Manual Therapy vs Combined Care? This RCT Changes Everything for Disc Herniation | #534

Hello and welcome to The Evidence-Based Chiropractor. I'm your host, Dr. Jeff Langmaid. On today's episode, we are back with another brand new piece of research that ties into probably what you see each and every day in your practice, which are individuals coming in with disc herniations and radiculopathy. This a fantastic study. It's titled Short-Term Effects of Manual Therapy Combined with Functional Magnetic Stimulation in Individuals with Lumbar Disc Herniation with Radiculopathy. It's a randomized clinical trial. We always love to see those RCT, which means it is, generally speaking, pretty high-quality research. We're going to dive into this brand new study, talk about the take-home messages, how you can communicate it to your patients in your practice, and much more on today's episode. Before we get started, I will give a few shoutouts to some partners and sponsors of this podcast that I hope you'll support. One of them is Leander Tables. They're gonna hook you up with $1,000 off their Series 950 using the code EBC2026. You can visit their page in the show notes down below, connect with their team, let 'em know you're a listener, you'll save $1,000. Additionally, Shockwave Centers of America, $500 off one of their units. And a free cart. $1,500 in savings just by being a listener to this podcast. Thank you, Shockwave Centers of America and Leander Tables for being partners. I'm gonna drop those links down below, and if you are listening, I encourage you to connect with their teams. But as I said at the top on today's episode, we are talking research. Each and every day you walk into your practice, I'm pretty sure you have patients coming in with disc herniations and radiculopathy, and it's all of the same things we are accustomed to. They have pain shooting down their leg. They can't sit very long, they can't drive, they can't sleep. And some of them probably come in with MRIs already done that showcase to you very clearly at L4, L5, L5-S1, there's a disc herniation. Many of them probably have already tried medications. Many probably have already been told they might need surgery as the next step. But the interesting part is Many of these individuals do not end up having surgery. In fact, clinical guidelines show that conservative care, chiropractic care, what you provide is the best first-line treatment for lumbar disc herniation with radiculopathy. But the big challenge is, even with great care in your practice, some patients get better more slowly, some get stuck with persistent pain, and others kind of bounce between treatments trying to find something that will work for them. I'm sure you've heard this story from an innumerable amount of people in the amount of time that you've been in practice. And the researchers asked a very interesting question knowing this, which is what happens if we combine traditional manual therapy with a newer technology called functional magnetic stimulation? And they're basically saying, could that combination actually produce faster pain relief, potentially better nerve function, and/or better overall outcomes? So today we're gonna highlight this RCT, which is called, which is a randomized clinical trial, published in 2026, so literally hot off the press, that tried to answer these exact questions. So by the end of this episode, I hope that you'll walk away with a few things. One is understanding the key findings from this study that we'll discuss. Two are, I'm gonna say, the numbers that us as chiropractors should know, and most importantly, how to use this research with people in your community and with the patients in your practice. So This study was looking again at individuals with lumbar disc herniation with radiculopathy. Now, many people with disc herniation, disc protrusion, disc bulges, fragments, you name it, extrusions, may not have radiculopathy. Good for them. That is a good thing. But there are a certain subset of individuals that have the herniation with the radiculopathy. So classic scenario, disc material pushing outside the normal space and compressing physically, uh, or chemically irritating a nerve root that can lead to symptoms that you're very well acquainted with— sciatic pain down the leg, numbness and tingling, neurological symptomatology, limited mobility, you name it. So this research study notes that about 5% of adults will experience lumbar disc herniation with radiculopathy in their life, most commonly between the ages of 30 and 50. So that's a— I want to just highlight that stat right there for a moment. 5% of people between 30 and 50 will experience lumbar disc herniation with radiculopathy. Now, we all know if you line up 100 people between 30 and 50 years old, you take MRIs of all of them, you're going to see disc bulges, disc herniations on an overwhelming majority. And for most people, most of the time, that's nothing to get too excited about. Nice to take preventative measures, but there's nothing catastrophically wrong. Time and gravity are undefeated, as I'm sure you've heard me say. But 5% of individuals having radiculopathy with that herniation between 30 and 50, that's significant. If you live in a town with a population of 100,000, or, you know, in the greater area of where you live, let's say it's even 25,000, 50,000, 100,000. Let's say you're in a metropolitan area like me, 500,000, a million. There's a lot of people between 30 and 50 years old, and 5% of them is a really big number. That could be literally thousands, and in some cases tens of thousands of people in your community, in your circle of practice right now that might be struggling with a condition that you are the best solution for as a frontline option. So that's massively powerful. And, you know, I'll kind of come back to this later, but it just makes me always think, are we doing, are you, I'll put the onus on you, Doc, are you doing everything you can to tell that story? Do, do as many people as possible in your community that are struggling with this issue know that you're the best solution? Most of the time that should be and can be done through content, through email marketing, through video, through blog posting, and then maybe a portion through paid ads. But don't do the 90% paid ads, 10% of everything else. Unless you love spending money on paid ads and you love spending more money on new patient acquisition each and every year for diminishing returns, then by all means do that. But don't sleep on the basics. Please make sure you're getting out there with great video content. Make sure you're getting this message out there for referrals and reactivations. I'll say, ahem, ahem, using Patient Pilot, the best patient communication engagement tool in chiropractic bar none, which is 50% off right now. You can check that out at smartchiropractor.com. But make sure you are doing the things necessary to get the results that you want, and that's helping as many people as you can. So in this study, the most common disc levels that had, uh, the disc herniation as well as the radiculopathy was something you see every day. Again, L4, L5, L5-S1. Um, and although many patients improve within 4 to 6 weeks, there are a larger portion than probably we'd like to admit that do develop chronic symptomatology, and that chronicity creates a lot of challenges. So that is really where better conservative upfront strategies become really, really valuable, is allowing somebody to repair and recover in the acute stage before they transition into that chronic stage. So the researchers in this study wanted to test whether combining two approaches could actually improve the outcomes. One, manual therapy that include core spinal mobilization, neurodynamic mobilization, movement-based nerve mobilization, uh, very well known to help reduce pain and improve mobility, of course. Second was FMS, functional magnetic stimulation. FMS uses high-intensity magnetic fields to stimulate motor neurons and create muscle contraction. So The magnetic field strength used in this study ranged from 0.5 to 3 Tesla, which is strong. It's pretty strong. That's strong enough to induce electrical currents in nerves and muscles. So the hypothesis was— and to put that in perspective real quick, different kind of technology. But you think about a 3 Tesla MRI, right? That's top of the line. So that's pushing some juice, right? And even at even a half Tesla, 0.5, we've all seen images. They're not the best compared to a 3 Tesla, but that's enough to like get through the body and really be able to visualize what's going on. So from a stimulation perspective, that's a pretty good amount of juice. So their hypothesis was relatively straightforward: if manual therapy addresses mechanical nerve irritation and magnetic stimulation influences neurological and neuromuscular processes, then combining them might actually produce greater improvements overall. And that's what they wanted to test.

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This was a randomized controlled trial. It's one of the strongest study designs that they have in any clinical research. They had 40 adults, MRI confirmed lumbar disc herniation with radiculopathy. And basically they assigned these individuals to 2 groups. One group was manual therapy plus functional magnetic stimulation. Group 2 was manual therapy alone. Each of these groups, 10 treatment sessions over 3 weeks, and they looked at a few different outcomes kind of before and after. They looked at pain intensity, functional disability, neuropathic nerve pain, nerve sensitivity, and mobility. And these were measured using tools that you probably have heard of many times, which is the numeric Pain Rating Scale, Roland Morris Disability Questionnaire, the S-LANSS, uh, Neuropic Pain Scale— I hadn't heard of that one— and then of course the good old straight leg raise testing. So really well-designed clinical trial, and the numbers are where things get really interesting. So let's tackle pain reduction first. Patients receiving manual therapy plus magnetic stimulation, they did improve much more than manual therapy alone. As a matter of fact, lumbar pain decreased by 3.75 points in the combined treatment group and 2.2 in the manual therapy group alone. And importantly, the combined treatment exceeded the minimum clinically important difference, meaning that patients actually felt a meaningful improvement. It wasn't, you know, there's statistically significant, there's clinically significant, and then there's just the numbers a little bit better. This was in the clinically important or clinically significant realm. It— for radicular leg pain, uh, big one that we all care about, leg pain dropped 4 points in the combined treatment group, 1.8 5 points in the manual therapy alone. So it's more than double the improvement. Key point here as we continue to go through these, you're going to notice the manual therapy group continues to improve. They're doing really good alone. It's just that the FMS seemed to, at least so far, uh, bolster those results. Functional disability— disability scores dropped really dramatically. Patients receiving combined treatment improved by 9.95 points. Manual therapy alone, 5.8 points. So big improvements across the board, but combined was a little bit better. And neuropathic pain, particularly important, uh, both groups started around a 14 to 15 on the scale. Combined treatment dropped to 4.6. Manual therapy alone dropped to about 7. So that's really, really meaningful. And let's not forget about the straight leg raise. Combined treatment group SLR improved by 21 degrees, manual therapy group by 12 degrees. So big difference in neuromobility. So why are these improvements happening? Well, there's a couple different mechanisms that the researchers propose. First, that manual therapy and neurodynamic mobilization, they reduce the mechanical stress on the nerve. They help improve nerve gliding, reduce compression, decrease neural mechanosensitivity. But the functional magnetic stimulation may be adding another layer. The stimulation appears to influence both peripheral and central pathways. Now, so does an adjustment, however, in a different way. So there are studies that suggest magnetic stimulation may be able to reduce inflammation, improve microcirculation, enhance cellular metabolism, and activate, uh, endogenous opioid pathways. So the body's natural pain relief systems. And when these two, manual therapy and FMS, are combined, mechanical and neurological, it might create a multimodal neuromodular effect. So you really influence mechanically and neurologically at the same time. So, you know, first things first with this study, manual therapy works. Like, let's make that super clear. I wanna make that very, very clear. The manual therapy group in this study improved significantly in every single way. Pain decreased, function improved. But the research did suggest, you know, something important, that the future of musculoskeletal care may have a multimodal component. Chances are you're probably already doing multimodal approaches in your practice. You might be doing a functional movement assessment. You might be providing exercise. Maybe you're doing stim. Maybe you have additional modalities, spinal decompression, whatever it might be. There's a lot of tools at your disposal. Soft tissue work, don't forget about that. There's a lot of opportunity here. This one just happened to focus on the manual therapy and the FMS. So patients do— we've probably seen, you've probably seen in your practice, they respond best when there's multiple mechanisms because everybody's dynamic. And a lot of times it's not just one thing, right? People come in with baggage, you know, however long they've been alive, you know, 20 years, 30 years, 40 years, 50 years, 70 years of baggage. Injuries, toil, stress, mechanical difficulties, you know, time, gravity, over— you know, all of those things add up to when somebody walks in your front door. And people are dynamic, and that's a beautiful thing. And it also is a wonderful thing that we as chiropractors have the opportunity to address and help people in such a diverse way. So, you know, you have things available— manual therapy, movement, neuromodulation, exercise, patient education. And when all of these strategies align No surprise, outcomes do tend to improve. So letting people know in your community, in your practice, that disc herniations often improve without surgery— often, not always— disc herniations often improve without surgery. Research consistently shows conservative care helps most patients recover. This is really important, and I just, I can't overstress this. Many people, if they see the word herniation on a report, they think it means surgery, and they think don't get adjusted. That is over 50% of human beings. You know, that's— it's probably 99% of human beings. But in places where chiropractic is even, you know, very available— you know, United States, UK, Australia, Canada— it is still a majority of people who think disc herniation means do not go to the chiropractor. Not go to the chiropractor. So are you getting that message out there to your patients and to your community? Also letting people know the goal is not just reducing pain. It's improving function, and that takes time. Don't get people out of your practice the day that they get out of pain. They haven't changed habits, and chances are the underlying reasons what drove them into your office are still there. So, you know, don't— you focus on function, focus on function. Yes, address pain, but focus on function and let people know that movement-based therapies improve nerve mobility and they can reduce irritation and help the body recover naturally. Make sure you're putting the words together so people really, really understand. And you could do this during a report of findings, of course, patient education, content marketing, all of those things. So the big takeaway here is that this was a randomized clinical trial that showcased patients with lumbar disc herniation and radiculopathy did really well both with manual therapy alone and even better with manual therapy combined with functional magnetic stimulation. Both helped, but the combined gave a little bit better improvement overall. So getting out there, telling that story, and as more research like this comes out, it continues to strengthen the evidence behind who we are and what we do. Because when it comes to treating disc herniations and nerve pain, helping the nervous system move, adapt, and recover naturally, what we do is often exactly what people need. We just need to be able to get out there, have great research, but also be able to turn that research like we did today into action. So I love the study. I hope you did as well. As we wrap up, big shout out to NovoPulse and their OA Recovery Program. If you have people coming in with osteoarthritis, which is probably 70% of people walking through your front door, The NovoPost OA Recovery Program is a fantastic way not only to attract more of that, but to help those people at a higher level. Connect with their team by the link down below. And the Diabetes Reversal Group— diabetes type 2, big, big, big issue. Diabetes Reversal Group, massive success, massive success. Super easy to implement because they do all the hard work. Click on down below, watch the video, and connect with their team. It'll be well worth your time to explore for your practice. If you've not left a rating or review for this podcast, I would love it if you would scroll on down, take a moment, and do so. 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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