgery? This came out in 2025. It's brand new in brain and sp. They again analyzed 55 randomized controlled trials. This had over 4300 patients with six critical questions about post surgical physical therapy, including timing, effectiveness, activity restrictions, and even complementary approaches like spinal adjustments and acupuncture. So let's dive in of why this study matters. We will highlight the most important clinical pearls and also how this ties into your communication with your patient. So why does this matter? Well, as you are very well aware, lumbar disc herniations are the leading cause of spine surgery worldwide. And disectomy is a super common procedure. I think over a million per year if I'm not mistaken. But after surgery, there's often the Question, what's the best way to rehab these patients? And until now, there's really been no unified evidence on when to start therapy, what kind works best, or if activity should be restricted. And this study changes that. It consolidates decades of literature and provides a roadmap forward. So across the board, there are a few key findings here. One is that physical therapy after lumbar disc herniation surgery was shown to do a few things, all of which are very good. One, reduce back and leg pain. Two, improve function and quality of life. Three, three, boost return to work rates, and four, lower anxiety, depression and fear avoidance behaviors. All of those are super powerful. And I'll take a step to the side briefly, which is often after the surgery, these patients will be scripted to go to physical therapy. And if you're a chiropractor listening, which I assume you are, it kind of becomes, where do I fit in? How do I approach this? So, so this really, I think, provides this study a lot of great information for how you can approach this. One is that in many ways, as we'll dive into in detail across this episode, I think you can pick up the therapeutic aspect, the therapy aspect, just as a physical therapist can in many cases, almost immediately post surgery, if you position yourself there and then move into adjustments as time goes on, we'll talk about what that means. So one direct quote from this study that's powerful is, therapy improves functional outcomes after lumbar disc surgery. Most exercise programs targeting endurance, mobility and strength are effective. Again, I like to talk about the balance of strength and flexibility. Here they talked about endurance, mobility and strength. Those are all key words that should light you up. And it's like, that's me. Exactly. And that is why many of these individuals should have your care. As a matter of fact, my opinion, nobody, in the absence of red flags, should have surgical intervention without a complete course of chiropractic. And I also would say it's insane to go through surgery and not have chiropractic, at least as a part of your post surgical rehab, if not the leader of your post surgical rehab. So I talked at the beginning that there were six big questions that this study answered. And the first one, it was very basic. Is physical therapy effective post surgery? And the evidence was absolutely clear that it's a resounding yes. Intensive exercise regimens, particularly those focused on strength, mobility and endurance, consistently produced better outcomes than not. Also, physical therapy reduced psychological distress and helped patients return to work faster. Really important point of this, not only are people petrified pre surgically no Kidding. But they can have a lot of distress post surgery. Why? Because a very Johns Hopkins trained neurosurgeon once told me, 33% of my patients get better, 33% stay the same, 33% deteriorate. So that's a lot of people, 66% that are the same or worse. So that's super stressful. And even those that get better can be really stressed out when they get out of surgery. And it wasn't as minimally invasive as they thought. I saw the commercial. It seemed like they were just gonna stand up and run down the beach. They that's not the way it really works. And that's really distressing to many patients. And that's an opportunity for you to connect with them knee to knee, heart to heart, and describe the roadmap forward. The second big question that was asked was, should activity be restricted after surgery? The answer is no. Bracing corsets, long periods of activity restriction did not improve outcomes. Short term rest was no better than early activity in preventing complications or improving recovery. So the bottom line here is that you should be encouraging safe and early movement. If you see, I mean, how many times have you seen somebody post surgery wearing a brace and then you see them weeks later and they're still wearing the brace. Now there are outlying cases where that's necessary, but in most cases, most of the time that's diminishing their improvement, not helping it. Often that's because they're fearful of moving, so they're wearing the brace to get by, which, guess what, that affects their outcomes. And it also, of course, deteriorates the muscles that need to be seen stabilizing as opposed to deteriorating. The third big question, when should physical therapy start? The answer is earlier is often better, but not always immediate or early. Post op rehab showed benefits like shorter hospital stays, better pain control, faster return to work. But there are some studies that found no difference between starting at 6 weeks versus 12 weeks post op. So there's a little bit of flexibility there. Early rehab is promising, but more research is needed to really understand the optimal timing. And again, this is a broad based study. A lot of this is going to come down to perhaps what region of the disc herniation was it? Cervical, thoracic, lumbar? What was the surgical intervention? Was it minimally invasive? Dissect to me. Was it a laminectomy? Was it a laminotomy? Was it an anterior decompression procedure with a fusion? Like all of those things are going to, of course, make a massive difference in your post Surgery, rehabilitation. Question number four. Does supervised rehab or education help? Yes. Supervised therapy and education outperform home exercises alone. Behavioral and psychological interventions helped with things like coping, compliance and reduced pain anxiety. So these are areas where we can just be massive, massively helpful to anybody who's gone through a surgical procedure providing these supervised therapy and education and therapy. I use that in air quotes because this can be whatever is in your wheelhouse, you wanna get people moving, you wanna move them towards the balance of strength and flexibility. There are many ways to do that and you have those tools in your tool belt. And certainly from a behavioral and psychological perspective, being able to coach people up, there is nobody on planet earth that can do that better than you as a chiropractor. So being able to help set expectations, overcome fear, avoidance behaviors and help people move safely to the point where they get maximum benefit, massively, massively. Key. And why is it key? Because up to 25 to 35% of individuals that have one back surgery have another in any person you can help. That's a cascade that you don't want to be going down because if they had a minimally invasive surgery, normally, again, you get two bites at the apple before a fusion and sometimes it's one depending upon how much bone disc ligament was taken on the first surgery. So going back for a second surgery is a fast track in many cases to having fusion, which can be a life. It is a life altering procedure, sometimes for the good, often for the worse. So anything that you can do to get out there for those individuals, and maybe they didn't know about you before, or maybe they did, but you don't need to take it personally. If you've worked with, you should be open to helping anybody, I'm gonna say, especially those who have had advanced interventions so that you can break that cycle before they end up in a really, really bad place. So the next question, question number five that they asked, what type of exercise is best? Well, the winners were what we've highlighted earlier. Dynamic trunk strengthening, extension based exercises, aquatic therapy and lumbar pelvic leg kinetic chain exercises. Now, aquatic therapy, you might not have a pool or a whirlpool in your practice, probably not. But all the rest of those easily done in your practice. Lumbar pelvic leg kinetic chain exercises. Talk about the core of what we do as chiropractors. Extension based exercises, dynamic trunk strengthening, all of those are really, really right within what you can provide in your practice. Probably today, probably already do. But the questions then become, how have you communicated that out to your community. Do they even know that you take care of people post surgically? I, I can tell you most people don't think they should see a chiropractor post surgically. Why? Because they're scared of the adjustment and they're scared that something's going to break. They're scared something's going to get worse. Most people, most, and I'm going to say probably 80 to 90% of people post surgically, and I think I'm being conservative, don't believe they should see a chiropractor not even neutral. Do not. So how do you overcome that? You overcome that by putting out blogs, putting out social media, putting out emails to your list highlighting how you can help them so that they can make an informed decision. Question number six ties in directly to who we are and what we do. Can complementary therapies help? The answer is yes. Spinal adjustments all showed benefit in addition to acupuncture as well. So in the section called complementary therapies, the authors of this study reviewed several interventions including spinal adjustments. They found that spinal adjustments provided effective improvement in post operative recovery and low back pain. So they looked at again adjustments as a broader analysis on complementary and non pharmacological modalities. And they found that adjustments can improve pain levels, accelerate return to normal function and they're well tolerated, especially after the acute surgical healing phase. In other words, not getting in there too early. Manipulation was not shown to increase complication, which is really, really important. So what's the implications for you? Well, the evidence supports a collaborative integrative model where you can contribute meaningfully, excuse me, to recovery, especially in the following ways. Couple different ones. One, safe pain relief without medication. What you do provides a non opioid, non invasive approach to reduce any lingering pain or discomfort. Two, restoring spinal mobility. Post surgical stiffness, altered gait, asymmetrical loading, super common. All of this is happening post surgically. So when you can get in there with your spinal adjustments, you can restore normal movement patterns and reduce compensatory strain. Massively impactful to avoid the cascade of future surgery, patient confidence and fear reduction. Manual therapy. Spinal adjustments often reassure patients that they feel cared for, especially when they're anxious about movement. And number four, it's part of a holistic rehab program. This is about utilizing strength training, extension based exercises, postural correction education and adjustments altogether. So the biggest thing to consider when adjusting is ensuring that you have that post surgical clearance. So you don't want to go too early with this. This is why I say, as you Insert yourself into post surgical recovery. You want to start with all of your strengthening and exercise. You want to start with exercise, right? You want to start with your strengthening and flexibility. Then over time with surgical surgeon approval, that's when you're gonna move into adjusting. The last thing you wanna do, even if there's no causation, is have some correlation between adjusting somebody too early and an issue popping up. So you wanna definitely be safe than sorry in that case. But that doesn't mean you need to wait to deliver care. You can deliver care with everything you do around the adjustment until it's time to do that. So this is hopefully super empowering for you because I think this reframes the post surgical conversation. This provides evidence based support for your role in co managing surgical patients. You can totally confidently say research shows physical therapy, including chiropractic care helps post surgical patients recover faster and stay better. You can say that to other doctors, you can say that on social media, you can say that on your blogs. You can tell your patients that. Why? Because it's true. And it's really important to also remember to include a holistic program. Your strength and mobility training, your movement based rehab, your pain education and coping strategies and collaborating with the surgeons and PTs in your community. Again, the heart of what we do at the evidence based chiropractor with our MD connection program, we have docs getting 2030 just naturally organic referrals each and every month to their practice. MD Connection through evidence based chiropractor. Longest running, I see some people out there coaching and training on this. Quite frankly, many of them learned their processes through me. So this is really, this is the real deal. So if you want to build those relationships, you want to build them in an efficient and effective manner. Come on over, check out what we have going on. The evidencebasedchiropractor.com join the MD connection month to month. No. You know, 99 bucks. Absolutely no commitment makes it super easy for you to get out there and start building relationships that drive referrals and educating your patients. Again, this is not only a B2B business to business conversation, this is a B2C conversation. So ensuring that the people in your community who have no clue or believe they shouldn't come see you now start to understand that they should. So some clinical takeaways are to start patients on therapy as early as safely possible. You should choose your rehab programs that include strength, mobility and extension based movements. You should also utilize education, behavioral support, complementary therapies and you should certainly ditch all of those outdated practices like bracing and activity restriction. So this is great information. Again, I think you can share this with all of the other doctors and therapists in your community, as well as to your patients. If you have not left us a rating or review, I would love it if you would do so. Scroll on down, tap some stars, leave me a line of feedback. I'd love to hear it. And before we wrap up, I wanna say a few words about turncloud. Turncloud is the EHR where no one needs a user manual. They've created an intuitive application and they've stripped away everything that's not essential. You can learn more and connect with them@TurnCloud.com Again, that is TurnCloud.com Other than that, I hope you have a fantastic week in practice and I will talk to you soon. Thank you for joining us on this episode of the Evidence Based Chiropractor. If you want to grow your practice, come back for next week's episode. If you want to grow faster, visit theevidencebasedchiropractor.com and join our MD Marketing membership today. Sam.