The Evidence Based Chiropractor Blog

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

Jeff Langmaid 5/23/14 Jeff Langmaid 5/23/14

Lumbar Stenosis- by The Evidence Based Chiropractor

A recent (2014) study in SPINE examined the use of decompression without fusion for lumbar stenosis. They found that decompression without fusion can be just as effective as methods involving fusion, but has significant cost saving advantages and fewer complications. Generally, this decompression is accomplished by a laminectomy.

If fusion is warranted, they encourage the use of bone graft as opposed to instrumentation (hardware). It seems as though bone grafting is also more cost effective while providing similar outcomes. The study found that complication rates rose significantly for patients who underwent a laminectomy with fusion compared to those who just received a laminectomy.

It makes sense to me that limiting the use of instrumentation/hardware would yield decreased complications and perhaps even slight outcomes advantages. Instrumentation (while necessary with certain procedures) permanently alters the bio-mechanics of the spine and places vertebral segments adjacent to the surgical site at increase risk for degeneration.

Additionally, I believe it is important to stress that previous research has shown that chiropractic care (specifically flexion/distraction technique) has provided relief from lumbar stenosis. The complication rate for conservative chiropractic care is significantly lower than surgical intervention, and both have proven to be effective treatments. The degree, or amount of stenosis (and its impact on function) will play a large role in determining whether conservative care is an option for each individual patient. The bottom line is that physicians should be aware that surgical intervention is not the only treatment option available for patients with lumbar stenosis.

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Jeff Langmaid 5/19/14 Jeff Langmaid 5/19/14

Should I Consider Chiropractic or Physical Therapy? - by The Evidence Based Chiropractor

Patients suffering from spine pain can often be unsure of the best treatment available. Two of the most common choices are chiropractic care and/or physical therapy. In this blog we will investigate the differences between these two options and learn which may help you the most.

Physical therapy for spine complaints generally includes passive modalities (ice, heat, electrical stimulation, ultrasound, etc) combined with stretching and strengthening exercises. Research shows moderate evidence (depending on the longevity and region of complaint) for these adjunctive treatment modalities. Physical therapy is usually performed by a physical therapist or physical therapy assistant under a script from your primary care physician. Interestingly, many health professionals have found that these modalities are best used after proper biomechanics have been established.

The hallmark of chiropractic care is spinal manipulation or adjustments. Chiropractors are the undisputed experts in this form of treatment due to their extensive training. This is one of the reasons chiropractic care and spinal manipulative therapy have a distinct advantage over physical therapy for the conservative care of spine complaints. Adjustments provide a direct effect on biomechanics of the spine and as we touched on earlier; establishing improved biomechanics is the first step in spine care. Of specific note is not all adjustments are high velocity. Many adjustive techniques utilize slower movements. Your chiropractor can speak with you regarding which adjustive technique will best serve your needs. Chiropractic care is administered by a Doctor of Chiropractic. Your chiropractor is able to diagnose, evaluate, treat or refer without the aide of another physician; although they may communicate and work with many primary care providers in your area.

After establishing an improvement in segmental motion (biomechanics of the spine) your chiropractor may choose to use some passive modalities. Additionally, he/she may provide you with instruction for stretching and strengthening exercises. In many research studies chiropractic care and spinal manipulative therapy have resulted in superior outcomes when compared against physical therapy for spine complaints. In my opinion this is for two distinct reasons. First- the adjustment or spinal manipulation is one of the most powerful, safe, and effective tools for influencing the spine. Second- chiropractors have the training and expertise to not only provide a spinal adjustment, but also to tailor either passive modalities or an exercise program to your exact needs (if necessary).

For many patients, chiropractic care is the best choice possible for conservative spine care. The information above is just the tip of the iceberg regarding conservative care of the spine, but highlights the major differences between physical therapy and chiropractic care.

A growing body of research continues to show the safety and efficacy of chiropractic care for various spine conditions. Reputable primary care physicians are referring to chiropractors each and every day but remember, you don't need a script to make an appointment with a doctor of chiropractic today!

Jeff Langmaid 5/15/14 Jeff Langmaid 5/15/14

A Randomized Clinical Trial Comparing Medication, Acupuncture, and Chiropractic Adjustments- by The Evidence Based Chiropractor

In 2003, SPINE produced a randomized clinical trial comparing medication, acupuncture, and spinal manipulation for chronic spine pain. The medication which was predominately used in this study was either Celebrex, Vioxx, or paracetamol. Chiropractic care was predominately high-velocity, low amplitude adjustments at a frequency of two treatments per week.

They looked at both chronic cervical and lumbar spine pain. The average patient in the medication group had pain for 4.5 years; for the acupuncture group it was 6.4 years; and for the spinal manipulation group the average duration of pain was 8.3 years. The maximum treatment duration was 9 weeks.

The researchers found that "...for chronic spinal pain syndromes, it appears that spinal manipulation provided the best overall short-term results, despite the fact that the spinal manipulation group had experienced the longest pretreatment duration of pain."

This finding is extremely significant, as many patients with chronic pain end up being referred to a pain management physician or neurologist. Often, these physicians choose to treat chronic pain with increasing quantities of medications, eventually leading the way for narcotics. Orthopedic surgeons and primary care physicians encounter patients with chronic spine pain every day in practice. It is imperative they know the benefits of conservative chiropractic care before relying on the medications afforded by a pain management doctors.

Jeff Langmaid 5/15/14 Jeff Langmaid 5/15/14

The Dilemma of Spine Patients with Cardiac Conditions- by The Evidence Based Chiropractor

Most primary care physicians are utilizing one of three different "treatment" options for patients with spine complaints. They are treating in-house (aka- giving medication), referring to physical therapy, or referring to an orthopedist. The catch is that millions of Americans are currently taking medications for various cardiac conditions.

Did you know that patients who are taking cardiac medications are unable to take NSAID's?

While even the patients without contraindications generally should not be prescribed NSAID's (according to many guidelines) , the patients who are unable to take NSAID's most certainly should be a target of our outreach efforts. By taking care of these patients we provide value to the primary care office (they are unable to treat these patients themselves) while also offering a option (chiropractic care) which is recommended by numerous back pain guidelines and publications.

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Jeff Langmaid 5/5/14 Jeff Langmaid 5/5/14

Spine Devices Perhaps More Dangerous Than Surgery Itself- by The Evidence Based Chiropractor

Medtronic is a medical device company which produced BMP-2 (bone morphogenetic protein-2) for use in lumbar spinal fusions. The thought was when a patient needs a single level anterior approach fusion of the lumbar spine, the surgeon can use a cage filled with BMP-2 to stimulate bone growth (fusion). This would eliminate the need to gather bone from the hip which can be painful and leads to a secondary surgical site. In a laboratory, BMP-2 performed wonderfully and bone grew extremely well.

However, as many patients unfortunately found out, this was too good to be true. Up to 85% of the surgeries involving BMP-2 in 2007 (which is over 85,000 surgeries) were done by using the compound off-label. Surgeons began using it in the cervical spine and with both anterior and posterior fusions. In some cases, bone grew so fast that patients began suffering blocked airways and an inability to swallow as bone literally grew out of control from the cervical spine.

Perhaps the most damning part of this is that the US Senate Committee of Finance determined that Medtronic executives secretly drafted favorable journal articles when BMP-2 was found to perform no better than traditional bone grafting techniques.

Circumstances like this undermine public confidence, produce harm, and in some cases permanently impact a patients quality of life. A patient going for surgery is placing full trust in a surgeon; and when that trust is intentionally broken the patient deserves full compensation while the doctor deserves the most severe penalties available by law.

As chiropractors, we must consistently promote the use of conservative care. Many patients who do not fully exhaust conservative care options end up going to have surgical intervention. Perhaps they went for a few physical therapy visits or maybe even had an injection. Barring red flags, progressive neurological deficits, or an emergency situation; patients should be encouraged to fully explore all conservative measures prior to surgery.

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