Blog, Chirosecure Live Event March 17, 2024

Chiropractic Malpractice Insurance – Chiropractic vs Physical Therapy for Low Back Pain

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  We suggest you watch the video while reading the transcript.

Hi, I’m Dr. Mark Studin, and first I’d like to thank ChiroSecure for having me today and giving me the forum to share this information. And again, I am deeply thankful. Today we’re going to be talking about one of the most important topics that I think I’ve created, uncovered, reported on, perhaps in God, maybe my whole career.

And it’s really about the best provider for pain. Now, I do want to share with you, and we’re going to go to the slides. I do want to share with you that I want to acknowledge that chiropractic is not just about back pain. And if that’s the sole purpose and focus of your practice, I really support that because we need everybody.

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However, chiropractic is so much more. And in my own career, and it’s not what I believe, it’s what I’ve witnessed. And I’ve witnessed systemic diseases. People get better. Asthmatics breathe. High blood pressures go away and on. And you practice how you choose and how you feel is best for your office.

And we need all hands on deck, but I’m also keenly attuned into utilization. And I could tell you that for the doctors I consult for that in the past. 11 years we’ve increased referrals or we’ve accounted for an additional 1, 873, 000 referrals into the chiropractic profession that weren’t there before purely based on similar information like this and the doctor’s credentials.

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Now I wanted to uncover, actually I uncovered something that’s good for every chiropractor and it’s easy. Thank you. It’s just easy. It’s something we all learn in chiropractic colleges and we can do. And it’s based upon the evidence in the literature. So there’s nothing I’m going to share with you today.

That’s not in the literature. Now you’re going to see QR codes. And by the way, it’s called the outcome assessment of physical therapy and chiropractic spinal adjustments on low back pain, and it’s about outcome research. And we’re talking the best solution for back pain. And by the way, that is the funnel into our chiropractic practices.

It’s back pain. Like it or not, it just is. It also happens to be the number one cause of disability in the planet Earth and the number one cause of expenditure of opioids in society. But I want to share with you that on every page you’re going to see a QR code. I urge you with the highest level, scan any of those QR codes to get the full research article.

And it’s housed in the U. S. Chiropractic Directory. under the research tab. But I want to share with you, this article was published in the NIH and the National Institute of Health. So it’s not just my opinion. It’s actually a published article and everything in that article is based on evidence in the literature.

Now, anytime I talk about physical therapy research, it’s based upon an article that was published. It just came out and I got an advanced copy of it and it was published by five DPTs, Doctors of Physical Therapy, a couple of PhDs and one chiropractor. who actually teaches physical therapy in the University of Pittsburgh, and they’re also opening a chiropractic college there.

It’s really a physical therapy derived article. Now, where was the research done, or the statistics derived? And by the way, the cohort, which is number of people, usually in a research article 10, 20, 50, etc., the cohort, I believe, is 4, 000. 600, give or take a couple of hundred. That’s a lot. When I look at the chiropractic cohort and I give you the chiropractic statistics, it’s 6, 800.

And then we’re going to talk about a cohort when I share a statistic with you later that’s staggering, which really underscores the issue. But I like to read the abstract of the article and it says, opioid use is an indicator of the efficacy of chiropractic care for low back pain. All physical therapy modalities.

Realize no lowering of opiate use, while the addition of active passive care increases up to 90%. So 90 percent of physical therapy patients increase opi opioid or opiate use with low back pain, which is staggering. And what they do is, what’s the physical therapy? It’s heat, stim, therapeutic exercise, neuromuscular re education.

All of that with a physical therapy manipulation. And we talk about that in the article, but we’ll talk about that right now. It says while the addition of active passive care increases opiate use by 90 percent and only if you do physical therapy manipulation, which is arthrokinematic or orthokinematic maneuvers or gliding through the facet plane.

It does nothing, and if you do anything else, which occurs in 90% of the PT visits, it increases opiate use actually by 80% longer. Physical therapy care increases the use of opiates, spinal injections, MD specialty care and hospitalizations, including surgeries. Chiropractic care reduces the use of opioids by 55%.

with a patient satisfaction of 96 percent while decreasing disability by 313 percent compared to physical therapy. The mechanism is neuroplastic changes with central segmental motor control and chiropractic, high velocity, low amplitude thrust, where a PT manipulation does not affect these changes. We do not manipulate.

We don’t. We deliver a high velocity thrust. And if you are manipulating, you’re feeding into the problem. It doesn’t resolve the problem. It doesn’t create, manipulation does not create central segmental motor control. Stop using those words interchangeably. It is not a philosophical issue. It has nothing to do with philosophy.

It has to do with the evidence in the literature. And if you follow the science and the evidence in the literature, You will understand, and I’ve, and in this article, I lay it all out. I think there’s 36 or 37 references. It is all laid out, which shows you and explains to you, and it’s all there and proven in the scientific arena.

Despite the outcomes and the evidence, which I just shared with you, most of our health care systems and providers they influence still list physical therapy as the cornerstone of treating low back pain, costing hundreds of billions annually. Low back pain is escalating and it is readily available. I’m sorry, low back is escalating and it is considered a worldwide epidemic where an evidence based treatment Cost effective solution is readily available, but grossly underutilized.

There is a prejudice against chiropractic no matter who we get well, no matter what the scientific arena says, no matter what the patients say. This is not a referendum against physical therapy or medicine. This collaboration with every healthcare discipline is required, and each provider brings a unique skill set to the healthcare marketplace.

However, with low back pain. The evidence in the literature strongly suggests that to help eradicate the low back epidemic low back pain epidemic and reduce the use and cost of opioids, chiropractic should be the first provider. Now listen, you’re up against big pharma and they’re making actually 1.

55 trillion dollars in 1922 on opioids according to the U. S. Congress Financial something commission. Okay. 1. 55 trillion. Chiropractic will save It’s actually 1. 25 trillion. I’m sorry. We lower the cost by 74 percent and that’s in the literature. It’s all evidence That was a 2018 article. We can actually save our society 750 billion dollars.

But they’re not going to do it. Let me rephrase that. Big Pharma is going to push like crazy. This is their cash cow. You know how many orthopedists own physical therapy centers where they work for them? They’re not going to change it. It’s going to be a fight and it’s going to be a fight, not to the finish, but maybe to the beginning of the solution.

Too many people are suffering because you see when we get into it, it’s not a referendum against any care. I, there’s a time and place for everything, but the question is, where do you begin? Where do you start? What’s the most important thing? So when we look at it, it’s non specific back pain. It’s the root of the problem.

It was disproven in 1895. on a theoretical perspective by a guy most of you might have heard of called B. J. Palmer. Again, this is not a philosophical thing. It’s not about chest thumping, but he was one of the first ones. That was the year x ray was invented by Andrew Rankin in 1895. Oh, William Rankin, I’m sorry.

In 1895, same thing. B. J. Palmer didn’t have x rays, he didn’t have MRIs. But his theory was so darn close, he was correct. In the scientific literature from Yale University School of Medicine Department of Orthopedic and Rehabilitative Medicine, Panjabi, White, and Johnson, in 1975, published their first article on spinal biomechanics, and where the pain is probably coming from, or possibly.

And then they published again and again and again, And if you look today in the genre of spinal biomechanical pathology, there’s 16, 600 articles in that genre. Somewhere around 2017 18, a piece of, excuse me, a piece of technology was developed called Symverta. And Symverta actually shows, and let me give you an example, it actually shows where the lesion is coming from.

So in this case, it’s, there’s severe cervical pain With no anatomical pathology and erroneously diagnosed, is nonspecific. Nonspecific back pain. Nonspecific back pain. Where is it? I left it here. No fracture. No tumor. No infection. Nonoperable disc. No advanced arthropathy, which is degeneration. Some erroneous cold and arthritis.

It’s arthropathy. No systemic disease, but it’s very specific. But it’s called nonspecific back pain. So if medicine can’t throw a drug at it and they can’t cut it out, they say it’s nonspecific. And by the way, you want to know what one of their major solutions is? Psychotherapy, movement behavior modification.

If it hurts like this, don’t do it. I’m not joking. I swear. It’s in the Mayo Clinic’s literature. Today, in 2024, physical therapy is the cornerstone of treating low back pain, which increases opiate use, which is the benchmark for the efficacy of treatment of low back pain. Opioid use. Does it help it? Does it hurt it?

It doesn’t only hurt it, it smashes the model, and it skyrockets it, upwards of 90%. That’s absurd. But in this particular patient, there is no fracture, tumor, infection. Operal herniation, et cetera, nothing. But here, there’s demonstrative evidence right here at C5. Your blue line is pathology. Ignore the other line their impairment ratings, which have nothing to do with this conversation.

But your blue line is pathology. And this is from Civerta, which is an evidence based instrument, which is a measuring device. And it’s an analytical device. Here is showing, how do you, this is easy. Even my 11 year old grandson, I said, Chase, where’s the problem? He goes, oh, it’s right here, Grandpa. It’s the big one.

And that, it’s just so easy because that segment has ligamentous issues, it’s got osseous issues, and it’s causing pain. And we know if the joint is, has got pathology and a biomechanical pathology, some of you might call it subluxation. I don’t care what you call it. But I’m crossing boundaries into different professions and using terms that everyone can understand to break down barriers to increase utilization.

So I’m going to call it biomechanical pathology. So when that joint goes out of position, there’s a meniscus which displaces. The joint approximates. The nociceptors on the facets are firing in the joint capsule, which holds it together, which are the ligaments. There’s pisidian core pus your stretch receptors, your affinity core pus, your crimp receptors.

You’ve got a golgi tendon apparatus, which also feeds into the lateral or, and you have more nociceptors in there, which picks up chemical and thermal changes, which feeds into the lateral horn, which then spills over into the deep paraspinal muscles. The first set of your mechanoreceptors, the deep paraspinal muscles are your proprio receptors through the through the, I forget the name of the ion channels that go back into the lateral horn up the spinal thalamic tract through the peri ductal gray area.

Ping pongs off. Different parts of the area, goes efa down, disparate parts of your body to create biomechanical homeostasis. And here is the genesis of it. Here is demonstrably showing where all that’s from and you can have cervical or thoracic pain from low back problems And you can have lumbar problems from neck pain from neck issues and neck pain.

So it are from neck pathology So it’s about finding the primary lesion. So we know all any Chiropractic can fix it. I schmancy here And I’m showing you how to identify the primary lesion because there are ways to do that demonstrably But any chiropractor using biomechanical listings on an x ray like we learned in chiropractic college.

Those things give you the similar, not as good, but similar information. So here’s your outcomes with physical therapy. Opioid use is increased by 80 percent if two or more modalities are used, which is 89. 89 percent of the patient, or 90%. Modalities such as manual therapy, this is right for the research, active care, physical activity, passive care, exercise therapy, heat, needle therapy, acupuncture, dry needling.

Therapeutic Exercise, Neuromuscular Rehab, Ultrasound, Mechanical Traction, and E Stim. It’s just what everyone does in physical therapy and it increases that. If you do no opioid, if you do only manipulation, it doesn’t reduce it at all. It stays flat. Nothing. It does zero. Spinal injections increase by 32%.

If any one modality is used. Spinal injections increased by 53%. If any two or more modalities are used. MD specialty care, including hospitalizations, go up by 27 percent with one modality. And by 50 percent of two or more modalities are used. And that’s the reference, folks, right here. Here’s your reference, but scan the QR code.

It’ll bring you right to the article. It’s free. Zippity doo dah. It costs you nothing. I never hide research behind firewalls or pay thing, payports. It’s all yours. Conversely, chiropractic. Opioid use decreases by 55 percent with chiropractic care. It decreases by 56 percent with chiropractic care on the elderly.

Opioid prescriptions decreased by 54 percent for over a year following chiropractic. Prescription costs decreased by 74%. Here’s your reference, 2018. Disability. 2017 with chiropractic care, opioid use decreases by 313% versus physical therapy and decreases by 239% for primary disability with chiropractic care.

Your cohort here is 5,511 patients. Here’s my favorite one. Naan, God, I can’t pronounce this Naan in 2020. Found that 96 percent of patients are satisfied with chiropractic care, including back pain. You want to know what the cohort was folks? 8, 023, 000 patients. It was a four month study nationally. 8 million was the cohort and almost everybody Got better.

Almost everybody. It’s just an overwhelming statistic. Again, why doesn’t everyone shout this for them? Why doesn’t every provider feed and listen? If I had cancer, I wouldn’t go to a chiropractor. I’d want someone who treats cancer who can help cure me. And people do get cured. By the way and I don’t care how you’re doing it, but by the same token, if you’ve got back pain, which is only a little piece of what we do, Why wouldn’t they, would you want them to send them to us?

And by the way, pain is the funnel into your chiropractic practices. When I first opened up, I had an old mimeograph machine. I could smell the ink. And I used to mimeograph flyers, fold up, I got a mailing list and I hand wrote things and I mailed them. And it was about well, about wellness and staying well and I’m going to adjust you and I’m and a lot of, all the philosophical things perhaps I grew up with.

And I got a call from someone in my neighborhood, and I live close to New York City in the suburbs, and this woman said, Dr. Studer, I work on Madison Avenue, the marketing capital of the world, and you seem like a nice young man. I know you’ve just opened up, but I want to share two things with you, a little unsolicited advice.

Number one, your flyer is very unprofessional. It was printed on a mimeograph machine. It wasn’t professionally done, and it looks like crap, but it appears that your reputation might be that look. So I said, I appreciate it. Secondly, she said, in healthcare. Here’s what we’ve learned on Madison Avenue.

People are motivated by two things to see a doctor. Pain and fear. That’s it. Pain and fear. If it don’t hurt, I ain’t going anywhere. Do I want to stay well? Oh, absolutely. That usually happens when you get to be my age. I’m 68. Oh my God. All of a sudden things are starting to hurt. Now all of a sudden I’m going to start eating well.

I don’t smoke, but if I did, oh my God, I’m going to stop now. I don’t drink, but if I did, I’d say, my God, maybe I should stop now. Too late folks. Just want to share that with you. However, the majority of patients are motivated by pain and fear. So if half our society, and it’s actually 34 percent of the global population at any given time, is suffering from back or neck pain.

That’s a lot of people. That’s a huge amount of people. So if that’s the case, you’ve got a large audience to reach out to. Once you get them in your office, you have an opportunity to educate them on anything you want. Nutrition, exercise, wellness, mental attitude. You could do whatever you want when they’re in your office, provided it’s within your lawful scope.

And don’t let anyone stop you. But this is your funnel from getting them in. Now, the other thing when we’re dealing with medical providers or even lawyers, it’s credentials. Okay. It’s credentials. And I want to let you know that in the Academy of Chiropractic, One of the things that we really focus on is credentials.

So we have a relationship with Cleveland University, Kansas City College of Chiropractic, which is our CE partner. We get all our chiropractic CE credits through them. Actually, that’s not true. We get some through the Federation of Chiropractic Licensing Boards, which every state should be a part of. And we work through a myriad of other things.

So we’re accredited in every state. But we also have our courses accredited through the State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences. Now, I happen to become a professor in the medical school, in the Department of Family Medicine. Part of that reason is I wanted an entree for publishing, and which is why the article which this link brings you to, and I urge you to click on that link to get this article, it’s just a cleaner pathway to get published.

And it’s working. It’s just working. We’re getting published in the NIH on a regular basis now. And that’s fantastic. But, I want to share with you, if I was on one Main Street, in downtown Salem, Oregon, or Tampa, Florida, or Birmingham, Alabama, and you were on two Main Streets, in those same communities.

And someone went to you and said, where were you trained? You have all these statistics, all this information. Oh, I was trained at Life Chiropractic College. I was trained at North, at National University. I was trained at at a Northeastern Chiropractic College, a Northeastern University. And that that’s very impressive.

Then they come to me and say, where were you trained? I was trained through the State University of New York at Stony Brook Jacobs School of Medicine. Who are they going to go to? They’re coming to me, folks, because I’ve now made you irrelevant. And it’s the same course. It’s the same information. It’s the same professors.

It’s the same everything. But perception drives reality. And you don’t have to like it, I don’t have to like it, but there is a prejudice towards medical doctors versus chiropractors, just like there should be a prejudice versus chiropractors on top of physical therapists. Unfortunately, we come out short because big pharma and organized medicine loses money from us.

But we’re going to keep fighting that fight and ensure we’re in front of their face. But when you start sharing your academic credentials on the medical side. That you’ve been trained through graduate medical education postdoctorally. All of a sudden, your reputation just changed. Like it or not, I don’t like it.

I don’t think it’s fair. It’s reality. But guess what happens? The floodgates open up. I have doctors now getting 100 to 140 new cases a month. Having a six week wait just to get into their office. Purely predicated on their credentials. And it just works. It just works. I have one doctor who has shared with me just just recently that in the past five years, one orthopedic group with nine orthos referred him 1, 500 cases.

Just based on his credentials and resultant knowledge base. That’s it. And it goes on and on around the country. It works. It works. It works. So this is what’s going on in the industry. This is what’s happening. This is what you can be a part of. So folks, listen, I want to thank you so much for allowing me to share this time with you.

I’m Dr. Mark Studin. And again, thank you ChiroSecure for allowing me to bring this to you. And I look forward for our next chapter.

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