https://www.listennotes.com/e/f790b37307824a0184243ec4f9891bd7

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 Langmaid. On today's episode, we have another awesome new study that we're gonna highlight and it is a good one. It is brand new. It's a multicenter randomized control trial out of Korea and it takes on a very big question. And that question is what's more effective for non acute lumbar disc herniations, non pharmacological care like spinal adjustments and acupuncture or conventional medications and injections. We're gonna highlight what they found, how you can communicate it and why it matters, all on today's episode. But before we get started, I wanna say a few words about patient pilot by the smart chiropractor. If you would like to start reactivating more of your patients, we would like to help. We've made some massive upgrades including, I think we're the only service on the market that has a welcome back offer. For clarity, you probably have a new patient offer and chances are not have anything to welcome patients, your inactive patients back into your practice. That is a massive friction point. So if you'd like to help us solve that friction point and help you get more patient reactivations, we would love to help communicating with each and every one of your patients on your patient list for like a couple cents a month. If that's not worth it to you, I don't know why you listen to this podcast, but if you want to check out what we have going on and work with us, you can@thesmartchirofractor.com but as I said at the top, today's episode is all about research. The title of the study, of course, I'll drop a link down below, is comparative effectiveness of non pharmacological and pharmacological treatments for non acute lumbar disc herniation. A multicenter pragmatic, randomized, controlled parallel grouped study. Now, this study was published in the Journal of Clinical Medicine February 2025. So it is brand new. It basically was comparing real world non pharmacological treatment, including spinal adjustments, with traditional pharmacological care for patients that had sciatica or low back pain, chronic lasting more than three months due to a lumbar disc herniation. And they're trying to ask the question we highlighted at the top which is which one of these routes is better. Now, before we get there, let's talk a little bit about the context of this study. Lumbar disc herniation, as you're probably well aware, one of the most common causes of low back pain and sciatica and its treatment is often kind of this hodgepodge of injections, NSAIDs, conservative care, opioids, all of it. And we've highlighted through many, many other studies the bad advice hundreds of millions of people are getting regarding the care. And partially some of this could be due to guidelines. Now, the American College of Physicians came out years ago recommending non pharmacological care first things like spinal adjustments, acupuncture, heat, exercise makes a lot of sense to me. If we're talking about the Hippocratic oath, however, that doesn't mean that everybody goes that direction. So there are other guidelines in the UK and Denmark that actually downplay the role of spinal adjustments. And the facts are the facts that real world care still leans really heavily on medication and injections, especially ironically in the US and Canada, where the American College of Physicians have recommended non pharmacological care. Now the good news about that is that's all opportunity for your business because there's many people out there getting bad recommendations that don't solve their problem. You probably see it all day, every day. We what you see as a fractional percentage of what goes on in your community. So it's happening all day, every day, everywhere. Now the bad news about it is people are wasting a lot of money and in the worst case scenario, suffering irreparable and, you know, catastrophic harms, if I'm just honest about it, injections, you know, relatively safe, but mostly ineffective. And when they're not safe, it can result in real issues. Medications, it depends on the medication, right? NSAIDs, relatively low harms and low risks, that's something you want to live on. But low harm and low risk, when properly utilized, opioids should basically never be used for spinal care. Yet they are still all day, every day, with, to date, no actual ramifications on these doctors. So I say that to really just highlight what's going on and say it's our opportunity, it's our job, it's our responsibility to get out there and help as many people as possible with what we do. Why? Because of the low risk, low harm, high upside, and we continue to learn more that what you do day in and day out, in most cases, most of the time is the best option for patients in Your community, barring red flags, of course. So this study really helps, I think, close that gap between what patients are getting and what actually works best. So in this study they had a couple dozen patients with mri, confirmed lumbar disc herniations, and again sciatica, low back pain lasting more than three months. So by definition chronic. Right. They were randomized into two groups. The non PHM group, as they said, which included acupuncture, acupressure, manual therapy, spinal adjustments, and the PHM group, which included pain meds, injections, nerve blocks and other quote, unquote, conventional care. Patients were treated twice a week for eight weeks and they had follow up through 27 weeks, so about a half of a year. So the key findings in this drum roll please. Was the non pharmacological treatment won out pain relief. At week nine, non pharmacological care had a statistically significant improvement that was in back pain, now in leg pain at week nine, also statistically significant for non pharmacological care. When we looked at disability, the Oswestry disability Index, no statistically significant difference, but the non pharmacological care had, it was more favorable in that group, didn't meet the level of statistical significance, but it outperformed. And longer term, we saw pain scores, they saw pain scores continue to improve in the manual therapy group and actually rebounded slightly in the traditional care group once the intervention stopped. Well, why does this happen? Well, they stopped taking the medication when you stopped taking the medication. And the medication was not designed and does not solve the actual problem. Well, guess what? The pain comes back. That's clear. We see it all day, every day. But I can tell you right now, many people in your community don't think that way. They just don't know. People aren't coached and trained in school as far as how to take the best care of their body. Many people, most people, of course, didn't go to chiropractic school. They didn't go to medical school. They are really detached from the reality of what's going on with their body or how it works to, compared to, I'm going to say, how they've been marketed or hope it works. And when we see the pharmacological interventions, so to speak, advertised a gazillion times a day, all day, every single day in the United States, it does play a role. And we see the medical model over the last 30, 40, 50 years, you know, really exploit pharmacological interventions. Better health through chemistry. I mean, what this is really something that's played a Massive role, I'm gonna say, in the lack of health in our communities and in our country. So again, I'm not trying to point the finger, I'm just trying to showcase this is the truth and reality of what's going on. And us as chiropractors, us as natural healthcare providers often can become somewhat blinded to this fact because we're like, well this is how, of course how people think about things. Well, quite often it's not and you have to be able to understand how the people in your community are thinking about their health to have an accurate, to have an influential and to have a direct conversation with them. So this study also highlighted the fact that non pharmacological care had better cost effectiveness. Again, I'm not a big fan of, I don't think cheaper is better. I know a lot of studies and a lot of, especially when we look at healthcare systems, they're trying to reduce cost all the time. I think it's more about value than cost. And what's value Values in the eye of the beholder often is what's reported in the study. So it's there if that strikes your fancy. Safety, spinal adjustments super safe. No adverse events related to spinal adjustments were observed in this study and the only treatment related adverse events were headaches in the pharmacological group which were directly of course linked to the medication. So this reinforces what we know and what the research has showcased for many years, that spinal adjustments are safe even in MRI confirmed disc herniations. And this is an important component, that little bit right there. There are a lot of people in your community. I've seen hundreds throughout my time at orthopedic groups of people that thought because they had a disc bulge, a disc herniation, insert disc issue here, that it was clear to them no way would I see a chiropractor for this. I have a disc bulge. Right. And, and that's a predominant thought. So you have to overcome that thought. How do you overcome that thought? Through consistent education. Time back to where we started at the beginning. This is what we do with patient pilot. There's a lot of people on your that you've seen throughout your career. Inactive patients that stopped coming in that time and gravity are undefeated. How come they are choosing another chiropractor down the street? And I'm going to be blunt with you, they are. We've stood at 15% utilization for a really long period of time. That means the same people are going around to see different chiropractors in your town. What are they doing? They're going inactive, they're seeing somebody else's offer with clarity and they're starting as a new patient there until they're not. And then they move, move on and move on. How do you combat that, so to speak? You combat that by having a lot of clarity on what it costs to come back in. Not by manipulating the situation, but by being super clear. That's what Patient Pilot helps you do is consistently communicate to your patient list if you'd like and we recommend it, have a welcome back offer. I didn't say deep discount offer. The price is the price. But make it clear because the lack of clarity absolutely crushes any conversion and it limits your ability to help people and generate revenue for your business. So tying back to the study, one of the quotes from the authors that I liked were our findings reinforce the safety of spinal manipulation for patients with no non acute lumbar disc herniation. And they even cite previous research that found no link at all between spinal adjustment or manipulation and mri. You know, MRI disc discs on MRI worsening or even serious complications like cauda equina. No link whatsoever. So how does this apply to you and your practice? I think there's a couple key talking points here. One is just identifying the fact that hey, there's recent research showing that what we do here with spinal adjustments outperform medications and injections for long term relief of disc related back pain. That's true based upon what they found in this study and it's clear, it's easy to say. Also, not only is non drug, non pharmacological care safer, it's actually more cost effective. People do care about that. I'm not ignoring that. So I think that's a very positive thing you can say. And I think it's also just bluntly honest, which we're now seeing science confirm what chiropractors have seen for decades, which is we can help a lot of these people. And again, 20, 30 years ago, the science was a little thin in terms of really highlighting how chiropractic adjustments work. What's the safety? We've seen just a plethora, hundreds, maybe thousands of studies come out over the last 20 to 30 years, which is really great. So from a clinical application standpoint, their care plans in this, remember, eight to 12 weeks, don't give up too early. I see a lot of young docs, especially those in the sports, sports chiropractic realm, evidence based chiropractic realm, however you want to define that. I believe that there's too Many chiropractors cutting care too quickly, you know it to be true and often I'm just, you know, again, I'll be straight up today. It's a lack of wanting to have a financial conversation and it's a fear mechanism that you're cutting care too early. And you know that it takes time to change habits. You have pain again, last thing to come, first thing to go, they get rid of pain. Great. Have they modified any of their biomechanics if they had soft tissue injury? It takes time for that stuff to heal. Not one or two visits, not four or five visits in many cases. And to guide that process along is really, really, really important. So I loved this study because it was real world clinical care. There weren't restrictions on the doctors or the institution. They got to treat how they wanted and and then we got to sort through the data, which is great. It's just what you do with your patients every day. You're making decisions based upon their goals and your findings and ensuring that you're driving towards their goals. Also, it was just empowering to see that chiropractic led non pharmacological care didn't just like match traditional care. It outperformed it across the board, which was really, really important to see, important to have continually documented and important now for you to take this information now you have the responsibility to go out there and tell that story. Some final takeaways here. Manual therapy, spinal adjustments, safe, cost effective, powerful alternative to drugs, injections for chronic disc herniation. And the future is shifting away from opioids and injections towards the type of care you've delivered all along. And I'll kind of go back on the statement I just said and I'll say chiropractic isn't an alternative, it's actually advanced. And the science continues to showcase this. As a matter of fact, it's advanced enough where we're still discovering mechanisms of action, still trying to understand how the multifaceted aspects of what you do when you deliver an adjustment can impact that person's life. That's awesome. It's exciting. Sometimes it can be a little frustrating when it's not just an easy A plus B equals C. But I think that's one of the most advantageous places that we can be as a profession. Now, before we round up, I want to say a few words about turncloud. It is the only ehr where you do not need a user manual. If that sounds interesting to you and you would like to improve the efficiency of practice, have a conversation with them cost nothing. Take a few minutes out of your day. It just may change the workflow of what you do forever. That is time well spent. Turncloud.com I'll drop that link down below. If you have not left a rating or review for this podcast, I would greatly appreciate it if you do so. If you're on your phone, you can scroll on down, tap how many stars, leave a line or two. A text would be really awesome. It helps more and more docs find out if you found value in this podcast. I will make that ask. Please scroll on down, tap some stars, leave some feedback. That helps us tremendously and thank you so much. Thank you for being a chiropractor. I hope you have a fantastic week in practice and I will talk to you soon.

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