Vertebrogenic Pain – A Thought Shift & Leisure Time Physical Activity Effects On Mortality

The Chiropractic Forward Podcast: Evidence-based Chiropractic Advocacy

CF 249: Vertebrogenic Pain – A Thought Shift & Leisure time Physical Activity Effects On Mortality Today we’re going to talk about Vertebrogenic Pain. Time for A Thought Shift & Leisure time Physical Activity Effects On Mortality 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 making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow, look down your nose at people kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. If you haven’t yet I have a few things you should do.

• Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.
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You have found yourself smack dab in the middle of Episode #249 Now if you missed last week’s episode , we talked about steps per day and how that’s related to dementia and we talked about vets and chiropractic. What a wonderful combination. Make sure you don’t miss that info. Keep up with the class.

On the personal end of things…..

Ugh, slow Monday man. I hate it and it give me anxiety but I’m using the extra time to make things happen, my friends. Yes indeed. This is being written on September 19th so we are still in the middle of the yearly back to school slowdown. When back to school gets us down, what’s the best way to handle it? Frist, as I’ve mentioned in recent podcasts, you get stuff done! Start through all of the things that have been piling up. Get that stack knocked out. Secondly, marketing wise, what has been successful for you in the past? Have you slowed down on your posting frequency on social media? Pick it up and get to posting. Has it been any community outreach or direct marketing?

Time to re-engage, right? Thirdly, settle the hell down. You didn’t pee on the mayor’s dog and the whole town is not mad at you. Or me. I think this is me talking to me by the way. Lol. Marketing is the most effective thing we can do for our clinic so we are spending this time calling and checking on patients that are more recent but have not really kept up with their schedule. Not in a bully or harrassing kind of way but a ‘staying top of mind’ kind of way and showing concern. What are the big things that speak to people? For me and my practice specifically, I think it can be boiled down to 10 things.

1. No long waits
2. Evaluation and treatment on the same day
3. New patient appointments within 48 hours
4. They will know the cost before their visit – at least as close as we can get to the cost
5. Not everyone gets x-rays
6. No pills and no surgery
7. Online scheduling
8. No long treatment plans
9. Treatment by a Board Certified Orthopedic specialist
10. Fast and efficient first appointment

These go for our medical side as well as for our chiropractic side. I think hammering these points consistently is an effective strategy. And, they aren’t talking points. It’s how we do things. Here’s another thing I’ll share with myy patients when appropriate; when I have a difficult decision to make as far as recommendations or treatment, I fall back on one principle. That principle is ‘what would I do with this person if this person were an immediate family member?’ That is a guiding principle that will get you the closest to every right answer out there that you can make. Alright, that’s enough of the personal side of things. Let’s get to the meat and taters.

Item #1

The first one is called “Vertebrogenic Pain: A Paradigm Shift in Diagnosis and Treatment of Axial Low Back Pain” by Conger et. al. (Aaron Conger 2022) and published in Pain Medicine on July 20, 2022. Hot sauce coming up!

• Clinicians and researchers have long recognized that better subgrouping of individuals with CLBP is necessary for more targeted and effective treatments. Commonly described sources of CLBP include the zygapophyseal joints, sacroiliac joints, and intervertebral discs (often termed “discogenic” pain)
• Historically, the term “discogenic pain” has been associated with disc degeneration and internal disc disruption with the presence of fissures in the annulus fibrosus and associated nociception via branches of the sinuvertebral nerve
• Previously, it was thought that pathological neurovascular ingrowth penetrated into annular fissures, leading to increased sensitivity and nociception via the sinuvertebral nerve
• However, more recent evidence appears to refute the occurrence of such neurovascular ingrowth in many cases
• In the late 1990s, a team of researchers led by Dr. Heggeness reported that vertebral bodies were richly vascularized by vertebral capillaries and innervated by nociceptors that traced back to a single source, the basivertebral nerve. Basivertebral nerve. Let’s call it the BVN, please and thank you.
• It’s a branch of the sinuvertebral nerve and it densely innervates the endplates.
• With progressive segmental degeneration or acute injury, altered force transfer and endplate stress can result in changes to endplate morphology and composition with concomitant impairment in permeability and transport
• Vertebral bodies demonstrated endplate nociceptor densification in areas of damage that were associated with increased disc degeneration.
• They also found that only 30% of annular tears in degenerated discs had pathologic neural ingrowth, compared with 90% of adjacent endplates (which were twice as densely innervated)
• This distinction between annular and endplate innervation is likely due to differences in nerve ingrowth potential. For the annulus, nerve ingrowth is inhibited by physical pressure and proteoglycans whereas nerves can easily proliferate in fibrovascular bone marrow adjacent to sites of endplate damage
• Accumulated damage to the discovertebral complex may result in chemical and mechanical sensitization of endplate nocioceptors
• These histopathological findings led to exploration of an “endplate-driven” model of discovertebral pain, with nociception largely occurring via the BVN to a greater extent than the sinuvertebral nerve
• This research supports an “endplate-driven” model of anterior column degeneration and existence of a fourth distinct structural source of low back pain, popularly termed vertebrogenic pain

The rest of the article goes on to talk about the research and the benefits of BVN nerve ablation. Of course, that’s not where our minds go immediately when we’re looking at a disc issue, endplate or annular. We’re looking at movement, functionality, and things of that nature.

But, I thought it was interesting because I have been taught over the years, even more recent years, that when an annulus cracks, it’s easier to become painful again because the nerves grow into that fissure and are deep toward the nucleus pulposus upon healing than they were prior to injury. So, for that reason, we have assumed that’s why the biggest predictor of future pain is the presence of prior back pain. This updated information seems to, for the most part refute that information. And I’m OK with that. I love new knowledge.

I love updating my education and staying on top of the cutting edge when I’m able to.

Before getting to the next one, Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office. When you decide you can’t live without those products, send me an email and I’ll give you the hookup. They will 100% differentiate your clinic from your competitors.

I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it.

Item #2

The last one this week is called, “Association of Leisure Time Physical Activity Types and Risks of All-Cause, Cardiovascular, and Cancer Mortality Among Older Adults” by Watts et. al. (Watts EL 2022) and published in JaMA Network Open on August 24th 2022. That’s slapy ya mama hot!

Why They Did It

• Higher amounts of physical activity are associated with increased longevity. However, whether different leisure time physical activity types are differentially associated with mortality risk is not established..
• They wanted to answer the question, “Are different types of leisure time physical activity differentially associated with mortality risks among older adults?”

How They Did It

NIH Cohort study of 272 550 older adults

What They Found A total of 272,550 participants age at baseline, 70.5 years provided information on types of leisure time activity, and 118,153 died during follow-up of 12.4 years.

• In comparison with those who did not participate, 7.5 to less than 15 metabolic equivalent of task hours per week of racquet sports and running were associated with the greatest relative risk reductions for all-cause mortality,
• Followed by walking for exercise,
• other aerobic activity
• golf
• swimming
• and cycling

Each activity showed a curvilinear dose-response association with mortality risk; low metabolic equivalent of task hours per week of physical activity for any given activity type were associated with a large reduction in mortality risk, with diminishing returns for each increment in activity thereafter. Associations were similar for cardiovascular and cancer mortality.

Wrap It Up

This cohort study of older individuals found differences between different types of leisure time activities and mortality risk, but there were significant associations between participating in 7.5 to less than 15 metabolic equivalent of task hours per week of any activity and mortality risk. There you have it go jump into some tennis, racquet ball, or pickle ball and then go for a run. You future self with thank your current self. 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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Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

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

Bibliography

Aaron Conger, D., Matthew Smuck, MD, Eeric Truumees, MD, Jeffrey C Lotz, PhD, Michael J DePalma, MD, Zachary L McCormick, MD, (2022). “Vertebrogenic Pain: A Paradigm Shift in Diagnosis and Treatment of Axial Low Back Pain.” Vertebrogenic Pain: A Paradigm Shift in Diagnosis and Treatment of Axial Low Back Pain 23: S63-S71.

Watts EL, M. C., Freeman JR, (2022). “Association of Leisure Time Physical Activity Types and Risks of All-Cause, Cardiovascular, and Cancer Mortality Among Older Adults.” JAMA Netw Open 5(8). s

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