Chiropractic Before or After a Spinal Injection: The Facts!

Suffering through the pain associated with a disc herniation can be debilitating. When a spinal disc is pressing on a nerve it can result in excruciating pain that may seem like it will never go away.

Quite often medical doctor’s recommend nerve root injections (also known as Epidural Steroid Injections) if they see on an MRI that the disc is pressing on a nerve. But how many times do they also recommend chiropractic care with the injections? Not often enough.

Over 9 million spinal injections are given every year for spine-related pain. That is over 24,000 every day! Injections are often given when a patient is suffering from radiculopathy or a compressed nerve root.

Over 24,000 SPINAL injections are given every day!

I believe there is a better, research-supported way to find relief. But first, let's set the stage a bit.

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The 3 tissues that can pinch a nerve and cause pain are:

• Spinal Discs

• Bone Spurs and Osteophytes

• Ligament Overgrowth and Hypertrophy

Whether the compression is caused by a disc, ligament, or bone- the nerve doesn't care. It's aggravated and causing pain. Statistically, many of these people are going to visit their medical doctor to find relief. Over 30% of the patients in a primary care doctors office are there for treatment of a musculoskeletal complaint.

When they go to see their medical doctor with radiculopathy, the medical doctor may prescribe an anti-inflammatory, and perhaps physical therapy. Then an MRI is ordered. 

What do they find? 

Well, if it's a disc pressing on the nerve, the next stop for that patient is quite often a physiatrist, pain management doctor, or neurologist for a spinal injection. The goal of the injection is to decrease the inflammation and "numb" the area, which may provide temporary relief at best. And what happens when the injections stop working? It's off to the surgeon.

I believe there is a better path to relief.

I thought it would be interesting to look at the research showcasing the use chiropractic or injections for the treatment of radiculopathy. First up was a study from JMPT in 2013. The title is "symptomatic MRI-confirmed lumbar disc herniation patients comparing high-velocity low amplitude spinal manipulative therapy or image guided lumbar nerve root injections."

 And guess what the researchers found?

The researchers found, "both of the treatment groups had significant decreases in their pain scores at one month with a 60 percent reduction for the spinal manipulative therapy cohort and a 53 percent reduction for the nerve root injection group".

The spinal manipulation group had much better outcomes than the nerve root injection group.

Additionally, they found, "lumbar nerve and injections are commonly used, and accepted treatment option for these patients whereas lumbar spinal manipulation as a treatment for disc herniation remains controversial amongst some healthcare professionals." 

That tells us that there is some work to do on the relationships building front. With the volume of nerve root injections and all the risks- people should be exploring conservative care, such as chiropractic, first!
(in the absence of red-flags and extenuating circumstances)

Keep in mind this is a symptomatic, MRI-confirmed lumbar disc herniation. The disc is placing direct pressure on the nerve. And while both groups found improvement, the chiropractic group, the spinal manipulation group, ultimately outperformed the nerve root injection group. That's exciting!

The fact that a conservative care option can outperform a ton of steroids being dumped on an inflamed nerve is impressive.

Additionally, another study titled "spinal manipulation post-epidural injection for lumbar and cervical radiculopathy: a retrospective case series" had some interesting results. For instance, happens if you give an adjustment to someone who has already had an injection? 

Unfortunately, many people believe they are past chiropractic when they get the injection. And the researchers found the opposite is true.

They found, "the majority of the patients showed a positive response with only one treatment procedure".

Additionally, the researchers found, "theoretically epidural injections are proposed to address the inflammatory and central components of spinal pain whereas spinal manipulation is proposed to address the mechanical and neural aspects of the pain syndrome". 

Spinal manipulation is proposed to address the mechanical aspect of the pain, and you're getting physical motion into the joint with many chiropractic techniques. But they also cited the neural elements such as the impact to a central nervous system and the opening of the foraminal canals, decreasing the pressure on the nerve.  

Finally, the researchers found, "this data suggests that spinal manipulation post-epidural injection is a safe non-surgical procedure to use in the treatment of a patient with radiculopathy of spinal origin." 

So not only do many patients get well with chiropractic care before (or instead) of getting an injection, but even those individuals who went through an injection still saw improvement with chiropractic care.

This research is important information for your patients to know and is also as a great conversation starter for the providers in your community. Those conversations may save dozens, if not hundreds of people from going through expensive and sometimes dangerous, injections. 

We've featured both of these pieces of research as monthly research for our members of The Evidence Based Chiropractor; which is the complete system for relationship building with other healthcare providers in your community. Click here to learn more!

Click Here to Download a Powerful Free Research Brief

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! 

10X Your Next Seminar Using This Instagram Hack

At Rockstock in Huntington Beach, one of the big things that I noticed was that it seemed like everyone knew everyone. But, there are many events and seminars that feel a bit lonely. It can make you feel like your in a silo. But, I want to tell you that you can use Instagram to connect with other docs that are close by to you and make connections, so you're not feeling alone or siloed at the events and seminars you attend.

And the easiest way to do it is when you take out your phone, go to Instagram. Then search by "places." And when you search by locations you can tag precisely where you're hanging out. So recently I was at the Hyatt Regency in Huntington. I can tag that location and Instagram will give me a list of everybody that's posted (in chronological order) and tagged the Hyatt Regency. So I was able to find a bunch of other docs that were posting pictures from Rockstock. And then I can comment on the photos, shoot them a direct message, follow them, etc. If you go to a unique event and you don't know anybody there whatsoever you can just hop on Instagram. 

Especially if it's an event that has a couple of hundred chiropractors- you'll notice that quite a few start to post pictures. People are engaged. People are pulling out their phones and taking photos of slides, and many of them are then putting those on Facebook or Instagram. 

So I just want to give that quick tip for you. If you're at a seminar or a conference, and it feels like you don't know anybody,  Instagram can make it a lot easier to connect with like-minded docs and make a few friends in the process. 

The 10 Best Chiropractic Website Tips

Our chiropractic website tips are here to make your website stand-out and attract more new patients. 

via GIPHY

Click Here to Download a PDF Version of These Tips!

1) Consistent Blogging- content is KING

At this point EVERY chiropractic website should contain an active blog.  On the internet (and with search engines), content is KING.  Keeping an up-to-date blog filled with relevant content is absolutely essential to having a website that is working for you and your practice. I recommend updating your blog at least 2x month with a medium length piece of content.

2) Be Smart With Your Web Address- use the right keywords so people can find you on Google

Your URL, or web address, is a surprisingly overlooked component of your SEO. The best URL’s are brief and contain your business name. Think apple.com or facebook.com. In other words, you want to avoid anything that resembles www.JonesFamilyChiropracticandRehab.com/home-1-2-4-gck Keep it simple and as easy to remember as possible!

3) CTA- have a CLEAR call to action or next step for your visitor

Have you noticed anything when you visit Google, Yelp, and many of the other most popular website in the world. How many actions can you take a google.com? One! There is one clear call to action. When someone arrives at your website, make the ONE action you want them to take very apparent. Pro-tip- “wellness awaits you” is not a compelling call to action. 

4) Practice Information- this may sound obvious, but make sure your phone/address/email are easily accessible

If someone goes to your website on their smartphone are they able to press a button and call your office immediately? If not, you may be missing out on a tremendous amount of new patients. You would be shocked at how many chiropractic websites don't have this simple functionality. 

5) Email Opt-In- build an on-going list of potential new patients with a pop-up box or welcome mat

You have probably heard of “funnels” or email sequences. But before you start turning prospects into patients with these tools you need something…their email! Be sure to have a solid email collection tool on your website such as sumo.com 

Click Here to Download a PDF Version of These Tips!

6) Install Google analytics- as Nike says, “Just Do It”

You can only improve what you measure. Google analytics is completely free and gives all of the statistics you need to refine and improve your website. It’s simply the best free tool available to check the performance of your website. 

7) Load a Facebook Pixel- essential for re-targeting and having high converting FB ads

A facebook pixel is an invisible piece of code on your website that you can use to improve the response of your ads. And if you are spending any money on ads, you want them to work! To learn more about re-targeting click here. 

8) Mobile Friendly- over 50% of people will view on their phones, make sure it’s looking good

Duh. Is your website look great on an tablet or smartphone? Or is half the content hanging off the side of the screen? If your website isn't mobile responsive, then you are losing a ton of traffic and may even be being penalized by Google in the search engine rankings. 

via GIPHY

9) Social Media Account- link your social account to your website and vice-versa

Don’t forget to link your social media accounts to your website. If someone visits your website they should easily be able to check out your presence on social media. This will help build your audience and establish rapport. 

10) Speed- check your speed using a tool like Google PageSpeed. This helps with SEO

For many potential patients your chiropractic website is their first contact to your brand. Simply having a website is no longer enough. But, having a great website does not require $1,000 per month or your own web developer. 

There you have it. Ten of best steps you can take to ensure your website stands out front the crowd and attracts more new patients. 

Click Here to Download a PDF Version of These Tips!

Research That Matters: Neck Pain and Chiropractic Adjustments

Are chiropractic adjustments safe for people with neck pain? Well, let's take a look at the research and find out! 

Top research journals such as the Annals of Internal Medicine, SPINE, and the Journal of Manipulative and Physiological Therapeutics have shown chiropractic adjustments to be both extremely safe and effective for the treatment of neck pain.

Chiropractic adjustments are considered safe and effective for the treatment of neck pain.

Not only have they shown chiropractic adjustments to provide more relief than most medications, but the effects are long-lasting.

Click below and watch the video the learn more-