Return To Play After Herniation & Water vs. PT Exercises

CF 216: Return To Play After Herniation & Water vs. PT Exercises Today we’re going to talk about return To Play After Herniation & Water vs. PT 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. 

• Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
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You have found yourself smack dab in the middle of Episode #216 Now if you missed last week’s episode , we talked about the MCM Mastermind that I am a member of & we talked about CAM Acceptance Among Medical Specialists. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I’m still settling back in after that Florida mastermind that we talked about last week. Still getting my mind wrapped around the information and the best ways to implement the ideas.  One of my biggest obstacles to practice has been good, evidence-based, patient-centered guidelines for dosing. Meaning, how many times should a patient be seen? Well, one of the mastermind members is Dr. Jay Greenstein. If you don’t know him, I suggest you get that remedied muy pronto mi amigo.  Jay has done a lot of work with Clinical Compass and based on research in the Journal of Manipulative and PHhysiologica Therapies and based on Haas’s research in Spine, Dr. Greenstein has been kind enough to guide me along. 

Here’s a lesson for me and for listeners. As far along as you are, whether in the beginning, in middle, or toward the end, you can always learn. Now, instead of saying 3x/week for a couple of weeks, and then we’ll see where you’re at….instead of that, I have firm, research-based, Clinical Compass-approved recommendations for what I tell them. 

My biggest gap is patient stick-to-it-iveness. I may see 80 new patients a month but still only see 650 visits that month. Because my new patients don’t typically make it to the first re-exam.  It’s not like I don’t know this problem. It’s always been an issue. Some of us have money issues. We do the stuff to make more money but we’re not always sure we deserve more money or deserve to live well, blah blah blah. That’s the mental health aspect of dealing with money. 

I turned financial talks over to the staff because I’m not good with money discussions when it comes to people paying me. I’m fine when I’m talking about stuff I’m doing to try to make money. I’m not good when we’re talking about me making money from someone. It’s just what it is.  Here’s the thing though, if I know it’s backed and supported and even encouraged as far as guidelines, then it’s on. I have no problem with making the recommendations and making them stronger.  So, there you are. Once my recommendations are better, my income improves immediately. This means I can easily training those under me and comfortably hire more providers, etc.

All from one thing; more effective communication with my new patients from the get-go. 

Also, I’m reading the book Traction: Get a Grip on Your Business by Gino Wickman. This was recommended by several in the MCM Mastermind so I’m already in Chapter 6 on this sucker and wondering why I didn’t read it years ago. It’s there to help identify issues, communicate more effectively with your team, and get the right people in the right seats.  What are you working on professionally this week? Email me at dr.williams@chiropracticforward.com.

I’d love to hear it. 

Let’s hop in Item #1

The first one today is called “Return to Play After Symptomatic Lumbar Disc Herniation in Elite Athletes: A Systematic Review and Meta-analysis of Operative Versus Nonoperative Treatment” by Sedrak, et. al. (Sedrak 2021) and published in Sports Health on Feb 10 of 2021 and only a year old is still significantly steamy. 

Why They Did It

The prevalence of symptomatic lumbar disc herniation (LDH) in athletes can be as high as 75%. For elite athletes diagnosed with LDH, return to play (RTP) is a major concern, and thus comparing surgical with nonoperative care is essential to guide practitioners and athletes, not just in terms of recovery rates but also the speed of recovery. The purpose of this systematic review is to provide an update on RTP outcomes for elite athletes after lumbar discectomy versus nonoperative treatment of lumbar disc herniations.

How They Did It

• Systematic review and meta-analysis
• A search of the literature was conducted using 3 online databases (MEDLINE, EMBASE, and PubMed) to identify pertinent studies.

What They Found

• Twenty studies met the inclusion criteria and were included in this review. 
• Overall, 663 out of 799 patients (83.0%) returned to play in the surgical group and 
• 251 out of 308 patients (81.5%) returned to play in the nonoperative group. 
• No statistically significant difference for return to play rate was found 
• The mean time to return to play for patients undergoing lumbar discectomy was 5.19 months, and 4.11 months for those treated conservatively.

Wrap It Up

There was no significant difference in return to play rate between athletes treated with operative or nonoperative management of LDHs, nor did operative management have a faster time to return to play.  Athletes should consider the lack of difference in return to play rate in addition to the potential risks associated with spinal surgery when choosing a treatment option.  Clear enough on that, folks? You don’t even need my commentary on it. That’s as plain English as you can get right?

Item #2

The second one today is called “Efficacy of Therapeutic Aquatic Exercise vs Physical Therapy Modalities for Patients With Chronic Low Back Pain A Randomized Clinical Trial” by Peng et. al. (Peng M 2022) and published in JAMA Network Open on January 7, 2022, booyah it’s on fire. 

Why They Did It

To assess the long-term effects of therapeutic aquatic exercise on people with chronic low back pain.

How They Did It

• This was a 3-month, single-blind randomized clinical trial with a 12-month follow-up period
• A total of 113 people with chronic low back pain were included in the experiment.
• Participants were randomized to either the therapeutic aquatic exercise or the physical therapy modalities group. 
• The therapeutic aquatic exercise group received aquatic exercise, whereas the physical therapy modalities group received transcutaneous electrical nerve stimulation and infrared ray thermal therapy. 
• Both interventions were performed for 60 minutes twice a week for 3 months.

What They Found

• Compared with the physical therapy modalities group, the therapeutic aquatic exercise group showed greater alleviation of disability, with adjusted mean group differences after the 3-month intervention, at the 6-month follow-up, and at the 12-month follow-up
• At the 12-month follow-up point, improvements were significantly greater in the therapeutic aquatic exercise group vs the physical therapy modalities group in the number of participants who met the minimal clinically important difference in pain

Wrap It Up

The therapeutic aquatic exercise program led to greater alleviation in patients with chronic low back pain than physical therapy modalities and had a long-term effect up to 12 months. This finding may prompt clinicians to recommend therapeutic aquatic exercise to patients with chronic low back pain as part of treatment to improve their health through active exercise rather than relying on passive relaxation. 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 the 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. 

Store Remember the evidence-informed brochures and posters at chiropracticforward.com.     

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

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 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.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  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. 

Connect 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  

Bibliography

Peng M, W. R., Wang Y, (2022). “Efficacy of Therapeutic Aquatic Exercise vs Physical Therapy Modalities for Patients With Chronic Low Back Pain: A Randomized Clinical Trial.” JAMA Netw Open 5.  

Sedrak, P., Shahbaz, M., Gohal, C., Madden, K., Aleem, I., & Khan, M, (2021). “Return to Play After Symptomatic Lumbar Disc Herniation in Elite Athletes: A Systematic Review and Meta-analysis of Operative Versus Nonoperative Treatment.” Sports Health 13(5): 446-453.