Is Your Patient 'Too Old' for an Adjustment? New Research Says You're Wrong | # 548

Hello and welcome to The Evidence-Based Chiropractor. I'm your host, Dr. Jeff Langmaid. On today's episode, we are back with more brand new research. It's a great one. It's an updated systematic review all around spinal adjustments in older adults with chronic spinal conditions. So chances are this paper is going to be super pragmatic to what you see every single day in your practice. We'll talk about what the researchers found, what it means for your practice, how to communicate it, and much more on today's episode. I literally just got back from speaking at Parker Seminars Miami. If you were one of the individuals in the room with me, thank you so much for coming in. I had a full room, it was awesome. That is always super exciting as a speaker. So thank you to everybody that came out, and huge thank you to Parker Seminars. If you have not been to Parker Seminars, whether it's Dallas, whether it's Miami, whether it's Las Vegas, I highly encourage you to do so. They put on some of the best in the business in terms of seminars. Also, few shoutouts before we get started. Leander Table, $750 off their Series 950 using the code EBC2026. Shockwave Centers of America, $500 off one of their shockwave units and a free cart. $1,250 in savings right there. As well as big shoutout to RehabFix and their hybrid program. If you're looking to build revenue beyond the four walls of your practice, while also still having the ability to see patients knee to knee, heart to heart. RehabFix Hybrid Program is absolutely fantastic. I'll drop a link down below. Connect with Grant and his team over there. But as I said at the top on today's episode, this one is all about spinal adjustments for older adults. We'll link it in the show notes. And this is something I think that's really practical because there's a lot of times people come in, whether they're, you know, asking for a parent, asking for themselves, or maybe even there's another medical doctor, healthcare provider that is like, well, how old is too old, right? You know, just because somebody's older, you know, what does that mean? How does that impact their ability to not only receive care but get great results in your practice? Well, we're going to look at that and much more. This is an updated systematic review from the Journal of Canadian Chiropractic Association, and again, looking at spinal adjustments for older adults with spinal conditions. So we're talking about chronic low back pain, chronic neck pain, lumbar spinal stenosis, and combined neck and back disability. So this is not that 28-year-old athlete who kind of just tweaked their back at the gym coming in for a tune-up or two. We're talking about people that are 65, 72, 80 years old. And many of these people have probably been in pain— have been in pain for months, years, or even decades. As you know, pain is never, literally never, what drives people in your practice. Is the result, the life effect of that pain. They've lived with pain for a long time, but all of a sudden, they were unable to do something in their life. That's the life effect. They were unable to do something in their life that meant enough to them to overcome the friction of coming into your practice. Time, money, effort, energy, all of those things. And that's just real-world mechanics. So I always say, and I talked about it this weekend, actually, at Parker, Turn over the rock. So if somebody says they're coming in for the pain, don't just ask about the pain. You have to, if you want to connect with the individual and you want to encourage them and influence them to get the best results in your practice, it has to go beyond that. Well, what does that pain prevent you from doing? What's the life impact and life effect of the pain? I call it turning over the rock. And it's really, really critical for us as clinicians to always turn over the rock. Pain is the rock. It's really easy to see, you can't miss it. But have you turned over the rock? Have you asked that extra question? How is that pain impacting you? What's it prevent you from doing? What really brought you in here today? Really great question. So many people who are older, of course, coming into your practice, chances are they've probably already tried medication. Maybe they've had injections, maybe physical therapy. Maybe they've just been living with it again for weeks, months, or years. And they're wondering if non-surgical conservative help you know, is something for them. And the big takeaway from this review is actually really, really easy. It's that spinal adjustments appear to be a pretty darn good option, uh, for older adults with chronic spine conditions. And the outcomes, we're going to talk about that in a moment. Every case is not a slam dunk, but this is not about hype, nor is it about fear. It's really about practically looking at where what we do, the hallmark of what we do with the adjustment fits in with older adults. So we're gonna break it down in plain English, pull out those key findings and much more. So this is a systematic review and the authors really wanted to answer a very, very focused question. How effective are spinal adjustments for older adults with chronic spinal conditions? And that matters because older adults aren't just like younger people with more birthdays, right? In some ways they are, but they often have more complex clinical pictures. They have more advanced degenerative changes, they might have osteoporosis, they might have reduced bone density, maybe med— multiple medications, mobility limitations, balance issues, all of this and much more because as you know, time and gravity are undefeated. So this really does morph into a different thing when there's an older adult with chronic, by definition chronic, right? It's been around more than 12 weeks, spinal issues. And again, we're looking at multiple different spinal issues and most importantly, It's also really critical to keep in mind they might recover more slowly from episodes of spine pain, uh, and maybe more likely even to develop some chronic symptomatology. So this is all about setting expectations, setting agreements, and helping lay the foundation of understanding in a way that the person can actually understand that makes sense. And that makes it easy for them to come in and get the care that they need. So low back pain, as you well know, with this on this podcast, remains the leading cause of years lived with disability around the world. Neck pain also another major global disability driver, and both become really more and more relevant as people age. Older adults with back pain are more likely to experience decreased mobility, reduced independence, and increased healthcare costs. And that's key because for a 72-year-old patient, pain relief is important. But often functional improvement is even more important. Can they walk around? Can they get off, out of the chair? Can they travel? Can they play with their grandkids? All of this is the life effect and really what you need to uncover and should be uncovering for sure during every patient intake. Getting that information, confirming verbally, getting a clear understanding because this is about being able to ultimately prescribe the right care plan. And the care plan is only gonna be based upon two things. I recommend literally saying this, by the way. Our care plans are based upon two things. The findings during your examination and the health goals that you've told me about. That's it. And that's what your care plan should be. It should be a combination of what's their goal, because a goal of pain relief is different than a goal of long-term reducing the risk of something. And then their findings. Your findings during your exam dramatically change the care plan. How old are they? What have they experienced? What imaging, not imaging? What have they gone through in the past, et cetera, et cetera. That's really all a care plan is, is combining those two items. And most people, they have no clue. They kind of just think you're winging it. So tell them, don't let them think that. Let people know, hey, our care plans are based upon two things. We're gonna go through a thorough examination evaluation. That's gonna give me detailed information about what's going on with you. The second part of that is health goals. That's what you're gonna tell me. I need to know not only where you're at today, but where you want to be in the future in an ideal place. And really, what's that life effect, life impact? What drove you in? To this practice today, because I know pain might be one of the reasons, but chances are it's that something else really pushed you over the edge. What is that for you? Simple language, simple communication, but ultra powerful when you're starting a relationship with a patient. So the authors of this study looked at randomized controlled trials published from 2016 to 2024, focused again on older adults with chronic conditions. And the intervention they were looking at, of course, was spinal manipulative therapy, quote unquote. I'll say spinal adjustments. And that included, you know, everything from flexion distraction and drop table. It was not technique specific within that. And they were looking at pain outcomes related to pain, function, disability, quality of life, activities of daily living. And when available, they also looked at the healthcare utilization, like medication use, surgeries, injections. Across those studies, they saw over 1,200 patients. They ended up with 9 reports, 7 RCTs, randomized controlled trials. And there were about 1,200 patients totaled. About 600— excuse me, 580 received spinal adjustments. Patients range— the older adults in this study were 55 to 94 years old. The conditions include an array of things: chronic low back pain, chronic neck pain, lumbar spinal stenosis, combined neck and back disability. So right away, this is really useful because it's specific. They're not asking, does chiropractic help everybody with everything? They're saying, does randomized control evidence really tell us that spinal adjustments for older adults provide benefit? It's a much stronger and more clinically useful question.

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The review again included 7 randomized controlled trials, um, and 5 studies were judged high quality, uh, which is nice, uh, 2 studies acceptable quality, uh, no studies with low quality. So this was not just a bunch of low quality studies. These were all randomized controlled trials, uh, and I think they did a really good job sourcing these studies. For, uh, low back pain, there were 5 randomized controlled trials, chronic neck pain 2, lumbar stenosis 1, combined neck and back disability 1 as well. The follow-up periods, they range anywhere from 5 weeks to 36 weeks, so mostly short and intermediate term in terms of those outcomes. And the overall conclusion across the board was that spinal adjustments, uh, provide really good benefit, um, especially compared with other care options for chronic spinal conditions. And we'll dive into the deeper level of results. So we'll start with chronic low back pain. The results I think were solid. They weren't like revolutionary for chronic low back pain, but we saw benefit. One study found statistically significant benefit in disability favoring spinal adjustments over sham for 12 weeks. And statistically significant does not always mean clinically meaningful. So important to keep that in mind. There was another interesting study 12 weeks spinal adjustments plus home exercise had a better responder rate. 16% more participants experienced a, you know, 30 to 50% reduction in pain than the control group. So that is also important to keep in mind. So the takeaway on chronic low back pain in short is that spinal adjustments appear to be at least comparable, if not better, to many other conservative care options out there. And combining with exercise and what they refer to as quote unquote good clinical management, that goes down to communication, et cetera. But really pairing spinal adjustments with exercise for chronic low back pain, really good idea. Um, probably something you are already doing in your practice. Now we go to lumbar spinal stenosis. Things get even more interesting. There was one randomized controlled trial that looked at older adults with lumbar spinal stenosis. And the spinal adjustment group received manual therapy plus individual exercise. Comparison groups include medical care, group-based exercise, um, and the manual therapy and individual exercise showed greater reductions in the Swiss Spinal Stenosis Questionnaire scores compared to medical care and/or group exercise. Um, so that is a really positive direction, clearly favoring manual therapy, spinal adjustments, let's say, and individualized exercise as well. So that is a really nice one. Secondary outcomes showed higher proportion of responders for symptoms and walking capacity at 2 months with manual therapy and individual exercise compared to medical care. And this suggests that individualized, hands-on, active approach— probably what you're doing all day, every day— can really help some of those individuals with lumbar spinal stenosis. And, and for chiropractors, this is big because spinal stenosis is number one reason why older adults have spinal surgery. So anytime you can decrease symptomatology, keep them out of red flag territory, that means they have options, right? Surgery is only mandated when somebody either gets to the point where they're making the decision to have it, or there's a red flag. Uh, elective spine surgery is a massive, massive business, and, uh, people do not need to go into that before necessary. Far too— hundreds of thousands of people, in my opinion, every single year are having elective surgeries that probably shouldn't. If they're looking for the best long-term outcome. I don't care how minimally invasive a surgery is, uh, it is still changing the biomechanics forever. Additionally, there's not a day goes by that you won't see a new spinal device, a glue, an injection. Uh, I have seen very little of that pan out to be these wondrous things, and I have seen many of it come and go over the course of time. Many surgeons at their core are still doing a lot of the same work they were doing. They're doing it better, but they're doing a lot of the same work in the same kind bucket of how they do their work that they were doing 10, 20 years ago. And that is tenable results at best. As you probably heard me say, I worked with a Johns Hopkins trained neurosurgeon that I greatly respect. And he told me straight up, 33% of my patients get better, 33% say the same, 33% get worse. He was happy with those results. I'm not, this is not an indictment of him, but I'm saying you and I would be mortified at those results because we're like, well, we expect 90% of our patients to get better. 33% get better? I don't know if I'm gonna be able to show up to work next week. May be embarrassing and certainly could be mentally taxing. It is, you know, spine surgery is a hard job, but it also is something that creates a lot of revenue for the spine surgeon, for the hospital, for the ambulatory surgery center, and all of the ancillary individuals involved. So without getting on a soapbox and going too crazy on this, please keep an eye on your patients that are exploring surgical intervention and please keep taking care of those individuals that don't have red flags, with conservative care. Chronic neck pain, probably the most encouraging in the study, um, and it was a, it was a really good one. Uh, there were many patients that had at least a 50% reduction, uh, in pain. And there is a secondary analysis that found, uh, spinal adjustments plus home exercise reduced cost, improved pain and mobility, uh, 1 year later compared to the control interventions. So really, really impactful as far as that goes. Ultimately, this study— there's a lot of meat in this study. I'm kind of giving a highlight reel over the top here. I'll link it down in the show notes if you want to dive in. But the bottom line is this systematic review, uh, reinforced that older adults are not outside the chiropractic conversation. Even 94-year-olds with spinal stenosis are not outside the conversation of coming into your practice. So, you know, older adults with chronic spine pain often have limited options. Medications for them can carry more risk. There can be more potential side effects. There can be more medication interaction. Surgery, especially over 80 years old, typically that's when elective surgeries really stop happening because of the comorbidities, because of the challenges under anesthesia, 'cause of the recovery. There's not too many surgeons, except in extreme cases, that are gonna do elective surgery after 80. So surgery might not be an option, or they might, it's probably not desired, but it's certainly not an option for a lot of these individuals. And injections, you know, limited temporary benefit at best. I won't even get started on injections here. But the bottom line is what you do matters. And when you can show up and help people understand that what you do matters, and I'm just going to say it absolutely straight, lumbar spinal stenosis, number one reason older adults are having spine— spinal surgery. If you're not consistently putting out blogs, position statements, reels, reactivation messages around that topic, then you're probably— now if this is not a focus of your practice in any way and you're actually only a pediatric doc, then it's not relevant for you. But if you are somebody that takes care of these individuals and you're not consistently putting out content, you're missing opportunity to help them and you're leaving them out to dry. You're leaving some people out in your community that have no idea that you might be the best solution for them. So positioning yourself as that spine care provider who combines skilled hands-on care, movement, education, functional recovery. Man, talk about a strong market position to be in as long as you are communicating that with confidence. And specifically, if you're putting out all content around younger individuals, that does not translate. The specificity of your messaging is critical. Letting people know you're speaking to them, like literally, well, who's that one older adult in your community you're speaking to? And putting out hyper-specific content around that. It doesn't mean you need to abandon everything else you're doing. It means if you're looking to help these individuals, be thoughtful and be specific with how you are going about putting out the messaging. Again, this can take place across your reels, it can take place across your report of findings, it can take place when you're asking for referrals from patients coming in. All of those items and all of those are great opportunities to help people understand. And of course, MD Connection with the evidence-based chiropractor, number one, referral program in chiropractic bar none, with those MD referrals. And MD, I don't care if it's an MD, a DO, a midwife, a doula, an NP, an ARNP, I don't care about the credentials. It's really about healthcare referrals. Are you reaching out to other healthcare providers? Are you letting them know that those individuals that might have limited options, older adults that can't take the medications, not good candidates or don't want surgery, man, talk about being a lifeline for some of these individuals that have chronic pain. They've been living in pain for a long time. Their functional ability is decreasing. And this is life-changing stuff because we know that when individuals slow down and stop moving, that's when bad things happen, right? There used to be the saying, you know, you don't get old and stop moving, you stop moving and get old. So you want to help people have good segmental, regional, and whole body motion. You wanna coach that along, and man, talk about a great opportunity to, and you'll literally see this with people as you're in practice 5 and 10 years, you're literally helping extend their life because they're slowing down, and when that happens, it's not a good thing. So when you can help these individuals stay mobile, stay active, stay independent, stay off medications, stay out of the OR, man, talk about a massive benefit you're providing to them their family, and your community at large. So keep doing it, keep getting out there. Uh, please, if you have not left a rating or review for this podcast, scroll on down and do so. If you have not connected with the Diabetes Reversal Group— type 2 diabetes, massive issue— they make it super easy to have a program where you just refer the patient to them. Um, there it can be financially beneficial for you while also getting the patient a really, really nice Evidence-based program, Diabetes Reversal Group. Connect with their team, see if this is something— use something so easy to add on in your practice. As well as OA, osteoarthritis, the Novopost OA Recovery Program. Fantastic program if you're looking to build out a line of business around osteoarthritis relief and recovery in your practice. We'll drop a link down below. Thank you so much for tuning in. Thank you for being a chiropractor. Have a fantastic week in practice. And I will talk to you soon.

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