CF 205: Chiropractic Adjustments For The Cervical Spine Really Work & Lumbar Radiculopathy Treatment Today we’re going to talk about research backing the use of spinal manipulative therapy for neck pain. A systematic review and meta-analysis even! Big stuff. Then we’ll talk about treatment for lumbar radiculopathy. What extra tips can you pick up? 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 #205 Now if you missed last week’s episode, we talked about The Case Of The Disappearing Disc & Vitamin D And Back Pain. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
Alright, we got some stuff shaking folks. So, let’s talk about it. First thing, Drake leaving. Who the hell is Drake you might ask? Well, that’s our Parker university intern that’s been with us since last August. We’re spoiled as hell having Drake with us these days. We’re going to miss his help and honestly, he’s just a good guy. We’ll miss him personally as well. Yes, I tried to hire him but not everyone wants to move to Amarillo so getting associates in this area can be a bit of a challenge. So I’m saying it, if you want to come to Amarillo, you’re always more than welcome to send me a resume at [email protected] and I’m happy to take a look.
We have fun. We get people better. And life is good. I mentioned a couple of weeks ago that we had a turnover and we’d be having a new front desk staffer coming on board. Well, this is the week and here we go. We may have gotten lucky on this one people.
First, we hire off of Indeed. I’m sure they think I’m a bit of a prick but I use the assessment tools. They have to fill out a couple of assessments that test their knowledge. One is on EHR, another is general office procedure and stuff like that. Well, so many of them just go down the line clicking jobs and submitting without understanding that the assessments weed that out. If they don’t take the time to fill out the assessments, they didn’t care enough about the job to read about it. Which means I don’t care enough about them to waste my time learning more about them. So I move right past them.
This girl has worked for an urgent care and only looked elsewhere because they didn’t have a full-time position like she needed. My friends actually work at the urgent care and vouched for her. We have the ones we’re interested in come in for a working interview. All of the staff agreed she was the clear choice both in experience as well as in personality. Our office culture is one defined by fun. We jump scare each other. We laugh. We kid. We are always appropriate but there are times we could be more professional but….again…we have fun. And Our patients love it.
They commonly comment in our Google Reviews about how they love that everyone is so happy, having fun, and enjoying their work. It’s easy when you have the crew I have. We do work. We work hard. Some days suck. Some days fly by. But think about it, we spend more time with our staff than we spend with our own families for the most part. Right? So why not having fun? Why not have a sense of family, of belonging, and a sense of being a team? Why not? So we’ll be making a new teammate this week. She’s going to be amazing. I just have a feeling.
Also, I believe it was last week we discussed side gigs. I mentioned my recent success in the voice over industry and that I’ve been schooling up on real estate investing and all that good stuff. I mentioned that I planned on parlaying that voice over success into real estate investments. Well, I’ve been analyzing houses and I’ve been learning about remote management of short-term rentals and the pros and cons vs having a long-term rental and all of that good stuff. Well, I identified 9 properties down in Lubbock TX. Lubbock is about an hour and a half to the south of Amarillo. It’s the home of Texas Tech and Buddy Holly. It’s also where one of my kids goes to college. It’s also the place where my other kid who is currently an 8th grader will likely go if I haven’t retired and moved to Florida when she goes to college.
Lots of football games, basketball games, baseball games….lots of visits to the medical school there in town….lots of big-name concerts. It’s all good news for having a short-term rental.
Go back and listen to last week’s episode if you want to know why short-term rentals make more sense for tax reasons than other investments right now. Anyway, I found 9 houses that my wife went to look at last week. She made an offer on one and, once we refi our rental house here in Amarillo, we’ll be able to pull out about $150,000 to put on 1-2 others. One of which is a flip we think we can profit $30k in about three months if there are no surprises or hiccups. So…..I’m a fact finder. I’ve been finding facts for about a year now. Watching YouTubes. Taking little classes. Listening to podcasts. Reading books. Meeting people and building a small network. So, we’re on it. We’re excited. We’re pumped. We’re busy as hell.
It’s kind of crazy the faith I have in my wife’s decisions. In lots of ways, she’s the smartest person I believe I’ve ever met. Our first house we bought together, I was on the road traveling with my band somewhere down in south Texas when she made an offer on it. I’d never even seen the house.
The one I live in now, I actually saw and agreed on.
The 2-3 down in Lubbock, I haven’t seen either. But I’m buying them. Lol. It’s crazy but she’s a hell of a teammate on this stuff and her vision of what she can do with a house has blown me away. She has some serious skills and I can’t wait to see what happens when she puts them to use on these investments.
The first one is called “Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials” by Chaibi et. al. (Chaibi A 2021) and published in the Journal of Clinical Medicine in October 2021 and that’s got some smoke on it! Let me say that I’ve been yelling for some research on the effectiveness of SMT for neck pain for 4 years here on this podcast. I’ve talked to different researchers about it. They said they couldn’t get funding for it. Now, here we are with a small step for a chiropractor but a giant leap for chiropractor-kind…..or something like that.
Why They Did It
Acute neck pain is common and usually managed by medication and/or manual therapy. General practitioners (GPs) hesitate to refer to manual therapy due to uncertainty about the effectiveness and adverse events (AEs);
How They Did It
- To review original randomized controlled trials (RCTs) assessing the effect of spinal manipulative therapy (SMT) for acute neck pain.
- Data extraction was done in duplicate and formulated in tables.
- Quality and evidence were assessed using the Cochrane Back and Neck (CBN) Risk of Bias tool and the (GRADE) criteria
- Six studies were included.
What They Found
- The overall pooled effect size for neck pain was very large -1.37 (95% CI, -2.41, -0.34), favoring treatments with SMT compared with controls.
- They had a single study that showed that SMT was statistically significantly better than medicine (30 mg ketorolac im.) one day post-treatment.
- Minor transient adverse events reported included increased pain and headache, while no serious adverse events were reported
Wrap It Up
SMT alone or in combination with other modalities was effective for patients with acute neck pain. However, limited quantity and quality, pragmatic design, and high heterogeneity limit our findings. So, once again, researchers….please listen. We have enough information on the low back. We know we knock it out of the park on low back pain. Even our haters mostly know we kill it on low back pain. Those douches over at sciencebasedmedicine.whatever mostly admit we’re good on low back pain. And trust me, if you change their damn minds, you’re on to something. So, let’s expand to the neck, please. Pretty please? Dr. Goertz, Dr. Pohlman, Drs influential with Chiropractic Compass, can we please continue down this path of exploring our effectiveness and low risk for adverse events in the neck because honestly, THIS clinically is what is holding us back.
Professionally, it’s the vitalists in our profession. But clinically, it’s the perception that we do harm when treating the neck. Can we do harm? Well hell yes we can. Do we commonly do harm and are we likely or probable to do harm? Oh hell no. Why would you ask such a dumb question?
This one is called “The Effect of Spinal Mobilization With Leg Movement in Patients With Lumbar Radiculopathy-A Double-Blind Randomized Controlled Trial” by Satpute et. al. (Satpute K 2019) and published in Archives of Physical Medicine and Rehabilitation on December 3rd of 2018. It’s mushy…not solidified but not as warm as we like.
Why They Did It
To evaluate the effect of spinal mobilization with leg movement (SMWLM) on low back and leg pain intensity, disability, pain centralization, and patient satisfaction in participants with lumbar radiculopathy.
How They Did It
- A double-blind randomized controlled trial.
- The setting was in a General hospital.
- 60 adults with the mean age of 44 years old were included
- They were al diagnosed with subacute lumbar radiculopathy
- They were randomly allocated to receive spinal mobilization with leg movement exercise and electrotherapy or exercise and electrotherapy alone.
- All participants received 6 sessions over 2 weeks.
- The primary outcomes were leg pain intensity and Oswestry Disability Index score. Secondary variables were low back pain intensity, global rating of change (GROC), straight leg raise (SLR), and lumbar range of motion (ROM)
- Variables were evaluated blind at baseline, post-intervention, and at 3 and 6 months of follow-up
What They Found
- Significant and clinically meaningful improvement occurred in all outcome variables.
- At 2 weeks the spinal mobilization with leg movement group had significantly greater improvement than the control group in leg pain and disability.
- Similarly, at 6 months, the spinal mobilization with leg movement group had significantly greater improvement than the control group in leg pain and disability.
- The spinal mobilization with leg movement group also reported greater improvement in the global rating of change and in SLR range of motion.
Wrap It Up In patients with lumbar radiculopathy, the addition of spinal mobilization with leg movement provided significantly improved benefits in leg and back pain, disability, SLR ROM, and patient satisfaction in the short and long term. 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.
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!
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!
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.
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
- Chaibi A, S. K., Russell MB (2021). “Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.” J Clin Med 10(21): 5011.
- Satpute K, H. T., Bisen R, Lokhande P, (2019). “The Effect of Spinal Mobilization With Leg Movement in Patients With Lumbar Radiculopathy-A Double-Blind Randomized Controlled Trial.” Arch Phys Med Rehabil 100(5): 828-836.