CF 363: Lateral Lumbar Stenosis & Manual Therapy Combines With PT

Today we’re going to talk about Lateral Lumbar Stenosis & Manual Therapy Combines With PT

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 [email protected]

If you haven’t yet I have a few things you should do. 

You have found yourself smack dab in the middle of Episode #363

Now if you missed last week’s episode, we talked about Coffee In The Morning & PRP Beats Cortisone In Meta-Analysis.

Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things….. Still progressing on the sale of 60% of the clinic. That’s an ongoing process, of course. It’s hard to turn over almost 30 years of blood, sweat, and tears but I’m also tired of blood, sweat, and tears, if you know what I mean. Lol.  We are in the part of it all now where we’ve been sent a contract and have hired a contract attorney down in Dallas to review it and make sure we’re not doing anything entirely stupid. I trust this company and really like the folks running it. Quite a bit as a matter of fact. 

But, let’s face it; it’s a business and when the contract is generated by them, it probably favors them. Of course. It’s important to spend the money and hire your own advocate just to make sure. Regardless of your feelings of the folks running it. At the end of the day, it’s your baby and it’s your future so you gotta have an advocate so you know what you’re getting into.  That’s where we are with that. Just waiting on that process to play out. And I’ll keep you updated as always.  What else? I have my MCM Mastermind meeting in Charleston next weekend so don’t be surprised if I don’t have the chance to get an episode out next week.

Daddy’s gotta work and all. 

Then we’re planning the European extravaganza starting May 21st. Never been to Europe so I don’t have a clue what to expect but we’ll dummy through it all and get it figured out.  I’m starting to see some patients come back now. Now that the Winter is lifting, people have recovered from the holidays, and deductibles are getting met….they’re starting to return slowly but surely.

Also, the VA hired their own chiro a year ago or so and we saw our veterans having to go to the VA for treatment.  We lost a ton of business with that little move but, great news! Their chiropractor quit so we’re seeing the vets returning again too! Lots of familiar faces finally coming back to see us.  I’m not in the 180 appointments per week range that I really like but we’re climbing. We’re probably around 145-155 or so this week. Not too far off.  Alright, no reason for idle chat, let’s just hop in. 

Item #1 First one this week is called, “Lateral Lumbar Spinal Stenosis: Associations With the Oswestry Disability Index, Visual Analogue Scale, and Magnetic Resonance Imaging” by Norisyam et al and published in Cureus 12/13/23 Remember, the citations can be found at chiropracticforward.com under this episode. 

DOI: 10.7759/cureus.50475 Review began 12/04/2023 Review ended 12/07/2023 Published 12/13/2023 © Copyright 2023 Norisyam et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC- BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Why They Did It Degenerative lumbar spinal stenosis is a communal problem in the sixth decade of life involving L4/L5 and L5/S1 levels. Lateral spinal stenosis is often underestimated because of no established relationship between the clinical symptoms and MRI findings.  We conducted a study to establish an association between the degree of anatomical lateral stenosis, posterior disc height, and disc degeneration from MRI with the daily disability and pain severity for lateral lumbar spinal stenosis

How They Did It This was a cross-sectional study involving 121 patients with distinct clinical symptoms of lateral lumbar spinal stenosis evaluated from February 2018 to December 2019.  The clinical data were evaluated using the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS), while MRI was assessed qualitatively for the anatomical gradation of lateral spinal stenosis, the magnitude of posterior disc height, and the extent of disc degeneration. 

What They Found The analysis of 121 patients showed the mean age of the patients was 58.7 ± 7.1 years old.  The number of female patients was higher compared to male patients, 52.9% and 47.1%, respectively.  97.5% of the patients were married or cohabiting, and 76.0% had an abnormal body mass index.  49.6% of the patient presented with a crippling disability with ODI assessment, while 59.5% presented with high pain intensity with VAS assessment.  MRI assessment of anatomical grading lateral stenosis of L4/L5 level revealed that 45.5% of the patients had grade 2 lateral recess stenosis, 63.6% had grade 2 foraminal stenosis, and 44.6% had extraforaminal stenosis.  L5/S1 level analysis showed that 43.0% had grade 2 lateral recess stenosis, 62.0% had grade 2 foraminal stenosis, and 29.8% had extraforaminal stenosis.

Wrap It Up There was no significant association between the clinical symptoms of pain and disability and the MRI findings for the anatomical gradation of lateral spinal stenosis, the magnitude of posterior disc height, and the extent of disc degeneration.  A comprehensive clinical evaluation remains essential for an accurate diagnosis, emphasizing the necessity of appropriately correlating MRI findings with their clinical significance.

I would add that in the Ortho Diplomate, it was made clear that it is not the grade of stenosis or the size of the holes that matters. What matters is what’s happening to the stuff going through the holes. For lack of a better term.  If the stuff in the holes is inflamed, stenosis would be more pronounced, basically.  Here in my clinic, a good combination for stenosis has been an anti-inflammatory diet, low level laser, and the Dr. Carmen Amendolia protocol. It’s been impressive. Just a lil tip from your ol Uncle Jeffro. 

Item #2 Our second one today is called “The Influence of Active, Passive, and Manual Therapy Interventions on Escalation of Health Care Events After Physical Therapist Care in Veterans With Low Back Pain” by Mayer et al and published in Physical Therapy and Rehabilitation Journal in July of 2024 and it’s hotter n a pancake off the griddle. 

John M Mayer, Michael Jason Highsmith, Jason Maikos, Charity G Patterson, Joseph Kakyomya, Bridget Smith, Nigel Shenoy, Christopher L Dearth, Shawn Farrokhi, The Influence of Active, Passive, and Manual Therapy Interventions on Escalation of Health Care Events After Physical Therapist Care in Veterans With Low Back Pain, Physical Therapy, Volume 104, Issue 10, October 2024, pzae101, https://doi.org/10.1093/ptj/pzae101

Why They Did It The objective of this study was to examine the associations between active, passive, and manual therapy interventions with the escalation-of-care events following physical therapist care for veterans with low back pain (LBP).

How They Did It A retrospective cohort study was conducted in 3,618 veterans who received physical therapist care for LBP between January 1, 2015 and January 1, 2018.  The Department of Veterans Affairs (VA) Corporate Data Warehouse was utilized to identify LBP-related physical therapist visits and procedures, as well as opioid prescription and non–physical therapy clinic encounters.  The association between physical therapist interventions with 1-year escalation-of-care events were assessed using adjusted odds ratios from logistic regression.

What They Found Nearly all veterans (98%) received active interventions, but only a minority (31%) received manual therapy.  In the 1-year follow-up period, the odds of receiving an opioid prescription were 30% lower for those who received manual therapy in addition to active interventions, as compared with patients who received only active interventions.  Moreover, the odds of receiving primary care, specialty care, and diagnostic testing were 30% to 130% higher for patients who received electrical stimulation or more than 1 passive intervention in addition to active treatments, as compared with patients who received only active interventions.

Wrap It Up The use of manual therapy along with active interventions was associated with reduced prescription of opioids, while utilization of specific passive interventions such as electrical stimulation or multiple modalities in conjunction with active interventions resulted in increased escalation-of-care events. The use of active interventions, which is supported by most clinical practice guidelines, was the cornerstone of physical therapist care for veterans with LBP.  However, the use of clinical practice guideline–recommended manual therapy interventions was low but associated with reduced opioid prescriptions. I would extend that to include spinal manipulative therapy, just continues to pile up.

And up and up and up. Sooner or later, the healthcare industrial complex (whatever that might be) HAS to pay attention and at some point, it will start to be outside of the standard of care when medical providers ignore it. 

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. 

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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.

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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          

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