Chiropractic Before or After a Spinal Injection: The Facts!

Suffering through the pain associated with a disc herniation can be debilitating. When a spinal disc is pressing on a nerve it can result in excruciating pain that may seem like it will never go away.

Quite often medical doctor’s recommend nerve root injections (also known as Epidural Steroid Injections) if they see on an MRI that the disc is pressing on a nerve. But how many times do they also recommend chiropractic care with the injections? Not often enough.

Over 9 million spinal injections are given every year for spine-related pain. That is over 24,000 every day! Injections are often given when a patient is suffering from radiculopathy or a compressed nerve root.

Over 24,000 SPINAL injections are given every day!

I believe there is a better, research-supported way to find relief. But first, let's set the stage a bit.

Click Here to Download a Powerful Free Research Brief

The 3 tissues that can pinch a nerve and cause pain are:

• Spinal Discs

• Bone Spurs and Osteophytes

• Ligament Overgrowth and Hypertrophy

Whether the compression is caused by a disc, ligament, or bone- the nerve doesn't care. It's aggravated and causing pain. Statistically, many of these people are going to visit their medical doctor to find relief. Over 30% of the patients in a primary care doctors office are there for treatment of a musculoskeletal complaint.

When they go to see their medical doctor with radiculopathy, the medical doctor may prescribe an anti-inflammatory, and perhaps physical therapy. Then an MRI is ordered. 

What do they find? 

Well, if it's a disc pressing on the nerve, the next stop for that patient is quite often a physiatrist, pain management doctor, or neurologist for a spinal injection. The goal of the injection is to decrease the inflammation and "numb" the area, which may provide temporary relief at best. And what happens when the injections stop working? It's off to the surgeon.

I believe there is a better path to relief.

I thought it would be interesting to look at the research showcasing the use chiropractic or injections for the treatment of radiculopathy. First up was a study from JMPT in 2013. The title is "symptomatic MRI-confirmed lumbar disc herniation patients comparing high-velocity low amplitude spinal manipulative therapy or image guided lumbar nerve root injections."

 And guess what the researchers found?

The researchers found, "both of the treatment groups had significant decreases in their pain scores at one month with a 60 percent reduction for the spinal manipulative therapy cohort and a 53 percent reduction for the nerve root injection group".

The spinal manipulation group had much better outcomes than the nerve root injection group.

Additionally, they found, "lumbar nerve and injections are commonly used, and accepted treatment option for these patients whereas lumbar spinal manipulation as a treatment for disc herniation remains controversial amongst some healthcare professionals." 

That tells us that there is some work to do on the relationships building front. With the volume of nerve root injections and all the risks- people should be exploring conservative care, such as chiropractic, first!
(in the absence of red-flags and extenuating circumstances)

Keep in mind this is a symptomatic, MRI-confirmed lumbar disc herniation. The disc is placing direct pressure on the nerve. And while both groups found improvement, the chiropractic group, the spinal manipulation group, ultimately outperformed the nerve root injection group. That's exciting!

The fact that a conservative care option can outperform a ton of steroids being dumped on an inflamed nerve is impressive.

Additionally, another study titled "spinal manipulation post-epidural injection for lumbar and cervical radiculopathy: a retrospective case series" had some interesting results. For instance, happens if you give an adjustment to someone who has already had an injection? 

Unfortunately, many people believe they are past chiropractic when they get the injection. And the researchers found the opposite is true.

They found, "the majority of the patients showed a positive response with only one treatment procedure".

Additionally, the researchers found, "theoretically epidural injections are proposed to address the inflammatory and central components of spinal pain whereas spinal manipulation is proposed to address the mechanical and neural aspects of the pain syndrome". 

Spinal manipulation is proposed to address the mechanical aspect of the pain, and you're getting physical motion into the joint with many chiropractic techniques. But they also cited the neural elements such as the impact to a central nervous system and the opening of the foraminal canals, decreasing the pressure on the nerve.  

Finally, the researchers found, "this data suggests that spinal manipulation post-epidural injection is a safe non-surgical procedure to use in the treatment of a patient with radiculopathy of spinal origin." 

So not only do many patients get well with chiropractic care before (or instead) of getting an injection, but even those individuals who went through an injection still saw improvement with chiropractic care.

This research is important information for your patients to know and is also as a great conversation starter for the providers in your community. Those conversations may save dozens, if not hundreds of people from going through expensive and sometimes dangerous, injections. 

We've featured both of these pieces of research as monthly research for our members of The Evidence Based Chiropractor; which is the complete system for relationship building with other healthcare providers in your community. Click here to learn more!

Click Here to Download a Powerful Free Research Brief

10X Your Next Seminar Using This Instagram Hack

At Rockstock in Huntington Beach, one of the big things that I noticed was that it seemed like everyone knew everyone. But, there are many events and seminars that feel a bit lonely. It can make you feel like your in a silo. But, I want to tell you that you can use Instagram to connect with other docs that are close by to you and make connections, so you're not feeling alone or siloed at the events and seminars you attend.

And the easiest way to do it is when you take out your phone, go to Instagram. Then search by "places." And when you search by locations you can tag precisely where you're hanging out. So recently I was at the Hyatt Regency in Huntington. I can tag that location and Instagram will give me a list of everybody that's posted (in chronological order) and tagged the Hyatt Regency. So I was able to find a bunch of other docs that were posting pictures from Rockstock. And then I can comment on the photos, shoot them a direct message, follow them, etc. If you go to a unique event and you don't know anybody there whatsoever you can just hop on Instagram. 

Especially if it's an event that has a couple of hundred chiropractors- you'll notice that quite a few start to post pictures. People are engaged. People are pulling out their phones and taking photos of slides, and many of them are then putting those on Facebook or Instagram. 

So I just want to give that quick tip for you. If you're at a seminar or a conference, and it feels like you don't know anybody,  Instagram can make it a lot easier to connect with like-minded docs and make a few friends in the process. 

The 10 Best Chiropractic Website Tips

Our chiropractic website tips are here to make your website stand-out and attract more new patients. 

via GIPHY

Click Here to Download a PDF Version of These Tips!

1) Consistent Blogging- content is KING

At this point EVERY chiropractic website should contain an active blog.  On the internet (and with search engines), content is KING.  Keeping an up-to-date blog filled with relevant content is absolutely essential to having a website that is working for you and your practice. I recommend updating your blog at least 2x month with a medium length piece of content.

2) Be Smart With Your Web Address- use the right keywords so people can find you on Google

Your URL, or web address, is a surprisingly overlooked component of your SEO. The best URL’s are brief and contain your business name. Think apple.com or facebook.com. In other words, you want to avoid anything that resembles www.JonesFamilyChiropracticandRehab.com/home-1-2-4-gck Keep it simple and as easy to remember as possible!

3) CTA- have a CLEAR call to action or next step for your visitor

Have you noticed anything when you visit Google, Yelp, and many of the other most popular website in the world. How many actions can you take a google.com? One! There is one clear call to action. When someone arrives at your website, make the ONE action you want them to take very apparent. Pro-tip- “wellness awaits you” is not a compelling call to action. 

4) Practice Information- this may sound obvious, but make sure your phone/address/email are easily accessible

If someone goes to your website on their smartphone are they able to press a button and call your office immediately? If not, you may be missing out on a tremendous amount of new patients. You would be shocked at how many chiropractic websites don't have this simple functionality. 

5) Email Opt-In- build an on-going list of potential new patients with a pop-up box or welcome mat

You have probably heard of “funnels” or email sequences. But before you start turning prospects into patients with these tools you need something…their email! Be sure to have a solid email collection tool on your website such as sumo.com 

Click Here to Download a PDF Version of These Tips!

6) Install Google analytics- as Nike says, “Just Do It”

You can only improve what you measure. Google analytics is completely free and gives all of the statistics you need to refine and improve your website. It’s simply the best free tool available to check the performance of your website. 

7) Load a Facebook Pixel- essential for re-targeting and having high converting FB ads

A facebook pixel is an invisible piece of code on your website that you can use to improve the response of your ads. And if you are spending any money on ads, you want them to work! To learn more about re-targeting click here. 

8) Mobile Friendly- over 50% of people will view on their phones, make sure it’s looking good

Duh. Is your website look great on an tablet or smartphone? Or is half the content hanging off the side of the screen? If your website isn't mobile responsive, then you are losing a ton of traffic and may even be being penalized by Google in the search engine rankings. 

via GIPHY

9) Social Media Account- link your social account to your website and vice-versa

Don’t forget to link your social media accounts to your website. If someone visits your website they should easily be able to check out your presence on social media. This will help build your audience and establish rapport. 

10) Speed- check your speed using a tool like Google PageSpeed. This helps with SEO

For many potential patients your chiropractic website is their first contact to your brand. Simply having a website is no longer enough. But, having a great website does not require $1,000 per month or your own web developer. 

There you have it. Ten of best steps you can take to ensure your website stands out front the crowd and attracts more new patients. 

Click Here to Download a PDF Version of These Tips!

The Ultimate Chiropractic Marketing Success Secrets Revealed

Marketing a chiropractic practice can be tough. I mean, real tough (think parallel parking in Manhattan). 

It’s difficult to get all the marketing strategies, all the different marketing approaches, and all the experts insights without spending countless hours visiting dozens of websites.  

Also, depending on your practice type (family, sports, rehab) and philosophy (yes, please or no, thank you) you can end up struggling to implement changes. 

A classic case of paralysis by analysis. 

Well…

What if you had the best influencers, from all sides of chiropractic, come together and tell you their top strategies for growth?

I have good news for you. It’s here.

I bribed, pleaded, and blackmailed (ok, I didn’t blackmail anyone) the top minds of chiropractic marketing to offer insight into their strategies for chiropractic success. By calling in a few favors and twisting a few arms, I was able to wrangle up Beau Pierce, Jerry Kennedy, Matthew Loop, Laurence Tham, Bobby Maybee, Tristan Schaub, and Erik Brower. 

So I did what any reasonable man would do, I made them an offer they couldn’t refuse.

No one was harmed during the making of this blog post, although we came pretty close (ask Tristan about it sometime).

So without further adieu; here is the Ultimate Chiropractic Marketing Success Secrets Revealed. 

What is the biggest misconception that chiropractors have about utilizing social media? 

“The biggest misconception about social media is that it takes a lot of time. If done in a certain way, the doctor can create systems which feed the office traffic and new patient referrals for years to come. Unlike a postcard drop where you may reap the benefits one time only. Slow but steady always wins the race. Consistency moves mountains. The goal is to get one system in place, automate it the best way possible, then stack another layer onto the marketing machine. And YES, the doctor needs to put some time in. No one that's ever become a wealthy industry influencer online outsourced their entire social media outreach. That's the cold hard truth. You are your brand. Your voice is unique and needs to be heard if you want to build a loyal following that knows, likes, and trusts you”, says Matthew Loop, expert social media marketer and author of Social Media Made Me Rich. 

Also focusing on the SOCIAL aspect is key. Beau Pierce, the founder of Circle of Docs, told me, “Many doctors think of social media as a glorified bullhorn and nothing more than a chance to "show off."  Once they fully grasp the true understanding of Why you should use social media and the ability to build a community of people who are looking for your knowledge, then they rally behind it.”

Tristan Schaub, of ChiroSushi and the ChiroSushiSummit, kept it real by saying, “Chiropractors think that all they need to share is “ChiroContent”. Chiropractic is about Life. Social Media is now Life. Chiro's need to realize that their social media should emphasize the social part of social media and get creative with their content on a consistent basis.”

What is the best framework to market your practice without “selling”? 

“Marketing without selling depends 100% on communication skills and relationships.  Every part of your marketing has to communicate a specific and targeted idea or feeling.  The ideas must be conveyed in a way that tells patients what their implied benefit is when using your services.  When you bring people to your practice that way, then you can focus on goal based, functional planning in cooperation with the patient.  They will come in with a certain expectation that your marketing hopefully set for them (hopefully).  Then you frame their experience around those expectations and specific personalized goals.  When you make those goals measurable, and you manage expectations and work to build relationships, you can easily market without selling.”, Bobby Maybee- founder and admin of the Forward Thinking Chiropractic Alliance

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Exclusive Success Tips from Laurence Tham of Drive Your Practice

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If you want to market without selling, you have to be in the community building/relationship building business. It's a different mindset. You have to start implementing cost-effective tools and systems that are designed to provide value and stay in touch over the long haul. 

Newsletters are a great example. Sending emails to people doesn't cost much, and when done correctly, it can be a great relationship builder. The same can be said for written newsletters. It's a bit old-school to send someone something in the mail. It also costs more than doing things online, but printed newsletters are an excellent way to stay in touch with your existing patients. If nothing else, use them to stay in touch with your VIPs. Your most valuable patients are worth the extra effort. 

“Social media can also be used as a community/relationship builder. It's more difficult to do that it used to be because social media has become a very noisy place. But there is still potential there if done correctly. Unfortunately, most chiropractors don't have a social media strategy that makes any sense, so they are just wasting time.” Jerry Kennedy, Black Sheep 

“The best way for a chiropractor to amplify their message and establish authority is to master the art of Facebook outreach along with social proof marketing. With Facebook, you can flip a switch and target your ideal prospective patient, build your name quickly, hit critical mass in your local community, and create a surge of new patient referrals each month. Some of these strategies are free while others can be implemented on a shoestring budget. On the social proof side of things, review platforms like Google and Yelp can influence opinion instantly. People buy chiropractors like they buy books on Amazon. The first thing the prospective patient does is look at what others are saying about you. If you have dozens of reviews, you look like the obvious logical choice. If you don't have any patient feedback, you don't look review worthy.”- Matthew Loop

What is the greatest challenge in building an audience online?  

“Staying consistent with the audience you have while opening up your strategies to welcome new followers and not alienating the latter”.- Tristan Schaub 

Remember, you don't need to always jump to the next online fad. “The greatest challenge that chiropractors have when building an audience online is knowing where to start. It's easy to get overwhelmed with social media and think you need a new tool or course every week. That's not the case, though. Certain foundational principles have worked for years and continue to be effective. Start with one platform like Facebook and implement one practice growth strategy. Then, as you and your staff get comfortable, you can always layer more on top. Don't get preoccupied with Instagram, Snapchat, Twitter, or Pinterest yet. Follow one course of action until successful. Stay away from the shiny objects until you're seeing a steady flow of new patients”.- Matthew Loop

Also, keep in mind the story of the tortoise and the hare. It rings true online. “Consistency.  Flat out.  When you start out, you post all the time, write articles, etc.  but once the glimmer and shine of that new website start to fade, you must force yourself to stay consistent.  My best advice to create a calendar and rhythm.  Schedule out what you are going to post and then do it.  Stay consistent. If you want to write one article a week and do a podcast, then stick to that schedule... force yourself to commit and then over deliver with your content”.  - Beau Pierce 

So there you have it, the best frameworks, action items, challenges to building your online presence, and growing your practice from the top minds in chiropractic. 

To not only survive, but thrive, in the modern healthcare era, we all should be building our audiences and expertise. 

But you don't need to reinvent the wheel. By using a tried and true framework, you can make the process efficient. Then, by knowing where others have struggled, you can avoid those missteps and grow at a faster rate. 

So you made it to the end of the article. Now it’s time to go cause a ruckus. 

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Special Bonus: Check out Erik Brower from Amped in this exclusive video interview! 

Chiropractic is 98% BS- A Response to Joe Rogan

Joe Rogan recently came out with a very very viral and popular podcast and video where he said 98 percent of Chiropractic is BS. Well, I am a chiropractor. I run The Evidence Based Chiropractor which is focused on chiropractic research; as well as working hand in hand every day with Johns Hopkins trained neurosurgeons and more. 

So, I wanted to create a short video for Joe and everyone else out there showcasing where he was right, where he might be wrong, and a few other tip so the next time that he visits a chiropractor he can have a better experience. I think that he had a lot of great points, he just was a little bit misguided. 

Some things that Joe was correct on is that for many medical doctors they don't focus on preventative maintenance of the spine. They're not talking about yoga, they're not talking about proper spinal hygiene, they're not talking about ergonomics and sitting up straight and really strengthening those core muscles around the spine. Joe is 100 percent correct that typically medical doctors don't talk about that. Now ironically, chiropractors are the best health care professionals to talk about exactly those topics. 

So if you are into CrossFit if you are into staying active later in your years; if you want to have the highest quality of life; proper spinal hygiene, flexibility, and taking care of your spine under gravity is unbelievably important. But again, ironically, during Joe's 98 percent of Chiropractic is BS rant, he failed to mention that chiropractors are the best health care professionals to give advice directly on those topics. 

Also Joe was correct that when a disk bulges or herniates, it can create a situation where that disk presses up against a nerve as it travels out of the spine column. This can result in nerve compression. If that happens in the neck it can cause pain, numbness, tingling, and more down into the shoulders arms and hands. Now if that compression, that disc pressing on the nerve, happens in a low back, it can cause pain, numbness, tingling symptoms down into the buttocks and into the legs. 

But again, rather ironically, Chiropractic has been universally promoted and stood behind as the primary treatment option, the first treatment option, that you should explore if you are suffering from a bulge or herniated disc. Groups like the American College of Physicians the American Pain Society, prestigious research journals such as Spine Journal, European Spine Journal and more have all made recommendations that chiropractic care, chiropractic adjustments, are one of the primary options that you seek if you happen to be suffering from a bulge or a herniated disc. 

Now obviously Joe did not have the best experience with his chiropractor. And it's not fair of me to comment specifically on his case because I don't have his medical records in front of me. But there are a few items that I think he can learn, as well as you, that can help you have the best experience the next time you visit a chiropractor. Number one is communication is key. 

Joe said he was treated for over a year and then I got the MRI and there was a bulging disc. He said he knew he had it the whole time. Now if you've been treated for more than six or eight weeks without improvement, if you have muscle atrophy, if you have worsening nerve pain, then absolutely an MRI may be indicated to be able to get a better look at the pathology or the problem that's causing that pain. 

But remember even after that MRI comes back with a bulged or a herniated disc quite often your best first line of defense that the research proves out time and time again is starting your care in a chiropractic office. So if you have any questions about this please comment below. I would love to hear back what you have to say. 

I would also love it if Joe eventually saw this video I would love to have a chat with him and see where I can provide value for him and more education regarding where chiropractic starts where chiropractic stops and what the current data says regarding the usage of chiropractic care. I hope you have a great day and I'll talk to you.