CF 109: 10 Back Facts & How Does Chiropractic Perform When Integrated?
Today we’re going to talk about helpful and unhelpful myths concerning low back pain and then we’ll cover a paper on just how well chiropractic care performs in an integrated, clinical setting. Good stuff on tap today.
But first, here’s that sweet sweet bumper music
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.
We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.
I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
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You have found yourself smack dab in the middle of Episode #109
Now if you missed last week’s episode, we talked about why MRIs are on the outs and we talked about the ease of the arm squeeze test. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
Well, nothing blew up this week. So……we’re taking our blessings and moving forward. One of the biggest tricks is to not take life for granted and we learn this in various ways as we age. It’s an on-going process of education here.
I think one of the best looks a person can project is one of gratitude. Are you truly grateful? Grateful for what you have? For your family? Are you grateful that you got to do something as basic as just wake up and greet the day?
It’s hard for me to remember to be grateful for the little blessings in life every day. Maybe it’s narcissistic on some level but I wake up and start thinking about my stuff. What I have to accomplish. Is my schedule full? Is it going to be a long day?
I have had a difficult time for a little while now and I’m trying to center myself more now. Trying to see the blessings. Trying to be grateful and carry that with me. Sustained throughout the day.
Not all days are created equally. Sometimes I do great. Sometimes someone pissed in my Post Toasties. And that’s OK.
I’m Christian so it’s nice to fall into that. A message of hope and love never hurt anyone. Not anyone I’ve ever met anyway.
Now, Before we dive into the reason we’re here, it’s good to support the people that support evidence-informed practitioners. Well, ChiroUp certainly does just that.
If you don’t take advantage of the deal I’m about to offer you, I think you just might be crazy.
Regular listeners know I’ve used ChiroUp since for well over a year now. I’m going to tell you want it is and then share a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months. So listen up!
ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean:
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This save you so much time – no more explaining & re-explaining your patient’s care, because they have access to it right there at their fingertips.
You can be confident that your patients are getting the best possible care because the reports and exercises are populated based on what the literature recommends and isn’t that reassuring? All of that work has been done FOR you by people that are deep into the research.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice.
If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL and, to sweeten the deal, you can use code Williams99 to pay only $99/month for your first 6 months
That’s ChiroUp.com and super saver code is Williams99.
Let’s kick off the research portion of our program with a paper titled “A Hospital-Based Standardized Spine Care Pathway: Report of a Multidisciplinary, Evidence-Based Process” by Paskowski et. al(Paskowski I 2011). and published in the Journal of Manipulative and Physiological Therapeutics in February of 2011. Old man river right there but it’s OK. Still very relevant.
Why They Did It
“The purpose of this report is to describe the implementation and results of a multidisciplinary, evidence-based, standardized process to improve clinical outcomes and reduce costs associated with treatment and diagnostic testing.”
I can just imagine myself or a colleague approaching an FQHC or a rural health clinic….or simply marketing to the medical field…..and using this report to show more depth to their argument on why we need to be integrating. On why we need to be treating their non-complicated musculoskeletal patients.
How They Did It
- The clinic was Jordan Hospital where they implemented a multidimensional spine care regimen using the National Center for Quality Assurance Back Pain Recognition Program as the foundation.
- Patients were triaged and patients were categorized into 1 of 5 different classifications based on history, exam, directional preference exercise, spinal manipulation, traction, or spinal stabilization exercises.
- There were 518 patients included in the study
What They Found
- 430 of them were treated with chiropractic for about 5.2 visits at a cost of $302.
- The mean pain rating went from 6.2 down to 1.9 out of 10
- 95% of the patients rated their care as “excellent.”
Wrap It Up
“Jordan Hospital Spine Care demonstrated the quality and value of care rendered to a population of patients. This was accomplished with a relatively low cost and with high patient satisfaction.”
This is from 2013. We’ve covered this paper in the past but it’s relevant. This integrated treatment has improved somewhat but it’s nowhere near as prevalent as it should be. We should have DCs active in integrated settings in every town of every state here in the US.
Ask yourself why it is that we don’t? The research is there. The Federal gubment is covering it through the VA. So….why?
My opinion is that there is still too large of a population of chiropractors claiming they can do things that are not backed by anything more than case studies. Just my opinion.
If our talking points stay true to acute and chronic pain, non-complicated conditions of the neuromusculoskeletal system, and what the literature says we can do about them, then we are on solid footing. We are standing on the shoulders of people that have done the research. That’s where we should be. At all times. Get away from the fringe and come to the center.
OK, our last item this week is called “Back to basics: 10 facts every person should know about back pain” by O’Sullivan et. al(O’Sullivan PB 2019). and published in the British Journal of Sports Medicine in December of 2019.
And that makes it smokin’ hot like a Texas chili cookin contest. Sizzlin hot, people.
Now, this isn’t really a traditional research paper but more of an update of the information and current thinking if you will. With that being said, what we’ll do is simply hit some of the more interesting highlights.
They start by pointing out the impact of low back pain which we should all be pretty familiar with by now. They say low back pain maintains its prevalence because there a lot of misunderstandings and myths running rampant like little gremlins about the condition.
Gremlins just mess the place up right? So do unhelpful beliefs.
These authors identified 10 common beliefs that are unhelpful about low back pain and then outlined how they can influence behavior and psychological responses to pain. And then countered with 10 big facts about low back pain that we MUST be aware of.
Now that you got the rules of the game, let’s get the ball kicked off here.
Here are Ten Unhelpful Beliefs about Low Back Pain – follow along and see if you currently hold any of them yourself.
- it’s usually a serious medical condition.
- it will become persistent and deteriorate later in life
- persistent low back pain is always related to tissue damage
- Imaging is always needed to detect the reason for low back pain
- pain related to exercise and movement is always a warning that harm is being done to the spine and a signal to stop or modify activity.
- it is caused by poor posture when sitting, standing, and lifting
- it is caused by weak ‘core’ muscles and having a strong core protects against future low back pain. – I bet they got a bunch of you on that one!!!
- repeated spinal loading results in ‘wear and tear’ and tissue damage
- pain flare-ups are a sign of tissue damage and require rest
- treatments like strong medications, injections, and surgery are effective, and even necessary, to treat low back pain.
OK, how’d you do? How’s your information on low back pain shaping up? Remember, these are all MYTHS. Not truths.
I love when the authors say the following, “Unhelpful beliefs may lead to unhelpful behaviors such as avoiding: normal spine postures (ie, slouch sitting), movement (ie, flexing the spine) and meaningful activities (ie, spine loading, physical activity, social activities, and activities of daily living and or work). Unhelpful beliefs may also lead to unhelpful protective behaviors such as muscle guarding, bracing ‘core’ muscles and slow and cautious movement.”
This is powerful stuff folks. It really is.
They also say, “Unhelpful LBP beliefs may contribute to a negative mindset regarding LBP, leading to pain vigilance, fear of engaging in valued activities and worries for the future. Coupled with a lack of self-efficacy and adaptive skills to effectively self-manage, these factors can impair mental health (eg, cause stress, anxiety, depression).”
Every word is gold. When I have a patient come in from another practitioner telling me that they were told they have the spine of a 60-year-old when they’re only 35……man oh man……that kind of garbage just makes my pee hot.
My staff can see it on my face when new patients tell me stuff like that. I just sink. Because I know what those words did to this person’s mentality. And for what reason? Why? To scare someone into more visits? To try to set the scene for some kind of seriousness that is typically not even there to start with? It’s low-quality care. It’s scare-care. And it’s damaging.
To end on a positive note, here are TEN HELPFUL facts about low back pain.
- Fact 1: LBP is not a serious life-threatening medical condition.
- Fact 2: Most episodes of LBP improve and LBP does not get worse as we age.
- Fact 3: A negative mindset, fear-avoidance behaviour, negative recovery expectations, and poor pain coping behaviours are more strongly associated with persistent pain than is tissue damage.
- Fact 4: Scans do not determine prognosis of the current episode of LBP, the likelihood of future LBP disability, and do not improve LBP clinical outcomes.
- Fact 5: Graduated exercise and movement in all directions is safe and healthy for the spine.
- Fact 6: Spine posture during sitting, standing and lifting does not predict LBP or its persistence.
- Fact 7: A weak core does not cause LBP, and some people with LBP tend to overtense their ‘core’ muscles. While it is good to keep the trunk muscles strong, it is also helpful to relax them when they aren’t needed.
- Fact 8: Spine movement and loading is safe and builds structural resilience when it is graded.
- Fact 9: Pain flare-ups are more related to changes in activity, stress and mood rather than structural damage.
- Fact 10: Effective care for LBP is relatively cheap and safe. This includes: education that is patient-centred and fosters a positive mindset, and coaching people to optimise their physical and mental health (such as engaging in physical activity and exercise, social activities, healthy sleep habits and body weight, and remaining in employment).
If you want to help patients get better faster, in a sustainable way, you educate them in a positive, hopeful, and productive way. A million visits and scare care is old school and it’s not right.
How about we measure a good chiropractor by how quickly and effectively he can get a person well and recovered and managing any remaining issues at home rather than how many times they can run a patient through their doors? Wouldn’t that be refereshing?
My PVA is at about 10. The nationwide PVA through ChiroUp is at about 7.5. What’s yours? How good are you at getting people well and turning them loose until they hurt again?
Food for thought my friends.
Remember the evidence-informed brochures and posters at chiropracticforward.com.
I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few.
It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient.
And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health!
At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.
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We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.
We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
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About the Author & Host
Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
O’Sullivan PB, C. J., O’Sullivan K, (2019). “Back to basics: 10 facts every person should know about back pain.” British Journal of Sports Medicine.
Paskowski I, e. a. (2011). “A hospital-based standardized spine care pathway: report of multidisciplinary, evidence-based process.” J Manipulative Physiol Ther. 34(2): 98-106.