arthroscopic surgery

Brain Activity From Spinal Manipulative Therapy & PT Is As Good As Arthoscopic Surgery For Meniscus Issues

CF 240: Brain Activity From Spinal Manipulative Therapy & PT Is As Good As Arthoscopic Surgery For Meniscus Issues Today we’re going to talk about the Brain’s Activity as a result From Spinal Manipulative Therapy & we’ll talk about how PT Is As Good As Arthoscopic Surgery For Meniscus Issues 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. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #240 Now if you missed last week’s episode , we talked about Changing One’s Mind About Pain and how the cognitive aspect of pain has to be addressed. Fascinating stuff, folks. Truly. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I’m headed to Sarasota this weekend for the MCM Florida Mastermind with Kevin Christie and others. And when I say ‘others’, I mean big-timers. It’s a privilege to be invited and to be a member of this private group of masterminds.  I’m talking about Kevin, of course, but Brett Winchester, Jay Greenstein, Mark King, Ben Fergus, Scott Schreiber, and more! Power-hitters. If you are interested in being a part of this mastermind, email Dr. Christie at [email protected] We’re keeping it around 20 members and I believe we have about 15 at the moment. So, there are a few more seats. But don’t waste time because those spots might fill up PDQ. For you Yanks……that means pretty damn quick.  Going to Sarasota on Thursday means that all patients are getting packed into a 3 day work week. We have 52 on the schedule today as a result so this one is short and sweet my dear friends.  But I will say, the numbers are back to looking encouraging. At least until the back-to-school slow down comes along. We see it every year and I’m sure this one will be no different. Although, we are going to be doing some ‘Back to school doesn’t mean forget the chiropractor’ style marketing to try to combat it.  If you see back-to-school slowdowns every year, what are you doing to offset it? Let me know and I can share it with our audience. Email me at [email protected] Let’s get going with the research. 

Item #1

The first one today is called, “Effect of Physical Therapy vs Arthroscopic Partial Meniscectomy in People With Degenerative Meniscal Tears. Five-Year Follow-up of the ESCAPE Randomized Clinical Trial” by Noordyn et. al. (Noorduyn JCA 2022) and published in JAMA Network Open on July 8, 2022. Aye aye aye, that’s a hot plate of hot pie!

Why They Did It

There is a paucity of high-quality evidence about the long-term effects (ie, 3-5 years and beyond) of arthroscopic partial meniscectomy vs exercise-based physical therapy for patients with degenerative meniscal tears. The authors wanted to know….is exercise-based physical therapy just as good or equal to arthroscopic partial meniscectomy during a 5-year follow-up period in patients aged 45 to 70 years with a degenerative meniscal tear?

How They Did It

  • 278 patients completed the 5-year follow-up
  • A noninferiority, multicenter randomized clinical trial was conducted in the orthopedic departments of 9 hospitals in the Netherlands. A total of 321 patients aged 45 to 70 years with a degenerative meniscal tear participated. Data collection took place between July 12, 2013, and December 4, 2020.
  • Patients were randomly allocated to arthroscopic partial meniscectomy or 16 sessions of exercise-based physical therapy.
  • The secondary outcome was progression in knee osteoarthritis shown on radiographic images in both treatment groups.

What They Found

  • From baseline to 5-year follow-up, the mean (SD) improvement was 29.6 (18.7) points in the surgery group and 25.1 (17.8) points in the physical therapy group. 
  • The crude between-group difference was 3.5 points. 
  • Comparable rates of progression of knee osteoarthritis were noted between both treatments.

Wrap It Up

  • In this noninferiority randomized clinical trial after 5 years, exercise-based physical therapy remained noninferior to arthroscopic partial meniscectomy for patient-reported knee function. 
  • For us English speakers, that means that exercise was just as good as arthoscopic surgical intervention and didn’t lead to any increase in knee osteoarthritis
  • Physical therapy should therefore be the preferred treatment over surgery for degenerative meniscal tears. 
  • These results can assist in the development and updating of current guideline recommendations about treatment for patients with a degenerative meniscal tear.

Before getting to the next one, I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! It’s live again. Use the code HOTSTUFF upon purchase at droprelease.com to get $50 off your purchase. Y’all, it makes a world of difference. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. My patients love it and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Hear me now and believe me later.

Item #2 The last one this week is called “Spinal Manipulative Therapy Alters Brain Activity in Patients With Chronic Low Back Pain: A Longitudinal Brain fMRI Study” by Tan et. al. (Tan W 2020) and published in Frontiers In Neuroscience on November 19th of 2020. Not as hot as it once was I suppose. 

Why They Did It They say that we know Spinal manipulative therapy (SMT) helps to reduce chronic low back pain (cLBP). However, the underlying mechanism of pain relief and the neurological response to SMT remains unclear. The authors were trying to get some clarity on the mechanism. Why does it help?

How They Did It

  • We utilized brain functional magnetic resonance imaging (fMRI) upon the application of a real-time spot pressure mechanical stimulus to assess the effects of SMT on patients with cLBP.
  • Brain fMRI was performed for Group 1 at three time points: before an adjustment, after the first adjustment session, and after the sixth adjustment. 
  • The healthy controls (Group 2) did not receive an adjustment and underwent only one fMRI scan. 
  • During fMRI scanning, a real-time spot pressure mechanical stimulus was applied to the low back area of all participants. 
  • Participants in Group 1 completed clinical questionnaires assessing pain and quality of life

What They Found

Before SMT, there were no significant differences in brain activity between Group 1 and Group 2.  After the first adjustment, Group 1 showed significantly greater brain activity in the right parahippocampal gyrus, right dorsolateral prefrontal cortex, and left precuneus compared to Group 2.  After the sixth adjustment, Group 1 showed significantly greater brain activity in the posterior cingulate gyrus and right inferior frontal gyrus compared to Group 2.  After both the first and sixth adjustments, Group 1 had significantly improved outcomes scores than the control group

Wrap It Up

The authors say, “We observed alterations in brain activity in regions of the default mode network in patients with cLBP after SMT. These findings suggest the potential utility of the default mode network as a neuroimaging biomarker for pain management in patients with cLBP. In a sense, we can re-map faulty wiring through motion, function, and proprioception which are all things provided in a good adjustment and targeted exercise. If all you’re doing is adjustments though, reconsider. A broad management protocol is the key.  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. 

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!

Chiropractic evidence-based products

Integrating Chiropractors

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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 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

Noorduyn JCA, v. d. G. V., Willigenburg NW, (2022). “Effect of Physical Therapy vs Arthroscopic Partial Meniscectomy in People With Degenerative Meniscal Tears: Five-Year Follow-up of the ESCAPE Randomized Clinical Trial.” JAMA Netw Open 5(7).  

Tan W, W. W., Yang Y, Chen Y, Kang Y, Huang Y, Gong Z, Zhan S, Ke Z, Wang J, Yuan W, Huang W, Zee C, Chen Z, Chen BT (2020). “Spinal Manipulative Therapy Alters Brain Activity in Patients With Chronic Low Back Pain: A Longitudinal Brain fMRI Study.” Front Integr Neurosci.