What Your Spine Surgeon Hasn't Told You...

Did you know there was a study released in 2010 that found people with herniated discs in their lower back that received chiropractic care had the same results as those who underwent surgical intervention?

Yes, that is true. 

This study was done by JMPT, and it was titled "Manipulation or Microdiscectomy for sciatica: a prospective randomized controlled study." We know millions of people every year suffer from bulged or herniated disks that cause pain in their low back that can travel down their legs. 

And far too many people end up taking medications that do not work, perhaps injections that do not work, and ultimately they end up in surgery. Over 500,000 spinal fusions are performed each year in the United States. Surgical "correction" is when the disc that is pressing on the nerve is chopped away. Well, in this study the individuals went through chiropractic care were able to improve the disk, take the pressure off the nerve, and find sweet relief. 

Far too many people don't know about chiropractic. They've tried physical therapy. They've tried medications. They've tried injections. The think the only option left is to go under the knife, and it's not true.

This study took individuals that had failed all of those measures. People that had already gone through therapy, already gone through massage, already gone through medications, and then put them either into surgery or chiropractic. 

So if you are somebody out there that maybe has tried therapy tried injections and even tried medications and not got the relief you desired. Do not think that surgery is your only option.

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"these patients must have also failed at least three months of nonoperative management including treatment with analgesics (which is medication), lifestyle modification, physical therapy massage therapy, and or acupuncture." 

"most of the patients who are considered surgical candidates for the treatment of radiculopathy improved with standardized spinal manipulative care to the same degree as those who underwent surgical intervention." 

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There is a time and place (in a tiny percentage of individuals) where surgery is the best and only option. But the beauty of this study is that if you undergo chiropractic care, you have the same opportunity to improve as if you had surgery right off the bat. But here's the catch. If you go through surgery first, any chiropractic care after that is working on a spine that has been altered and or compromised. However, if you try chiropractic care first, and let's say that does not get where you need to be, then you still have surgery as an option down the road. So do not burn those bridges too quickly with surgery before it's necessary. 

Additionally, these researchers found that 10 to 20 percent failure rate for individuals who go through that microdiscectomy. And I think that might be a little bit conservative. 

So if you are somebody who has been suffering from low back pain, from sciatica, from challenges with the disks and the nerves in your spine do not dismiss chiropractic care. I know there are a lot of individuals out there that maybe aren't exposed to chiropractic care.

They end up going to their primary care doctor, who might not have the best tools for spine-related pain and a medication script as written. The patient of course doesn't get well because they have a mechanical problem not a medication issue. So the patient goes back because they still have pain. The primary care doctor says, "Why don't you go get an MRI since you didn't get well with the medication."  Lo and behold what do we find? The MRI shows a disc that is bulged or herniated, pressing the nerve causing pain. That doctor then correctly says, "A-ha that's the problem, a disc is pressing on the nerve." And what happens next? An injection loaded you up with steroids and hoping for the best. Many times that is not a permanent solution and that individual ends up going down that path towards surgical intervention. 

I want to bring it out there that there is an alternative path. Chiropractic needs to at least be a pit stop on that road. Research showing that chiropractic care can succeed at least to the same degree as surgical intervention is extremely important for people to understand because many times they may not be getting this information from their primary care doctor. 

So there you have it. 

What your spine surgeon may not have told you is that you need to try chiropractic care before entertaining the idea of any surgical intervention. 

It's smart. The research proves it, and you will ultimately be better for it. Chiropractic care has been shown to decrease intradiscal pressure, opening up those delicate holes  (foraminal canals) where the nerves travel out and has helped get millions of people well from injuries to the disks and the nerves. 

So if you have heard that an injection or that surgery might be in your future, be sure to try out chiropractic care first. Or if you have a loved one, relative, or a friend who has been guided down that path; be sure that you bring up chiropractic care to them. It just may save their life! 

Maintenance Chiropractic: Does the research support it or vilify it?

Maintenance chiropractic care: does the research support it or does the research vilify it? That is our topic of the day. And right off the bat, I would love to know if you prescribe or recommend maintenance care in your practice?

Maintenance chiropractic care has been around a long time, and there's always been, in my opinion, some questions regarding the criteria for it. Does it help people or does it not? And to date, there has been very scant research that looked at it in any capacity whatsoever.

But we were very fortunate in the year 2011 SPINE, the esteemed top-tier research journal, took a look at maintenance care.

So SPINE published a fascinating paper. The paper is titled "Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome." Again I'll say that one more time in 2011s SPINE put out a research paper titled "Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome".

I'm going to read a couple of quotes from the study that I believe to be very important and start to tell the story. The researchers found "nonspecific low back pain represents about 85 percent of low back pain patients seen in a primary care center and about 10 percent will go on to develop chronic disabling low back pain". So they just kind of setting the stage. 

We know historically, through The Evidence Based Chiropractor, 30% of a primary care doctors daily volume of patients are a spine or musculoskeletal patient. What they're saying is nonspecific low back pain represents about 85 percent of those individuals. What they're also saying is about 10 percent will go on to develop chronic disabling low back pain chronic pain over three months of course. 

Now the researchers also touch on something else that has chiropractors I think we could find very interesting. The researchers also found  "the postulated modes of action of manipulation include disruption of articular adhesions, improvement of trunk mobility, relaxation of hypertonic muscle by sudden stretching, the release of entrapped synovial folds, attenuation of Alph motor neuron activity, and enhancement of proprioceptive behavior and the release of beta-endorphins." This gets down to the mechanism of action on a chiropractic adjustment.

The third quote that I want to bring up from this paper is compelling. The researchers found "as patients did benefit from the maintenance treatments we believe that periodic patient visits permit proper evaluation, detection, and early treatment of an emerging problem, thus preventing future episodes of low back pain." 

Let me say that one more time. The researchers at SPINE concluded, "as patients did benefit from the maintenance treatments we believe that periodic patient visits permit proper evaluation, detection, and early treatment of an emerging problem thus preventing future episodes of low back pain." 

I'll tell you I've practiced in multiple multi-disciplinary clinics where I've interacted with orthopedic surgeons, neurosurgeons, physiatrist's you name it, day in and day out. And one thing that I will say is that over the last ten years I've noticed that, from a surgical perspective, a lot of the docs do have an understanding that spine related complaints are a result of long-term deterioration and degenerative changes with microtrauma throughout an extended period of time. 

Many times when people end up in the surgery realm or in the interventional realm they have degenerative processes and changes that have taken a long long time to get there. And what I have seen and found over the last 10 years is that MD's and DO's are more open than ever to the fact that these are ongoing processes. So if you, as a chiropractor, are doing the right thing to encourage the person to stay active and to increase segmental mobility. You know they're going to continue to live on planet Earth, gravity is going to continue to take its toll. But when you can do some things periodically to help that patient stay as active as possible, that's a huge win. 

At The Evidence Based Chiropractor, a lot of what we focus on is the research and building relationships with other healthcare providers from a relationship standpoint. No surgeon is excited to "go back in" on a patient with repeat surgeries. There is a law of diminishing returns with surgery. That is an understatement. So it's an essential for us, as chiropractors, to be able to articulate what the research has showcased regarding maintenance care. Now that doesn't mean you see the person one time every day for the rest of their lives. Don't get me wrong. Everybody is different. 

Think about 90% of people experiencing spine pain in their life, that's significant. And 10% of those individuals potentially going on to develop chronic disabling pain that often results in surgery. Well, its reassuring to know chiropractic care has the potential to break that cycle. 

Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome?

Chiropractic is 98% BS- A Response to Joe Rogan

Joe Rogan recently came out with a very very viral and popular podcast and video where he said 98 percent of Chiropractic is BS. Well, I am a chiropractor. I run The Evidence Based Chiropractor which is focused on chiropractic research; as well as working hand in hand every day with Johns Hopkins trained neurosurgeons and more. 

So, I wanted to create a short video for Joe and everyone else out there showcasing where he was right, where he might be wrong, and a few other tip so the next time that he visits a chiropractor he can have a better experience. I think that he had a lot of great points, he just was a little bit misguided. 

Some things that Joe was correct on is that for many medical doctors they don't focus on preventative maintenance of the spine. They're not talking about yoga, they're not talking about proper spinal hygiene, they're not talking about ergonomics and sitting up straight and really strengthening those core muscles around the spine. Joe is 100 percent correct that typically medical doctors don't talk about that. Now ironically, chiropractors are the best health care professionals to talk about exactly those topics. 

So if you are into CrossFit if you are into staying active later in your years; if you want to have the highest quality of life; proper spinal hygiene, flexibility, and taking care of your spine under gravity is unbelievably important. But again, ironically, during Joe's 98 percent of Chiropractic is BS rant, he failed to mention that chiropractors are the best health care professionals to give advice directly on those topics. 

Also Joe was correct that when a disk bulges or herniates, it can create a situation where that disk presses up against a nerve as it travels out of the spine column. This can result in nerve compression. If that happens in the neck it can cause pain, numbness, tingling, and more down into the shoulders arms and hands. Now if that compression, that disc pressing on the nerve, happens in a low back, it can cause pain, numbness, tingling symptoms down into the buttocks and into the legs. 

But again, rather ironically, Chiropractic has been universally promoted and stood behind as the primary treatment option, the first treatment option, that you should explore if you are suffering from a bulge or herniated disc. Groups like the American College of Physicians the American Pain Society, prestigious research journals such as Spine Journal, European Spine Journal and more have all made recommendations that chiropractic care, chiropractic adjustments, are one of the primary options that you seek if you happen to be suffering from a bulge or a herniated disc. 

Now obviously Joe did not have the best experience with his chiropractor. And it's not fair of me to comment specifically on his case because I don't have his medical records in front of me. But there are a few items that I think he can learn, as well as you, that can help you have the best experience the next time you visit a chiropractor. Number one is communication is key. 

Joe said he was treated for over a year and then I got the MRI and there was a bulging disc. He said he knew he had it the whole time. Now if you've been treated for more than six or eight weeks without improvement, if you have muscle atrophy, if you have worsening nerve pain, then absolutely an MRI may be indicated to be able to get a better look at the pathology or the problem that's causing that pain. 

But remember even after that MRI comes back with a bulged or a herniated disc quite often your best first line of defense that the research proves out time and time again is starting your care in a chiropractic office. So if you have any questions about this please comment below. I would love to hear back what you have to say. 

I would also love it if Joe eventually saw this video I would love to have a chat with him and see where I can provide value for him and more education regarding where chiropractic starts where chiropractic stops and what the current data says regarding the usage of chiropractic care. I hope you have a great day and I'll talk to you.

The Marketing Pardox- Pick Two: Fast, Cheap, Great

A or B. Morning or Night. 1 or 2. 

Choices.

As small business owners we are faced with choices everyday. This includes choices with our marketing. These choices often have individual opportunities and challenges. Unfortunately, there is a rarely a PERFECT answer.

It's really the classic chiropractic marketing paradox.

All marketing, including chiropractic marketing, is about choices.

Deciding between fast, cheap, and great is one of the toughest because as small business owners resources can often be tight. The important thing to keep in mind is that you can still have a fantastic result; as long as you know which choice you are hedging against.

But my knowing the chart below, and making an informed decision about where you will place your resources, you can accomplish your goals.

The really interesting thing about the marketing paradox is that it is pretty much applicable to all areas of our life!

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Back Pain, Chiropractic, and Disc Degeneration- Episode 40

This episode we explore the research highlighting the intersection of back pain, chiropractic care, and disc degeneration.

If you or someone you know has experienced back pain, then this is an episode you don't want to miss.