New Research on Chiropractic Care: Trends, Evidence Gaps, & Guidelines | Podcast Ep. 464

Foreign hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmay. This week we are back with research, a fantastic brand new study that is chiropractic and spinal manipulation. A review of research trends, evidence gaps and guideline recommendations. This, this is a good one. It's a new one and it sets the tone for where we are at currently in the literature. Before we get started, I wanna say a few words about neck care. Objective assessments of the cervical spine. That is what neck care is all about. Reliable assessments and exercises for neuromuscular control, proprioception, range of motion and sensory motor integration. Their hardware software combo is out of this world, off the charts. If you are serious about assessment tools for the cervical spine in your practice, neck care is a necessity. Neckcare.com, i'll drop a link down below in the show notes. But as I said at the top, today's episode is all about research. I'll drop a link to this in the show notes as well. The title again. Chiropractic and spinal Manipulation. A review of research trends, evidence gaps and guideline recommendations. This basically came out recently and it's synthesizing where is the meat of the data. So there is one off papers. We touch on a lot of those papers on this podcast. This was looking at what I'm gonna call the preponderance of the data, the preponderance of the research and saying what can we glean from that? So we know of course chiropractic is a profession that really focuses on the diagnosis and management of neuromusculoskeletal challenges and disorders with an emphasis on the spine movement based healthcare profession, as I like to say. Good news, chiropractic services in the United States anyway has increased quite a bit. 12 month prevalence back in the day 1980, my birth year, 4% all the way up to 7% in 2002. So between 1980 and 2002, almost a doubling of the 12 month prevalence and most recently in 2022, 11% of the population. So that is a jump by leaps and bounds. I hear these wacky things sometimes where people are like, well we're utilized 15 or 20%. I'm like, you gotta be kidding me. It's not even close to that, but it's approaching, it's getting closer. So from 4% 1980 in my literal lifetime up to 2022, 11% is a big jump. It's a meaningful jump and we're talking about literally hundreds of millions of people. A jump of 6, 7% is a really, really big deal. And hopefully that trend continues. I still say that that's low. Why do I say that that's low? Because we know the prevalence of just back pain alone is like 30%. We know the lifetime incidence of back pain is like 90%. It's. And we also know that in the absence of red flags, nearly every one of those individuals should be coming in to see a chiropractor. So we still have, I'm gonna say, a long way to go, but we've come a long way and that cannot be forgotten. And they kind of highlight that. Just around that same time, mid to late 1970s, chiropractic saw a pretty dramatic change. And that change has continued on to today. And that's happened within the profession and within where the profession sits in the landscape of healthcare. So there's just crazy amount of changes, like tons of research produced, obviously, chiropractors getting into multiply, multidisciplinary settings, more schools being started and being successful. There's just a lot of changes. And some of this of course, ties in to the flagship US Supreme Court decision to uphold a lower court decision, which basically was when the American Medical association was trying to get rid of chiropractic, as they've done to other professions. And they did that unsuccessfully with chiropractic, as they have done with other professions, and basically brought them in and under for that control. Separate conversation for a separate day. But since that time in the late 70s, there's been big changes within chiropractic. And one of those big changes was the development of the first clinical practice guidelines to recommend spinal manipulation for low back pain. And this was authored by the US Agency for Healthcare Policy and Research, or all the way back in 1994. So this is also what kind of blows my mind is you will see people online all day, every day. Dr. Google's all over the world like, there's no research about chiropractic. There's a clinical practice guideline way back, like decades and decades ago. So anytime somebody says that type of comment shows just how little they know. So that's a. It's a completely insane thought to say, well, there's no research that shows chiro. There's so much research at this point in time, as a matter of fact, we're going to talk about how many papers have been produced and it is thousands upon thousands upon thousands. Now, not all are the highest quality research, but that's the same in every research realm. So there's nothing different with who we are and what we do and a clinical practice guideline as well is a big deal. So when we look at that from 1994, it, it's not like they started researching chiropractic in 1993 and came out with a guideline in 94. It takes a long time, we're talking about the government here. It takes a long time for the US Agency for Healthcare Policy and Research to come out with a clinical practice guideline. And they came out with one suggesting spinal manipulation, spinal adjustments for low back pain all those decades ago in 1994. We have also seen as of 2019, 5% now of chiropractors practice within a integrative or hospital based setting. And there's increased, increased demand. Five percent's wild. I think back to 2011, 2012, when I joined my first multidisciplinary group, I think I was like one of 20 doctors in the world, you know, chiropractors really practicing within a large scale setting. And that has changed pretty dramatically with again 5% of chiropractors in integrative or hospital setting. And this, these changes and these trends. You know, there's also The Medicare aspect, 1972, the authorization of Medicare coverage specifically for subluxations and for adjustments. The long way to go there. But that's been around a while. And this study really was looking, or this paper really was looking at what are the gaps and what do we know. So they used a, what they call a state of the art approach to look at chiropractic research from 1972 all the way up to 2024. So that is a long timeframe. They identified 6,286 chiropractic related articles from 1972 to 2024, over 6,200 studies they found. And of course they whittled that down over time and they really took a hard look what I'm gonna say at these clinical practice guidelines as we highlighted earlier. And they included 33 CPGs or clinical practice guidelines. And there were some pretty big trends. There's some really great charts in terms of the year, what the condition was, what the recommendation was based upon that year in that condition. Really great charts and graphs in this study. So if you haven't checked it out again, I'll drop a link down in the show notes. Be sure to be sure to check it out. So spinal manipulation was most often they took away some items out of these 32 clinical practice guidelines or 33, excuse me, which is a lot over the course of time. So spinal manipulation, spinal Adjustments most often recommended for low back pain, neck pain, sciatica and lumbar radiculopathy, and tension type headaches. Probably no surprises there in the use of spinal adjustments for low back pain favored in over 90% of the statements, and the use of spinal adjustments for neck pain favored in 100% of the statements. So this is like overwhelming. This isn't like 51%, 52%, a majority, 50.1%, not even close. 90% of these clinical practice guidelines had a favorable recommendation for spinal adjustments for low back pain, 100% spinal adjustments for neck pain. Now, they also took a look because they brought this up to 2024. Remember, there were more recent recommendations that favored spinal adjustments for pregnancy related low back pain, postpartum related low back pain that just came out in 2022, cervical radiculopathy, 2018, cervicogenic headaches, 2019, fibromyalgia, 2022, tension type headaches, 2020 and 2022, and shoulder pain, 2021. And in some cases, these actually recommended older rec. These overrode older recommendations that advised again against spinal adjustments or adjustments, especially if we're talking extremity, spinal or extremity adjustments or chiropractic care for these conditions. So that's a pretty good array of conditions when we're looking at low back neck pain, radiculopathy, lumbar and cervical headaches, fibromyalgia, shoulder pain. This is a thick percentage of the population. Let's put it clearly. There's tens of millions of people, if not probably over 100 million people plus, struggling with that constellation. Not all of them have everyone, but at least one of those symptoms or conditions, that's a massive opportunity for us. And the bonus where I'm saying with this is these are literally what the clinical practice guidelines are saying. Yeah, go for it. We recommend this. This is not exploratory, it's not experimental. For something to get into a clinical practice guideline means that it's been around. It means that there has been a consensus of researchers, of the public, of the institutions saying this is the best way to take care of this for what we know at this moment in time. Clinical practice guidelines, of course, can evolve over time. But if the evolution has been stark from chiropractic never being in a clinical practice guideline up until 1994 to now having 33 clinical practice guidelines that recommend a pretty wide array of challenges and conditions that affect people all day, every day, when I'm talking about low back pain, neck pain, radiculopathy headaches, fibromyalgia, shoulder pain. These are not esoteric conditions. These are things that people are dealing with all day, every day that cause, you know, these are the top causes of dysfunction and disability. And they are directly what we can impact. And we need to stand in. We need to lean into that, Stand up and lean in to those recommendations, because there's a lot of people, and I'm gonna say probably 50% or more of people who, number one, have no idea that that's actually the case. Meaning there are clinical practice guidelines recommending adjustments in chiropractic care for these conditions, but they probably think it's the complete opposite, which is a big problem and really where education comes in. So clinical practice guidelines recommending spinal adjustments, they were categorized, you know, in terms of duration of symptoms, not for every single condition. And 100% of recommendations said yes for chronic low back pain and spinal adjustments, 88% said yes for acute and subacute low back pain and adjustments, 8, 80% said yes for general low back pain, regardless of duration and spinal adjustment. So these are all big, big deals. Now, they also touched upon something that ties into this. When we think about those individuals that might be skeptical or against whatever that's supposed to mean, you know, chiropractic, often it comes down to safety. So they highlighted the fact that terms such as legal vertebral artery and stroke have diminished pretty dramatically since 2010. And that trend has continued over time because. Drumroll. New studies show no definitive causal association between spinal adjustments and adverse vascular events such as cervical arterial dissection. No definitive causal association. Now, there can be things such as rib fracture. There are always risks with everything. But they're highlighting the fact that these are rare and they occur between 1, basically between 1 and 2 million adjustments, that there is some form of an adverse event. In their adverse events, they're saying fracture with absolutely no definitive causal association between SMT and stroke. That is a big deal. They also found a growing number of clinical practice guidelines recommending the use of spinal adjustments for a growing number of musculoskeletal conditions. We kind of touched on this a moment ago, but this continue to expand out the more that we continue to learn about the mechanisms of action, about how impactful an adjustment can be, from the segmental biomechanics to the peripheral nervous system, central nervous system, biochemical marker changes in the brain, gating pain. All of these items that we're continuing to uncover and reveal the true power of what we do with our hands, which is so wild we continue to evolve the clinical practice guidelines accordingly, which is a really, really great thing. Now, it is only recently that these guidelines have recommended spinal adjustments for both cervicogenic and tension type headaches, and this has been an interesting aspect because I'll quote them here. This early interest in subsequent CPG adoption for cervicogenic and tension headaches may be explained by the fact that neck pain, commonly treated by chiropractors and is present in approximately 90% of patients with these types of headaches. We probably know that inherently, but that number still shocked me. Reading it, 90% of patients with tension or cervicogenic headaches are going to have neck pain associated with it. So really being able to get in there and ensure that the segmental biomechanic I'm just going to cut to the chase. Delivering adjustments to those people in the absence of red flags is a really good idea because when they have neck pain and tension, slash cervicogenic headache, getting in there and addressing the I'm going to call the root cause, which is really a lot of segmental challenges in the biomechanics of those joints, is a really impactful thing that we can do. So their conclusions were Quote Most chiropractic research articles and CPGs regarding SMT have focused on spinal pain in adults. From 1972 to 2024, research has transitioned from legal topics and case reports to to randomized trials, observational studies and evidence syntheses. We found that there is substantial growth in the number and rigor of standard scientific methods of chiropractic research articles over the past 50 years, resulting in multiple CPG recommendations favoring SMT. These findings reinforce the clinical utility of SMT for spine related disorders. End quote. So as you can see, this is a fantastic article. There's a lot to dive into and again, I love some of the charts and graphs which are a lot easier just to look at than to try to read on this podcast. So I'll drop a link to this down in the show notes. If you have any questions, please feel free to hit me up. I will do my best to answer them. If you'd love to use research like this to build referral relationships in your community, that's what we do with MD connection at the evidence based Chiropractor. You can go over to the evidencebasedchiropractor.com and check that out. Additionally, if you want to get what I'm gonna call the most friendly user friendly EHR out there, turncloud is it minimalist design without being sparse practical yet elegant. Turncloud's design is really designed to give you the most efficient path in your everyday practice, stripping away anything that's not essential and making everyday functions simpler. Turncloud.com turncloud.com, i'll drop that link down below. No user manual needed. I hope you have a fantastic week in practice and I will talk to you soon.

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