CF 026: Chiropractic Better Than Physical Therapy and Usual Medical Care For Musculoskeletal Issues - chiropracticforward

CF 026: Chiropractic Better Than Physical Therapy and Usual Medical Care For Musculoskeletal Issues

Chiropractic Better Than Physical Therapy and Usual Medical Care For Musculoskeletal Issues. 

Today we’re going to talk about chiropractic better than physical therapy and new info and new articles coming out on how chiropractors fit into an integrated care protocol and we’ll explore chiropractic vs. physical therapy according to research. Which should be the first referral in the medical kingdom and why? We hope you’ll help us by liking, sharing, and retweeting our content.  

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.  

Before we get started, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. On another note, we are accepting speaking engagements so shoot us an email at dr.williams@chiropracticforward.com so we can connect. 

I need to thank Dr. Chris Carr out in Pittsburgh, PA with the Health Nuts Podcast for having me as a guest on Tuesday, May 29th. I had a blast. We talked all about stroke risk, or the lack thereof, and all kinds of good stuff. Make sure you check it out at the link in the show notes

Click here to listen to Health Nuts episode 37 with guest Dr. Jeff Williams

 http://directory.libsyn.com/episode/index/id/6644712/tdest_id/531106

Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. That’s a tall order but that is the goal. When you know the research, which is what we talk about every week, then you start to speak to colleagues in a more effective way. With stats, research, and confidence. 

You have scooted into Episode #26

But first, my week has been one of renewal I’d say. Don’t we get into a rut sometimes where we go through our lives in a robotic sense? I’m as guilty of it as the next person. As I’ve said here on the podcast before, I’m a big music fan. I used ot be a traveling musician. I wrote and recorded the bumper music you just heard. i am a sculptor. Check out River Horse Art on Facebook. I build live edge furniture if you’d like to see the stuff at Amarillo Furniture and Live Edge Customs on Facebook. I have lots of interests but…..don’t we fall into ruts regardless of how many hobbies or interests we have?

The trick, I think, is outside influence. The right kind of outside influence. Undoubtedly, many of you are non-Christian and I’m not the kind of Christian to tell anyone they’re right or wrong but, if you’ll hang with me just a sec, maybe I can make sense to the non-christians as well. 

On the way to work this morning, I was listening to a podcast by a preacher named Jenetzen Franklin. Now, I usually listen to murder mysteries, music, news, or silence but, every now and then, I just get a calling of sorts to listen to something faith based. Well, that happened this morning. 

This episode was called Don’t Call This Common. Franklin was talking about how we go through our days in a robotic mentality many times. He was saying how, nothing blessed by God can be called common. From our relationships, family and friends, our interactions, our offices, our patients, our work in general. Nothing we do is common. Our days, our jobs, our profession, and our results are extraordinary indeed. What would out patients do without us in their lives? You don’t have to be a Christian to understand how lucky we are to wake up in the morning. How lucky we are to kiss our spouses and out kids. Or how lucky we are to work in a job that makes us happy and allows us to make such a difference in others’ lives. 

It is truly extraordinary. 

Thank you for indulging me there for a minute and allowing me to share my heart with you for a little bit. It’s one of those days of renewed energy and renewed perspective for me. I hope my thoughts spark something similar in you as well. 

Let’s get to some articles and research to get you thinking and speaking in the right direction. 

Last week, we discussed a new paper by Dr. Goertz which had to do with how integrating chiropractors into treatment for Vets suffering from musculoskeltal issues. Mostly low back pain(Goertz C 2018). 

Here’s an article written by Reuters’ writer Lisa Rapaport on the paper(Rapaport L 2018). 

It’s called “Adding chiropractic to back pain care may reduce disability.” I’d like to say from the top that I’m unhappy with the title. What’s this “May reduce” garbage exactly? If Lisa knew about 1/10th of the research, she’d leave out the questioning tone of the title. That’s like saying that heart surgery MAY save lives. You know, some people die during heart surgery so……it doesn’t ALWAYS work does it? Some people don’t have completely outcomes from low back fusion so….low back surgery MAY work. Follow me? 

Dr. Goertz had a couple of interesting quotes included in the article. The first quote is, “Spinal manipulation (often referred to as chiropractic adjustment) may help heal tissues in your body that form as a result of injury, decreasing pain and improving your body’s ability to move correctly.” The other was, “It is also possible that manipulation impacts the way that your body perceives pain through either the brain or the spinal cord and/or decreases pain from muscle strain, inflammation and/or spasm in the muscles next to your spine.”

Great quotes from a great doctor and a researcher that has been a game-changer for our profession. But, wouldn’t you say there are questions in those quotes as to exactly how Chiropractic works in the first place? What is it about chiropractic or spinal manipulation that actually caused the effectiveness and the reduced pain? Like, what it is exactly? 

Take for example the cardiologist: they are effective because they go in and place a stent or there was blockage in one of the arteries feeding the heart so they either cleared it or bypassed it and now it works better. There’s no doubt as to why they were effective. 

I think until we come up with a unified, provable reason as to why we chiropractors get the results we get, we may always be struggling to explain ourselves in a manner that resonates and makes sense to colleagues in the medical field and to the layperson with back pain out in the general population. 

This needs some work and some resolution in my humble opinion. 

We have mentioned this next paper before so we won’t go through the whole thing again but, when you are discussing chiropractic with medical professionals, it’s clear the MDs prefer to send their musculoskeletal patients to the physical therapist first before taking the next steps toward shots and surgery. That’s progress from immediate medication and shots but, it may not be the most effective referral they can make. What can we do to show that chiropractic better than physical therapy?

Let me first say that I love physical therapy and physical therapists. This is not a competition in my opinion. Yes, we cross over into each others’ territory daily but, that is business and that is life. I think physical therapy most definitely has it’s place. Post-operative rehab is the spotlight in my mind for physical therapy. What would surgical patients do without physical therapy following minor and major surgeries? They are game changers. 

Now, if we talk about pain caused by discs or something originating in the spine, my 20 years has shown me they have little effectiveness in this area. We all know Mckenzie and core building exercises are beneficial. We all know this stuff. You don’t need to be a physical therapist to figure that out. But effectively treating discs…..I have not seen that much at all. For discs, in general, chiropractic better than physical therapy.

In fact, I had a patient that was treating with us. She was a young, healthy, fit, athletic girl having a significant, MRI-confirmed disc issue. We worked and worked with her to the point that she was feeling great. Without consulting yours truly, she got the idea in her head that, if she added physical therapy to the regimen, her results would be twice as good as they already were. 

Well, she went to one appointment with the PT and came back in tears, unable to walk or function, and no matter how much we worked with her from that point, we were never able to get her back to where we had her. She ended up having low back surgery. In her 20’s. Again, in this case, chiropractic better than physical therapy.

Of course that’s not the common experience of patients that go to PTs and I’m not discouraging going to PTs. As I said, we all have our function and certain things we are truly effective in treating. A truly integrated approach is the ideal way to work it. 

But let’s be clear, this podcast is called “Chiropractic Forward.” We aren’t here to advocate for physical therapists. They have plenty of folks doing that. We aren’t here to bash them either by the way. Our function is chiropractic advocacy based on research and evidence. 

In this systematic review and meta-analysis by Ian Coulter, et. al., he concludes by saying, “ There is moderate-quality evidence that manipulation and mobilization are likely to reduce pain and improve function for patients with chronic low back pain; manipulation appears to produce a larger effect than mobilization. Both therapies appear safe(Coulter I 2018).” So…..chiropractic better than physical therapy.

Now, when we argue that patients should be seeing a chiropractor prior to, or in conjunction with, a physical therapist, keep in mind this study from 2017 called, “Association Between the Type of First Healthcare Provider and the Duration of Financial Compensation for Occupational Back Pain” by Marc Andre Blanchette et. al. (Blanchett M 2017). 

The study focused on patients in the workers comp system. What practitioner they saw, how long and expensive was treatment, and did they have reoccurrence of the pain?

The authors concluded by saying, “The type of healthcare provider first visited for back pain is a determinant of the duration of financial compensation during the first 5 months. Chiropractic patients experience the shortest duration of compensation, and physiotherapy patients experience the longest. These differences raise concerns regarding the use of physiotherapists as gatekeepers for the worker’s compensation system.” Bam….chiropractic better than physical therapy.

Chiropractors…..can I get a hell yeah? Maybe an Amen?!?

What about this paper from 2014 called “Cost-effectiveness of manual therapy for the management of musculoskeletal conditions: a systematic review and narrative synthesis of evidence from randomized controlled trials,” by Tsertsvadze(Tsertsvadze A 2014)?

When comparing manual therapy with usual medical care and physical therapy, the authors concluded the paper by saying, “Preliminary evidence from this review shows some economic advantage of manual therapy relative to other interventions used for the management of musculoskeletal conditions, indicating that some manual therapy techniques may be more cost-effective than usual GP care, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability.”

And lastly for this topic, there’s this paper from 2003 from Korthals-de Bos, et. al. called “Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. Randomized controlled trial” that was published in the British Medical Journal(Korthals-de Bos IB 2003). Shazzam…..chiropractic better than physical therapy.

The authors wanted to evaluate, contrast, and compare effectiveness of manual therapy to physiotherapy/physical therapy and to care by a general medical practitioner in regards to neck pain specifically.

They concluded the paper by saying, “Manual therapy (spinal mobilisation) is more effective and less costly for treating neck pain than physiotherapy or care by a general practitioner.”

So, as you can see, there are several, research-backed arguments to be made to medical colleagues when you are asking them for their referrals rather than physical therapy being their knee-jerk reaction and first choice.

Go forth with confidence and assertiveness knowing that your profession is validated in a thousand different ways. 

Key Takeaways

Chiropractic kicks butt any way you want to look at it when you’re looking at it through a research-based lens and it’s great to see it continually excel and surpass usual medical care and physical therapy in terms of effectiveness, cost-effectiveness, and risk vs. reward. 

As I mention at the end of every episode, I want you to know with absolute certainty that when Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.

When you look at the body of literature, it is clear: research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good to excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic evidence-based podcast in the world. 

We cannot wait to connect again with you next week. From Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

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Bibliography

Blanchett M (2017). “Association Between the Type of First Healthcare Provider and the Duration of Financial Compensation for Occupational Back Pain.” J Occup Rehabil 27(382).

Coulter I (2018). “Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis.” Spine 0(0).

Goertz C (2018). “Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain A Comparative Effectiveness Clinical Trial.” JAMA 1(1): E180105.

Korthals-de Bos IB (2003). “Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial.” British Medical Journal 326(7395): 911.

Rapaport L (2018). “Adding chiropractic to back pain care may reduce disability.” Reuters 0(0).

Tsertsvadze A, e. a. (2014). “Cost-effectiveness of manual therapy for the management of musculoskeletal conditions: a systematic review and narrative synthesis of evidence from randomized controlled trials.” J Manipulative Physiol Ther 37(6): 343-362.

CF 008: With Dr. Craig Benton – Brand New Information Based on Results Chiropractic Proven Effective For Low Back Pain

CF 016: Review of The Lancet Article on Low Back Pain (Pt. 1)

CF 015: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 3 of 3)

CF 007: Awesome Alternatives To High Blood Pressure Treatment

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