Blog, Chirosecure Live Event March 7, 2021

Chiropractic vs. Physical Therapy for Spine – Mark Studin, DC

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And we’re alive.

Hi, I’m Dr. Mark Studin from the Academy of Chiropractic, and I’d like to thank ChiroSecure for the opportunity to share this information with you today. And today, we’re going to talk perhaps about the hottest trend in our profession and that’s chiropractic versus physical therapy for spine. Let’s just start to the slides.

We’re good.

What, what we’re going to do is we’re going to look at five topics and I want to share with you that this is a very aggressive agenda for 30 minutes, but I’m going to give you a brief overview and just nieces in relation. And at the end of the 30 minutes, I’m going to give you an Avenue to get all of this information in a free portal to you. It’s actually free to the profession, to the world for everyone to say the questions are who is the best first provider for spine issues. Number two, what is the evidence? And it has to be based upon evidence. It can’t be my prejudice belief through Rose colored glasses. And I’m not Pollyannish to think that those looking from the outside in aren’t going to say it’s a prejudicial opinion because it really is. But when it’s based upon the evidence, there is no prejudice.

And the evidence is what’s found in the literature that verifies that chiropractors better render better treatment outcomes versus physical therapist. But what is the evidence that renders DCS having lower disability than physical therapy? What is the evidence-based physiology that drives DCS to get better outcomes versus PC PTs respondents, the first provider, and how do you overcome those prejudices in the medical community to bypass the PTs for the DCS to get rid of that dog? The first thing you have to do is look at this very complicated graph and let’s break it apart because all you need to do is count to eight. Your patient goes into an MD primary office, usually complaining of back pain, back pain, neck pain, back pain, that’s it. And we’ll talk about the prevalence of that within the MD primer, but it’s highly prevalent. What is the MD? Do they write a prescription muscle relaxers steroids, such as a Metro dose pack or an inset painkillers, not opiates are opiate painkillers and that’s their first level.

And I’m going to say this multiple times today, there can never be a pharmacological solution for mechanical issue. It just doesn’t exist. And therefore you have the beginning of failed, a failed pathway, not just treatment, but the drugs are going to fail. And I’ve got a tremendous amount of literature about each of these things showing how they fail, but then they’re off to an ortho surgeon usually. And by the way, I will never ever, ever, ever, ever, ever, ever, ever, ever refer a patient to a general orthopedic surgeon for spine. They are great for shoulders, knees, hips, ankles, et cetera, extremities, not spine. It should be a neurosurgeon or an orthopedic spine surgeon who has that a fellowship in orthopedic spine period, never a general surgeon, but what happens is 8% as a rule have anatomical issues that need surgery, fracture, tumor, infection, herniation, et cetera, which is compressing the cord, et cetera.

But the other 92% are mechanical issues that cannot be seen by the MD’s at least for a surgical issue. So what do they do? They release those 92% to physical therapy. And the physical therapist is actually an evidence-based. We’re going to talk about this failed provider as a first provider for spine. It’s an evidence-based, they’re going to fail. And as a rule, it fails, then what do they do? They go back to their primary or back to the ortho for more drugs. And they’re going to send them back for a second round of physical therapy or until their benefits run out and it’s going to fail again. But now they don’t go. They go back to the primary or the ortho, but now they’re off the pain management. That’s their final solution. Pain management is legalized drug addiction, drug them up to shut them up because they don’t know what to do.

They don’t know what to do. And the problem starts right here at that 92%. I am not against those patients who need surgery. I’m not against it when it’s clinically indicated, but those 92% are based on dogma, not fact dog, but is the MDs nonspecific back pain? What that means is they don’t know what it is. So they just send them off to PT or drug them up because they don’t medicine doesn’t have a solution. I’m going to be talking in a future seminar and a future. One of these specifically about non-specific back pain and showing in fact that is specific and there are tools to help you because that dog is based on theory, not based upon facts, but if you look at we’re going to number this, you see number one through eight, we’re going to start at number one, the MDs triaged, the primary care triages in a recent study by Humphreys.

So Caskey McEntire, Casa Ben and Patrick in 2007 in the United States, upwards of 25% of all primary care medical doctor visits are for MSK, musculoskeletal complaints, back pains, shoulder pains, et cetera. Um, making it one of the most common reasons for consulting a physician. However, it’s been estimated less than 5% of undergraduate and graduate medical curriculum in the United States. In 2.2, 6% in Canon medical schools is devoted to musculoskeletal medicine, 25% of their patient population. And between two to 5% of treatment, the following results were published in this paper for the basic company, examinations of various professions and the frontline of diagnosis and treatment of musculoskeletal condition. Um, th the past in table two, et cetera, the passing score was 73% recent medical graduates, 18% medical students, residents and staff physicians, 20% osteopathic students, 29%. It’s just incredible. They’re grossly under-trained to handle MSK conditions, according to Rassie, et Al they reported regarding medical providers, most respondents 92.2%.

Believe that musculoskeletal education has not been sufficient. Almost every single medical doctor feels they need more, but Wieden reported that in 2013, the average annual dollars spent for back pain per person for filling opioid prescriptions were 74% lower among chiropractic recipients compared with non chiropractic recipients. This is now tying in to the drug use, and I’m going to always compare what I’m discussing, whether it be medicine, whether it be physical therapy, et cetera, to chiropractic. So chiropractic had a 74% lowered dollar amount spent on opiates. Wheaton also reported the, like the adjusted likelihood of filling the prescription was 55% lower for chiropractic patients. Then non chiropractic patients. Again, there cannot be a pharmacological solution for a mechanical problem. Something even as strong as an opiate, doesn’t fix the problem. Now, according to an independent research, and now we’re going to number three, the surgeon, according to independent research by myself, I’ve lectured to thousands and thousands of orthos, neuros, and neurosurgeons.

And I always sit and chat with them. I do, I do surveys, polls, et cetera. 8% of spinal cases are anatomical lesions. So if they see a hundred patients a week eight are going to need surgery, that’s it? What do they do with the other 92? Where do they go? Well, according to the Cleveland clinic, this is today’s well-published care pet for non-specific back pain. Cleveland clinic says these patients may be best served the right prompt, access of care. The physical therapist or nurse practitioner is entry-level providers when pain persists beyond four to six weeks, the care path defines when referrals for surgery should happen or behavioral issues, which is disgusting. The Mayo clinic says physical therapy is the cornerstone of back pain treatment. Have physical therapists can apply a variety of treatments, such as heat ultrasound, East them muscle release techniques to your back and soft tissue.

This is why it’s a perpetual failed pathway because there were referring them in those 92% are going to fail pathways. Now, today we’re focusing only on those 92%, and we’re going to talk about capturing that market share based upon the evidence you imagine getting 92% of every medical primary care referrals for back pain. We need 10 times the amount of chiropractors we have. Let’s get into physical therapy. First, I want to say upfront that I love physical therapy. I’ve had multiple types of practices. I’ve worked as a solo practitioner. I’ve worked with associates, I’ve worked in, um, uh, integrated practices with MDs. Repeat these. I love PE teas. I want you to know the front for extremity and the duties. The lineation of duty of care was simple. Spine went to the Cairo. Extremity, went to the PTA. Physical therapy is best suited for all.

Rehab is the first provider except spine that those as a chiropractice aren’t fit remedies, PTs are outstanding for that. However, let’s look at why physical therapy fails for spine is the first provider. Let’s talk about spinal competency and go back to their home freeze paper. Also published in the paper, basic company, examinations, various books, fractions, et cetera, and here, um, on this particular, the killer table, the following the social passing score of 70% integrator physical therapists, 21% on musculoskeletal care physical therapy at the doctoral level, by the way, Dr. A level just means they learn a lot more of what they already know. They’re not going into diagnosis and trials. They’re not 26%. A chiropractic student was 64.7%. I’m a little upset about that. I think those should have been higher, but nonetheless compare 21 and 26% to 64%. Now let’s look at a Marist college and it’s a school I believe in upstate New York.

And then it’s contemporary doctor of physical therapy program. As far as case management goes three credits in pathology, two credits in diagnostic imaging, all image modalities, where the emphasis on the roller of imaging, not interpretation. There are three credits and cardiopulmonary management, the three credits in differential diagnosis related to the proficiency of screening interview. In other words, just based upon taking a history and that’s it, the doctor of physical therapy program was never intended to train PTs to be any type of primary care provider or a portal of entry, the health care system. If you look at the state of Texas as an example in chapter three to two point and the statute referral requirements for physical therapy, except as authorized by paragraph two of the subsection of physical therapist is subject to discipline for the board for providing physical therapy training, but without a referral from a qualified healthcare practitioner licensed by the appropriate licensed board who within the scope of the professional licensure is authorized to prescribe treatment of individuals.

Qualifying referral sources include physicians, dentists, chiropractors, podiatrist, PAs, nurse practitioners, exceptions to the referral requirement. A PT may evaluate not treat a PT teammate and provide instruction to a person who is asymptomatic relating to the instructions being given without a referral to promote health, wellness, and fitness, put them in a gym. Here’s the end result. Matthew McCarty at the end Davis landed in 2013, reported on medical and physical therapy back pain treatment from 99 to 2010 representing 440 million visits and revealed an increase in opiates of 19 to 2019, a 10% increase for low back pain with continual physical therapy referrals. They are not trained to triage. They don’t understand how to diagnose. They shouldn’t be the first provider. And there are universities now pushing primary, very spine care programs and putting physical therapy out there. The forefront, it is a public health risk. And I mean that sincerely, according to blanch it in 2016 medical care, uh, ended spinal re spinal related compensation and medical doctor 12% longer than chiropractic and physical therapy required 239% more time to end full compensation than chiropractic.

So if someone one’s out on disability and compensation, according to a 2016 report ma uh, physical therapy as a 239% greater increase amount yeah. Of time regarding partial, this is full compensation, partial compensation, physical therapy, 313% more time. So if Wednesday’s reported a 32% decrease in average weekly costs of medical expenses during disability compared to physical therapy. So in other words, cars with 32% cheaper Mafi et Al reported the cost of managing low back pains, not fixing anything, just managing with PT has reached $106 billion in healthcare costs 106 billion in healthcare costs. If we keep going, okay, Evans, now let’s look at some of the reasons why, because the reasons why are critically important Evans reported that a low velocity manipulation, PT, no matter how well it followed author kinematic and principles of intraarticular movements will not affect your weight. The release of substance P only a chiropractic spinal adjustment with cavitation substance P is, uh, probably more, uh, neutrophil it’s, uh, it’s a protein that is released when you adjust your patient with cavitation.

And it does things such as pain mini mediation anti-inflammatory because what happens is it affects central sensitization. Cora NATA reported that a non PT chiropractic high velocity, low amplitude adjustment caused significant changes in pain sensitivity. And when I say higher, I mean, central sensitization brain spinal cord, and the local and different spinal regions that manual therapy PT does not provide central central sensitization. One of the things you have to understand is when you render that chiropractic high velocity, low amplitude adjustment, it’s affecting the brain. Remember that safety pin cycle, it’s not really bone spinal cord, bone it’s bone nerve, spinal cord up to the Spotify kilomet track through that, that was through all the different parts of the brain of ping pongs around. Then it goes back then he apparently through the thalamus and they had th um, disparate areas. So the body can create biomechanical homeostasis.

That’s the safety pin cycle in up bouncing around the brain, affecting different areas, going back down and effectuating homeostasis. There’s a lot of things that happen with a high velocity, low amplitude chiropractic spinal adjustment that you notice that it use the word manipulation. This is not a philosophical issue. PTs manipulate osteopaths manipulate chiropractors render a chiropractic spinal adjustment that argument’s now off the table, because if you start using the word manipulation, manipulation, manipulation, manipulation, again, it’s not a philosophical issue. What they’re going to think is you’re doing author a kinematic or osteokinematics principles of intraarticular movement as those other professions do. That is not what we do read FA Al found that a high velocity, by the way, here’s, here’s the references. Everything I’m giving you read his 2014 revealed unilateral bilateral, and multi-level hypo LGC pain reduction because of central nervous system changes. Physical therapy, mobilization and oscillation therapy has zero nada, zilch, Viet garnish, nothing, no changes, only a chiropractic high velocity, low amplitude thrust.

Now again, when all of that fails and the two rounds of drugs and PTs, you’re off to pain management, legalized drug addition, drug them up to shut them up for the rest of their life. And I’ve seen it all too often. So Puente’s reported that chiropractic had a 250% decrease in disability during the duration of the first episode, compared to the MDs care, they had our report an 82% of year Harvard medical students fail the basic competency of musculoskeletal aptitude tests that was reflected in inaccurate diagnoses. Devotion revealed that 87% of chiropractic patients exhibited decreased pain verified by electro-diagnostic testing while 82% can’t even diagnose it properly. 87% of our patients are getting well Peter’s I hate this statistic. Peterson reported 69% of chronic back pain sufferers reported significant improvement, chiropractic care. My research revealed that that alone would save $110 million annually, which I think is way low, but I don’t think 69% is fair.

I think that number’s closer to 90%, just from my own personal experience in the pits treating patient again, we’ve reported the adjusted likelihood of filling a prescription opiate analgesic was 55% lower. Can you imagine that 55% lower in opiates? Why? Because they’re so busy treating the effect when, where of non specific back pain, which is dogma, not true because what medicine is saying, I don’t know what’s wrong. So let’s just drug them up. So we could do one of these close our eyes to it, drug them up to shut ’em up. And that is not the solution because there can never be a pharmacological solution to a mechanical issue. And by the way, what’s that mechanical issue. We’re going to do a whole presentation on this. You’re ready. Here’s what subluxation is. And what the adjustment does. You have two bones that approximate each other, actually in between the bones, there’s a little Plinko or a spacer.

Okay. And that little spacer, when you have a macro trauma, like a car accident, sports injury, or repetitive microtrauma that spacer dislodges. Now the bones approximate the Fossette, that’s your bone on nerve. It’s not the nerve. That’s your bone on nerve. And then what occurs is there are nociceptors on the facades, but also in the ligament. And I’m doing a whole program on ligament, physiology and neurology and pathology, but in the ligament that holds the bones there’s pacinian corpuscles were Finney. Corpuscles, nociceptors all the stretch and Crip receptors. And it has to do with McKenna reception appropriate section fires off to the lateral horn up through the spinal thalamic tract into the thousands had ping pongs around the anterior cingulate, the prefrontal cortex and motor cortex, sensory cortex hypothalamus, and a few other areas back down through the [inaudible] and now it affects different areas. And then what occurs is, is by that high velocity, low amplitude thrust, you’re putting that spacer back in to keep that bone out of position with the muscles.

If it’s there a long time are conditioned to hold it in the wrong position and it’ll eventually slip back out. So you need to do chiropractic care repetitively. Now, if in fact you leave it there too long based upon Wolff’s law and the, and the PSO electric effect, the bone will remodel can never fix it. But if the, and you have to manage your case, just like a diabetic is managed or high blood pressures, you can’t fix anything. You’re going to keep it spaced. But if that bone is not yet remodeled, you can make a true correction of lastly, which is why people early in life must get their spine check to see if in fact this phenomenon is going on with their body. I call it a path on neuro biomechanical lesion, which is consistent with the literature, but there’s been another name for it since 1895, it’s called the vertebral subluxation complex.

And I don’t really care what you call it. Pathway neuro bio biomechanical lesion stick with our, our, our, our historical jargon of, of subluxation. How about to the vertebra? I don’t care, but that’s the mechanism and everything I just shared with you is literature-based everything. Our next program is going to be a full explanation on what I just shared with you. Okay? That plea of going out of position, the bones are approximating. I’m going to be doing 30 full minutes on just that simple, simple, simple, and really is because remember, and here’s the key. This, this will explain why chiropractic is the best, first choice to respond and hint. It has to do you see this? It has to do with this. It’s really, really simple, but you see the problem is folks, you have outcome of a perpetuating, this failed care path, the outcome right now, if you follow the Mayo clinic and the Cleveland clinics recommendation, and the 92% that ended up in physical therapist’s office, you have perpetual pain leading to oxies okay to opioid addiction.

And then Wolff’s law that kicks in. And then you’ve got a degenerative society where people are like, like, like you see in the, in the, um, in the nursing homes, just all bent over. All of those things are going to occur. Not should not, could not might they will. Because again, you cannot have a form of a pharmacological solution to a mechanical issue. If I said that enough, I want to beat it into your brain. You’ve got to be able to help the body create homeostasis. The body needs to be plumbed biomechanically between the glabella, the chin epi, sternal notch, belly button, pubic synthesis, and on the side ear, low shoulder, hip plump, AP and lateral. Because if not, the body’s going to start doing this and making you bent and crooked and twisting around. So it can, it can create a homeostasis and it’ll do that through different positions of antalgia, whether it be head forward, head back, whatever it is, the body’s going to always try to create homeostasis.

And, but when it does that, it’s going to put average pressure on the bone has Julius Wolff set in approximately 1859. If there’s added pressure on the bone, the bone is going to remodel. And if you want an example of that, if you wear glasses, take them off, run your hand behind you. You’re you’re going to feel the divot, the weight of the glasses remodeled those bones that’s Wolff’s law and the PA’s electric effect is the mechanism behind it, which has been known for decades, which is what that occurred, which what, what creates that to occur. And that’s a topic for a whole nother conversation, but that’s important. Now, what we have to understand is shifting referrals. Listen, I love chiropractic. I understand that there’s a business hand and there’s a service hand. We’ve just discussed the service hand. But how can you have a business hand if you don’t understand what your service is, but you have to have that through four things, actually evidence.

And I’ve given you a lot and I’ll show you where to get a lot more. Just a moment. You need the demonstrative proof and the proof comes with testing. So you need to and instruments that could give you the modulator of proof, not just I told you so, and we’re going to give you that in a future program, but then you have to understand there’s peer to peer case management. I’ve sat with so many neurosurgeons and orthopedic surgeons and neurologist. You know what they say to me? I love chiropractic care. I just haven’t had a chiropractor smart enough to work with. And I mean that sincerely. And it’s funny because one of my doctors in Cedar park, Texas, Aaron Smith, who I’ve trained, Aaron walked into an orthopedic surgeon’s office. He was in practice, I believe eight or nine years at that point. And I spent months training him months.

He told me, Dr. Mark, I walked in, the guy gave me five minutes to kiss his ring. That’s it? You wanted my referrals. And we spent over an hour and all we discussed was MRI acquisition protocols. You said, I would walk that meeting with 150 referrals the first year, because I was the smartest chiropractor he’s ever spoken with. And he knew I could manage the cases. If you go in and you talk technique and theory and philosophy, you’re cook, they don’t care. You don’t go in and ask them their surgical. I use a double Trendelenburg super-duper knife technique. They don’t tell you their technique. Why are you telling them yours? You’re supposed to get your patients better. They want to know if you can manage the cases. All it takes is one thing, credentials, credentials, credentials, credentials, that’s it. And you need the knowledge behind them.

There’s programs out there such as becoming trauma care, qualifying hospital, qualified, advanced education and MRI interpretation, all of these different things that help you triage cases, because that’s what they want. Well, that’s what the medical community wants. Lawyers want that to because something else, according to let’s look at chiropractic is, is the first provider in primary spine care and only chiropractic, not PT. Howling added. I talked about how long before, and this is in 2015, the mean total hip spine and shoulder panel related healthcare costs per patient during a four month study were 40% lower when patients initially consulted chiropractors compared with those, uh, initially consulting MDs. The reason for this difference was a lower use of healthcare services. Other than first contact gear in patients initially consulting DCS compare with initially consulting MDs. We got him better. We didn’t need to do a zillion different things.

We didn’t need to image every single patient. They didn’t have to go to surgeries at any 12 or three or four courses of, of, of, of, uh, steroids, nonsteroidals muscle relaxers, opiates. Those things are expensive. Now, the T the estimated total expenditure for neck and back pain between 2018 and 2027, 10 years that we as chiropractors could save is 4.6, $5 trillion to the healthcare delivery system based on inflation. And today’s statistic using this report above. Think about that. We could save 4.6, $5 trillion to the healthcare delivery system simply by having chiropractic is the first provider in order to understand that you have to discover your why, and that’s what we’re going to do the next time we do the, you need to know why now, if you want a research and you want all of these statistics, God, or the us chiropractic directory, us chiropractic

It’s easy click on the research tab. There’s hundreds of these articles, hundreds and hundreds and hundreds. And to date we’ve gotten, this is probably the most visited chiropractic site in the industry. Uh, since 2012 June, we’ve had 20 million, 635, 866, um, looks. And this is as of three days ago, um, in, uh, March of 2021, but it just, it’s just incredible. I mean, chiropractic spinal adjustment population versus mobilization, uh, chiropractic home manager pre-imposed spine, no evidence exists was in chiropractic care and cervical artery dissection. There’s a whole series in here in chiropractic versus PTA. Um, it’s just really cool now to learn more about our live programs and our consulting platforms. We have an online university with incredible courses, no basket weaving one-on-one. I mean, the real deal, please visit the Academy of Um, our symposiums are two and three days long. Uh, everything is online.

You don’t have to travel anywhere. Those days are over. Technology is wonderful. Um, and we do them usually in may and, uh, either November or December. So please, I urge you to come share your learning experience with us. Um, I am humbled by those who choose to give their valuable time and a hundred money with this. And we work very hard to earn it all and to make sure that we deliver quality content. Everything we do is for CE credits and, um, and I look forward to sharing it with you. I always, always, always, always available always. So you need me, here’s my cell phone number. Here’s my email address. Call me any time your heart desires. So listen, I’d like to take just a half a moment and thank ChiroSecure for offering me the opportunity to share this information with you. I love chiropractic it’s my passion. If it helps chiropractic, if you need help on Wallin, just call me. I’ll do anything. It’ll be my pleasure within my power. Um, our, our host, uh, next time I believe in this series is Janice Hughes. Uh, I’d like to thank you for sharing the time with me, have a great day

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