In this episode of The Evidence-Based Chiropractor, Dr. Jeff Langmaid reviews the newly released Spine20 Recommendations 2025: Sustainable Spine Care for All, a global policy and consensus paper from the Spine20 alliance. He outlines the massive global burden of spine disorders—affecting roughly 1 billion people and projected to rise—highlighting the economic and workforce impacts. The episode breaks down the paper’s four recommendation domains: (1) Sustainability – urging nations to adopt evidence‑based spine care models supported by registries, incentives, public‑private partnerships, tele‑rehab, digital screening tools, and AI; (2) Public Health Integration – proposing a tiered, stepped‑care model that embeds spine care into primary care and prevention programs, positioning chiropractors in early conservative tiers; (3) Occupational Health and Safety – introducing the PREMIUM acronym (Prevent, Recognize, Educate, Modify, Implement, Unite, Monitor) to reduce work‑related back pain and guide workplace programs; (4) Capacity Building – calling for expanded multidisciplinary rehabilitation for spinal cord injury aligned with WHO Rehab 2030. Langmaid connects each domain to chiropractic strengths—early conservative management, patient education, activity restoration, biopsychosocial care, and non‑pharmacologic treatment—arguing that chiropractors are well‑placed to lead the shift toward sustainable, data‑driven spine care. He outlines practical opportunities for practices: developing workplace spine programs, documenting conservative pathways, adopting digital monitoring and outcomes tracking, and leveraging AI‑enabled tools. The episode concludes with encouragement for chiropractors to align their services with these global trends, communicate their value to health systems and employers, and seize growth opportunities, while also delivering sponsor acknowledgments.
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Hello and welcome to The Evidence-Based Chiropractor. I'm your host, Dr. Jeff Langmaid. This week we are back with another brand new research study just came out in 2026. It's called Spine20 Recommendations 2025: Sustainable Spine Care for All. Great study laying out where we're at today, what the future could look like, and I think a lot of applicability to to the global shift that's occurring within spine care, and that can apply directly into the care that you give and how you communicate it out in your community. So we're going to dive into this study and much more on today's episode. As we get started, big shout out to our partners at Leander Tables. You can save $1,000 off their Series 950 using the code EBC2026, visiting their page down in the show notes, connecting with their team. Fantastic tables, hooking you up with $1,000 off. And Shockwave Centers of America, $500 off and a free cart one of their Shockwave units. Great units. Dr. Dan over there will connect and take care of you. And by being a listener to this podcast, you can continue to save. So thank you so much for tuning in, and thank you to our partners. There'll be a few more at the end of today's episode as well. So if you thought about what the biggest opportunity in spine care is right now, uh, I, I'm not gonna— I don't think it's a new technique. It might not even be a new modality or even a new piece of technology. But it really might be the global shift that's occurring in how spine care is delivered. And that's what this paper talks about. Of course, we'll drop a link down in the show notes. Spine20, which is a global alliance of spine societies, they released their 2025 policy recommendations. And at first, you know, I can eye roll on this a little bit and it sounds like, well, high-level policy talk and then not really my thing, but there are some very real and practical implications for chiropractors in everyday practice in what they released. So we're going to talk about the massive global burden of spine disorders. We're going to talk about why current systems are failing patients and where conservative spine care providers like you and me fit into the future of spine care. So we'll talk about this kind of in plain English, show you exactly why it matters to your practice. So again, the title: Spine 20 Recommendations 2025: Sustainable Spine Care for All. It's not a clinical trial. It's not a randomized controlled trial. It's a global policy and consensus paper developed by Spine20. So their goal was to create what they call an evidence-informed policy recommendation for G20 nations to improve spine care worldwide. Now, why do they care about this? Well, most of it because the numbers are really, really staggering. So according to this paper, spine disorders affect almost 1 billion people worldwide, and, and that number is projected to exceed 1 billion people by 2025. So if you sit a moment, just let that sink in. This is not like a niche issue. This— you've heard that low back pain, spine issues, number one cause of disability, but this is one of the largest global healthcare burdens that we face. So the authors of this paper emphasized that low back pain and neck pain are leading causes of disability, as we've said. They're major drivers of labor market exclusion, and they're significant contributors to rising healthcare costs. And despite all of that, spine disorders remain underprioritized in almost every national health policy. And that's the gap that Spine20 is at least trying to start to close by publishing a paper like this. So if we pull out some of the numbers that we as chiropractors should really care about, the massive global burden is the headline here, right? The paper highlights that 9— about 900 million people currently live with spine disorders. 620 million are affected by low back pain alone, and that's continued to expect to rise at least through 2050. So this reinforces something that I think we all know clinically, that the demand for spine care is not shrinking. If you have human beings in your community, there is no shortage of opportunity for you to grow as a practice. I'm gonna say it's really the communication of who you are and what you do to as many people as necessary to hit your own growth markers is really the challenge. We'll talk about that separately. But the economic and workplace impact is really substantial. And, you know, spine conditions can contribute to a variety of things. And none of these are great. High absenteeism from school and work, welfare dependence, reduced workforce participation, and rising healthcare expenditure. So for practice owners, it's not just a clinical issue, this is an economic one as well. And the paper actually repeatedly notes current gaps, which are fragmented care pathways, no kidding, underdeveloped rehab access, no kidding, high out-of-pocket costs, especially for advanced interventions, no kidding, low public health awareness, overreliance on passive care and medication. So if it sounds familiar, it really should, because it mirrors, I think, what we all see each and every day. So Spine20 structured their recommendations. If we start to dive into recommendations, well, okay, that's great, but what are the recommendations? There's 4 primary domains, and we'll walk through each one individually. Domain 1 was what they called sustainability, and the core recommendation was that Spine20 recommended countries implement sustainable Evidence-based spine care models. I wonder if they'll become sponsors of the podcast. Just kidding. But they're evidence-based spine care models. They— that are supported by registries, incentives, and public-private partnerships. So the problems that they identified in this domain were that workplace injury rates remain really high, that rehab services can be unaffordable at times, national spine registries are often absent, they're not even existing, and care pathways are super fragmented. So it's a systems problem, you know, not just a clinical one. So they recommended national spine registries, incentivized outcome targets, tele-rehab expansion, very interesting, public-private partnerships, digital screening tools, and AI-supported platforms. So yeah, AI is specifically mentioned. So they are taking what I'm going to say is a forward-facing view of this. And that's, that's kind of cool. So we'll dive into more, but I want to hit all the domains here to kind of set the stage.
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So domain number 2 was public health integration. This was a big one. SPINE20 recommends integrating spine care health into primary care, into public health policy, and into prevention programs. So the problems that they identified were the underrecognized in benefits, they were undermeasured in healthcare systems, and often treated episodically with analgesics. Again, this is looking at sort of the global, of course that's not what you do in your practice, but the global, which is really important. And also lacking early rehab pathways. So this is huge because it highlights that the reactive care model, that major med is doing is dominating and it's not working. So they recommended a tiered spine care model of education, a community, community level include things like education, reassurance, activity, at a district level, which is multidisciplinary assessments, limited imaging, advanced imaging, rehab, and then referral centers. So it was really a stepped care model. And us as chiropractors could, if we wanted to, fit squarely into the early conservative tiers. So that's, that's inspiring. Domain number 3, occupational health and safety. It's extremely clinically relevant. So back pain is identified as a leading cause of work loss globally, not heart disease, not diabetes, but back pain. So the, the factors, risk factors, sedentary behavior, repetitive lifting, static posture, workplace stress, uh, you know, aging workforce, fear avoidance beliefs, basically your reception area all day, every day, are the risk factors, right? So they have what they proposed as what they called a PREMIUM, and we'll get through that, it's an acronym, approach. P, prevent sickness absence. R, recognize symptoms early. E, educate patients. M, modify work. I, implement guidelines. U, unite stakeholders. And M, monitor adherence. And this is a really chiropractic-friendly model as I was going through that. So lots of good stuff. Domain number 4, capacity building. This was specifically relative to spinal cord injury. So basically, they highlight that spinal cord injury care is under-resourced, that diagnosis is often delayed, and the paper called for expanded rehab multidisciplinary teams, a WHO Rehab 2030 alignment, and improved monitoring systems. So, you know, the big takeaways here kind of now That's the frameworks. Now let's dive into why this matters. Well, it matters because the global healthcare system is actively moving, actively moving towards earlier conservative and integrated spine care. And that's exactly where we live as a profession. So this paper reinforces, in my opinion, what I call a ton actually of chiropractic strengths. 1, early conservative management. 2, patient education. 3, activity restoration. 4, work-focused care. 5, biopsychosocial approaches. 6, non-pharmacologic management. And if anything, this document actually continues to validate the direction that many of us are already moving as chiropractors. So the trends highlighted suggest that there's going to be a growing demand for workplace spine programs, for early intervention practices, for conservative spine pathways, for digital monitoring— pretty cool— and for outcomes tracking. So practices that align with these trends will be ahead of the curve. And I'll repeat those one more time because some of these you probably already are doing, some of them you might not be. Doesn't mean you need to do it tomorrow, but the more that you can, as we talked about last episode with community talks, when you're giving the answers to the questions that people already have. So here's where I'm going with this. If you are going in to speak with a healthcare organization, with a care provider, with an institution about becoming a referral source, becoming integrated, or whatever that looks like, if you are already doing every single thing that they're gonna ask about and you have data for it, you're the choice, you're in, it's good. If you hit half of them, half is good. If you're not doing any of them, tough uphill battle, right? So workplace spine programs. We talked about this on last week's episode with upper cross syndrome. Early intervention, that's kind of what you do inherently. Conservative spine care pathways, just kind of documenting that a little bit. Like we all know what we do, but we often don't have it really well documented. Documented. It doesn't need to be crazy, but just getting that, starting to think about getting that documented, people will ask for that eventually. Digital— and then the two that probably may not be in your practice today: digital monitoring, outcomes tracking. So I love this study because it really highlights, uh, practical application, meaning when you can emphasize early screening, fear avoidance assessments, work status tracking, return to work planning. These are themes that are strongly supported in the paper and are going to make it, if you're doing it, really easy to communicate with other healthcare organizations, with other business organizations, with other whoever, uh, as time goes on. So workplace spine care, clearly a major priority globally, and it supports things like corporate wellness programs, which you might already be doing or could be doing, ergonomic consults, might already be doing, could be doing, occupational partnerships, injury prevention workshops. These are all massive growth both opportunities for your practice. And I'll go through this one more time. Corporate wellness programs, ergonomic consults, occupational partnerships, injury prevention workshops, all of them, you don't have to do all of them, but each of them individually are just massive opportunities. This paper also speaks about tech and AI that we highlighted quickly. You know, telehealth rehab, digital platforms, AI-powered screening. You know, practices that adopt this type of technology will already be aligned with where global spine care is heading. So the recommendations send a super clear message, in my opinion, that the spine care is moving towards things like early intervention, conservative management, you know, data-driven systems, digital solutions. And that should be really good news to you as a chiropractor because much of this future is probably already built into what you're doing each and every day. So now is really the opportunity to communicate it better, to kind of take stock and make sure you're measuring things appropriately, make sure it's actually integrated and not just like a bolt-on to your practice. And then positioning your practice within this evolving global model, because spine care disorders are not going away. They are growing. And the healthcare providers, the chiropractors who align with sustainable and function-based care are gonna be the ones that are leading the next decade of spine health. So I hope this paper inspired you. I thought it was really cool to see a study that that bluntly had nothing to do with chiropractic directly really reference a lot of what we are doing. So I hope that the spine care world catches up to where we have been as chiropractors, and this is a good step in that right direction. Before we wrap up, big shout out to our partners at NovoPulse and their OA Recovery Program. I'll drop a link down below. Connect and learn more. Osteoarthritis is walking through your door each and every day. NovoPulse has a turnkey program to help you help more of those people. Speaking about walking through your front door each day, type 2 diabetes, Diabetes Reversal Group, fantastic program, massive results, and no implementation needed from you. You can click the link down in the show notes, watch the video, and learn more. If you've not left a rating or review for the podcast, I would love it if you would take a moment and do so. That helps more docs and more people find this podcast. So if you'd leave a rating or review, that would be awesome and deeply appreciated. Whether it is your first listen or your 530-some-odd listen, I would love it if you would do so. Thank you so much. And as thank yous conclude, thank you 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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