CF 219: Neurodynamic Moves Solve Problems – So Does The Inversion Table Today we’re going to talk about inversion tables and Neurodynamic exercises. But first, here’s that sweet sweet bumper music
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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. If you haven’t yet I have a few things you should do.
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You have found yourself smack dab in the middle of Episode #219 Now if you missed last week’s episode , we talked about Masterminds – chiropractic masterminds and the MCM Mastermind I’m in specifically with Dr. Kevin Christie. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
What a weekend down in Lubbock, TX for the Texas Chiropractic Association’s MidWinter conference. I got to hang out with my friend Dr. Tim Bertlesmen. What a guy, what a teacher, and what a positive force for our entire profession. Sitting through one of his courses is like having golden knowledge nuggets just chunked at you from a nerf gun. Pow, pow, kablam, splat. Just like that. Over and over. Only you don’t dodge the nuggets. You just step right into them and let them sink right in. He as good as it gets out there.
One of his nuggets I’ll share with you is hip abductors. If you are not assessing your new patients for weak hip abductors, get to researching and make it happen, muy pronto mi amigo. Luckily, in my coursework with the Diplomate of the International Academy of Neuromusculoskeletal Medicine, Dr. Bertlesman is an instructor and taught us about hip abductors a few years ago. Now, my secret is out!! Lol. Really though, be checking those hip abductors because they can be the missing puzzle piece to longstanding low back pain, hip pain, knee pain and chondromalacia patellae, and ankle and foot problems. Up to and including plantar fasciitis.
I got to teach while at the conference. I’ve taught a couple of courses for the TCA but they were COVID-era virtual courses. This was the first 2-hour live crowd presentation that I’ve been the presenter on and I have to say; I was a tad anxious but once I got started and into the material, it went very well and smoothly. I had some good buddies in the crowd so it was even a bit like a conversation rather than a presentation. I had several tell me that was the most they’ve taken away from a course in several years. Made me feel good and gave me encouragement that I’m going in the right direction.
Then if you’ve been listening, you know I have a rental down there on Airbnb so spent Sunday at the rental staining the deck and the fence. A not-so-nice end to the seminar weekend. Business seems to be picking back up which seems to be directly related to the omicron variant settling back down here in the Texas Panhandle. But, we can’t discount the fact that more people are meeting their deductibles in mid-February to early March as well. Either way, who cares? It equals to more business! Onward to research
Item #1
I’m just going to say that I got the research today from ChiroUp’s research roundup and thank you again to Dr. Tim Bertlesmen and Dr. Brandon Steele for being outstanding. This one is called “Lumbar disc disease: the effect of inversion on clinical symptoms and a comparison of the rate of surgery after inversion therapy with the rate of surgery in neurosurgery controls” by Mendelow et. al. (Alexander D. Mendelow 2021) and was published in Journal of Physical Therapy Science in 2021 so it’s hot hot hot.
Why They Did It
We have previously shown inversion therapy to be effective in a small prospective randomised controlled trial of patients with lumbar disc protrusions. Our purpose now was to measure symptoms and to compare the surgery rate following inversion for 85 participants with the surgery rate in 3 control groups.
How They Did It
- Each of the 85 inverted participants acted as their own control for the “symptomatic” part of the study.
- In the “Need for surgery” part of the study, one control group was made up of similar patients with leg pain and sciatica who were referred to the same clinic in the same year.
- Two additional control groups were examined: the original control group from the pilot trial and the lumbar disc surgery waiting list patients.
What They Found
- Inversion therapy relieved symptoms: there were improvements in the Visual Analogue Score, Roland Morris and Oswestry Disease indices, and Health Utility Score compared with their pre-treatment status.
- Also, the 2-year surgery rate in the inversion participants in the registry (21%) was significantly lower than in the matched control group (39% at two years and 43% at four years).
- It was also lower than the surgery rate in the other 2 control groups.
Wrap It Up
Inversion therapy relieved symptoms and avoided surgery. And let me tell you personally, we do decompression, we do inversion, we do McKenzie….we have lots of ways of going at low back pain. I’ve seen inversion poo poo’ed in evidence-based FB groups. I’m telling you, they don’t know what they’re talking about, for the right patient, inversion can be a game-changer. Insurance won’t pay for it but the patient will if it’s reasonable and makes sense.
Item #2
The second one today is called “Effect of Neural Mobilization Exercises in Patients With Low Back-Related Leg Pain With Peripheral Nerve Sensitization: A Prospective, Controlled Trial” by Alshami et. al. (Ali M. Alshami 2021) and published in the Journal of Chiropractic Medicine in June of 2021 and it’s hot hot hot as well If you don’t know what Neurodynamic moves, exercises, etc are….go Google up nerve flossing or nerve gliding or neurodynamic exercises. That should get you up to speed.
Why They Did It
The aim of this study was to investigate the short-term effect of slider and tensioner exercises on pain and range of motion (ROM) of straight leg raise (SLR) and slump tests in patients with low back-related leg pain with peripheral nerve sensitization.
How They Did It
- It was a prospective, controlled trial,
- 51 patients with low back-related leg pain with peripheral nerve sensitization
- They were divided into 3 treatment groups:
- slider (slider neural mobilization exercise + transcutaneous electric nerve stimulation [TENS]),
- tensioner (tensioner neural mobilization exercise + TENS), and
- control (only TENS).
- Each patient received 6 sessions over 2 weeks.
- The following outcomes were measured at baseline and after the first, third, and sixth sessions: visual analog scale (VAS) for pain and ROM of SLR and slump tests were performed for the symptomatic side.
What They Found
- Compared with controls, patients receiving the slider and tensioner exercises showed a greater decrease in pain at the third and sixth sessions
- There was a significant difference in the ROM of the SLR test between the slider and controls at only the sixth session
- Patients in the slider and tensioner groups demonstrated greater improvements in the ROM of slump test at all sessions compared with controls
- There were no significant differences between the slider and tensioner groups in any outcome at any session.
Wrap It Up
Patients in both slider and tensioner neural mobilization exercise groups demonstrated improvements in pain and ROM in patients with low back-related leg pain with peripheral nerve sensitization compared to those in the control group. Item #3 Number three today is called “Effectiveness of Neural Mobilization Techniques in the Management of Musculoskeletal Neck Disorders with Nerve-Related Symptoms: A Systematic Review and Meta-Analysis with a Mapping Report”‘ by Varangot-Reille et. al. (Clovis Varangot-Reille 2021) and published in Pain Medicine on October 11, 2021, steamy plate of knowledge nuggets coming up!
Why They Did It
The objective was to assess the effectiveness of neural mobilization (NM) techniques in the management of musculoskeletal neck disorders with nerve-related symptoms (MND-NRS).
How They Did It
They conducted a systematic review with meta-analysis, using pain intensity, disability, perceived function, cervical range of motion, and mechanosensitivity as the main outcome measures. The systematic review included 22 studies
Wrap It Up
Neural mobilization appeared to be effective to improve overall pain intensity when embedded in a physiotherapy treatment in the management of musculoskeletal neck disorders with nerve-related symptoms. When compared with no intervention, it was effective to improve neck rotation, disability, and function. However, it was not superior to other types of treatments in improving overall pain intensity, neck pain intensity, arm pain intensity, cervical range of motion and disability, except for mechanosensitivity.
Item #4
I’m an overachiever today, our fourth paper is called, “Neurodynamics is an effective intervention for Carpal Tunnel Syndrome” by Stephanie Wise and Jordon Bettleyon (Stephanie Wise and Jordan Bettleyon 2021) and published in the Journal of sport Rehabilitation on December 20th, 2021 – Kablamo – that’s some heat people.
Why They Did It
Is neurodynamics effective in reducing pain and reported symptoms in those with CTS?
How They Did It
Four studies were included, with 2 studies utilizing passive neural mobilizations, one study using active techniques, and one study using active neural mobilizations with splinting.
What They Found
All studies showed large effect size for pain, symptom severity, and physical function.
Wrap It Up
Neurodynamics is an effective treatment for CTS. Splinting is only effective when combined with neurodynamics. I’m hammering this home because radiculopathy doesn’t have to go directly to surgeons and it’s not just a pop and street them either. We have lots of things we can do McKenzie, we have decompression, we have neurodynamic exercises, low-level laser may be a possible treatment, traction, is it TOS??? Lots of stuff to run through before we need to worry about something more intensive and invasive.
Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.
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The Message
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 preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!
Key Point:
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…. That’s Chiropractic!
Contact
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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 – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger