disc

Factors Leading To Surgery For Some Discs & Disc Innervation

CF 183: Factors Leading To Surgery For Some Discs & Disc Innervation

Today we’re going to talk about the innervation of the disc and we’re going to talk about some factors that can lead to surgery for lumbar disc herniations.  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. 

  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #183 Now if you missed last week’s episode , we talked about Adjustments as immune boosters and we talked about pain. Is it mind or is it matter? Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

It’s been a bit of a whirlwind these last few weeks.  I’ve talked a little more recently about launching my very first book. It’s out. It’s available on Amazon. It’s called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. And I’d love for you to go pick up a copy for yourself. You can get either ebook or a paperback sent to your front door. Your call.  Here’s why I think you need it. All of the research we talk about here and lots before I started the podcast, has been categorized for you into conditions and body regions. So, if you need some research on neck pain, flip to the section and there you go. Migraines? SI joint issues? Go to those sections and there you go.  This comes in handy when you have a talk to give and don’t have the time to go searching through pubmed all day.

Or when a patient asks you a question on something specific. Or a host of any other reasons. It’s a reference for your practice for your education, patient education, and community education.  So go grab that up while you’re thinking about it. 

As mentioned in a previous episode, we visited New Orleans, Then we were home for one weekend. Then the next weekend we were off to Dallas for the Texas Chiropractic Association’s ChiroTexpo event which is our state’s convention basically.  Two board of directors meetings for me plus some networking, classes, and problem-solving. Essentially. 

I have seen him speak before. I went to Forward 19 in St Louis before the Rona came along and saw Brett Winchester talk. We had him in Dallas at this event and he did not disappoint. I was able to better connect with Brett here in Texas. We will absolutely have him on a future podcast and in the meantime, if you want to learn more about Dr. Winchester, check out his podcast at Gestaldt Podcast.  The dude is sharper than a tack, has worked with the St. Louis Cardinals, and is one of those on the top and on the edge so check him out if you’re smart. 

Then, even though Dr. Kevin Christie was already a friend, we really got to hang out and shoot the proverbial shoo shoo in Dallas, along with Dr. Winchester. And it was just a good time had by all. 

I used to be lone wolf, folks. I used to not care about the profession. I just cared about my office, my numbers, my business. Me, me, me. I got a bit shamed into joining the TCA. Then, they had a vacancy on the Board of Directors due to the director in my district having cancer. Well, how can you say no? I was thrown into the fire with no context, no history, no experience, and little idea of what to say or how to act. But I was thrown in with a group of about 20 people that lead the profession and develop leaders from scratch. That’s what they did for me. We got there. We made it happen. 

Fast forward about a decade or so and I was on the Board of Directors for about 5 years, been the Chiropractic Development Initiative Chair, served as the Public Relations Chair, and am now going into the second year as the Department Coordinator for Scientific Affairs. I help steer the speakers we have at our events among other things. 

Associations need your membership dollars and you need to be members. But that’s just a mostly passive notion. The REAL benefit is realized when one becomes active and plugged into the association. Meaning, through being active and involved at just about every step, I have developed a network of close friends and colleagues from around the entire state of Texas that, even though some practice differently than I, would still go to bat for me, support me, and back me. And I them. 

We have developed brothers and sisters, camaraderie, and family with each other. I cannot begin to share with you how many times I’ve had questions or issues that I was able to just call up one of my TCA buddies and get a solid answer for it.  This medical integration I’m going through right now. Do you think I just up and decided to do it and jumped into the fire? Hell no.

I called all of my TCA buddies who have done it previously.  One is now my consultant on it. The attorney that wrote the law that allows for this integration is TCA’s lobby team. He’s the one that has created the paperwork and contracts for me.  Literally, none of what I am today is possible to the degree it’s been possible if not for being active, plugged in, and a solid member of the TCA leadership. 

I don’t say this to brag that I’m active or brag about my positions in the TCA or to boast in any way. I say this to let you know that there is a difference between being a member and being an active member. Between building something larger than yourself and your own practice and doing your own small thing. Between being an influential leader and being a bench warmer.  Get into the game. Raise your hand. You can thank me later.

Our profession needs evidence-based, patient-centered leaders like you. Don’t bitch about our profession if you’re not willing to step in and do something to change it. 

Item #1

This one is called “Factors Associated With Progression to Surgical Intervention for Lumbar Disc Herniation in the Military Health System” by Anderson et. al. [1] and published in Spine Journal on March 15, 2021 which means it’s got the hot spread all over it. 

Why They Did It

To determine surgery-free survival of patients receiving conservative management of lumbar disc herniation (LDH) in the military healthcare system (MHS) and risk factors for surgical intervention

How They Did It

  • The Military Data Repository was queried for all patients diagnosed with lumbar disc herniation from 2011-2018
  • Follow-up time to surgical intervention was defined as the time from diagnosis to first encounter for lumbar microdiscectomy or lumbar decompression in either a military treatment facility or in the civilian sector. 
  • The Military Data Repository was also queried for history of tobacco use at any time during military healthcare system care, age at the time of diagnosis, sex, military healthcare system beneficiary category, and diagnosing facility characteristics. 
  • Multivariable Cox proportional hazards models were used to evaluate the associations of patient and diagnosing facility characteristics with time to surgical intervention.
  • A total of 84,985 military healthcare system beneficiaries including 62,771 active duty service members were diagnosed with lumbar disc herniation in a military treatment facility during the 8-year study period. 
  • A total of 10,532 (12.4%) military healthcare system beneficiaries failed conservative management onto surgical intervention with lumbar microdiscectomy or lumbar decompression. 

What They Found

Among all healthcare beneficiaries, several patient-level (younger age, male sex, and history of tobacco use) and facility-level characteristics (hospital vs. clinic and surgical care vs. primary care clinic) were independently associated with a higher risk of surgical intervention.

Wrap It Up

Lumbar disc herniation compromises military readiness and negatively impacts healthcare costs. military healthcare system beneficiaries with lumbar disc herniation have a good prognosis with approximately 88% of patients successfully completing conservative management. However, strategies to improve outcomes of conservative management in lumbar disc herniation should address risks associated with both patient and facility characteristics.

CHIROUP ADVERTISEMENT

Item #2 Our last one today is called “Innervation of the Human Intervertebral Disc: A Scoping Review” by Groh et. al. [2] and published in Pain Medicine in June of 2021 and that’s current hot. As in present-day, burning up the face of the Earth as we speak, hot. 

Why They Did It

Changes to the intervertebral disc (IVD) have been associated with back pain, leading many to postulate that the IVD may be a direct source of pain, typically referred to as discogenic back pain. Yet despite decades of research into the neuroanatomy of the IVD, there is a lack of consensus in the literature as to the distribution and function of neural elements within the tissue. The current scoping review provides a comprehensive systematic overview of studies that document the topography, morphology, and immunoreactivity of neural elements within the IVD in humans.

How They Did It

Articles were retrieved from six separate databases in a three-step systematic search and were independently evaluated by two reviewers.

What They Found

Three categories of neural elements were described within the IVD: perivascular nerves, sensory nerves independent of blood vessels, and mechanoreceptors. Nerves were consistently localized within the outer layers of the annulus fibrosus. Neural ingrowth into the inner annulus fibrosus and nucleus pulposus was found to occur only in degenerative and disease states.

Wrap It Up

While the pattern of innervation within the IVD is clear, the specific topographic arrangement and function of neural elements in the context of back pain remain unclear. I mostly included this because, in our Neuromusculoskeletal Diplomate program, they were clear about the innervation encroaching into a disc injury and how that makes re-injury somewhat easier and sometimes more painful. Because the nerves are further into the structure of the disc once the injury has occurred and then subsequently resolved.  Very interesting stuff.  That’s all I have the time for today folks. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

 

Chiropractic evidence-based products

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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.

Website https://www.chiropracticforward.com

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TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

1. Anderson AB, B.M., Pisano AJ, Watson NI, Dickens JF, Helgeson MD, Brooks DI, Wagner SC,, Factors Associated With Progression to Surgical Intervention for Lumbar Disc Herniation in the Military Health System. Spine (Phila Pa 1976), 2021. 46(6): p. E392-E397.

2. Adam M R Groh, M., Dale E Fournier, MSc, Michele C Battié, PhD, Cheryle A Séguin, PhD,, Innervation of the Human Intervertebral Disc: A Scoping Review. Pain Med, 2021. 22(6): p. 1281-1304.

Adjusting Disc Herniations and Bulges

CF 135: Adjusting Disc Herniations and Bulges

Today we’re going to talk about Adjusting Disc Herniations and Bulges. Is this a good idea or a bad idea and what does the research have to say about it? But first, here’s that sweet sweet bumper music
Chiropractic evidence-based products

Integrating Chiropractors

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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. 

  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!

Do it do it do it. 

You have found yourself smack dab in the middle of Episode #135

Now if you missed last week’s episode , we talked about the impact sleep can have on cardiovascular issues and we talked about what the profession of chiropractic can learn from the podiatry profession. There was a great discussion there I believe and great lessons we can learn. Why did podiatrists start at about the same time as chirorpactic but they’re so much more recognized, respected, and integrated compared to the chirorpactic profession? We talked about it. Make sure you don’t miss that info. Keep up with the class. 

Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper. 

On the personal end of things…..

Keepin on keepin on folks. That’s it. Staying in business. One day at a time. So far so good. I hope you found some use out of our discussion a couple episodes back about tactics myself and others are using to get those patients returning back to your office. I think I was able to share some valuable info in that regard. 

Dr. Blake Bennett posted in our private Facebook group saying, “We mailed a thousand letters to patients who were in in the past couple years and a couple weeks later we mailed another 500 postcards to patients who haven’t been in longer than that. Email every 2-3 weeks to those on the list. He says the response was great and June was a good month.”

Providing value and giving back. Thank you Dr. Bennett. I know others in need appreciate your advice as do I. 

Let’s get on with the reason for the topic today. I saw a post not long ago in the Forward Thinking Chiropractic Alliance where a colleague was asking if it’s OK to adjust segments where there is a confirmed disc herniation or bulge. It was refreshing to see a resounding YES from all of my colleagues. 

My answer was “Yes” as well. I’ve been through this from the back end though and I’ll share some of that story with you. It’s a story I’m not happy about, I’m not proud of, and I’m not happy revisiting. It was a hard time in my life to be honest. But, it’s part of my story regardless so here goes.

Many moons ago I treated A LOT of personal injury cases. We all know some of those patients are better than others. This was not one of the great patients but she was fine. No big issues. She had a disc injury and I diagnosed it appropriately I’ll have you know. 

Now something to know about me; I’m all about gentle motion. I don’t like it when someone cranks my noggin around just looking for that crack sound. I’m not interested in that and I treat people the way I want to be treated. I’m very gentle, non-agressive, use little to zero rotation in the cervical area, and just won’t be rough with it. 

Same went for this lady. And, like so many other patients, she responded well. I tracked her from the beginning where she was having pain 75% of the time down to a much lower rating on the numeric rating scale and only about 25% of the time. She was happy, I was happy and all was gleeful in the land of daily practice. 

Until…..until her daughter attended an appointment with her one day. She came in with her just up in arms and actually screaming at me because I had the audacity to work on her mother when she had a disc herniation and clear mention of the disc herniation on her MRI report. 

I asked her if she’d ever been to a chiropractor before or knew anything about chiropractic. She had not. She knew nothing about what we do or why we do it. So, I tried to explain briefly and tell her how her mother was doing so much better and how she had improved, blah, blah, blah. Didn’t matter. She didn’t know anything but she knew enough to be straight up pissed the hell off that I’d ever work with her mother with that disc herniation. 

It made for an interesting day for sure. But not as interesting as the day I received notice from my state’s governing board that they had received a complaint on me from this patient. While it had this patient’s name on the complaint, it should have had the daughter’s name on it because the patient and I had a good relationship. 

So, no matter how good the notes were, no matter how well I tracked the improvement, guess what? I STILL had to hire an attorney to defend me to my own Board. Now, it’s important to understand that the Board isn’t here for us. They’re stated goal is to protect the interest of the public when it comes to chiropractors. Let’s be fair, they see the worst of the worst. Literally. They can, after some time, become a bit jaded and maybe even start to actually EXPECT the worst when they get a complaint. 

I literally could not believe I had to take two days off of work, fly to Austin, TX, get a hotel, and defend myself against something that was so black and white. But again, let’s be fair, the folks at the TBCE weren’t there. They didn’t witness what I saw. They didn’t see the happiness of the patient with her improvement. They weren’t there when we just did manual mobilization rather than agressive adjustments. I can’t blame them. It was the process and I had to go through it. Right or wrong. And trust me, if you’ve listened to this podcast long enough honesty is big with me. This was wrong. It should have never gotten beyond the initial complaint. But whatever. I went to Austin. 

Now, one of my colleagues and friends was on the enforcement committee and she asked me some straight forward questions with the attorney sitting there. I don’t know why the hell he was even there other than to collect a check because he didn’t say a damn thing or do a damn thing. 

This was before I went through a diplomate but after going through Croft’s Whiplash Biomechanics and Traumatology course. What I’m saying is I’m better today than I was back then but I was far from being a slacker back then. I answered all of the questions, walked out, and the attorney told me what a great job I did and then we waited. 

I ended up getting a warning but nothing on my record. No action taken against me. I was pissed then and am still pissed that I’d get a warning for anything at all. I didn’t deserve a warning. It wasn’t warranted because I didn’t do anything wrong. 

Now, the reason for that story for a couple of reasons. First, I want you to understand the value of documentation. Had I not had the documentation showing the improvement of this patient over her treatment, I would have been absolute toast based solely on the word of a patient’s daughter. A person that has never been to a chiropractor and knows nothing about the profession. That’s number one. So documentation people; don’t just document to remember what you did. Document to protect yourself and your staff. It sucks but you have to do it. 

The second reason I told that story is that this experience led me to start looking up research on discs and adjusting. Was I actually wrong and I just didn’t know it? I went searching for the answers because if I were to keep adjusting people, you damn well better believe that I’m going to be adjusting people with discs that many times are herniated or bulging. That’s either knowingly doing it and most times unknowingly doing it. 

Hell, we know that 60% of patients between the ages of 40 and 50 years old have disc findings that are completely asymptomatic. No pain at all. Still, when you’re adjusting a 40 – 50 year old, you have a 60% chance of adjusting someone with a bulge or herniation. So it made sense to me to protect myself from ever running into this crap again down the road. 

If I had those paper in front of me when I went in there to defend myself, maybe I don’t even get a warning. But, if someone is sitting on the enforcement and questioning concerning adjusting areas with disc issues, they need to be on top of that research as well. And they might have been. I don’t know. All of the folks at the TBCE have become well thought of friends and colleagues now that I’ve been active in the Texas Chiropractic Association for so many years. Not the case at the time though. I only knew one of them back then. Even though there’s been a turnover since this happened many moons ago, I’m still friends with even the new TBCE crew and they’re all highly respected and thought of by me. Good good people just trying to do a good job. 

Anyway, We’re going to go through some papers here for you so you can get a clear picture on this topic. 

Item #1

OK, Item #1 this week is called “Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study” by McMorland, et. al. publshed in the Journal of Manipulative Physiological Therapeutics in October of 2010(McMorland G 2010). 

Why They Did It

The purpose of this study was to compare the clinical efficacy of spinal manipulation against microdiskectomy in patients with sciatica secondary to lumbar disk herniation (LDH).

How They Did It

  • 121 patients were in the study
  • Patients had to have failed at least 3 months of nonoperative management like analgesics, lifestyle modification, physiotherapy, massage, or acupuncture. 
  • They were randomized to either surgical microdiskectomy or standardized chiropractic spinal manipulation
  • Patients could opt to crossover to the other treatment after 3 months

What They Found

Significant improvement in both treatment groups compared to baseline scores over time was observed in all outcome measures. After 1 year, follow-up intent-to-treat analysis did not reveal a difference in outcome based on the original treatment received

Wrap It Up

“Sixty percent of patients with sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention. Of 40% left unsatisfied, subsequent surgical intervention confers excellent outcome. Patients with symptomatic LDH failing medical management should consider spinal manipulation followed by surgery if warranted.”

Who does this not make perfect sense to? Well….besides my patient’s daughter that is? Oh, and just about any medical physician you can find. I just don’t know how they haven’t latched onto this research yet. Honestly. 

Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. If you’re into IASTM also known as instrument assisted soft tissue manipulation, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend. 

Drop Release is a revolutionary tool that harnesses the body’s built-in protective systems to make muscles relax quickly and effectively.  This greatly reduces time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day.

It’s inventor, Dr. Chris Howson, from the great state state of North Dakota has is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase. 

Go check Drop Release at droprelease.com and tell Dr. Howson I sent you.

Item #2

This is a great one here called “Outcomes From Magnetic Resonance Imaging–Confirmed Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulative Therapy: A Prospective Cohort Study With 3-Month Follow-Up” by Peterson et. al. published in the Journal of Manipulative and Physiological Therapeutics in August of 2013(Peterson C 2013). 

Why They Did It

The purpose of this study was to investigate outcomes of patients with cervical radiculopathy from cervical disk herniation (CDH) who are treated with spinal manipulative therapy.

How They Did It

  • 50 Adult Swiss patients with neck pain and dermatomal arm pain; sensory, motor, or reflex changes corresponding to the involved nerve root; and at least 1 positive orthopaedic test for cervical radiculopathy were included.
  • Magnetic resonance imaging–confirmed CDH linked with symptoms was required.
  • Baseline data included 2 pain numeric rating scales (NRSs), for neck and arm, and the Neck Disability Index (NDI). At 2 weeks, 1 month, and 3 months after initial consultation, patients were contacted by telephone, and the NDI, NRSs, and patient’s global impression of change data were collected
  • High-velocity, low-amplitude spinal manipulations were administered by experienced doctors of chiropractic.
  • Acute vs subacute/chronic patients’ NRSs and NDIs were compared using the Mann-Whitney U test.

What They Found

  • At 2 weeks, 55.3% were “improved,” 68.9% at 1 month and 85.7% at 3 months.
  • Statistically significant decreases in neck pain, arm pain, and NDI scores were noted at 1 and 3 months compared with baseline scores
  • Of the subacute/chronic patients, 76.2% were improved at 3 months.

Wrap It Up

Most patients in this study, including subacute/chronic patients, with symptomatic magnetic resonance imaging–confirmed CDH treated with spinal manipulative therapy, reported significant improvement with no adverse events.

Item #3

This one is from Bergmann, et. al. and published in the Journal of Manipulative and Physiological Therapeutics in 1998 called “Manipulative therapy in lower back pain with leg pain and neurological deficit.(Bergmann TF 1998)”

Why They Did It

To discuss a case of sciatica associated with lower back pain that originates in a disc. We discuss the use of manipulative therapy as a conservative approach and compare it with other conservative methods and with surgery.

How They Did It

  • The patient suffered from lower back and left leg pain that had increased in severity over a 6-day period. There was decreased sensation in the dorsum of the left foot and toes. Computed tomography demonstrated the presence of a small, contained disc herniation.
  • The patient was initially treated with ice followed by flexion-distraction therapy. This was used over the course of her first three visits. Once she was in less pain, side posture manipulation was added to her care. Nine treatments were required before she was released from care.

Wrap It Up

“We need a nonsurgical, conservative approach to treat lower back pain with sciatica as an alternative to and before beginning the more aggressive, and potentially hazardous, surgical treatment. There is some support for the idea that lumbar disc herniation with neurological deficit and radicular pain does not contraindicate the judicious use of manipulation. there is ample evidence to suggest that a course of conservative care, including spinal manipulation, should be completed before surgical consult is considered.”

Item #4

The last one we’ll cover here is called “Spinal manipulation in the treatment of patients with MRI-confirmed lumbar disc herniation and sacroiliac joint hypomobility: a quasi-experimental study” by Shokri et. al and published in Chiropractic and Manual Therapies in May of 2018(Shokri E 2018).

Why They Did It

To investigate the effect of lumbar and sacroiliac joint (SIJ) manipulation on pain and functional disability in patients with lumbar disc herniation (LDH) concomitant with SIJ hypomobility.

How They Did It

  • Twenty patients aged between 20 and 50 years with MRI-confirmed LDH who also had SIJ hypomobility participated in the trial in 2010.
  • Patients who had sequestrated disc herniation were excluded
  • All patients received five sessions of spinal manipulative therapy (SMT) for the SIJ and lumbar spine during a 2-week period. 
  • back and leg pain intensity and functional disability level were measured with a numerical rating scale (NRS) and the Oswestry Disability Index (ODI) at baseline, immediately after the 5th session, and 1 month after baseline.

What They Found

A significantly greater mean improvement in back and leg pain was observed in the 5th sessions and 1 month after SMT

Wrap It Up

Five sessions of lumbar and SIJ manipulation can potentially improve pain and functional disability in patients with MRI-confirmed LDH and concomitant SIJ hypomobility.

There are more but I don’t want this episode to be an hour long. If I have a patient with a hot disc, I don’t typically adjust on day one. We focus on getting the patient moving. We sit them on a theraball and have them move their hips in circles, front to back, side to side, figure eights, and whatever other way we can think of. Most have a direction of preference that is in trunk extenstion. If this is right for the patient, we will do extension bias exercises. 

We make sure they are keeping their low back nice and stiff, neutral, and strong in every movement they make. We make sure they know what position to sleep in. We stress the importance of not laying down and hoping it goes away. Rather than that, they really need to be walking and doing the exercises. If they have people that just underwent surgery walking the next day, then doesn’t that same concept make sense for discs? Well of course it does. They typically come back the next day with the pain reduced enough to be able to do some light mobilization on the low back. I am careful to not be agressive and to not put an extreme amount of rotation into the spine. We want movement but we also want the spine as straight, strong, and neurtal as possible. 

Make sure you have schooled them on this concept. Tell them to make sure they behave like they have a long flourescent light bulb taped to their back and their job is to not break it. If you can remove the triggers that caused the pain, it’ll go a long way toward their recovery. 

Alright, that’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.

Let’s get to the message. Same as it is every week. 

Key Takeaways

Store

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

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 preventativly 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 – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

 

Bibliography

  • Bergmann TF, J. B. (1998). “Manipulative therapy in lower back pain with leg pain and neurological deficit.” J Manipulative Physiol Ther 21(4): 288-294.
  • McMorland G (2010). “Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study.” J Manipulative Physiol Ther 33(8): 576-584.
  • Peterson C, e. a. (2013). “Outcomes from magnetic resonance imaging — confirmed symptomatic cervical disk protrusion patients treated with high-velocity, low-amplitude spinal manipulative therapy: a prospective cohort study with 3-month follow-up.” J Manipulative Physiol Ther 36(8): 461-467.
  • Shokri E, K. F., Sinaei E, Ghafarinejad F, (2018). “Spinal manipulation in the treatment of patients with MRI-confirmed lumbar disc herniation and sacroiliac joint hypomobility: a quasi-experimental study.” Chiropr Man Therap 26(16).