The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 1)

CF 308: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 1) Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 1) 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 giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 
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You have found yourself smack dab in the middle of Episode #308 Now if you missed last week’s episode, we talked about Sciatica & Mental Stimulation And Dementia.  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Man…..just getting ready for Christmas and all that good stuff. Actually, we are ramping up marketing. We’re doing it the wrong damn way though. Here’s what I mean; we are doing reactive marketing rather than proactive marketing.  I market every week with social media posts, emails, and internal stuff. But REALLY maketing and spending some money to do so, yeah, I haven’t done much of that for one big reason. Because I still have somewhat newer staff. And yes….I’m one of those that doesn’t have a professional marketer or rep. I send our staff out to market.  Here’s the best reason why. We are off on Tuesday afternoons because I’m either doing continuing ed or I’m doing VoiceOver. Instead of warming up a chair in teh clinic doing absoluttey nothing, let’s go spread the word of this amazign clinic in Amarillo, TX called Creek Stone.  I’d rather pay an hourly wage for half-assed marketing than an hourly wage for professional time-killing and trying to look busy.  So yes, we’ve been painfully slow compared to my normal so we are kicking the marketing into high gear and with the help of a coupld of my Mastermind besties, we have some really great ideas that we think can be very effective in getting this clinic back at the top of the game.  The staff overturn in the last year has just been brutal, folks. I’ve never in 26 years experienced anything like it. It has kept us mostly stagnate but beyond valleys are the peaks and I feel pretty good about the peak we’re about to come up on.  We have some great direction with the marketing but also great direction on website SEO and we finally feel that we have solved our billing and collections equation and finally have one that we feel really really good about.  While we have a slow down, it has given us the time to plug some holes and get our house back in order and get ready for the growth that is about to happen.  I want to go on a little trip here with the next several episodes of the podcast so let me lay the base coat for you. At the TCA, one of my buddies and our legislative homey, Dr. Craig Benton from Lampassas, TX, is trying to get movement on the Medicare Equality Bill and we are doing what we can to get more congressmen signed onto the bill.  As part of that initiative, Craig sent an email that had a paper attached showing benefits of spinal manipulative therapy. It was from the World Health Organization. Well, one of our executives from the TCA emailed back wondering why, in 2023 with all of the info on the benefits of smt, there is still a designation of very low confidence for SMT. In fact, if I recall correctly, ultrasound was poor and smt was very poor or something of that nature.  So, this executive asked where the WHO got its information, so I started diving into the paper and found a list of their research for SMT. I thought it would be interesting to go through them to answer our questions and maybe we all learn something.  So…..why the hell not? And remember this. At the end of each and every episode of this podcast I say, “he 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.”  I want you to know that I don’t just say that, I walk that walk and have for around 15 years. If you’re not active, get your ass moving.  Item #1 In that spirit, the first one today iis called “Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial” by Balthazard et. Al. and published in BMC Musculoskeletal Disorders in August 2012.  Remember, the paper citations are in the show notes. Also, this is a pilot study. I don’t include pilot studies in this podcast usually but, the WHO is using it to determine the effectiveness of SMT so we might as well cover what the WHO is using.  Balthazard P, de Goumoens P, Rivier G, Demeulenaere P, Ballabeni P, Dériaz O. Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial. BMC Musculoskelet Disord. 2012 Aug 28;13:162. doi: 10.1186/1471-2474-13-162. PMID: 22925609; PMCID: PMC3518179. Why They Did It Recent clinical recommendations still propose active exercises (AE) for CNSLBP. However, acceptance of exercises by patients may be limited by pain-related manifestations.  Current evidence suggests that manual therapy (MT) induces an immediate analgesic effect through neurophysiologic mechanisms at peripheral, spinal and cortical levels.  The aim of this pilot study was first, to assess whether MT has an immediate analgesic effect, and second, to compare the lasting effect on functional disability of MT plus AE to sham therapy (ST) plus AE. How They Did It
  • Forty-two low back patients without co-morbidities, randomly distributed into 2 treatment groups, received either spinal manipulation/mobilization (first intervention) plus exercise, or detuned ultrasound (first intervention) plus exercise. 
  • Eight therapeutic sessions were delivered over 4 to 8 weeks. 
  • Immediate analgesic effect was obtained by measuring pain intensity (Visual Analogue Scale) before and immediately after the first intervention of each therapeutic session. 
  • Pain intensity, disability (Oswestry Disability Index), fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), erector spinae and abdominal muscles endurance (Sorensen and Shirado tests) were assessed before treatment, after the 8th therapeutic session, and at 3- and 6-month follow-ups.
What They Found
  • Thirty-seven subjects completed the study. 
  • MT intervention induced a better immediate analgesic effect that was independent from the therapeutic session 
  • Independently from time after treatment, manual therapy with exercise induced lower disability and a trend to lower pain. 
  • Six months after treatment, Shirado test was better for the sham treatment group. 
Wrap It Up
  • This study confirmed the immediate analgesic effect of MT over ST. 
  • Followed by specific active exercises, it reduces significantly functional disability and tends to induce a larger decrease in pain intensity, compared to a control group. 
  • These results confirm the clinical relevance of MT as an appropriate treatment for CNSLBP.
Item #2 Our last one today is called, “Spinal manipulative therapy-specific changes in pain sensitivity in individuals with low back pain” by Bialosky et. Al. and published in Journal Of Pain in February 2014.  Bialosky JE, George SZ, Horn ME, Price DD, Staud R, Robinson ME. Spinal manipulative therapy-specific changes in pain sensitivity in individuals with low back pain (NCT01168999). J Pain. 2014 Feb;15(2):136-48. doi: 10.1016/j.jpain.2013.10.005. Epub 2013 Oct 27. PMID: 24361109; PMCID: PMC3946602. Why They Did It Spinal manipulative therapy (SMT) is effective for some individuals experiencing low back pain; however, the mechanisms are not established regarding the role of placebo. SMT is associated with changes in pain sensitivity, suggesting related altered central nervous system response or processing of afferent nociceptive input. Placebo is also associated with changes in pain sensitivity, and the efficacy of SMT for changes in pain sensitivity beyond placebo has not been adequately considered. How They Did It
  • We randomly assigned 110 participants with low back pain to receive SMT, placebo SMT, placebo SMT with the instructional set “The manual therapy technique you will receive has been shown to significantly reduce low back pain in some people,” or no intervention. 
  • Participants receiving the SMT and placebo SMT received their assigned intervention 6 times over 2 weeks. 
  • Pain sensitivity was assessed prior to and immediately following the assigned intervention during the first session. 
  • Clinical outcomes were assessed at baseline and following 2 weeks of participation in the study.
What They Found
  • Immediate attenuation of suprathreshold heat response was greatest following SMT. 
  • Group-dependent differences were not observed for changes in pain intensity and disability at 2 weeks. 
  • Participant satisfaction was greatest following the enhanced placebo SMT.
Wrap It Up The results of this study indicate attenuation of pain sensitivity is greater in response to SMT than the expectation of receiving an SMT. These findings suggest a potential mechanism of SMT related to lessening of central sensitization and may indicate a preclinical effect beyond the expectations of receiving SMT. 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.     

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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
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One comment on “The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 1)

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