CF 372: Spinal Manipulative Therapy and Lumbar Re-operation & SMT And Fall Risk Today we’re going to talk about Spinal Manipulativer Therapy and Lumbar Re-operation & SMT And Fall Risk 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 #372 Now if you missed last week’s episode, we talked about Pain Reprocessing Therapy & Chiropractic And Tramadol.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things….. I’m gearing up for a few things around here. The first is that I’ve got three main pushes for the immediate, right now, as we speak. We did this in the Mastermind group you always hear me talk about. Each of us decided what our main push is. But, since I have so many things and moving parts going around here at all times, I actually have three main focuses.  They are:

So, what are my plans for each? Well, that’s what I’m figuring out while we have a little back-to-school slowdown.  To boost numbers, it makes sense to boost marketing. That could be more boosted posts on social media, targeted ad campaigns, more effective content creation, Google Ads, sales funnels, internal marketing, referral marketing, and on and on and on. 

We have a company that is helping us with Google Ads and content creation so we’re already acting there. We have a great website company so we are SEO optimized and going the right direction there. 

We could run a re-activation campaign internally. I’m not sure what that looks like off the top of my head but we can figure it out. Lots of ideas to help boost numbers.  It’s been weird since COVID, honestly. As soon as business starts building and we’re getting our numbers back, something always seems to happen. A long term attorney relationship changes hands and the new attorneys aren’t as dependable.

Or the VA hires their own chiropractor, and on and on.  It just seems like the Universe is holding us back for some reason so we’re just trying to bend the universes will back in our favor. We can do it. I’ve been doing it for years. 

On the second one, the Mastermind will be a huge help to us in getting Shockwave all launched and successful. Those folks have been all over Shockwave for the last year.  I’m not worried about #2 and shockwave at all. 

Number three is a little more difficult. Some of the medical services we have are fairly saturated. Joint regeneration like biologics and PRP…..well a lot of orthos are already doing them and who goes to this outlier over here vs. going to an ortho for that? Of course, on the other hand, a lot of orthos are quick to surgery so you have a bunch of them running patients off too.  Bio-Identical hormone pellets, lots of folks are doing Bio-T. Trigger point injections, IV Therapy, Semaglutide…..yep, it’s all pretty saturated so breaking through the noise is tough. 

It’s all marketing. How do you break through the noise? They call it the USP or unique selling proposition. Which means, what makes you different? I think what makes us different is that with the services we offer, we can treat the body in a whole body context. Medical, alternative care, exercise….everything. That part is still unique. 

Short of surgery, everything under one roof. That’s our USP and we’re going to hammer the hell out of it. 

Item #1 Our first one today is called, “Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study” by Trager et al and published in BMC Musculoskeletal Disorders in January of 2024 and es steamy, hot to the touch.  Remember, the citations can be found at chiropracticforward.com under this episode. 

Trager, R.J., Gliedt, J.A., Labak, C.M. et al. Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study. BMC Musculoskelet Disord 25, 46 (2024). https://doi.org/10.1186/s12891-024-07166-x

Why They Did It Patients who undergo lumbar discectomy may experience ongoing lumbosacral radiculopathy (LSR) and seek spinal manipulative therapy (SMT) to manage these symptoms.  We hypothesized that adults receiving SMT for lumbosacral radiculopathy at least one year following lumbar discectomy would be less likely to undergo lumbar spine reoperation compared to matched controls not receiving SMT, over two years’ follow-up.

How They Did It We searched a United States network of health records (TriNetX, Inc.) for adults aged ≥ 18 years with lumbosacral radiculopathy and lumbar discectomy ≥ 1 year previous, without lumbar fusion or instrumentation, from 2003 to 2023.  We divided patients into two cohorts: (1) chiropractic SMT, and (2) usual care without chiropractic SMT. 

What They Found Following propensity matching there were 378 patients per cohort (mean age 61 years).  Lumbar spine reoperation was less frequent in the SMT cohort compared to the usual care cohort. 

Wrap It Up This study found that adults experiencing lumbosacral radiculopathy at least one year after lumbar discectomy who received SMT were less likely to undergo lumbar spine reoperation compared to matched controls not receiving SMT.  While these findings hold promise for clinical implications, they should be corroborated by a prospective study including measures of pain, disability, and safety to confirm their relevance.  We cannot exclude the possibility that our results stem from a generalized effect of engaging with a non-surgical clinician, a factor that may extend to related contexts such as physical therapy or acupuncture.

Item #2 Our second one today is called, “Chiropractic Spinal Manipulation and Fall Risk in Older Adults With Spinal Pain: Observational Findings From a Matched Retrospective Cohort Study” by Trager et al and yes, the man is a rock star….obviously. It was published in Cureus in October of 2024 and that’s hot as hell as well. 

Trager RJ, Burton WM, Loewenthal JV, Perez JA, Lisi AJ, Kowalski MH, Wayne PM. Chiropractic Spinal Manipulation and Fall Risk in Older Adults With Spinal Pain: Observational Findings From a Matched Retrospective Cohort Study. Cureus. 2024 Oct 24;16(10):e72330. doi: 10.7759/cureus.72330. PMID: 39583476; PMCID: PMC11585376.

Why They Did It Limited research suggests that spinal manipulative therapy (SMT) might positively influence balance, yet its association with falls remains underexplored.  We hypothesized that older adults receiving chiropractic SMT for spinal pain would have a reduced fall risk during 13 months of follow-up compared to matched controls.

How They Did It We searched >116 million patient records from TriNetX to identify adults aged ≥65 years with spinal pain.  After excluding those with major fall risk factors, we formed SMT and non-SMT cohorts, using propensity score matching  We explored the cumulative incidence of falls and fractures and negative control outcomes

What They Found

Wrap It Up This study suggests that older adults receiving SMT for spinal pain may have a reduced risk of falls.  However, given the observational nature of the study and the lack of significant differences in limb fracture incidence, the clinical significance of these findings remains uncertain.  Further research, including randomized controlled trials, is needed to explore injurious falls, care utilization, pain, and costs.

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.

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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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