The Evidence Based Chiropractor Blog

Hundreds of chiropractic marketing and research articles to help you grow.

Jeff Langmaid 8/14/14 Jeff Langmaid 8/14/14

Disc Herniations- Injections or Chiropractic Care? - by The Evidence Based Chiropractor

Research shows chiropractic care to be better than injections for disc herniation's.

Disc herniations (also known as slipped discs, disc bulges, disc extrusions, etc) are a common problem which can lead to disabling pain. Pain down the extremities (arms or legs) is called radicular pain and can stem from a disc herniation which is affecting a nerve root. Radicular pain can result in numbness, tingling, burning, or muscle cramps.

Many people who suffer from a suspected disc herniation visit their primary care physician. Usually, their primary care physician will examine the patient and refer them for a MRI. If the MRI shows a disc herniation the patient is often sent to an orthopedic specialist and injections may be recommended as a treatment option.

Last year over 9 million injections were given in the United States, which is roughly 25,000 per day.

Many patients don't know that injections are only effective about 50% of the time (per Columbia University Neurosurgery Department). Also, they have substantial risks. The Journal of Bone & Joint Surgery found that every injection increases the risk of a vertebral fracture by 21% (in the lumbar spine).

As a matter of a fact, a research article produced in 2013 compared the effectiveness of chiropractic care by spinal manipulation to nerve root injections for symptomatic disc herniation's. They concluded,

“A systematic review of the literature done the next year concluded that spinal manipulation is a very safe and cost-effective option to treat lumbar disc herniation"

and

“Both of the treatment groups had significant decreases in their NRS scores at 1 month with a 60% reduction for the Spinal Manipulative Therapy cohort and a 53% reduction for the Nerve Root Injection group.”

In this study, spinal manipulative therapy, the hallmark of chiropractic care, provided greater relief than the injections!

While many physicians are beginning to embrace the overwhelming research showing the efficacy of chiropractic care, their are still other physicians who are reluctant to provide evidence-based care. If you or someone you know is suffering from a disc herniation, it may be in your best interest to be evaluated by a chiropractic physician.

-The Evidence Based Chiropractor is the fastest growing chiropractic marketing group in the profession. The service, founded and run by Dr. Jeff Langmaid, is dedicated to increasing chiropractic utilization by showcasing research. Marketing to medical doctors through research is proven, cost effective, and can dramatically improve your incoming referrals. Join us. Lets grow chiropractic together.

Jeff Langmaid 8/13/14 Jeff Langmaid 8/13/14

Placebo Outperforms Fibrin Sealant Treatment for Chronic Lumbar Discogenic Pain- by The Evidence Based Chiropractor

A trial was recently presented at the International Spine Invention Society Annual Meeting which looked at fibrin sealant treatment for chronic lumbar discogenic pain. Fibrin sealant treatment is going through trials to determine efficacy and safety which may affect FDA clearances.

While the study did not indicate any potential risks or safety issues, the placebo of saline was found to perform better than the fibrin sealant. For discogenic pain, often annual tears in the annulus fibrosis are present. Fibrin sealant has been investigated as a mechanism to stabilize the disc and reduce pain; although this latest research study shows that the potentially expensive procedure may not provide adequate efficacy. At 26 weeks post treatment 40.7% of the control/placebo group had 50% improvement in VAS scores compared to only 35% of the patients receiving the fibrin sealant.

Previous research has shown chiropractic care, specially flexion-distraction technique, as a viable treatment for discogenic pain due to the reduction in intradiscal pressure.

Jeff Langmaid 8/11/14 Jeff Langmaid 8/11/14

Chiropractic and Stroke- by The Evidence Based Chiropractor

Every few years it seems as though chiropractic and stroke is a hot button issue. Just this week the American Heart Association released a paper which provoked the currently unfounded theory that chiropractic cervical manipulation may be directly associated with an increased risk of stroke. Dr. McCoy, from McCoy Press, released a very eloquent press release which in part states that zero causation has ever been established between chiropractic cervical manipulation and stroke. Additionally, of all the research which has ever been done regarding association; the results are inconclusive at best.

Per an article on WebMD, "Neck manipulation is associated with about one death per 1 million people due to cervical artery dissection, he (Dr. Overland) said.

By comparison, nonsteroidal anti-inflammatory drugs (NSAIDs) cause 153 stroke deaths per 1 million people, narcotic medications cause 53 stroke deaths per 1 million people, and spinal surgery of the neck causes 500 stroke deaths per 1 million people, Overland said."

I fully support continued research to evaluate potential risks and benefits associated with chiropractic care. A thorough evaluation of all risks should be paramount. However, statements and articles like the one published by the American Heart Association simply provoke myth, conjecture, and fear. By current research standards you are 153 times more likely to suffer a stroke by taking NSAID's, and 500 times more likely to suffer a stroke after spinal surgery than from a manipulation. While, unfortunately, there is no direct screening procedure to determine the potential of a stroke-like event occurring, a thorough case history and examination is imperative to identify any patients who may have risk factors.

Jeff Langmaid 8/8/14 Jeff Langmaid 8/8/14

Spending on Pharmaceuticals, Hospital Services, and Ambulatory Care- by The Evidence Based Chiropractor

"A study by the OECD found that the U.S spends 152% more on pharmaceuticals than the average OECD country. Disturbing statistic isn’t it? But how about spending in the other healthcare sectors? The same study found that the U.S spends 163% more on hospital services, and 238% more on ambulatory care services than the average OECD country."

Disturbing statistics. With all this spending we should be the "healthiest" country in the world. Unfortunately, that is not the case. However, by promoting conservative care and emphasizing interdisciplinary communication and cooperation, we can go along way towards improving our posting in the world of healthcare.

Jeff Langmaid 8/7/14 Jeff Langmaid 8/7/14

Cervical Steroid Injection Helps Only 1/3rd of Patients- by The Evidence Based Chiropractor

A recent study presented at the International Spine Invention Society Annual Meeting showed that only 1/3rd of patients who received cervical steroid injections actually benefitted from the procedure. Specifically, they looked at patients suffering from cervical disc herniations. The patients had previous MRI confirmed nerve root compromise.

They found that 1 month after a transforaminal injection, only 35.4% reported a reduction in their radicular pain. Last year, researchers found that every steroid injection in the lumbar spine increased the risk of fracture by 21.%. Although we don't yet know the risk of fracture in the cervical spine, it appears to be quite a chance to take if the treatment (the injections) are useless in two-thirds of patients.

Chiropractic care has been shown to be a safe and effective treatment option for patients with cervical radiculopathy. As a matter of fact, a recent study showed direct reduction in nerve root pressure when a flexion/distraction type chiropractic technique was used in the cervical spine.