The Evidence Based Chiropractor Blog

Hundreds of chiropractic marketing and research articles to help you grow.

Jeff Langmaid 6/12/14 Jeff Langmaid 6/12/14

The Dangers of NSAID's - by The Evidence Based Chiropractor

NSAID's are taken by millions of Americans each and every day. Below is another great infographic from Mercola which outlines just how dangerous these over-the-counter drugs can be.

Did you know that current research shows spinal manipulation to be a clinically superior treatment option than Diclofenac for spine pain? A few months ago, members of The Evidence Based Chiropractor received a monthly MD Research Brief from SPINE Journal which was a double blind RCT comparing spinal manipulation to Diclofenac. The authors concluded that, "“Final evaluation showed manipulation being significantly better than NSAID and clinical superior to placebo.” Are you a member yet?

-The Evidence Based Chiropractor is the leading DC/MD marketing and outreach group in the world. Our service is dedicated to increasing chiropractic utilization by showcasing research. Marketing to medical doctors through research is efficient, cost effective, and can dramatically improve your incoming referrals. Join us. Lets grow chiropractic together.

Jeff Langmaid 5/29/14 Jeff Langmaid 5/29/14

The Business of Spinal Fusions- by The Evidence Based Chiropractor

Spinal fusions are big business in the United States. In 2013, over 87% of the surgical spinal procedures involved a fusion. The US performs over double the amount of yearly fusions compared to Canada, the United Kingdom, Western Europe, and Australia. Nearly 500,000 fusion are being performed this year (nearly 250,000 were performed in 2001).

Are these procedures providing superior outcomes for our patients? It would appear the answer is no.

In 2006, a Medicare physicians panel found that "it was less than reasonably likely that spinal fusion would provide a long-term benefit for patients suffering from degenerative disc disease." Medicare never translated this finding into their policies, however, other insurers have picked up on the fact that spinal fusion utilization may be far greater than its effectiveness.

Blue Cross & Blue Shield has now excluded spinal fusion as a covered procedure for degenerative disc disease without gross instability. They recommend at least 3 months of conservative spine care. Cigna also has a similar recommendation. Even the International Society for the Advancement of Spine Surgery said “increasing success and optimism may be leading some surgeons to overuse procedures beyond what the current state of medical evidence really supports.” Also of note is between 2006-2009 the cost of a spinal fusion nearly doubled. This is in part due to the surgical implant companies increasing the pricing of instrumentation.

Many health care facilities are building multidisciplinary health care centers. These spine centers include medical doctors, chiropractors, and other allied health practitioners. Preliminary data shows that these spine centers are providing a higher quality of care, with great patient satisfaction, good outcomes, and a model of care based on best practice and evidence based guidelines for spine care. Whether or not a spinal fusion is right for you is a decision to be made between you and your doctor. However, growing evidence would suggest that conservative spine care may be more effective for many individuals.

Jeff Langmaid 5/23/14 Jeff Langmaid 5/23/14

Lumbar Stenosis- by The Evidence Based Chiropractor

A recent (2014) study in SPINE examined the use of decompression without fusion for lumbar stenosis. They found that decompression without fusion can be just as effective as methods involving fusion, but has significant cost saving advantages and fewer complications. Generally, this decompression is accomplished by a laminectomy.

If fusion is warranted, they encourage the use of bone graft as opposed to instrumentation (hardware). It seems as though bone grafting is also more cost effective while providing similar outcomes. The study found that complication rates rose significantly for patients who underwent a laminectomy with fusion compared to those who just received a laminectomy.

It makes sense to me that limiting the use of instrumentation/hardware would yield decreased complications and perhaps even slight outcomes advantages. Instrumentation (while necessary with certain procedures) permanently alters the bio-mechanics of the spine and places vertebral segments adjacent to the surgical site at increase risk for degeneration.

Additionally, I believe it is important to stress that previous research has shown that chiropractic care (specifically flexion/distraction technique) has provided relief from lumbar stenosis. The complication rate for conservative chiropractic care is significantly lower than surgical intervention, and both have proven to be effective treatments. The degree, or amount of stenosis (and its impact on function) will play a large role in determining whether conservative care is an option for each individual patient. The bottom line is that physicians should be aware that surgical intervention is not the only treatment option available for patients with lumbar stenosis.

Jeff Langmaid 5/19/14 Jeff Langmaid 5/19/14

Should I Consider Chiropractic or Physical Therapy? - by The Evidence Based Chiropractor

Patients suffering from spine pain can often be unsure of the best treatment available. Two of the most common choices are chiropractic care and/or physical therapy. In this blog we will investigate the differences between these two options and learn which may help you the most.

Physical therapy for spine complaints generally includes passive modalities (ice, heat, electrical stimulation, ultrasound, etc) combined with stretching and strengthening exercises. Research shows moderate evidence (depending on the longevity and region of complaint) for these adjunctive treatment modalities. Physical therapy is usually performed by a physical therapist or physical therapy assistant under a script from your primary care physician. Interestingly, many health professionals have found that these modalities are best used after proper biomechanics have been established.

The hallmark of chiropractic care is spinal manipulation or adjustments. Chiropractors are the undisputed experts in this form of treatment due to their extensive training. This is one of the reasons chiropractic care and spinal manipulative therapy have a distinct advantage over physical therapy for the conservative care of spine complaints. Adjustments provide a direct effect on biomechanics of the spine and as we touched on earlier; establishing improved biomechanics is the first step in spine care. Of specific note is not all adjustments are high velocity. Many adjustive techniques utilize slower movements. Your chiropractor can speak with you regarding which adjustive technique will best serve your needs. Chiropractic care is administered by a Doctor of Chiropractic. Your chiropractor is able to diagnose, evaluate, treat or refer without the aide of another physician; although they may communicate and work with many primary care providers in your area.

After establishing an improvement in segmental motion (biomechanics of the spine) your chiropractor may choose to use some passive modalities. Additionally, he/she may provide you with instruction for stretching and strengthening exercises. In many research studies chiropractic care and spinal manipulative therapy have resulted in superior outcomes when compared against physical therapy for spine complaints. In my opinion this is for two distinct reasons. First- the adjustment or spinal manipulation is one of the most powerful, safe, and effective tools for influencing the spine. Second- chiropractors have the training and expertise to not only provide a spinal adjustment, but also to tailor either passive modalities or an exercise program to your exact needs (if necessary).

For many patients, chiropractic care is the best choice possible for conservative spine care. The information above is just the tip of the iceberg regarding conservative care of the spine, but highlights the major differences between physical therapy and chiropractic care.

A growing body of research continues to show the safety and efficacy of chiropractic care for various spine conditions. Reputable primary care physicians are referring to chiropractors each and every day but remember, you don't need a script to make an appointment with a doctor of chiropractic today!

Jeff Langmaid 5/15/14 Jeff Langmaid 5/15/14

A Randomized Clinical Trial Comparing Medication, Acupuncture, and Chiropractic Adjustments- by The Evidence Based Chiropractor

In 2003, SPINE produced a randomized clinical trial comparing medication, acupuncture, and spinal manipulation for chronic spine pain. The medication which was predominately used in this study was either Celebrex, Vioxx, or paracetamol. Chiropractic care was predominately high-velocity, low amplitude adjustments at a frequency of two treatments per week.

They looked at both chronic cervical and lumbar spine pain. The average patient in the medication group had pain for 4.5 years; for the acupuncture group it was 6.4 years; and for the spinal manipulation group the average duration of pain was 8.3 years. The maximum treatment duration was 9 weeks.

The researchers found that "...for chronic spinal pain syndromes, it appears that spinal manipulation provided the best overall short-term results, despite the fact that the spinal manipulation group had experienced the longest pretreatment duration of pain."

This finding is extremely significant, as many patients with chronic pain end up being referred to a pain management physician or neurologist. Often, these physicians choose to treat chronic pain with increasing quantities of medications, eventually leading the way for narcotics. Orthopedic surgeons and primary care physicians encounter patients with chronic spine pain every day in practice. It is imperative they know the benefits of conservative chiropractic care before relying on the medications afforded by a pain management doctors.