Improving Movement Patterns for Chronic Low Back Pain | Podcast Ep. 376

Foreign hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langme. Today we have a fantastic piece of research that we're going to highlight. It came out this year in 2023. It is all around the effectiveness of spinal stabilization exercises on movement performance in adults with chronic low back back pain. If you consider yourself a movement based healthcare provider or you're somebody that has back pain, this is a great study with a lot of clinical pearls. Can't wait to dive in and it is hot off the press. Before we get started, I want to say a few words about Patient Pilot by the Smart Chiropractor. If you have an email list of over 300 people in your ehr, in other words, schedule a demo. Let's have a conversation. Patient Pilot is by far the number one reactivation solution. Our average doc put in perspective for you. I'll give you exact numbers. Has 1200 people on their email list and generates over 26 reactivations each and every month. So you can push and pull those numbers depending upon the size of your list. But if you do not have automated email campaigns that consistently generate reactivations weekly, not monthly or quarterly, weekly, you're missing out on a huge opportunity to extend the service to the people who know, like and trust you. Schedule a demo today. See how we can help atthe smart chiropractor.com but as I said at the top of today's episode, we are talking research. I'm going to drop a link to this study in the show. Notes down below came out in the International Journal of Sports Physical Therapy. It's titled Again the Effectiveness of Spinal Stabilization Exercises on Movement Performance in Adults with Chronic Low Back Pain. Why is this a big deal? Because low back pain costs a lot of money. I feel like we start a lot of the episodes this way, but I don't think it can be overemphasized. I've said it before, I'll say it again. The fact that nearly everybody deals with back pain, that it costs between 100 and 200 billion billion a year in direct and indirect costs and every chiropractor is not completely full is an absolute travesty. It's not going to happen automatically. This is why communication and marketing is critical, not discount ads to get somebody in. It still blows my mind that that's a thing. I'll save that for another day. Getting out there with consistent communication is absolutely critical to other healthcare providers and to your community. That's why we have the evidence based Chiropractor and the smart chiropractor. So if we can help you with that, we would love to do so. We help hundreds of chiropractors each, and they're super happy, so you can be too. However, in addition, low back pain is a leading cause of disability, as we have covered. Now, where does this. What's the challenge with this? Well, there's a lot of absenteeism at work. There's a lot of loss of productivity and quality of life issues. This is like just a loss of fun. I mean, we've all seen people come in that are in either chronic pain, acute abject pain. You know, spinal conditions have a direct effect on our psyche. I mean, there's just such a link between depression and all of those things with spinal issues that we don't see as often or as much with extremity issues, this is a big deal and a real thing. We see it all day, every day. But have you really considered the impact and are you really doing everything you can to ensure that you get out there? That is the question. Now, from a clinical perspective, aberrant movement patterns, such as a painful arc, lateral shifting, gower sign are all associated with lumbar instability or a movement coordination impairment, as they put it in the research. And patients with chronic low back pain often develop compensatory movement patterns when they're doing functional tasks. Right. Stepping over an obstacle, squatting. These sort of functional tasks often become aberrant and. And we end up with compensatory movement patterns, which eventually you're gonna pay the piper. Body's not designed to move that way. We are super adaptable, and that is a great thing. But eventually the stress causes a breaking point. And that breaking point is usually pain. Of course, pain, last thing to come, first thing to go. So observation and analysis of movement quality, as they theorize, could be and may be key elements in low back pain management, specifically for people with subacute or chronic pain. And I couldn't agree more. So they focus on fms, Functional Move Screen. And as they talk about it, as a quantitative assessment tool that was developed to assess movement performance by identifying limitations and restrictions of movement patterns and to determine whether abnormal movements are present. So individuals, athletes, whoever it might be, with lower FMS scores have been found to be associated with a higher risk of musculoskeletal injury. It's an interesting prognostic or predictive factor. And a recent study found that people with chronic low back pain demonstrated lower FMS scores compared to healthy individuals. Additionally, FMS appears to be a useful Functional assessment to measure and identify movement deficits in patients with low back pain. So this is all just setting up for the fact that this is an important movement based test. Now I know there is a variety of them out there. FMS is one of them. There's great aspects to each of them. Just this study was focusing on fms. So they highlighted a earlier meta analysis of exercise therapy for the treatment of low back pain. And it reported therapeutic exercise was effective in decreasing pain in patients with chronic lumbar. Lumbar pain. However, debates continue regarding the specific type of exercise that could be more effective. Sounds a lot like adjusting techniques, right? It's like there's so many out there. They all do wonderful. How do you really parse them out? Well, they highlight the fact that spinal stabilization exercises have been advocated recently as potentially the best choice or over general exercises at reducing pain and enhancing proprioception. And spinal stabilizing exercises have been shown to be effective in treating patients with low back pain. But it's not known if spinal stabilizing exercises would improve movement performance, which is exactly what this study analyzed and looked at. So this was a double blind, randomized clinical trial comparing general exercise to spinal stabilizing exercise. There's a variety of exclusitory factors and about 10 of them. So I'll list them real quick. So this was randomized control, which is awesome. Top level of research aside from maybe a meta analysis or a systematic review. However, there were some things where they said you're not going to be included in this study. Not a great candidate. Number one, serious spinal conditions like fracture, infection, tumor. Number two, signs of nerve root compression, radiculopathy. Number three, history of lower extremity or surgery. Right. So previous surgery. 4 history in hip, knee or ankle pain in the previous two years. Five, pregnancy six, systematic joint disease like rheumatological diseases. Seven, vestibular or balance disorders. Eight, ongoing treatment for inner ear, sinus or respiratory infection. Nine, a history of falls or falling and ten, a need for walking aids like a cane or walker. So pretty self explanatory on why those exclusion criteria were in place to really create a uniform set of individuals that don't have, how would you say maybe causative or correlative challenges that could impact the results. Right. Trying to really grind down to chronic low back pain and how spinal stabilizing exercises might be able to change the movement patterns and functional movement patterns specifically. So the participants completed two questionnaires, a fear avoidance beliefs questionnaire and a patient reported outcome measurement Information System A Prom 29. Those were the primary tools that they utilized. Now, the functional movement screen, or FMS test kit was used to assess the movement performance of seven different movement patterns for this study and for each participant in the study. The FMS pain scores, Oswestry measurement scores were also collected at baseline and then at two weeks, four weeks, and eight weeks after the initiation of treatment. Those pain measurements were collected at the beginning of each session as well and before and after each test. That really we're trying to identify, okay, when people are doing general exercise, when some people are doing, you know, spinal stabilizing exercises, how does this affect movement performance? Does it affect movement performance? And what can we expect? And the results were pretty good. And I don't think they're gonna be too shocking for anybody listening to this podcast. So a total of 40 participants met the inclusion criteria and completed the eight week exercise program. So the participants in general had mild low back pain with an average pain score of 3.5 out of 10. So kind of just setting some of those baselines there. Now, the results did suggest that exercises prescribed to the individuals with chronic low back pain should be specific to and target spinal stabilizers in order to improve quality of movement as compared to general exercises. And the quality movement is like range of motion, flexibility exercises, et cetera, or excuse me, the general exercises were more range of motion and flexibility exercises, whereas the spinal stabilizing exercises focused more so on the, no surprise, spinal stabilizers of the spine. So they found that there was positive benefit to the specificity, and the results support that spinal stabilizing exercises are effective in enhancing spinal stabilizer function, improving and thus improving movement performance. Deficits in spinal stabilizers are considered to be the primary cause of spinal instability leading to low back pain. I'll say that one more time because it's that important. Deficits in the spinal stabilizers are considered to be the primary cause of spinal instability leading to low back pain. I want to take a little bit of a left turn here. Now, there is spinal instability that is emergent, right? It's an emergency type situation. They're gonna have cauda equina. There could be real damage. That is a real thing. And thankfully it happens very rarely. So let's break this down. Spinal instability leading to low back pain most of the time. I'm gonna harp again back to these elective surgeries. You don't need the surgery if you have spine. It's the spinal stabilizing muscles that are the primary cause. It's not that they are eminently emergent in a catastrophic situation. So where am I going with this? I'm kind of beating around the bush. I'll say it super cleanly and clearly. Many elective surgeries for spinal instability in the absence of a red flag should not be performed. What these people need are spinal stabilizing exercises. That is the cause. It's not that they're missing a rod or a screw that they've needed their whole life. It's that they need to do spinal stabilizing exercises that can make a material impact in their ability to functionally move to reduce pain and to ultimately live a high quality of life. The literature supports the use of spinal stabilizing exercises for people with low back pain for for improving neuromuscular control and endurance, strengthening deep spinal muscles, reducing pain, and enhancing proprioception related to the dysfunction. Movement Based Healthcare Movement based healthcare. Preaching to the choir. If you're listening to this podcast, probably. But this is to emphasize truly the importance of what we do. Tying back to the beginning about 10, 15 minutes ago, how is it that all of our clinics aren't full? There are millions, tens of millions. There are more people than we could serve as chiropractors struggling with these issues that are taking medications that have high risks and side effects, that are getting injections which provide short term relief in the acute stage at best and pretty much no other benefit long term. And I think they're detrimental long term for an array of different reasons, or having elective spine surgeries because they met some sort of insurance criteria of taking an aspirin every day for six weeks and go into PT two times and they're like, well, we exhausted conservative care. That's how the, that's how this works and that's what we need to change. But it only happens through us taking massive action day in and day out on our social channels, through our email communications with other healthcare providers. What higher calling is there? So anyhow, at eight weeks, the spinal stabilizing group had a reduction in pain scores of 1.4 points from baseline, which is a great thing. I mean, we talked about the baseline 1.4. You might be. 1.4 is not that much. They started at 3.5. So you're knocking out, you know, 30 some odd percent of pain, which is a big deal. And the results of this study ultimately suggested that spinal stabilizing exercises are more effective in enhancing movement performance than general exercises over a period of eight weeks in individuals with chronic low back pain. In addition, all participants in both groups demonstrated reduction in pain intensity and disability while attending supervised sessions the first four weeks of the study. So that's a good thing as well. Movement is critical, however specific movement is better. That's the way I would put that. This study demonstrated that supervised spinal stability exercise sessions seem to maximize the benefits of this treatment, including improving quality of movement and reducing the aberrant movement that is associated with chronic low back pain. So inspire people to get up and moving. Do it in your practice, prescribe it at home, however you want to go about that. Get those joints moving segmentally so that in my opinion then they can do regional and whole body movement. That is what is key and measure each and every step of the way. That is how you get fantastic results in your practice. So lot of great clinical pearls. I'll drop a link to this study down in the show notes so please be sure to check it out. If you have not left a rating or review for this podcast, I would love it if you take a moment and do so. You can scroll on down on your phone if you're checking out this on Apple podcasts, click how many stars, write a sentence or two. It's good to know people out there are listening and if you're liking liking it, I'd love to love to hear from you. Additionally, before we wrap up, schedule a demo with Zingit. They are gonna hook you up with a $100 DoorDash gift card for completing a demo. What does Zingit do? Well, they can help power reviews. An average of 23 Google reviews per month and a patient show rate of at least 94% and that just scratches the surface of the value Zingit can bring to your practice. They're a fantastic text based solution. Head over to zingit.comoffer zingit.com offer so you can schedule your demo and again they'll hook you up with $100 DoorDash gift card for the opportunity to showcase maybe some things you're missing in your practice. No better opportunity to do so. I'll drop that link down in the show notes and finally, Power Step just got a great response from somebody. A doc on a post I made yesterday about Powerstep saying thanks so much for hooking me up. I put in my name and Powerstep sent me a free sample pair. I love what I got. You can be the same way. Powerstep was designed by a podiatrist over 30 years ago. They are awesome orthotics. They are what I use, what my dad uses and they're willing to hook you up with a free sample pair@pro.powerstep.com sample pro.powerstep.com sample use the code EBC for evidence based Chiropractor. They'll send you a free sample pair. Head over there and do it. We'll drop the link down in the show notes. Other than that, I hope you have a fantastic week in practice and I will talk to you soon.

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