lumbar stenosis

Lumbar Stenosis

CF 230: Lumbar Stenosis

Today we’re going to talk about lumbar stenosis

But first, here’s that sweet sweet bumper music

 

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 #230

Now if you missed last week’s episode , we talked about T-sp Adjustments For Neck, Not Headache & Physical Activity In Children. Make sure you don’t miss that info. Keep up with the class. 

 

On the personal end of things…..

As I mentioned last week, I just finished the book called Who Not How by Dan Sullivan and another dude. Lol I can’t remember his name and don’t have time to look. Brad Hanby or something like that. Anyway, I’m on the hunt for an associate as a result. Great book and I know that with some help, not only will I have more time available to be a more effective clinic owner and doctor, but I’ll have the opportunity to grow the practice as well. It’ll be great. Give me a holler if interested in working in a busy evidence-based, patient -centered and medically integrated clinic that is making a difference int he Texas Panhandle. That’s us. 

Now, I’ve started reading a book recommended to me by Ben Fergus of the GRIP method fame and a fellow member of the MCM Mastermind you’ve heard me mention. This book is called Think Again by Adam Grant. It’s all about learning to search for the things you don’t really know and be willing to re-think your thoughts and stances on things. I’m still just getting into it a bit but it’s pretty alright and it’s teaching me some stuff. 

I also started a book by Gray Cook called The Business Of Movement I saw recommended by Jason Hulme recently in a Facebook group. It’s probably the Forward Thinking Chiropractic Alliance group if I’m guessing. Anyway, that one just came in the mail. Hell, I need an associate just so I’ll have time to read and get up to date. I also just joined an online class called Quadrant Analysis that I’m looking forward to diving into. 

So, I’m not perfect. Don’t follow everything I do. I could do better soap notes. I could do a lot of things better but….#1 our patients are 99% likely to refer us to their friends and family #2 ChiroUp tells me our clinic has about an 80% improvement rate for any and all conditions considered. #3 I’m 49, been in this sucker for 24 years, and I can’t wait to learn more and more. We can always learn more. We can always get better. We never know it all. If I ever find an associate that wants to come to the Texas Panhandle, that’ll be one of the first things I make sure they understand. If you ever stop learning, you’re either ignorant or you’re arrogant. Each is equally appalling. 

Boom, snap, pow, slap. 

Some of you may have seen a post by a ‘chiropractor’ …..I use the term loosely when referring to this dummy. She put on social medial recently the following, “An ovarian cyst is a functional gift from nature to make your more attractive and fertile after a traumatic loss. An enlarged prostate is a fit from nature to make you more potent after feeling degraded as a man. Tumors are not mistakes, they are purposeful adaptations.”

Bless her heart…. This little knucklehead is running around spouting this stuff and, yup you guessed it…is a chiropractor. I’m quoted in an article now saying she’s insane. Mostly because that’s my opinion and the only one I can think of that makes any sense with regard to a statement like that. 

I bring it up because you have to know these loony birds are out there soiling our names and our hard work. The people that listen regularly here are normal, educated, and hard working evidence based patient centered chiropractors out there changing the world and elevating this profession beyond quack BS that has held the profession back for so long. If however you stumbled upon this podcast and you believe stuff like this is plausible, please, don’t leave. Don’t go anywhere. 

Let me introduce you to evidence and research and sanity. 

Before getting into the research, 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.

Let’s get to it.

 

Item #1

This frist one is called “Diagnosis and Management of Lumbar Spinal Stenosis A Review” by Katz et. al. (Katz JN 2022) and published in JAMA on May 3, 2022, that was just like 3 weeks ago damn the heat….It burns

This is more of an article than a standard research paper so lets hit the high points with some relevant quotes from the report.

“Affects an estimated 103 million persons worldwide. Most are treated nonoperatively. Approximately 600 000 surgical procedures are performed in the US each year for lumbar spinal stenosis.”

The prevalence of the clinical syndrome of lumbar spinal stenosis in US adults is approximately 11% and increases with age.”

“The diagnosis can generally be made based on a clinical history of back and lower extremity pain that is provoked by lumbar extension, relieved by lumbar flexion, and confirmed with cross-sectional imaging, such as computed tomography or magnetic resonance imaging (MRI)”

More specifically, from my learning through the Neuromusculoskeletal diplomate program, a little clinic pearl here is the shopping cart sign. If they have to use a shopping cart to lean forward over in order to be able to walk through the grocery store, and sitting almost immediately alleviates the pain, there’s a great chance you have some stenosis on your hands. Pain on extension or extension/rotation can bolster the diagnosis. 

Then, on the MRI or CT, if you see the sedimentation sign where the nerve roots stay suspended in teh central canal rather than settling on the bottom of the canal due to gravity. You now have pretty convincing evidence of stenosis. 

“In a series of patients with lumbar spinal stenosis followed up for up to 3 years without operative intervention, approximately one-third of patients reported improvement, approximately 50% reported no change in symptoms, and approximately 10% to 20% of patients reported that their back pain, leg pain, and walking were worse.”

That makes a strong argument for no surgery doesn’t it? Look, most do fine with targeted exercise. There is a stenosis protocol in ChiroUp if you’re not usiing the program. While I am a ChiroUp devotee, I actually use the protocol and program from Dr. Carmen Amendolia. You can find all of his info at spinemobility.com It’s excellent and we see really good results using it. 

“Multiple clinical trials have studied manual therapy for spinal stenosis, including lumbar distraction mobilization, hip and sacroiliac joint mobilization, manual stretching, and muscle strengthening. In a clinical trial33 of 58 participants with lumbar spinal stenosis, 79% reported being at least somewhat better following a 6-week program that included manual therapy, treadmill walking, and strengthening and stretching exercises compared with 41% of patients randomized to the flexion exercise group.

The results were similar at 1 year. Schneider et al31 randomized 259 patients with lumbar spinal stenosis to 1 of 3 treatment groups: medications with or without epidural injections, manual therapy with individualized exercise, and group exercises. Participants randomized to manual therapy combined with individual exercises had improved their Zurich Claudication Questionnaire scores significantly more at the 2-month follow-up (mean difference, 2.0; 95% CI, 0.4 to 3.6) than did those randomized to medications with or without injections. Participants randomized to group exercises had similar improvement to those receiving medications and/or epidural injections (mean difference, −0.4; 95% CI, −2.1 to 1.3). The differences between groups were negligible at 6 months.”

“Epidural steroid injections may offer modest short-term pain relief but do not appear to last more than 3 weeks.”

“Long-term benefits of epidural steroid injections for lumbar spinal stenosis have not been demonstrated. Surgery appears effective in carefully selected patients with back, buttock, and lower extremity pain who do not improve with conservative management. “

 

Wrap Up

Lumbar spinal stenosis affects approximately 103 million people worldwide and 11% of older adults in the US. First-line therapy is activity modification, analgesia, and physical therapy. Long-term benefits from epidural steroid injections have not been established. Selected patients with continued pain and activity limitation may be candidates for decompressive surgery.

The key to remember about stenosis is that it isn’t necessarily the size of the hole rather what is happening to the structures going through the hole. If there is no realy inflammation or complication, stenosis patients may never know they have it. 

Alright, that’s it this week. 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. 

 

 

 

 

 

 

 

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

Katz JN, Z. Z., Mass H, Makhni MC, (2022). “Diagnosis and Management of Lumbar Spinal Stenosis: A Review.” JAMA 327(17): 1688-1699.

 

Current Knowledge On A Robust Low Back Pain Diagnosis

CF 125: Current Knowledge On A Robust Low Back Pain Diagnosis Today we’re going to talk about picking apart a Lumbar pain diagnosis. What’s the latest information according to research? 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.   Today, I want to use a current paper from November on low back pain and diagnosing it correctly. I’m going to use the paper as the main source of info here but I’m going to be peppering in my own learning as a Fellow of the International Academy of Neuromusculoskeletal Medicine. I’m a nerd when it comes to the low back for whatever reason. Maybe because its the best researched of the conditions we treat. I don’t know. But I nerd out of this stuff and, if you follow along, by the end of today’s episode, you should be able to raise your low back diagnosis game considerably.    Item #1 This one is called “Current evidence for the diagnosis of common conditions causing low back pain; systematic review and standardized terminology recommendations” by Robert Vining, et. al(Vining R 2019). and published in Journal of Manipulative and Physiological Therapeutics in November of 2019……hot enough, here we go.  Why They Did It The purpose of this systematic review was to evaluate and summarize current evidence for the diagnosis of common conditions causing low back pain and to propose standardized terminology use. How They Did It
  • A systematic review of the scientific literature was conducted from inception through December 2018
  • Electronic databases searched included PubMed, MEDLINE, CINAHL, Cochrane, and Index to Chiropractic Literature
  • Of the 3995 articles screened, 36 (8 systematic reviews and 28 individual studies) met final eligibility criteria
  • Diagnostic criteria for identifying likely discogenic, sacroiliac joint, and zygapophyseal (facet) joint pain are supported by clinical studies using injection-confirmed tissue provocation or anesthetic procedures
  • Diagnostic criteria for myofascial pain, sensitization (central and peripheral), and radicular pain are supported by expert consensus–level evidence
  • Criteria for radiculopathy and neurogenic claudication are supported by studies using combined expert-level consensus and imaging findings.
What They Found
  • The absence of high-quality, objective, gold-standard diagnostic methods limits the accuracy of current evidence-based criteria and results in few high-quality studies with a low risk of bias
  • These limitations suggest practitioners should use evidence-based criteria to inform working diagnoses rather than definitive diagnoses for low back pain
Let’s dive in a bit, shall we? Discogenic pain, they say provocation discography is the diagnostic reference standard test used to confirm discogenic pain but it costs a lot, it’s not well standardized and there are some pretty significant risks of adverse effects. So the authors are recommending the centralization phenomenon as an office-based test to try to confirm discogenic pain. I’d add a few other signs of the pain being disc in nature. Here are a few off the top of my head:
  • The patient locates their pain axially and at L5 or above, not laterally
  • You cannot typically provoke the pain when pressing P to A on the segment
  • Walking helps
  • The Slump Test is highly useful here
  • Pain on coughing or sneezing or going from seated to standing
  • Pain that is worse sitting and better when lying down
  • Pain that can be centralized or peripheralized
  • Diminished motor, sensory, or reflexes
  • About 40% of low back pain patients under the age of 50 are discs
  • And pain that radiates beyond the knee
Myofascial Pain – They recommend myofascial pain be defined as nociceptive signaling from within muscle or fascial tissues that may or may not include referred pain or the presence of trigger points. Diagnostic criteria consistent with this definition include tenderness within a muscle with or without referred pain and reproduction of familiar pain with palpation or use. SI Joint Pain – Despite the existence of numerous provocation tests designed to identify SI joint pain, current scientific evidence does not support the diagnostic utility of individual tests. I can agree with that. Therefore, they say that SI anesthetic injections or blocks are the current diagnostic standard but of course, we don’t do that do we? No, we test the SI joints in several different ways and try to have a consensus. 
  • SI joint pain prevalence is about 22.5% of your low back patients
  • Fortin’s finger test raises your suspicion considerably
  • Walking hurts
  • Seated to standing usually hurts
  • For a robust diagnosis of SI, you should have 3 of the following 5 positive tests. 
  • Sacroiliac compression test
  • Distraction / gapping test
  • FABER test
  • Gaenslen’s test
  • Thigh thrust
Facet Joint Pain – They point out a study by Laslett et. al. saying a reporting of 3 out of 5 findings is sufficient to make a facet dx. They are:
  • Patient over 50
  • Paraspinal pain
  • Relieved with walking
  • Relieved with sitting
  • Positive extension/rotation
I will add to that list that facet joints constitute roughly 30% of your low back patients. The extension/rotation test is important. If it’s positive, it can still be something other than facets. But, if it’s negative, it’s almost certainly NOT a facet. Get that again, if extension/rotation is NOT positive, it’s almost certainly NOT facet.  In addition, you can push paraspinal on the patient and provoke the pain whereas, as mentioned, with a disc, you cannot provoke it by palpation.  Typically, long-lever activities are bothersome. Things like vacuuming, doing the dishes, or folding laundry. Anything that involves being slightly bent forward for a period of time.  Stenosis – They say “Neurogenic claudication occurs when spinal stenosis is severe enough to cause symptoms from intermittent neural compression or ischemia, most commonly from degenerative changes within the spine.” They say they “recommend diagnostic criteria reported by Nadeau et al. Which are symptoms triggered with standing, relieved by sitting, symptoms above the knees, and positive shopping cart sign.” For me here in my clinic, I use the protocol Carmen Amendolia created and validated through research. It’s been highly effective for us and our patients.  Piriformis Syndrome Current diagnostic criteria are available only through a systematic review of clinical features reported in the scientific literature: 
  1. ipsilateral leg radiation, 
  2. (2) greater sciatic notch tenderness, 
  3. (3) buttock pain, 
  4. (4) positive SLR, and 
  5. (5) pain with sitting
I would add that resisted external rotation could give you a hint. Put your hands on the lateral sides of the patient’s knees bilaterally. Then tell the patient to try to spread their legs while you resist. It’s painful, you have another very simple hint that you may be dealing with a piriformis issue.  So there you have it with my own learning from the neuromusculoskeletal diplomate program salted and peppered in for a good robust discussion. Yes, there are other considerations like lumbar sprain strain and things like that but these are the biggies.  If you weren’t before, you should be well-equipped after this episode to kill it on a low back diagnosis.  Alright, that’s it. Y’all be safe. 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 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
Home
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography Vining R, S. Z., Minkalis A, (2019). “Current evidence for diagnosis of common conditions causing low back pain; systematic review and standardized terminology recommendations.” J Man Manip Ther 42(9): P651-654.

CF 045: Harvard Health, Low Back Stenosis, Allergy Autism

CF 045: Harvard Health, Low Back Stenosis, Allergy Autism

As the title this week indicates, I’ve taken some files that have been gathering a little bit of dust in the dark corner and I’m bringing them out into the light.

Today we’ll talk about an article in Harvard Health, we’ll talk about low back stenosis research (something that doesn’t get a lot of attention), we’ll talk about a JAMA article on allergies and autism, and we’ll hit on a paper attempting to explain why some patients respond while others do not. 

Integrating Chiropractors

 

But first, you know what’s up, I wrote and recorded our jingle so you might as well just sit back and enjoy this candy for your ears. When you do create something, it’s going to be in EVERY show don’t ya know!! Here’s that bumper music

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have collapsed into Episode #45

OK, first thing, we should probably talk about the Texas vs. Oklahoma game that just happened this last weekend. By the time this posts, it’ll be two weeks ago but, still need to brag. What a game that was. I’m a Texas boy but either way would have been fine since most of OU’s players are from Texas anyway. I go for all of the Texas teams. 

I want to thank Kyle Swanson for the shout out on the Forward Thinking Chiropractic Alliance group a couple weeks ago. He’s a Texas A&M Aggie. Look, like I said, I root for A&M too so we would probably be buddies in the real world if I’m guessing out loud. 

Front Desk Staffing

Let’s get to the ongoing saga of hiring a new front desk staff. If you’ve been following along, you’ll remember that hiring a new front desk staff member has been nothing but a soup sandwich. 

Messy. Gloppy, Unreal and confusing. Those are just some words I’m laying on you. I have more words for what we’ve been through on this deal but then my podcast would have an explicit designation and I try to keep it clean around here. 

But, I believe progress has been made. We seem to have a new one that seems to be on top of her game. If she’s a “sticker,” then the search may very well be over. Of course, she’s not young which is probably why she’s a sticker so far. She’s closer to my age than any of the others have been. I’m not saying that young people have no work ethic…..I’m just saying that all of the young people that we interviewed for this job have no work ethic. 

That sounds like I’m against young people, millennials, blah blah blah. I’m not. I have had some VERY intelligent and capable young people come through here as employees over the years. There are very smart, very talented young folks out there. We just didn’t encounter any of them for this round of hiring. That’s all I’m saying. 

Moving on

October has really taken off in terms of listens for the podcast. I can only guess you’re sharing episodes here and there with your network. To that, I say thank you. If I ever see you somewhere and you tell me you have been sharing my stuff, and hold your hands out like, “bring it in big boy,” well then…you’re getting a hug my friend.

I’m a hugger. Which can probably be scary if you don’t know me. I’m 6’4” and like 280 so….big guy coming through! But, those that know me know that I’m a teddy bear. Unless you try to steal my food. Then it’s pretty much on at that point. 

On to the research

Let’s get on with trying to make your practice better. When your practice is better, your life is better. 

Let’s start with the Harvard Article. It was published in November 2017. I have it linked at chiropracticforward.com for you all in the show notes for episode 45. The name of the article is “Where to turn for low back pain relief[1]” and I couldn’t find the name of the author so there ya go. 

https://www.health.harvard.edu/pain/where-to-turn-for-low-back-pain-relief

The subtitle of this Harvard Medical journal….medical journal……is this: in most cases, a primary care doctor or chiropractor can help you resolve the problem. What the hell??? It seriously says that in a Harvard Medical article. I’m trying to catch my breath here. Sorry…..

It was published in November of 2017. The article says that there are many causes of low back pain and some of the most common is an injury to muscles or tendon which we know is called a strain and then injury to back ligaments which we call a sprain. And then there are herniated or bulging discs. 

Going through the DACO program tells me that the prevalence between disc, facet, and SI joint pain stands at 40% for the disc, 30% for the facet, and 22.5% for the SI joint pain. BUT….over the age of 50 years old, it flips a little and the Facet joint gains prevalence over disc or SI pain. Just some nuggets to tuck away in your nugget pouch. 

This article just blows me away when it gets to the “Where to Turn” subtitle. Beneath this subheader, it says, “Since you shouldn’t try to diagnose your own back pain, make your first call to a professional who can assess your problems, such as a primary care physician or a chiropractor.”

Both can serve as the entry point for back pain says Dr. Matthew Kowalski who serves as a chiropractor with the Other Clinical Center for Integrative Medicine at the Harvard-affiliated Brigham and Women’s Hospital. 

What the hell is happening here? Am I in the Twilight Zone where everything is flipped and the medical world finally gets it?

The article goes on to say “A well-trained chiropractor will sort out whether you should be in their care or the care of a physical therapist or medical doctor.”

And here’s the difference between evidence-based/patient-centered chiropractors and those that are not. 

The more not evidence-based amongst us, the ones that drive a billion people through their doors for everything from allergies to whatever…..they will not typically be turning those patients over to the medical doctor or the PT. 

Moving to the next paper, it’s called “Comprehensive Nonsurgical Treatment Versus Self-directed Care to Improve Walking Ability in Lumbar Spinal Stenosis: A Randomized Trial” authored by Carlo Ammendolia, et. al. It’s all about low back stenosis. This paper is co-authored by DCs, AND MDs. It was published in the Archives of Physical Medicine and Rehabilitation on October 27, 2017[2]. 

Why They Did It

They wanted to the effectiveness of a comprehensive nonsurgical training program to a self-directed approach in improving walking ability in low back stenosis.

How They Did It

  • It was a randomized controlled trial
  • It was done in an Academic hospital outpatient clinic
  • Participants suffered neurogenic claudication
  • MRI confirmed lumbar spinal stenosis
  • Subjects were suffering low back stenosis and randomized

What They Found

The conclusion stated, “A comprehensive conservative program demonstrated superior, large, and sustained improvements in walking ability and can be a safe nonsurgical treatment option for patients with neurogenic claudication due to LSS”

Low back stenosis can be helped

Dr. Ammendola has an amazing lumbar spinal stenosis program and training course. I have not personally taken it just yet but, it’s on my list after I finish up the DACO program. It comes HIGHLY recommended and this paper shows us why. 

Trucking on, this one is called “Do participants with low back pain who respond to spinal manipulative therapy differ biomechanically from nonresponders, untreated controls or asymptomatic controls?” It was published in Spine Journal in September of 2015 and authored by Wong, et. al. [3]

Why They Did It

To determine whether patients with low back pain (LBP) who respond to spinal manipulative therapy (SMT) differ biomechanically from nonresponders, untreated. Some, but not all patients with low back pain report improvement after a visit to the chiropractor. Why does that happen?

What They Found

After the first SMT, SMT responders displayed statistically significant decreases in spinal stiffness and increases in multifidus thickness ratio sustained for more than 7 days; these findings were not observed in other groups.

Wrap It Up

Quote, “Those reporting post-SMT improvement in disability demonstrated simultaneous changes between self-reported and objective measures of spinal function. This coherence did not exist for asymptomatic controls or no-treatment controls. These data imply that SMT impacts biomechanical characteristics within SMT responders not present in all patients with LBP.”

And our last one this week comes to us from JAMA, also known as the Journal of the American Medical Association. This one is called, “Association of Food Allergy and Other Allergic Conditions With Autism Spectrum Disorder in Children.[4]” It was authored by Guifeng, et. al. and published in 2018. Again, these papers are cited in the show notes at chiropracticforward.com under episode 45 so check them out yourself please. 

The question they attempt to answer here is, “What are the associations of food allergy and other allergic conditions with autism spectrum disorder (ASD) in children?”

They say in the paper that Common allergic conditions, in particular, food allergy, are associated with autism among US children, but the underlying mechanism for this association needs further study.

The study was a population-based, cross-sectional study used data from the National Health Interview Survey collected between 1997 and 2016

The conclusion was quote, “In a nationally representative sample of US children, a significant and positive association of common allergic conditions, in particular, food allergy, with ASD was found.”

They now need to find out the cause and underlying mechanisms so they can attempt to reverse the upswing of autism here in America. 

So….it appears maybe it’s not all due to vaccines after all. 

Integrating Chiropractors

That wraps it up for us this week. I hope you enjoyed it. Research can be boring but, it can be fascinating too when you allow it to help guide your thought process when you are approaching your daily tasks and deciding on treatment options for your patients. 

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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability.

It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Being the #1 Chiropractic podcast in the world would be pretty darn cool. 

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:

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

 

Bibliography

1. School, H.M., Where to turn for low back pain relief. Harvard Health Publishing, 2017.

2. Ammendolia C, Comprehensive Nonsurgical Treatment Versus Self-directed Care to Improve Walking Ability in Lumbar Spinal Stenosis: A Randomized Trial, in North American Spine Society Meeting. 2017, Archives of Physical Medicine and Rehabiliation: Orlando, FL.

3. Wong AY, Do participants with low back pain who respond to spinal manipulative therapy differ biomechanically from nonresponders, untreated controls or asymptomatic controls? Spine, 2015. 40(17): p. 1329-37.

4. Guifeng X, Association of Food Allergy and Other Allergic Conditions With Autism Spectrum Disorder in Children. JAMA, 2018. 1(2).

 

CF 016: Review of The Lancet Article on Low Back Pain (Pt. 1)