Increased Chiropractic Visit Frequency Renders Better Outcomes

By: Mark Studin DC

Reference: Studin M., (2022) Increased Chiropractic Visit Frequency Renders Better Outcomes, Chiropractic Economics, 68 (15) pgs. 24, 26-27

It has been well-established that chiropractic renders positive outcomes for mechanical spine pain. DeVochet et. Al (2005) reported that 87% of chiropractic patients reported improvement. Leeman et. Al (2014) reported that 95% of chronic pain patients reported improvement. Shokri et. Al (2018) reported that 95% of sacroiliac joints, a primary pain generator in low back pain improved with manipulation (chiropractic spinal adjustments or CSA). Yang et. Al (2022) verified through functional MRI (fMRI), that immediate changes in the brain involving pain, and emotional and cognitive changes were achieved using spinal manipulation (CSA) and reported further diminishing chronic low back pain in all patients.

The above outcomes are all related to pain and do not consider the biomechanical changes in the spine that are necessary to “normalize” the pain generators. These pain generators make up the mechanoreceptors and Nociceptors. They are compromised of Pacinian Corpuscles, Ruffini Corpuscles, Golgi Ligament Organs, and the Nociceptors found in the joint capsule and on the facets. The fMRI changes reported by Yang et. Al (2022) are a direct result of a CSA causing afferent innervation, as reported by Coronado et.al (2012) from the mechanoreceptors and nociceptors into the lateral horn. According to Montero et. Al (2021), these evoke central sensitization with both primary and secondary hypoalgesia.

The pain mechanisms are a result of biomechanical failures and neurological compromise as described herein, which are a result of joint capsule (ligamentous) subfailures. Holsgrove et. Al (2016) reported “Any disruption to the various hard and soft tissue structures of the facet joint has the capacity to elicit pain. The facet capsule and synovial folds are innervated by nociceptive and mechanoreceptive afferents. Pain can result from direct damage of nociceptors but can also be produced indirectly through damage to the mechanoreceptors, which alters feedback and increases neck instability, leading to pain in muscles and/or from muscular contractions.” (Pg. 1)

Chronic pain indicates a persistent biomechanical failure and a constant firing of the nociceptors and mechanoreceptors to the central nervous system. Chronic neck and low back pain as reported by Herman et. Al (2021) “usually cannot be cured, but it can be managed.” (Pg. E62) Medicine has for too long, has tried to apply a pharmacological solution to a mechanical problem, with poor outcomes. Cifuentes et. Al (2011) reported that medical management of mechanical spine pain had a 250% increase in disability duration vs. chiropractic care and Herman et. Al (2021) reported that if patients didn’t receive chiropractic care, their pain would have been double.

It was reported by Herman et. Al that 30-60% of patients in the United States with chronic low back pain have seen a chiropractor creating an easy “pool” of people to study. Herman et. Al’s results of studying 2024 patients indicate that more frequent visits (greater than once weekly) over a 3-month period rendered better outcomes. The study also found that adding complementary therapy (i.e., massage, etc.) rendered better functional improvement. It was also found that the more significant the pain initially, the more frequent chiropractic care per week rendered better outcomes.

According to Shokri et. Al. (2018), “compared to common treatments for lumbar disc herniation   chiropractic care is 37,000 to 148,000 times safer than non-steroidal anti-inflammatory drugs and 55,000 to 444,000 times safer than surgery.” Whedon, Mackenzie, Phillips, and Lurie (2015) reported on the safety in general of chiropractic patients and based their study on 6,669,603 subjects after the unqualified subjects had been removed from the study, total patient number accounted for 24,068,808 office visits. They concluded, “No mechanism by which SM [spinal manipulation] induces injury into normal healthy tissues has been identified” (Whedon et al., 2015, p. 5). This study supersedes all the rhetoric about chiropractic and stroke and renders an outcome assessment to help guide the triage pattern of mechanical spine patients.

Chiropractic is safe, creates a mechanical solution for biomechanical pathology, and renders better outcomes when used as clinically indicated. Should the medical community and insurers read the evidence in the literature, chiropractic isn’t the best “first choice” for mechanical spine pain, it should be the ONLY first choice. There are tools in the industry (i.e., Symverta) that render demonstrative guidance to DCs on where and when to adjust, and when MMI has been attained. These demonstrative tools also give evidence of the biomechanical changes made with a CSA. It is tools like this and others that will help “bridge the knowledge gap” to bring chiropractic to the forefront as a Primary Spine Care Provider.

References:

1. DeVocht, J. W., Pickar, J. G., & Wilder, D. G. (2005). Spinal manipulation alters electromyographic activity of paraspinal muscles: A descriptive study. Journal of Manipulative and Physiologic Therapeutics, 28(7), 465-471.
2. Leeman, S., Peterson, C., Schmid, C., Anklin, B., Humphrys, K. (2014). Outcomes of acute and chronic patients with magnetic resonance imaging-confirmed symptomatic lumbar disc herniations receiving high-velocity, low-amplitude, spinal manipulative therapy: A prospective observational cohort study with one year follow up. Journal (3), 155-163
3. Shokri, Esmaeil, et al. "Spinal manipulation in the treatment of patients with MRI-confirmed lumbar disc herniation and sacroiliac joint hypomobility: a quasi-experimental study." Chiropractic & Manual Therapies 26.1 (2018): 1-7
4. Yang, Yu-Chan, et al. "The Changes of Brain Function After Spinal Manipulation Therapy in Patients with Chronic Low Back Pain: A Rest BOLD fMRI Study." Neuropsychiatric Disease and Treatment 18 (2022): 187.
5. Coronado R., Gay C., Bialosky J., Carnaby G., Bishop M., George S., (2012) Changes in Pain Sensitivity following Spinal Manipulation: a Systematic Review and Meta-Analysis, Journal of Electromyography Kinesiology, 22(5) 752-767
6. Gevers‐Montoro, Carlos, et al. "Neurophysiological mechanisms of chiropractic spinal manipulation for spine pain." European Journal of Pain 25.7 (2021): 1429-1448.
7. Holsgrove T, Jaumard N., Zhu N., Stiansen N., Welch W., Winkelstein B., (2016) Upper Cervical Spine Loading Simulating a Dynamic Low-Speed Collision Significantly Increases the Risk of Pain Compared to Quasi-Static Loading With Equivalent Neck Kinematics, Journal of Biomechanical Engineering, 138 / 121006: 1-10
8. Herman, Patricia M., et al. "Visit frequency and outcomes for patients using ongoing chiropractic care for chronic low-back and neck pain: An observational longitudinal study." Pain physician 24.1 (2021): E61.
9. Cifuentes, M., Willets, J., & Wasiak, R. (2011). Health maintenance care in work-related low back pain and its association with disability recurrence. Journal of Occupational and Environmental Medicine, 53(4), 396-404
10. Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2015). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66-69 years. Spine, 40(4), 264-270