CF 042: w/ Dr. Tyce Hergert – Chiropractic Maintenance Care / Chiropractic Preventative Care
Today we have a special return appearance from a friend of the show and we’re going to talk about chiropractic maintenance care also known as chiropractic preventative care. Chiropractors have recommended a regular schedule to their patients for generations but it was mostly as a result of experience and intuition. But what about research on the matter? We’ll get to it.
But first, here’s that bumper music
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
Be sure you have signed up for our newsletter slash email. You can do that at chiropracticforward.com and it lets us keep you updated on new episodes and new evidence-based products when they come out. Yes, eventually there will be some pretty cool things available through us. We won’t email any more than once per week and the value outweighs the risk. Kind of like in cervical manipulation. So just go get that done while we’re thinking about it.
You have confidently strutted right into Episode #42 and we are so glad you did.
I would really like to just turn this mic on and automatically be the #1 chiropractic podcast in the world but that’s not the real world, right? But I have to say that we continue to grow. I’m impatient and it’s never quite fast enough but we are continually growing and that’s always exciting. When you see the growth chart consistently going up and to the right, then hell yeah. Ka-bam shazam.
We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.
But first, my week has been nuts. When was the last time you tried to hire someone? It’s absolutely stupid these days. Honestly, I posted a job on indeed.com. I got literally 175 resumes, scheduled 15 interviews, only 7 showed up for the interview, and we have one really good prospect.
This is the second round by the way. We tried to hire for the front desk position a few weeks ago and went through 120 resumes. We actually hired a girl but then her dad got sick and after thinking it over, decided we weren’t a good fit. Lol. Can you imagine?
I don’t know if you can tell from this podcast or not but….I’m generally a pretty darn good guy and really care about my staff and care about people and care about making connections with others.
I don’t yell, I don’t fuss a lot. Even when they’re wrong. That’s just not my style. I don’t think I stink or anything having to do with body functions so, I can’t figure it out other than people have just changed. Or has it always been hard to find good help? All I know is that I’m having a hell of a time finding the right front desk personnel and it’s making me more than a little crazy.
Welcome Dr. Tyce Hergert from Southlake, TX
Now that we have all of that out of the way, I want to welcome our guest today. You could say we sort of know each other. In fact, we grew up in the same neighborhood from elementary school all the way through high school. Even though I was a couple years older, we definitely knew each other. He lived right next door to my best friend and we played football in his front yard pretty often.
We were at the University of North Texas at the same time living in Denton, TX and then we were down at Parker College of Chiropractic at the same time as well. If that weren’t enough, we have both served in statewide leadership positions for the Texas Chiropractic Association. In fact, Tyce is part of the reason I got involved in the first place.
He took it a step further than me though. Dr. Hergert actually served as the President of the TCA two terms ago and helped steer the profession to a historic 4 chiro-friendly bills passed in the state legislature that year. This is important because the bills that were passed in our favor prior to that would be basically zero, none, nada, goose-egg, zilch.
About an Integrated Practice
Dr. Hergert also runs an integrated practice down in Southlake, TX so he’s an excellent resource for our kind of podcast.
Some people kind of think he’s a big deal and there’s a good argument to be made for that but I’m not going to be the one making it because I’ve known him way too long.
Not only is he an ex-Pres for the TCA, but he also has the bragging rights of being a guest on 2 of our top five most popular episodes of all times here at the Chiropractic Forward Podcast. Those are episodes 6 and 11 with 11 actually being our most listened to episode of all time so congrats to Dr. Hergert on that.
If you enjoy his guest appearance on this episode, although I’d be a bit flabbergasted as to why you enjoyed it….you can always get more of Tyce on those. Again, I’m not sure why you’d ever want to do that. Lol.
Welcome to the show Dr. Hergert. Thank you for taking the time to join us.
Tell us a little bit about Southlake, TX for the ones unfamiliar with the Dallas/Ft. Worth area.
Tell us a little bit about running an integrated practice. What’s it like? Have you become more of an owner/administrator or are your elbow deep in treatment and the physical aspects of seeing patients all day every day still?
Getting To The Research
This first paper….I alluded to back in episode #36 but very briefly. We covered a little more in depth back in Episode #19 as well which posted back in April of this year. I think in light of a brand new paper that just came out, it’s worth covering this one again if you do not mind. It’s all about chiropractic maintenance and chiropractic preventative treatment.
It’s called “Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome?” and was published in the prestigious Spine journal.
For the purpose of this study, keep in mind that SMT stands for spinal manipulation therapy. Also of special note is that chiropractors perform over 90% of SMTs in America so I commonly interchange SMT or spinal manipulation therapy with the term “Chiropractic Adjustment.”
Why They Did It
The authors of this paper wanted to check how effective spinal manipulation, also known as chiropractic adjustments, would be for chronic nonspecific low back pain and if chiropractic maintenance and chiropractic preventative treatment adjustments were effective over the long-term in regards to pain levels and disability levels after the initial phase of treatment ended.
How They Did It
- 60 patients having chronic low back pain of at least six months duration
- Randomized into three different groups:
- They included 12 treatments of fake treatment for one month
- One group had 12 treatments of chiropractic adjustments for a month only
- They also had a group with 12 treatments for a month with maintenance adjustments added every 2 weeks for the following 9 months.
- Outcome assessments measured for pain and disability, generic health status, and back-specific patient satisfaction at the beginning of treatment
What They Found
- Patients in groups 2 and 3 had a significant reduction in pain and disability scores.
- ONLY group 3, the group that had chiropractic maintenance and chiropractic preventative treatment adjustments added, had more reduction in pain and disability scores at the ten-month time interval.
- The groups not having chiropractic maintenance and chiropractic preventative treatment adjustments, pain and disability scores returned close to the levels experienced prior to treatment.
Wrap It Up
The authors’ conclusion is quoted as saying, “SMT is effective for the treatment of chronic nonspecific LBP. To obtain long-term benefit, this study suggests maintenance SM after the initial intensive manipulative therapy.”
The authors’ conclusion is quoted as saying, “Spinal manipulative therapy is effective for the treatment of chronic nonspecific low back pain. To obtain long-term benefit, this study suggests maintenance Spinal Manipulation after the initial intensive manipulative therapy.”
Dr. Hergert, what do you have to say on this one? I’m not sure what there is to say except, “Told you so!”
What do you typically recommend to your patients as far as chiropractic maintenance and chiropractic preventative treatment care goes?
Actually, this one is a webpage linked in the show notes for you at ChiropracticForward.com in episode #42.
This article was compiled by Dr. Anthony Rosner, Ph.D and called Documentation Supporting Maintenance Care.
The article starts by saying that the RAND Corporation studied a subpopulation of patients who were under chiropractic care compared to those who were NOT and found that the individuals under continuing chiropractic care were:
- Less likely to be in a nursing home
- Were less likely to have been in the hospital the previous 23 years
- They were more likely to report better health status
- Most were more likely to exercise vigorously
Although it is impossible to clearly establish causality, it is clear that continuing chiropractic care is among the attributes of the cohort of patients experiencing substantially fewer costly healthcare interventions.
The next paper on chiropractic maintenance and chiropractic preventative treatment is by Dr. Rosner and talks about was a review of a larger cohort of elderly patients under chiropractic care and those not under chiropractic care. Basically, comparing monies spent on hospitals, doctor visits, and nursing homes They found the following: Those under chiropractic care saved almost three times the money those NOT under chiropractic care spent for healthcare.
- $3,105 vs. $10,041
Those under chiropractic care saved almost three times the money those NOT under chiropractic care spent for healthcare. $3,105 vs. $10,041
How’s it looking so far, Tyce?
Tyce, you’re going to like this one. Chances are, you’re probably going to want to tell people all about this one.
Let’s get to the newer paper I mentioned before. It’s called The Nordic Maintenance Career program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain – pragmatic randomized controlled trial and it was compiled by Andreas Eklund, et. al.
Why They Did It
The authors wanted to explore chiropractic maintenance and chiropractic preventative treatment in the chiropractic profession. What is the effectiveness for prevention of pain in patients with recurrent or persistent non-specific low back pain?
How They Did It
- 328 patients
- Pragmatic, investigator-blinded. Pragmatic. What does that mean exactly? According to Califf and Sugarman 2015, It means it is “Designed for the primary purpose of informing decision-makers regarding the comparative balance of benefits, burdens and risks of a biomedical or behavioral health intervention at the individual or population level” Meaning they are attempting to run a trial to inform decision-makers of responsible guidelines going forward. That’s it for the dummies like me in the room.
- Two arm randomized controlled trial
- Included patients 18-65 w/ non-specific low back pain
- The patients all experienced an early favorable result with chiropractic care.
- After an initial course of treatment ended, the patients were randomized into either a maintenance care group or a control group.
- The control group still received chiropractic care but on a symptom-related basis.
- The main outcome measured was the number of days with bothersome low back pain during a 1 year period.
- The info was collected weekly through text messaging.
What They Found
- Maintenance care showed a reduction in the number of days per week having low back pain
- During the year-long study, the chiropractic maintenance and chiropractic preventative treatment group showed 12.8 fewer days.
- The chiropractic maintenance and chiropractic preventative treatment received 1.7 more treatments than the symptom-related group.
Wrap It Up
The authors wrap it up by saying, “Maintenance care was more effective than symptom-guided treatment in reducing the total number of days over 52 weeks with bothersome non-specific LBP but it resulted in a higher number of treatments. For selected patients with recurrent or persistent non-specific LBP who respond well to an initial course of chiropractic care, MC should be considered an option for tertiary prevention.”
Maintenance care was more effective than symptom-guided treatment in reducing the total number of days over 52 weeks with bothersome non-specific low back pain.
Basically, both groups still underwent chiropractic maintenance and chiropractic preventative treatment. It’s like we tell people, stay on a schedule and you’ll do well. Wait until you hurt and the chances are good that you’ll spend the same amount getting over that complaint anyway.
This study showed that exactly except, over the course of just one year, the maintenance chiropractic care (preventative chiropractic care) people had 1.7 more visits but suffered pain almost 13 days less.
Bring it home
Are two appointments extra worth almost 2 weeks less of having pain in a year’s time? I say hell yes.
Are two appointments extra worth almost 2 weeks less of having pain in a year’s time? I say hell yes.
Dr. Hergert…what say you?
Lay some sage-like wisdom on us here and bring it all home for us won’t you please?
This week, I want you to go forward with the knowledge that, when you write “patient recommended preventative chiropractic care schedule going forward” you can do so confidently knowing your are right and there is research showing it.
You don’t have to recommend chiropractic maintenance and chiropractic preventative treatment simply because you heard to do that at school or because your old boss always did it.
You can make those recommendations because it’s best for your patients.
Dr. Hergert, do you have anything to add, this is probably your last time on the podcast after all.
Thank you so much for hanging out with us today, I was kidding of course. We will make time and do it again down the road.
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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.
The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Being the #1 Chiropractic podcast in the world would be pretty darn cool.
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:
Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
1. Senna MK, Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome? Spine (Phila Pa 1976), 2011. Aug 15; 36(18): p. 1427-37.
2. Rosner A. Documentation Supporting Maintenance Care. Chiro.org 2016; Available from: http://www.chiro.org/research/ABSTRACTS/Documentation_Supporting_Maintenance_Care.shtml.
3. Coulter ID, Chiropractic Patients in a Comprehensive Home-Based Geriatric Assessment, Follow-up and Health Promotion Program. Topic in Clinical Chiropractic, 1996. 3(2): p. 46-55.
4. Rupert R, Maintenance Care: Health Promotion Services Administered to US Chiropractic Patients Aged 65 and Older, Part II. J Manipulative Physiol Ther, 2000. 23(1): p. 10-19.
5. Eklund A, The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain—A pragmatic randomized controlled trial. PLoS One, 2018. 13(9).