Why This Common Back Pain Treatment Gets a Pass (When Chiropractic Doesn't)

[0:00] Jason: Alright. So we showed people a study, a 132 trials over 7,900 patients, and we described the results. Modest short term pain relief, no long term benefits, and potential serious complications. And then we asked, would you still recommend this treatment? And people lost their minds. They said things like, this is why chiropractic is pseudoscience or dangerous quackery. This should be illegal. You know? But there was one small problem.

[0:24] Kathy: It wasn’t about chiropractic.

[0:26] Jason: That’s right. It was epidural steroid injections. You know, the thing that your doctor recommends after an MRI shows a bulging disc, the real medicine option.

[0:36] Jason: Same weak evidence, but somehow when a physician does it with a needle and a fluoroscopy machine, nobody calls it quackery.

[0:43] Kathy: Today, we’re talking about why the exact same data gets a pass or gets crucified depending on entirely on who’s holding the syringe or, in your case, whose hands are on the spine. That’s right. This is the pitch.

[0:58] Jason: What happens when a chiropractor and a physical therapist get together to make a health and wellness podcast? But chiropractors and physical therapists don’t like each other. Oh, think again.

Kathy: I’m doctor Kathy Lynch, physical therapist who likes to help people move and get stronger.

Jason: I’m doctor Jason. I’m an evidence based chiropractor who uses humor just as much as adjustments to help people get better. Welcome to the pitch podcast. Remember, there’s no I in pitch.

[1:23] Jason: Kathy. We’re back.

Kathy: Hello. Yes. Hello, everybody.

Jason: I’m doctor Jason Young.

Kathy: And I’m doctor Kathy Lynch.

Jason: Yes. And this this is our podcast.

Kathy: Mhmm. Hello. The Pitch podcast.

Jason: How are you doing today, Kathy?

Kathy: Pretty good.

Jason: You’re doing pretty good. Pretty pretty summer ball.

Kathy: Summer ball. Summer basketball. Yes. Yes. Good day.

Jason: Oh, for the high school.

Kathy: Mhmm.

Jason: How are the Spartans doing?

Kathy: Hey. Shout out to coach Dan. Yes. The future is bright.

Jason: We know that coach Dan is out there listening

Kathy: He is. Every single time. Mhmm.

Jason: So, have you guys played games?

Kathy: We are playing in we have a controlled scrimmage tonight. We have some games this weekend. So

Jason: Alright. Yeah. Alright. School full of ballers.

Kathy: That’s right.

Jason: I love it. Yes.

[2:03] Jason: And, you know, we’re taking the summer off from sports since Yes. Alston’s, knee is still healing. Mhmm. Definitely on track. K. And he’s asking when he can come back for the follow-up. I think we need the follow-up because soon to run this week. Yes. Yes. Yes. He’s he’s excited. Mhmm. I think he’s trying to keep it a secret from us, though, so we’re not like, go running. Oh. No. Mandy declared that for for the youngs, this is going to be hot girl summer. Okay. Yes. Which is something that I had to look up. Okay. But she said it’s not about our health. It’s about looking good. So I love it. Yeah. I’ve I’ve gotta get bikini fit.

[2:40] Jason: So, hey. Hey. Shout out to Karen again. Yeah. Karen. So, it’s good stuff. Alright. Alright. Well Our talk episode good stuff today. Yeah. And, you know, so we did that whole kinda tease in the Yeah. In the cold open. Mhmm. And I feel like we covered all the the information. So, Raul, we’ll just roll the closing credits. I think I think we’re done. Everybody’s got the point. We’re done here. No. We’re gonna go hard in the paint on this one. So, Kathy, do you ever, like, refer people out for

[3:12] Jason: epidural steroid injections?

[3:14] Kathy: I actually do.

Jason: You do?

Kathy: I do when it is, like, last we have we’ve tried everything, and the person’s still in significant pain.

Jason: Yeah. Yeah. It is kind of the court of last resort, so to speak. Mhmm. But did you know that most of the major guidelines put epidural steroid injections squarely after you and I Wow. In the packing order? Yeah. It’s true. The, I guess we should talk about what they are. Yeah. Right? So,

[3:44] Jason: an epidural steroid injection, which neither of us do because it’s outside of our scope. Yeah. So take that with a grain of salt. But, epidural, the word dural, it it describes kind of the wrapping paper around the brain and the spinal cord. Epi means near. So it’s an injection that’s near kind of, that wrapping paper around the nerve that leaves, the spinal cord, goes out to your arm, your leg, wherever. Okay?

[4:15] Jason: And, steroids, that’s like cortisone, things like that. And so the theory behind this is if you have an inflamed nerve, then you inject some of these steroids near that nerve, and it helps the inflammation to die down. And there’s a few other types of, procedures too that we’re gonna kind of cover today. Another one is, called a facet injection. So the facet joints, that’s basically where you have one vertebrae that overlaps the other,

[4:46] Jason: and it’s got its own kinda capsule. And those capsules move just like any other joint, like a knee joint or an elbow joint or anything like that.

Kathy: Little knee joints in your spine.

Jason: Exactly. It’s your spine knees. Yes. Yes. Your your spine knees. But there’s fluid in those joints. Sometimes those joints will get inflamed. Mhmm. And, sometimes they might do, injections in those facet joints as well. And then there’s another, procedure that kinda gets wrapped up in this too that, is called radioablation.

[5:16] Jason: Mhmm. And so, this one this one sounds crazy, but, basically, what they do is they go in and using radio frequencies, they they essentially burn the nerve. Right. And so, when you burn the nerve, it doesn’t work anymore. Yeah. And so if you have a signal that’s constantly being sent that’s that’s causing you, like, sciatic pain, true sciatic pain

Kathy: True sciatic which goes where?

Jason: Down past the knee. Yeah. Then, you know, the the idea there is, hey. Let’s interrupt those signals so that you can get moving, get active, and things like that. Mhmm.

[5:53] Jason: So that is kind of the groundwork that’s laid. Mhmm. Now these procedures are incredibly common. Mhmm. Very common. Do you have any guesses to how many are done every year? Every year? Yeah. In The US.

Kathy: Hundreds of millions.

Jason: Well, the the epidural steroid injections alone are nine million.

Kathy: Oh, wow. Nine million injections a year. Wow. Yes. That’s it. I would have thought more.

Jason: Yeah. Well, they’re they’re they’re actually on the

Kathy: Maybe Maybe just our area.

Jason: Well, I think they’re on the decline because I think the guidelines have even changed. Okay. Yeah. Like, last year,

[6:30] Jason: was it last year? Yeah. I think it was about a year ago. I had a patient who came to me, and she was doing pain management. And she said, hey. The the pain management doctor is recommending that I get epidural steroid injections. So what do you think? And so, you know, I’ve got my opinions, but I decided let’s go check the evidence. Yeah. And what what popped up was, actually, the the level of recommendation for it got downgraded.

Kathy: Did it really?

Jason: Yes.

[7:01] Jason: There’s a good reason for it. Yeah. They’re just not that effective.

[7:06] Kathy: So for, facet joints or for disc, was there a was it was there a difference between the two? Like, whether it was effective for either

[7:16] Jason: That’s a good question. So yes. K. So first of all, there’s there’s a few reasons that somebody might get some of these injections. Right? And, first of all, it’s I already said first of all. So I guess I guess I’m on second. Okay.

Kathy: Yeah. Thank you for holding me to that.

Jason: Sure. Third of all

[7:37] Jason: no. Sorry. Second, so first, there’s a reason. Okay. Now I’m all confused. Okay. Letter c. Yeah. Alright. No nobody’s getting these for acute back pain. Right? So you’re not waking up one morning or you’re not, like, you know, picking something up in in your garage, and then it’s like, oh, I tweaked my back. Let me go get an epidural steroid injection. So that’s not how they’re being used. These are typically being used for people who have chronic

[8:11] Jason: back pain. K. Chronic back pain, the arbitrary definition is, twelve or more weeks of of of back pain. And so, yeah, when when we look at these kinda different classifications of it, there is back pain, which is just local back pain, meaning I’ve got pain that’s right there in my spine and nowhere else. And then there’s something called radicular back pain, which you you know that word. Be honest. When you learned the word radiculopathy,

[8:44] Jason: did you think that they were trying to punk you? Yeah. It’s like, it’s the stupidest sounding word. Radiculopathy. I’ve got radiculopathy. Okay. So you want me to just show up and say that to somebody? Like, would you like me to film while I do? Sir, you’ve got radiculopathy. Right? K. But it’s a thing. It’s a real thing. K? Radiculopathy comes from the same root as, radicu radiculation or ridiculous. It’s

Kathy: That’s not right. Be a word, but it doesn’t sound like one when I say it. Think it is.

Jason: Right. Radiation. Right? So it’s it’s

Kathy: Radiating from

Jason: Yes. Symptoms that radiate from the spine.

[9:23] Jason: They they’re called radicular symptoms or radiculopathy. And so that is like the pain, numbness, tingling, muscle weakness that’s shooting down your leg or your arm or whatever. So epidural steroid injections, they they have they they don’t even help with pain.

Kathy: No. They don’t.

Jason: Like, at least not according to the evidence.

Kathy: K. What do they propose to help with?

Jason: It’s a great question. Yeah. And I know and I’ll just say this. First thing Yes. First, two things. Okay?

[9:56] Jason: First thing, and I’m getting these in order now. Okay. We’re not giving any health care advice.

Kathy: No. This is entertainment.

Jason: Entertainment. Whoo. Disclaimer. Disclaim. Alright. The second thing is that somebody’s probably listening. They’re like, well, this is no. Because I had I had this done, and it did help with my pain. Mhmm. And, so one thing to understand about studies is that studies are not real people. Right? The only type that is is a case study. Yes. A case study is a study of, like, one person, one case Mhmm. And you can’t really generalize it to everybody.

[10:28] Jason: But the things that are more generalizable, there’s gonna be exceptions. And so if you’re listening and you’re disagreeing with me, then you’re probably that exception. Yeah. And, also, if you’re disagreeing with me, you’re disagreeing with what the study says. Yeah. So, you and me, we’re still friends. Yeah. Hey, Kathy. What was I talking about? Quick question. Yeah.

[10:53] Kathy: Quick question, Kathy. I think it’s about,

[10:55] Jason: radicular pain. Yes. Oh, and what does it actually help for? Yes. Yes. K. Yeah. So these aren’t good for pain. Yes. They they sometimes help pain, but you get short term outcomes anywhere from a couple of days

[11:08] Jason: to a few weeks Mhmm. To I’ve even had some people get them and they just feel awful. They feel worse. They don’t love the steroid. No. Yes. But, the thing that they’re most effective for is disability. So, for example, if somebody, cannot get up and walk because of their radicular symptoms, then this is when something like this might be on the table, might come into play, might be useful. Mhmm. Outside of that, though, if you’re like, man, I’ve got this chronic annoying back pain, and this might be the thing that just, like, gets it done. Yeah. Probably not.

[11:45] Jason: So K. So, yeah, decent for disability, not effective for pain. Okay. You wanna know a secret? I do. It’s a dirty secret. It affects both of us.

[12:01] Kathy: Like, as people?

[12:02] Jason: No. As as professionals. Oh, alright. Yeah. There isn’t a whole lot out there that according to studies is really super effective

[12:13] Kathy: for low back pain. That that is the truth. Yeah. Yes.

[12:16] Jason: They call it low quality evidence. Mhmm. And so people are like, that’s not true because there’s really high quality evidence for exercise. Not so. Not really. Yeah. It’s, rated very low to the low end of moderate. Right. Yeah. And, there’s a few reasons for that. And when you look at these studies and how they’re done, there’s something called heterogeneity, which is like, when when they’re making these decisions, they they’ll have maybe, like, you know and the one that we talked about in the cold open they had, what was it, a 132

[12:52] Jason: studies that they looked at? Mhmm. The quality of evidence gets downgraded if those 132 studies aren’t very similar. Right? Like, you might have one that looks at a whole big group of people. You might have one where they used, a certain type of needle and another one, they use a different type of needle or the dosages aren’t the same. It’s not reproducible. Right? Yeah. Yeah. So they’re kind of all over the place, and that brings the quality of the evidence down. K. Same thing with exercise. Yeah. Because do you prescribe all the same exercises as every other PT?

[13:24] Jason: Yes. You do. Okay. Shells. Yes. Three sets of 10. Yeah. Right? Yeah. Yeah. Uh-huh. So, yeah, that that’s one of the issues with all these studies is everybody’s got kinda different kung fu. With chiropractic, one of the the issues is is there’s, like, a 100 different technique systems. So when you say spinal manipulation, what does that mean?

Kathy: Yeah. Could mean a lot of different things. Really good point.

Jason: Yeah. Yeah. So, so that’s why the quality of evidence

[13:55] Jason: tends to be low. But low quality evidence doesn’t necessarily mean that, like, the data is fake or it’s not good, because even low quality evidence can help us to see a direction.

Kathy: Mhmm.

Jason: So, what I mean by that is, you can have a study that that shows that, like, maybe we’re looking at things on a scale of one to 10. Right? You can have a study that shows that your treatment, which is clamshells, three sets of 10.

[14:26] Jason: Right? That

Kathy: Especially for back pain.

Jason: Especially for back pain. Right. Definitely. And, and fixing their weak core

Kathy: Uh-huh.

Jason: Right and turning on

Kathy: The glutes.

Jason: The glutes. Yeah. You have dead glutes.

Kathy: Yes. Yes.

Jason: Reviving the glutes. Gluteal resurrection. K? That that can give you, like, maybe five points of pain relief. Right? And so comparing all these different studies and everything like that, you might find that there’s a varying number of the magnitude of the effect. So when we say low quality of evidence

Kathy: Yeah.

Jason: That’s what we’re talking about is the magnitude. Is it five points?

[15:03] Jason: Is it two points? Is it one point? So we can’t really we can’t really tell. But when you look at all these studies together, if you’re seeing that they all kinda trend towards, yeah, there’s a positive effect and it reduces pain, that is the direction. Right? So the direction could be good even if the magnitude isn’t no. So a lot of times when we hear low quality evidence, it’s we don’t understand what’s the magnitude

Kathy: Right.

Jason: Of the effect.

Kathy: Right.

Jason: So, yeah. And injections,

[15:33] Jason: it’s no different.

Kathy: Mhmm.

Jason: Right? They they they suffer from the same problems as the rest of us.

Kathy: Yes.

Jason: Which is that it is we don’t understand the magnitude of it. And, but but there are people that benefit from it. There’s people that don’t.

Kathy: Yeah. I have patients where they have definitely benefit from it,

[15:53] Kathy: but then I also have patients probably fifty fifty Mhmm. That don’t, and they’re wondering why it doesn’t work. Mhmm. But then there’s like I said, I do have patients. I just had a patient last month that,

[16:06] Kathy: had one done because she was having just consistent pain into her glute. Some pain, like, down, didn’t go past her knee, so it wasn’t static.

Jason: Well, well, well, what do we know about that?

Kathy: But she did get an injection. So far, it’s still pain free. Mhmm. But would who knows how that’s who knows how long that will last? Yeah. And, so it is kinda diagnostic. Like, okay. They hit the right spot. They hit the inflammation.

Jason: Yes. Out the inflammation.

[16:39] Kathy: But when the cortisone wears off,

[16:42] Kathy: are we back to square one?

Jason: Yeah. So You bring up a really great thing because that’s probably the greatest value of some of these techniques is diagnostically. So the idea is, hey. We can see on an MRI that you have a disc bulge. We can see that there’s some encroachment on a nerve. And, we’ve talked about this over and over on the show that you can see those things on an MRI, and it doesn’t always correspond with symptoms.

Kathy: Right.

Jason: But one of the ways that you can confirm that this does correspond with symptoms is let’s let’s do an injection near the nerve. Yeah. And if it turns off the symptoms, then we know that that compression is enough that it’s causing

[17:20] Jason: irritation, ergo. If we go in and do a surgery, a decompression, something like that Mhmm. Probably a better chance of a good outcome.

Kathy: Right. So it’s better than a surgery. And

Jason: Yes.

Kathy: A lot of times they’ll use it before a surgery

Jason: Right. Just so that you know that we got a pretty good chance of this getting better. Yeah. Otherwise, it’s kind of a coin toss. It is it is $50.50. Yeah. Yeah. And, one of the well, there’s two other things that make this not my favorite, treatment.

[17:51] Jason: One of those things is a safety profile of it. So this this is the big knock that people have against chiropractic Mhmm. Is it’s dangerous. Yeah. Right? You’re killing people. You’re giving people strokes all over the time. We’ve done other episodes about it, so I’m not gonna rehash all that data. But, there is an association between, cervical manipulation and stroke, and it is an association. There isn’t any evidence, in the literature that confirms a causal link between

[18:23] Jason: getting your neck adjusted and having a stroke. Some people just they have dissections. They have strokes. Some people are going to the chiropractor because of symptoms of the condition they’re already having. Mhmm. Now with that, though, comes even though it’s extremely rare, very rare, there’s people, especially in the social medias, that are like, dude, if you go get one adjustment, you’re gonna have a stroke. You will die. Yes. There’s there are piles of bodies underneath chiropractic clinics.

[18:56] Jason: Yeah. It looks like it looks right next to the morgue. Yes. It looks like a Native American burial ground. Right? Like, it looks like it looks like Gettysburg. You know? But, which totally is not the case. These these cases are extremely rare. And, but but, you know, we get we get labeled with it.

Kathy: Yeah.

Jason: But epidural steroid injections have a higher rate of stroke. And

Kathy: Do they really?

Jason: Yeah. Yeah. Higher rate of stroke. Than today. Okay. They have a higher rate of epidural hematoma.

[19:28] Jason: So we already went over what epidural means. Yeah. What’s a hematoma? Hematoma, no no good. Yeah. No good. No good. Yeah. It’s it’s bleeding. Mhmm. That basically makes a bruise, and that bruise can compress the spinal cord lead to, hemiplegia, paraplegia Mhmm. Quadriplegia, which is, fancy words that I paid a lot of money to learn that mean paralysis. Yes. Yeah. And, some of those cases are permanent. Mhmm. And,

[19:59] Jason: most of them fortunately are transient, but some of them are permanent. Mhmm. And, these these complications, they happen at a higher rate than they do with chiropractic, certainly higher rate than they do with physical therapy Mhmm. Which is completely safe. A 100% safe. 100% safe. Yes. Yes. It’s to the point of being completely inert. Now, there’s also the risk of abscesses, fungal infections, fungal meningitis.

[20:28] Kathy: Say infections. Yep. Mhmm.

[20:30] Jason: I think, a few years back, there was, a string of fungal meningitis infections that was related to a bad lot of medication. And so, you know, there’s real risks that are associated with that, but, you know, the average person listening, they’re probably, oh, yeah. Chiropractic, that’s a little sketchy. Mhmm. Maybe a little bit dangerous. Certainly, PT is completely safe. But they don’t they don’t think about, you know, these epidural injections. Mhmm. So Mhmm. Now

[21:03] Jason: even though I said that, they’re still, like, mostly really safe. The serious complications are rare, but depending upon the numbers that you look at, it’s anywhere from, like, eight to four hundred times more common to have a, a complication with a spinal injection than a chiropractic. Wow. Yeah.

[21:25] Kathy: That is that is not what I expected.

[21:27] Jason: Yeah. It’s it’s it surprises a lot of people. It sure does. Right? Yeah. Because, like, oh, you should need to go get a steroid injection. Yeah. Mhmm. Wow. And and, you know, I think that when people

[21:39] Jason: talk about it, they they do it with such a straight face that it’s like, hey. We’re just gonna do we do them all the time. Mhmm. And they’re not lying Right. Because most of the time, things turn out very well. There are some times when people can have, you know, increased nerve pain pain or bad reaction to it. Mhmm. And, so that’s that’s one of the issues. It’s it’s not as safe as other it it’s still considered conservative Yes. Spine care. Yes. But it’s not as safe as other forms of conservative spine care. So,

[22:11] Jason: you should not rush right out to get,

Kathy: Shouldn’t be your first choice.

Jason: No. And there’s there’s no guidelines Mhmm. That that would put it in that place. Yeah.

Kathy: Yeah. The people who probably should be referring for this, if it’s necessary, would be people like you and me Mhmm. Who are first line, according to most major guidelines whenever it comes to back and neck pain. Mhmm. So Mhmm. And then with safety two Yeah. If I may.

Jason: Please.

Kathy: The neck and upper back are the most risky areas.

[22:43] Kathy: So most efficacy and safety for the lower back, the riskiest place is gonna be neck and upper back for those injections. So Meningitis

[22:53] Jason: because much closer to the brain.

[22:57] Kathy: That’s what they say for most people. Mhmm. There are some people that depending upon where their head is in relationship to their their bootiest maximus

Jason: Buttocks?

Kathy: Yes. Then then the low back in that case is much closer to the brain. You all probably know a person that I’m talking

[23:17] Jason: It’s a it’s a condition we wish was more rare. However, what do they call it? Cranial rectal inversions? Should we talk about this as a cranial rectal inversion

Kathy: We should.

Jason: Therapy? Yeah. Can Kenan help with that?

Kathy: Yeah. I I hope so. Yeah.

Jason: Yeah. In that case, meningitis is the cure.

Kathy: Oh my goodness.

[23:48] Jason: So that so that was one thing. So there’s the safety portion. Yes. The other portion is the cost. Now, Kathy

[23:56] Kathy: Yes. Let’s talk about this. On

[24:00] Jason: capitalism, on the open market, what would what would you pay for a a nice a nice epidural steroid injection? Like, what would that be worth to you? Now last time you guessed, there was a 100,000,000 of these being done. I’m gonna give you a clue. Even close. It is less than a $100,000,000 a shot.

[24:23] Kathy: It just seems like there’s a lot of people getting steroids. Yeah. It’s like that is a 100,000,000. Well, there’s so there’s 9,000,000 people. Yeah. I’m I’m gonna kinda ballpark this. Yeah.

Jason: A $134,000,000,000 spent every year on spine care. Mhmm. K? There’s nine million of these injections. Chiropractic accounts for about 6,000,000,000 Okay. Of that. Okay? Physical therapy, about $25.

[24:55] Jason: No. I don’t I don’t know the the number for physical therapy. I don’t know if it’s been done. I imagine it’s probably it’s probably similar Yeah. To chiropractically close. Maybe a little more. Yeah. Okay. So how much do you think

Kathy: So what what was the what was the total amount spent on today? 34. Okay. $134,000,000,000.

[25:13] Jason: And chiropractics, 9? 6. 6,000,000,000 is that. So PT is 6. Yeah. Sure. K. So there goes 12, so we’re down to a $122,000,000,000. And there’s 9,000,000 of these injections. Wow. It’s Now leave some room for surgery. Okay. Because that’s part of it. Oh. But injections

[25:32] Kathy: Surgery is at least a 100,000,000,000. Maybe. But

[25:37] Jason: Spine so how much per injection? Per injection. Well, it’s more than 500. It’s not what I would say. But It’s definitely more than 500. It’s more than 500. Yeah. It’s gonna be enough to satisfy a lot of people’s deductibles. Yeah. It’s $1,200 on average. Per injection? Yeah. For one injection, it’s about $1,200.

[25:55] Kathy: I think we’re in the wrong business. Yeah. So to,

[25:58] Jason: to go on average, to go to a chiropractor, if you’re paying cash out of pocket, it’s $67. Mhmm. And so you can have one spinal injection or 18 chiropractic visits, and it’s probably similar for physical therapy. Although you guys are ballers, let’s say it’s a $100 for you. We’re about a 100. Yeah. You know, so that’s between a dozen and 18 visits with a chiropractor or physical therapist or one shot,

[26:29] Jason: and your results are the same. The same exact The same results with just a little more risk. Just a little bit. Like, if death. If risk was a line, you just, like, whoop, give it a little squeezy squeeze. Right?

[26:46] Kathy: Okay. But nerve ablations Yes. Let’s talk about nerve ablations. These are fascinating.

[26:52] Jason: Yeah. They’re four times as expensive as spinal injections and no more no more effective. Yeah. So you can get 80 chiropractic visits for the cost of one nerve ablation. Wow. Yes. And at six months, there is no difference in outcomes, and that is pain as well as disability. No difference in six months? Yeah. So the the best long term outcomes of conservative care for spine care is physical therapy. It’s exercise. Mhmm. At about 12 so

[27:30] Jason: everybody does pretty good under six months. Right? It’s kind of a toss-up. K. Go to chiropractor, physical therapist. You can get your shots. You can do your drugs, whatever. Mhmm. Right? You can, you know, burn sage. I don’t know what you do. You can think happy thoughts. Absolutely. Yeah. Under six months, it’s anybody’s game. At about six months, chiropractic is still doing pretty good. Twelve months, physical therapies left pretty much everybody in the dust because,

[28:02] Kathy: at some point, you got a rehab. Right? Yeah. And it’s you don’t have an active, like, inflammatory issue. You have a, like, how would you call it? Dead glutes. Yes. Chronic gluteal death. Right? Yeah. And so that that is a big deal. So you could go like, let’s say that you’re paying a $100 a month to go to physical therapy Mhmm. Which that’s extremely conservative. That would be cheap. Right? Yeah. Yeah. You could do a year of physical therapy for the same price as one shot. Mhmm. That one shot is gonna give you maybe

[28:38] Jason: a couple weeks to three months Mhmm. Of relief. Mhmm. And physical therapy would give you a year of relief, and that’s according to the studies. Right? Or jeez, you could just like, all you can eat chiropractic, like, chiro chiro buffet. Right? So, yeah, it’s a crazy thing. So my question to you, Kathy, is given all this Yeah. Why don’t people love me? Like, why do they hate chiropractors?

[29:09] Kathy: They just wanna hate on you guys. Uh-huh. You know? What is it about what you do that brings out the haters?

[29:19] Jason: It yeah. And so the crazy thing is I asked that Yeah. And instantly, some skeptic, like, popped into their head. Oh, well, what you do is a complete sham, and it doesn’t it doesn’t beat placebo. It’s like but rewind a little bit because we had this discussion. Yes. It’s all about the same. Yes. None of the evidence is, like, amazing. There’s high heterogeneity.

[29:40] Jason: So get rid of that. Get rid of that argument. It’s not good. Oh, well, it’s the like, chiropractor, they’re killing people. No. No. No. No. No. No. We already had that discussion too. Yeah. Right? Yeah. Then they wanna bring up the ghost in the room. Oh. Right? Chiropractors are weird because they think that, you know, the founder saw a ghost. And, you know, so there’s just And you can treat allergies. Right. Right. Oh, it’s it’s the, it’s the wild claims. Yeah. Yes. The pseudoscientific claims Yeah. Or the the misleading

[30:11] Jason: misinformation claims. Mhmm. So misinformation like, you know, spending $5,000 for a treatment that’s gonna last you for, you know, six weeks Mhmm. Is is a good investment. Mhmm. Mhmm.

[30:24] Kathy: It’s our society, though, too. Like, we we will pay money to get that quick fix. Yeah.

[30:30] Jason: Well and so here’s another interesting thing is what you believe matters. Yes. It’s a huge part of whether you get better or not. Mhmm. We’ve had this conversation,

[30:41] Jason: before too, and so the patient’s buy into a treatment matters. Mhmm. Haven’t you have you had patients that are just like, hey. Can we can we just get this done so that I can go ahead and skip to surgery? Get my MRI? Yeah. Yeah. All the time. Yeah. Let’s just knock this out so I could get surgery. Yeah. I think we talked about that on our Google episode. We did. Right? And so it’s, you know, patient beliefs matter a lot, and there’s some people that they they just have supreme faith that as long as there is a needle or a scalpel involved, that that is going to be the fix. And the doctors are physicians are the experts. Yeah. And

[31:19] Jason: and it’s great marketing for physicians, and it’s also terrible marketing for physicians. Yeah. And the reason we believe that is I mean, you look at, our culture, you look at our media and stuff like that, we’ve got shows like House. We got shows like Griffin keeps watching Grey’s Anatomy. Oh, yeah. He’s back. Can you believe that can you believe that show is still on the air? Not believe they’re still producing episodes. Yeah. It’s crazy. It’s like, so Meredith is Same thing. She’s still on it? Yeah. Yeah. And she’s, like, participating in bring your granddaughter to work. Oh. You know? She’s gotta be. Right? She’s like, this is my grandson,

[32:01] Jason: Michael, and here we are. School. Yeah. Right. I yeah. He’s a he’s a third year resident now. It’s like, why is that show still in the air? But, you know, you have all these shows, and they make they make physicians into heroes. Yes. And which isn’t inaccurate. I think physicians definitely are heroes. Save lives. Yes. But the Hollywood version of a physician, it’s not the same as a real life version No. Of a of a physician. And so

[32:32] Jason: I think that’s kind of unfair to them. It places a lot of pressure on them. And I think what we see right now is we’re at an all time low of people putting trust in the medical establishment,

[32:45] Kathy: and I don’t think that that is physician’s fault. No. It’s the system. It’s the system. It’s the system. It’s the system. And to be fair, I see people with a lot of pain every day. Right? Nerve pain is at the top of the list. It’s a different beast. It is a different beast. It is it’s sometimes intolerable.

[33:07] Kathy: Yeah. You can’t sit. You can’t lay. You can’t stand.

[33:11] Jason: You can’t do nothing. What about people who come in and they say that they have nerve pain, and they just don’t know? Right? Like, oh, yeah. I think it’s a nerve back in front of me. Sure. You would not be so casual, sir. Would know. Yeah. It’s it’s nerve pain. Yeah. Right. People people have nerve pain. They don’t come in No. Wearing jeans. They do not. They come in in pajamas. They they

[33:33] Kathy: have not slept. They have not slept. They’ve rarely they’re barely eating. Yeah. They’re drinking something, just only snake meds.

[33:42] Jason: Yeah. Women who have nerve pain don’t show up in makeup. They don’t. No. No. No. No. No. No. No. You’re in survival mode. Yeah.

[33:48] Kathy: Yeah. So, you know, that is tempting when you’re in that much pain. You just want it to go away. Yeah. So the idea that this shot could at least even cut it in 50 to 50% Mhmm. Is

[34:01] Jason: people are like, I will pay whatever it takes. Right? Yeah. Or I will have my insurance pay whatever. Yes. I the my insurance will pay whatever this takes. Yeah. Well, that’s the thing that’s confusing to me too is insurance companies, they have access to all this data. Yeah. Why do they keep paying for

[34:17] Kathy: for these injections? It’s not interesting. And when they cut me off after nine visits sorry. That patient with back pain, nine visits. Yeah. They’re not better yet. They can do their exercises at home. It’s Instead, I’ll pay $1,200 for this one shot Yeah. That has a fifty fifty chance. And it’s it’s so confusing to me because,

[34:36] Jason: like, there’s there’s all these, videos on social media now where they show doctors who are live streaming, basically, their peer to peer calls.

Kathy: Oh, yes. I’ve seen those.

Jason: Have you seen those? They’re amazing.

Kathy: Yes.

Jason: You have people that they they just they don’t have the qualifications

[34:52] Jason: to be considered a peer

Kathy: Right.

Jason: With the person they’re talking to. You have doctors who are trying to get authorization for procedures, mid procedure.

Kathy: Yes. It’s like Outrageous. That’s so stupid.

Jason: Yeah. Right? And so there’s but there’s incentives to insurance companies to to support some of the insanity. Mhmm. And it’s like, I wonder what would health care look like if you had no insurance.

Kathy: Yeah. I I think across the board, it would be far less expensive. Mhmm.

[35:22] Jason: No doubt. I mean, one of the reasons that I that my prices are what my prices are is because of insurance. Yes. Right? And and it’s because of averages of co pays and things like that. But if I was but if people were paying market value for what I do Mhmm. Then, you know, I I might make a lot less money. Yeah. Right? And, so if you’re one of my patients and you’re listening to this, just fast forward past this part. Thank you. Fast forward. Thank you for your insurance. So but, but across the board, like, that’s the way that it is. And people don’t understand too that,

[35:57] Jason: I mean, the even what I’m saying about this, it might be even a little bit illegal because providers aren’t allowed to talk with each other about prices. What they’re getting paid.

Kathy: Yeah. It’s price fixing.

Jason: What do you get paid? Can’t tell you. Price fixing.

Kathy: Yeah.

Jason: And so your associations can, like, collectively bargain for you and everything. But, like, the whole thing, it’s it’s so crooked, and it’s so ironic that, the the system that we’re relying on to make us healthy is so

[36:28] Kathy: dysfunctional So dysfunctional. Toxic

[36:31] Jason: and unhealthy.

[36:33] Kathy: It is the lowest it’s ever been. Yeah. And, I mean, we’ve known this crisis has been coming, and we’ve done nothing Yeah. About it. Yeah. Nothing about it. The thing we’ve done about it is we’ve involved politicians. Yes. This is true. We’ve involved politicians. Good happens. Can be bought. And they get involved.

[36:51] Jason: Yeah. It’s I and I don’t I don’t know what has to happen Mhmm. To to change it. But,

[36:59] Jason: but just to get back to, like, when when I talked about the trust being so low Yeah. And medical providers, I mean, they don’t deserve that because there’s, your your doctor is a good person. There’s there’s some people that get into medicine because they wanna make a lot of money. You can make a lot of money, but that’s maybe 1% of them. Yeah. Most of those people are in it because they love helping people. They they love the idea that they can help save a life, that they can make a life better. They can make life longer, happier. They love kids. They love old people. Mhmm. You know? And that is what the average doctor is like. Mhmm. But it is not what the system allows them to behave like Right. Which is

[37:43] Jason: which is, like, it’s soul crushing. Yeah. It really is.

[37:47] Kathy: Doctors, I feel like, are naturally problem solvers, and they do not have the time to solve the problem for the patient sitting in from. They don’t. They get fifteen minutes, and they gotta see 25 people a day. Yeah. At what point do they have time to research or call, phone a friend, doc doctor friend and say, hey. Have you seen this before? They get to call Meredith Grey That’s right. Get some answers. Yeah. Yeah. I mean, that’s what they want to be able to do, but the system does not allow it.

Jason: No. And,

[38:19] Jason: in our community here, like, we’re we’re losing doctors.

Kathy: Yeah. Corvallis is kind of a

Jason: I know I’m getting nervous about living here because I agree. As I get older and I need more appointments and stuff like, right now in my car, I’ve got, like, this great big jug. Yeah. You know what the big jug is? Some people are like, oh, I’ve gotten that jug. Oh. Yeah. It’s a colonoscopy jug. Oh. Right? Time? Yeah. It’s like you gotta drink all this stuff and everything like that. It’s like, oh, boy. So it’s like, yeah. I I’m just at an age and stage where

[38:51] Jason: this this ride needs more maintenance, I guess. And so, it’s, like, I I’m I’d be lying if the thought hadn’t crossed my mind. Is there a better or a safer place to live? Because, like, you get some of these big hospital systems coming in and everything. Mhmm. And we have doctors that are just like, I don’t know if I can say in this community Yeah. Because they you know, I don’t get to practice actual medicine. Right. And that really worries me. Mhmm. Right? Because what if I need something? Yeah. Exactly.

[39:25] Jason: I have I have things like, some of these, things I need to get like, I have to get referred to Salem Mhmm. Because they can’t get me in here. I can’t refer patients to, a neurologist here Nurse which, and that’s that’s that’s really a, like, a real paradox too because there’s sometimes when people are like, chiropractors claim that they can just fix everything and treat everything. You’re pricing outside your scope. And it’s like, okay. I I hear you.

[39:57] Jason: So in this situation, what’s the right thing to do? Should I refer them to a neurologist? Okay. Yeah. I agree. Can I refer them to a neurologist? Not here. No. I can’t. Yeah. Right? You have to go see your primary care doctor Mhmm. In six months. Mhmm. And then they have to refer you to a neurologist Mhmm. That you can see in four months. And, hopefully, ten months from now Mhmm. Your nerve damage is not irreversible. Right. It’s still move your arm. Mhmm.

[40:23] Kathy: Yeah. More and more of my patients are going to Salem or

[40:27] Kathy: Eugene if they need to have surgery because wait times around here for surgeons are six months, eight months. Yeah. Yeah. It’s a big problem. It’s insane. Mhmm. So, and we had universal health care, you know, because those people wait a long time.

[40:44] Jason: It’s almost like we have the capitalist version of universal health care. Oops. Food just ran into the microphone. Yeah. And so I it’s very frustrating. And the other thing too is that we brought this up before. We have a shortage of doctors Mhmm. In the country. We’re we’re behind by, like, a 120,000.

[41:05] Jason: Mhmm. There’s no way that we can catch up. Right? That’s why we need nurse practitioners and PAs. Mhmm. I was talking to you I mean, I was talking to, an MD friend of mine who just didn’t have anything nice to say about nurse practitioners. It’s like, what’s going on? Yeah. So first ticket to the moon, I will take I will take that trip. I know that there’s no health care there. Start over. Right? Yeah. Yeah. It’s like then then at least I’d understand. Oh, yeah. There’s the health care here sucks because I’m one of six people.

[41:39] Kathy: So anybody need a spinal adjustment? Oh gosh. Blue flag. Yeah. This is just the cheeriest episode Yeah. Of the pitch podcast that we’ve ever done. Gloom. Yeah. We started, don’t let anybody stab you in the spine, and now it’s like, PS. We’re all gonna die.

[41:58] Kathy: No. But Keep your heads up out there, though. Yeah. It’s gonna be okay. Well and solutions, I think, will come because they have to. They have to. Yeah. We’re with our backs against the wall and

[42:08] Jason: Is that a pun?

[42:12] Kathy: No pun intended. All the puns intended. Yes.

[42:15] Jason: But I think it’s this is one of the reasons that clinics are important. Mhmm. Right? So, like, what you do Mhmm. Your clinic, is important. What I do is important because, we need to keep primary care doctors and specialists seeing the people that they need to see. Yeah. Right? So,

[42:43] Jason: if somebody if somebody can be helped by physical therapy Yeah. They should be at physical therapy. Yes. They should not be at a primary care doctor Yes. Because we need primary care doctors helping people Mhmm. Who are sick, who have internal, like, organ conditions and stuff. Yeah. We need to help them to stay in their lane, right, by staying in our lane. And one of the worst things that we see is whenever you have these professions that that are infighting.

[43:14] Jason: And there’s some stuff that we could probably just let go of from a financial standpoint. Like, we don’t need to be pushing so many epidural steroid injections. Yeah. Right? And, like, it would be good if they’re like, hey. Maybe you should go to a physical therapist or chiropractor or whatever you prefer Mhmm. First. And if they think it’s a good idea, then, yeah, get this injection. And that might help you to know, do I need a surgery?

[43:43] Kathy: So I wish we could normalize people when they have pain thinking, you know what? I’m just gonna call my physical therapist or chiropractor. Mhmm. How many times do you get? Well, I get this a lot. Well, it took me six weeks getting my primary care to get a referral here. Oh, good. Yeah. I always had to you don’t need a referral. Just call me. Mhmm. Just call the clinic. We’ll get you in. Yeah. I wanna get a referral. You don’t need a referral.

[44:06] Jason: So that stigma is better already. You could’ve you could’ve been better already. And I think, one of the things I

[44:16] Jason: like, the the domino effects of that because I know chiropractic, we get a bad rap for, there’s doctors out there that wanna have these never ending treatment plans. Like, I wanna see you for forty, fifty, 60,000 visits or something like that. Well, if we’re seeing the the people that we should be seeing, we don’t have room for, you know, these long treatment plans. Right. I had a patient this morning who they went to, like, one of these, like, fitness classes Mhmm.

[44:50] Jason: Lifting something heavy. And they came in, and, they’re already improving. Like, they’ve gotten better since it started. We did an exam, determined that there was nothing dangerous going on. Right? Seemed like just a strain back. Mhmm. And so the treatment plan was, hey. You should start you should start lifting again. Mhmm. Right? Let’s let’s do some some graded exposure to lifting. Like, don’t go back to exactly the thing that got it, but let’s start lifting some stuff again. I’m gonna give you some exercises.

[45:22] Jason: Let’s get your back adjusted so that we know that it’s just moving like it should. Mhmm. If you did nothing, it’s probably gonna get better on its own. But let’s just try and speed that up and give you some confidence that you can go back to doing something that’s healthy for you, which is exercise. Yeah. Right? And so, of course, I wanna see her for 18 visits. Yeah. And I thought maybe 36. No. We’re just we’re just planning on, like, three or four visits. Yeah. Right? And so, and that’s what it should look like. Mhmm. And there’s some people who want more. There’s some people who need more. Mhmm. And we do that. But in the meantime, we don’t we don’t have to we don’t have to do anything that’s, like, really,

[46:02] Jason: like, over the top. Yeah. And and that is what keeps enough that’s what keeps enough health care available for everybody. Mhmm. Yes. Laughing about off camera stuff.

[46:18] Kathy: Sorry. Trying to keep it quiet. It’s time for a game.

[46:22] Jason: I think it’s game time. Yeah. I like that. I get some water in my mouth, and you say it’s time for a game. Let’s do this. Alright, Kathy. Let’s see if you’ve been paying attention. Uh-huh. We’re gonna play

[46:35] Jason: a game that I call spinal tap. Okay. Let’s do this. Not the not the movie on board. Alright. Darn. Is this a real procedure, or did I just make that up? Okay. Love it. And it’s pretty much played how I just said. Okay. Alright. You ready? Let’s go. Epidural steroid injection. Real. That is real. Very good. Oh, and something that I meant to bring up about this. One of the things that’s interesting about epidural steroid injections

[47:05] Jason: is they can’t even really tell if it’s the steroids. Oh. There’s a thought that it might just be the saline

[47:12] Kathy: Yes.

[47:13] Jason: Or the local anesthetic that Yes. This injection. Have they done sham? Yeah. They have. And that is why it doesn’t perform well against sham treatments. Oh, okay. You you might not even need that at all. Right? Mhmm. I you might just pinch people in the back of me. There you go. That feel better? How’s your foot drop now? Is it better? Look at that. Yeah. Uh-huh. It’s moving. How’s your tricky leg?

[47:39] Jason: Oh, that’s a good callback. Alright. How about this one? Bilateral spinous process block.

[47:45] Kathy: Bilateral spinous process no.

[47:48] Jason: Numbing the bony bumps that you can feel down your bed. No. Yeah. That’s fake. Okay. There’s there’s no value in that. I passed that one. Okay. What about this? A stellate ganglion block. Stellate? Spell that, please. S t e l l a t e.

[48:05] Kathy: Stellate

[48:07] Jason: what? Ganglion

[48:08] Kathy: Okay. Block. I’m on board with the ganglion.

[48:11] Kathy: Mhmm. I don’t know about I don’t know if I know about stellate, but so we’re we’re gonna go with it. It’s real. It is real. Yeah. Stellate?

[48:19] Jason: Stellate. Gosh. I think that means, like, star shaped. Yeah. Yeah. Okay. And, you know, the ganglion is a structure right near the spine. I did learn that one. Yeah. Mhmm. Alright. Intradiscal helium decompression.

[48:35] Kathy: No.

[48:38] Jason: Yeah. It makes you just like this.

[48:42] Jason: Yeah. We’re not injecting inert gas into, although I did see, that they’re experimenting with injecting, substance into nucleus pulposus

Kathy: Oh. To, like, pump up. Pump them up?

Jason: Yeah.

Kathy: Make us taller?

Jason: Yeah. Well, just to, like, like, help with the discus.

Kathy: Yes. Okay.

Jason: Exactly. Alright. But the thing is, if you have a decrease, it’s probably because you have damage to the fibers around that. And so it’s like, how are you gonna keep that stuff from just leaking out the side? Anyway, we’ll see. It’s being tested in other countries.

[49:18] Jason: Medial branch block.

Kathy: Yes. Real.

Jason: Okay. Absolutely real. That’s an easy one. What about a ganglion impar block?

[49:27] Kathy: I don’t know what an impar is. So

[49:30] Jason: that is one that is at the very bottom of the spine, like, down around the tailbone k. The sacrum area, coccyx. Real or fake?

Kathy: I’m gonna say fake.

Jason: That is real. That is real. K. And that’s its real name. Let’s do a couple more. K. Oh, how about this one? Dural sheath micro bubble therapy.

[49:49] Kathy: No.

Jason: Okay. I don’t even know what that would be. We already did radio frequency ablation. You know, that’s real.

Kathy: Yep.

Jason: What about an epidural blood patch?

[50:01] Kathy: Blood?

[50:02] Jason: Yes. An epidural blood patch. Do you want the description?

Kathy: Yeah.

Jason: A small amount of your own blood injected into the epidural space to seal a spinal fluid leak.

Kathy: Sure.

Jason: Yes. It is real. Real. And in fact, I have somebody that I wanna bring on who wants to talk about cerebral spinal fluid leaks.

Kathy: Yeah. Okay. Yeah.

Jason: He’s a guy that I went to chiropractic school with. K.

[50:23] Jason: And, okay. We’ll do one more. Kyphoplasty.

[50:29] Kathy: Yeah. Sounds really dangerous, but I think it’s real.

Jason: It is real. Yes. It’s a balloon

[50:35] Jason: plus bone cement to stabilize a compressed, or like a compressed vertebrae.

Kathy: Mhmm.

Jason: So when you have a compression fracture and it wedges, they balloon, and then they put cement in in order to fix your cat close. Yeah. Yeah. Yeah. Really cool. K. Alright. That’s the game.

Kathy: Love it. Yes. A lot of big words in that game. So,

[50:55] Jason: we’re gonna have to charge people extra for this episode. Takeaways.

[50:59] Kathy: K. Takeaways that the evidence for spinal injections is the same as the evidence for chiropractic. Yeah. But you can get more chiropractic or bang for your buck Yeah. With chiropractic.

[51:21] Jason: Yeah. And, $5,000 per nerve ablation. Yeah. And and I I hope that’s a take home for a lot of people is that, in in our broken health care system, we need to insist on cost efficiency. Yes. Not cost efficiency for insurance companies, Cost efficiency for the whole system. Because when we’re using the most expensive treatments to do things, it is the people who pay. It is not the insurance companies. We pay in premiums. We pay in taxes.

Kathy: Yep.

Jason: We pay in administrative costs.

Kathy: Yeah.

Jason: We’re paying it.

Kathy: Absolutely. Yes. Yes. We are paying out the no.

Jason: Yes. Because insurance companies are not in the business of losing money.

Kathy: They are not.

Jason: They’re casinos.

[52:08] Kathy: Yes. Exactly.

Jason: Alright. Well, good stuff. So, shout out to our sponsors Yes. Body Health Chiropractic and Wellness Center. Whoo. Yeah. Let’s go. Corvallis in Albany. Yep. And then Encore Physical Therapy only in Corvallis. Yes. But PT is so good. You’re gonna want more. A lot more. Yeah. Even at a $100 a month. At least 36 visits. Yeah. At least 36 visits. You don’t you don’t need insurance approval. Right? It’s America. Okay. And, also,

[52:39] Jason: please subscribe to our podcast Yes. Whether you’re on Spotify, Apple Podcasts. I had a patient who pulled us up on some weird podcast app that I’ve never seen before. Apparently, we’re on that. And we would love we would love a rating. Yeah. Right? Like, a good four or five star. Just kidding. Just five stars. Just five stars. And if you feel like we deserve a one star rating, just give us a five star instead. Add four to it? Yeah. Because if you don’t see the value of this, you probably can’t count anyway.

[53:10] Jason: No. Like, a great rating would be helpful. It helps to spread the word. And, one more thing, like, we want we want comments and Yes. We love feedback. Yes. If you go to oh, the new website. I didn’t talk about this. I updated the website. So there is now a Wiki. Right? You can get on, and you can see all the little, like, running jokes and stuff that we have. There is, a full episode guide, a directory of all the guests. We have all of our sponsors, affiliate links, all that kind of stuff, and there’s a spot where you can vote on what you wanna see on the pitch podcast. And you can send us recommendations on shows that we’ll ignore, and we’ll just do what we want anyway.

[53:49] Jason: No. Just kidding. So, yeah, pitch podcast got pitchpodcast.com. That is pitch.com. Kathy. Holy smokes. Pitchpodcast.com. Yes. Go there. Look around. It’s a really great time. Go there with your friends. Get a bunch of friends together. On a Friday. Pop some popcorn. Yes. Yeah. Gather around The YouTubes. Yeah. A MacBook, an iPad. Yes. Right? Even if you have Android, we’ll still take you. Yeah. Yes. So,

[54:23] Jason: oh, and the most important thing that we should bring up is there is no I in pitch.