Chiropractic Forward Podcast: Recent Episodes
Dr. Jeff Williams
Each week, Chiropractic Forward discusses how research, evidence, and experience puts Chiropractic Care firmly in the driver's seat for non-complicated neuromusculoskeletal complications. Advanced chiropractic knowledge, learning, and active chiropractic protocols have been clinically proven to be effective for mechanical pain. The newest recommendations coming from the medical world align chiropractic with the most effective protocols currently available for back and neck pain.
Episode 391 – Testing A Sham Adjustment & SMT For Acute Neck Pain Hey everybody, welcome to episode 391. I'm Dr. Jeff Williams and I'm your host for the Chiropractic Forward Podcast.
Episode 390 – Manual Therapy Plus Exercise & Multidisciplinary Rehab For Low Back Pain Hey everybody, welcome to episode 390. I'm Dr. Jeff Williams and I'm your host for the Chiropractic Forward Podcast. This week we'll cover Manual Therapy Plus Exercise & Multidisciplinary Rehab For Low Back Pain first though, here's that sweet sweet bumper music!
CF Episode 389: PNF Stretching For Knee OA & A 50-Year Review Of Chiropractic Research Today we're going to talk about PNF Stretching For Knee OA And A 50-Year Review Of Chiropractic Research. First here's that sweet sweet bumper music.
Today we're going to talk about Shockwave Therapy for Hamstring Injuries and Vitamin D for Respiratory Infections.
Today we're going to talk about Water Instead of Diet Drinks & Neuromobilization In The Chronic Neck
But first, here's that sweet sweet bumper music
Today we're going to talk about PRP For Knee OA & Diagnosing Cervical Arterial Dissection
CF 385: Tears In The Shoulder Are Waaayyy Normal & Adolescent Cannabis Use Is Dangerous Long Term Mentally
Today we're going to talk about Tears In The Shoulder Are Waaayyy Normal & Adolescent Cannabis Use Is Dangerous Long Term Mentally
CF 384: Motor Weakness In Cervical Radiculopathy & Exercise And Dementia
Today we're going to talk about Motor Weakness In Cervical Radiculopathy & Exercise And Dementia
CF 383: Platelet-Rich Plasma In Knee Osteoarthritis & Telehealth Mindfulness-Based Interventions
Today we're going to talk about Platelet-Rich Plasma In Knee Osteoarthritis & Telehealth Mindfulness-Based Interventions
CF 382: SMT And Disc Regression & Biopsychosocial Factors For Hip Osteoarthritis
Today we're going to talk about SMT And Disc Regression & Biopsychosocial Factors For Hip Osteoarthritis
But first, here's that sweet sweet bumper music
CF 381: SMT And Reoperation Rates & The Most Expensive Condition
Today we're going to talk about SMT And Reoperation Rates & The Most Expensive Condition
CF 380: Low Back Chronic Pain & Osteoporosis Medications and the Decrease in Societal Fracture Risk
Today we're going to talk about Low Back Chronic Pain & Osteoporosis Medications and the Decrease in Societal Fracture Risk
But first, here's that sweet sweet bumper music
CF 379: Opioids And Low Back Pain & Transforaminal Epidural Steroid Injection
Today we're going to talk about Opioids And Low Back Pain & Transforaminal Epidural Steroid Injection
But first, here's that sweet sweet bumper music
CF 378: Differences In Whiplash And Normal Neck Pain & SMT And Scoliosis
Today we’re going to talk about Differences In Whiplash And Normal Neck Pain & SMT And Scoliosis
But first, here’s that sweet sweet bumper music
CF 377: Neuroplastic Responses to Chiropractic Care & Screen Time And Depression
Today we’re going to talk about Neuroplastic Responses to Chiropractic Care & Screen Time And Depression
But first, here’s that sweet sweet bumper music
CF 376: Acupuncture For Chronic Low Back & Spinal Manipulative Therapy For Acute Neck Pain
Today we’re going to talk about Acupuncture For Chronic Low Back & Spinal Manipulative Therapy For Acute Neck Pain
But first, here’s that sweet sweet bumper music
CF 375: Neural Mobilization & Cannabis And Heart Attacks And Strokes
Today we’re going to talk about Neural Mobilization & Cannabis And Heart Attacks And Strokes
CF 374: Non-surgical Disc Treatment & Cognitive Functional Therapy
Today we’re going to talk about Non-surgical Disc Treatment & Cognitive Functional Therapy
CF 373: Vertebral Artery Dissection Recognized And Referred By Chiropractor
Today we’re going to talk about Vertebral Artery Dissection Recognized And Referred By Chiropractor
But first, here’s that sweet sweet bumper music
CF 372: Spinal Manipulativer Therapy and Lumbar Re-operation & SMT And Fall Risk
Today we’re going to talk about Spinal Manipulativer Therapy and Lumbar Re-operation & SMT And Fall Risk
But first, here’s that sweet sweet bumper music
CF 371: Pain Reprocessing Therapy & Chiropractic And Tramadol
Today we’re going to talk about Pain Reprocessing Therapy & Chiropractic And Tramadol
But first, here’s that sweet sweet bumper music
CF 370: Unnecessary Surgery & Gabapentin Linked To Dementia
Today we’re going to talk about Unnecessary Surgery & Gabapentin Linked To Dementia
But first, here’s that sweet sweet bumper music
CF 369: Cervicogenic Headache Treatment & Seeing A Chiropractor First Means Less Expense Overall
Today we’re going to talk about Cervicogenic Headache Treatment & Seeing A Chiropractor First Means Less Expense Overall
CF 368: Spinal Manipulative Treatment And Biochemical Markers & SMT For Lumbar Disc Herniation
Today we’re going to talk about Spinal Manipulative Treatment And Biochemical Markers & SMT For Lumbar Disc Herniation.
But first, here’s that sweet sweet bumper music
CF 367: Transcranial Direct Current for Fibromyalgia & Methotrexate For Knee Osteoarthritis
Today we’re going to talk about Transcranial Direct Current for Fibromyalgia & Methotrexate For Knee Osteoarthritis
But first, here’s that sweet sweet bumper music
CF 366: Europe, SMT Review, & Informed Consent
Today we’re going to talk about Europe, SMT Review, & Informed Consent
CF 365: Dosing Lumbar SMT & Short Term Effects of Different Forms of SMT
Today we’re going to talk about Dosing Lumbar SMT & Short Term Effects of Different Forms of SMT
CF 364: SMT And Stroke & Metformin For Knee Osteoarthritis
Today we’re going to talk about SMT And Stroke & Metformin For Knee Osteoarthritis
But first, here’s that sweet sweet bumper music
CF 363: Lateral Lumbar Stenosis & Manual Therapy Combined With PT
Today we’re going to talk about Lateral Lumbar Stenosis & Manual Therapy Combines With PT
But first, here’s that sweet sweet bumper music
CF 362: Coffee In The Morning & PRP Beats Cortisone In Meta-Analysis
Today we’re going to talk about Coffee In The Morning & PRP Beats Cortisone In Meta-Analysis
But first, here’s that sweet sweet bumper music
CF 361: Healthcare Expenditures & Sleep And Pain
Today we’re going to talk about Healthcare Expenditures & Sleep And Pain
But first, here’s that sweet sweet bumper music
CF 360: Selling Part Of The Clinic, Females Controlling High Blood Pressure, & Muscle Strength and Cardiorespiratory Fitness
Today we’re going to talk about Selling Part Of The Clinic, Females Controlling High Blood Pressure, & Muscle Strength and Cardiorespiratory Fitness
CF 359: Do Physicians Follow Guidelines & Updated Chiropractic Trends
Today we’re going to talk about Do Physicians Follow Guidelines & Updated Chiropractic Trends
CF 358: First Provider Matters & Neural Mobilization
Today we’re going to talk about First Provider Matters & Neural Mobilization
But first, here’s that sweet sweet bumper music
CF 357: Utilization and Expenditure of Chiropractic & Hormone Therapy In Females
Today we’re going to talk about Utilization and Expenditure of Chiropractic & Hormone Therapy In Females
But first, here’s that sweet sweet bumper music
CF 356: Opioid Use, PT, and Chiro & Neural Mobilization And Pain
Today we’re going to talk about Opioid Use, PT, and Chiro & Neural Mobilization And Pain
CF 355: Daily Water Intake & Curcumin
Today we’re going to talk about Daily Water Intake & Curcumin
CF 354: Chiropractic Treatment Of Mild Traumatic Brain Injury & New Cancer Treatment Approach
Today we’re going to talk about Chiropractic Treatment Of Mild Traumatic Brain Injury & New Cancer Treatment Approach
CF 353: Head And Neck Cancer & Degenerative Cervical Myelopathy
Today we’re going to talk about Head And Neck Cancer & Degenerative Cervical Myelopathy
But first, here’s that sweet sweet bumper music
CF 352: PT In The ER & Back Pain And Mortality
Today we’re going to talk about PT In The ER & Back Pain And Mortality
But first, here’s that sweet sweet bumper music
CF 351: Guides Treating Non-specific Low Back Pain & Pain-Catastrophizing With Chronic Pain
Today we’re going to talk about Guides Treating Non-specific Low Back Pain & Pain-Catastrophizing With Chronic Pain
CF 350: Acupuncture For Sciatica & Adolescent Cannabis Use And Academic Achievement
Today we’re going to talk about Acupuncture For Sciatica & Adolescent Cannabis Use And Academic Achievement
But first, here’s that sweet sweet bumper music
CF 349: Proprioceptive Neuromuscular Facilitation & SMT Adverse Events
Today we’re going to talk about Proprioceptive Neuromuscular Facilitation & SMT Adverse Events
But first, here’s that sweet sweet bumper music
CF 348: SMT Research Review & Mobile Phones And Cancer
Today we’re going to talk about SMT Research Review & Mobile Phones And Cancer
CF 347: Plant vs. Animal Fat & Screen Time At Bedtime
Today we’re going to talk about Plant vs. Animal Fat & Screen Time At Bedtime
But first, here’s that sweet sweet bumper music
CF 346: REM And TMD & Psychological Factors In Knee Osteoarthritis
Today we’re going to talk about REM And TMD & Psychological Factors In Knee Osteoarthritis
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 giving evidence-based chiropractic a little personality and making it profitable.
We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.
I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. I’m so glad you’re spending your time with us learning together.
Chiropractors - I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com
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 resource for you and is 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.
- Like our Chiropractic Forward Facebook page,
- Join our private Chiropractic Forward Facebook group, and then
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- Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com
You have found yourself smack dab in the middle of Episode #346
Now if you missed last week’s episode, we talked about SMT Comparison Of Short-Term Effects & GLP-1 And Obesity-Associated Cancers
Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
Alright let’s talk about business. What are you all seeing? I spent a lot of time over the last several months wondering if I made someone mad, pissed on the mayor’s dog, or something like that.
Now, business seems to be picking back up a smidge. Before I went to NYC I had almsot 200 in one week by myself. I don’t have an associate so that was a challenge. Now this week, and we’re early in the week, I have 165 lined up. I think NYC knocked me back down but that’s OK. 200 in a week is honestly more than I want. I think about 180 is probably my sweet spot and I’m only 15 off of that so far this week.
Anyway, I’m seeing a return of business and new patients. Being evidence-based, we depend on a consistent flow of new patients. So that’s what we got going here. A few things have played a part. We really buckled down and spent the money on website SEO. We started getting out and about in the community more. Shaking babies and kissing hands. And we made some key changes in our personnel. Once we were out with the bad seed, it just seemed like a cloud lifted. We have one more dark cloud on their way out in a couple of weeks and have a ray of sunshine replacing it and we can’t wait.
It’s all good in the hood so we’re on the right path. Business is good.
Another thing, yes the economy matters to our businesses and how much tax we pay each year but, don’t get tied up in politics if you can keep from it. They don’t care as much about you as they say they do. And for the love of all that’s holy, keep it off of Facebook and social media. If you’re posting political crap on your socials every day all day, you limit your patient base to half of your community because a republican will never treat with a mouthy democrat provider and a democrat will never treat with a mouthy republican provider. That’s a freaking guarantee. Both sides of the aisle need care and you can’t do that if you’re mouthy. Be smart, wise, trustworthy, and have good character. Treat people right and carry yourself correctly and the money will take care of itself.
Just a tip from your Ol Uncle Jeffro.
Item #1
Our first one this week is called, “Elevated pain sensitivity is associated with reduced rapid eye movement (REM) sleep in females with comorbid temporomandibular disorder and insomnia” by Reid, et al and published in Pain Medicine on March 28 2024 and it’s hotter than cat piss.
Remember, the citations can be found at chiropracticforward.com under this episode.
Matthew J Reid, Katrina R Hamilton, Sophie J Nilsson, Michael Alec Owens, Jane L Phillips, Patrick H Finan, Claudia M Campbell, Alexandros Giagtzis, Dave Abhishek, Jennifer A Haythornthwaite, Michael T Smith, Elevated pain sensitivity is associated with reduced rapid eye movement (REM) sleep in females with comorbid temporomandibular disorder and insomnia, Pain Medicine, Volume 25, Issue 7, July 2024, Pages 434–443, https://doi.org/10.1093/pm/pnae022
Why They Did It
Patients with chronic pain disorders, including Temporomandibular Disorders (TMDs) endorse high levels of sleep disturbances, frequently reporting reduced sleep quality.
Despite this, little is known about the effect that daytime pain has on the microstructure and macro-architecture of sleep. Therefore, we aimed to examine the extent to which daytime pain sensitivity, measured using quantitative sensory testing (QST), is associated with objective sleep parameters the following night, including sleep architecture and power spectral density, in women with TMD.
How They Did It
144 females with myalgia and arthralgia by examination using the Diagnostic criteria for TMD completed a comprehensive quantitative sensory testing battery consisting of General Pain Sensitivity, Central Sensitization Index, and Masseter Pressure Pain Threshold assessments.
Polysomnography was collected the same night to measure sleep architecture and calculate relative power in delta, theta, alpha, sigma, and beta power bands.
What They Found
Central Sensitization, General Pain Sensitivity Indices, and Masseter Pain Pressure Threshold were significantly associated with lower REM% both before and after controlling for covariates.
Pain sensitivity measures were not significantly associated with relative power in any of the spectral bands nor with any other sleep architectural stages.
Wrap It Up
Our findings demonstrate that higher generalized pain sensitivity, masseter pain pressure threshold, as well as central sensitization were associated with a lower percentage of REM in participants with myofascial pain and arthralgia of the masticatory system.
These findings provide an important step toward understanding the mechanistic underpinnings of how chronic pain interacts with sleep physiology.
Item #2
Our last one this week is called, “Quantitative sensory testing, psychological factors, and quality of life as predictors of current and future pain in patients with knee osteoarthritis” by Hertel et al and published in PAIN in August of 2024 and it’s a steamy pile of saucy spice.
Hertel, Emmaa; Arendt-Nielsen, Larsa,b,c,d; Olesen, Anne Estrupe,f; Andersen, Michael Skippera; Petersen, Kristian Kjær-Staala,b,. Quantitative sensory testing, psychological factors, and quality of life as predictors of current and future pain in patients with knee osteoarthritis. PAIN 165(8):p 1719-1726, August 2024. | DOI: 10.1097/j.pain.0000000000003194*
Why They Did It
This exploratory study aimed to explain baseline OA pain intensity and predict OA pain after administration of a nonsteroidal anti-inflammatory drug in combination with paracetamol for 3 weeks.
How They Did It
The Knee Injury and Osteoarthritis Outcome Score (KOOS) pain score was used to estimate OA pain presentation. One hundred one patients were assessed at baseline and follow-up using QST (pressure pain thresholds and temporal summation of pain [TSP]), symptoms of depression and anxiety, pain catastrophizing scales (PCSs), and health-related quality of life.
Linear regression with backward selection identified that PCS significantly explained 34.2% of the variability in baseline KOOS pain, with nonsignificant contributions from TSP.
Pain catastrophizing score and TSP predicted 29.3% of follow-up KOOS pain, with nonsignificant contributions from symptoms of anxiety.
What They Found
When assessed separately, PCS was the strongest predictor (32.2% of baseline and 24.1% of follow-up pain), but QST, symptoms of anxiety and depression, PCS, and quality of life also explained some variability in baseline and follow-up knee OA pain. Further analyses revealed that only TSP and PCS were not mediated by any other included variables, highlighting their role as unique contributors to OA pain presentation.
Wrap It Up
This study emphasizes the importance of embracing a multimodal approach to OA pain and highlights PCS and TSP as major contributors to the baseline OA pain experience and the OA pain experience after OA treatment.
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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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.
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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
CF 345: SMT Comparison Of Short-Term Effects & GLP-1 And Obesity-Associated Cancers
Today we’re going to talk about SMT Comparison Of Short Term Effects & GLP-1 And Obesity-Associated Cancers
But first, here’s that sweet sweet bumper music
CF 344: Obesity In Adolescents & Combined Cognitive Behavioral Therapy and Physical Therapy
Today we’re going to talk about Obesity In Adolescents & Combined Cognitive Behavioral Therapy and Physical Therapy
But first, here’s that sweet sweet bumper music
CF 343: Knee Osteoarthritis Recommendations & Ruptured Breast Implants
Today we’re going to talk about Knee Osteoarthritis Recommendations & Ruptured Breast Implants
But first, here’s that sweet sweet bumper music
CF 342: Cancer Vaccines & Cognitive Behavioral Therapy
Today we’re going to talk about Cancer Vaccines & Cognitive Behavioral Therapy
But first, here’s that sweet sweet bumper music
CF 341: Lumbar Disc Regression & Music’s Effect On Dementia
Today we’re going to talk about Lumbar Disc Regression & Music’s Effect On Dementia
But first, here’s that sweet sweet bumper music
CF 340: Semaglutide And Kidneys & Trying To Target Just One Vertebra
Today we’re going to talk about Semaglutide And Kidneys & Trying To Target Just One Vertebra
But first, here’s that sweet sweet bumper music
CF 339: Multivitamins Effect On Mortality & Acupuncture Effect On PTSD
Today we’re going to talk about Multivitamins Effect On Mortality & Acupuncture Effect On PTSD
But first, here’s that sweet sweet bumper music
CF 338: Psychologically Treating Chronic Pain & GLP-1 Safety
Today we’re going to talk about Psychologically Treating Chronic Pain & GLP-1 Safety
CF 337: PRP For Knee Osteoarthritis & Cervical Dizziness With Cervical Spondylosis
Today we’re going to talk about PRP For Knee Osteoarthritis & Cervical Dizziness With Cervical Spondylosis
CF 336: SMT And Lumbar Discectomy & Initial Providers Matter
Today we’re going to talk about SMT And Lumbar Discectomy & Initial Providers Matter
But first, here’s that sweet sweet bumper music
CF 335: Flavored Vape Issues & Adverse Events From Cervical Spinal Manipulation
Today we’re going to talk about Flavored Vape Issues & Adverse Events From Cervical Spinal Manipulation
CF 334: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 15)
Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 15)…..it’s the final part of the series.
CF 333: Colo-Rectal Cancer Recognition & Less Gabapentin With Chiropractic
Today we’re going to talk about Colo-Rectal Cancer Recognition & Less Gabapentin With Chiropractic
But first, here’s that sweet sweet bumper music
CF 332: Individual Alpha Frequency & McKenzie vs. Cranio-Cervical Flexion
Today we’re going to talk about Individual Alpha Frequency & McKenzie vs. Cranio-Cervical Flexion
CF 331: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 14)
Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 14)
But first, here’s that sweet sweet bumper music
CF 330: Chiropractic And Benzodiazepine & Curcumin And Carpal Tunnel
Today we’re going to talk about Chiropractic And Benzodiazepine & Curcumin And Carpal Tunnel
But first, here’s that sweet sweet bumper music
CF 329: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 13)
Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 13)
CF 328: Current Tendinopathy Thoughts & Chiropractic Vs. Medical Costs
Today we’re going to talk about Current Tendinopathy Thoughts & Chiropractic Vs. Medical Costs
But first, here’s that sweet sweet bumper music
CF 327: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 12)
Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 12)
CF 326: SMT And Cauda Equina & SMT And Discectomy
Today we’re going to talk about SMT And Cauda Equina & SMT And Discectomy
CF 325: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 11)
Today we’re going to talk about “The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 11)”
CF 324: Cancer-Finding Blood Tests & Neck Pain Treatment Differs By Initial Provider
Today we’re going to talk about Cancer-Finding Blood Tests & Neck Pain Treatment Differs By Initial Provider
But first, here’s that sweet sweet bumper music
CF 323: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 10)
Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 10). Yes, every other week we are covering the papers that the World Health Organization used to recommend spinal manipulative therapy at ‘very low confidence’. What we’ve seen so far are papers that are either very old, very small sample sizes, or prone to bias.
But first, here’s that sweet sweet bumper music
CF 322: Young Athletes With CTE & Catastrophizing, Fear Avoidance, and Pain
Today we’re going to talk about Young Athletes With CTE & Catastrophizing, Fear Avoidance, and Pain
But first, here’s that sweet sweet bumper music
CF 321: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 9)
Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 9)
CF 320: PT For Sciatica & Laser For Neck Pain
Today we’re going to talk about PT For Sciatica & Laser For Neck Pain
But first, here’s that sweet sweet bumper music
CF 319: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 8)
Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 8).
If you haven’t been following along, the World Health Organization has recommended spinal manipulative therapy for back pain, however, they rated it at very low confidence. Which is the same rating they gave ultrasound. We know SMT is more effective than that so I went into the recommendations, I found the papers the WHO cited as their references for their rating of SMT, and now I’m covering each and every one of them. We’re doing this every other week and now we’re on Part 8.
Also if you’re following along, you’ll know that a lot of these papers are extremely old compared so newer more impressive and more favorable papers that have emerged in more recent years. You’ll also, if you’re like me, continue to get more and more certain that there is an agenda in the WHO leadership that keeps SMT from taking its rightful step forward in the treatment of non-complicated Neuromusculoskeletal issues.
Stick with me, we’ll talk more about it.
But first, here’s that sweet sweet bumper music
CF 318: How Specific Are Adjustments & Nerve Flossing Effectiveness
Today we’re going to talk about How Specific Are Adjustments & Nerve Flossing Effectiveness
CF 317: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 7)
Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 7)
CF 316: Chronic Pain Central Sensitization & Patient Barriers To PT
Today we’re going to talk about Chronic Pain Central Sensitization & Patient Barriers To PT and, I would argue….chiropractic care.
But first, here’s that sweet sweet bumper music
CF 315: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 6)
Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 6). If you’ve been following along, and I hope you have…The WHO updated their recommendations recently for pain. Spinal maniuplative therapy was include so we’re on the menu. But, they rated SMT at very low confidence, which is the same as what they rated ultrasound. So, in the eyes of the WHO, smt may be about as effective as ultrasound. Yeah, we’re call BS so we are going through each paper they used to make this determination and they all, except for a few, are old, outdated, and pretty much stink. We’ll talk about it….
But first, here’s that sweet sweet bumper music
CF 314: Omnivorous vs Vegan & SMT For Chronic Neck Pain
Today we’re going to talk about Omnivorous vs Vegan & SMT For Chronic Neck Pain
CF 313: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 5)
Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 5)
CF 312: Pet Ownership And Cognitive Decline & PT Effectiveness
Today we’re going to talk about Pet Ownership And Cognitive Decline & PT Effectiveness
CF 311: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 4)
Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 4)
CF 310: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 3)
Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 3)
CF 309: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 2)
Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 2)
CF 308: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 1)
Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 1)
But first, here’s that sweet sweet bumper music
CF 307: Sciatica & Mental Stimulation And Dementia
Today we’re going to talk about Sciatica & Mental Stimulation And Dementia
CF 306: Pain Neuroscience Education & Cannabis And Bipolar Disorder
Today we’re going to talk about Pain Neuroscience Education & Cannabis And Bipolar Disorder
But first, here’s that sweet sweet bumper music
CF 305: Over Manipulation Syndrome
Today we’re going to talk about Over Manipulation Syndrome
But first, here’s that sweet sweet bumper music
CF 304: Interesting Thoughts On Low Back & Degenerative Cervical Myelopathy
Today we’re going to talk about Interesting Thoughts On Low Back & Degenerative Cervical Myelopathy
But first, here’s that sweet sweet bumper music
CF 303: Corticosteroids And The Hip Joint & Chronic Pain After Surgery
Today we’re going to talk about Corticosteroids And The Hip Joint & Chronic Pain After Surgery
CF 302: Spinal Manipulative Therapy And Benzodiazepines & Yanking Someone’s Head Off
Today we’re going to talk about Spinal Manipulative Therapy And Benzodiazepines & Yanking Someone’s Head Off
CF 301: Excessive Generalization Of Fear Avoidance
Today we’re going to talk about….
But first, here’s that sweet sweet bumper music
CF 300: Disc Resorption & Pickleball Injuries
Today we’re going to talk about Disc Resorption & Pickleball Injuries.
CF 299: Colorectal Cancer In The Young & AI-Powered Chronic Pain Management
Today we’re going to talk about Colorectal Cancer In The Young & AI-Powered Chronic Pain Management
CF 298: Patterns Of Cancer In The Young & BMI And Mortality
Today we're going to talk about Patterns Of Cancer In The Young & BMI And Mortality
CF 296: Vertebrogenic Pain & Fish Oil Benefit Claims
Today we’re going to talk about Vertebrogenic Pain & Fish Oil
CF 295: Two Surgeries, Two Outcomes & Cervical Artery Dissection and Spinal Manipulative Therapy
Today we're going to talk about Two Surgeries, Two Outcomes & Cervical Artery Dissection and Spinal Manipulative Therapy
CF 294: Kids’ Screen Time & Physical Activity In Older Adults
Today we're going to talk about Kids’ Screen Time & Physical Activity In Older Adults
CF 293: Nerve Pain Treated Naturally & The First Provider Seen Makes A Difference
Today we're going to talk about Nerve Pain Treated Naturally & The First Provider Seen Makes A Difference
CF 292: Discs In Low Back Pain & Unnecessary Surgeries Via COVID
Today we're going to talk about Discs In Low Back Pain & Unnecessary Surgeries Via COVID
CF 291: Racial and Ethnic Disparities In Chronic Low Back Pain & Pregnancy And Cannabis Use
Today we're going to talk about Racial and Ethnic Disparities In Chronic Low Back Pain & Pregnancy And Cannabis Use
CF 290: Headaches In Kids & Multiple Myeloma Research
Today we're going to talk about Headaches In Kids & Multiple Myeloma Research
CF 289: Motor Control Stiffening & Spinal Manipulation And The Vertebral Artery
Today we're going to talk about Motor Control Stiffening & Spinal Manipulation And The Vertebral Artery
CF 289: COVID-Delayed Surgeries & Lumbar Stenosis Research
Today we’re going to talk about COVID-Delayed Surgeries & Lumbar Stenosis Research
CF 287: Mindfulness For Knee Replacement & The Use Of Tuina
Today we're going to talk about Mindfulness For Knee Replacement & The Use Of Tuina
CF 286: Nonsurgical Decompression & Sugar Substitutes
Today we're going to talk about Nonsurgical Decompression & Sugar Substitutes
CF 285: Neuroplasticity and Chronic Pain & Surgeons Showing Excised Disc Fragments To Postsurgical Patients
Today we're going to talk about Neuroplasticity and Chronic Pain & Surgeons Showing Excised Disc Fragments To Postsurgical Patients
CF 284: Acupuncture For IBS & How Chronic Pain Develops
Today we're going to talk about Acupuncture For IBS & How Chronic Pain Develops
CF 283: The Rate of Chronic Pain in the US & Adolescents And Cannabis Use
Today we're going to talk about The Rate of Chronic Pain in the US & Adolescents And Cannabis Use
CF 282: New Dietary Ideas & The Doctor’s Words Matter
Today we're going to talk about new dietary ideas and the doctor’s words matter.
CF 281: w/ Lindsey Mumma - Excellence in Practice & Pelvic Floors. Oh, How They Suck!
Today we’re going to be joined by the amazing breath of fresh air called Dr. Lindsey Mumma. A force to be reckoned with, and an interview you’re going to absolutely love.
CF 280: Catastrophizing and Proprioception
Today we’re going to talk about catastrophizing and we’ll talk about proprioception in chronic low back pain patients as well.
CF 279: Newer Information On Nonsurgical Spinal Decompression
Today we’re going to talk about newer non-surgical decompressioninformation.
Item #1
The first on today is called “Effects of non-surgical decompression therapy in addition to routine physical therapy on pain, range of motion, endurance, functional disability and quality of life versus routine physical therapy alone in patients with lumbar radiculopathy; a randomized controlled trial” by Fareeha Amjad, Mohammad A Mohseni-Bandpei, Syed Amir Gilani, Ashfaq Ahmad, Asif Hanif and published in PubMed on March 16 2022. Dayum. That’s hot.
Why They Did It
The objective of this study was to determine the effects of decompression therapy in addition to routine physical therapy on pain, lumbar range of motion (ROM), functional disability, back muscle endurance (BME), and quality of life (QOL) in patients with lumbar radiculopathy.
How They Did It
· A total of sixty patients with lumbar radiculopathy were randomly allocated into two groups, an experimental and a control group, through a computer-generated random number table.
· Baseline values were recorded before providing any treatment by using a VAS, Urdu version of Oswestry disability index, modified-modified Schober's test, prone isometric chest raise test, and SF-36 for measuring the pain at rest, functional disability, lumbar ROM, back muscle endurance, and quality of life, respectively. All patients received twelve treatment sessions over 4 weeks, and then all outcome measures were again recorded.
What They Found
· By using the ANCOVA test, a statistically significant between-group improvement was observed in VAS, Oswestry disability index, back muscle endurance, lumbar ROM, role physical (RP), and bodily pain (BP) domains of SF-36, which was in favour of decompressiongroup.
Wrap It Up
It was concluded that a combination of non-surgical spinal decompression therapy with routine physical therapy is more effective, statistically and clinically, than routine physical therapy alone in terms of improving pain, lumbar range of motion, back muscle endurance, functional disability, and physical role domain of quality of life, in patients with lumbar radiculopathy, following 4 weeks of treatment.
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
Our last one this week is called, “Regression of lumbar disc herniation by physiotherapy. Does non-surgical spinal decompression therapy make a difference? Double-blind randomized controlled trial” by Aynur Demirel, Mehmet Yorubulut, Nevin Ergun and published in PubMed on September 17, 2022. Hot potato!
Why They Did It
The aim of the study determining whether or not Non-invasive Spinal Decompression Therapy(NSDT) was effective in resorption of herniation, increasing disc height in patients with lumbar disc herniation (LHNP).
How They Did It
· A total of twenty patients diagnosed as lumbar disc herniation and suffering from pain at least 8 weeks were enrolled to the study. Patients were allocated in study (SG) and control groups (CG) randomly.
· Both groups received combination of electrotherapy, deep friction massage and stabilization exercise for fifteen session. The study group received additionally Decompression different from control groups. Numeric Anolog Scale, Straight leg raise test, Oswestry Disability Index (ODI) were applied at baseline and after treatment. Disc height and herniation thickness were measured on Magnetic Resonance Imagination which performed at baseline and three months after therapy.
What They Found
· Both treatments had positive effect for improving pain, functional restoration and reduction in thickness of herniation. Although reduction of herniation size was higher in the study group than control groups, no significant differences were found between groups and any superiority to each other
Wrap It Up
This study showed that patients with lumbar disc herniation received physiotherapy had improvement based on clinical and radiologic evidence. Decompression can be used as assistive agent for other physiotherapy methods in treatment of lumbar disc herniation.
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.
CF 278: SMT and The Low Back & How Much Exercise Is Actually Needed
Today we’re going to talk about SMT and The Low Back & How Much Exercise Is Actually Needed
CF 277: Safety of SMT in the Cervical Spine & Chiropractors’ Beliefs Around the Need for X-rays
Today we’re going to talk about the safety of SMT in the cervical spine & Chiropractors’ beliefs around the need for x-rays.
CF 276: Subacromial Dry Needling & Lumbar Discs With Stenosis Present
Today we’re going to talk about Subacromial Dry Needling & Lumbar Discs With Stenosis Present
CF 275: Remote Myofascial Release & Manual Versus Instrumental Spinal Manipulation
Today we’re going to talk about Remote Myofascial Release & Manual Versus Instrumental Spinal Manipulation
CF 274: Spinal Stabilization For Chronic Pain & Dry Needling
Today we’re going to talk about a dry needling and we talk about spinal stabilization for chronic back pain.
CF 273: SMT And Fibromyalgia & SMT And Adverse Events
Today we’re going to talk about SMT And Fibromyalgia & SMT And Adverse Events
CF 272: Postpartum VAD and Pregnancy CAD
Today we’re going to talk about postpartum VAD and pregnancy CAD.
But first, here’s that sweet sweet bumper music
CF 271: Outdoor Play, Screentime, And The Impact Of Exercise
Today we’re going to talk about outdoor play, screentime, and the impact of exercise.
But first, here’s that sweet sweet bumper music
CF 270: Spinal Manipulative Therapy Adverse Events & SMT With Lumbar Herniation
Today we’re going to talk about Spinal Manipulative Therapy Adverse Events & SMT With Lumbar Herniation
But first, here’s that sweet sweet bumper music
CF 269: Children, Activity, and Depression and Axially Loaded MRIs
Today we’re going to talk about Children, Activity, and Depression and Axially Loaded MRIs
CF 268: Postoperative Acupuncture & Activity And Depression
Today we’re going to talk about Postoperative Acupuncture & Activity And Depression
But first, here’s that sweet sweet bumper music
CF 267: Pain Reprocessing Therapy & Meditation-Based Therapy For Chronic Pain
Today we’re going to talk about Pain Reprocessing Therapy & Meditation-Based Therapy For Chronic Pain
But first, here’s that sweet sweet bumper music
CF 266: Risk/Reward For Low Back Pain Treatments & Chiropractors In An Interprofessional Practice Setting
Today we’re going to talk about Risk/Reward For Low Back Pain Treatments & Chiropractors In An Interprofessional Practice Setting
CF 265: Where To Adjust & Types Of Adjustments
Today we’re going to talk about knowing where to adjust and different types of spinal manipulation
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. I’m so glad you’re spending your time with us learning together.
Chiropractors - I’m hiring at my personal clinic. I need talent, ambition, drive, smart, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com
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 #265
Now if you missed last week’s episode, we talked about potential early diagnosis of spondylolysis as well as clinical guides on low back pain treatment.
Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
Alright folks, I just got back from Fort Lauderdale hanging out with my MCM Mastermind family of chiropractors. What a good time. We have some new practitioners in the group. Fresh blood! New docs to learn from and new docs to teach.
It’s such a diverse group but all evidence-based. No vitalistic voodoo. Which is why it’s the right spot for me.
We learned from Ray Tuck. Now, Ray has around 9 clinics and his talk was about being the CEO of your company and let’s face it, I’m the worker mule in mine so it hit home with me and gave me some inspiration and some great ideas.
If you’ve been following along with the podcast, I’ve had a hell of a Fall this year. Numbers down, staffing issues, two deaths in the family…..just lots of stuff piling up that isn’t normally part of our existence.
On the staffing stuff, I lost my office manager that’s been with me 5 years. That was 3 weeks ago. Then, her bestie that works for me quit. That was 2 weeks ago. Then, while I was in Florida, their other bestie that works here sent me a text. It was a Friday night and she decided that she had just completed her last day of work. No two weeks notice. I guess that would show too much respect or gratitude. Lol.
Anyway, if you’re keeping count, that’s 3 employees gone in 3 weeks. I only have 4 full timers to start with. To say it’s a challenge this week is to minimize things. It’s a big thing.
BUT I have a super hero wife who is here today and who is killing it just like she kills anything she does. I’ve been slow since September. I’ll promise you, with my wife up front, I’m going to be so busy I’m not going to know what the hell to do with myself.
Then, we have two new girls. One is on her 3rd week here and one is on her 2nd week here. We just ran about 32 in one morning and they knocked it out of the park.
So……the story is, we’re OK and if you have a lot of turnover, you’re going to be OK. We can only do our best. I’ve done everything I know to be good to my staff, treat them like my family, be so good to them and foster an environment that is so fun and positive that they’d never dream of leaving.
Yeah, that doesn’t work. I am who I am. I’ll always treat my people well and take care of them and feel protective of them. But no more backflips trying to hold onto people. Not anymore. There are so many lessons available to us if we just make sure we’re paying attention.
That’s the negative. The positive is this; I have a true opportunity to re-set. To put my values and culture out there for the new staff to buy into and understand. I can cultivate what I want this place to always be without any old baggage preventing the message from hitting home.
What are my values? I’m glad you asked:
- Customer Service
- Evidence based
- Patient centered
- Honesty
- Ethical
- Morals
- Character
- Trustworthiness
- Authentic
- Kind
- Supportive
- Responsible
- High level
- Family and
- Loving
It’s vital this new crop of staff members understand these things. Understand who we are as owners.
Another thing I learned from Ray Tuck this weekend is don’t be afraid to open up the books and show your staff. You don’t have to show what you’re making each year or any of that but make sure they understand that you’re not buying a yacht while you bitch at them about the things you need from them. Show them your margins are much thinner than they might have imagined. It has an impact on them.
Also, we are considering hiring two part-timers rather than one full-timer. That will cut down on burn out, they’ll get to see their kids more, they can cover each other’s shifts, and if one quits, there is built-in redundancy to prevent any freak outs. The one staying can simply train the next part timer. Sounds like a solid solution to me. That right there is one benefit of being in a mastermind. Smart people giving you thoughts that are a little out of the box but that are working for them.
So, with my wife in control until new hires are up to speed, we about to kill it and you’ll all be happy to never hear me bellyaching about having a light schedule. Lol.
Item #1
The first on today is called, “Review of methods used by chiropractors to determine the site for applying manipulation” by Triano et al and published in Journal of Chiropractic & Manual Therapies on 21 October 2013.
Why They Did It
The authors did the study to evaluate the literature on the validity and reliability of the more common methods used by doctors of chiropractic to inform the choice of the site at which to apply spinal manipulation.
How They Did It
- Structured searches were conducted in Medline, PubMed, CINAHL and ICL, supported by hand searches of archives,
- The quality of evidence was ranked using QUADAS for validity and QAREL for reliability, as appropriate.
What They Found
- A total of 2,594 titles were screened from which 201 articles met all inclusion criteria. The spectrum of manuscript quality was quite broad, as was the degree to which the evidence favored clinical application of the diagnostic methods reviewed.
- The most convincing favorable evidence was for methods which confirmed or provoked pain at a specific spinal segmental level or region.
- There was also high-quality evidence supporting the use, with limitations, of static and motion palpation, and measures of leg length inequality.
- Evidence of mixed quality supported the use, with limitations, of postural evaluation.
- The evidence was unclear on the applicability of measures of stiffness and the use of spinal x-rays.
- The evidence was of mixed quality, but unfavorable for the use of manual muscle testing, skin conductance, surface electromyography and skin temperature measurement
Wrap It Up
-
A considerable range of methods is in use for determining where in the spine to administer spinal manipulation. The currently published evidence falls across a spectrum ranging from strongly favorable to strongly unfavorable in regard to using these methods.
-
In general, the stronger and more favorable evidence is for those procedures which take a direct measure of the presumptive site of care– methods involving pain provocation upon palpation or localized tissue examination.
-
Procedures which involve some indirect assessment for identifying the manipulable lesion of the spine–such as skin conductance or thermography–tend not to be supported by the available evidence.
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
Our last one this week is called, “Comparison of spinal manipulation methods and usual medical care for acute and subacute low back pain” by Michael Schneider and published in PubMed on February 15, 2015. Hot potato!
Why They Did It
This study was a comparative effectiveness trial of manual-thrust manipulation (MTM) versus mechanical-assisted manipulation (MAM); and manipulation versus usual medical care (UMC).
How They Did It
-
A total of 107 adults with onset of LBP within the past 12 weeks were randomized to 1 of 3 treatment groups: manual-thrust manipulation, mechanical-assisted manipulation, or usual medical care. Outcome measures included the Oswestry LBP Disability Index (0-100 scale) and numeric pain rating (0-10 scale).
-
Participants in the manipulation groups were treated twice weekly during 4 weeks; subjects in usual medical care were seen for 3 visits during this time. Outcome measures were captured at baseline, 4 weeks, 3 months, and 6 months.
What They Found
-
Linear regression showed a statistically significant advantage of manual-thrust manipulation at 4 weeks compared with mechanical-assisted manipulation and usual medical care.
-
Responder analysis, defined as 30% and 50% reductions in Oswestry LBP Disability Index scores revealed a significantly greater proportion of responders at 4 weeks in manual-thrust manipulation (76%; 50%) compared with mechanical-assisted manipulation (50%; 16%) and usual medical care.
-
Similar between-group results were found for pain: manual-thrust manipulation; mechanical-assisted manipulation; and usual medical care. No statistically significant group differences were found between mechanical-assisted manipulation and usual medical care, and for any comparison at 3 or 6 months.
Wrap It Up
It was found that manual-thrust manipulation provides greater short-term reductions in self-reported disability and pain scores compared with usual medical care or mechanical-assisted manipulation.
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.
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
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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.
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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
Schneider M (2015). "Comparison of spinal manipulation methods and usual medical care for acute and subacute low back pain: a randomized clinical trial." Spine Feb 15; 40(4): 209-217.
Triano, J. J., Budgell, B., Bagnulo, A (2013). "Review of methods used by chiropractors to determine the site for applying manipulation." Chiropr Man Therap 21(36).
CF 264: Early Diagnosis Of Spondylolysis and Clinical Guides For Low Back Pain
Today we’re going to talk about potential early diagnosis of spondylolysis as well as clinical guides on low back pain treatment.
CF 263: Low Back Surgery & White Rice And Your Heart
Today we’re going to talk about spinal surgery for low back pain & white rice and your heart.
CF 262: Physical And Psychological Pain & Disc Herniations And Pain
Today we’re going to talk about physical and psychological aspects of pain and we’ll talk about low back pain after disc herniations
CF 261: The Stroke Issue – New Information
Today we’re going to talk about the age-old issue chiropractors continue to be burdened by. The weird myth that our adjustments cause strokes. We have some newer info I’m going to share with you on it in this week’s episode.
CF 260: 5 Year Roundup and All Time Top Ten Episodes
Today we’re going to talk about our 5 Year Roundup and we highlight the All Time Top Ten Episodes
CF 259: Cervical Curvature & Lumbar MRI Findings In Asymptomatics - New Stuff
Today we’re going to talk about Cervical Curvature & Lumbar MRI Findings In Asymptomatics - New Stuff
CF 258 w/ Dr. Anthony Houssain - Choosing the Right Location, Clinic/Gym Hybrids, & The Value Of Masterminds
Today we’re going to be joined by my good friend, Dr. Anthony Houssain and we’re going to be talking about several relevant topics that can make a difference for any chiropractor. We’re covering Choosing the Right Location, Clinic/Gym Hybrids, & The Value Of Masterminds
CF 257: Tensile Force On Vertebral Artery During Adjustments & Exercising For Pain
Today we’re going to talk about Tensile Force On Vertebral Artery During Adjustments & Exercising For Pain
CF 256: Aspirin And Fall Risk & Caffeine And Child Growth
Today we’re going to talk about Aspirin And Fall Risk & Caffeine And Child Growth
CF 255: Nonpharmacologic Treatment In The ER & Spinal Manipulative Therapy For Non-musculoskeletal Conditions
Today we’re going to talk about Nonpharmacologic Treatment In The ER & Spinal Manipulative Therapy For Non-musculoskeletal Conditions
But first, here’s that sweet sweet bumper music
CF 254: Gluteal Tendinopathy - You Don’t Know What You Don’t Know
Today we’re going to talk about Gluteal Tendinopathy - You Don’t Know What You Don’t Know
CF 253: Spinal Cord Stimulator vs. Placebo & Low Back Pain, Chiropractic, And Opioids
Today we’re going to talk about Spinal Cord Stimulators vs. Placebo & we’ll talk about Low Back pain, Chiropractic, And Opioids
CF 252: High Blood Pressure And Cognitive Decline & Does The Popping Noise Matter?
Today we’re going to talk about High Blood Pressure And Cognitive Decline & Does The Popping Noise Matter?
CF 252: Sleep, Pain, And Central Sensitization
Today we’re going to talk about Sleep, Pain, And Central Sensitization
CF 251: Communicating Imaging Findings & Acupuncture For Acute Pain
Today we’re going to talk about Communicating Imaging Findings & Acupuncture For Acute Pain
CF 250: Night Owls Diabetes And Heart Disease & Medical Marijuana And Pain
Today we’re going to talk about Night Owls Diabetes And Heart Disease & Medical Marijuana And Pain
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
CF 248: Steps Per Day And Dementia & Vets And Chiropractic
Today we’re going to talk about Steps Per Day And Dementia & Vets And Chiropractic
CF 247: w/ Dr. Jay Greenstein - inspiration, Experience, Passion, and Progress
Today we’re joined by the one and the only, Dr. Jay Greenstein, He’s going to share some amazing insight and you’re going to love every bit of it.
CF 246: Healthcare Utilization for Spine Pain & Sensorimotor Retraining on Pain Intensity
Today we’re going to talk about Healthcare Utilization for Spine Pain & Sensorimotor Retraining on Pain Intensity
CF 246: Healthcare Utilization for Spine Pain & Sensorimotor Retraining on Pain Intensity
Today we’re going to talk about Healthcare Utilization for Spine Pain & Sensorimotor Retraining on Pain Intensity
CF - Ep. 245 Upregulated Central Nervous System Shared Decision Making With The Patient
Today we’re going to talk about Upregulated Central Nervous System & Shared Decision Making With The Patient.
CF 244: Recognizing Cervical Artery Dissection
Today we’re going to talk about Recognizing Cervical Artery Dissection
But first, here’s that sweet sweet bumper music
CF 243: Chiropractic Adjustments To Avoid Other Procedures & Male Vets With Chronic Pain
Today we’re going to talk about Chiropractic Adjustments To Avoid Other Procedures & Male Vets With Chronic Pain
CF 242: Effectiveness Of Neck Exercise For Disc Herniation and Supine vs. Prone MRIs
Today we’re going to talk about Effectiveness Of Neck Exercise For Disc Herniation and Supine vs. Prone MRIs
CF 241: Does Supplementation Work & Non-Surgical Treatment For Stenosis
Today we’re going to talk about if vitamin Supplementation Works for preventing cardiovascular issues or cancer and we’ll talk about Non-Surgical Treatment For Stenosis
CF 240: Brain Activity From Spinal Manipulative Therapy & PT Is As Good As Arthoscopic Surgery For Meniscus Issues
Today we’re going to talk about the Brain’s Activity as a result From Spinal Manipulative Therapy & we’ll talk about how PT Is As Good As Arthoscopic Surgery For Meniscus Issues
CF 239: Change Your Mind About Pain
Today we’re going to talk about changing your mind when it comes to pain and how looking at it differently can help our patients get in control of it.
CF 238: Chiropractic And Benzodiazepines & Mirror Therapy For Chronic Pain
Today we’re going to talk about benzodiazepines and chiropractic as well as mirror therapy for chronic pain.
Chronic Pain Talk & Thoughts
Today we’re going to talk about one of my favorite topics; Chronic Pain.
CF 236: You Are What You Eat & Screen Time For Kids
Today we’re going to talk about what you eat and mental health and we’ll talk about screen time for kids.
CF 235: The Inflammatory Response’s Effect On Chronic Pain & The Entry Point For Low Back Pain
Today we’re going to talk about the inflammatory response’s protection from chronic pain, which is fascinating.. and we’ll talk about where patients should be starting their journey for low back pain.
CF 234: Chiropractic For Medicare Patients & Avoiding Vertebral Artery Stress During Adjustments
Today we’re going to talk about Chiropractic saving Medicare patitents money and adverse events and a better position for preventing strokes when adjusting the neck.
CF 233: SMT and Geriatrics & Lower Costs - Back To Work Faster With Chiropractic
Today we’re going to talk about SMT and Geriatrics & Lower Costs - Back To Work Faster With Chiropractic
Today we’re going to be joined by Dr. Chris Chippendale all the way from the UK. Dr. Chippendale is highly accomplished and I’m looking forward to hearing what he has to share with us with regard to his experience training chiropractors, tutoring, lecturing, and promoting evidence-based, patient-centered, ethical practice. That fits in perfectly with our brand of chiropractic.
CF 231: Adjustments For Scoliosis & Importance Of Pain Perceptions
Today we’re going to talk about Adjustments For Scoliosis & Importance Of Pain Perceptions
CF 229: T-sp Adjustments For Neck, Not Headache & Physical Activity In Children
Today we’re going to talk about T-sp Adjustments For Neck, Not Headache & Physical Activity In Children
CF 228: Exercise For Depression & Manipulation For Tendinopathy Today we’re going to talk about Exercise For Depression & Manipulation For Tendinopathy
CF 226: Cognitive Behavioral Therapy & Restless Leg Syndrome Today we’re going to talk about Cognitive Behavioral Therapy & Restless Leg Syndrome
Pain and COVID & Imaging Can Mislead
Today we’re going to talk about Pain and COVID & how in the hands of the wrong practitioner, Imaging Can Mislead
Today we’re going to talk about manual therapy for chronic pain the the complexities within.
CF 223: Kids’ Mental Status & Zero Calorie Drinks Today we’re going to talk about the children, how are they doing lately? And then we’ll talk about whether low or no calorie beverages have any real use for us.
CF 221: The Importance of Movement & Steps Today we’re going to talk about The Importance of Movement & Steps
CF 219: Neurodynamic Moves Solve Problems - So Does The Inversion Table
Today we’re going to talk about inversion tables and Neurodynamic exercises.
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Today we’re going to be joined by Dr. Kevin Christie of the Modern Chiropractic Marketing podcast and also the originator of the MCM Mastermind group you’ve been hearing me talk about in the last few weeks. We’ll get to it all. The whys, wheres, goods, bads, and beauty of being in a mastermind group.
Today we’re going to talk about return To Play After Herniation & Water vs. PT Exercises
Today we’re going to talk about the MCM Mastermind and CAM acceptance in the medical community.
CF 173: Nutrition for Pain, CBT for Pain, TMJ, & 2020 Deaths
Today we’re going to talk a lot about pain. Nutrition for chronic pain, CBT and CFT for chronic pain, we’ll talk about TMJ treatment, and we’ll talk about deaths in 2020. This episode is full of info so let’s dive in.
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our Facebook page,
- Join our private Facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter.
You have found yourself smack dab in the middle of Episode #173
Now if you missed last week’s episode , we talked about useless research and we talked about insult vs. inflammation. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
I don’t know if I mentioned it or not but I got my book back from Dr. Chris Howson up in the Great State of North Dakota. He spent some time editing it. Dr. Howson is the inventor of the Drop Release tool and is just a super dude on top of being brilliant. If you don’t know about Drop Release, go check it out at https://droprelease.com. It’s pretty cool and something you can use to speed up soft tissue work in your practice.
Now that we have gone through that process, I am teaching myself the way to self-publish this dude. When there are so many options, it can be daunting. It’s hard to know exactly where to go and how to do it.
So that is the process I’m undergoing currently. Fortunately, I just noticed a colleague of mine that has recently published a book and it’s #1 on Amazon in its category. I reached out to her and she gave me a path to follow. So down the path I go.
Still working on the medical integration here at the office. I’ve been having weekly calls with the integration consultant we are using. We are using Dr. Tyce Hergert down in Southlake, TX who has been integrated for 5-6 years at this point. Maybe even longer. He’s been through it for sure. If you are going through integration and need a little guidance, email me at dr.williams@chiropracticforward.com and I’ll get you in touch with Dr. Hergert.
Our attorney and CPA group got together and got it all figured out so we are moving forward with that aspect of it. Now, if we can just get that Nurse Practitioner hired. I made a mistake that could be seen as misleading. On the Indeed ad I placed, I put the wage at $65/hr. What wasn’t in the ad because there wasn’t a place for it, is that we have only about 33 hrs of hands on time per week. We are starting our NP off at around $85-$90k per year.
I think one of the NPs got PO’d at me because I was absolutely hiring her. No doubt. She was the one. When it came down to it, she asked my the yearly salary. I told her and she said she wouldn’t and couldn’t do it for less than $125k/year.
Well, damn. Back almost at square one on that end of things. I had made my mind up on her. Not only that, I think she was mad at me. Lol. So, I went and changed it to the yearly salary to make sure I wasn’t being misleading in any way.
Now, the goal is to start at $85k and have them up to $120k within 3-4 years. But you can’t start something brand new at that level when you have no clue how it’s going to all work out and come together. It’s already a huge risk to start with. Why make any riskier from the get go?
So, that’s where all of that stands for now. Getting the book together, getting the medical entity rolling, and getting busy as hell again. Oh my gosh. It’s going to take a minute to get used to treating the numbers we were treating back before COVID came along. Today, as I found a little window to start typing today, I’ve got 56 on the schedule. That hasn’t happened since December of 2019. Maybe January of 2020. Maybe.
February 2020 came along and destroyed business. BAM…..30% at least was gone. We went from 185-200 visits per week all the way down to 115 or so. It wasn’t awesome. I’m not going to lie. OK, it was awful actually. We paid the bills but nobody made any money. That’s for damn sure.
Now, for the last 2-3 weeks, things are beginning to get a little crazy again. Thank goodness. I hope you are experiencing the resurgence I am experiencing. I think deep down, we all know it’s going to be OK but it’s sure refreshing to finally start to feel it and see it.
Onto the research!
Item #1
The first one today is called “Do Nutritional Factors Interact with Chronic Musculoskeletal Pain? A Systematic Review” by Elma et. al. [1] and published in the Journal of Clinical Medicine in March of 2020 and that’s only a little smoky but still hot enough!
Why They Did It
They say, “Dietary patterns may play an important role in musculoskeletal well-being. However, the link between dietary patterns, the components of patients’ diet, and chronic musculoskeletal pain remains unclear. Therefore, the purpose of this review was to systematically review the literature on the link between dietary patterns, the components of patients’ diet and chronic musculoskeletal pain”
How They Did It
- (PRISMA) guidelines were used
- Online databases PubMed, Embase, and Web of Science were used
- 20,316 articles screened and only 12 found eligible to be included in this review
- They consisted of 9 experimental and 3 observational studies
What They Found
- 7 out of 9 experimental studies showed a pain-relieving effect of dietary changes
- Protein, fat, and sugar intake were found to be associated with pain intensity and pain threshold
Wrap It Up
In an interesting conclusion, the authors say, “Plant-based diets might have pain relieving effects on chronic musculoskeletal pain. Patients with chronic rheumatoid arthritis pain can show inadequate intake of calcium, folate, zinc, magnesium, and vitamin B6, whilst patients with fibromyalgia can show a lower intake of carbohydrates, proteins, lipids, vitamin A-E-K, folate, selenium, and zinc. Chronic pain severity also shows a positive relation with fat and sugar intake in osteoarthritis, and pain threshold shows a positive association with protein intake in fibromyalgia.”
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Item #2
This second one is called “CBT and CFT for Chronic Pain” by Graham Hadley and Matthew Novitch [2] and published in Current Pain and Headache Reports on April 1, 2021. Dammit stand back, we got a hot one.
Why They Did It
Chronic pain is a widespread public and physical health crisis, as it is one of the most common reasons adults seek medical care and accounts for the largest medical reason for disability in the USA.
- Chronic pain is associated with decreased functional status, opioid dependence and substance abuse disorders, mental health crises, and overall lower perceived quality of life.
- Evidence suggests that persistent low back pain (pLBP) is a multidimensional biopsychosocial problem with various contributing factors. Emotional distress, pain-related fear, and protective movement behaviors are all unhelpful lifestyle factors that previously were more likely to go unaddressed when assessing and treating patient discomfort….
- and as we just covered, diet might play a part in it as well.
- Those that are not properly assisted with these psychosocial issues are often unlikely to benefit from treatment in the primary care setting and thus are referred to multidisciplinary pain rehabilitation physicians.
- This itself increases healthcare costs, and treatments can be invasive and have risks of their own.
- Therefore, less expensive and more accessible management strategies targeting these psychosocial issues should be started to facilitate improvement early.
- As a biopsychosocial disorder, chronic pain is influenced by a range of factors including lifestyle, mental health status, familial culture, and socioeconomic status.
- Physicians have moved toward multi-modal pain approaches in order to combat this public health dilemma, ranging from medications with several different mechanisms of action, lifestyle changes, procedural pain control, and psychological interventions.
- Part of the rehabilitation process now more and more commonly includes cognitive behavioral and cognitive functional therapy.
- Cognitive functional therapy (CFT) and cognitive behavioral therapy (CBT) are both multidimensional psychological approaches to combat the mental portion of difficult pain control.
- While these therapies are quite different in their approach, they lend to the idea that chronic pain can and should be targeted using coping mechanisms, helping patients understand the pathophysiological process of pain, and altering behavior.
- CFT differs from CBT functionally, as instead of improving managing/coping mechanisms of pain control from a solely mental approach, CFT directly points out maladaptive behaviors and actively challenges the patient to change them in a cognitively integrated, progressive overloading functional manner
- With a robust set of data, one can conclude that CBT and CFT are exceptional therapeutic methods in improving chronic pain or the overall well-being of our patients.
Item #3
This one is called “The Leading Causes of Death in the US for 2020” by Ahmad et. al. [3] and published in JAMA on March 31, 2021 and that’s definitely some hot stuff right there.
This is more of an article rather than research and it won’t take us long to hit the high points here.
- Provisional estimates indicate a 17.7% increase in the number of deaths in 2020 (the increase in the age-adjusted rate was 15.9%) compared with 2019, with increases in many leading causes of death.1 The provisional leading cause-of-death rankings for 2020 indicate that COVID-19 was the third leading cause of death in the US behind heart disease and cancer
- Cause-of-death data are based on the underlying cause of death, which is the disease or condition responsible for initiating the chain of events leading to death.
- The provisional number of deaths occurring in the US among US residents in 2020 was 3 358 814, an increase of 503 976 (17.7%) from 2019
- COVID-19 was the third leading cause of death in 2020, with an estimated 345 323 deaths, and was largely responsible for the substantial increase in total deaths from 2019 to 2020.
- Substantial increases from 2019 to 2020 also occurred for several other leading causes. Heart disease deaths increased by 4.8%, the largest increase in heart disease deaths since 2012
I know……I know….car wrecks were reported as COVID and all that. I know….you do you boo.
Item #4
This last one is called “Manual therapy for temporomandibular disorders: A review of the literature” by Kalam ir et. al. [4] and published in Journal of Bodywork and Movement Therapies in January of 2007. Definitely not hot.
Why They Did It
The contemporary biopsychosocial health paradigm emphasizes a reversible and conservative approach to chronic pain management. Manual therapy for temporomandibular disorders (TMDs) claims to fulfil these criteria. An assessment of the utilization and efficacy of manual therapy for this condition is therefore required.
How They Did It
- A review of the literature pertaining to manual therapy for TMDs was undertaken between September and December 2005. Keywords used in the search were: TMD, manual therapy, massage, manipulation, mobilization, adjustment, chiropractic, osteopathy, physiotherapy, exercise.
- A four member reviewer panel identified eight (n=8) randomized controlled trials of sufficiently reliable power to be suitable for inclusion in the review, of which only three included manipulative treatment of the temporomandibular joint.
Wrap It Up
The results of manual therapy trials for this condition suggest that manual therapy is a viable and useful approach in the management of TMD. Manual therapy has also been shown to be more cost effective and less prone to side effects than dental treatment.
Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week.
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
Subscribe Button
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 preventativly 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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Fellow of the International Academy of Neuromusculoskeletal Medicine - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography
-
Elma O, Y.S., Deliens T, Coppieters I,, Do Nutritional Factors Interact with Chronic Musculoskeletal Pain? A Systematic Review. J Clin Med, 2020. 9(3): p. 702.
-
Hadley G, N.M., CBT and CFT for Chronic Pain. Current Pain Headache Reports, 2021. 25(35).
-
Ahmad F, A.R., The Leading Cause of Death in the US for 2020. JAMA, 2021.
-
Kalamir A, P.H., Vitiello A,, Manual therapy for temporomandibular disorders: A review of the literature. J Bodyw Mov Ther, 2007. 11(1): p. 84-90.
CF 161: w/ Dr. Bobby Maybee - Everything Evidence-Based Chiropractic, Insight, Instruction, & Inspiration
Today we’re going to be joined by Dr. Bobby Maybee who has been involved in so many things chiropractic but most notably he’s the leader of the Forward Thinking Chiropractic Alliance and co-founder of the Chiropractic Success Academy. This is going to be an excellent episode folks. Full of insight, instruction, and inspiration.
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our Facebook page,
- Join our private Facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter.
You have found yourself smack dab in the middle of Episode #161
Now if you missed last week’s episode, we talked about lumbar spinal fusion surgery. This was new, current, and very much in favor of conservative, non-pharmacological, non-surgical care. Keep up with the class.
On the personal end of things…..
I’d like to hear how some of you are busier than normal or how some of you have only dropped off a bit during COVID. I wrapped up my stats from 2020 and it was a bit of a blood bath around my joint if I’m being honest and I’m always honest with you all. That’s the only way we move forward. Honesty.
So, let’s cover a few of the key stats. By the way, if you’re not keeping good stats and measuring all of your office metrics, I can’t tell you what a mistake it is that you’re making. My office turned around when I started accurately tracking my metrics. How can you know where you’re going or measure success in a quantifiable way if you’re not measuring it?
As you’ll find out more and more in the coming months, I’m very big on keeping stats because it turned my office around. I know the value. Anyway, let’s get to some of my take-aways from my 2020 stats.
- One of the big kickers for me is that my new patients were down 36.1% from 2019. Yeah, that hurt like hell, folks. That’s despite picking up in our marketing efforts, posting and boosting our cleaning and disinfecting efforts, and growing our social media following. Our area was hit hard with COVID. On the New York Times site, Amarillo, TX at different times and even recently has been #13 nationwide in areas hit the hardest. At one time, we were #2 on their list of the areas with the newest cases. People just did not feel comfortable going anywhere around here at different times during the year. Some times were more comfortable than others of course but overall….uncomfortable.
- As a result of the new patient issue, my overall visit numbers suffered and were down 33.8%. So, we saw 33.8% fewer visits over the course of the year in 2020. When you consider the value of one visit in my office, well…..let’s just say that adds up to a considerable amount of income lost.
- You’ll start to see a theme here when I tell you that my total services billed were down 36.6% and net services when we remove our write-offs sat at about 40% down. Ugh, right? But, we worked hard on our billing, of course. When you have extra time, you turn to bill and collections efforts. As a result, our total collections were only down 25.4%. Funny how that happens.
- We could go through a whole bunch of different metrics but I have an amazing guest today we need to get to. The most important stat is the final overall total. When we include all of the things that make us money like chiropractic, rehab, laser, decompression, acupuncture, massage, and on and on….when we combine it all, our total collections across the board were down 25.4% in 2020. While that’s a tough pill, I’m not alone. Many of you have had the same difficulties. Many of you have had it worse. And I’m sorry. It’s been difficult for us all. But the good news is that I think it’s lightening up and if improvement and progress make us all feel good, it won’t take much to improve and show progress over 2020. Will it? I think not so here’s to all good things in 2021. Let’s get all of our practices back on track and help some folks get out of pain and avoid surgery.
Now, without further adieu, let’s get to our guest today.
Today we are joined by the always interesting and talented Dr. Bobby Maybee hailing from the Pacific Northwest. Portland, Oregon to be exact.
Dr. Maybee initially began the Forward-Thinking Chiropractic Alliance (FTCA) in 2014 as an attempt to change the landscape and conversation of the chiropractic profession of social media.
Since then the FTCA has gone on to create evidence-based content in a grassroots nature. This content is typically for the internet, and in an educational format through continuing education courses, and is staunchly evidence-based.
Dr. Maybee hosts “Forward, The Podcast of the Forward-Thinking Chiropractic Alliance.” As well, he was just elected chair of the Oregon Board of Chiropractic Examiners Peer Review Committee and is a member and supporter of the American Chiropractic Association.
Dr. Maybee is a 2004 graduate of Western States Chiropractic College. In his free time, he co-manages a household of 5 children, 2 dogs Jett and Abbie, and a cat named Goober.
And the best reason we can ever have to thank someone for something, Dr. Maybee is a veteran of the US Air Force which no doubt lends itself to him being such a good and effective leader.
Welcome to the show Bobby, tell me how Portland is this morning. How’s the weather?
Introduction
-
Tell me your chiropractic story. Why chiropractic for you?
-
Tell me what got you to the place where you are the expert in the clinic that you are. What experiences or certifications built that person?
-
Tell me about your practice in Portland
-
With as many kiddos as you have and as many things as you’re involved in, what does a typical week look like for you?
-
How did the FTCA get started?
-
I see here and there online that some vitalists have really started to make the term ‘evidence-based’ a keyword, a trigger word, or a point of contention. Have you noticed that as well and how do you think a healthcare professional comes to mock evidence and research?
-
What is your vision for the FTCA and what does the group move closer and closer to accomplishing them?
-
I was at the Forward 19 event in St Louis and really enjoyed it. Tell us about what goes into creating something like that? How do you pull it off?
-
Recently, I have been on a rant. I see vitalists say kooky stuff and I’m physically and mentally unable to ignore it. I have a recent episode on a guy that wants to teach other chiropractors how to treat 9 new patients and 99 established patients within three hours. Then I had an episode on the shake-up of the WFC Research committee. As I mentioned in the episode, you were there in Berlin when it all started going sideways. Can you walk us through it all as far as you know it to be?
-
I think I’ve seen you vacillate on the topic of unity or not. Where do you stand on the whole deal? Is it possible the two sides can continue to live together? Or do you see groups like the Primary Spine Practitioner start to gain steam?
-
Tell us about the CSA that you and Dr. Kevin Christie have put together.
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Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week.
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
Subscribe Button
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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Fellow of the International Academy of Neuromusculoskeletal Medicine - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
CF 158: Primary Spine Care, Frozen Shoulder, & Evidence-Based Is More Cost-Effective
Today we’re going to talk about the primary spine care model integrated into a primary care setting. What happens when that’s the mode of treatment? Then we’re going to talk about some Frozen Shoulder (adhesive capsulitis) research in JAMA recently. wrap up with a new paper on Evidence-based, patient-centered care vs. the other way of doing things.
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our Facebook page,
- Join our private Facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter.
You have found yourself smack dab in the middle of Episode #158
Now if you missed last week’s episode , we talked about chiropractors that spread misinformation, we talked about patients needing movement, and we talked about love. I’m a softy at heart believe it or not. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
We are sitting here on a Monday 12/21 as of the typing up of this episode. Christmas is upon us. Nothing crazy special going on beyond that.
There are a couple of things I’ll mention. The first is that I got the Mirror gym you hang on a wall. It’s basically like having a trainer in your living room. Lots of you are already used to this sort of a deal with products like Peloton but it’s new to me and it’s pretty awesome. I’m doing stuff like Tai Chi, yoga, boxing, kickboxing, and stuff like that. Stuff I’d never do otherwise and it’s pretty darn cool.
We turned what used to basically be a dog room into a small gym and it’s been pretty cool so far. I’m enjoying it. I’ve always been a skinny dude stuck in a big dude’s body. So, now that I’m down 33 lbs on weight watchers, and I’ve added the home gym to the mix, I feel like I’m on the way to realizing the skinny dude. Eventually. Lots of work left to do first though.
Scondly, I’m getting the vaccine in a day or two if everything works out. I have mentioned several times on the podcast that I have very positive relationships with a lot of folks in my local medical community. Through that network, my wife and I will be getting ours this week. I’m ready to get that dude and start moving on with life.
No I’m not worried about it. Understanding I’m have some level of influence and some level of leadership with my friends, family, and patients, I feel it’s important to get out front and set an example on this deal.
Especially being a chiropractor. When you see so many of us disenfranchised because of the vitalists in our profession out there preaching the harms of vaccines when they wouldn’t know how to make it through a research paper on the vaccine to save their lives…..well, wouldn’t it be refreshing to see evidence-based chiropractors stepping up and leading the way on this vaccine?
Here’s my stance on it. Maybe it helps you if you’re on the fence. Maybe it doesn’t but here it is anyway.
I’m not an epidemiologist or a maker of vaccines. I have researched masks, COVID, transmission of Covid, and things like that. Not as much on the vaccine on the vaccine itself though.
Scientists understand so much more about that sort of research than I’ll ever know. A Fox Poll says 61% of Americans will get the shots while only 23% are strictly against taking it. There was a 16% that were unsure. Probably the ones waiting to see if everyone does OK with it before they step up. And I don’t think that’s unreasonable.
The point is, those getting it like me…..I’m not the minority on it.
For me, it’s not only about life or death. I have a 20-something-year-old patient that can’t go back to work because she’s still positive 6 weeks later. I know a nurse that was positive for over nine weeks. I know Patients that had to go to physical therapy for weeks. Long haulers is a real deal.
In the end, it’s an easy decision for me. I’m not worried at all really. There’s risk crossing the road.
If I get sick, I have to close my office for at least 2 weeks if not more. That means I lose a lot of money, there will be patients drop off of the schedule, we’ll miss new patients, and I’ll be sick AND anxious the entire time. If COVID doesn’t make me nauseous, the destruction of my business while I’m out sick will.
Besides myself, I have 13 or so other employees adn their families depending on my presence. My business depends on my presence and does not run when I’m not there. That’s a little different than a lot of other folks.
I’m not doing that if I can prevent it. If a vaccine allows me to prevent it, well then, a vaccine it is.
We chiropractors work within inches of people’s faces and in close contact with them. That puts us at more risk than the average Joe and, if we have it, puts our patients at serious risk of getting it from us.
If you’re like me, we work with a lot of elderly and immunocompromised patients. I’m not willing to put them at risk like that when all I had to do was trust in science and just get the damn vaccine.
They ran human trials on 35000-45000 or so people with no unacceptable issues. That’s a huge sample size. I’ve seen this thought on the FTCA group before. It’s probably a Bobby Maybee special quote but, back before Facebook, people would have just taken the vaccine. They weren’t worried about this stuff back before Facebook told them to worry about it.
No matter what’s out there these days, you have people casting doubt on it for zero reason. Maybe it’s a call for attention at all costs. Who knows? But it’s to the point now where science and experts are constantly doubted and discounted. And that’s about as dumb and dangerous as can be.
It was OK to cure smallpox and polio but COVID......nah bruh.
If there were real questions, would basically the entire medical complex be in line taking it? My guess is that hey wouldn’t.
What if someone can afford to be out of work or out of their office for 2-4-6 weeks and they want to wait to get it? I think it’s reasonable if someone wants to wait to see if anyone has adverse effects before they take it. I don’t think that’s unreasonable at all.
But I think that it’s just delaying the fact that most everyone is going to do fine with it and most people are going to end up getting it. They started it in England two weeks ago. Nothing has happened. Because they already did the test trials to make sure nothing would happen .
Considering the success of the testing, I think the people not getting it are at far more risk than the people that are getting it.
Besides all that, I’m ready to get back in my life. Traveling, doing fun stuff, having a life.....important stuff. Like seeing my mom and step pops and being able to visit my dad in the nursing home for the first time since March.
More power to those that have been doing those things all along but for the above mentioned reasons, we have not.
So that’s where I’m at. We are all on our own walk and we all need to do what we think is best. Staying healthy, staying open and available, and continuing to provide for my family, my staff, and my patients is what I think is best.
So, I’m out front on this. It’ll be good for my patients and family to see a picture of me getting my vaccine on social media. It’ll be good for my patients to see it. And it’ll be good for those in the medical community that are friends with me to see it. It’ll reaffirm that no….I’m not one of THOSE chiropractors.
I encourage you to be out front with it if you get one. Be a leader and blaze the trail.
And Merry Christmas, Dammit.
Item #1
The first one today is called “Implementation of the primary Spine Care Model in a Multi-Clinician Primary Care Setting: An Observational Cohort Study” by Whedon, et. al. (Whedon JM 2020) and published in the Journal of Manipulative and Physicological Therapeutics on September 1, of 2020. And that’s a blistering blast of hotness.
If you don’t recognize the Whedon name, he is very prolific in chiropractic research.
Why They Did It
The objective of this investigation was to compare the value of primary spine care with usual care for management of patients with spine-related disorders within a primary care setting.
How They Did It
- They retrospectively examined existing patient encounter data at 3 primary care sites within a multi-clinic health system
- Designated clinicians serve in the role as primary spinal care as the initial point of contact for spine patients, they coordinated the care, and they followed up for the duration of the episode of care
- A primary spinal care doctor may be a chiropractor, PT, or medical or osteopathic physician trained in primary spinal care for spine-related disorders
- They had sites where the primary spinal care was implemented as well as control sites where they just stuck with the usual care model
- They examined clinical encounters occurring over a 2 year period from February 2016 to March 2018.
What They Found
- Primary spine care was associated with reduced total expenditures compared with usual care for spine-related disorders
- At site one, the average per-patient cost was $162 in a year and $186 in year two.
- That is compared to site II, a control site, where the cost in year one was $332 and $306 in year two. And in site three, also a control site offering only usual care, where the cost in year one was $467 and year two was $323
Wrap It Up
Among patients with SRDs included in this study, implementation of the PSC model within a conventional primary care setting was associated with a trend toward reduced total expenditures for spine care compared with usual primary care. Implementation of PSC may lead to reduced costs and resource utilization, but may be no more effective than usual care regarding clinical outcomes.
CHIROUP ADVERTISEMENT
Item #2
Our second item today is called “Comparison of Treatments for Frozen Shoulder: A Systematic Review and Meta-analysis” by Challoumas, et. al. (Challoumas D 2020) and published in JAMA Open on December 16, of 2020 and it does not get one degree hotter than that people!
Why They Did It
The authors here wanted to know the answer to the question , “Are any treatment modalities for frozen shoulder associated with better outcomes than other treatments?”
How They Did It
- It was a meta-analysis of 65 studies with 4097 participants
- They searched Medline, EMBASE, Scopus, and CINHAL in February 2020.
- Studies with a randomized design of any type that compared treatment modalities for frozen shoulder with other modalities, placebo, or no treatment were included.
- Data were independently extracted by 2 individuals
- Pain and function were the primary outcomes, and external rotation range of movement (ER ROM) was the secondary outcome
- Length of follow-up was divided into short-term (≤12 weeks), mid-term (>12 weeks to ≤12 months), and long-term (>12 months) follow-up.
What They Found
- Despite several statistically significant results, only the administration of intra-articular (IA) corticosteroid was associated with statistical and clinical superiority compared with other interventions in the short-term for pain
- Subgroup analyses and the network meta-analysis demonstrated that the addition of a home exercise program with simple exercises and stretches and physiotherapy (electrotherapy and/or mobilizations) to intra-articular corticosteroid may be associated with added benefits in the mid-term
Wrap It Up
The findings of this study suggest that the early use of intra-articular corticosteroid in patients with frozen shoulder of less than 1-year duration is associated with better outcomes. This treatment should be accompanied by a home exercise program to maximize the chance of recovery.
Item #3
Our third and final one this week is called “Cost comparison of two approaches to chiropractic care for patients with acute and sub-acute low Back pain care episodes: a cohort study” by Whedon et. al. (Whedon JM 2020) and published in the Chiropractic and Manual Therapies on December 14, 2020. Get your red hots right here, get ‘em hot right here.
I told you Whedon was prolific. That’s two papers in this one episode that he’s the lead author on and I did not do that on purpose. I didn’t realize who the authors of the papers were until I started typing. He’s on his A game.
Why They Did It
The abstract leads off by saying, “Low back pain (LBP) imposes a costly burden upon patients, healthcare insurers, and society overall. Spinal manipulation as practiced by chiropractors has been found be cost-effective for treatment of LBP, but there is wide variation among chiropractors in their approach to clinical care, and the most cost-effective approach to chiropractic care is uncertain. To date, little has been published regarding the cost effectiveness of different approaches to chiropractic care. Thus, the current study presents a cost comparison between chiropractic approaches for patients with acute or subacute care episodes for low back pain.”
How They Did It
- It was a retrospective cohort design to examine costs of chiropractic care among patients diagnosed with acute or subacute low back pain.
- The study time period ranged between 07/01/2016 and 12/22/2017
- They compared cost outcomes for patients of two cohorts of chiropractors within health care system: Cohort 1) a general network of providers, and Cohort 2) a network providing conservative evidence-based care for rapid resolution of pain.
- They used generalized linear regression modeling to estimate the comparative influence of demographic and clinical factors on expenditures.
- A total of 25,621 unique patients were included in the analyses
What They Found
- The average cost per patient for Cohort 2 (mean allowed amount $252) was lower compared to Cohort 1 (mean allowed amount $326
- Patient and clinician related factors such as health plan, provider region, and sex also significantly influenced costs.
Wrap It Up
In general, providers in Cohort 2 were found to be significantly associated with lower costs for patient care as compared to Cohort 1. Utilization of a clinical model characterized by a patient-centered clinic approach and standardized, best-practice clinical protocols may offer lower cost when compared to non-standardized clinical approaches to chiropractic care.
So….just who the hell do you all know that’s been preaching this until his face is about to explode? That’s right, listeners of this podcast. One word, two syllables…..Day-um.
Evidence-based and patient-centered care is the future of chiropractic. It is first and foremost, treating our patients with respect and the best care and that’s what they deserve.
Secondly, it’s speaking the language of the medical community. Which is the language of research. When you’re using their language, you’re starting to communicate more effectively.
I think it’s time for superhero sound effects….boom, pow, snap, kawachow!
Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week.
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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 preventativly 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!
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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.
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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 - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
- Challoumas D, B. M., McLean M, (2020). "Comparison Of Treatments For Frozen Shoudler: A Systematic Review and Meta-Analysis." JAMA Open 3(12): e2029581.
- Whedon JM, B. S., Dennis P, Fischer VA, Russel R, (2020). "Cost comparison of two approaches to chiropractic care for patients with acute and sub-acute low Back pain care episodes: a cohort study." Chiropr Man Therap 28(68).
- Whedon JM, T. A., Bezdijan S, (2020). "Implementation of the Primary Spine Care Model in a Multi-Clinician Primary Care Setting: An Observational Cohort Study." J Man Physiol Ther 43(7): P667-674.
CF 157: Chiropractors Spreading Misinformation, Patients Need Movement & Love
Today we’re going to talk about misinformation on the part of chiropractors during the COVID pandemic, we’ll talk about three papers covering pain and how patients need a little love while they also need movement and physical activity.
But first, here’s that sweet sweet bumper music
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We’re the fun kind of research. Not the stuffy, high-brow 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.
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You have found yourself smack dab in the middle of Episode #157. The first episode to kick off our 4th year in the podcasting business. To be 100% honest, it doesn’t seem like I’ve been doing this for that long. It’s crazy to think about.
Now if you missed last week’s episode , we talked about our Top Ten episodes over the previous 3 years. It was our 3rd Year Anniversary episode. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
I had a pretty decent weekend. Still just staying in and being smart. We drove around and looked at lights with the kiddos. More just to get outta the damn house and do something different. The wifey, myself, and the two kiddos are about ready to give each other the People’s Elbow from time to time. People are all like….COVID is a time we get to slow down and reconnect with our families.
I’m all like, I’d like to connect with some of them. Physically. With my hands and tinged with some level of aggression. Lol. It’s hard as a parent to watch your kids waste away into boredom and just allow it to happen. I’m a big believer in doing things. Creating things. Being busy on some level. I believe an idle mind is a dangerous thing. So, I’m the parent telling them to get the hell up and make something of themselves. Maybe it’s me or maybe it’s my generation. Generation X is a generation of do-ers I believe.
Either way, they get tired of me urging them to do, to make, or just to freaking be. Be something! No, you can’t lie on your bed reading fictional books all day long. Maybe for an hour or so at night before bed instead of the xbox. That’s a good time to read don’t you think? Not for hours smack dab in the middle of the day.
I’m a big believer in art of all forms. So they get pushed to play the guitar, the piano, draw something, paint something. Write a story or a poem. Freaking create something. ANYTHING! Just don’t lay or sit around like a lump on a log all day. I won’t have it. I won’t create lazy bums to put out into the world. I just won’t. Yeah, it probably sucks to be my kid. I know. I admit it. My daughter is a 7th grader and I’ve already got her learning the discus. Pumping my own tires for a second here, I won state here in Texas in the discus and went to state in the shot put so I love re-visiting those days by coaching others. My son had no interest but Joss….she’s in and she’s doing great! My son, I’ve got him on the guitar and piano and he’s doing great too. All I ask for is activity and some progress. That’s all.
It actually snowed in Amarillo this weekend. Yes, we get snow somewhat regularly in my part of TX. We’re in the northern plains of Texas. We are flat and there are really no trees unless someone planted them. But we do have the nation’s second largest canyon called Palo Duro canyon and it’s awesome! If you’re ever close to Amarillo, you gotta check it out. Well worth it.
I’m typing this up on Monday morning 12/14. I saw on the news this morning that the first healthcare workers are getting the vaccine today. That’s pretty dang exciting. I already called my doctor buddies here in town and told them that when they feel it’s appropriate for us to have one, my wife and I would love to be on their list. I know a lot of folks are freaky about the vaccine and here’s my deal; by the time it’s my turn, any adverse events will already be well-known. They started in the UK las week. Adverse events are pretty much sorted out in about 8 weeks.
I’m tired of it. I’m over it. I’ve said it before here but, if I get the Rona, I have to shutter my clinic for 2-4 weeks. I can’t afford that. Well, technically, I can afford it but it would drain resources that don’t need to be drained if I just try to stay smart and healthy. So why wouldn’t I do everything I can? Besides that, I’m ready to get back to my life. Traveling, building things, and moving forward instead of this stagnate state we’ve all been in for 8 or more months. The vaccine is the first real step out of it.
I am so over other chiropractors out there. One of the vitalists I talked about and was ashamed of in Episode 153 called Some Chiropractors Could Be Better…..well that Flat-Earther has been on his Facebook railing against the vaccines and acting like he is an epidemiologist and trained in the safety and efficacy of vaccines.
He wasn’t. I went through chiropractic school. Other than chiro philosophy, no real education on vaccines was had and certainly not enough to pretend to be an authority on them. One way or another. For or against them. So why the hell are so many wading out into those waters? Just stay the hell out of the discussion. It’s so dumb. It really is.
Can you imagine telling a young mother their baby doesn’t need the measles vaccine because your magical powers of subluxation slaying will protect them by boosting their immune system? And then the baby actually gets measles?
Why in the hell would you want to put yourself or that mother and baby in that position. Just shut up. Back off. Stay in your lane, pal. You’re not that cool. Same goes for COVID. Do you really want to be in the position of telling your patient they really shouldn’t take that vaccine because you’re a spine whisperer and detecting subluxations protects from viruses if they’ll just come to see you every week for the rest of their lives? First you create dependency on YOU. That’s not right and it’s damn sure not evidence-based. Good for the ol’ wallet though isn’t it?
Second, you weren’t trained on it. So back off.
Third, can you imagine that patient getting it anyway and, God forbid, dying from it. What if that patient mentioned to their family members that they weren’t getting the vaccine because Dr. Jackhole told them they didn’t need it and shouldn’t take it. Would the family have a legal claim against you? My opinion is hell yes they do and you should be calling your malpractice carrier to see how to handle it.
The point being. Just remove all of that by keeping your mouth closed and staying out of vaccine discussions. It’s completely appropriate to say that getting it is an individual choice and they should talk to their doctor about the risks vs. the benefits and take it from there. Because that really is what they should be doing.
This vitalist and others like him are going to get more people killed because they love themselves on a level that leads them to believe they have all of the answers. They don’t. In fact, when they’re recording selfie videos of themselves walking around their offices or sitting and driving in their cars, they look insane. Crazy-eyed insane people.
Enough of that. I made my point. Some of you listen enough or we’re friends on Facebook so you know that I’m an artist of sorts. Guitar singer songwriter, charcoal drawing and portraits and sculpting. I’ve been sculpting a race horse lately and I did the bridle and saddle this weekend. Looking back on it, I may rather take a swift kick in the cajones then repeat that. Geez. Straps, buckles, loops, cuss words. But, it’s shining up finally. If you want to follow some of my artistic escapades on Facebook, go like and follow River Horse Art. It’s fun. If nothing else, I’m keeping life interesting at the very least.
Another thing totally unrelated to chiropractic is Hot chocolate bombs. Here’s a tip from your Ol’ Uncle Jeffro. Be damned careful what you put on FB during the holidays people. My wife Meg and daughter Bitsy... her real name is Joss....they were making these things and I shared it in FB just to brag on them a bit. They were just making them for family and friends and they are pretty cool.I’m on Weight Watchers…down 33 pounds now…and so I can’t indulge but I did share one with my wife and they are absolutely sinful, people. Holy cow. They’ll make your hair stand up.
Anyway, now it’s an overnight success business sort of thing. Geez. She has orders for about $300 worth of these things and a guy that may order around $1500 worth of them for his business connections and marketing purposes. What in the holy chocolate hell? So now I have a factory in my kitchen with two bumblebees buzzing all over it.
In business, you have probably heard me mention that we have been down since the second spike hit. Down quite a bit. I used to gripe that my new norm was 145 a week rather than my pre-COVID average of about 190 per week. Well, turns out it could get worse. We’ve been averaging about 125 a week since the second spike came on BUT…..but….this week is starting off right with 41 and four new patients today. Fingers crossed.
I told you we did a radio run and, believe it or not, people are starting to tell me they’ve been hearing our ads. Which is encouraging. It’s still too early for me to share what we’ve done and it that’s why this week is better. I’m not sure the powers at play just yet. I’m going to keep monitoring it and will let you know.
Enough, let’s get to the research, shall we?
Item #1
This first one is new and it goes with one of my talking points in the intro section. It’s called “Misinformation, chiropractic, and the COVID-19 pandemic” by Iben Axen, et. al. and published in Chiropractic & Manual Therapies in November of 2020. Hopping jalapeños that’s hot!
Why They Did It
Before we get to why they did it, I think we all know. Yes, we know. If fact, look, I knew people were crazy before COVID. There are just crazy people out there in the world. That’s a given. But I had no idea how many truly crazy and impressionable people there really are until this pandemic. Holy huge balls of insanity, people. I have seen the most disappointing stuff coming from people. Not just chiropractors but definitely some chiropractor as well. No doubt. They crazier than bed bugs. Crazier than a craphouse rat.
They begin by saying, “During this time of crisis, some chiropractors made claims on social media that chiropractic treatment can prevent or impact COVID-19. The rationale for these claims is that spinal manipulation can impact the nervous system and thus improve immunity. These beliefs often stem from nineteenth-century chiropractic concepts. We are aware of no clinically relevant scientific evidence to support such statements.
We explored the internet and social media to collect examples of misinformation from Europe, North America, Australia and New Zealand regarding the impact of chiropractic treatment on immune function. We discuss the potential harm resulting from these claims and explore the role of chiropractors, teaching institutions, accrediting agencies, and legislative bodies.”
Despite this grave situation, some chiropractors have advocated a misbelief that spinal manipulative therapy (SMT) or “adjustments” can boost immunity and thus should be offered as a preventive measure for viral infections. The World Federation of Chiropractic (WFC) noted this development on March 17th 2020 and refuted this in a public statement: “… .there is no credible scientific evidence to support this notion and to suggest otherwise is potentially dangerous to public health” . Nevertheless, some chiropractors continue promoting misinformation on social media putting the chiropractic profession at odds with scientific evidence.
The chiropractor (and I use that term loosely) I discussed is 100% one of these people. Geez, he’s embarrassing. But he takes videos of his huge pool and big backyard he got from seemingly bilking the holy crap out of impressionable patients and young dumb chiropractors but whatever.…
Anyway…they say that the estimate is that 20% of the chiropractic profession has the vitalist, faith-based, philosophy, I’m going to pop this and protect you from virus approach to taking advantage of patients. I mean….going about their business.
They say, “Misinformation about adjustments and immunity taints public understanding of viral prevention, undermines the coordinated efforts of health authorities, and has become a cause for concern among researchers and public health authorities”
Wrap It Up
Members of the chiropractic profession share a collective responsibility to act in the best interests of patients and public health. We hope that all chiropractic stakeholders will view the COVID-19 pandemic as a call to action to eliminate the unethical and potentially dangerous claims made by chiropractors who practise outside the boundaries of scientific evidence.
CHIROUP ADVERTISEMENT
Item #2
This one is called “Effect of Physical Exercise Programs on Myofascial Trigger Points–Related Dysfunctions: A Systematic Review and Meta-analysis” by Guzman-Pavon, et. al. (Guzman-Pavon MJ 2020) and published in Pain Medicine on October 4, of 2020. Sizzlin’ succotash! It’s hot!
Why They Did It
Remember, this is a systematic review and meta-analysis and those are at the top of the research pyramid. They’re mostly reliable.
They say, “Myofascial pain syndrome is one of the primary causes of health care visits. In recent years, physical exercise programs have been developed for the treatment of myofascial trigger points, but their effect on different outcomes has not been clarified. Thus, this study aimed to assess the effect of physical exercise programs on myofascial trigger points.”
How They Did It
- A systematic search was conducted in Pubmed, Web of Science, and Scopus.
- Articles analyzing the effect of physical exercise programs on pain intensity, pressure pain threshold, range of motion, and disability were included
- 24 randomized controlled trials were included
Wrap It Up
Physical exercise programs may be an effective approach in the treatment of pain intensity, pressure pain threshold, and range of motion among patients with myofascial trigger points.
Let me just tell you that physical exercise programs are absolutely effective. Not just in the physical sense but in the biopsychosocial aspect as well. When people are gradually moving more and gradually building their confidence in movement and their abilities, the brain, or the centralized part of the pain experience is affected in for the positive which brings the pain level down overall. It’s just fascinating but in short, moving means more than just physical activity when we’re talking about pain.
Item #3
Item #3 here is called “Excess Body Mass and Leisure Time Physical Activity in the Incidence and Persistence of Chronic Pain” by Shiri, et. al (Shiri R 2020) and published in Pain Medicine on November 11, 2020. Which makes hotter than a habanero. And that’s real hot.
Why They Did It
To estimate the effects of excess body mass and leisure time physical activity on the incidence and persistence of chronic pain.
How They Did It
A prospective cohort study.
three cohorts of employees of the City of Helsinki (18,562 observations) and defined incident chronic pain as having pain in any part of the body for more than three months at follow-up in participants without chronic pain at baseline. This was a great sample size.
Persistent chronic pain was defined as having pain for more than three months at both baseline and follow-up
Wrap It Up
As if we didn’t know this already, they say, “Obesity not only increases the risk of developing chronic pain, but also increases the risk of persistent pain, while leisure time physical activity reduces the risk of developing chronic pain.”
Now consider the obesity issue in America today.
Item #4
And finally, our last one is called “Perceived Injustice Helps Explain the Association Between Chronic Pain Stigma and Movement-Evoked Pain in Adults with Nonspecific Chronic Low Back Pain” by Penn et. al. (Penn T 2020) and published in Pain Medicine on April 24, 2020 which is hot enough because it just came out in the November 2020 issue. It’s not steaming but it is indeed very hot.
Why They Did It
For most patients with chronic low back pain (cLBP), the cause is “nonspecific,” meaning there is no clear association between pain and identifiable pathology of the spine or associated tissues. Just for the record here, Dr. Stuart McGill and his mustache would call total BS on the idea that nonspecific back pain exists. He’s say you just aren’t looking hard enough.
Anyway, they go on to say, “Laypersons and providers alike are less inclined to help, feel less sympathy, dislike patients more, suspect deception, and attribute lower pain severity to patients whose pain does not have an objective basis in tissue pathology. Because of these stigmatizing responses from others, patients with cLBP may feel that their pain is particularly unjust and unfair. These pain-related injustice perceptions may subsequently contribute to greater cLBP severity. The purpose of this study was to examine whether perceived injustice helps explain the relationship between chronic pain stigma and movement-evoked pain severity among individuals with cLBP.”
And honestly, these are things I haven’t considered before and I think it’s interesting as hell.
How They Did It
Participants included 105 patients with cLBP who completed questionnaires assessing chronic pain stigma and pain-related injustice perception, as well as a short physical performance battery for the assessment of movement-evoked pain and physical function.
What They Found
- Findings revealed that perceived injustice significantly mediated the association between chronic pain stigma and cLBP severity and physical function.
- Greater chronic pain stigma was associated with greater perceived injustice, which in turn was associated with greater movement-evoked pain severity.
Wrap It Up
“These results suggest that perceived injustice may be a means through which chronic pain stigma impacts nonspecific cLBP severity and physical function.”
So, today’s take-aways…..
- Be a science driven healthcare leader and practitioner. Don’t be crazy because you look insane and you make everyone else in your profession appear to be insane as well. That’s just rude as hell. Especially when you’re proving Parento’s Law by just 20% of you making the rest of us look like crazy people. We don’t appreciate it. Stop it now, dammit.
- Love your patients and if you worry about the outcomes, you won’t have to worry about the income
- And get them moving.
Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week.
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
Subscribe Button
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 preventativly 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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TuneIn
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About the Author & Host
Dr. Jeff Williams - Fellow of the International Academy of Neuromusculoskeletal Medicine - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography
- Guzman-Pavon MJ, C.-R. I., Martinez-Vizcaino V, (2020). "Effect of Physical Exercise Programs on Myofascial Trigger Points–Related Dysfunctions: A Systematic Review and Meta-analysis." Pain Med 21(11): 2986-2996.
- Penn T, O. D., Aroke E, (2020). "Perceived Injustice Helps Explain the Association Between Chronic Pain Stigma and Movement-Evoked Pain in Adults with Nonspecific Chronic Low Back Pain." Pain Med 21(11): 3161-3171.
- Shiri R, L. T., RAhkonen O, Leino-Arjas P, (2020). "Excess Body Mass and Leisure Time Physical Activity in the Incidence and Persistence of Chronic Pain." Pan Med 21(11): 3092-3101.
CF 155: Vegans & Broken Bones, Daily Step Count, Medical Cannabis
Today we’re going to talk about new research for vegans and the risk of broken bones, we’ll cover new information pertaining to a patient’s daily step count, and we’ll talk about a study on medical cannabis and it’s effectiveness in treating chronic pain. Good stuff today, folks.
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 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.
- Like our Facebook page,
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You have found yourself smack dab in the middle of Episode #155
Now if you missed last week’s episode , we talked about the shake up with the World Federation of Chiropractic and all of the goings on that went on with that. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
As of the typing of this, it is the Monday following Thanksgiving. I hope you all had a good one. I have a nice back patio, outdoor kitchen area with a fireplace and quite a bit of room to move around.
I have my mom and my stepdad over as well as my brother and his wife. With the four of my regular crew, that made 8 of us. Nobody went inside. We all just gathered outside on the patio and ate outside. It was great. It was safe. And we still got to have Thanksgiving.
We had two separate tables. One for my crew and one for the other four. We had my crew at one table because I work with 140 or so appointments per week, my son goes to a high infection rate college, and my daughter goes to junior high with over 1,000 kids every day. So, my crew was the wildcard in that crowd. So we sat separated just a bit to be sure we were protecting the others from any asymptomatic hoo ha.
It seemed to work very well. Again, I hope you all did well and stayed safe and happy and healthy. It was different for sure, right? Definitely one to remember. No doubt. Think of all of the things we took for granted before this mess. I know many of you have but I haven’t taken a trip or vacation or anything since February when we went to Key Largo.
I’m used to going on little vacays about once per quarter just to preserve my sanity. I think that’s important. Getting out of the office and getting some sea air or some mountain air in your face. But we haven’t been able to do any of that in the last 9 to 10 months and I’m missing it. I’m a traveler.
This has really taught us what we do and what we do not have control over. We do not have control over nature from what I can tell. Certainly not this virus. At least not yet we don’t.
This second spike has been severe where I live. Over 1,000 new cases in one day on the last count, over 750 FEMA staffers here helping our healthcare system keep up with the hospitalized patients. I haven’t seen this week’s numbers yet but we lost 24 residents to COVID in just two days last week. 24 deaths in two days. That was unheard of just a couple of months ago. I have lost a couple of patients to it. Fortunately, I haven’t lost any friends as of yet. I hope your friends are all staying safe and weathering the storm the same.
PRactice is just there. Nothing special going on right now. We are running a radio spot for this holiday season but I’m not sure how smart that is. Luckily, they gave us a killer deal on the run so we couldn’t resist. They made us a deal we couldn’t refuse. I’m not sure all of the ads in the world will get everyone out of the mental and financial funk any time in the next several months.
But I’ll report back. If it works, I’ll share what we did so you can do the same. On the other hand, if you’re doing something that is working for your clinic and getting people back in the numbers you want to see, send me an email at dr.williams@chiropracticforward.com and let us know so we can let others know and help everyone out with getting their numbers back closer to normal.
Item #1
Let’s start with one called “Medical Cannabis for the Management of Pain and Quality of Life in Chronic Pain Patients: A Prospective Observational Study” by Safakish, et. al. (Safakish R 2020) published in Pain Medicine in November of 2020. And it sizzles and steams as it sits.
Why They Did It
To evaluate the short-term and long-term effects of plant-based medical cannabis in a chronic pain population over the course of one year.
How They Did It
- 751 chronic pain patients initiating medical cannabis treatment.
- A longitudinal, prospective, 12-month observational study.
- Study participants completed the Brief Pain Inventory and the 12-item Short Form Survey (SF-12), as well as surveys on opioid medication use and adverse events, at baseline and once a month for 12 months.
What They Found
- Medical cannabis treatment was associated with improvements in pain severity and interference (P < 0.001) observed at one month and maintained over the 12-month observation period.
- Significant improvements were also observed in the SF-12 physical and mental health domains (P < 0.002) starting at three months.
- Significant decreases in headaches, fatigue, anxiety, and nausea were observed after initiation of treatment
- In patients who reported opioid medication use at baseline, there were significant reductions in oral morphine equivalent doses (P < 0.0001), while correlates of pain were significantly improved by the end of the study observation period.
Wrap It Up
Taken together, the findings of this study add to the cumulative evidence in support of plant-based medical cannabis as a safe and effective treatment option and potential opioid medication substitute or augmentation therapy for the management of symptoms and quality of life in chronic pain patients.
Alright, I’ll be upfront; I don’t like marijuana. I know some of you love the sweet sweet weed. I’ll never understand it. Trust me, I’ve been around it so many times I can’t count. I’m a former traveling muscian. For 10 years I traveled the circuit so you can only imagine.
I’ve been against its legalization from Day 1. I’ve seen it turn famiily members into lazy, unmotivated bums. I hate it. I hate the smell. I hate what it does to people and I hate the culture surrounding it.
But, I can’t argue with research and this says it helps. I’ve seen other reports that it works. Regardless, I’m for pill form, chewables, or gels. I will never before inhaling it. There is no amount of evidence on the planet that will make me think it’s OK to take smoke into your lungs. Especially when there are other options for it’s utilization.
So, this is encouraging. I hope its medical use becomes more widespread and more common because it sure as hell looks like it works for chronic pain and, at the end of the day, that’s what we’re here for.
CHIROUP ADVERTISEMENT
Item #2
This second one is called, “Association of Daily Step Count and Step Intensity With Mortality Among US Adults” by Saint-Maurice et. al. (Saint-Maurice P 2020) and published in JAMA in March of 2020. Dammit it’s hot enough.
Why They Did It
Describe the dose-response relationship between step count and intensity and mortality.
How They Did It
- Representative sample of US adults aged at least 40 years in the National Health and Nutrition Examination Survey who wore an accelerometer for up to 7 days ( from 2003-2006).
- Mortality was ascertained through December 2015.
- Accelerometer-measured number of steps per day and 3 step intensity measures
- Accelerometer data were based on measurements obtained during a 7-day period at baseline.
- They adjusted for for age; sex; race/ethnicity; education; diet; smoking status; body mass index; self-reported health; mobility limitations; and diagnoses of diabetes, stroke, heart disease, heart failure, cancer, chronic bronchitis, and emphysema.
Wrap It Up
Based on a representative sample of US adults, a greater number of daily steps was significantly associated with lower all-cause mortality. There was no significant association between step intensity and mortality after adjusting for total steps per day.
I personally found it interesting that they found no big association between step intensity and mortality. Very interesting. So, let’s make sure we’re all moving. No matter the age.
Item #3
This one is an article by Rupert Steiner(Steiner R 2020) called “Vegans and non–meat eaters are more likely to suffer broken bones, Oxford University research show” and it was published in Market Watch on November 24, 2020 and it’s it’s hotter than the burning sun!
- We just hit the highlights for the articles so here we go:
- They start right off getting into the meat and taters by saying, "Non–meat eaters, especially vegans, are at higher risk of breaking their bones due to lower intakes of calcium and protein, according to new research by the University of Oxford published on Monday
- The EPIC-Oxford study, which involved almost 55,000 British people, concluded: “Non–meat eaters, especially vegans, had higher risks of either total or some site-specific fractures, particularly hip fractures
- Participants were categorized into four diet groups composed of 29,380 meat eaters, 8,037 fish eaters, 15,499 vegetarians and 1,982 vegans.
- The results showed over an average of 17.6 years of follow-up, researchers observed 3,941 cases of total fractures.
Food for thought and the damn pun was absolutely intended.
Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week.
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
Subscribe Button
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 preventativly 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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
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iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
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https://player.fm/series/2291021
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https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
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About the Author & Host
Dr. Jeff Williams - Fellow of the International Academy of Neuromusculoskeletal Medicine - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
- Safakish R, K. G., Salimpour V, Hendin B, Shoanpal I, (2020). "Medical Cannabis for the Management of Pain and Quality of Life in Chronic Pain Patients: A Prospective Observational Study." Pain Med 21(11): 3073-3086.
- Saint-Maurice P, T. R., Bassett D, (2020). "Association of Daily Step Count and Step Intensity With Mortality Among US Adults." JAMA 323(12): 1151-1160.
- Steiner R (2020). "Vegans and non–meat eaters are more likely to suffer broken bones, Oxford University research show." MarketWatch.
CF 153: Some Chiropractors Could Be Better
Today we’re going to talk about the subluxation - vitalistic group in our profession and we’ll probably make some grumpy vitalistic enemies in the process.
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our Facebook page,
- Join our private Facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #153
Now if you missed last week’s episode , we talked about spinal instability clinical pearls and we tal ked about degeneration and the facets. That was some good stuff you need to to have in your back pocket. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function
On the personal end of things…..
I’m doing hte same stuff you’re doing for the most part. I’m just struggling through this second wave of COVID. Trying to stay smart and trying to stay healthy. I wish I could say the same for everyone around me.
For example, I just had a staff member start this week off by telling me she started working a part time job on the weekends because she got an apartment she thought she could afford but it’s not as easy as she thought.
Anyway, at this part time job, her buddy drank out of her drink. She’s like, oh well, it’s just my friend. No big deal. Yeah, no big deal friend called her today…..2 days after that…..and is feeling bad and going to get tested. Now, does that mean my girl has it? Of course not. The friend wasn’t even symptomatic so the chances are low she has it in the first place and if she does have it now, the chances she was shedding the virus then are low.
Still…..come on man. Be smart. My daughter goes to school with 1000 plus kids every day and I don’t let her take a sip of my drink or anything like that. Much less a buddy at my part time job. Hell no. hell no.
So those are the things we get to battle with, right? We can control everything about what we personally do but we can’t control our kids at school with their friends. We can’t control my other kid at college and his behavior. We can’t control our staff when they’re not here at work.
We just do our best, keep our fingers crossed, and keep working diligently. And hopefully safely.
Not because I’m necessarily scared of getting it. Mostly because I don’t want to shut my practice down for 2 weeks minimum. Who can afford that?
So let’s get on with pissing people off shall we?
If you don’t understand by this point that there is a divide in our profession that simply cannot be healed, tied together, or unified, well….I don’t know what to do for you. You just need to pay more attention.
If at any point you have thought the two groups could come together, you are fooling yourself. This profession either needs to be split into two completely different degrees and entities or the vitalists need to practice their minimal practice and sit in the back seat and shut the hell up.
Yep….shots fired. I know. I’ll explain more as we go. Every now and then I get fired up and this is one of those times. I’m triggered. I’m the grumpy old ‘get the hell off of my lawn’ guy. More specifically, I’m ‘raise your damn game and quit actiing like fools’ guy.
I should tell you why I’m triggered first. As our listeners are well-aware, I am a member of lots of Facebook groups but the most notable would be the Forward Thinking Chiropractic Alliance. Most friends and family would classify me as conservative in finances and life in general but when it comes to my profession, I’m all about progressive change and forward momentum. So this group fits me very well.
Anyway, one of the members posted a screenshot of a doctor - trust me - I use that ‘doctor’ term extremely loosely here - it was a post of this guy claiming that with one table, by himself, he treated 99 chiropractic patients and 9 new patient exams all in 3 hours.
I did the math for you all. That’s right at 2 minutes per patient. Well, for many of us, that’s not too far off of the mark for established patients. Some of you are boutique practices and spend 30 minutes to an hour with each patient and charge out the wazoo for that. But, for most of us, we are adjusting, passing off to our staff for therapy and rehab and moving on to the next patient.
I want to be fair here. My face to face time is typically 3-5 mintues with an established just depending on what questions I have to answer, if there’s a new complaint popping up that needs evaluated, new patient education, and things like that. Some slightly less than 3 mintues, some quite a bit longer than 5 minutes.
Now, my patients’ whole visit will clock in on average around 20-30 minutes after therapy and/or rehab but that is delegated to the staff.
Here’s the real kicker for me on this joke. The new patients. I can not get past the new patients. Now I’ve seen 7 or 8 new patients in a day while juggling another 50 or more established patients. But damn man…that’s over the course of a 7 hour day. And, while I don’t think it makes me particulary any more special than anyone else, I have a Fellowship in neuromusculoskeletal medicine. I can come to a diagnosis somewhat quickly when compared to others.
Still, my exam, unless it’s a simple rib complaint or something easy like that, it’s going to take 30-45 mintues. Easy. And that’s with staff doing their history and intake part. Them filling out OATS takes time on top of that. Plus, I recorded a 7 minute, ‘Welcome to our practice’ video they all watch.
Look, there’s no damn way on this damn planet anyone calling themselves doctor works that many new patients through in 3 hours while juggling 99 established patients and claims they’re doing a good job. No way now how. Nope, no, negatory, NO!
Worst of all, he’s a vitalist, practice management guru so he’s offering to show other, impressionable knuckleheads how to mistreat patients all on their own. Solo crappery if you will. Crappy treatment all by themselves. With his crappy guidance. What a crappy deal.
I have 34 mutual friends with this person and that’s just disappointing. It truly is. Many of you know who I’m referring to but I see no point in mentioning names because the last thing I want is to bring him even more attention. Especially when I don’t see the reason even one person would pay him any at all.
I have no way of knowing how long they’re spending with new patients but let’s just agree that it’s not 30-45 minutes. There’s no way. I know this because if he spent 30 minutes with each of the 9 new patients, that would be about 4 and a half hours. Much more than the 3 hours he talked about in the post.
We are forced to assume it is much less than that. So let’s play with the math. Three hours is 180 minutes. I think we can all agree on that. A former attendee to one of his seminars said he bragged in the seminar that he could adjust a patient top to bottom in just 30 seconds. As a sidenote, he taught how to have the trash can right next to the door so that he could tear the face paper and grap the door knob in one smooth motion so as to have the door open and showing the person out before they’re even off of the table. That way, you don’t have to talk to them.
So you don’t have to talk to the patient……you get that? Good Lord, can you imagine a doctor having to speak to their patient after treatment is provided? The horrors!!!
Anyway, let’s say 30 seconds is his record but it actually takes one minute on average per patient. If 30 seconds is the fastest, can’t we assume there will at least be some greeting involved in the appointment? Some questions from time to time? There may be some 30 second appointments in there but there may be some minute and a half and some two minute appointments as well. I think that’s fair.
So, if each of the 99 established takes an average of one minute, which is stillsubstandard care by the way, if they all average one minute, then that leaves 81 minutes to examine and evaluate 9 new patients. That means he has roughly 10-15 minutes for each new patient to do the following if he’s going to adequately assess the patient and have a specific diagnosis outside of subluxation slaying and spine whispering.
He’s got to:
- Review the history taken by the staff before he came in
- Review the range of motion if taken in advance by the staff
- Review the vitals
- Meet the patient and listen to their story
- Assess gait
- Assess standing posture
- Check yellow flags and discuss any that are present with the patient
- Check for red flags - not everyone needs x-rays
- Check reflexes
- Check dermatomes
- Check muscle strength (not freaking AK)
- Check neurodynamic positions for radiculopathy
- Assess for Ehler-Danlos and hypermobility
- Check orthos
- Check neuro testing
- Check for extension/flexion bias positions in some cases
- Come up with an accurate diagnosis
- Educate the patient on their diagnosis
- If chronic pain is part of the case, he has to educate on CNS upregulation and the biopsychosocial aspect of pain which is at least a 5 mintues conversation.
- Teach proper movement and biomechancis to remove the daily pain triggers
- He has to answer questions the patient may have
Hell, I wonder if he’s ever had someone lay on their stomachs propped on their elbows for 3 minutes to see if they can identify a home self management strategy for their low back pain? Hell no. Three minutes wouldn’t fit into this doctor-centered model.
I have no way of knowing but I’m guessing the exam consists of ‘checking subluxation’ and telling them to lay down. Pop, pop, pop, the ridiculous power is on, see you tomorrow for you next life-saving adjustment. It’s silly. And it’s insane. And it’s not evidence-based. And it’s not patient-centered. It’s not special. It doesn’t take talent other than being able to sell targets garbage. It’s the lowest common denominator and nothing more.
The point being made here is that one cannot do an adequate, responsible, and appropriate exam in this amount of time. And assuming they average only one minute per patient face to face, that’s substandard as hell. Would you want your kid or brother or sister or mom or dad shuttled through an office like a bullet from a gun? Or would you want them to go to someone that cares, connects with them, slows down a tad and takes their time to listen and work with them? The answer is obvious and if you tell me you’d rather your family go to this guy or anyone like them, then you’re just being obstinate and disagreeable. It’s obvious which style is superior in healthcare.
Maybe working on an assembly line you’d like to see fast, efficient, and little attention given to the specifics. But not in healthcare. This model, I’m sorry to be blunt here….this model is garbage when we are working with the breathing, ever-changing human body.
And….oh this guy loves him some of him. Oh my goodness. If someone likes to look in the mirror every morning, it’s probably this guy. Now, he’s selling his unique brand of BS to others. He’s doing a good job of it too. He’s got sycophants all over now learning how to shuttle them out of the office without having to speak to them.
They’re in the comments section of this post proclaiming him a rock star! BS. Rock on! I can’t wait to do this when I get out of school! You’re an inspiration. How awesome!!! Blahditty freaking blah. BS, BS, BS.
I would comment, “What an embarrassment to our chiropractic community! What a fool! What about exercise and rehab? What about quality over quantity? You give our profession a bad name. You’re one of the reasons we have zero cultural authority and can’t pass a bill in the legislature because you and your followers are irresponsible!!!”
You know….things like that.
Now, I’ve been asked why I talk bad about other chiropractors. Running them down and such. I don’t call it that at all. I call it policing our own and calling out BS when it’s right under your nose. I don’t know about you but I don’t want BS under my nose. It stinks. And not only can I smell it, but everyone else I come into contact with smells it as well. So, basically, these people’s actions reflect on me, my business, and my livelihood. And yours as well. So if you’ve been going along to get along thinking it doesn’t matter, it does matter. It matters to your bottom line.
Can you imagine if we were to have more cultural authority and more integration into a regular healthcare protocol…..can you imagine how full our offices would be? Low back pain is the number one reason for disability globally folks. Yet we only see 10% of the damn population. It’s obvious why and the Palmer Gallup poll laid it out. The biggest reason people don’t go to chiropractors is because they don’t freaking trust us. Because of fools like this.
Lots of high volume clinics like this slay subluxations non-stop for weeks and weeks. Some see people every week for life. Think about a self-adjuster. The more they did it, the easier it got to the point they created instability in their neck, they have consistent chronic pain, and now they’re a mess. Can we see this happen in patients that are adjusted too often for too long? Of course we can!!
These spine whipering TORs are many times creating instability and causing chronic pain. Which is the damn thing the knuckleheads are supposed to be treating in the first place. But they were too lazy to get educated beyond college and some continuing education each year about proper documentation and how to adjust an elbow.
What if they have a hypermobile EDS patient that really needs weight training but they just keep hammering away at what they call subluxations? This is low quality garbage for people that aren’t taking the time to properly evaluate their patients in the new patient exam.
In one of his videos he says, “The patient doesn’t care about anything other than does the doctor care and can he help me?” Again, I use that doctor term exceedingly loosely. I have to just say that he is 100% wrong. Yes, patients do care about those two things but you know what else they care about?
They also care that their doctor is smart. Is on top of his game. Is making decisions in the best interest of the patient and not the clinic or the doctor’s wallet. They care about proper biomechanics so they don’t re-injure their back. They care that if they’re hyper mobile, maybe they shouldn’t be adjusted and should focus on weight training instead. They care that a slight decrease in neck curvature isn’t really the harbinger of death and disease some chiros act like it is. They want to know their doctor is making decisions on their care based on accurate diagnoses. Is making decisions on their care based on research and not philosophy. Trust me, they care about a hell of a lot more than
How incredibly arrogant of this supposed doctor to think he has the only answer to what patients care about. They’re not freaking sheep with little to no thought processes. They’re smart as hell in many cases and they absolutely care about a whole lot of stuff is missing. Saying they don’t is selling them short and it’s unfortunate that he’s going around teaching that. One more example of him being doctor-centered rather than patient-centered. “I....the doctor....knows what the patient really wants and cares about. They can’t think for themselves.” Garbage.
Of course patients don’t care about the biopsychosocial aspects of pain. They don’t even know what the hell that is. But we as professionals should absolutely know and absolutely care and leverage it to our advantage. We should know about upregulated CNS and educate patients about it. Because it matters.
The question might be, “Why would people keep going back?” Well a lot don’t but, in general the ones that do have typically had the crap scared out of them based on x-rays that usually shouldn’t have even been taken in the first place. “Looky here, loss of curvature, that is so concerning. I’m really worried about this and what it means for your future if we don’t get that fixed. That’ll be 58 visits this year at a cost of $4800. That’ll be upfront and here’s the contract to hold you to it.”
Predatory, unbelievably unethical, astoundingly unprofessional, and embarrassing.
Fro every patient referred to a clinic like this, I’d guess they lose one that thinks they and every other chiropractor on the planet is insane. Thank you vitalists. I really appreciate it. So much. thank you.
Clinics like this only see their successes. So they think they’re amazing. I’ll be honest, I see A LOT of patients coming to see me from practices like this because patients can’t stand being shuttled through like cattle, not being listened to, feeling that the care is substandard, being scared by the doctor into treatment, being scared into contracts, and things of that sor They feel taken advantage of and they don’t like it. And I don’t blame them. I just appreciate them for giving me a chance to show them that the majority of chiropractors don’t engage in foolish crap. That we can play an integral part in resolving their pain.
I have heard the most embarrassing stories about chiropractors from patients that escaped clinics like this.
A chiropractor can still focus on subluxations but do it in an evidence based, patient-cantered way. Wanna help more people? Hire more docs to handle that patient load and be able to have the time it takes to spend with the patients to do a proper job. Serve more people.
Just hire more people to do it.
I just want better from this guy and people like him. I want a standard in our profession. I want more from our profession. I want to have a conversation with someone in the medical field or someone that knows very little about chiropractic and not feel the need to apologize for guys like this.
He’s clearly a talented guy and a leader on some level. I just wish the talent was more focused on evidence-based, patient-centered endeavors.
Basically, I don’t have a problem with people practicing under the subluxation model when they’re not advising against vaccines. We didn’t learn enough about them to be a damn authority on it. Stay out of the conversation either direction. It is not ours to have. Can you imagine telling a mother not to get a baby vaccinated and then the baby gets measles? Steer clear of that conversation.
Anyway, I don’t mind people practicing that model. At the end of the day, we are all moving bones. The adjustment is the cornerstone of my practice but it’s only a piece of my practice. IT’s not the end-all-be-all. IT’s a puzzle piece but the piece is the biggest piece of my puzzle and it’s right in the center of the puzzle. Nothing more nothing less. It’s not spiritual. It’s just a really big, very effective tool I have.
My issue is the thought that a thorough and comprehensive exam is not necessary. That connecting with patients is not important. That talking with them, answering their silly questions, and educating them is not important.
It all is very important and all of it, like it or not, takes time. It just does and time is a constant we must all contend with and work within the contraints of.
So….that’s me, folks. Raw. And mostly censored because trust me, I cuss like a sailor when I’m not on this podcast. I could make this discussion so much more colorful and it’s deserving of the cuss words.
I know many of you know this guy and you think he’s the bees knees and you’ll probably tune out here and think I’m just an awful person because I’m talking this way about him but here’s the deal, we cannot let quackery and foolishness not only permeat what should be an evidence-based, patient-centered healthcare discipline…..but it is pervasive. Not only is it permeating, but it’s pervasive. You don’t have to look far to find a sycophant.
I have 34 nutual friends with this knucklehead afterall. What more do I need to say? So, more akin to the medical field, we should recognize BS, we should call it out, and we should educate against it. And that’s what I’m doing. Every week.
It’s not the subluxation-based thing that gets me. I’m used to that. It’s the culture around it that is insane. Don’t vaccinate, as long as you stay adjusted, don’t worry about COVID, or any other disease, I say a knucklehead guru in school telling me adjstements pushed cancer out of guy’s body. Come on, man.
When New Mexico had a shortage of practitioners and allowed chirorpactors to go to two extra years of education to get an advanced practitioner certificate to help prescribe and help handle the patient load, you know who showed up to testify against their own colleagues? Vitalist, subluxation-based, crazy-eyed imbecile chiropractors holding on to green books, the words of BJ, and a philosophy created in the late 1800’s. Yeah, great look folks.
You know who is against the ACA’s push for Medicare parity? Yeah, not just the usual suspects like the AMA. Nope, hell, the AMA’s best teamates against chiropractic are the vitalists. Yeah, I’ve seen the sychophants of Matthew McCoy railing against us being treated equally under Medicare. Explain that for me….someone….please explain that.
Again, it’s not the subluxation. I don’t personally use or care for that word or philosophy but that’s not it. IT’s the insane leaders of that cult and the culture surrounding it that makes me want to punt baby bunnies into the damn stratosphere.
So, if you’re a subluxation person, my beef is not with you as long as you’re not scaring and taking advantage of your patients. As long as you’re not telling them to see you 80 times this year to keep them healthy and all that. I have no beef with you.
Especially if you’re a Christian. Telling a patient that they were made imperfectly by a God you put every bit of your faith in makes no sense. at all. Y’all I’m a Christian. God makes no mistakes. He didn’t put us on Earth imperfect and in need of a chiropractor every week of our lives or be a miserable wreck of a person just waiting around on death’s doorstep. What a foolish concept for the faith-based models out there. The Body By God group. It’s silly. Sure be faitful, no problem there. But don’t tell people that they need you. Otherwise God can’t express himself fully without you. Yes, that is one of their talking points in case you were wondering. Insanity.
Current guides tell us to use spinal manipulative therapy for movement dysfunction, use exercise and rehabilitation, use low level laser, use heat, yoga, acupuncture, and soft tissue manual therapy, use balance and proprioceptive training as well. These are all ways of leveraging modalities to great effect in resolving pain. They also teach us to NOT create dependency in the patient upon us. They shouldn’t depend on us. We should be teaching them ways to self manage ongoing pain at home and see them for periodic flare-ups.
That’s evidence-based and that’s patient-centered. 180 degrees opposite of what this practice I’m speaking about is doing.
There are so many amazing chiropractors in the world that have raised their games to such a level that they can command respect and money for their opinions and treatment. Then…..there just aren’t. They’re educationally lazy but they can sure talk a great game.
I’d like to see eveyrone raising the level. Raising the standard and taking this profession into an era of growth, progress, and respect.
Item #1
It’s called “The disappearance of the primary care physical examination - losing touch” by Dr. Paul Hyman(Hyman P 2020), and MD and it was published in JAMA on August 24, 2020.
Damn the sizzle!!
It’s an article so high points we will hit upon
He starts out by asking, “What is a physica examination worth?” He says he’s noticed that physical exams seem to be falling by the wayside in recent years and that fact has been highlighted for him since looking at the daily schedule and determining which will be see face to face in the days of COVID.
He says that an exam is clearly needed at times for a diagnosis but that he’s realizing other ways he commonly uses exams as well. He says it is a means through which he pauses and physically connects with patients. It’s a way to demonstrate his knowledge and authority to the patient. He says it’s also a chance to persuade patients and reevaluate their narrative.
On the part about demostrating your knowledge, what are you demonstrating when you do a minimal, piss ant exam? Whether you know it or not, you may be demonstrating your lack of knowledge, right? Especially when that patient has had enough of your crap and goes to someone that knows what they’re doing. When the patients say, “This is awesome! The other chiropractor didn’t do any of this,” well, we have a pretty good idea of where you’ve been before getting to us.
He goes on to say, “When patients and I disagree on a plan, the physical examination not only provides data, it also acts as an arbiter.”
He makes an excellent point here when he says, “In an admission of my own insecurity, the physical examination remains one of the few domains where I maintain a sense of professional skill and authority. I have never been much of a proceduralist. The mainstay of what I offer to patients is the ability to listen to them, to use critical thinking skills, and to offer my knowledge and experience. But those skills are sometimes challenged in a world where patients research their own health and develop their own medical narratives. The physical examination remains a place where I offer something of distinct value that is appreciated.”
You cannot make a difference in patients’ lives when you don’t know what the hell is wrong with them because you didn’t have the knowledge it takes to be accurate or because you only took 10 minutes to examine them.
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Item #2
This second item is called “Chiropractic, one big unhappy family: better together or apart?” by Leboeuf-Yde et. al. (Leboeuf-Yde C 2020) from February 2019 and published in Chirorpactic and Manual Therapies.
Again, it’s an article so hittin the high spots.
They say that the profession has a long history of internal conflict. Today, the division is between the ‘evidence-friendly’ faction that focuses on musculoskeletal problems based on a contemporary and evidence-based paradigm, and the ‘traditional’ group that subscribes to concepts such as ‘subluxation’ and the spine as the centre of good health. This difference is becoming increasingly obvious and problematic from both within and outside of the profession in light of the general acceptance of evidence-based practice as the basis for health care.
They argue here that the situation within the chiropractic profession corresponds very much to that of an unhappy couple that stays together for reasons that are unconnected with love or even mutual respect.
We also contend that the profession could be conceptualised as existing on a spectrum with the ‘evidence-friendly’ and the ‘traditional’ groups inhabiting the end points, with the majority of chiropractors in the middle. I personally call the ones in the middle agnostics. They take a little subluxation/innate talk to heart but think evidence-based is the way to go but are not motivated about learning any of the evidence and research. Or just don’t know where to go to find it.
They say this middle group does not appear to be greatly concerned with either faction and seems comfortable taking an approach of ‘you never know who and what will respond to spinal manipulation’. We believe that this ‘silent majority’ makes it possible for groups of chiropractors to practice outside the logical framework of today’s scientific concepts.
In their conclusion they say, “There is a need to pause and consider if the many reasons for disharmony within the chiropractic profession are, in fact, irreconcilable. It is time to openly debate the issue of a professional split by engaging in formal and courageous discussions. This item should be prioritised on the agendas of national associations, conferences, teaching institutions, and licensing/registration as well as accreditation bodies. However, for this to happen, the middle group of chiropractors will have to become engaged and consider the benefits and risks of respectively staying together or breaking up.”
No matter where you stand on it, it’s though-provoking and I’m sure to find email inbox filling. Lol. I’m sure I get plenty of hate mail on this episode but I’ll get a lot of support as well. I cannot simply sit by and see BS and sweep it up under the rug. We have to meet it and stand boldly in front of it, and turn it away. For the betterment of ourselves, our profession, and our patients.
Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week.
Key Takeaways
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
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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 preventativly 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.
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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 - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Hyman P (2020). "The Disappearance of the Primary Care Physical Examination—Losing Touch." JAMA Internal Med 180(11): 1417-1418.
Leboeuf-Yde C, I. S., Young K, Kauchuk G, Hartvigsen J, (2020). "Chiropractic, one big unhappy family: better together or apart?" Chiropr Man Therap 27(4).
CF 152: Spinal Instability Clinical Pearls & Degeneration and Facets
Today we’re going to talk about Spinal Instability Clinical Pearls & Degeneration and Facets
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 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.
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Do it do it do it.
You have found yourself smack dab in the middle of Episode #152
Now if you missed last week’s episode , we talked about chiropractors integrating into a medical setting. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function
On the personal end of things…..
We shall see if we are climbing back after the three day ice storm and the resurgence of COVID has hit us in the last two weeks. We are starting the week, I’m writing this on a Monday….with 120 on the schedule. Of course, we haven’t filled in all of Wednesday or Friday appointments….we have fresh injuries that will see us all three days so those will fill in quite a bit more and I’m hoping to at minimum get back up to the 145 mark that has been our average since Rona began.
Which is way down from my weekly appointment average of 182 from last year. But 145 is decent and I can roll with that until people are more comfortable in getting out and going into public spaces and businesses. Right now, they just aren’t. And that’s understandable.
Many of you live in places where there is widespread mask use and they take social distancing seriously. Well, Amarillo, TX would not be one of those places. We have some of the kindest and most giving folks on the planet here in Amarillo but there is a reason we’re number 2 on the New York Times list of places that are about to go through a bad time with the Rona.
People here just don’t want to wear masks and by golly aren’t going to be told to wear them either. It’s disappointing. For example, just today, my wife and I went to a restaurant we know is not typically busy and we have a little table we can usually sit in where nobody else is around us. That table for the first time was not open today. But there was a table I could see that had nobody near it.
We go to this restaurant often enough that the servers know us and they know we are taking the Rona very seriously. So they sit us away from everyone. We are sitting there eating and when we’re about to finish up, they sit a group of about 7 dudes one table away from us. Not a damn one of them come in wearing a mask. I couldn’t get out of there fast enough. I was disappointed that they didn’t make a choice to wear the masks and I was disappointed that the restaurant didn’t enforce the state mandate to wear them. I was also very disapointed that they chose to sit them next to us. But….while I love my town and I love my people, that’s this area of the country for you.
It’s frustrating as hell. Our hospitals are full. FEMA is here helping us. They’ve brought in over 750 helpers from outside of our area. Our hospitalization rate is almost 40% right now. Yeah….that bad. And we still have people walking around like it’s a hoax and not wearing masks. It’s insane to me.
It’s spiking out there everywhere though. Not just here in Amarillo. Stay safe people. Stay vigilant. It’s our responsibility not only to ourselves and our families but to our elderly and immunocompromised patients and our staff. You may be young and athletic yourself but if you get it, even if all you have is a low grade temp or a minor headache and that’s it…..you still have to stay home and lose income for two weeks minimum.
Be smart. Don’t be one of these vitalists out there thinking they’re freaking superman because they got their adjustment this week. That’s the most insane of all. Sorry vitalists. It’s true.
Yes….dammit….I’m a bit gripey today!! Why do you ask?
I’m just done with it honestly. I’m over it. I’m over the election. I’m over everyone being offended about everything. I’m over riots and violent protests. I’m over so much these days and I can’t imagine that you’re any different.
We’ll get through it. Just hold on. Be kind and be brave. Be kind and be brave. We don’t need much more than that do we?
Item #1
This one is called “Relationship Between Endplate Defects, Modic Change, Facet Joint Degeneration, and Disc Degeneration of Cervical Spine” by Lee et. al(Lee S 2020). and published in Neurospine on June 30, 2020, and it sizzles as it sits!!
Why They Did It
The “disc degeneration precedes facet joint osteoarthritis” hypothesis. in cervical spine degeneration, the multifactorial analyzes of disc degeneration (DD), Modic changes (Mcs), facet degeneration, and endplate degeneration (ED) is still limited.
How They Did It
Retrospectively recruited 62 patients from 60-70 years old
They evaluated the following:
- disc height,
- segmental angle,
- ossified posterior longitudinal ligament,
- endplate degeneration,
- facet joint degeneration,
- uncovertebral joint degeneration,
- disc degeneration,
- spinal stenosis,
- Modic changes, and
- cord signal change
What They Found
- The interrelationship of degenerative parameters showed close relation between uncovertebral joint degeneration, spinal stenosis, disc degeneration, ossified posterior longitudinal ligament, Modic change. endplate degeneration, and cord signal change has partial relation with degenerative finding.
- Facet joint degeneration only has relation with uncovertebral joint degeneration and Modic changes.
Wrap It Up
They conclude, “Our results may indicate that facet joint degeneration that occurs independently, rather than as a result of other degenerative factors.
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Item #2
This one is called “A Screening Tool for Patients With Lumbar Instability: A Criteria-related Validity of Thai Version” by Chatprem et. al.(Chatprem 2020) and published in Spine Journal on November 1, 2020, the roof, the roof, the roof is on fire.
Why They Did It
The aim of this study was to examine the performance characteristics and validity of an existing lumbar instability questionnaire as a screening tool for lumbar instability among chronic low back pain (CLBP) patients.
How They Did It
Lumbar instability screening tool responses and x-ray assessments were reviewed from a sample of 110 patients with CLBP (aged 20-59 years).
What They Found
- Fourteen (12.73%) patients had radiological lumbar instability. These patients reported a higher mean lumbar instability questionnaire score than those without radiological lumbar instability.
- A questionnaire score of at least 7 had a sensitivity of 100% and a specificity of 26.04% for detecting lumbar instability when compared with x-ray examination.
- A lumbar instability screening tool total score of at least 7 was ruled out lumbar instability in CLBP patients. This cutoff score may be used as a marker of conservative treatment response.
Now just to expand on that idea a bit here; many chiropractors have a mental block when it comes to spinal instability.. What I mean is that many are so subluxation-minded that they do not understand that spinal instability is not good and that adjusting too much too often can actually be the cause of spinal instability.
If I’m speaking to a vitalistic, philosophy-minded chiropractor, I’m going to say, “You’re not always slaying subluxations, Mr. Vitalist. Many times, you’re so eager for the almighty dollar and the awesome sound of pops over and over again that you create the very problem that you hoped to fix in the first place.
That is the reason our profession has developed scaled back guidelines for treatment. Have you ever encountered a neck self-adjuster? I used to be one when I was kid. It starts off pretty darn difficult to adjust your neck. Then, with repetition, it gets more and more loose to the point that all you have to do is turn your head and it starts poppping.
That is essentially what many vitalists are doing with patients when they see them repeatedly time and time again month after month, year after year. What the hell else would you expect.
Then the instability causes chronic pain that they think just needs more adjustments which actually cause more instability and more chronic pain. The cycle is perpetual and the vitalist chiropractor isn’t smart enough to figure out why they can’t get this patient feeling better. After all….isn’t it all about the mighty subluxation?
Why do they fuse spinal segments? To reduce the movement in order to reduce the pain. Doesn’t it seem there are patients that benefit more from exercise and support than from adjustments?
It turns out there are. Those that are hypermobile on the Beighton Scale and those that have instability. Just to update your knowledge on spinal segmental instability, the smoking gun of spinal instability would be
- Vertebral body anterolisthesis
- Broad-based disc bulging - flat tire vs. aired up
- Facet joint enlargement
- Ligamentum flavum hypertrophy
- Possible Modic changes.
Facet pain can often get confused with instability as well. A good example is when a patient has pain just to the left of the lumbar spine, over the facet. You push on it and it hurts. You can provoke facet pain by poking on it. But, you can provoke instability by poking on it as well.
There are a couple of general ways to focus in on what’s going on there and differentiate the two. You can have the patient stand and extend at the waste, the perform extension rotation both ways. If this doesn’t bother the patient, it’s almost certain it’s not a facet issue. Extension rotation is that accurate.
If when prone, poking on the facet hurts, you can stabilize the low back region temporarily by have the patient perform a super man / reverse plank type of a position and then, while they’re in the position and those low back muscles are good and tight and supportive, poke on the sore spots again. If the reverse plank position helps that pain, there’s a good chance it’s instability.
Also, if the low back commonly hurts when they roll over in bed, that’s could be a sign of instability as well. You don’t want to adjust instability folks. You want to strengthen it. Make it solid. In my office, we start that by doing McGill’s Big 3, the side plank, modified curl up, and the bird dog exercises.
Did you learn something? I hope, if you were lacking in this, I was able to shed some light on it for you. If you have any questions on this feel free to email me at dr.williams@chiropracticforward.com so we can discuss.
Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week.
Key Takeaways
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
Subscribe Button
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 preventativly 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.
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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 - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Chatprem, T., Puntumentakul R, Boucaut R, Wanpen S, Chatchawan U, (2020). "A Screening Tool for Patients With Lumbar Instability: A Criteria-related Validity of Thai Version." Spine (Phila Pa 1976) 45(21): E1431-E1438.
Lee S, S. D., Lee JS, Sung SK (2020). "Relationship Between Endplate Defects, Modic Change, Facet Joint Degeneration, and Disc Degeneration of Cervical Spine." Neurospine 17(2): 443-452.
CF 150: The Fate Of An OxyContin Producer & The Outdated Use of MRI Diagnosing Cervical Dysfunction
Today we’re going to talk about the outdated use of MRI to diagnose cervical dysfunction and then the fate of an oxycontin producer.
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our Facebook page,
- Join our private Facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #150
Now if you missed last week’s episode , we talked about about the costs of preventable disease and then we’ll talk about whole body vibration for function and bone mineral density in postmenopausal, osteoporotic women. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function
On the personal end of things…..
On the personal side of things, it’s an alright week. Nothing too crazy other than the rise in the Rona around the nation.
We got my biggest week last week since Rona hit us. We had 170 visits last week. Still down from my average of 182 pre-Rona but way up from an average of 135-145 post Rona.
So progress. Then this week, we’re having three days of snow, ice, and sleet. So....it’s a Texas Two Step. Two steps forward and one step back.
Patience is a virtue. Blah. Such is life.
I thought I’d share a recent experience with you all in an effort to let you know you’re not alone, we can’t make them all happy, and how I handled it.
So last weekend I got an email. It wasn’t positive. In fact, it was a bit combative. Let’s just say it wasn’t flattering. Now, I’d like to be fair to myself here. In 22+ years, I’ve had conflict or whatever you want to call it….let’s call it miscommunication. I’ve had miscommunication with patients only 3-4 times. Five if I’m pushing it. But this goes to serve as an example, you’re never too old or in practice too long to be above being questioned. In fact, in today’s culture of disrespecting ‘experts’ for lack of a better word, questioning authority, and an overall culture of lacking mutual respect…..well, I think it makes sense that we’re all more likely to have some miscommunication issues here and there.
Then, online reviews throw a whole other kink into the plan doesn’t it? So, due to respect for this person and HIPAA, I will be very vague here but in general, this person had a significant cervical disc radiculopathy. Sometimes you make a diagnosis and you’re not 100% sure but you’r heading that direction. Not with this one. There was no doubt. They were very upset. Crying. Nauseous. Not feeling well and rating the pain at a 7 out of 10 on the VAS scale.
We tried some over the door traction but it really made the person nauseous so that was out. I tried some retraction/extension exercises and started them on nerve gliding exercises to try to make some headway.
Second treatment comes and we are able to do a little more. Now they’re rating it at a 4 out of 10. Looks like we’re on easy street right? We got this!! We did very light decompression and the patient said it felt good and they were doing better.
OK. Whew. Another one on the road to avoiding surgery.
Not so fast. For whatever reason, this patient never showed up again. I don’t always think about my patients but I did think about this one because they were so severe on day one. I wondered how they were doing and why I never saw them again.
Well, this weekend’s email answered that for me. There’s no need to read the whole email just because there’s no need but the sentiment of it was that I had a conversation with them that they characterized as saying that anxiety was causing the pain and that I told them I couldn’t help them. What they took from the conversation was that I should have ordered an MRI on day one basically, that I blamed mental and emotional issues on the part of the patient for their pain and they felt that was unprofessional and uneducated. And potentially ego driven on top of all of that. They mentioned they sought out an MRI, went to a neurosurgeon, and had a two-level fusion and are on the road to recovery with the help of PT.
Oh….you know I’m always honest with you folks because honestly, that’s not flattering stuff. Nobody wants to look into themselves and say, “Does this person have a point? Where did I go wrong and how can I prevent that from happening again with someone else?
But here’s the truth, I literally don’t recall that conversation whatsoever. I have a thousand different conversations every week. But I know me. I’ve never in my life told a patient that they have mental or emotional problems and those are the source of their pain. Nor have I ever insinuated that anxiety is the pain source when it’s clear as a bell that it’s radiculopathy secondary to a disc issue. My staff has heard me repeat the same discussions, the same lines, and the same jokes day after day, month after month and they’ll be the first to tell you I’ve never said anything of the sort.
So, flummoxed as I have been, I slept on that email for the rest of the weekend thinking about it. The last thing you want to do is respond out of anger. You definitely don’t want to respond out of a defensive posture. Especially when you’re reasonably sure you did nothing uneducated or ego-driven. A response like that will only make us look more unprofessional than they already think we are and maybe even potentially provoke.
So, in short, I did not address the ego comment because I felt it was unecessary. I’ll just take my lumps on that one. I mentioned how happy I was to hear from them and hear they are recovering. I genuinely was glad. Even if the email was less than flattering. At least they got some aspect of a resolution. Even if I wasn’t the end solution. I don’t feel there’s any ego on my part in that sentiment.
I explained that we typically do a trial treatment of a week or two before deciding on advanced imaging and that would have definitely been in the considerations had we treated beyond two appointments. That’s appropriate. Some can make an argument that there was radiculopathy so we could have gotten and MRI on day one. But, if we’re honest, how many patients do you have that have radiculopathies that you are able to clear fairly quickly without resorting to an MRI? My guess is quite a few because that’s my experience. We just don’t have to get very many. But again, we have to have the chance to find out, right?
I discussed briefly that I am very much on top of current research and thinking with regards to pain and neuromusculoskeletal issues and may have been assessing yellow flags. I discussed briefly what the biopsychosocial aspect of treatment entails these days but didn’t want to dwell on it much. Mostly because I never felt it was an anxiety, mental, emotional driven thing to start with. It was clearly a disc. But I hope the mention somehow rebuts the idea that I need more education.
I offered that as a potential reason we may have had some miscommunication.
I also mentioned that there have been very few patients over the years that I would just straight up tell them “I can’t help you.” I told them that I’m typically one of the most stubborn practitioners and will hold on until it’s crystal clear I’m not helping. That, for me, has never happened after only two visits.
In a nutshell I said that being patient centered, evidence-based, and having high patient satisfaction was the most important thing to me and that I don’t recall the exact conversation or the wording but that I can learn from the email and can use it to make me better at my job and that I apprecaited them taking the time to share their thoughts with me.
In the end, I was glad to hear about them feeling better and I apologized for any miscommunication on my end.
While that sounds like a very long email, it wasn’t and I took the time to make sure it was hopefully as eloquent as a guy like myself can generate. Without arrogance, ego, combativeness, or being defensive. But WITH being caring, being professional, and being thoughtful.
Even though it may not be reciprocated, I respect this person and I DO hope they are feeling better. And, whether we feel like these things are our fault or whether we think we did anything wrong or not, we can ALWAYS always learn from stuff like this. We can always be better. I can promise you, I learned to not be lackadaisacle when it comes to speaking to patients about central nervous system upregulation or sensitization. Or when discussing the biopsychosocial aspect of pain.
People don’t know what we know about that stuff and we shouldn’t assume that it’s an easy topic and everyone ‘gets it.’ Or will get it. I really cannot explain what happened there but, I do know it made me step back and think through it though. It made me check my communication.
Again, I don’t tell you all this stuff because I love it or love to talk about it. I don’t tell you all my patient numbers weekly because I love it. I share this stuff with you because what is happening with me is real. It’s real life. And if it’s happening to me, then it IS happening to many of you. And if it’s not currently happening to you, it CAN or WILL and you may learn from me.
Not as a mentor per se but as that Ol’ Uncle Jeffro. Alright, enough with the stress talk. Geez. Not very often at all. Maybe once every 5 years or so but when it happens……geesh. I take it personally, I take it home, I dwell on it, and I’m not too proud to admit that it affects me. I care. I truly do. If you get anything from this podcast and all of these episodes, it should be that I care. I care about chiropractic patients, our profession, ethics, morals, professionalism, education, and doing it the right way.
I care.
Item #1
Let’s start out with this article that was in CNN Business last week. It’s an article by Chris Isidore called, “OxyContin maker to plead guilty to federal criminal charges, pay $8 billion, and will close the company”(Isidore 2020). It was published on October 21, 2020, it’s cold as hell in Texas but that….that’s hot.
The highlights of the article are that Purdue Pharma, the maker of OxyContin, has agreed to pleading guilty and to pay more than $8 billion. Not only pay $8 billion but to also close down the company.
What?
Yeah, they say the money will go to opioid treatment and abatement programs. "Purdue Pharma actively thwarted the United States' efforts to ensure compliance and prevent diversion," said Drug Enforcement Administration Assistant Administrator Tim McDermott. "The devastating ripple effect of Purdue's actions left lives lost and others addicted."
They say, “The company doesn't have $8 billion in cash available to pay the fines. So Purdue will be dissolved as part of the settlement, and its assets will be used to create a new "public benefit company" controlled by a trust or similar entity designed for the benefit of the American public. The Justice Department said it will function entirely in the public interest rather than to maximize profits. Its future earnings will go to paying the fines and penalties, which in turn will be used to combat the opioid crisis."
Maybe it’s just me but that sounds Big Brother as hell to me. Don’t get me wrong, pharma companies, in many instances, are of the devil but to dissolve them, then recreate them and they be basically government run? I don’t know about all that but to me, that’s what this sounds a bit like.
They go on to say, “That new company will continue to produce painkillers such as OxyContin, as well as drugs to deal with opioid overdose.
“The company, which filed for bankruptcy in 2019, pleaded guilty to violating federal anti-kickback laws, as it paid doctors ostensibly to write more opioid prescriptions.” What a-holes. Paid doctors to write more opioid prescriptions. And what a-hole of a doctor do you have to be to take payment to write addicting prescriptions in the first damn place? Honestly.
Meanwhile, we recently crossed the 450,000 dead mark. Dead from opioid-related overdoses. All the while we evidence-based chiropractors sit and watch stuff we could help treat just spiral out of control. We’re sitting on the bench waiting for the coach to put us in the game but we just rarely get our number called.
If they want to make surgeons the quarterback of the football team, at least we could be the running back or tight end or something. Geez. We could be a key part of the pain team and research has told the stake holders several times. But nope. We’re stuck riding the pine.
A little further down in the article, my worries are actually hit on when they say, “So some states are objecting to the settlement. Twenty-five state attorneys general wrote to US Attorney General William Barr last week arguing against the plan to create a government-controlled company out of the assets of Purdue Pharma, arguing that the government should not be in the business of selling OxyContin.” And I agree with the 25 state attorneys general. That, to me, is not what American was built on.
Again, don’t get me wrong, I’m all about punishing the hell out of a corrupt and evil company like Purdue Pharma. I’m even all about putting them out of business. Hell, the Statler family that runs this business pulled $10 billion out of the company and placed into family trusts before filing bankruptcy. It’s a bad group of people. Lop they’re damn heads off if you think they deserve it…..OK, maybe not to that extent but you get my point.
But, putting a company out of business and then stepping in as the government to take it over and run it…..no. I don’t like it. But that’s just me.
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Item #2
Alright, my last one today is called “Twenty years of ‘insanity’ in diagnosing underlying clinically relevant cervical dysfunction using traditional MRI” by Anton Bowden and published in the Journal of Spine Surgery in September of 2018 and it goes a little sumpin’ like dis.
Why They Did It
Bowden starts by saying “Studies dating back several decades have failed to show strong correlation between abnormal MRI scans of the intervertebral discs and clinical symptoms. Which you know if you’ve been following along. This is part of why the patient I mentioned earlier was mad at me for not immediately ordering an MRI.
He continues, “The recently published 20-year prospective longitudinal study of cervical spine disc degeneration by Daimon et al.(Daimon K 2019), is perhaps the strongest confirmation to date affirming that intervertebral discs naturally degenerate with age, and that evidence of degeneration alone is insufficient information with which to make a conclusion regarding the root cause of a patient’s symptoms.”
We have covered that paper here on the Chiropractic Forward Podcast before.
discusses the study at length saying, “Daimon et al. found that while MRI signal intensity longitudinally decreases across all cervical disc levels, there is a peak in structural degeneration that occurs at the C5–C6 level, with C4–C5 and C3–C4 having progressively lower degeneration rates. Since the C5–C6 level also corresponds with the highest flexion-extension range of motion of the cervical spine, a mechanical component of the degeneration process appears to be highlighted by the study. Once the C5–C6 level has been destabilized due to degeneration, sequential acceleration of degeneration at adjacent levels was observed. This insight has relevance to current discussions regarding adjacent-segment disease subsequent to arthrodesis and arthroplasty.
The authors also observed that 95% of subjects experienced degenerative progression over the 20-year study period, while only 67% developed clinical symptoms. This observation lends strength to the argument that trying to fight all forms of disc degeneration is an insolvable fight against nature, at least for the foreseeable future.”
I was happy to see him mention this, “As a biomechanist, I would be remiss to point out that imaging alone is missing fundamental information regarding the dynamic function of the spine. Spines that look very similar while lying down in the MRI may move very differently while going about activities of daily living—and the consequences can be dramatic for mechanical loading and pain in the discs and adjacent spinal structures “
Here on the show in some of the earlier episodes, we covered the fact that discs that show little to no issues in the supine position can look very different when seated or standing. Signficantly different as a matter of fact. The research has been done on this yet I’ve had discussions with two separate radiologists and both of them guessed there would be little to no change in the disc with position change.
That’s just not the case is it? I’m happy to see this author recognize the fact.
Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week.
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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 preventativly 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.
Website
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About the Author & Host
Dr. Jeff Williams - Fellow of the International Academy of Neuromusculoskeletal Medicine - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
- Bowden, A. (2018). "Twenty years of ‘insanity’ in diagnosing underlying clinically relevant cervical dysfunction using traditional MRI." J Spine Surg 4(3).
- Daimon K, F. H., Nishiwaki Y, (2019). "A 20-year prospective longitudinal MRI study on cervical spine after whiplash injury: Follow-up of a cross-sectional study." J Ortho Science 24(4): 579-583.
- Isidore, C. (2020) "OxyContin maker to plead guilty to federal criminal charges, pay $8 billion, and will close the company." CNN Business.
CF 149: Preventable Disease And the Impact & Whole Body Vibration For Function and Bone Density
Today we’re going to talk about the costs of preventable disease and then we’ll talk about whole body vibration for function and bone mineral density in postmenopausal, osteoporotic women.
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our Facebook page,
- Join our private Facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #149
Now if you missed last week’s episode , we talked about manipulation for concussion, sleep and cognitive decline, and we talked aobut demential predictors and prevention. Super interesting stuff. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function
On the personal end of things…..
We were busier last week. If you’ve listened for very long, I’ve tried to be open and honest about my numbers each week so that listeners will know where they stand. They’re either doing better or they’re doing about the same. Some will be doing worse. Either way, maybe I can be a measuring stick of some sort.
The best I have done since COVID reared it’s stupid face is 145 visits in one week. That’s down from an average of 182 per week in 2019. So, that’s quite a difference. I keep immacualte stats so I know that in 2020, I have averaged 117 per week but that includes when we were closed and then when we were emergency only.
Since we finally got up and running full steam back in May, I have averaged 136 per week. That puts me at about 75% of my pre-COVID point. So, I just need to average about 46 more visits per week to get back to 100%. No big deal right? Lol. That’s a solid jump but I’m a do-er and I have positive energy and a healthy amount of confidence.
And, we got a good start last week. Last week for the first time, I beat the 145 mark that I had been limited to and saw 158. Just in time for the Rona to start surging back and freaking people out again. Lol. Such is my luck. We shall keep trudging, keep being smart, and keep doing what we can to stay healthy.
If it all works out, we should be back to 100% by the end of the year. That’s my goal at least. As I type this out, we have 48 on the books today which is about 10-12 more than we’ve been seeing on Mondays. So things are looking up.
Be safe folks, we’re not out of the crap yet. In fact, as of the time I’m typing this, it’s worse than it has been for a while. Just keep being safe, keep working, and do what you can to take care or yourself and those around you.
Item #1
The first one we’re going to talk about today is called, “The cost of preventable disease in the USA” by Galea, et. al(Galea S 2020). published in The Lancet on October 1, 2020. Aye chiuaua. es too mucho caliente.
https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30204-8/fulltext?fbclid=IwAR3VMx1p1cZZTdT9o3_b6GkgSzfbImiOPPKLJFElqMKaHN5Vi-3OpkqwDTg
This is more article and discussion so as usual when we cover stuff like this, we’ll just hit the high points and summarize it for you.
They start by stating that a substantial proportion of poor health in populations is preventable and cite the Global Burden of Diseases, INjuries, and Risk FActors Study that suggests nearly half of all health burdern in the US is attributable to a list of 84 modifiable risk factors.
They say that globally, up to half of all deaths fall into the category of preventable deaths. They estimate that more than 1/4 of health-care spending was due to these preventable illnesses. Not only that but the US heatlhcare spending is notoriously expensive spending 16.9% of its GDP on healthcare which is TWICE as much as the average of other similar countries.
In fact, our spending is mroe than the 2019 GDP of 171 coutnries in the world. All but the 19 wealthiest.
They ask a wonderful question, “Why do we continue to accept such a high burden of preventable disease, even when the cost of it is known?” Great question. Especially when you’re looking at it from a chiropractor’s point of view. Fusion surgeries run around $50,000 each, are basically useless, and put the patient at signficant risk of additional, expensive surgery. Epidural injections are useless as well. We have plenty of studies showing how we save money and cost much less than traditional medical care for back pain. We have surveys and research showing that our patient outcomes and satisfaction are superior to PT and general practitoners. We have the American College of Physicians, The Joint Commission, and The Lancet recommending spinal manipulation and exercise as first-line treatments. Yet, we are not inundated with referrals for chronic and acute low back pain.
We should be absolutely flooded with referrals. We should be emptying out lobbies of furniture so we have more room in the corner to put a new referral. But nope. Hell no. My opinion is because we have vitalist chiropractors trying to convince patients they have to see them every week for the rest of ever…..as long as ye shall live….forever and ever amen. Taking x-rays and convincing them they’re going to die if they don’t fix that decreased curvature. Telling patients they’re going to pop their back and fix their gall bladder issue.
THAT’S why we can’t have nice things. You have these evidence-based, patient-centered chiropractors over here going, “What they hell? We can help these people so much!” But we’ll never get the chance because vitalists don’t know how to stay in their lane. To be fair, they were taught their lane was much larger than research suggests it is. We do what we’re taught. The difference is, some of us are better at smelling BS than others.
Too many chiropractors have a stopped up nose and can’t seem to smell very well. Which is unfortunate.
Back to the article, they say, “The high burden and cost of preventable disease should push us to think differently about health at a foundational level.” And to that I say, “Indeed, Sir.”
They also say that we should embrace the notion that no amoutn of preventable death or illness is acceptable and that about $730 billion could be repurposed. Like to pay our debt…..just a suggestion.
They conclude by saying, “high body-mass index, high systolic blood pressure, high fasting plasma glucose, dietary risks, and tobacco smoke exposure account for most of the spending on preventable illness. Preventing these risk factors would require an engagement with subsidising the availability of nutritious foods, disincentivising the commercial production of harmful products, investing in early childhood education that leads to healthy exercise and dietary habits, and creating cities that encourage healthy behaviours.”
For example, why does healthy food cost more than garbage food? That’s exactly reverse of what it should be. If we really care about lower socioeconomic folks and you want to fight for universal healthcare and things of that sort, wouldn’t it make sense to protest stuff like that?
Why aren’t we seeing picket lines outside of Tyson food factories or in front of grocery stores. They could be carrying signs that say, “Stop keeping our poor fat” or “make healthy affordable” or stuff like that. I’ll keep watching the TV. I’m not holding my breath though. Making healthy food affordable isn’t quite as sexy as all of the other reasons people are finding to stay outraged these days.
Don’t get me wrong, I’m not making light of peaceful and respectful protest. That’s what Amercia is built on. I’m less understanding of the destruction, riots, and death that have come with so many of the more recent activities.
Anyway, it’s a great article and I’ve linked it in the show notes at chiropracticforward.com if you’d like to go a little further in depth in the thing. Chiropractors can help this issue though. The research is there. They just have to start giving it a try. I think they’d be surprised with the results. Unless they referred to a vitalist. Then, when the patient reported back to the MD, the MD would probably never make another referral to a chiropractor as long as they lived once they realize that their referral made them look like an idiot. Just a guess.
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Item #2
This one is called “Effect of Whole-Body Vibration Exercise on Power Profile and Bone Mineral Density in Postmenopausal Women With Osteoporosis: A Randomized Controlled Trial” by ElDeeb, et. al(ElDeeb A 2020). published in the Journal of Manipulative and Physiological Therapeutics in May of 2020…..eh….it’s not fresh from the fire but it’s still steaming out of the microwave.
https://www.jmptonline.org/article/S0161-4754(20)30044-0/fulltext
Why They Did It
To investigate the effect of whole-body vibration (WBV) on muscle work and bone mineral density (BMD) of the lumbar vertebrae and femur in postmenopausal women.
How They Did It
- 43 postmenopausal women with low bone mineral density
- randomly assigned to WBV and control groups
- Both groups got calcium and Vit D supplementation once per day
- The WBV group additionally got WBV exercises 2x/week for 24 weeks
- Hip power generation and absorption, knee power absorption and generation, ankle power generation adn absoprtion were all measured.
- Dual-energy X-ray absorptiometry was used to measure bone mineral density of the lumbar spine and femor before and after intervention
What They Found
- There were significant increases in the hip muscle work, knee muscle work, ankle musle work during gait in the WBV group.
- Bone mineral densityof the lumbar spine and femur were significantly increased in the WBV group.
- However, there were no significant changes in teh control group
- The posttreatment values of the hip, knee, and ankle muscle work and the bone mineral density of the WBV group were significantly higher htan the posttreatment values of the control group.
Wrap It Up
The conclusion states, “Whole-body vibration training improved the leg muscle work and lumbar and femoral bone mineral density in postmenopausal women with low bone mineral density.”
Pretty interesting stuff, folks. Is this definitive proof? No. The sample size is small but it is randomized which is good. Would I advertise that I’m going to increase osteoporotic BMC? Nope. If my mom had osteoporosis, would I have her on the WBV? You bet your sweet bippy I would.
Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week.
Key Takeaways
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
Subscribe Button
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 preventativly 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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Fellow of the International Academy of Neuromusculoskeletal Medicine - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
ElDeeb A, A.-A. A. (2020). "Effect of Whole-Body Vibration Exercise on Power Profile and Bone Mineral Density in Postmenopausal Women With Osteoporosis: A Randomized Controlled Trial." J Manipulative Physiol Ther 43(4): P384-393.
Galea S, M. N. (2020). "The cost of preventable disease in the USA." The Lancet 5(10): E513-E514.
CF 145: Kids Still Hurt, Manipulation For Lumbar Radiculopathy, & Lack Of Attention On The Boards For Biopsychosocial Matters
Today we’re going to talk about how kids can hurt, SMT for chronic lumbar radiculopathy, lack of testing on biopsychosocial matters.
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our Facebook page,
- Join our private Facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #145
Now if you missed last week’s episode , we talked about some of the most common musculoskeletal surgeries and the incredible lack of research backing them up. We also talked about how chiropractic performs when lined up against multidisciplinary treatment. Check it out after this one. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.
On the personal end of things…..
I think I’m getting busier. Feels like it anyway. 143 last week and the new patients are staying steady. Which is a good thing. I have the kind of practice that depends on new patients. When you’re evidence-based and you don’t make a ton of long-term recommendations…..you don’t make patients think they need to depend on you every week for the rest of their lives….well then, you have a constant turnover of patients.
My longest recommendation is for about a 3 month plan. Honestly, most people are feeling so good that they don’t wrap up a 3 month plan. Some of you agree with that and some of you will say I should be holding them to the program but, research is clear on this.
We should be teaching patients to self-manage at home. Not depending on us. And that’s part of it. Once they start self-managing and they’re feeling great, where’s the motivation to pay someone to mostly do what they’re doing at home already? I get it. And I don’t fuss with patients over their schedules when they’re doing amazing in the first damn place. There’s a point where that type of fussing and borderline bullying starts to look like greed. And I’m sure none of us want to look greedy. At least I don’t.
That’s the epitome of being patient-centered, right?
But the point is, patient-centered, evidence-based chiropractors need a steady stream of new patients.
Now don’t get me wrong; I have wellness patients. They just aren’t the bulk of my practice. If I just depended on wellness/maintenance patients, we’d be in a world of hurt up in here, up in here.
Not long ago, evidence-based chiros threw monkey poo at maintenance. Then Andres Eklund came around and cleaned up the monkey mess. Then a systematic review recently came out saying maintenance care can now be considered evidence-based. It felt like slipping into a warm coat in the winter, ya know. Lol.
Now, that doesn’t mean once a week for life like the subluxation slayers lay on people. For the right population, once every month or two….or maybe every three months….that does indeed make difference and make some sense. If you’re unfamiliar with Andres Eklund, just go to our episodes link at chiropracticforward.com and use the search function there to search for maintenance care or Nordic papers and dive in. It’s wonderful stuff.
I love it when the hard work has already been done by people smarter than me. It’s good stuff.
Outside of all that boring stuff, still just trying to stay strong and healthy. I’m exercising much more regularly and really watching what I’m eating. It’s paying off too. I lost 7 pounds last week. Yeah, I know what you’re thinking…..how could Jeff get any sexier than he already is but I’m just going to say, hold my beer and watch. My michelob ultra beer that is…..because, you know….I’m on a diet and all. Lol.
I have one kid at Texas Tech where COVID is spreading like a bad STD and then I have another in person in junior high. So far in the first 5 weeks they’ve had 2 teachers and 2 kids out with the Rona. That may sound like a lot but, honestly, this junior high has about 1400 kids so……that’s not much.
The kid at Tech thinks he wants to come home every 2 weeks for the weekend. I love seeing the little knucklehead but another part of me is like…..you stay over there on that side of the house…..I’ll be on this side. He’s a big hugger. I’m normally good for a hug and all but…..Rona has me trying to stay healthy. You can’t turn down a hug from your kiddo though. Still……it’s a bit nerve wracking.
I tell people and you may have heard me say it but, most folks do fine if they get COVID and I expect I’ll do fine as well. Other than being out of shape and overweight, I’m not particularly unhealthy. Most folks, if they get it, they just stay home in bed, fluids, all that rigamarole but no big deal really.
Me….and most of you….we have to close down out businesses essentially. I have 14 employees, y’all. They have families. We bill out anywhere from $20k-$25k per week typically. At minimum, I’m probably out for 2 weeks. That means missing out on up to $50k in billing.
One word, two syllables….Day-um….Hell no. I’ll just do everything I can to stay healthy in the first place. Even if some knuckleheads don’t understand or get it.
Speaking of…..These anti-maskers….good Lord. I don’t know how they are where you live but here in Texas, did you know all kinds of degrees have morphed into now allowing the owner of the degree to now be an expert on epidemiology? Very powerful degrees. I’ve never heard of a degree that morphs into epidemiological expertise but evidently, it’s a fact these days.
I saw a great quote from a fellow chiro that went something like this, “I guess I just don’t understand the argument anti-maskers make in general. Regardless of anything, for me, as a healthcare professional, I need to be flexible and consider being wrong as part of my logic. Simply put, maybe masks work, maybe they don’t but it really doesn’t matter what you believe. The question sreally is, if you’re wrong can you live with the consequences?
I wear a mask because I believe it reduces the risk of exposure for me and to those around me, but more importantly, if I’m wrong I won’t hurt anybody at all. Including myself. If you don’t wear a mask and you’re wrong, then the effects can be devastating during a really off day when things go they way they’re not supposed to go.
Or, how about the sneeze test? Have someone sneeze on you with a mask on and then have them sneeze on you without a mask on.
Which do you prefer?
End of story.
Let’s get on with it. We have some pretty cool stuff to breeze through today.
Item #1
Let’s start with this one called “Musculoskeletal pain distribution in 1,000 Danish schoolchildren aged 8–16 years” by Fuglkjaer et. al. it also has Jan Hartivigsen on it as well. It was published in Chiropractic and Manual Therapies in August of 2020(Fuglkjaer S 2020).
Hot tamale, hot tamale, that tamale….it’s hot…
Why They Did It
The objectives were to group children aged 8 to 16 according to their distribution of pain in the spine, lower- and upper extremity, determine the proportion of children in each subgroup, and describe these in relation to sex, age, number- and length of episodes with pain.
How They Did It
Data on musculoskeletal pain from about 1,000 Danish schoolchildren was collected over 3 school years (2011 to 2014) using weekly mobile phone text message responses from parents, indicating whether their child had pain in the spine, lower extremity and/or upper extremity. Result are presented for each school year individually.
What They Found
- Around 30% reporting no pain, around 40% reporting pain in one region, and around 30% reporting pain in two or three regions.
- Most commonly children experienced pain from the lower extremities at about 60%, the the spine at about 30%, and then upper extremities at about 23%.
- Twice as many girls reported pain in all three sites
Wrap It Up
Danish schoolchildren often experienced pain at more than one pain site during a schoolyear, and a significantly larger proportion of girls than boys reported pain in all three regions. This could indicate that, at least in some instances, the musculoskeletal system should be regarded as one entity, both for clinical and research purposes.
Item #2
This one is excellent. It’s called “Spinal manipulation for subacute and chronic lumbar radiculopathy: a randomized controlled trial” by Ghasabmahaleh, et. al. and published in The American Journal of Medicine on September of 2020(Ghasabmahaleh S 2020).
Sizzlin, smokin’. some stout stuff, y’all.
Why They Did It
The authors wanted to evaluate the efficacy of spinal manipulation for the management of non-acute lumbar radiculopathy.
How They Did It
- It was performed in a university hospital
- It was a randomized controlled trial with two parallel arms.
- 44 patients with unilateral radicular low back pain lasting more than 4 weeks were randomly allocated to manipulation and control groups.
- The primary outcome was intensity of the low back pain on the VAS scale
- Secondary outcome was the Oswestry Disability Questionnaire score
- In addition they measure spinal ranges of motion.
- All patients had physiotherapy
- The manipulation group got three sessions of manipulation therapy, one week apart.
- For manipulation, they used Robert Maigne’s technique.
What They Found
- Both groups experienced a significant decrease in back and leg pain
- However, only the manipulation group showed significantly favorable results in the Oswestry scores, and the straight leg raise test.
- All ranges of motion increased significantly with manipulation but the control group showed favorable results only in right and left rotations and in extension
- Between-group analyses showed significantly better outcomes for manipulation in all measurements with large effect sizes
Wrap It Up
They wrap it up by saying, “Spinal manipulation improves the results of physiotherapy over a period of three months for patients with subacute or chronic lumbar radiculopathy.”
I say hell with that conclusion. Lol. I say that PT ADDS TO spinal manipulation. I’ve told my patients for years now that there is great research for spinal manipulation and there is great research for exercise. It’s not about one or the other. They’re not mutually exclusive. The research is best for combining the two.
If you go to a PT and just get exercise, that’s not the full meal deal. You’re a taco or two short of a combo meal there.
If you go to a chiropractor and only get adjustments, yes, there should be some relief but, again, you a taco short. You could be better.
You don’t want evidence-based chiros out there in the world wishing you didn’t suck so much. Get on the exercise rehab. Learn. I didn’t used to know much about it. Hell, if I’m being honest, there’s A LOT more I still need to learn but I’m a hell of a lot better than I once was.
Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. I love new toys! If you’re into soft tissue work, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend.
Drop Release uses fast stretch to stimulate the Golgi Tendon Organ reflex. Which causes instant and dramatic muscle relaxation and can restore full ROM to restricted joints like shoulders and hips in seconds.
Picture a T bar with a built-in drop piece. This greatly reduces time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day. Drop Release is like nothing else out there, and you almost gotta see it to understand, so check out the videos on the website.
It’s inventor, Dr. Chris Howson, from the great state of North Dakota, is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase.
Go check Drop Release at droprelease.com and tell Dr. Howson I sent you.
Item #3
Last one today is called “The prevalence of psychosocial related terminology in chiropractic program courses, chiropractic accreditation standards, and chiropractic examining board testing content in the United States” by Gliedt et. al. published in Chiropractic and Manual Therapies on 21st of August 2020(Gliedt J 2020).
On the hottest, freshest frijoles for the Forward fans.
Why They Did It
Chiropractors treat spine complaints and therefore should be trained in the full spectrum of the biopsychosocial model. This study examines the use of psychosocial related terminology in United States doctor of chiropractic program (DCP) curricula, the Council on Chiropractic Education (CCE) standards, and the National Board of Chiropractic Examiners (NBCE) test plans.
How They Did It
Nineteen academic course catalogs, CCE curricular standards and meta-competencies, and NBCE test plans were studied
Wrap It Up
Despite evidence suggesting the influential role of psychosocial factors in determinants of health and healthcare delivery, these factors are poorly reflected in United States DCP curricula. This underappreciation is further evidenced by the lack of representation of psychosocial terminology in NBCE parts III and IV test plans. The reasons for this are theoretical; lack of clarity or enforcement of CCE meta-competencies may contribute.
So when you hear people ask what we can do to make this profession better, stronger, and more respected…..this is just one more thing that can be done.
Our institutions can recognize the biopsychosocial aspect of chronic pain, they can teach it, they can teach yellow flags, and then they can test it.
Then we can look at making entrance into the schools a little more stringent and we can look at taking the subluxation slayers and spine whisperer courses out of our colleges. If someone wants to learn how to be doctor-centered and use x-rays to manipulate patients out of thousands of dollars a year, they need to be learning that garbage outside of an accredited chiropractic college. It has no place in our institutes beyond some historical perspective.
Over and out. Mic drop, bam, shazam, ala cazam.
That’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week.
Key Takeaways
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
Subscribe Button
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 preventativly 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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Fellow of the International Academy of Neuromusculoskeletal Medicine - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Fuglkjaer S, V. W., Hartvigsen J, Dissing KB, Junge T, Hestbaek L, (2020). "Musculoskeletal pain distribution in 1,000 Danish schoolchildren aged 8–16 years." Chiropr Man Therap 28(45).
Ghasabmahaleh S, R. Z., Dadarkhah A, Hamidipanah S, Mofrad R, Najafi S, (2020). "Spinal manipulation for subacute and chronic lumbar radiculopathy: a randomized controlled trial." The American Journal Of Medicine.
Gliedt J, B. P., Holmes B, (2020). "The prevalence of psychosocial related terminology in chiropractic program courses, chiropractic accreditation standards, and chiropractic examining board testing content in the United States." Chiropr Man Therap 28(43).
CF 144: Common Surgeries Aren’t Well-Researched & Chiropractic Wins Again
Today we’re going to talk about how some of the most common musculoskeletal surgeries aren’t very well-researched and we’ll talk about how chiropractic performs when lined up with multidisciplinary treatment.
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our Facebook page,
- Join our private Facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #144
Now if you missed last week’s episode , we talked about a new paper that came out in JAMA that said spinal manipulative therapy doesn’t work and what our research experts have to say about that and what my big mouth has to say about it. Make sure you don’t miss that info. Keep up with the class. There may come a time you need to make a stance on that.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.
On the personal end of things…..
I’m trudging through the designated doctor program here in Texas to assess extent of injury, return to work, and all of that fun fun stuff. I’m not even sure why I’m doing it. Just to have back up plans. I like multiple streams and I like options. If I get as busy as I was in 2019, I’ll never have the need for it. If it stays where I’m at - 75% of where I was, well it may be something I entertain.
Either way, will it make me a better doctor for personal injuries, work comp, and all patients in general? Hell yeah it will. Even if I never use it for a DD exam, I’ll be a better doc after going through it. Guaranteed. Even if I don’t pass the damn test!! Which I hear is stupid and has nothing to do with the curriculum. Even if I fail the test, I’ll be better.
It is slowly cooling off here in the Texas Panhandle. While I realize we just went through the longest Spring and Summer known to mankind, I’m going to miss it. Despite all that went into making it the longest Spring and SUmmer ever….I’m going to miss the aspect of time slowing down, sitting on the back patio with my wife, dinner outside in the outdoor kitchen, swimming in the pool, and just being warm in general.
Oh how I despise the cold weather. Lol. Here’s where you Northerners call me a pansy but….it’s like needles when the cold wind blows. I grew up a couple of hours north of where I live now and there was a difference in weather. At times, it would get bone chilling cold growing up. I would take a shower in the morning before school, drive there and park, and walk into the school. My wet hair from showering would freeze before I got into the building. Now that’s cold, folks.
I grew up with that, yes, even in Texas. My hometown is called Perryton, TX and it’s only 7 miles from the tiny little strip of Oklahoma and it’s about 45 miles from Kansas. So, it’s not deep in the heart of Texas. It’s way up North.
My point is, I went to school down in Natchitoches, Louisiana and then lived in Dallas for about 6 years before relocating back to the Texas Panhandle and Amarillo, TX.
Having not been in the cold cold for 8-10 years got me spoiled to the point that I can’t hardly even tolerate cold weather anymore. At all. For any reason. It borderline pisses me off.
Everything dies, it’s cold, it’s windy, people are all yay about pumpkin spice crap, my bones ache a bit, and I’m bitchy 2/3 of the time.
I’m just warning you all, this is what you get to look forward to dealing with for the next 3-4 months. My whiny butt being all cold weather fussy. But here’s the saving grace and the best thing since sliced bread; the remote start vehicle.
Yes, as any good Texan, I have a pickup and that dude has remote start with defrost and heated seats. You damn right. This is the ONE thing that has made Winter somewhat tolerable for me and, being a good Christian, I thank God and the car companies on the frigid mornings for blessing us all with such wonderous inventions like the remote start.
Now, I don’t want you North Dakota or Canadian friends of mine rolling your eyes too hard at me here. I’m sure you’d melt down here in TX in the Summers so…..we agree to play to our strengths and roll on down the road. Trust me, go through two-a-days in college in Louisiana and tell me how tough you are. Lol. Something you don’t see on TV when you watch football is the humidity. It’s REAL.
I went from three-a-days at one college playing football here in the Texas Panhandle to two-a-days in Louisiana. Not a problem by anyone in the Panhandle but in Lousiana it looked like a battlefield with players dropping left and right with cramps and having to get IVs there on the practice field….it was insane. So, I’m cold intolerant but I can handle the other end of it. Don’t be too hard on me. Lol.
What does all of this have to do with chiropractic and research? Not a damn thing. Just a little bit of fun rambling and brain dump.
Let’s get on with the real reason we’re here.
Item #1
This first one came to me from Dr. Craig Benton, one of my buddies, down in Lampassas, TX where it’s always a bit balmy almost year round. It’s called “Integrating a multidisciplinary pain team and chiropractic care in a community health center: an observational study of managing chronic spinal pain” by Prater et. al(Prater C 2020). and published in Journal of Primary Care & Community Health on September 10th of 2020. Holy smokin scorchin’ blaze of newness!
Look, y’all should know how I feel about chronic pain by now. This is right down my alley. Not a dark alley. No, one that’s lit up like a airport runway. Bright alley.
Why They Did It
They say that chronic pain is one of the most common diseases in the US with the underserved population being most affected for obvious reasons. They say the underserved are at more risk of opioid misuse or overuse since they lack therapeutic access otherwise. For this reason, they are looking for other avenues to provide treatment to chronic pain sufferers.
How They Did It
- This was a prospective observational pilot study
- Held at a community health center
- Measured the effectiveness of two interventions among the underserved population
- The two interventions were
- Multidisciplinary team
- Chiropractic care
- The outcomes measured were pain and functional disability measured via the Pain Disability Questionnaire and reduction of opioid dosage at 6 and 12 months.
- 35 folks complete baseline an dfollow-up outcome measures from August 2018 to May 2020
Wrap It Up
A key finding was quote, “Participants in the chiropractic team and those completein ghte study before COVID-19 were found to have significantly greater improvement at follow-up.”
Well isn’t that sexy? Indeed.
“This observational study within a community health center resulted in improvement in spinal pain and disability with chiropractic care versus a multidisciplinary pain team. Offering similar services in primary care may help to address pain and disability, and hopefully limit external referrals, advanced imaging, and opioid prescriptions.”
This was a pilot study with a small sample size. Nothing to do back flips about but it’s a start down this path or thinking and learning so hopefully, we’ll see some very cool and very positive things for the chiropractic profession down the line if papers like this continue to come out.
Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. I love new toys! If you’re into soft tissue work, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend.
Drop Release uses fast stretch to stimulate the Golgi Tendon Organ reflex. Which causes instant and dramatic muscle relaxation and can restore full ROM to restricted joints like shoulders and hips in seconds.
Picture a T bar with a built-in drop piece. This greatly reduces time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day. Drop Release is like nothing else out there, and you almost gotta see it to understand, so check out the videos on the website.
It’s inventor, Dr. Chris Howson, from the great state of North Dakota, is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase.
Go check Drop Release at droprelease.com and tell Dr. Howson I sent you.
Item #2
I think I got this one from Dr. Craig Benton as well. Dr. Benton is a former guest of this podcast. Sounds like we need to have him back on. He’s my allstar this week. Thank you, Dr. Benton. For keeping me in business and helping me keep everyone, including myself, educated.
This one is called, “Surgery for chronic musculoskeletal pain: the question of evidence” authored by Harris et. al(Harris IA 2020). and published in Pain Journal in September of 2020. Blisters!!! I got blisters on my fingers!!!
You Beatles fans…..you’ll get it.
Why They Did It
They say that globally, the most common reasons surgery is performed relates to the musculoskeletal system and outside of injury, the most common reasons pertain to arthritis and back or neck pain. AKA - chronic pain. Yes, I love me some chronic pain people! Not suffering from it. Learning about it and treating it.
They say, “Although the surgical treatment of chronic pain generally relies on attributing pain to objective, often visible changes on imaging studies, the causes of chronic pain are more complex and are strongly influenced by psychosocial factors.”
Things like Yellow Flags. Go look up yellow flags and Annie O’Connor’s book called World Of Pain please and thank you.
They say that surgeries like debridement of degenerative joints and things of that nature ignore the complexity of chronic pain. They look at surgery as purely mechanistic in nature with little to no involvement otherwise and the procedures often rely on observational evidence only, rather than rigorous, comparative trials.
In addition, they say that when the trials have actually been performed for these surgeries have been mostly subejective and measurements are usually not blinded to reduce bias of the outcomes.
Do you want yourself or loved ones cut into when the procedure has not been thoroughly investigated, researched, and tested? Uh hell no. No thank you.
This paper was writte to demonstrate that observational evidence is not adequate when you consider the costs and risks of surgrical intervention. They advocate surgical procedures should undergo randomized controlled trials with blinding and showing statistical and clinically important symptomatic improvement when compared to no surgery at all.
Wouldn’t you expect that they already do this???? Evidently not. At all, really.
Ultimately in this paper the goal here was to quantify what kind of support exists in the literature for some common procedures.
How They Did It
- First thing to do was identify the common procedures performed for chronic pain
- Secondly they had to identify the number of published RCTs comparing each procedure to a control group treated without that procecure
- They did a search of the Cochrane Central Register of Controlled Trials
- Each paper was reviewed by two independent authors
What They Found
- A very low proportion of the RCTs on teh selected procedures compared the procedure to not performing the procddure. 64 from the more than 6,735 studies. Less than 1% if you’re keeping track. Is that not stunning? And infuriating?
- Of those 64, only 9 were favorable to surgery.
- When considering individual surgical procedures, the majority of comparative trials did not favor surgery
- None of the studies using patient blinding for any procedure found it to be significantly better than not having the surgery at all.
Wrap It Up
We conclude that many common surgical procedures performed for musculoskeletal conditions causing chronic pain have not been subjected to randomised trials comparing them to not performing the procedure. Based on the observation that when such studies have been performed, only 14% (on average) showed a statistically significant and clinically important benefit to surgery; there is a need to produce such high quality evidence to determine the effectiveness of many common surgical procedures.
Furthermore, the production of high-quality evidence should be a requirement before widespread implementation, funding or professional acceptance of such procedures, rather than the current practice of either performing trials after procedures have become commonplace, or not performing comparative trials at all.”
Wouldn’t you like it in the year 2020, when we hear bragging about the amazing advances of medical wonders and technology, and sometimes rightfully so…..would you like it if these things that should go unsaid are actually done?
Wouldn’t you like to know that your mom’s spinal surgery procedure was fully vetted. It was researched against not doing it at all? They haven’t done that? Seriously?
Look, ever heard of phantom limb pain? Just in case, it’s where a limb is amputated. Cut off completely. Yet, it still hurts. Why the hell does something that is gone and no longer exists still hurt? It’s because chronic pain lives as much or more in the brain as it lives in a peripheral source.
So, if you go in and do surgery on arthritis for a chronic pain sufferer, what are the real chances that you got rid of that pain? How many people have arthritis that commonly doesn’t bother them much at all beyond the first 15 or so minutes after they wake up? The answer isn’t precise but it’s probably a hell of a lot if I’m placing bets.
Did you know that if a person has surgery and they’re in chronic pain syndrome that even if the surgery goes perfectly, they will still have a 60% chance of developing pain at the new site of surgery? That’s what happens when you have a sensitized or upregulated central nervous system. It’s on high alert and using pain to make your future decisions and to protect you. You have to turn the volume down on the central nervous system if you’re ever going to control the pain in the brain. It’s actually the MOST IMPORTANT aspect of treating chronic pain.
How many people get surgery when they don’t need it because the arthristis isn’t really the issue. When the issue actually lies withing the limbic system in the brain? To be fair, how many people get adjusted by the chiropractor a million times because they’re trying to pop out the pain? Hell, doing that a million times only deepens the issue.
Don’t get me wrong, there’s SMT benefit in regard to proprioceptive input, sensorimotor function, movement dysfunction, blood flow, and pain modulation but…..beyond a certain point, it will create instability and that will deepen the issue.
I tell new chronic patients that we treat this issue through a combined approach. They must be approaching the issue from a cognitive aspect simultaneously with my physical treatment as well as the exercise/rehab. If we have that comprehensive, three-pronged approach to their condition, we are going to stand a much better chance at getting this sucker under control.
If you’re adjusting and sending them out the door, that’s low-level and borderline ineffective at best. At the worst, with too many appointments, you compound the issue by adding spinal instability to the mix. Too many chiropractors and subluxation slayers just do not understand this concept. They think they’re being specific. Research is pretty clear. You’re adjusting segments at a time. Not one. You’re not that good.
Alright, that’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week.
Key Takeaways
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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 preventativly 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!
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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 - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
- Harris IA, S. V., Mittal R, Adie S, (2020). "Surgery for chronic musculoskeletal pain: the questions of evidence." Pain 161(9): S95-S103.
- Prater C, T. M., Battaglia P, (2020). "Integrating a Multidisciplinary Pain Team and Chiropractic Care in a Community Health Center: An Observational Study of Managing Chronic Spinal Pain." Journal of Primary Care & Community Health.
CF 143: New Paper: Spinal Manipulation Has No Effect On Chronic Pain - Our Experts Rebuttal
Today we’re going to talk about a new paper in JAMA saying that spinal manipulative therapy has not effect. Yeah…..BIG topic today so keep your seat, buckle up, I got some stuff to say.
But first, here’s that sweet sweet bumper music
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You have found yourself smack dab in the middle of Episode #143
Now if you missed last week’s episode , we talked about nonoperative disc treatment, Vitamin D3 for depression, and the biopsychosocial part of chronic pain. I used big words on this one folks. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.
On the personal end of things…..
First thing is, my website is jacking up in the last few weeks and it’s about to make me lose every marble I ever had in my noggin. So if you prefer reading the transcript on the website or listening via the website, I apologize if you’ve had issues doing so lately. Trust me, I am working diligently with people that know how to do this stuff to get it lined out and working properly and dependably
Next, my kid is coming home for the weekend from college. Pretty excited to see the knucklehead.
My practice was busier this week. Not necessarily in the total numbers of visits. We ended up somewhere back around 140 last week. Which was about where we started when we came back from COVID full time.
We were at about 140-145 or so per week and then fell off to about 125. That was mad Jeff time. Pouty Jeff time there. But, it was also back to school time and that’s traditionally the slower part of the year for me.
Last week, we ended up with about 22 new patients in one week. Hell yeah I’ll take it. Bet you’re sweet bippy….pass me some more of that deep dish of deliciousness.
That 22 should boost next week’s totals and that makes for content Jeff. Not happy…..no….I’m still down from Pre-Rona and still don’t have an associate so….not happy Jeff but definitely more content Jeff. Not only did I have the 22 new patients but a heaping spoonful of re-exams on patients that haven’t been in since the Rona began ruining crap.
So, all in all, we’re moving the right direction.
I was listening to an episode of mine from a couple of weeks ago. Kind of like game tape. Like the coaches go back and watch the game tape so they can learn about what they want and don’t want. My wife just says I like to hear myself talk and to her I say….you are fake news.
But anyway, I predicted that by now, more schools would be closing down. At the moment, I stand corrected. More schools have not yet shut down. I also said that I hope I am wrong. And I’m saying right now that I’m glad I was wrong. I’m a big enough man to say it out loud and proclaim mine own idiocy!!
Or am I an idiot. Today, which is 9/4, happy birthday to my wife Meg BTW, today I took note that Lubbock has reported 849 new cases in the last 3 days. Three days, y’all.
They’re averaging 283 new cases every single day. And it’s because of that college. A little birdy in the Texas Tech healthcare system told me they got an internal email sayign basically that things are getting our of control on the campus already because people living off campus are being dumb and spreading it on campus. They say it’s expected to get a lot worse after this weekend.
So, maybe I’m not an idiot afterall. We know the incubation on this thing is about 2 weeks and they went to school right at 2 weeks ago. And now here we are.
I do still believe it’s only a matter of time but for now, I was sort of wrong and I’m sort of OK with it.
Let’s get on with it shall we?
Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. I love new toys! If you’re into soft tissue work, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend.
Drop Release uses fast stretch to stimulate the Golgi Tendon Organ reflex. Which causes instant and dramatic muscle relaxation and can restore full ROM to restricted joints like shoulders and hips in seconds.
Picture a T bar with a built-in drop piece. This greatly reduces time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day. Drop Release is like nothing else out there, and you almost gotta see it to understand, so check out the videos on the website.
It’s inventor, Dr. Chris Howson, from the great state of North Dakota, is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase.
Go check Drop Release at droprelease.com and tell Dr. Howson I sent you.
Item #1
Alright, lets get to this POS paper. I say that because it doesn’t confirm my bias. Lol. It’s called “Effect of Spinal Manipulative and Mobilization Therapies in Young Adults With Mild to Moderate Chronic Low Back Pain: A Randomized Clinical Trial” by Thomas et. al(Thomas J 2020). published in JAMA on August 5, 2020. Hot steamy pile of dog crap here…big plate of shooey.
Why They Did It
To evaluate the comparative effectiveness of spinal manipulation and spinal mobilization at reducing pain and disability compared with a placebo control group (sham cold laser) in a cohort of young adults with chronic LBP. As if this question has not already been answered a million jillion times.
How They Did It
- The study was single-blinded
- placebo-controlled randomized clinical trial
- 3 treatment groups
- Conducted at the Ohio Musculoskeletal and Neurological Institute at Ohio University from June 2013 to August 2017
- 4903 subjects eligible
- 4741 did not meet inclusion criteria
- 162 patients with chronic Low Back Pain qualified for randomization
- Participants received 6 treatment sessions of
- spinal manipulation
- spinal mobilization
- sham cold laser therapy - placebo - during a 3-week period.
- Outcome measures were the change from baseline in Numerical Pain Rating Scale (NPRS) score over the last 7 days and the change in disability assessed with the Roland-Morris Disability Questionnaire 48 to 72 hours after completion of the 6 treatments.
What They Found
- There were no significant group differences for sex, age, body mass index, duration of LBP symptoms, depression, fear avoidance, current pain, average pain over the last 7 days, and self-reported disability.
- At the primary end point, there was no significant difference in change in pain scores between spinal manipulation and spinal mobilization, spinal manipulation and placebo, or spinal mobilization and placebo
- There was no significant difference in change in self-reported disability scores between spinal manipulation and spinal mobilization, spinal manipulation and placebo, or spinal mobilization and placebo
So it appears from this paper that spinal manipulation and spinal mobilization has absolutely NO utility NO use and makes NO sense for anything. Basically. This….when so many other papers have shown incredible uitlity, incredible effectiveness, and incredible cost-effectiveness. It makes very little to zero sense at all.
Wrap It Up
Their conclusions was as follows, “In this randomized clinical trial, neither spinal manipulation nor spinal mobilization appeared to be effective treatments for mild to moderate chronic LBP.”
OK, I had to consult with those much smarter than I to really get a full picture of what’s going on here. Because I feel like someone’s picking on us a little here. You cannot have so many papers supporting spinal manipulative therapy and then this say there’s no use whatsoever. You simply can’t. Something smells awry in the land of Denmark, up in here, up in here.
I’ll start with Dr. James Lehman. Dr. Lehman is an Associate Professor of Clinical Sciences at the University of Bridgeport/College of Chiropractic and Director of Health Sciences Postgraduate Education. Dr. James Lehman is a board-certified, chiropractic orthopedist. He teaches orthopedic and neurological examination and differential diagnosis of neuromusculoskeletal conditions. In addition, he provides clinical rotations for fourth-year chiropractic students and chiropractic residents in the community health center and a sports medicine rotation in the training facility of the local professional baseball team. He’s the driving force behind the Diplomate program for Neuromusculoskeletal Medicine.
As Director, Dr. James Lehman developed the three-year, full-time resident training program in chiropractic orthopedics and neuromusculoskeletal medicine. The program offers training within primary care facilities of a Federally Qualified Health Center and Patient-Centered Medical Home. While practicing in New Mexico, he mentored fourth-year, UNM medical students. He has been generous with advice and mentorship for yours truly as well. We could go on and on.
I sent this paper to Dr. Lehman and asked for his opinion on it.
Dr. Lehman said, “I am not favorably impressed with the study for several reasons. It is my opinion that this study was simplistic and non-specific. When studies base the effort on determining the outcomes of a specific modality without a specific diagnosis, I question the outcomes.
As a chiropractic specialist, I use the definition promulgated by the National Pain Strategy. Chronic pain occurs more than 50% of the days for six months or longer. This study mentioned that pain occurred only greater than 3 months with no mention of the number of days that pain was experienced. In addition, this study used only mild and moderate chronic pain. It is my opinion that these patients may be experiencing mild symptoms for several reasons that are not relieved by manual medicine interventions. For example, poor posture and distress with resultant myofascial pain without joint dysfunction. Another example would be a patient with a true chronic pain condition that has centralized in the CNS. These patients normally experience only a reduction in pain for a short period of time.
This study offers a simplistic diagnosis and not one that indicates the need for manual medicine interventions.
I always question studies that base the need of spinal manipulation on the finding of reduced joint motion. Although chiropractic programs teach motion palpation, the evidence demonstrates the examination procedure to be less than dependable.
“Regardless of the degree of standardization, interrater reliability of motion palpation of the thoracic spine for identifying pain and motion restriction performed by experienced examiners was poor and often not better than chance. These findings question the continued use of motion palpation as part of the clinical assessment as an isolated tool to detect loss of intersegmental joint play.” Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4480941/
As we know, patients that present for chiropractic care for chronic low back pain demonstrate pain scale findings higher than 2/10 but more likely 5-10/10. Less than 5/10 indicates that the pain does not interfere with the patient’s activities of daily living. Hence, I believe the study was poorly designed. Why study the effectiveness of a manual medicine for an insignificant condition?
Thank you Dr. Lehman for such a thorough response and for laying out his thoughts so effectively on this. He really is a gem of this profession.
I exchanged emails with Dr. Christine Goertz. Her resume is again, so long and impressive that we can’t do it right here but, in short, she is the Chief Operating Officer of the Spine Institute for Quality. She is also an Adjunct Associate at the Department of Orthopaedic Surgery, Duke University Medical Center and Adjunct Professor in the Department of Epidemiology, College of Public Health at the University of Iowa.Sshe has received nearly $32M in federal funding as either principal investigator or co-principal investigator, primarily from NIH and the Department of Defense, and has authored or co-authored more than 100 peer-reviewed papers.
I almost hated to ask Dr. Goertz because I know how busy she is, but honestly, who better to ask, right? And, at the end of the day, I followed an old saying I’ve kept in mind my whole life. And that saying is, “No asky, no getty”
And, as expected, she did not have the chance to dive into it head first but did offer this, “Although I can’t comment on the details of the methods Without a deeper dive, one thing that strikes me is the decreased utility of studying spinal manipulation in isolation, as it is generally delivered in the larger context of chiropractic care.”
Which alludes to something I’ve said on this podcast so many times. Chiropractic according to every chiropractor outside of strictly subluxation slayers, is not a modality. It is a profession with A LOT of tools under its umbrella. Still, there’s something smelly about a paper claiming absolutely zero effectiveness of SMT. Really? None?
I emailed one of the smartest dynamic duos I have ever experienced in my entire chiropractic career, Dr. Anthony Nicholson and Dr. Matthew Long. They’re like the batman and robin of chiropractic geniuses. Honestly, good luck finding more intelligent and more thoughtful chiropractors anywhere. They are the creators of all online education curriculum through the CDI courses which are what is used by the Diplomate of Neuromusculoskeletal Medicine. Dr. Nicholson is a Diplmoate of Orthopedics as well as a Diplomate in Neurology.
Dr. Nicholson shared this with me. He said, “In relation to the article, firstly, I’d say that I don’t have researcher-level credentials in critiquing study design, validity, statistical methods etc.
I do obviously read a fair bit of research and integrate that with teaching and clinical experience.
This study seems pretty light to me in several respects and I’m not surprised by the conclusions. The number of participants was pretty low (162), which lowers the power of the study to draw accurate conclusions. Overwhelmingly though, here is the dilemma: there is obviously a strong desire to test certain clinical interventions and compare them.
This means reducing the number of variables and attempting to isolate the specific effect of each intervention to the greatest degree possible. The problem is that these interventions aren’t meant to be delivered in such a sterile way. This omits the extremely important context effect and ritualistic aspect of a clinical encounter. It doesn’t take into account the words, concepts, explanations and empathy of the doctor that creates a certain context in which the specific intervention is delivered. The same goes for any intervention, be it drugs or surgery. Pain is all about meaning. We are priming a patient’s brain to receive a certain sensory input in terms of what that means.
The bottom line is that a clinical interaction is so much more than the sum of its parts, and each individual part is very tricky (I won’t say impossible, but you could say it’s pretty close) to evaluate in isolation. Where does that leave us? I don’t know!
But, what I do know (like all clinicians I suspect) is that I see meaningful changes to people’s lives everyday with these interventions when they’re wrapped in the right clinical context (a successful therapeutic alliance with the patient that is built upon trust and rapport). It’s difficult to study that!”
I don’t know how one could say it any better than Dr. Nicholson. He has such a way with words, I swear. Are all Australians as eloquent? I’m not sure. I’m a Texan, I’m pretty gruff and rough around the edges I’m afraid. I don’t speak his language but luckily I understand it. Lol.
His partner in CDI and in fighting chiro crime….remember the batman and robin reference….anyway, Dr. Matthew Long wrote an outstanding article on this type of study that I’ll link in the show notes. Please go check it out.
He says, “For many chiropractors the realities of clinical practice and the supposed truths of scientific research often seem irreconcilable. This is particularly apparent when reviewing research that investigates the effects of spinal manipulation upon a specific condition.
Often there is little, if any, difference in outcome between the placebo (sham) intervention and the 'real' procedure. In both cases the patient is seen to improve, often quite substantially. However, the study is unable to show conclusively that the active treatment is better than the sham. This phenomenon is especially prevalent when the intervention is being tested for its capacity to reduce pain, which carries a large emotional connotation into the experimental setting. We can see this in a recent migraine study by Chaibi and colleagues (1), who concluded that the significant beneficial effect obtained by sufferers was "probably a placebo response".
To most clinicians this is deeply unsatisfying. While it is true that the science of placebo has undergone a reappraisal and a softening of opinion in recent years, the average hard working chiropractor probably feels that there is more to their daily practice than simply putting on a good show.
While many experiments are based upon our ability to modulate pain, others seek to determine how manipulation might influence the the biomechanics of a patients spine. After all, the dominant model by which spinal manipulation has been justified for over 100 years is largely mechanical in nature (whilst acknowledging the desire to reduce some sort of neural distress that resulted).
Unfortunately these biomechanical experiments are sometimes even less impressive in their outcomes, and there is little difference between the active treatment and the control. However, before we become too jaded I think that we should pause for a moment and ask ourselves two important questions:
- Are we posing research questions based upon a legacy model of spinal manipulation?
- Can the design of these studies preclude us from finding any meaningful answers?
It is my contention that the science of neuromusculoskeletal health has evolved considerably, and yet we are perhaps still looking at the world through an outdated lens.
This dynamic duo are the future of this profession. I’m including the link to the article in the show notes at this point in the show so go there to episode 143, scroll down and click on it. Stop arguing like a damn teenager and just do it or you go to bed with no supper. Don’t you roll your eyes at me, Give me your phone, you’re grounded.”
Another very relevant though from Dr. Long in the article is this:
“Some of the things we know about spinal manipulation include:
-
It is not a mechanical realignment.
-
It does not help relieve pain by increasing range of motion.
-
It can produce changes in smoothness and quality of movement, which are critical for stability and control.
-
It influences the brain's perception of the spine, and how it can (and should) move.”
It goes on and, as with anything from Dr. Nicholson and Dr. Long, it is eloquent, easy to understand, and basically amazing. This is why you always hear the Neuromusculoskeletal Medicine Diplomates talk about the outstanding education you get in the program. It’s largely due to these two amazing doctors and educators.
Go read the rest of that article, please.
https://cdi.edu.au/clarity/its_the_whole_package.php
Now, last but absolutely not least is one of my new favorite research superstars in our profession. We are going to have her on a future episode so keep watching for that. Dr. Katie Pohlman from Parker University was kind enough to send me her thoughts on the paper.
Dr. Pohlman is Director of Research at Parker University and an inaugural fellow of the Chiropractic Academy of Research and Leadership (CARL) program. She received Researcher of the Year in 2020 from the American Chiropractic Association (ACA), is the current Vice President of the ACA’s Council on Women’s Health, and has served as Vice President of the ACA’s Council on Chiropractic Pediatrics. Dr. Pohlman received her Doctor of Chiropractic (D.C.) degree and M.S. in Clinical Research from Palmer College of Chiropractic and her Ph.D. in Pediatrics from the University of Alberta. We could keep going but I think you get the point.
She’s one of the most impressive ‘newer’ researchers in our profession. I say newer in quotes because I only found out about Dr. Pohlman in the last few years. But trust me here, you’re going to be hearing and seeing A LOT more out of her in the future.
Dr. Pohlman said this, “This was a well-designed study of manipulation and mobilization with a strong placebo arm. The population were young, non-obese individuals with chronic back pain.
As stated in the discussion, the sample population baseline pain level on a 0-11 scale was ~4.3, which I feel left little room the clinical meaningful 2 points decrease. The study also used characteristics from a clinical prediction rule for inclusion of patients.
The characteristic list that they use included patients having pain for less than 16 days. Since this study was looking at chronic pain this characteristic was not included.
I support the idea of pre-identifying responders versus non-responders; however, the characteristics used in this study may not have been most useful for chronic pain patients.
A more useful model at this time is the Andres Eklund ‘s psychological subgroups (which also have not be validated… watch for more studies in the near future).
(NOTE: this study was published after the start of the RCT being discussed.)
Another consideration for this study was the 3 weeks of care and the manipulation/mobilization techniques that were used. I will leave these concerns for clinicians to discuss.”
Katie is wonderful for taking time out of her day to offer us some insight on this.
Now, I want to address the F4CP. The Foundation For Chiropractic Progress. They came out shortly after this paper with a press release in support of this paper. Saying it’s correct, they support it, and it is further proof that a D.O. or any other practitioner outside of a Doctor of Chiropractic is clearly ineffective.
The insinuation is that no other practitioner can deliver an adjustment as well and as effectively as a chiropractor and that had the study included spinal manipulative therapy delivered by chiropractors, it would have shown clear effectiveness.
Because, you know….chiropractors are evidently the ONLY practitioners that can adjust I guess.
Let me get this straight up front; I love the F4CP. I support them. I love what they’ve done for our profession and are doing for our profession. I would say that I believe there are some TICs and some TORs in there and that’s not necessarily helpful for the evidence-based side of the profession but overall, it’s a great group and does a good job of being well-rounded and representing the profession as a whole.
With that being said, on this paper, I think the F4CP is just wrong to support the paper like this. For me, it’s lazy and almost comes off like the way a politician would slide around something. You know what I mean? Avoid the elephant in the room and say, “See there, had they used chiropractors, it’d been a different dealio all together because we’re the superstars nobody else can be. I don’t know…..I guess if the other spinal manipulative therapy people would maybe….I don’t ….try not to suck so much….that’s be great and all”
It’s BS and I don’t like their handling of it. I like their handling of just about everything else but whoever pulled the trigger on this, I just can’t agree with. There are holes to be poked in it. There are too many papers showing the effectiveness to sit around and let 3 PhDs set the tone for spinal manipulative therapy going forward.
You think insurance companies, chiro haters, and trolls aren’t going to grab this and run like they stole something with this thing? Of course they will. And are. Hell, I’ve seen where chiropractors themselves are now saying the manipulation isn’t all that effective. Chiropractors y’all. Then you have the Airrosti folks who don’t adjust. We all have to do what we do and what we feel but come on man. I always say chiropractic isn’t an adjustment, it’s a profession. But let’s have some real talk here. The adjustment is still damn well the cornerstone of the profession. Don’t any of you kid yourselves on this. It is and it is for a reason.
So for me, on this deal, the F4CP is wrong. Sorry to any of you that may be in the F4CP. I’m aware you didn’t ask my opinion first but I’m giving it second. Lol.
I do support you overall. Just not here.
The study isn’t an indictment of chiropractic in general but I’d say that this paper doesn’t take any of the other things a chiropractor does into account at all. When the pain is centralized and the CNS is upregulated, simple manipulation is a start but is only a tiny piece of the puzzle.
Alright, that’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week.
Key Takeaways
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
Subscribe Button
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 preventativly 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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Fellow of the International Academy of Neuromusculoskeletal Medicine - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Thomas J, C. B., Russ D, (2020). "Effect of Spinal Manipulative and Mobilization Therapies in Young Adults With Mild to Moderate Chronic Low Back Pain: A Randomized Clinical Trial." JAMA Open 3(8).
CF 140: w/ Dr. Chris Howson: Chiropractors In Hospitals & Drop Release
Today we’re going to be joined by Dr. Chris Howson of the great state of North Dakota where we’ll be talking about chiropractic integration in a hospital setting as well as his new invention called Drop Release.
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our Facebook page,
- Join our private Facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #140
Now if you missed last week’s episode , we talked about chiropractors affected by COVID, 2019 opioid overdoses, and insurnace compensation for chiropractic. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.
On the personal end of things…..
I am writing this on 8/17/20 which means I’m taking my son to college this afternoon for his freshman year. It’s my first kid to fly the coop and we’ll see how it goes. Many of you did this same thing years ago. Many of you don’t even have kids so I won’t dwell on it long.
I’ll just say, especially to the young ones, there’s no time to waste. Whether it’s starting your own retirement account, starting your kids a college fund, or asking that girl on a date. There’s no time to waste because landmarks like I’m going through this week…..they arrive before you know it. Almost by surprise even.
Before you know it, you’ll look up and you’ve been in business 20 years, your kids are graduating, you looking at retirement in the next 10-15 years and you don’t know exactly how it all happened. But it did and if you’re not a forethinker, it’ll punch you square in the nose and make your eyes cross.
Just a word from your wise ol’ Uncle Jeffro.
I don’t want to talk too much because we have a guest today. Before we welcome him, I want to do a proper introduction.
- 2004 graduate of Northwestern.
- Practicing in Grand Forks ND,
- has spent the last 9 years in an integrated practice setting.
- Has a strong background in sports and applies that “get em back on the field” mentality to all his patients.
- Member of FTCA, NDCA, and ACA.
- Currently pursuing the orthopedic diplomate.
- Inventor of the Drop Release.
Tell me a little bit about yourself and your family.
I always say that chiropractic isn’t something that immediately comes to mind when one is deciding what they want to be when they grow up. So how did you come to be a chiropractor?
Where did you go to school?
What in your background or your schooling best prepared you for your current practice setting? Did you have any mentors that were particularly impactful along the way?
We have talked at length on this podcast about integrating into the Federally Qualified Health Centers or FQHCs but your situation is a little bit different. Can you explain what you’re doing and how you got there? And how it’s different from an FQHC.
What kind of patient is your typical patient in the hospital setting? Are you just confined to acute low back or what?
Have you had any issues or had to stand your ground when it came to those in the medical field that don’t necessarily love the chiropractic profession?
Numbers
Do you see your model as something that can be repeated in TX, NC, CA, to Florida? And how? How could those interested start on the path you’re blazing up in ND?
Do you see your current way of practicing as your life long way or do you have plans to be in the private sector down the line?
So, we get along very well because we are both go getters and entrepreneurs. If people have been listening, lately, I’ve been giving them a code for a discount on a new little invention called Drop Release. You happen to be the inventor of Drop Release. I actually first met you in person at the Forward ’19 event in St. Louis when you were working your Drop Release exhibit booth. Tell us all how you came up with the idea. How did you take it from concept to reality? That’s the biggest hurdle most folks don’t get over.
We might as well give them the code to save some money on Drop Release if they want one, don’t you think?
Thanks for joining us, Chris. I appreciate it.
Alright, that’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week.
Key Takeaways
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
Subscribe Button
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 preventativly 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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Fellow of the International Academy of Neuromusculoskeletal Medicine - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
CF 139: Chiropractors Affected By COVID, 2019 Opioid Overdoses, Insurance Compensation For Chiropractic
Today we’re going to talk about Chiropractors Affected By COVID, 2019 Opioid Overdoses, Insurance Compensation For Chiropractic
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our Facebook page,
- Join our private Facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #139
Now if you missed last week’s episode , we talked about NSAIDs, cognitive behavioral therapy and vitalists ignoring stuff. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.
On the personal end of things…..
Personal means personal right? Well, I’m still working on getting the whole voice over gig set up and rocking and rolling. What’s voice over you may ask? Well, the voices you hear on commercials, eLearning, promos, radio bumpers, and even cartoons and stuff like that. That’s voice over work.
Here’s my thought and I’ve said it here before; I don’t want to die in my office working on people when I’m 80. God bless those of you that love the daily grind so much that that’s your goal. It takes all sorts doesn’t it? But that’s not me. I want to hire an associate and mentor them over the course of some certain amount of time and then sell my practice to them eventually.
I’m a musician/singer/songwriter. I’m a sculptor. A portrait artist, furniture builder and all kinds of other things. I love to travel as well. So, what kind of work could I do that would allow me some retirement income and can be done literally from anywhere in the world with an internet connection? Voice over of course. So, I started working on it once the Rona showed up. I’m taking some classes and building some skills and equipment and knowledge.
The thought process is, if I start now, in 5 years it may be a very viable way to add to my weekly income in retirement. I have other things I’m looking at as well but this is the one I’m knee deep in right now.
I have friends that tell me they only get 24 hours in a day and I get more like 48. Lol. That’s not true of course but I do keep moving, keep thinking, keep working pretty much non-stop and I move from one thing to another fairly quickly trying to multi-task and get it all done on some sort of time scale.
I adhere to an old saying I try to always remember; time is just time. You’re either investing in it or you’re wasting it. I don’t like to waste time all that much. There’s always time to sit and relax here and there but, in general, I’m not much for wasting it.
As far as business, we’re marketing like crazy. I’ve put more into marketing in the last 3 months than I have in the last three years and guess what…..80%. We’re still at about 80% of where I was and like I said last week, that’s my new normal and I’m done making myself crazy about it. I’ll take this extra time and I’ll continue to invest in it.
erous. So I’m anxious to see what happens. I have things working inside chiropractic. I have things working outside chiropractic. Let’s see which mud sticks to the wall. If any of it sticks at all, right? We never know but it’s exciting to be productive. It’s exciting to be creative. And it’s exciting to have the prospect of more income and more options as to your future.
That’s where I’m at right now. I just turned 48. I have less time in front than behind. I’m not getting younger so it’s time to step on the gas. And that’s what I’m doing. This pandemic crap isn’t going to last forever and I plan on sitting pretty in time to retire so let’s just get started right now shall we?
Item #1
Speaking of ‘pandemic crap’, here’s a paper called “The impact of COVID-19 on the chiropractic profession: a cross-secitonal survey on opinions, professional changes, and personal hardships of US chiropractors” by Neff et. al(Neff S 2020). published in Chiropractic and Manual Therapies posted on 15 of July 2020 and dammit if that’s not hot then I don’t know what is, people.
Now, before I get going on this one, I recognize three of the authors’ names from the Forward Thiking Chiropractic Alliance group on Facebook. Once again, if you’re considering yourself an evidence-based, patient-centered chiropractor rather than a vitalist, get in that group. You can learn a ton. Anyway, Shawn Neff, Rebecca Deyo who I’ve mentioned on this show before, and Annabelle MacAuley. All very smart, very talented doctors of chiropractic.
Why They Did It
The research was conducted to collect self-reported data on how COVID-19 has affected U.S. doctors of chiropractic. I’m glad someone is paying attention to us and all. Honestly, chiropractors get the fat end of the bat don’t we? Who got PPE delivered to your office by the state back in April?
Yeah, me either. Anyway……
How They Did It
- An electronic survey was sent to U.S. chiropractors nationwide via social media and email.
- The survey collected
- personal and practice demographic information,
- office protocols,
- changes made during COVID-19,
- chiropractic profession opinions/stances,
- information related to stress, and
- personal beliefs/opinions.
- Data was analyzed using descriptive statistics.
What They Found
- 750 U.S. chiropractors responded.
- Just over half of respondents reported moderate levels of stress, and
- Just over 30% reported severe levels due to a variety of reasons related to both personal and professional circumstances.
- The primary stressors were financial and business concerns.
- The highest stress levels were among employers responsible for others.
- A majority reported beliefs that the chiropractic profession should not advertise that spinal manipulation provides any immune system benefit.
- 13% of the respondents believed chiropractors should be marketing immune benefits during this time.
- A shift toward telehealth was reported, with 18% adding it to their services.
Wrap It Up
“Stress levels were high across the population. A range of opinions existed regarding spinal manipulation and immunity benefits. The majority reported there was not sufficient evidence to support such a belief; however, a group of respondents believed that chiropractors should be marketing immune-enhancing benefits to the population. A logical next step would be to study why such beliefs persist. This information may be useful in better understanding how chiropractors have experienced the global effects of COVID-19 across the United States.”
So…..if you want to know how many are vitalists and how many are evidence-based or, at minimum….agnostic….then doesn’t this give us some hints? A vitalist would claim to take pressure off of nerves allowing the innate life force to better express itself rendering you immune to disease. That sounds like about 13% of chiropractors surveyed.
That tells me 87% call shenanigans on the rest of it. It’s been a while since I heard a number. We know its the minority but damnit they’re a loud minority aren’t they? They’ve kept us right here without cultural authority for over 100 years at this point. 87% is pretty high though. Maybe it’s changing.
I saw another recent survey where only a very small percentage of chiropractors were interested in learning more about chirorpactic philosophy. I think it’s fine as a historical thing. Just not as something that keeps controlling our profession and keeps us at the bottom of the barrel.
Love me or hate me, at least I’m honest and you know where I stand.
Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. I love new toys! If you’re into soft tissue work, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend.
r
Drop Release uses fast stretch to stimulate the Golgi Tendon Organ reflex. Which causes instant and dramatic muscle relaxation and can restore full ROM to restricted joints like shoulders and hips in seconds.
Picture a T bar with a built-in drop piece. This greatly reduces time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day. Drop Release is like nothing else out there, and you almost gotta see it to understand, so check out the videos on the website.
It’s inventor, Dr. Chris Howson, from the great state of North Dakota, is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase.
Go check Drop Release at droprelease.com and tell Dr. Howson I sent you.
Item #2
This second one is a report from CNN on opioids called “Drug overdose deaths jump in 2019 to nearly 71,000, a record high, CDC says” by Shelby Lin Erdman on July 16, 2020(Erdman 2020). Hot stuff….come on now. Make way people!
This was an article so we’ll be like a boat on the lake and just skip across the high spots. How about that?
- Drug overdose deaths in the US jumped last year by about 4.8%.
- 2018 was slightly down from 2017
- 2019 bumped back up to 71,000 overdose deaths.
- The former president of the American Medical Association, Dr. Patrice Harris, said the numbers show why it's important to remove any obstacles to treatment for those addicted to drugs. While I think that’s worthy, I think it’s important to not that there should be no obstacles in place to see alternative practitioners in the first place when some of these folks presented with pain. The White House report in 2016 and The Lancet report on back pain both agreed there are obstacles in place preventing these kinds of patients from seeing chiropractors.
Item #3
This one is called “Trends in Insurance Coverage for Complementary Health Care Services” by Whedon et. al(Whedon JM 2020). published in Journal of Alternative and Complementary Medicine on July 7, 2020. The roof, the roof…it’s on fire.
Why They Did It
Complementary health care professionals deliver a substantial component of clinical services in the United States, but insurance coverage for many such services may be inadequate. The objective of this project was to follow up on an earlier single-year study with an evaluation of trends in reimbursement for complementary health care services over a 7-year period.
How They Did It
- The authors employed a retrospective serial cross-sectional design to analyze health insurance claims for services provided by licensed acupuncturists, chiropractors, and naturopaths in New Hampshire (NH) from 2011 to 2017.
- They restricted the analyses to claims in nonemergent outpatient settings for Current Procedural Terminology code 99213, which is one of the most commonly used clinical procedure codes across all specialties.
- They evaluated by year the likelihood of reimbursement, as compared with primary care physicians as the gold standard.
What They Found
- The total number of clinical services claimed was
- 26,725 for acupuncture,
- 8317 for naturopathic medicine,
- 2,539,144 for chiropractic, and
- 1,860,271 for primary care.
- Initially, likelihood of reimbursement for naturopathic physicians was higher relative to primary care physicians, but was lower from 2014 onward.
- Odds of reimbursement for both acupuncture and chiropractic claims remained lower throughout the study period.
- In 2017, as compared with primary care the likelihood of reimbursement was
- 77% lower for acupuncturists,
- 72% lower for chiropractors, and
- 64% lower for naturopaths.
Wrap It Up
“The likelihood of reimbursement for complementary health care services is significantly lower than that for primary care physicians in NH. Lack of insurance coverage may result in reduced patient access to such services.”
So when we talk about barriers to seeing safer, non-invasive practitioners, don’t tell me there are none. Don’t piss on my leg and tell me it’s raining.
What was the Tommy Boy reference? You can get a good look at a t-bone by sticking your head up a bull’s ass but wouldn’t you rather take the butcher’s word for it? Or no…..it’s gotta be YOUR bull. Lol. Great movie.
Anyway….buncha hullabaloo. Research and surveys are so clear and mostly consistent when they say spinal pain is so bad yet chirorpactic is so good at treating it. Not only in terms of effectiveness but also in terms of patient satisfaction and even long term outcomes when compared to traditional treamtent. The damn White House report a few years ago said there are barriers. The Lancet said it. I’ve seen it other places that aren’t coming to mind but it’s clear there are barriers in place set up by the stakeholders, the insurance gurus, the medical professionals….. All go 180 degrees from what the research tells them to do.
And they keep going that way. It feels like it’s not turning around. At all. So…..shenanigans. I’m calling shenanigans.
Alright, that’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week.
Key Takeaways
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
Subscribe Button
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 preventativly 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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Fellow of the International Academy of Neuromusculoskeletal Medicine - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Erdman, S. L. (2020) "Drug overdose deaths jump in 2019 to nearly 71,000, a record high, CDC says." CNN.
Neff S, D. R., MacAuley A, Lawrence D, (2020). "The impact of COVID-19 on the chiropractic profession: a cross-sectional survey on opinions, professional changes, and personal hardships of U.S. chiropractors." BMC Chiro Man Ther.
Whedon JM, e. a. (2020). "Trends in Insurance coverage for Complementary Health Care Services." J Altern Complement Med.
CF 138: That Episode Where Vitalists Tune Out & NSAIDS vs. Cognitive Behavioral Therapy
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our Facebook page,
- Join our private Facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #138
Now if you missed last week’s episode , we were joined by Dr. Aric Frisina-Deyo and discussed his research endeavors and even more importantly, his integration into the FQHC setting, what it’s like and how he did it. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.
On the personal end of things…..
So far so good. Looking at getting these kids back to school. What a great national debate. Of course, as with anything and everything else, everyone wants to make it a political issue rather than a public health issue. Which is always incredibly disappointing.
Listening to a podcast from JAMA, it sure seems it’s not a one size fits all decision. It looks like the answer lies within each different community. Here’s what I do know for sure regardless of how well kids carry it or how poorly kids spread it, there WILL be some kids get sick and have an extremely hard time with it. Teachers WILL get sick and some WILL die. That’s if they keep the schools open beyond the first week or two. I think it’ll depend on how quickly people start getting sick again.
Now, I’m not advocating for or against kids going back to school but I sure don’t want anyone being surprised when it happens. Because it will. For example, I have a friend that is a teacher. Late 50’s early 60’s. Chronic asthma and just had a heart cath. He does NOT want to go back and I don’t blame him one bit.
Some of the larger schools….you simply cannot socially distance. Do you remember what a school hallway looks like during class change? Anyway, these types of teachers, my prayers go out to them. My prayers go out to families like mine that have kids still in school and are worried about their kids and their kids bringing it home to them.
I’ve said it here before; I think that if I get it, I probably do just fine. Yeah, I’m overweight but not so much that I can’t be active and all that. I’m type O+ blood type. I exercise and I don’t have any underlying issues like high blood pressure. I feel like I may get sick as hell but I do well.
But the BIG issue is that if I get it, I STILL have to shut my clinic doors for an undetermined number of weeks and that’s just simply not something I’m in a hurry to do. I’m sure you are not either. So, if for no other reason than to keep your doors from closing, it makes sense to continue to protect yourselves and your patients to the highest level possible.
I’m just a few days away right now from taking my son to his first semester of college at Texas Tech in Lubbock, TX. How the hell is college and living in a dorm going to work out for these kiddos? I feel like I can read the future and my crystal ball tells me these kids are going to pass it back and forth like a beer pong ball. Is that good or bad? Well, on one hand it’s good because most all of them will do extremely well with it and that will work toward herd immunity.
On the other hand, some will not do so well and some will get sick…..the parents will come pick them up and take them home to care for them and….welll…..you know how it goes from there.
So, I’m concerned. I feel we are going to see what this bug can really do once school starts back up. That’s just my personal opinion. But, we’ve also heard some of the punch this dude packed back in the Spring has gone away and, while people are still dying from it, they are not dying in the numbers they were back in the Spring.
Don’t get me wrong here, I’m not cowering in fear in the corner afraid to touch people in my practice. Outside of the first two weeks, we’ve been open 100%. I’m seeing about 140 per week right now. Shaking hands…..maybe even a little hug here and there. I just wear a mask and wash my hands a lot. We ahve the UV air scrubbers. We check temp and symptoms when they come in the door. We clean like crazy. But nothing I would consider overboard and…..So far so good.
So….what do we do? We sit, wait, and watch. Just like we have been doing since February. In a way, I almost envy the deniers, the non sciencers. They are just going through this oblivious with little to no sense of danger and non-ending mockery of the sciencers of the world. They say ignorance is bliss and you can see it on display on social media every day all day. Unless you’re like me of course. I have the non-sciencers snoozed for 30 days so I don’t have to see the foolishness and can still enjoy myself.
I’m no expert in virology. I’m no epidemiologist. The difference between me and the non-sciencers is that I’ll freely admit that and will go actively looking for the answers in the research, from the experts, and through JAMA rather than ignoring science, ignoring experts, and listening to foolishness and propagating idiocy.
But…..that’s just me.
Item #1
Let’s get to this first one called “Nonsteroidal Anti-inflammatory Drugs vs Cognitive Behavioral Therapy for Arthritis Pain; A Randomized Withdrawal Trial” by Fraenkel, et. al. (Fraenkel L 2020) and published in JAMA on July 20, 2020. Hot tater, pitch it around, hot tater…
Why They Did It
Is replacing meloxicam with placebo about the same as continued meloxicam, and is engaging in a telephone-based cognitive behavioral therapy program about the same as continuing meloxicam for patients with knee osteoarthritis?
How They Did It
- 364 patients that took NSAIDs for knee osteoarthritis most days of the week for at least 3 months
- The subjects stopped takin gth eNSAID an dtook 15 mg per day of meloxicam
- Those who remained eligible were randomized in a 1:1 ratio to receive meloxicam or placebo for 4 weeks
- Participants receiving meloxicam then continued this medication for 10 weeks, while those receiving placebo participated in a 10-week cognitive based therapy program
What They Found
- A total of 180 were randomized to get the placebo followed by CBT
- 184 were getting the meloxicam
- The estimated difference in the WOMAC pain score between the two groups after 4 weeks was 1.4
- After 14 weeks, the difference was .8
- There was no statistically significant difference in the pain or in disability
Wrap It Up
Among patients with knee osteoarthritis, placebo and cognitive behavioral therapy (after placebo) are inferior to meloxicam. However, the WOMAC pain score differences between the 2 groups were small, and there were no statistically significant differences in participants’ global impression of change or function after 14 weeks.
Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. I love new toys! If you’re into soft tissue work, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend.
Drop Release uses fast stretch to stimulate the Golgi Tendon Organ reflex. Which causes instant and dramatic muscle relaxation and can restore full ROM to restricted joints like shoulders and hips in seconds.
Picture a T bar with a built-in drop piece. This greatly reduces time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day. Drop Release is like nothing else out there, and you almost gotta see it to understand, so check out the videos on the website.
It’s inventor, Dr. Chris Howson, from the great state of North Dakota, is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase.
Go check Drop Release at droprelease.com and tell Dr. Howson I sent you.
Item #2
This one is called “The accreditation role of Councils on Chiropractic Education as part of the profession's journey from craft to allied health profession: a commentary” by Innes et. al. (Innes S 2020) published in Biomed Central on July 22, 2020. Whew….whew the hotness. Cool it down here.
This is an article so we’ll hit the high spots here:
- Chiropractors see themselves as well positioned to provide safe, effective and economical care for the on-going financial burden that spinal pain imposes. However, in many places of the world, the chiropractic profession continues to find itself struggling to gain acceptance as a mainstream allied health care provider.
- They say there is a need for scrutiny of international chiropractic educational accreditation standards, which are the responsibility of Councils on Chiropractic Education (CCEs)
- They found that there is sufficient evidence to identify areas of concern that could be addressed, at least in part, by improvements to CCEs’ educational standards and processes.
- Areas included a lack of definitions for key terms such as, ‘chiropractic’, ‘diagnosis’, and ‘competency’, without which there can be no common understanding at a detailed level to inform graduate competencies and standards for a matching scope of practice.
- They go on to say there is some evidence to suggest that in some cases this level of detail is avoided in order to enable a “big tent” approach that allows for a diversity of approaches to clinical care to co-exist. This combined with the held view that chiropractic is “unique”, highly valued, and best understood by other chiropractors, explains how students and practitioners can cling to ‘traditional’ thinking. This has implications for public safety and patient quality of care.
- They say that despite the global implications of low back pain, the low utilization of chiropractic has remained unchanged over the past 35 years or so. Mostly because we are not gaining mainstream acceptance to the point of being on equal footing with others. Why the hell could that be ya think?
They wrap up the conclusion as follows, “If chiropractic care is to gain mainstream acceptance worldwide then it needs to adopt, through revitalised CCE accreditation standards and processes, those of other allied healthcare professions and wholeheartedly embrace science, evidence-based practice and patient centred care.”
Ya can’t say it any clearer than this folks. This is the core of the issue. If you are a regular listener, then you know a couple of weeks ago, we covered a bit older paper about what chiropractic can learn from podiatry. This…..this is it just in different words. Non-sciencers act like WE’RE the ones destroying the profession of chiropractic.
Where I stand, and the way I see it, the evidence-based, patient-centered practitioners…..the sciencers….are the ones desperately trying to save the profession, its reputation, and bring it into the year 2020 instead of the early 1900s.
This is a loooonnnggg article. I didn’t read all of it. I didn’t have the time but, my conclusion for you is this; we have to learn, adapt, upgrade, and advance. You just have to people. Dammit.
Item #3
In yet one more effort to make the vitalists hate me, this new one is called “The clinical utility of routine spinal radiographs by chiropractors: a rapid review of the literature” by Corso, et. al. (Corso M 2020) and published in Biomed Central Chiropractic and Manual Therapies on July 9, 2020, sizzlin’ sausage and saurkraut surprise….
Why They Did It
To determine the diagnostic and therapeutic utility of routine or repeat radiographs (in the absence of red flags) of the cervical, thoracic or lumbar spine for the functional or structural evaluation of the spine and to investigate whether functional or structural findings on repeat radiographs are valid markers of clinically meaningful outcomes.
How They Did It
- They searched MEDLINE, CINAHL, and Index to Chiropractic Literature from the days of Adam and Eve to November 25, 2019.
- They used rapid review methodology recommended by the World Health Organization
- 959 citations, 176 screened, and 23 critically appraised.
What They Found
Nine low risk of bias studies investigated the validity and reliability of routine or repeat radiographs. These studies provide no evidence of clinical utility.
Wrap It Up
“We found no evidence that the use of routine or repeat radiographs to assess the function or structure of the spine, in the absence of red flags, improves clinical outcomes and benefits patients. Given the inherent risks of ionizing radiation, we recommend that chiropractors do not use radiographs for the routine and repeat evaluation of the structure and function of the spine.”
If you’re just now hearing this, welcome to the show. We’ve been saying this for a while now. ACA has been saying this through Choosing Wisely since about 2016 or so. I cannot fault you for wanting x-rays on the first visit. Some are just uncomfortable otherwise. Who am I to tell you to not shoot those?
However, the repeated and updated x-rays…..nope. No sir. No ma’am. Cut it out. If you’ve been listening, there is even some idea or evidence that repeated x-rays like this may potentially be an impetus for neurodegenerative disease. So…..if you bought that x-rays machine thinking it was going to be a cash register ringing up the dollars for you, you’re going to have to stop, take a step back, re-evaluate your practices, and use it like most other healthcare practitioners use imaging. Sparingly and only when necessary.
Alright, that’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week.
Key Takeaways
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
Subscribe Button
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 preventativly 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.
Website
http://www.chiropracticforward.com
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YouTube
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iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Corso M, C. C., Mior S, TKumar V, Smith A, Cote P, (2020). "The clinical utility of routine spinal radiographs by chiropractors: a rapid review of the literature." BMC Chiro Man Ther 28(33).
Fraenkel L, B. E., Suter L, (2020). "Nonsteroidal Anti-inflammatory Drugs vs Cognitive Behavioral Therapy for Arthritis Pain A Randomized Withdrawal Trial." JAMA.
Innes S, L.-Y. C., Walker B, (2020). "The accreditation role of Councils on Chiropractic Education as part of the profession's journey from craft to allied health profession: a commentary." BMC Chiro Man Ther 28(40).
CF 136 Chiropractic’s Effect On Strength and More, Status of Muscle Relaxers, And The Best Recovery Posture
Today we’re going to talk about Chiropractic’s Effect On Strength and More, Status of Muscle Relaxers, And The Best Recovery Posture
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our Facebook page,
- Join our private Facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #135
Now if you missed last week’s episode , we talked about adjusting in the areas of known disc complications, bulges, herniations..things of that sort. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.
On the personal end of things…..
Nothing new to report really. We aren’t growing in our visit count week to week but, at the same time, we aren’t shrinking either. We’re holding steady at about 80% of where we were before the COVID train wreck and here’s what I’ve sort of decided.
I’m just going to be OK with 80%. Like I said last week, while we’re billing out less and collecting less, we’re also spending less both in the practice as well as in my personal life. Some of you aren’t. Some of you think it’s a hoax and all that stuff. You’re going out and traveling and vacationing and all that jazz.
We aren’t. We are not afraid but we also do want to be smart and be diligent. I’ve come to the mindset that if I wind up getting it, I’ll probably do just fine with some time but regardless of how severe or mild symptoms are, I’ll STILL have to shut my office down. Now, how many of us can afford to just shut the doors for 2-4 weeks without any issues?
Honestly, I’m a saver so I could actually do it and survive but I damn sure don’t want to. I have other plans for that money don’t you know. It wasn’t saved so that I could cover my practice financially if I get sick for a month. Hell no. It was saved to invest.
So, we are being smart, we are wearing our masks and no….I don’t give one damn what anyone thinks about masks. Honestly. This has been the most disappointing aspect of human observation in recent memory. The mask debate or debacle. Absolutely a waste of time and energy talking or listening to people on that deal.
Anyway, we are wearing our masks. Our patients are wearing their masks. We are still cleaning and having our lobby closed. We are still not allowing visitors in with our patients. We are still using our UV air scrubbers in each room.
We are still doing it to keep my most fragile patients safe and confident in us as a clinic, we doing it all to protect the staff, and we’re doing it to protect me as much as possible so we don’t all have to shut down for a month. Makes perfect sense to me.
We know some things that increase you chances of having a hard time with COVID. Or at least there is some research to back up that low vitamin D puts you at risk. Obesity, underlying conditions like diabetes, low testosterone, smoking, and being of the blodd type A. These are just a few things I recall off the top of my head.
My question to you is, “What factors under your control are you bolstering or addressing?” I am over weight. I’m naturally a big guy but I’ve gotten a little lazy in the last 5 years. OK…..A LOT lazy. I started to Couch to 5K program a few weeks ago and am slowly trudging through that. My knees are super pissed at me about it but I’m still doing it.
I have addressed any hormone issues I needed to look at. I have gotten on a Vitamin D replacement regimen. I am trying to get more sleep more consistently. I don’t smoke.
Of course there’s nothing you can do about what type of blood you are but….my point is, what steps are you taking to lower your risk of complications should you wind up with it? I’d love to hear if you’ve changed anything at all or if you’re just like the Russian boxer Drago in Rocky 4…..If he dies, he dies.
Item #1
Let’s get to it. This first one is not sexy. I’m saving the better ones for here in just a minute. Let’s start off nice and simple here with one called “Effects of Two Different Recovery Postures during High-Intensity Interval Training” by Mchaelson, et. al(Michaelson J 2019). and published in Translational Journal of the ACSM in February of 2019. Hmmmmmm…..yep… Hot enough. Out of the way.
Why They Did It
The purpose of this study was to examine the effects of two different recovery postures, hands on head (HH) and hands on knees (HK), as a form of immediate recovery from high-intensity interval training (HIIT).
How They Did It
- Twenty female Division II varsity soccer players completed two experimental trials in a randomized, counterbalanced order.
- Each trial consisted of four intervals on a motorized treadmill consisting of 4 min of running at 90%–95% max heart rate with 3 minutes of passive recovery between each interval.
- Heart rate recovery was collected during the first 60 seconds of each recovery, where volume of carbon dioxide and tidal volume were recorded each minute during the 3-min recovery period.
What They Found
Results showed an improved heart rate recovery, greater tidal volume, and increased volume of carbon dioxide, with hands on the knees when compared with hands on the head.
Wrap It Up
“These data indicate that HK posture may be more beneficial than the advocated HH posture as a form of immediate recovery from high-intensity interval training.”
Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. If you’re into IASTM also known as instrument assisted soft tissue manipulation, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend.
Drop Release is a revolutionary tool that harnesses the body’s built-in protective systems to make muscles relax quickly and effectively. This greatly reduces time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day.
It’s inventor, Dr. Chris Howson, from the great state state of North Dakota has is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase.
Go check Drop Release at droprelease.com and tell Dr. Howson I sent you.
Item #2
Item 2 is called “Assessment of Physician Prescribing of Muscle Relaxants in the United States, 2005-2016” by Soprano et. al(Soprano S 2020). and published in JAMA Open on June 24, 2020 and that’s damn sure a steaming heaping helping right there.
Why They Did It
They wnated to measure national trends in muscle relaxant prescribing over a 12-year period. 2005-2016
How They Did It
- It was a cross-sectional study
- It used data from the National Ambulatory Medical Care Survey
- The study included those with ambulatory care visits with non-federally funded, office-based physicians in the US
- Included almost 315,000,000 office visits.
What They Found
- Get this y’all - During the study period, office visits with a prescribed muscle relaxer nearly doubled from 15.5 million in 2005 to 30.7 million in 2016
- Although visits for new muscle relaxer prescriptions remained stable, office visits with continued muscle relaxer drug therapy tripled from 8.5 million visits in 2005 to 24.7 million visits in 2016
- Older adults accounted for 22.2% of visits with a muscle relaxer prescription. Concomitant use of an opioid was recorded in 67.2% of all visits with a continuing muscle relaxer prescription.
Wrap It Up
“This study found that SMR use increased rapidly between 2005 and 2016, which is a concern given the prominent adverse effects and limited long-term efficacy data associated with their use. These findings suggest that approaches are needed to limit the long-term use of SMRs, especially in older adults, similar to approaches to limit long-term use of opioids and benzodiazepines.”
And we wonder how we ended up with an opioid and pill problem. Cheese ’n’ rice people. Godzilla it’s just clear as day but nobody’s listening. Are you inundated with referrals from physicians in 2020? Some of you are. Most of you, the large very vast majority of you are not at all and it’s a shame because we can prevent so much of this garbage.
Item #3
Alright, the last item and my favorite one this week. It’s called “Effects of Chiropractic Care on Strength, Balance, and Endurance in Active-Duty U.S. Military Personnel with Low Back Pain: A Randomized Controlled Trial” by Vining et. al(Vining R 2020). published in the Journal of Alternative and Complementary Medicine in July of 2020. Another helping of boiling thought nuggets for you to feast upon.
Why They Did It
They wanted to investigate whether chiropractic care influences strength, balance, and/or endurance in active-duty United States military personnel with low back pain
How They Did It
- It was a prospective randomized controlled trial using a pragmatic treatment approach
- Participants were randomly allocated to 4 weeks of chiropractic care or to a wait-list control
- Chiropractic care consisted of spinal manipulation, education, advice, and reassurance
- Naval Air Technical Training Center branch clinic at the Naval Hospital Pensacola Florida
- One hundred ten active-duty military personnel 18-40 years of age with self-reported LBP
- Outcome measurements included Isometric pulling strength from a semisquat position was the primary outcome. Secondary outcomes were single-leg balance with eyes open and eyes closed, and trunk muscle endurance using the Biering-Sorensen test. Patient-reported outcomes such as pain severity and disability were also measured. Outcomes were measured at baseline and 4 weeks. Linear mixed-effects regression models over baseline and 4 weeks were used for analysis.
What They Found
- Participants had mean age of 30 years, 17% were female, 33% were non-white, and 86% reported chronic LBP.
- Mean maximum pulling strength in the chiropractic group increased by 5.08 kgs and decreased by 7.43 kgs in the wait-list group, with a statistically significant difference in mean change between groups
- Statistically significant differences in mean change between groups were also observed in trunk muscle endurance and balance with eyes closed, but not in balance with eyes open
- Differences in mean change between groups were statistically significant in favor of chiropractic for LBP-related disability, pain intensity and interference, and fear-avoidance behavior.
Wrap It Up
“Active-duty military personnel receiving chiropractic care exhibited improved strength and endurance, as well as reduced LBP intensity and disability, compared with a wait-list control.”
Alright, that’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week.
Key Takeaways
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
Subscribe Button
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 preventativly 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.
Website
http://www.chiropracticforward.com
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About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
- Michaelson J, B. L., Suprak D, McLaughlin W, Dahlquist D, (2019). "Effects of Two Different Recovery Postures during High-Intensity Interval Training." Translational J ACSM 4(4): 23-27.
- Soprano S, H. S., Bilker W, (2020). "Assessment of Physician Prescribing of Muscle Relaxants in the United States, 2005-2016." JAMA Open 3(6).
- Vining R, L. C., Minkalis A, Gudavalli MR, Xia T, Walter J, Coulter I, Goertz C, (2020). "Effects of Chiropractic Care on Strength, Balance, and Endurance in Active-Duty U.S. Military Personnel with Low Back Pain: A Randomized Controlled Trial." J Altern Complement Med 26(7): 592-601.
CF 135: Adjusting Confirmed Disc Herniations and Bulges
Today we’re going to talk about Adjusting Confirmed Disc Herniations and Bulges. Is this a good idea or a bad idea and what does the research have to say about it?
But first, here’s that sweet sweet bumper music
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 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.
- Like our Facebook page,
- Join our private Facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #135
Now if you missed last week’s episode , we talked about the impact sleep can have on cardiovascular issues and we talked about what the profession of chiropractic can learn from the podiatry profession. There was a great discussion there I believe and great lessons we can learn. Why did podiatrists start at about the same time as chirorpactic but they’re so much more recognized, respected, and integrated compared to the chirorpactic profession? We talked about it. Make sure you don’t miss that info. Keep up with the class.
Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.
On the personal end of things…..
Keepin on keepin on folks. That’s it. Staying in business. One day at a time. So far so good. I hope you found some use out of our discussion a couple episodes back about tactics myself and others are using to get those patients returning back to your office. I think I was able to share some valuable info in that regard.
Dr. Blake Bennett posted in our private Facebook group saying, “We mailed a thousand letters to patients who were in in the past couple years and a couple weeks later we mailed another 500 postcards to patients who haven’t been in longer than that. Email every 2-3 weeks to those on the list. He says the response was great and June was a good month.”
Providing value and giving back. Thank you Dr. Bennett. I know others in need appreciate your advice as do I.
Let’s get on with the reason for the topic today. I saw a post not long ago in the Forward Thinking Chiropractic Alliance where a colleague was asking if it’s OK to adjust segments where there is a confirmed disc herniation or bulge. It was refreshing to see a resounding YES from all of my colleagues.
My answer was “Yes” as well. I’ve been through this from the back end though and I’ll share some of that story with you. It’s a story I’m not happy about, I’m not proud of, and I’m not happy revisiting. It was a hard time in my life to be honest. But, it’s part of my story regardless so here goes.
Many moons ago I treated A LOT of personal injury cases. We all know some of those patients are better than others. This was not one of the great patients but she was fine. No big issues. She had a disc injury and I diagnosed it appropriately I’ll have you know.
Now something to know about me; I’m all about gentle motion. I don’t like it when someone cranks my noggin around just looking for that crack sound. I’m not interested in that and I treat people the way I want to be treated. I’m very gentle, non-agressive, use little to zero rotation in the cervical area, and just won’t be rough with it.
Same went for this lady. And, like so many other patients, she responded well. I tracked her from the beginning where she was having pain 75% of the time down to a much lower rating on the numeric rating scale and only about 25% of the time. She was happy, I was happy and all was gleeful in the land of daily practice.
Until…..until her daughter attended an appointment with her one day. She came in with her just up in arms and actually screaming at me because I had the audacity to work on her mother when she had a disc herniation and clear mention of the disc herniation on her MRI report.
I asked her if she’d ever been to a chiropractor before or knew anything about chiropractic. She had not. She knew nothing about what we do or why we do it. So, I tried to explain briefly and tell her how her mother was doing so much better and how she had improved, blah, blah, blah. Didn’t matter. She didn’t know anything but she knew enough to be straight up pissed the hell off that I’d ever work with her mother with that disc herniation.
It made for an interesting day for sure. But not as interesting as the day I received notice from my state’s governing board that they had received a complaint on me from this patient. While it had this patient’s name on the complaint, it should have had the daughter’s name on it because the patient and I had a good relationship.
So, no matter how good the notes were, no matter how well I tracked the improvement, guess what? I STILL had to hire an attorney to defend me to my own Board. Now, it’s important to understand that the Board isn’t here for us. They’re stated goal is to protect the interest of the public when it comes to chiropractors. Let’s be fair, they see the worst of the worst. Literally. They can, after some time, become a bit jaded and maybe even start to actually EXPECT the worst when they get a complaint.
I literally could not believe I had to take two days off of work, fly to Austin, TX, get a hotel, and defend myself against something that was so black and white. But again, let’s be fair, the folks at the TBCE weren’t there. They didn’t witness what I saw. They didn’t see the happiness of the patient with her improvement. They weren’t there when we just did manual mobilization rather than agressive adjustments. I can’t blame them. It was the process and I had to go through it. Right or wrong. And trust me, if you’ve listened to this podcast long enough honesty is big with me. This was wrong. It should have never gotten beyond the initial complaint. But whatever. I went to Austin.
Now, one of my colleagues and friends was on the enforcement committee and she asked me some straight forward questions with the attorney sitting there. I don’t know why the hell he was even there other than to collect a check because he didn’t say a damn thing or do a damn thing.
This was before I went through a diplomate but after going through Croft’s Whiplash Biomechanics and Traumatology course. What I’m saying is I’m better today than I was back then but I was far from being a slacker back then. I answered all of the questions, walked out, and the attorney told me what a great job I did and then we waited.
I ended up getting a warning but nothing on my record. No action taken against me. I was pissed then and am still pissed that I’d get a warning for anything at all. I didn’t deserve a warning. It wasn’t warranted because I didn’t do anything wrong.
Now, the reason for that story for a couple of reasons. First, I want you to understand the value of documentation. Had I not had the documentation showing the improvement of this patient over her treatment, I would have been absolute toast based solely on the word of a patient’s daughter. A person that has never been to a chiropractor and knows nothing about the profession. That’s number one. So documentation people; don’t just document to remember what you did. Document to protect yourself and your staff. It sucks but you have to do it.
The second reason I told that story is that this experience led me to start looking up research on discs and adjusting. Was I actually wrong and I just didn’t know it? I went searching for the answers because if I were to keep adjusting people, you damn well better believe that I’m going to be adjusting people with discs that many times are herniated or bulging. That’s either knowingly doing it and most times unknowingly doing it.
Hell, we know that 60% of patients between the ages of 40 and 50 years old have disc findings that are completely asymptomatic. No pain at all. Still, when you’re adjusting a 40 - 50 year old, you have a 60% chance of adjusting someone with a bulge or herniation. So it made sense to me to protect myself from ever running into this crap again down the road.
If I had those paper in front of me when I went in there to defend myself, maybe I don’t even get a warning. But, if someone is sitting on the enforcement and questioning concerning adjusting areas with disc issues, they need to be on top of that research as well. And they might have been. I don’t know. All of the folks at the TBCE have become well thought of friends and colleagues now that I’ve been active in the Texas Chiropractic Association for so many years. Not the case at the time though. I only knew one of them back then. Even though there’s been a turnover since this happened many moons ago, I’m still friends with even the new TBCE crew and they’re all highly respected and thought of by me. Good good people just trying to do a good job.
Anyway, We’re going to go through some papers here for you so you can get a clear picture on this topic.
Item #1
OK, Item #1 this week is called “Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study” by McMorland, et. al. publshed in the Journal of Manipulative Physiological Therapeutics in October of 2010(McMorland G 2010).
Why They Did It
The purpose of this study was to compare the clinical efficacy of spinal manipulation against microdiskectomy in patients with sciatica secondary to lumbar disk herniation (LDH).
How They Did It
- 121 patients were in the study
- Patients had to have failed at least 3 months of nonoperative management like analgesics, lifestyle modification, physiotherapy, massage, or acupuncture.
- They were randomized to either surgical microdiskectomy or standardized chiropractic spinal manipulation
- Patients could opt to crossover to the other treatment after 3 months
What They Found
Significant improvement in both treatment groups compared to baseline scores over time was observed in all outcome measures. After 1 year, follow-up intent-to-treat analysis did not reveal a difference in outcome based on the original treatment received
Wrap It Up
“Sixty percent of patients with sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention. Of 40% left unsatisfied, subsequent surgical intervention confers excellent outcome. Patients with symptomatic LDH failing medical management should consider spinal manipulation followed by surgery if warranted.”
Who does this not make perfect sense to? Well….besides my patient’s daughter that is? Oh, and just about any medical physician you can find. I just don’t know how they haven’t latched onto this research yet. Honestly.
Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. If you’re into IASTM also known as instrument assisted soft tissue manipulation, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend.
Drop Release is a revolutionary tool that harnesses the body’s built-in protective systems to make muscles relax quickly and effectively. This greatly reduces time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day.
It’s inventor, Dr. Chris Howson, from the great state state of North Dakota has is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase.
Go check Drop Release at droprelease.com and tell Dr. Howson I sent you.
Item #2
This is a great one here called “Outcomes From Magnetic Resonance Imaging–Confirmed Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulative Therapy: A Prospective Cohort Study With 3-Month Follow-Up” by Peterson et. al. published in the Journal of Manipulative and Physiological Therapeutics in August of 2013(Peterson C 2013).
Why They Did It
The purpose of this study was to investigate outcomes of patients with cervical radiculopathy from cervical disk herniation (CDH) who are treated with spinal manipulative therapy.
How They Did It
- 50 Adult Swiss patients with neck pain and dermatomal arm pain; sensory, motor, or reflex changes corresponding to the involved nerve root; and at least 1 positive orthopaedic test for cervical radiculopathy were included.
- Magnetic resonance imaging–confirmed CDH linked with symptoms was required.
- Baseline data included 2 pain numeric rating scales (NRSs), for neck and arm, and the Neck Disability Index (NDI). At 2 weeks, 1 month, and 3 months after initial consultation, patients were contacted by telephone, and the NDI, NRSs, and patient's global impression of change data were collected
- High-velocity, low-amplitude spinal manipulations were administered by experienced doctors of chiropractic.
- Acute vs subacute/chronic patients' NRSs and NDIs were compared using the Mann-Whitney U test.
What They Found
- At 2 weeks, 55.3% were “improved,” 68.9% at 1 month and 85.7% at 3 months.
- Statistically significant decreases in neck pain, arm pain, and NDI scores were noted at 1 and 3 months compared with baseline scores
- Of the subacute/chronic patients, 76.2% were improved at 3 months.
Wrap It Up
Most patients in this study, including subacute/chronic patients, with symptomatic magnetic resonance imaging–confirmed CDH treated with spinal manipulative therapy, reported significant improvement with no adverse events.
Item #3
This one is from Bergmann, et. al. and published in the Journal of Manipulative and Physiological Therapeutics in 1998 called “Manipulative therapy in lower back pain with leg pain and neurological deficit.(Bergmann TF 1998)”
Why They Did It
To discuss a case of sciatica associated with lower back pain that originates in a disc. We discuss the use of manipulative therapy as a conservative approach and compare it with other conservative methods and with surgery.
How They Did It
- The patient suffered from lower back and left leg pain that had increased in severity over a 6-day period. There was decreased sensation in the dorsum of the left foot and toes. Computed tomography demonstrated the presence of a small, contained disc herniation.
- The patient was initially treated with ice followed by flexion-distraction therapy. This was used over the course of her first three visits. Once she was in less pain, side posture manipulation was added to her care. Nine treatments were required before she was released from care.
Wrap It Up
“We need a nonsurgical, conservative approach to treat lower back pain with sciatica as an alternative to and before beginning the more aggressive, and potentially hazardous, surgical treatment. There is some support for the idea that lumbar disc herniation with neurological deficit and radicular pain does not contraindicate the judicious use of manipulation. there is ample evidence to suggest that a course of conservative care, including spinal manipulation, should be completed before surgical consult is considered.”
Item #4
The last one we’ll cover here is called “Spinal manipulation in the treatment of patients with MRI-confirmed lumbar disc herniation and sacroiliac joint hypomobility: a quasi-experimental study” by Shokri et. al and published in Chiropractic and Manual Therapies in May of 2018(Shokri E 2018).
Why They Did It
To investigate the effect of lumbar and sacroiliac joint (SIJ) manipulation on pain and functional disability in patients with lumbar disc herniation (LDH) concomitant with SIJ hypomobility.
How They Did It
- Twenty patients aged between 20 and 50 years with MRI-confirmed LDH who also had SIJ hypomobility participated in the trial in 2010.
- Patients who had sequestrated disc herniation were excluded
- All patients received five sessions of spinal manipulative therapy (SMT) for the SIJ and lumbar spine during a 2-week period.
- back and leg pain intensity and functional disability level were measured with a numerical rating scale (NRS) and the Oswestry Disability Index (ODI) at baseline, immediately after the 5th session, and 1 month after baseline.
What They Found
A significantly greater mean improvement in back and leg pain was observed in the 5th sessions and 1 month after SMT
Wrap It Up
Five sessions of lumbar and SIJ manipulation can potentially improve pain and functional disability in patients with MRI-confirmed LDH and concomitant SIJ hypomobility.
There are more but I don’t want this episode to be an hour long. If I have a patient with a hot disc, I don’t typically adjust on day one. We focus on getting the patient moving. We sit them on a theraball and have them move their hips in circles, front to back, side to side, figure eights, and whatever other way we can think of. Most have a direction of preference that is in trunk extenstion. If this is right for the patient, we will do extension bias exercises.
We make sure they are keeping their low back nice and stiff, neutral, and strong in every movement they make. We make sure they know what position to sleep in. We stress the importance of not laying down and hoping it goes away. Rather than that, they really need to be walking and doing the exercises. If they have people that just underwent surgery walking the next day, then doesn’t that same concept make sense for discs? Well of course it does. They typically come back the next day with the pain reduced enough to be able to do some light mobilization on the low back. I am careful to not be agressive and to not put an extreme amount of rotation into the spine. We want movement but we also want the spine as straight, strong, and neurtal as possible.
Make sure you have schooled them on this concept. Tell them to make sure they behave like they have a long flourescent light bulb taped to their back and their job is to not break it. If you can remove the triggers that caused the pain, it’ll go a long way toward their recovery.
Alright, that’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week.
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
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 preventativly 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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography
- Bergmann TF, J. B. (1998). "Manipulative therapy in lower back pain with leg pain and neurological deficit." J Manipulative Physiol Ther 21(4): 288-294.
- McMorland G (2010). "Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study." J Manipulative Physiol Ther 33(8): 576-584.
- Peterson C, e. a. (2013). "Outcomes from magnetic resonance imaging — confirmed symptomatic cervical disk protrusion patients treated with high-velocity, low-amplitude spinal manipulative therapy: a prospective cohort study with 3-month follow-up." J Manipulative Physiol Ther 36(8): 461-467.
- Shokri E, K. F., Sinaei E, Ghafarinejad F, (2018). "Spinal manipulation in the treatment of patients with MRI-confirmed lumbar disc herniation and sacroiliac joint hypomobility: a quasi-experimental study." Chiropr Man Therap 26(16).
CF 133: Getting Patients Returning, Shoulder Impingement, Cervical Manipulation, & X-rays and Neurodegenerative Disease
Today we’re going to talk about getting your patients back in your office, we’ll talk about shoulder impingement, cervical manipulation research, and we’ll talk about low dose x-rays being the cause of neurodegenerative disease.
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our Facebook page,
- Join our private Facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #133
Now if you missed last week’s episode , we talked about giving, we talked about maintenance care, dry needling, and we also talked about vitalism. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.
On the personal end of things…..
The last two episodes have had talk about vitalism and all of that. I got red in the face and gripey and some would even say…..disagreeable.
None of that this week. Fun and positivity. I made the mistake of going back to recording the personal part of the podcast….this part of the podcast….two weeks in advance. Well, it bit me in the butt an episode or two back. I should know by now that that damn COVID’s going to change the program. Lol. I said it was looking good and numbers were great and by the time we get to air time, 2 weeks down the road, the roadmap was different and crap was firing up everywhere again. It sounded silly for it to be firing up everywhere and there I am on a fresh episode talking about how good it’s looking. Lol. So…..I’m not going to mention anything like that again.
Besides, you guys are probably not in the mood to hear more about it anyway. Instead, I’ll tell you that I’m at about 81% of where I want to be. The least I want to see per week is about 180 appointments. Each week. 13 - 15 new patients per week. That’s the LEAST I want to see.
As of this recording, last week I saw 146 and 15 patients. So, I’m not at 180 yet but I’m more comfortable with my new patient count. Let’s keep that rocking and the other numbers should take care of itself sooner than later. It’s a Monday afternoon and I have 120 on the books. That’s before Wednesday gets booked up, Thursday, and Friday. So, starting a Monday with 120 already booked for the week, that tells me we have a good chance at a continued recovery.
What are your numbers looking like? Is your practice starting to get back to normal and stabilize? What are you doing to make sure your business survives this mess? I want to hear about it so I can share with our audience. If you’ll share with us on the Facebook page, in teh Facebook group, or by sending me an email at dr.williams@chiropracticforward.com…..I’ll make sure and share with the rest of our listeners. This can be an excellent way to help others that are struggling right now.
Last week I talked about giving. Well, this is a great way to give back to your profession and colleagues that may not be doing as well as we are.
I’ll start.
I doubled down on Social Media
Instead of one post a day, we went to 3 per day and 4 per day on the weekends.
We went from just talking about chiropractic to fun posts with a little bit of chiropractic here and there. About every 4th or 5th post. We want to entertain. I don’t know that anyone wants to be sold anything right now but, I don’t personally mind commercials or being interrupted if I’m simultaneously being entertained. So that’s what we did. We started entertaining our crownd
We asked for people to help us by inviting their friends to our page. And they did! We hit numbers that would have taken us 3 years to build. We hit them in only about 4 days. I was amazed. Just because we asked and, it seems that at this time, more people are willing to help others.
Of course that’s if they’re not bitching at each other about masks.
I got back to my weekly emails to my patients. I had fallen off to emailing only once every 3-4 weeks. Now I’m back on a weekly schedule.
I revamped my To Do list to include everything thing that I need to accomplish every day so I don’t forget or let things lapse. I want to stay on point with getting our message out every day, every week, every month.
I decided to try a professional company for Facebook ads. We still have a lot of really mixed results on that sucker right now so I haven’t talked much about it but I’ll let you know how we do down the road.
In the meantime, as if I needed something else to occupy my time, I started a voice over career on the side. Lol. To go along with my sculpting, drawing, and art career. To go along with my furniture building career. Which will go along nicely with my singer/songwriter/guitar playing career.
Geez….is that the very definition of A.D.D. or what?
But yeah, if you need any commercials voiced for you, holler at me. I’m happy to help.
Back to the office, I got back to doing weekly YouTube videos. Every week like clockwork. That made me get back to writing my own weekly blog. That’s work I used to hire out to a guy in South Africa but I took it back over for a bit and it’s been fun actually.
So, as you can see, I’ve made A LOT of changes to get back on track and get this sucker not just where it was this time last year, but 10% or more bigger. Why the hell not?
Overall, I have made it a point to highlight what we are doing to help keep them as safe as we can. If COVID is the barrier, then we need to do everything we can to remove that barrier.
Alright, like I said, you guys and gals send me you suggestions of things you are doing to get your patients back in your clinic.
Item #1
This first one this week is called ‘Relationship between shoulder impingement syndrome and thoracic posture’ by Hunter et. al.(Hunter D 2020) and published in Physical Therapy journal in April of 2020 and that means that that is one hot son of a mother!!
Why They Did It
They say that shoulder impingement is the most common form of shoulder pain and a persistent musculoskeletal problem and that we have had limited success in treating it. They wanted to test whether or not thoracic posture has anything to do with it.
How They Did It
- This was a case control study.
- Thoracic posture of 39 participants with shoulder impingement was measure using the modified Cobb angle from a lateral x-ray.
- They accounted for age, gender, and dominant arm
- T-sp range of motion was measure with inclinometer
What They Found
- Individuals with shoulder impingement had greater thoracic kyphosis and less active thoracic extension
- Greater thoracic kyphosis was associated with less extension ROM
Wrap It Up
“Individuals with shoulder impingement had a greater thoracic kyphosis and less extension ROM than age- and gender-matched healthy controls. These results suggest that clinicians could consider addressing the thoracic spine in patients with shoulder impingement.”
Item #2
Item #2 this week is called “The Effect of High Velocity Low Amplitude Cervical Manipulations on the Musculoskeletal System: Literature Review” by Giacalone et. al.(Giacalone A 2020) published in Cureus in April of 2020 which makes it too hot to handle for me!
Why They Did It
They say that cervical manipulative techniques are mostly used for the treatment of biomechanical joint dysfunction, but little is known about the possibly using them in order to achieve better performance on healthy subject
How They Did It
- A systematic search was carried out on the Pubmed electronic database from the beginning of January to March 2020.
- Two independent reviewers conducted the screening process through the PRISMA diagram to determine the eligibility of the articles.
- The inclusion criteria covered randomized controlled trial (RCT) manuscripts published in peer-reviewed journals with individuals of all ages from 2005 to 2020.
- The included intervention was thrust manipulation or HVLA directed towards the cervical spine region.
- After reviewing the literature, 21 of 74 articles were considered useful and relevant to the research question.
What They Found
- HVLA techniques, on subjects with musculoskeletal disorders, are able to influence pain modulation, mobility and strength both in the treated area and at a distance.
- Cervical manipulations are effective in management of cervicalgia, epicondylalgia, temporomandibular joint disorders and shoulder pain.
- With regard to results on strength in healthy subjects, given the divergent opinions of the authors, we cannot yet state that manipulation can significantly influence this parameter.
Item #3
Our last one is called ‘Low-dose x-ray imaging may increase the risk of neurodegenerative diseases’ by Caroline Rodgers(Rodgers C 2020) and published in Medical Hypotheses in April of 2020…..look at April…..not just bringing us COVID…but also bringing us a bunch of plates of steamy hot stuff.
As the journal says, this is a hypotheses. The hypothesis presented in this paper explores the possibility that X-ray imaging commonly used in dental practices may be a shared risk factor for sporadic dementias and motor-neuron diseases. As the evidence will suggest, the brain is ill-equipped to manage the intrusion of low-dose ionizing radiation (IR) beyond that which is naturally occurring.
When the brain's antioxidant defenses are overwhelmed by IR, it produces an abundance of reactive oxygen species (ROS) that can lead to oxidative stress, mitochondrial dysfunction, loss of synaptic plasticity, altered neuronal structure and microvascular impairment that have been identified as early signs of neurodegeneration in Alzheimer's disease, Parkinson's, amyotrophic lateral sclerosis, vascular dementia and other diseases that progressively damage the brain and central nervous system.
Common assumptions regarding the risks of low-dose IR will be addressed, such as: 1) comparing rapid, repeated bursts of man-made IR sent exclusively into the head to equivalent amounts of head-to-toe background IR over longer periods of time; 2) whether epidemiological studies that dismiss concerns regarding low-dose IR due to lack of evidence it causes cancer, heritable mutations or shortened life spans also apply to neurodegeneration; and 3) why even radiation-resistant neurons can be severely impacted by IR exposure, due to IR-induced injury to the processes they need to function.
If X-ray imaging is found to be associated with neurodegeneration, the risk-versus-benefit must be reevaluated, every means of reducing exposure implemented and imaging protocols revised.
So…..we here at Chiropractic Forward will be following along here. Because if this turns our to confirm that radiation causes neurodegenerative disease, you know what that means for the chiropractors shooting x-rays on each and every patient and then doing several follow up x-rays on them?
They won’t be happy campers. But, maybe they’ll start following more guidelines that say no x-rays outside of red flags. I’ve said several times that I’m not against chiropactors that shoot initial x-rays. I’m really not. Some are just more comfortable working on people when they’ve seen what they can see.
My issue is using the initial x-rays as a scare tactic and communicating in a catastrophic way to acheive a long treatment schedule out the patient. One they likely don’t need at all.
My other issue would be repeating x-rays several times through treatment. That’s not evidence-based and the patient doesn’t need them.
Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week.
Key Takeaways
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
Subscribe Button
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 preventativly 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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Giacalone A, F. M., Magnifica F, Ruberti E, (2020). "The Effect of High Velocity Low Amplitude Cervical Manipulations on the Musculoskeletal System: Literature Review." Cureus 12(4): e7682.
Hunter D, R. D., McKeirnan S, (2020). "Relationship Between Shoulder Impingement Syndrome and Thoracic Posture." Phys Ther 100(4): 677-686.
Rodgers C (2020). "Low-dose X-ray Imaging May Increase the Risk of Neurodegenerative Diseases." Med Hypotheses 142(109726).
https://traffic.libsyn.com/secure/chiropracticforward/CF_133__Getting_Patients_Returning_Shoulder_Impingement_Cervical_Manipulation__X-rays_and_Neurodegenerative_Disease.mp3
CF 132: Giving, Maintenance Care, Dry Needling, and Vitalism
Today we’re going to talk about Giving, Maintenance Care, Dry Needling, and Vitalism
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our Facebook page,
- Join our private Facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #132
Now if you missed last week’s episode , we talked about 5 principles to change clinical practice. There was some great information in that one all based on a recent paper that came out. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.
On the personal end of things…..
One foot in front of the other. I’ve been thinking a lot lately. I know this concept but I don’t do it intentionally. Still….I definitely do it. I give away stuff and help others when I like them, their product, or service. I promote them without expecting anything in return. Because I don’t expect anything in return. I do it because of the reasons stated.
Then, what happens is that through giving to others, things come back around and are given to you. That’s the way it works. Again, I don’t give to get something back. To me, that’s just not how it works. You have to give because you have a giving heart. Not a greedy heart just giving to get.
I talk about people that I believe in and things that I use because I like them and I think they’d be useful to you. I talk about other people’s stuff more than I talk about my own stuff. I have some awesome evidence based patient education brochures and posters on our website but I talk more about Forward Thinking Chiropractic Alliance than you hear me talk about my stuff.
If you’re evidence-based, I firmly believe you need to be a part of the FTCA. It’s that simple. We had Kevin Christie with Modern Chiropractic Marketing Podcast on a couple weeks ago. He does it right. That’s why he was on. I believe in Dr. Christie, I like Dr. Christie, and I support him.
ChiroUp, not only do I really like the co-owners personally, but I don’t know what I ever did without the product. Honestly, I have no idea. I was less than before I had ChiroUp in my office.
It’s why you always hear me speak about the diplomate/fellowship through the international academy of neuromusculoskeletal medicine. I’m not sure I’ve ever professionally believed in anything more than the education you get through them.
It’s why I talk often about involvement with the Texas Chiropractic Association. It’s because I hope you’ll see the value in being active and involved in your own associations. Doing so was one of the key gamechangers in my professional life. You can count on that.
Same goes for philanthropy. If you’re not giving back to your local non-profits monthly, you really should consider doing so. It’s easy and it’s fun. We’ve made it a cornerstone of my personal business.
This isn’t a ‘oh look at me and how awesome I am’ thing here. It’s just an honest conversation about something I was thinking the other day. Does any of this come back to benefit me financially? I don’t know. I really don’t have a clue. And honestly, I don’t care. Once again, that’s not why we give. We give because we have a giver’s heart. Not only do I like and believe in the people and the products or the causes, but I also think that our listeners will find value in it. If I’m providing you value, then you know you’ll get the best, most valuable information through this podcast.
So, maybe, even if others aren’t necessarily talking us up or pumping our tires, it still comes back, huh? Either way, there’s nothing better than giving. At least for me. I came across a quote that made some sense recently. Pablo Picasso said that the meaning of life is to find your gift. The purpose of life is to give it away.” That’s a giver’s heart. Exactly what I’m talking about. Seems like it worked out for Pablo.
I think about give vs. take and I think of people that are takers. Taking money from patients when they don’t need the treatment. But a doctor scared them into a ton of extra visits because it’s good for stats and the bottom line. That’s a taker.
Being in a position to help but deciding to never do anything to help anyone unless it benefits them personally or financially. That’s a taker.
Just being in the world to see what you can get out of it instead of what you can contribute. That’s a taker. What can you do to make your space better? How can you spread a little love and kindness?
Just some random thoughts today. Hope it meant something to you.
Item #1
Let’s get started with this one called “The Nordic maintenance care program: maintenance care reduces the number of days with pain in acute episodes and increases the length of pain free periods for dysfunctional patients with recurrent and persistent low back pain - a secondary analysis of a pragmatic randomized controlled trial” by andreas Eklund et al(Eklund A 2020) and published in Chirorpactic and Manual Therapies in April 2020. Hot cakes coming up, hot cakes people.
Why They Did It
Eklund has shown in two previous papers the benefit of treating preventatively but thae benefit varied across psychological subgroups.
The aims of this study were to investigate
- pain trajectories around treatments,
- recurrence of new episodes of LBP, and
- length of consecutive pain-free periods and total number of pain-free weeks, for all study participants as well as for each psychological subgroup.
How They Did It
A secondary analysis of data from a randomized controlled trial of patients seeking chiropractic care for recurrent or persistent LBP used 52 weekly estimates of days with low back pain that limited activity.
What They Found
- Patients receiving maintenance care had flat pain trajectories around each new treatment period and reported fewer days with pain compared to patients receiving the control intervention.
- The entire effect was attributed to the dysfunctional subgroup who reported fewer days with activity limiting pain within each new LBP episode as well as longer total pain-free periods between episodes with a difference of 9.8 weeks compared to the control group.
- There were no differences in the time to/risk of a new episode of LBP in either of the subgroups.
Wrap It Up
Data support the use of MC in a stratified care model targeting dysfunctional patients for MC. For a carefully selected group of patients with recurrent and persistent LBP the clinical course becomes more stable and the number of pain-free weeks between episodes increases when receiving MC.
Item #2
Item 2 is called ‘Dry needling for spine related disorders: a scoping review’ by Funk et. al(Funk MF 2020). published in Chiropractic and Manual Therapies in May of 2020…..bringin’ the heat people! Bringing the heat!
Why They Did It
The depth and breadth of research on dry needling (DN) has not been evaluated specifically for symptomatic spine related disorders (SRD) from myofascial trigger points (TrP), disc, nerve and articular structures not due to serious pathologies. Current literature appears to support dry needling for treatment of trigger points. Goals of this review include identifying research published on dry needling treatment for spine related disorders, sites of treatment and outcomes studied.
How They Did It
A scoping review was conducted following Levac et al.’s five part methodological framework to determine the current state of the literature regarding dry needling for patients with spine related disorders.
That sound fine and freaking dandy but what the hell is a scoping review vs. a systematic review? Well, I did the work for you and here’s what we have. Within the framework of research methods, a well- done scoping review is considered at a higher level than a straightforward review of literature or an integrative review, but not as in depth as a Cochrane or Johanna Briggs model systematic review
Researchers may conduct scoping reviews instead of systematic reviews where the purpose of the review is to identify knowledge gaps, scope a body of literature, clarify concepts or to investigate research conduct. While useful in their own right, scoping reviews may also be helpful precursors to systematic reviews and can be used to confirm the relevance of inclusion criteria and potential questions.
Although conducted for different purposes compared to systematic reviews, scoping reviews still require rigorous and transparent methods in their conduct to ensure that the results are trustworthy.
And now we’ve both learned something so that’s awesome.
Wrap It Up
Back to the paper here; I’m not even going to get into the meat and taters here on this paper because you’ll zone off and might even tune out. I have it cited in the show notes if you really want to find it and dive in. Getting straight to the conclusion, the authors say, “For spine related disorders, dry needling was primarily applied to myofascial structures for pain or TrP diagnoses. Many outcomes were improved regardless of diagnosis or treatment parameters. Most studies applied just one treatment which may not reflect common clinical practice. Further research is warranted to determine optimal treatment duration and frequency. Most studies looked at dry needling as the sole intervention. It is unclear whether dry needling alone or in addition to other treatment procedures would provide superior outcomes.”
We covered a paper on dry needling last year that suggested it had little use. It appears it does indeed have some use. They just don’t know how to best use it yet. If that makes sense.
Item #3
Our last one today is called ‘Vitalism in contemporary chiropractic:a help or a hinderance?” by J. Keith Simpson and Kenneth J. Young(Simpson J 2020) and published in Chiropractic and Manual Therapies June 11, 2020. See the sizzle on that stacks of steaming sizzlers.
Why They Did It
Chiropractic emerged in 1895 and was promoted as a viable health care substitute in direct competition with the medical profession. This was an era when there was a belief that one cause and one cure for all disease would be discovered. The chiropractic version was a theory that most diseases were caused by subluxated (slightly displaced) vertebrae interfering with “nerve vibrations” (a supernatural, vital force) and could be cured by adjusting (repositioning) vertebrae, thereby removing the interference with the body’s inherent capacity to heal. DD Palmer, the originator of chiropractic, established chiropractic based on vitalistic principles. Anecdotally, the authors have observed that many chiropractors who overtly claim to be “vitalists” cannot define the term. Therefore, we sought the origins of vitalism and to examine its effects on chiropractic today.
Discussion
Vitalism arose out of human curiosity around the biggest questions: Where do we come from? What is life? For some, life was derived from an unknown and unknowable vital force. For others, a vital force was a placeholder, a piece of knowledge not yet grasped but attainable. Developments in science have demonstrated there is no longer a need to invoke vitalistic entities as either explanations or hypotheses for biological phenomena. Nevertheless, vitalism remains within chiropractic. In this examination of vitalism within chiropractic we explore the history of vitalism, vitalism within chiropractic and whether a vitalistic ideology is compatible with the legal and ethical requirements for registered health care professionals such as chiropractors.
They say that despite the obstacle of vitalism, chiropractic has made extraordinary inroads into the health care system worldwide. Having emerged from the pre-scientific health care era in the United States of America (USA) in the early twentieth century it now has a global footprint with representation in approximately 100 countries. It is the third largest regulated primary contact health care profession in the western world
Conclusion
Vitalism has had many meanings throughout the centuries of recorded history. Though only vaguely defined by chiropractors, vitalism, as a representation of supernatural force and therefore an untestable hypothesis, sits at the heart of the divisions within chiropractic and acts as an impediment to chiropractic legitimacy, cultural authority and integration into mainstream health care.
Y’all know by now how I feel about it. When you have someone following current research, updating their procedures and thought process as the knowledge base expands, and taking care of their patients and running their businesses in an ethical way with the highest of morals and love, then you’re my kind of person. I respect you and I’m proud of you. Most of our listeners are that kind of practitioner.
If you’re scaring people into a bunch of visits based on stuff research says is no big deal, if you’re convincing people they depend on seeing you consistently, if you’re engaging in vaccine discussions when you’ve read a book or two but never been proper educated to do so, when you’re stats and your profits come before the true needs of the patient, then I don’t respect you and I wonder how you sleep at night with the knowledge of how you are screwing and stealing from patients coming to you for your help weighing heavily on your conscience. They come to you for your help. Not to buy you a big house. Not to be lied to. Not to have false, fake, or outdated ideas shoved up their poop shoot and to be taken advantage of.
Stop it dammit. It’s gross and you give everyone that truly works their asses off a bad name. You’re the reason someone that gets a diplomate or some other significant continueing education ro certification…..you’re the reason they still get laughed at behind their backs. You should be ashamed of what you do to yourselves, your colleagues, and your profession.
I’m really not a bitchy guy. I’m a fun-loving ‘let’s have a beer’ kind of guy. But very few things grind my geears worse than this stuff. Honestly. It’s the wrench in my gears, the salt in my wound if you will. I think about it and I start breaking out in hives and get all rashy. My eyes about roll out of my damn head onto the floor.
I’ll be in a better mood next week. I hope.
Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week.
Key Takeaways
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
Subscribe Button
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 preventativly 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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Eklund A, H. J., Jensen I, Leboeuf-Yde C, (2020). "The Nordic maintenance care program: maintenance care reduces the number of days with pain in acute episodes and increases the length of pain free periods for dysfunctional patients with recurrent and persistent low back pain - a secondary analysis of a pragmatic randomized controlled trial." Chiropr Man Therap 28(19).
Funk MF, F.-D. A. (2020). "Dry needling for spine related disorders: a scoping review." Chiropr Man Therap 28(23).
Simpson J, Y. K. (2020). "Vitalism in contemporary chiropractic: a help or a hinderance?" Chiropr Man Therap 28(35).
CF 131: New Information On 5 Actions To Change Clinical Practice
Today we’re going to talk about moving toward being patient-centered. There are 5 actions recommended. What does it even mean? I might just ruffle some feathers here but a damn I do not giveth.
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our Facebook page,
- Join our private Facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #131
Now if you missed last week’s episode , we were joined by Dr. Kevin Christie with The Modern Chiropractic Marketing podcast and author of a new book that’s coming out on chiropractic marketing. Kevin is a rising star in chiropractic and is a must-not-miss. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.
On the personal end of things…..
Still climbing in the patient numbers. Where I’m located here in Amarillo, TX, there is a population of approximately 280,000 people. Last week, on Thursday and Friday we added 3 total cases of COVID on Thursday and only 2 cases on Friday. Then the following Monday, we added 11.
So, as you can see, the numbers here are no longer high. People are sort of ‘over it’ and you can see that and hear it when you talk to the patients. Hell, I’m sort of over it but still being smart. I’m having friends to the house again but we stay outside by the pool and have a couple of adult beverages.
I have a friend that is a musician. Last weekend, he played a rodeo on Woodward, OK. He said there were probably 1,000+ people at the event and it was indoors. So, in Woodward, OK at least, they are REALLY over it. No way in hell I’m grouping up with that many people indoor or outdoor right now. It just doesn’t make sense to me for now.
I guess if I were 28 and at the top of my game physically it wouldn’t make any difference to me either. But going to an event where people are yelling and cheering right behind, beside, and in front of me….big nopers right now. Ain’t happnin’
I noticed that while cases seem to be leveling off across America, they’re not increasing or decreasing as much as you’d like but, what I noticed is that the deaths are going down. Fairly signficantly. So wouldn’t that fit with the news that started coming out a couple weaks ago about the virus losing some potency?
People are still getting it but not as many dying from it. Another explanation could be that we’ve gotten better at treating it. Either way, that’s not my lane so I’m not going to act like the expert. I’ll just say hell yay-us and keep the good news coming so we can all get back to life as it was meant to be lived.
I hope you’re all well and staying healthy. As always, if you care about the kind of information I share every week and you listen consistently, I’m proud of you. I think you care about the right stuff and even though I don’t know you all, I consider you my friend.
Item #1
Let’s kick this week’s research reviews off with this one called ‘It is time to move beyond body region silos to manage musculoskeletal pain; five actinos to change clinical practice’ by Caneiro et. al(Caneiro JP 2020). published in British Journal of Sports Medicine in 2020. We got a hot one over here!!
This paper actually has a lot of big names in the industry like Caneiro, O’Sullivan, O’Sullivan and Jan Hartvigsen. If you don’t know Jan’s name, you just haven’t been a regular listener.
Why They Did It
They say that current clinical research, education, and practice approaches musculoskeletal pain and conditions in silos. Basically it’s a focus on body regions like the knee, hip, neck, shoulder, etc.
But current thinking actually shows that the pain disorders are frequently comorbid and share common biopsychosocial risk profiles for pain and disability.
They say that a shift to focusing on the person is what is needed and that this would encourage the doctors to:
- focus on the patients’ context and modifiable biopsychosocial factors that influence their pain and disability
- Use education to facilitate active management approaches (targeted exercise therapy, physical activity, and healthy lifestyle habits) thus reducing reliance on passive interventions
- Consider evidence-based surgical procedures only for those with a clear indication and where guideline-based non-surgical approaches have been rigorously adhered to.
Well who the hell can’t get behind all of that? Honestly, it’s odd when you think about it that in the year 2020, we’re still saying that surgery should be evidence-based and follow certain guides and that conservative treatment should be first basically. How’s that not just common sense and common procedure in 2020? We’re supposed to have freaking flying cars by now but the medical field doesn’t have this stuff down they way they should just yet?
It’s money. I know. I understand it. But it’s frustrating as hell all the same.
In this paper, the authors say to be truly patient-centered, they have five actions they recommend for managing a person with musculoskeletal pain, irrespective of body region.
- Screen for biopsychosocial factors and health comorbidities. Notice this is #1 on their recommendations. If you’re just getting them in a pop a crack a lack and sending them on without this step, your results are going to be less than you or the patient desires. They say we need to communicate clearly with the patient to identify potential biopsychosocial drivers of the pain and then provide the therapy to fill that gap. These things include pain beliefs, emotional and coping responses to pain, social contest, physical and lifestyle factors and the presence of comorbidities. They recommend using the Orebro Musculoskeletal Pain Questionnaire.
- Embrace patient-centered communication. This one is huge and this is one of the key things we learned in the Fellowship training for the neuromusculoskeletal medicine program. Clinicians should use open and reflective questioning to elicit the patient’s understanding of factors, which include the pain experience (tell me your story), causation beliefs (what do they think is the cause of the pain?), coping (what do you do when the pain increases?), impact (Tell me how your symptoms affect your ability to move and function), concerns (do your symptoms worry you?), beliefs (why do you think you shouldn’t bend/lift, or run?), social factors (tell me about your home life or work life), goals (what are you rgoals?), and expectations. Yes, to an extent, updated research and thinking has us behaving a bit like a psychologist I think. It’s not my favorite stuff. But, when you learn and consider how much pain is held in the brain due to these yellow flag indicators, then you start to realize that pain, certainly chronic pain, cannot just be treated at a peripheral source. You have to address the pain from a central sensitization perspective at least equally or you risk never being able to help these patients.
- Educate beyond words using active learning approaches. doctors have to embrace education as a central part of patient care if we are going to change behavior. We have to dispel myths about pain, imaging findings, and activity engagement (for example, hurt does not equal harm). They say that behavioral learning like exercise therapy can be used to bust myths that are unhelpful. Myths and beliefs that lead to things like fear avoidance.
- Coach towards self-management. A large portion of the chiropractic profession wants and desires patients to depend on them week after week, month after month and that’s just not real world stuff. And it’s not helpful for the patient’s recovery either. We should be empowering patients to engage in exercise, valued activities and a healthy lifestyle with confidence. Can you feel the difference here? “Mary, I know you’re only 35 but you already have some degenerative discs in your neck and I’m so concerned about it. This should be considered urgent and I’m going to need to see you 5 million times for the rest of your life.” Is that helpful or is this helpful? “Mary, I know you read on your rad report here that there is a finding of a degenerative disc in your neck but the truth is, that’s very common and not something you should be concerned with. Certainly not over-concerned with. I actually prefer the word ‘deconditioned’ over ‘degenerative.’ A good percentage of 30-40 year old patients have some mildly deconditioned discs but these rarely ever cause any issues. You’re young, you’re strong, and you’re healthy. We’re going to get everything moving correctly and then I’m going to give you some excellent exercises to really focus on the region and build plenty of support. You’re going to do great.” When you stack those two next to each other, it’s easy to see how harmful one is as opposed to the other more positive, more hopeful one. I got a little side tracked there, the point is, help them take control and self manage. Active amnagement relieves pain and improves function across pain conditions and health comorbidities.
- Address comorbid health factors. They say clinicians should refer for co-care in teh presence of comorbid mental and physical health complaints like high levels of emotional distress, eating disorders, and type 2 diabetes. The authors say they contend that multidisciplinary care needs to be integrated, with consistent messages across the team to prevent care fragmentation and patient distress.
Wrapping up the paper, the authors say Patient-centered care will optimize the value of healthcare provided. Shifting funding to support high-value evidence-based care options and educating society will be critical to enable this transition and will likely be cost-effective. Integrated cross-discipline clinical networds are required for effective co-care. We believe clinicians are ready to change, but they require the support of health systems and payers.
One word….two syllables. Day-um. You day-um right. But, health systems and payers are stuck on the part of our profession that doesn’t care about movement, function, yellow flags, exercise, or proper patient-centered practice. They’re stuck on the portion of our profession that is TIC or TOR or principled or whatever the hell useless drivel they’re using this week.
The hardcore, philosophy, doctor-centered, faith-based rather than evidence-based group of chiropractors are smaller but they’re so much louder. And dangerous. They’re flat-earthers. They’re the reason the evidence-based group will never reach any kind of cultural authority.
You can have a GROUP of guys and girls go through years of continuing education and maybe get a couple of diplomats in neuro or orthopedics or rehab….wahtever….and they can be the smartest chiropractor on the planet and almost 100% of their patients get well.
And then you have just ONE lowsy-ass guy or girl go and bait and switch just ONE patient into 80 visits in a year with a contract and all of the bells and stupid whistles of a doctor-centered practice, and that group that worked so so hard loses every ounce of legitimacy. Because of ONE jackhole that refuses to understand or read research or refuses to sacrifice some money in the interest of their patients well-being.
It’s gross. It’s awful. But it’s chiropractic. We are already looked at with a side-glance untrusting gaze. So any deviance of behavior that would be widely considered normal is magnified. Just one ruins the batch for all of us.
I remember a preacher once saying that you gain trust in drops but you lose it in buckets. The reality in chiropractic is that just one faith-based, doctor-centered jackhole loses trust in ALL chiropractors in buckets. For ALL of us.
My plea is to start sharing this podcast with your subluxation friends. Especially the young students that haven’t yet decided to be ‘principled.’ Maybe we can help lead them down the right path from the very start. The more people are exposed to the research and to the idea of being patient-centered, the more they’ll latch onto it. They have to. One is borderline evil, and the other is not. It’s backed by science. One destroys reputations for the sake of the dollar. One builds reputations and respect. One is built on ideas and theories over a century old that cannot or have not been proven while the other is backed by science and progress. How is it even a damn choice to begin with?
We’re either a healthcare profession. Or we are a faith. True healthcare professions do research and then they do more and they change according to what works well and they drop the stuff that doesn’t, and on and on to the point of really being on the cutting edge of the science and on the health of our patients.
I’ll never understand how such a percentage of our profession can’t get on board with that. Whatever the answer to that question might be, it’s that answer that keeps us at the bottom of the cultural authority ladder.
Unfortunately, I don’t see if changing any time soon. Not until the governing boards decided it’s time to change once and for all.
Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week.
Key Takeaways
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
Subscribe Button
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 preventativly 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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Caneiro JP, R. E., Baron CJ, et. al., (2020). "It is time to move beyond ‘body region silos’ to manage musculoskeletal pain: five actions to change clinical practice." Br J Sports Med 54: 435-443.
CF 130 w/ Dr. Kevin Christie: Doing It Right, Marketing Chiropractic, & Book Release
Today we’re going to be joined by Dr. Kevin Christie of the Modern Chiropractic Marketing Podcast and we’re going to talk about marketing of course but more specifically, marketing responsibly and marketing the right way.
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our Facebook page,
- Join our private Facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #130
Now if you missed last week’s episode , we talked about Chronic Pain and Exercise. That episode had some excellent stuff in it from Craig Liebneson, Annie O’Connor and several others. Great stuff. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.
On the personal end of things…..
When we have a guest, we typically dispense with the personal practice observations. Other than my sharing with you all that it looks like I’m about to fully entertain hiring an associate. You know I’ll keep you all updated on this process and how it goes. Something that is that big of a change is, of course, stressful as hell. Throw in a pandemic and you might just say I’ve up to my damn ears and eyes but sometimes, you’re led one direction or the other. Sometimes opportunity knocks and you must answer the door. We’ll see how it goes.
Right now though, let’s get to our guest today.
Kevin Christie understands the unique pressures of the evidence-informed chiropractor. Kevin has run his own practice for over fourteen years. With two offices and multiple staff (plus associates), he knows how important it is to not just be excellent at treating patients but being a great leader and marketer as well.
Kevin has worked with the NFL, PGA Tour, and has been featured on ESPN and Fox Sports.
Using the best tools available to us in the digital age, Kevin empowers evidence-informed chiropractors to achieve their own dreams of running a successful practice.
Welcome to the show Dr. Christie, can I call you Kevin and you call me Jeff?
- First thing’s first, congrats on the new baby. Are you getting any sleep?
- Tell me a little about you. Being located in Boca Raton now, did you grow up in Florida?
- What’s your chiro story? Why, of all of the things to be in the world, did you choose chiropractic?
- I first became aware of you through your podcast. I was doing a little chiro podcasting research when I decided to turn my weekly blog into a weekly podcast. Then through your podcast, I sought out and joined your Facebook group by the same name. Your funnel worked on me. What got you so interested in podcasting, marketing, and Facebook groups?
- While I am mostly about research and evidence-based, patient-centered practice on this podcast, marketing is something I’ve done a lot of work on and is a big part of what I do day-to-day. It has definitely played a big part in what I talk about here on the podcast from week to week. I haven’t personally heard you weave current research literature into your marketing teachings but I know you are very evidence-based in your practice approach. How does being evidence-based and patient-centered play into your marketing strategies and techniques?
- You have teamed up with Dr. Bobby Maybee to create a group called Chiropractic Success Academy. Tell me about it. How is it different than the run of the mill guru practice management groups? What doctors fit this group the best?
- You do so many things, what does a regular week pre-COVID, look like for you?
- If there were a younger chiropractor, fairly fresh out of school that wanted to be a Dr. Kevin Christie, where would you tell them to start and what steps would you tell them to take? What have been your career ‘game-changers’?
- Speaking of younger chiropractors, when we met face to face in St. Louis at the Forward ’19 event, you told me about preceptors. I went an applied at Logan and I’m in. But I think there’s something more appealing about a young chiropractor going to Boca Raton rather than Amarillo, TX. I can’t quite put my finger on what it is but, for some of the older docs out there looking at needing some help and they have a teacher’s heart, can you share some of your preceptorship experiences with our audience?
- Tell me about this new book you have coming out that Parker is publishing. How’d it all come about?
I reallly appreciate you taking the time. There’s literally someting for every chiropractor in this episode, good luck with the book, I know I’ll be buying one.
Item #1
Why They Did It
How They Did It
What They Found
Wrap It Up
Before we get to our guest this week, I did a thing
Being an evidence-informed practitioner can present a set of problems at times. Mostly problems with regard to patient volume because we don’t typically treat patient with long-term recommendations. So we see them come and go depending on if they hurt or not. It can lead to lulls, disappointment, and boredom if there’s not a steady stream of new patients coming through your pearly gates each and every month.
I have taken various courses over the years at Udemy so when I decided to create a course, I immediately thought Udemy would be a good place to start.
While I’m still building the course and adding content every week, it’s live and ready to go for those interested in getting started. I’m putting the link to the course at this point in the show notes. You can go to chiropracticforward.com, go to Episodes and find this episode and just scroll till you find it.
https://www.udemy.com/course/marketing-evidence-based-chiropractic/?referralCode=36A4D91C66B48300360B
Over the last two years or so, I’ve averaged almost 80 new patients every month as a solo practitioner. If you’re interested, I created, basically, my playbook for marketing and my thoughts on each topic or technique. I also have created downloads, checklists, and examples to show what my stuff looks like.
Just go to udemy.com and do a search on Marketing An Evidence Based Chiropractic Practice and check it out. It will grow and expand in the coming months and if you get just one patient from the ideas shared in it, it paid for itself. Now imagine if you get a bunch….well then it’s priceless. udemy.com and the course is called Marketing and Evidence-based Chiropractic Practice.
Item #2
Why They Did It
How They Did It
What They Found
Wrap It Up
Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week.
Key Takeaways
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
Subscribe Button
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 preventativly 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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
CF 128: Tylenol Fails For Back Pain, Cervical Disc Research, & CAM For Headache/Migraine
Today we’re going to talk about Tylenol Fails For Back Pain, Cervical Disc Research, & complementary and alternative medicine For Headache/Migraine
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our facebook page,
- Join our private facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #128
Now if you missed last week’s episode , we were joined on the show by Dr. William Morgan. You wanna hear a truly impressive indivicual speak and share, this is one of those episodes my friends. I wouldn’t steer you the wrong way. Go to last week’s episode and give it a listen. We talked about all kinds of good stuff, we talked about excellence, we talked about Parker, we talked about chiropractic in general and Dr. Morgan shared some experiences with us about treating the President of the United States of America. Wow. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.
On the personal end of things…..
I don’t know how long I’ve been back full force now but it’s been some time. As with anything, you start to adopt new procedures and then those new things become habit and hardly even noticeable anymore.
I see chiros asking what others are wearing. Some don’t take COVID seriously so they don’t wear anything, to be honest. They just wash hands as if washing your hands takes it out of the air or prevents the coughing from putting it out there for you to breathe. I wear a mask. I glasses so I just wear them for any eye cover. Who knows if that even matters? It probably doesn’t.
I wear gloves. Not because I’m afraid to tough anyone. I started out without gloves but the sanitizer and soap washing all of the time ate my hands up. Bad. So, gloves have solved that problem for me. Maybe I just need some new soap and I can go back to no gloves.
Now after some unfortunate interactions on Facebook I’m stepping up onto my soapbox for a good old fashioned rant and, when I’m done, I hope we can still be friends.
The more interactions with people I have, even a select few supposedly educated chiropractors, the more I’m aware of how uneducated people can truly be.
How can you confuse the mask issue? Yes, in the beginning, they said masks weren’t useful. Back when they were trying to prevent a run on N95 masks so the hospitals could have them available.
But for months now, they have recommended them for everyone when social distancing cannot be avoided. AKA; a chiropractor’s office.
Their latest update reiterates it. The best guess estimates are that 40% of COVID cases were due to a ‘healthy’ asymptomatic spreading it.
They also just said last week that up to 35% of positives were in completely asymptomatic cases. That’s excellent news!! That means that a little over 1/3 of people that get it do extremely well and never even know they have it. That’s amazing.
The problem is that that 1/3 is responsible for 40% of the cases because they don’t know they have it and are spreading it.
How can we be so sure that masks are effective? There are three papers that were done. One in a bus, one in South Korea, and one in Washington State that suggest masks are EXTREMELY effective in stopping COVID in its tracks.
Let’s start with the choir practice(Hammer L 2020)
(https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e6.htm?fbclid=IwAR2iRGtCRNMPhYoxCtQnP1jGYobAhunSqWMH4DSpuga5oKaOHa4VbAH7pNc)
Following a 2.5 hour choir practic attended by 61 persons, including a symptomatic, 32 confirmed and 20 probably secondary COVID cases occurred. If you’re counting, that’s 52 of the 61 members of the choir.
3 patients were hospitalized and 2 died. Transmission was likely facilitated by close proximity during practice and augmented by the act of singing.
Alright, now, let’s talk about the bus.
In short, scientists in China studied a guy in China who passed it on to 13 others. On the bus, his germs jumped as far as 4.5 meters to other travelers and it lingered in the air for up to 30 mi nutes after the guy got off of the bus. 4.5 meters for us Americanos is almost 15 feet.
Now, let’s talk about a new paper that came out on May 13 so it’s recent news. This paper was in the journal called Respiratory Medicine by Gao, et. al.(Gao M 2020) called ‘A study on infectivity of asymptomatic SARS-CoV-2 carriers’.
This paper follows a case of an asymptomatic spreader and 455 contact encounters to try to assess the infectivitiy of asymptomatic carriers.
The 455 contacts wore masks, the test subject wore masks. and nobody got sick. They didn’t give COVID to any of the 455. And all wore masks. This included family members.
Medical Express posted an article on May 17th about some research out of Hong Kong where they tested a masking mechanism with hamsters. https://medicalxpress.com/news/2020-05-hamster-masks-coronavirus-scientists.html
The research by the University of Hong Kong is some of the first to specifically investigate whether masks can stop symptomatic and asymptomatic COVID-19 carriers from infecting others.
They placed hamsters that were artificially infected with the disease next to healthy animals. Surgical masks were placed between the two cages with air flow travelling from the infected animals to the healthy ones.
The researchers found non-contact transmission of the virus could be reduced by more than 75 percent when the masks were used.
Two thirds of the healthy hamsters were infected within a week if no masks were applied. Not only that but, those that did become infected were also found to have less of the virus within their bodies than those infected without a mask. The most effective use of the masks was when the person wearing the mask was the infected one.
Problem with that is that nobody knows who is infected because up to 35% of people inffected don’t have any symptoms or feel sick.
So, you can pass it up to 15 feet away, you can be in close proximity to 61 others and give it to 52 of them, or we can all wear masks and mostly avoid giving it to anybody. Hmmmm. Let me do the math, carry the three….and….yep, I’ll wear masks for a little while. A mask is a small ask, people. That’s the new slogan. Just give me credit. That’s all I ask.
If you don’t require masks in your office as the CDC recommends right now, you’re putting yourself, your staff, and your immunocompromised patients at risk.
You can wash your hands until the skin falls off and think you’re protecting everyone and doing a good job but you’re not taking it out of the air. The Czechoslovakian government got it right in their slogan, “My mask protects you and yours protects me.”
No it’s not the damn flu. While the CDC’s latest updates has a lot of good news in it, it’s still clear it’s not the damn flu. If you claim it is, you are simply not very educated on it and you’re probably doing your patients a disservice by saying that it is.
COVID is estimated to have a .4 mortality rate. Flu is estimated at .1 so COVID is FOUR TIMES as deadly. We see that day to day because in a BAD flu year, between 60k to 80k people die of it. IN A YEAR.
COVID has killed over 100,000 Americans in just about 3 months or so. It’s not the same as the damn flu.
But, 0.4% is waaaayyy better than it was initially thought. Some other current news from Reuters out of Italy is that it is losing it’s potency. Meaning, it may have mutated to a less deadly version. That’s awesome news.
In the beginning, I was worried and stressed and anxious. We all were. It was brand new and nobody knew anything about it. Not even the experts. Hell, when AIDS was brand new, the fear was that mosquitos could infect you. Then we learned more and then we were more safe.
As more and more is known about this virus, I’m no longer as worried for myself or my family or even most of my patients. The newest CDC guesstimates show that 96.6% of COVID patients never even have to go to the hospital. That’s a pretty great stat right there.
However, I AM afraid for my mother. I AM afraid for my Dad who is in a nursing home. I AM afraid for my other family member who is immunocompromised. I AM afraid for my patients that are immunocompromised.
I AM going to continue to be safe and be smart for those people. Not out of fear but out of an abundance of education and because it’s not the flu. I hope you’re doing the same.
While there’s a 96.6% chance none of us ever have to go to the hospital because of it, there’s a 100% chance I’d have to close my office for a bit. I don’t know about you but I can’t afford that. This podcasting gig doesn’t pay anything so I guess I need to mind my p’s and q’s and be smart about my day to day bidniz.
I know several that say but, but, but….what about….but. All that crap is noise. Uneducated, noise tinged with a healthy healty dose of arrogance. It really is OK to follow science and evidence. We’ve been preaching it for 3 years now. Why would COVID change that? Let science guide you. Not Bill Gates, Trump, or Pelosi. What does the science say? Stop listening to Fox and CNN. What does the science say? Stop listening to conservative or Liberal talk show hosts. What does the science say? Stop listening to Uncle Roy, the ranch manager or the warehouse worker. What does the science say? As far as that goes, stop listening to the physician on the hospital steps spouting politically biased crap and tying it into a COVID talk. Who the hell cares? What does the damn science say?
Keep it simple. Don’t let things confuse the topic. How severe, how easily spread, how can you avoid spreading or catching? Simple crap here. The rest of those people are uneducated and arrogant noise. Noise I tuned out over a month ago.
Alright, rant over.
Item #1
Our first Item this week is called “Efficacy and safety of Paracetamol for Spinal Pain and Osteoarthritis: Systematic Review and Meta-Analysis of Randomized Placebo Controlled Trials” by Machado, et. al(Machado G 2015). and published in British Medical Journal in March of 2015.
Why They Did It
They wanted to investigate the efficacy and safety of paracetamol (acetaminophen) aka Tylenol… in the management of spinal pain and osteoarthritis of the hip or knee.
How They Did It
- Systematic review and meta-analysis
- Medline, Embase, AMED, CINAHL, Web of Science, LILACS, International Pharmaceutical Abstracts, and Cochrane Central Register of Controlled Trials from inception to December 2014.
- Paper considered for inclusion were all randomised controlled trials comparing the efficacy and safety of paracetamol with placebo for spinal pain (neck or low back pain) and osteoarthritis of the hip or knee.
- 13 randomised trials were included
What They Found
- There was "high quality" evidence that paracetamol is ineffective for reducing pain intensity and disability or improving quality of life in the short term in people with low back pain.
- For hip or knee osteoarthritis there was "high quality" evidence that paracetamol provides a significant, although not clinically important, effect on pain and disability in the short term.
- "High quality" evidence showed that patients taking paracetamol are nearly four times more likely to have abnormal results on liver function tests
Wrap It Up
“Paracetamol is ineffective in the treatment of low back pain and provides minimal short term benefit for people with osteoarthritis. These results support the reconsideration of recommendations to use paracetamol for patients with low back pain and osteoarthritis of the hip or knee in clinical practice guidelines.”
Item #2
This one is called “Relationship of Modic Changes, Disk Herniation Morphology, and Axial Location to Outcomes in Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulation: A Prospective Study” by Kressig et. al(Kressig M 2016). and published in Journal of Manipulative Physiology and Therapeutics in October 2016.
Why They Did It
The authors here wanted to evaluate whether cervical disc herniation (CDH) location, morphology, or Modic changes (MCs) are related to treatment outcomes.
How They Did It
- (MRI) and outcome data from 44 patients with CDH treated with spinal manipulative therapy were evaluated
- MRI scans were assessed for cervical disc hernation location, morphology, and modic changes
- Pain and Neck Disability Index data were collected at baseline; 2 weeks; 1, 3, and 6 months; and then again at 1 year
Wrap It Up
Although patients who were Modic positive had higher baseline NDI scores, the proportion of these patients improved was higher for all time points up to 6 months. Patients with Modic I changes did worse than patients with Modic II changes at only 2 weeks.
Item #3
Our last one is called, “Complementary and Alternative Medicine Use Among US Adults With Headache or Migraine: Results From the 2012 National Health Interview Survey” by Zhang et. al(Zhang Y 2017). and was published in Headache journal in September of 2017.
Why They Did It
They did this to answer the following questions: (1) Which copmlementar and alternative (CAM) modalities are used most frequently among migraine/headache sufferers? and (2) What are the self-reported reasons for CAM use among migraine/headache sufferers?
What They Found
The most frequently used CAM modality for headache/migraine was manipulative therapy at only 22%. Herbal supplementation was at 21.7% usage, and mind-body therapy was at 17.9%. The top 3 reasons given for using CAM for headaches were for general wellness, at about 28.7%, improving overall health at about 26.8%, and for reducing stress at about 16.7%.
Although CAM is used by many sufferers of headaches and migraines, its use specifically for the the headache or migraine is low in the US.
Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, belive it, count on it.
Let’s get to the message. Same as it is every week.
Key Takeaways
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
Subscribe Button
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 preventativly 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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
- Gao M, Y. L. (2020). "A study on infectivity of asymptomatic SARS-CoV-2 carriers." Resp Med.
- Hammer L, D. P., Capron I, Ross A, (2020). "High SARS-CoV-2 Attack Rate Following Exposure at a Choir Practice — Skagit County, Washington, March 2020." CDC Weekly 69(19): 606-610.
- Kressig M, P. C., McChurch K, Schmid C, (2016). "Relationship of Modic Changes, Disk Herniation Morphology, and Axial Location to Outcomes in Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulation: A Prospective Study." J Manipulative Physiol Ther 39(8): 565-575.
- Machado G, M. C., Ferreira P, Pinheiro M, (2015). "Efficacy and safety of Paracetamol for Spinal Pain and Osteoarthritis: Systematic Review and Meta-Analysis of Randomized Placebo Controlled Trials." BMJ 350(h1225).
- Zhang Y (2017). "Complementary and Alternative Medicine Use Among US Adults With Headache or Migraine: Results From the 2012 National Health Interview Survey." Headache 57(8): 1228-1242.
CF 127 w/ Dr. William Morgan: A Conversation About Excellence, Research, Parker University, and Chiropractic
Today we’re going to be joined by Dr William Morgan, President of Parker University and over-all impressive human being.
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our facebook page,
- Join our private facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #127
Now if you missed last week’s episode , we talked about immunity boosting, coconut oil failures, and screen time and its apparent association with autism. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.
When we have a guest, we typically dispense with my personal thoughts and practice experiences over the course of the week. We will do that same this week outside of this; I was with many of you. I closed shop for 2 weeks. Solid. Closed. Then, I gradually started back with urgent/emergent care just like our governing board in Texas recommended.
At this point, I’m in my 3rd week of being completely re-opened. Even to wellness and maintenance care. While I’m used to 180-220 patient visits per week, I’m now experiencing about 110-120. We’re low. Obviously. But, it’s growing every week. People are beginning to tire of the restrictions on their activities and, I’d assume to some extent, are becoming somewhat numb or less concerned…..or more comfortable I guess with the risk aspect of it all.
Ragardless, they’re starting to return. I’m pretty sure those of you that closed and did a gradual re-opening like me are experiencing much the same. Now if we can get the massage therapists back to work safely. We’re still waiting to see what happens on that end of it.
OK, let’s get to our guest today. I tell you sincerely, we are hitting the high spots on this show. WI’m just sitting here thinking about all of the amazing guests we’ve had over the last three years and just in the last few months we’ve had Dr. Stu McGill, Dr. Mike Massey, and now Dr. Williams Morgan. It’s been fun to watch this thing of ours grow and continue to grow. You, the listener, is the main reason for that growth and I just want to continue to thank you and tell you how important you are to me and how much I appreciate you.
Usually, bios and intros can be a bit mundane. Not today, my friends.
When your guest has been the chiropractor to the US Congress, the US Supreme Court, and to the White Hosue, well, you know it’s going to be a good one don’t you?
Not only that but Dr. William Morgan, as mentioned, is the President of Parker University, and active member of the Texas Chiropractic Association and has been testifying on chiropractic issues in the last two Texas Legislative Sessions, and is happy and proud to be a Texan. That’s my kind of guy right there!! Our Texan pride is indeed legendary and probably annoying to anyone outside of the state.
At age 17, he joined the Navy and served with an elite Marine Recon company as a hospital corpsman. During that time, he qualified in parachuting, military diving, submarine insertion, jungle warfare, combat swimming, explosives, mountaineering, winter warfare and Arctic survival. Additionally, he attended anti-terrorist training at the FBI Academy. After leaving active military service and transferring to the Navy Reserves, Dr. Morgan began his educational journey to become a doctor of chiropractic. While at Palmer College of Chiropractic-West, he transferred to a Naval Special Warfare platoon as the unit’s primary hospital corpsman. He was sent to Special Operations Technician training to learn the principles of dive medicine. For the next eight years, he served as a dive medicine corpsman/combat swimmer for a platoon of Navy frogmen in Naval Special Warfare Unit One.
In 1985, Dr. Morgan received his Doctorate of Chiropractic from Palmer College of Chiropractic–West and soon after, married fellow Palmer graduate, Clare Pelkey. They practiced for thirteen years in California. In 1998, Dr. Morgan was chosen to establish the first chiropractic clinic at the National Naval Medical Center in Bethesda, Maryland, which later became Walter Reed National Military Medical Center. In 2015, Walter Reed recognized Dr. Morgan with its highest honor for clinical excellence, the Master Clinician’s Award. During the last 18 years at the military’s most prestigious medical centers, he practiced in an integrative setting, providing chiropractic care to the injured troops returning from the wars in Iraq and Afghanistan.
In the year 2000, Dr. Morgan was appointed as the Chiropractor to Congress at the U.S. Capitol. At the Office of the Attending Physician to Congress, doctors of many specialties care for members of Congress and the Supreme Court. In 2007, Dr. Morgan began serving as the White House Chiropractor. He was appointed chiropractor for the United States Naval Academy football team in 2009 (which never lost to Army while under his care).
In 2011, Dr. Morgan was appointed to the United States Navy Musculoskeletal Continuum of Care Advisory Board, an entity created to address the prevalent injuries sustained by U.S. Armed Forces Personnel during active-duty operations. Dr. Morgan also served on the Spine Subcommittee, which helps develop care algorithms for treating spinal conditions and determining the future of musculoskeletal management in the U.S. Armed Forces.
Dr. Morgan has completed a 2,000-hour residency in Integrated Medicine. He served on the Board of Trustees for Palmer College of Chiropractic for ten years. He is a Diplomate of the American Academy of Pain Management and has held adjunct faculty positions at F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences and New York Chiropractic College. Additionally, Dr. Morgan served as a consultant for the U.S. Department of Veterans Affairs (VA), helping to implement the VA’s chiropractic benefit and advocate for chiropractic research
Parker University inaugurated William E. Morgan as their seventh President in 2016. Upon arriving in Texas, he became an active member and supporter of the Texas Chiropractic Association (TCA). Almost immediately, he organized a leadership summit to establish a legislative agenda strategy for chiropractors in Texas. Texas Chiropractors had not won a significant legislative victory in two decades, but in 2017 four bills advantageous to the chiropractic profession passed. Additionally, Morgan has assisted in fundraising, membership recruitment, and awareness for the TCA. As lifetime member of the American Chiropractic Association (ACA), he has also held several leadership positions in the organization.
Just last year, I was at the TCA President’s Gala when Dr. Morgan was awarded the Keeler Plaqque which is awarded to the chiropractor of the year but is also a lifte time service award of sorts. It’s the most prestigious award the TCA gives so it’s quite an honor. And here in Texas, we are quite honored to have Dr. Morgan on our team. As a sidenote, I’m honored to know Dr. Morgan personally and really appreciate him agreeing to come on this podcast so let’s hop into it.
Welcome to the show Dr. Morgan, thank you so much for caving to my pestering and agreeing to shut me up by finally coming on the show.
Having the background you have, you’ve spent serious time on both coasts of our great nation. Now you find yourself dead center, right in the middle of the country. What was the allure of Texas for you, how has Texas treated you, and what has been your favorite thing about living here in Texas?
Did you have any early perceptions of Texas or Texans when you moved here that proved to be false and did you have any that proved to be absolutely true?
Everyone has a chiropractic story, what led you to want to be a chiropractor?
Can you share a little about how you got to the point of climbing the ranks and becoming the chiropractor to Congress, the Supreme Court, and the White House? How did it all come about?
Can you share some of the legally shareable and more unique stories or experiences of treating those types of patients?
You moved to Dallas, TX to tak the helm of Parker University as their 7th President. Just a little background on me personally, I was there when Jim Parker was still around. I was there when he passed away and his son Karl took over and I believe Fab Mancini was coming on board about the time I graduated. I’m well acquainted with Parker of yesteryear. When you got to Parker, what was one of the first things you wanted to change?
What would you say has/have been the changes you’ve made since arriving that you are the most proud of?
When I was in school there, exercise/rehab honestly was not a big aspect of the curricula. I know a bit about you and Parker Fit. Have exercies and rehabilitation taken on a larger role since 1998?
Some areas of the country never experience something you all unfortunatley went through last year. Tell us a bit about the tornado, the aftermath, and going forward from it.
Now, from one awful event to another. Our current global pandemic. How is Parker University handling this event? What can students expect going forward?
During this crazy time, there have been a lot of divisions in the country from opening vs. closing to ‘I refuse to wear a mask’ vs. ‘can you please wear a mask’? Our profession, unfortunately, is no different. It’s been divided along clear lines for decades and this pandemic has brought some of the divisions into the spotlight. One of them is between those that promote spinal manipulative therapy as a way to boost immunity and those that do not support that. When this was really first unfolding and our Texas Board of Chiropractic Examiners, the WHO, the WFC, and the ACA were all telling chiropractors the support for immunity boosting is not present in the research literature, you and Dr. Katie Pohlman (I love Katie and need her on the show BTW)…you and Dr. Pohlman recorded a very smart and well-stated video saying that indeed, the research literature cannot support immunity boosting at this time. Obviously, I was and am 100% on board with it and I said all of that to ask you this, was there any fallout to that? How did you handle it? And what went into the decision to record it in the first place.
Let’s move to legislative issues. What have you felt is our biggest issues in Texas and on the national level when it comes to chiropractic?
I have said repeatedly on this show that due to the opioid crisis and due to the emerging research over the last 5-10 years, I truly feel there’s not been a better time to be a chiropractor since the 1980s. As the President of a chiropractic college, what is the status of our profession right now? Not just in terms of the pandemic but over the course of the last year. Over the course of the next 5 years. Am I right about it being a great time? Am I wrong? Or a little bit of both?
Thank you for joining us today!
Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, belive it, count on it.
Let’s get to the message. Same as it is every week.
Key Takeaways
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
Subscribe Button
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 preventativly 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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
https://traffic.libsyn.com/secure/chiropracticforward/CF_127_w__Dr._William_Morgan__A_Conversation_About_Excellence_Research_Parker_University_and_Chiropractic.mp3
CF 126: No Immune Benefit, Coconut Oil Fails, and Screen Time & Autism
Today we’re going to talk about Immune boosting via spinal manipulative therapy, we’ll talk about coconut oil and it’s mirage, and we’ll talk about autism and screen time. It’s a good one today folks!
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our facebook page,
- Join our private facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #126
Now if you missed last week’s episode , we talked about current knowledge on making a robust low back pain diagnosis. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.
On the personal end of things…..
We’re still hanging in there. For me personally, I shut down in the beginning for two weeks. Completely shut down. Some stayed open the whole time and never made a lot of changes. So at this point, understandably, they’re ahead as far as getting their patient base back to 100%.
For me, I’m more around 65%-70% of my normal load. Whild the entrepreneur in me is not real happy with that, the business owner that was needing to take a breath and breathe a little bit is happy about it.
At this point, it is what it is. Literally. There’s only so much we have control over. I am a saver by nature. I started a mulit-account system years ago that socks money away for different purposes. I have about 7 or 8 different accounts that I move money to at the end of each week. So, fortunately, I don’t take loans. Other than student loans and house loans, I don’t get into much debt at all.
That only goes so far and I’m not willing to drain it all just to keep employees when I don’t have enough business but, if things continue to go well and we see the numbers coming back to a more normal state and then hopefully stabilize, I don’t believe I’ll have to do anything like drain accounts or let employees go. I love my staff and I’ll fight for them. But I won’t go broke for anyone. Except maybe my kids or my mom.
So far so good. This crap has a time limit. We won’t be stuck with it like this forever. Maybe longer than we want but not forever. One foot in front of the other, one day at a time. We’ll get there.
Item #1
Let’s start out easy today. This one is called “Association of Early-life social and digital media experiences with development of autism spectrum disorder-like symptoms” by Karen Heffler, et. al. (Heffler K 2020) and published in JAMA on April 20, 2020 and that’s a hot one folks.
Why They Did It
They wanted to answer the question, “Are screen media exposure and social and demographic factors associated with the risk for autism spectrum disorder on a modified checklist for autism in toddlers at 2 years of age?
How They Did It
- Data for this cohort study were derived from the National Children’s Study,
- A total of 2152 children were enrolled at birth from October 1, 2010, to October 31, 2012.
- Data were analyzed from December 1, 2017, to December 3, 2019.
- Caregivers reported whether the child viewed television and/or videos (yes or no) at 12 months of age, hours of viewing at 18 months of age, time spent by the caregiver reading to the child (number of days per week compared with daily) at 12 months of age, and frequency of playing with the child (daily or less than daily) at 12 months of age
- Prematurity, maternal age at birth, child sex, household income, race/ethnicity, and caregiver English-language status were included in analysis.
Wrap It Up
“This cohort study found greater screen exposure and less caregiver-child play early in life to be associated with later ASD-like symptoms. Further research is needed to evaluate experiential factors for potential risk or protective effects in ASD.” Basically, “Less screen exposure and more parent-child play at 12 months of age were associated with fewer ASD–like symptoms at 2 years of age”
Before we get to the next item this week, I did a thing
Being an evidence-informed practitioner can present a set of problems at times. Mostly problems with regard to patient volume because we don’t typically treat patient with long-term recommendations. So we see them come and go depending on if they hurt or not. It can lead to lulls, disappoitnment, and boredom if there’s not a steady stream of new patients coming through your pearly gates each and every month.
I have taken various courses over the years at Udemy so when I decided to create a course, I immediately thought Udemy would be a good place to start.
While I’m still building the course and adding content every week, it’s live and ready to go for those interested in getting started. I’m putting the link to the course at this point in the show notes. You can go to chiropracticforward.com, go to Episodes and find this episode and just scroll till you find it.
https://www.udemy.com/course/marketing-evidence-based-chiropractic/?referralCode=36A4D91C66B48300360B
Over the last two years or so, I’ve averaged almost 80 new patients every month as a solo practitioner. If you’re interested, I created, basically, my playbook for marketing and my thoughts on each topic or technique. I also have created downloads, checklists, and examples to show what my stuff looks like.
Just go to udemy.com and do a search on Marketing An Evidence Based Chiropractic Practice and check it out. It will grow and expand in the coming months and if you get just one patient from the ideas shared in it, it paid for itself. Now imagine if you get a bunch….well then it’s priceless. udemy.com and the course is called Marketing and Evidence-based Chiropractic Practice.
Item #2
Item #2 is called “Coconut Oil’s Health Halo A Mirae, Clinical Trials Suggest” by Jennier Abbasi (Abassi J 2020)and published in JAMA on April 8, 2020….hot cakes, smokin’ hot cakes.
This one is an article so let’s just get to the highlights.
She starts by saying that clinic trials don’t support the public’s positive perception of coconut oil. She points to a study that was published in Circulation that found coconut oil actually increases low-density lipoprotein cholesterol (which is the bad kind of cholesterol) and offers no benefit for weight, blood glucose, or inflammation markers.
She says coconut oil has been marketed as a miracle for about a decade and a 2016 New York Times survey showed 72% of Americans consider it a health product. This while on 37% of nutritionists felt it was beneficial when compared to other oils.
What they’ve learned more recently include:
- Compared to nontropical vegetable oils, coconut oil significantly increased total cholesterol.
- Coconut oil did not significantly affect triglycerides or markers of glycemia, inflammation, and body fat compared with others
- Researchers calculated that coconut oil use could translate to a 6% increase risk of major vascular events and a 5.4% increase in teh risk of coronary heart disease mortality.
There’s much more to the article so I encourage you to find it and read it if you’re interested in coconut oil but in summary: Coconut oil should not be viewed as healthy oil for cardiovascular disease risk reduction and limiting coconut oil consumption because of its high saturated fat content is warranted and it offers no proven health benefits compared to other cooking oils and seems detrimental on important blood lipids. As such, the prudent approach would be to avoid it in comparison to other cooking oils”
Item #3
Alright here’s we arrive at the main event. This brand new article coming out on May 4, 2020….there’s a serious amount of sizzle on this sucker and not just because it’s brand new but also because a large number of chiropractors are going to call shenanigans on it. The topic of chiropractors helping boost immune function through spinal manipulative therapy has been such a hot topic on social media since this pandemic started that I won’t hardly get on and read a general chiropractic group and it’s posts. I won’t do it. My eyes start rolling out of my damn head so why intentionally punish myself? Honestly.
This article is called “A united statement of the global chiropractic research community against the pseudoscientific claim that chiropractic care boosts immunity” and is authored by the biggest of the big chiropractic researchers that include Pierre Cote, Andre Bussieres, JD Cassidy….hello stroke research…Jan Hartvigsen, Greg Kawchuk, Charlotte Leboeuf-Yde, Silvano Mior, Michael Schneider and more than 140 signatories.
It was published in Chiropractic and Manual Therapies just a week or so ago as I mentioned.
Background - As I said this pandemic has made chiropractors lose their minds. Including myself if I’m being honest. Not about the immune system. But about safety and keeping myself and my people and patients safe.
Anyway, they say that during this time, the ICA posted reports claiming that chiropractic care can impact the immune system. These claims aren’t in line with the WHO and the World Federation of Chiropractic.
The researchers reviewed the two reports posted by the ICA on their website on March 20th and the 28th. They explored the method used to develop the claim that SMT can boost the immune system and they discuss the scientific merit of the claim. They go on to explain why the claim lacks scientific credibility and is dangerous to the public.
Get this; over 150 researchers from 11 countries reviewed and endorsed this article and response.
Some of the more notable quotes include:
Advancing extraordinary claims without providing extraordinary evidence should raise significant concerns about the scientific validity of the ICA’s position. In their reports, the ICA claims that individuals who received chiropractic care during the 1918 Spanish flu pandemic were 51 to 91 times less likely to die than those who were treated by medical doctors. These effect sizes are too large to be trustworthy and are a red flag of pseudoscience, because extraordinary claims require extraordinary evidence. Using data from a 100-year-old non-published, non-randomized controlled trial to suggest that chiropractic adjustments reduces mortality from the flu is scientifically and socially irresponsible.
We consider that proclaiming the benefits of chiropractic adjustment/spinal manipulation on immunity during a pandemic is plainly irresponsible and demonstrates a lack of understanding of science, the coronavirus pandemic and public health risks.
By only citing basic science experiments, the ICA appear to have overlooked the WHO guidance on implementation research, which clearly states that basic science experiments do not provide relevant justification for implementation of a health intervention
We call on the ICA to explain why it does not adhere to internationally accepted standards of research implementation but instead rely on unconnected basic science studies when linking chiropractic care to immune system function.
Pseudoscience has the potential to mislead and misinform at any time; even more so in the midst of a pandemic when the public is vulnerable. The current coronavirus pandemic demands that we act responsibly by adopting sound public health practices as recommended
Their conclusion is that, in the ICA reports, they provided no valid clinical scientific evidence that chiropractic care can impact the immune system. Not only that but they call on political and regulatory forces to hold accountable those making the claims.
Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, belive it, count on it.
Let’s get to the message. Same as it is every week.
Key Takeaways
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
Subscribe Button
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 preventativly 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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Abassi J (2020). "Coconut Oil's Health Halo a Mirage, Clinical Trials Suggest." JAMA 323(16): 1540-1541.
Heffler K, S. D., Subedi K, (2020). "Association of Early-Life Social and Digital Media Experiences With Development of Autism Spectrum Disorder-Like Symptoms." JAMA Pediatr.
CF 123: Primary Spinal Practitioner, Gabapentin, Cervical Curvature
Today we’re going to talk about….
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our facebook page,
- Join our private facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #123
Now if you missed last week’s episode , we talked about chiropractic primary prevention research, we talked about TENS use for migraines in the ER, and we talked about research for acupuncture with chronic pain. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.
On the personal end of things…..
Well another pandemic week in the books. I’m recording this on April the 29th, 2020 and it’s quite a mess still. We have states that are still climbing in cases dramatically but still opening up businesses.
I’ve been telling people that I’m in the middle on this deal. We have to get out. We can’t stay in our cocoons and watch our businesses die. I was that way for a bit honestly. But we just can’t do that. At the same time, it’s not time to open wide and let ‘er rip either. We have to have a measured opening keeping a watch on the cases.
The great news emerging is the number of asymptomatics they are identifying. It really does all come down to testing. You don’t know what you’re dealing with if you can’t tell who the heck has it. Wouldn’t it be amazing if we are blessed enough to be one of those asymptomatics that simply have no symptoms and no idea we even had the damn thing?
The problem is that at least for now, we have to go about as if we are asymptomatic carriers basically. The last thing I’d ever want is to inknowingly give it to my 74 year old mother or my 80 year old step dad. That’s not my idea of being a good person at all. Lol.
I also have a dad in a nursing home and that’s been tough for sure. I know they do what they can to entertain them but they’re basically forced to keep all of the residents separated in case the bug is lurking about. So, they end up in their rooms most if not all of the day I think.
We haven’t been allowed in to see him since middle March or so. Which is frustrating. He had a stroke so he’s not always all there and can be a bit confused about why people aren’t visiting. Getting him on the phone has been a challenge as well but we’re making due.
It’s a tough time for everyone right now. But I’m a glass half full guy. This too shall pass. We’re going to be OK. People are going to eventually get out and about. People are going to eventually start re-engaging in the economy. Until then, financial institutes and the government will continue to make accomodations for business owners.
Keep the faith brothers and sisters. The general curve in our country right now is downward. I believe there’s light at the tunnel. Just stay smart and stay safe until we reach that light.
Before we get started, I did a thing
I’ve always wanted to help others with their message and how they’re getting it out there. Keeping that in mind, during this lull in business due to the pandemic, I decided to try something different and invest my time instead of waste it. I’ve certainly had the time to invest as have most of us.
I did two episodes on marketing an evidence-based practice a few months ago and both of those episodes are among our most listened to, most popular episodes so I know there is value there and I know there’s an interest in the topic.
Over the years, if I wanted to learn more about excel, I’d take a course over at udemy.com. If I wanted to learn more about marketing, udemy proved to be a valuable resource. If you’re not familiar with sites like Udemy or Teachable, you should go check it out.
I haven’t really looked into what other chiropractors are using it for but I thought, if I wanted to offer a course, Udemy would be a good place to start. While I’m still building the course and adding content every week, it’s live and ready to go for those interested. If it’s not, it will be live in only a day or two.
If you’re interested, I created, basically, my playbook for marketing and my thoughts on each topic or technique. I also have created downloads, checklists, and examples to show what my stuff looks like.
https://www.udemy.com/course/marketing-evidence-based-chiropractic/?referralCode=36A4D91C66B48300360B
Just go to udemy.com and do a search on Marketing An Evidence Based Chiropractic Practice and check it out. See what you think. It’s my first online course to create so any feedback is appreciated. Over time, I’ll be updating the content and adding graphics, and things like that as I finish the initial bulk of the work and am able to revisit and re-work parts that could use it. Plus, I plan on responding to feedback and make any needed changes from there as well.
https://www.udemy.com/course/marketing-evidence-based-chiropractic/?referralCode=36A4D91C66B48300360B
Item #1
This one is not a research paper as much as it is an article. It is from way back in 2011 but is as relevant or more relevant that it’s ever been today. This one is called, “The establishment of a primary spine care practitioner and its benefits to health care reform in the United States” by Donald Murphy et al(Murphy D 2011) and published in Chiropractic and Manual Therapies journal. I have the citation in the show notes if you’d like to look deeper at this
Why They Did It
They highlight the issue with spine related treatments, the costs, the lack of any real effectiveness to justify they rising costs, and make the argument that a key answer to theses issues includes having a group of practitioners trained to function as primary care practitioners for the spine.
Let’s hit some of the highlights here:
- Spine-related disorders (SRDs) are among the most common, costly and disabling problems in Western society. For the purpose of this commentary, we define SRDs as the group of conditions that include back pain, neck pain, many types of headache, radiculopathy, and other symptoms directly related to the spine. Virtually 100% of the population is affected by this group of disorders at some time in life.
- A variety of physicians and other providers have traditionally been involved with the diagnosis and treatment of these patients. This includes primary care physicians, chiropractic physicians, orthopedic surgeons, neurosurgeons, physiatrists, osteopathic physicians, physical therapists, psychologists, massage therapists, kinesiologists, naprapaths and acupuncturists. This has resulted in what has been termed the "supermarket approach" to the management of SRDs [19]. That is, the SRD patient is faced with an environment in which there is a large number of practitioners, each offering a solution to SRDs, with the patient left to sort out which of these disparate approaches is best for his or her particular problem. Oftentimes this determination is based more on salesmanship and marketing than on science, clinical benefit and cost-effectiveness. Lawd don’t we know some surgeons and some chiropractors that are salesmen? And scare care tacticians?
- Treatment for SRDs has become increasingly specialist-focused, imaging-oriented, invasive and expensive.
- One approach to health care reform would designate primary care physicians (PCPs) or groups of PCPs as "patient homes", responsible for the comprehensive care and management of a designated patient population under a risk-sharing agreement
- In their book Redefining Health Care [26], Porter and Teisberg state that for health care reform to be successful, it must incentivize competition based on value, i.e., outcome per dollar spent. To maximize value in health care, they recommend physicians and other health care providers organize themselves around conditions in which they have maximal expertise and experience (chronic kidney disease, diabetes, SRDs) rather than around medical specialties (orthopedics, internal medicine, neurology, etc.) and compete on the level of providing the best health outcomes for these conditions at the best possible cost (i.e., providing value). Ohhhh, that sounds fun because the Palmer/Gallup surveys show chiropractors get patients better for less money and patients are happier with chiropractors than PTs and GPs. I think the good chiropractors would fair particularly well in this scenario.
- We think that the health care system needs an appropriately trained and skilled clinician who can fill the role of a primary care provider for the diagnosis and non-surgical management of SRDs; a "primary care physician for the spine”.
- The primary spine care practitioner will require a particular skill set that includes the ability to apply evidence-based procedures, appropriately educate and motivate patients and effectively prevent and manage disability related to SRDs. The benefits in terms of improved outcomes of care for SRDs, improved patient satisfaction, and reduced costs (i.e., the value of care for SRDs) would be well worth the effort of grooming practitioners toward filling this role.
Dr. Murphy and his crew have established the Primary Spine Practitioner Certification Program through the University of Pittsburgh. I’ve provided their link in the show notes. If I were 10 years younger, I’d probably do it now that I’ve completed the Ortho Diplomate.
https://www.psp.pitt.edu
Item #2
On to item #2 called “Anticonvulsants in the Treatment of Low Back Pain and Lumbar Radicular Pain: A Systematic Review and Meta-Analysis” by Enke et. al.(Enke O 2018) published in the Canadian Medical Association Journal in July 2018.
Why They Did It
The use of anticonvulsants (e.g., gabapentin, pregabalin) to treat low back pain has increased substantially in recent years despite limited supporting evidence. We aimed to determine the efficacy and tolerability of anticonvulsants in the treatment of low back pain and lumbar radicular pain compared with placebo.
How They Did It
- A search was conducted in 5 databases for studies comparing an anticonvulsant to placebo in patients with nonspecific low back pain, sciatica or neurogenic claudication of any duration.
- The outcomes were self-reported pain, disability and adverse events.
- Risk of bias was assessed using the Physiotherapy Evidence Database (PEDro) scale
- Quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE)
- Nine trials compared topiramate, gabapentin or pregabalin to placebo in 859 unique participants.
What They Found
- Fourteen of 15 comparisons found anticonvulsants were not effective to reduce pain or disability in low back pain or lumbar radicular pain;
- For example, there was high-quality evidence of no effect of gabapentinoids versus placebo on chronic low back pain in the short term or for lumbar radicular pain in the immediate term
- The lack of efficacy is accompanied by increased risk of adverse events from use of gabapentinoids, for which the level of evidence is high.
Wrap It Up
“There is moderate- to high-quality evidence that anticonvulsants are ineffective for treatment of low back pain or lumbar radicular pain. There is high-quality evidence that gabapentinoids have a higher risk for adverse events.”
Item #3
Our last one is called “Cervical lordosis in asymptomatic individuals: a meta-analysis” by Guo et. al(Guo G 2018). and published in the Journal of Orthopedic Surgery and Research in 2018.
Why They Did It
Cervical lordosis has important clinical and surgical implications. Cervical spine curvature is reported with considerable variability in individual studies. The aim of this study was to examine the existence and extent of cervical lordosis in asymptomatic individuals and to evaluate its relationship with age and gender.
How They Did It
- A comprehensive literature search was conducted in several electronic databases
- Random effects meta-analyses were performed to estimate the proportion of asymptomatic individuals with lordosis and the effect size of cervical lordotic curvature in these individuals which followed metaregression analysis to examine the factors affecting cervical lordosis
- Data from 21 studies were used in the study.
- 15,364 asymptomatic individuals, age 42.30 years
What They Found
- 64% individuals possessed lordotic curvature
- Degree of lordotic curvature differed by method of measurement
- Lordotic curvature was not significantly different between symptomatic and asymptomatic individuals but was significantly higher in males in comparison with females
- Age was not significantly associated with lordotic cervical curvature
Wrap It Up
Majority of the asymptomatic individuals possesses lordotic cervical curvature which is higher in males than in females but have no relationship with age or symptoms.
There are a lot more papers out there on cervical curves and the meaning and impact of hypolordosis. Here’s the deal, I’m standing strong that hypolordosis is minimally impactful and is not anywhere near important enough to to sell $6,000, 70 visit annual plans to correct it.
It’s just not. And I don’t care what the owner of a curvature correction system says about it or what biased BS research they try their best to pump out there. It’s Just NOT.
It’s a hell of a marketing scare tactic and it’ll put money in your pockets but it won’t give you respect and it might even keep you up at night if you allow your conscience to have a seat at the table.
Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, belive it, count on it.
Let’s get to the message. Same as it is every week.
Key Takeaways
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
Subscribe Button
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 preventativly 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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography
Enke O (2018). "Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis." CMAJ(190): E786-793.
Guo G, L. J., Diao Q, (2018). "Cervical lordosis in asymptomatic individuals: a meta-analysis." J Orthop Surg Res 13(147).
Murphy D, J. B., Paskowski I, Perle S, Schneider M, (2011). "The establishment of a primary spine care practitioner and its benefits to health care reform in the United States." Chiropr Man Therap 17.
CF 124: w/ Dr. Michael Massey - What We Are Doing Wrong, Medicolegal Thoughts, and How We Better Protect Ourselves
Today we’re joined by Dr. Michael Massey. We’re going to talk about What We chiropractors Are Doing Wrong, we’ll talk about Medicolegal things, and we’ll talk about How chiropractors can go about Better Protecting Ourselves
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our facebook page,
- Join our private facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #124
Now if you missed last week’s episode , we talked about the primary spinal practitioner program, gabapentin, and cervical curvatures. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.
On the personal end of things…..
Before we get to our guest this week, I did a thing
Being an evidence-informed practitioner can present a set of problems at times. Mostly problems with regard to patient volume because we don’t typically treat patient with long-term recommendations. So we see them come and go depending on if they hurt or not. It can lead to lulls, disappoitnment, and boredom if there’s not a steady stream of new patients coming through your pearly gates each and every month.
I have taken various courses over the years at Udemy so when I decided to create a course, I immediately thought Udemy would be a good place to start.
While I’m still building the course and adding content every week, it’s live and ready to go for those interested in getting started. I’m putting the link to the course at this point in the show notes.
https://www.udemy.com/course/marketing-evidence-based-chiropractic/?referralCode=36A4D91C66B48300360B
Over the last two years or so, I’ve averaged almost 80 new patients every month as a solo practitioner. If you’re interested, I created, basically, my playbook for marketing and my thoughts on each topic or technique. I also have created downloads, checklists, and examples to show what my stuff looks like.
Just go to udemy.com and do a search on Marketing An Evidence Based Chiropractic Practice and check it out. It will grow and expand in the coming months and if you get just one patient from the ideas shared in it, it paid for itself. Now imagine if you get a bunch….well then it’s priceless. udemy.com and the course is called Marketing and Evidence-based Chiropractic Practice.
I usually drop some personal thoughts and updates on the clinic and things like that. When we have a guest join me on the show, I typically drop that section and just get on with it. It’s no different today. So, let’s get on with it.
Today we are joined by Dr. Michael Massey who hails from the great state of Tennessee. Athens, TN to be exact with is just Northeast of Chattanooga.
Dr. Michael Massey has been in private practice for nearly 30 years and is no stranger to the inner workings of insurance companies or the creation and administration of regulations. He has worked in and around commercial and federal insurance carriers for most of his time in practice, serving as a liaison, a consultant, and a contracted employee.
He is also a certified coder, a certified healthcare quality manager, and a quality assurance/utilization review diplomate. He has additionally served as the president of his state chiropractic association, a delegate to the American Chiropractic Association, the chairman of the ACA Coding and Reimbursement Committee, and as a 10-year member of his state Board of Chiropractic Examiners, while simultaneously serving as a delegate to both the Federation of Chiropractic Licensing Boards and the National Board of Chiropractic Examiners.
He also regularly serves as a nationally-sought expert witness for malpractice and insurance fraud cases. This diverse experience offers him a unique perspective and a comprehensive skill set to speak on insurance matters, coding, documentation, HIPAA, Medicare, compliance, personal injury ,and risk management.
Welcome to the show Dr. Massey. May I call you Mike or Michael?
Now, first question is, how are you enjoying this grand global pandemic we’re currently blessed with?
I have been to Nashville a few times but only recall going through Chattanooga one time when I was on a family vacation back when I was a freshman in high school. I recall it being one of the most beautiful areas I’d ever seen and, from what I remember, I’d probably still classify it that way. I did a little research on Athens, TN. It appears the population is 13,458 hoomans. My region is about 280,000 for comparison sake. What’s it like practicing in a small town setting where you only have that many to draw from for new patients? Or are you close enough to Chattanooga that you can draw off of their population as well?
We met through the miracles of the private Facebook group called the Forward Thinking Chiropractic Alliance. You are typically pretty active in the group and then we met face to face at the Forward ’19 event out in St. Louis back in September. You were teaching a class on Documentation with Dr. Greg Friedman.
I love the group. I’m active here and there, I’ve joined the membership, I support the group. I see the value for sure. While I’m minimally active, I have learned a lot from others just by lurking a little. OK….lurking a lot. What would you say you’ve found to be your biggest takeaway from the FTCA group? What’s been the big bang for the buck for you with it?
Documentation is not typically something find much fascination in but you guys did a good job taking a dry subject and communicating the information in a way that was interesting.
Coding and documentation, for me, can be like pouring salt or maybe hot sauce in my eyeballs. I find it displeasing in general. So, what on Earth got you into coding and documentation? Why is that, of all things, your wheelhouse?
From a procedural coding perspective, what are the most common mistakes made by chiropractors?
How about from a diagnostic coding perspective?
I don’t know how other states are but here in TX, we have to have 4 hours of medicare, ethics, and documentation every year. Required hours. I think it’s insane to force grown professionals to do this when we could be learning how to take better care of our patients. I can see maybe every other year or every 5 years as a refresher. But I’m not down with every year. What’s your view on this?
Relative to clinical documentation, what are the top two or three nuggets of advice you’d offer to both newer doctors as well as those who have been in practice for a while?
You’ve had a good bit of experience working with insurance companies, can you offer some insight into their perception of our profession? Where do they seem to believe we fit best in the system? What are their primary concerns or frustrations with us?
Now we collaborated briefly on a case you were working on recently having to do with stroke. I believe you were defending a chiro if I’m not mistaken. How’d it turn out? Did the good guys win the day?
When we’re talking about risk management, as we just mentioned, you have experience doing expert witness work for malpractice cases. Is there any consistency in the types of lawsuits you’re seeing? Are the allegations typically similar? Are there specific things chiropractors do/don’t do that seem to trigger lawsuits?
How did you get into the med/legal work?
How do you prepare to be a good witness?
What are a few critical risk management tips you wish every chiropractor knew?
Let’s talk about something I know is near and dear to you and you’ve been putting together for a while now. Pretty much since we first traded private messages through Facebook. It’s called Practice Mechanics and it’s something you’ve put together with Dr. Rob Pape out in California.
Rob is another very active member and moderator with the FTCA group. I talk a lot about FTCA on this podcast. I should push my private group as much as I push FTCA. Lol. But there are less in my private group and the FTCA members are way more active.
Anyway, Rob is like the jedi ninja dude in there and always has an interesting take on whatever the post of the day happens to be. Tell me about Practice Mechanics, tell me about teaming up with Rob on this project, and give us some clue of who it would be good for, where it’s at, and where it’s going? What’s the big picture?
We’re going to link the Practice Mechanics website at this point in the show notes at chiropracticforward.com so you can go find out more about it. https://www.practice-mechanics.com
Thanks for coming on the show with us, Dr. Massey.
Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, belive it, count on it.
Let’s get to the message. Same as it is every week.
Key Takeaways
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
Subscribe Button
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 preventativly 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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
CF 119: Chiropractic Business Opportunity & How Chiropractic Solves The Opioid Issue
Today we’re going to talk about some recent numbers that came out in JAMA on healthcare spending. Then we’ll talk about how chiropractic has the answer to the healthcare spending issue.
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our facebook page,
- Join our private facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #119
Now if you missed last week’s episode , we had one of our biggest episodes in the history of Chiropractic Forward and than’s because we were joined by the one and only clinical ninja and world renowned expert himself, Dr. Stu McGill.
I was a bit of a fanboy so I’m still not sure how strong my part of it came out but I can tell you that Stu is ALWAYS strong and this information is a ‘Do Not Miss’ type of thing. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
On the personal end of things…..
I’m doing the same thing as you’re probably doing. I’m freaking out a little or a lot. OK, some of you aren’t but I have no idea how you’re able to chill out. I’m not a hype type of guy. Hopefully by now you know I’m a very reasonable kind of guy.
Here’s what I got; I record these podcasts two weeks prior to airing. This pandemic is changing every day so for me to offer opinions, comfort, hope, and things of that nature just seems pointless right now. Because nobody knows what the hell the landscape will be when this goes live.
Just know this, if you are a listener, I love you. Even if we’ve never met. I love you. Please be safe. Please listen to the CDC and not chiropractors that think they can end this through adjustments. Please stay in touch with the elderly you are connected to. Encourage them, help them if they need it. They’re scared too. Probalby more so than the rest of us.
It’s time to be humans. Not partisans. Not North, South, East, or West. Not even American, Korean, Italian, or Chinese. It’s time to be humans and do our parts to keep this thing from doing any more damage than it has to do.
And, as a Christian myself, if you are a Christian or religious whatsoever, pray. Whether you think it’ll do any good or not. I can promise it won’t hurt.
If you are living day to day financially, I wish I had something amazing to say but, I WILL offer this. The more businesses struggle. The more this goes on, the more you’ll see the sytem buckle and bend to accomadate you. That may look like no payroll tax, tax relief, tax incentives, extended lease payment options on your office spaces, school loan interest was already waived and it won’t surpise me if there’s a suspension on school loan defaults as well, government paid leave for employees, and on and on.
What I’m saying is that some things are out of our control. This is out of our control. Hell, by the time this airs, we may all be on madatory shutdown and you may be listening from home.
Here’s what you have to know; The country cannot have thousands and thousands and thousands of businesses going under. Landlords cannot have non-leased, empty buildings
The system will figure out how to keep everyone afloat.
Stay strong and stay hopeful. Stay clean and stay separate for a bit and maybe we can get a handle on it.
Alright, enough of that. I’m sure we’re all sick of hearing it by now.
Item #1
Let’s start with this one called “US Health Care Spending by Payer and Health Condition, 1996-2016” by Dieleman et. al(Dieleman J 2020). published in JA
Here’s the deal, this was March 3rd so….just before this mass hysteria started. Healthcare spending may look different now but, this was from 1996-2016 before anyone ever heard of this pandemic.
Why They Did It
They wanted to answer the question, “How does spending on different ehalth conditions vary by payer and how has this spending changed over time?
How They Did It
- Information was collected from the following: government budgets, insurance claims, facility reccords, hosuehold surveys, and official US records from 96-2016.
- They used the info to estimate spending for 154 health conditions
- Spending growth rates were calculated for each type of payer as well as each type of condition.
What They Found
- From ’96 to 2016, healthcare spending when up from $1.4 trilliion to $3.1 trillion.
- For the mathematically challenged, that is up $1.7 trillion. I was always under the impression that our system and our treatments should get MORE efficient through the year rather than more and more expensive.
- In 2016, private insurance paid for 48% of it
- Public insurance paid for 42.6% of it
- Out-of-pocket was 9.4%
For the stuff that matters to us chiropractors specifically,
- In 2016, among the 154 conditions, low back and neck pain had the highest amount of health care spending with an estimated $134.5 billion
- 57.2% of that was paid by private insurance
- 33.7% of it was paid by public insurance
- 9.2% was paid out-of-pocket
Other musculoskeletal conditions cost the system a further $129.8 billion. So if we’re keeping count here peeps, that means the total cost of musculoskeletal system issues cost the system in 2016 and grand total of 264.3 billion dollars.
I’ll have you know that the second most expensive condition was diabetes coming in at a grand total of $111.2 billion. That’s a full $153.1 billion dollars less than m/s issues.
So that we’re not drowning in numbers here….remember this; M/S conditions cost 264.3 billion. The next most expensive was diabetes at $111.2 billion.
Do you smell some opportunity there? I sure as hell do. You realize they used to be putting a good number of those people on muscle relaxers and opioids but they aren’t anymore. Right? Now, a large number of those people need an alternative and we are uniquely poised and positioned to be that help. To be that alternative.
Mmmmm….when this mess calms, I’ve got some ideas. You should be cooking up what brew you want to have ready as well.
Item #2
Our second and last item here is called “Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain” by Whedon, et. al(Whedon JM 2020). and published in Pain Medicine on March 6 2020. Smokin plate of whatcha havin!!
Why They Did It
They say that utilization of nonpharma pain management may prevent unnecessary use of opioids. The objective here was to evaluate the impact of chiropractic utilzation on the use of prescription opioids among patients with spinal pain.
How They Did It
- This was a retrospective cohort design for analysis of health claims data from three states for the years 2012-2017
- They included 101,221 adults from 18-84 yr old that had office visits to a primary or a chiropractor for spinal pain.
- They identified two types;
- Recipients of both primary and chiropractic care
- Non-recipients that got primary care but not chiropractic.
- They compared the two groups as far as the risk for filling an opioid prescription.
What They Found
“Patients with spinal pain who saw a chiropractor had half the risk of filling an opioid prescription. Among those who saw a chiropractor within 30 days of diagnosis, the reduction in risk was greater as compared with those with their first visit after the acute phase.”
So, your next social media graphic is this; “patients who saw a chiropractor had half the risk of filling an opioid script.”
Then the next one will be; “Patients that saw a chiropractor in less than 30 days of diagnsis had were more than half as likely to fill an opioid prescription.”
Then the next one will be “US spends $236 billion on musculoskeletal pain but those treating with a chiropractor are less than half as likely to fill an opioid script.” See how I tied that all together for you? Did you see what I did there?
Don’t just listen to this stuff. Turn it into something. I’m trying to help you! Or, you can just join our private Facebook group and I’ll try to start making these more often so you can just share them without going through the effort.
I’m totally cool with that.
Alright, the message is the same ever week.
Subscribe Button
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 preventativly 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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
- Dieleman J, C. J., Chapin A, (2020). "US Health Care Spending by Payer and Health Condition, 1996-2016." JAMA 323(9): 863-884.
- Whedon JM, T. A., Kazal L, (2020). "Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain." Pain Med.
CF 118: w/ Stu McGill - Clinical Jazz, Treating Kids Like Pros, Thoughts On Posture, and Being A Low Back Ninja
Today we’re going to be talking with the low back ninja himself, Dr. Stu McGill. What an honor. If you know anything about Dr. McGill, then you truly know what a big deal it is to have him as a guest.
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our facebook page,
- Join our private facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #118
Now if you missed last week’s episode #117, we talked about spinal manipulation with and without myfascial release added to the mix and we discussed reseearch behind vitamin d3 to help for migraine headache. Really interesting stuff. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
No personal disaster stories this week. I want to dive right in.
Before we get to Dr. McGill, I want to briefly mention ChiroUp.com. Look folks, if you haven’t heard of this program, you just don’t know what you’re missing. ChiroUp has solved almost all of my biggest issues in practice. Not only with a gap in knowledge initially in rehab but with time management.
It saves time, it educates patients on exercise, activities of daily living, and your recommendations, it encourages Google reviews, it tracks your patients’ success, it gives you all kinds of marketing templates and ideas, if you don’t know a particular exam or treatment protocol for a certain body region, it has videos to show you - in short….it’s amazing.
If you’d like a free trial period followed by 6 months at only $99/month, go to chiroup.com and use the code Williams99 That way you get the discount and they know who’s greasing the wheels.
Now, Dr. Stu McGill
Dr. Stuart M. McGill is a professor emeritus, University of Waterloo, where he was a professor for 30 years. His laboratory and experimental research clinic investigated issues related to the causal mechanisms of back pain, how to rehabilitate back-pained people and enhance both injury resilience and performance.
His advice is often sought by governments, corporations, legal experts, medical groups and elite athletes and teams from around the world.
His work produced over 240 peer-reviewed scientific journal papers, 5 books, and many international awards. He mentored over 37 graduate students during this scientific journey.
During this time he taught thousands of clinicians and practitioners in professional development and continuing education courses around the world.
He continues as the Chief Scientific Officer for Backfitpro Inc. Difficult back cases are regularly referred to Dr. McGill for consultation.
I went through his CV on the Backfitpro website and I’d be here for an hour if I read it all out to you. It’s truly impressive as is Dr. McGill himself.
What an honor it is for us to welcome Dr. McGill on the show today. Dr. McGill, thank you so much for taking the time. Where are you as we speak and how’s the weather treating you?
-
In the book, “Back Mechanic', you seem to minimize the psychosocial aspect of chronic back pain and instead focus on removing the physical pain triggers. More and more emerges about the psychosocial aspect. Do you think it’s a fad or have you changed your mind any on it as it’s popularity seems to be rising?
-
For those few that are relatively unfamiliar with your work, what would be your best summary? What are your key points or takeaways? Things like flexion is mostly bad, it depends, and strength building doesn’t mean pain improvement....
-
You say that disc injuries often resolve in about two weeks. In your experience, is there a specific kind of disc injury that tends to stick around and be pesky for longer than that?
-
Here is a question from our private Facebook group. If trunk flexion is not generally advisable, how does one go about building ab muscles just purely for asthetics....to get a six pack essentially. What’s the best way to advise our active patients on this?
-
Let’s say you have a patient that has had chronic low back pain for years. Just general, dull chronic pain. Let’s say you diagnose and treat and they come out of it. Now they feel great and they want to go a step further and start getting active in the gym. Now I suspect your answer will include, “It depends,” and to avoid the triggers or movements that once hurt but, in general, how to you counsel them on the best way to start without taking a step back?
-
Recent recommendations came out about posture from what I believe was the primary chiropractic association in Canada. They said there really is no bad posture but what is important is the frequent change in postures. Taking out pain triggers, what is your opinion on this idea of no bad postures?
-
In reviewing your certification process, I see live hours for Level 1 and they’re in amazing places like Australia, Brazil, The Netherlands, Toronto, and on and on. My question is, are there any plans to offer some of this online for the practitioner that is unable to travel in the manner required? Or is it more of a hands on class and live hours are vital?
-
I realize this is a big question and there can be a lot of stuff to unpack here but I think it’s worth asking. So that those of us in the field can know where we stand as far as how we go about assessing a new patient…..To adequately assess a patient and generate a diagnosis, how long should it take on average to do a good job and be accurate? I understand you evaluate a new patient for 3 hours or more.
-
Here’s probably another huge question but, what comes first for you: Corrective exercise or Gamification?
10.
-
With low back pain being the #1 reason for disability globally, and with all of the research you’ve been involved with, are we gaining on it? Why do I still get patients in my clinic with stories that make it clear that the medical profession is still not really paying attention?
-
We are seeing more and more information emerge suggesting it’s good for young athletes to be multi sport athletes rather than specializing and being essentially treated as a professional athlete while still very young and developing. On a podcast interview I listened to with you as the featured guest, you say you just can’t be good at everything because your spine basically needs to be tailored the the specialty. Can you go into this a little bit and is there a way to find the balance between the idea that you can’t be good at it all but that you also should look at being a multi-sport athlete? At least at a young age.
-
Also from our private facebook group, what are some assumptions you made 5 years ago (or some other time) that you no longer agree with? If any.
-
Tell me about backfitpro.com
Key Takeaways
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
Subscribe Button
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 preventativly 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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
CF 117: Spinal Manipulation With & Without Myofascial Release and Vitamin D3 and Headaches
Today we’re going to talk about manipulation with and without myofascial release added and we’ll cover a cool paper on vitamin D3 and headaches. Good stuff today in regard to smarts being handed out for free.
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our facebook page,
- Join our private facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #117
Now if you missed last week’s episode , we talked about the safety for chiropractic care in kiddos and we talked a little about an excellent article by Jan Hartvigsen called “What Is Chiropractic’. Definitely some food for thought. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
On the personal end of things…..
Let’s talk about ebbs and flows, shall we? Here’s the thing; our practices ebb and flow. If someone tells you their practice looks like a business chart where it’s only up and to the right, they’re all hat and no cattle if you catch my drift.
I told you all in the 10 Keys To Success episode recently that last year, I saw an average of 73.4 new patients every month last year. But in February of this year……I haven’t gotten the exact numbers as of the recording here but I believe it’s only somewhere around 30.
Now, many of you would be jumping with joy to have 30 new patients in a month and I apologize if my displeasure is a put off. It’s not meant that way. You must admit that if you love having 25 in a month, only haveing 8 or so is disappointing. Agreed?
So please keep the discussion in context. Now, what happened? Did I take a piss on someone’s dog and everyone found out? Of course not. I may do that to a cat but never a dog!!! Lol.
Here’s what I think. I took four working days to go on vacation. Then, snow and ice messed with about another 2 and a half days or so. Essentially, I lost about 6 working days in February. Partly because of me. Partly not because of me.
Then, for a hybrid insurance practice like mine, we have to battle with the fact that insurance plans reset in January. So, January and February are typically slower months to begin with. We basically took an already slower month and them made it worse by missing a little over a week of it.
That’s a recipe for disaster. Dammit. I haven’t been in an amazing place since my dad’s health went south back in November but February was just a good way to put the cherry on the top.
Here’s the deal though. Is it time to cash in the chips, throw my hands in the air, and say screw this. I’m out!!!????
Of course not. I’ve been around the game long enough to understand practice, understand life, and understand that I’m sitting on a cash cow of a practice and we just had a crap month. This too shall pass.
Yes, I’m going to feel it in a couple of months. But that too will be short-lived. Fro example, I’m typing this on a Wednesday in the first week of March and for this week, we already have 11 new patients on the books and I expect more. Plus the re-exams are up there too.
So, my practice is starting to level off again and get back to what I’m used to seeing. Hell yes it’s stressful when numbers aren’t where you want them. Hell yes it’s easy to get in the dumps and I do get in the dumps. But you can’t even imagine how productive I’ve been with the extra free time. Organizing marketing campaigns with our marketing manager, social media and website content, and basically TCB - taking care of business man!!!
The marketers say don’t wait until it’s slow and then bust your butt marketing. Market like that year around. Yeah, I like that and it sounds great but that’s really fairytale land crap when you’re busting your butt like we did last year. There was no time. Literally.
When people say they don’t have time, to me, that means it wasn’t a priority because we make time for the things that are priorities. Except when you literally do not have the time. And we didn’t.
Now we do and we’re on it. I’ll keep you updated with how we proceed. I absolutely expect this coronavirus freak out to affect all of us. If people aren’t going to Las Vegas or Seattle, you can damn sure bet they don’t go to our offices as well. But, it’ll pass.
You’ll stop seeing it on the news so much, deductibles will get met, and practices will fill up. At least…..mine will. Lol. And if you’re making good use of any extra time and being a marketer of what you do rather than a do-er of what you do, then yours will fill up too.
If you’re playing video games at work on your computer, I can almost guarantee yours will not fill up.
Before we dive into the reason we’re here, it’s good to support the people that support evidence-informed practitioners. Well, ChiroUp certainly does just that.
If you don’t take advantage of the deal I’m about to offer you, I think you just might be crazy.
Regular listeners know I’ve used ChiroUp since for well over a year now. I’m going to tell you want it is and then share a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months. So listen up!
ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean:
In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, activities of daily living, & for their exercises.
This save you so much time – no more explaining & re-explaining your patient’s care, because they have access to it right there at their fingertips.
You can be confident that your patients are getting the best possible care, because the reports and exercises are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you by people that are deep into the research.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice.
If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL and, to sweeten the deal, you can use code Williams99 to pay only $99/month for your first 6 months
That’s ChiroUp.com and super saver code is Williams99.
Item #1
Let’s start with a paper called “Effectiveness of Spinal Manipulation and Myofascial Release Compared With Spinal Manipulation Alone on Health-Related Outcomes in Individuals With Non-Specific Low Back Pain: Randomized Controlled Trial” by Boff et al (Boff TA 2019)and published in Physiotherapy in Nov. of 2019 that’s only 3 months ago and it’s……Hot
Why They Did It
They wanted to investigate the effectiveness of spinal manipulation combined with myofascial release compared with spinal manipulation alone in individuals with chronic non-specific low back pain.
How They Did It
- It was a randomized controlled trial
- There was a 3-month follow up.
- 72 patients between 18 and 50 years old participated
-
They were placed in two different groups
-
Spinal manipulation
-
Spinal manipulation + myfascial release
-
They were treated twice a week for three weeks
- Assessments were performed at baseline, three weeks post treatment, and at three months after treatment.
What They Found
- No significant differences were found between the two group for pain intesity and disability
- They found an overall significant difference between-groups for CNLBP disability, though this effect was not clinically important and was not sustained at follow-up. Stay tuned for my thoughts on this please…..
Wrap It Up
They concluded, “We demonstrated that spinal manipulation combined with myofascial release was not more effective compared to spinal manipulation alone for patients with chronic non-specific low back pain.”
OK, fair enough. Nothing was found. But, what about that treatment frequency? 2x/week for 3 weeks…..only four visits in 2 weeks. We ARE talking about chronic pain guys and gals.
What about 3x/week for 3 weeks for starters? Some of these people will never get out of pain completely and we’re trying to reduce the frequency and reduce the intensity.
Basically, I absolutely buy into the fact they didn’t see a lot of difference. But I also don’t think they gave it very long. What do you think? Shoot me an email at dr.williams@chiropracticforward.com and let me know or jump into our private Facebook group and start a discussion.
Item #2
This one is called “Vitamin D3 might improve headache characteristics and protect against inflammation in migraine: a randomized clinical trial” by Ghorbani, et. al(Ghorbani Z 2020). and published in Neurological Sciences in January of 2020 - Dammitt - I burned myself. The heat and all…
Why They Did It
Due to anti-inflammatory effects of vitamin D3, they aimed to explore the effects of supplementation with this vitamin on headache characteristics and serum levels of pro and anti-inflammatory markers in migraineurs.
How They Did It
- It was a placebo-controlled, double-blind study
- It included 80 episodic migraineurs who randomly assigned into two equal groups to receive either daily dose of vitamin D3 2000 IU (50 μg) or placebo for 12 weeks.
- At baseline and after the trial, headache characteristics were determined using diaries and serum levels of interleukin (IL)-10, IL-6, inducible nitric oxide synthase (iNOS), and cyclooxygenase-2 (Cox-2) were assessed via ELISA method
What They Found
At the end of trial, analysis revealed that vitamin D3 supplemented group experienced significantly lower headache days per month
reduced attacks duration
less severe headaches
and lower analgesics use per month
This was all when compared to the placebo
Wrap It Up
The authors concluded, “Based on the results of this study, we found that 2000 IU (50 μg)/day vitamin D3 supplementation for 12 weeks could improve headache characteristics and might reduce neuro-inflammation in episodic migraine.”
If all of you tell me that you get 100% of your headaches patients completely headache free, I’m going to raise my eyebrow at you in the skeptical posture and deep deep deep down inside, I’m going to think you’re full of horse hockey. Plain and simple.
This paper can give us some insight into other avenues to explore. I’m not saying go put all of your headache patients on Vitamin D3 but, if you have some that are not responding, it makes sense to read through this paper and decide for yourself about recommending it. Or, alternatively, collaborate with their primary on the matter.
That’s it for this week. I’m outties, Hope you enjoyed the show. I humbly ask you, if you know a colleague that would enjoy this material every week, please share the show with them. There’s only one way we make a difference in the chiropractic profession and that is through your help.
Thanks in advance!
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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 preventativly 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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
- Boff TA, P. F., Ben AJ, Bosmans J, (2019). "Effectiveness of Spinal Manipulation and Myofascial Release Compared With Spinal Manipulation Alone on Health-Related Outcomes in Individuals With Non-Specific Low Back Pain: Randomized Controlled Trial." Pysiotherapy 107: 71-80.
- Ghorbani Z, T. M., Rafiee P, (2020). "Vitamin D3 might improve headache characteristics and protect against inflammation in migraine: a randomized clinical trial." Neuro Sciences.
CF 116: Chiropractic Safety In Kids & What Is Chiropractic?
Today we’re going to talk about chiropractic safety for kids and then we’ll spend some time talking about a paper attempting to define what chiropractic is.
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 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.
- Like our facebook page,
- Join our private facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #116
Now if you missed last week’s episode , we talked about epiduran steroid injections and why to give them the heave ho, asap, mi amigo. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
On the personal end of things…..
I’ve had some wah wah news to share with you guys since my Dad’s stroke in November and issues with my office getting broken into, and my bonus dad having his hospitalizaions and all that. I’ll just get to it.
I lost two friends this week. One on Monday and one on Tuesday. While I can’t consider them my inner circle friends, they were friends over a course of many years and it’s never fun. More importantly, when they’re your age, it makes you consider your own mortality and honestly, who the hell wants to consider their own mortality?
Certainly not me so we’re going to keep trucking.
The week of recording this episode, my interview with Dr. Jerry Kennedy on RocketChiro’s podcast went live. Other than there being video where you can see my ugly face, I thought it was a lot of fun and we covered all kinds of topics most of you would probably find interesting. You can find that at rocketchiro.com and click on podcasts.
This week, I also spent an hour and a half on the witness stand testifying in court in regard to a car wreck patient of mine. I haven’t seen him in a couple of years. I haven’t had to testify in a few years.
The idea of testify once mortified me. Absolutely petrifying. Lol. Some of you can relate because it probably scares the crap out of you too.
The thought of having your notes up on the big screen….ugh. You better be a good note taker!! When you’re teaching staff to take good SOAP notes, tell them that their notes can be up on a big huge screen with you name underneath them!
Anyway, it was weird, the friendly attorney, the one that asked me to come testify, he asked me questions for roughly an hour and half. When it was the bad guy’s turn, he asked me like 3 little simple, insignficant questions. Like, he had nothing. Nothing to ask me. Lol.
I don’t know if it’s because I was doing a good job throwing out research findings and whiplash injury factoids that he wanted me to shut up and get off of the stand……or…..if I was as insignficant as a fly and he had no use for me. Lol.
For my own sanity and mentality….I’m going with option #1. I’m sure you understand.
This podcast folks, it’s really started to take flight in the last few months. More and more people are starting to latch on and I couldn’t be more pleased to see that hard work does actually pay off with consistency.
And that’s what I’ve tried to provide you all consistent, high level information tainted with a bit of personality and entertainment. Maybe….just maybe it’s an effective combination. I’m not where I’d like to be but we are certainly moving in the right direction. About 30,000 downloads for a nichey little podcast like this just isn’t bad, folks.
If you have helped me along the way, I want to tell you thank you. If I see you at an event, I hope you’ll come introduce yourself and we can hug it out. I’m a friendly dude. What can I say?
All I can ask is, if you know someone that would be interested in the information you find here, please share us with them. Pump our tires a little bit and show them how to find us and connect. That’s all. That’s it. And thank you.
Before we dive into the reason we’re here, it’s good to support the people that support evidence-informed practitioners. Well, ChiroUp certainly does just that.
If you don’t take advantage of the deal I’m about to offer you, I think you just might be crazy.
Regular listeners know I’ve used ChiroUp since for well over a year now. I’m going to tell you want it is and then share a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months. So listen up!
ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean:
In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, activities of daily living, & for their exercises.
This save you so much time – no more explaining & re-explaining your patient’s care, because they have access to it right there at their fingertips.
You can be confident that your patients are getting the best possible care, because the reports and exercises are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you by people that are deep into the research.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice.
If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL and, to sweeten the deal, you can use code Williams99 to pay only $99/month for your first 6 months
That’s ChiroUp.com and super saver code is Williams99.
Item #1
This first one is called “The safety of spinal manipulative therapy in children under 10 years: a rapid review” by Corso, et. al(Corso M 2020). and published in Chiropractic & Manual Therapies in February - dammit that’s some hot fresh smart biscuits, people…
Why They Did It
“The safety of spinal manipulative therapy (SMT) in children is controversial. We were mandated by the College of Chiropractors of British Columbia to review the evidence on this issue.”
How They Did It
- They conducted a rapid review of the safety of SMT in children (< 10 years).
-
They aimed to:
-
describe adverse events;
- report the incidence of adverse events; and
-
determine whether SMT increases the risk of adverse events compared to other interventions.
-
They searched commonly used databases like MEDLINE, CINAHL, and Index to Chiropractic Literature
- They searched from 1990 to 2019 - That’s a pretty large search I think most would agree.
- They used rapid review methodology recommended by World Health Organization
What They Found
- Most adverse events are mild (e.g., increased crying, soreness).
- One case report describes a severe adverse event (rib fracture in a 21-day-old) and another an indirect harm in a 4-month-old
- Whether SMT increases the risk of adverse events in children is unknown.
Wrap It Up
The risk of moderate and severe adverse events is unknown in children treated with SMT. It is unclear whether SMT increases the risk of adverse events in children < 10 years.
OK - looky here. I may be a country bumpkin. I may just be a Texas Flatland dipstick but here’s my take. Even in politics…..it’s all about the kids isn’t it? Haven’t you noticed that? If you can bring the kids into it, BAM!!! You have instant impact statement don’t you?
So, with the powers that have waged war on the profession of chiropractic for generations, don’t you think that if there were indeed any real, consistent, and common adverse effects from chirorpactors working on kids, that we’d damn sure know about it by now?
Honestly, they searched almost 30 years of records. Are you stepping in what I’m tossing down? Let’s be honest, some goofy stuff happens here and there but this paper doesn’t ell me it’s unclear. Knowing this profession and the medical profession and the history of conflict there, this paper tells me there’s nothing to see here. Keep on trucking and getting the kiddos to feeling better if they need it.
Don’t work them over for no damn reason but if they have a complaint, by all means, help them. Please.
Item #2
This second one is called “So, what is chiropractic? Summary and reflections on a series of papers in Chiropractic and Manual Therapies” by Jan Hartvigsen and Simon French(Hartvigsen J 2020). Published in Chiropractic & Manual Therapies on January 30, 2020
Nothing but steamy plates of fresh filets of brain food, folks!
The authors start the abstract by saying, “This commentary brings the 2017–2019 thematic series What is Chiropractic? to a close. The 18 papers published in the series contribute to a better understanding of what chiropractic is, where chiropractors practice and function, who seeks their care, what chiropractors do, and how they interact with other healthcare professionals. “
Several papers in the series highlighted deeply rooted disagreements within chiropractic about fundamental issues pertaining to ideology, acceptance of scientific evidence as the basis for clinical practice and the future of chiropractic.
If the chiropractic profession is to remain relevant in today’s evidence-based healthcare environment, there is an urgent for the profession to undertake further research to describe what chiropractic is, what chiropractors do, and provide evidence for the value of these activities to patients and healthcare decision makers.”
Boy is that an understatement…..
They close out the body of the paper with what struck me as some powerful thoughts.
“Papers in this series have again revealed deeply rooted disagreements within the chiropractic profession about what chiropractic is, and what it should be, as a profession, as well as disagreements and variation in relation to education of chiropractors and chiropractic clinical practice.”
In our opinion, it is ironic that while chiropractic has a strong presence in large parts of the world, is taking on increasingly important roles in disability prevention [6, 7, 17], in the military [5] and in interprofessional care [8] as well as growing research capacity [16], discussions about fundamental values and direction of the profession are unresolved.
This unresolved issue creates confusion for stakeholders and threatens to impede professionalization and cultural authority. If chiropractors are to remain relevant in today’s evidence-based healthcare environment, there is an urgent need to agree on, and further describe, what chiropractic is, what chiropractors do and importantly to provide evidence for value of these activities to patients and societies.”
Dr. Hartvigsen and Dr. French are dead on target here but it’s 100% pointless. You will never unite this profession until the old guard changes or dies out. Some say, ‘what does it matter as long as we’re getting people better?”
Here’s why it matters. Many of us have worked our asses off raising our game and there are knuckleheads out there parading around as experts, scaring patients into long-term contracts, and making us all look like straight up idiots and I don’t appreciate it. I don’t like to walk into a room of medical doctors and see the way they look at me when someone tells them I’m a chiropractor and know the reason is because of these knuckleheads.
So, if you’re a go along to get along type of person…..THAT’s why it matters
I happened to be on Reddit kicking around the Chiropractic subReddit and came across a girl who was a patient of a chiropractic clinic on the West side of St. Louis. Saint Charles to be specific.
The issue started out because this office was leaning HARD on her to market them to her friends and family and get her to get patients into their office.
OK let’s start there. I am not afraid to ask a patient every now and then if they have remembered to tell everyone they ever met about this amazing new office and the results they got here. I do it in a non-pushy, comical way but at the same time, I am encouraging some word of the mouth stuff to happen. Make sense? I hope so because it makes sense to me.
Now, that’s OK. But what she was describing was the doctors on her at every visit and coming close to harassing her about it.
OK, not cool but not a deal breaker but then she started to go into more of her story with these knuckleheads. Here’s what she said.
I signed a one year contract with what they call a “wellness center.”
Two chiropractors run it. I have already received 5 months of treatment and have 7 to go.
The payments are due over a 10 month period of time, but I will receive 12 months of treatment in total when it’s done.
Anyways, my chiropractor every day pushes his clients to refer other clients. I am new to the area and I’ve told him that I’m new.
Also, I’m not his marketing team. Like sheesh. Well, today he said to me “you’ve lived here long enough, you have someone by now you can send in here and save their life with chiropractic.” I’m started to feel harassed.
Save their life with chiropractic. Look folks…..I’m all about valuing chiropractic and what we do for our patients but ‘Save their life?” That and turn the power on type stuff makes me want to throw up in my mouth a bit. I’d rather run a cheese grader on my legs than hear that crap.
Anyway - she continued
But here’s my main issue:
When I signed the contract, they said the RETAIL for 12 months of care is over $5k. Since you will be signing a contract it will be taken down to $3,350
So I pay $335 every month for ten months. I’ve already paid 5 months. They said if this contract is broken early, you will then owe the difference for each visit you have received of what the “retail fee” would have been, since you are being discounted for having a long term contract.
I believe their “retail fee” is $55/visit and my “discounted fee” is $36 per visit. I’ve probably had close to 40-50 visits so I’d back owe close to $1,000.
She concluded by saying, “Please help me! I was snaked by these people because I just wanted pain relief!”
If you agree with the tactics this clinic is using against this woman, just stop listening to me. Put your phone down now. I can’t with you or anyone like you. It’s shameful and it pisses me off.
To scare them into a contract, to make them feel they’re locked into the contract and they’ll owe a fortune if they try to get out, and to carry on as a healthcare practitioner or to carry on as anything other than a snake oil salesman out on the street corner…..I just can’t.
So here’s what she’s going to do. Or what I hope she’s going to do. I hope and am encouraging her to contact the state board of examiners for Missouri and tell them her story. If there is an issue there, they’ll open a complaint. If there is not an issue, I’m going to open up a complaint with the Board of Chiropractic Examiners in Missouri. Lol
I’m fortunate enough to be in Texas. Texas chiropractors can’t pull this crap anymore. Thank God.
I’ll repeat what I’ve said countless times on this podcast
- There is no place for contracts for your healthcare. Ever.
- It is a profession with A LOT of room in the scope. Chiropractic is not a modality. It’s a profession.
- It is not a church. It’s not a faith-based system. It is a scientifically validated profession but only when you’re using evidence-based research. Not piddly case studies that fit your bias or studies performed by the stakeholder of the system they’re selling.
- Professions have a birth. Then they have learning and progress into the current state and construct you see. They do not have a birth and then remain in the same place with the same amount of information and techniques for over 100 years. The medical field doesn’t do that. Physical Therapy doesn’t do that. Chiropractic shouldn’t do that.
- Be a doctor. Don’t be a salesperson. It’s gross and, even if nobody says it to your face, it’s embarrassing to you and to the rest of us.
Well, how many enemies have I made right there? Lol. Honestly, I don’t care at this point. Let’s be honest with each other can’t we? We’re all mostly grownups I hope.
Be an a-hole, take advantage of people, scare people, bully people, and screw people and you’ll find that maybe you make a lot of money but that doesn’t come without consequence. Whether it’s turning your soul a shade of blackish/gray or whether it’s the snickers, sneers, and giggles behind your back as you walk by, or maybe whether it’s the eventual realization of what you’ve done to the reputations of not only your family and friends but also to your colleagues. Whatever forms it takes, there are consequences to living and behaving like that.
On the other hand, be a good person. Be smart. Be ethical and have a moral compass. Then good things happen. You can walk upright and proud.
Always.
Key Takeaways
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
Subscribe Button
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 preventativly 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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
- Corso M, C. C., Mior S, Taylor-Vaisey A, Cote P, (2020). "The safety of spinal manipulative therapy in children under 10 years: a rapid review." Chiropr Man Therap 28(12).
- Hartvigsen J, F. S. (2020). "So, what is chiropractic? Summary and reflections on a series of papers in Chiropractic and Manual Therapies." Chiropr Man Therap 28(4).
CF 115: Why Steer Your Patients Clear Of Epidural Steroid Injections
Today we’re going to talk about more recent findings on epidural steroid injections and what this new information tells us in regard to what how we should be directing recommendations for our patients.
But first, here’s that sweet sweet bumper music
Subscribe button
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. r
We’re the fun kind of research. Not the stuffy, high-brow 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.
- Like our facebook page,
- Join our private facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #115
Now if you missed last week’s episode , we talked about TEN Keys To practice success. If you listen to just one episode this year, this is the one. Nobody wants to push their brew too much because then you look narcissistic but..I really think many of you can benefit from 22 years of my mistakes. Lol. That’s not egotistical. That’s just the damn truth. So go listen to that episode as soon as you’re done with this one. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
On the personal end of things…..
I just returned from Key Largo, Fl so I’m behind this week. I was gone Monday and Tuesday this week so I’m doing everything I can to get all of my stuff done this week. Including this podcast. I usually start writing a podcast on Monday morning and here I am on Thursday morning getting finally started.
So, it’ll probably be a little shorter than the others
If you’ve not been to the Florida Keys go ahead and pull out your bucket list and get that sucker added asap. It was amazing. I’m usually chomping at the bit to get back to work but not this time.
I won’t take long here but we flew into Key West and drove 2 hours up the keys along the overseas highway to Key Largo. Key West is a little more raucous which will fit some well but Key Largo is a little more laid back and that’s what we wanted.
First thought is that driving that overseas highway is a trip. I’m not talking physically. It’s a trip mentally. In some spots, it’s you, the highway, and the ocean. That’s literally it. It’s insane. We flew in and started driving. The sun went down and at one point, the sky became the exact same color as the ocean. It was some outer space experience man. I don’t know….it was crazy for this flatlander from the Texas Panhandle. Definitely a cool thing to see and do.
Beyond that, we stayed at the Playa Largo Resort and Spa and I cannot recommend it enough. My wife and I actually had a three-day spa package so two massages and a facial. I’m just going to drop two syllables / one word……Day-um.
It was awesome, there restaurants on the resort were excellent, the fires at night, the sunsets, 80 degress every day, laying on the beach all damn day and being served funny drinks….I was not ready to come home.
But I did. And here I am in 28 degree weather with snow flurries. Whatever the hell ever. I’m trying to fenagle a way to get a vacation property down there. That’s how much we loved it. It’s like an exotic island destination but everyone speaks english and looks and sounds just like you. And all the laws are the same. It’s still America.
Anyway, just go. Just make it happen.
Mentor quotes:
Dino Pappas said “I think the biggest things for me were: 1). Don't forget about yourself --- We give and give and give to other people, our community, and our patients. We often don't take care our ourselves and our identity becomes providing for others. Don't forget about what brings you joy. You can't fully help others unless you take care of yourself. 2). Clinical Skills Do Not Equal Business Success...I worked hard to build my skillset, but patients don't necessarily care about that. They care about their results, their outcome and the presentation of the business via business systems. If there's drama in anything else (front office staff not cordial or prompt, insurance not verified, patient phone calls not made or returned) that impacts the patietn's happiness and ultimately can impact their outcome. We are all running a patient care business, not a practice and there's a difference. 3). Begin With The End In Mind & Reverse Engineer From There: Sit down before you go into practice and create your vision board, your goals and identify what your exit willl be. Engineer your life, your practice and your systems around those long term goals. Think and operate strategically, not tactically.” I agree with every word. Dino is right here in Texas and is a smart smart doctor. If you’re near him, give him a call and connect. I promise, buy him some breakfast and you’ll walk away a smarter person.
Dr Bill Lawson who was just on our podcast a couple of weeks ago says, “I would say treat every patient as if they are your family. It is from them where you build your practice. Don’t be afraid to look outside the box. There’s so many ways to create little streams of income. Say no to the scams! There are a lot of them out there. Read the Parker Principals. There’s something in that wisdom. Keep learning! Get a specialty diplomate. At the end of the day, it’s not how much money you made, it’s how much you got to keep! Low overhead equals low stress.”
Fro me personally, I tell patients, when I’m having a difficult time deciding what to do with them, that I just ask myself, “If htis were my daughter or son sitting in front of me, what would I tell them to do?” When I approach patients in that manner, I will ALWAYS make the right decision.
Another former and future podcast guest, Dr. David Graber up in New Jersey said, “Get help, but only from doctors who are where you want to be. Someone might be a great clinician and a great person, but can't make a living in practice, don't go to them for practice advice. Think long-term - reputation, respect, clean conscience, profit, stress, etc. Meet people, meet people meet people. People who feel ripped-off don't stay, return, or refer - treat people fair. Get at least 600-1200 patients as a base that use your services on a regular or irregular basis. Develop competency in the 3M's of practice: marketing, management, money. Learn how to run your business or have someone else do it for you (usually your spouse or parent who have an interest beyond $). You will never arrive, especially in 2020- practices are recreated regularly. The relationships and interaction with patients are the best thing about practice, nuture & enjoy it, and never forget that or take it for granted.”
Dr. Jerry Kennedy of RocketChiro says, “1.) Get help. You aren't ready to be successful. Trying to do everything yourself is foolish. 2.) Networking is more important than you think. The more business owners and professionals in your community who know you, like you, and trust you...the easier your practice growth will be. 3.) Calm down. Success is a process. Processes take time. You're going to be fine. 4.) Enjoy the journey. You're going to get older faster than you think.”
One of our former podcast guest stars and the chiropractor of the Florida State Seminoles, Dr. John Van Tassel had this to say, “Dino is absolutely right. Project where you want to be at the end, then set a plan for that. Don't acquire skills and say "Let's see where this takes me. Be kind. Be kind to people by crating an atmosphere, an organization where you can serve them. Being kind doesn't just mean be polite. Speak their language. Meet them where they are. Find the dysfunction and teach them the importance of correcting that, rather than just turning off the pain alarm. But there is more: As I taught a staff member recently, triple booking me because 3 different patients insisted they HAD to be seen at 8 is not being kind, not being polite, it is letting the patients run the asylum. Not one of those three received patient satisfaction that day. That's not being kind. That's being a door mat. You MUST stand up on your hind legs and be IN CHARGE in order to be kind and give patients what they need. You must set policies that allow you to serve patients, and do not waver from those policies. What rings to me is "real kindness gives others a feeling of hope" So it is being kind to others that you take a break to refresh yourself. It is kindness to others that you build your skill set and knowledge base. It is the drive to serve through kindness that moves you to plan who you are going to be, then execute the plan. It is with kindness that we build ourselves into a gift worth giving through service. It is through kindness that we protect ourselves in all relationships. Protect the gift.
Wow - right? I havne’t thought of kindess in that way before. What outstanding words.
Before we dive into the reason we’re here, it’s good to support the people that support evidence-informed practitioners. Well, ChiroUp certainly does just that.
If you don’t take advantage of the deal I’m about to offer you, I think you just might be crazy.
Regular listeners know I’ve used ChiroUp since for well over a year now. I’m going to tell you want it is and then share a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months. So listen up!
ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean:
In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, activities of daily living, & for their exercises.
This save you so much time – no more explaining & re-explaining your patient’s care, because they have access to it right there at their fingertips.
You can be confident that your patients are getting the best possible care, because the reports and exercises are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you by people that are deep into the research.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice.
If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL and, to sweeten the deal, you can use code Williams99 to pay only $99/month for your first 6 months
That’s ChiroUp.com and super saver code is Williams99.
Item #1
The first item is called “Comparing the short-term cost-effectiveness of epidural steroid injections and medical management alone for discogenic lumbar radiculopathy” by Pennington et. al. published in Clinical Neurology and Neurosurgery in get this the date on it is actually April of 2020(Pennington Z 2020). Taht’s as smoking hot as it gets. Stand back it’s steamy…
Why They Did It
Epidural steroid injections (ESIs) are a commonly used treatment strategy for low back pain and lumbar radiculopathy. However, their cost-effectiveness and ability to mediate long-term quality of life (QOL) improvements is debated. We sought to analyze the cost-effectiveness of lumbar epidural steroid injections (ESIs) compared to medical management alone for patients with lumbar radiculopathy and low back pain.
How They Did It
- QOL outcomes were prospectively collected at 3- and 6-months following initial consultation
- Metrics included the EuroQol-5 Dimensions (EQ-5D) questionnaire, the Pain Disability Questionnaire (PDQ), the Patient Health Questionnaire (PHQ-9) and the Visual Analogue Scale (VAS)
- Cost estimations were based on Medicare national payment amounts, median income, and missed workdays
- One hundred forty-one patients met our inclusion/exclusion criteria
- 89 received ESI and 52 were treated with medical management alone.
What They Found
- Both groups showed improved scores at 3 months but were similar to one another
- No significant difference was seen between groups for total costs or cost utility ratios
- Medical management alone was more cost effective at both points owing to lower expenditures, however these differences were not significant.
Wrap It Up
The authors concluded by saying, “Epidural steroid injections were not cost-effective at either the 3-month or 6-month follow-up period. At 3 months, epidural steroid injections provide similar improvements in quality of life outcomes relative to medical management and at similar costs. At 6 months, neither epidural steroid injections nor conservative management provide significant improvements in quality of life outcomes.”
My first thought is well….No Shit Sherlock!!
Then, my next thought is that we’ve covered research showing only limited effectiveness in the short-term and absolutely zero effectiveness in the long-term and no difference in whether a patient ends up having surgery.
Then we covered research demonstrating how steroid shots put the bones of certain individuals at a disadvantage down the road.
We have also covered research showing how chiropractic beats them at a lower cost, non-invasively, more effectively, and non-pharmacologically.
No brainer here folks. Just always default to the recommendations from the American College of Physicians recommending spinal manipulation, acpuncture, and massage as first-line therapies for acute and chronic low back pain and steroid injections as a last-line option right above surgery. After every other option has failed. I’ve cited that paper in the show notes for episode 115 at chiropracticforward.com It was authored by Qaseem, et. al. Go get it. (Qaseem A 2017)
Since I’m short on time this week, that’s all we’re covering for this episode but it’s new, it’s fresh, and it’s HIGHLY relevant.
Recommend to your patients that they do NOT get these shots. They have side effects. They have consequences. They don’t typically work and if they do, it’s strictly short-term relief with absolutely zero long-term benefit. If you’re an evidence-informed doctor, you are the one that should be fixing them. Nobody else.
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
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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 preventativly 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.
Website
http://www.chiropracticforward.com
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TuneIn
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About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
- Pennington Z, S. M., Lubelski D, Mehta V, (2020). "Comparing the short-term cost-effectiveness of epidural steroid injections and medical management alone for discogenic lumbar radiculopathy." Clinical Neurology and Neurosurgery 191.
- Qaseem A (2017). "Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians." Ann Intern Med 4(166): 514-530.
CF 114: TEN Keys To Practice Success
Today we’re going to talk about some of the things I would tell myself if I were just starting out. How would I mentor myself at this point in my life? How would I counsel and mentor ANY doctor? I believe old dogs certainly can learn new tricks because 22 years into practice and I’m learning new tricks. Better believe it.
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our facebook page,
- Join our private facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #114
Now if you missed last week’s episode , we were joined by Dr. William Lawson of Austin, TX and we talked about a paper he participated in that was concerned with setting treatment guidelines for neck pain. Newer paper and newer information so make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
On the personal end of things…..
Alright, nothing blew up this week. We had some snow last week so that was nice. Kids stayed home from school and I stayed home in the morning but made it to work that afternoon. It was a nice change in the schedule.
I’m actually headed to the Florida Keys on Thursday morning. I’ve never been and that’s exciting! My wife has massages and facials booked and when I put an s on the end of those words, I’m serious. Every day starts with either a massage or a facial and that’s the stuff makes me feel warm and fuzzy inside. Count me in.
Here at the office, I have 5-6 massage therapists. I pay for my own massages. I don’t take advantage of them. But I try to get at least one per month and more when time allows. I’m a junkie. So it should be a great long weekend there in Florida. Plus it’s not too hot this time of year. I’d probably melt down there in the Summer.
I got news last week that the legendary Stu McGill will be joining us on the show in March. That’s some cool news right there. How do you ask someone like Stu questions that he doesn’t normally get that are still thoughtful and insightful?
The short answer is I don’t know but I’m listening to some past interviews and trying to be prepared for the back Jedi. The ninja, if you will.
I’ve been a little lazy about getting guests lately but I really enjoyed having Bill Lawson last week, I’m looking forward to Stu, and I think more guests are in order! I’m sure you get tired of hearing me ramble on so I’m making a resolution here and now more guests!
This week, I’ll be recording a podcast with Dr. Jerry Kennedy of Rocket Chiro, previously called BlackSheepDC. He has been kind enough to invite me to speak with him on his podcast about marketing and promoting chiropractic through research. Using research to communicate what we do and why and what to expect in the results according to research. I’m looking forward to that so be looking for it. I’ve only been a guest once before on a podcast called Health Nuts but it was fun. This one should be too. Dr. Kennedy and I line up very well in how we see things.
Before we dive into the reason we’re here, it’s good to support the people that support evidence-informed practitioners. Well, ChiroUp certainly does just that.
If you don’t take advantage of the deal I’m about to offer you, I think you just might be crazy.
Regular listeners know I’ve used ChiroUp since for well over a year now. I’m going to tell you want it is and then share a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months. So listen up!
ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean:
In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, activities of daily living, & for their exercises.
This save you so much time – no more explaining & re-explaining your patient’s care, because they have access to it right there at their fingertips.
You can be confident that your patients are getting the best possible care, because the reports and exercises are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you by people that are deep into the research.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice.
If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL and, to sweeten the deal, you can use code Williams99 to pay only $99/month for your first 6 months
That’s ChiroUp.com and super saver code is Williams99.
Item #1
For today, I want to cover something outside if our norm here. This is more of a mentor post if I may be so bold. If you’re new to the podcast listenership, we typically cover some personal points over the previous week and then jump right into covering 2-4 research papers having to do with the activities we are involved in every day in our offices.
I happened to see a post by Dr. Kevin Christie with The Modern Chiropractic Marketing Facebook group last week. He asked the group, “What is your one piece of advice to the younger Docs that you wish you knew or followed in the earlier years of practice?”
This one post of Kevin’s demanded over 90 comments the last I checked. Some of the recommendations were goofy of course. It’s a fun group. You expect so of that. Some serious, some were fairly irrelevant and off target.
It got me to thinking; if I have done this for over 22 years and I been successful at it, is there any words of wisdom I could share that you would find valuable? I hope I’ve not been sampling my own brew too much but, I have to say I think I can pass on some nuggets to you.
First thing is, you can learn something from ANYONE. Even if its learning what NOT to do. Lol. Sometimes you can learn both of those from the same person and I think I certainly fit that bill. I’ve made mistakes, people. Mistakes that are hard to admit.
Next, I don’t own multiple clinics. I haven’t franchised. Hell, I don’t even have an associate; even though I should have had one years ago. So, let’s keep it in context and let’s be honest about it. I hate people that inflate their numbers. It’s obnoxious and gross. If I’m anything, I’m honest. Sometimes to a fault. My wife calls me a damn boy scout. She means it to tease but I’m kind of OK with that. I am not comfortable with lying and have alway liked ethics and high morals so in that spirit, here we go.
This is purely to demonstrate why I probably have some good stuff to share. Although January and February always bring a bit of a slow down, on average I see about 18-23 new patients per week. Over the course of 2019, I averaged 73.4 new patients per month and 726 visits per month. My PVA was about 9.8 visits. And then you have to understand that I have massage and acupuncture thrown in on top of that stuff.
We’re doing alright. It’s a BIG overhead and super busy office. I’m one of those guys. Not necessarily on purpose either. It’s by necessity. I know some docs that can see 6 patients in a day, command and outstanding fee, and do just as well. All I can say to that is…..freaking teach me. Please. Lol. I’m busy as hell at almost all points during the day and it can be exhausting. But that’ll be covered a little more later.
Now, standing where I now stand, what would I tell new docs? What advice would I pass down to myself if I were just starting out in business? Here we go, let’s work through it:
#1 - Value Yourself & Value What You Do
What is the #1 reason you are a chiropractor? Maybe it’s to help people. A very nobile reason and I would guess the reason most of us got into the business. But let’s not make any mistakes, it’s called a business for a reason. You didn’t getting into the business to help people and starve. If you did, you’re a knucklehead. Straight up.
Now, I have issues with money. I didn’t come from a lot of money so I guess on some level, I’ve always felt guilty about making it or prospering in a big way. I’ve traditionally had a hard time giving recommendations for treatment. Even when I know for a damn fact that they are going to help address long-standing pain. I’m telling you, it’s a mental game.
Because I struggled with money early in the game, I automatically allow my experiences to paint my handling of others when it comes to money or finances.
Not as much 22 years into the game but I still struggle to an extent if I’m being honest. But I came to really begin to value my service, my office, my employees, my family, and I began to value my patients. This was a profound turnaround for me that happened when I started really immersing myself in the available research.
How in the hell can you sell something you’re not sure the value of to start with? Look, it’s different now but, when I came out of Parker in ’98, it was a philosophy mill and I never fit that mold. From day #1. I was not a chiropractic philosophy guy. I didn’t fit anywhere and felt I had probably made a big mistake.
It wasn’t until I started to seek out and find chiropractors like me and started paying attention to all of the high level research that I started to see firm value in what I did and how I could help others. THAT’s when things started to click for me.
OK, I finally see a clear path that makes sense, I start walking that path and I’m rocking and rolling. In fact, I start killing it. Conviction in your words really does matter it turns out. Now what’s the most important thing?
#2 - Take Care Of Business
Remember I said it’s a business so that means you must take care of business. I saw the value and started killing it but I wasn’t trained in matters of the office. I did a lot of PI in the early days. A LOT of PI. If you’ve done it before then you know that you have to settle with the attorneys all the damn time. Frustrating, yes….indeed. But part of the game.
Anyway, because of settling all of the time, Accounts Receivable was not necessarily an accurate stat. I kept an insane amount of stats but I was missing ONE KEY stat. It was the one that tells you your profit per appointment. Man oh man. Missing that one stat taught me a very very expensive lesson several years ago.
You’ve probably heard me say in previous episodes that I lost almost a million dollars over the course of about 3 years. This happened for several reasons. It makes a guy feel like an idiot to admit it but, it happened. It’s part of my life. I had an employ that I trusted, that I trained, and then trained, and then got trained more, and then provided resources for so she could ask any questions. I even got the training to come here to my office and work with her.
I want to be clear, nobody was stealing. She just wasn’t disputing denials, re-billing, some of the billing just wasn’t done at all but she never said a word, even though I’d made it clear to tell me if she needed help or had questions, etc. Well…..she didn’t so I was dumb enough to think it was all taking care of itself. Once the timely filing deadlines have passed, that’s it. Done deal. That money is bye by.
Hell, my stats showed me that I was seeing a ton of folks and getting a ton of folks better. I was killing it! So I thought. You could fall prey to the same mistake. That’s why I’m sharing my sheer stupidity with you. I’m not a proud man.
I knew things weren’t jiving so I brought in an internal auditor to sort the mess and oh hell what a mess it was. I had no idea. One month, for example, I lost $40.00 per visit and another month I lost $21.00 per visit. LOST.
So, my fault was in buying in to my employees and rooting too hard for them. Getting personally invested in their success and fighting for them. That’s just who I am and that’s how it came about. I’m still that person today. I’m just a hell of a lot smarter about what I will and will not tolerate. That’s the difference now.
I’m not a smart man but I know when my bank account is getting closer and closer to zero. Lol.
At the end of the day, when I say take care of business, I mean that your business ultimately depends on the billing and collections. If you’re not billing or collecting, you’re not in business. Period. Either make damn sure your billing/collections person is a rockstar or outsource it to a professional and experienced company.
Without question. Just do it and don’t second guess it. And never pay an outsourced business a flat fee. They should be on a percentage of collections. That way they have motivation to get your AR to zero.
You can use the profit per visit stat to help you determine where you are as far as collections. It’s the one stat out of all of them that could have saved me at least half a million dollars. That’s important enough to cover it real quick.
You find your Profit Per Visit (PPV) by subtracting your Cost Per Visit (CosPV) from your Collected Per Visit (ColPV.
ColPV - CosPV = PPV
I’m going to tell you how to find those right quick so get out your pens and pencils ladies and gentlemen.
Let’s start with the Collected Per Visit number. Find that by dividing your Total Collection Amount (TCA) by your Total Number of Visits (TNV).
TCA / TNV = ColPV
So let’s say we’re doing last January for example. I want my collected per visit number so I’m going to look and divide my total collections in January by the number of visits I saw in January. Bam, there you go. One number down.
Now we need to find our Cost Per Visit number. For that one, we just divide our Overhead (OH) in January by our Total Number of Visits. You should see how it all revolves around your Total Number of Visits right? Because it does.
OH / TNV = CosPV
Anyway, it’s simple, you just have to be told how to do it. Now, subtract Cost Per Visit from Collected Per Visit and you will have your Profit Per Visit number. That number tells you whether you’re knocking it out of the park or sucking the dirt of all of those others that really are knocking it out of the park.
I’d say if you’re Profit Per Visit is around $40-$60, you’re where you want to be. Some are more and some are less but that will all come down to where you are as far as your overhead. KEEP AN EYE ON IT.
These equations are illustrated a little clearer for you in the show notes at chiropracticforward.com so go there and check it out.
#3 - Stat Keeping
The easiest way you can say it is like this; how can you know where you’re going if you don’t know where you’ve been? Honestly, it wasn’t until I joined a practice consulting group that I learned the value of keeping stats. Unfortunately, that group didn’t keep the profit per visit stat. Ugh. Anyway, moving on…..
It’s vital to be able to compare your current situation from the past performance. Hav eyou ever had a month where you were in the dumps because you thought your practice was slower than normal? And maybe you were ready to just go ahead and jump off the cliff or drive your car into a tree? Or something equally self-harming?
Well, I have too. But, because I keep stats so thoroughly, I’m able to pull them up and compare now to last year at this time. Not only that but I can compare to the 10 years prior to that and see the growth and then I don’t panic and I don’t feel like all hope is gone. It’s really nice to know where I’ve been. Plus, it can help you plan where you want to go and set realistic, reachable goals.
Outside of valuing my services, keeping stats has probably been the most important change I’ve made over the years. It’s that big of a deal.
#4 - Marketing
If you’ve listened to my podcast any time at all, then you know what I think of marketing. And it can be summed up in these words, “You must be a marketer of what you do. Not just a do-er of what you do.
The names you most associate with a particular industry aren’t usually the best. They were just better at telling people how good they are. Put it this way, do you really think McDonald’s makes the best hamburger? Hell no they don’t. Yet, there they are. Around the world, absolutely killing the burger industry.
Also, a Dan Kennedy classic you’ve heard from me before. It’s YCDBSOYA which stands for You can’t do business sitting on your ass. You better be someone that becomes a mover and a shaker because the success will not belong fo the meek and the mild in this story. It will belong to the ones that aren’t afraid to tell people what they do in an honest and ethical way.
If you’d like some great thoughts and ideas on marketing an evidence-based practice, check out our two-part series we did on it. They were episodes 98 and 99 and are linked in the show notes. They were called Big Ideas On Marketing Evidence-Based Practices and published on October 31st of 2019 and part two was published on November 8 of 2019 so go find them and get to work.
Part I
https://www.chiropracticforward.com/big-ideas-on-marketing-evidence-informed-practices-part-one/?v=7516fd43adaa
Part II
https://www.chiropracticforward.com/big-ideas-on-marketing-evidence-based-practices-part-two/?v=7516fd43adaa
#5 - Control Overhead
Here’s the honest truth, I suck at this one. I like toys and I like having extra hands to help. Here’s the deal, when you have an office of employees, none of them…..NONE OF THEM care about your business as much as you do. Even my most valued employee doesn’t value it like I do and she’s amazing.
They find reasons to be gone. They wake up with a cough, their belly hurts, blah blah blah. I’ve heard them all. And on a side note, I do it like schools do it. If you have a fever, keep your butt at home. If you do not have a fever, get your butt in gear. If you miss work, you better have a doctor’s note. Plain and simple. Remember it’s a business and you have to take care of business.
Anyway, I am usually one person over-staffed because I got tired of being short-handed all the damn time. I saw someone on Dr. Christie’s post say that people need to remember that overhead walks on two legs. Meaning, employees are your biggest aspect of your overhead. And it can get out of hand fast. I used to think a $42,000 per month overhead was the most ridiculous thing I’d ever heard of. A colleague of mine told me that was his overhead and I was about half of that at the time. Now, I’m around $5k-$10,000 beyond that on average every month.
It sneaks up on you so keep an eye on it. Protect it. When a sales person calls me, I tell them straight up, “I’m not just out looking for more reasons to raise my overhead so if it doesn’t blow my shorts off, it’s a no from me.” Pretty simple.
#6 - Background Checks
Speaking of employees, I about pulled a dummy a year or two ago. I hired a girl with front office healthcare experience. Hell, she worked at a cardiologist’s office for quite a while! I was so excited. I hired her and she was just killing it at the front desk. I mean killing it when we’d been through several that were just awful. i was so excited. Then, one of my other employees told me she’s pretty sure this new girl has a mugshot out there somewhere so she went looking.
Dammit if she didn’t find a damn mugshot. So, I called up one of my besties who happens to be a copper copper crime stopper and guess what? This girl working my front desk for the last two or three weeks….turns out she was just in jail for stealing from a cardiologist’s office. At about the same time, a friend of mine that works at that cardiologist’s office called me to see if I’d hired their ex-employee….Lol. I felt like an idiot but, we caught it in time and we went ahead and let her go before she could do any damage.
But the lesson was learned. Do background checks. They may be so good and capable and smart so that they can figure out how to manipulate your system to steal from you. Just a thought.
#7 Never Stop Learning
We never know it all, folks. If we ever get to a point that we can stop learning, then we should be traveling the world lecturing and teaching other doctors to be clinical ninjas.
I’m not there and I’m betting only about .05% of chiropractors are there. Always learn. I just finished the ortho diplomate and now I’m on to Stu McGill, Donald Murphy, and the latest research that is continually coming out.
I can’t remember where I heard this quote but, “be a learn it all, not a know it all.” This also means to always be taking advice. Be quick to take advice! Seek it out. I remember when I was growing up and my Dad saying, “Son, just remember, no matter how big and bad and strong you get, there’s always someone out there that can beat your ass to a pulp.” This is true. Lol.
But what else is true is that no matter how smart any of us think we are, there is always someone smarter and more capable. The best part about that is that we can learn from them! Without them beating our asses to a pulp, by the way. Lol
Dr. Greg Kawchuk says we should consume at least one science per day. Meaning, find the papers and consume them. If you have the time to go beyond the abstract, please do. But consume at least one science per day. It’s good for your brain, your soul, your profession, and you patients.
I just told my wife the other night….I’m going through Stu McGill’s ‘Back Mechanic’ book right now. I told her it’s amazing that I’ve been through Murphy’s CRISP protocol book and I’ve been the through the ortho diplomate program and it’s amazing and so cool that even in the frist 30 pages of Dr. McGill’s book, I’m learning even more stuff to stick in the toolbox.
It’s exhilirating. Keep the foot on the gas pedal folks. Never stop soaking up material at the quickest pace possible.
#8 - Mentorship
I waited 11 years or so. I tried to do it on my own. Hell, I didn’t have the money to get a mentor in the first place anyway. But, if I were advising my new doc self, I’d say get a mentor…..as in yesterday.
I can tell you that I don’t see the value in long-term contracts with them though. There is really only so much you can learn from a mentor so why would we pay thousands more when we exhaust the learning potential.
At some point, you cease being the student and the group starts learning from you. This is the point that you should graduate into being a member at no charge because you are contributing as much or more than you are extracting. If that makes sense.
I have had about 2 and a half mentors. One was outstanding and I damn sure paid a high price financially for it. The other was very philosophy minded and we just didn’t jive. I didn’t know how philosophy minded in the beginning but I got out once I figured it out.
That doesn’t mean I didn’t learn from him though. I got a great hiring process out of that group. I got some great marketing techniques that I could tailor to my own evidence-based means.
I always reated mentors or practice management groups like buffets. I took what looked good to me and worked for me and I left what I didn’t like and what didn’t fit me.
I think buying into one person or one system and diving in 100% usually isn’t the best way to do things. Hell, I’m a Christian and I think that way about preachers too. People rallying around one personality and devoting everything and all energy to it……yeah….not my style.
Just treat them like a buffet and you’ll be fine. I like the idea of a mentor or practice management group that lines up with your way of practicing and I like them mostly because they can keep you focused and keep you accountable for your stats and your practice goals.
I’m in a great spot in practice and I’ve still considered jumping into a new one just to see if I can get some new, fresh ideas. You should too. Just don’t make an egomaniac more and more rick while they are actively in the process of propgating garbage and ruining our chances of getting this profession where it belongs. Please.
Good ways to get started for an evidence-based chiropractor would be joining the Chiropractic Success Academy, joining the Chiropractic Forward Facebook group, joining the Forward Thinking Chiropractic Alliance Facebook page, and joining the Evidence Based Chiropractor Facebook page.
Look, I get that this next one isn’t a popular topic but hear me out before you tune me out.
#9 - Join Your Associations
What you get out of your involvement is directly equal to what you put into it. By sitting on the Board of Directors for the Texas Chiropractic Association, I made more connections and friends than I could ever count for you or explain to you. It was a dramatic turning point for me personally and professionally.
These doctors I was on the Board with became life-long friends to me. They’ve helped me solve countless problems over the years when I needed them the most. When I had the billing debacle I mentioned earlier, guess who gave me the way out? A Board member that I called asking for suggestions on billing/collections companies.
If I’m thinking about ideas for my business, for expanding, for integrating or making any sort of changes, who do you think I ask?I have a network of about 15-20 high level, successful doctors here in Texas and we help each other. We pass advice and information back and forth.
It was never that way before I became a TCA member and got active. I was by myself making it up by myself with poor information to go on.
My involvement in the TCA got me into getting a Diplomate. Connections through the TCA is what setting me up for the next 5 years.
Yes, your association needs you and your talents but more importantly, YOU need your state association. In ways you don’t realize or ever thought of. I thought it would be a time suck and a money suck. I couldn’t have been more wrong.
Something on this point that I can promise is that if you just join and continue to sit in your office and do nothing, you’ll be helping your association but you’ll get little out of it. At least in regard to what I just described.
BUT, if you hop in and volunteer, you’ll be exposed to a whole slew of other chiros that will eventually become your comrades in the battle. Your connections will be deep. It’ll happen. Trust me. And you’ll appreciate it.
Besides all of the things I just mentioned, our state and national associations NEED to have more and more evidence-based practitioners helping steer and advise this profession as we proceed into the next 10, 20, 30 years and beyond.
Just do it. It’s worth it.
#10 Don’t Forget About YOU
It’s easy to get caught up in practice. It’s easy to feel like your practice owns you rather than you owning your practice. Hell, I feel that way right now. It happens to everyone. But what I’m trying to do these days is to learn to set aside more time for me and my family.
Burnout is very real and it doesn’t do you, your family, your employees, or your patients any favors at all. I’ve been burned out at various times so many times. It’s miserable. And it can get to the point that even a long weekend doesn’t make any damn difference. Because all the stuff piles up and you have to wade through it when you get back. It sucks.
To battle back, I try to have a trip planned at least once per quarter. That way, there is always something to look forward to and plan for. Something on the horizon.
Now, there is a big difference between taking some time for yourself and being a lazy ass bum. Nobody likes a lazy ass. Everyone respects a worker and a giver so don’t take this one to the extreme. It just means to fit yourself in some time too. That’s all.
Remember that nobody will be on the death bed and will be thinking, “You know, I really wish I had spent more time at work.” It’s the truth.
Some trips are big and you can write off as your yearly shareholders meeting. Some are just 5-6 hour drives to Dallas or up into Colorado Springs or the New Mexico mountains. The point is, get out of your office. See no patients.
See your family. That’s the point.
Certainly, there are more things an old wolf like me can share. There are a lot of things I have yet to learn but I’m seeking. I’m searching it out and soaking it all up. Every single damn day.
If you have anything to add to the conversation, hop into the private group called the Chiropractic Forward Facebook group and share with the group. We’d love to hear from you. What would you tell a new doc going into practice?
I asked this question in the Chiropractic Forward group and asked the docs to share some of their recommendations:
Dr. Kenneth Chillson over in Cologne Germany says, “The number one cause of failure is the fear of failure. So, stop focusing on the fear and start focusing on what you think needs to be done right now. Believe in yourself, because you are the only one that will.
Dr. Craig Benton in Lampassas, TX says, “Have no fear we can help a ton of people that don't even know it yet. Get your message out there.” I would add….but be responsible about what you’re putting out there as you message. Remember to be the doctor that you are and what you say and do reflects on the rest of us. Don’t make me or any of the rest of us look bad. We don’t deserve it. Be cool.
Dr. Don White down in Ft. Worth says, “Never be afraid to say no to a “Good deal” for a contract as an associate if it isn’t a good deal. Better yet ask for more when you get the first offer. Have other people that know more than you do look at any and all contracts before you agree and sign anything. (Contracts for employment, a buildout, a lease, management group, etc)” He also said having a business plan is key for him.
That’s it. That’s my top 10. I hope you enjoyed the show this week as much as I enjoyed the brain dump you go through when you start pulling out all of the old files in your noggin and searching through them.
I hope you found value in it and found some things you can use to help you better, make your family better, make your practice better, and make your patients better.
The best news is that there’s never been a better time to be a chiropractor in the last 30 years. You’re where you are for a reason.
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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.
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And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health!
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About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
CF 113: w/ Dr. William Larson - Brand New Guidelines On Neck Pain Treatment
Today we’re going to be joined by Dr. William Lawson to talk about some brand new guidelines that came out in December regarding neck pain and the treatment of neck pain for chiropractors. Be sure and listen so you’re up on the lastest and you’re not doing it wrong!
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 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.
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You have found yourself smack dab in the middle of Episode #113
Now if you missed last week’s episode , we talked about what effect lifestyle might have on dementia and we talked about whether or not the feeling of having a stiff back actually means that you have a stiff back. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily.
I swear to you, I see chiropractors always asking about research papers and what research is there on this or that. I want to yell at the top of my lungs to go and check my damn website. But, you don’t want to look like you’re self-serving and pumping your own tires so…..I say nothing. It IS called social media for a reason. It’s not called get online and sell your stuff to everyone all the time. So I don’t.
With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
It just makes sense to be but hell, I used it all of the time because I can’t remember everything off the top of my head. I’m old now. My brain doesn’t brain like that anymore.
On the personal end of things…..
Guys and girls…..you wouldn’t believe me if I told you. That’s if you’ve been listening regulary over the last 3 months. Now remember, there’s a two-week delay on these podcasts so keep that in mind but, yesterday afternoon my step-dad went to the ER with heart issues. He’s 80 and he’s the one that had the appendectomy on Christmas day.
Keep in mind that my biological dad is still in a nursing home at 76 years old after he suffered a stroke back on November 9th.
Lots of other stuff is going on with other members of my family as well but those are the biggies for now.
Anyway, it looks like he’ll be getting a heart cath today. I’ll keep you updated.
On the bright side, I got my certificate to get in a big fancy frame. It’s the one that says I’m a Diplomate of the International Academy of Neuromusculoskeletal Medicine and I have to be honest, I rememberr being brand new in practice and really admiring the fact that some would go to the lengths of getting a Diplomate.
I never considered that I would ever be one to do it though. When I got out of college, I didn’t want to see another book or class. I would say I was a bit of a lazy student back in the college days. I learned better from studying notes than I learned from listening to some boring teacher drone on and on day after day.
Other than the lab classes, it was torture for me. I learn better by having words in front of me and studying them over and over. That’s why school was so damn difficult for me. Especially histology. Lordy lordy. We had a 98 year old with a monotone voice teaching us histology at Parker in Dallas. Can you imagine a more dry subject and it was taught by the most dry person with the dry-est delivery. Hell no, folks. Hell no. If I had them, I would have given up the nuclear codes just to get him to shut up. It was awful.
Anyway, the thought of my undergoing another 2 year course of study to get a Diplomate just wasn’t on the radar. And it stayed that way for about 20 years. Until one day. One day I was walking through the exhibit hall at ChiroTexpo ’18 in Dallas, TX and I met one Dr. Tim Bertelsman. He was pumping the tires on ChiroUp. BTW, if you want to go to chiroup.com and sign up with the code Williams99, you can get the first six months for only $99/month. You won’t regret it.
Anyway, once he went through all of the amazing stuff that ChiroUp can do for me and my patients, he looked up at me…..I’m a pretty tall dude….and he said I should come to his lecture on back pain later that day. He said that it counts as 10 hours toward the 50 live hours needed toward the Orthopedic Diplomate. He said very confidently, “Come check it out. You’ll like it. You’ll stay.”
He got a chuckle out of me on that. I had other things I wanted to do for the weekend. Ten hours in a classroom wasn’t in the plans. Hell, being in TCA leadership, I already get about 40 or more hours a year anyway.
Plus, The Diplomate was not on my radar so that didn’t mean anything to me but I was intrigued by the idea of focusing my knowledge and thoughts on the low back so I made sure I sat in on his class. At least for a bit just to check it out.
Well, it’s obvious at this point, but I sat through the whole weekend. Dr. Bertelsman just nailed it. He’s engaging and interesting and extremely knowledgeable. He’s a star on the speaking circuit.
So, I finished that class and thought, if that information was so good, what could I learn from the next one and on and on? Plus, I’d already knocked out 10 of the 50 live hours. Makes sense to at least look at it as a possibility.
The more I looked at it, the more I realized that the Academy, Dr. James Lehman with University of Bridgeport, and the Australian group with Dr. Anthony Nicholson and Dr. Matthew Long called Chiropractic Development International have all reall really gone to great lengths to make getting that Diplomate easily accessible. They are working together to create a new culture of chiropractors. Chiropractic practitioners that are on a different level - a different plane from you regular run of the mill general chiropractor.
I would have to say they have done just that. With only 5 live hour weekends required over the course of a year and half to 2 years, and the ability to take all of the other 250 hours in the comfort of you home…..well, it made sense. I get a ton of hours every year anyway so….why not?
I put the pedal to the metal and got the hours knocked out in about 6 months and spent the rest of my time just studying and reviewing the material. It worked out. Here we are, about the frame a certificate.
The point is, it’s more convenient than it’s ever been and you can and should do it. If for now other reason than to be the best in your community at assessing, diagnosing, and treating. I mean really, who the hell doesn’t want that?
We are joined on the podcast today by the doctor that made it more convenient for folks in Texas to take on the Diplomate program. Dr. William Lawson is our guest today.
Dr. Lawson is located down in Austin, TX
He has a diplomate in Chiropractic Orthopedics as well as a Diplomate in Integrative Medicine college of pain management.
He has a masters degree in Health Care Administration
He is certified in acupuncture
He is heavily involved in the Texas Chiropractic Association
He is an Air Force veteran
He does Designated Doctor work as well as medicolegal work
Let’s welcome Dr. William Lawson to the show. Thanks for taking some time out to come on the show today, Bill. Welcome!
This is actually your second time on The Chiropractic Forward show. The last time was September 27, of 2018 and it was episode #41. Here we are in episode 113 so it’s been a bit. Tell me what all has been going on in the life of Dr. Lawson since then
A quick review at chiropracticforward.com tells me that the last time you were on, we spent the episode discussing research targetting the cervical region. I remember fussing because we have so much research based around the lumbar region and low back pain but nothing near as robust for the cervical region. Then, you got involved in research paper having to do with neck pain and treatment. Tell us how that came about and tell us what part you played in it. What was your contribution to it?
So it turns out, all I have to do is raise a fuss to get neck pain some attention and voilah…..here we are. : )
I noticed in the Acknowledgements section, some of our other friends were also involved in contributing. Drs Kris Anderson up in North Dakota, Dr. Craig Benton in Lampassas, TX, your name of course, and Dr. Dean Smith who is active with the Evidence Based Chiropractor group. Looks like an excellent group.
Let’s go ahead and give it this paper the Chiropractic Forward treatment if that’s OK
This paper you were involved in is called “Best-Practice Recommendations for Chiropractic Management of Patients With Neck Pain” authored by Wayne Whalen, Ronald Farabaugh, Cheryl Hawk and a slew of others. It was published in the Journal of Manipulative and Physiological Therapeutics on December 20, 2019 - Hot potato…
Why They Did It
Dr. Lawson, since you were involved in it, walk us through their reasoning for doing the paper if you will.
How They Did It
I must admit to only reading the abstract so far so lead us a little deeper into how they go about formulating these guidelines and recommendations?
For those that don’t know or don’t really get deep into research, can you give us a layman’s explanation of what exactly a Delphi Panel is?
What They Found/Wrap Up
Tell us what they came up with. At the end of the day and after all of the effort, what do we have going forward?
(This is a good point to go beyond the abstract and cover the 16 points made in the Best-Practice Recommendations For Chirorpactic Management of Neck Pain section of the paper)
- Begin care management with a thorough history.
- Follow the history with a condition-specific examination. It is the duty of the provider to perform an examination consistent with the complexity of the case, based initially on history, which includes the mechanism of injury.
- Evaluate patients with complaints of neck pain for potentially serious red flags.
- Consider referral for diagnostic imaging or other studies based on established clinical practice guidelines (see “Diagnostic Imaging” later).
- Develop a care plan based on the history and examination. The care plan includes appropriate diagnostic tests. Sometimes referred to as a report of findings, the history, examination findings, plan of care, and prognosis should be reviewed with the patient through a process of shared decision-making and with their consent to proceed obtained.17
- Document factors that may delay recovery. (Yellow Flags?)
- Develop a working diagnosis and, when clinically indicated, consider differential diagnoses.
- Reassure the patient regarding the generally benign nature of minor neck pain and encourage activity and movement. With moderate to severe neck pain, emphasize the importance of treatment plan compliance.
- Determine whether to (a) manage the patient exclusively, (b) co-manage, or (c) refer to another provider.
- 10.Begin treatment with a brief trial of care, 6 to 12 visits, followed by evaluation for treatment effectiveness. The initial trial is not the same as a limit or cap on care.
- 11.Evaluate the patient briefly during each encounter, pre- and post-treatment. Conduct a more focused condition-specific evaluation after each benchmark in the treatment plan. Examples: Every 6 to 12 visits, or in 30-60-90-day intervals.
- 12.Some patients’ responses to treatment may not follow a predictable pattern, or they may not respond. In this case, consider a modification to the treatment plan that may include, but may not be limited to (a) change in technique and/or modality, (b) referral to another provider within the same discipline for a second opinion, (c) referral to another provider outside the discipline for a second opinion and consideration of other treatment approaches, or (d) referral for diagnostic tests (eg, X-ray, magnetic resonance imaging [MRI], computed tomography scan, neurodiagnostic or blood studies)
- 13.Refer patients with new or worsening symptoms or evidence of psychological issues to providers with expertise in those areas (eg, behavioral health).
- 14.Determine at each visit and/or evaluation if the patient is improving, is worsening, or has plateaued, and discharge if appropriate.
- 15.Encourage and provide home and self-care approaches.
- 16.Document the history, clinical examination, treatments performed, rationale for and response to care, and any referrals.
In the paper, just after the section we just covered, they recognize that not all patients recover fully. Unfortunately, we’re all well-aware. Tell me a bit about what they have to say about that.
For patients who have reached MTB, the question then becomes: What is the best course of care to help control the ongoing pain? In general, patients unable to reach full recovery fall into one of these categories:
- *1.
No physician/provider intervention is necessary. The patient has residual minor neck pain but can manage it with self-care strategies: ice, nonsteroidal anti-inflammatory drugs, home-based exercise. - Physician/provider intervention is necessary in periodic episodes of care. The patient experiences pain that exceeds his or her ability to self-manage and must return for care in an episodic fashion.
- Physician/provider intervention is necessary on an ongoing basis. The patient experiences pain that exceeds his or her ability to self-manage, and in the absence of care the condition deteriorates. These patients often benefit from 1 to 2 visits per month to providers of nonpharmacologic conservative care who use spinal manipulation, to be reevaluated every 6 to 12 visits.*
Now, I have been seeing this paper being shared and discussed all over the Forward Thinking Chiropractic Alliance Facebook page as well as the Evidence-based Chiropractor Facebook group. Those are all very like-minded docs in there and we all love practice guidelines, the idea of professional standardization, a certain level of standards within that construct, and those sorts of things.
So it’s no surprise that a paper putting guidelines into the profession is well-accepted by those groups. I wonder if you’ve seen or noticed any thoughts or opinions elsewhere? Basically, what is the paper’s reception as far as the rest of the profession is concerned? Or do you know? A lot of chiropractors don’t know a thing about research or new research and may not even know it exists.
Let’s start wrapping it up a bit, do we have any more research papers you’re contributing to? What is next on your horizon?
Thanks for coming on the show this week
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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 preventativly 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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
CF 112: Lifestyle Effect on Dementia & Feeling Stiff May Not Mean Stiff
Today we’re going to talk about Lifestyle and Dementia and Does feeling stiff in the back really mean your back is actually stiff?
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our facebook page,
- Join our private facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #112
Now if you missed last week’s episode , we talked about how the American Family Physicians my be warming up to chiropractic and what supplements actually have some evidence behind them. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
On the personal end of things…..
You remember how I mentioned that my life has been a bit of a soup sandwich lately? Yeah, well, I had my front door glass broken out yet again. That’s twice in about 3 weeks. We’ve not had any issue whatsoever with our building or break-ins in over 10 years in the same locations. All of the sudden, bam…. here we are about $500 lighter in deductible fees and about to be a lot lighter in the bank account because now I have to invest in some security cameras.
Because I’m done folks. Luckily, they caught the little a-holes and they’re sitting in the Randall County Jail. I’m hoping that’ll be their new home for a while. Hopefully long enough for them to learn their lessons.
Other than than, life is motoring a long. Wrapped up January in fine fashion. My goals are always 10% better. If you can do better than that, then heck yeah. But for me, 10% better is a minimum for me each year. In each category. Are you keeping stats? I mean accurate, robust stats.
I keep them for just about everything I can think of. And you should too. I hit my numbers big time in 2019. Now, I’m getting with my main marketing girl and trying to see how we’re going to improve 10% over what was already a big big year for us.
That’s another question I have; without getting into politics, I’m going to tell you that all was well up through 2014 or so. But then 2015 and 2016 came along. We dropped off. Not dangerous numbers but I’d classify it as a significant dropoff for sure.
Then came 2017 through 2019 and we saw tremendous growth and numbers. So, my question, if we look at what was happening in the USA around that time, we had the winding down of the Obama Presidency and the election of a different President.
Now, anyone can say anything they want about the White House’s current occupant but I don’t think anyone can deny that the economy has been hitting on all cylinders.
So back to the question at hand; does it matter at all which President is in office? Which party holds the office at The White House? Does it matter?
I may get some blow back here but I’m trying to look at it in a non-partisan, non-political way and say, that in my expereince, it has mattered and my business has done much better since the 2016 election than the years prior to.
Now let’s be fair, a lot of research has emerged in that time. The American College of Physicians recommended spinal manipulation, the White House recommended spinal manipulation, The Lancet Papers came out, Dr. Goertz kicked the VA doors down with her research…..basically, I don’t think it’s one thing like which party is in the Presidency.
But, can we deny that when the economy is killing it like right now, that patients seem more willing and more confident to spend money? My uneducated but experienced guess is that yes, the economy has an effect on our businesses and the party in power affects the economy.
Alright, those of you that disagree, go fire up my email inbox. I’m always all ears and willing to learn so feel free to tell me all about it.
I want to talk about some much much cooler stuff than that right now though. I want to discuss some papers on lifestyle and genetics in regard to dementia as well as if feeling back stiffness actually means you have a stiff back. Pretty interesting stuff there.
Before we dive into the reason we’re here, it’s good to support the people that support evidence-informed practitioners. Well, ChiroUp certainly does just that.
If you don’t take advantage of the deal I’m about to offer you, I think you just might be crazy.
Regular listeners know I’ve used ChiroUp since for well over a year now. I’m going to tell you want it is and then share a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months. So listen up!
ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean:
In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, activities of daily living, & for their exercises.
This save you so much time – no more explaining & re-explaining your patient’s care, because they have access to it right there at their fingertips.
You can be confident that your patients are getting the best possible care, because the reports and exercises are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you by people that are deep into the research.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice.
If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL and, to sweeten the deal, you can use code Williams99 to pay only $99/month for your first 6 months
That’s ChiroUp.com and super saver code is Williams99.
Item #1
Let’s start out with this one in JAMA called “Association of Lifestyle and Genetic Risk With Incidence of Dementia” by Lourida, et. al. and published on July 14, 2019(Lourida I 2019)….it’s not sizzlin but it’s steamy folks.
Why They Did It
The authors objective was to investigate whether a healthy lifestyle is associated with lower risk of dementia regardless of genetic risk.
How They Did It
- The study included 196,383 subjects
- They were followed up for 1,545,433 person-years
- This paper was a retrospective cohort study i
- It included adults of European ancestry aged at least 60 years
- The subjects had no cognitive impairment or dementia at baseline.
- They joined the UK Biobank study from 2006-2010 and were followed until 2016 or 2017
- They scored for dementia
- and paid close attention to lifestyle factors such as smoking, physical activity, diet, and moderate alcohol consumption
Wrap Up
The authors concluded the following, “Among older adults without cognitive impairment or dementia, both an unfavorable lifestyle and high genetic risk were significantly associated with higher dementia risk. A favorable lifestyle was associated with a lower dementia risk among participants with high genetic risk.”
So, just to keep you all smart, in summary, no matter where you fall on the genetic risk coninuum, don’t smoke, eat healthy, drink in moderation, and get some exercise. And tell your patients to do the same.
OK, Item #2
This one is called “Feeling stiffness in the back: a protective perceptual inference in chronic back pain” by Stanton, et. al. and was published in Scientific Reports in August of 2017(Stanton TR 2017). Not smoking hot but only a couple years or so old.
Why They Did It
The authors were looking to test the idea or notion that have a back that FEELS stiff actually means you have a stiff back. They wanted to propose a new hypothesis and that is that feelings of back stiffness are a protective perceptual construct, rather than reflecting bimechanical properties of the back. This new theory, if proven, would have far-reaching implications for treatment of pain and stiffness going forward.
How They Did It
They used three different experiements to challenge the veiw by demostrating that feeling stiff doesn’t actually relate to objective measure of actually being stiff. In addition, objective back stiffness doesn’t differ any between those who report FEELING stiff vs those who do not.
What They Found
Those reporting a feeling of stiffness actually are showing self-protective responses and they significantly overestimate force applied to their spine.
Wrap It Up
Here we show that a conscious experience of feeling stiff does not reflect true biomechanical back stiffness, but may rather represent a protective perceptual inference that may serve to reduce movement and re-injury. By showing that feelings of stiffness do not relate to biomechanical stiffness measures and that biomechanical measures of stiffness do not differ between those with and without feelings of stiffness, this suggests that information other than actual joint stiffness is influencing this perceptual inference
Correct me if I’m wrong but, to an extent that sounds similar to what we commonly hear called ‘fear avoidance’. What would you say is a common way to deal with fear avoidance? I would be bold enough to suggest that an effective means is the concept of ‘hurt vs harm.’
Fear avoidance can keep patients in chronic pain syndrome but if they start moving and start exercising, they start trusting their bodies more and more. We are clear to them that some movements may hurt a little bit and that’s OK. It’s part of the process. But, if the movements feel ‘harmful’, they should stop and let’s take a closer look at what’s going on.
We all know that most exercises for most people are not actually harmful. Once they get moving and making progress, they get excited don’t they? Fear avoidance goes down, activity level goes up, and health gets a boost.
The patient is a winner and the doctor is a winner. Hell, the patient’s family is a winner. Have you ever had to be around a chronically painful or ill patient? It’s misery for all involved. Plus, what if the person in chronic pain typically cooks for the family? Obviously, everyone here is the winner because I like some biscuits.
Key Takeaways
Store
Remember the evidence-informed brochures and posters at chiropracticforward.com.
Subscribe Button
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 preventativly 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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Lourida I, H. E., Littlejohns TJ, (2019). "Association of Lifestyle and Genetic Risk With Incidence of Dementia." JAMA 322(5): 430-437.
Stanton TR, M. G., Wong AYL, Kawchuk G, (2017). "Feeling stiffness in the back: a protective perceptual inference in chronic back pain." Sci Rep 7(9681).
CF 110: Dry Needling vs. Massage & What Is Your Exit Number?
Today we’re going to talk about new research comparing dry needling to ischemic compression. Really interesting information on this so don’t miss it. Also, I get into my story a bit. How I came to be where I am and I’m hoping to encourage and give a little guidance for the younger docs as well as the older ones. This one was a fun one to think through. I hope you enjoy what I have to share.
But first, here’s that sweet sweet bumper music
Subscribe button
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 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.
- Like our facebook page,
- Join our private facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends.
Do it do it do it.
You have found yourself smack dab in the middle of Episode #110
Now if you missed last week’s episode , we talked about 10 back facts and 10 back myths. We also talked about how chirorpactic performs when it’s used as part of an integrated strategy. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
We are going skiing this weekend. If you haven’t been to the Enchanted Circle part of New Mexico, you should definitely go some time. The town in that circle are Taos, Angel Fire, and Red River. There is skiing for everyone. Probably the easiest is Red River and it’s a pretty cool little town because the slope comes right down into the town. Like there’s a bar right there at the bottom.
And that’s where I’ll be found if you happen to be looking for me.
Here’s where I’m trying to get in my work/life balance. For that reason, I thought I’d tell you a quick story about how I’ve arrived at the spot I am in my practice. Where I’ve been and where I’m going.
When we are young, we work. Or at least we should work. And I mean work hard. you have to build and most of us start from very little. I started working for another chiropractor for the first 5 years. He was not fair, he did not pay bonuses, it was not a positive experience for me. I had basically nothing.
I moved on, under threat of a lawsuit from him, to open up just down the road. I had 3 rooms in a run down building that I shared with a commodities trader and an insurance company. We do what we have to do folks. And I did. I answered the phones, I wrote the appointments down in a little book, I cleaned my office, I’d say I did the billing but I didn’t. I never sent anyone a bill. I didn’t know what the hell I was doing. Nobody ever taught me.
In the town I was in, there were about 14,000 people and I saw 14 chiropractors set up and then close shop in the 11 years I had a presence there.
That should have told me something right? Well I’m a creature of habit but even I finally woke up and realized I had to make a change. So, I started renting space from another chiropractor in Amarillo, which was about 40 miles from where I was practicing. I split time between the two cities. Three days in Amarillo and two in the small town.
Guess what? I started actually getting busy and seeing more and more patients in my new spot so, eventually, I was able to get rid of the small town and move everything to Amarillo.
Adversity is a constant in our lives though. And I have to say that I absolutely LOVE when people underestimate me. It warms my heart because I know what I’m made of and determination plays a huge part in my DNA. If someone tells me I can’t do something, it’s almost like they’ve just guaranteed that I will.
Well, the guy I was renting from ended up being about half crazy so I left there and opened up my own practice finally. Up until I left his building, we had split the cost of marketing for personal injury patients. He thought the attorneys needed us more than we needed them. I felt like it was in our best interest to develop a personal relationship with the attorneys. Take them to eat lunch, things like that.
Well, guess who got all of the PI business when I left? Right…..me. I still didn’t have much to my name at that point but I had that business and it gave me the confidence to do it.
I graduated college in 1998 and here it was 2008 and I’m finally opening my own practice. And again, though my business had picked up a bit, I still had nothing. The first ten years were supplemented with playing music. Hell, back then I was making about $55k a year just playing the guitar and singing songs. What a blessing to be able to survive the lean years that way. But I was killing myself staying up late and all that stuff.
This new office, I made and painted all of the base boards. We bought furniture at consignment stores and antique shops and auctions and estate sales. It was done on a budget but, compared to what I had been a part of prior to 2008, it was absolutely gorgeous.
Only 1500 sq ft but plenty for what I needed at the time. My mom had just retired and decided she wanted to help me get started so she worked for me for about 6 months for free before I could hire someone to help and let her retire in peace and quiet….away from the craziness. Aren’t mom’s amazing?
This brand new practice grew and grew and slowly grew until we were able to expand in 2015. The space next door to us came up for lease so we just expanded into the space. The construction was a challenge for sure but worth every noise and bang and clank and saw that we listened to for 6 months of the build out.
Now we have about 4,000 sq ft. and it looks like a museum. On purpose. If you’ve listened very long then you know that I’m a sculptor and I build live edge furniture. We also like to travel and we try to buy art from original artists when it makes sense.
So, art and design and unique furniture are woven throughout rooms with traditional chiropractic modalities. Lol. Sounds crazy but it works. And it’s a space that I love to come to and patients really seem to love as well.
With the extra space we now have 5-6 massage therapists, and acupuncturist, and we even added a day spa with an esthetician. How does that tie into chiropractic? It doesn’t. It ties into the massage acupuncture - dayspa and it gives us more cash based services so we will one day hopefully be less and less dependent on insurance companies.
So, we have built something of value and with substance despite two threats of lawsuits, despite having little to nothing to get started with, against the odds, without really knowing how to run a business, and without having it really figured out. We’ve lost a lot of money along the way because we didn’t always know exactly what we were doing but necessity is the mother of invention. We figured it out. We learned on the job. On the fly.
Another thought on this is that I was learning and learning…. I learned how to do graphic design so I didn’t have to pay someone to make graphics for my marketing. I learned how to build a website and how to do website SEO to get it to #1 on Google. I didn’t have the money to pay someone else so I had to figure it out. I learned how to network and join associations and clubs.
I learned different stuff like the Kennedy Decompression Technique. I went through Croft’s Whiplash Biomechanic & Traumatology certification. I was mostly PI for years so why wouldn’t I do what I could to be the best at it? For you ChiroTouch users, I even created a macro around the research from his course. You can find that at personalinjurymacro.com. Now those are good things to go through and learn from, but it wasn’t until I felt that we were finally done building that I turned my attention more toward perfecting.
That’s when I started the orthopedic diplomate. I have goals set for what I want to do next. I have FAKTR on the list and I have SFMA on the list. I have the McKenzie course on the list. I’m wrapping up the CRISP book on the cervical region. It’s just as a amazing as the CRISP book was on the lumbar region. The next book is the 3rd edition of Craig Liebenson’s Rehabilitation of the Spine.
See what I mean? I’m done building so now, I want to perfect.
So, why did i tell you all my little story? Why did my going skiing spur me telling you the short version of my story? Well, because I want young doctors to understand what it takes. Many do understand it. Many do not. When people say it’s a journey, man that’s no lie.
You have to work, you have to be present, your practice is going to own you for a while, you have to network and kiss babies and shake hands. Then, somewhere down the line, you reach a point where you are successful enough that you must transition to where you start to value your time in ways that are different from how you started out.
You have to start making a pivot and the timing is different for everyone. And that’s where I’ve been for the last two years or so. Finally, at 45 I started to get it. I have to start valuing my time with my family, my personal time, and time to learn more. IF the office and patients run my schedule at all times, there will never be enough time for the rest of what makes up a life full of quality and enjoyment and loving relationships with spouses and friends and family. It’s impossible.
Some of the things I’ve started doing to ease the burden of burnout, which is very real by the way….some of the things are to implement an exit plan. I don’t mean next year or even in the next 5 years but, sitting here today at 47, what will be my exit plan? How will I one day retire and still be financially secure? Well, my dad having a stroke has taught me that I need long-term care insurance….just in case. I’ve seen the difficulties long-term care presents. I’m doing what I can to protect my wife and I.
I need disability insurance as well. I’m drinking beer at the base instead of skiing this weekend. Not because I’d rather drink beer than ski but because they call them accidents because they’re not planned. If I hurt myself skiing, the loss in money is incalculable. I retired from skiing on purpose.
Beyond those things, I’m identifying activities and expertise I have to offer that others may find valuable at some point. Then, I want to monetize those skills and that knowledge so that retirement still offers income opportunities.
Those are exit strategies that if I start today, may mature and pay off when the exit is finally engaged.
In the meantime, for today and next month and next year…..I think it’s important to plan a trip at minimum once per quarter. Whether you just go to your mom and dad’s 2 hours away or you fly to Europe or wherever. A trip once per quarter gives you something tangible, not very long away in terms of workdays, and some time away from your daily grind.
Once per quarter trips are meant to re-charge your batteries. They give you more time with your family and your friends. And honestly….time to your damn self. When was the last time you were able to just sit down and do whatever the hell it was that YOU wanted to do? It’s been a while for me.
So, my schedule, I decided to take control of it. Monday is a full day with a 2-hour lunch and I get off at 6. Tuesday I work through lunch and only go from 9-2:30. I use my afternoon for continuing education or personal business tasks….whatever. Wednesday is a full day BUT I take a 3-hour lunch. Lots of good free time there in the middle of the day and it makes the afternoon shorter. Thursday is a long day just like Monday. Then on Friday I work through lunch and go from 8-1. This again gives me time to travel for the weekend, for happy hour with my friends or my wife, for taking the kids to a movie, or to do more paper work in the office if I’m behind.
So I have three days during the week that have a little me-time built in there and that’s just invaluable. At the same time, I have the room, if we fill completely up…I have the room in my schedule for 255 patients in the week and about 25 new patients. If we fill up of course. I typically average about 15-20 new patients per week and more like 180 visits per week so I’m nowhere near being full.
So I guess I wanted to tell my story a bit because I want to hopefully inspire the younger doctors to stick with it. To have that fire and to be a do-er. You either make things happen, let things happen, or wonder what the hell just happened. Be the one that makes things happen.
Even when you make a mistake or fall down, at least you are trying. You’ll learn, you’ll figure it out. You’ll be OK. Just be smart, be honest and ethical, communicate the right way and it’ll work out.
For the older docs like me, I wanted to inspire you a bit about making the pivot. Some of you want to die in your office working with patients when you’re in your 80’s. Yeah, that’s not me. I have too many interests in my life. I have songwriting, sculpting, . I want to make you think about making that pivot. What are your talents and skills that you can monetize down the road to help you retire when you really want to?
I had a very wealthy friend ask me one time, “Jeff, what is your exit number?” I didn’t know what the heck he meant. His background is that he builds oil field saltwater disposal wells, he annoys the big oil companies by making the wells successful enough that the big oil companies buy him out. Pretty cool gig and the payoff is huge.
He explained to me that he always goes into a new deal with his exit number in mind. He knows what he wants to get out of it before he really gets elbow deep into the muck.
How do you translate that into chiropractic practice? It made me think quite a bit. I still don’t know my exit number. I have an idea but don’t know it exactly.
But I know this, If you think your practice is worth $1 million dollars, you’ll might get $350k.
That’s not bad. But, will it fund healthcare in your old age? Will it fund those trips to Europe or Australia that you never had the time to take before? Will it leave the legacy to your kids you wanted to leave? Of course that’s for everyone to answer on their own.
But think about it. What is your exit number and what steps do you need to take today to hit that number to allow you to engage the exit?
I have to admit, I sat down to just put some random thoughts on the paper before I recorded it and this literally turned into a random, not very focused, brain dump. I apologize for that but I hope you got something out of it. If there’s one thing age provides, it’s hopefully a bit of wisdom but definitely experience.
I’ve lost close to a million dollars before. Over a three year period, I held onto a staff member too long. I believed in them. I fought for them by training them more and more and I just had no idea how deep they were in over their head.
I finally hired an internal auditor to come in and pick things apart and give me the bad news. I knew something was wrong but had no clue. The staffer wasn’t stealing. They were just not billing correctly, not disputing denials, and all that good stuff. Anyway, it added up to about a million dollars over about 3 years.
I’m just going to pause long enough to say this; it’s not every day that you find out you’ve lost almost $1 million dollars. But, with the help of an amazing wife, some really cool friends, and Bud Light….I came to terms with it and I let it go.
So, losing that kind of money…..that’s not wisdom right? That was stupid of me. But it gave me experience not very many of you have!! But, where money can be lost, it can just as easily be made.
You can’t keep a person with a purpose down. Chiropractors typically have a purpose. We are resilient and through all of the battles we’ve been through on the state level with the Texas Medical Association, one thought remains true for me. If we were wrong….if we weren’t affective….if we didn’t help our patients in tremendous ways, with all of the forces against chiropractors through the years, we would have been wiped out years ago.
Yet, here we are. Still here. It’s because we make such a difference in our patients’ lives and because we have the purpose behind us.
Keep on keeping on friends. There’s not been a better time to be a chiropractor in the last 30 years.
This is actually a research-based podcast so I should at least take the time to share a paper rather than just my opinions or experiences.
Before we dive into the reason we’re here, it’s good to support the people that support evidence-informed practitioners. Well, ChiroUp certainly does just that.
If you don’t take advantage of the deal I’m about to offer you, I think you just might be crazy.
Regular listeners know I’ve used ChiroUp since for well over a year now. I’m going to tell you want it is and then share a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months. So listen up!
ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean:
In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, activities of daily living, & for their exercises.
This save you so much time – no more explaining & re-explaining your patient’s care, because they have access to it right there at their fingertips.
You can be confident that your patients are getting the best possible care, because the reports and exercises are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you by people that are deep into the research.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice.
If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL and, to sweeten the deal, you can use code Williams99 to pay only $99/month for your first 6 months
That’s ChiroUp.com and super saver code is Williams99.
Item #1
Our only item this week is called “A sonographic comparison of the effect of dry needling and ischemic compression on the active trigger point of the sternocleidomastoid muscle associated with cervicogenic headache: A randomized trial.” by Togha et. al and it was published in the Journal of Back and Musculoskeletal Rehabilitation in November of 2019(Togha M 2019)…..close enough, hot tamale hot tamale…..
Why They Did It
Cervicogenic headache (CeH) is among the common types of headache which has an undesirable influence on the quality of life. The myofascial trigger point (MTrP) within the sternocleidomastoid (SCM) muscle is one of the most important causes of CeH.
The purpose of this study was to compare the effect of dry needling (DN) and ischemic compression (IC) on the headache symptoms as well as myofasckial trigger point-related features in subjects with cervicogenic headache originating from mysofascial trigger points of the sternocleidomastoid muscle using a sonographic method.
How They Did It
- 29 females aged 35 years on average with clinical diagnosis of cervicogenic headache were used
-
They were randomly divided into the following groups
-
dry needling group
- Ischemic compression group
-
control group
-
The dry needling and ischemic compression groups each received 4 treatments
- Outcomes were measured 2 weeks before and 2 weeks after treatment.
What They Found
- Significant improvement was found int eh headache intensity, duration, frequency, pain pressure threshold, and myofascial trigger point area.
- No significant differences were observed between dry needling and ischemic compression though.
- Pearson correlation showed a significant correlation between headache intensity and the myofacial trigger point elastic modulus
Wrap It Up
The authors summed it up in the conclusion, “Both interventions could reduce headache symptoms, pain pressure threshold, and myofascial trigger point area. Neither intervention was found to be superior to the other in short-term follow-up. Ischemic compression may be preferred since it has fewer unwanted side effects compared to dry needling.
Based on the data, it may be concluded that some myofascial trigger point biomechanical features such as stiffness may influence the produced headache symptoms.”
Good stuff in that paper right there because, literally, I’ve been thinking about adding dry needling to my toolbox and, as of right now, it’s moved from the top of my list.
I know this episode was a little scattered and not quite as focused as all of the rest but I felt like I could offer some advice and maybe even a little guidance. Maybe I’m just an old dude wanting to talk and hoping someone listens. Maybe I helped lead and encourage. That’s always the goal.
Subscribe Button
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 preventativly 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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Togha M, B. F., Jafari M, Nasiri A, (2019). "A sonographic comparison of the effect of dry needling and ischemic compression on the active trigger point of the sternocleidomastoid muscle associated with cervicogenic headache: A randomized trial." J Back Musculoskeletal Rhabil.
CF 111: American Academy of Family Physicians Warming To Chiropractic & Evidence Behind Supplements
Today we’re going to talk about how the American Family Physicians my be warming up to chiropractic and what supplements actually have some evidence behind them?
CF 107: Insurance Warming To Chiropractic in 2020 & Chiropractic For Lumbar Herniation and Sciatica
Today we’re going to talk about what to expect with Insurance coverage in 2020 and we’ll talk about some thoughts on chiropractic and sciatica according to what the research tells us.
But first, here’s that sweet sweet bumper music
Subscribe button
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 kind of research. We’re research talk over a couple of beers.
Welcome, 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.
- Like our facebook page,
- Join our private facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends.
Do it do it do it.
You have collapsed into Episode #107
Now if you missed last week’s episode on joint replacement life spans, spinal infections, and vitamin D w/ calcium supplementation, then make sure you don’t miss that info.
I think there were some good solid knowledge nuggets found there within so make sure you’re up to date and not falling behind the rest. Keep up with the class won’t you?
On the personal end of things I have to say that this has been one of the more challenging of Christmases if I’m being honest. Beyond the disruption of normal schedules and normal business that goes on with the holidays…..we expect those things. The disruption stinks and it can make us lose money. That is frustrating.
However this one was a bit different for me. If you’re a regular listener then you know that my Dad had a stroke on November 9th so that’s still a daily deal. Going out to the rehab hospital, working with his hand and wrist, elbow, and shoulder to see if I can spark any kind of sensation or movement.
Then on Christmas Eve, my stepdad needs to go to the ER so I drive over to their house and drive my mom and Fred to the VA ER at about 10pm.
Well, we end up sitting there until about 5am. Turns out he has appendicitis but no surgeons until the morning. We had a little time to go home and get a few hours of sleep before having to be back up at the hospital for surgery at about noon on Christmas Day.
So, I got a few hours of sleep in, went by the rehab hospital to check on Dad, went back to pick my mom and family up, then off to the hospital. It only took them about 45 minutes and here’s the amazing thing.
Fred had his appendix out at about 12:45 in the afternoon and was out of the hospital and at his house by 6:30pm.
Outstanding!! And he’s done great. Hell, he said the worst part is where they shaved him and the hairs growing back in are wanting to catch on his clothing. Lol.
So, as you can guess, it was a bit of a miserable Christmas. Back in my rascally days, 5am was nothing to me. In fact, I saw 5:00am pretty regularly after having been up all night hooting and hollering and acting a fool. But at 47, 5:00am is some mystical thing that I only hear about sometimes from my health freak friends that get up to work out in the mornings.
I hope you holidays were more amazing than mine. I hope you got to spend some quality time with your loved ones and I hope the best for all of us in this new year. Upward onward and forward.
Before we dive into the reason we’re here, it’s good to support the people that support you don’t you think? I’m about to throw you a deal and if you don’t take advantage of this deal, I just think you might be crazy.
If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!
ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean:
In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises.
You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips.
You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! Short testimony
If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months
That’s ChiroUp.com and super double secret code Williams99.
Item #1
Our first item of interest today is called “More Payers Backing Chiropractic Care in 2020” by Sherry McAllister(McCallister S 2019). It was published in the Managed Healthcare Executive on December 23, 2019.
Hot potato, coming through….
Just taking this article point by interesting point:
She says research has shown private and government health plans may inadvertently be steering their members toward opioids by not covering, restricting benefits, or charging higher co-pays for chiropractic care.
Indeed and we’ve covered that here as well. This was laid out particularly well in a White House report from 2017 or so I believe. They were actually very clear in pointing out that current Medicare and healthcare policies actually create barriers to conservative management rather than pharmaceutical modalities.
Think about it; when a prescription of opioids cost $10-$20 but a visit to a PT or chiropractor can bust the bank…..well, what you going to pick if you’re not very educated on all of the options available?
She points out a recent study from Boston University showing that patients with a deductible greater than $1500 were less likely to choose a doctor of chiropractic as their entry-point provider.
However, as she points out, United Healthcare has announced a certain employer-sponsored medical plan that will have zero out-of-pocket spending, which will include their deductible….if they opt to go to a chiropractor for treatment of low back pain first. Hell yeah. Hell yeah is what I have to say about that.
We’ve been sitting here at the end of the tunnel waiting on this train that has been delayed for decades. I’m getting old waiting on this stupid POS but it looks like we might be seeing the light coming down the way and hearing the rumbling on the line.
Medical doctors will never lead the charge when it comes to sending these patients to chiropractors. It must come from the payers and maybe we’re starting to see the push. Hell, we know we save the system money so why on Earth would they NOT lead the charge?
UHC estimates that by 2021 this design can reduce imaging by 22%…..good luck getting some chiros to scale back on x-rays UHC….good luck. They estimate it can reduce spinal surgeries by 21%….I’d guess more than that, reduce opioid use by 19%…..more than that I’d guess, and reduce total cost for members and employers. Agreed and agreed.
McAllister goes on to discuss how other healthcare plans are coming on board by expanding or emphasizing coverage in 2020 for chiropractic including Tricare which handles the military folks here in America. Instead of just active duty troops, Tricare is expected to approve extending chiropractic coverage to family members, retirees, and family members!!
Kowapow, people. Sha-freaking-zam to the bamalam.
She points out this is most likely in response to a 10-year study of military members through 3 different clinical trials showing chiropractic was instrumental in increasing strength, endurance, and response time among service members with lower back pain. Again, we have covered these here on The Chiropractic Forward podcast if you’ve been following along.
Chiropractic’s own Dr. Christine Goertz has been instrumental in some of those clinical trials.
Mrs. McAllister points out that even non-military seniors in some part of America could be getting upgraded access to chiropractic through benefit expansions of Medicare Advantage plans.
We know that insurance plans do not like wellness care because they’re stupid and short-sighted but Anthem Blue Cross in California expanded wellness benefits for its Medicare Advantage plans to include up to 24 visits per year with a chiropractor, massage therapist, and/or acupuncturist at no extra cost. Same goes for folks in Philadelphia. Good stuff here people.
When you hear veteran chiropractors such as myself say there’s not been a better time to be a chiropractor in the last 30 years, since the Mercedes 80’s, now you are seeing why. It’s happening before your eyes I believe.
This is all excellent news for chiropractors, massage therapists, and acupuncturists. Now, when can we expect things to really change and translate into more patients in your doors and more money in the bank? Well, who the hell knows? But, I can tell you that the American College of Physicians started recommending spinal manipulation for back pain in 2016, the Journal of the American Medical Association supported that recommendation in a 2017 article, The Lancet’s series on Low Back Pain supported the recommendations in 2017, The White House Report we mentioned backed it all up, Consumer Reports, The Joint Commission, CDC, NIH, and the FDA all came in line with this new thinking.
So, you see the more of these organizations and voices of authority that come on board, the more we’re going to see in our offices. But it is a snowball and the ball has just started rolling at the top of the hill.
The trick is going to be to take advantage of it all by following research and evidence. By expanding and bringing chiropractic closer to the medical community rather than leaving it in some archaic form from 100+ years ago.
Stick with it. It’s moving the right direction and it’s going to be OK.
Item #2
The second paper is an older one. It’s from way back in 2006. Old man river…. that old man river…
It’s called “Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations.” It was authored by V Santilli et. al. and published in Spine Journal(Santilli V 2006). If it’s in Spine, it’s prolly muy bueno amigo.
Why They Did It
The stated goal here was to assess the short and long-term effects of spinal manipulation on acute back pain and sciatica WITH disc protrusion.
How They Did It
- It was a randomized double-blind trial comparing active and simulated manipulations in rehabilitation medical centers in Rome and its suburbs
- They had 102 ambulatory patients with at least moderate pain on a visual analog scale for local pain and/or radiating pain.
- They implemented appropriate outcome measurements
- Manipulations or simulated manipulations were performed five days per week by chiropractors with a number of sessions which depended on pain relief or up to a max of 20
- They used a rapid thrust technique which I’m assuming is high velocity low amplitude such as diversified
What They Found
- Manipulations appeared more effective on the basis of the percentage of
- pain-free cases
- number of days with pain
- number of days with moderate or severe pain
- Patient receiving manipulations had a lower mean VAS score
- There were no adverse events
Wrap It Up
“Active manipulations have more effect than simulated manipulations on pain relief for acute back pain and sciatica with disc protrusion.”
Pawya!!
Item #3
Our last one today is called “Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study” authored by McMorland et al and published in the Journal of Manipulative Physiological Therapeutics in October of 2010. Old man river….not quite that old though. 10 years isn’t fresh in the research world but that’s OK, it’s still a good one we should all know about.
Why They Did It
They wanted to compare the clinical efficacy of spinal manipulation against microdiskectomy in patients with sciatica secondary to lumbar disk herniation
How They Did It
- It was a randomized clinical study
- 120 patients were included all of which were referred by a primary to neurosurgeons
- All had unilateral lumbar radiculopathy secondary to lumbar disc her4niation
- The herniations were present at L3/4, L4/5, or L5/S1
What They Found
Significant improvement in both treatment groups compared to baseline scores over time was observed in all outcome measure
Wrap Up
“Sixty percent of patients with sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention.
Of 40% left unsatisfied, subsequent surgical intervention confers excellent outcome.
Patients with symptomatic LDH failing medical management should consider spinal manipulation followed by surgery if warranted.
Three syllables….one word, folks. Bamalam. Bam-a-lam, people….
It’s happening. It’s coming. Stay the course, make smart decisions. Be the expert. Use research and the Chiropractic Forward Podcast to do it.
Subscribe Button
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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show us that patients can get good to excellent results for headaches, neck pain, back pain, and joint pain just to name just a few.
It’s safe and cost-effective. It can decrease surgeries & disability and we normally do it through conservative, non-surgical means with minimal hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering 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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography
McCallister S (2019) "More Payers Backing Chiropractic Care in 2020." Managed Healthcare Executing.
Santilli V, B. E., Finucci S, (2006). "Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations." Spine J 6(2): 131-137.
CF 106: Joint Replacement Expectations, Spinal Infections, & Vitamin D with Calcium
Today we’re going to talk about Joint Replacement Expectations how long can you expect a joint replacement to actually last, we’ll talk about Spinal Infections - what are some of the signs and symptoms according to research, and they we’ll cover a paper in JAMA on supplementation with Vit D alone vs. Vitamin D with Calcium. Stick around for a great show.
But first, here’s that sweet like a Christmas candy cane bumper music
Subscribe button
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 kind of research. We’re research talk over a couple of beers. So go get one and crack it open because we’re off and running.
Welcome, 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.
- Like our facebook page,
- Join our private facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends.
Do it do it do it.
You have ping ponged into Episode #106. And my Parker alums will remember all of the ping pong that went on there at the student rec room. Pretty heated matches right there!
Now if you missed last week’s episode on Groupon deals, Gabapentin, and on Weight Loss…. make sure you don’t miss that info. As I tend to do, I got a little red in the face and probably got a bit dramatic and opinionated but I felt better by the time it was over with.
Did you know that if you have an Alexa product, you can now just say something like, “Alexa, play The Chiropractic Forward Podcast on Apple Podcasts” and kablooey! You here the golden throated stylings of yours truly! Lol. You can say skip ahead 30 seconds, play previous episode, and on and on so pretty cool right there.
On the personal end of things the Holidays are always stressful and this season has been a bit extra with my Dad having the stroke and being in the rehab hospital. That and whatever other daily trials and tribulations that come along with raising teenagers.
It’s been journey but isn’t life just like that? Whack a mole every day. Whackin whacking whacking. Sometimes it’s exhausting. Obviously, I have a little turmoil poking it’s head up here and there lately but I’m a good swimmer.
What I mean is, this world is full of sinkers and swimmers. Very rarely do you find simple water treaders. We’re sinking or we’re swimming. The sinkers let life happen to them rather than happening to life.
They either make things happen, let things happen, or wonder what the hell just happen.
On the other hand, swimmers are making things happen every day. Things keep coming at them and they keep batting them away and they stay above water. Hell, some of them make a game out of it and adapt to have the best breaststroke or back stroke you’ve ever seen.
Those are the ones that just act like they’re indestructible. Well, I’m not indestructible. At all. I’ve been going through a season lately for sure. Nothing about business. All about my dad and other family stuff here and there. Luckily, I have an amazing wife and support structure. Good support allows swimmers to swim. She allows me to be a swimmer. No doubt.
Enough about all that. Again, I share personal aspects because I know many of you will either relate on some level and ideally maybe even draw some inspiration. Others can learn from it I think. At least that’s my hope.
By the time this airs, Christmas will have come and gone. I hope you had the merriest of Christmases. Being a Christian myself, I can’t tell you how much I love the season, the music, the magic of giving. Even with all of the hustle and bustle and pain in the butt it brings, it’s a special time of year and I try to keep it special for me and the family.
Before we dive into the reason we’re here, it’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices.
If you don’t take advantage of this deal, I just think you might be crazy.
If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!
ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean:
In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises.
You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips.
You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! Short testimony
If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months
That’s ChiroUp.com and super double secret code Williams99.
Item #1
This one is called “Vitamin D and Calcium for the Prevention of Fracture. A Systematic Review and Meta-Analysis” it was authored by Yao, et. al. and published in JAMA Open on December 20, 2019(Yao P 2019).
Hot hot hot like Texas in the Summer.
Why They Did It
Considering that vitamin D and calcium are recommended for prevention of fracture but prior RCTs have reported conflicting results, the authors wanted to assess the risks of fracture associated with differences in concentrations of 25-hydroxyvitamin D in observational studies and the risks of fracture associated with supplementation with Vitamin D alone or in combination with calcium in RCTs
How They Did It
- Systematic review and meta-analyses.
- 34,243 participants.
- They mined data from PubMed, EMBASE, Cochrane Library and other RCT databases
- Observational studies involving at least 200 fracture cases and RCTs enrolling at least 500 participants and reporting at least 10 incident fractures were included
- RCTs compared Vit D or Vit D with calcium with control
- Two researchers independently extracted the data and assessed possible bias
Wrap It Up
The authors concluded “In this systematic review and meta-analysis, neither intermittent nor daily dosing with standard doses of vitamin D ALONE was associated with reduced risk of fracture, BUT daily supplementation with both vitamin D and calcium was a more promising strategy.” To the tune of a 16% reduced risk of hip fracture. I’d sure as hell take that reduced risk if it’s my mom, wife, sister, or if it’s a patient.
So, if you have a patient with osteoporosis and I know that you absolutely do…..it looks evidence-based to tell them to supplement with Vitamin D but only if they add Calcium to the mix.
I love getting smarter and better. This is a nugget that does just that for us.
Item #2
Joints!!
How many knee replacements do you check reflexes on during the month? We average around 70-80 new patients per month so the answer in my office is, ‘several’.
You probably already know that surgeons don’t like to do knee or hip replacements on younger folks because they don’t want the replacement to wear out before the patient dies. They don’t want the patient to have to go through the damn thing twice basically.
The Lancet medical journal recently published two papers on the topic. One on the hip and one on the knee. One was called “How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up” and the other was called oddly enough “How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.” They were both authored by the same group led by Jonathan Evans and were published in The Lancet on February 16, 2019. Not hot off the press but not room temperature either. Very luke warm, folks. (Evans J 2019, Evans J 2019)
Why They Did It
For both papers, it’s pretty obvious why they did it. They want to know how long hips and knees last when replaced. Easy peesy.
How They Did It
- The papers were systematic reviews and meta-analyses
- Medline and Embase were used from Sept 12, 2017 to current
- They used 140 eligible articles
- They also reviewed reports of national joint replacement registries
Wrap It Up
On the hip paper, they concluded “Assuming that estimates from national registries are less likely to be biased, patients and surgeons can expect a hip replacement to last 25 years in around 58% of patients.”
On the knee paper, they concluded “Approximately 82% of total knee replacements last 25 years and 70% of unicondylar knee replacements last 25 years.”
Isn’t good to have a solid number you can confidently tell your patients when they’re thinking about making that appointment with the orthopedic surgeon?
Item #3
Our last paper this week is on spinal infection. It’s called “Red flags for the early detection of spinal infection in back pain patients” authored by Yusuf et. al. and published in BMC Musculoskeletal Disorders in December of 2019. (Yusuf M 2019)
Sizzlin’ hot like a Summer sidewalk come on.
Why They Did It
The aim was to conduct a systematic review specifically reporting on studies that evaluated the diagnostic accuracy of red flags for Spinal Infection in patients with low back pain.
How They Did It
- Again they mined the biggies like Medline, Cochrane, and EMBASE, but also Pedro, Web of Science, OpenGrey, and Grey Literature Report
- 40 papers were accepted
- A total of 2224 cases of spinal infection were identified
What They Found
- Spinal pain and fever were the most common clinical features
- Diabetes and IV drug use were the most occurring determinants
- MRI was the most used imaging and
- Staphylococcus aureus and mycobacterium tuberculosis were the most common microorganisms detected.
Wrap It Up
The authors wrapped it up saying, “The current evidence surrounding red flags for spinal infection remains small, it was not possible to assess the diagnostic accuracy of red flags for spinal infection…..the most frequently reported clinical feature was the classic triad of spinal pain, fever and neurological dysfunction.”
Key Takeaways
Store
Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly.
If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders.
Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it.
Subscribe Button
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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show us that patients can get good to excellent results for headaches, neck pain, back pain, and joint pain just to name just a few.
It’s safe and cost-effective. It can decrease surgeries & disability and we normally do it through conservative, non-surgical means with minimal hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering 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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography
- Evans J, E. J., Walker R, Blom A, Whitehouse M, Sayers A, (2019). "How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up." The Lancet 393(10172): 647-654.
- Evans J, W. R., Evans J, Blom A, Sayers A, Whitehouse M, (2019). "How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up." The Lancet 393(10172): 655-663.
- Yao P, B. D., Mafham M, (2019). "Vitamin D and Calcium for the Prevention of Fracture. A Systematic Review and Meta-analysis." JAMA Open 2(12).
- Yusuf M, F. L., Selfe J, (2019). "Red flags for the early detection of spinal infection in back pain patients." BMC Musculoskelet Disord 20.
CF 104: Year Two Big Hits Wrap Up
This is episode #104. Fifty two times two = 104. That means two solid years of pumping out the Chiropractic Forward Podcast religiously. Pumping it out like a damn piston people. Dependable and powerful.
BAM, kowapow!!! We’re going to talk about the most listened to episodes from the previous two years and we’ll talk about why they continue to be so darn popular.
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 kind of research. We’re research talk over a couple of beers.
Welcome, 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.
- Like our facebook page,
- join our private facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
Do it do it do it.
You have done the electric slide into Episode #104. The two-year anniversary party is engaged. Yaya!! If you know me, doing really anything at all dependably for two straight years every single week is pretty good.
I’m high maintenance people. In some ways anyway. I can’t be bothered with this and sometime that. I don’t seem to have time for some of the simplest tasks. You know how it is.
I don’t go camping either. Nope. I need plumbing. I need central heat and air. And I need a decent bed. None of that camping foolishness unless it’s in a bus of some sort. Then……prolly. Otherwise, I’m too high maintenance and I’m not ashamed. I’m good with hanging out by a rocky mountain river for a bit. Maybe even hiking in the forest a bit. But then, back to the hotel. Come on now.
Also, the beach. Am I the only one that can’t lay around on a damn beach all freaking day long? It’s not even remotely possible. It’s insane actually. I’m the kind, I hate sand all up on me everywhere. That’s the worst feeling.
And then, after sitting around and soaking up the beauty for about 30 mintues…..maybe an hour…..it’s time to look around for something else to do. I can’t sit around and drink all day. Not unless I want to be out of commission the next day. Maybe two days. See…..I’m a little high maintenance. But don’t tell anyone. It’s our little secret.
Now if you missed last week’s episode on spinal manipulation’s effect on the brain, on forward head posture and if it’s really related to neck pain, and we talked about how smoking is related to pain throughout the body, make sure you don’t miss that info. It was good stuff and very well-listened to!
On the personal end of things, my Pops is back in the hospital. He had a mini stroke, TIA sort of thing that spooked the folks at the rehab hospital that they sent him over to the big hospital to be sure everything is A-OK.
He’s looking and talking roughly the same as before he spooked everyone so I’m hoping we are back on track. Maybe he was just feeling a little extra on that day. He called his wife and his neighbor at around 2am last night so his brain still has some confusion but he’s doing OK overall. A lot of folks have been in a lot worse shape from strokes. Still not sensory or motor in the left upper and lower extremities. Unfortunately.
Before we dive into the biggest episodes in Chiropractic Forward History, it’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices.
If you don’t take advantage of this deal, I just think you might be crazy.
If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!
ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean:
In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises.
You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips.
You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! Short testimony
If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months
That’s ChiroUp.com and super double secret code Williams99.
First thing you gotta know is that as I list these off, the link to the specific show will be in the show notes so that you can have quick access to the episodes that sound the most interesting to you.
OK, let’s start with #10 -
#10
https://www.chiropracticforward.com/cf-068-british-medical-journal-research-surgeons-against-back-surgery-and-pediatric-chiropractic-under-attack/?v=7516fd43adaa
Our tenth ranked episode was Episode #68 and was called “British Medical Journal Research, Surgeons Against Back Surgery, and Pediatric Chiropractic Under Attack”
Any time the British Medical Journal is going to come out and say that moderate quality evidence suggests that SMT has effect on short term pain relief and increased function, we’re going to talk about it and we did.
We also talked about Dr. David Hanscom, MD who wrote a book called Back In Control and who is also on the war path against chronic pain and surgery for the wrong candidate. Sounds like a guy I can get on board with right there. He’s well-versed in upregulated, sensitized CNS and I highly recommend his book to any practitioner or chronic pain sufferer.
#9
https://www.chiropracticforward.com/episode-9-dr-tom-hollingsworth-case-chiropractic-texas/?v=7516fd43adaa
Number nine all time is actually Episode #9 oddly enough and that was when I had my good friend and colleague, Dr. Tom Hollingsworth of Corpus Christi, TX join me to discuss the Case Against Chiropractic in Texas. Evidently that episode is still riging true for chiropractors because it’s still getting downloaded. The thing is, the Texas Medical Association is still suing us here. This case is still going. The episode aired on February 15 of 2018 so moving in on two years ago and the case is to the point where the TMA has won and we are waiting to see if the TX Supremes will hear the case.
Keep your fingers crossed and go listen if you don’t know what it’s about because whatever happens here in TX can, and probably will, happen anywhere.
#8
https://www.chiropracticforward.com/big-ideas-on-marketing-evidence-informed-practices-part-one/?v=7516fd43adaa
It was very recent. Episode #98 and it was called “Big Ideas On Marketing Evidence-Informed Practices.” This episode and it’s part II episode were listened to in big numbers and well-received. Which is exciting. I’ve always seen myself as a marketerpersonally but, primarily for the podcast, a voice of reason, responsibility, honesty, ethics, and yes….of course, research.
But, I’m a marketer as well and how the heck do you market an Evidence-based practice? Well, there’s Jeff Langmaid with the Evidence-based Chiropractor material. There’s Dr. Kevin Christie with The Modern Chiropractic Marketer material. There’s Dr. Christie teaming up with Dr. Bobby Maybee and the Chiropractic Success Academy. And then there’s myself and the Chiropractic Forward Podcast.
That’s it as far as I know. We are the outlets to help you market responsibly and ethically. There are a million other programs but A LOT of them are questionable at minimum. So, I have to say that I was pleased to see that so many found those marketing episodes to have value.
#7
https://www.chiropracticforward.com/how-to-not-miss-a-dissection-de-legitimizing-complementary-medicine/?v=7516fd43adaa
“How To Not Miss A Dissection & De-legitizing Complementary Medicine” This was episode #69. Well this one hit it big because people don’t want to get in trouble!! We are here to help people. Certainly not hurt people. That’s not what we’re built for. I went over a lot of policies I have here in my office that have so far helped me avoid and crazy situtations.
I think every practitioner that is in practice for 21 plus years will have a couple little adverse things here and there like a patient actually getting a little worse in the short term and things like that but, I’ve been fortunate enough to avoid anything scary or serious. I think mostly because I’m very cognizent and aware of the research and do eveyrthing I can to avoid anything scary. Now I’m going to knock on wood and you should go get this episode because there was some real solid, immediate useful information in it.
#6
https://www.chiropracticforward.com/w-dr-jame-lehman-pt-1-national-scope-chronic-vs-high-impact-chronic-coordinated-care-medicaid-daco-to-dianm/?v=7516fd43adaa
“National Scope, Chronic vs. High Impact Chronic Pain, Coordinated Care/Medicaid, and DACO to DIANM”
Episode #96 - For this episode, which again was very recent, we were fortunate enough to be joined again….for the second time…by Dr. James Lehman of the University of Bridgeport and a key driver of the DACO/DIANM program and a frequent author of articles in Dynamic Chiropractic.
This one shot right up to the top of our most listened to episodes because Dr. Lehman is a legend first of all and second it’s because he gives some amazing, profitable, and entrepreneurial ideas about the future of coordinated care. He also taught us about the difference between chronic pain and high impact chronic pain.
I’d say the main thing though was his push for a modernized, national scope rather than 50 different scopes of practice in the US. Fascinating stuff from Dr. Lehman in this one. Don’t miss it.
#5
https://www.chiropracticforward.com/w-dr-anthony-nicholson-part-one-decoding-chronic-pain/?v=7516fd43adaa
Our fifth most listened to episode was episode #80 with Dr. Anthony Nicholson called “Decoding Chronic Pain” and I’m here to tell you that if anyone can help you decode chronic pain, it’s Anthony Nicholson.
This episode, you get to hear it for free but I’m telling you, it’s a master class in chronic pain. Have you ever wondered about central nervous system sensitization or upregulation? Have you wondered what centralized pain vs. peripheral pain is? And no….I’m not talking about McKenzie protocols.
I have covered a lot of material on chronic pain over the last two years but THIS is typically the source of my information. Dr. Anthony Nicholson si a neuro diplomate as well as an ortho diplomate. He is a genius and when he speaks, you need to be listening. So go listen. Don’t you dare miss that one.
#4
https://www.chiropracticforward.com/cf-055-w-dr-james-lehman-the-future-of-chiropractic-chiropractic-specialization-chiropractic-integration/?v=7516fd43adaa
This one was episode #55 and I told you all Dr. James Lehman was a legen y’all. Well here he is for the second time in our top ten most listened to episodes.
This one was called “The Future of Chiropractic, Chirorpactic Specialization, & Chiropractic Integration.” Again, Dr. Lehman shared information that can make the entrepreneurial mind start swooning and swimming. Seriously. Knowledge nuggets raining down like manna from heaven people.
#3
https://www.chiropracticforward.com/dr-tyce-hergert-astounding-expert-information-immediate-headache-relief/?v=7516fd43adaa
Our third most listened to is Episode #6 done with Dr. Tyce Hergert of Southlake Texas as our guest. The episode was called “Expert Information on Immediate Headache Relief”. Dr. Hergert and I covered several papers on how chiropractic helps knock those dudes out. Tyce is a pretty entertaining individual typically and is most certainly one of the smartest your going to find.
#2
https://www.chiropracticforward.com/debunked-the-odd-myth-that-chiropractors-cause-strokes/?v=7516fd43adaa
Our second most listened to episode is still probably my favorite personally. It was episode #13 and is called “DEBUNKED: The Odd Myth That Chiropractors Cause Strokes.”
This was a lot of fun for me because it was part brain dump, part entertainment, and part educational.
I said in a recent episode that there are few things in the world more satisfying than being able to slap someone straight across the face metaphorically by saying, “I can get that research paper for you if you like.” Well, this is THAT episode.
I cover literally everything I could think of. From the risks vs. benefits, the research behind SMT for the neck. The research behind SMT for headache. The research AGAINST SMT causing strokes. The issues the medical field should REALLY be worried about when it comes to adverse effects. Man, I covered it all and while I’m aware it’s not very humble of me to say, I just don’t understand how a hater can really go through it and still be convinced chiropractors cause strokes.
I just don’t. I feel like the information is just that thorough. Go listen to episodes #13, #14, and #15 and see what you think by the time you hear it all.
#1
https://www.chiropracticforward.com/cfepisode11dr-tyce-hergert-new-guides-chiropractic-doctors-ignoring/?v=7516fd43adaa
Well looky there, Dr. Tyce Hergert makes two appearances in our top five….not even the top ten….no, the top five. Only the best for Dr. Hergert. Which that’s fine. All those folks down in Southlake Texas think they should only get the best anyway. Lol. It’s jokes I make jokes.
We go way back. Like….to 3rd or 4th grade basically. For real. Grew up in the same neighborhood in Perryton, TX - look it up - we were in Parker Chiropractic College at the same time and we’ve been serving in the Texas Chiropractic Association together for years. He’s actually an ex-President of the TCA so definitely worth listening to.
This particular episode was called New Guides For Low Back Pain That Medical Doctors Are Ignoring.
Surprise surprise, they’re STILL ignoring guides set forth by their own damn organizations and associations.
We talked about Section 2706 of Obamacare. We covered a lot of ground and people have responded by making Episode 11 our #1 listened to episode of the first 2 years of the Chiropractic Forward Podcast.
It’s been fun and we’re still rocking and rolling and whatnot. Don’t you go anywhere. You keep coming back every Thursday for the new episodes.
Keep sharing us on Facebook and Twitter. Keep writing reviews on podcast platforms. Keep stoppign by the shop at chiropracticforward.com and let’s keep seeing where this here train will lead.
I’m hoping it leads to more evidence-informed practitioners comign out of college each and every semester. More and more and more until some of the garbage we see right now becomes the exception rather than the rule.
Together, with your involvement here and with your help, we can make it happen.
Store
Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly.
If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders.
Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it.
Subscribe Button
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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show us that patients can get good to excellent results for headaches, neck pain, back pain, and joint pain just to name just a few.
It’s safe and cost-effective. It can decrease surgeries & disability and we normally do it through conservative, non-surgical means with minimal hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering 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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
CF 095: An Inverse Relationship With Chiropractic & Opioids, Anti-Inflammatory Diets, & Screen Time Might Make Dummies
Today we’re going to talk about the relationship between chiropractic and opioids, we’ll talk about anti-inflammatory diet ideas, and a little ditty about screen time and dumb butts.
But first, here’s that sweet sweet bumper music
Subscribe button
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun and accessible while we make you and your patients better all the way around. Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have slinkied into Episode #95
Now i you missed last week’s episode on my trip to St. Louis for the Forward ’19 seminar, decompression research, and young baseball pitchers, make sure you don’t miss that info. I’d like to think that all of our episodes are such that you walk away better than before you hit the play button. That’s my goal anyway.
I usually am not at a lack of words when it comes to the personal side of what’s been going on lately. I have to say though, not much is going on around the office these days. It’s slower this week but not much slower. I’m just trying to get everything done.
For a chiropractor, what exactly does that mean? Well, I’ve created two or three new graphics for social media posts and loaded them into the hopper for realease later this week.
I proofread two blog articles my writer sent to me for two websites. I’ve gotten those posted after making corrections.
I’ll be proofreading and scheduling my patient weekly email as soon as my staff member finishes it.
I met with our marketing staff member to go over what marketing we are doing and want to do before she headed out onto the town this morning.
It’s 1 pm and I’ve already seen two new patients and my fair share of established patients.
I’ve dealt with a roof leak, a staff member that ended up with a migraine that required us to take her to be treated. Taht’s a whole different crazy story.
I get off early on Tuesdays to go home and study for the DACO part II test so I’ve got that going for me today.
So…..my point is, even when we are a bit slower, we don’t slow down. Hell, that’s when we are actually able to ramp it up.
If you are not doing external AND internal marketing consistently, you are behind your colleagues. Wake up. Dan Kennedy has a saying I follow. It’s YCDBSOYA. That stands for you can’t do business sitting on your ass.
I hate a liar but I love a hustler. I mean that in the ethical manner. Not hustling someone as in lying and cheating for financial gain. I mean hustling as in constantly busy getting the word out about how amazing your office is. The more you hustle in that manner, the more business you see. It’s magical like that.
You want a slow practice, sit on your butt in your office playing games on the computer. That’s exactly how you can accomplish that.
You would have a hard time coming up with any form of marketing that I either have not tried or am not currently doing. I’m probably doing some marketing you’ve never even thought of.
So, here’s your pro tip. When things get a little slower in the fall when the kids get back to school, that’s when you have the time it takes to really market effectively. So do it.
I may end up doing a marketing epsiode. I should totally do that. If I forget in the next several weeks, y’all send me an email or two and I’ll do it.
The first paper we’ll breeze across is a brand new one about the association between chiropractic use and opioid use.
First, It’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices.
If you’re a regular listener of our podcast, you know I used it since about June of 2018. Let me tell you about it.
ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean:
In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises.
You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips.
You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! Short testimony
If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months
That’s ChiroUp.com and super double secret code Williams99.
Item #1
OK, back to the research. As I mentioned, this first paper is called “Association Between Chiropractic Use and Opioid Receipt Among Patients with Spinal Pain: A Systematic Review and Meta-analysis” Now remember, systematic reviews and meta-analyses are at the top of the research pyramid. It was authored by Corcoran, et. al(K 2019). and published in Pain Medicine on September 27, 2019…whoa….that’s like last week. Scorching hot off the presses, watch out, don’t burn your finger prints off….
Why They Did It
They wanted to investigate the current evidence to determine if there is an association between chiropractic use and opioid receipt.
How They Did It
- The study was as systematic review and meta-analysis
- The databases mined for information were Medline, pubmed, embase, amed, cinahl, and web of science.
- The search was through April 18 of 2018
- They identified 874 articels
- Those were whittled down to 6 articles
- 5 studies focused on back pain while one focused on neck pain
What They Found
In a random-effects analysis, chiropractic users had a 64% lower odds of receiving an opioid prescription than nonusers.
Bam pop snap!
Come on MDs, DOs, and all of your flock. It’s time to start turning the back and neck pain folks over to the profession that continually proves, through research I might add, that we can get them better safely, effectively, non-invasively, non-pharmaceutically, with better outcomes assessments, and better patient satisfaction than any other healthcare practitioner in the world.
If it’s really all about the patient, and you all REALLY mean that, then start referring these patients to evidence-informed chiropractors. Like yesterday.
If you want to try PT first, OK. Do that. Then, when PT isn’t as effective as the patient was hoping it to be, send them to an evidence-informed chiropractor.
That’s if it really is all about the patient.
Item #2
Item 2 is from Harvard Health Publishing from Harvard Medical School and is called “Foods that fight inflammation.” (2014)They published it in June of 2014. It’s an older study. Old Man River, that old man river….
They start by asking what does an anti-inflammatory diet do? Your body creates inflammation in response to anything it recognizes as foreign. Things like microbes, plant pollens, and chemicals. That’s great obviously but sometimes inflammation persists right? The article goes on to state that many major diseases like cancer, heart disease, diabetes, arthritis, depression, and even Alzheimer’s have been linked to long-standing, chronic inflammation.
Dr. Frank Hu, professor of nutrition and epidemiology in the Dept. of Nutrition at Harvard School of Public Health says, “Many experiemental studies have shown that components of foods or beverages may have anti-inflammatory effects.”
Wouldn’t it be nice if we can reduce our risk of these deadly serious diseases just by eating more of the right stuff?
First they list foods they have identified as CAUSING inflammation so that you can stay away from them. Take a deep breath, this is going to hurt a little bit. OK, it’s going to hurt a lot.
- Refined carbohydrates - yes, white breads, pastries, noodles, yep I know
- French Fries - no real loss there.
- Soda and other sugar-sweetened drinks. Honestly, if you’re still drinking soda as an adult, you’re behind the curve.
- Red Meat - like burgers, steaks, and processed meat like hot dogs and sausage. Although I saw a report this morning that red meat isn’t as bad as they thought.
- Margarine - shortening, and lard
The anti-inflammatory foods they highlight are:
- Tomatoes
- Olive oil
- Green leafy vegetables - spinach, kale, and collards
- Nuts - almonds and walnuts
- Fatty Fish - like salmon, mackerel, tune, and sardines
- Fruits - strawberries, blueberries, cherries, and oranges.
That would be a brief overview of the article but I’d encourage you all to go read the whole thing. Very interesting stuff. I just wanted to give you the short version of it.
Store
Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly.
If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders.
Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it.
Item #3
On to our last item here. It doesn’t have anything to do with musculoskeletal issues but might be a little something you could print up and put in your lobby for your patients to look over and think - Dayum.
It’s called “Association Between Screen Media Use and Academic Performance Among Children and Adolescents A Systematic Review and Meta-analysis” by Adelantado-Renau, et al and published in JAMA Pediatrics on September 23, 2019(Adelantado-Renau M 2019).
Why They Did It
They were trying to find out if there was any association between screen-based activites and academic performance areas among children and adolescents.
How They did It
- They took 58 cross-sectional studies, television viewing and video game playing were inversely associated with academic performance.
- In addition, it was more profound in adolescents than it was for the smaller children.
Wrap It Up
- Television and video games were the worst of the screen time culprits.
- This study suggests that education and public health professionals should consider screen media use supervision and reduction as strategies to improve the academic success of children and adolescents.
Subscribe Button
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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
- (2014). "Foods that fight inflammation." Harvard Health Publishing https://www.health.harvard.edu/staying-healthy/foods-that-fight-inflammation.
- Adelantado-Renau M, M.-U. D., Cavero-Redondo, (2019). "Association Between Screen Media Use and Academic Performance Among Children and Adolescents A Systematic Review and Meta-analysis." JAMA Pediatr.
- K, C. (2019). "Association Between Chiropractic Use and Opioid Receipt Among Patients with Spinal Pain: A Systematic Review and Meta-analysis." Pain Med.
CF 093: Big Discs Can Disappear, Chronic Pain & Chiro Success, The First Week Can Tell You A Lot About The Fourth
Today we’re going to talk about the resorption of lumbar disc herniations (Hint: lots of the big ones don’t need surgery at all!), we’ll talk about chronic low back pain and the success of chiropractic, and we’ll talk about how, after the first visit, you might can tell how well your patient is going to do in the long-term.
But first, here’s that sweet sweet bumper music
Subscribe button
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun and accessible while we make you and your patients better all the way around. Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have tippy toed quietly into Episode #93 and I do appreciate your keeping it down for me. I’ve been a little tired here lately.
Now if you missed last week’s episode on the history of chiropractic, you need to make sure you don’t miss that. It was really fun episode to put together. Especially for a history junkie/nerd like myself. I believe here recently September 18 to be exact, it was the anniversary of DD Palmer inventing chiropractic. We talked a little about whether he invented it or borrowed it or whatever. We talked about that in that episode. Pretty interesting.
Other more recent episodes you need to be aware of would be the Closing Patients episode. Go learn more about that garbage please. It’s important.
Also waaaayyyy back (old man river) episode 13 was on Debunking the Myth that chiropractors cause strokes. Enough of that trash. It’s not true and you need to know why, how, when, and how to tell others that it’s bunk info.
For you older chiros, bunk means bad info.
One other I think new listeners should go back and find would be about 6-8 weeks ago, episode 90 I believe. It was our mini-class basically on Decoding Chronic Pain. What priceless info. It’s like you went to a seminar and got all of the information for free straight from Dr. Anthony Nicholson. He’s crazy smart.
Or the way they say it in Boston….he’s wicked smaht.
I’m currently getting ready to head to St. Louis for the Forward ’19 seminar. It’s all a part of the FTCA Facebook Group and website group. By the time this episode airs, it will already have come and gone but you know I’ll tell you all about it next week.
I’m looking forward to meeting a lot of the folks from the group that I see interacting with each other all of the time. I’m looking forward to networking and bouncing ideas off each other as well.
There may be some cocktails in the mix as well so, you know, there’s that too.
I’m still going through the DACO studying. I have part II coming up on November 9th. Wouldn’t it be nice if you could just get a Diplomate because you took all 300 hours and passed all of the tests and quizzes along the way?
If you ask the older guys that did the DABCO several years ago, they’ll tell you I’m whining and I need to just shut up because they had it way worse. And you know what? They’d be right. They DID have it way worse. Still, I have a very busy practice, I have a 47 year old brain that doesn’t retain the amount it once did, and I’ve been studying for the part I and the Part II during my free time since probably May. And you know what? I’m tired of studying. Lol.
I’m ready for it to be over and done with. Geez. Stress, studying, sustained over a long period of time….there’s absolutely a reason that we don’t have a large number of doctors getting the specialization diplomates. It’s carried out over too long of a period. But that’s just fussing. The hours of actual class have been amazing learning. I have stood under the niagara falls of knowledge nuggets people. I swear.
I’m all in. I’m ten times better than I ever thought I was and for some things, I thought I was pretty put together. I spent a lot of years putting together and taking apart different aspects of a low back exam. I was already coming into it very much up on lumbar differential diagnosis. I’m still better than I was.
I knew jack squat in regard to the shoulder compared to what I now know. Same goes for the hip, knee, and on down the line.
If you need some help getting some info and starting down the track of that Ortho Diplomate, let me know. Send me and email at dr.williams@chiropracticforward.com and I’ll be glad to do what I can to get you going.
We’ll get to the paper on whether discs can resorb in just a sec but first, It’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices.
If you’re a regular listener of our podcast, you know I used it since about June of 2018. Let me tell you about it.
ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean:
In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises.
You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips.
You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! Short testimony
If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months
That’s ChiroUp.com and super double secret code Williams99.
Item #1
https://www.ncbi.nlm.nih.gov/pubmed/28072796/
Let’s start the research part of the show with one called “Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis” by M Zhong, JT Liu, H Jiang, et. al(Zhong M 2017). and published in Pain Physician in 2017. Not new enough to play the Hot stuff sound byte and not old enough to sing old man river to you. Just somewhere in between so we’ll just play some random sound byte for you here. Lol.
You know me…..heavy on the entertainment part here.
Anyway, here’s Why They Did It
the wanted to analyze the incidence of spontaneous resorption after conservative treatment of low back discs using CT and MRI imaging.
How They Did It
This paper was a meta-analysis, meaning they took information from a whole bunch of previously done papers and compiled the best information that could be extracted from them to come up with their findings.
They used a search of the literature from 1990 all the way through 2015. That’s 15 years for those of you that didn’t take mathematics in school. They used very common databases called PubMed, Embase, and the Cochrane Library to find these papers for inclusion.
What They Found
The overall incidence of spontaneous resorption was 66.66%. Oddly enough they say that the incidence in the UK was a whopping 82% while in Japan it was only 62%. What the hell gives there? I’m not worldly enough to know the significant differences in lifestyles of those two countries to figure out why that would be. Maybe one of you world travelers can offer us some suggestions. Email me. I’d love to hear it.
Wrap It Up
Wrapping up this paper the authors conclude, “The phenomenon of LDH reabsorption is well recognized. Because its overall incidence is now 66.66% according to our results, conservative treatment may become the first choice of treatment for LDH.”
Now what do I personally know about this? I know that was your next question that was just on the tip of your tongue so I’m going to answer it for you.
We know, and this comes through the DACO teaching, that a couple of things can give you clue to whether or not a herniation will eat itself. That sounds like will ferrell doing harry carry on saturday night live. If you were a hot dog….would you eat yourself? I know I would. Lol.
Anyway….Lord help me. Anyway, a couple of things:
The make up of the herniation
The extent of migration
If there has been endplate damage / modic changes, with that, you might see some trash or garbage inside the herniation on MRI. It may look speckled. When it looks speckled, it is more stubborn and less likely to go away on its own.
On the other hand, if it’s made up of more nuclear material, it’s smoother in appearance and more likely to be able to be reabsorbed.
On top of that, when a herniation has more than a 4mm migration, it’s further out there and the body is more likely to recognize it as an issue and more likely to do something about it by breaking it down and getting rid of it.
This is EXCELLENT news for people with these big discs that you may have at one time thought were most certainly surgical. I used to think they were. I think a lot of surgeons probably still think they are. But not all of them are. That’s a researched fact at this point.
Item #2
https://www.ncbi.nlm.nih.gov/pubmed/12214186/
This one is called “Can patient reactions to the first chiropractic treatment predict early favorable treatment outcome in persistent low back pain?” by I Axen, A Rosenbaum, and T Wren, et. al. and was published in Journal of Manipulative Physiological Therapeutics in 2002(Axen I 2002). Old Man River….
Why They Did It
To investigate whether 3 distinct patterns of reactions to chiropractic care predict early favorable treatment outcomes in patients suffering persistent low back pain.
What They Found
OF the 115 patients int eh most favorable prognostic group, 84% reported to be definitely improved but the 4th visit vs. 63% of the 384 in the intermediate group, and 30% of the 116 in the least favorable prognostic group.
Wrap It Up
“Among chiropractic patients with persistent low back pain, it is possible to predict which patients will report definite improvement early in the course of treatment.”
Basically, if you’re getting good response in the first week or so, game on. That patient is likely to have an excellent outcome.
On to the paper on chronic low back pain patients being referred form a spine surgeon it just a second. Let’s try our best to pay the bills first.
Let’s talk about GoChiroTV. GoChiroTV is a patient education system for your office that actually saves you money. Instead of spending money on cable TV or looping a DVD over and over in your lobby, the bite-sized videos are specifically made to inform your patients about the importance of chiropractic, healthy living, and to encourage referrals while, at the same time, presenting the benefits of all of the different products and services that you offer. Specific to your office.
That’s right. It works by using a tailor-fit video playlist that only promotes the products and services offered in your specific practice. Not only that but the videos are updated automatically on a weekly basis so there’s no need to manually update your playlist AND you don’t have to learn any complicated software. You get to just set it and forget it. And don’t we busy doctors need just that?
Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions. That’s CFP19, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription.
Go visit GoChiroMedia.com to check out the demo reels and get started on your free trial.
Item #3
https://chiromt.biomedcentral.com/articles/10.1186/s12998-018-0225-8
This last item is called “An observational study on trajectories and outcomes of chronic low back pain patients referred from a spine surgery division for chiropractic treatment” by Brigitte Wirth et. al. and it was published in Chiropractic & Manual Therapies in 2019(Wirth B 2019). There it is fresh outta the oven and slapped on your plate for gobblin’ purposes.
Why They Did IT
The aim of this study was to describe the trajectories and outcomes of patients with chronic LBP referred from the spine surgery division to the chiropractic teaching clinic.
How They Did It
- The patients filled in an 11-point numeric rating scale (NRS) for pain intensity and the Bournemouth Questionnaire (BQ) (bio-psycho-social measure) at baseline and after 1 week, 1, 3, 6 and 12 months.
- The Patient’s Global Impression of Change (PGIC) scale was recorded at all time points apart from baseline
- The data was analyzed using linear mixed model analysis and repeated measures ANOVA
What They Found
- Between June 2014 and October 2016, 67 participants (31 male, mean age = 46.8 ± 17.6 years) were recruited, of whom 46 had suffered from LBP for > 1 year, the rest for > 3 months
- At baseline, mean NRS was 5.43 and mean BQ was 39.80 points
- NRS significantly decreased to 4.05 after 12 months but a significant reduction was not observed BEFORE 6 months after treatment start. So….it took time to see the difference. But don’t a lot of our evidence-informed crowd give you the poo face stink eye if you see patients more than just a couple of weeks? Food for thought judgy judgers!!
- Now, the Bourneouth Questionnaire - it significantly diminished to 29 points after 12 months and showed a significant reduction in just the first month after treatment started.
- Also, the proportion of those showing overall improvement significantly increased from 23% after 1 week of treatment up to 47% after 1 month of treatment.
Wrap It Up
“Chiropractic treatment is a valuable conservative treatment modality associated with clinically relevant improvement in approximately half of patients with chronic LBP. These findings provide an example of the importance of interdisciplinary collaboration in the treatment of chronic back pain patients.”
That’s some great info right there folks. Ingest it. Roll it around. Not everyone on Facebook has all of the answers. Not even your mentors have ALL of the right answers. We all have to find our own way don’t we? I know I did.
And we all have to keep learning. Neuroplasticity is real. We keep learning. We keep growing and hopefully we keep altering our perception of what is and what can be. Research helps us do that don’t you agree?
This week, I want you to go forward with…..
Key Takeaways
Store
Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly.
If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders.
Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it.
Subscribe Button
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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
- Axen I, R. A., Robech R, Wren T, Leboeuf-Yde C, (2002). "Can patient reactions to the first chiropractic treatment predict early favorable treatment outcome in persistent low back pain?" J Man Physiol Ther 25(7): 450-454.
- Wirth B (2019). "An observational study on trajectories and outcomes of chronic low back pain patients referred from a spine surgery division for chiropractic treatment." BMC Chiro Man Ther 6.
- Zhong M, L. J., Jiang H, (2017). "Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis." Pain Physician 20(1): E45-E52.
CF 092: The History of Chiropractic (Do You Know What You Think You Know?)
Today we’re going to talk about the history of spinal manipulative therapy and the history of chiropractic.
But first, here’s that sweet sweet bumper music
Subscribe button
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun and accessible while we make you and your patients better all the way around. Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have collapsed into Episode #92
Now i you missed last week’s episode on the 10,000 Steps Myth, the neuro aspect of an adjustment, and sodas kill, make sure you don’t miss that info.
Keep up with your colleagues and listen. Also, don’t miss Episode #13. I systematically debunk the myth that we chiropractors cause strokes. I’m not having it, y’all. It’s just not reality and I show you how to fight the myth.
Also, a few episodes back we talked about Closing Patients and my opinion on that. It may not be what you think it is.
This week has been more of just catching up. My new schedule I mentioned last week either has my world screwed epically or it’s working beautifully. Lol. Time will only tell but I’m pretty confident we’re doing just fine.
If you missed last week, I talked about implementing a firmer policy of having patient time and new patient/paper time.
Since doing that, we have been a bit lighter on the schedule that in recent weeks past but I am getting so much more done right now and it feels good. I have more energy at the end of the day. And doesn’t it feel good to feel good?
It’s cool. For now. If it gets much lighter on the schedule, I’ll hit the WTF? Button and switch gears. WTF….that stands for Why The Face right?Lol.
Kidding!! I know what it means but I run a mostly clean business here!! But, the point was….. I’m not worried at all right now.
We are about to get to all things History here but I saw an interesting thing on Facebook this week and it made me want to punt a kitten. I thought I’d share.
I was on Facebook and saw a couple of knuckleheads coming live from a coffee house. They do it once a week. Doesn’t sound too miserable just yet, does it? It’s actually a decent idea. Get the coffee shop in on it and Facebook live it once a week from the coffee shop talking about certain issues and what your solution to the certain issues might be. Maybe take questions from the crowd there too. Not a bad idea honestly.
Hell, I’d do that myself. Problem is that I’m too damn busy to do it and I’m not a morning person so I’m not getting up early enough to do it before work. Just forget it. Freaking forget it.
These guys are there at like 10 am on a specific day and I’m like….why aren’t you at work working on people in your work place where people work at 10 am on a work day? Lol.
They say build it and they will come and Maybe they haven’t built it just yet so the crowds are not coming just yet. I don’t know. Maybe they just make this coffee shop thing a priority for now and choose to not be working on a work day. Either way, one day the one dude wore a cap in the video and the next week he wore a tight little top knot man bun.
YESSSS I’m old. Yess I think it looks unprofessional. Yes…it makes me crazy like so many other things of his generation tend to do, and yes…..I’d rather take a kick in the nuggets than to allow someone that looks and talks like him work on me or my kid.
But…..Yes….there’s a chiropractor for everyone so…..what the hell do I know. Look the way you want I suppose. I’ve heard they have chiros in Florida and California that dress in flip flops and shorts so….when it Rome I guess.
Here’s my deal, they target kids and parents. Nothing wrong with that. But, they are busy talking about kids that can’t concentrate at school and how there’s just a disconnect in what God meant them to be capable of and what they are currently doing and, if the parents just bring them in to the chiropractor, these guys can help the kids make the connection back and lead that kiddo to the awesome shining light of a life that God intended for them.
Ummmm…..no you can’t. Is that judgy? Yup. Sorry, whether you admit it or not, we make snap judgements of each other. Rightly or wrongly. IT’s a fact of life. My snap judgement is…..son of a mother. Son of a motherless goat.
There are so many great chiropractors engaged in research, engaged in diplomat programs. Engaged in taking themselves and this profession to the next level. And this crap trashes all of it. Chunks it all in to the garbage immediately.
They chunk it in the garage with their ‘truth’. You hear that crap all of the time now. Speak YOUR truth. We all have our own truth. When did that start exactly? There’s the truth and that’s it. There’s not your truth, my truth, my dog’s truth, some talking head on TV’s truth…..none of it. There is only THE truth.
And the truth is I’ve seen nothing convincing about this sort of stuff. Absolutely 100% nothing to the level allowing people to get on Facebook touting the ability in a voice that says “You’re great parents. You’re doing everything for your kiddo and we know that. You just need the right kind of help.” Srsly? I you could just get the parents on your brogram…..err…I mean program.
Come on bruh. Bro. Broseph, I can see it now, they sell brotein shakes at their office and it’s part of the brogram that Billbro Baggins and his buddy Chillbro Swaggins put together after a night of hitting the hookah.
Show me the support for chiropractors resolving ADHD, autism, and all of that other stuff they claim to help with. Show me it in systematic trials. Maybe randomized controlled trials. Hell, just something peer reviewed and published in a reputable journal?
But DON’T show me a damn case study or pilot study. Don’t do it or I’ll name you publicly. Lol. I can’t handle people that think case studies hold up to proper scrutiny. They do not. They’re interesting and, for the most part, that’s it.
They could be doing these in business suits and ties and start spouting unsupported claims like this and they would still look like space cadets claiming they have been to the moon, looked back at Earth, and it is indeed flat despite all evidence to the contrary. Seriously. Srsly.
I can’t stand this sort of gibberish. It’s a waste of time and talent.
I’m getting to Item #1 in just a second but we can’t get started without mentioning the sponsor of the first half of our show,
Let’s talk about GoChiroTV. GoChiroTV is a patient education system for your office that actually saves you money. Instead of spending money on cable TV or looping a DVD over and over in your lobby, the bite-sized videos are specifically made to inform your patients about the importance of chiropractic, healthy living, and to encourage referrals while, at the same time, presenting the benefits of all of the different products and services that you offer. Specific to your office.
That’s right. It works by using a tailor-fit video playlist that only promotes the products and services offered in your specific practice. Not only that but the videos are updated automatically on a weekly basis so there’s no need to manually update your playlist AND you don’t have to learn any complicated software. You get to just set it and forget it. And don’t we busy doctors need just that?
Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions. That’s CFP19, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription.
Go visit GoChiroMedia.com to check out the demo reels and get started on your free trial.
Item #1
Now we know a little about our more recent history like chiropractors used to go to jail for treating patients. We know that the AMA has wanted us banished form Earth since our inceptions. Most chiropractors know this stuff. And you should know this stuff.
But, I remember Dr. Anthony Nicholson, on one of his guest spots with us, I remember him mentioning that spinal manipulative therapy was actually one of the mainstays of treatment before the explosion of the physician/medical complex. I honestly did not know that.
So, when I stumbled across this paper called “A History fo Manipulative Therapy.” I started reading. It was written by Erlan Pettman(Pettman E 2007) who is actually a PT and published in the Journal of Manual Manipulative Therapeutics in 2007, Old man river…..it’s an oldie but goodie, people.
So, the author is a PT and this is basically his devotion to getting spinal manipulative therapy under the scope of physical therapists. Or to get more PTs to utilize it. I don’t know but, he says that the earliest reference to its use is in 400 BC back in Europe.
Interestingly, he says that spinal manipulative therapy rose simultaneously in cultures from Indonesia, Hawaii, Japan, China and India, to Central Asia, Mexico, Nepal, Russia, and Norway. All things I did not know. He also mentions that historical reference to Greece show the first direct evidence of its use and that it was well-established at the 400 BC mark so certainly predated that time going even further back.
Get this: Hippocrates who lived from 460-385 BC and who is referred to as the father of medicine….you know….the whole hippocratic oath thing….anyway, even back then he wrote a book on joints and described using spinal manipulative therapy. He even noted that the treatment should be followed by exercises. That’s sort of being ahead of ones time wouldn’t you agree?
This is such an interesting paper that I do hope you’ll check it out. I’m linking it in the show notes right here at this point in the text of the podcast.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565620/
While it’s very interesting, it is also very long and you’re not going to stick with me through it. There’s enough here that I may need to do an entire episode just on this paper because it’s THAT fascinating.
Briefly, he says that as common as spinal manipulative therapy was throughout the origins of mankind, it appears that physicians and surgeons began to abandon the acceptance of it in the 18th century. Though he can’t say exactly why, he offers that it could conceivably be from using the technique for the wrong candidate or potentially the perceived danger in manipulating a spine weakened by tuberculosis which was ravaging the population at that time.
So that’s where the downturn started for spinal manipulative therapy and, as he says, by the 19th century, a significant part of the medical establishment has a true disdain for bonesetters and their practices.
While there were many throwing the proverbial poo at spinal manipulative therapy, there were others with the power to recognize the obvious. Robert Jones, the founder of British Orthopaedics, wrote, “We should mend our ways rather than abuse the unqualified. Dramatic success in their hands should cause us to enquire as to the reason. It is not wise or dignified to waste time denouncing their mistakes, for we cannot hide the fact that their successes are our failures” INDEED Mr. Jones. Indeed….
Were you told that DD Palmer invented chiropractic? Of course you were. I was too. And, in as far as ‘chiropractic’ is an industry or a profession, he did. But, he did not invent the idea of ‘bonesetting’ through some magical discovery. At least it doesn’t appear that way in this article.
The author talks about Andrew Taylor Still. Still was also a magnetic healer. He suffered from chronic headache and took note one day. He had fallen asleep with his neck wedged between the roots of an oak tree. Upon waking, he had no more headaches. From there he began conceiving a theory about health and how it could only be maintained and, therefore, disease defeated, through normal function of the musculoskeletal system. This was all in 1874. Still went on to create the practice of Osteopathy. Did you know that Still’s practice was only about a day’s drive from DD Palmer’s town?
An astute listener will see the parallels of where osteopathy WAS and originated very similar to where chiropractic was and originated. And very astute listeners will make note of where osteopathy is now and where some in the chiropractic profession wish to keep us…..right back where we started. No progress. No learning. No breakthroughs. Nothing. It’s dumbfounding to say the least.
The author also talks about DD Palmer in the article. How could you not? He says that he was not the first to use the word subluxation nor was he the first to describe the use of the spinous and transverse processes as levers to adjust said subluxation. Those honors go to Johannes Hieronymi, William and Daniel Griffen, and Edward Harrison.
Did you know that in the 1920’s chiropractic was on life support but that the GI Bill after WWII was what enabled returning soldiers to go to chiropractic college and really bolster the numbers? I didn’t know that. Pretty cool.
Also of particular note is that in 1958, the National New from the National Chiropractic Association warned about the rising numbers of PT’s training in manipulative procedures. So…..that’s been a thing for a long time it seems. Lol.
Just a fascinating read for us chiropractors. Go give it a look see and see what you think. I’d love to hear your impressions. Email me at dr.williams@chiropracticforward.com and let me know what you thought.
It’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices.
If you’re a regular listener of our podcast, you know I used it since about June of 2018. Let me tell you about it.
ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean:
In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises.
You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips.
You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! Short testimony
If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months
That’s ChiroUp.com and super double secret code Williams99.
This week, I want you to go forward with…..
Key Takeaways
Store
Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly.
If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders.
Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it.
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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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
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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 - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Pettman E (2007). "A History of Manipulative Therapy." J Man Manip Ther 15(3): 165-174.
CF 091: 10,000 Steps Myth, Is An Adjustment Neuro Too, Soft Drinks, & It’s OK To Not Adjust
Today we’re going to talk about….
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 and accessible while we make you and your patients better all the way around. Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have collapsed into Episode #91
Now if you missed last week’s episode on Healthcare, the Days Of Old, make sure you don’t miss that info. It was a bit of a brain dump. The week before that was on Decoding Fibromyalgia and we had a great episode before that one called Closing Patients…..we’ve had a lot of beneficial discussion on Facebook come out of that episode and it’s definitely worth checking out.
We can’t get started without mentioning the sponsor of the first half of our show,
Let’s talk about GoChiroTV. GoChiroTV is a patient education system for your office that actually saves you money. Instead of spending money on cable TV or looping a DVD over and over in your lobby, the bite-sized videos are specifically made to inform your patients about the importance of chiropractic, healthy living, and to encourage referrals while, at the same time, presenting the benefits of all of the different products and services that you offer. Specific to your office.
That’s right. It works by using a tailor-fit video playlist that only promotes the products and services offered in your specific practice. Not only that but the videos are updated automatically on a weekly basis so there’s no need to manually update your playlist AND you don’t have to learn any complicated software. You get to just set it and forget it. And don’t we busy doctors need just that?
Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions. That’s CFP19, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription.
Go visit GoChiroMedia.com to check out the demo reels and get started on your free trial.
In personal practice, I have to say I’m testing. What I mean is that you never have everything as cookie cutter as you’d like do you? I used to have patient time and paper time and life was good. i got plenty done but never seemed to break through as far as patient load.
I had a new front desk scheduler come on board and she basically ignored my paper time patient time dynamic and, after some time, my practice blew up and went crazy as hell.
Now, the key is, did the roof blow off because she put the patient preference in regard to the schedule…..did she put their wants first? So they loved it because it was so convenient? Or, was it a natural progression of practice and it happened to simply coincide?
Who the hell knows? I think we do a lot of things right so I don’t know. Here’s what I’m certain of though. If we continued putting patients wherever they wanted to be on the schedule rather than forcing them into a formatted schedule that still takes advantage of peak and most requested times…..if we continue to allow patients to run our practice rather than us running the practice….I’m quitting!! Lol
Here’s the thing, I don’t want to brag about numbers and things of that sort. I’m just telling you that it’s been at a point where, when the patients run the schedule, I have zero time to produce a great podcast, zero time to collect thoughts on anything at all, hell I don’t have time to go to the bathroom.
So, a couple of weeks ago, I decided it was time to put a foot down. A foot down outfitted with a steel-toed boot! We will have paper time and we will have new patient time. Period.
Here we are with week #2 of the schedule playing out and you know what? We are a little slower today than normal. I’ve been in practice long enough to know that is not a big deal. Sometimes, it’s just that way. But there still is that part of me that wonders what in the hell? Is it the new schedule? Is it this is it that?
Blah…. So, even 21 years later, it can be a rollercoaster. It can be a day to day, week to week, month to month thing and that drives me crazy. Mostly because I believe I have an anxiety disorder.
Again, I share these more personal problems or issues with you all because I know some are going through the exact same thing and some younger docs WILL.
I’ve been making plans on being at the Forward Thinking Chiropractic Alliance’s conference called Forward ’19 in St. Louis, MO….actually Chesterfield, MO but had I said that first, you’d have no damn clue where I was talking about and you’d have to get out your Google machine and waste time looking for the damn place and I don’t want to do that to you. OK?
It’s the little things I do for you all right? Anyway St. Louis on the weekend of September 20-22….it’s that weekend. They have Gray Cook as the headlineer. They also have , Greg Kawchuck, Annie O’Connor, Christine Goertz, a guy I got to know a bit through the DACO program and a great speaker and doctor, Dr. Brandon Steele, and several more. It’s a time to not miss. Plus, hell, I’ll be there.
I’ll be staying at the Drury Inn there in Chesterfield and it’s right next door to a Cheesecake Factory so, honestly, what’s not to love about this weekend that’s coming up on us rather quickly?
They aren’t paying me to tell you about it. In fact, nobody associated with the FTCA has even asked me to mention it. But, I think it’s important and I think attendees will walk away as better doctors. That’s why I’m going. 10% better every day, week, month, and year. 10% better.
go to https://www.forwardthinkingchiro.com/convention if you’re interested.
Item #1
We have a short one to kick this off with. It’s called ‘For Mortality, Busting The Myth of 10,000 Steps Per Day” by Jennifer Abbasi and published in the Journal of the American Medical Association in July of 2019 (Abbasi J 2019), hot cakes, hot stuff.
Jennifer says the goal of reaching 10,000 steps every day has been a thing for a while now but, in truth, that may not actually be necessary. She said that older women who walked more than their peers and lower death rates in a recent study in JAMA Internal Medicine but….here’s the gotcha part….but the mortality benefit was seen with as few as 4400 steps.
She says the recommendation of 10,000 steps may be disinclusive - is that a word?I think you know what I mean. She says 10,000 steps can be daunting to many. Especially older people and can actually keep them from walking any more. Whereas 4,400 is much more realistic and the that’s where the benefit is actually seen.
Interesting stuff right there and definitely worth mention. I’m taking that to my practice. You should too.
Item #2
This is one called “Spinal manipulation therapy: is it all about the brain? A current review of the neurophysiological effects of manipulation” by Giles Gyer, Jimmy Michael (don’t trust someone with two first names), and James Inklebarger, et. al(Gyer G 2019). It was published in the Journal of Integrative Medicine in September of 2019. Hell, it’s September of 2019 right here right now. Hot potato, hot potato…..
They start out by saying that the the mechanisms underlying the pain modulatory effects of spinal manipulative therapy remain elusive. And although biomechanics and neurophysiological phenomena have been thought to play a role in the effects we see, more and more studies are showing improved outcomes suggesting peripheral, spinal, AND supra spinal mechanisms are playing a part.
If you listen to our episode with the esteemed Dr. Christine Goertz, she was very clear in saying that we are currently a long way away from being able to say exactly how adjustments get the amazing results they get. That’s frustrating in a way isn’t it? It is for me. I want to know exactly how.
In describing the article, she says, “The body of literature reviewed herein suggested some clear neurophysiological changes following spinal manipulation, which include neural plastic changes, alteration in motor neuron excitability, increase in cortical drive and many more.”
I have cited this article in case you want to go and find it. It’s in the show notes at chiropracticforward.com so go check it out. But I couldn’t find the whole article. At least not yet. Not until one of you awesome listeners sends it to me at dr.williams@chiropracticforward.com I would be grateful.
But it is good for discussion. I actually did an episode dedicated to this topic. It was Episode #56 and I’m linking right here at this spot in the show notes so you can hear it. I actually had several people emailing me with some thanks on that one.
https://www.chiropracticforward.com/cf-056-what-does-a-spinal-manipulation-do-in-medical-terms-what-i-despise-about-my-profession/?v=7516fd43adaa
The first reason this one was a big episode is because there were some knucklehead wannabe chiropractic gurus out in California claiming to have reversed spinal arthritis after two weeks of draining a patient’s bank account….errr. cough…I mean….of treating the patient 4x/day for 3 weeks. Which quickly adds up to a whole pile of steaming fresh hot brown….BS.
That episode came with pictures and illustrations in the show notes even. I was really fired up there. Lol.
Anyway, the main reason I’m talking about that episode right now is that I provided a pretty solid description of the latest research and ideas on what an adjustment just may actually be doing for our patients.
Basically,
A recent paper by Anderstt et al. (2018) confirmed that cervical manipulation results in facet gaping. This force also improves regional motion across multiple spinal levels during and post-manipulation.
“This study is the first to measure facet gapping during cervical manipulation on live humans. The results demonstrate that target and adjacent motion segments undergo facet joint gapping during manipulation and that intervertebral range of motion is increased in all three planes of motion after manipulation. The results suggest that clinical and functional improvement after manipulation may occur as a result of small increases in intervertebral ROM across multiple motion segments.”
And according to the DACO learning
It appears that manipulation relies upon signaling properties of the muscle spindles that lie embedded in the paraspinal tissues. As the spindle registers rapid lengthening of the muscle it transduces this into a large proprioceptive barrage.
The unique nature of a manipulation seems to alter the responsiveness of second-order neurons in the dorsal horn and make them less sensitive to incoming nociceptive signals from injured tissues.”
Adjustments are gapping the facets, improving proprioception and sensorimotor function, helping the body and brain know better where everything is and know better how it’s supposed to move thus, improving that movement and function.
So, until new research comes out that makes us throw all of our best information out the window, that’s what I’m going with and, for evidence-informed practitioners, would suggest you adopt as well.
Short break here….
It’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices.
If you’re a regular listener of our podcast, you know I used it since about June of 2018. Let me tell you about it.
ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean:
In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises.
You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips.
You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! Short testimony
If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months
That’s ChiroUp.com and super double secret code Williams99.
Now, Item #3
This one is an obvious one and is called “Association Between Soft Drink Consumption and Mortality in 10 European Countries(Mullee A 2019)” by Amy Mullee, PhD, Dora Romaguera PhD, and Jonathan Pearson-Stuttard, BMBCh whatever the hell that is.
Brand new info here. They took 451,743 individuals from 10 countries in Europe consuming more sugar-sweetened and artificially sweetened soft drinks.
What they found was that those drinking more of either of those had a higher risk of all-cause mortality. Consumption of artificially sweetened soft drinks was positively associated with deaths from a circulatory disease while those consuming sugar-sweetened soft drinks suffered more deaths from digestive disease.
So, why not cut them all out? I think water rules the day and NOT tap water by the way. I drink a lot of coffee and tea but I’m doing my best to drink more water. I know I’m supposed to. I get it but dammit it has no umph to it so water just sort of pisses me off and leaves me wanting. Lacking. And basically bitchy.
Anyway, Item #4
This one is called “Association Between Maternal Fluoride Exposure During Pregnancy and IQ Scores in Offspring in Canada” by Rivka Green, Bruce Lanphear, and Richard Hornung, et al and published in JAMA Pediatrics in August of 2019(Green R 2019). Look out hot stuff everywhere, steamin’ plate…
The question they wanted to answer was, is maternal fluoride exposure during pregnancy associated with childhood IQ in a Canadian cohort receiving optimally fluoridated water?
Their conclusion was as follows “In this study, maternal exposure to higher levels of fluoride during pregnancy was associated with lower IQ scores in children aged 3 to 4 years. These findings indicate the possible need to reduce fluoride intake during pregnancy.”
Interesting stuff. Especially for those of you that make pediatrics and prenatal care such a big part of your practice. Knowledge nuggets all over the place today. You can’t listen today and avoid getting hit in the head with at least one of them. It may slap some sense into the recipient. At least that’s the goal.
OK, last thing I have on tap today is Item #5
It’s called “Chiropractic conservatism and the ability to determine contra-indications, non-indications, and indications to chiropractic care: a cross-sectional survey of chiropractic students” by Guillaume Goncalves, Marine Demorier, and others. I say and others because I’m not even about to try to pronounce the next name. There would be a verbal murder of probably a perfectly good name and I don’t want to play any part in that.
It was published in BMC Chiropractic and Manual Therapies in 2019. Once again, too hot to handle, step back one….no two steps…
In the background section of the abstract, they start by saying “While there is a broad spectrum of practice within chiropractic two sub-types can be identified, those who focus on musculoskeletal problems and those who treat also non-musculoskeletal problems. The latter group may adhere to the old conservative ‘subluxation’ model. The main goal of this study is to determine if chiropractic students with such conservative opinions are likely to have a different approach to determine contra-indications, non-indications and indications to chiropractic treatment versus those without such opinions.”
What They Found
- They had 359 student respond out of 536.
- They generally recognized a number of contra-indication as well as indications for treatment
- What the problem was was in identifying non-indications for treatment.
- The subluxation students were much more willing to treat someone even when there was nothing relevant wrong
- For example, they were much more willing to treat a 5-yr-old kid with no history of back pain or disease to prevent future back pain and to also prevent non-musculoskeletal disease.
Wrap Up
Their conclusion was “It is concerning that students who adhere to the subluxation model are prepared to ‘operationalize’ their conservative opinions in their future scope of practice; apparently willing to treat asymptomatic people with chiropractic adjustments. The determinants of this phenomenon need to be understood.”
I can help them understand it. It’s BS passed on by wannabe gurus and colleges like Sherman and Life and was once shoveled in large amounts by Palmer and my alma mater, Parker. Although, to my understanding, those discussions are fewer and further between at Palmer and Parker these days.
Look, I’ve made no secret, I’m not a Subby, a TOR, or a TIC. I’m an evidence-informed chiropractor. Just like Subbys and other evidence-informed chiropractors…..I too get great results for my patients.
Unlike SOME of my Subby counterparts….not all of them….but certainly SOME of them…….I communicate with the medical field in effective ways that make sense to them, I do not take advantage of my patients, I do not use techniques and recommendations not back in part by evidence and research, I run a patient-centered practice, and don’t treat when I shouldn’t and treat when I should, and I do not try to see how many times I can run a patient through my doors based on the idea that I’m going to prevent some sort of mythical loss of curve issue 30 years in the future. Folks, we’re highly educated. It doesn’t happen that way and in 2019, we damn well know it doesn’t happen that way.
Your bank account might not like it but your patients will and they’ll know you care and they’ll know you’re different than the rest when you’re worried about them and NOT their wallet or their purse.
The golden rule isn’t just for kiddos. IT’s for everyone regardless of age. Treat others the way you want to be treated. If you want to be treated a million times through your life because you may lose some degree of curvature in your neck, then 10/4, rock on with your bad self.
I for one have no interest in that for myself so I’d never recommend it to anyone. Why would I? Other than financial motivation of course.
I wouldn’t.
Before we sign off here, I made some awesome evidence-informed brochures and posters for your offices. Go check them out at the store link at chiropracticfoward.com
While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it.
Subscribe Button
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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography
- Abbasi J (2019). "For Mortality, Busting the Myth of 10 000 Steps per Day." JAMA Open 322(6): 492-493.
- Green R, L. B., Hornung R, (2019). "Association Between Maternal Fluoride Exposure During Pregnancy and IQ Scores in Offspring in Canada." JAMA Pediatr.
- Gyer G, M. J., Indlebarger J, Tedla JS, (2019). "Spinal manipulation therapy: Is it all about the brain? A current review of the neurophysiological effects of manipulation." J Integrative Med.
- Mullee A, R. D., Pearson-Stuttard J, (2019). "Association Between Soft Drink Consumption and Mortality in 10 European Countries." JAMA Open.
CF 090: Healthcare Of Old - Days Gone By
Today we’re going to talk about how healthcare has changed - gone are the days of this and gone are the days of that. And there will be plenty of room for me to spread some personality in there too. If you’re a regular listener, you know I’m never lacking an opinion.
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 and accessible while we make you and your patients better all the way around. Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have collapsed into Episode #90
We can’t get started without mentioning the sponsor of the first half of our show,
Let’s talk about GoChiroTV. GoChiroTV is a patient education system for your office that actually saves you money. Instead of spending money on cable TV or looping a DVD over and over in your lobby, the bite-sized videos are specifically made to inform your patients about the importance of chiropractic, healthy living, and to encourage referrals while, at the same time, presenting the benefits of all of the different products and services that you offer. Specific to your office.
That’s right. It works by using a tailor-fit video playlist that only promotes the products and services offered in your specific practice. Not only that but the videos are updated automatically on a weekly basis so there’s no need to manually update your playlist AND you don’t have to learn any complicated software. You get to just set it and forget it. And don’t we busy doctors need just that?
Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions. That’s CFP19, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription.
Go visit GoChiroMedia.com to check out the demo reels and get started on your free trial.
We have some great stuff this week. It’s a short week due to Labor Day so this episode may run a little short and that’s OK. I try to not get too long winded. I think I went on about 45 minutes when we talked about Closing Patients two episodes ago. But, a little gripe session never hurt anyone. If you’ve ever wondered whether Closing patients is right or wrong, get my take by going and listening to episode #88. I lay it out pretty clearly there.
And don’t forget, last week’s podcast about Fibromyalgia. New info on fibro and treatment. Good stuff there in episode #89
Item #1
I want to start with an article that kind of struck me as…..huh….interesting. It’s called ‘The Old Days of Medicine Are Gone” by Michael Weiss(Weiss M 2019) and it was published in MedPage Today on January 17, 2019. Hot potato, heads up now.
Weiss is a cardiologist and I have cited this article in the show notes over at chiropracticforward.com. This article refers to medical doctors specifically but there are a lot of parallels that we doctors of chiropractic can relate to.
The article starts by saying that in the last 5-6 years, physicians have become less and less powerful. So have their patients. This disempowerment is due to a lot of things according to this article. Chief among them are:
- Health management organizations
- Managed care and
- The insurance exchange
Mr. Weiss says that all of these factors have taken power from the doctors and put the power into the hands of the large insurance companies and in the hands of the government. Well, that’s been going on for at least a generation.
I remember a pencil pusher with an insurance company several years ago, a person who doesn’t have any kind of degree other than following prompts on a computer…..I remember them telling me how to treat a patient. What they needed. How many times….I was stunned. I will just say that I had a strongly worded conversation that I’m certain went in one ear, bounced around in that dude’s empty noggin, and fell out the other without making any impact.
But I remember thinking, we are allowing insurance companies, the guys with a financial stake and a financial bias, we are allowing these people to tell us how and when to treat patients when they’ve never seen them in their lives. These patients are just numbers on a page to these companies and they’re going to tell us how to treat them.
Same goes for the government. Whether it’s a popular opinion or not, makes not one damn to me. I’m going to tell you that when you put all of your healthcare decisions in the hands of one big fat, red-taped fat bureuacratic entity that has already screwed up Medicare and Social Security for no reason at all, due to both sides of a messed up aisle, well, you are once again numbers on a page and sometimes you get what you deserve. Of course that doesn’t mean everything’s peachy and we don’t need some changes to the healthcare system. We most certainly do. Universal healthcare medicare for all though…..I don’t see how that is the solution. Again, one fat, slow, dumb entity that has a history of screwing up big programs isn’t what I personally want making all of the healthcare decisions for me and my family but to each their own.
Getting back to the article, Mr. Weiss says this physician disempowerment was basically a money grab on the parts of these powers and on the part of the pharmaceutical industry. Well…..of course. I think all that goes without saying doesn’t it? But I’m glad someone is indeed actually saying it. We should be shouting it out loud but, will it change anything? Politicians won’t do anything about it when big pharma is in their pockets and they’re scared of the insurance companies.
Anyway, he says that doctors’ incomes have been progressively on the decline for years. Can i get an ‘amen’ on that my people. Testify!! He says this cash-strapped generation of physicians have been forced out of private practice into working for hospitals and huge conglomerates and that gone are the days of Wednesday off for golf, gone are the days of being called a doctor rather than a provider, gone are the days of being respected, gone are the days when patient’s would say “But what does the doctor say?” rather than “Will the insurance pay?”, gone are the days when a physician could direct care they deemed necessary. Even the prescription pad is becoming useless since insurance doesn’t cover a lot of the scripts written these days.
He says gone are the days when a physician could sit down and perform a detailed and thorough examination. Instead, we have be busted down to being typists, chaotic clerks, mindlessly clucking away at meaningless electronic health records benefiting only large entities. Hallelujah!!
In order to make money these days, it has to be quantity and, unfortunately, quality many times suffers. For better or worse. When your income goes down, you see more to maintain the income you have built your life around. Quality of care suffers. Not intentionally. Nobody is morally corrupt typically. It’s just a natural consequence. You have bills to pay and you’ll figure out a way.
Take a radiologist. They used to get about $35 for reading a neck series. Now, after Obamacare, they make $7-$10. I happen to know a radiologist very well so you can trust what I’m telling you. At least here in Texas. Could be different in your area. What happens when you income gets reduced by roughly 2/3 but you still have a big house and some extra toys you have purchased?
Maybe you have a big garage sale and get rid of the extra fat? Ah hell no, that’s not what happens. Instead of 5 films read in 30 minutes you read 10. Think you might have an elevated risk of missing something? Of course you do.
Back to the article….I keep getting side-tracked, he says gone are the days when a physician had the luxury of utilizing their skills of observation. He says now there are cookbook guides that have become the puppet masters of the physicians. I’d like to go on record right now, as part of a profession that has no standardization whatsoever…..I’m all for researched and evidence-backed guides. I love it. Give us some guides. Hell, don’t just give them to us, FORCE us to abide by them. Please? Lol. Just make sure they weren’t generated by a damn insurance company. That’s all.
He says gone are the days of decent hospital stays and the days of when a patient could be cured of infections from a decent stay at the hospital. Now, he claims that patients are kicked out of the hospital early and take the buggies back to their community and spread them which leads to resistant buggies. I’d argue that commonly prescribing antibiotics when it’s a virus was problematic and the cause of a lot of resistance back in the day as well? He left that out oddly enough.
He hit on a HUGE one when he says gone are the days of reasonable costs for a doctor visit or a drug co-pay. Now, since Obamacare, we see double and triple premiums, up to $100 co-pays, and double or triple deductibles.
This sucker continues but, before I get to the rest of it, I need to talk about one of our amazing sponsors here at the show. It’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices.
If you’re a regular listener of our podcast, you know I used it since about June of 2018. Let me tell you about it.
ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean:
In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises.
You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips.
You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! Short testimony
If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months
That’s ChiroUp.com and super double secret code Williams99.
Back to the article, Mr. Weiss says gone are the days of visiting an ER and getting immediate care as if illness is the priority. Instead, we gotta get that co-pay covered first.
He claims the days of physicians not having to worry about a patients insurance are gone. But…haven’t those days been gone since the 80’s or so? Honestly? That’s not something new. He says though that the insurance companies have encouraged minute clinics where the nurse pracs, and he says soon the pharmacists, will be giving the medical advice.
He doesn’t seem to like this idea much but he’s OK with people waiting for hours to see a ‘physician’ because there aren’t enough of them. I’m pretty OK with nurse practitioners for the more mundane stuff. Plus, in my experience, NPs are more likely to refer to chiropractors for whatever reason.
While Mr. Weiss is right to some extent, a lot of this is just whining in my opinion. The traditional physician doctor had their run with all of the power, the glory, and the golden ticket they cash when they get their medical degree. And, to an extent, they damn well still have a certain amount of power, glory, and golden ticket status. Although to a lesser extent currently. Admittedly.
It’s one of the last quotes of the article that gets my goat a bit. He says, “Physicians’ voices have been drowned out, their plights buried, leaving their patients helpless,,,,”
Well freaking whaaaa Weiss. Yes, chiropractic has the status it has in healthcare right now because a certain portion of its practitioners refuse to progress. In fact, they work to inhibit any progress and cripple any efforts to expand the profession. Yep, it’s there and it’s undeniable but, when we talk about having voices drowned out, plights buried, and helpless patients, let’s go a little deeper.
I’ve said it a million times but the medical field is going to look back on spinal fusions in 20 years and wonder what the hell they were thinking. I think I heard where lumbar fusion surgery has gone up 500+% in the last decade or so with little to zero hard stats that show any improvement in outcomes.
Oh looky there, I see a herniation. Let’s cut that out and you should be good as new. We know so much more now. We know you can’t cut out pain. We know you don’t treat an image. You treat the patient in front of you because most of the time, there is little to no correlation between what you see on an x-ray and what the person’s pain generator is.
We know now that chronic pain is mostly in the central nervous system. Not out in some peripheral part of the body. You cannot typically get rid of chronic pain by cutting something out. We know more and more now that it just doesn’t work that way.
Yet, I feel confident promising you that right now, several fusions across the country are taking place. As I type this out. We also know that less than half of those fusion surgeries will be successful, right?
We know this stuff. Yet, they continue. Unabated. So, while I agree that insurance, the government, and the whole managed care concept have screwed up our healthcare system, I would say that physicians have played very key parts in their own downfall. Hello….opioid crisis anyone? Unnecessary surgery? Surgeries for the wrong candidates? Super bugs from overprescribing? Any of this ringing any bells?
Have you heard the podcast called Dr. Death? Basically, a so called spinal surgeon down in Plano, TX maimed several patients and even killed several and the hospitals protected him and enabled him to keep hurting people over and over and over again.
It’s not just insurance companies and big pharma that has cause any fall from grace. And let’s be clear, I don’t think there’s been a fall from grace. Go to a hospital and see the interactions. Everyone still defers very clearly to the physician and I don’t see that changing. It’s just now they have to work more, follow rules, and get paid less. I think that’s the big gripe.
And to that I’d say, welcome to my world friend. Welcome to my world.
But again, it’s not just the system. Medical doctors have done their part. And, as a chiropractor, I’d argue that part of that is they have largely ignored the American College of Physicians’ recommendations to try spinal manipulative therapy, exercise, massage, acupuncture, yoga, thai chi, and heat first for back pain.
Those are the first-line recommendations and they are in concert with The Lancet papers on low back pain, the CDC, the FDA, the Joint Commission, The White House, and just about anyone else with any sense at all when it comes to non-complicated musculoskeletal pain. Yet, as I said, fusions are going on all over the country right now. As I speak. That’s when only 5% of back pain sufferers truly need surgery.
When does someone truly need spinal surgery? When they hurt? Nope. Not usually anyway. Remember, you can’t cut pain out. Outside of an obvious case of a spinal fracture, tumor…..the bad bad stuff….I think it’s commonly accepted that surgery is necessary in a loss of bowel or bladder function, saddle anesthesia - cauda equina- type stuff, or a progressive neural deficits.
So, if only 5% of back pain sufferers truly need surgery, why are so many still happening every day? After all of the research and after all of the updated recommendations?
Well, I’d say it’s financial. Get this, according to the American Medical Group Association’s Physician Compensation Survey says their research spine surgeons make $688,500 a damn year on average.
Me personally, I’m doing pretty well in practice. But, it took me 16 years before I really started putting the pedal to the metal. Now part of that was my fault because I was traveling around playing music. Part of it was chiropractic’s fault because we have a system that eats its own.
Either way, check this out, it took me 16 or so years to really build but, for an orthopedic surgeon, during the first two years of employment, bring in $400k and by their third year, $670k. Allied Physicians reported the maximum orthopedic spine surgeon salary was $1,352,000.
Crazy. We have some chiropractors that make that kind of money but it’s not many and it’s not very likely.
Anyway, I agree with some aspects of the article. Other aspects make me chuckle because, although it’s to a much lesser extent, physicians of our day are dealing with some of the things we’ve been dealing with for years and years.
If we could just communicate with them the fact that we evidence-based chiropractors can play such a big part in helping them treat their patients and getting them back to work and back to life, I probably would have more sympathy.
Hell, people come to us because we’re experts in what we do, because we are safe, and because we’re effective but, a large part of the medical field looks at us like stumbling idiots playing doctor and hurting our patients. While that may be true for some in our profession as well as for some in THEIR profession (hello Dr. Death), for the most part, we are all highly educated, highly capable doctors getting patients well.
Maybe when they begin seeing us in that light, we start to see some sort of deeper, more meaningful integration. It’s started here and there in some pockets of awesomeness but not in general. It’s still a goal worth chasing.
That’s assuming we chiropractors can get our of our own way. Otherwise, if I were a medical doctor, I wouldn’t want any part of something I could only explain as pseudoscience. I WOULD however be interested in a healthcare discipline that had the randomized controlled trials backing the meat of their modality. Count me in on that.
And that’s the way I see it today.
Store
Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly.
If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders.
Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it.
Subscribe Button
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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Weiss M (2019). "The old days of medicine are gone." Medpage Today - KevinMD.com.
CF 086: Sports Performance / Chiropractic Care Standardization / Proprioception
Today we’re going to talk about Sports Performance / Chiropractic Care Standardization / Proprioception
But first, here’s that arm like a big fuzzy coat bumper music
Subscribe button
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have tripped into Episode #86 and when I say tripped, I don’t mean so much the LSD kind of trip but more like the I’m an idiot and fell face first in a room full of people sort of tripped. So, welcome you fools!! Lol. I kid, I joke. I’m honored to have you here today. We have some good stuff to cover.
Before we get started, let’s talk about GoChiroTV. GoChiroTV is a patient education system for your office that elminates the need for cable TV or looping the same DVDs over and over again in your waiting room. The bite-sized videos are specifically made to inform your patients about the importance of chiropractic and healthy living. To encourage referrals and to present the benefits of all of the different products and services you offer.
It works by using a tailor-fit video playlist that only promotes the products and services available in your practice. Not only that but the videos are replaced automatically on a weekly basis. There’s nothing complicated. You truly can just set it and forget it.
Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions. That’s CFP19, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription and you can’t hardly beat that deal.
Go visit GoChiroMedia.com to check out the demo reels and get started on your free trial. Take your practice to the next level with GoChiroTV.
Introduction
We’re here to advocate for chiropractic while we also make your life easier using research and some good solid common sense and smart talk.
Personal Happenings
I always feel that, if I share personal experiences with you guys, first you’ll know me as a person better and I don’t see anything wrong with that. Second, you may identify and sympathize. Third, if you can’t necessarily identify with what I go through, you may be able to learn from it if you get to that point.
With that I’ll say that 2019 has been quite the year for us around my office. New faces, lots of new patients, and less and less time to do things outside of seeing patients. My work/life balance is out of balance at the moment and I’m afraid my health is starting to show some dents in the armor.
I think I have an undiagnosed anxiety thing and, typically, I’m very good at managing anxiety and stress and having 4 or 5 balls up in the air at the same time. I’m a juggler people. And I have been for quite a long time.
But, in January, something clicked. Something changed. I don’t say this to brag. I say this to explain. My practice numbers just started to climb during a time that we are traditionally slow. Really slow. The holidays are usually a time when you just know you’re going to have extra time to catch up on all of those things that have been piling up in front of you. Back to school time as well right? It’s always been a down time for me for one reason or another.
Yeah, well, not this year. The holidays only got busier. Much busier. The kids go back to school in two weeks and there’s been no slow down this Summer. Which is awesome. But my problem is, I don’t know what I did to cause the influx. If I knew, you better believe I’d be repeating it!! Over and over and over.
The end story is, growing is great but growing can be stressful. That’s why they call it growing pains right? Think about it: how many staff member do I need to handle the patient load? Am I over staffed or understaffed? Do I need an associate? Which one is the right one? Will they take care of things like it’s their own and they care? Where do I get good contract for one? I have a bathroom that needs tiled and I have an Air conditioner that need’s replaced. My dog pissed on the carpet this morning. Blah blah blah.
You all know how it goes. Every aspect of practice has stressors. When you’re new in practice and don’t have a heavy load, you’re sitting looking at your watch, playing on the computer, hopegully you’re out marketing, and you’re stressed about how you’re going to provide for your family.
I’m aware that being too busy is a nice problem to have. I don’t want to come off as a spoiled brat here. I’m just saying that I have been stressed and it’s starting to affect me a bit. We have been blessed and we are going to take blessings and we are going to turn them into more blessings for us and for our patients and staff.
It’s just getting through some of the mud and muck along the way. I just need to keep my anxiety under the surface a little longer. Lol. So that nobody thinks I’m insane.
I’ve fooled them this long haven’t I?
On another note, Charlie Manson. Y’all, I was fascinated by their shenanigans when I was in high school but got over it. Every now and then I’ll see something about it and I’ll perk up and listen but I went to see the new movie Once Upon A Time In Hollywood.
I’ve been seeing where some hate it and some love it and I’ve seen a bunch of ehhh comments but I gotta tell you. I’m firmly in the hell yeah category. Brad Pitt and Leo DiCaprio knocked that sucker straight out of the parking out onto the parking lot. It was funny, it was vintage, it was nostalgic, and no…..of course it didn’t happen that way but it was excellent.
If you went, shoot me an email at dr.williams@chiropracticforward.com and tell me what you thought. I can share you thoughts next week on the podcast. Or you can get on our Facebook page or our private Facebook group and we can discuss.
Item #1
Let’s get to our first item here. It’s titled “The effects of spinal manipulation on performance-related outcomes in healthy asymptomatic adult population: a systematic review of best evidence” and written by Meliss Corso, Silvan Mior, Satrah Batley, et. al. It was published in BMC Chiropractic and Manual Therapies in June 2019. Brand new…..hot stuff people. (Corso M 2019)
Why They Did It
The authors wanted to perform a systematic review regarding the effect spinal manipulative therapy has on athletic performance in asymptomatic adults.
What They Found
They concluded “The preponderance of evidence suggests that SMT in comparison to sham or other interventions does not enhance performance-based outcomes in asymptomatic adult population. All studies are exploratory with immediate effects. In the few studies suggesting a positive immediate effect, the importance of such change is uncertain. Further high-quality performance specific studies are required to confirm these preliminary findings.”
That doesn’t mean we can’t help with pain and discomfort which aids in better performance. But it does suggest that, if a person feels great, getting spinal manipulative therapy isn’t very likely to make any difference in how fast they are or how far they can throw.
Item #2
This one is called “The Chiropractic Hospital-Based Interventions Research Outcomes Study: Consistency of Outcomes Between Doctors of Chiropractic Treating Patients With Acute Lower Back Pain” by JA Quan, et. al and was published in the Journal of Manipulative and Physiological Therapeutics in June 2015 so 4 years old. (Quon JA 2015)
Why They Did It
The aim of this study was to determine if effectiveness differs between community-based doctors of chiropractic administering standardized evidence-based care that includes high-velocity low-amplitude spinal manipulative therapy (SMT) for acute low back pain (LBP).
How They Did It
- A secondary analysis of randomized controlled trial and observational pilot study data was performed with nonrandom allocation to 4 DCs.
- Patients included those with Quebec Task Force categories less than or equal to 2 and acute LBP of 2 to 4 weeks' duration.
- The intervention included high-velocity low-amplitude SMT.
- Outcomes assessed using Roland Disability Questionnaire (RDQ) at 24 weeks.
What They Found
The findings of this study show that regardless of the treating DC, most patients with acute LBP without radiculopathy appear to experience consistent levels of improvement in terms of BP and general PF after receiving guidelines-based treatment that include s a component of standardized HVLA SMT.
If we dive into the paper, they mention that until now, inconcsistency hasn’t been regarded as a significant barrier to chiropractors getting referrals from the medical realm. Butthere are guarded attitudeds about chiropractors when we’re talking about quality of care and that’s been confirmed in other papers.
In fact, in a survey of 487 Canadian and American orhtopedic surgeons, they found that about 71% of them held either a neutral or a negative view of chiropractors. That means only 29% of them looked at us in a positive way. 29%. Dammit
Also, when you break down that 71% of neutral or negative….you get 26% were neutral but 45% were in the negative category. Dammit.
73% of orthopedic surgeons thought chiropractors provided unnecessary treatment. Yeah, they’d probably just do better if you intubated them, knocked them completely out, and drove screws through the bones of their spine to fixate the segments on top of each other and then sewed them back up, and then sent them home with a bunch of pills. That’d probably be much more necessary. Sure thing chief.
Hell, 52% of them thought chiropractors make their patients dependent on short-term relief. I will say that it feels good to feel good and why wouldn’t a patient want to feel good as often as they can? But putting the shoe on the other foot here, let’s assume they’re right, isn’t being addicted to safe, conservative, non-invasive treatment better than being addicted to opioids or some sort of medication? Our nation’s opioid crisis suggests it is better.
The paper itself is really a preliminary study and meant to further knowledge and information for other papers down the line but I found it more interesting because of the orthopedic survey discussion. Pretty interesting. And….disappointing I’d add but that was 4 years ago. Maybe those numbers are changed a bit from then to now? Not sure.
This is a great spot to take a short break to talk about ChiroUp. If you’re a regular listener of our podcast, you I use it and I’ve told everyone how amazing it is since about June of 2018. Well now they’re a sponsor of our show and we are really excited to have ChiroUp on board the train.
Have you heard about the #1 online resource for chiropractors? Well, let me tell you about it.
ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean:
In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises.
You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips.
You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! Short testimony
If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months
That’s ChiroUp.com and super double secret code Williams99.
I’m trying to save you people some money here alright?Trust me, you’re not going wrong with ChiroUp. In fact, in studying for the Diplomate of the Academy of Chiropractic Orthopedists part two exam, I’m studying the orthopedic tests and videos from the ChiroUp website. It’s phenomenal.
Anyway, on to Item #3
It’s called “Neck proprioception compensates for age-related deterioration of vestibular self-motion perception” by G Schweigart, RD Chien, and T. Mergner. It was published in Experimental Brain Research all the way back in 2002. Bringing the old man out of the archives here. (Schweigart G 2002)
Why They Did It
Vestibular functions are known to show some deterioration with age. Vestibular deterioration is often thought to be compensated for by an increase in neck proprioceptive gain. That’s what the authors were studying here….. this presumed compensatory mechanism.
What They Found
Generally, we hold that the transformation of the vestibular signal from the head down to the trunk proceeds further to include the hip and the legs as well as the haptically perceived body support surface; by this, subjects yield a notion of support kinematics in space.
As a consequence, spatial orientation is impaired by chronic vestibular deterioration only to the extent that the body support is moving in space, while it is unimpaired (determined by proprioception alone) during body motion with respect to a stationary support.
Just to add a little sidebar here: did you know that muscle spindles are our motion detectors? Think about this. There are 16 muscle spindles per gram of muscle in our fingers. Our hands and fingers are highly sensitive with regard to proprioception arent they? Think of a musician playing with their eyes closed.
You know exactly where your fingers are without looking at them or really even thinking about them. How about typing? You don’t look right?
Now, we only have about 2 muscle spindles per gram of muscle in the traps. Which makes sense. Why do we proprioceptively need to know where our traps are? They’re attached to our axial skeleton. They’re not going anywhere. They’re not out flapping in the wind like our hands right?
Here’s the weird deal though: in our deeper cervical muscles, we have 242 muscle spindles per gram of muscle. That IS our axial skeleton basically so why so many spindles? There’s no flapping out in the wind with the upper cervical muscles either. But, it is the connection between our head and the rest of our body.
It is to the point that anatomists look at the upper cervical muscles as more of a proprioceptive organ rather than as simply muscles.
Our three proprioceptive inputs are the eys, the vestibular organ, and the muscles of the upper cervical area. When you do a Romberg’s test and you remove proprioceptive input from the eyes, and the vestibular organ….., part of what you are measuring is the input from the upper cervical region.
It’s fascinating. Absolutely fascinating when you dive off into it a bit and I encourage to do so.
Store
Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly.
If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders.
Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it.
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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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
http://www.chiropracticforward.com
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TuneIn
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About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Corso M, M. S., Batley S, (2019). "The effects of spinal manipulation on performance-related outcomes in healthy asymptomatic adult population: a systematic review of best evidence." BMC Chiro Man Ther 27(25).
Quon JA (2015). "The Chiropractic Hospital-Based Interventions Research Outcomes Study: Consistency of Outcomes Between Doctors of Chiropractic Treating Patients With Acute Lower Back Pain." J Man Physiol Ther 38(5): 311-323.
Schweigart G, C. R., Mergner T, (2002). "Neck proprioception compensates for age-related deterioration of vestibular self-motion perception." Exp Brain Res 147(1): 89-97.
CF 085: Highly Paid Drug Dealers, Keto Diet News, Axial Traction, Stroke Research
Today we’re going to talk about Highly Paid Drug Dealers, Keto Diet News, Axial Traction, Stroke Research
But first, here’s that cool like a velvet Elvis bumper music
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OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have tip toed into Episode #85
Man, we have a show for you today. I’m still cleaning out some archives. Some papers that have been building up while we have been having guests. Some great guests that we have had more recently have been Dr. Anthony Nicholson from Australia who plays such a big part in the DACO program. The guy is a genius and eveyrone in our profession should know about him. We talked about decoding chronic pain just a few weeks ago so listen. What are you waiting for?
Then we had the chiropractor for Florida State, Dr. John Van Tassel and he is just a wise, accomplished, mentor that you need to go and hear what he has to say. Again, what are you waiting for? Go now!
Speaking of the DACO, I went to Dallas, I drove to the University of Texas in Arlington, TX …..that’s between Dallas and Ft. Worth for you out-of-towners…and I sat in a little cublicle next to some college kid with a bad case of the sniffles and I took my part one exam toward getting my Diplomate of the Academy of Chiropractic Orthopedists.
I had heard from several sources that it was a hard test and that there really was no way in particular to prepare for the test because it is literally all over the map. And my sources did not tell any fibs people.
There were the most random, crazy questions on that thing. Things I’d never think to study because we didn’t learn them but, it seems my guessing picker was in order on that day because I passed. Or….they took pity on my and passed me because I’m a swell dude. Either way, I passed.
Don’t let my experience with this test dissuade you from going through the DACO by the way. The test is being changed and updated for the next round and I suspect it will be more relevant to the course teachings. That’s my guess anyway.
So, now it’s on to part two in November. I am taking a two-week break from studying and then I’ll dive back into that rigamarole.
I’m happy to introduce a new sponsor for the Chiropractic Forward Podcast called GoChiroTV. GoChiroTV is a patient education system for your office that will eliminate the need for running cable TV or the same DVDs over and over again in your waiting room. The bite-sized videos are specifically made to inform your patients about the importance of chiropractic and healthy living, encourage referrals, and present the benefits of all the different products and services you offer.
It works by using a tailored-fit video playlist that will only promote the products and services available at your practice, and the videos are replaced automatically on a weekly basis. There’s no need to manually update your playlist or learn any complicated software. You truly can set it and f orget it.
Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription.
So visit GoChiroMedia.com (that’s g-o-c-h-i-r-o-m-e-d-i-a-.com) to check out the demo reels, and to get started on your free trial. Take you practice to the next level with GoChiroTV.
Introduction
Let’s get on to the research shall we?
Item #1
Our first paper here is one from NPR called “Opioid-Maker Insys Admits To Bribing Doctors, Agrees To Pay $225 Million Settlement” and was published in June of 2019. The title leads us….you know where it’s going. (Emanuel G 2019)
Insys Therapeutics, an opioid manufacturer, has agreed to pay $225 million to settle the federal government's criminal and civil investigations into the company's marketing practices. As part of the settlement, Insys Therapeutics admitted to bribing doctors to prescribe its opioid painkiller.” Oh my….do tell!
The courts proved that the company set up a fake "speaker program." The doctors involved were not paid to give speeches, but were paid to write prescriptions of the company’s fentanyl-based medication called Subsys.
And, you guessed it…..many times the painkiller was prescribed to patients who did not need it.
The founder of Insys Therapeutics, John Kapoor, is among the highest ranking pharmaceutical executives to be convicted amid the opioid epidemic. Sentencing of the former billionaire is scheduled for September.
Highest paid drug dealers in the world right there.
Item #2 is called “Changes in Spinal Height After Manual Axial Traction or Side Lying: A Clinical Measure of Intervertebral Disc Hydration Using Stadiometry” by Dylan Rubinic, a physical therapist. It was published in the Journal of Manipulative and Physiological Therapeutics in the March/April 2019. Hot stuff right here. (Rubinic D 2019)
Why They Did It
The authors were trying to figure out what effects axial traction have on someone compared to side lying when it comes to increased spine height after sustained loading.
How They Did It
21 patients with no symptoms were used.
They either had traction force for 2 rounds of 3 minutes
Or they had sustained side lying for 10 minutes
Spine height was measured with a stadiometer.
What They Found
There was a significant increase in the height after both manual therapy AND sustained side lying. Well what the hell does that tell us then?
Wrap It Up
This was a preliminary paper to set the stage for futre papers but it’s interesting. They say, “Both manual axial traction force and sustained side-lying position were equally effective for short-term change in spine height after a loaded walking protocol among healthy asymptomatic individuals.” So does that mean that traction is no good? I don’t see that at all here. I say there was little to no difference in asymptomatic, healthy spines when done for three minutes.
That’s all I see. What about compressed, degenerated, or dehydrated discs with annular fissures and without annular fissures with associate radiculopathy and without associated radiculopathy…..and and and and and.
Lots of stuff to look at but at least they’re looking at it and I look forward to finding out where it all goes.
Item #3
Keto diets. The current big thing. Item #3 is called “The Ketogenic Diet for Obesity and Diabetes—Enthusiasm Outpaces Evidence” by Shivam Joshi, MD, Robert Ostfeld, MD, and Michelle McMacken, MD and was published in JAMA Internal Medicine on July 15 2019. Brand spankin new people. (Joshi S 2019)
Before we dive into Keto Diets, let’s take a sec to talk about ChiroUp.
Have you heard about the #1 online resource for chiropractors? Well, let me tell you about it.
ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean:
In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises.
You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips.
You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! Short testimony
If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months
That’s ChiroUp.com and super double secret code Williams99.
OK, on to the article.
They start by acknowledging the keto craze but say that the excitement doens’t necessarily equal the effectiveness or the evidence in supporting it.
The point out that a metanalysis of 13 studies lasting more than a year showed that a keto diet shwoed less than one kilogram of additional weight loss over high carb, low fat diets. Hmmmmm very interesting….
IN addition, a different meta-analysis showed energy expenditure and fat loss was greater with low-fat diets vs. a keto diet.
I’m going to quote the article directly here because they say it better than I can. They say, “In terms of the risk-benefit balance of the ketogenic diet, the potential adverse effects may give one pause.
A review of the literature on ketogenic diets for the treatment of pediatric epilepsy reveals multiple adverse effects, ranging from the relatively benign but inconvenient “keto flu,” to less common but deadlier occurrence of cardiac arrhythmias from selenium deficiency.
Other documented adverse effects include nephrolithiasis, constipation, halitosis, muscle cramps, headaches, diarrhea, restricted growth, bone fractures, pancreatitis, and multiple vitamin and mineral deficiencies.
The greatest risk, however, of the ketogenic diet may be the one most overlooked: the opportunity cost of not eating high-fiber, unrefined carbohydrates. Whole grains, fruits, and legumes are some of the most health-promoting foods on the planet. They are not responsible for the epidemics of type 2 diabetes or obesity, and their avoidance may do harm.”
Item #4
In our continuing series of showing anyone thinking that chiropractors cause strokes that they are the equivalent of archaeic flat Earthers, we go with this paper called, “Effect of cervical manipulation on vertebral artery and cerebral haemodynamics in patients with chronic neck pain: a crossover randomised controlled trial” by Nicholas Moser, Silvano Mior, Michael Noseworthy, et. al. It was published in BMJ Open in 2019.(Moser N 2019)
Why Thye Did It
Their stated goal in the paper is quoted as, “We aimed to determine whether cervical spine manipulation is associated with changes in vertebral artery and cerebrovascular haemodynamics measured with MRI compared with neutral neck position and maximum neck rotation in patients with chronic neck pain.
They did it at The Imaging Research Centre at St. Joseph’s Hospital in Hamilton, Ontario, Canada. I have to say, I love those damn Canadians. They really do a great job on bringing quality and important research to the table for this profession.
They used 20 patients here with a mean age of 32 and mean neck pain lasting 5.3 eyars.
They tested maximal neck rotation followed by cervcial manipulation and/or
Cervical manipulation followed by maximal neck rotation.
What They Found
“Our results are in accordance with previous work, which has shown a decrease in blood flow and velocity in the contralateral vertebral artery with head rotation. This may explain why we also observed a decrease in blood velocity with manipulation because it involves neck rotation. Our work is the first to show that cervical manipulation does not result in brain perfusion changes compared with a neutral neck position or maximal neck rotation. The changes observed were found to not be clinically meaningful and suggests that cervical manipulation may not increase the risk of cerebrovascular events through a haemodynamic mechanism.”
Subscribe Button
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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Emanuel G (2019). "Opioid-Maker Insys Admits To Bribing Doctors, Agrees To Pay $225 Million Settlement." NPR.
Joshi S, O. R., McMacken M, (2019). "The Ketogenic Diet for Obesity and Diabetes—Enthusiasm Outpaces Evidence." JAMA Intern Med.
Moser N, M. S., Noseworthy M, (2019). "Effect of cervical manipulation on vertebral artery and cerebral haemodynamics in patients with chronic neck pain: a crossover randomised controlled trial." BMJ Open 9(5).
Rubinic D, K. V., Dudley J, Owens SC, (2019). "Changes in Spinal Height After Manual Axial Traction or Side Lying: A Clinical Measure of Intervertebral Disc Hydration Using Stadiometry." J Manipulative Physiol Ther 42(3): 187-194.
CF 084: Multifidus & Disc Degeneration, Opiates & First Provider, Craniocervical Instability
Today, it’s like the olden days here at the Chiropractic Forward Podcast. That’s right. No guests, just moiah. Me. Unfiltered and onery as usual. I’ve had stuff piling up in my archives and we’re going to sprint through some of it and see what sticks. We’re going to talk about the multifidus and some new research on it having to do with disc degeneration, we’ll talk about why what provider you see after low back injury can make all the difference, and we’ll talk about some hint that fibromyalgia and even POTS is theorized to be caused by craniocervical instability. Maybe?
It’s a heaping plate of knowledge noodles so keep your seat, the Italian mama that feeds you too much is in the kitchen. But first, here’s that yummy like a meatball bumper music
Subscribe button
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have shimmied into Episode #84
Before we get started,
I’m happy to introduce a new sponsor for the Chiropractic Forward Podcast called GoChiroTV. GoChiroTV is a patient education system for your office that will eliminate the need for running cable TV or the same DVDs over and over again on a loop in your waiting room. The bite-sized videos are specifically made to inform your patients about the importance of chiropractic and healthy living, to encourage referrals, and to present the benefits of the specific and different products and services you offer.
It works by using a tailored-fit video playlist that will only promote the products and services available at your practice, and the videos are replaced automatically on a weekly basis. There’s no need to manually update your playlist or learn any complicated software. With this system, you tcan truly just set it and forget it.
Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions, which also comes with a 45-day free trial to see if it’s right for your practice and…your discounted rate will be locked in for as long as you have a subscription.
So visit GoChiroMedia.com (that’s g-o-c-h-i-r-o-m-e-d-i-a-.com) to check out the demo reels, and to get started on your free trial. Take your practice to the next level with GoChiroTV.
And thanks to them for being involved in what we’re trying to accomplish here.
Personal Happenings
If you hear something here that you really like and would like it in written form rather than spoken, just hop onto chiropracticforward.com, find the episode, and just scroll down to copy and paste it. If you’re using it for content or on your website for some reason, just be cool and give us some credit please. I’d sure appreciate it and I’m sure the researchers we discuss would too.
Item #1
Our first paper to cover is called “Physical activity attenuates fibrotic alterations to the multifidus muscle associated with intervertebral disc degeneration” and is authored by G. James, D. M. Klyne, et. al. and was published in European Spine Journal in May of 2019(James G 2019).
Why They Did It
The authors here say that chronic low back pain….chronic…longstanding low back pain literally changes and remodels the multifidus muscles. They go on to say that physical activity reduces the local inflammation that comes before multifidus fibrosis during intervertebral disc degeneration (IDD), but its effect is unknown. This study aimed to assess the development of fibrosis and its underlying genetic network during intervertebral disc degeneration and the impact of physical activity.
How They Did It
This research was actually done on mice. To keep the entertainment value of this podcast as high as possible, I’m not going to get specific here as far as substance P, MMP2, blah blah blah. We’ll just head right to the conclusion of the paper.
They say “these data reveal the fibrotic networks that promote fibrosis in the multifidus muscel during chronic intervertebral disc degeneration. Furthermore, physical activity is shown to reduce fibrosis and regulate the fibrotic gene network.”
So they’re saying move it move it move it.
Item #2
This next paper is called “Initial Provider Specialty Is Associated With Long-term Opiate Use in Patients With Newly Diagnosed Low Back and Lower Extremity Pain” and is authored by TC Azad, D Vail, and J. Bentley et. al. It was published in the esteemed Spine Journal in February of 2019. (Azad TD 2019)
Why They Did It
The authors wanted to determine whether provider specialty influences patterns of opiate utilization long after initial diagnosis. I’d say that’s a great question to be asking these days. When we have 72,000 die in one year from opioid-related causes, that should be up there on the ‘what the hell’ list wouldn’t you agree?
How They Did It
The study was a retrospective longitudinal cohort analysis of patients diagnosed in 2010, with continuous enrollment 6 months prior to and 12 months following the initial visit.
They identified 478,981 newly diagnosed opiate-naive patients.
They estimated the risk of early opiate prescription and long-term opiate use based on the provider type at initial diagnosis.
What They Found
- 40.4% of the patients received an opiate prescription within 1 year and 4% met the criteria for long-term use.
- The most common provider was family practice. They were associated with 24.4% risk of early opiate prescription and a 2% risk of long-term opiate use.
- Risk o freceiving an early opiate prescription was higher among patients initially diagnosed by emergency medicine or at an urgent care.
- Risk of Long-term opiate use was highest for aptietns initially diagnosed by pain management doctors or by physical medicine and rehabiliation providers.
Wrap It Up
Initial provider type influences early opiate prescription and long-term opiate use among opiate-naïve patients with newly diagnosed low back and lower extremity pain.
Looky here ya see, I’m just going to lay it out for you. Zero percent of opiate-naive patients get prescribed OR hooked on opiates from seeing a chiropractor. Zero.
I’ll even go further than that and say that approximately 70-80% of them get good to excellent results and improvement of their complaint. I know this through the ChiroUp tracking system they use across the country.
You know what else I know through the ChiroUp tracking? I know that these results happen in only about 7 visits. Kow a Chow!! I know you can’t see it but you can picture that karate chop placed precisely to deliver a virtual coup de grace.
Alright, Enough silliness. On to out final item here.
But before we do that - Let’s take a short break to talk about ChiroUp. If you’re a regular listener of our podcast, you I use it and I’ve told everyone how amazing it is since about June of 2018. Well now they’re a sponsor of our show and we are really excited to have ChiroUp on board the train.
Have you heard about the #1 online resource for chiropractors? Well, let me tell you about it.
ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean:
In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises.
You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips.
You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! Short testimony
If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months
That’s ChiroUp.com and super double secret code Williams99.
Item #3
Item #3 is an article titled “Could Craniocervical Instability Be Causing myalgic encephalomyelitis/chronic fatigue syndrome, Fibromyalgia & POTS?” written by Cort Johnson and published in Health rising.org on February 27, 2019. (Johnson 2019)
This was actually sent to me by a cardiologist friend of mine and I’m really glad he sent it my way because it’s interesting as hell. Follow along.
I’ll read you the first paragraph here, “Jeff had a typical ME/CFS onset: he was a young, healthy and active individual before being felled by a viral infection and a high temperature. The infection left him with headaches, dizziness, muscle weakness and pain, sound and light sensitivity, and a general sense of being worn down that was exacerbated by exercise – which he soon had to stop altogether. Socializing was the next activity to go as he buckled down to focus on getting through graduate school.”
The article goes on to talk about all of his various visits to specialists and how nothing seemed to work. In fact, he continued to decline in health all of the way to the point that he was essentially bedridden with little to no tolerance for any kind of exertion. We’re talking little energy to chew food and being wheeled into the bathroom to take a shower. Serious stuff.
Turning his head one way could cause him to nearly lose consciousness and he felt a little like a bobble doll when he walked. His head felt heavy.
Doing his own homework to try to basically save his own life, he stumbled across craniocervical instability, aka atlantoaxial instability, aka cranial-cervical syndrome and things started to make sense for Jeff.
Here’s another quoted paragraph from the article, “The strange headaches, the heavy head, the problems turning his head in one direction, the autonomic nervous system issues – they could all be explained by loosened or lax ligaments at the junction between his skull and his vertebrae which kept his head properly situated atop his body.
With his head destabilized, his spinal column was contacting and compressing his brainstem – throwing his autonomic nervous and sensory systems out of whack. His ANS had become so disturbed that even during sleep when it theoretically should have been mostly at rest – it was oscillating up and down causing bizarre heart rates.”
Craniocervical instability has been associated with conditions like rheumatoid arthritis, Ehlers Danlos Syndrome, Downs Syndrome, and other inflammatory conditions. The doctors were dismissive that, outside of any of these conditions, that he could actually have it.
Just to expound on Ehlers Danlos a bit, one in 15 of EDS patients have craniocervical instability. 1 in 15 is a pretty good amount. Just another good reason to familiarize yourself with the Beighton scale and see if your EDS patients have other issues like we’re discussing here.
It seems the correct imaging for CCI is a dynamic CT scan with flexion and extension view but not everyone can get dynamic CTs can they? I believe flexion and extension x-rays can give you a hint as well.
So, skipping to the end of the story, Jeff had a fusion of the top two vertebrae to his skull and all symptoms poof disappeared. Which is awesome and good for him for diagnosing his issue and for being an advocate for himself. Those medical doctors can be a bit pesky when you go against what they think.
The article also says there are only a few neurosurgeons in the world that can perform this sort of fusion. I sent the article to another friend of mine who just happens to be a neurosurgeon himself. He said that the whole article was really interesting and he was glad I sent it but he was confused why they think that there are only a few in the world that can do this surgery. He said they have to do it all of the time but, admittedly, it’s because of trauma. Not CCI.
Still, it seem this is a surgery most neurosurgeons can do if needed.
Great article, and great story that I’m linking in the show notes for you so click on it and check it out for yourself. There is a ton more with differenct patient stories so give it a read through. It’ll make you better.
https://www.healthrising.org/blog/2019/02/27/brainstem-compression-chronic-fatigue-syndrome-me-cfs-fibromyalgia-pots-craniocervical-instability/?fbclid=IwAR2-w_HO_DIVRbCD3OdcuUi-5ioUyKDM_5Fq1Bir_WlXkX8w2kykMoef6ro
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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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
That’s Chiropractic!
Store
Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly.
If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders.
Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it.
Contact
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
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About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography
Azad TD, V. D., Bentley J, (2019). "Initial Provider Specialty Is Associated With Long-term Opiate Use in Patients With Newly Diagnosed Low Back and Lower Extremity Pain." Spine 44(3): 211-218.
James G, K. D., Millecamps M, (2019). "ISSLS Prize in Basic science 2019: Physical activity attenuates fibrotic alterations to the multifidus muscle associated with intervertebral disc degeneration." Euro Spine J 28(5): 893-904.
Johnson, C. (2019). "Could Craniocervical Instability Be Causing ME/CFS, Fibromyalgia & POTS? Pt I – The Spinal Series." Health Rising
CF 082: w/ Dr. John Van Tassel - Florida State Athletics, Mentoring, & Life/Work Balance
Today we’re going to talk with one of the neatest gentlemen I have had the honor of interacting with in the last couple of years. You are absolutely going to love this conversation with Dr. John Van Tassel from Tallahassee, Florida about being a chiropractor for a Division I college. You just wait, you’ll see what I mean.
But first, here’s that sneaky like a Florida gator bumper music
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OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have slithered right into Episode #82. When you have a guest from Florida, you think of gators and snakes. And Pablo Escobar and Miami Vice but we try to not get too under the table here on the Chiropractic Forward Podcast.
Before we hop into the episode, let’s talk about GoChiroTV. GoChiroTV is a patient education system for your office that will eliminate the need for running cable TV or the same DVDs over and over again in your waiting room. The bite-sized videos are specifically made to inform your patients about the importance of chiropractic and healthy living, encourage referrals, and present the benefits of all the different products and services you offer.
It works by using a tailored-fit video playlist that will only promote the products and services available at your practice, and the videos are replaced automatically on a weekly basis. There’s no need to manually update your playlist or learn any complicated software. You truly can set it and forget it.
Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription.
So visit GoChiroMedia.com (that’s g-o-c-h-i-r-o-m-e-d-i-a-.com) to check out the demo reels, and to get started on your free trial. Take you practice to the next level with GoChiroTV.
Introduction
We’re here to advocate for chiropractic while we also make your life easier using research and some good solid common sense and smart talk.
Go check our evidence-based brochures out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you?
How about the previous two episodes we did with Dr. Anthony Nicholson on Chronic pain? That was basically a mini-masterclass folks. I hope you know that. If you know nothing of any substance about chronic pain, the previous two episodes are your starting points.
You have to listen to me here. Just go listen. Thank me later. He is the Niagara Falls of knowledge nuggets folks.
In personal happenings, my family experienced some unpleasantness this past weekend. My 7 year old blue European Great Dane passed away. We got the Euro Dane because they are supposed to be heartier than their American Dane counterparts.
They think she developed some sort of tumor that zapped her weight, had her dehydrated, and just unable to walk or do anything. Not cool. It was the opposite of anything fun but, she’s not suffering and that’s the best you can ask for on that sort of deal.
Now on to our special guest today. INTRODUCTION
He is a heck of a communicator. Any discussion I have seen him take part in on the Forward Thinking Chiropractic Alliance Facebook page….he’s the most thorough, most sensible, most sage-like if you will. I’ve even sent him patients all the way from where I sit here in Amarillo, TX.
He’s the Yoda of chiropractors and I love reading his stories. If someone asks him a question, he doesn’t respond with a paragraph. He sits down and really thinks about it, considers it at length, and then responds with about a 5 paragraph guidance manual and I love it.
Not to mention the fact that he’s one of the most accomplished you’ll find in any group anywhere.
All of that is personal experience and fine and dandy but how about we give him an official introduction?
- Graduating from Logan College of Chiropractic, Dr. John Van Tassel has been a chiropractor since 1991 and is the owner of Athletic and Family Chiropractic in Tallahassee, Florida.
- He has been an adjunct professor at Tallahassee Community College and Florida State University.
- He has been the FCA Sports Council Doctor of the Year
- The ProSport Chiropractic Doctor of the Year for the Southeast Region
- And has been a contributing author in various publications
What really gets one’s attention about Dr. Van Tassel is that he is the team chiropractor for the Florida State Seminoles. A perennial powerhouse of anything athletic in the SEC.
We’re going to talk about all of it and you’re going to be fascinated so here we go.
Let’s welcome to the show, the pride of Tallahassee, Dr. John Van Tassel. Thank you so much for taking the time out of your schedule to be with us today.
Let’s start with a little humor. The first thing I want to know is…..what in the heck is up with Florida? There was even a Facebook game going around for a while where you just Google your birthday and the words “Florida man…” Lol. Are Floridians just inherently crazy?
Tell me….we all have a story that got us where we are. I always like to ask this question because chiropractic is a bit of a niche choice when choosing a career. What was your story toward being a chiropractor?
Now I noticed you’re originally from North Carolina. Why the move to Tallahassee.
We became acquainted either through the evidence based chiropractic group or the forward thinking chiropractic alliance group. I can’t remember which but one of them for sure. They’re great groups. You’ll find people that are bull-headed that it’s their way or they scoff at you but that’s with any group really. Mostly….overall….they’re very friendly, very helpful, and very giving people. Giving of their experience and information as well as giving with their assistance should you need something.
I always encourage anyone that considers themselves on the evidence-informed spectrum of the profession to join both groups. I learn SOMETHING from each of them just about every week.
With that being said, I think you’ll agree that you are one of the more active members of the FTCA. Tell me about how you got involved with the Forward Thinking Chiropractic Alliance and what keeps you coming back daily.
One of the things that obviously sets you apart from the run-of-the-mill chiropractor is your involvement with Florida State. Let’s start at the beginning and just talk about that for a bit. How did you get started with a D-I program? Was it a specific certification that moved you in that direction? What’s it like day to day, month to month, and year to year? And has it morphed through the years?
In our preparation for this episode, you mentioned that you enjoy mentoring younger practitioners. With that in mind, what advice do you feel is vital for someone just starting out trying to open or build their own practice?
Continuing with the mentoring theme, what do you find to be the important aspects of maintaining a healthy work/life balance?
You seem to have a unique ability to recall things. For example, I can’t remember what I had for lunch yesterday but you can recall happenings and conversations from 20 years ago.
I really think, and I believe most of the FTCA members would agree, that you have the best stories and should probably be working on your first book by now.
With that in mind, can you re-tell the one you shared yesterday about the carpal tunnel patient that went to the GP who basically told her you didn’t know what you were talking about?
Now, the reason I asked for that one specifically, is because you’re in an arena where you commonly interact with other practitioners from the medical field. Are you experiencing this sort of bias against chiropractic in that world as well? Why do you think MD’s still don’t understand what it is that we do?
One of my favorite stories of your was about your Wall of Fame down your hallway. I’m sure there are plenty of recognizable names on that but your favorite is Mrs. Jones. Someone nobody outside of your practice and her personal circle would know. Is that a story you would mind sharing with us?
I want to close with this because this may be something that people can really use as the key takeaway from our time together today.
I was reading one of your posts that went like this, “I was just thinking about something while A plumber unclogs my system at the house. I tell people, patients and students and athletes mostly, that desire and passion and determination are key. But it’s our habits that get us where we are going. We accomplish goals by developing habits.”
Now, I don’t know how a plumber brings to mind things like goals and habits but, I couldn’t agree more. What would you say are your core habits that have made the difference in your career?
This week, I want you to go forward with…..
Key Takeaways
Lead Magnet
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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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
CF 079: w/ Dr. Kris Anderson:
Today we’re going to be joined by a special guest Dr. Kris Anderson from North Dakota. Yes, North Dakota’s finest is here to tell us about some of the stuff he’s got shaking and there’s a lot of stuff shaking thanks to this amazing guy.
But first, here’s that silky satiny bumper music
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OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have collapsed into Episode #79
Introduction
We’re here to advocate for chiropractic while we also make your life easier using research and some good solid common sense and smart talk.
Store
Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. I just got in my first box. I started with the non-surgical spinal decompression brochures. I wanted them for myself and ordered enough to send you some too!
If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders.
Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it.
DACO
Let’s talk a bit about the DACO program. I’m still studying. Nothing sexy there. I will say that the second time through the material is really really valuable. At least for me it is. I forget so much. Especially being 46. Not only am I older and I don’t remember things at the level I once did, but I also think I’m undiagnosed ADD.
If I see anything shiny, man, I’m off in a completely different direction. When you have computers and phones dinging at you all the damn time, it’s tough. I have tried to minimize my notifications on the electronics. I’ve tried to keep my phone turned to do not disturb and all that good stuff. I can’t deal with all the racket when I’m trying to focus on something.
So, yes, the second time through, for me, is of high value.
Personal Happenings
If you hear something here that you really like and would like it in written form rather than spoken, just hop onto chiropracticforward.com, find the episode, and just scroll down to copy and paste it. If you’re using it for content or on your website for some reason, just be cool and give us some credit please. I’d sure appreciate it and I’m sure the researchers we discuss would too.
Now, let’s get ot our guest today.
Sometimes, we have doctors on as guests that not everyone knows. I think that if you do not know our next guest, you either should or will know him in due time. He is a mover and shaker in our profession and is really just getting started. Some people cannot be ignored and I think our guest is one of those. Without a doubt.
He is the current President of the North Dakota Chiropractic Association and was voted Chriopractor of the Year last year for the NDCA. That’s a pretty big deal.
He has worked on behalf of the State of North Dakota with payers, legislatyors, government agencies, and other healthcare and community stakeholders. We’ll be finding out more about that in a bit.
He has helped conduct research on safety as well on a smoking cessation pilot study.
He was part of a study team whose systematic review of manual therapy for pediatric patients was published in BMC Complementary and Alternative Medicine.
He treats part time as an employee of his local FQHC. Which stands for Federally Qualified Health Center. He’s their first chiropractor so I can’t wait to learn more about how that is progressing and what challenges he is encountering as he goes.
If all of that were not enough, he is currently the AMA RUC HCPAC ACA Alternate Advisor. Don’t feel bad if you don’t know what that is because I had to ask too. We’ll tell you about it. Some of it is super double top secret but interesting for sure.
He is also in the middle of a North Dakota Department of Health grant to help expand detection and management of hypertension within our profession.
Now….now do you see why we have him here with us today? You may or may not know the name Kris Anderson but I feel confident the entire profession is going to know who he is by the time he’s done leaving his dent on our profession.
We are happy to welcome Dr. Kris Anderson to the Chiropractic Forward Podcast today. Thank you for joining us today Dr. Anderson.
My first question for you is, “When the hell do you ever sleep?” You have a ton of stuff going on.
I noticed on your CV that you worked as a barista at Starbuck’s during your time at Palmer. I’m not sure how anyone can hold a job while going through chiropractic college but, is this a skill that has paid off for you? Do you have an espresso machine in your office?
When I go through your information, you are involved in so many things. For example, I see your are District 4’s representative for Clinical Compass, Delphi Panelist, Grantee from ND Dept. of Health, Committee member for Notrh Dakota State Board of Chiropractic Examiners, ACA, and on and on. Where does all of this stem from? I’ve never even considered district representative for Clinical Compass was even a thing. Lol.
We covered a paper you were part of back in Episode #68. In fact, that may be how we became familiar with each other. The paper was callled “Manual therapy for the pediatric population: a systematic review. It was in the BMC Complementary and Alternative Medicine(Prevost C 2019) just this year. I want to know all about it. How did you get involved with the team? Tell us a little about the process.
This study came out at just about the same time as the Australians and certain spots in Canada started dealing with attacks on their rights to treat pediatric patients woith chiropractic care. What amazing timing. First, are pediatric patients a significant part of your practice and secondly, what has been the reception globally in regards to the paper’s findings?
As you probably well know, Texas has been in quite a battle with our state medical association. You are clearly as deeply involved in your state’s association. What challenges are the North Dakota chiropractors facing in 2019?
Do you have any specific goals to work on as President of the North Dakota Chiropractic Association?
Tell me about the gig with the FQHC? Dr. James Lehman was on our podcast in episode #55 and he was discussing the FQHC’s and integrating. He felt integration into them would be helped by completing a specialization like the DACO or something like that. What is your opinion on that? How did you get involved?
What does your day at the FQHC look like?
Being the FQHC’s first chiropractor, what biases or other issues are you finding yourself having to address and navigate?
Tell us more about the grant you are in the middle of for the North Dakota Department of Health? How did it come about? What is the mission?
Let’s talk about alphabet soup….. AMA RUC HCPAC ACA Alternate Advisor. I promise, almost no person alive knows what all of that stands for so do us a favor and break it down for us and tell me what the purpose is. What’s the goal and how does it help chiropractors?
Those of us that have been active know the difference between being a member and being an active member. What has it meant to you both personally and professionally to not only be a member of your state association but to also be active in it?
When we are sitting in our offices in Amarillo, TX or in Grand Forks, North Dakota, Washington DC and the ACA seems far away and somewhat out of reach. What have you seen is an effective way to become active with the ACA on a national level?
What’s coming down the pike for you in the next 5 years and in the next 10 years? Where do you see all of your efforts headed. Or where do you hope they’re headed?
Thanks for joining us
There you have
Subscribe Button
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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Prevost C, G. B., Carleo B, (2019). "Manual therapy for the pediatric population: a systematic review." BMC Comp Altern Med 19(60).
CF 076: w/ Dr. David Graber - Chiropractic Technique, Chiropractic Gurus, Teaching
Today we’re going to be talking with Dr. David Graber from New Jersey. Parsippany, NJ to be specific.
But first, here’s that bumper music
Subscribe button
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have collapsed into Episode #…..
Introduction
We’re here to advocate for chiropractic while we also make your life easier using research and some good solid common sense and smart talk.
Store
Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly.
If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders.
Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it.
F4CP
We will be launching an athletes and opioids eBook toward the end of this month. It’s called A case for chiropractic disrupting the cycle of pain, prescriptions, and addiciton. I’m linking it in the show notes so go get and check it out.
https://www.f4cp.org/package/home/viewfile/whiathletes-and-opioids-ebook
DACO
Let’s talk a bit about the DACO program
Let’s get to our guest today. As I mentioned at the top of the show, we have Dr. DavidCF ep. 76 Graber with us today.
- Dr. Graber graduated from New York Chiropractic College in 1985 and got his Sports Diplomate in 1996.
- He is a fromer NYCC assistant instructor of diagnosis and technique.
- He developed and taught over 20 different post-graduate courses in Chiropractic technique and theory, and rehabilitation.
- He was voted chiropractor of the year in 2012 by the Association of New Jersey Chiropractors
- He is the charman of the ANJC council on technique and clinical excellence.
-
And he’s here with us today.
-
Welcome to the show
- Tell me about your journey into chiropractic
- Tell me about your journey into evidence-based chiropractic
- When did you start getting into speaking and giving presentations? How did that come about?
- I noticed a powerpoint where you taught cervical adjusting. After going through the powerpoint, how many ways are there to adjust a neck? Minus the techniques Rambo and Chuck Norris use of course : )
- You say you know how to suck at a technique. I don’t know anyone that wants to suck but, in order to avoiding sucking, you must explain.
- You mention the people that are publishing research and teaching courses on Chiropractic technique and how to approach them as if they were a financial planner. Can you explain that a little further for us?
- I can’t think of anyone better than you to ask this question of. I see so many polar opinions concerning this: with the rising popularity of the YouTube folks like Cipriano and Gregory Johnson, AKA - Ring Dinger - what is you opinion of the Y-axis adjustment? Is it as dangerous as some think?
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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
http://www.chiropracticforward.com
Social Media Links
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YouTube
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iTunes
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Player FM Link
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Stitcher:
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TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
http://traffic.libsyn.com/chiropracticforward/CF_076__w__Dr._David_Graber_-_Chiropractic_Technique_Chiropractic_Gurus_Teaching.mp3
CF 075: Chiropractic Residencies, Fat Cat Drug Dealers, Osteoporosis & Yoga, & Pain Science
Today we’re going to talk about chiropractic residencies, fat cat drug dealers, Osteoporosis and Yoga, and we’ll talk a bit about some pain facts. You’ll find something for everyone in this episode so just sit back and enjoy a cornucopia of tasty knowledge nuggets won’t you?
But first, here’s that bubbalicious bumper music
Subscribe button
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have skipped gleefully into Episode #75
Introduction
We’re here to advocate for chiropractic while we also make your life easier using research and some good solid common sense and smart talk.
F4CP
We has launched an athletes and opioids eBook called “A case for chiropractic: disrupting the cycle of pain, prescriptions, and addiciton.” I’m linking it in the show notes so go get and check it out.
https://www.f4cp.org/package/home/viewfile/whiathletes-and-opioids-ebook
DACO
Let’s talk a bit about the DACO program. I freshened up my info on BPPV recently while going back through the drills and reviewing the material. Did you know that 85%-90% of BPPV is caused by the particles drifting off into the posterior canal? Epley maneuver is the best technique to take care of it when in the posterior canal.
As a side note: If you want to sound smart, those particles are actually called otoliths until they move into a semicircular canal. When they do that, they become canaliths. Probably because they’re in a canal? Makes sense to me.
Epley Maneuver knocks out BPPV of the posterior canal in about 85% of cases. However, if it does not knock it out, start looking at the horizontal canal, 10% of the time, or check for the anterior canal. There are other head maneuvers to try for those different instances so you’ll have to get smarter at that point or refer to a specialist. When they’re in a different canal, they can get a bit nasty.
Personal Happenings
I have to tell you all that 2019 has been a bit of a freak year for growth around here. Absolutely crazy. April was a record-breaking month for me as you’ve probably heard me talk about in past episodes. We are looking at bringing on an associate to help us with the load. The thing you worry about is, “Is it a fluke and we slow down to the point that we don’t need the extra help and now I’m stuck with an associate?”
I don’t move into anything quickly without a lot of thought. But, even if it did slow up a bit, an associate should be there to help grow the practice rather than just take some heat off the owner, right? These are the thoughts keeping me busy at the moment. I’m sure I’m not the only one out there thinking them either.
If you have any comments or suggestions, shoot them to me at dr.williams@chiropracticforward.com and I’ll probably share them in a future podcast. That may be an interesting topic.
Let’s get to the good stuff
Item #1
Our first item is called “Establishing a residency program for a chiropractic specialty in a public hospital system: Experiences from Denmark” by O’Neill, et. al. and published in Journal of Chiropractic Education in April of 2019[1].
As you may guess, this one has to do with establishing a residency program for chiropractors in Denmark. Just as the title mentions. The paper describes experiences and lessons from a 5-year postgraduate, hospital-based residency program. 5 Years.
One word - two syllables - Day-um
Three pilot programs were done between 2009 and 2016. What they decided so far is that there needs some improvement to structure and content that they’re on the right track for sure. And…..wouldn’t you agree?
How much better would we be individually and as a group if we had a year or two of residency in a hospital setting? Our profession would be in a completely different space right now. That’s a guarantee I don’t mind making.
While I’m sure students aren’t quick to jump on the idea, just imagine the network you’d build while doing your residency. The connections. The learning going forward. The benefits of residency programs throughout the globe are endless.
I’d love to see our profession move in that direction sooner rather than later. I know a couple of schools have started this in American and I believe Canada but I’m not sure which ones and to what extent just yet. If you have that info, shoot it to me. I’d love to hear more about it.
Item #2
Let’s move on to a Fat Cat Drug Dealer - aka John Kapoor, the owner of Insys Therapeutics. His claim to fame? The first pharmaceutical boss to be convicted in a case linked to the US opioid crisis according to an article in BBC News[2].
“A Boston jury found Kapoor and four colleagues conspired to bribe doctors to prescribe addictive painkillers, often to patients who didn't need them. The former billionaire was found guilty of racketeering conspiracy for his role in a scheme which also misled insurers.”
“The court heard that Kapoor - who was arrested in 2017 on the same day President Donald Trump declared the opioid crisis a "national emergency" - ran a scheme that paid bribes to doctors to speak at fake marketing events to promote Subsys.”
Alright, there is more to the article but that’s good enough for our purposes. I have to say that it’s hard for me to get excited about someone going to jail for up to 20 years but I have to say, in this case, gimme a hell yeah, and amen, and why didn’t he get more time? Really, when you consider this dude contributed to over 72,000 opioid related deaths in one freaking year…..why isn’t he getting life in prison?
And this dude looks like a fat crypt-keeper. Like an unsavory Mr. Scrooge. He fits the part perfectly. I don’t know how anyone can get in this dude’s corner. Seriously. Terrible. Good riddance and if someone ever deserved to be worth 1.8 billion and then lose it and go to prison, it’s someone like this knucklehead.
I’m not against medication. Hell, I’m not even against opioids when absolutely necessary and with close oversight. Medication certainly has its place. But not when it’s done like this guy did it.
Good riddance and take out the garbage.
Item #3
This next item is called “11 Important Things To Know About Pain” written by Nick Efthimiou who is an osteopath. It was published on April 30, 2018 so just a little over a year ago….published in Integrative Osteopathy and cited in the show notes[3].
I mentioned a week or so ago that pain has really started to move into my head space in a way that it never did prior to going through the DACO program. Pain plays a big part in the DACO and, as a result, I find myself more and more fascinated with the topic.
I love the way the article suggests that we know more about pain typically than our patients know and it is hard to convey that information effectively so they suggest we use concrete language rather than abstract language, we use examples that relate well to us or the patient, and we repeat the key concepts until they stick with the patient so there’s no misunderstanding.
- Pain doesn’t equal tissue damage - He says this is the most important thing to understand about pain. He says there are countless examples of people experiencing tissue damage and not feeling any pain at all and vice versa.
- Pain is protective - Whether it is protective of an injured body part or protective of a threat to our brain’s concept of self pain is a biological process that is meant to keep us safe.
- Pain is produced by the brain and localized to the body - Our brains produce a conscious experience based on input from the sensory nerves. Nociception is “noise” from the body. Sensory nerves that respond to thermal, mechanical or chemical stimulation are constantly sending signals to the spinal cord. Most of this is blocked, because it is just that – noise. However, when when those nerves are stimulated to a greater degree – think an injury, or contacting a hot surface – then your brain becomes aware of the change to the noise levels. Your brain, not knowing exactly what is going on, will respond by producing pain, and will decide to protect the area where the increased nociception is coming from. To make matters even more complex, we can have pain in the absence of nociception – think of amputees with phantom limb pain
- Chronic Pain is Different To Acute Pain - Acute pain is usually a response to either a tissue injury or other immediate threat, it subsides as the injury or threat does. Chronic pain is the result of changes to the nervous system which make it more sensitive. This means the nervous system and brain become “hyper protective”, generating pain with little or no provoking stimulus. If something is wrong with the central control room, then everything linked to it (which is everything), can be affected.
- Recurrent pain and multisite pain are both forms of chronic pain - Both recurrent pain and multisite pain are forms of chronic pain, and need to be managed as such. Often multisite pain starts as a single site, and progresses to multisite, chronic pain.
- Pain is never simple, even when it seems so - Pain is not linear, as in this happened and now this hurts. It is emergent. An emergent process is when two or more things combine to form something that doesn’t share the properties of the things that make it up. Because of this, and all the invisible and unconscious factors that contribute to us experiencing pain, we can never say that pain is simple.
- Pain is not caused by “poor posture” weak muscles or being “out of alignment.” - It actually, many time, just the reverse. Poor posture is more likely caused by pain and poor posture is adopted as a defensive mechanism. Bam. That’s where I see minds exploding across our listenership. Kapow!
- Osteopaths (and other practitioners) don’t “fix” pain - When it comes to pain, the resolution lies within your own body and brain. Even pain relieving drugs can only work if you are in the right context – morphine doesn’t always help, while sometimes a placebo pill works better than the real thing. Pow. Snap. Kabam!
- Everything can “work” - There are claims from therapists, doctors and other kinds of healers about all kinds of treatments for all kinds of pain. It’s likely all of these people have numerous success stories to confirm that what they do works. This is not a bad thing at all. It is actually the goal of many therapies. The problem comes, when interventions are sold in misleading ways, i.e. they are sold as doing something unrealistic or impossible. Uhuh. I know some pretty whacky chiropractors. Of course let’s be fair. I know some wacky medical physicians as well.
- 10.Inflammation is a good thing - Inflammation is the body’s way of healing.Yes, it can be painful, but pain is a protective response. And you know what needs protecting? Injured tissues. That is not to say you need to completely rest an injured tissue by the way. It is simply saying that suppressing inflammation (particularly with drugs) can impair and delay healing. Stop with the ice. They also say though, chronic inflammation is not a good thing and should be managed differently than acute inflammation.
- How you live is more important than what you do - What is most important, particularly for sufferers of chronic pain, is living well, despite your pain. Healthy lifestyle habits contribute to healthy bodies and brains.
This stuff lines up with the DACO, it’s crazy. The folks that generated the DACO information, Dr. Anthony Nicholson and Matthew Long could have written this article. Word for word. In fact, before I got the end of the article and finally saw the name of the author, I emailed the article to Dr. Nicholson asking him if it was him that wrote it. Lol.
Item #4
One more very short one. This one is called “Soft tissue and bony injuries attributed to the practice of yoga: a biomechanics analysis and implications for management.” It was authored by Lee, et. al. and published in Mayo Clinic Proceedings in March of 2019[4].
Here’s the conclusion, “Yoga potentially has many benefits, but care must be taken when performing positions with extreme spinal flexion and extension. Patients with osteopenia or osteoporosis may have higher risk of compression fractures or deformities and would benefit from avoiding extreme spinal flexion. Physicians should consider this risk when discussing yoga as exercise.”
News you can use people. I do hope you enjoy the show as much as I enjoy bringing it to you. It’s a blast. Do us a favor and tell someone won’t you?
This week, I want you to go forward with these points:
- Establishing a chiropractic residency program for every school should be priority #1. For the school, the student, the patients, and the profession.
- Drug dealers usually get what they have coming to them.
- Chronic pain is a beast although it IS a fascinating beast.
- Don’t do any crazy yoga if you have osteopenia or osteoporosis.
Subscribe Button
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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography
-
O'Neill SFD, Establishing a residency program for a chiropractic specialty in a public hospital system: Experiences from Denmark. J Chiropr Educ, 2019.
-
Insys Therapeutics founder John Kapoor convicted in US opioid case. BBC News, 2019.
-
Efthimiou N 11 Important Things To Know About Pain. Integrative Osteopathy, 2018.
-
Lee M, Soft Tissue and Bony Injuries Attributed to the Practice of Yoga: A Biomechanical Analysis and Implications for Management. Mayo Clin Proc, 2019. 94(3): p. 424-431.
CF 074: Manipulation For Special Forces, Manipulation For Cervical Disc Herniation, Lazy Americans
Today we’re going to talk about how adjustments affect our special forces - pretty interesting stuff! We’ll talk about cerrvcial disc herniations and whether adjustments can help, and we will talk about lazy Americans. It’s a fascinating one today so don’t go anywhere.
But first, here’s that silky smooth bumper music
Subscribe button
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have collapsed into Episode #74. Bing bang boom, knocking ‘em down, one after another. We are doing more and more guest spots lately and have several guests set up to come on the show. You’re going to love them.
Some are known names, some are not but all are interesting and bring something unique to the table that we are able to learn and grow from. Keep coming back time and time again. You’ll see what I mean.
Introduction
We’re here to advocate for chiropractic while we also make your life easier using research and some good solid common sense and smart talk.
F4CP
Just to let you all know - the F4CP will be launching an athletes and opioids eBook toward the end of this month. It’s called A case for chiropractic disrupting the cycle of pain, prescriptions, and addiciton. I’m linking it in the show notes so go get and check it out.
https://www.f4cp.org/package/home/viewfile/whiathletes-and-opioids-ebook
DACO
We have been in the habit of discussing the DACO program weekly because I’ve been going through it. Well, I’m done with all of the hours so what do I tell you now? Am I supposed to tell you all about how I’m studying? That doesn’t sound very fascinating to me at all. In fact, that may be a cause for blood to leak from your ear holes.
Today, I’ll just talk very briefly about one of the courses I reviewed yesterday in going back over the material. It’s one I didn’t pick up on very strongly the first time. It had to do with disc herniations that were more up in the T11/12 or L1/2 area and how they can mimic other issues further down the line. It’s really interesting stuff but went into how a hyperreflex on a patellar reflex and numbness in the anterior part of the thigh or calf without associated pain should move our thinking to an upper motor neuron lesion which would mean it’s higher up.
Remember, the spinal cord ends at L1/2 right? You need to know this stuff because that sort of issue may mean immediate surgical consult.
Interesting stuff. I got it a little better the second time around. I’m better today than I was yesterday.
Also, in the Chiropractic Forward Group, I posted a graphic from Yokuhashi et al demonstrating common signs and symptoms of Thoracolumbar junction disc herniations. I also added a great Epley maneuver that is easy to perform as well as an easy classification flow chart for reviewing MRIs and classifying herniations.
It’s a private group so just go over there and request me to add you and, assuming you’re not crazy and curing cancer through your adjustments…..I’m happy to add you to the group.
Personal Happenings
If you hear something here that you really like and would like it in written form rather than spoken, just hop onto chiropracticforward.com, find the episode, and just scroll down to copy and paste it. If you’re using it for content or on your website for some reason, just be cool and give us some credit please. I’d sure appreciate it and I’m sure the researchers we discuss would too.
Item #1
Let’s get it rockin and rolling with a paper that one of my favorites is a co-author on. Lead author on this one is James DeVocht, then Robert Vining, Dean Smith, Cynthia Long, Thomas Jones and a previous guest with us here, yes - one of our favorites, Dr. Christine Goertz[1]. The superwoman of chiropractic research right there and will be a presenter at ChiroTexpo in downtown Dallas, TX June 1-9. I’ll be there, front row, with a smile. And maybe a drink. It depends on how early her talk is.
Anyway, this one is called “Effect of chiropractic manipulative therapy
on reaction time in special operations forces military personnel: a randomized controlled trial” This one was in BMC and published this year.
Why They Did It
Considering that chiropractic manipulative therapy has been reported to improve reaction time in some studies, and considering that reaction time can be vital for special forces military men and women, these authors were interested in if chiropractic treatment could be effective in improving reaction time for this type of patient.
How They Did It
- 120 special ops personnel were accepted into the study.
- This study was a prospective, randomized controlled trial so 60 in one group and 60 in the other.
- It was conducted at Blanchfield Army Community Hospital, Fort Campbell, KY
- One group received 4 treatments while the other received none over a two-week trial period.
- Assessments used were hand/foot reaction time, choice reaction time, Fitt’s Law, whole-body respponse time,
What They Found
No between-group statistically significant differences were found for any of the five biomechanical tests, except immediate pre- and post-changes in favor of the CMT group in whole-body response time at both assessment visits.
Wrap Up
The authors’ conclusion was as follows, “A single session of CMT was shown to have an immediate effect of reducing the time required for asymptomatic SOF qualified personnel to complete a complex whole-body motor response task. However, sustained reduction in reaction or response time from five tests compared with a wait-list control group was not observed following three sessions of CMT.”
OK, what’s the take-away and where does that lead research in the future. Here is a question, “We know chiropractic has immediate but somewhat unsustained effectiveness. So, what if they are regularly adjusted? As in 3-5 times a week for 4 weeks when compared to the other non-treatment group? Is it sustained longer then?”
If we know they’re going on a mission, and they are treated once a day, or even twice a day. What about athletes and their reaction times? Good stuff here folks.
I think there are a lot of interesting questions just waiting for an answer.
Item #2
Alright, moving on to cervical manipulation and cervical discs. There are two papers here so we will shorten it up and hit the highlights. Just the meat and taters please waiter, thank you.
The first is called …well, the title is so damn long we’re going to call it cervical disc herniation and a comparison between adjustments and nerve root injections. If they want to people to repeat the whole title, they need to make them a touch shorter.
You can look the full title up in the show notes for this episode. It was published in the Journal of Manipulative and Physiological Therapeutics in 2016 and authored by Cynthia Peterson, et. al.[2]
Why They Did It
They wanted to assess the outcomes for improvement, pain, and costs between nerve root injections and spinal manipulation.
How They Did It
104 patients w/ MRI-confirmed symptomatic cervical disc herniations.
52 had nerve root injections and 52 had spinal manipulative therapy.
Conclusion
Get this, the Improvement for manipulation vs. injection….manipulation in the subacute/chronic population showed 86.5% improvement while injections had 49%.
Next paper on this topic is from the same author, Cynthia Peterson, et. al, and is called “Outcomes From Magnetic Resonance Imaging–Confirmed Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulative Therapy: A Prospective Cohort Study With 3-Month Follow-Up”[3] It was published in October 2013 in Journal of Manipulative and Physiologics Therapeutics and it goes a sumpin like a this.
Why They Did It
The purpose of this study was to investigate outcomes of patients with cervical radiculopathy from cervical disk herniation who are treated with spinal manipulative therapy.
What They Found
Most patients in this study, including subacute/chronic patients, with symptomatic magnetic resonance imaging–confirmed CDH treated with spinal manipulative therapy, reported significant improvement with no adverse events.
Item #3
Lazy Americans - I’ll admit from the get go here. I’m lazier than I want to be and weigh more than I want to weigh. No doubt. I’m 46, I get to work at 8am and besides a two hour lunch, I leave at about 8pm. Working out doesn’t typically get the attention it deserves. But I can tell you this, it’s not because I’m sitting around idle playing video games so…..I feel better in making that clear. Lol.
This was an article from AP called “Americans getting more inactive, computers partly to blame[4].” It was written by April 23, 2019 so hot stuff here.
The highlights of the article are as follows:
- Americans spend almost 1/3 of their waking hours sitting
- Sitting time increased over the last 10 years by about an hour per day to the point teens are sitting for 8 hours a day and adults are sitting for 6 1/2 hours per day.
- By 2016, 50% of kids and adults spent an hour or more of leisure time on computers
- TV use was unchanged.
- U.S. activity guidelines released last fall say adults need at least 150 minutes to 300 minutes of moderate-to-vigorous activity each week, things like brisk walking, jogging, biking or tennis.
- Muscle strengthening two days weekly is also advised.
- Kids aged 6 through 17 need 60 minutes of moderate-to-vigorous physical activity daily.
OK, they have convinced me. It’s time to force myself to get busy walking, biking, and lifting some weights. I have everything already. It’s just the time and the energy that I need to figure out. But I’m working on it.
Do you ever feel like your practice owns you rather than you owning your own practice? Of course you do. It’s all about balance and I feel like I have none. I feel like its all work right now and, while that is a good problem to have, a good problem is still a problem.
April brought us a lot of blessings. It brought us about 80 new patients which is a lot for me. I’m used to about 50-55 new patients but 2019 has been a whole different thing. From December on, it hasn’t been a roller coaster. It’s been straight up and I can’t thank the Lord enough for the blessings but managing to treat them at a high level when it’s just me is most certainly a balancing act.
Luckily, the DACO course has provided me with some quick ways of evaluating things that I didn’t have before so I can move through new patients with efficiency. Spinal manipulation is a fairly quick and straight forward process. I have staff that walk them through the exercise/rehab portion. It’s not so much the treating.
I think the time suck is the communicating / connecting part of the deal. The questions, the idle talk that is meaningless but is vital to relationships. That is what takes up so much of the day. For some, coming to our office is the trip of the day or the outing of the week for them. It’s an event. And they want to experience it and chit chat and connect. And we better be on board for it with a smile and kindness.
Still, it’s time for me to start moving in a direction that lightens my load. That may look like raising prices or it may look like hiring an associate. I’m not sure. But I’ll know when I know. I don’t do anything by accident usually. I do a lot of homework. I ask around. Through my involvement with my state association, my network of advisers is vast and valuable.
So, I’ll keep you up to date on any happenings as far as all of that goes.
For now, let’s get to the message.
Subscribe Button
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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography
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DeVocht J, V.R., Smith D,, Effect of chiropractic manipulative therapy on reaction time in special operations forces military personnel: a randomized controlled trial. BMC Chiro Man Ther, 2019. 20(5).
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Peterson C, P.C., Hodler J,, Symptomatic, Magnetic Resonance Imaging–Confirmed Cervical Disk Herniation Patients: A Comparative-Effectiveness Prospective Observational Study of 2 Age- and Sex-Matched Cohorts Treated With Either Imaging-Guided Indirect Cervical Nerve Root Injections or Spinal Manipulative Therapy. J Man Manip Ther, 2016. 39(3): p. 210-217.
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Peterson C, e.a., Outcomes from magnetic resonance imaging — confirmed symptomatic cervical disk protrusion patients treated with high-velocity, low-amplitude spinal manipulative therapy: a prospective cohort study with 3-month follow-up. J Manipulative Physiol Ther, 2013. 36(8): p. 461-7.
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Press, A. Americans getting more inactive, computers partly to blame. WTOP, 2019.
CF 073: w/ Tim Bertelsman - Chiropractic Standards, Chiropractic Specialists, Importance of State Associations
Today we’re going to be talking with Dr. Tim Bertlesman about all kinds of things. Kind of like a discussion amongst friends where anything is really on the table but we’ll hone in a little on chiropractic standardization, chiropractic specialities, and our experiences working on the state levels for our respective state associations.
It’s going to be another great one that you’ll want to share with your colleagues but first, here’s that syrupy bumper music!
SUBSCRIBE
Introduction
We’re here to advocate for chiropractic while we also make your life easier using research and some good solid common sense and smart talk.
Store
Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly.
If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders.
Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it.
F4CP
We will be launching an athletes and opioids eBook toward the end of this month. It’s called A case for chiropractic disrupting the cycle of pain, prescriptions, and addiciton. I’m linking it in the show notes so go get and check it out.
https://www.f4cp.org/package/home/viewfile/whiathletes-and-opioids-ebook
DACO
Let’s talk a bit about the DACO program. Well, our guest today is intimately involved with the DACO here in America and, in fact, is the one that unknowingly got me into this whole thing.
I finished it. It’s all done. I’m just going ot start studying for the exams now. The first one will be on July 20th. If I come back from that one with my dobber in the dirt, then it didn’t go so well but we don’t plan on that happening.
Since our guest is a big part of it all, we’re going to leave the DACO talk there and meet him.
Our guest graduated from Logan College of Chiropractic in 1991. He then went on to get his CCSP there at Logan as well finishing those up in 1994.
In addition to the CCSP, he is a DACO, a Diplomate of the Academy of Chiropractic Orthopedists and is an instructor for their live hours. So he gets to travel around getting unsusepcting and impressionable docs involved in the DACO.
He is not only a member of the ACA and the Illinois Chiropractic Society, but is also a former President of the Illinois Chiropractic Society.
He is also, and maybe most-importantly, the co-founder of ChiroUp which has to be seen to be believed quite honestly. You can do that by going to ChiroUp.com. I’m a member and you probably will want to be as well.
Let’s get it started here. Welcome to the show Dr. Tim Bertlesman. Thank you for joining me today.
- 300 hours later - I want to thank you for getting me into this mess called the DACO. I’m blaming it all on you and Bill Lawson.
- Tell me about your journey into chiropractic
- From your CV, I see that you did the CCSP right out of school. What all have you done through that specific certification?
- Can you tell us the most striking difference between the two other than one is more geared toward sports?
- Tell me about your practice, what does it look like, who do you see mostly?
- Tell me about your journey into the DACO and what benefits you have personally realized from it.
- You and your business partner, Dr. Brandon Steele, do a great job at staying on top of the most current research. How do you do that? What are your sources?
- I want to hear a little about this friendly rivalry between you and Dr. Steele.
- Did you realize that when I put your name into a Google search to learn a little more about you that Bertlesman Chiropractic pulled up with Dr. Steele’s picture on it? I think his evil plan is beginning to come to fruition.
- When I had Dr. Steele on the show, we talked a bit about Standardization…as in making expectations more uniform for patients visiting chiropractic offices….. and we talked about Specialization such as through the DACO or the CCSP or CSCS. Can you share your thoughts on those two topics for us?
- Tell me about your involvement with your state association and what it has meant to you both personally and professionally
- What have you been able to accomplish or have you tried to accomplish legislatively? What struggles are the Illinois and Missouri chiropractors in the middle of these days?
- Tell me about chocolate cookies and sushi
- The Clinical Internship - Community Health Center
- Hospital externship at Deaconess Medical Center
-
I noticed a couple of things from your ‘About Me’ page on your website that I’d love to hear more about.
-
If people want to get more of Tim Bertelsman, what should they do? Where do they need to go to get their ‘fix’? I know you’ll be at ChiroTexpo in downtown Dallas again this year June 7-9. What else?
This week, I want you to go forward with…..
Key Takeaways
Lead Magnet
Subscribe Button
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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
CF 072: Kids Need A Rest, Chiropractic In Europe, & Exercise For Chronic Pain
Today we’re going to talk about a surgeon that says let kids slow down, the shape of chiropractic in Europe, how exercise affects chronic pain.
But first, here’s that bumper music
Subscribe button
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have collapsed into Episode #72
Introduction
We’re here to advocate for chiropractic while we also make your life easier using research and some good solid common sense and smart talk.
Store
Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly.
If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders.
Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it.
F4CP
We will be launching an athletes and opioids eBook toward the end of this month. It’s called A case for chiropractic disrupting the cycle of pain, prescriptions, and addiciton. I’m linking it in the show notes so go get and check it out.
https://www.f4cp.org/package/home/viewfile/whiathletes-and-opioids-ebook
DACO
Let’s talk a bit about the DACO program
Personal Happenings
If you hear something here that you really like and would like it in written form rather than spoken, just hop onto chiropracticforward.com, find the episode, and just scroll down to copy and paste it. If you’re using it for content or on your website for some reason, just be cool and give us some credit please. I’d sure appreciate it and I’m sure the researchers we discuss would too.
Item #1
“Noted surgeon Dr. James Andrews wants your young athlete to stay healthy by playing less” by Dennis Manoloff of the The Plain Dealer(Manoloff D 2013). It was posted back in February of 2013 so a little old but has been making the rounds here lately in the private groups and with several colleagues. And it’s right up our alley when you consider we are also trying to keep kids out of surgery.
Some highlights are when Dr. Andrews says they have worried for too long about patching people up rather than preventing the injury in the first place. Amen brothers and sisters.
When asked why kids are getting hurt more and more these days, he says there are really two factors. One being that kids specialize too much now and what he calls professionalism.
Specialization means kids are just playing one sport these days instead of being well-rounded athletes with a wide array of different activities and skills. When they’re only doing one thing and they’re doing it over and over and over…..well, that’s a recipe for surgery due to overuse.
He says ‘professionalism’ is taking these young kids that are 12 or 13 and working them like they are professional athletes with year-round training and activity.
Advice he would give parents that can help us guide our conversations with patients and parents was
- Use proper mechanics in any sport.
- Don’t play year round. Their kiddo needs at least two months off each year to recover from a specific sport. Ideally, 3-4 months.
Basically, sometimes we have to look at mom and dad and say, cut it out or a surgeon will be cutting something out.
I just made that up but you can use it if you like it. You don’t even have to give me credit for it unless you make money from it. Lol.
Alright, Item #2, comin’ through.
Before the DACO course, chronic pain (while it should have been) was not on my radar at ALL as far as something I was interested in and something I wanted to learn to solve. It sure it now though and this next paper fits right in.
It’s called “Exercise-induced hypoalgesia: A meta-analysis of exercise dosing for the treatment of chronic pain” by Anne Polaski, Amy Phelps, Matthew Kosted, and more(Polaski A 2019). It was published in January 2019 and I’ve cited it in the show notes.
Why They Did It
As more and more studies are showing the effects of exercise as a first-line treatment for “nearly all forms of chronic pain,” things like dosing for different treatment modalities has not been explored just yet.
What They Found
As you can deduce from the title, this was a meta-analysis.
They say in the abstract, “increasing the frequency of exercise sessions per week is most likely to have a positive effect on chronic pain patients.”
In the end, as is always a part of the conclusion, more research is needed but there is a modest effect.
Item #3
This one was in BMC Chiropractic & Manual Therapies in April of 2019. Hot stuff….comin up! It’s called “The shape of chiropractic in Europe: a corss-setional survey of chiropractor’s beliefs and practice(Gislason H 2019).” It was written by Halldor Gislason, Jari Salminen, Linn Sandhaugen, and other names I refuse to attempt at this time.
Why They Did It
Considering the ongoing split in the profession, the authors were looking to report an adherence to unorthodox descriptiions of chiropractic and the types of chiropractic practice in Europe.
How They Did It
They sent out an online survey amongst European chiropractors in 2017. They sent it out through social media and through the different membership associations.
What They Found
- They got back 1,322 responses back representing about 17.2% fo the profession.
- The responses were boiled down to fit into 2 different groups of practices.
- The two groups were categorized as orthodox and unorthodox.
- The orthodox group made up 80% of practitioners
- The unorthodox group made up 20%
Some Key Differences
- 23% of the unorthodox chiropractors x-rayed over 50% of their new patients while the orthodox chiropractors x-rayed only 5% of theirs.
- The amount of unorthodox chiropractors seeing over 150 visits per week was more than double the amount seen by the orthodox chiropractor.
- Then, of course, there’s info demonstrating how unorthodox hates vaccines while orthodox chiros are fine with them.
Wrap Up
They concluded by saying, “in parallel with other research, this survey suggests that key practice characteristics in contravention of national radiation guidelines or opposition to evidence based public health policy are significantly more associated with non-orthodox chiropractic paradigms.”
Now, what does that mean exactly? Well, for those of us on the evidence-informed end of the spectrum, it means that we are in concert with 80% of the profession in Canada and in Europe. From what I recall, about 80% of the profession in America is either evidence-informed or somewhere in the middle. Basically, agnostic.
It’s not my place to argue if subluxation is a real thing or is not a real thing because I believe people define it differently. My opinion, not research because there is none to my knowledge….but my opinion is that if one defines a subluxation as something that can be removed thus fixing cancer, infections, and things like that…..well, my opinion is that that definition puts you in the unorthodox category and puts you in the 20%.
That’s my opinion anyway and that’s worth diddly squat in the unorthodox community so, take as you may.
We can also discuss the x-rays. I honestly have no problems with initial x-rays. I realize that flies in the face of a lot of newer guidelines but I believe that we get gut feelings that don’t fit into the definition of a ‘red flag’ per se. You damn well better get x-rays on those deals.
I’d also say, if you have a history of x-raying every single patient that comes through the doors, that’s also putting you in the 20% that is defined as unorthodox and it’s also meaning that you’re considered an outlier.
Outliers MUST keep an eye out if you have contracts with insurance companies. If you’re going to be an outlier, you’d best be a cash practice. Whether it be right or wrong in your opinion, insurance companies do NOT like outliers and unorthodox practitioners. And, honestly, who can blame them?
If I’m writing a bunch of checks and I have 80% of the profession over here mostly following guidelines, seeing people a reasonable amount of visits, I’m going to be cool with that 80%. If I have 20% of guys and girls over here seeing people 100 times per year when they have absolutely zero pain and taking repeated x-rays through the year, well…..if I’m writing those checks, I’m going to have a problem with that 20% at least 100% of the time.
Do whatever you’re going to do but you should give at least SOME consideration to what I’m saying.
Subscribe Button
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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Gislason H, S. J., Sandhaugen L, (2019). "The shape of chiropractic in Europe: a cross-sectional survey of chiropractor’s beliefs and practice." BMC Chiro Man Ther 27(16).
Manoloff D (2013). "Noted surgeon Dr. James Andrews wants your young athlete to stay healthy by playing less." The Plain Dealer.
Polaski A, P. A., Kostek M, (2019). "Exercise-induced hypoalgesia: A meta-analysis of exercise dosing for the treatment of chronic pain." PLoS One.
CF 071: w/ Dr. Anthony Nicholson - Medical Referral, Chiropractic Specialization, Chiropractic Standardization (Part 2)
Today we continue with Part 2 of our interview with Dr. Anthony Nicholson all the way from Australia talking about medical referral, chiropractic specialization, and chiropractic standardization. I’ll tell you more about him in just a minute but Dr. Nicholson is a fountain of knowledge nuggets as I said last week. Don’t go anywhere. This is about to get good.
First, here’s that ‘so glad you stopped by’ bumper music
Subscribe button
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have cavorted right into Episode #71 and we are so glad you did.
Introduction
We’re here to advocate for chiropractic while we also make your life easier.
Store
Part of doing that is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly. We are still getting some kinks worked out right now on the shipping and handling.
If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders.
Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it.
DACO
We won’t go in too deep on my latest DACO endeavors because we have Mr. DACO teacher with us again this week. Again, the DACO stands for Diplomate of the Academy of Chiropractic Orthopedists. I will say quickly that I have completed the Pain In The Frame symposium part of the course and it was probably my favorite.
Also, I’m only 29 hours away from finishing at this point. It’s all gravy now folks as I’m back onto the Communication Drills which go fairly quickly and easiy
I covered this in Part 1 last week but, for those that don’t know anything about this Aussie from down under or why we would be having him on the Chiropractic Forward Podcast, let me take a minute to introduce him again properly.
Dr Anthony Nicholson is the CEO of Chiropractic Development International (CDI), a global continuing education organization for chiropractors that he co-founded in 2002. CDI’s innovative online learning technology has led to formal accreditation in over 35 states in North America, along with a growing learner base in the UK, Europe and South East Asia. CDI provides 250 hours of advanced online clinical training for the Neuromusculoskeletal Medicine Program offered by the University of Bridgeport in Connecticut and had developed an online board examination for the Academy of Chiropractic Orthopedics.
As a partner of Spine Partners Wahroonga in Sydney Australia, Dr Nicholson is also a full-time chiropractic physician in private practice, is a board certified chiropractic neurologist (DACNB) and is board certified in Chiropractic Orthopedics (FACO).
In addition, he is an adjunct senior lecturer in Neuromusculoskeletal Diagnosis and Evidence-based Practice at Macquarie University ion Sydney’s north shore.
He is outstanding and was put on this Earth to be an educator so sit back and get some education as we get into Part 2 of our interview all the way from Australia!
- Before we get into what your company, CDI, is….let’s talk about why you think it’s important to specialize or get credentialed. I know it’s important. You know it’s important but, you just might say something in the exact way that resonates with someone on it so I wanted to hear your thoughts on it rather than simply assuming.
- For those that don’t know what CDI is, can you give them a bit of a description and tell them what you do and maybe even what the mission is? What is the International Neuromusculoskeletal Medicine program
- I have told listeners there are different types of learning through the CDI platform. There are eLearning courses, Diagnostic Drills, Communication Drills, and then Pain in the Frame and another on Dizziness. What would you like to add as far as the courses you offer go?
- How did the idea of CDI get started and can you tell me a bit about your business partner in CDI, Dr. Matthew Long?
- How did it evolve into being a part of the DACO program globally?
- Have you done any of your own research or are you thinking about doing some of your own studies?
- What do you do with all of the DACO’s that you guys are building? Have we thought of some way to use them collectively?
- Do we know how many DACOs or DABCOs are running around out there in the world?
- What is next for CDI and what is the ?
- Do you feel that our profession’s standardization will ever be an attainable goal? I have a hard time seeing how the two sides of the profession can ever meet. What do you think our profession will look like in another 15-20 years?
- An interesting question I’ve seen 2 or 3 times recently online in different groups: since you and Dr. Long are so well-spoken, I’d love your thoughts on it. If evidence-based chiropractors are mostly focused on resolving musculoskeletal pain, what then makes us any different than a physical therapist?
- Where do people find you online?
- Do you ever travel to the US to do talks or seminars?
Thank you so much for taking time out of your day to join us. I hope our listeners got as much use out of our talk as I did. It’s groups like the CDI and specialization programs like the DACO that are helping put chiropractors where we should be.
Thank you for everything you’re doing.
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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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
http://www.chiropracticforward.com
Social Media Links
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Chiropractic Forward Podcast Facebook GROUP
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YouTube
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iTunes
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Stitcher:
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TuneIn
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About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
CF 070: w/ Dr. Anthony Nicholson - Medical Referral, Chiropractic Specialization, Chiropractic Standardization
Today we have a very special guest on the show talking about medical referral, chiropractic specialization, & chiropractic standardization. I’ll tell you more about him in just a minute but Dr. Anthony Nicholson will be joining us all the way from Australia folks. And boy is he a fountain of knowledge nuggets. This is going to be an excellent show so don’t you go anywhere. Just keep your seat.
First, here’s that ‘yummy like taffy’ bumper music
Subscribe button
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have beamed yourself right into Episode #67 just like Captain Kirk all dashing and daring.
Introduction
We’re here to advocate for chiropractic while we also make your life easier.
Store
Part of doing that is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly. We are still getting some kinks worked out right now on the shipping and handling.
If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders.
Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it.
DACO
On the DACO this week, I’m going to tell you that I started the masterclass called Pain In The Frame and I am absolutely fascinated with the information. But, we are not going to talk about my specific experiences on the DACO right now because our guest today is one of the creators of the entire online education program. In fact, when I’m taking the online classes for Pain In The Frame or the eLearning video series, our guest is the one in the videos doing all of the talking and all of the teaching!
I need to go a little more into his history here before we bring him on the show.
Dr Anthony Nicholson is the CEO of Chiropractic Development International (CDI), a global continuing education organization for chiropractors that he co-founded in 2002. CDI’s innovative online learning technology has led to formal accreditation in over 35 states in North America, along with a growing learner base in the UK, Europe and South East Asia. CDI provides 250 hours of advanced online clinical training for the Neuromusculoskeletal Medicine Program offered by the University of Bridgeport in Connecticut and had developed an online board examination for the Academy of Chiropractic Orthopedics.
As a partner of Spine Partners Wahroonga in Sydney Australia, Dr Nicholson is also a full-time chiropractic physician in private practice, is a board certified chiropractic neurologist (DACNB) and is board certified in Chiropractic Orthopedics (FACO).
In addition, he is an adjunct senior lecturer in Neuromusculoskeletal Diagnosis and Evidence-based Practice at Macquarie University ion Sydney’s north shore.
On a person note, I can tell listeners of The Chiropractic Forward Podcast that, if they do indeed sign up for the DACO program through the University of Bridgeport like I’ve been telling them to, and they use the CDI online group to get through it, when they get to the portions that are video based, our guest, Dr. Anthony Nicholson, is the one in the videos being smart and teaching you all of the stuff you need to know. I feel like I already know him just from watching his videos.
So with that said, here we go,
Welcome to the show today, Dr. Nicholson, I’m so glad to have you with us all the way from Australia.
- I need to know something before we get going here. What’s the weather like in Sydney Australia? Do you guys ever really have what you’d consider a Winter like we have here in the US?
- Also, there is an internet myth here in the US about Australia and I want to know if you’re ready to debunk it right here, right now. The myth being that the water goes down the opposite direction when the toilet is flushed in Australia as opposed to what we are used to here in America. Lol. It has to be in the design of the bowl, right?
- Tell me about chiropractic in Australia. How does it differ from places like the US or the UK?
- How long have you been a chiropractor?
- How did you first start to enter into the evidence-based chiropractic realm or were you there from the beginning?
- Tell us what your practice looks like from day to day? Who do you typically see?
- Where do your referrals typically come from and how did you foster that referral source in the beginning?
- How do you continue to foster that referral source today?
Subscribe Button
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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Today we’re going to talk about a risk vs. benefit assessment strategy to exclude Cervical Artery Dissection and we’ll talk about de-legitimizing complementary medicine. We’ll have some fun and maybe even get a little worked up.
But first, here’s that sweet sweet bumper music
Subscribe button
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have crumbled into Episode #69 .I have to tell you that I had a friend razzing me saying I need to change the bumper music. He knows that I’m a musician and that I wrote the music, played all of the parts on the bumper music, and recorded it. It’s nice, if you’re going to create a podcast, if you don’t have to pay someone for the bumper music. Lol. He needs to get used to the bumper music because it’s not going anywhere unless I write and record another one somewhere down the road.
Introduction
Moving on….We’re here to advocate for chiropractic while we also make your life easier using research and some good solid common sense and smart talk.
Store
Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly.
If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders.
Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it.
DACO
Let’s talk a bit about the DACO program. I’m down to my last 39 hours and it’s feeling pretty good. The stuff I have learned having to do with the way we communicate with a patient….what effect that has on a person and their tendency for chronic pain is fascinating. I don’t want to nerd out too much on you right now but, as you probably know, we have little muscle spindles (also known as motion detectors) in all parts of our body. They help us know where our limbs are or how we are oriented in the three dimensions.
OK, so we have 16 little motion detectors per gram of muscle in our fingers. OK, 16 per gram in our fingers. Remember that. We’re pretty good with knowing where our fingers are without paying attention to them right? Think about typing for example.
We only have 2 motion detectors per gram of muscle in our traps. Not very many.
Now consider that we have 242 little motion detectors per gram of muscle in the deeper intrinsic muscles of the upper cervical spine. That’s an insane amount when compared to other areas of our body wouldn’t you agree?
There are so many….to the point that anatomists are looking at these upper cervical muscles as a receptor organ as much as they look at them as muscles. When you consider you get your balance, sensorimotor function, all the way down to how your individual vertebrae move atop each other based on how your upper cervical spine takes in proprioceptive information and translates that into subconscious muscle functions like posture……One word……two syllables…..Day-um. Daaaayum.
Personal Happenings
If you hear something here that you really like and would like it in written form rather than spoken, just hop onto chiropracticforward.com, find the episode, and just scroll down to copy and paste it. If you’re using it for content or on your website for some reason, just be cool and give us some credit please. I’d sure appreciate it and I’m sure the researchers we discuss would too.
Item #1
As many of you have probably heard, a very popular yoga instructor was holding an odd pose some time ago and caused herself to suffer a tear in an artery in her neck which led to a stroke. She’s fine now so thank goodness. Her story has been circulated a bit and, unfortunately, ABC’s Good Morning America decided to bring chiropractic into the spotlight on the deal. Which is total and utter BS.
Anyway, they went into the whole Kate Mae debacle and that the LA coroner laid the blame on the chiropractor for causing it when we know that the most common cause of cervical artery dissections is traumatic onset. And we also know that Katie Mae had a bad fall at a photo shoot before going to the chiropractor.
From my understanding of the case, the chiropractor didn’t cause that stroke. He didn’t help it but he damn sure didn’t cause it.
If you want more…..as in a lot more,….please go listen to Episodes #13, 14 and ,15 of this podcast. They will line it all out for you in common sensical, magical, reasoning. You’re going to love it.
If you don’t know the research that shows the benefits for cervical manipulation vs. the almost zero risk, well then you need to listen to those episodes and I’ll link them in the show notes so you can find them easily. 13, 14, and 15 just go listen to them and learn how to back up your positions if you’re ever questioned. Please.
That leads us into this first one called “A risk-benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: A comprehensive review” by Aleksander Chaibi and Michael Bjorn Russell[1]. It was published in the Annals of Medicine in the December edition 2018.
https://www.tandfonline.com/doi/full/10.1080/07853890.2019.1590627
Introduction
They start out by saying.”Cervical artery dissection refers to a tear in the internal carotid or the vertebral artery that results in an intramural hematoma and/or an aneurysmal dilatation. Although cervical artery dissection is thought to occur spontaneously, physical trauma to the neck, especially hyperextension and rotation, has been reported as a trigger.”
Since manual and manipulative therapy are common treatments for headache and neck pain, which just so happen to be the most prevalent symptoms of cervical artery dissection, the authors aim of this review is to provide an updated step-by-step risk-benefit assessment strategy regarding manual therapy and to provide tools for clinicians to exclude cervical artery dissection.
They say that cervical mobilization and/or manipulation have been suspected to trigger artery dissection but this is based on case studies (low level research) that are unable to establish direct causality.
They relate to the ‘chicken and the egg’ discussion as to what came first; the artery dissection or the manipulation? So, instead or proving a nearly impossible causality hypothesis, this paper aims to provide clinicians an updated step-by-step risk-benefit assessment strategy tool in order to
- raise our understanding of cervical artery dissection
- understand the risk and applicability of cervical manual-therapy
- give us clinicians tools to better detect and exclude the condition.
I’m all about this. We almost never…almost never are the actual cause of an artery dissection. Our deficit is not recognizing it when it comes in, adjusting the region and APPEARING that we caused it. THAT’S our big issue. Perception. Not causality.
This is a fairly lengthy paper so we are going to continue just hitting the highlights and the more interesting aspects of it without getting pulled down into too many stats and minutiae. There’s that word again. Take it. Use it. Love it.
They say that headache and/or neck pain are the most common initial symptoms while other symptoms are Horner’s syndrome and lower cranial nerve palsy. The headache, understandably, is a new headache. New onset. And it’s unilateral. Why would you have it on both sides when there was only one artery dissection?
The headache has a sudden onset and the time from headache onset to stroke can be from a few minutes to a few weeks. Which is scary as all hell. That’s what my teenager calls ‘Nightmare Fuel.’
Headaches and neck pain are two of the biggest reasons patients seek out care at our clinics, I think you’ll agree. And, although these are thought to occur spontaneously, physical trauma to the neck (especially traumas involving hyperextension and rotation, are highly suspect for triggering one.
They say, considering it’s happening and people are coming to us with it happening, it’s sort of really really important that we are able to catch the red flags. Especially considering what can happen if we miss them.
By the way, this isn’t a ‘Scared Straight’ kind of episode. I hate when gurus try to sell their products by trying to scare the holy hell right out of you. That lights me up every time. If I’m in a seminar and some dope starts a diatribe about how offices that aren’t listening can lose their entire practice and thousands and blah blah blah. If I’m in that class, I get up and show them my backside as I exit.
The HIPAA gurus are the worst aren’t they? They have to ready to leave and jump off a cliff if you don’t hire them for $10,000. It’s stupid and a good way to slip a vulnerable person into depression. Nope, that’s not what we’re doing here.
First, I’m not selling anything. Unless you love my office brochures. But that’s just to make life easier. Nothing bad happens if you don’t want them. Lol.
Second, this is a message of ‘Hey, looky here….we get some scary stuff coming in to our offices here and there, and…..if you’ll just pay attention for a little bit here, we may help you keep people safe and get them the help they really need.”
That’s all
OK, continuing on: One big thing you have to remember is that the World Health Organization regards annual mobilization and/or spinal manipulative treatment conducted by chiropractors to be a safe and effective treatment with few, mild, transient adverse effects. The adverse effects being local soft tissue tenderness and tiredness on treatment day, maybe some muscle soreness, things like that.
There is no strong evidence at all that spinal manipulative therapy is the culprit.
When describing the internal carotid artery and the vertebral arteries, this statement about the vertebral arteries really jumped out at me. They said, “the vertebral artery is thought to more susceptible to injury due to extreme rotatory head movements, especially in the transverse foramen of the first cervical vertebra.”
You guys and gals out there using rotation in your cervical adjustments….I think there’s an argument to be made here. Can you get the same effect in your patients by doing away with the rotation-based adjustments and going more to extension/lateral flexion type maneuvers like a Diversified cervical break for example? The answer is yes by the way. You most certainly can get the same effect.
A big difference from regular neck pain is that when a dissection is present the pain is typically sudden, sharp, severe, steady and described as being different from prior neck pain experiences. In general it’s describes as throbbing (remember - it’s vascular), it can be said that it’s pounding, pulsing, and beating.
Compared to descriptions for purely musculoskeletal complaints which can be described as aching, sore, heavy, hurting, deep, cramping, or dull. There are pretty stark contrasts between the two.
Also, in general, musculoskeletal pain can be reproducible or provoked or diminished. You can change it basically. Whereas, with a vascular event, you cannot change it. Vascular events aren’t changed by using analgesics either. In Vertebral Artery Dissection specifically, the pain will often progress to the occipital area and medially along the nuchal line.
The paper highlights the need for a good History to be taken on the intake. Certainly regarding the time of onset.
- Any recent trauma? (I added that one)
- Was there a recent acute respiratory infection?
- Hyperhomocysteinemia such as Vitamin B6, B9, or 12 deficiency?
- Is there a low body mass index and low cholesterol history?
- Is the patient a smoker?
- Do they have pulsating tinnitus?
- Any connective tissue disorders like Ehlers-Danlos type IV, Marfan’s, Osteogenesis Imperfecta?
They state that a dissection presents to a chiropractic office at a rate of 1 time per 8.1 million patient encounters.
The paper mentions an interesting paper we’ll have to look up and cover. They say no serious adverse events were reported in a large prospective national survey conducted in the UK that assessed all adverse events in 28,807 chiropractic treatments which included 50,276 cervical spine manipulations. Hell yeah.
It’s just nice that the further into research you get, the more and more you find in favor of chiropractic. It is so rare that you see conclusions saying things like, “spinal manipulative therapy had no effect.” You just don’t see it usually.
As part of their conclusion the authors make a recommendation that I will echo gladly, enthusiastically even.
They say, “Although the chiropractic profession evolved in the early nineteen hundreds as an art, philosophy, and science, neck manipulation should not resemble a martial art. Thus, when cervical manipulation techniques are being conducted, one must be specific when manipulating a single spinal segment, minimizing the end range in cervical techniques, especially rotational techniques, and minimizing force, all of which have been recommended to reduce the risk of serious AEs.”
Now, with many of your EHR software programs, you can set up your own macros. So I did. About a year ago. If I even sniff a dissection, They get the interrogation.
Here’s how the interrogations starts, I hammer nails up under each finger nail and ask them why they’re in my country and what are their plans to destroy my government? That’s not true. Nobody would come see me after word got out that I really work for the CIA. Lol
OK, seriously, here’s how it goes in my office. I took these directly off of my macro:
- First, I check all upper arm strength
- Then sensation side to side including the face
- Can they raise their eyebrows?
- Is there any difference in the size of the pupils?
- Nice, even smile?
- Have them stick their tongue out….does it deviate to one side or the other?
- Cross your hands and grab their hands like a double hand shake and have them grip your hands equally and see if there’s a difference.
- Have them shrug both shoulders and resist gentle pressure downward on the shoulders.
- Do they have a headache that came on suddenly and can be sharp or throbbing?
- Do they have a headache that gets worse when they lay down?
- Do they have difficulty speaking or swallowing?
- Do they have any visual abnormalities?
- Do they have unsteadiness or lack of coordination beyond what they would consider normal?
- Do they have a recent onset of hiccups?
- Are they having recent onset of pulsing tinnitus?
- Do they have any nausea and/or vomiting?
- Does the patient have signs of nystagmus?
- Are there any other neurological symptoms present?
- How about light-headedness, fainting, disorientation, or disturbances in ears, tremors, or sweating?
I originally planned on covering four papers this week but the stroke issue is just such a big deal, I chose to go a little more in depth so we’ll put those other papers on the back burner for now but we will get to them.
I will briefly cover one more very short little finding that ties in to this. It’s called “De‐legitimizing complementary medicine: framings of the Friends of Science in Medicine‐CAM debate in Australian media reports” It was written by Monique Lewis[2] and published on the 21st of February 2019 in Sociology of Health and Illness.
The abstract starts by saying that complementary and alternative medicine has developed into a a complex and formidable commercial, sociocultural and political force in Australia, and given it’s influence, it is a relevant subject for scholars, health practitioners, health communicators, journalists, policy-makers, and consumers of healthcare products and services.
This paper considers a newer group in Australia called Friends of Science in Medicine which is an activist group of medical practitioners, researchers, and scientists.
This paper searched for articles mentioning this group and then measured the patterns and frequencies of media frames, intonation, and sources that are featured in Australian mainstream news.
The negative headlining and intonation of reports predominated, along with framing Complementary and Alternative Medicine…..AKA….US…as a lucrative, undisciplined, and unethical industry as well as an illegitimate healthcare approach.
The findings of the paper also offer findings into how journalists respond, replicate, or reconstruct the framings that are provided by an influential and elite group of medical practitioners and scientists, and readdresses issues surrounding the need for more critical health reporting in Australia.
OK…..let’s give the friends of science in medicine some credit where it is due can we? Are we and other CAM providers lucrative? Good Lord, I sure as hell hope so. I have a family and a couple of knucklehead kids to send through college. That ain’t cheap, folks. I’m sure you’re aware.
Are we undisciplined? Some of us, absolutely are. No doubt. Too many of us, I’d say. There are people out there on their own islands with crystals and all kinds of potions doing whatever to whoever with no research to back it and no rhyme to the reason but, there are A TON of us who are highly educated and highly disciplined. It seems they’re just looking to lump us all into one group regardless I guess.
Are we unethical…..well, like any profession, the answer is that there are some predatory chiropractors seeing patients 100 times a year. Shooting a ton of unnecessary x-rays and scaring people into long-term care. Whether that’s unethical or not is up to the individual practitioner to decide but I can sure see how an outsider looking in could determine it unethical. Again, on the other hand, there are a lot of us going by commonly accepted guidelines and probably risking actually UNDERtreating patients out of fear of giving the appearance of being one of ‘those chiropractors.’ There is certainly nothing unethical about that, my friends.
Are we illegitimate. Well hell no. And if they’re not calling out PTs with all of these labels, then they’re just being complete asses because, like or not, the lines between PTs and DCs are very blurry these days. They cannot pretend chiropractors are bad guys but continue to embrace PTs at the same time. Because, in many cases, there is no difference other than spinal manipulative therapy. Hell, PTs work in DC’s offices.
This Friends of Science in Medicine is a group of bitchy people that really have little more to do that to form a silly group that makes them feel powerful on some level. Kudos to them. Take it from me. It’s hard as hell to build something that has influence in any sector of life these days. So, whatever. Yay for them. But it’s nothing. They can scream and holler but, at the end of the day, they’ll take care of their patients and we’ll take care of ours.
There is an ever-expanding market today of patients looking for chiropractic. They no longer want the Friends of Science in Medicine’s pills. They no longer want the visits where you go in, some guy or girl in a white coat pretends to listen to you but cuts you off and then gives you a script for some pill that might, just might make you back end fall out of your body. We’re past that now. But they aren’t.
We’re past surgery for this and for that. We’re past a pill for this or for that. We tried it. The result is called The Opioid Epidemic and it’s going to claim more lives in America than the Civil War did before too long. Last year claimed more lives than 20 years of counting deaths from the Vietnam War. Are you kidding me that these fools think they have some moral freaking high ground to stand on, behind a big white, glistening podium, and look down on other practitioners that are getting patients better non-invasively, non-pharmacologically, safely, and effectively?
Are you freaking serious right now with this ball of crapoloa? You can’t make it up. This world gets dumber and dumber by the day and it’s the so-called people in power leading the way. Not those of us in the trenches changing the lives of our patients. It’s the leaders that are the fools.
That crap makes me want to go kick a kitten and step on a baby rabbit.
Santa Maria…..makes me want to cuss in Spanish. I swear.
OK, I’m done. Chiropractors doing things in a patient-centered way are awesome. Here’s the message.
Subscribe Button
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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
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About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
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Chaibi A, R.M., A risk-benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: A comprehensive review. Annals of Medicine, 2018.
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Lewis M, De‐legitimising complementary medicine: framings of the Friends of Science in Medicine‐CAM debate in Australian media reports. Sociology of Health & Illness, 2019.
CF 068: British Medical Journal Research, Surgeons Against Surgery, and Pediatrics Under Attack
Today we’re going to talk about a BIG new study helping us out in the British Medical Journal, we’ll talk about spinal surgeons against spinal surgery, and we’ll talk about manual therapy in pediatrics under attack. That’s a big topic right now. Especially down in Australia.
But first, get ready to shake your tail feathers……here’s that bumper music
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OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have done the mashed potato right into Episode #68. Just like we were back in the 50’s. Sometimes I wonder if I was born in the wrong generation. Seriously. Speaking of, if you’d like to hear what we listen to in my office all day every day, go to Spotify and get my Old, New, Memphis & Motown Too. My profile is amarillopacc. That’s the amarillo platypus, absinthe, crustacean, crap ton.
You’re welcome…. I’m here all week. Tip your waitresses.
Introduction
Now, we’re here to advocate for chiropractic while we also make your life easier.
Part of that is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly.
If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders.
Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it.
DACO
Let’s talk a bit about the DACO program. I went on a short little spring break vacay last week so didn’t get many hours in. I got three hours I believe. The class I took was Class 3 of the Pain In The Frame series. It was over chronic shoulder pain. I have to tell you that the neurology is not something that comes naturally to me but, in the same breath, I want you to know that it is presented in a way that is finally understandable. Even by me and when it comes to hardcore neuro topics, that’s saying a lot, folks. Seriously.
And the concept is repeated repeatedly. That sounds redundant but I know you’re pickin up what I’m throwin down here.
Dr. Anthony Nicholson who is part of the team that has set up the educational program, and who will also be a guest in the very near future here with us on the podcast, he was a neuro diplomate before getting his DACO so there is plenty of neuro but don’t let that scare you. Had I known that going in, it probably would have scared me a touch but, it’s no biggie. It’s explained very well and though I didn’t completely grasp it the first time or two it was run by me, I got by the 10th time for sure. Lol.
I’m a slow learner. Lol. I beat myself up. I’m almost done with the whole thing and I have a 95 in the class. Trust me, I’m not a neuro guy. I hate hardcore neuro but it’s excellent stuff that you need to know and if I can do it, I promise you can too.
Be looking for that interview with Dr. Nicholson all the way from Australia in just a couple of weeks or so. Maybe sooner. He’s fascinating.
Personal Happenings
If you hear something here that you really like and would like it in written form rather than spoken, just hop onto chiropracticforward.com, find the episode, and just scroll down to copy and paste it. If you’re using it for content or on your website for some reason, just be cool and give us some credit please. I’d sure appreciate it and I’m sure the researchers we discuss would too.
Item #1
Onward we march to the first item here. It’s a biggie and it’s brand new. It’s called “Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials” and authored by Sidney Rubinstein, Annemarie de Zoete, Marienke van Middelkoop, and a herd of others[1]. It was published in the British Medical Journal on March 13th of 2019.
Hot stuff coming through
The first thing I’ll say here is that there is a pyramid of research hierarchy out there. I’ll post it in the show notes at www.chiropracticforward.com episode #68 so go check it out. If you look at it, you’ll see that randomized controlled trials and systematic review/meta-analysis studies are at the very top of the hierarchy.
Well, this paper, for example, as the title says, is a systematic review and meta-analysis of randomized controlled trials. See what I’m saying here? That’s why it’s a biggie.
Why They Did It
They wanted to assess the benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain. Ah….low back gets all the attention. Still waiting to see them get those cervical pain studies rolling. Anywhoo…..
They did a systematic review on 47 randomized controlled trials including 9,211 participants that all examined the effect of spinal manipulation or mobilization in adults over 18 years old with chronic low back pain with or without referred pain. They did not accept the studies that looked at sciatica exclusively.
What They Found
- Moderate quality evidence suggests that spinal manipulative therapy has similar effects to other recommended therapies for short term pain relief.
- The same quality evidence suggests a small, clinically better improvement in function.
- High quality evidence suggested that , compared with non-recommended therapies, SMT results in small, not clinically better effects for short term pain relief and small to moderate clinically better improvement in function.
- They say about half of the studies examined adverse and serious adverse events. They say most of the observed adverse events were musculoskeletal related, transient in nature, and of mile to moderate severity.
They concluded, “SMT produces similar effects to recommended therapies for chronic low back pain, whereas SMT seems to be better than non-recommended interventions for improvement in function in the short term. Clinicians should inform their patients of the potential risks of adverse events associated with SMT.”
I have to say, when we dive a bit deeper in, while the study shines brightly on spinal manipulative therapy and its practitioners, we as chiropractors can’t lean on this thing completely for the good OR the bad. That’s because, of the 47 randomized controlled trials accepted, chiropractors were the practitioners delivering the manipulative therapy in only 16 of them. Fourteen were delivered by a PT, 6 by a medical manipulator (whatever the hell that is), 5 by a DO, 2 by a bonesetter…(that’s a real thing?) and on and on.
So, keep that in mind. This isn’t fully representative of what chiropractors do and how effective we can be.
Also, the techniques used in the 47 studies ranged from high velocity, low amplitude like a Diversified adjustment, to low velocity, low amplitude passive movement techniques or a combination of both of those.
Again, not entirely representative of what we chiropractors that move the bones do. In my opinion.
What they say down deep in the paper that, considering recent systematic reviews and information showing that SMT and massage should be considered cost-effective options for low back pain and then this study showing the effectiveness…..basically….what are we waiting for to get this rocking and rolling. OK, not their words exactly but….yeah, I said that but I said it based on their research speak.
I am including and infographic the authors generated on this that cuts to the chase and may be something you can use for your waiting room. Go check it out.
Great paper, very impactful, and it supersedes the recommendations that you heard us talking about from The Lancet Medical Journal back in episodes #16, 17, and 18 of this podcast.
I’ve said it so many times and it remains a true, considering the forces and powers that have been against us for generations, if we were inherently wrong in what we do, we would have been wiped off the face of the Earth years and years ago. Yet we persist. It is my opinion that we do not persist because of creative sales, influential legislation, and millions and billions in lobbying efforts. It’s because we are right in what we do on the most basic levels.
Item #2
Our second item this week is an interesting article I came across from painchats.com called “This Spine Surgeon says Avoid Spinal Surgery for Low Back Pain: Stop and Think Carefully about Back Surgery.” the article is written by David Hanscom, MD and linked in our show notes for episode 68 at chiropracticforward.com[2].
His actual website is https://backincontrol.com but this article was in painchats.com.
The article starts off with this, “If you’re considering having spinal surgery as the final fix for your back pain, I’d like to help you to think again about your options.
I’m a spinal surgeon and I want you to know that surgery is not your best option for recovery from low back pain.
Surgery for relieving back pain has never been shown to be effective in a stringent research study. The most careful research paper published in 2006 demonstrated that only 22% of patients were satisfied with the outcomes two years later. Essentially, all research shows consistently poor outcomes for fusion surgery performed for back pain.”
Well….all I have to say is….HALLELUJAH!!!
We are going to look back at x-rays of fusions in 10-15 years and wonder what in the hell the surgeons were thinking. Mark my words people.
He breaks it down into reasons. I will shorten the article but please, go read the whole thing. It’s really good and makes so much sense.
Reason #1: Fusion surgery doesn’t help pain. I love everything about this section but in particular this quote, “We also know that disc degeneration, ruptured discs, bulging discs, arthritis, and narrowed discs have been clearly shown to NOT be the source of chronic back pain.” Thank you for some common sense, man!
Reason #2: Increased risk of more pain after surgery. Obviously, people having spinal surgery want less pain so you can easily see the issue here. He says if you’re already having chronic pain elsewhere, totally unrelated to the surgical issue, you are going to develop chronic pain at the new surgical site up to 60% of the time.
Day-um… But that ties in so nicely with the neurology I’ve learned in the DACO program. When your CNS is already hyper sensitized or up-regulated, it makes sense that new insult is going to behave this way. He also says that re-operation rates within the first year are as high as 20%. Aren’t you just ecstatic that we don’t have to deal with patients that have had failed spinal surgery from day to day in our offices? Good Lord, the surgeons can have it. I don’t want it.
Reason #3: Other treatment options are more effective. Praise the Lord and Hallelujah once again. He ties in the new finding in neurology for chronic pain. The stuff I’ve been talking about in the DACO program. He says, “Your brain memorizes pain just like an athlete, artist, or musician learns his or her skill.”
The best example is that of phantom limb pain. There is no limb, yet, the pain persists, right? I’m hoping that in your mind you just agreed with me and said, “Right,” to yourself.
He says that once a patient understands the neurological nature of chronic pain, it becomes solvable and the key is to shift off the painful and unpleasant circuits onto functional and enjoyable ones or create detours around them. Basically re-wiring the brain to an extent.
I can’t encourage you all enough to go read this article. Again, I’ve linked it in the show notes so go check it.
Item #3: Chiropractic used for in infants and pediatrics has become quite the hot topic recently. Especially with the government in Australia looking at restricting any chiropractic treatment to the point where it may not be able to be utilized in patients under the age of 12 years old if I remember correctly.
In addition, this is expected to be spreading. If my information is correct, it’s already looking to head that way in British Columbia as well as Ontario. So, it’s worth paying attention to.
My first advice would be this: If you want to film your adjustments and put them on the interwebs, then go for it but, when it comes to hanging newborns upside down and performing manipulations on them that make them cry out and things of that nature…..I would encourage you to do your fellow pediatric chiropractors a favor and NOT put those videos on the internet.
Not because I think you’re wrong. I don’t mess with babies myself but that’s because I’m not trained in it and am honestly uncomfortable with it. But that doesn’t mean I think it’s wrong either. Regardless, it’s not about right or wrong as much as it is perception. Particularly the perception by people that don’t know anything about or don’t understand chiropractic at all. Especially those ignorant but then also in a seat of power and influence.
Just don’t freaking do it, OK? That’s what I’m saying.
With all that in mind let’s get going with this one called “Manual therapy for the pediatric population: a systematic review” authored by Carol Prevost, Brian Gleberzon, Beth Carleo, and others[3]. It was published in BMC Complementary and Alternative Medicine on 24 of July 2018. Remember the research hierarchy pyramid and remember that this is a systematic review of 50 studies.
What They Found
Moderate-positive overall assessment was found for 3 conditions: low back pain, pulled elbow, and premature infants. Inconclusive unfavorable outcomes were found for 2 conditions: scoliosis (OMT) and torticollis (MT). All other condition’s overall assessments were either inconclusive favorable or unclear. Adverse events were uncommonly reported. More robust clinical trials in this area of healthcare are needed.
This one is called “Utilization of Chiropractic Care in US Children and Adolescents: A Cross-Sectional Study of the 2012 National Health Interview Survey” authored by Dr. Trent Peng, et. al[4]. Dr. Peng is also a member of our Chiropractic Forward private group on Facebook. Congratulations Dr. Peng!
Why They Did It
The purpose of this study was to describe the prevalence of chiropractic utilization and examine sociodemographic characteristics associated with utilization in a representative sample of US children and adolescents aged 4 to 17 years.
How They Did It
They analyzed data from 9,734 respondents to the 2012 National Health Interview Survey and chiropractic utilization in the past 12 months was the targeted outcome.
What they found
They found that
- The 12-month prevalence of chiropractic utilization in US children was 3.0%
- The adjusted odds (95% confidence interval) of chiropractic utilization were higher among 11- to 17-year-olds
That’s just to give you an idea of how underserved the younger population is
Last thing, it’s titled, “Change in young people's spine pain following chiropractic care at a publicly funded healthcare facility in Canada” authored by Christian Manansala, Steven Passmore, Katie Pohlman[5], and others and published in Complementary Therapies in Clinical Practice online on March 16, 2019.
Hot stuff, coming up.
That’s five articles this week. We are getting some serious schooling here right? The reason for this one was knowing that spinal pain in young people has been established as a risk factor for pain later in life, and considering the fact that recent guidelines recommend spinal manipulation and other modalities for back pain, the authors wanted to begin exploring the response to chiropractic treatment in young people with spinal pain.
We already know it helps all of us old people but what about the kids?
The study utilized a retrospective analysis of prospectively collected quality assurance data attained from the Mount Carmel Clinic chiropractic program database.
What they found
Young people 10-24 years old showed statistically and clinically significant improvement on the numeric scale in all four spinal regions following chiropractic management.
The official conclusions reads as follows, “The findings of the present study provide evidence that a pragmatic course of chiropractic care, including SM, mobilization, soft tissue therapy, acupuncture, and other modalities within the chiropractic scope of practice are a viable conservative pain management treatment option for young people.”
Of course. For us that’s a duh sort of thing but, until it is written in research, you can’t treat it as a duh thing. While we think it’s an obvious conclusion, it’s not so obvious to others so thanks to these fine folks for doing the hard work and allowing all of us to stand on the shoulders of your efforts.
This week, I want you to go forward with:
- Big time research in medical journals keep proving you made the right decision to be a chiropractor. I know you didn’t need that validation personally but professionally, it’s a hell of a nice thing to have in our back pockets.
- Chronic back pain will never be cured by a surgery-first mentality and we knew that. But, our central nervous system plays as much a part in the resolution of pain as any mechanical factor plays a part in it.
- Pediatrics is under attack. Stop filming what you do. You’re not wrong but perception plays as much a part in the problems pediatric chiropractors are having as does any thing else. We get results in kids too but, if you don’t watch it, it’ll get taken away. Be smart.
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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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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 - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography
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Rubinstein S, d.Z.A., van Middlekoop M,, Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ, 2019. 364(1689).
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Hanscom D “This Spine Surgeon says Avoid Spinal Surgery for Low Back Pain: Stop and Think Carefully about Back Surgery.”. Pain Chats, 2019.
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Prevost C, G.B., Carleo B,, Manual therapy for the pediatric population: a systematic review. BMC Comp Altern Med, 2019. 19(60).
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Peng T, C.B., Gabriel K,, Utilization of Chiropractic Care in US Children and Adolescents: A Cross-Sectional Study of the 2012 National Health Interview Survey. J Manipulative Physiol Ther, 2018. 41(9): p. 725-733.
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Manansala C, P.S., Pohlman K,, Change in young people's spine pain following chiropractic care at a publicly funded healthcare facility in Canada. Complementary Therapies in Clinical Practice, 2019.
http://traffic.libsyn.com/chiropracticforward/CF_068__British_Medical_Journal_Research_Surgeons_Against_Surgery_and_Pediatrics_Under_Attack.mp3
CF 067: w/ Dr. Christine Goertz - Chiropractic Research, What Does The Science Say, And Where Are We Going?
Today, we have one of the giants of chiropractic research as our guest. I will go further into her background in a moment but we have Dr. Christine Goertz joining us today and, if you do not know who she is, it is time to listen up. Don’t you go anywhere because this is going to be an excellent episode full of great information.
But first, here’s that “oh how sweet it is” bumper music
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OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have bounced your way into Episode #68 and we are so glad you did.
Introduction
We’re here to advocate for chiropractic while we also make your life easier.
Store
Part of that is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly.
If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders.
Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it.
Guest Introduction
Christine Goertz, D.C., Ph.D., is the Chief Operating Officer of the Spine Institute for Quality. She is also an Adjunct Associate at the Department of Orthopaedic Surgery, Duke University Medical Center and Adjunct Professor in the Department of Epidemiology, College of Public Health at the University of Iowa. Prior to joining Spine IQ, she was Vice Chancellor of Research and Health Policy at Palmer College of Chiropractic for eleven years.
Dr. Goertz received her Doctor of Chiropractic (D.C.) degree from Northwestern Health Sciences University in 1991 and her Ph.D. in Health Services Research, Policy and Administration from the School of Public Health at the University of Minnesota in 1999. Her 25-year research career has focused on working with multi-disciplinary teams to design and implement clinical and health services research studies designed to increase knowledge regarding the effectiveness and cost of complementary and integrative healthcare delivery.
She has extensive experience in the administration of Federal grants, both as a PI and as a program official at the National Institutes of Health (NIH). Dr. Goertz has received nearly $32M in federal funding as either principal investigator or co-principal investigator, primarily from NIH and the Department of Defense, and has authored or co-authored more than 100 peer-reviewed papers. Her primary area of focus is the investigation of patient-centered, non-pharmacological treatments for spine-related disorders. Dr. Goertz is a former member of the NIH/NCCIH National Advisory Council and currently serves on the Board of Governors for the Patient Centered Outcomes Research Institute (PCORI), where she has assumed numerous leadership roles. In September 2018 Dr. Goertz was appointed to a 3-year term as Vice Chair of the PCORI Board by the Comptroller General of the United States.
Welcome to the show Dr. Goertz. I can’t tell you how excited I am to have on our podcast.
Can I first ask you what was the impetus for your wanting to get into the research end of the profession? How do you come to the decision to dive into research full-time vs. treating patients day-to-day like so many of us do?
I noticed on your CV that you are currently an adjunct professor with the Department of Orthopaedic Surgery at Duke University Medical Center in Durham, North Carolina and also an Adjunct Professor in the Department of Epidemiology, College of Public Health, University of Iowa. All the while, you are working with The Pine Institue for Quality (AKA Spine IQ). Can you tell us what a regular day looks like for you?
Whether you know it or not, you have been a game-changer for this profession. You have, likely unknowingly, played a big part in some of our podcast episodes. I want to start with a paper we covered. I called it The Veterans Paper and it was HUGE. Though I call it the Veterans Paper, you say it was done as part of the Department of Defense. I wonder….did you notice anything BIG after it was published in JAMA? Was it, in your opinion, any more impactful than your other papers?
Here’s what happened as soon as that paper came out from my perspective; almost immediately, we began getting interest from our local VA and, once we completed credentialing, we started seeing referrals. Before that paper…..nothing. No interest. I don’t know if you’re ready to take all of the credit for that but I’m going to give it to your regardless. On behalf of the entire evidence-informed chiropractic profession, thank you for that.
In emails we have exchanged leading up to our time together today, you mentioned you have a large pragmatic trial funded by the NIH in the VA. Can you tell us anything about that?
In your work called “Insurer Coverage of Nonpharmacological Treatments for Low Back Pain - Time for a Change” published in JAMA October 2015, you say there are no policies emphasizing nonpharma treatment at the forefront of the patient experience, no meaningful levels of coverage for care professionals focussing on nonpharma therapy, and no policies providing financial incentives in favor of nonpharma. I have seen your work make huge differences but have to admit, I’m still seeing reimbursements for chiropractors being a challenge. We have folks out here struggling in practice in spite of everything in our favor. Have you experienced any changes after this came out in JAMA? Can we expect these sentiments you describe to gather steam in the next year or so?
In another piece of yours called “What does research reveal about chiropractic costs?” you say something I want to commend you on. You say, “without a doubt, the most common issues raised by those outside the profession relate to the quality and consistency of chiropractic care delivery.” I think we can all agree that standardization is likely the biggest hurdle our profession faces in regard to integration. Do you believe chiropractic residency training would better prepare chiropractic providers to offer high quality care within medical facilities?
I’m currently over 2/3 of the way through the Diplomate for the Academy of Chiropractic Orthopedists. I see the value every day but, in your opinion, should Board Certification become the norm for chiropractic providers rather than the exception?
In that same paper, when talking about costs for chiropractic care you point out that we are likely equal or less in cost. You say, “In particular, it appears that patients who visit a chiropractor are less likely to undergo hospitalization, resulting in lower global healthcare costs than those who receive medical care only.” Do you feel that the medical field is coming to the point they are seeing our potential in improvement as well as our cost-effectiveness on more of a widespread scale or are there just little pockets here and there? Is the medical field starting to catch on but the insurance companies are still not allowing the change? What are you seeing on your end of things?
You recently were part of a paper that was published just this year, 2019, called, “Effect of chiropractic manipulative therapy on reaction time in special operations forces military personnel: a randomized controlled trial.” I really have to talk to you researchers about trying to shorten the names of these papers.
Anyway, you all concluded on that one that one session of chiropractic manipulative therapy had immediate effect of reducing the time required for asymptomatic special operations forces to complete a complex whole-body motor response task. Tell me….what are we looking at here? Where is this line of research leading future research?
I personally love it and think it has extremely high value so when I ask you this question, please don’t take it as a negative. Are you responsible for instigating the Palmer-Gallup Poll? What were the main goals for starting it and has it lived up to the original thought process behind its beginning?
I thought this was an interesting question. A listener and member of our private group on Facebook, Dr. Trent Peng, suggested I ask you which chiropractic adjustment techniques are sufficiently evidence-based in the scientific literature?
In an article by Lisa Rappaport, called “Adding chiropractic to back pain care may reduce disability,” she interviewed you for the article. She had a quote in the article from you that said, “Spinal manipulation (often referred to as chiropractic adjustment) may help heal tissues in your body that form as a result of injury, decreasing pain and improving your body’s ability to move correctly.”
The other was, “It is also possible that manipulation impacts the way that your body perceives pain through either the brain or the spinal cord and/or decreases pain from muscle strain, inflammation and/or spasm in the muscles next to your spine.”
The first comment I have on this is that I love the second quote because there is more and more information coming out about what part the central nervous system plays in regard to pain. Pain sensitization, movement dysfunction, joint proprioception and thing of that nature. I thought that quote brought some of that into consideration without getting too complicated for a normal reader. So, kudos on that!
I remember thinking to myself that there are a lot of “may help” and “it is possible” kind of language. I understand that researchers shouldn’t formulate opinions or conclusions in definite terms or absolutes and I completely understand that, but my question to this point is do you ever see a time that all chiropractors can say with a high degree of confidence exactly what happens and exactly why it helps people heal or feel better?
I was sent a paper I believe you have in progress called “Assessment of chiropractic care on strength, balance, and endurance in active-duty US military personnel with low back pain: a protocol for a randomized controlled trial. In the Background section, you all say, Chiropractic care may facilitate the strengthening of trunk muscles, the alteration of sensory and motor signaling, and a reduction in pain sensitivity, which may contribute to improving strength, balance, and endurance for individuals with low back pain.”
As you probably know, here in Texas, we are in a perpetual battle against the Texas Medical Association. Recently, they won a decision that was upheld on appeal to remove the ‘neuro’ snippet from our scope description of treatment the neuromusculoskeletal system. Essentially, they say we only treat the musculoskeletal system. With the research you have done and are currently involved in, what do you say to this?
What has been your favorite project or finding you have been a part of so far?
What has been your favorite paper, project, or finding that a colleague has written but you were not a part of?
What conclusion have you had to draw at the end of a paper that surprised you the most?
How do you see quality research translating into a greater level of inter-professional collaboration and how do you see the future of chiropractic unfolding in terms of integration into the healthcare system?
A tie-in question here, where do you see the profession in 10 years?
I know that low back is one of the biggest reasons for disability worldwide, if not the biggest. It deserves the attention it has received. We have research on low back pain now to the point that even traditional chiropractic detractors can’t really argue all that much with us on low back pain. But we still have a fight on our hands when it comes to cervical manipulation. My question is why do you think we don’t see more research for cervical manipulation and do you see the spotlight ever changing and the research beginning to focus on cervical manipulation and the benefits for neck pain and headache/migraine?
In the private Chiropractic Forward Facebook Group, we are curious….what are you up to right now? What are you working on?
Apart from what you are working on right now, what are your goals in regard to research in the next 10 years?
Thank you so much for taking time out of your day to join us. I hope our listeners got as much use out of our talk as I did. I truly believe that our profession is where it is and going the direction it’s going in large part because of you an d your efforts.
And I thank you so much.
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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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogge
CF 065: Tinnitus & New Guides For Neck-Related Headaches
Today we’re going to talk about a couple of papers touching on tinnitus as well as a paper that just came out on practice guides for persistent headaches associated with neck pain. We’ll have some fun learning some new info if you stick around.
But first, here’s that ‘better than a back rub’ bumper music
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OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have drifted into Episode #65. And I don’t mean drifted like a feather or a piece of wood in the ocean. No, I’m talking about dangerous, careless, speedy drifting in the car around a curve, man. That’s the drifting I’m talking about. I talk like I’ve drifted before. I haven’t. Well, at least not intentionally. We won’t talk about that one time down in Alpine, TX. Lol. Hey, I used to be in a touring band. What do you want from me? I used to be on the on’ry side. That’s all I’m saying.
I’m still a little ornery but age has settled me quite a bit. Which is a good thing. I look at kids these days. My son is a teenager and really, for the most part, he’s just so good. No drugs, no drinking, loving as he can be. I think back to when I was his age. I was legitimately a menace to society. I mean that literally. It’s a wonder I’m alive but, as with most from my generation, we made it didn’t we? In spite of the lead paint, lack of bicycle helmets, and all that stuff.
I want to take just a few seconds to thank Dr. David Graber. He gave The Chiropractic Forward Podcast a shout-out to a room of about 1000 chiropractors during his talk at the Parker Seminar in Vegas a week or so ago. While that doesn’t seem like that big of a deal, I’ll just say that, when you feel like a lot of times, you’re on your own and everything depends solely on you and your actions or, in-actions, it is a blessing to have others help share the word. When you guys share or help get the message out in any little way, it’s like I breath a little easier if that makes any sense. It’s like I’m part of a team rather than out here on an island shouting through a megaphone hoping a ship passing by hears me.
Anyway, I know I thanked you in our private Facebook group but wanted to do so here as well. Very much appreciated, Amigo.
Introduction
Let’s get on with it here. We’re here to advocate for chiropractic and to give you some awesome information to make your life easier from day-to-day. We’re going to keep you from wasting time in your week and give you confidence in your recommendations and treatments. And I feel confident in guaranteeing that to you if you listen and stick to it here at the Chiropractic Forward Podcast.
Store
Part of saving you time and effort is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly.
DACO
Let’s talk a bit about the DACO program. That’s the Diplomate of the Academy of Chiropractic Orthopedists. Why do the DACO? Because, if you want to integrated, you need to certificate. Or more accurately, you need to specialize and get accredited. That’s what the Diplomate is about. Bells, whistles, letters behind your name….yes. More importantly, you’ll be leaps and bounds beyond where you were prior to do it.
Recent classes have been Tinnitus which we’ll talk about in a moment, carpal tunnel syndrome as part of a double crush syndrome, and managing hip osteoarthritis. Fascinating stuff.
I saw a chiropractic student upset on Facebook the other day. He was upset because of some video that popped up on social media. It was an anti-vaccination speech and, honestly, it was pretty vile and hateful in the stance against vaccines. Look, you have whatever opinion you want on vaccines, we’re never going to get into that here. That’s not why I mention it.
The student clearly did not agree with this speech from CalJam and was wondering what kind of profession he’s spending all of this money to be a part of. He was basically questioning what kind of future he’s going to have when you have a profession that is getting continuing education hours for speeches like that.
I could confidently tell him, and you by the way, that there has never been a better time to be a chiropractor. At least not in the last 35-40 years anyway. We’ve all heard about the Mercedes 80’s. They sound real nice but they’re a pipe dream at this point.
Right now, there has never been the research backing up what we do. We have it overflowing. Not only in our effectiveness either. We have research on how we’re more effective than PT and MDs. We have research on how our patients are more satisfied with our outcomes than any other practitioner. We have research on how we do all of that while costing less.
Never before have we had a national epidemic. This little thing we call the opioid epidemic that is driving every healthcare practitioner to look for non-pharma means of treating their patients. That means you and me.
And never before have we had the capability or opportunities that we have now to integrate with our medical colleagues and become more and more a part of a team of healthcare practitioners.
We are moving more to the center rather than staying out on the fringes of healthcare like the red-headed step child.
No offense to red-heads or step-children.
Anyway, Diplomate programs are more than letters behind a name. They’re about progressing you and your profession. Building knowledge and respect.
I get nothing for talking about the DACO. I just think certification and professional standardization are important things. Email me at dr.williams@chiropracticforward.com if you have some questions about getting started.
Personal Happenings
And the hunt for a front desk rock star continues. I want to share with you the fact that indeed.com and Facebook work ads are great at netting you about 1.3 million resumes but not good, well-qualified candidates. Every damn time I post a job listing, I’ll get around 150 recipients. Only a very limited few are worth anything. Most aren’t even qualified for the job.
For instance I got a resume yesterday from a dude that can run a fork lift. Hey, I like forklift drivers fine but that won’t get it done at the front desk of a healthcare facility, right? It’s an insane waste of time going through all of these but, what the hell else are you going to do? you have to have an employee. And I’m not going to my friends to ask if they know of anyone because I don’t want my friends hitting me up for a job. Lol. If that doesn’t work out, not only have you lost an employee but you’ve also lost a friend.
No thanks!
Item #1
I have had an increase in tinnitus in my left ear after a plane ride I took back from Austin a couple of weeks ago. Bad enough that I went to a specialist for it. Turns out, she said I have, in some frequencies, moderate loss. I said, “What?” Lol.
Well, I’ve been a touring musician before so, what’s new? I could have told you that. But, it’s been bad in just the past couple of weeks so something changed in that window of time. I started taking some DACO classes and noticed one on tinnitus so jumped to that drill for obvious reasons.
I don’t want to go into details of the class but I do want to talk about some of the research cited for the class and we’ll start with this one called, “Does multi-modal cervical physical therapy improve tinnitus in patients with cervicogenic somatic tinnitus?” It was authored by S Michiels, P Van de Heyning, and a bunch of other very difficult names and published in Manual Therapy in 2016(Michiels S 2016).
Why They Did It
Tinnitus can be related to many different etiologies such as hearing loss or a noise trauma, but it can also be related to the somatosensory system of the cervical spine, called cervicogenic somatic tinnitus (CST). Knowing that case studies have suggested a positive effect of cervical spinal treatment on tinnitus, this study wanted to dive a little deeper on it.
How They Did It
It was a randomized controlled trial of subjects having a combination of tinnitus and neck pain. Like a combo meal, instead of a burger and fries, it was neck ache and ear ringing. Make that two please, thank you.
Each subject received cervical physical therapy for 6 weeks which equaled 12 sessions.
What They Found
Cervical physical therapy can have a positive effect on subjective tinnitus complaints in patients with a combination of tinnitus and neck complaints.
Pretty cool stuff there.
Item #2
Let’s double down with this one from Oostendorp, et. al. called “Cervicogenic somatosensory tinnitus: An indication for manual therapy? Part 1: Theoretical concept” published in 2016 in Manual Therapy(Oosterndorp RA 2016).
The Big Idea
Tinnitus can be evoked or modulated by input from the somatosensory and somatomotor systems. This means that the loudness or intensity of tinnitus can be changed by sensory or motor stimuli such as muscle contractions, mechanical pressure on myofascial trigger points, transcutaneous electrical stimulation or joint movements.
Interesting yeah? I think so.
They go on to say, “The neural connections and integration of the auditory and somatosensory systems of the upper cervical region and head have been confirmed by many studies. These connections can give rise to a form of tinnitus known as somatosensory tinnitus.
Broadening the current understanding of somatosensory tinnitus would represent a first step towards providing therapeutic approaches relevant to manual therapists. Treatment modalities involving the somatosensory systems, and particularly manual therapy, should now be re-assessed in the subgroup of patients with cervicogenic somatosensory tinnitus”
And that’s just what they’re doing. Fascinating stuff considering that you’ve always heard, “you’ll just have to live with it.” Basically, if you can change the intensity, quality, or frequency of the ringing, by moving your jaw or stressing the cervical spine in different directions, there’s more than a solid chance that you can change it completely through cervical manipulative or manual therapy.
If I remember correctly the guesstimate was around 65% of the cases may be affected by chiropractors for the positive.
Hell yeah and pass the potatoes people.
Item #3
Our last thing today is called “Non‐pharmacological Management of Persistent Headaches Associated with Neck Pain: A Clinical Practice Guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration” written by Pierre Cote, Hainan Yu, Heather Shearer, et. al. and published in European Journal of Pain in February 2019(Cote P 2019).
Hot off the presses and I know you like it served hot like that. Cold or lukewarm education just isn’t as good as piping hot brain nuggets.
Why They Did It
To develop an evidence‐based guideline for the non‐pharmacological management of persistent headaches associated with neck pain (i.e., tension‐type or cervicogenic).
How They Did It
This guideline is based on systematic reviews of high‐quality studies. A multidisciplinary expert panel considered the evidence of clinical benefits, cost‐effectiveness, societal and ethical values, and patient experiences when formulating recommendations.
What They Found
When managing patients with headaches associated with neck pain, clinicians should:
- rule out major structural or other pathologies, or migraine as the cause of headaches;
- classify headaches associated with neck pain as tension‐type headache or cervicogenic headache once other sources of headache pathology has been ruled out;
- provide care in partnership with the patient and involve the patient in care planning and decision‐making;
- provide care in addition to structured patient education;
- consider low load endurance craniocervical and cervicoscapular exercises for tension‐type headaches (episodic or chronic) or cervicogenic headaches >3 months duration;
- consider general exercise, multimodal care (spinal mobilization, craniocervical exercise, and postural correction), or clinical massage for chronic tension‐type headaches;
- do not offer manipulation of the cervical spine as the sole form of treatment for episodic or chronic tension‐type headaches;
- consider manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine for cervicogenic headaches >3 months duration. However, there is no added benefit in combining spinal manipulation, spinal mobilization, and exercises; and
- reassess the patient at every visit to assess outcomes and determine whether a referral is indicated.
All of this is just a part of making us all better day to day. Those paying attention have the leg up. No doubt.
Here’s the problem with being patient-centered instead of doctor-centered. We have to be OK with watching the high volume practices running through like cattle….we have to be OK watching them make millions while we have an average case treatment of only 7-10 visits.
So what? Big deal. I always say that I could have a bigger house and more vacations but I sleep very well at night and, being a Christian as I’ve mentioned before, I’m at peace knowing I’m square with my maker and treat people the way they should be treated.
Religious or not, patient-centered doctors can always take comfort in the fact that they’re doing what is in the best interest of their patients.
It’s a lovely thing isn’t it? Honesty, ethics, love, cumbaya, and all that tom foolery….. They’re just little bricks that are the building blocks of an excellent life and career.
Subscribe Button
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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Cote P, Y. H., Shearer HM, (2019). "Non‐pharmacological Management of Persistent Headaches Associated with Neck Pain: A Clinical Practice Guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration." European Journal of Pain.
Michiels S, V. d. H. P. (2016). "Does multi-modal cervical physical therapy improve tinnitus in patients with cervicogenic somatic tinnitus?" Man Ther: 125-135.
Oosterndorp RA, B. I., Mikolajewska E, (2016). "Cervicogenic somatosensory tinnitus: An indication for manual therapy? Part 1: Theoretical concept." Man Ther: 120-123
CF 064: Chiropractic Wins Again, Push Ups Say A Lot, Low Iron & The Disc
Today we’re going to talk about how chiropractic and spinal manipulative therapy win again, we’ll talk about how push ups may tell us more than what you see on the surface, we’ll discuss some new information on low back discs and how they’re affected by low iron, and then we’ll gloss over a paper on physical therapy to toss you some thought nuggets.
But first, jsut for my friend and collegue, Dr. Michael Henry down in Austin, here’s that ‘you know you love it’ bumper music. He’s a big fan.
Subscribe button
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have shimmied all 60’s like into Episode #64
Introduction
We’re here to advocate for chiropractic and to give you some awesome information to make your life easier from day-to-day. We’re going to keep you from wasting time in your week and give you confidence in your recommendations and treatments. And I feel confident in guaranteeing that to you if you listen and stick to it here at the Chiropractic Forward Podcast.
Store
Part of saving you time and effort is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. I noticed an error on the shipping charge. That has been corrected now.
Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if somehting is out of sorts or isn’t working correctly.
DACO
Let’s talk a bit about the Diplomate of the Academy of Chiropractic Orthopedists probgram also known as the DACO. I finished up all 50 of the required live hours this weekend down in Austin, TX during the Texas Chiropractic Association’s legislative seminar.
Not only did I get all of the hours wrapped up but I also got to see a lot of colleagues I have been doing battle along side with for the last 8 years or so. You may or may not know that the Texas Medical Association is particularly aggressive and attacks at will for anything and everything. Which means we have to constantly raise funds to defend the attacks.
It’s this cute thing we do with each other from year to year. It’s really a special relationship chiropractors have with the TMA. I keep thinking one day they’ll start listening to their own profession and leave us the hell alone but nope. Not so far. Not until they have full and complete control of chiropractic care in Texas. Which is not going to happen. Just so you know..
They sued us because 2 docs in texas who were Neuro Diplomates were doing VONT testing. I’d never even heard of VONT until this last time we got sued by TMA. IF you can give me a good reason why a neuro diplomate cannot do VONT testing, I’ll send you a candy bar or some chicklets or something like that.
It’s enough to make a guy crazy. I got to meet a lot of bright new people ready to help the TCA fight and overcome. Andrea Ohmann recently moved to Texas from Minnesota. She is in a hospital setting if I understood correctly. She’s a bright star to keep an eye on. I also need to thank Dr. Jamie Marshall for listening to us down in Conroe, TX. I really appreciate it!
I got to see Staff Sergeant Shilo Harris speak. I mentioned him a couple of episodes ago but I have to tell you, this man is a hell of a speaker and he’s in our corner specifically. He gives chiropractic care all of the credit for helping him get through all of his injuries and surgeries. He was blown up by an IED in Iraq and has been through absolute hell to get to where he is now and chiropractic was key to getting him there.
Very emotional and very impactful. I can’t imagine a legislator being confronted by him and his story and not being forced to see it our way. It’s powerful. Thanks to Shilo for eveything he’s doing for this profession. I hope you’ll go to http://shiloharris.com and see what he’s about.
Beyond that our DACO hours were taught by Jeffrey Miller who is a chiropractor on staff at the University of Missouri medical school. He’s not as sharp as a tack. He’s actually sharper than a tack and told me he’d love to join us on the podcast so I’m going to do us all a favor and get that set up. We also have Dr. Christine Goertz’s episode coming up quickly so keep your eyes peeled for that one too.
This get on with this deal here.
Item #1
Our first item here is called “Manipulative Therapies: What Works” and is authored by Dr. Michael Smith, an MD, and his herd of collegues. It was published in American Family Physician on Febraury 15, 2019(Smith M 2019). I got this one from Dr. William Lawson in Austin, TX who is a DABCO and a swell dude on top of that.
In case you missed it, this herd of authors are medical doctors. They start by saying that manipulative therapies include things like osteopathic manipulative treatment which is the same as chiropractic manipulative treatment.
They say that, when you compare manipulative therapy to oral analgesics, cervcial manipulation and/or mobilization appears to provide better short-term pain relief and improved funciton in patietns with neck pain.
They go on to say that manipulative therapy may be as effective as amitriptyline for treating migraine headaches and can reduce the frequency and intesity of pain.
While there is some evidence showing that manipulative therapy can reduce length of hospital stays for preterm infants, there is ZERO research for some of the other reasons we see chiropractors treating infants. Things like otitis media, colic, allergies, and respiratory conditions.
That was all in the abstract. That’s the medical world starting to take note. Can you hear it? When do the insurance companies start to take note as well?
THAT’S REALLY when our lives start changing. Oh happy day….I have a dream. A dream where we are no longer pursecuted for being right all the damn time. A dream that chiropractors don’t go around saying crazy crap and making the rest of us look bad. I have a dream people. I’m not going to pretend to be as good of an orator as Martin Luther King Jr. but you get the point.
You know that the more of these articles that come out, the more they have to start gathering steam. Turn on a light bulb at night in South Texas and see what happens. The bugs start swarming. Turn on this kind of light and you’ll see these articles begin catching more and more attention until we finally have a consensus in the medical field. A consensus that says, “Hell, looks like they’ve been onto something this whole time. We better take another look at it.”
This is an excellent paper. And we need to keep seeing this more and more. Even if they’re talking specifically about osteopathic manipulative therapy, we know that chiropractors do it too and, in fact, chiropractors do almost all of it these days. DO’s have moved almost completely to medicine. We are the ones moving joints. Make no mistake about it.
Item #2
Pushups…what can they tell us? Well, it appears they can tell us quite a lot from an article in StudyFinds called “Men Who Can Do More Than 40 Push-ups Far Less Likely To Develop Heart Disease.(Finds 2019)”
This article covers a new study that showed that men posessing the ability to perform 40 push-ups in one attempt are much less likely to suffer from heart disease wihtin the next 10 years.
They showed where middle-aged men who can put in more than 40 in a single try have a 96% less chance of having heart disease when compared to those who could complete no more than 10 push-ups.
So, it appears, to me…..that it’s time to start doing some push-ups muy pronto.
Item #3
This one comes to us from the American Journal of Translational Research and is called “Iron defficiency accelerates intervertebral disc degeneration through affectring the stability of DNA polymerase epsilon complex(Zhang C 2015).”
It was published in November of 2015 and appears to be mostly Chinese researchers. Could be Japanese, Korean, or Vietnamese but the name of the lead author is Chungiang Zhang and whole host of names that appear to be just as difficult to pronounce.
We will not get deep into the details here because I’m not too proud to admit that the information here goes far above my head in many ways. I’ve said it before, I’m no guru. I’m like Alex Trebec on Jeopardy. He delivers the info but I promise he’s no expert on every question coming across his lips. Lol.
But, when we stick with the basics, we see that iron serves as an important cofactor of iron-containging proteins that play critical roles in the maintenance of DNA stability and cell cycle progression. They say that disturbed iron homeostasis gives rise to things like cancer and anemia.
In addition, they say that they found clear correlation between iron deficiency and intervertebral disc degeneration.
They wrapped up their paper by saying, “In summary, our study suggests that iron deficiency is an important factor in the aggravation of IDD. Proper iron supplementation may be an effective strategy to alleviate the symptoms of patients with intervertebral disc degeneration.”
Item #4
Our last on the list, it has to do with PTs and is called “Minimal physical therapy utilization compared with higher physical therapy utilization for patients with low back pain: a systematic review,” authored by Heidi Ojha and a gaggle of others and published in Physiotherapy Theory and Practice in February 2019(Ojha H 2019).
This was a systematic review to compare the effects of minimal physical therapy utilization (two visits or less) vs. typical physical therapy utilization consisting of 3 or more visits on patient-important outcomes for patients with low back pain.
They say this research is needed because there is such variation in physical therapy use for those with low back pain.
Interestingly, they found that, when compared with minimal utilization, higher utilization demonstrated no significant differences on pain, disability, or quality of life at the 1-year follow-up.
Even more interesting was that the conclusion of the paper said the following, “While higher utilization may not result in significant improvements in patient-important outcomes, it may be more cost-effective for patients with chronic or complex LBP conditions when compared to minimal utilization.”
So, what the hell is that? It’s not going to make you any difference to see us a lot but the price point is agreeable so, by all means, we’d like to see you a crap load. Which isn’t as much as a crap ton. By the way. But I think you see what I mean.
I have noticed so many papers that basically cast a lot of doubt on PT in general while all we seem to find in regards to manipulative therapy are positive reaffirmation of the chiropractic profession.
It just makes me wonder where the tipping point is to be honest. When does the medical industry start to look at chiropractic as being more effective for these conditions that PT and making those referrals accordingly? I had some insight on a PT private group on Facebook a couple of weeks ago.
The PTs were piling on a chiropractor’s advertisement techniques. Let’s be fair, the DC was a knucklehead and wasn’t being honest and identifying himself as a chiropractor in his marketing but, for discussion purposes here, that’s beside the point.
They were bashing not only on that chiropractor but our profession as a whole. I bash on aspects of my profession as well but, where the rubber hits the road, we average better patient outcomes, we are safe, we are effective, and we average higher patient satisfaction. Even if some in our profession would win a county craziness competition.
Don’t believe me? Go listen to Episode #49 of this podcast where we go over the Parker-Gallup poll. Very interesting episode and there are some valuable marketing nuggets in that one for you as well. Definitely worth the listen.
Also Episode #26 talks about PTs and DCs. The age old grudge match. Go check them out and see what you think.
Some in our profession are simply imbeciles. That sounds harsh but for a time after graduating, I held no interest in furthering my education. I wanted to coast. I’d done the hard work, right? I was so smart already after all those years of college. Well, you don’t know what you don’t know. And, I can admit that for a few years there, I was an imbecile.
They learned enough to pass but that doesn’t make them smart or ethical and that’s sad. But again, when said and done, our profession consistently proves itself and is proven by insurance companies, governments, polls, surveys, and universities.
From what I’ve seen recently, I can’t say the same for them and I just can’t see where they feel they have some moral high ground or platform to stand on and spout a bunch of denigrating thoughts at us.
I thought it’d be a good idea once to refer to a PT. I had a car wreck patient and thought they could use PT and at that time, I wasn’t equipped to do much rehab. So onto the PT they went. In two damn weeks, the PT ran up a bill that would have literally taken me 4 months to run up. I was astounded. And, in that two week period, there was little to no improvement for the patient.
On a separate occasion, I had a disc patient finally settled down and doing great. She was very active and very much into working out. I had her disc settled down to a point that she thought she’d go get PT on top of what I was doing. She did not talk to me about it. She just did it. Her thought process was that it would just be that much better to combine the two. Chiropractic and PT. Honestly, that’s not bad thinking in theory.
She came back after one visit almost unable to walk or function. We tried and tried to get it to settle back down but she ended up taking herself to a surgeon to get our of pain. Sorry PTs. Quit talking smack and work with us instead of against us.
Ideally, PTs and chiropractors work hand in hand and complement each other. Many offices can and should operate in this manner. In reality though, I see PTs as great for post-operative rehab and rehab after certain types of injury. When it comes to joints and spines in general though, they can’t touch us. They talk bad about us, they steal services from us, they think they have the moral ground on us, but they can’t touch us.
Those of us practicing in an evidence-informed manner anyway. Those not practicing evidence-informed actually continue to provide them with whatever moral ground they believe they have.
I for one would like to move on from the beginnings and progress our profession much like the MDs have done over the last 150 years. They went from blood-letting, leeches, and labotomies to what they can do now. Yet, there’s still a part of our profession wanting to hold on dearly to our originations of 100+ years ago.
Chiropractors, let go. Progress. Practice current, in the current day and age. Practice evidence-informed. It’ll help you and it’ll help the profession in general.
That’s my opinion anyway. Take it or leave it.
This week, I want you to go forward with
- Chiropractic wins and wins and wins again. We made the right decision. We just need to only use our powers for the good.
- Push-ups….let’s get to doing them!
- Iron deficiency for disc degeneration is something worth looking at.
- When we are practicing evidence-informed chiropractic care, PTs only wish they could get the results we can get.
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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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography
Finds, S. (2019) "Men Who Can Do More Than 40 Push-Ups Far Less Likely To Develop Heart Disease." StudyFinds.
Ojha H, M. M., Johnston M, (2019). "Minimal physical therapy utilization compared with higher physical therapy utilization for patients with low back pain: a systematic review." Physio Theory Practice.
Smith M (2019). "Manipulative Therapies: What Works." AMerican Family Physician 99(4): 248-252.
Zhang C (2015). "Iron deficiency accelerates intervertebral disc degeneration through affecting the stability of DNA polymerase epsilon complex." Am J Transl Res 10(11): 3430-3442.
Today we’re going to reach into my bag of papers that have been sitting and gathering a little dust waiting for their time in the sun. We’re talking about government-regulated rehab. Is it any more effective than doctor-regulated? Do you send rotator cuff issues straight to a surgeon and is that the smartest thing? We’ll also skim over some new info on carpal tunnel.
But first, here’s that “goes down so smooth” bumper music
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OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have Frankenstein-shuffled into Episode #63 all creepy like
Introduction
Why does this podcast even exist? We’re here to advocate for chiropractic and to give you some awesome information to make your life easier from day-to-day. We’re going to keep you from wasting time through your week by giving you confidence in your recommendations and in your treatments.
This is something I feel confident in guaranteeing you if you listen and stick to it here at the Chiropractic Forward Podcast. I’m no guru but I do believe I was blessed with some amount of common sense that somehow continues to keep me in the game. You are ABSOLUTELY going to pick up some nuggets that you can use in your own practice.
Store
Part of saving you time and effort is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for your. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. My goal is to get enough pre-orders to pay for all of the intiial order before the end of March. If you guys will go to chiropracticforward.com…..Just click the STORE link at the top right of the home page and you’ll be off and running.
https://www.chiropracticforward.com/shop/
We can order any of the posters whenever but, I want to get pre-orders in place for the brochures since they have to be ordered in bulk. With pre-orders helping me do that, I can get them ordered at the end of March, get them to me in about a week and then get them to you in a week so, they’d be in your hands roughly mid-April. So, if you’re team Chiropractic Forward, go check them out and order up. I’ll make it happen for us all.
I’m getting them for my office as well ya see. I can’t wait to get them. And, I have a ton more I’m working on. But, I’ll be using funds from the first batch, to fund the next batch of these brochures. Rome wasn’t built in a day folks, cut me some damn slack. Help me out with the first batch and we’ll be up and running. Who knows what we can get done around here together?
DACO
DACO talk, hell yeah. I’m back to rocking and rolling thanks to the guys down under in Australia. They are very intuitive and really do go out of their way to make sure you’re enjoying the courses and getting what you can out of them.
Recent courses for me have been Acute Torticollis in the Adult and Osteoporotic Compression fractures - Recognizing the Clues.
I dreaded stepping into the whole idea of 300 hours added to an already full load of work, family, and hobbies. Honestly, I’ve said before, I see 60-70 new patients a month, wife and two kids, I build live edge furniture, I’m a musician many weekends, and a sculptor who’s trying to teach himself to paint and…well…I like to get ornery and have a beer here and there on the weekends too. (you need to grow up)
I don’t say that to brag and say Oh look at me look at me. I’m trying to make the point that, if I can do it, you can do it. Here’s the deal, I was always learning and adding and reading research papers and all of that stuff anyway. I thought I’d take one live class and get some continuing education hours. Hell, I figured I’d sit in the class for a couple of hours and then go have lunch with my wife.
Yeah, that didn’t happen. In fact, I’m blaming it all on Dr. Tim Bertlesmen for getting me into it. He and Dr. Brandon Steele are the partners in ChiroUp and he was teaching a class here for the Texas Chiropractic Association’s state convention last summer. I saw him in the expo hall and he told me to come check the class out. I said I’ll check it out for a bit. He said, “You’ll like it. You’ll stay for the whole thing.” Dammit if he wasn’t right. Lol. Just amazing information that could be used immediately and I literally feel that way about every class I’ve had since then. So, you see, it hasn’t been stressful. It hasn’t really been any work. It’s just been enjoyable learning that I would have been doing anyway. I might as well get something out of what I was already doing anyway, right?
When the hell do I have time to add 300 hours to my plate? Well, I take off about 2:30 on Tuesday afternoon to do a class. I usually take one on Saturday morning when I’m up before the rest of the family. Sometimes I’ll take another on Sunday. That puts me at about 9 hours a week. Easy peesy.
CD 059: Don’t Be Dumb on Cervicogenic Headache
Today we’re going to talk about headaches. More specifically, we’re going to talk about cervicogenic headaches. How can we recognize cervicogenic headache, and get better at diagnosing and treating cervicogenic headache?
But first, here’s that delicious bumper music
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OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have crashed into Episode #59 like a bull in a china cabinet. You know, I’ve been told before that I’m a little like a bull in a china cabinet. That what I don’t break I poo on. Was that more palatable than some of the other words I could have used? I certainly hope so because me saying it that way just doesn’t sound very Jeff-like but I try to keep it mostly high brow and not too profanity-laced.
DACO
As always, let’s talk a bit about the DACO program. I decided I kind of dread the eLearning episodes. Although the information is excellent, I’m one of those that doesn’t want to miss a word in the notes. These can be somewhat complex topics and, I’m afraid that if I miss something, it’ll be important and I’ll have trouble making sense of it all when I re-visit it.
That could be my undiagnosed anxiety issue at play. Who the hell knows but it’s a fact so that means that I have to transcribe the entire 20-40 minutes of video or I’m not happy with the final result of the class. There are notes on these classes. A worksheet that helps organize it all but, there is a lot on the videos that is not on the worksheet so transcribe I must and I’m starting to despise that process.
It’s admittedly a quirk of mine and probably won’t be your experience on the deal if you give it a try. As a result, I have started combining the Communication Drills. So I’ll take an eLearning episode and then I’ll take a Communication Drill and basically alternate them to keep me from getting burned out and to keep me moving forward efficiently. I’m averaging 8 or so hours a week so we’re still clicking along like a tired locomotive.
Recent classes have been Managing Migraine Headaches, Diagnosing Cervicogenic Headaches, A Neurological Approach to Scoliosis, and Thinking Laterally With The Disc Patient.
Coming Up
I gotta tell you, you all really liked the episode we did with Dr. James Lehman, episode 55, and the one we did on what I despise about this profession, episode 56. We are up over 7,200 downloads and that’s pretty exciting y’all. This little thing of ours is rocking and rolling and shows no signs of slowing down either.
That’s because THE Dr. Christine Goertz is coming on the show in late February. Wow! That’s a biggie! I’m going to let you in on a little secret. You’d already know this if you were in our private Chiropractic Forward Group on Facebook. You would have even had the chance to suggest questions for me to ask her when she comes on the show. You should probably go ahead and become a member.
Speaking of the episode where we talked about the magical disappearing osteophytes, I was a little worried if I’m being honest about that one. I hated being negative like that and I was bit concerned some of you would have a problem with that. Oh contrare, I think I had more feedback on that one than any of our episodes.
It appears you guys agree and there is indeed no room for that mystical hunk o junk in our great profession. Of course there isn’t. We knew that. Sometimes you just have to blow off a little steam and be the old guy saying, “get off my lawn ya punks!”
That was episode 56 for me. “Get off my lawn and stop driving so fast in a 30 mph zone yeah steampunk loving jackasses! And quit looking at my daughter like that before I shoot you in the nose hole!” We’re in Texas and all. lol.
Cervicogenic Headache
Alright, let’s tackle cervicogenic headache a bit here. The first thing I want to say here is that, prior to the DACO classes, I had assumed that cervicogenic headache had a much higher prevalence than it does in reality. In your clinic, it really doesn’t show up all that much compared to the other forms of headaches.
Breaking that down a little, tension-type headaches are the most prevalent at 38% of cases, migraines are next at 10%, and cervicogenic headache brings up the rear-end of the group at about 4% of cases.
If it only makes up 4% of cases, why the heck are we covering it this week you may ask. Well, let me answer that since you’re so damn inquisitive today.
Because it still makes up your patient base, you need to be able to notice it, and it’s one of the forms we can be fairly effective in treating.
First thing we gotta do is rule out a pathological headache by testing
- Steady gait over a normal base
- Normal vital signs
- Normal Romberg’s test
- Quick screen of cranial nerves looking for extra-ocular movements, nystagmus, symmetrical pupils with normal reaction to light, normal facial muscle tone, and things like that.
- And then a basic screen of tendon reflexes, motor power and pathological reflexes like babinski’s and hoffman reflexes
So, what does a cervicogenic headache typically look like? Well, the first thing is that it is technically a secondary headache which means it is the symptom of something else that’s going on.
Cervicogenic headache is usually
- Unilateral, side-consistent pain referred from a source in the neck. In fact, many times, you can elicit the head pain by pressing on the facets of the C2/3 region.
- Usually, the pain starts in the upper cervical region and then spreads toward the front of the head, orbital region, temples, vertex, or ears.
- The pain may also spread to the ipsilateral shoulder or arm
- Also, the pain is precipitated or aggravated by special neck movements or sustained neck posture.
- It’s mostly in the adult population with females being four times more affected than men.
- Sufferers can have subocciptial neck pain, dizziness, and even lightheadedness
Paper #1
Let’s look at this paper called “Cervical musculoskeletal impairment in frequent intermittent headache. Part 1: subjects with single headaches” authored by G. Jull and published in 2007 in the International Headache Society[1].
They were testing musculoskeletal function in headache types like tension-type, migraine, and cervicogenic.
In all but one measure (kinesthetic sense), the cervicogenic headache group were significantly different from the migraine, tension-type headache and control groups.
They found that collectively, restricted movement, in association with palpable upper cervical joint dysfunction and impairment in the cranio-cervical flexion test, had 100% sensitivity and 94% specificity to identify cervicogenic headache.
It doesn’t get much more sensitive and specific than that does it? 100% and 94%. Bam, you got a cervicogenic headache Patient Jones and I have pretty much zero doubt about that. Yes…that feels good to be that confident.
Paper #2
This next paper is called “Upper cervical and upper thoracic manipulation vs. mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial[2].” It was authored by James Dunning, and what looks like about 30 others and published in BMC Musculoskeletal Disorders in 2016.
In the beginning here they authors say that no studies have directly compared the effectiveness of cervical and thoracic manipulation to mobilization and exercise in individuals with cervicogenic headache. Thus the reason for the study.
They had 110 participants here that were randomized to receive both cervical and thoracic manipulation or mobilization and exercise.
What They Found
“Six to eight sessions of upper cervical and upper thoracic manipulation were shown to be more effective than mobilization and exercise in patients with CH, and the effects were maintained at 3 months.”
Time for super hero sound effects….Bam, snap, pow, shazam!
One of these days, I’m really going to incorporate sound effects into my efforts here but until then, you’re stuck with my ridiculous super hero effects. Lol.
Paper #3
Moving on, this next paper is called “Dose response for chiropractic care of chronic cervicogenic headache and associated neck pain: a randomized pilot study.” It was authored by M Haas, et. al. and published in the Journal of Manipulative and Physiological Therapeutics[3].
Why They Did It
To acquire information for designing a large clinical trial and determining its feasibility and to make preliminary estimates of the relationship between headache outcomes and the number of visits to a chiropractor.
What They Found
There was substantial benefit in pain relief for 9 and 12 treatments compared with 3 visits.
The authors concluded, “A large clinical trial on the relationship between pain relief and the number of chiropractic treatments is feasible. Findings give preliminary support for the benefit of larger doses, 9 to 12 treatments, of chiropractic care for the treatment of cervicogenic headache.”
Paper #4
Roughly that same group led by M. Haas, et. al. later published this one in 2018, just last year, called “Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial.” It was published in Spine Journal[4].
They were looking to settle in on the optimal number of visits for the care of cervicogenic headache with spinal manipulative therapy.
It was a two-site, open-open-table randomized controlled trial with 256 participants.
What They Found
There was a linear dose-response relationship between spinal manipulative therapy visits and days with cervicogenic headache. For the highest and most effective does of 18 treatments, days suffering from cervicogenic headache were reduced by half and about 3 more days per month than for the light-massage control group.
And there you have it people, more information than you probably expected to get on Cervicogenic headache today.
This week, I want you to go forward knowing more about cervicogenic headache than you did before you listened to this podcast. I want you to see it, test for it, recognize it, and fix it!
Subscribe Button
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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography
-
Jull G, Cervical Musculoskeletal Impairment in Frequent Intermittent Headache. Part 1: Subjects With Single Headaches. International Headache Society, 2007. 27(7).
-
J, D., Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC Musculoskelet Disord, 2016. 17(1): p. 1.
-
Haas M, Conservative physical therapy management for the treatment of cervicogenic headache: a systematic review. J Man Manip Ther, 2013. 21(2): p. 113-24.
-
Haas M, Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial. Spine, 2018: p. S1529-9430.
CF 057: What Is Contributing To Low Back Pain And More Opioid Bashing
Today we’re going to talk about What Is Contributing To Low Back Pain And More Opioid Bashing from us. We hate them and they don’t do any good anyway so why did 72,000 people have to die at their hands last year in America?
But first, here’s that bumper music
Subscribe button
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have fumbled your way into Episode #57
Junk I Say
Let’s first talk a bit about junk I say. I drive myself crazy and here’s why; I get flustered sometimes. I don’t know why. Honestly, I’d like to eventually go on the speaking circuit but I think I’ll be terrible at it. Lol. I get flustered.
I always listen to the episodes after they post. For a couple of reasons but it’s kind of like why a football team will watch game tape the day and week after a game. I do the same thing. I want to identify where I can improve and how I can make myself and the show better from week to week.
Well, I invariably catch myself saying stuff that makes no sense. Like in the recent episode where I discussed the lack of research for lumbar fusion, I referred to an orthopedic surgeon as an osteopath. What? Trust me…..I know the damn difference so things like that make me want to punch myself in the nose a little.
Another is that, without thinking, I’ve been calling it the diplomate of american chiropractic orthopedists. Yeah….that’s not what it is and I know that. Lol. It’s the Diplomate of the Academy of Chiropractic Orthopedists and those folks can be member of the American Chiropractic Orthopedists. You see the confusion, right?
Anyway….I’m not a dummy people. Well, most days anyway. I still ahve my brain farts but I’m usually fairly put together. Or at least I like to think I am. Reminds me of a comedian I heard when I was a kid. He said, “I may look dumb, but that doesn’t mean I’m not!” Yeah….so you just think about that for a bit.
The DACO
Speaking of the DACO program, “What’s the latest?”, you may ask. To that I would answer that a lot is going on actually. I slowed down for a bit but picked it back up during the holidays with the spare time I had.
More communication drills including ideas and instruction on how to tactfully disagree with our medical counterparts. For instance, if they diagnose a patient with a disc and we are CERTAIN it’s an SI, how are you going to let them down softly and keep them from going away mad ala Motley Crue…girl….don’t go away mad. Just go away.
You know we all have egos and you know damn well that “king ego” exists in the medical world. How do you tell those people they’re at odds with the research? I’m afraid there are some of them that would rather be wrong than be corrected.
How do you tell them that they diagnosed a tension-type headache when, in reality, the symptoms are more in line with a cervicogenic headache? And then, how do you tell a GP that probably doesn’t like cervical manipulation that you recommend just that?
Things that make you go “Hmmmm….”
At the end of each of the Communication Drills, they give you a script to help you in the future should the need pop up for the you to artfully and tactfully slap around Mr. King Ego without them really knowing you payahed them across the face with a glove.
Short Show
Alright, it’s a crazy week. I’m trying to close out 2018 as far as stats go and all that good stuff so this episode ain’t gonna be a big one.
Before we get to it though, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It’s just an email. We’ll send you one once a week when a new episode pops up and, if we have something cool to tell you about, I’ll include it in that email. No extra emails. Don’t be so stingy with that damn email address.
Don’t be like a college kid with the last piece of pizza. Don’t be that kid.
Onto the Research
Let’s get to the goodies, folks. Let’s start with this one from BMC Musculoskeletal Disorders by Shanthi Ramanathan, Peter Hibbert, Louise Wiles, Christoperh Maher, and William Runicman called “What is the association between the presence of comorbidities and the appropiratenes sof care for low back pain? A population-based medical record review study[1].”
First thing here is that Chris Maher is a busy guy, y’all. Seriously. He is a Physical Therapist and I believe lives in Australia if I remember correctly. He was on a paper we discussed recently having to do with lumbar fusion as well as being on The Lancet series of papers for low back pain. He’s a mover and shaker
Why They Did It
Knowing that low back pain is non-specific in 90% of cases, low back pain is treated as an independent entity even though we know other conditions exist with it or contribute to it. What comorbidities? Things like obesity, diabetes, heart disease, high blood pressure, arthritis, etc…
What They Found
One hundred and sixty four LBP patients were included in the analysis. Over 60% of adults with LBP in Australia had one of 17 comorbidities documented, with females being more likely than males to have comorbid conditions.
Wrap Up
This study established that the presence of comorbidities is associated with poorer care for LBP. Understanding why this is so is an important direction for future research.
Paper #2
Onward we march…. This one is called “Chiropractors’ views on the use of patient-reported outcome measures in clinical practice; a qualitative study.” It was written with Michelle Holmes as the lead author followed by Felicity Bishop, David Newell, Jonathan Field, and George Lewith and it was published in Chiropractic and Manual Therapies in December of 2018[2].
I know you people like the new stuff.
Why They Did It
Patient-reported outcome measures (also known as OATS in my office and probably your office as well. OATS meaning Outcome Assessments)
Anyway, OATS are widely available for use in musculoskeletal care there’s not much research exploring the implementation of OATS in clinical practice. They wanted to see what chiropractors’ views were on OATS to identify any barriers and facilitators to implementing OATS in chiropractic care.
What They Found
“Chiropractors are increasingly using OATS in their clinical practice. The aim of this qualitative study was to examine the views of chiropractors on using OATS. Exploring chiropractors’ experience of using OATS, this study identified how clinician knowledge and engagement and organisational barriers and facilitators affect implementing OATS in chiropractic care, such as choosing the appropriate OATS and systems to use in their practice. Chiropractors also identified possible training needs of chiropractors regarding OATS, with training including the process and benefits of using OATS in clinical practice.”
Now, in our “beating a dead horse segment,” let’s bash the hell out of opioids shall we? Well, don’t mind if I do!
This one is by Jason Busse, a Chiropractor by the way, and associate professor in the department of anesthesia at McMaster University’s school of medicine in Ontario, Canada……. Canada has it going on, folks. Seriously. Here’s a chiropractor in the department of anesthesia at a school of medicine. We need to get that guy on our podcast don’t you think?
The paper was also written by Li Wang, PhD, and Mostafa Kamaleldin. Easy for you to say.
It’s called “Opioids for Chronic Noncancer Pain; A systematic review and meta-analysis[3]” and appeared in JAMA in December of 2018.
Why They Did It
They wanted to find out if the use of opioids to treat chronic noncancer pain was associated with greater benefits or harms compred with placebo and alternative analgesics.
Wrap It Up
In this meta-analysis of RCTs of patients with chronic noncancer pain, evidence from high-quality studies showed that opioid use was associated with statistically significant but small improvements in pain and physical functioning, and increased risk of vomiting compared with placebo. Comparisons of opioids with nonopioid alternatives suggested that the benefit for pain and functioning may be similar, although the evidence was from studies of only low to moderate quality.
CNN’s Spin
CNN actually did an article by Michael Nedelman[4], on this paper where they get a little deeper saying the following, “For adults with chronic pain, opioids offer narrow improvements over a placebo for pain and physical functioning, on average, according to a new analysis published Tuesday. And the majority of patients will experience no meaningful benefit.”
Subgroups of the studies included in the analysis suggest that non-opioid alternatives -- such as NSAIDs, certain antidepressants and medical cannabis -- may offer similar benefits to opioids on average. But the evidence for that is less strong, Busse said.
Here’s my question for Dr. Busse, “Considering the fact that the American College of Physicians and The Lancet promote spinal manipulative therapy for acute and chronic low back pain as an alternative to opioids, and considering you are a chiropractor, why did your research not include spinal manipulative therapy as one of the alternative treatments?”
My guess is that maybe there were not enough randomized controlled trials comparing spinal manipulative therapy directly to opioids? I’m not sure why to be honest.
But, we do know from JAMA that a current review found that spinal manipulation therapy is associated with moderate improvements in pain and function in patients with acute low back pain[5].
We know from Keeney et al that there “Reduced odds of surgery were observed for...those whose first provider was a chiropractor. 42.7% of workers [with back injuries] who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor[6]."
From Haas et. al[7]., we know “Acute and chronic chiropractic patients experienced better outcomes in pain, functional disability, and patient satisfaction; clinically important differences in pain and disability improvement were found for chronic patients.”
There are so many others that I just don’t have the time to get into right now but, I’m certainly interested in papers comparing the two directly to each other. I bet I already know the answer and I bet you do too.
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The Message
Here’s why you know the answer alreayd……it’s because we know 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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
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About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography
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Ramanthan S, H.P., Wiles L, Maher C, Runicman W,, What is the association between the presence of comorbidities and the appropriateness of care for low back pain? A population-based medical record review study. BMC Musculoskelet Disord, 2018. 19(391).
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Holmes M, B.F., Newell D, Field J, Lewith G,, Chiropractors’ views on the use of patient-reported outcome measures in clinical practice: a qualitative study. Chiropr Man Therap, 2018. 26(50).
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Busse J, W.L., Kamaleldin M,, Opioids for Chronic Noncancer Pain: A Systematic Review and Meta-analysis. JAMA, 2018. 320(23): p. 2448-2460.
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Nedelman, M., Opioids offer little chronic pain benefit and wane over time, study says, in CNN. 2018: CNN Online.
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Page N, Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain. Journal of American Medical Association (JAMA), 2107. 317(14): p. 1451-1460.
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Keeney BJ, Early predictors of lumbar spine surgery after occupational back injury: results from a prospective study of workers in Washington State. Spine (Phila Pa 1976), 2013. May 15(38): p. 11.
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Haas M, A practice-based study of patients with acute and chronic low back pain attending primary care and chiropractic physicians: two-week to 48-month follow-up. J Manipulative Physiol Ther, 2004. Mar-Apr;27(3): p. 160-9.
CF 056: What Does A Manipulation Do In Medical Terms & What I Despise About My Profession
Today we’re going to talk about what a chiropractic manipulation is, we’ll talk about what it does and what happens there. We’re also going to talk about what I sincerely despise about our great profession. Depending on how fired up I get here, this one should be a good episode.
But first, here’s that bumper music
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OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have dropped into Episode #56 and we’re so glad you did. We showed some good growth over the last month and I want to take just a second to thank you for listening and sharing. By now, you all know how important that is to a newer thing like we are trying to build here and thank you thank you.
Let’s talk a bit about the DACO program which stands for Diplomate of Academy of Chiropractic Orthopedists. First though, I’m still thinking about that episode from last week with James Lehman, head of the DACO for Univ. of Bridgeport Connecticut. What a great episode. Make sure you go back and listen to Episode 55. It’s excellent folks.
On the DACO, I have moved beyond the Diagnostic Drills and have entered what are called the Communication Drills. These drills help you develop your skills when interacting with those in the medical profession. When you’re writing out a note to a patient’s GP, how to use ideas and words to help position yourself correctly.
I’m about 6 Communication Drills into it and I’m digging them. There’s a lot of repetition in the drills but repetition builds habits and I’m on it like white on rice.
For example, if you needed to explain why you are adjusting a sacroiliac joint to a medical practitioner that largely assumes the SI joint is basically fused and couldn’t be the cause of generalized back pain, what exactly would you say?
Think about that one for a minute. I had to think about it too so don’t feel bad if you’re not sure how you’d go about it.
Do you write them a 5 page summary of the history of manipulation, how it works, with research citations and proof that we are more effective than physical therapy? Or do you set yourself up as more of a diagnostician than a therapist?
My vote and the vote of the folks running the education here is that we set ourselves up as a diagnostician, pick one topic per letter and try to narrow it down to some simple ideas that we can communicate with them in ways they understand.
Very cool stuff. Trust me on this. And, again, if you need some help getting started on the DACO, I’ll be glad to point you in the right direction if you want to send me an email at dr.williams@chiropracticforward.com
Foolishness in the Profession
I’m going to take the first part of the episode today to be a little negative and I want to apologize for that but, you cannot have light without some darkness to give it perspective right? Don’t forget, I’m an artist.
Remember that these episodes are running two weeks behind. I record them, edit them and all that good stuff and they post two weeks after I record them. While this one is probably posting somewhere around the 17th of January, I recorded it on December 27th. By the way, I hope you all had an excellent Christmas.
I am leaving names and places out of this for two reasons:
- I don’t like pointing the finger directly at people, running them over in the street and then backing up over them publicly, and then doing it again but still need to tell the story and give my take on it.
- For me, there’s nothing good about this at all and I don’t want to give them any more attention than they have already received. The less people know about them, the better in my opinion.
Over the Christmas holiday, someone posted in one of the private evidence-based Facebook groups a picture that a group of chiropractors posted on social media claiming to have reversed and eliminated degenerative, arthritic osteophytes on x-rays after seeing a patient 4 times per day over the course of 3 weeks.
A Christmas miracle right?
OK, there are so many problems here that I truly don’t even know where to start. If I get to rambling, please forgive me.
The first thing is that there are tons of healthcare practitioners every day making insane claims. Chiropractors, DOs, AND MDs. It’s not only in our profession but, our profession…..well…..let’s just say we’re no stranger to stuff like this unfortunately and in 2018 with all of the amazing research in our favor, it’s getting damned old to be honest.
This claim, however, is just too over the top for me and it really highlighted what I absolutely despise about our amazing profession and why things like the Chiropractic Forward Podcast and Group are necessary. Why the Forward Thinking Chiropractic Alliance group and the Evidence-based Chiropractic group are necessary.
I will include a picture of the Instagram post from this group in the show notes so you’ll see exactly what everyone else saw.
Let’s pick things apart just a little bit.
From the get go here you must understand that this group is trying to be practice gurus and speakers and are trying to be the millennial mystical greats of the chiropractic profession. Not only do they have their practice page, but they’ve got a technique training group, and then they have a practice management group they’re trying to build.
So, you see, they’re doing everything they can to have profound influence on our great profession. That’s important to note because there’s a point that a person has to decide if we want what we’re about to talk about here to play a big part in how you are perceived by other professions and professionals.
Are we OK with being guilty by association essentially?
The first thing on this case is that there were probably zero red flags for x-rays in the first place if I’m guessing. I can’t say that for sure since I didn’t take the history on this patient but I have a strong hunch.
Next, only a very very few amount of people need to be seen once a day. Maybe twice a day in an extreme case. But four times per day? OK, let’s say you had that unicorn of a patient come through your doors and they actually needed 4 times per day. Four times per day for three damn weeks?
Where in the hell do you have someone teach you that a patient would ever need that much?
What guru is giving people those kinds of treatment guidelines? Are we just making it up and ‘winging it’.
Unfortunately, it’s my guess that this is a regular treatment recommendation beyond just this patient.
OK, next….a follow up x-ray just three weeks after the first set. Seriously? I believe that ACA’s Choose Wisely was put together for this very reason. Because chiropractors have a reputation of lighting up patients.
I’m not against initial x-rays honestly. Sure we can typically rule out the need for x-rays with a good history, etc.. But, what if your gut just tells you to shoot them even when there are no red flags? I say you better do them!
Sometimes people just like to know what’s going on and who am I to argue with that? But, follow up x-rays three weeks down the road? Outside of a new injury, the answer is no. Likely never.
Let’s be positive for a second though. They look like they can adjust just fine and I have no doubt they make a good number of their patients feel better.
Dr. James Parker of Parker College of Chiropractic used to say something similar to, “Chiropractic is so effective that I could hit everyone in the ass with a board and get a good number of them better.” Something like that anyway. I didn’t agree with a whole bunch of what he said but I get his point on that one.
Theatrics
I only have one problem with their adjustments and it’s a bit of a trend with their age group that I’ve started to notice. It’s the theatrics. I call it the ‘artistic adjustment’ and I’ve got very little use for it personally.
Here’s what I mean: it’s the slow and seemingly thoughtful process of approaching the patient and beginning to work on them followed by exaggerated hand motions and movements and almost dancing around in some awkward way.
Now look, for some, it’s art and it’s awesome. I’d say I get it but I don’t or I wouldn’t even be talking about it. And it’s not only this group. I’ve seen several of the younger guys doing this in videos on social media and I cringe every single time.
Does it put the patient at any increased risk? No, not at all to my knowledge. It just looks absolutely ridiculous and foolish and, in my opinion, puts us all at more scrutiny from other professions when they see foolishness highlighted in our people.
That’s probably just the old man in me now that I’m 46 looking at these 20-something kids and wondering what in the hell they could possibly thinking. It probably is. Elvis once irritated the hell out of Frank Sinatra fans right? I’m not oblivious to this fact.
However, I’m still waiting to see that MD on YouTube and Facebook dancing around their actual real patients, drawing blood with exaggerated hand motions, and then writing a script out with flare. All while having a goatee and wearing a dressy vest and flat top hat. I’m not going to hold my breath on that one.
You might could point at ZDogg but he only makes spoof videos. Not real treatment videos. Oh, and he typically makes a lot of sense from what I’ve seen.
But all of this is purely opinion and preference. I guess just you do you….create your own truth…and all that stuff the young people say is the deal here. Lol
It turns out that I wasn’t the only one that took offense to the claims of healing arthritis. Our colleagues in the Forward Thinking Chiropractic Alliance Facebook group took to social media on this.
They called out this group and they were well-within their rights to do so. They pointed out several issues including but not limited to different positioning of the patient, different parameters of x-rays that can easily explain the difference in the before and after x-rays, they pointed out how the interpretation of the research they provided was flawed, they showed how the spurs were still there, and basically, they gave these guys a good dressing down.
So, what happened?
Well, one of the main guys took down all of the false claims and posted a sincere apology for being misled by his school and not fully understanding the research, for not fully understanding x-rays, and for posting outlandish claims. That was followed up by a promise to stop any further apparent craziness, have more respect for his colleagues and how his actions affect us all, and a commitment to proceed in an evidence-informed manner forever and ever amen.
I’m lying. That’s not what happened at all.
What actually happened is that one of the main guys in this group got on their Facebook page and doubled down on the claim while simultaneously and arrogantly claiming everyone was wrong, compared birthing a new idea of osteophyte absorption to actual child birth, and insinuated that he was above the rest in knowledge, peace, love, completeness, circle of life, acceptance, speaking YOUR truth instead of the ACTUAL truth, healing immersion experiences, understanding, and a whole bunch of other nonsensical new age, mystical drivel. Or at least that’s the way I interpreted it all.
And it was all delivered with what I took as, “You’ll never be on my level” giggles in between sentences.
That’s what happened. Oh, and of course, any post that wasn’t in praise on their page was deleted. It’s best if your tribe only sees YOUR truth instead of the REAL truth.
And they’ve been out of school around 4-5 years or so of course they already have it all figured out like so many others in their age group. Of course they should be leading a group and having influence over other chiropractors. Of course….it all makes sense. That is if you live in the freaking Twilight Zone.
Good Lord, help us all.
There are some absolutely amazing young people in our profession in this age group. Stunningly smart, exceedingly capable, and individuals I would trust my health with in a heart beat. I’ve seen them, met them, and interacted with so many of them. I’ve worked along side many of them through the Texas Chiropractic Association.
This group, the group that claims reversal of arthritis….for me….they are not among them.
Why on Earth am I tell you all about this? Why am I being so negative when I’m typically a very positive person?
Because you need to know what is going on in our profession. You cannot ignore the loud, obnoxious minority. You need to understand that we are not only up against a medical profession that largely dislikes us and looks for reasons to chip away at our abilities to practice, but we are also up against those in our own profession that are either intentionally or unintentionally trying to drag us down and keep us in the dark ages of the profession.
For many chiropractors, it seems like it’s almost like a religion. It’s not. It’s a healthcare profession and when it comes to treating the public, you need to be based in science, research, and evidence. You also need to be committed to best practice principles.
Let’s be clear, there is no research anywhere that I’ve seen or am aware of showing any magical unicorn ability of the body to absorb arthritic osteophytes. It’s impossible to my knowledge and to the knowledge of so many other chiropractors I saw discussing and interacting on this thing this week.
If I’m proven unequivocally wrong somehow, not only will I apologize and will provide you their names and will probably go there for treatment myself.
One of the main guys in this group posted that he’d never seen anyone outside of other chiropractors call another chiropractor quacks. Well, I’d start by directing him to a website by MD Stephen Barrett. Just the name of the website should make a point. I’m not saying it or leaving it here because I don’t want any of you going there and giving him clicks so that’s all on you to do your research.
Most chiros are aware of Barrett anyway.
I’d then direct him to a mailer sent out by the Texas Medical Association’s political action committee a few years ago when the we chiropractors had a viable candidate running for a state congressional seat. Dr. Mike VanDerWalle is a chiropractor with over 30 years in practice in Austin, TX. Very well-respected and thought of.
The TMA PAC sent a mailer out to all of his potential constituents (and you better believe plenty of his patients) that had a duck on one side of it and it said, “Quack, quack, quack.” On the other side of it, the TMA PAC compared Dr. VanDerWalle to Dr. Pepper and Dr. Jekyll.
So you see, we are hated, despised, and ridiculed to this very day by the national and state associations. Your opinion is irrelevant. It’s a fact. The TMA just won a lawsuit against Texas Chiropractors removing neuro from our term neuromusculoskeletal in our scope. That’s a big deal for only having five letters.
That happened last month 2018.
Be vigilante. Be aware. Call out BS when you see it. You cannot allow it if you hope to ever get this profession where it should be. So many people need us and they have no idea. It’s up to us. Do your part.
Now, something positive before I stroke out.
How do you describe a manipulation? If you were on an airplane sitting next to a neurosurgeon and he asked you exactly how manipulation works and affects the body and pain, what would you tell him? Have you thought about it?
The folks at ChiroUp have thought about it and probably because they’re DACOs, the DACO program also has an interesting description to offer.
Dr. Brandon Steele with ChiroUp offered a good explanation for cavitation back in October on their blog. I’ll leave the link for you in the show notes.
https://chiroup.com/how-do-you-explain-joint-cavitation/
He described the need for better communication with the patients regarding cavitation and whether something “goes” or pops. Too many times, patients equate a successful treatment with cavitation. You know what we’re saying here.
To quote Dr. Steele’s blog, he says, “Joint manipulation improves range of motion across individual and multiple vertebral segments. A recent paper by Anderstt et al. (2018) confirmed that cervical manipulation results in facet gaping. This force also improves regional motion across multiple spinal levels during and post-manipulation.
“This study is the first to measure facet gapping during cervical manipulation on live humans. The results demonstrate that target and adjacent motion segments undergo facet joint gapping during manipulation and that intervertebral range of motion is increased in all three planes of motion after manipulation. The results suggest that clinical and functional improvement after manipulation may occur as a result of small increases in intervertebral ROM across multiple motion segments.”
Evidence-based chiropractors can bridge the patient education knowledge gap by incorporating current research into simple explanations.”
The DACO program I’ve been discussing put it all into an excellent description. Check this out and let me know what you think about it.
“Chiropractic adjustments exert their effects upon the nervous system in a variety of ways.
In recent years the neuroscience community has taken great strides in uncovering the mechanisms at play. These include analgesic responses at the dorsal horn level, as well as activation of the descending inhibitory pathways from brainstem regions such as the periaqueductal gray.
There is also a compelling body of research that suggests profound changes in sensorimotor integration within the cortex.
It appears that manipulation relies upon signaling properties of the muscle spindles that lie embedded in the paraspinal tissues. As the spindle registers rapid lengthening of the muscle it transduces this into a large proprioceptive barrage.
The unique nature of a manipulation seems to alter the responsiveness of second order neurons in the dorsal horn and make them less sensitive to incoming nociceptive signals from injured tissues.”
THAT’S communicating in the RIGHT way, folks. THAT’S gaining respect and furthering our profession.
There’s no mystical, new age babble necessary when you actually pay attention to real research instead of pseudo-research that no real clinician would pay any attention to.
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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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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 - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
CF 055: w/ Dr. James Lehman - The Future Of Chiropractic, Chiropractic Specialization, & Chiropractic Integration
Today we’re going to talk to one of the giants in our profession, Dr. James Lehman. We will be talking to Dr. Lehman all about all sorts of things but mostly about the future of chiropractic. What is is looking like for those of us in the profession over the course of the next 15-30 years?
But first, here’s that delicious bumper music
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OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have fluttered into Episode #55 kind of like the feather on Forrest Gump. Come on, you know the feather from literally one of the best movies of all time. Yes, that feather.
This is normally the point in the program where I mention the DACO program and how I am progressing through it but, for reasons that will become obvious fairly quickly, we are going to save that talk for just a little later in our program.
However, I will tell you I have 80 online hours at this point and some of my more recent classes have been Why does my shoulder keep hurting and how to diagnose tension-type headache. If you recall from a week or so ago, two classes on migraines were among the classes so, after this last week, I’m getting a handle on the headache mystery.
I have just about completed all of the Diagnostic Drills. There are 40 of them and I’ve finished 39 of them. The last one is on ankle sprain and what we really need to know about them. Then, we move on to Communication Drills that reinforce these Diagnostic Drills and help you write to your colleagues in an effective and professional way to describe your findings. I’m looking forward to those!
Now, let’s go ahead and get on with the reason we’re all here. Before we speak with Dr. James Lehman, I want to go through a little background information on him for you so you are well-aware of who he is and where he is coming from.
Dr. James Lehman is an Associate Professor of Clinical Sciences at the University of Bridgeport/College of Chiropractic and Director of Health Sciences Postgraduate Education (HSPED).
Dr. Lehman completed his MBA at the University of New Mexico and doctorate in chiropractic medicine at the Logan College of Chiropractic in St. Louis, Missouri.
Dr. Lehman is a board-certified, chiropractic orthopedist. He teaches orthopedic and neurological examination and differential diagnosis of neuromusculoskeletal conditions. In addition, he provides clinical rotations for fourth-year chiropractic students and chiropractic residents in the community health center and a sports medicine rotation in the training facility of the local professional baseball team.
As Director, Dr. Lehman developed the three-year, full-time resident training program in chiropractic orthopedics and neuromusculoskeletal medicine. The program offers training within primary care facilities of a Federally Qualified Health Center and Patient-Centered Medical Home. While practicing in New Mexico, he mentored fourth-year, UNM medical students.
Welcome to the show Dr. Lehman, it’s an honor to have you on the Chiropractic Forward Podcast this week.
How did the job at UofB become a reality for you? How did you make that happen or even make it a possibility?
Can you tell me about your position at UofB?
What are your responsibilities?
What does a regular day for you look like?
Dr. Lehman and myself became acquainted with each other through the DACO program. In case you have been hiding under a rock, zoning off during our podcasts, or maybe this is the very first podcast you’ve listened to of ours, DACO stands for Diplomate of American Chiropractic Orthopedists.
What got you so interested in the Orthopedic side of our profession?
What was it that made you want to specialize originally?
Can you tell us a little about your experience with chiropractic integration over the years?
Have you had some battles to fight internally against medical practitioners?
What are some of the pitfalls and what are some of the rewards beyond seeing the patients recover?
Can you tell us about FQHCs? I had no idea they existed, especially in my city, until you showed me. Integrating into an FQHC was something that was never on my radar until we talked in Dallas.
At this point in our discussion, I need to tell you, the audience, that Dr. Lehman has played a vital role in furthering the DACO program. Through his position at the University of Bridgeport Connecticut, and through a partnership of sorts with online education through Chiropractic Development International out of Australia, obtaining the DACO has become very do-able and very attainable for all that may be so inclined.
Dr. Lehman, can you tell us a little about how you and the University of Bridgeport got involved in the DACO and how it’s going so far? How did you identify the need and then go about filling that need?
Can you tell us why you feel like specialization like the DACO is so important to doctors of chiropractic these days?
Why has this become your mission?
Through email, you suggested to me that, for the chiropractic profession to gain the respect of the healthcare system, a reasonable definition of chiropractic would be a good starting point. You offered a definition that doesn’t restrict providers nor does it highlight ‘subluxation.’ That definition is as follows:
“The evidence-based practice of differential diagnosis, patient-centered treatment and prevention of pain and human disease as taught by CCE-approved chiropractic colleges, institutions, or schools.”
Tell me how you came up with this definition.
Just to tell a quick personal experience, I have been introduced before by one neurosurgeon to another neurosurgeon using a disclaimer. He said, “He’s not one of THOSE chiropractors. He’s one of the good guys.” Which, I have to say that I appreciated the vote of confidence but at the same time it made me think, “With such a prevailing sentiment toward our profession, how will we ever integrate successfully or is it even possible?”
Do you think that even those of us that are specializing are going to be forever introduced with a disclaimer? I personally don’t see how a profession as split as ours progresses and integrates successfully. Is there a solution to this or are we just stuck with the split and the internal fighting?
With the knowledge that PTs are now utilizing spinal manipulative therapy, what do you feel is going to happen with our profession in the next 15-30 years?
In the two classes I’ve sat through with you as a speaker, you were adamant about Informed Consent. I read your paper on that topic after I got back from Dallas and thought is was pretty interesting. Informed Consent doesn’t sound like a particularly interesting or sexy topic to the general population so, would you mind telling us about that and what interested you enough in a topic like Informed Consent to actually publish a paper on it?
We covered the vast divide in our profession, what are some other big obstacles you see on the horizon for our profession right now?
In our private Chiropractic Forward Group, when we discussed about you episode coming up, Dr. Brandon Steele said I need to ask you this question, “What can students do right now to prepare for current tremds in Healthcare? Are there residencies, certifications, internships or other equivalents they should be considering going through to prepare for their future after graduation?”
Also in the private group, Dr. William Lawson, who has been a guest with us before, told me to ask you about rural healthcare centers and how a chiropractor can work in or own a rural healthcare center.
being with us and taking time out of your day. I really appreciate you and what you are doing for our profession. I don’t know where we would be without folks like you and others just like you.
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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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
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YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
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About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
CF 054: Lumbar Fusion Surgery and It’s Evidence Or Lack Of
Today we’re going to talk about a great new paper coming to us fron Internal Medicine Journal on Lumbar fusion surgery and it’s evidence or lack of. What’s the word on lumbar fusion surgery? We’ll tell you.
But first, here’s that silky smooth Chiropractic Forward bumper music
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OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have glided all fast and furiously into Episode #54 and we’re happy to have you here smokin tires and all. Kill the engine and take a chill pill won’t you?
DACO
Let’s talk a bit about the Diplomate of Chiropractic Examiners program quickly. I’m sitting at around 76 of my online hours and I have to get 250 of those. Yes, if you were wondering, it is going by slowly here lately but I’m going to have a little time this week and weekend to put the pedal to the metal and get after it.
Some classes from this past week were migraines, migraines in children, thoracolumbar junction difficulties, and chronically injured hamstrings.
Spelling Issues
These courses come from a group in Australia and they really take the long road when it comes to spelling. Did you guys know that? First thing that’s crazy about the Aussies is that they use esses instead of z’s. For example, recognize is spelled with an s rather than a “z”.
When you see the word orthopedic spelled orthopaedic, it’s because of them and the English. We take the short cuts and say, hey, recognize has a z sound in it so let’s spell it with a z. Hey orthopedic has an e sound in the middle of it so let’s drop the dumb a since we don’t need it and let’s just spell it orthopedic.
Here’s another one. Behavior. These goofy people spell it behaviour. They snuck in a u right there at the very end of the word like they thought they were going to get away with it or something. Uh uh. Nope. We Americans don’t need the u at the end so we just end it in or. Because we’re cool and ain’t nobody got time for that crap.
The most annoying one is probably edema or estrogen. They start both of those words with an O. Who the hell would ever spell estrogen Oestrogen? Or edema spelled oedema? That’s absolutely uncalled for and I’d appreciate them re-evaluating their use of the English language in this manner.
Absolute ridiculosity.
I am currently designing some really cool stuff all based in research and current evidence that I think you will all be interested in. At least I hope you are because, from what I’ve seen in researching, it’s like nothing else out there.
Go to chiropracticforward.com right now while you’re thinking about it, just under this week’s episode, you’ll see an area where you can sign up for the newsletter. It’s only once a week and it’ll help us tell you about what we’re working on when we get it ready to go live!!
Now, let’s get to the reason for the season here.
The is titled “Lumbar Spine Fusion: What Is The Evidence(Harris I 2018)?” and it was written by Ian Harris, Adrian Traeger, Ralph Stanford, Chistopher Maher, and Rachelle Buchbinder. I recognize at least two of these names from the low back pain series published in The Lancet earlier this year.
If you have not been through those papers, please listen to episodes #16, 17, and 18 of this Chiropractic Forward podcast for all the info you need on that.
Basically, in this paper, they say that lumbar spinal fusion is common and associated with high cost and a risk of serious adverse events. They state that they aim to summarize systematic reviews on the effectiveness of lumbar spine fusion for most diagnoses.
Of important note is where they say that they found NO high-quality systematic reviews and the risk of bias of the randomized controlled trials they found was generally high. For something as serious as lumbar fusion surgery. Where they cut into the body, take two vertebrae that usually aren’t unstable on each other, and then drive screws into them and affix hardware to fuse them together for ever and ever amen.
No high quality systematic reviews and the RCTs out there generally carry a high risk of bias. Great. Duly noted. Awesome.
They go on to say that the available evidence doesn’t support a clinical benefit from spine fusion compared to non-operative treatment or stabilization without fusion for thoracolumbar burst fractures.
They say that surgical intervention for metastatic carcinoma of the spine associated with spinal cord compromise improves mobility and neurological outcome. That was based on a single trial.
That was the high points of the abstract but let’s move in a little more and get on the micro level of this thing.
This study takes info from Australia and, in the land down under, lumbar spine fusion is the fourth most costly surgical procedure, behind knee replacement, hip replacement, and C-sections. For a procedure with no high-quality systemic reviews. The first word that comes to mind for me here is, “Damn.”
The most common reasons used for lumbar spine fusion procedures would be intervertebral disc disease (which nearly everyone beyond 50-60yrs old has), degenerative scoliosis, and spinal canal stenosis.
The main purpose here was to compare lumbar spinal fusion to non-operative means. Not to compare it to other surgical procedures.
Conclusion
As part of the conclusion the authors say, “The available evidence does not support the hypothesis that spine fusion confers a clinical benefit compared to non‐operative alternatives for low back pain associated with degeneration. Similarly, the available evidence does not support the hypothesis that spine fusion confers a clinical benefit compared to non‐operative treatment or stabilization without fusion for thoracolumbar burst fractures.
Benefits of spine fusion compared to non‐operative treatment for isthmic spondylolisthesis are unclear (one trial at high risk of bias). Surgical intervention for metastatic carcinoma of the spine associated with spinal cord compromise improves mobility and neurological outcome (based on a single trial).
Ideally spine fusion for spondylolisthesis, burst fractures, back pain or degenerative conditions (degenerative scoliosis, spinal stenosis, recurrent disc herniation or instability), should only be performed in the context of high quality clinical trials until the true value for each of these conditions is established.
Until better quality evidence is available, treatment will continue to be guided by expert clinical opinion based on evidence at high risk of bias. Patients contemplating spinal fusion should be fully informed about the evidence base for their particular problem, including the relative potential benefits and harms of fusion compared with non‐operative treatments.
Let’s transition from that to an excellent guideline called When Surgery is OK and this comes from the legendary Dr. Stu McGill.
To keep this episode from getting too long and out of hand, let’s hit the highlights. This is a 3 page document so we’ll shorten it to the extent that makes sense while still squeezing the good stuff out of it. Use these thoughts and ideas when deciding if surgery is indicated.
Stu says try the virtual surgery game and consider surgery only when it fails. Meaning pretend you had surgery today and tomorrow is the first day of recovery. It is characterized by gentle movements and activities but mostly a forced day of rest. The days following a typical post-surgical progression involves restricted activity. If this helps, no surgery at this time.
Consider surgery when neurological issues are substantial, such as loss of bowel and bladder control. Note: that does not include radiating symptoms like sciatica, peripheral numbness, atrophy, etc….
Consider surgery in cases of trauma. When structures are unstable and need to be stabilized.
Consider surgery only when pain has been unrelenting and severe for a substantial period of time. Pain can be a terrible and misleading reason to get surgery.
Select the surgeon. Dr. McGill says everyone likes to state that they had the best surgeon. He has found that asking the nurses and physical therapists at the hospital which surgeon has the best results is a wise way to go.
Discuss the pain with the surgeon. Ask what the pain generator is and if they can cut it out. IF there are several tissues involved, chances of success are getting worse. Also if there is damage at several levels.
Clarify what the success rate is. What does success even mean in your case? Does that mean you survived or does it mean you did OK for a bit before relapsing into pain? You want long-term success to any and all other options available.
Beware of new treatments. That one should really go without any further discussion. Don’t be a pioneer on the patient side of surgical procedures.
Beware of disc replacement - Dr. McGill states in this paper that he has not seen a successful case as of the writing of the article.
Always exhaust the conservative options - He says you may believe that since you tried physical therapy and it didn’t help that only surgery remains. It just may be that the exact therapy tried was not the right one for your specific condition.
Beware of institutes that offer to view medical images and, with no other information, advise patients on surgery. Pictures are not linked to pain. He argues that a thorough clinical assessment is absolutely essential. I want to butt in on this one. The laser institute and orthopedic surgeons are all over the commercials on TV with this one.
I will take this time to admit, because they’re doing these free MRI reviews, I’m offering the same in my region but here’s why. It’s evidently enticing or they would not offer it and I KNOW for a fact they have a higher-paid marketing department that has decided it is indeed effective.
That’s one of the reasons I’m doing it but the real reason is because I know that the majority of these people, if they get a free MRI review at the osteopath or the laser spine institute, they’re very likely to be lined up for surgery whereas I, after a thorough exam, will be lining them up for conservative, non-invasive therapy and I can usually keep these people from surgery and useless shots.
There’s a difference. My free MRI review is to prevent them from surgery. Their free MRI review, in my opinion is to QUALIFY them for surgery.
In wrapping this article or paper up, Dr. McGill says the following, “Tissues in the back become irritated with repeated loading. Consider accidentally stuffing a toe or biting the lip repeatedly - eventually the slightest touch causes pain. This is symptom magnification because the tissues are hyper sensitized. Reduction of the hypersensitivity in the toe or lip only occurs following a substantial amount of time after the accidental stub or bite has stopped.”
Dr. McGill goes on to say, “For example, people with flexion bending intolerance of the spine may may replicate this every time they rise from a chair. Correcting this movement fault, metaphorically taking the hits away, results in less sensitized tissues, an increased repertoire of pain-free tasks, and a return of motion. Motion returns once the pain goes away.”
Boom. Snap. Pow. Shazam. KaBAM!! Super hero abilities via the chiropractor and ZERO surgery. How clever.
I don’t care what your chiropractic practice looks like. OK….I lie. As long as it doesn’t make mine look hokey or bad, then I don’t care what your practice looks like. Some are geared toward getting people out of pain. Some are geared to some wellness protocol. Some are floundering because they don’t know where they belong or exactly what they’re trying to accomplish.
I’ll admit that, at one point in time, I was one of them.
But, one common thread through all sorts of practices is this, we keep people from surgery. Maybe not 100% of the time but we do a hell of a job with the tools we’ve been given and I love the direction that opioids and lumbar fusion surgery failures are pushing our profession.
Sometimes even in spite of ourselves.
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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 instead of chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.
Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!
Key Point:
Patients should have the guarantee of having the best treatment offering the least harm.
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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Help us get to the top of podcasts in our industry. That’s how we get the message out.
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.
Website
http://www.chiropracticforward.com
Social Media Links
https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
https://twitter.com/Chiro_Forward
YouTube
https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
https://player.fm/series/2291021
Stitcher:
https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography
Harris I, T. A., Stanford R, (2018). "Lumbar spine fusion: what is the evidence?" Internal Med J.
CF 049: The Palmer/Gallup Poll 2018 Discussion On Chiropractic Marketing
Today we’re going to talk about the 2018 version of the Palmer Gallup poll that has some great info including some marketing nuggets for your nugget pouch so stick around as we get into the details
But first, make way for that sweet sweet bumper music
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OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have crumpled into Episode #49. We are moving in on a solid year of Chiropractic Forward episodes and that feels good. Every single week. We haven’t missed one week this past year. There is most certainly a sense of accomplishment and doesn’t it feel good to feel good? Of course it does.
Let’s talk a bit about the DACO program - Same as last week. Just trudging along. Last week I took classes on benign paroxysmal positional vertigo, poster canal, anterior and horizontal canals, Epley’s maneuver and all that goes along with that. I also had a class on Lumbar spinal stenosis that I learned some new tidbits on. Great stuff. My offer stands, if any of you want to start looking at it, I’d be glad to give you a little guidance in getting yourself started.
How’s about youse guys head over to chiropracticforward.com and get yourself on our newsletter. I have some cool stuff coming down the pike and I want you to be the first to know about it and I want you to save money because you were cool enough to be on our email list. No more than once a week. That’s my guarantee. It’s just an email address folks. Not a big deal.
You have heard my woes and my front desk worries over the past month or two. I told you last week that it appears my wife has herself a new full time gig and guess what? With her help, we had not only one of the best Octobers we have ever had, we had one of the best months (numbers-wise) that we have ever had in 20 years.
I believe there’s something to this “wife working the front desk” idea people. Something to think about for sure. If you can work with your wife or husband that is. You may have to pee strategically around the office just to mark your territory and let it be known this is your domain but, nobody will work as hard for the office as someone that has a vested interest in it. I’m a firm believer in that.
We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.
This week I want to talk about the Palmer/Gallup poll that has been coming out annually for a couple of years now. I think it’s two years but cannot recall off the top of my head.
Regardless, let’s talk about the 2018 version. I look forward to it’s release every year because you can get some marketing ideas from it if you’re looking at it the right way.
Any time you start a new generic marketing program, they have you create your ideal avatar or you ideal customer. The customer that not only comes in and you love to see them come through the door but the customer that is coming in and paying good money to see a good doctor. The people that love you and go otu into the world to tell everyone every good thing they can about you and the ones that are the first to leave you a great Google review.
THAT’S the ideal patient isn’t it? If we could only fill up our offices with that specific, amazing person all day every day. We’d never even think about giving up our practices and moving to an exotic place with umbrellas and funny drinks.
Well, we may still think about doing that but it wouldn’t occupy as much brain space if these people were all that ever came through out door.
Don’t we just love seeing these perfect patients? Smiles, good vibes, and excitement. And sometimes food!! I have one bring us pumpking spiced cake and sugar cookies last week. We need to work on a nutritional talk for sure but you get the point.
I am linkinng the poll in the show notes so go check it out Episode 49 at chiropracticforward.com
http://www.palmer.edu/uploadedFiles/Pages/Alumni/gallup/palmer-gallop-annual-report-2018.pdf
The first thing we really get into here is the Summary and I think that’s really where we are going to stay instead of going too deep in because we’ll wind up with a 4 hour episode and I don’t want that any more than you do so let’s hit the high spots and call it good.
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Neck and back pain is common among adutls in the US - yes, we knew that now didn’t we? They say about 2/3 of US adults (62% to be specific) have had neck or back pain that was significant enough that they saw a healthcare professional for care at some point in their lifetime, including 25% who did so in the last 12 months.
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25% of the population sought care in the last year for pain. I bet 25% did not seek care for wellness.
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80% of American adults prefer to see an expert in spine care for neck and back conditons rather than a general medicine professional who treats anything and everything. I think we all know who the experts are right? It’s us….
He’s a problem though, 67% of them prefer to see someone that can prescribe medication or surgery to treat neck or back pain. Only 28% want to see someone that does not use prescription medication or surgery. That one is a bit of a kick to the nether region. I thought we were making more progress on that front.
I can’t tell if the next point contradicts the previous one or not. You decide. They say that prescription pain meds aren’t preferred as first-line care for about 79%. i can only guess they are preferring a practitioner that can prescribe just in case it declines to the point of needing it but they don’t necessarily want to start with pills? Maybe…..
- When it comes to healthcare providers, people say that chiropractic doctors and medical doctors are the top choices for neck or back pain care. In the last year, 62% say a medical doctor while 53% saw a chiropractic doctor.
Going a little deeper there, 34% say a PT and 34% visited a massage therapist.
I think it’s of important note here that half of the people that went to the chiropractor went because they said that chiroparctors provde the most effective treatment for their pain. That’s pretty damn awesome right there. We’ll get to the other half here in just a minute.
The overwhelming feeling in this subsection is the the keyword is “EFFECTIVENESS.” Can you say, “Marketing Nugget?” How effectively can you relay your effectiveness?
I would offer to you the idea that this podcast is an EXCELLENT way to speak about your effectiveness as well as to back up your effectiveness. You just have to listen and you have to take what you learn and turn that into kick butt content and marketing material.
Since not everyone is particularly gifted at marketing or creating content, we are working on helping you out in that aspect. Stick with us. It’ll happen. Just go to chiropracticforward.com and get on the email list to stay on top of that.
Outside of ‘effectiveness,’ safety was another reason people chose chiropractors and PTs for their back and neck pain. In fact, about half of those coming to the chiropractor said safety was why they chose chiropractic.
So, we have the big TWO reasons. Only two. That people go to chiropractors nationwide. They are Effectiveness and Safety. That should be useful information for you guys and gals to take and run with.
- The fourth point of the summary was types of care. They found a lot of people utilizing self-management at home, as they should. They say 53% of American adults went to get massages to control pain. They say 47% had chiropractic care for their pain. And 42% went to a PT.
That means we have a lot of people doing more than one thing right? It would make perfect sense to not be a one-trick pony in your practice. For instance the subluxation guys and gals only adjust. They’ll see a patient 100 times a year and only adjust. Nothing else. Oh wait, I lie. There’s a local guy here that will pray over each one before using the activator on them all so I guess it’s a little more than just the adjustment.
I don’t want to make light of prayer. I’m a Christian and am well aware of the power of prayer but when it’s done after joining Body By God type management programs, well, it just seems a bit disengenuous doesn’t it? If we’re being honest?
Anyway, if you have to see someone that many times a year, you’re probably a terrible chiropractor and you’re probably doing more damage than you are doing good.
Back to doing more than one thing: it’s clear patients are not looking for just an adjustment. It appears they’re looking for chiropractic, they’re looking for massage, they’re looking for some exercise/rehab considering 72% were looking into yoga.
Although it’s not in this article, I believe many are looking for acupuncture these days. As discussed earlier, they may potentially be looking for meds so why couldn’t you offer anti-inflammatories like turmeric or boswellia just to name a few. I say this because this poll showed that 73% of people took an over the counter medications like acetaminophen or ibuprofen. Definitely food for thought.
- Patient Experiences
Patients that visited a chiropractor, a PT, or an MD over the last year said they received a high level of care. That’s good news.
For chiropractors specifically, 9 out of 10 patients said
- The chiropractor listened to them
- DCs provided convenient and quick care
- We demostrated caring and compassion
- The chiropractor explained things well
- And they spent the right amount of time with them
Approximately 90% of patients had all of that to say about chiropractic doctors. That’s oustanding news, folks. That means that we can fight amongst ourselves and, while I would argue the straights are keeping us from full integration, in the eyes of patients, almost ALL of us are doing a good job!
For Physical Therapists, overall, they were hitting around the 83%-86% area.
For MD’s, they didn’t do too well honestly. But didn’t we expect that? Here’s how they fared:
- 72% say their MD listens
- 67% said they often explain things well
- 66% said they demonstrate care and compassion
- 53% said they have quick access and are convenient
No surprise there. In fact, the surprise comes when we see that so many are still going to the GP for non-complicated musculoskeletal pains. That’s the real surprise.
When you consider that chiropractors hit around 90% for all of those and you see MDs around 64% for the same metrics, well…..that’s not so good right?
I see A LOT of opportunity here. If you are of the marketing mind, I’m sure you see the same!
This podcast isn’t just for listening to some mindless drivel folks. I am trying to give you stuff that you can use immediately after you listen. If you pay attention to what I’m telling you every week, you can turn around and communicate FACTS to your patients, your staff, and to those in the medical field in your region.
I’m friends with a neurosurgeon and a vascular surgeon because I’m not freaking crazy. I can communicate research to them in an effective way that they understand. I’ve taught them a ton they didn’t already know. Plus we all like a cereveza here and there so that works out well for us.
What I’m saying is that you should be listening to this podcast to learn for sure. But you should also be listening to it with the mindset of, “How am I going to take this information and use it in either my marketing or in my communication with my community?”
Believe me or don’t. I hope you believe me. The information I am bringing to you is the information you should be using. Not the subluxation stuff. Not the philosophy stuff. Literally, straights in our profession are the only people on this Earth that give a damn about that stuff.
Nobody else knows or cares. Nobody.
But research, safety, and effectveness, well…..when you’re talking in those terms, then you are getting somewhere.
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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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.
The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Being the #1 Chiropractic podcast in the world would be pretty darn cool.
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.
Website
http://www.chiropracticforward.com
Social Media Links
- https://www.facebook.com/chiropracticforward/
- Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
- https://twitter.com/Chiro_Forward
- https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
- https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
- https://player.fm/series/2291021
Stitcher:
- https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
- https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the author:
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
http://www.palmer.edu/uploadedFiles/Pages/Alumni/gallup/palmer-gallop-annual-report-2018.pdf
Episode #46: Chiropractic Effectiveness - Chiropractic Integration - Chiropractic Future
Today we’re going to talk about what I think is some good news that bodes very well for the future of our profession integrating and playing well with others. We’ll discuss a paper on non-pharma ways of treating pain and then we’ll discuss an article showing how road blocks are set up to keep Americans from following those recommendations.
Stick with us as we shake it all out, but first, here’s that bumper music
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Welcome to the podcast today, I am still pretty new to the podcast game so, in case you don’t know me just yet,...I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have gallivanted into Episode #46 and we are so glad you did.
Let’s tarlk a bit about the DACO program, I have gone through 30 hours live and have taken 12 hours online so far. That makes 42 of the 300 but hey, who’s counting right? The last one I took had to do with Cervical pain and neural tension. I’m man enough to admit that, while I have an A in the class, I missed a question on this one and here’s what I’m going to say…..STOP. Stop asking trick questions dammit.
Honestly, you can know the material cold but the way they ask some of the questions, there’s no telling what the hell the answer is. “Which statement makes the most clinical sound?” Fine…no problem. But, as you read through them, there is maybe one answer that is very thorough while the others are not technically incorrect but aren’t quite as comprehensive as the one answer. Then, yes…..the feared…..ALL OF THE ABOVE. Uh huh….just ask the damn question and be fair about it. That’s all I’m saying. On one hand, one answer is most definitely more clinically sound than the others. On the other hand, all of them have some correct aspects. So, you’re bound to miss some here or there and, with only 5 questions, you miss one, you make an 80. An 80 is hard for me to swallow friends.
So….cut it out people. Be fair in your questioning. Thank you very much
The material though, my goodness. I can’t even begin to tell you all how wonderful the material is. Of course, I like some of the classes more than others. The one on pain was not necessarily my favorite but I muddled through it and still know a ton more about pain than I did prior to. Pain is a difficult topic but they did an excellent job of lining it out for us.
Every class makes a difference. Without a doubt. Let me know if you need some guidance on getting started on your DACO. Which was the main thing for me….just getting started in the first place. IT’s a bit confusing but once you get enrolled and get that first class under your belt, you’re good to go. Just email me at dr.williams@chiropracticforward.com
If you haven’t yet, please go sign up for our Chiropractic Forward newsletter by going to chiropractic forward.com and it’ll pop up right there. You can’t miss it. It almost punches you right in the face. Help us keep pass along important stuff here by getting on that newsletter. Never any more than once per week. Promise.
Evidently you and your colleagues are catching onto this here podcast. We appreciate it and we appreciate your continuing sharing it with you people. That’s the only way to grow.
So far, we still have the front desk staff in place. So that’s been amazing to not be obsessing about. It is really hard to find the right person with the right qualities to fill that spot. I’m not spouting fake numbers when I tell you that we see an average of about 60 new patients per month by myself. No associate. I had a colleague recently tell me they don’t think they could do that by their self . I have to admit, I didn’t realize it was an impressive amount. Lol. I was glad to hear it though. Here’s my deal though, I don’t hold onto them. I see them, get them better, and see them again in a year or so when they re-injure something.
I see about 40 or so visits per day and that’s pretty manageable when you have a great staff. I still work from 8-1 on Fridays too. The majority of my time is spent with new patients trying to figure them out. After we have a direction with a patient however, we have a team of people that really help take the work load off of me other than the actual adjusting. And, in case anyone is wondering out there, I adjust manually, Diversified with some drops here and there. Very little activator. Some muscle work when appropriate but there’s not a lot of fluff in a visit once we are rocking and rolling with a case. I tell them that I can really drag this visit out and make it last a lot longer than it takes if they want me to but most are ready to get in and out and back to work. And that works well for us too.
Anyway, back to the original point: it’s hard to find someone that is not intimidated by the insurance demands, new patients, existing patients, etc….looking them in the eyes all day every day all day. Plus, a third of the building is massage, day spa services so, the right person is key. They get intimidated and leave. Lol. I suppose it’s a good problem to have. But, so far so good with the new one!
As I’ve said before, I will certainly keep you updated.
We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.
Let’s kick off the discussion today with one from McGregor, et. al. 2014 called “Differentiating intraprofessional attitudes toward paradigms in health care delivery among chiropractic factions: results from a randomly sampled survey.” It was published in BMC Complementary and Alternative Medicine[1].
In the background section of the abstract the authors' discuss how healthcare has increased in complexity and there has developed a need for inter professional collaboration. Amen, brothers and sisters. It goes on to talk about how different factions within the chiropractic profession are contrary to each other and how one faction holding unorthodox practice beliefs and behaviors may compromise inter professional relations going forward.
The purpose of this paper was, "to quantify the professional stratification among Canadian chiropractic practitioners and evaluate the practice perceptions of those factions."
How do you go about figuring this stuff out? Luckily, there are far more intelligent people out there in the world. They took a stratified random sample of 740 Canadian chiropractors and surveyed them in an attempt to determine faction membership and how professional stratification could be related to views that could be considered unorthodox to current evidence-based care and guides.
What they found
Out of 740 questionnaires, 503 came back.
Less than 18.8% of the chiropractors were in the faction considered to be unorthodox in the perceptions of conditions they treat.
They also state that prediction models suggest that unorthodox perceptions of health practice related to treatment choices, x-ray use, and vaccinations were strongly associated with unorthodox group membership.
The conclusions reached here were as quoted, "Chiropractors holding unorthodox views may be identified based on response to specific beliefs that appear to align with unorthodox health practices. Despite continued concerns by mainstream medicine, only a minority of the profession has retained a perspective in contrast to current scientific paradigms. Understanding the profession’s factions is important to the anticipation of care delivery when considering interprofessional referral.”
Basically, what they’re saying is that, in Canada at least, there are 20% of you chiropractors walking around saying your nerve doctors, that you fix everything under the sun, and you’re releasing the innate and turning on the power. Those 20% are REALLY putting 80% of us that have busted our butts and learned the latest science and research….you’re putting us at risk of staying right where we’ve always been rather than expanding, integrating, and being the experts in what we do. We are masters at what we do but there are 20% out there keeping anyone that matters from taking the rest of us seriously.
Parento’s principle proves to be a real thing once again. 20% of chiropractors do all of the work in discrediting the other 80% of the profession.
Let’s go to the next paper before I lose my mind.
This one is called Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care[2]. It was published in June of 2018 in Explore: The Journal o fScience and Healing and was written by Heather Tick MD along with a team of other medical doctor/PhDs. Dr. Tick is a specialist in pain management in Seattle Washington. She even has her own website and blog. All that good stuff. You can check it out at heathertickmd.com if you are so inclined.
A little more about her: She co-founded and directed one of the first inter-disciplinary pain centers in Toronto from 1991 – 2008 and has been involved in research with the University of Waterloo at the Department of Kinesiology, the Canadian Memorial Chiropractic College (CMCC), the University of Washington, and the University of Arizona. She served as the Director of the Integrative Pain Clinic at the University of Arizona in the Department of Family and Community Medicine until Dec 2011, when the University of Arizona Health Plan recruited her to start the integrative medicine pain clinic for Medicaid patients.
Dr. Tick currently serves at the forefront of research and teaching as a Clinical Associate Professor at the University of Washington in the departments of Family Medicine and Anesthesia & Pain Medicine and is also the first holder of the prestigious Gunn-Locke Endowed Professorship of Integrative Pain Medicine at the University of Washington.
In this paper, Dr. Tick starts by saying “Medical pain management is in crisis; from the pervasiveness of pain to inadequate pain treatment, from the escalation of prescription opioids to an epidemic in addiction, diversion and overdose deaths.” I like that opening quote. I like it a lot, folks. She’s saying that the medical way of managing pain isn’t working and throwing more pills at it is a downward spiral. And I agree as I’m sure you do as well.
She goes on saying, "There is pressure for pain medicine to shift away from reliance on opioids, ineffective procedures and surgeries toward comprehensive pain management that includes evidence-based nonpharmacologic options.
"Transforming the system of pain care to a responsive comprehensive model necessitates that options for treatment and collaborative care must be evidence-based and include effective nonpharmacologic strategies that have the advantage of reduced risks of adverse events and addiction liability.”
The evidence demands a call to action to increase awareness of effective nonpharmacologic treatments for pain, to train healthcare practitioners and administrators in the evidence base of effective nonpharmacologic practice, to advocate for policy initiatives that remedy system and reimbursement barriers to evidence-informed comprehensive pain care, and to promote ongoing research and dissemination of the role of effective nonpharmacologic treatments in pain, focused on the short- and long-term therapeutic and economic impact of comprehensive care practices.
Here’s what I hate to do: I hate quoting an abstract word for word. It’s usually dry and well….boring. But, what she says here is so spot-on, quoting it was the best way to get it across in an equal manner. Meaning that I couldn’t say it better myself.
She nails it:
- It’s not working
- We need non-pharma options that are backed by evidence
- There are barriers set up to prevent non-pharma options from being utilized
- There is ignorance in regards to non-pharma options and that needs to be addressed through education
- Continued research is needed
Further down into the paper, the authors mention in one spot that chiropractic care is 60-70% less likely to be reimbursed. Is that accurate? We are typically covered by most insurance plans no? When they are saying that there are barriers set up to prevent complementary options, this may fit her rhetoric or point but I just haven’t experienced it being that much less likely to have coverage. They cite a paper by James Whedon, Et. al. where they found, for New Hampshire[3], there was 60%-70% less reimbursement. I wonder if that is consistent throughout the US or if it’s isolated to New Hampshire? That’s a great question and if one of you out there in podcast listening land knows the answer, please email me at dr.williams@chiropracticforward.com and fill me in. I’m curious and I’m pretty sure the rest of us out there are too.
Under their Evidence-Based Non-pharm Therapies for Acute Pain, they point out that non-pharma therapists have shown effective in acute pain with opioid paring in the hospital setting as a result of their use and the therapies mentioned in the paper are acupuncture, chiropractic, osteopathic manipulative therapy, massage, physical therapy, relaxation, and cognitive behavioral therapy.
The authors also site spinal manipulative therapy as being effective for chronic pain including migraines, cervicogenic headache, neck pain, low back, hip pain, patellofemoral syndrome, and on and on. Of course we chiropractors know this stuff but it’s great to see it in black and white and as part of a paper written exclusively by MDs and PhDs.
This is a long paper with a lot of excellent information. I highly encourage your checking it out. Just go to our show notes for links and citations.
A great take-away from this paper is this quote, "In general, the costs of evidence-based nonpharmacologic options are nominal compared to medical costs of treating chronic pain with risk mitigation and greater potential for engaging patients in ongoing self-care.”
The last paper I want to talk about is by our very own Dr. Christine Goertz, DC, PhD with Steven George, PT, PhD as her side-kick and is published in JAMA. It’s called "Insurer Coverage of Nonpharmacological Treatments for Low Back Pain—Time for a Change[4]” and published on October 5 of this year so, just this month. Brand new.
Dr. Goertz begins by relating low back pain with the obvious opioid crisis and goes into last year’s recommendation that you’ve heard here a million times. The recommendations from the American College of Physicians for low back pain which recommended spinal manipulative therapy as first-line therapy for chronic and acute low back pain. We will talk about it in upcoming episodes but Dr. Goertz also mentions the new Gallup-Palmer Poll where they found that 78% of US adults prefer to use non-pharma options for back and neck pain.
In the article, she cites a paper by Heyward, et. al[5]. called “Coverage of Nonpharmacologic treatment for low back pain among US public and private insurers” that found coverage of some therapies (like chiropractic) was available in most health plans but that there are significant barriers to patient access identified. Barriers such as visit limits, prior authorization requirements, and high out-of-pocket expenses. And that payment policies targeted toward coordination of pharmacological and nonpharmacological care were virtually nonexistent.
She says pretty clearly the following: In regards to most health plans surveyed, they did not have policies in place that:
- emphasize the use of nonpharmacological treatments at the forefront of the patient experience
- provide meaningful levels of coverage for care professionals who focus on guideline-adherent non drug therapies like spinal manipulation, exercise, massage, acupuncture, and cognitive behavioral therapy
- us financial incentives that favor the use of nonpharmacological options over commonly prescribed pharmaceuticals, including opioids
She also calls out health care executives quite effectively I thought by saying, "Relative to stigma, Heyward et al found that health care executives did not believe expanded coverage of nonpharmacological treatments is supported by the existing literature. As outlined in the ACP guideline referenced earlier, in many cases nonpharmacological treatments offer equal benefit or even improved benefit, with lower risk, than commonly used pharmaceutical options.”
And by suggesting that future coverage policies should be based on unbiased reviews of the evidence appropriately balancing risk with benefit rather than prior dogma or biases.
Lastly, Dr. Goertz discusses cost-effectiveness and the need for future payment policies to decrease patient out-of-pocket expenses to strongly encourage earlier us of evidence-based non-harms options. The Heyward paper demonstrated how trips to PTs or DCs are usually 6-12 visits with an out-of-pocket of $150-$720 or more. She then showed how Lin et. al. showed the median cost of a 30-day supply of preferred generic opioid by commercial insurers is $10.
How does that add up for the Joe Blow citizen on the street? It doesn’t.
I love how they sum it up by saying, "Restricting access to opioids without addressing the underlying problem of chronic care management for low back pain is unlikely to positively affect the opioid crisis. Well-conceived guidelines that encourage the use of evidence-based, nonpharmacological treatment options exist and must be enabled by changes in public health policies that better guide care delivery and reimbursement.”
Boom, Snap, kapow, Shazam...
Honestly, where would we be without Dr. Goertz? We’d still be moving the direction we’re moving in because of the opioid issue but she has done some amazing work that is putting us on the fast track where we hope to go rather than on the snail’s pace.
This week, I want you to go forward understanding that It’s happening folks. we are now able to cite papers in JAMA that are pro-chiropractic. Pro-complementary health care. Anti-pharma. This is big stuff. We are in the right place at the right time. And, it was in part, the failure of many in the medical kingdom that put us here.
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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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.
The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Being the #1 Chiropractic podcast in the world would be pretty darn cool.
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:
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Insurer Coverage of Nonpharmacological Treatments for Low Back Pain—Time for a Change | Complementary and Alternative Medicine | JAMA Network Open | JAMA Network
Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care - Explore: The Journal of Science and Healing
https://www.ncbi.nlm.nih.gov/pubmed/28304182?dopt=Abstract
Differentiating intraprofessional attitudes toward paradigms in health care delivery among chiropractic factions: results from a randomly sampled survey | BMC Complementary and Alternative Medicine | Full Text
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2705853
Bibliography
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McGregor M, Differentiating intraprofessional attitudes toward paradigms in health care delivery among chiropractic factions: results from a randomly sampled survey. BMC Comp Altern Med, 2014. 14(51).
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Tick H, Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care. Explore J Science Healing, 2018. 14(3): p. 177-211.
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Whedon JM, e.a., Insurance Reimbursement for Complementary Healthcare Services. J Altern Complement Med, 2017. 23(4): p. 264-267.
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C, G., Insurer Coverage of Nonpharmacological Treatments for Low Back Pain—Time for a Chang. JAMA, 2018. 1(6).
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Heyward J, Coverage of Nonpharmacologic Treatments for Low Back Pain Among US Public and Private Insurers. JAMA, 2018. 1(6).
CF 045: Harvard Health, Low Back Stenosis, Allergy Autism
As the title this week indicates, I’ve taken some files that have been gathering a little bit of dust in the dark corner and I’m bringing them out into the light. Today we’ll talk about an article in Harvard Health, we’ll talk about stenosis research (something that doesn’t get a lot of attention), we’ll talk about a JAMA article on allergies and autism, and we’ll hit on a paper attempting to explain why some patients respond while others do not.
But first, you know what’s up, I wrote and recorded our jingle so you might as well just sit back and enjoy this candy for your ears. When you do create something, it’s going to be in EVERY show don’t ya know!! Here’s that bumper music
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have collapsed into Episode #45
OK, first thing, we should probably talk about the Texas vs. Oklahoma game that just happened this last weekend. By the time this posts, it’ll be two weeks ago but, still need to brag. What a game that was. I’m a Texas boy but either way would have been fine since most of OU’s players are from Texas anyway. I go for all of the Texas teams.
I want to thank Kyle Swanson for the shout out on the Forward Thinking Chiropractic Alliance group a couple weeks ago. He’s a Texas A&M Aggie. Look, like I said, I root for A&M too so we would probably be buddies in the real world if I’m guessing out loud.
let’s get to the ongoing saga of hiring a new front desk staff. If you’ve been following along, you’ll remember that hiring a new front desk staff member has been nothing but a soup sandwich.
Messy. Gloppy, Unreal and confusing. Those are just some words I’m laying on you. I have more words for what we’ve been through on this deal but then my podcast would have an explicit designation and I try to keep it clean around here.
But, I believe progress has been made. We seem to have a new one that seems to be on top of her game. If she’s a “sticker,” then the search may very well be over. Of course, she’s not young which is probably why she’s a sticker so far. She’s closer to my age than any of the others have been. I’m not saying that young people have no work ethic…..I’m just saying that all of the young people that we interviewed for this job have no work ethic.
That sounds like I’m against young people, millennials, blah blah blah. I’m not. I have had some VERY intelligent and capable young people come through here as employees over the years. There are very smart, very talented young folks out there. We just didn’t encounter any of them for this round of hiring. That’s all I’m saying.
October has really taken off in terms of listens for the podcast. I can only guess you’re sharing episodes here and there with you network. To that I say thank you. If I ever see you somewhere and you tell me you have been sharing my stuff, and hold your hands out like, “bring it in big boy,” well then…you’re getting a hug my friend. I’m a hugger. Which can probably be scary if you don’t know me. I’m 6’4” and like 280 so….big guy coming through! But, those that know me know that I’m a teddy bear. Unless you try to steal my food. Then it’s pretty much on at that point.
Let’s get on with trying to make your practice better. When your practice is better, your life is better.
Let’s start with the Harvard Article. It was published in November 2017. I have it linked at chiropracticforward.com for you all in the show notes for episode 45. The name of the article is “Where to turn for low back pain relief[1]” and I couldn’t find the name of the author so there ya go.
https://www.health.harvard.edu/pain/where-to-turn-for-low-back-pain-relief
The subtitle of this Harvard Medical journal….medical journal……is this: in most cases, a primary care doctor or chiropractor can help you resolve the problem. What the hell??? It seriously says that in a Harvard Medical article. I’m trying to catch my breath here. Sorry…..
It was published in November of 2017. The article says that there are many causes of low back pain and some of the most common are injury to muscles or tendon which we know is called a strain and then injury to back ligaments which we call a sprain. And then there are herniated or bulging discs.
Going through the DACO program tells me that the prevalence between disc, facet, and SI joint pain stands at 40% for the disc, 30% for the facet, and 22.5% for the SI joint pain. BUT….over the age of 50 years old, it flips a little and the Facet joint gains prevalence over disc or SI pain. Just some nuggets to tuck away in your nugget pouch.
This article just blows me away when it gets to the “Where to Turn” subtitle. Beneath this subheader, it says, Since you shouldn’t try to diagnose your own back pain, make your first call to a professional who can assess your problem, such as a primary care physician or a chiropractor.” Both can serve as the entry point for back pain says Dr. Matthew Kowalski who serves as a chiropractor with the Other Clinical Center for Integrative Medicine at the Harvard-affiliated Brigham and Women’s Hospital.
What the hell is happening here? Am I in the Twilight Zone where everything is flipped and the medical world finally gets it?
The article goes on to say “A well-trained chiropractor will sort out whether you should be in their care or the care of a physical therapist or medical doctor.” And here’s the difference between evidence-based/patient-centered chiropractors and those that are not.
The more not evidence-based amongst us, the ones that drive a billion people through their doors for everything from allergies to whatever…..they will not typically be turning those patients over to the medical doctor or the PT.
Moving to the next paper, it’s called “Comprehensive Nonsurgical Treatment Versus Self-directed Care to Improve Walking Ability in Lumbar Spinal Stenosis: A Randomized Trial” authored by Carlo Ammendolia, et. al. This paper is co-authored by DCs, AND MDs. It was published in the Archives of Physical Medicine and Rehabilitation on October 27, 2017[2].
Why They Did It
They wanted to the effectiveness of a comprehensive nonsurgical training program to a self-directed approach in improving walking ability in lumbar spinal stenosis
How They Did It
- It was a randomized controlled trial
- It was done in an Academic hospital outpatient clinic
- Participants suffered neurogenic claudication
- MRI confirmed lumbar spinal stenosis
- Subjects were randomized
What They Found
The conclusion stated, “A comprehensive conservative program demonstrated superior, large, and sustained improvements in walking ability and can be a safe nonsurgical treatment option for patients with neurogenic claudication due to LSS
Dr. Ammendola has an amazing lumbar spinal stenosis program and training course. I have not personally taken it just yet but, it’s on my list after I finish up the DACO program. It comes HIGHLY recommended and this paper shows us why.
Trucking on, this one is called “Do participants with low back pain who respond to spinal manipulative therapy differ biomechanically from nonresponders, untreated controls or asymptomatic controls?” It was published in Spine Journal in September of 2015 and authored by Wong, et. al. [3]
Why They Did It
To determine whether patients with low back pain (LBP) who respond to spinal manipulative therapy (SMT) differ biomechanically from nonresponders, untreated. Some, but not all patients with low back pain report improvement after a visit to the chiropractor. Why does that happen?
What They Found
After the first SMT, SMT responders displayed statistically significant decreases in spinal stiffness and increases in multifidus thickness ratio sustained for more than 7 days; these findings were not observed in other groups.
Wrap It Up
Quote, “Those reporting post-SMT improvement in disability demonstrated simultaneous changes between self-reported and objective measures of spinal function. This coherence did not exist for asymptomatic controls or no-treatment controls. These data imply that SMT impacts biomechanical characteristics within SMT responders not present in all patients with LBP.”
And our last one this week comes to us from JAMA, also known as the Journal of the American Medical Association. This one is called, “Association of Food Allergy and Other Allergic Conditions With Autism Spectrum Disorder in Children.[4]” It was authored by Guifeng, et. al. and published in 2018. Again, these papers are cited in the show notes at chiropracticforward.com under episode 45 so check them out yourself please.
The question they attempt to answer here is, “What are the associations of food allergy and other allergic conditions with autism spectrum disorder (ASD) in children?”
They say in the paper that Common allergic conditions, in particular food allergy, are associated with autism among US children, but the underlying mechanism for this association needs further study.
The study was a population-based, cross-sectional study used data from the National Health Interview Survey collected between 1997 and 2016
The conclusion was quote, “In a nationally representative sample of US children, a significant and positive association of common allergic conditions, in particular food allergy, with ASD was found.”
They now need to find out the cause and underlying mechanisms so they can attempt to reverse the upswing of autism here in America.
So….it appears maybe it’s not all due to vaccines after all.
That wraps it up for us this week. I hope you enjoyed it. Research can be boring but, it can be fascinating too when you allow it to help guide your thought process when you are approaching your daily tasks and deciding on treatment options for your patients.
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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.
The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Being the #1 Chiropractic podcast in the world would be pretty darn cool.
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.
Website
http://www.chiropracticforward.com
Social Media Links
- https://www.facebook.com/chiropracticforward/
- Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
- https://twitter.com/Chiro_Forward
- https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
- https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
- https://player.fm/series/2291021
Stitcher:
- https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
- https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the author:
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography
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School, H.M., Where to turn for low back pain relief. Harvard Health Publishing, 2017.
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Ammendolia C, Comprehensive Nonsurgical Treatment Versus Self-directed Care to Improve Walking Ability in Lumbar Spinal Stenosis: A Randomized Trial, in North American Spine Society Meeting. 2017, Archives of Physical Medicine and Rehabiliation: Orlando, FL.
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Wong AY, Do participants with low back pain who respond to spinal manipulative therapy differ biomechanically from nonresponders, untreated controls or asymptomatic controls? Spine, 2015. 40(17): p. 1329-37.
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Guifeng X, Association of Food Allergy and Other Allergic Conditions With Autism Spectrum Disorder in Children. JAMA, 2018. 1(2).
CF 044: w/ Dr. Dale Thompson - Evidence-based Chiropractors Practicing Evidence-based Chiropractic
Today we’re going to talk about being an evidence-based chiropractor. What does it mean to be practicing evidence-based chiropractic and we’re going to be talking about with Dr. Dale Thompson from Iowa. USA.
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But first, here’s that bumper music you’ve come to know and love.
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have collapsed into mosied Old West style into Episode #44
Now that I have you here, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It makes it easier to let you know when the newest episode goes live, when someone new signs up it makes my heart leap a little, and in the end, it’s just polite and we’re polite in the South.
We are really starting to pick some steam. Thank you to you all for tuning in. If you can share us with your network and give us some pretty sweet reviews on iTunes, I’ll be forever grateful. By now, we all know how the interwebs work. You have to share and participate in a page if you are going to see the posts or if the page will be able to grow.
How has your week been? Mine has been great. I attended my third DACO class and this one with the man, the myth, the legend, Dr. James Lehman. And he was excellent. Which isn’t surprising but sort of is and here’s why. Being the head of the DACO program for the University of Bridgeport Connecticut, Jim was just there to audit the class which was originally to be taught by Dr. Miller who I’m not familiar with just yet.
Well, we had a huge storm come through the Dallas/Ft Wroth metroplex that screwed everything up including my drive into town all the way from Amarillo. I literally got dumped on by gallons of water per second for about 4 hours to get there.
Pure misery y’all and that’s not exagerrating. In fact, all of the rivers, lakes, and low lying streets were flooded. The word of the day for the newscasters on TV was the word “Swollen.” All of the bodies of water were quote, Swollen.
Anyway, the storm made it impossible for Dr. Miller to get to Dallas but, good fortune was shining on the DACO program in Dallas and it’s participants. Dr. Lehman was there to audit his first class in over a year and he was able to simply step in and teach instead of Dr. Miller.
So, I got some good solid learning from the man himself who, as luck would have it, has agreed to be a future guest on the Chiropractic Forward podcast so just hold onto your britches because we’re going to make it happen.
We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.
I want to start by introducing this week’s guest. You have likely heard me talk all about the Forward Thinking Chiropractic Alliance Facebook group as well as the Evidence-based Chiropractic Facebook. I’m pretty fond of the two groups as well as our own Facebook group I’d invite you to called oddly enough the Chiropractic Forward Facebook group. We have a Chiro Forward page where we update everyone on new episodes but we also have the group where we post the research papers and discuss and connect outside of the podcast.
Getting back to the first two groups I mentioned, Dr. Thompson is a very active member of those two groups…..
I wanted to have Dr. Thompson on today because it’s my guess that many listeners, certainly students, may or may not be familiar with the term evidence-based vs. subluxation based. There are a lot of other terms thrown around that mean nothing to others like TORS and medi-practors and all that fun stuff. But, I thought this would be a great time to just sit and talk about the differences.
Welcome to the show Dr. Thompson. Thank you for joining us today. How’s the Iowa weather this fine Fall Thursday morning?
I already went through your introduction and am wondering, How do you make the leap from embalmer and the mortuary all the way to being a chiropractor? Tell me about that.
Dr. Thompson, can you tell me a bit about your practice? What does it look like?
Has you always been an evidence-based guy?
What initially got you into the research side of things in the profession?
You post so much research, I’m not sure how you have the opportunity to find it all and go through it all. How in the heck do you do it?
Dr. Thompson, back on September 16th, you posted something for the newer members of the group to read. Your post was called Practicing Chiropractic Wisely: Why I Like Being an Evidence-Based Chiropractor
I thought it would be interesting if we simply spent our time together going through your list together and explaining or expounding where appropriate if you’re OK with that.
- I can go to a conference and know if the speaker is generally telling the truth or is trying to sell a lie. Tell us why this one made your list if you don’t mind.
- I know it’s better to say “I don’t know” than to make something up. Do you feel that the philosphical-minded chiros in the crowd tend to make up things on the spot? Or is this more a point that they explain everything with the term subluxation and start pounding down the high spots?
- I know the best chiropractic related books were written in the last 10 years... not 100 years ago. I’m guessing this one is aimed at the green books from Palmer as well as the books those spawned over the years?
- I can sit down with a layperson or an orthopedic surgeon and explain what I do...and they both get it. I can tell them what research says about our effectiveness and they’ll get it. I dumb it down. This is imbalanced, weak, or doesn’t move very well. We are going to try to balance, strengthen, and move it. Pretty simple. Maybe too simple. How exactly do you approach it that works best for you?
- I can read a research paper and know if it’s good or bad and how it may apply to what I do. What criteria do you use to determine it’s worth? I’m guessing meta-analysis, systematic reviews, and randomized controlled trials are at the top of your list. Sample numbers? Journal impact? What all do you take into account? In this context, I’m assuming you are using it to insinuate that the more philosophical subluxations crowd points to research but you would argue it is not good research. Am I correct in that assumption?
- I can take the best evidence and apply it and yet also have the freedom to find novel ways to approach a problem. This reminds me of a previous guest we had on the podcast a few episodes ago. Dr. Brandon Steele. He was making the distinction between evidence-based vs. evidence-informed. It sounds like you are describing evidence-informed here. Is that correct?
- I have several tools in my tool bag and they will not be exactly the same next year as they are not the same as last year. Can you expand on that for us, Dr. Thompson?
- I can take a seemly complex problem and find a simple solution as well as understand the complexity of an apparently simple problem. Explain your intent on this one and the purpose for your including it, please.
- I am more comfortable having questions I can’t answer than having answers I will not let be questioned. Oh, man….if the others weren’t fuel for the subluxation crowd, this one certainly is. Discuss….
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- I understand my patients want their problems fixed in a cost effective and within a reasonable time, that they don’t want long term care. Wouldn’t you agree that you are a terrible chiropractor if you have to see someone 100 times in a year to get them well or keep them well?
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- I know my clinical strengths and limitations as well as the strengths and limitations of other healthcare professionals. Can you tell me some of the claims you have personally witnessed that leads you to this being on your list?
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- I can make a good living without sacrificing patient centered care to achieve it. “I tell people that I could make a heck of a lot more money but I sleep very well at night. In addition, it’s a point of mine in my practice to never put my staff in a postion that, should my ethics or way of practicing ever be called into question for some reason, I’d never want them to feel like they had to, or needed to lie for me. That’s a bit of a guiding principle for me. Another principle I find myself following daily is that, if I’m giving my patients the same recommendations I would give my mother, brother, father, or sister, then we will always be going in the right direction. Tell me what being patient-centered means to you personally.
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- I do not have to jump on board the latest health fad but I can, and may, scrutinize it using logic, reasoning and supporting evidence. Fill me in. Where does this one come from?
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- I can respect my colleagues desire to practice different than me but I still demand they do so in an evidence-based and ethical manner. To play Devil’s Advocate, what if they’re told they ARE actually evidence-based? What if they have papers they can point to? What if they have somre gurus throwing together research to form a diagram and brain lamp to charge $800 a pop ala Dan Sullivan?
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- I can appreciate that sometimes positive and unpredictable changes can occur in other body systems while under my care but I won’t use that to try to lure people in to see me. Examples?
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- My patients come first, my profession second and I am last. Now THAT is the true definition of a patient-centered practice and I think most would agree.
Switching focus a little bit from evidence-based chiropractors vs. subluxation-based chiropractors, what is your opinion of or how do you deal with people like Stephen Barrett or Edzard Ernst or any of the knuckleheads over at that science-based website?
It’s my hope that, by hearing from docs like you, me, the guys from the DACO program, etc…that they will understand.
Understand that when sitting through those classes or seminars they’re made to sit through….throse classes and talks that make them roll their eyes because they’re all about a philosophically based model….those classes. It’s my hope that they’ll understand they don’t have to practice that way and hopefully they understand there is another way to go about it.
Also, some chiropractors get out of school not knowing what they believe since they’ve been inundated many times with all kinds of information. Some good and some bad.
Just saying the words, “not knowing what they believe” sounds silly when we have the research out there in piles and piles. I have patients say, “I believe in Choirpracty” all of the time and I’m clear with each of them that we aren’t part of a church and that Chiropractic isn’t something one has to believe in.
That goes for chiropractors and students as well.
Dr. Thompson, I want to thank you for coming on the show today and running through it with us.
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rbsolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is a mechanical pain and responds better to mechanical treatment instead of chemical treatments.
The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Being the #1 Chiropractic podcast in the world would be pretty darn cool.
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:
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
CF 043: Stroke Caused By Chiropractor
Today we’re going to talk about Stroke caused by the chiropractor and we’re to show you once again what a pile of hooey the idea is and we’ll even talk a bit about where it came from.
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Stick with us but first we’re going wade through this here bumper music.
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have collapsed into Episode #bee bopped into Episode #43 and we are so glad to have you. I’ve noticed that podcasts are going into Seasons….Shows you how much I pay attention to stuff outside of what I’m doing. I’m ashamed. I should do Seasons. Here’s the deal though. I enjoy it so much. I actually WANT to put one out every week. It’s not work when you’re having fun right?
It can be a little stressful creating content and talking points but hey, we get through it and have a lot of fun in the process.
What a great month this has been in regards to listens and downloads. You’ve heard me say it before but it’s fun to watch. Because I’m numbers nerd and who the heck doesn’t like to see growth of a brain child?
Speaking of growth, I’ve started work on something that I hope you’ll love. I’ll hope you’ll think about using for you own offices, and I think may be pretty cool. I’ll fill you in more and more as we go along but just know, I’m working on somehting and you should get yourself on our email list at www.chiropracticforward.com so I can tell you about it and maybe pass along discounts, stuff like that. Email list. Do it.
How has your week been? Mine….well….I have to continue the saga of hirnig a new front desk person. Hell people. Actual hell. The first one just didn’t show up. The second one we hired lasted three days. Three freaking days, folks.
But, we think we have a winner in place now. You know I’m going to keep you all updated on this deal. This by itself has been enough for it’s own reality show. I’ve never seen anything like it. The workforce right now just doesn’t seem to want to work. At least that’s my experience lately.
We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.
First thing’s first. I have covered this stroke topic in depth. As in….very indepth. In Episodes 13, 14, and 15. If you do nothing else this week as far as educating yourself, make sure you go listen to those three episodes or read it on our blog at Chiropracticforward.com all of which are linked here in the show notes.
Podcast Episodes:
- Episode #13: https://www.chiropracticforward.com/debunked-the-odd-myth-that-chiropractors-cause-strokes/
- Episode #14: https://www.chiropracticforward.com/cf-episode-14-debunked-the-odd-myth-that-chiropractors-cause-strokes-part-2-of-3/
- Episode #15: https://www.chiropracticforward.com/cf-015-debunked-the-odd-myth-that-chiropractors-cause-strokes-part-3-of-3/
Blog: https://www.chiropracticforward.com/blog-post/debunked-the-odd-myth-that-chiropractors-cause-strokes-revisited/
YouTube Video: https://youtu.be/tRXpG_Ie0Rs
So, why go over stroke again? Well, one reason is because it’s been a while since we touched on the topic. Another being that I heard a prominent speaker just this year talking about chiropractors causing strokes and implying that it happens fairly often. That’s a pro-chiropractic speaker by the way acting as if chiropractors are the sole reason for a stroke on a regular basis.
I don’t think that is necessarily the way the discussion was meant but it could definitely have been interpreted in that manner if those listening didn’t have the information from our Debunked series.
The other reason I wanted to cover stroke again is that is the main thing in regards to safety that the medical kingdom tries to hole over us. Or that they’ve been told about us. And, instead of doing their work on this, they just believe it.
New habits take 20 days to cement. We need new habits in the medical realm so I’m doing my part by taking away one of the main things they have against us. One may argue that the philosophy and subluxation model is another thing they hold against us but, all I can do about that is continue to disseminate evidence-based information and keep plugging. We’ll see where that part of it goes in the future.
For now though, it’s about strokes this week here on the Chiropractic Forward podcast. Now, let’s compare and contrast shall we?
Did you know that the RAND Institute estimates a chiropractic adjustment is the sole cause of a vertebral artery dissection at the rate of only about 1 in 1 million or more adjjustments? And did you know that your chances of winning an Oscar stand at about 1 in 11,500? Your chances of hit by lightening are 1 in 176,426?
How about this: NSAIDS like ibuprofen and acetaminophen cause around 16,000 deaths per year and send 100,000 people to the ER in America….EVERY YEAR.
Let’s let all that sink in. I say all of that just to put things into context and to make the point that the medical kingdom needs to quit making such a big damn deal out of trained and licensed chiropractors adjusting necks.
We’re starting with this paper 2015 by Kosloff and friends titled, “Chiropractic care and the risk of vertebrobasilar stroke: results of a case-control study in U.S. commercial and Medicare Advantage populations[1].” It was published in Chiropractic & Manual Therapies.
Why They Did It
This is obvious. We’re looking at the real chances of chiropractic adjusments being the culprit for strokes.
What They Found
There were 1,829 vertebral basilar artery stroke cases
Findings showed no significan associaiton between chiropractic visists and VBA stroke
The Authors’ Conclusion
“We found no significant association between exposure to chiropractic care and the risk of VBA stroke. We conclude that manipulation is an unlikely cause of VBA stroke. The positive association between PCP visits and VBA stroke is most likely due to patient decisions to seek care for the symptoms (headache and neck pain) of arterial dissection. We further conclude that using chiropractic visits as a measure of exposure to manipulation may result in unreliable estimates of the strength of association with the occurrence of VBA stroke.”
Just like a rolling stone we are moving on and gathering no grass…..
This next paper is from Church, et. al. and is called, “Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation[2].” It was published in Cureus in February of 2016.
Just to review the research hierarchy for those unaware, systematic reviews and met-analysis papers are at the tippy top of the food chain just above randomized controlled trials. It’s like people in the animal kingdom. We’re the top predators ya know.
Anyway, the point is: this is reliable information folks.
We already know why they did it so let’s skip to what they concluded. “. There is no convincing evidence to support a causal link between chiropractic manipulation and CAD. Belief in a causal link may have significant negative consequences such as numerous episodes of litigation.”
Uhhuh….numerous episodes of litigation based on belief and NOT based in fact or research.
Now we come to the guy that helped put the matter to rest once and for all. If you are unaware of John David Cassidy, let me introduce you. He is a professor at the University of Toronto Dalla Lana School of Public Health and is a PhD.
Let’s start with his newer one concerning this topic. It’s called “Risk of Carotid Stroke after Chiropractic Care: A Population-Based Case-Crossover Study[3].” It was published in the Journal of Stroke & Cerebrovascular Diseases in 2017. Newer stuff folks.
As you’ll see, this paper deals with CAROTID artery and stroke specifically whereas the next and last paper deals with the VERTEBRAL artery and stroke.
The why is obvious once again so, what did they find?
They compared 15,523 cases to 62,092 control periods using exposure windows of 1, 3, 7, and 14 days prior to the stroke.
There ws no significant difference between chiropractic and PCP risk estimates.
They found no association between chiropractic visits and stroke in those 45 years of age or older.
The Conclusion
“We found no excess risk of carotid artery stroke after chiropractic care. Associations between chiropractic and PCP visits and stroke were similar and likely due to patients with early dissection-related symptoms seeking care prior to developing their strokes.”
You’re about to notice a trend here. Next paper is by Cassidy et. al. as well and is called, “Risk of Vertebrobasilar Stroke and Chiropractic Care
Results of a Population-Based Case-Control and Case-Crossover Study[4].” This is the Daddy of papers proving that chiropractic adjustments are not the sole cause of strokes.
Again, everyone knows why the research was done so let’s get to the meat and taters.
- It was done over a nine year period from April 1993 to March of 2002.
- There were 818 vertebrobasilar artery strokes hospitalized in a population of more than 100 million person-years.
- There was no increased association between chiropractic visits and VBA strok in those older than 45 years.
The Conclusion and nail in the coffin
“VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.”
It’s like the action hero cartoons “Shazam” “Pow” “Bang” “Smack!”
I’ve said it a thousand times. “If we were wrong, we’d have been wiped out years ago.” Lord knows every force of the medical kingdom focused on our demise for generations and that goes from the national and state associations all the way into the national and state legislatures.
How do you fight against that amount of money and power and survive if you’re not inherently right in waht you’re doing? We can argue amongst ourselves till the cows come home about how to do our jobs but, in the end, we help our patients, we get them better when nobody else can, and….well…we’re right.
So, the haters in the medical field can take a long walk off a short pier and stick in their ears. I’m not always professional and that’s OK. I’ve always felt being strictly professional all of the time is more than just a little bit boring. We need more spice, personality, and a lot more laughter in life don’t we?
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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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.
The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Being the #1 Chiropractic podcast in the world would be pretty darn cool.
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.
Website
http://www.chiropracticforward.com
Social Media Links
- https://www.facebook.com/chiropracticforward/
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- https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
- https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link
- https://player.fm/series/2291021
Stitcher:
- https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn
- https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the author:
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Research Paper Links:
https://www.ncbi.nlm.nih.gov/pubmed/26085925
https://www.ncbi.nlm.nih.gov/m/pubmed/18204390/
https://www.ncbi.nlm.nih.gov/pubmed/27014532
https://www.ncbi.nlm.nih.gov/m/pubmed/27884458/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2271108/
Bibliography
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Kosloff T, e.a., Chiropractic care and the risk of vertebrobasilar stroke: results of a case–control study in U.S. commercial and Medicare Advantage populations. Chiropractic & Manual Therapies, 2015. 23(19).
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Church E, e.a., Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation. Cureus, 2016. 8(2): p. e498.
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Cassidy, e.a., Risk of Carotid Stroke after Chiropractic Care: A Population-Based Case-Crossover Study. J Stroke Cerebrovasc Dis, 2017. 26(4): p. 842-850.
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Cassidy, e.a., Risk of Vertebrobasilar Stroke and Chiropractic Car. Spine, 2008. 33(4S): p. S176-S183.
CF 042: w/ Dr. Tyce Hergert - Chiropractic Maintenance Care / Chiropractic Preventative Care
Today we have a special return appearance from a friend of the show and we’re going to talk about chiropractic maintenance care also known as chiropractic preventative care. Chiropractors have recommended a regular schedule to their patients for generations but it was mostly as a result of experience and intuition. But what about research on the matter? We’ll get to it.
But first, here’s that bumper music
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
Be sure you have signed up for our newsletter slash email. You can do that at chiropracticforward.com and it lets us keep you updated on new episodes and new evidence-based products when they come out. Yes, eventually there will be some pretty cool things available through us. We won’t email any more than once per week and the value outweighs the risk. Kind of like in cervical manipulation. So just go get that done while we’re thinking about it.
You have confidently strutted right into Episode #42 and we are so glad you did.
I would really like to just turn this mic on and automatically be the #1 chiropractic podcast in the world but that’s not the real world, right? But I have to say that we continue to grow. I’m impatient and it’s never quite fast enough but we are continually growing and that’s always exciting. When you see the growth chart consistently going up and to the right, then hell yeah. Ka-bam shazam.
We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.
But first, my week has been nuts. When was the last time you tried to hire someone? It’s absolutely stupid these days. Honestly, I posted a job on indeed.com. I got literally 175 resumes, scheduled 15 interviews, only 7 showed up for the interview, and we have one really good prospect.
This is the second round by the way. We tried to hire for the front desk position a few weeks ago and went through 120 resumes. We actually hired a girl but then her dad got sick and after thinking it over, decided we weren’t a good fit. Lol. Can you imagine?
I don’t know if you can tell from this podcast or not but….I’m generally a pretty darn good guy and really care about my staff and care about people and care about making connections with others.
I don’t yell, I don’t fuss a lot. Even when they’re wrong. That’s just not my style. I don’t think I stink or anything having to do with body functions so, I can’t figure it out other than people have just changed. Or has it always been hard to find good help? All I know is that I’m having a hell of a time finding the right front desk personnel and it’s making me more than a little crazy.
Now that we have all of that out of the way, I want to welcome our guest today. You could say we sort of know each other. In fact, we grew up in the same neighborhood from elementary school all the way through high school. Even though I was a couple years older, we definitely knew each other. He lived right next door to my best friend and we played football in his front yard pretty often.
We were at the University of North Texas at the same time living in Denton, TX and then we were down at Parker College of Chiropractic at the same time as well. If that weren’t enough, we have both served in statewide leadership positions for the Texas Chiropractic Association. In fact, Tyce is part of the reason I got involved in the first place.
He took it a step further than me though. Dr. Hergert actually served as the President of the TCA two terms ago and helped steer the profession to a historic 4 chiro-friendly bills passed in the state legislature that year. This is important because the bills that were passed in our favor prior to that would be basically zero, none, nada, goose-egg, zilch.
Dr. Hergert also runs an integrated practice down in Southlake, TX so he’s an excellent resource for our kind of podcast.
Some people kind of think he’s a big deal and there’s a good argument to be made for that but I’m not going to be the one making it because I’ve known him way too long.
Not only is he an ex-Pres for the TCA, he also has the bragging rights of being a guest on 2 of our top five most popular episodes of all times here at the Chiropractic Forward Podcast. Those are episodes 6 and 11 with 11 actually being are most listened to an episode of all time so congrats to Dr. Hergert on that.
If you enjoy his guest appearance on this episode, although I’d be a bit flabbergasted as to why you enjoyed it….you can always get more of Tyce on those. Again, I’m not sure why you’d ever want to do that. Lol.
Welcome to the show Dr. Hergert. Thank you for taking the time to join us.
Tell us a little bit about Southlake, TX for the ones unfamiliar with the Dallas/Ft. Worth area.
Tell us a little bit about running an integrated practice. What’s it like? Have you become more of an owner/administrator or are you elbow deep in treatment and the physical aspects of seeing patients all day every day still?
This first paper….I alluded to back in episode #36 but very briefly. We covered a little more in depth back in Episode #19 as well which posted back in April of this year. I think in light of a brand new paper that just came out, it’s worth covering this one again if you do not mind.
It’s called “Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome?” and was published in the prestigious Spine journal[1].
For the purpose of this study, keep in mind that SMT stands for spinal manipulation therapy. Also of special note is that chiropractors perform over 90% of SMTs in America so I commonly interchange SMT or spinal manipulation therapy with the term “Chiropractic Adjustment.”
Why They Did It
The authors of this paper wanted to check how effective spinal manipulation, also known as chiropractic adjustments, would be for chronic nonspecific low back pain and if chiropractic maintenance adjustments were effective over the long-term in regards to pain levels and disability levels after the initial phase of treatment ended.
How They Did It
- 60 patients having chronic low back pain of at least six months duration
- Randomized into three different groups:
- 12 treatments of fake treatment for one month
- 12 treatments of chiropractic adjustments for a month only
- 12 treatments for a month with maintenance adjustments added every 2 weeks for the following 9 months.
- Outcome assessments measured for pain and disability, generic health status, and back-specific patient satisfaction at the beginning of treatment
What They Found
- Patients in groups 2 and 3 had a significant reduction in pain and disability scores.
- ONLY group 3, the group that had chiropractic maintenance adjustments added, had more reduction in pain and disability scores at the ten-month time interval.
- The groups not having maintenance adjustments, pain and disability scores returned close to the levels experienced prior to treatment.
Wrap It Up
The author's conclusion is quoted as saying, “SMT is effective for the treatment of chronic nonspecific LBP. To obtain long-term benefit, this study suggests maintenance SM after the initial intensive manipulative therapy.”
Dr. Hergert, what do you have to say on this one? I’m not sure what there is to say except, “Told you so!”
What do you typically recommend to your patients as far as chiropractic preventative care or chiropractic maintenance care goes?
Paper #2: Actually, this one is a webpage linked in the show notes for you at ChiropracticForward.com in episode #42.
http://www.chiro.org/research/ABSTRACTS/Documentation_Supporting_Maintenance_Care.shtml
This article was compiled by Dr. Anthony Rosner, Ph.D and called Documentation Supporting Maintenance Care[2].
The article starts by saying that the RAND Corporation studied a subpopulation of patients who were under chiropractic care compared to those who were NOT and found that the individuals under continuing chiropractic care were:
- Less likely to be in a nursing home
- Were less likely to have been in the hospital the previous 23 years
- They were more likely to report better health status
- Most were more likely to exercise vigorously
Although it is impossible to clearly establish causality, it is clear that continuing chiropractic care is among the attributes of the cohort of patients experiencing substantially fewer costly healthcare interventions[3].
The next paper Dr. Rosner talks about was a review of a larger cohort of elderly patients under chiropractic care and those not under chiropractic care. Basically, comparing monies spent on hospitals, doctor visits, and nursing homes[4] They found the following: Those under chiropractic care saved almost three times the money those NOT under chiropractic care spent for healthcare.
- $3,105 vs. $10,041
How’s it looking so far, Tyce?
Tyce, you’re going to like this one. Chances are, you’re probably going to want to tell people all about this one.
Let’s get to the newer paper I mentioned before. It’s called The Nordic Maintenance Career program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain - pragmatic randomized controlled trial and ir was compiled by Andreas Eklund, et. al[5].
Why They Did It
The authors wanted to explore maintenance care in the chiropractic profession. What is the effectiveness for prevention of pain in patients with recurrent or persistent non-specific low back pain?
How They Did It
- 328 patients
- Pragmatic, investigator-blinded. Pragmatic. What does that mean exactly? According to Califf and Sugarman 2015, It means it is “Designed for the primary purpose of informing decision-makers regarding the comparative balance of benefits, burdens and risks of a biomedical or behavioral health intervention at the individual or population level” Meaning they are attempting to run a trial to inform decision-makers of responsible guidelines going forward. That’s it for the dummies like me in the room.
- Two arm randomized controlled trial
- Included patients 18-65 w/ non-specific low back pain
- The patients all experienced an early favorable result with chiropractic care.
- After an initial course of treatment ended, the patients were randomized into either a maintenance care group or a control group.
- The control group still received chiropractic care but on a symptom-related basis.
- The main outcome measured was the number of days with bothersome low back pain during a 1 year period.
- The info was collected weekly through text messaging.
What They Found
- Maintenance care showed a reduction in the number of days per week having low back pain
- During the year-long study, the maintenance chiropractic care (preventative chiropractic care) group showed 12.8 fewer days.
- The maintenance chiropractic care (preventative chiropractic care) received 1.7 more treatments than the symptom-related group.
Wrap It Up
The authors wrap it up by saying, “Maintenance care was more effective than symptom-guided treatment in reducing the total number of days over 52 weeks with bothersome non-specific LBP but it resulted in a higher number of treatments. For selected patients with recurrent or persistent non-specific LBP who respond well to an initial course of chiropractic care, MC should be considered an option for tertiary prevention.”
Basically, both groups still underwent maintenance chiropractic care (preventative chiropractic care). It’s like we tell people, stay on a schedule and you’ll do well. Wait until you hurt and the chances are good that you’ll spend the same amount getting over that complaint anyway.
This study showed that exactly except, over the course of just one year, the maintenance chiropractic care (preventative chiropractic care) people had 1.7 more visits but suffered pain almost 13 days less.
Are two appointments extra worth almost 2 weeks less of having pain in a year’s time? I say hell yes.
Dr. Hergert…what say you?
Lay some sage-like wisdom on us here and bring it all home for us won’t you please?
This week, I want you to go forward with the knowledge that, when you write “patient recommended preventative chiropractic care schedule going forward” you can do so confidently knowing your are right and there is research showing it.
You don’t have to recommend maintenance chiropractic care (preventative chiropractic care) simply because you heard to do that at school or because your old boss always did it.
You can make those recommendations because it’s best for your patients.
Dr. Hergert, do you have anything to add, this is probably your last time on the podcast after all.
Thank you so much for hanging out with us today, I was kidding of course. We will make time and do it again down the road.
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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.
The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Being the #1 Chiropractic podcast in the world would be pretty darn cool.
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.
▶︎Website
http://www.chiropracticforward.com
▶︎Social Media Links
- https://www.facebook.com/chiropracticforward/
- Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
- https://twitter.com/Chiro_Forward
- https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
▶︎iTunes
- https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
▶︎Player FM Link
- https://player.fm/series/2291021
▶︎Stitcher:
- https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
▶︎TuneIn
- https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the author:
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography
-
Senna MK, Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome? Spine (Phila Pa 1976), 2011. Aug 15; 36(18): p. 1427-37.
-
Rosner A. Documentation Supporting Maintenance Care. Chiro.org 2016; Available from: http://www.chiro.org/research/ABSTRACTS/Documentation_Supporting_Maintenance_Care.shtml.
-
Coulter ID, Chiropractic Patients in a Comprehensive Home-Based Geriatric Assessment, Follow-up and Health Promotion Program. Topic in Clinical Chiropractic, 1996. 3(2): p. 46-55.
-
Rupert R, Maintenance Care: Health Promotion Services Administered to US Chiropractic Patients Aged 65 and Older, Part II. J Manipulative Physiol Ther, 2000. 23(1): p. 10-19.
-
Eklund A, The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain—A pragmatic randomized controlled trial. PLoS One, 2018. 13(9).
Episode #41: w/ Dr. William Lawson - Chiropractic Research For Neck Pain
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Today we’re going to talking with Dr. William Lawson from Austin, TX about chiropractic research for neck pain and what research is available for it. While low back gets all of the attention in the research, neck pain has taken a back seat but not today!
But first, here’s that bumper music
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
Have you taken the time to go to chiropracticforward.com and sign up for our newsletter? Doing that makes it easier to let you know when the newest episode goes live and we have a ton of ideas around here for the future and we want to be able to let you know about it. An email once per week isn’t going to make you crazy so please go do that so we’re on the same page.
I also want to let you know about our Facebook page AND our separate Facebook group. Both are called Chiropractic Forward oddly enough. On the page, we let you all know when a new episode goes live and we share some quotes from the episodes. Through the private Facebook group, we share the papers we went over and lots of time we connect and discuss there so go join up and let’s connect.
We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.
You have done the mashed potato all James Brown, 60’s style into Episode #41. You know what that means? It means it’s going to be cooler than usual episode.
That’s because, as I mentioned before, we have a guest with us. Dr. William Lawson hails from Austin, TX and has his Diplomate of American Chiropractic Orthopedists designation. Yes, ladies and gentleman, I brought another DACO to you today. Last week, we had Dr. Brandon Steele, also a DACO, so you may be starting to notice a slight trend.
I met Dr. Lawson through his involvement in the Texas Chiropractic Association. Dr. Lawson is responsible for getting the DACO program to come to Texas and for having the TCA host the program. He’s responsible in a roundabout way for getting me into this whole DACO mess and I thank him for it.
A little more about Dr. Lawson
- Prior to attending Parker College of Chiropractic in Dallas, -Texas I served in the United States Air Force.
- Graduated from Parker College of Chiropractic 1993.
- Designated Doctor with Tx Workers Compensation since 1996
- Diplomate American Academy of Integrative Medicine, college of pain management, 2000.
- Diplomate American Academy of Pain Management 2001.
- Diplomate American Board of Chiropractic Orthopedists, 2002
- Certified in acupuncture , 2004
- Former hospital privileges Vista Hospital Houston and Pecan Valley Surgical Center in San Antonio.
- Masters degree from UT Pan American in Health Care Administration, 2015
- Current Chair of State Affairs with TCA
- Current VP of Texas Council of Chiropractic Orthopedists.
Welcome to the show Dr. Lawson. Since we are friends, formality seems awkward, if you call me Jeff, I’ll call you what? William or Bill?
When did you become a DACO and what was the impetus? What started that journey?
What have you noticed about yourself and about your business in regards to pre-DACO and post-DACO?
Let’s get into the research. The first thing I want to say here is that we cannot talk about cervical manipulation without addressing the yoke the medical field has tried to lay on us for generations. That is the myth that chiropractors go around causing strokes in everyone all the time.
I took three episodes of this podcast to address this myth. The series is called “DEBUNKED: The Odd Myth That Chiropractors Cause Strokes” and are specifically episodes #13, #14, and #15. It’s just common sense talk and, if you have any questions in your mind prior to listening to them, they should all be answered by the time you are done.
I will link them in the show notes as well as the corresponding YouTube Video and the Blog so that you can get the information in your preferred method.
PODCAST EPISODES:
- https://www.chiropracticforward.com/debunked-the-odd-myth-that-chiropractors-cause-strokes/
- https://www.chiropracticforward.com/cf-episode-14-debunked-the-odd-myth-that-chiropractors-cause-strokes-part-2-of-3/
- https://www.chiropracticforward.com/cf-015-debunked-the-odd-myth-that-chiropractors-cause-strokes-part-3-of-3/
BLOG:
- https://www.chiropracticforward.com/blog-post/debunked-the-odd-myth-that-chiropractors-cause-strokes-revisited/
YOUTUBE:
https://youtu.be/tRXpG_Ie0Rs
Now that we’ve addressed this craziness, we can get on with how well we take care of our neck pain patients.
Dr. Lawson, I want to hear from you as much as you want to be heard from so, please….if I cover something that you have some extra info on or you just want to add a comment to, please interrupt me and lay it on us!!
We’ll start with the oldest one we have tee-d up here and go to the most recent.
This first one is from 2001 and is called “A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain[1].” The lead author is G. Bronfort and, if I recall correctly, his full first name is Gert. If you’ve spent any time listening to our podcast, you’ve probably heard his name. He’s fairly prolific with research papers.
Why They Did It
Their stated goal for this project compared the effectiveness of rehab exercises vs. spinal manipulation for chronic neck pain.
What They Found
- Patient satisfaction was higher spinal manipulation + exercise was superior to spinal manipulation alone
- There was no statistical difference noted between the two groups
- However, when combined, exercise + manipulation showed greater gains in all measures of strength, endurance, and range of motion.
Wrap It Up
The authors concluded, “For chronic neck pain, the use of strengthening exercise, whether in combination with spinal manipulation or in the form of a high-technology MedX program, appears to be more beneficial to patients with chronic neck pain than the use of spinal manipulation alone.”
Dr. Lawson, what’s your take on this study? At this point, it’s 17 years old. Is it relevant still and how?
Next paper, this one’s called, “Chronic mechanical neck pain in adults treated by manual therapy: a systematic review of change scores in randomized clinical trials[2].” It is by H. Vernon, et. al. and was published in the Journal of Manipulative Physiological Therapeutics in 2007.
Why They Did It
This was a systematic analysis of effectiveness in randomized clinical trials of chronic neck pain. The stipulations here are that the neck pain could not be caused by whiplash and could not include a headache or arm pain. Just straight up chronic neck pain.
What They Found
Out of 1980 papers, they found 16 to accept and include in this project.
No trials included trigger point therapy or manual traction
Wrap It Up
“There is moderate- to high-quality evidence that subjects with chronic neck pain not due to whiplash and without arm pain and headaches show clinically important improvements from a course of spinal manipulation or mobilization at 6, 12, and up to 104 weeks post-treatment. The current evidence does not support a similar level of benefit from massage.”
Dr. Lawson, in this study, for those that don’t know research hierarchy, a randomized clinical trial is some of the more reliable, solid research wouldn’t you agree?
The only thing more impactful in the research world than randomized clinical trials are meta-analyses and systematic reviews. Well, this is a systematic review of 16 randomized clinical trials.
My point being: this is a reliable systematic review. No doubt about it. This is a great paper, Dr. Lawson and I have no idea how it’s escaped me 11 years into this thing. I have other papers by the same group of authors but somehow missed this one?
Would you like to add any comments on this paper?
OK, moving on, this paper is called, “Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial[3].” This one comes to us by G. Bronfort, et. al. as well and was published in the Annals of Internal Medicine in 2012.
This is not my favorite paper as we’ll talk about after we go through the conclusion.
Why They Did It
“To determine the relative efficacy of spinal manipulation therapy (SMT), medication, and home exercise with advice (HEA) for acute and subacute neck pain in both the short and long term.”
How They Did It
- It was a randomized controlled trial
- They used 1 university research center and 1 pain management clinic in Minnesota
- The sample was 272 people from 18-65 years old having nonspecific neck pain from 2-12 weeks
- The treatment consisted of 12 weeks of spinal manipulative therapy or home exercise advice.
What They Found
For pain, SMT had a statistically significant advantage over medication after 8, 12, 26, and 52 weeks
Home exercise was superior to medication at 26 weeks
No important differences in pain were found between SMT and HEA at any time point
Wrap It Up
Bronfort concluded, “For participants with acute and subacute neck pain, SMT was more effective than medication in both the short and long term. However, a few instructional sessions of HEA resulted in similar outcomes at most time points.”
As I mentioned, I have covered this paper before but it’s not my favorite because this is also a paper that I have seen chiropractic detractors use against us. Here’s how: they say that cervical manipulation is extremely risky and, if the outcome of simple exercises at home is just as effective, then what’s the point in cervical manipulation for neck pain?
What would you say in response to this particular argument?
Keepin on keepin on here. This next one is from the Journal of Manipulative Physiological and Therapeutics back in 2014 called “Evidence-based guidelines for the chiropractic treatment of adults with neck pain[4].” This one was done by Bryans, et. al.
Why They Did It
They wanted to develop evidence-based treatment recommendations for the treatment of nonspecific mechanical neck pain in adults.
How They Did It
They did a systematic literature search of controlled clinical trials published through December of 2011 and then organized each into strong, moderate, weak, or conflicting)
What They Found
41 randomized controlled trials met the criteria for inclusion.
Strong recommendations were made for the treatment of chronic neck pain with manipulation, manual therapy, and exercise combined with modalities.
Strong recommendations were also made for treating chronic neck pain with stretching, strengthening, and endurance exercises alone.
Moderate recommendations were made for the treatment of acute neck pain with manipulation and mobilization in combination with other modalities.
Wrap It Up
The authors closed by saying, “Interventions commonly used in chiropractic care improve outcomes for the treatment of acute and chronic neck pain. Increased benefit has been shown in several instances where a multimodal approach to neck pain has been used.”
Do you feel like this is going a little more in our favor than the Bronfort paper but still leaves a little to be desired? For instance, when we look at low back pain papers, it’s clear. Spinal manipulation is as effective or more effective than anything else out there. Even physical therapy or exercise. We’re not getting that satisfaction so far. Am I wrong?
We’re trucking along here. Next paper titled “Mobilization versus manipulations versus sustain apophyseal natural glide techniques and interaction with psychological factors for patients with chronic neck pain: randomized controlled trial[5].” This one was published in the European Journal of Physical Rehabilitation Medicine in 2015 and written by A. Lopez-Lopez, et. al.
Here’s my first question: “Why would you hyphenate the same name?” How can you be Lopez-Lopez and why would you want to say the name twice or make everyone else say the name twice? Isn’t it a bit redundant? Can we just say Lopez and move on?
OK, I get side-tracked sometimes so I have to get myself back on track here and there. Since I’m not familiar with this paper or the authors at all, I want to switch it up a little on this one.
I want Dr. Lawson to go over this paper from top to bottom and tell us everything we need to know about this one. I see it’s a randomized controlled trial so it already has my attention. I’m unfamiliar with sustain natural glide (AKA SNAG). Is that term you are familiar with? It’s all yours doc.
Their conclusion was “The results suggest that high velocity/low amplitude and posterior to anterior mobilization groups relieved pain at rest more than SNAG in patients with neck pain.”
Let’s get to our last paper here by Korthalis-de-bos, et. al. It’s called “Cost-effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomized controlled trial[6].” It was published in the British Medical Journal back in 2003.
Why They Did It
The authors wanted to evaluate the cost-effectiveness of physical therapy, manual therapy, and care by a general practitioner for patients with neck pain.
How They Did It
- The project was an economic evaluation alongside a randomized controlled trial.
- 42 general practitioners recruited 183 neck pain patients
- The patients were randomly split for treatment by spinal mobilization, physical therapy, or general practitioner care.
What They Found
The authors wrapped that paper up by saying, “Manual therapy which consisted of spinal mobilization, is more effective and less costly for treating neck pain than physiotherapy or care by a general practitioner.”
I wanted to wrap up our talk with that paper because, first of all, it’s from the British Medical Journal so it got some weight. Second it’s alongside randomized controlled trials, and third, it’s one of the main ones that cuts through the noise and says very clearly, “mobilizing the spine is more effective and cost less for neck pain than seeing your primary or a physical therapist.”
Is it just me or is it time to move focus from low back pain and put more effort an attention to how effectively we treat neck pain?
It just makes complete sense to me. If we are so effective for low back pain in the eyes of researchers, why don’t we have the same pile of research for neck pain? Both are mechanical in origin. If we can affect low back pain, it makes perfect sense that we can affect neck pain.
Chiropractors see it every single day. I’m not telling you anything. I just get so frustrated at the lack of focus on neck pain, which is part of the reason we’re doing this podcast today.
Dr. Lawson, what do you have to add here before we sign off?
I want to thank you for joining us on the Chiropractic Forward Podcast. I hope you’ve enjoyed it as much as I have.
Maybe we talk some DC Ph.D.’s out there into making neck pain their next project.
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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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.
The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Being the #1 Chiropractic podcast in the world would be pretty darn cool.
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.
▶︎Website
http://www.chiropracticforward.com
▶︎Social Media Links
- https://www.facebook.com/chiropracticforward/
- Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
- https://twitter.com/Chiro_Forward
- https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
▶︎iTunes
- https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
▶︎Player FM Link
- https://player.fm/series/2291021
▶︎Stitcher:
- https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
▶︎TuneIn
- https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the author:
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography
-
Bronfort G, A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain. Spine (Phila Pa 1976), 2001. 26(7): p. 788-97.
-
Vernon H, H.B., Chronic mechanical neck pain in adults treated by manual therapy: a systematic review of change scores in randomized clinical trials. J Manipulative Physiol Ther, 2007. 30(6): p. 473-8.
-
Bronfort G, Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain: A Randomized Trial. Annals of Internal Medicine 2012. Ann Intern Med, 2012. 156(1): p. 1-10.
-
Bryans R, Evidence-based guidelines for the chiropractic treatment of adults with neck pain. J Manipulative Physiol Ther, 2014. 37(1): p. 42-63.
-
Lopez-Lopez A, Mobilization versus manipulations versus sustain apophyseal natural glide techniques and interaction with psychological factors for patients with chronic neck pain: randomized controlled trial. Eur J Phys Rehabil Med, 2015. 51(2): p. 121-32.
-
Korthals-de Bos IB, Cost-effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. British Medical Journal, 2003. 326(7395): p. 911.
Episode #40
w/ Dr. Brandon Steele: Chiropractic Standardization & The Future of Chiropractic
Today we’re going to talk with Dr. Brandon Steele about a lot of stuff but specifically, we’ll talk about Chiropractic standardization, educational advancement, and the future of chiropractic. Stick around for an awesome discussion with an extremely sharp doctor on the forefront of our profession.
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But first, here’s that bumper music
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
Now that I have you here, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It makes it easier to let you know when the newest episode goes live and if we come up with something pretty cool we need to be telling you about. We won’t use it any more than once per week and that’s about all you need to know. It’s not as big of a deal as most of you have in your mind. Just go do it right now while you’re thinking about it.
We continue to grow our listenership here. I’m a stats nerd. Trust me, I check them more than what one may consider a healthy amount of times. It’s just who I am. Thank you to you all for tuning in.
If you can continue to share us with your network, we sure would appreciate it.
We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.
You have passed out and woke up right here in Episode #40
We have a special guest with us this week. As I said from the top we have Dr. Brandon Steele with us today. He is a very respected speaker and has the awesome chance to travel all over doing just that.
I first became aware of Dr. Steele when I began taking courses in the DACO program. Dr. Steele is one of the instructors and I got to sit in a classroom for two days listening to him cover everything we needed to know about the shoulder.
I also much have some full disclosure here I think. Dr. Steele is a co-owner of ChiroUp with Dr. Tim Bertlesman and I’m a user/subscriber of ChiroUp. But, ChiroUp isn’t sponsoring this episode. I haven’t received a thing from them. Not even a free membership. Cough cough…
Seriously though, I’m having Dr. Steele on today because we think a lot alike from what I can tell, I love what they are doing with the DACO program, and I love where I think ChiroUp can help take our industry down the road. So, without further adieu…….
Welcome to the show Dr. Steele. Let’s start off with the obligatory question of, “What made you decide to be a chiropractor?”
In our discussion in Dallas, you told me that you’ve moved around a bit. Where are you from and what led you to St. Louis?
I have seen the terms evidence-based and evidence-informed used for what we do. I must admit my ignorance of the subtle differences here. I have assumed that, since I follow research, guidelines, and things like that, that I am indeed what is referred to as an evidence-based chiropractor. Can we assume the same about you?
When exactly did you decide to start traveling more in the direction of evidence and research rather than the philosophical route in the profession? Was there an aha moment?
Tell me a little bit about your hilarious alter-ego, the wide lapeled chiropractic huckster we see you play in videos from time to time on the ChiroUp Facebook page.
Part of the idea of being more into the research and being based or informed with the evidence, I think, is to standardize our profession to some extent as well as increasing the level of education of the run of the mill chiropractor. We know we don’t have a low level of education at all so….can you go into that a little bit for us? What do you mean when you speak about standardizing the profession?
Tell me everything about the DACO program. What got you involved with the DACO program originally?
Our regular listeners should be well-aware of you, Dr. Tim Bertlesman, and ChiroUp at this point. I’ve been pumping your tires for a bit. How did you and Dr. Bertlesman become acquainted with each other and then decide to go into business together?
Now, tell us a bit about ChiroUp. It feels like to me that it is really starting to hit it’s stride.
Obviously, you want it to be successful for your own financial reasons….we all want to see our businesses to well….. but don’t you see something more than that for the profession coming out of ChiroUp? How do you think ChiroUp can affect or change our profession for the better in the years to come?
What is in the future for ChiroUp as far as updates, functionality…..things like that?
What are some of your upcoming speaking events so people can come see you do your thing?
How can listeners find you on social media or on the internet and contact you or learn more about you and what you do?
So there you have it folks, Dr. Brandon Steele. I told you that you would love this podcast episode.
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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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.
The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Being the the #1 Chiropractic podcast in the world would be pretty darn cool.
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.
▶︎Website
http://www.chiropracticforward.com
▶︎Social Media Links
- https://www.facebook.com/chiropracticforward/
- Chiropractic Forward Podcast Facebook GROUP
https://www.facebook.com/groups/1938461399501889/
- https://twitter.com/Chiro_Forward
- https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
▶︎iTunes
- https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
▶︎Player FM Link
- https://player.fm/series/2291021
▶︎Stitcher:
- https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
▶︎TuneIn
- https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the author:
Dr. Jeff Williams - Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Episode #39: Communicating Chiropractic
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Today we’re going to talk about communicating chiropractic and chiropractic utilization. What am I talking about? Stick around
But first, here’s that bumper music
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
Now that I have you here, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It makes it easier to let you know when the newest episode goes live, when someone new signs up it makes my heart leap a little, and in the end, it’s just polite and we’re polite in the South.
We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.
You have potato sack jumped yourself right into Episode #39. In case you are new to the Chriorpactic forward podcast, there is a different way to get into this podcast. Moomwalk, do the twist, electric slid, grooved, you get the point.
I want to start the research part of our podcast today with a pretty cool paper that just passed through my email. I have my buddy and colleague, Dr. Craig Benton down in Lampasas, TX to thank for this one. It’s called “Characteristics of Chiropractic Patients Being Treated for Chronic Low Back and Neck Pain.” It was authored by PM Herman, et. al. and published in the Journal of Manipulative Physiology and Therapeutics on August 15th of 2018[1]. Brand spankin new, people. https://www.ncbi.nlm.nih.gov/pubmed/30121129
Why They Did It
Since chronic low back and chronic neck pain dominate our population and since chiropractic is a common approach to the conditions, the authors wanted to explore the characteristics of chiropractic patients suffering the conditions here in the United States.
How They Did It
- They collected information from chiropractic patients with different levels of information that included regions, states, sites, providers and clinics, and patients.
- The sites and regions were San Diego, Tampa, Minneapolis, Seneca Falls and Upstate New York, Portland, and Dallas.
- Data was collected through an iPad prescereening questionnaire in teh clinic and through emailed links to full screening and baseline online questionnaires
What They Found
- There were 518 patients with chronic low back pain only
- There were 347 with chronic neck pain only
- There were 1159 with both chronic low back pain and chronic neck pain.
- In general most participants were highly educated white females that had been using chiropractic care for years.
- Over 90% of the participants reported high satisfaction with their care, few used narcotics, and avoiding surgery was the most important reason they chose chiropractic care.
Wrap It Up
The authors concluded, “Given the prevalence of CLBP and CNP, the need to find effective nonpharmacologic alternatives for chronic pain, and the satisfaction these patients found with their care, further study of these patients is worthwhile.”
As a sidenote, at the first ChiroTexpo event for the Texas Chiropractic Association state convention, these researchers were there recruiting offices for this paper which is kind of cool.
How much of the population do chiropractors see on average? At least in American? For years, the number has been from 7% to 11% but there is research out there that suggests the number is actually bigger. We can answer that question a little more accurately thanks to some research from Palmer that was published back in 2015.
It’s called “Americans’ Perceptions of Chiropractic,” it was performed in conjunction with Palmer and Gallup, and was submitted by James O’Connor of Palmer and Joe Daly of Gallup[2]. I have linked it in the show notes for you.
https://www.palmer.edu/uploadedFiles/Pages/Alumni/gallup-report-palmer-college.pdf
The report states from the get go that half of acults in the US have been to a chiropractor as a patient.
- 14% of adults say they saw a chiropractic within the last 12 months.
- 12% say they saw a chiropractor in the last five years
- 25% say they saw a chiropractor more than 5 years ago
- Women are more likely to love and visit their chiropractor regularly
- Adults under 50 are more likely to say that the chiropractor is their first stop for neck or back pain.
- Over 50% of adults strongly agree or agree somewhat that chiropractors are effective at treating neck and back pain.
All of this is great news, y’all. Great news. In the conclusion of this report from Gallup and Palmer College, they say yes…over half of Americans view chiropractors as effective for neck and back pain but uncertainty about costs and misinformation about potential dangers of chiropractic are potential obstacles to them utilizing our services.
I addressed the whole stroke issue the medical field has tried to saddle us with in a blog, in a YouTube video, and in a series of three podcasts and highly encourage you to re-visit the information in episodes 13, 14, and 15. I will link them for you in the notes.
The blog, YouTube video, and podcast series is called “DEBUNKED: The Odd Myth That Chiropractors Cause Strokes.” You must have this information. If you do anything this week, do that. I laid it all out and I did it in blog form, video form, and podcast form so you could pick your preference and get the information. So do it.
YouTube: https://youtu.be/tRXpG_Ie0Rs
Blog: https://www.chiropracticforward.com/blog-post/debunked-the-odd-myth-that-chiropractors-cause-strokes-revisited/
Podcast Episode #13: https://www.chiropracticforward.com/debunked-the-odd-myth-that-chiropractors-cause-strokes/
Podcast Episode #14: https://www.chiropracticforward.com/cf-episode-14-debunked-the-odd-myth-that-chiropractors-cause-strokes-part-2-of-3/
Podcast Episode #15: https://www.chiropracticforward.com/cf-015-debunked-the-odd-myth-that-chiropractors-cause-strokes-part-3-of-3/
The report suggests we try to be transparent when it comes to the costs of chiropractic which also means providing details on insurance coverage, visits required, etc. Here’s the deal though…..if someone comes up to me on the street and asks me how much it costs to come see me, what the hell am I supposed to say?
Quite literally, I don’t have a single damn clue what it’s going to cost them. I don’t know what kind of insurance they have. I don’t know if their issue is acute, chronic, or a combination of issues spanning acute as well as chronic. I don’t know if their deductible is met. I don’t know what their co-pay is. I don’t know any of that crap and I’m sure as hell not going to be having a long enough conversation when I’m out and about with friends or family to figure it out either.
Palmer is crazy on that part of this. People are grown-ups. They have a Google machine in their pockets. Figure out what your deductible is and how much you’ve met. Figure out what your co-pay is. Google up the offices in your area and try to get an idea of how they practice. If they’re talking about fixing ear infections, boosting your immunes system, and not getting your kids vaccinated, well….chances are they’re going to want to see you 1.23 million times through your lifetime.
If they’re talking about exercise/rehab, evidence, research, and things of that nature, then they’re going to address your issue quickly and relatively inexpensively.
Then get on your Facebook machine and ask your friends which evidence-based chiro in your area you need to be seeing and go do that. It’s easier today than ever before. Palmer doesn’t really need to put that directive on chiropractors in my opinion.
They go on to say that about 37% of Americans are unsure whether or not chiropractic is dangerous. Palmer suggests we chiropractors try to convey more clearly the level of education we have gone through. I think that’s a great suggestion. I do hate the fact that MDs and DOs aren’t going around having to tell everyone about the classes they took and we DCs obviously do need to do that but, it is what it is. You want that in Espanol? Here it is: “Es lo que es.”
Just trying to spice it up folks. Go with it alright?
The report had some cool news. What news is that you might say? To that, I’d say this: current users of chiropractic typically see their doc an average of 11 times per year which they say shows a strong committment to chiropractic care.
If the description is strong committment to chiropractic care, then count me in. I’m on board. I’m on that team.
The last sentence of the report says this, “The chiropractic community would do well to increase awareness among the public about the benefits of chiropractic care and the costs associated with it, including offering flexible methods of payment and assistance with navigating insurance, to ensure potential users have what they need to make an informed decision regarding care.”
OK….where to start here?
Dammit. We all know all too well that chiropractors increasing awareness among the public about the benefits of chiropractic care is a slippery slope. Do I want to encourage a chiropractor that doesn’t believe in vaccinations to be out there talking about the amazing benefits of Chiropractic? Ummmm….nope. Nope, I sure don’t.
Now, if you have a doc talking about how awesome chiropractic is and how spinal manipulation combined with exercise rehab is a powerful combination and is now recommended by the American College of Physicians, JAMA, The Lancet, the FDA, the CDC, The Joint Commission, the current occupant of The White House, and even Consumer Reports…..well hell….I think you have a winner on your hands.
Luckily, the only docs listening to me right now are the ones that are going to be talking about the latter rather than the former.
So listen up evidence-based men and women…..unfortunately, you have to start telling people more about your education and you have to start telling people more about the research and evidence and support behind what it is we do from day to day.
I’d like to say that it is super duper big time double fortunate that you have resources like, oh say, maybe a podcast called the Chiropractic Forward Podcast that does all of the work for you by gathering and talking about research every week that can help you on this.
Now, onto our last topic this week. This one is an article from June 19, 2018 that was posted on the ACA Blog and linked in the notes on our website for this episode.
https://www.acatoday.org/News-Publications/ACA-Blogs/ArtMID/6925/ArticleID/374/Communicating-Chiropractic-An-Algorithm-to-Answer-Difficult-Questions
The title of the article is “Communicating Chiropractic: An Algorithm to Answer Difficult Questions[3].” It was written by Dr. Stephanie Halloran who did an excellent job on this article in my opinion. Dr. Halloran is the chiropractic resident with the VA Connecticut Healthcare System.
Dr. Halloran started the article by covering some common questions that can be asked of chiropractors within an interdisciplinary setting. The questions she mentions are:
- What are the typical conditions treated by chiropractors and specific treatments utilized?
- What are containdications for treatment?
- Waht are the mechanisms of manipulation and/or acupuncture?
- What adverse events from chiropractic treatment, including post-treatment soreness and cervical manipulation and stroke?
All sound like reasonable questions but think about them for a minute. What would your responses be to them and would your answers really stand up to scrutiny in the medical kingdom?
Dr. Halloran cites her site director, VA Chiropractic Program Director Dr. Anthon Lisi as being key in helping her formulate an approach we can use to guide us to develop our own answers to these questions. She lines out 4 steps we should be looking at.
- Have a great depth of knowledg e - She says, “First and foremost, you must have an extensive understanding of what you are being asked. Whether the inquiry is as vague as “What is chiropractic?” or more specific, such as “What is the physiologic mechanism of manipulation?” or more sensitive, such as “Does cervical manipulation cause stroke?” it is imperative to know what the evidence does and doesn’t support. “ My goodness…where on Earth could you ever be educated on research and what the evidence says? Hmm….I’ll just wait here until….yes. You’ve found it right here!
- Selectively Present that knowledge - Answer with only the most pertinent information. Sometimes less is more and sometimes more is too much information but, be sure you can expound on the neurophyusiological effects if specifics are asked.
- Be mindful of an appropriate stopping point - She says, “It is reasonable to assume that an encounter will occur at some point with a specialty physician possessing unwavering negative views of chiropractic treatment, and the reality is some will not be swayed despite the evidence presented. The goal of the interaction is to present the evidence, to meet them where they are, and to leave the door open for further conversation at a later date.” And then you punch them in the face and push them down on the playground while saying nanny boo boo.
- Remain altruistic throughout - She says we need to stay focused on the overal goal of health care which is, according to her “to increase functional outcomes, improve quality of life, and provide the best care for patients.” I can get on board with that description myself.
She wraps it up by saying, “In respect to success in integration, my biggest take-away from being exposed to interprofessional collaboration on a day-to-day basis in the VA is the need for chiropractors to prepare answers to questions regarding what chiropractic care is, common conditions seen, neurophysiological effects of treatment, and the incidence of adverse events. These answers should be instantaneous and provide evidentiary support. One must also be prepared to hit the brakes when met with substantial resistance and to admit lack of familiarity with a topic, when appropriate.”
Can’t we all agree with this article? It makes perfect sense. If you can’t communicate and relay what it is you do, then what are you doing?
This week, I want you to go forward with the idea that we are not a dying profession. We are, in fact, growing and our utilization is growing. We maintain that growth by better communication and better patient education as to our level of education and our cost-effectiveness. In addition, in regards to integration, let’s make sure we are prepared to answer questions and do it in a way that is 100% backed by solid and respected research and evidence. You can’t lose when it’s done that way.
Subscribe Button
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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.
The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Being the the #1 Chiropractic podcast in the world would be pretty darn cool.
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.
▶︎Website
http://www.chiropracticforward.com
▶︎Social Media Links
- https://www.facebook.com/chiropracticforward/
- https://twitter.com/Chiro_Forward
- https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
▶︎iTunes
- https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
▶︎Player FM Link
- https://player.fm/series/2291021
▶︎Stitcher:
- https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
▶︎TuneIn
- https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
Bibliography
-
Herman PM, Characteristics of Chiropractic Patients Being Treated for Chronic Low Back and Neck Pain. J Manipulative Physiol Ther, 2018.
-
O'Connor J, Gallup-Palmer College of Chiropractic Inaugural Report: Americans' Perceptions of Chiropractic. Palmer College of Chiropractic, 2015.
-
Halloran S, Communicating Chiropractic: An Algorithm to Answer Difficult Questions, in ACA Blog, ACA, Editor. 2018: ACA Blog.
Episode #38
With Dr. Jerry Kennedy - Chiropractic Marketing Done Right
Today we’re going to be talking about Chiropractic marketing done right with The owner of Black Sheep DC, Dr. Jerry Kennedy who describes himself as a Chiropractor, a chiro coach, a podcast host, a relationship marketing nerd, and a chiropractic meme wizard. All great descriptions. Dr. Kennedy sounds as busy as I am.
But first, here’s that bumper music
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have hoofed it into Episode #38
We have a great guest that I have become familiar with through a couple of my favorite private Facebook groups. One being the Forward Thinking Chiropractic Alliance and the other being Evidence-Based Chiropractic. We are departing a little from our regular format today and I want to tell you why I asked Dr. Kennedy to be a guest on our podcast today. He’s got it figured out when it comes to Chiropractic marketing.
First, I’m a bit of a nerd myself when it comes to Chiropractic marketing. I didn’t claim to be an amazing marketer but I love it. I love the concept of marketing. I love the thought of marketing. I love the simple fact that using one color vs. the other can make a complete difference in the success of a campaign. It’s fascinating is what I’m saying.
With that being said, Dr. Kennedy is known for relationship marketing. I admit I hadn’t heard the term before hearing Dr. Kennedy use it but I love it because, from what I can tell, it describes me to a tee.
While Dr. Kennedy is agnostic in regards to whether someone practices in an evidence-based way or practices in a more philosophical based practice, I feel his way of approaching patients and approaching practic-building exactly lines up with my way of building relationships through evidence-based means. Like I said, “Chiropractic marketing done right.”
Dr. Kennedy is not sponsoring this show and I am not a member of Black Sheep. I just like what he’s doing and want you all to know about it. I like the spirit of giving and, down the road, Chiropractic Forward is going to be given opportunities to get our name out there because of it. That’s the way the world works in my experience. Give and ye shall receive.
I think we were both given the gift of gab so this episode should just be a great conversation on Chiropractic and Chiropractic Marketing done the right way.
So here we go, “Welcome to the show Dr. Kennedy we are so glad to have you with us today. Where are you coming to us from today?”
I already gave you a so-so intro because I’m not really that interesting overall but, to be comprehensive here, can you tell us more about yourself? I don’t want to leave any high points out like kids and all the really important stuff.
Now, I’ve done my homework and listened to several of your podcasts but still don’t know……why call it Black Sheep DC or Black Sheep Chiropractor?
Let’s get into what we’re here for Relationship-based chiropractic marketing. I believe I know what it means to me and I’m pretty sure I know how you mean it but would you describe it for us if you don’t mind?
Would you agree that Relationship Chiropractic marketing works well for those already running a patient-centered practice? By patient-centered, I mean docs that are doing what is best for the patient rather than what is best for their practice goal numbers they’re trying to hit that particular month. For me, those are doctor-centered practices. I just wanted to be clear on my thought process just in case our definitions of patient-centered vs. doctor-centered were different.
In your program, are you advising on internal and external Chiropractic marketing strategy or is it mostly and in-office and social media thing?
I remember in one of your podcasts, you mentioned how you can’t sit around on your butt expecting things to get better. I’m paraphrasing here but it reminded me of a Dan Kennedy saying he calls YCDBSOYA which stands for You Can Do Business Sitting On Your Ass. At the beginning of my chiropractic career, I’d say that was an issue with me. Mostly because I didn’t know what it was I needed to be doing. Ignorance in general when it came to marketing.
Without giving away any of your secrets, those are reserved for your members, what advice do you try to give people to get them involved in the community and basically get them off their butts?
If I remember right, you are a proponent of the newsletter for Chiropractic marketing - How do you keep them fresh? I send weekly emails to an email list but have to admit, it’s hell keeping it new and fresh.
Any solid opinion on Direct Mail - Yea or nay?
Is there a new wave of the future when it comes to marketing that people are missing right now? Things like maybe Periscope or Virtual Marketing…..or something else I don’t know about yet?
One thing we have in common, we have a knack for creating memes. I love them and I love making them. It’s an outlet for my sarcastic, smart-aleck side to come out in hopefully a fun way. Two of your more recent ones I loved would be the one with the stunned looking kid and the caption reads, “That moment you realize a successful business is the key to being a successful chiropractor.”
Those of us that have been in the mix a while know this usually through painful experience. What was the impetus for this one?
The other more recent one that cracked me up a little bit was the guy saying Whoa there….if you're going to tell me how to adjust you, it’s going to cost you extra. I think we’re all familiar with the reason for that one.
You recently stopped your free podcast after 184 episodes. Tell us a little about that decision and did you get any pushback on that?
What would be your overriding goal for each person that signs up for your Chiropractic marketing programs?
This is the one somewhat challenging question. It’s been my opinion my whole professional life that patient-centered docs hopefully get their patients over the complaint fairly quickly, effectively, and cost-efficiently while doctor-centered practices are busy trying to hit certain numbers, seeing patients many more times than current guidelines and recommendations allow, and claiming to have effects on conditions there is little to no good research for.
Without getting you to take sides, throw rocks, or any of that…… and without trying to stir the pot too much, how in your opinion, is it possible for a subluxation, philosophical-based, 100 visits a year style of a practitioner to also be patient-centered and relationship-based Chiropractic marketing?
Tell us where listeners can find you and connect with you if they’re interested in relationship marketing and in learning more about Back Sheep DC
Thank you so much for joining us……
Before you all go, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It makes it easier to let you know when the newest episode goes live, you’ll never hear from us more than once a week, and in the end, it’s just an email for goodness sakes!
Subscribe Button
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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.
The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Being the #1 Chiropractic podcast in the world would be pretty darn cool.
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.
▶︎Website
http://www.chiropracticforward.com
▶︎Social Media Links
- https://www.facebook.com/chiropracticforward/
- https://twitter.com/Chiro_Forward
- https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
▶︎iTunes
- https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
▶︎Player FM Link
- https://player.fm/series/2291021
▶︎Stitcher:
- https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
▶︎TuneIn
- https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
Episode #37
Stretching Before Playing. What’s the Verdict?
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Today we’re going to talk about stretching before playing. We’ll go through some research and hopefully give you a general idea of what is the right recommendation to make to your patients.
But first, here’s that bumper music
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
Now that we are locked in and rocking, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It’s just an email. We don’t sell it, we won’t use it any more than once per week when a new episode comes out, and it’s the best way for lots of you to get a reminder when episodes go live.
Did you know that I literally get more emails from myself than I get from anyone else? It’s true. As soon as I think of something that needs to get done, I send myself an email. Muy pronto. If I don’t, it’ll be gone in the ether. Like a wisp of smoke. It’s there and then shwoosh….it’s gone. Lol. That may be just a consequence of aging but it’s been that way for some time now. We just learn how to deal with those things and develop the coping mechanisms that allow life to continue as unimpeded as possible.
Back to school, yes, we have the knuckleheads back in school and, while they were unhappy, I was all smiles inside. I love being on a schedule and school offers that regimented, time table type of deal. That’s what I operate best under. When the kids are here, there, and everywhere, I just lose my mind a little honestly so, for my colleagues that have kids…..hell yeah. We made it through Summer.
We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.
You have high-stepped right into Episode #37
I mentioned some time ago that I really enjoy some of the private groups on Facebook. Specifically, I enjoy the Forward Thinking Chiropractic Alliance and the Evidence-based Chiropractic Facebook groups. I would be crazy to fail to mention our OWN private Facebook group which is called oddly enough the Chiropractic Forward Facebook group.
You can learn so much stuff you weren’t even expecting to find out or didn’t even know you didn’t know. That’s the best kind of learning I think.
On that note. In one of those groups, there was a discussion not too long ago on stretching before an athletic event. When I was an athlete from elementary age all the way through college, we stretched. We stretched a lot.
In playing football in college, I couldn’t tell you whether stretching made any difference in game time performance because there was never an opportunity to NOT stretch.
However, I actually won state here in Texas in the discus and competed at state in the shot put when I was in high school and I can tell you from personal experience and knowing my body very well back then…..I always felt weaker when I stretched before an event. Luckily, we were allowed to kind of do our own thing in track and field when it came to warm ups and I started avoiding stretching purely based on the way it made me feel weaker.
I found I got a lot more use out of visualization and relaxing my mind. On that note, I had a college coach recommend a book to me that made all of the difference to me in regards to performance. It was called Peak Performance and authored by Charles A. Garfield. It is a phenomenal book. Mostly because it didn’t offer general ideas on visualization and relaxation. It gave you specific, easy to use exercises that allowed you get it and use it immediately. I can’t recommend it highly enough if you can still find it. I’m old now so my copy may one of the few left. But, I did leave a link in the show notes that takes you to a copy at Barnes and Noble if interested.
https://www.barnesandnoble.com/p/peak-performance-charles-a-garfield/1002544001/2660075437651?st=PLA&sid=BNB_DRS_New+Marketplace+Shopping+Textbooks_00000000&2sid=Google_&sourceId=PLGoP164994&gclid=CjwKCAjw2MTbBRASEiwAdYIpsYwXv0NZHGrUz_0PwqMoqv50DDrvGEyioRTGr44p8jln__5aujnRaxoCKkEQAvD_BwE
Now, was my idea that stretching made me weaker before a throwing event? Let’s dive and see what the research has to say on it. Since there are several papers to run over and our time is limited here, I will not be going very deeply into each paper. We will get the general ideas, I will cite them in the show notes for Episode 37 at chiropracticforward.com and, if you want to learn more, you can find the papers linked there or in our private Chiropractic Forward Facebook group.
OK, let’s see what we have here. Let’s start with one called Current concepts in muscle stretching for exercise and rehabilitation by PT and PhD Phil Page[1]. It was published in International Journal of Sports Physical Therapy in February of 2012.
Why They Did It
The purpose of this clinical commentary is to discuss the current concepts of muscle stretching interventions and summarize the evidence related to stretching as used in both exercise and rehabilitation.
There are three muscle stretching techniques frequently described in the literature: Static, Dynamic, and Pre-Contraction stretches.
Static stretching is the probably the type of stretching we all commonly think of. It’s where you hold a specific position and tension or stretch the muscle or the muscle group. We hold it for 10 or so seconds and usually do that for 3 sets. Traditionally anyway.
Next is Dynamic stretching which is characterized by either active or ballistic dynamic stretching. Active dynamic stretching involves moving a limb through its full range of motion to the end range and repeating it several times while Ballistic dynamic stretch involves rapid, alternating movements or “bouncing” at the end-range of the motion. Ballistic dynamic stretching is no longer recommended due to an increased risk of injury.
The last of the three is Pre-contraction stretches. This involves a contraction of the muscle being stretched or a contraction of its antagonist muscle before stretching. According to Dr. Page’s paper, the most common type of pre-contraction stretching is proprioceptive neuromuscular facilitation (PNF) stretching. There are several different types of PNF stretching including “contract relax” (C-R), “hold relax” (H-R), and “contract-relax agonist contract” (CRAC); these are generally performed by having the patient or client contract the muscle being used during the technique at 75 to 100% of maximal contraction, holding for 10 seconds, and then relaxing.
This paper is all about any and all stretching depending on the person and activity so there’s no really specificity in the recommendations but you can derive some generalizations here.
For warm up for sports and exercise purposes, Dr. Page says that static stretching is most beneficial for athletes requiring flexibility for their sports like gymnastics, dance, etc. He says that dynamic stretch may be better for athletes that will be running or jumping like basketball players or sprinters. However, he states that stretching has not been shown to reduce incidence of overall injuries.
Next, here’s one called “Effects of dynamic and static stretching on vertical jump performance and electromyographic activity” by PA Hough et. al. published in Journal of Strength Conditioning Research in 2009[2]. This was randomized controlled trial. This one is actually older than the last one but I wanted to cover the last one prior to this one so that you’d know the differences in the types of stretching. So…..on with the show here.
Why They Did It
The purpose of this study was to assess the effects of static stretching and dynamic stretching on vertical jump performance and electromyographic activity of the vastus medialis.
What They Found
- There was significantly greater EMG amplitude in the dynamic stretched individuals that the static stretch folks.
- The vertical jump was statistically greater in the dynamic stretch group than the static stretch as well.
- Static stretch actually has a negative influence on vertical jump while dynamic has a positive impact.
Wrap Up
“This investigation provides some physiological basis for the inclusion of DS and exclusion of SS in preparation for activities requiring jumping performance.”
Let’s keep it moving. Here’s one called “Effects of running, static stretching and practice jumps on explosive force production and jumping performance” by W.B. Young et. al. published in Journal of Sports Medicine and Physical Fitness in 2003[3].
Why They Did It
The purpose of the study was to compare the effects of running, satis stretching of the leg extensors and practice jumps on explosive force production and jumping performance.
What They Found
The results of this particular study showed that sub maximum running and practice jumps had a positive effect whereas static stretching had a negative influence on explosive force and jumping performance. It was suggested that an alternative for static stretching should be considered in warm-ups prior to power activities.
That definitely confirms my personal experience back in track and field in high school. All we really knew back then was static stretch.
Right on into the next paper by JC Gergley called “Latent effect of passive static stretching on driver clubbed speed, distance, accuracy, and consistent ball contact in young male competitive golfers” published in Journal of Strength and Conditioning Research in 2010[4].
Why They Did It
This investigation was conducted to determine the effect of 2 different warm-up treatments over time on driver clubhead speed, distance, accuracy, and consistent ball contact in young male competitive golfers.
What They Found
The authors concluded, “The results of this inquiry strongly suggest that a total-body passive static stretching routine should be avoided before practice or competition in favor of a gradual active dynamic warmup with the clubs. Athletes with poor mechanics because of lack of flexibility should perform these exercises after a conditioning session, practice, or competition.”
We continue with “The acute effects of static stretching compared to dynamic stretching with and without an active warm up on anaerobic performance” authored by Bradley Kendall and published in International Journal of Exercise Science in 2017[5].
Why They Did It
“The Wingate Anaerobic Test (WAnT) has been used in many studies to determine anaerobic performance. However, there has been poor reporting of warm-up protocols and limited consistency between warm-up methods that have been used. With the WAnT being such a commonly-used test, consistency in warm-up methods is essential in order to compare results across studies. Therefore, this study was designed to compare how static stretching, dynamic stretching, and an active warm-up affect WAnT performance.”
It was hypothesized that the dynamic stretching would lead to greater peak power than the static stretching protocol. However, results of post hoc analyses failed to detect a significant difference. For the other measured variables no significant differences were found.
However, the Bonferroni adjustment is quite stringent and may have failed to detect a significance due to the small sample size in this study. When comparing dynamic stretching to static stretching, Cohen’s effect size suggested that dynamic stretching may have a small to moderate effect on performance. The comparison between static and dynamic stretching approached significance and had a small to moderate effect, supporting studies that have concluded dynamic stretching to be more beneficial then static stretching prior to anaerobic performance output.”
And here we arrive at our last article called “Injury prevention and management among athletic populations: to stretch or not stretch?” by Kieran O’Sullivan and Sean McAulliffe of Ireland and Gregory Lehman of Canada. This article appeared in Aspetar Sports Medicine Journal in 2014[6].
Since this article is long, we won’t get too detailed here. We will hit the high spots and link it in the show notes for episode #37 at ChiropracticForward.com and hopefully you can read it in depth
http://www.aspetar.com/journal/upload/PDF/201412891228.pdf
Why They Wrote It
The authors wanted to discuss whether there is evidence that static stretch is worth including in athlete management.
I found it interesting to see a quote at the beginning of this article that said, “There is consistent evidence that SS increases flexibility in the short-term, although the gains in flexibility decrease relatively quickly, such that they are lost within 30 minutes.”
They summarized static stretch as follows:
- SS increases flexibility in both the short- and long-term
- Flexibility is also increased by strength training, especially eccentric training.
- Interestingly, strength training appears to increase both tendon stiffness and overall MTU stiffness, while simultaneously increasing ROM
- Neither SS nor strength training appears to consistently decrease the stiffness of the joints.
- none of the reviews showed a beneficial effect of SS on performance
- Maximal strength appears to be more commonly negatively affected by SS than explosive muscular performance or power
- Sustained SS does not appear to enhance running or walking efficiency even when ROM is increased. Results are equivocal with SS and endurance performance. In contrast, strength training consistently improves endurance performance
- Acute SS for greater than 45 seconds should be avoided immediately before participation in activities where strength or power are important
- Shorter durations of SS are also hard to justify immediately before participation in activities where strength or power are important
- In endurance activities, acute SS is hard to justify immediately before participation as performance may be reduced
- SS is far less effective than strength training in enhancing strength and power and it’s unclear whether adding SS might reduce the strength gains achieved, so why do it?
- There is not sufficient evidence to endorse or discontinue routine stretching before or after exercise to prevent injury among competitive or recreational athletes
- In terms of injury prevention, it appears SS has very little to offer and should not be used.
- Alternatively, a meta- analysis showed that strength training reduced incidence of sports injuries to less than one third
They summarized the article by saying, “the only area in which SS might seem to offer a specific advantage is in the area of increasing flexibility. There may be times when the most important goal is enhancing flexibility (e.g. ballet) and in these isolated circumstances SS may be justifiable. However, there remains a lack of evidence that gains are superior to those of a strength training programme. Even if strength training is eventually confirmed as being inferior to SS at increasing flexibility, the fact that strength training improves performance, pain, disability, injury and return to sport rates mean strength training must be a mainstay of athletic development and training, in contrast to SS.”
What a fascinating article. We only touched on a few of the larger ideas in the article but it’s FULL of information and learning. If sports and stretching are a part of your focus, the article is a must. Everything they talk about is cited properly so you can really dive in face first if you want.
Great stuff folks.
I’m going to say that my notion in high school, in my mind, has been confirmed. I just felt weaker if I performed static stretch for more than just a few seconds. Like the stretching just took the wind out of my sails.
I’ve learned a ton through putting this podcast and I hope you have too! Hell, that’s what we’re here for right?
Go forward this week with more confidence in your recommendations for stretching before athletic activity. If we didn’t hit enough here for you, dive into the show notes and the citations at chiropracticforward.com Episode #37 and do some of your own homework. You’ll be better for it. I promise.
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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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.
The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Being the the #1 Chiropractic podcast in the world would be pretty darn cool.
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.
▶︎Website
http://www.chiropracticforward.com
▶︎Social Media Links
- https://www.facebook.com/chiropracticforward/
- https://twitter.com/Chiro_Forward
- https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
▶︎iTunes
- https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
▶︎Player FM Link
- https://player.fm/series/2291021
▶︎Stitcher:
- https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
▶︎TuneIn
- https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
Bibliography
-
Page P, CURRENT CONCEPTS IN MUSCLE STRETCHING FOR EXERCISE AND REHABILITATION. Int J Sports Phys Ther, 2012. 7(1): p. 109-119.
-
Hough PA, Effects of dynamic and static stretching on vertical jump performance and electromyographic activity. J Strength Cond Res, 2009. 23(2): p. 507-12.
-
Young WB, Effects of running, static stretching and practice jumps on explosive force production and jumping performance. J Sports Med Phys Fitness, 2003. 43: p. 21-7.
-
Gergley JC, Latent effect of passive static stretching on driver clubhead speed, distance, accuracy, and consistent ball contact in young male competitive golfers. J Strength Cond Res, 2010. 24(12): p. 3326-33.
-
Kendall B, The Acute Effects of Static Stretching Compared to Dynamic Stretching with and without an Active Warm up on Anaerobic Performance. Int J Exerc Sci, 2017. 10(1): p. 53-61.
-
O'Sullivan K, Injury prevention and management among athletic populations: To stretch or not stretch. Aspetar Sports Medicne Journal, 2014. 3(3): p. 624-628.
Episode #36
A MishMash Of Chiropractic Research On Herniation, Trends, and Ineffectiveness
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Today we’re going to talk about research on Chiropractic, research on health trends, and research on disc herniation as a result of a visit to your friendly neighborhood chiropractor. Is that real or is that a bunch of hooey? We’ll talk about it so come along.
But first, here’s that bumper music
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
Now that I have you here, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. Nope, I don’t have some big prize for you if you sign up. Not big offers. No magical marketing tactics with which to get your email address. Just what we hope is a podcast full of value to you and your business.
Being on the newsletter list just makes it easier to let you know when the newest episode goes live and, maybe in the future we’ll have some cool stuff to offer those on our email list. Also, when someone new signs up it makes my heart leap and wouldn’t you like to be the one responsible for making someone’s heart leap today?
We have a lot of great guests lined up to come on the show! Next week I believe we are going to have Dr. Anthony Palumbo from Staten Island, New York. Dr. Palumbo is very active in the New York State Chiropractic Association and practices in a multidisciplinary practice. We’re going to have a good time picking his brain.
The week after that, I believe we have Dr. Brandon Steele from ChiroUp and from the DACO program joining us. He’s an excellent resource for what is going on in our profession and where we see things heading in the future for chiropractic. I’m really looking forward to that one.
We have the green light from Dr. Jerry Kennedy of the Black Sheep DC marketing program to come on the show. We just need to get that date lined up. We have Dr. Tim Bertlesman from the DACO program and also the President of the Illinois Chiropractic Association lined up down the road.
Good stuff on the way so make sure you’re staying tuned into our little corner here in Podcast land.
We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.
You have fainted very dramatically into Episode #36 and we’re so glad you did.
How’s your week been so far? I shared on the last podcast how we have had a rough 2018 but things have leveled off and we up and running. It feels a little like a sprint these days to tell you the truth. Lol. And thank the good Lord for it.
Speaking of thanking the Good Lord, my 16 year old son has been raised in church. Not every single Sunday. I like to sleep sometimes ya know. But, often enough to say he’s been a church-goer as has my 11 year old daughter. We’ve not pushed anything on him but he has taken it upon himself to an extent to further the church part of his life.
He’s gone to a church camp in New Mexico the last two summers and this year he returned ready to get baptized. So he did. Last Sunday he went to church and took a bath and we couldn’t be more proud of that little dude. He’s actually not so little anymore but, we worry about our kids don’t we? We worry about if we’re raising them right. Am I raising him to be a good man? Am I raising him to work hard and be dependable? Will they be ready for the world? Have I somehow enabled him to be weak? Am I raising him to feel entitled instead of working his butt off for things in his life
I think parents have all of these worries. I might argue that if you’re not asking yourself at least some of these questions, you might give them a deeper look. I’m not parenting expert. That’s just my opinion.
Anyway, my point is, we got this aspect of his life right so far. We sure love that kiddo and we love the direction we see him headed. Kids can be a game-changer for sure. From conception throughout their entire lives, they consume our mind space without even realizing it. And that’s OK. We wouldn’t have any other way most to the time.
With school back in session now, what are some of the ways that you keep your practice from slowing down? Back to school is historically a slow time for us and we’re never quite sure how to keep that from happening. Email me at dr.williams@chiropracticforward.com and tell me how you do it. I’ll be glad to share on next week’s podcast if you don’t mind.
This week, I just want to throw some seemingly random papers at you and we’ll start with one called “Effectiveness of classic physical therapy proposals for non-specific low back pain: a literature review.” It was written by F Cuenca-Martinez[1], et.al. and published in Physical Therapy Research in March of 2018. This is a group of physical therapists writing this paper just so you are in the know.
Why They Did It
The authors were hoping to evaluate the effectiveness of classical physiotherapy in management of non-specific chronic low back pain.
How They Did It
- They did a literature search in English electronic databases from November- December in 2015 for only randomized controlled trials
- They only accepted the studies addressing chronic non-specific low back pain treated by manual therapy and different types of exercise methods.
What They Found
Back School exercises an dMcKenzie’s method were both ineffective
Spinal manipulation proved effective when performed on the lower back and on the thoracic region but only immediately after it was received and not in the medium or in the long term.
Massage proved effective for short term relief
Wrap It Up
The authors conclusion was “Based on the data obtained, classical physiotherapy proposals show ineffectiveness in the treatment of chronic non-specific low back pain. More multidimensional studies are needed in order to achieve a better treatment of this condition, including the biopsychosocial paradigm.”
What do we get from this? First thought is, the papers they cite are, at this point, old and considering the papers we have been covering, are really pretty irrelevant to an extent. I mean, any good information will always be good information but only until better information becomes available. The most recent paper cited for the spinal manipulation portion of this project is over 5 years old. So….what the hell?
Second….it’s a bit discombobulated when you read through the abstract. I’m either bad at following along (which is highly likely) or it’s just worded so oddly. I dove into the full paper to try to makes heads or tails of what they have going on here. It sounds like physical therapists are just trying to be cheeky monkeys and throwing poo at spinal manipulation and we’re not having it. Mostly because they’re wrong and because we are better and more cost-effective at treating low back pain than they are. Period over and out.
The authors, in regards to spinal manipulation, refer to three studies. One by Oliveira, et. al[2]., one by Bronfort et. al[3]. and one by Senna and Machaly[4]. The Bronfort study was done on 300 patients and they found basically no difference between those that had physical therapy vs. chiropractic vs. home exercises. They all ended up the same. But, they didn’t cite the work we covered previously showing that chiropractic combined with exercise is more effective that physical therapy.
Or the paper from Episode 26 by Korthals-de Bos[5] that concluded “Manual therapy (spinal mobilization) is more effective and less costly for treating neck pain than physiotherapy or care by a general practitioner.”
There was also no mention of the paper by Blanchette et. al. that we covered in Episode #26 that showed that chiropractic patients experience the shortest duration of compensation, and physical therapists’ patients the longest. Blanchette says in that conclusion, “These differences raise concerns regarding the use of physiotherapists as gatekeepers for the worker’s compensation system.” And all the chiropractors said, “Amen, hallelujah brothers and sisters.”
And the Senna paper they cite actually concluded by saying, “SMT is effective for the treatment of chronic nonspecific LBP. To obtain long-term benefit, this study suggests maintenance SM after the initial intensive manipulative therapy.”
I’m done with that paper.
Let’s move on from these PTs and their poo-throwing.
Here’s one called “Chiropractic care and risk for acute lumbar disc herniation: a population-based self-controlled case series study” by Cesar Hincapie, et. al[6].
Why They Did It
The objective was to investigate the association between chiropractic care and acute lumbar disc herniation with early surgical intervention, and contrast this with the association between primary care physician (PCP) care and acute lumbar disc herniation with early surgery
What They Found
Both chiropractic and primary medical care were associated with an increased risk for acute LDH requiring ED visit and early surgery. Our analysis suggests that patients with prodromal back pain from a developing disc herniation likely seek healthcare from both chiropractors and PCPs before full clinical expression of acute LDH. We found no evidence of excess risk for acute LDH with early surgery associated with chiropractic compared with primary medical care.
This Hincapie fella also had a prior paper published not long ago[7] where he discussed and explored the perception among different medical disciplines and among chiropractors as to whether spinal manipulation causes lumbar disc herniation. It was an interesting paper. We covered it in episode #27 if you’d like to give it a listen.
https://www.chiropracticforward.com/cf-027-wanted-safe-nonpharmacological-mean-of-treating-spinal-pain/
Then there’s this paper that came out recently titled “Spine Degenerative Conditions and Their Treatments: National Trends in the United States of America” and published in Global Spine Journal February 2018. It was authored by Buser et. al[8].
Why They Did It
The aim of this study was to report the current trends when talking about spine degenerative disorders and their various treatments.
How They Did It
Patients diagnosed with lumbar or cervical spine conditions within the orthopedic Medicare and Humana databases were included
What They Found
- Within the Medicare database there were 6 206 578 patients diagnosed with lumbar and 3 156 215 patients diagnosed with cervical degenerative conditions between 2006 and 2012
- There was an increase of 18.5% in the incidence of fusion among lumbar patients
- For the Humana data sets there were 1 160 495 patients diagnosed with lumbar and 660 721 patients diagnosed with cervical degenerative disorders from 2008 to 2014
- There was a 33% (lumbar) and 42% (cervical) increases in the number of diagnosed patients. However, in both lumbar and cervical groups there was a decrease in the number of surgical and nonoperative treatments.
Wrap It Up
The authors wrap it up by saying, “There was an overall increase in both lumbar and cervical conditions, followed by an increase in lumbar fusion procedures within the Medicare database. There is still a burning need to optimize the spine care for the elderly and people in their prime work age to lessen the current national economic burden.”
What do we get from that? I’d say that it’s clear from research we’ve covered here that neck and back pain is stepping forward for sure. It is being recognized for the problem it really is while treatments available in the medical kingdom continue to show scattered results. Chiropractors are the most uniquely positioned to knock this stuff out of the park.
Fusion surgeries have gone crazy sky high in the last ten years while the outcomes have remained unchanged.
Epidural steroid injections have been done at a blistering pace over the last decade with no better outcomes.
Physical therapists are even starting to question their own effectiveness. Take this article in the journal called Physical Therapy written by Colleen Whiteford et. al[9]. Here is the opening paragraph. Get a load of this:
“We are writing to relay our consternation about the guideline article by Bier et al in the March issue of PTJ. We fully support the increasing emphasis on critical evaluation fo the assessment and intervention models used in physical therapist practice. Teh long-overdue acknowledgment of research that does not support much of what constitutes the bulk of physical therapist practice is a refreshing and honest introspection that can potentially initiate much needed change within our profession. Without such change, our profession is destined to continue on our current path of practice that is increasingly shown to be yielding outcomes that are less than desirable. Such exploration inevitably leaves us with gaping holes in practice that can be unsettling. Teh natural and responsible tendency is to search for alternate measures and interventions to fill this gap.”
I’m going to tell you one of those alternatives they’ll be looking to adopt and are looking to adopt is spinal manipulation. You better listen to me folks. If you’ve listened to our podcast much here then you know they’ve already adopted adjustments and renamed it to translatoric spinal manipulation.
We can keep monkeying with these chiropractors out on the edge of the ether talking about curing everyone on the planet of everything known to man or we can keep moving in the direction of science and in the direction of evidence. My preference is obvious.
If you haven’t yet, can you leave us a great review on whatever platform it is that you’re listening to us on? iTunes, Stitcher, or whatever it may be. We sure would appreciate it.
Subscribe Button
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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.
The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Being the the #1 Chiropractic podcast in the world would be pretty darn cool.
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.
▶︎Website
http://www.chiropracticforward.com
▶︎Social Media Links
- https://www.facebook.com/chiropracticforward/
- https://twitter.com/Chiro_Forward
- https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
▶︎iTunes
- https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
▶︎Player FM Link
- https://player.fm/series/2291021
▶︎Stitcher:
- https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
▶︎TuneIn
- https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
Bibliography
-
Cuenca-Martínez F, Effectiveness of classic physical therapy proposals for chronic non-specific low back pain: a literature review. Phys Ther Res, 2018. 21(1): p. 16-22.
-
Oliveira RF, Immediate effects of region-specific and non-region-specific spinal manipulative therapy in patients with chronic low back pain: a randomized controlled trial. Phys Ther Res, 2013. 93(6): p. 748-56.
-
Bronfort G, Supervised exercise, spinal manipulation, and home exercise for chronic low back pain: a randomized clinical trial. Spine, 2011. 11(7): p. 585-98.
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Senna MK, Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome? Spine (Phila Pa 1976), 2011. Aug 15; 36(18): p. 1427-37.
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Korthals-de Bos IB, Cost-effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. British Medical Journal, 2003. 326(7395): p. 911.
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Hincapie C, Chiropractic care and risk for acute lumbar disc herniation: a population-based self-controlled case series study. European Spine Journal, 2018. 27(7): p. 1526-1537.
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Hincapie C, Chiropractic spinal manipulation and the risk for acute lumbar disc herniation: a belief elicitation study. European Spine Journal, 2017.
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Buser Z, Spine Degenerative Conditions and Their Treatments: National Trends in the United States of America. Global Spine J, 2018. 8(1): p. 57-67.
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Whiteford C, On “Clinical Practice Guideline for Physical Therapy Assessment and Treatment in Patients With Nonspecific Neck Pain,” Bier JD, Scholten-Peeters WGM, Staal JB, et al. Phys Ther. 2018;98:162–171. Physical Therapy, 2018.
Episode #35
Chiropractic and Disc Herniations
Today we’re going to kick around information on disc herniations, disc bulging, and radiculopathy as a result. Is there anything we can do about it? Well, I’m a chiropractic advocate and research backs us on it so I’ll say, “Hell yes.” Come along with us won’t you.
First, I feel some sweet sweet bumper music moving in….
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
Now that I have you here, I want to ask you to go to chiropracticforward.comand sign up for our newsletter. It makes it easier to let you know when the newest episode goes live and it makes me feel good. Don’t you like to make people feel good? Of course you do so….do it do it.
Also, our group on Facebook. It’s called the Chiropractic Forward Group and I think that’s as appropriate of a name as I could come up with. Lol. Just in case you didn’t know, there’s the page on Facebook. That’s for getting the word out and telling people about the podcast. Then there’s the private group. That’s for interacting with each other, learning from each other, posting new papers when they come out, and maybe organizing into a powerful group someday, somewhere down the line. That sort of deal must grow organically. It can’t be forced so we won’t try to do that.
We’ll just let you all know about it’s existence and hope to start seeing you over there. Let’s start a conversation outside of the podcast!
We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.
You have back-flipped head on into Episode #35
Before we talk about all of the disc herniations stuff, I want to tell you all about my weekend. I spent Saturday and part of Sunday morning with my butt firmly planted in a chair in a hotel conference room listening to Dr. Brandon Steele talk about shoulder issues. He was the teacher as his company ChiroUp was a sponsor of the event but he was there teaching as part of the DACO program which is run by the University of Bridgeport.
What the heck is DACO right? Well what used to be called DABCO is now called a DACO which stands for Diplomate of American Chiropractic Orthopedists. I have mentioned before where I sat through the first 10 DACO hours back in June. That was over the low back. These ten were over the shoulder. Topics covered included Scapular dyskinesis. I knew nothing of this mess and, I already identified and started working with one of these patients the day after I got home. We also covered shoulder impingement, rotator cuff issues, thoracic outlet syndrome, and adhesive capsulitis to name a few.
Good stuff all around and, even if I don’t go all the way through the DACO program, I get better and better every time I take a class. And not just better. I get exponentially better.
In talking with Dr. Steele this weekend, he agreed to come on to the podcast as a guest. We’ll get that all lined up. I have a ton of questions for him. Some questions about the DACO program, some about ChiroUp (it’s really a game-changer and you better use my name if you sign on!!!), and I want to ask him about practice standardization and some things along those lines. It should be a fun conversation so make sure you keep you eyes out for it in the near future.
I encourage you…..a lot of what we talk about here is integrating with the medical community and really stepping up. Part of that is taking the steps to get educated at higher and higher levels. The DACO is in line with that. I have zero association with the people running it. I get nothing in return for referrals. I just believe in what they’re doing. I encourage you all to look into this DACO program. If you don’t know where to start, just email me at dr.williams@chiropracticforward.com and I’ll get you pointed in the right direction.
Now, on to disc issues.
Have you ever been told we can’t do anything for discs? Have you been told to not adjust if they have a low back disc issue? Do you know how to recognize a disc issue? What’s the best way to treat it? So many questions!!
Here’s the deal for me today. I’m no guru. I’m going to throw research on you but in the end, a lot of it is just experience. So, don’t take my word as the gold standard. I didn’t expect you to anyway but, I wanted to be sure. Lol.
Let’s look first at recognizing discs. There are some simple questions that can get you moving in the right direction on this:
- Does you have static position irritation meaning, do you have to move around in your chair often to get comfortable?
- Do you have pain going from seated to standing?
- Is there a positive Milgram’s
- How about a positive Modified Slump test?
- Valsalva’s is part of that but some do it separately.
- Same with SLR. I was taught that pain on SLR in the first 30 degrees, when the nerve is first tensioned, was indicative of a disc issue but the DACO folks say it’s between 30 and 70 degrees.
- Worst position is seated
- Best is lying down
- Deep buttock pain
- Pain in the first 1/3 of trunk flexion or trunk extension that cannot be alleviated by bracing or tightening a belt around the waist.
- Radiating pain into the leg
- As a general rule of thumb, the further pain radiates beyond the knee, the more likely it being is caused by a disc.
- Sometime you’ll encounter diminished reflexes or differences in sensory or motor information from side to side.
When should we get an MRI for disc issues? Red flags like history of cancer, fever, chills, recent unexplained weight loss, immunosuppression, and corticosteroid use give you a reason. Symptoms lasting longer than 6 weeks or symptoms showing progressive neurological deficit also give you a reason to get that MRI.
What can we do about it?
Again, that’s going to depend on who you ask. Are we going by The Lancet? Are we going by some chiropractic gurus? Are we going by the medical fields recommendation or by physical therapists techniques? I say yes, yes, and yes.
I had a neurosurgeon buddy of mine tell me, whatever the hell works without doing surgery…..do that. I agree. That’s why we are friends coincidentally.
So, knowing all of that, I’m going to tell you what has been effective for me in my practice. The first thing is something that the insurance companies call experimental and investigational. I think they’re full of it. They don’t seem to be in any hurry to pick up new services to have to pay for do they? But you know what? I’d rather them NOT cover it so we can actually get paid what it is worth.
What I’m talking about here is decompression. This was a game-changer for me in my practice. I have three short stories for you here. They all have to do with guys I tried to send to the surgeon. I’m not going into why we ordered the MRIs or the exam findings. It would take too long for this format so we’re going to jump to the chase in each of their cases.
- The first is a dude was in town visiting for work and was only going to be here for a few months before returning home. The MRI showed us that his herniation was 14 mm caudal migration. I sent him straight to the surgeon. The surgeon set him up for surgery in 6 weeks. The guy was on board with having surgery but couldn’t wait 6 weeks for some kind of relief. Any kind of relief. He begged me to do decompression. I figured that we could go light. In the end, it’s traction and he had no contraindications to decompression so we did it. This guy was back to working and dancing around in the office in about a week and a half y’all. If you want to say it’s placebo, that’s OK, we’re just going to disagree. If you want to say people just like to be touched and I could have pulled on his big toe and it may have had the same effect, I’m going to tell you to jump in a lake.
- The second was a guy that was a truck driver. He was in his 70’s and had had heart surgeries and was on blood thinners. He was a physical wreck honestly. When he came in, he was in a wheel chair and unable to work or function. I got an MRI and his herniation was posterior with 18 mm of caudal migration. That used to be a ticket to the surgeon so off he went. Well, his cardiologist would not take him off of the blood thinners so surgery was out of the question. He came back to me just like the other case we discussed. He had no other options and would I please do decompression on him to try to get him some relief. It had been going for quite some time. OK, sure. I’m a nice guy but I told him, I doubt it’s going to help something like you have going on. Yeah, yeah, yeah, hook me up please. So we did. Guess what? He came in just a time or two later on a walker instead of a wheelchair. Then, a week or so later, he came in without a walker. Then a month or two down the road, he got a new job and was out there telling everyone that would listen about what we were able to do for him. You can take a long walk off a short pier if you’re going to suggest that was anything other than significant effectiveness due to direct intervention.
- Last and worst disc I’ve ever seen. He is actually a good friend of mine. He came in with numbness and weakness all the way into his foot. Limping, the whole deal. He worked in a warehouse and would have to be forklifted to the second floor where his office is because he couldn’t get there any other way. He thinks it was due to a motorcycle wreck several years ago. Whatever the cause, it was pretty crazy. His MRI showed 23mm of caudal migration. Almost all the way down to the next disc below. I had never seen that before and haven’t seen it since. I of course told him he needed to go to the surgeon muy pronto. He agreed but his wife, bless her heart, did not. And thank goodness. She was adamant about him not going to the surgeon. She strongly urged him to not go until he at least gave decompression a try. I told him about the first two cases we just talked about but that he was really in a different ballpark than those guys and I really didn’t know how I could help at all. They understood but decided to give it a go anyway. And thank God they did. Sometimes our patients teach us instead of us teaching them don’t they? It took a couple of months but he started to turn around and never had that surgery. I just checked with him the other day, 2 years later, and he’s doing great. He said he has a little numbness in the outside of his foot but nothing bad and nothing he can’t handle. All’s well and guess who the hero is? Well….his wife. She’s the hero. Lol. I’m still the buddy and buddies can’t be heroes.
These are the worst of the worst but what about all of the others that were more minor? Think of all of the successes we have had with discs over the years. When I say it’s a game-changer, I damn well mean it and, once again, I care not what insurance companies have to say about it.
Let’s look at some papers on it.
This one is called “Simple pelvic traction gives inconsistent relief to herniated lumbar disc sufferers” by Edward Eyerman, MD. It was published in the Journal of Neuroimaging in June of 1998[1].
Why They Did It
The aim was to do before and after MRIs to correlate improvement in the clinic with MRI evidence in terms of disc repair in the annulus, nucleus, facet joint, or in the foramen as a result of decompression treatment.
Eyerman was testing the effectiveness of decompression in a sample of 12 men and 8 women aged 26-74. No, not a big sample.
His MRI finding were as follows:
Disc Herniation: 10 of 14 improved significantly, some globally, some at least local at the site of the nerve root compression.
Measured improvement in local or general disc herniation size varied in range of 0% in 2 patients, 20% in 4 patients, 30% to 50% in 4 patients and a remarkable 90 % in 2 patients that did all 40 sessions.
As far as clinical outcomes of the subjects go, he noted that all but 3 patients had very significant pain relief, complete relief of weakness when present, and of immobility and of all numbness except for in 1 patient with herniation and 2 with foraminal stenosis without herniation.
Summed up, he said “Serial MRI imaging of 20 patients treated with the decompression table shows in our study up to 90% reduction of subligamentous nucleus herniation in 10 of 14. Some rehydration occurs detected by T2 and proton density signal increase. Torn annulus repair is seen in all. Transligamentous ruptures show lesser repair. Facet arthrosis can be shown to improve chiefly by pain relief.
Then we have this one by Thomas Gionis, MD published in the Orthopedic Technology Review in December of 2003[2].
They concluded, "Results showed that 86% of the 219 patients who completed the therapy reported immediate resolution of symptoms, while 84% remained pain-free 90 days post- treatment. Physical examination findings showed improvement in 92% of the 219 patients, and remained intact in 89% of these patients 90 days after treatment."
When is surgery necessary? Well, that’s going to depend on who you ask but a good general rule I follow is that cauda equina syndrome is a quick trip to a surgeon. I personally don’t like foot drop and am likely to send to a surgical consult. I think any progressive worsening of neuro symptoms is cause to pause and reconsider whatever you’re doing. If what you’re doing ain’t fixing it, change directions.
But there is this paper I found interesting. It’s from 2010 and called “Spontaneous Regression fo a Large Lumbar Disc Extrusion[3]” by Ryu Sung-Joo, MD and was published online for the Journal of Korean Neurosurgical Society. I have no idea what the quality of this journal is or what the impact is but it’s interesting and I’ve seen studies before about spontaneous resolution of disc herniations.
The authors say, “Although the spontaneous disappearance or decrease in size of a herniated disc is well known, that of a large extruded disc has rarely been reported. This paper reports a case of a spontaneous regression of a large lumbar disc extrusion. The disc regressed spontaneously with clinical improvement and was documented on a follow up MRI study 6 months later.”
The case report was on a 53 year old femaile after 6 months of low back pain and left lateral leg pain with numbness. Y’all go to the show notes and get the reference to this paper. The MRI images are great.
They mention, “After conservative treatment, her clinical symptoms subsided gradually but the numbness of her left lateral leg still remained. A second MRI study performed approximately 6 months after the prior examination reveal almost complete disappearance of the extruded fragment that had been located posterolateral to the L5 vertebral body, and no evidence of compression or displacement of the dural sac or nerve root.” Wowza.
They go on to explain, “Our patient is an example of the resolution of a large protruded disc without surgery. This phenomenon may be due in part to the fact that larger fragments have a higher water content8) and may regress through dehydration/shrinkage, retraction and inflammation-mediated resorption.” Meaning….her body ate it and it went bye bye.
They finished up the paper by saying, “Even in patients with large lumber disc extrusion, non-surgical conservative care can be considered as an option for the treatment when radiculopathy is acceptable and neurological deficit is absent.“
That’s pretty cool. I don’t think surgeons are going to want to hear it but it’s cool. If all they can do is surgery on cauda equina or foot drop, they’re going to have a hard time financially.
Alright, moving beyond decompression or spontaneous resorption, what else can we do?
Here’s one I got from Dr. Tim Bertlesman. It was authored by G McMorland and called “Manipulatio or microdiskectomy for sciatica? A prospective randomized clinical study[4].” This one was published in the Journal of Manipulative Physiology and Therapeutics in 2010 and goes like this. The authors concluded, “Sixty percent of patients with sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention. Of 40% left unsatisfied, subsequent surgical intervention confers excellent outcome. Patients with symptomatic LDH failing medical management should consider spinal manipulation followed by surgery if warranted.“
Go check it out in the show notes if you want the nuts and bolts and bells and whistles please.
Then there are your directional preferences exercises. If you have not familiarized yourself with directional preferences, please do so yesterday. They are based upon the idea of centralization and peripheralization. McKenzie’s program uses it, the CRISP protocol uses it, Kennedy’s decompression system uses it, and the DACO program teaches it. Do you see a pattern of some sort emerging here?
Other things that are helpful are exercise recommendations like McKenzie or Williams exercises depending on the directional preference, core building.
These patients also need strong at-home suggestions like:
- Get an inversion table for the house.
- Get back to work as soon as possible
- Don’t lay up in bed hoping it goes away
- Sleep correctly
- Work advice like get up and walk every 45 minutes or so
- Don’t use catastrophic language and make sure they know it’s not a disease and most disc cases resolve
I don’t have all of the answers but, I’m guessing none of you do either. In the end, it’s experience isn’t it? For example, without experience, I wouldn’t have known that it COULD be possible to help three guys with caudal migration of a disc from 14mm all the way up to 23mm. Nothing but experience can show someone that.
While we don’t know it all, we DO find means that are effective and help us get the job done and make a difference in our patients’ lives. That’s for sure.
This week, I want you to go forward with the knowledge that, in case you didn’t already know it, you’re powerful. You can take a situation that used to be sent straight to surgery and you can treat that complaint with safe, conservative, non-invasive, and non-pharmacologic means. That’s a hell of a deal right there, folks.
We’re not done talking about discs, decompression, and all of that fun stuff. There’s too much left in the tank to be done but, in the interest of time, we’ll get to it on another episode.
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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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.
The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.
Send us an email at dr dot williams at chiropracticforward.comand let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Being the #1 Chiropractic podcast in the world would be pretty darn cool.
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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Eyerman E, e.a., MRI Evidence of Nonsurgical, Mechanical Reduction, Rehydration and Repair of the herniated Lumbar Disc.J Neuro Imaging, 1998. 8(2).
- Gionis T, Surgical Alternatives: Spinal Decompression.Orthopedic Technology Review, 2003. 6(5).
- Ryu Sung-Joo, Spontaneous Regression of a Large Lumbar Disc Extrusion.J Korean Neurosurg Soc., 2010. 48(3): p. 285-287.
- McMorland G, Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study.J Manipulative Physiol Ther, 2010. 33(8): p. 576-584.
Episode #34: Chiropractic Information To Help You Form Your Practice
Today we’re going to talk about a couple of interesting articles that have come out recently touching on some chiropractic information and it’s all good in the neighborhood for chiropractors.
But first, here’s that bumper music
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. That’s this one…you’re listening to it right now so you don’t have to do anything else at this point. Just listen and chill out.
Since you’re here, I might as well ask you to go to chiropracticforward.com and sign up for our newsletter. It makes it easier to let you know when the newest episode goes live, when someone new signs up it makes my heart leap a little and in the end, wouldn’t you just like to know when new episodes come out and, what it we end up compiling a team and coming up with some great ideas? Heck yeah, you want to know about that stuff so make sure you’re on the newsletter. It’s just an email guys. Not diamonds or gold. Lol.
I want to share with you all the fact that our downloads on this podcast have almost DOUBLED from last month. We’ve picked up that much steam in just one month. Thank you to you all for tuning in. If you can continue share us with your network and give us some pretty sweet reviews on iTunes, I’ll be forever grateful.
If all you do is listen, that’s awesome and I’m glad you’re a part of this thing. But, if you can take the extra few seconds to share episode with buddies on Facebook or wherever, THAT’S the real difference.
We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.
You have bee bopped right into Episode #34
Before we get into it too far, I’m going to be honest with you all. 2018 has been a challenging year for me both business wise as well as personally. For several reasons really.
When your attention is taken away from where it needs to be, things tend to fall apart little by little and then finally, you go into a mode where you are all hands on deck and really focused on righting the ship.
Well, that happened to me at the end of 2017 and through a lot of 2018 as well. I’m only sharing this with you because I want listeners to understand that we’re in this dude together. Issues I deal with and are ultimately able to solve…..if I share those experiences with our listeners, I believe it serves to help you in your practice.
Here’s the deal, an evidence-based chiropractor, whether I like it or not, is somewhat dependent on a steady stream of new patients. That is due to the fact that we don’t try to see our patients a hundred times, right? We don’t develop the reputation of seeing how many times we can run our patients through the door. Do we?
Oh looky here….your insurance allows you to have 27 visits in a year and….what ya know….your specific condition requires exactly 27 visits to resolve. Ugh. That stuff makes me crazy and, unfortunately, chiropractors are notorious for it.
Just so chiros don’t think I’m bashing too hard here, medical doctors do useless surgeries just because they can do it and get paid for it with little to zero concern about the person it was done to. It’s rampant in all fields. I just notice the chiropractic side of it more than the others because I’m in it. No chiropractor holds on to 100% of their patients. It just doesn’t happen.
But, if those NUMBERS DOCTORS - the ones hitting certain stats and the ones that are doctor-centered rather than patient-centered….those guys and gals…..I wonder if they have any idea how many patients they drive away by having that kind of model. And I don’t mean drive away from just their practice. I’m also talking about the number of people they drive away from ANY chiropractor because they assume we’re all the same. It all gives me a rash when I think about it.
Anyway, new patients: we depend on a steady stream of them. Now, last year, I would average 55-65 new patients a month but, while we started having issues with billing/collections department, I really got down, I got stressed, and honestly, for a bit, doubted the future of my practice remaining in its current state. That leads to self-doubt too. Where you had a ton of confidence, there remains only a shred after having your foundation shaken, right?
As much as you’d like to avoid it, business gets brought home. Especially when it’s an all-consuming feeling of self-doubt and potential impending doom. Lol. Maybe I’m being a little dramatic looking back on it but, when you’re in it, it’s intense.
As a result of my focus being altered, my new patient count went to 38 here, 42 there. We’re talking 20+ less new patients per month there for a little while. Without changing anything to my knowledge.
I spoke with a colleague here in town and his numbers have been down as well so maybe it’s not just me. Who knows?
Here’s what I DO know though. As soon as things lined out in the billing/collections department, guess what, the new patient stream started to line out.
How’s that exactly? I don’t know. I’m guessing an increase in confidence in regards to finances leads to an increase in self-confidence and, when all of my focus isn’t on billiing/collections, I have the freedom to work on and consider other aspects of the business. And let’s face it, I’m just a much more pleasant person to be around when I’m not worried about the financial health of my company. I’m going to guess you all are the same way.
Seriously, once we made a change in the billing/collections department (as badly as I did not want to do it), my billing and collections turned around immediately. I mean immediately. Front desk staff became more confident. I became more confident. Patients started paying what they were supposed to pay. Outdated balances got current.
Long story short, what started out as a slow 2018 has become a little bit crazy for me and, if it continues, I’m going to have to hire an associate so I can come up for air. Just getting the podcast written up and produced has started to become a real chore in the last several weeks but I’m committed folks. I’m here for the long haul.
I hope you are too.
Let’s start our research talk with one from Chiropractic & Manual Therapies dated 17th of July, 2018 called “Chiropractic in global health and wellbeing: a white paper describing the public health agenda of the World Federation of Chiropractic[1]. This was authored by Michele Maiers, et. al.
The article begins by saying, “The World Federation of Chiropractic supports the involvement of chiropractors in public health initiatives, particularly as it relates to musculoskeletal health.” I noticed there is no neuro before the musculoskeletal description. Curious.
The authors then say there are three topics that require out focus as chiropractors and they are
- Healthy aging
- Opioid misuse
- Women, children, and adolescents’ health
I guess the men in the crowd are either built heartier or we’re just not quite as important. Lol.
The WFC want to help us in participating in these areas and promote chiropractic as partners in the broader healthcare system. That’s certainly something I can get on board with.
Now this article is pretty darn long so we’re just going to hit some of the more interesting spots. I will have it linked in the show notes so you can go hop online and read the whole thing word for word should you feel the desire.
In the background section of the article they say, “In an era where both medical costs and years lived with chronic disease are increasing, calls have been made for closer collaboration between public health officials and healthcare providers. The potential contribution of many providers, including chiropractors and other healthcare professionals, is often overlooked.”
But then they go on to say our profession needs to identify priority areas of focus and have plans for our engagement in public health based on these areas of focus.
I am wondering why they feel that men engaged in manual labor activities having chronic low back pain are not worthy of being a focus group here? We’ve talked so much about how low back pain is such a global epidemic and how so much work is missed as a result blah blah blah.
Maybe I’m just old school. I don’t have any stats to prove my thoughts here but, I would assume the majority of manual labor is on the backs of men. If I’m not right about that, please email me and show me the stats at dr.williams@chiropracticforward.com. If I’m wrong, I need to be educated.
Still, what gives on this? I want to be positive so let’s get back to the paper.
In the area of Healthy Aging, they state the world’s population is getting older and older with the amount of folks over the age of 60 years old expected to double in the first half of this century.
That’s assuming they get control of opioids right? We covered an article some time back that said the US expected lifespan has actually decreased in the last two years rather than increased because of opioids so there is that to keep in mind.
They mention that, “Musculoskeletal conditions are a leading contributor to non-communicable burden of disease, predominantly low-back pain and osteoarthritis.”
And…”Physical activity is key in the prevention, treatment, and management of most chronic conditions affecting older adults, including musculoskeletal complaints. Chiropractors should consider prescribing exercise, with or without manual therapy, for spine care in older adults. Such approaches are supported by an evidence-based framework, which includes clinical practice guidelines.”
Isn’t it nice to see the WFC using evidence-based terminology and approaching things from an evidence-based platform? Everything mentioned in this article has resources that are cited. It feels good and it gives me a warm fuzzy feeling all over.
They also talk about how falling is a major concern among the older crowd and how exercises and physical activity helping to maintain strength and balance can help prevent them.
They mention potential barriers to older folks getting chiropractic care. If you are a regular listener of our podcast, you know about the White House report that actually said CMS creates barriers to patients seeking care under a chiropractor[2]. I just linked that in the show notes if you want to look at it. It’s on page 57 so you can avoid reading the whole thing just to get that snippet.
https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-3-2017.pdf
When all Medicare covers is an adjustment, what are we supposed to do with these patients that are on a fixed income? Some can pay cash for the rest of the care. Some simply can’t. They’re trying to pay the electric bill.
How does that get resolved exactly? I think that’s what happens when we have government run healthcare in my opinion. They have to cut costs and the services they feel are of the least value will go away in terms of coverage.
I think that’s what is going on with Medicare. Research shows it’s effective but we can’t get anything other than an adjustment covered. What other reason would there be?
Onto focus area #2: Opioid misuse.
Boy we’ve covered this one. Like….a lot. Let’s see if they have anything new here for us to chew on.
Here’s a new stat I haven’t seen before, “Opioids account for 70% of the negative health impact associated with drug use disorders globally, and are considered the most harmful drug type .” They also say, “Approximately 69,000 people worldwide die from opioid overdose each year, with a large toll of overdose deaths in the United States and Canada.”
Then they say something I completely agree with, “The opioid misuse crisis creates an impetus for chiropractors and chiropractic organizations to collaborate with other healthcare providers, decision makers, and stakeholders. Patient centered, inter-professional collaboration should be expanded for the treatment of musculoskeletal pain, with chiropractors playing a larger role on multidisciplinary pain management teams.”
Notice they say “Patient-centered.” Not “Doctor-centered.” Not offices and doctors that do things to hit numbers. Not doctors that see a patient 80 visits. Not those guys. Patient-centered, evidence-based chiropractors are in the right spot right now folks.
OK, priority #3: Women’s, Children’s, and Adolescents’ Health.
When covering some of the relevant issues for this group, they cite pregnancy-related back pain and pelvic pain and post-partum spinal disorders which may impede recovery.
The second issue cited is hormonal changes, dietary factors, and physical inactivity are all factors for osteoporosis.
The third is violence against women and girls causing injury. I’m just not sure how, in the year 2018 we still have violence against women and girls or children in general. Human beings can be cretins can’t we? Lack of parenting? Inherent evil in the offenders? Who knows? It’s hard to postulate on something you understand nothing about.
Here’s something in the article I can agreed with 100% they say that women are the major decision maker for their families. If you are marketing men…..in most markets, you are wasting your money.
I can’t tell you how many men come in here and when we ask how they found us or what brings them here today, they say, “My wife. This is where my wife told me to be. I didn’t want to come. I don’t like doctors but my wife is tired of my griping about my back.”
Market the ladies and you market effectively. End of story.
To summarize the article, the WFC says they are developing tools with the goal of empowering chiropractors and WFC member organizations to engage in public health activities in the three identified priority areas. I’m looking forward to seeing what they’re going to come up with. Exciting stuff here.
The next article I want to cover quickly is one written by Dr. Christine Goertz called “What Does Research Reveal About Chiropractic Costs?” and it was published on the ACA Blog on July 10, 2018[3].
Dr. Goertz by saying something ALL evidence-based chiros can yell, “Amen,” at and that is where she says, “Without a doubt, the most common issues raised by those outside the profession relate to the quality and consistency of chiropractic care delivery. The second most commonly asked question invariably pertains to the costs associated with chiropractic care.”
So….AMEN!
Another amen quote would be this one: “(Evidence) consistently shows that patients with low back and neck pain who are treated by chiropractors have either similar or lower costs than those seeking care from other providers. In particular, it appears that patients who visit a chiropractor are less likely to undergo hospitalization, resulting in lower global healthcare costs than those who receive medical care only.”
Hallelujah.
When addressing cost of chiropractic care, Dr. Goertz mentions a paper we have covered here by Hurwitz[4] that concluded that found that healthcare expenditures for patients with low back pain, neck pain, and headaches were all lower in those who received chiropractic care alone when compared to any other combination of healthcare providers.
Well, that’s some sexy information isn’t it? Of course it is. You realize you can use articles like this and information you get from podcasts like this to help you educate your population and your area’s Medical professionals right? Are you listening or are you listening and utilizing? That’s a good question to think about. I have cited the Hurwitz paper in the show notes for your own independent review.
She then covers a paper by Martin et. al. that we will be covering soon. Over 12,000 patients with 4,300 or so using alternative healthcare. 75% of the alternative users (3,225) were treated with chiropractic. This is big for chiropractic since those treating with alternative means had $424 less in spinal care and $796 less in total healthcare costs. Average healthcare spending for alternative care users were on average $526 lower.
Huge, absolutely huge folks. If that doesn’t put a grin on your face, you’re dead. You need a defibrillator muy pronto, amigo.
This week, I want you to go forward with this: Don’t you understand that if we chiropractors were wrong, we’d have been wiped out by now? We are right. We have been right and we will continue to be right. What we do is so powerful that our profession has persisted and, in fact, prospered in spite of the non-evidence-based people out there on the fringe giving the rest of bad names. The hucksters and profiteers have not even been able to destroy it. They’ve held us back, no doubt. But they haven’t been able to extinguish us and that’s pretty powerful. We are right. Keep on keeping on with confidence.
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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.
The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Being the the #1 Chiropractic podcast in the world would be pretty darn cool.
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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Bibliography
-
Maiers M, Chiropractic in Global Health and wellbeing: a white paper describing the public health agenda of the World Federation of Chiropractic. Chiropr Man Therap, 2018. 26(26).
-
The President's Commission on Combating Drug Addiction and The Opioid Crisis. 2017.
-
Goertz C, What Does Research Reveal About Chiropractic Costs?, in ACA Blog. 2018: ACA Blog.
-
Hurwitz EL, e.a., Variations in Patterns of Utilization and Charges for the Care of Neck Pain in North Carolina, 2000 to 2009: A Statewide Claims’ Data Analysis. J Manipulative Physiol Ther, 2016. May 39(4): p. 240-51.
Relevant Links
- https://chiromt.biomedcentral.com/articles/10.1186/s12998-018-0194-y
- https://www.acatoday.org/News-Publications/ACA-Blogs/ArtMID/6925/ArticleID/371/What-Does-Research-Reveal-About-Chiropractic-Costs
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3494804/pdf/nihms401120.pdf
- https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-3-2017.pdf
Episode #33
Did You Need Proof That Chiropractors Help Headaches
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Today we’re going to talk about a couple of pretty cool papers that came out fairly recently, one of them only a couple of weeks ago from this recording, that had to do with spinal manipulation and the effectiveness in treating headaches and migraines. Psssst…..here’s a hint…..it’s good for chiropractors. Except for the very ending.
But first, here’s that bumper music
OK, we are back. You have shimmied into Episode #33
Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. I have to say that in the last month specifically, this podcast really started to take off in terms of downloads and listens.
You know, when you first start something, there’s an excellent chance that nobody really gives a hoot. Lol. Isn’t that always the fear when starting something new? Does anyone care? Am I going to be able to offer any value? I have diagnosed myself with an anxiety issue. I over think and over think things. In the end, it’s simply because, no matter what it is I’m doing, I just want to do a good job.
I tell my son that, even if I don’t necessarily like somebody on a personal level, if they are a hard worker, I will respect them. Everyone can respect a hard worker. Well, that’s what I try to be. I try to work hard and I try to bring things of value to me to you through writings, videos, social media, and podcast.
I’ll be honest with you. I have zero clue where all of this will eventually lead me. Lol. No clue at all. There’s no grand plan behind it.
All I know is I see it’s value and more and more of you are finding it’s value every week and it’s exciting. Maybe I’ll eventually put a course together for marketing your practice from an evidence-based perspective. Maybe I’ll have in-office patient education products. I’d love to be a speaker and travel the world bringing this information to evidence-hungry crowds. I have no idea where it can go but for now: I’m having fun.
Maybe it’s the old traveling musician in me. Maybe I just have to have people tuned in or I’m just lost. Lol. I have no idea but I know it’s fun and I’m glad you’ve come along with us so far. I’ll keep working hard if you’ll keep listening and we’ll just see where things go down the road together. I’m always keeping my eyes out for colleagues that see what I see. If that’s you, send me and email and let’s connect. Also, we’d like to ask you to join not only our Chiropractic Forward Facebook page but we also have a Chiropractic Forward Facebook GROUP where we have started sharing the papers we use, accepting comments, and will probably be including some of them in future episodes. We want our podcast to be a group effort if you’d like to participate. Come join us. The link is in the show notes.
https://www.facebook.com/groups/1938461399501889/
On a completely different note, I had mentioned back in mid June or so that I was at the ChiroTexpo event in Dallas that was put on by the Texas Chiropractic Association and I met Dr. Tim Bertelsman down there. He was there for two reasons. One reason was as a vendor for his and Dr. Brandon Steele’s ChiroUp product and the other reason was to teach the Low Back portion of the Diplomate of American Chiropractic Orthopedists (DACO) program put on through the University of Bridgeport.
As this episode is recorded, I am about a week and a half from going through my second ten-hour course. This one will be taught by Dr. Brandon Steele down in Dallas again and I’m looking forward to it.
This is a really valuable program these guys are teaching and I encourage you all to check it out but, what I really wanted to tell you about is this ChiroUp thing they have going on. It’s crazy. Crazy in a good way.
I saw in one of the private groups on Facebook where a poster was asking for some good pointers on report of findings.
Immediately, about 7 of the 10 posts had to do with recommending ChiroUp and, one of those posts was mine. I said it’s a game changer because, well….it is. I started using it about a month ago and it has literally changed the game for my busy office without adding a lot of demand to my staff. We’re talking patient education, activities of daily living, patient follow up, patient exercise-rehab recommendations, and even expediting online reviews. I have tried several products and services through my 20 years and most of them are just hype and take your money.
In my experience, so far….ChiroUp has been beyond what I expected. I’m jaded as hell. But, when Dr. Bertelsman started showing it to me, my jaw dropped a bit. I think I started slobbering. I’m not sure. Anyway, he showed it to me for about a minute and a half and that was it. Shut up and just take my money.
I want you to know, I don’t have any “deal” set up with those guys. Not yet anyways!! Lol. If it’s up to me I will because they’re amazing but, as of now, they don’t sponsor this show, no affiliate marketing deal….nothing like that. I’m just like your buddy down the road telling you hey man, I’m doing this thing and it’s been pretty freaking great. You should look at it. That’s all.
If you want to look into ChiroUp, go to www.chiroup.comand give it a look-see. And, if you like what you see and join up, you may mention our podcast and me, Dr. Jeff Williams. It never hurts for people to know who was out there pumping their tires, ya know. Sometimes what goes around comes around and I believe in always trying to project the good mojo.
We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.
It’s all about headaches from this point forward today. I want to first direct you to a podcast we did that cited a bunch of headache papers that I hope you’ll go and listen to right after you listen to this one. It was Episode #14 but 14 is right smack dab in the middle of a series of podcasts I did on Debunking the myth that Chiropractors cause strokes. Specifically, the series starts on episode #13, #14 is the one with the headache research, and #15 is the conclusion of the stroke series we did. I CANNOT stress enough how valuable I feel those three episodes are.
We will have them linked in the show notes.
https://www.chiropracticforward.com/debunked-the-odd-myth-that-chiropractors-cause-strokes/
https://www.chiropracticforward.com/cf-episode-14-debunked-the-odd-myth-that-chiropractors-cause-strokes-part-2-of-3/
https://www.chiropracticforward.com/cf-015-debunked-the-odd-myth-that-chiropractors-cause-strokes-part-3-of-3/
We will get going with this paper from February of 2018 called, “Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial.” It was done by Haas et. al[1]. and was published in the prestigious Spine Journal on February 23, 2018. Why They Did It Although the researchers know that spinal manipulation is effective for cervicogenic headaches (which is nice to see) there has been little information on the dosage of spinal manipulation for them. They wanted to evaluate the efficacy of chiropractic by comparing it to a light massage control group. How They Did It * This is a two-site, open-label randomized controlled trial.
- Participants were 256 adults with chronic cervicogenic headache.
- The primary outcome was the amount of days with cervicogenic headache in the previous 4 weeks evaluated at the 12- and 24-week primary end points
- Secondary outcomes included cervicogenic headache days at remaining end points, pain intensity, disability, perceived improvement, medication use, and patient satisfaction.
- Participants were randomized to four dose levels of chiropractic SMT: 0, 6, 12, or 18 sessions
- They were treated three times per week for 6 weeks and received a focused light-massage control at sessions when SMT was not assigned
- Linear dose effects and comparisons with the no-manipulation control group were evaluated at 6, 12, 24, 39, and 52 weeks.
Wrap It Up
In the authors’ conclusions they say, “There was a linear dose-response relationship between spinal manipulative therapy visits and days with cervicogenic headache. For the highest and most effective dose of 18 spinal manipulative therapy visits, cervicogenic headache days were reduced by half and about 3 more days per month than for the light-massage control.”
Here’s one I thought was pretty darn cool and it’s buried all the way down in the middle of a website for the Wiley Online Library. This site has all of the research covered at the 60thAnnual Scientific Meeting American Headache Society June 28-July 1, 2018 at the San Francisco Marriott Marquis in San Francisco, CA.
This particular paper covered was by C. Bernstein and called “Rationale and Design of a Randomized Controlled Trial of Chiropractic Therapy for Migraine Pain Alleviation[2]” Why They Did It
While medications are often a first‐line treatment for migraine, many migraineurs do not experience clinically meaningful responses to preventive drug treatments or discontinue medication use due to side effects. Chiropractic care is a non‐pharmacologic intervention commonly used for the treatment of pain conditions, including migraine. You got that right!
They go on to say, “Observational studies and small trials have shown that spinal manipulation may be an effective therapeutic technique to reduce migraine pain and disability. We present results of a meta‐analysis of spinal manipulation on migraine pain and disability and describe the design of a randomized controlled trial (RCT) evaluating comprehensive chiropractic care for the treatment and prevention of migraines.”
Oh yeah!! Sounding good. This talk appears to be on a new study they will be going through based on some preliminary work here.
How They Did It
- They searched PubMed and Cochrane Library databases for clinical trials that evaluated spinal manipulation and migraine related outcomes published through April 2017
- The effect sizes and heterogeneity for pain and disability were estimated using meta‐analytic methods.
- The Cochrane Risk of Bias Tool was used to evaluate the methodological quality of retrieved studies
- The results of this meta‐analysis informed the design of a randomized controlled trial evaluating the addition of chiropractic care to usual medical care for women diagnosed with low frequency episodic migraine.
What They Found
- On the basis of 6 identified RCTs, random effects models indicated that spinal manipulation significantly reduced pain with an overall moderate effect size
- Spinal manipulation also significantly decreased disability with an overall moderate effect size
- However, the existing studies focused primarily on isolated spinal manipulation and not on comprehensive chiropractic care. To address this gap in the literature, our RCT will assess the safety, feasibility, and effectiveness of multi‐modal chiropractic care for women aged 20‐55 who experience 4‐10 migraines per month and are not using preventive medications
- Our modular chiropractic care approach may include, as needed, posture correction/spinal stabilization exercises, soft‐tissue relaxation techniques, spinal manipulation/mobilization, breathing and relaxation techniques, stretches, self‐care, ergonomic advice, and/or bracing and supports
Conclusion
The authors said the following, “Our meta‐analysis indicated that spinal manipulation shows promise as a therapeutic technique to reduce migraine pain and disability, yet highlighted the need for rigorous studies evaluating the full scope of chiropractic care for migraineurs. The results of our meta‐analysis provide the rationale for the design of our RCT.”
I can’t wait to see the result of the RCT. Wanna know why? Because I already know the results. At this point, it’s anecdotal but the results will show that chiropractic care is significantly effective for headaches and migraines. I’m looking forward to hearing all about it.
If I don’t find it first, I know my colleague, Dr. Craig Benton down in Lampasas, TX. He’ll probably find it before me though. Lol. He’s on it every single day. I get a lot of information from a lot of different places but that guy just gets it first.
Lastly, I want to direct you to Episode #6 of our podcast. This one was with Dr. Tyce Hergert down in Southlake, TX called “Astounding Expert Information On Immediate Headache Relief. “
https://www.chiropracticforward.com/dr-tyce-hergert-astounding-expert-information-immediate-headache-relief/
We covered a paper. A paper that I thought had an outstanding quote in the conclusion.
The quote from the authors themselves reads as follows, “Upper cervical translatoric spinal mobilization intervention increased upper, and exhibited a tendency to improve general, cervical range of motion and induce immediate headache relief in subjects with cervicogenic headache[3].”
Now, in that episode we explain that it was authored by Physical Therapists and that they have come up with their own term for a chiropractic adjustment and their term is “translatoric spinal mobilization.”
The point being that chiropractic adjustments can provide immediate relief for cervicogenic headaches. That’s sexy folks. Straight up awesome.
The sub-points or something extra I’d like you to notice is the fact that physical therapists are moving in, adopting our ONE THING. So much so that they having taken it upon themselves to re-name our ONE THING for their own use.
This goes back to what we covered in episodes 28, 29, and 30….. We must integrate into the medical field and quit being out on the fringe. Otherwise, those that are already in the medical realm (physical therapists) will simply take our ONE THING, steal it, and we will still be sitting out there in the rain knocking on the window and watching them all eating steaks inside the private club. Lol.
That’s a little dramatic. There are those in our field that want to stay separate and distinct and I understand that. I understand your stance and your viewpoint. I just don’t agree with it. That’s all.
For me, integration into the medical realm ensures our profession’s survival and the health or our ONE THING. We make sure it sticks around. I’m afraid that if we stay out on the fringe, we LOSE our ONE THING to other professions, our reimbursements continue to fall, our income falls year after year because they getting “translatoric spinal manipulation” rather than chiropractic adjustments, and eventually, we cease to exist.
Just some random thoughts but, I truly think it’s time. Move toward the middle or suffer the consequences. I honestly see very few other options.
The research proves time and time again that we can EASILY move toward the middle. It’s coming out every week. More and more validation.
But, then there’s this. The ACA sent out an email recently discussing the fact that, in a continuing effort to be the absolute worst health insurance company in the world, United Healthcare is now discontinuing any coverage of chiropractic for the treatment of headaches[4]. What? What in the hell? Wait, let’s go through the website for UHC real quick so we know exactly what’s going on here. Got your gripey pants on? You’re going to need them.
On their website we’re linking here in the show notes:
https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/manipulative-therapy.pdf
UHC says the following:
Manipulative therapy is unproven and/or not medically necessary for treating: ·Non-musculoskeletal disorders, including but not limited to:
o Lungs (e.g., asthma)
o Internal organs (e.g., intestinal)
o Neurological (e.g., headaches)
o Ear, nose, and throat (e.g., otitis media)
- Temporomandibular joint (TMJ) disorder
- Scoliosis
Manipulative therapy is unproven and/or not medically necessary for preventive or maintenance care. The role of manipulative therapy in preventive or maintenance care has not been established in scientific literature. A beneficial impact on health outcomes has not been established.
They go on to say Craniosacral therapy (cranial manipulation/Upledger technique) or manipulative services that utilize nonstandard techniques including but not limited to applied kinesiology, National Upper Cervical Chiropractic Association (NUCCA), and neural organizational technique are unproven and/or not medically necessary for any indication.
Manipulative therapy is unproven and/or not medically necessary when ANY of the following apply:
- The member’s condition has returned to the pre-symptom state.
- Little or no improvement is demonstrated within 30 days of the initial visit despite modification of the treatment plan.
- Concurrent manipulative therapy, for the same or similar condition, provided by another health professional whether or not the healthcare professional is in the same professional discipline.
I went that far into the paper just for the “huh, really?” effect but the main point here is, how can they say that spinal manipulation/mobilization is not clinically proven for headaches? In addition to the papers I pointed to here in this podcast, there are more in the links and episodes I provided. As in around 10 or so others showing and proving effectiveness. Just in episode 14 alone.
What exactly do they need and why the change?
Is this part of the Texas Medical Association’s attack on Texas Chiropractors where they are attempting to remove the neuro- from the neuromusculoskeletal treatment scope from chiropractors? It sounds like it to me when you look at it. I get the internal organs part. I get the asthma part. I do NOT understand how they classify headaches as strictly neuro in nature and have made a line where they do not cover any neuro treatment for chiropractors.
It’s unreal. It really is. Here on this site, they cite Chaibi et. al. (2017) and Seffinger and Tang (2017). In these papers they site, both conclude that spinal manipulation was effective. The second paper showed spinal mobilization to be more effective than physical therapy but….guess what. They need more studies. Probably studies like I’ve been telling you all about for 7 months now.
This kind of stuff makes me want to punch myself in the nose and go home and kid my daughter’s cat. Straight up punt that sucker. That’s nothing new though but seriously. To borrow a phrase from one of my very favorite football coaches, “This kind of garbage just makes my pee hot.” It really does folks.
Chiropractic is absolutely effective for headaches. Every day all day and the research sure as hell shows it too.
Just keep on keepin on and stay strong, ladies and gents. What other option do you have without going back to school? It’s still the best time to be a chiropractor. It’s still the time in which there is more opportunity than ever before. This stupid insurance company cites only two papers and both of them showed effectiveness for headaches. It’s only a matter of time before all of the idiots start to catch up with the research and with what chiropractors have known for generations.
This week, I want you to go forward speaking with confidence and knowing that you are effective for headaches and migraines. You can change people’s lives. If you are not being effective for your patients’ headaches, seek some advice from a mentor. Sometimes it’s just a little tweak here and there and you’ll be on the road to being your patients’ hero. When done well, research backs us on this all over the place. For more proof, go check out show notes on Episode #14 or our Stroke blog at https://www.chiropracticforward.com/blog-post/debunked-the-odd-myth-that-chiropractors-cause-strokes-revisited/
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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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.
The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.
Send us an email at dr dot williams at chiropracticforward.comand let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Being the #1 Chiropractic podcast in the world would be pretty darn cool.
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.
▶︎Website
http://www.chiropracticforward.com
▶︎Social Media Links
- https://www.facebook.com/chiropracticforward/
- https://twitter.com/Chiro_Forward
- https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
▶︎iTunes
- https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
▶︎Player FM Link
- https://player.fm/series/2291021
▶︎Stitcher:
- https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
▶︎TuneIn
-
https://tunein.com/podcasts/Health--Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
-
Haas M, Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial.Spine, 2018: p. S1529-9430.
- Bernstein C. Rationale and Design of a Randomized Controlled Trial of Chiropractic Therapy for Migraine Pain Alleviation. in 60th Annual Scientific Meeting American Headache Society. 2018. San Francisco Marriott Marquis San Francisco, CA.
- Malo-Urries M, Immediate Effects of Upper Cervical Translatoric Mobilization on Cervical Mobility and Pressure Pain Threshold in Patients With Cervicogenic Headache: A Randomized Controlled Trial.J Manipulative Physiol Ther, 2017. 40(9): p. 649-658.
- Policy, U.H.C.M. Manipulative Therapy. 2018 1 June 2018]; Available from: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-medical-drug/manipulative-therapy.pdf.
Episode #29
Is Chiropractic Integration Healthy For The Profession?
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Today we have a very special guest and we’re going to be talking about the integration of chiropractic care into a medical based case management or medical team. This one may irritate the holy heck out of the straight chiropractors that preach being separate and distinct but I think evidence-based practitioners will find some good stuff here.
But first, here’s that bumper music
OK, we are back. Welcome back to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
Before we get started, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It makes it easier to let you know when the newest episode goes live and it’s just nice of you.
Also, I’m alway offering myself up for speaking opportunities or to be a guest on YOUR podcast. Just send me an email at dr.williams@chiropracticforward.com and we will connect. I always appreciate hearing from my brothers and sisters out there in the profession.
We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. That’s a tall order but that is the goal and I’ve never shy-ed away from big goals. You shouldn’t either!
You have tip toed ninja style into Episode #29
But first, my week …..I have to say that we started off slow at the start of this Summer season but, now that everyone is settling into the heat, it’s starting to get busy busy and that’s nothing but good good. What are the most effective means you’ve found to get your message out to your communities? Email me and I may just share you suggestions in future episodes.
This week, I want to welcome a friend of mine and a brother in arms in our battle for Chiropractic here in Texas. He has been involved deeply on the state level leadership for years at this point and has held several posts including the biggest one. Yes, he is currently the big cheese, the head honcho, the el jefe of the Texas Chiropractic Association. Until June of 2019, he will sit as the President of the TCA and we’re honored to have him with us on the Chiropractic Forward Podcast today.
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I want to welcome Dr. Devin Pettiet of Tomball, TX. Dr. Pettiet, thanks for being here and letting us pick your brain a little today.
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When I was coming up with this week’s topic, I really couldn’t think of anyone better than you to talk about chiropractic integration with. I know you pretty darn well but our listeners probably do not. Tell us a little bit about your practice.
- What originally got you involved in service to your profession? Was there a single incident or experience that flipped a switch in you?
I don’t want to speak for you but, for myself, I’m certainly on the evidence-based aspect of the chiropractic spectrum here. We would like for our thoughts and opinions to be separate from the TCA’s stance on different matters and we should state from the start that our thoughts and opinions are our own and not representative of the TCA. At the same time though, we are the kind of people that want to go to bat for everyone practicing as long as they are within the scope mandated by the State of Texas.
Now, How do you feel we chiropractors can start making headways into the medical field as spine specialists and….keeping the straights in mind….is it healthy for our profession to seek those avenues for ourselves?
We know it’s not a lack of research validating our profession but, with your years in practice and with your years of service in the TCA, what things come to mind as the biggest obstacles to chiropractic care fully integrating into medical referral programs or treatment protocols?
Over the years, have you seen any changes in the opinions of chiropractors from those in the medical community or in the way you interact with them?
Let’s go over a couple of papers and you just play Troy Aikman to my Joe Buck and provide commentary wherever you see fit.
This one is from February 2018 and is called, “Integration of Doctors of Chiropractic Into Private Sector Health Care Facilities in the United States: A Descriptive Survey.” It was written by S Salsbury, et. al. and I see Dr. Goertz listed as an author as well. She has really been a star for the chiropractic profession(Salsbury S 2018).
Why They Did It
The purpose of this study was to describe the demographic, facility, and practice characteristics of doctors of chiropractic working in private sector health care settings in the United States.
How They Did It
- The authors did an online, cross-sectional survey.
- They were looking for chiropractors already working in integrated health care facilities
- They collected demographic details, facility details, and the characteristics of the practice
- Using descriptive statistics, they analyzed all of the data they collected.
- The response rate was 76% which is odd because my email open rate when I email for TCA stuff is like 10%….
- Most respondents were male with the mean years of experience being 21 years.
What They Found
- Doctors of Chiropractic working in hospitals were 40%
- Multispecialty offices = 21%
- Ambulatory clinics = 16%
- Other health care settings = 21%
- 68% were employees and received a salary
- Most DCs used the same health record as the medical staff and worked in teh same clinical setting.
- Over 60% reported co-management of patients with medical professionals.
- In many clinics, the DCs were exclusive providers of spinal manipulation (43%) but most of the clinics saw the DCs receiving and making referrals to the primary, the PT, or to pain and ortho docs.
Wrap It Up
The authors concluded by saying, “Doctors of chiropractic are working in diverse medical settings within the private sector, in close proximity and collaboration with many provider types, suggesting a diverse role for chiropractors within conventional health care facilities.”
Here’s another by Paskowski et. al.(Paskowski I 2011) Called "A hospital-based standardized spine care pathway: report of multidisciplinary, evidence-based process.”
There were 518 patients and they developed a Spine Care Pathway protocol for their treatment. These patients underwent chiropractic care and physical therapy.
What They Found
Those that went to a Doctor of Chiropractic treated for about 5.2 visits costing an average of $302.
The pain was 6.2 on intake and 1.9 on exit.
95% that saw a chiropractic rated their care as excellent.
Then there’s this one from the Ontario Ministry of Health-commissioned report called The Manga Report which was a comprehensive review of all of the published literature on low back pain(Manga P 1993).
Some of the things this government-commissioned study had to say are just outstanding.
- There was an overwhelming amount of evidence showing the effectiveness of chiropractic in regards to the treatment of low back pain and complaint.
- They found that it is more cost-effective than traditional medical treatment and management
- Found that many of the traditional medical therapies used in low back pain are considered questionable invalidity and, although some are very safe, some can lead to other problems being suffered by the patient.
- They showed that chiropractic is clearly more cost-effective and that there would be highly significant savings if more low back pain management were controlled by chiropractors rather than the medical physicians.
- The study stated that chiropractic services should be fully insured.
- The study stated that services should be fully integrated into the overall healthcare system due to the high cost of low back pain and the cost-effectiveness and physical effectiveness of chiropractic.
- They also stated that a good case could be made for making chiropractors the entry point into the healthcare system for musculoskeletal complaints that presented to hospitals.
They concluded the paper by saying, “Chiropractic should be the treatment of choice for low back pain, even excluding traditional medical care altogether.”
There are a ton of reasons to integrate chiropractic into medical protocols that, if we tried to cover them all, we’d be sitting here for a very long time. The point here is that, when you consider these studies, when you consider the low back series in The Lancet that we covered in episodes 16, 17, and 18, when you read the recommendations from the American College of Physicians for acute and chronic low back pain, and you see the recent article in JAMA from Dr. Goertz on Vets and low back pain that we covered in episode
Dr. Pettiet, where do you see everything going on this??
How do we do our part to integrate our profession and move from the fringe toward the center?
Can we do that while still maintaining our identity as chiropractors?
Is the TCA doing anything that we can talk about publicly to step toward the center?
This week, I want you to go forward understanding that you have been and are doing the best thing there is out there for headaches, neck pain, and back pain. There is no other profession with the juice behind them that we have. Be smart, be responsible, and we may just be able to not just have our foot in the door, but to actually knock it down and burst in like a superhero.
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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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.
When you look at the body of literature, it is clear: research and clinical experience show that, in about 80%-90% of headaches, neck, and back pain, patients get good to excellent results with Chiropractic when compared to usual medical care. It’s safe, less expensive, decreases chances of surgery and disability. Chiropractors do it conservatively and non-surgically with little time requirement or hassle for the patient. And, if the patient has a “preventative” mindset going forward, chiropractors can likely keep it that way while raising the general, overall level of health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.
Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!
If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic podcast in the world.
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.
Social Media Links
- https://www.facebook.com/chiropracticforward/
- https://twitter.com/Chiro_Forward
- https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
- https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Manga P, e. a. (1993). "THE MANGA REPORT: THE EFFECTIVENESS AND COST-EFFECTIVENESS OF CHIROPRACTIC MANAGEMENT OF LOW BACK-PAIN." Funded by the Ontario Ministry of Health.
Paskowski I, e. a. (2011). "A hospital-based standardized spine care pathway: report of multidisciplinary, evidence-based process." J Manipulative Physiol Ther. 34(2): 98-106.
Salsbury S (2018). "Integration of Doctors of Chiropractic Into Private Sector Health Care Facilities in the United States: A Descriptive Survey." J Manipulative Physiol Ther 41(2): 149-155.
CF - Episode #28 -
“Will Chiropractic First Finally Take Its Place?”
As they say in Texas, Howdy y’all. You could also say, Hola Amigo in Texas as well, and as I learned last week, it’s How you doin? in New York. Today we’re going to be talking about whether or not Chiropractic should or could be poised to step up and take it rightful spot in healthcare globally. Buckle up, bucko.
But first, here’s that bumper music
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. So, glad you’re here with me. In case you are a youngster, the term “bucko” came from a young tike himself named Ritchie Cunningham on Happy Days played by Ron Howard. Yep, that Ron Howard, the famous director and was once a tiny tot named Opie on the Andy Griffith show. No, I’m not THAT old but….I know a little TV trivia here and there. And now it appears that you do too.
Ritchie, every now and then, would get all worked up into a fuss and call Fonzie or Potsy or whoever a “bucko.” Man…..you wanna talk about fighting words. Fonzie about ended him a time or two but, in the end, Fonzie was way too cool to beat up on Ritchie. OK, enough of that…
I want to ask you to go to chiropracticforward.com and sign up for our newsletter. We won’t be filling up your inbox and it’s easy to fill you in on all the new stuff. And, in the end, it’s nice of you and it will help keep the wrord circulating if you would like to help us. Likes, shares, and retweets also keep the world turning around and around and that’s really important stuff…..Keeping the world spinning and all….. if we can talk you into it.
Have you noticed we aren’t selling you anything? That doesn’t mean that we won’t if the right opportunity arises down the road but, I want you to know that I’m doing this podcast for the right reasons. I make furniture, I am a musician, I am a sculptor…..and, Just like anything else I do, I make the things that interest me and that come from my heart. If someone ends up buying what I’ve made down the road, then heck yeah!! Good for me. But, in the meantime, I do what I do because I love it and I guess I have enough ego that I think others may love it as well. I hope you guys and gals love it and find the value like I find in it.
As with every episode, we are honored to have you with us. We truly are. Now, here we go with some vital information that we think can build confidence and improve your practice which we think will improve your life overall. That’s a tall order but everyone needs goals.
You have Firecircled your way into Episode #28 ala Dr. Strange. My family is full of action movie junkies so just deal with the reference.
I think a great place to start is by saying that I stumbled upon a heck of a deal this last weekend when I attended the Texas Chiropractic Association’s ChiroTexpo down in Dallas at the Hyatt Regency. I realize the Hyatt Regency holds no meaning to those outside of Dallas but, it’s the hotel with the really cool lit up ball in downtown Dallas. Ah….yes, if you’ve seen the amazing Dallas Cowboys perform inside your TV box, you’ve probably seen the down town rotating restaurant ball on your screen.
Part of the program had to do with the Lumbar Management portion of the Diplomate of American Chiropractic Orthopedists program. I’m still getting the nuts and bolts of this dude figured out but, basically, it consists of five 10-hour live face-face seminars, 50 hours in total there. Then, 250 of online courses through the University of Bridgeport. After that, you sit for the DACO exam and, assuming you pass it, you now have the honor of being called a DACO and you have the knowledge to back it up. This class was one of the 10-hour sessions.
Now, I have to say, I literally thought I would sit in the class for a couple of hours, my eyes would glaze over, and my butt would start to hurt, and I’d get up and wonder around asking where the nearest trouble could be had because I’m onery on the weekends. I mean really, who the heck wants to sit in a classroom from 1-7pm on a Saturday night and 8-1 on a Sunday morning? Not this guy. Not all in one stretch like that.
But I did. I sat through all 10 of them. Yep, even surprised myself. Dr. Tim Bertlesman from Illinois was the instructor of the class and he kept it moving, he kept it extremely relevant, and he even kept it pretty funny. Basically, he kept my interest and you know what? I may…..just may…..do the whole program.
It’s evidence-based for sure. It’s patient-centered without a doubt. And it’s current with the research. If you’ve been paying attention, that’s right in my wheelhouse. If you’d like more information on this program, send me an email at dr.williams@chiropracticforward.com and we’ll connect. As I learn more and more about it all, I’ll be glad to share if you think you’d be interested as well.
He started off the class with some slides referencing a few studies that I haven’t seen just yet and I a lot of what he was saying is what I’ve been telling all of you for 28 episodes now. All of them. Every single episode.
The overwhelming sentiment here is that the door is open thanks to opioids. The chance we have waited for is here. Right now. We may not get it again. People are hungry for what we do and we now have all of the research we need to back ourselves and our profession up, to show complete validation, and thrust us into the mainstream of healthcare for non-complicated musculoskeletal issues. That’s here.
Let’s look at a little bit of it and see if you agree.
This is from April 2016 and was published in JAMA. It was authored by Dr. Deborah Dowell, MD, et. al. and was called “CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016(Dowell D 2016).”
Why They Did It
Realizing that opioids are a problem, that there are a limited number of long-term opioid research papers, and that primary care physicians need better, safer ways of managing chronic pain, the authors hoped to make recommendations for when to prescribe opioids outside of cancer treatment, etc….and when to not prescribe them.
How They Did It
- The Centers for Disease Control and Prevention (CDC) used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) protocol in order to assess the evidence type and make recommendations from there.
- Evidence was made up of observational studies or randomized clinical trials with notable limitations.
- No study evaluated long-term (over 1 year) benefit for opioids in chronic pain.
What They Found
- There are 12 recommendations
- Of the most importance was the recommendation that non-opioids is preferred for treatment of chronic pain. That’s where WE fit in folks.
- Opioids should only be used when benefits for pain and function outweigh risks but risks are use disorder, overdose, and death so….. Pretty much never.
- Before starting any opioid therapy, practitioners need to set goals and settle on how they will be discontinued if benefits do not outweigh risks.
- Blah….blah blah….a bunch of other language that does not pertain to us chiropractors.
Wrap Up
Non-pharmacologic therapy and non-opioid pharmacologic therapy are preferred.
I think that, before the American College of Physicians finally came right out and said to go see someone that performs spinal manipulation to treat acute and chronic low back pain, this was JAMA’s way of saying, “Hey guys and gals, ummm….we’ve created a bit of a mess and we had better start cleaning it up (cough chiropractic cough) and maybe we should look outside of usual medical care like pills (cough chiropractic cough) and drugs that people get hooked and drugs that kill people (cough Chiropractic).
JAMA has come along slowly but they’ve made great progress. Even since this paper originally came out.
For the next article, let’s look at this one called “Attorney General Janet Mills Joins 37 States, Territories in Fight Against Opioid Incentives,” released by the Office of the Attorney General on September 18, 2017(Roth-Wells A 2017).
The Attorney General in Maine, Janet Mills, joined 37 other states in the fight against opioids according to this article. The AG was quoted in the article as saying, “Last year Maine enacted a law limiting opioid prescriptions and that law is beginning to have a positive impact. Now health insurers need to reduce any financial incentives to prescribing these addicting narcotics and offer greater coverage for alternative therapies. As the chief legal officers of our States, we are committed to using all tools at our disposal to combat this epidemic and to protect patients suffering from chronic pain or addiction.”
The attorneys general contend that incentives that promote use of non-opioid therapies will encourage medical providers to consider physical therapy, acupuncture, massage, chiropractic care, and non-opioid medications, instead of narcotic drugs.
The article went on to list all 37 states that were signed on to this initiative but, sadly, my state of Texas was not on the list. That pesky Texas Medical Association really tends to get in the way. I see the other biggest states on the list in regards to the number of chiropractors practicing. Those states are California, New York, and Florida but, no, not Texas.
The next article is called “FDA Education Bluepring for Health Care Providers Involved in the Management or Support of Patients with Pain” and was published in May 2017(FDA 2017).
On page three, section two, the paper dicusses nonpharmacologic therapies. It states, “A number of nonpharmacologic therapies are available that can play an important role in managing pain, particularly msculoskeletal pain and chronic pain.”
It then goes on to mention categories. The categories they mention are Psychological approaches, and, while I think our patients look at us as chiropractors, financial advisors, psychologists, and a whole host of other professionals, this paper is speaking to cognitive behavioral therapy and, if I’m honest, I’m simply unfamiliar with that as a treatment regimen. I certainly have more to learn on that topic. They also mention physical therapy, of course. They mention surgical intervention and then they mention complementary therapy underwhich is mentioned acupuncture and chirlpracty.
I’ve not ever in my life heard the term “chiropracty” but at least we’re in the game, I suppose.
Then the paper closes the section by saying, “Health care providers should be knowledgeable about the range of available therapies, when they may be helpful, and when they should be used as part of a multidisciplinary approach to pain management.”
Isn’t that interesting? How many practitioners do you think came across this paper and this section of this paper? How many do you suppose have decided to take it upon themselves to get extra information and education in this particular topic?
Maybe some but, mostly, I would say that it is up to us chiropractors to do our part to educate our medical communities on this sort of information. It’s the FDA for goodness sake. It’s on a government website. It cannot be hard to point them in the right direction and for the medical practitioners to be able to trust the information if it’s coming from this sort of a platform or footing. But, they have to be shown the way. Most of them aren’t simply going to stumble on to it and say, “Oh hey, looky here. Looks like I’ve been wrong my whole life about chiropractic.”
They need some help and some guidance to find it and then hopefully to receive the information on their own. Regardless of where you start, using sources like the FDA, the Journal of American Medical Association, The Lancet, and the American College of Physicians is always a good idea. They are reputable and they are forms of information that the medical kingdom place a lot of stock and value in. It turns out that they’re on our side on this matter.
Next, let’s talk about The Joint Commission. “What is The Joint Commission?” you may ask yourself. You may ask yourself that question because that’s the question I asked myself when I first saw the paper so I did some homework for you.
A quick visit to their website tells us the following:
“An independent, not-for-profit organization, The Joint Commission accredits and certifies nearly 21,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.
Our Mission: To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.
Vision Statement: All people always experience the safest, highest quality, best-value health care across all settings.”
If you really read and understand what is said in that description, you’ll see the terms “improve health care for the public” and “providing safe and effective care of the highest quality and value” and safest, highest quality, best-value health care across all setting.” The vast majority of paper we have covered in the previous 27 episodes argue that chiropractic fits the bill in a lot of different ways.
This article comes from The Joint Commission Online and was published on November 12, 2014 talking about revisions to pain management standards that were to be updated just a couple of months later, January 1, 2015(The Joint Commission Online 2014). I want to give this group credit. They seem to have started to catch on to the need for nonpharma protocols about a year to a year and a half prior to the rest of the medical profession. Kudos to them.
In the blue box is the Standard PC.01.02.07 which is the code for assessing and managing patients’ pain. The revision states that both nonpharma and pharma play a part in pain management, the non-pharma strategies may include the following: acupuncture therapy, chiropractic therapy, osteopathic manipulative treatment, massage therapy, physical therapy, relaxation therapy, and cognitive behavioral therapy.
That stuff sound fairly familiar for the most part doesn’t it? We’ve been talking about it for months by now so it should indeed be familiar. Except for the cognitive behavioral therapy bit. I kid. Cognitive behavioral therapy is geared toward treating depression, anxiety disorders, phobias, and other forms of mental disorders. Certainly the disorders that may exacerbate chronic pain or, at minimum, prevent the patient from moving beyond the pain in any meaningful way.
Continuing on, here’s a paper from the prestigious Spine Journal by Jon Adams, PhD et. al. called, “The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults(Adams J 2017).”
Why They Did It
Just as the title of the paper indicates, the goal of the authors was to learn more about the prevalence, patterns, and use of chiropractic care in the US.
How They Did It
- They took a cross-sectional data from the 2012 National Health Interview Survey. The National Health Interview Survey (NHIS) is the principal and reliable source of comprehensive health care information in the United States, utilizing a nationally rep- resentative sample of the civilian noninstitutionalized popu- lation of the United States
- They used that information to analyze the lifetime and 12-month prevalence and utilization patterns of chiropractic use.
- They determined the profile of chiropractic users.
- They determined the predictors of chiropractic consultations.
What They Found
- Lifetime prevalence of chiropractic use was 24%
- 12-month prevalence of chiropractic use was 8.4%
- The use of chiropractic care has grown from 2002 to when the data stopped in 2012
- Back pain caused people to seek chiropractic care to the tune of 63%
- Neck pain caused them to go about 30% of the time.
- The majority of chiropractic users reported that it helped a great deal with their health problem and improved overal health or well-being.
Wrap It Up
The authors concluded by saying, “A substantial proportion of US adults utilized chiropractic services during the past 12 months and reported associated positive outcomes for overall well-being and/or specific health problems.”
When we dive a little further past the abstract and get down into this paper, it goes into the specific percentages for different questions:
Chiropractic led to:
- Better Sleep 42%
- Reduced Stress 40%
- Felt better overall and improved health 39%
- Was seen as very important to the user 48%
- Helped for a specific health problem 65%
- Didn’t help at all 4%
- 62% went to a chiropractor to treat the cause, not the symptom!
I want to finish up this week’s papers by citing one that came right out of the White House not long ago.
If you go to The President’s Commission On Combating Drug Addiction and The Opioid Crisis report and make your way down to page 57, you will see where the authors say the following, ““A key contributor to the opioid epidemic has been the excess prescribing of opioids for common pain complaints and for postsurgical pain. Although in some conditions, behavioral programs, acupuncture, chiropractic, surgery, as well as FDA-approved multimodal pain strategies have been proven to reduce the use of opioids, while providing effective pain management, current CMS reimbursement policies, as well as health insurance providers and other payers, create barriers to the adoption of these strategies.” That is from the White House.
If you continue to the very bottom of the page, you’ll see this quote, ““The Commission recommends CMS review and modify rate-setting policies that discourage the use of non-opioid treatments for pain, such as certain bundled payments that make alternative treatment options cost prohibitive for hospitals and doctors, particularly those options for treating immediate post-surgical pain.”
In Episode #11, when I brought this up to my long-time buddy and past TCA President Dr. Tyce Hergert, he said, “You mean like a specialist copay for chiro care and a lower copay for primary care? Or covering surgery 100% and NOT covering non-surgical means.” I couldn’t have said it any better.
Essentially, the United States Government is admitting there is professional discrimination at the highest levels…..hello Medicare and Health Insurance plans….I’m talking to you….this discrimination creates barriers to doing the smart thing.
The smart thing is seeing a chiropractor for your back pain. The “Big Guys” (AKA: American College of Physicians, The Lancet, the FDA, and the American Medical Association) recommend it and the government says policies are in place to prevent patients from following those recommendations.
Key Takeaways:
- The general population is starving for what we chiropractors do and for what we can offer them.
- All of the important entities in the medical kingdom now recommend what we do but primary practitioners and specialists haven’t caught on just yet.
- There are barriers set up within Medicare and insurance in general keeping people from seeking the safest, most cost-effective, non-pharma means to treat themselves.
- It’s up to US and nobody else to get the word out in our medical communities. Nobody is going to do it for us and that’s a guarantee.
I want you to go forward this week with confidence and validation but with the understanding that it is up to every single one of you to figure out how to educate your medical community in an evidence-based, patient-centered way an the first one that does it correctly and effectively may just win a pot of gold and become THE spinal authority in your community.
I would say that you also need to do your friend Dr. Williams, and all other chiropractors in the world, a big favor. That favor would be to help us get the word out about this podcast. If you find value in it, don’t you think others would too? I’m not sponsored here. I’m doing it because I love it. I don’t have $10,000 to promote the podcast on Facebook or Twitter so I have to keep asking our listeners to please do us a favor and go like our page on Facebook, Like and Share our content EVERY WEEK, FOLLOW us on Twitter, and RETWEET our content on Twitter.
These are incredibly easy things to do and I truly need your help with them if you would please be kind enough.
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I want you to know with absolute certainty that When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.
When you look at the body of literature, it is clear: research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good to excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.
Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!
If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic evidence-based podcast in the world.
We cannot wait to connect again with you next week. From Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Social Media Links
- https://www.facebook.com/chiropracticforward/
- https://twitter.com/Chiro_Forward
- https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
- https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Bibliography
Adams J (2017). "The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults." Spine 42(23): 1810-1816.
Dowell D (2016). "CDC Guideline for Prescribing Opioids for Chronic Pain - United States." MMWR Recomm Rep 65: 1-49.
FDA (2017). "FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain."
Roth-Wells A (2017). "Attorney General Janet Mills Joins 37 States, Territories in Fight against Opioid Incentives." Office Of The Maine Attorney General.
The Joint Commission Online (2014). "Revisions to pain management standard effective January 1, 2015 BrightStar Care recognized as Enterprise Champion for Quality for second year New on the Web." Joint Commission Online.
CF 027: Wanted: Safe, Non-pharmacological Means Of Treating Spinal Pain!
Today we’re going to talk about thoracic manipulation, lumbar manipulation, guidelines from Canada, and perceptions of our profession. Did you know that many people actually think that Chiropractic herniate low back discs all of the time?
But first, here’s that bumper music
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast and I am honored to have you join me today. Thank you to those of you that send emails and like and share our content on Facebook and Twitter. You make it fun. If you haven’t already noticed, we have “Tweetable” quotes from our show notes. All you have to do is click the Tweet button and you’re all set.
Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. That’s a tall order but that is the goal
You have cavorted your way into Episode #27. Yes, it’s a word. In fact, it’s a synonym of the word dance. Oh how I do love a thesaurus.
As I’m about to record this episode, it is June 4, 2018 and I am getting ready to head down to the Texas Chiropractic Association’s State Convention. Now, things like that used to make my eyes gloss over but, I wasn’t doing it right or looking at it through the right lens.
I was a traveling musician for several years and, honestly, chiropractic for me at the time was Plan B while I made a run at music. Well, as usually happens with musicians, it didn’t make me rich. Shock, shock…
During those years, I was a little bit like a guy out on an island all by himself. A lone wolf you might say. I didn’t know anything about research, guidelines, or anything like that. Hell, I was lucky to get to work on time back then.
Along with being on an island all alone, I thought the idea of being a member of my state association sounded like one to the biggest, best ways to waste my money. Money that I really needed at the time. Well, I was misinformed. Becoming a member of the Texas Chiropractic Association has been one of the best, most rewarding things I have done in my professional life.
First, I met a ton of people through the TCA. I have a network of colleagues and friends now. If I have a question about ANYTHING, I have an answer! In fact, I was having a hard time with collections for some time and a colleague is the one that came to my rescue.
Also, the TCA doesn’t just take my money, they take it and use it to help me in my daily life. They have fought some outstanding odds and won several times. They won where, if they had lost, I wouldn’t have the right to diagnose my patients and would be much like a physical therapist depending on referrals from MDs. I’d say that alone is worth my $48 a month wouldn’t you agree?
I went on to serve several years on the Board of Directors for the TCA and am the current chairperson for the Chiropractic Development Initiative fighting to pay for lawsuits, fighting to bolster our profession, and protect it.
The point here is, I hope you’ll seriously consider joining your state association as well as the American Chiropractic Association. My dues for both combined each month run around $155. It’s just another bill you pay and it goes to securing your job. It’s worth it and I hope you’ll think about doing it. Chiropractic Forward is not just an idea. I walk the walk by being a member and being active.
Sometimes I end up deviating from research and all that good stuff we do every week but, sometimes, you gotta share what’s on you mind. Thank you for indulging me.
Let’s get started with the research talk this week with a paper called “Rehabilitative principles in the management of thoracolumbar syndrome: a case report,” by Mathew DiMond who is a DC, DACRB around Bridgeport Connecticut(DiMond M 2017). For those that don’t know what a DACRB is, it stands for Diplomate of the American Chiropractic Rehabilitation Board. To put that into perspective, there are roughly 5,200 chiropractors in Texas and only 5 DACRBs.
Why They Did It
Dr. DiMond wanted to describe his management of a case where the patient suffered from thoracolumbar syndrome.
How They Did It
- The patient was a 33 year old woman.
- She had suffered back pain for 3 weeks
- Nerve tension tests and local tenderness were present
- Outcome Assessment tools used were the Oswestry Disability Index which was at 62% at baseline, the STarT low back screen tool (6 points total with 2 point subscale), the Numeric Pain Rating Scale (6/10), and the test-retest exercise audits.
- 3 treatments rendered to the patient
What They Found
Her scores were substantially improved. Oswestry improved to 8% , STarT (1 point total), Numeric rating scale 1/10.
Wrap It Up
The author concluded by saying, “The patient responded positively to chiropractic care. After a short course of care, the patient reported reduced pain, alleviated symptoms, and improved physical function.”
Now onto the next one. We don’t sit still around here. Bam, bam, bam!
This one is titled “Chiropractic spinal manipulation and the risk for acute lumbar disc herniation: a belief elicitation study” by Cesar Hincapie, et. al. and published in the European Spine Journal(Hincapie C 2017).
Why They Did it
We know low back pain is the number one reason for disability in the world and that chiropractic is moving into the forefront. The author noted that chiropractic has been reported to increase the risk for lumbar disc herniation without any high quality evidence to support the claim. The author wanted to determine the beliefs on this topic going forward.
I have to say all one needs to do is look toward the American College of Physicians new recommendations and The Lancet low back series recommendations for using chiropractic as a first line treatment for low back pain and that should tell you all you need to know on this but, we will go ahead and explore this simply to expand our learning and knowledge.
How They Did It
They used a belief elicitation design
They used 47 clinicians made up of 16 chiropractors, 15 family physicians, and 16 spinal surgeons.
The clinicians estimated how often a chiropractic adjustment could cause a lumbar disc herniation in a hypothetical group of patients with acute low back pain.
What They Found
- As one would expect, chiropractors were the most optimistic that the occurrence was rare. In fact chiropractors held the belief that spinal manipulation actually decreases the chance of disc herniation rather than increases it.
- Family physicians were mostly neutral
- Spinal surgeons expressed a slightly more pessimistic belief toward the idea
Wrap It Up
The researchers concluded, “Clinicians’ beliefs about the risk for acute LDH associated with chiropractic SMT varied systematically across professions, in spite of a lack of scientific evidence to inform these beliefs.”
My bias is obvious but, the thought of chiropractors going around herniating discs had to have come from someone that either hates chiropractors like the American Medical Association of the 60;s, 70’s, 80’s, and so on…..or it had to come from ignorance. I believe that paper was published just prior to the new updated recommendations putting chiropractic in the driver’s seat for acute and chronic low back pain but geez…. I do get tired of defending the profession.
Now let’s wrap up the week here with a paper from our chiropractic brethren for the frozen North otherwise known as Canada. The lead author is Dr. Andre Bussieres and the paper is called “Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain: A Guideline From the Canadian Chiropractic Guideline Initiative” and was published in the Journal of Manipulative and Physiological Therapeutics in May of 2018(Bussieres A 2018).
Why They Did It
The objective of this study was to develop a clinical practice guideline on the management of acute and chronic low back pain (LBP) in adults. The aim was to develop a guideline to provide best practice recommendations on the initial assessment and monitoring of people with low back pain and address the use of spinal manipulation therapy (SMT) compared with other commonly used conservative treatments.
How They Did It
- The authors assessed systematic reviews and randomized controlled trials using A Measurement Tool to Assess Systematic Reviews and Cochrane Back Review Group criteria.
- Evidence profiles were used to summarize judgements of the evidence quality.
- The Evidence to Decision Framework was used to help the panel to determine the certainty of evidence and strength of the recommendations.
- Consensus was achieved through the modified Delphi technique
- This guideline was peer reviewed by an 8-member multidisciplinary external committee.
What They Found
- Acute back pain (0-3 months)
Offer advice on posture and staying active, reassure the patients, education and self-management strategies, chiropractic care, usual medical treatment if deemed beneficial, or a combination of chiropractic care and usual medical treatment.
- Chronic back pain (3 months and beyond)
Offer advice and education chiropractic care or chiropractic care in conjunction with exercise, myofascial, or usual medical care.
- Chronic back-related leg pain
Offer advice and education with chiropractic care and home exercise such as positioning and stabilization exercises.
Wrap It Up
The authors concluded by saying, “A multimodal approach including SMT, other commonly used active interventions, self-management advice, and exercise is an effective treatment strategy for acute and chronic back pain, with or without leg pain.”
Help us spread the news folks. Go out and get on your roof and start yelling it to the masses. Retweet, like and share and all of the stuff you can help with on your end of it. You can find us on Twitter at chiro_forward and on Facebook. We’re there. We’re just waiting on you to join us so go do that right now
I realize this week was a little here and a little there but the point is that no matter what you’ve heard or been told in the past, those days are over. I believe they’re over for good at this point. We are the #1, non-pharma, safe, conservative, non-invasive, research-backed, evidence-backed, treatment for spinal pain, hands down. And that’s a heck of a place to be coming from wouldn’t you agree?
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I want you to know with absolute certainty that When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.
When you look at the body of literature, it is clear: research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good to excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.
Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!
If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic evidence-based podcast in the world.
We cannot wait to connect again with you next week. From Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Social Media Links
- https://www.facebook.com/chiropracticforward/
- https://twitter.com/Chiro_Forward
- https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
- https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Bibliography
Bussieres A, e. a. (2018). "Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain: A Guideline From the Canadian Chiropractic Guideline Initiative." Journal of Manipulative and Physiological Therapeutics 41(4): 265-293.
DiMond M (2017). "Rehabilitative Principles in the Management of Thoracolumbar Syndrome: A Case Report." Journal of Chiropractic Medicine 16(4): 331-339.
Hincapie C (2017). "Chiropractic spinal manipulation and the risk for acute lumbar disc herniation: a belief elicitation study." European Spine Journal.
Episode 26
Chiropractic Bests Physical Therapy and Usual Medical Care For Musculoskeletal Issues.
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Today we’re going to talk about new info and new articles coming out on how chiropractors fit into an integrated care protocol and we’ll explore the problem of chiropractic vs. physical therapy. Which should be the first referral in the medical kingdom and why?We hope you’ll help us by liking, sharing, and retweeting our content.
But first, here’s that bumper music
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
Before we get started, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. On another note, we are accepting speaking engagements so shoot us an email at dr.williams@chiropracticforward.com so we can connect.
I need to thank Dr. Chris Carr out in Pittsburgh, PA with the Health Nuts Podcast for having me as a guest on Tuesday, May 29th. I had a blast. We talked all about stroke risk, or the lack thereof, and all kinds of good stuff. Make sure you check it out at the link in the show notes
Click here to listen to Health Nuts episode 37 with guest Dr. Jeff Williams
http://directory.libsyn.com/episode/index/id/6644712/tdest_id/531106
Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. That’s a tall order but that is the goal. When you know the research, which is what we talk about every week, then you start to speak to colleagues in a more effective way. With stats, research, and confidence.
You have scooted into Episode #26
But first, my week has been one of renewal I’d say. Don’t we get into a rut sometimes where we go through our lives in a robotic sense? I’m as guilty of it as the next person. As I’ve said here on the podcast before, I’m a big music fan. I used ot be a traveling musician. I wrote and recorded the bumper music you just heard. i am a sculptor. Check out River Horse Art on Facebook. I build live edge furniture if you’d like to see the stuff at Amarillo Furniture and Live Edge Customs on Facebook. I have lots of interests but…..don’t we fall into ruts regardless of how many hobbies or interests we have?
The trick, I think, is outside influence. The right kind of outside influence. Undoubtedly, many of you are non-Christian and I’m not the kind of Christian to tell anyone they’re right or wrong but, if you’ll hang with me just a sec, maybe I can make sense to the non-christians as well.
On the way to work this morning, I was listening to a podcast by a preacher named Jenetzen Franklin. Now, I usually listen to murder mysteries, music, news, or silence but, every now and then, I just get a calling of sorts to listen to something faith based. Well, that happened this morning.
This episode was called Don’t Call This Common. Franklin was talking about how we go through our days in a robotic mentality many times. He was saying how, nothing blessed by God can be called common. From our relationships, family and friends, our interactions, our offices, our patients, our work in general. Nothing we do is common. Our days, our jobs, our profession, and our results are extraordinary indeed. What would out patients do without us in their lives? You don’t have to be a Christian to understand how lucky we are to wake up in the morning. How lucky we are to kiss our spouses and out kids. Or how lucky we are to work in a job that makes us happy and allows us to make such a difference in others’ lives.
It is truly extraordinary.
Thank you for indulging me there for a minute and allowing me to share my heart with you for a little bit. It’s one of those days of renewed energy and renewed perspective for me. I hope my thoughts spark something similar in you as well.
Let’s get to some articles and research to get you thinking and speaking in the right direction.
Last week, we discussed a new paper by Dr. Goertz which had to do with how integrating chiropractors into treatment for Vets suffering from musculoskeltal issues. Mostly low back pain(Goertz C 2018).
Here’s an article written by Reuters’ writer Lisa Rapaport on the paper(Rapaport L 2018).
It’s called “Adding chiropractic to back pain care may reduce disability.” I’d like to say from the top that I’m unhappy with the title. What’s this “May reduce” garbage exactly? If Lisa knew about 1/10th of the research, she’d leave out the questioning tone of the title. That’s like saying that heart surgery MAY save lives. You know, some people die during heart surgery so……it doesn’t ALWAYS work does it? Some people don’t have completely outcomes from low back fusion so….low back surgery MAY work. Follow me?
Dr. Goertz had a couple of interesting quotes included in the article. The first quote is, “Spinal manipulation (often referred to as chiropractic adjustment) may help heal tissues in your body that form as a result of injury, decreasing pain and improving your body’s ability to move correctly.” The other was, “It is also possible that manipulation impacts the way that your body perceives pain through either the brain or the spinal cord and/or decreases pain from muscle strain, inflammation and/or spasm in the muscles next to your spine.”
Great quotes from a great doctor and a researcher that has been a game-changer for our profession. But, wouldn’t you say there are questions in those quotes as to exactly how Chiropractic works in the first place? What is it about chiropractic or spinal manipulation that actually caused the effectiveness and the reduced pain? Like what it is exactly?
Take for example the cardiologist: they are effective because they go in a place a stent or there was blockage in one of the arteries feeding the heart so they either cleared it or bypassed it and now it works better. There’s no doubt as to why they were effective.
I think until we come up with a unified, provable reason as to why we chiropractors get the results we get, we may always be struggling to explain ourselves in a manner that resonates and makes sense to colleagues in the medical field and to the layperson with back pain out in the general population.
This needs some work and some resolution in my humble opinion.
We have mentioned this next paper before so we won’t go through the whole thing again but, when you are discussing chiropractic with medical professionals, it’s clear the MDs prefer to send their musculoskeletal patients to the physical therapist first before taking the next steps toward shots and surgery. That’s progress from immediate medication and shots but, it may not be the most effective referral they can make.
Let me first say that I love physical therapy and physical therapists. This is not a competition in my opinion. Yes, we cross over into each others’ territory daily but, that is business and that is life. I think physical therapy most definitely has it’s place. Post-operative rehab is the spotlight in my mind for physical therapy. What would surgical patients do without physical therapy following minor and major surgeries? They are game changers.
Now, if we talk about pain caused by discs or something originating in the spine, my 20 years has shown me they have little effectiveness in this area. We all know Mckenzie and core building exercises are beneficial. We all know this stuff. You don’t need to be a physical therapist to figure that out. But effectively treating discs…..I have not seen that much at all.
In fact, I had a patient that was treating with us. She was a young, healthy, fit, athletic girl having a significant, MRI-confirmed disc issue. We worked and worked with her to the point that she was feeling great. Without consulting yours truly, she got the idea in her head that, if she added physical therapy to the regimen, her results would be twice as good as they already were.
Well, she went to one appointment with the PT and came back in tears, unable to walk or function, and no matter how much we worked with her from that point, we were never able to get her back to where we had her. She ended up having low back surgery. In her 20’s.
Of course that’s not the common experience of patients that go to PTs and I’m not discouraging going to PTs. As I said, we all have our function and certain things we are truly effective in treating. A truly integrated approach is the ideal way to work it.
But let’s be clear, this podcast is called “Chiropractic Forward.” We aren’t here to advocate for physical therapists. They have plenty of folks doing that. We aren’t here to bash them either by the way. Our function is chiropractic advocacy based on research and evidence.
In this systematic review and meta-analysis by Ian Coulter, et. al., he concludes by saying, “ There is moderate-quality evidence that manipulation and mobilization are likely to reduce pain and improve function for patients with chronic low back pain; manipulation appears to produce a larger effect than mobilization. Both therapies appear safe(Coulter I 2018).”
Now, when we argue that patients should be seeing a chiropractor prior to, or in conjunction with, a physical therapist, keep in mind this study from 2017 called, “Association Between the Type of First Healthcare Provider and the Duration of Financial Compensation for Occupational Back Pain” by Marc Andre Blanchette et. al. (Blanchett M 2017).
The study focused on patients in the workers comp system. What practitioner they saw, how long and expensive was treatment, and did they have reoccurrence of the pain?
The authors concluded by saying, “The type of healthcare provider first visited for back pain is a determinant of the duration of financial compensation during the first 5 months. Chiropractic patients experience the shortest duration of compensation, and physiotherapy patients experience the longest. These differences raise concerns regarding the use of physiotherapists as gatekeepers for the worker’s compensation system.”
Chiropractors…..can I get a hell yeah? Maybe an Amen?!?
What about this paper from 2014 called “Cost-effectiveness of manual therapy for the management of musculoskeletal conditions: a systematic review and narrative synthesis of evidence from randomized controlled trials,” by Tsertsvadze(Tsertsvadze A 2014)?
When comparing manual therapy with usual medical care and physical therapy, the authors concluded the paper by saying, “Preliminary evidence from this review shows some economic advantage of manual therapy relative to other interventions used for the management of musculoskeletal conditions, indicating that some manual therapy techniques may be more cost-effective than usual GP care, spinal stabilization, GP advice, advice to remain active, or brief pain management for improving low back and shoulder pain/disability.”
And lastly for this topic, there’s this paper from 2003 from Korthals-de Bos, et. al. called “Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. Randomized controlled trial” that was published in the British Medical Journal(Korthals-de Bos IB 2003).
The authors wanted to evaluate, contrast, and compare effectiveness of manual therapy to physiotherapy/physical therapy and to care by a general medical practitioner in regards to neck pain specifically.
They concluded the paper by saying, “Manual therapy (spinal mobilisation) is more effective and less costly for treating neck pain than physiotherapy or care by a general practitioner.”
So, as you can see, there are several, research-backed arguments to be made to medical colleagues when you are asking them for their referrals rather than physical therapy being their knee-jerk reaction and first choice.
Go forth with confidence and assertiveness knowing that your profession is validated in a thousand different ways.
Key Takeaways
Chiropractic kicks butt any way you want to look at it when you’re looking at it through a research-based lens and it’s great to see it continually excel and surpass usual medical care and physical therapy in terms of effectiveness, cost-effectiveness, and risk vs. reward.
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As I mention at the end of every episode, I want you to know with absolute certainty that when Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.
When you look at the body of literature, it is clear: research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good to excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.
Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!
If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic evidence-based podcast in the world.
We cannot wait to connect again with you next week. From Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Social Media Links
- https://www.facebook.com/chiropracticforward/
- https://twitter.com/Chiro_Forward
- https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
- https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Bibliography
Blanchett M (2017). "Association Between the Type of First Healthcare Provider and the Duration of Financial Compensation for Occupational Back Pain." J Occup Rehabil 27(382).
Coulter I (2018). "Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis." Spine 0(0).
Goertz C (2018). "Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain A Comparative Effectiveness Clinical Trial." JAMA 1(1): E180105.
Korthals-de Bos IB (2003). "Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial." British Medical Journal 326(7395): 911.
Rapaport L (2018). "Adding chiropractic to back pain care may reduce disability." Reuters 0(0).
Tsertsvadze A, e. a. (2014). "Cost-effectiveness of manual therapy for the management of musculoskeletal conditions: a systematic review and narrative synthesis of evidence from randomized controlled trials." J Manipulative Physiol Ther 37(6): 343-362.
Vets With Low Back Pain: Usual Care + Chiropractic vs. Usual Care Alone
Today we’re going to talk about our military folks and low back pain. We have already shown how chiropractic is backed completely by research for low back pain. For us, that’s not even in question. But, this week, there’s brand new research out in JAMA, yes, THAT JAMA, talking about low back pain, the military, and chiropractic.
But first, make way for that bumper music
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
I want to humbly, with my hat in my hand and puppy dog eyes ask you to go to chiropracticforward.com and sign up for our newsletter. Make it easy on us to update you when a new episode come out. It’s just the nice thing to do folks.
On another note, do you need an hour or two for your Continuing Education seminar on low back pain guidelines or on Debunking the myth that chiropractors cause strokes? Do you need a guest for YOUR podcast?
Look no further, you have found your man. Just send me an email at dr.williams@chiropracticforward.com and we will get it done. Heck, we’re trying to get the word out about what we’re doing here don’t ya know?
We are honored to have you listening today. Here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. That’s a tall order but that is the goal
You have grooved nice and easy……. 70’s style right into Episode #25
As you may have heard me say several times before, I’m in practice. Day to day, week to week, month to month. In fact, I’ve been in active daily practice for over 20 years. I’ve answered the phones, booked the appointments, been an associate that basically answered to a receptionist. I’ve also been a busy chiropractor having a hard time keeping up with my own head.
I tell you this because I think it’s important to know that the information you get from me is not only from research journals but is also from daily experience. Twenty years of it at this point!
When we start discussing active military and veterans, if you’ve been in practice very long at all, you know these men and women are hurting and, many times, are not getting the help they desperately need. I see them every week. I’m actually in the process of signing up for the Choice Program as we speak so I can see more and more of them.
As a side note, you’d think that veterans are among the most honorable of all American citizens wouldn’t you? And wouldn’t you expect that the most honorable of all Americans would be worthy of healthcare that adequately addresses their needs based on current research and knowledge?
One would think but, as we see over and over, that just isn’t the case, unfortunately.
Here’s one example, a friend of mine….her father is in the VA hospital right now with several issues. She went to visit and was looking for his room. When she asked a staffer for directions, they directed her through this plywood board attached to a door that kind of opened up all together and allowed passage into the hallway that led to his room. Can you imagine our veterans being in a place that has plywood boarded up on the doors? One door…..any damn door?
Another would be the father of a friend of mine. He died waiting on a referral to a pulmonologist through the Choice Program. He couldn’t just go and make his own appointment. Not if he wanted it covered anyway. The VA system failed this decorated Vietnam Vet whereas medical professionals made it clear to him that his pulmonary hypertension could be treated after seeing a specialist to determine his specific level of PH. Well, the referral didn’t come and time ran out. Doesn’t seem right does it?
Let’s get to the musculoskeletal part of things. Military services leads to a high rate of chronic pain. That is just the facts. Knowing this fact, it is not surprising that veterans succumb to opioid overdose at twice the rate of the general population. That is just astonishing. It’s understandable but astonishing just the same. Not only were they twice as likely to succumb to opioid overdose, but they were twice as likely to be prescribed opioids in the first place!
One would think with the new recommendations from international low back experts published in The Lancet, new recommendations from the American College of Physicians, and the mountains of randomized controlled trials showing the efficacy of Chiropractic Care of low back pain, you’d expect to have an automatic referral from the VA primary care physicians. But, again, common sense doesn’t alway seem to reign in the medical kingdom. Money, politics, group-think, and false dogmatic believes of yesteryear tend to control the thought process. In my opinion, of course.
If you are unaware of the body of research, I’m sure this just sounds like belly-aching. I’m telling you as straightforward and as honestly as I can, chiropractic’s effectiveness has been proven through research so many times I can’t begin to count. We have been shown to be as effective or more effect than medication including NSAIDS. On top of that, we recently talked about research showing opioids having less effectiveness than NSAIDS. Veterans need a source of treatment for their musculoskeletal pain that is non-pharmacological, cost-effective, and has a high degree of overall effectiveness.
Everything and everyone already mentioned in this podcast (The Lancet, ACP, etc…) agrees one of those options is Chiropractic specifically.
With all of that in mind, let’s get into the paper that recently came out in the Journal of the American Medical Association (JAMA). It’s titled “Effect of Usual Medical Care Plus Chiropractic Care vs. Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain,” and authored by Dr. Christine Goetz, DC, PhD.
It was published in May of 2018(Goertz C 2013).
Why They Did It
The authors recognized the need for non-pharmacological low back pain treatments and hoped to determine if chiropractic care being added to traditional medical care resulted in a better outcome than if the chiropractic care was left out completely.
How They Did It
- For you research nerds, the paper was a 3-site pragmatic comparative effectiveness clinical trial using adaptive allocation
- It was conducted from September 28, 2012 to February 13, 2016
- The sites studied included 2 large military medical centers and 1 smaller hospital at a military training site.
- Active duty aged 18-50 with low back pain originating in the musculoskeletal system were accepted for the study
- Outcomes used were low back pain intensity measured through the Numerical Rating Scale (NRS) and disability using the Roland Morris Disability Questionnaire.
- Secondary outcomes measured were perceived improvement, satisfaction, and medication use.
What They Found
- 250 patients at each site were accepted.
- 750 total
- The mean participant age was 30.9
- 23% were female
- 32.4% were non-white
- Adjusted mean differences in scores at the 6-week mark were statistically significant favoring usual medical care PLUS Chiropractic Care.
- There were no serious related adverse effects.
Wrap It Up
The authors concluded, “Chiropractic care, when added to usual medical care, resulted in moderate short-term improvements in low back pain intensity and disability in active-duty military personnel. This trial provides additional support for the inclusion of chiropractic care as a component of multidisciplinary health care for low back pain, as currently recommended in existing guidelines. However, study limitations illustrate that further research is needed to understand longer-term outcomes as well as how patient heterogeneity and intervention variations affect patient responses to chiropractic care.”
I realize this is a brand new paper. I also realize that Dr. Goertz is among the leaders of the body of research when it comes to chiropractic. This is exactly why I question the need for further research to understand longer-term outcomes. We have had longer-term outcomes research. Plenty of them as a matter of fact.
If you go to this paper’s website and click on the link you’ll find in the show notes, ( https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2680417 ) you’ll notice that you can click on a “Comments” icon just under the “Download PDF” icon.
If you navigate to that Comment section and click on it, you’ll notice the following quote from May 21, 2018 from Dr. Frederick Rivara, MD, MPH at the University of Washington in Seattle, “As a sufferer myself of chronic low back pain, I was very interested to see the results of this comparative effectiveness trial. To me, it points out the importance of integrated care for the treatment of chronic conditions. What are the likely barriers to implementing this in medical practices in general? Do we really need more research on the right treatments for low back pain?” Here is Dr. Rivara’s stated conflict of interest at the end of the quote: he’s the Editor in Chief of JAMA Network Open. The Editor in Chief made that statement folks.
Key Takeaways
- We don’t need any more research into whether low back pain is effectively treated with chiropractic care. It’s been done a hundred times over. What we need is acceptance and a shift in the groupthink of the medical field.
- We also need to chiropractors to step up and take the golden scepter the medical field had dangled out there. It’s our for the taking.
- We also need more research into the effectiveness of chiropractic care for headaches and neck pain. The research is there supporting our effectiveness. No doubt about it. But, it needs to be there by the hundreds just like you see in low back pain. There needs to be so much of it that the deniers start to look like flat-Earthers in the healthcare world.
This week, I want you to go forward with doing some of your own research on vets and opioids, on Chiropractic and low back pain, and on the Choice Program through the VA. We can help our active military and our vets. We can help them better than anyone else for their low back pain and that includes physical therapists. There is research showing that exercise/rehab + chiropractic is more effective than exercise/rehab alone(Korthals-de Bos IB 2003, Coulter I 2018).
Either way you boil it down, we win. We can help these people so help me figure out how we get that message out there and how we’re supposed to reach out and grab it for our profession.
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I want you to know with absolute certainty that When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.
When you look at the body of literature, it is clear: research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good to excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.
Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!
If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic evidence-based podcast in the world.
We cannot wait to connect again with you next week. From Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Social Media Links
- https://www.facebook.com/chiropracticforward/
- https://twitter.com/Chiro_Forward
- https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
- https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Bibliography
- Coulter I (2018). "Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis." Spine 0(0).
- Goertz C (2013). "Adding chiropractic manipulative therapy to standard medical care for patients with acute low back pain: Results from a pragmatic randomized comparative effectiveness study." Spine 38(8): 627-634.
- Korthals-de Bos IB (2003). "Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial." British Medical Journal 326(7395): 911.
CF 024: They Laughed When I Said I Could Still Help
Today, we’re going to talk about people coming in to our office after having had back surgery wanting us to perform miracles. Well, why didn’t they come to us BEFORE the surgery would be my big question. We’ll toss all that stuff around today on the Chiropractic Forward Podcast.
But first, here’s that bumper music!
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
Before we get started, I want to ask you to go to chiropractic forward.com and sign up for our newsletter. On another note, do you need an hour or two for your Continuing Education seminar on low back pain guidelines or on Debunking the myth that chiropractors cause strokes?
Go no further, you have found your man. Just send me an email at dr.williams@chiropracticforward.com and we will get it done.
We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. That’s a tall order but that is the goal
You have done the electric slide right into Episode #24 and that’s exciting
Now, as I mentioned previously, how many times do chiropractors have new patients come through the doors but they’ve already had surgery? They’ve had surgery they hoped would be a quick fix usually. But it wasn’t.
Now, they’re sitting in your office, looking at you with a very scared and concerned face, and it’s up to you to lead the way and, hopefully, be able to provide them some sort of relief with your magical abilities.
I can tell you from 20 plus years of experience that it happens all of the time. At least a time or two per month for a busy practice. That’s what I would guess.
The truth is, sometimes we can help these people and sometimes we just can’t. I tell patients that surgery, many times, is permanent and anything we do toward trying to get some relief can be a little bit like pushing a wheelbarrow uphill. Depending on the weight in the wheelbarrow, we may get it to the top and we may not get it to the top but we’re sure as hell going to try while making sure we keep them safe from further damage.
At first glance, when you’re looking at an x-ray of a post-surgical patient, many times I find myself thinking, “What in the heck can I possibly do with this trainwreck.” I’m sure I’m not the only one to ever feel like that. It’s a little bit of a helpless feeling sometimes. Especially when you see parts missing like you’ll see in a laminectomy. Or when you see parts added like boney fusions or fusions with hardware. I get a sinking feeling in my stomach for patients like that.
Especially when we know for a researched-fact that these patients most likely did not have to endure those procedures. For any reason. If you aren’t sure about that statement, please review our podcast episodes we did no The Lancet low back series. Episodes #16, #17, and #18 dealt with this very issue.
Surgeries are gaining in popularity while the outcomes show no change. They are no longer recommending surgery for acute or chronic low back pain. Period. Sure, cauda equina syndrome, foot drop, and severe symptoms like that may indicate surgical intervention but, otherwise, they say no shots, no surgery, no bed rest, and no medications.
We will be hammering these things consistently until we start seeing some change. I can guarantee it.
OK, but…..what if nobody listened to the experts and they just did the surgery with no relief? Can we do anything about it?
Let’s look at a couple of possiblities:
- The spine was fused years ago and now, due to the immobilization and increased workload on the segments above and below, the segments above and/or below begin to show signs of wear and tear.
- The spine was not fused but the complaint never improved. This may be the case in people that have the microdiscectomies or epidural spinal injections.
Of course there are a lot of different, very specific outcomes that don’t fit in those two categories but I’d say these are the ones I commonly see.
Let’s take the first one: a fusion that caused issues above and below the fused segment. If you go through nonsurgical spinal decompression certification through the Kennedy Decompression Technique, you’ll be taught that a fusion with hardware is a hard contraindication. At least it was 6 years ago.
Assuming these people develop disc issues above or below the fusion, that would mean you can’t do any decompression on the site. An orthopedic surgeon that is familiar with non-surgical decompression however, may tell you that the segment is more solid after the fusion than it ever was before and decompression won’t cause any issues with the fusion itself.
OK, so, we’re stuck between two worlds on that and, honestly, if you’re an expert on this and you’re listening, email me at dr.williams@chiropracticforward.com and tell me your experience and understanding.
After bouncing the problem off of several highly trusted colleagues, I think a light pull on decompression is tolerated just fine and does in fact provide relief to fusion patients. No, you cannot pull them at 1/3 or 1/2 of their body weight. We’re talking a LIGHT pull. This combined with gentle McKenzie and Core exercises as well as self-management recommendations at home will go toward getting them back on their feet and getting back after it.
If any of you disagree, I’d love to talk about it. My first question would be, “What would the alternative be?”
I am by no means the final and ultimate opinion on this. We have to depend on trusted advice and clinical experience, don’t we? That’s just what I do and what I’ve found is that about 80% of patients just get better. There’s about 10% that gets better but not quite what we hoped for. Then there’s that 10% that …”Hey, we tried and it looks like I’m not your homey on this deal.”
Now, what about the second option? Let’s say that they had a discetomy but it was a failure (surprise surprise) and now it’s up to us to help the patient and attempt to keep them from enduring any more surgery or shots. What do you do? Maybe I should say, “What do WE do?”
I say adjust them!! After a certain healing time has passed, of course.
I say we do all the other stuff I mentioned previously for them as well. We may do decmopression. We may do laser. We certainly do McKenzies, Core Buidling, McGill’s Big Three, no bed rest, and home self-management.
If you have paid much attention to our previous episodes then you know the American College of Physicians and the global panel of experts on low back pain that published the low back pain papers in The Lancet back in March of 2018 say that spinal mobilization is a researched and recommended first-line therapy for acute and chronic low back pain.
In my opinion, a discetomy doesn’t change these recommendations much. Sometimes, cases are so specific, that they just don’t get researched in depth for that certain instance.
However, I CAN offer a case study if you’re willing to listen.
It was titled, “Chiropractic/Rehabilitative Management of Post-Surgical Disc Herniation: A Retrospective Case Report” and was published in the Journal of Chiropractic Medicine in the Summer edition of 2004(Estadt G 2004).
Why They Did It
To explore management of lumbar disc herniation following sugery using a regimen of chiropractic manipulation and exercise/rehab.
How They Did It
- The patient was a 54 yr old male
- The patient had a history of acute low back pain with left sciatic pain down the left posterior thigh and lateral calf as well as numbness inthe bottom of the left foot.
- The patient previously had steroid anti-inflammatory drugs and lumbar microdiscectomy surgery.
- The patient did not recover completely.
- The patient couldn’t walk without hurting and was unable to return to activities of daily living.
- He was antalgic in flexion.
- His lumbar range of motion was restricted in flexion as well as in extension.
- He had a positive SLR as well as foot drop on the left.
- Intervention consisted of patient education on posture, bending, and lifting.
- Exercise/Rehab was started in-office progressing to at-home based exercise/rehab.
- Active rehab was continued after early improvement (7 visits) in order to return lumbar spinal extensor strength.
- The patient was ultimately released to home therapy and supportive chiropractic care and continued to show improvement.
Wrap It Up
The author concluded, “Management of postsurgical lumbar disc herniation with chiropractic and active rehabilitation is discussed. Spinal deconditioning and weakness of the lumbar spinal extensor muscles appeared to be related to the patient’s symptoms. Patient education on proper posture, proper lifting techniques, core stabilization exercises, active strengthening exercise and chiropractic manipulation appeared effective in this case.”
OK, a case study with one subject. What does that tell us as far as research goes? Very little. What is the impact of the Journal of Chiropractic Medicine? It’s peer-reviewed and it has an impact factor of 0.74 and has climbed significantly since 0.36 in 2011.
Although this case study is only one patient’s experience, from my own anecdotal evidence, I would come very close to guaranteeing you and betting the farm that these results can be repeated time and time again.
I’ve seen it time and time again. My experience tells me we can help these people. YOU can help these people. Surgery doesn’t always mean we are helpless to pull out the power of chiropractic.
I want you to know with absolute certainty that When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.
When you look at the body of literature, it is clear: research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good to excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.
Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!
If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic evidence-based podcast in the world.
We cannot wait to connect again with you next week. From Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Social Media Links
- https://www.facebook.com/chiropracticforward/
- https://twitter.com/Chiro_Forward
- https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
- https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Bibliography
Estadt G (2004). "Chiropractic/Rehabilitative Management of Post-Surgical Disc Herniation: A Retrospective Case Report." Journal of Chiropractic Medicine 3(3): 108-115.
This week, I have some brand new research concerning spinal manipulation with laser therapy added as well as some research looking at laser therapy in general. We concentrate heavily on research having to do with musculoskeletal conditions and I think this week gives us an opportunity to look at spinal manipulation but to also look at a modality many Doctors of Chiropractic implement regularly in their day-to-day lives.
Before we get started, I want to draw your attention our website at chiropracticforward.com. Just below the area where you can listen to the latest episode, you’ll see an area where you can sign up for our newsletter. I’d like to encourage you to sign up. It’s just an email about once a week to let you know when the episode is updated and what it’s about.
Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. That’s a tall order but that is the goal.
You have boogied right on into Episode #22
But first, my week has been mixed man. Being a small business owner isn’t all peaches and cream is it? I tell you, sometimes you're up….sometimes you're down but we keep soldiering on. I’ve been in practice for 20 years and it can still be stressful. I found something that helps me though. Some of you already know this. It’s music. You can have elevator music on in your office if you like but I say NO.
First, your patients don’t really like that stuff. Just in case you didn’t know that, I’m telling you now. I spent the time last week to make a couple of playlists. One is called Memphis/Motown/Muscle Shoals and one is called Rat Pack. Now, I’m a former traveling musician. In fact, the bumper music you just listened to….I wrote that and recorded all of the parts on it from the guitars, bass, piano, everything.
My personal preference is Americana/Texas Country style music. If you have iTunes, you can find my old touring band called Copperhead and the album is called Remedy. That was us!
Anyway, Texas Country is my preference but, for my office, I and my patients are loving the older boogie and soulful stuff like Otis Redding, Wilson Pickett, The Temptations, Ray Charles, and anything that fits that style whether it’s old or new. Doesn’t matter. In fact, a lot of the newer artists are sounding like the great stuff from the older days. I love it. Then, to mix it up a bit, I throw in the Rat Pack list here and there with Sinatra, Harry Connick Jr, Michael Buble, Dean Martin, and guys like Wayne Newton. It’s great. Classy and cool. Anyway, the days have just started flying by. When you boogie all day, and your patients boogie all day, well…..it makes for an awesome place with an awesome experience.
If any of you have any interest in the playlists, send me an email or Facebook message and let’s talk about it. I love talking music!!!
Now, what we are REALLY here for.
Let’s start by saying that Low Level Laser has been around for many years in one for or another at this point in time. But, how many actually know where it came from, how it was discovered, and what research is there showing its effectiveness?
I would hope that, if you include a modality in your office, you have done some background work to show yourself and to demonstrate to your patients that there is backing research for the modality and they don’t just simply need to take your word for it. And, if you can find little to no evidence of effectiveness for a modality, my suggestion is that it should play no part in your services. Of course, that is my opinion and can be taken or dropped as may opinions commonly are.
Let’s start with the newest paper that mentions cold laser but does not really do anything to address effectiveness of cold laser. I think you can anticipate the outcome once you learn the basis but, it is new so we are talking about it.
This paper is called, “Spinal manipulation combined with laser therapy is more beneficial than laser therapy alone in chronic non-specific low back pain. A randomized controlled study,” and it was published in the European Journal of Physical Rehabilitation Medicine on April 24, 2018 and was authored by Subash Chandra Bose, et. al(Subash Chandra Bose GN 2018).
Why They Did It
The authors were looking to compare treatment regimens for exercise/cold laser/spinal manipulation vs. exercise/cold laser alone for patients suffering from chronic non-specific low back pain.
How They Did It
- Three hundred and thirty patients were included
- Study was randomized control
- Outcome measurements used were Visual Analog Scale, Roland and Morris Disability Questionnaire, Physical Health Questionnaire, and Health Related Quality of Life-4.
- Outcome measurements were taken at the beginning to measure the baseline total, at the 4-week mark, at the 6-week mark, and at the year mark.
- A blinded assessor was used to evaluate the Outcome Measures
What They Found
- 326 patients finished the program
- 304 patients finished through the 1-year mark
- ANOVA analyses proved statistically significant improvement in regards to the lessening of pain, in regards to increased range of motion, functional disability, depression, and Quality of Life.
- All of these significant improvements were seen in the Spinal Manipulation/Exercise/Laser Therapy group.
Wrap It Up
The authors conclusion was, “Spinal manipulation combined with laser therapy and conventional exercise is more effective than laser therapy and conventional exercise alone in chronic non-specific low back pain. Spinal manipulation is an adjuvant intervention and it can be applied in every day clinical practice.”
If you have paid attention to research, you probably predicted the outcome on this. Spinal manipulation appears to be the most effective means of treating non-complicated low back pain bar none. It just is. On top of laser plus exercise, on top of exercise, equal to more effective than NSAIDs…..it just is and research backs it time and time again.
But, this paper does nothing to look at cold laser specifically. It just shows us that spinal manipulation gets better results.
Let us say up front: low level laser, also known as cold laser, is not covered under insurance plans. As they explain it, the modality is experimental and investigational. I have a ton of experience and anecdotal evidence I could relay to you but, in the end, it’s research that you need for validation.
First, let’s go through a brief history on cold laser.
In 1967 a few years after the first working laser was invented, Endre Mester in Semmelweis University in Budapest, Hungary experimented with the effects of lasers on skin cancer. While applying lasers to the backs of shaven mice, he noticed that the shaved hair grew back more quickly on the treated group than the untreated group. It’s use wide array of uses have been explored since then and they had no idea where it would lead them.
When we think of lasers, we think of burning or cutting lasers. Cold laser is actually called low level laser. It’s different. You really don’t feel it during the treatment and It works by stimulating cell function. The second paper below by Cotler et. al. states “LLLT at low doses has been shown to enhance cell proliferation of fibroblasts, keratinocytes, endothelial cells, and lymphocytes. The mechanism of proliferation is thought to result from photo-stimulation of the mitochondria leading to activation of signaling pathways and up regulation of transcription factors eventually giving rise to increases in growth factors.”
Here is a paper from 2014 published in the International Journal of Oral and Maxillofacial Surgery called “Does low-level laser therapy decrease swelling and pain resulting from orthognathic surgery?” and authored by G. Gasperini, et. al(Gasperini G 2014).
Why They Did It
Hoping for alternatives to treating swelling and inflammation following orhognatic surgery, and noticing there was a lack of research for or against cold laser, the authors wanted to further investigate it’s effectiveness in that capacity.
How They Did It
- 10 patients having undergone bilateral sagittal split with Le Fort I osteotomy were randomly selected.
- The treatment protocol consisted of intraoral and extraoral treatment with the laser on one side of the face following surgery
- Fake application was performed on the other of the face. Remember that surgery was done on both sides.
- The two sides were compared for pain using the visual analog scale and for swelling.
What They Found
- Immediately after surgery, there was little to no difference for inflammation and pain in the two sides.
- On the side treated with cold laser, inflammation and swelling decreased significantly on day three, day seven, day fifteen, and day thirty.
- Self-reported pain was reduced on the treatment side at the one-day mark and at the three-day mark.
- After seven days, however, no pain was present on either side.
Wrap It Up
The authors of this paper concluded, “This LLLT protocol can improve the tissue response and reduce the pain and swelling resulting from orthognathic surgery.”
Here’s one from Dr. Roberta Chow, et. al, published in The Lancet in 2009 called “Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomized placebo or active-treatment controlled trials.(Chow R 2009)"
You should know the reputation of The Lancet. If not, it is one of the world’s oldest medical journals dating back to 1823. Being published in The Lancet is notable to say the least.
Why They Did It
The point was to perform a systematic review of the literature proving or disproving the effectiveness of cold laser in the treatment of neck pain.
How They Did It
The authors did an exhaustive search of the databases holding information comparing efficacy of cold laser implementing any wavelength vs placebo or active control for acute or chronic neck pain.
What They Found
- 16 Randomized Controlled Trials were identified
- 820 patients
Wrap It Up
“We show that LLLT reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain.”
Powerful in my opinion, folks.
This paper is called “The Use of Low Level Laser Therapy For Musculoskeletal Pain” by Howard Cotler et. al. and was published in 2015 in MedCrave Online Journal of Orthopaedics & Rheumatology(Cotler H 2015).
Why They Did It
With the current treatment options for chronic musculoskeletal pain consisting of NSAIDs, steroid injections, opiates, and surgery, the authors recognized a need to further treat chronic pain in a more effective manner as chronic pain continues to become more and more prevalent globally. Particularly chronic low back pain.
What They Found
The authors state that over 4000 papers found on pubmed show that cold laser does indeed show effectiveness on acute and chronic musculoskeletal pain. They state that heterogeneity of populations, treatments, and groupings means that not every single study was positive but the majority are positive. They also state that the overall positive studies should provide the practitioner with a certain level of confidence in implementing the modality in their treatment protocols.
Wrap It Up
The authors concluded the following, “One has to be realistic about the therapeutic use of LLLT. The previous discussion has shown that LLLT is beneficial for pain relief and can accelerate the body’s ability to heal itself. LLLT has a long history and strong basic science evidence, which supports its use in pain management. It has few side effects and is well tolerated by the elderly. A laser or LED does not correct situations involving structural deficits or instabilities whether in bone or in soft tissue. Also, LLLT should only be used as an adjuvant therapy for pain relief in patients with neuropathic pain and neurologic deficits. Successful outcomes, like all medical management, depend on good clinical skills linked with an understanding of the nature of injury, inflammation, repair, pain, and the mechanism of laser and LED effects.”
That’s good stuff I think you’d all agree.
And then there’s this paper from 2003 we will cover quickly. It’s called “Efficacy of low power laser therapy and exercise on pain and functions in chronic low back pain” and written by A. Gur, et. al.. It was published in Lasers in Surgery and Medicine(Gur A 2003). I do dislike including papers from 15 years ago since lasers and technology change rapidly these days, however, my thought process is that, hopefully, treatments become even more effective over the course of 15 years rather than less effective.
Why They Did It
The authors were trying to decided whether cold laser was effective (or was not effective) for treating chronic low back pain.
How They Did It
- 75 patients
- The outcome assessments were done through the visual analogue scale, the Schober test, through flexion and lateral flexion measures, through the Roland Disability Questionnaire, and through the Oswestry Disability Questionnaire.
- The measures were taken pre- and post-treatment.
What They Found
Except for lateral flexion specifically, significant improvement was noted in all groups and in all outcome measures taken.
Wrap It Up
The conclusion by the authors was, “Low power laser therapy seemed to be an effective method in reducing pain and functional disability in the therapy of chronic LBP.”
Key Takeaways this week:
I don’t care what the insurance companies say about cold laser being experimental and investigational. Cold laser is not a “chiropractic thing” and practitioners of all shapes, sizes, and professions are using it including dentists and surgeons. While there are some papers that aren’t positive, heterogeneity and styles and techniques make it difficult. However, the majority of papers on cold laser are very much positive and show effectiveness including those published in The Lancet.
Walk forward in your practice knowing that you are getting your patients better with cold laser and you are helping make a difference in their lives.
Going forward this week, Retweet us, like our page on Facebook, and SHARE us on Facebook so we can get those likes up and increase listenership and involvement. We need every bit of your help to do that. I can’t do it alone.
I want you to know with absolute certainty that When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.
When you look at the body of literature, it is clear: research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good to excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.
Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!
If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic evidence-based podcast in the world.
We cannot wait to connect again with you next week. From Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Social Media Links
- https://www.facebook.com/chiropracticforward/
- https://twitter.com/Chiro_Forward
- https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes
- https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Bibliography
- Chow R (2009). "Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials." Lancet 374(9705): 1897-1908.
- Cotler H (2015). "The Use of Low Level Laser Therapy (LLLT) For Musculoskeletal Pain." MOJ Orthop Rheumatol 2(15).
- Gasperini G (2014). "Does low-level laser therapy decrease swelling and pain resulting from orthognathic surgery?" Int J Oral Maxillofac Surg 43(7): 868-873.
- Gur A (2003). "Efficacy of low power laser therapy and exercise on pain and functions in chronic low back pain." Lasers Surg Med 32(3): 233-238.
- Subash Chandra Bose GN (2018). "Spinal manipulation combined with laser therapy is more beneficial than laser therapy alone in chronic non-specific low back pain. A randomized controlled study." Euro J Phys Rehabil Med.
In today’s podcast, we are going to talk about the crazy, run-away healthcare spending in America and we’re going to use an article straight from the leading authority, the Journal of the American Medical Association, to help us out.
Right now though, it’s time for bumper music!
Music
Before we get started, I want to share with you how much have enjoyed getting this podcast up and running. I strongly doubt it’s as popular as the other great chiropractic podcasts that have been up and going for a couple of years now. Heck, Chiropractic Forward has just been going since December so, at this point, one would expect for us to still be trying to gain attention and trying to gain some ears. And…..we are. No doubt.
But I can say that is has been pure joy to look up the downloads for each episode and seeing that, no…..its not just me that finds this stuff fascinating. Lol. You guys and gals are starting to listen and starting to pay attention. We’re still struggling for those like and retweets on Twitter. That’s the frustrating part if I’m being honest. To KNOW that you have put together an effective article on how chiropractors do not cause strokes and then to have such a hard time getting the word out. It’s frustrating to be sure but it’s also part of building something new and exciting. So, I will simply continue to remind you that we need your help if we are to make a difference and I will keep reminding you to like our Facebook page, follow us on Twitter, sign up for our weekly reminder newsletter through the form on our homepage, and share us with your network. We would certainly appreciate that help. Some of you may have actually gotten to see me arguing the stroke issue on our Facebook page. My gosh, some people, you could hit them with a research book full of papers in your favor and some would still argue just to try to prevent being wrong. Not only do I get to argue about stroke or whatever the topic may be, it always strays into generalize ignorant statements like, “Chiropractic is bunk.” I can use research to absolutely wipe the floor with people like that. And, the irritating thing is that the people, or trolls spouting off like that are usually computer majors, musicians, or something else completely removed from healthcare. It is enough to make a man insane if you allow it. So I don’t. Anyway, check us on Twitter and Facebook. Every now and then, you may find an enthusiastic discussion. lol. To say the least.
Since I haven’t yet, I’ll introduce myself, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. That’s a tall order but that is the goal.
You have shaked, shimmied, and rolled into Episode #21
I’d like to start by saying that it is good to see the medical world beginning to examine itself with a clear lens. We have seen them turn blind eyes to many things we notice and research notices. As we have mentioned, there has been little attention given to the updated recommendations in favor of chiropractic, massage, and acupuncture in February of 2017. It is yet to be known what, or if anything, will change following the series of low back pain papers recently published in The Lancet (March21, 2018).
I have been mentioning how I feel that the opioid crisis has opened many many doors recently in regards to the medical field, clinical pathways, and in they way they are starting to look at the costs. Kudos to those in the medical field for beginning to call out their own protocols and questions them for effectiveness vs. risk. Some procedures may be effective here and there but, in general, if the squeeze is not worth the push, then there is little to zero return on investment and it should be abandoned. Obviously, one’s health is different than a business stat sheet but the metaphor is a valid one I believe.
Obamacare was supposed to heal all of our healthcare woes, right? From what I can tell, all it did was squeeze out the middle class. The folks that make too much to be subsidized but do not make enough to not really care about the new jacked health insurance rates.
For example, the premiums here in Texas have doubled or tripled in many cases while the insurance companies cover less and less. The co-payments have gone from $15-$20 all the way up to $50 and even $100. The deductibles have gone from $250 or $1,000 all the way up to $5000 or $10,000. In addition, the insurance companies are now reimbursing healthcare providers less. in many cases, 3/4 less.
Did you know that here in Texas, where a medical radiologist was once reimbursed up to $28+ or so for reading a neck series, they now get paid in the ballpark of $7 for the same series? I promise the doctors are not living less of a life than they were prior to Obamacare. Not at all. But, what is likely happening unconsciously is they are probably reading more x-rays more quickly to attempt to make up for the reduction in their pay.
Would you agree that this may put patients at more risk? I’m not saying doctors make a conscious decision to put patients at risk but, if a professional in ANY industry has a house in town, a house and boat on the lake, 3 cars, time share on a private plane, and things of that nature, when their income is cut by 3/4 in some cases, they will tend to find ways to make that up in ways that make sense to them. Regardless of profession or industry.
Maybe Obamacare just makes them more efficient rather than raising the patient risk. I do not have the answer on this but I do know that radiologists are responsible for everything on a film and their license is at risk on each and every film. When the government cut their pay that dramatically, the government began putting people at more risk. In my opinion of course.
I am firmly on the side of the medical field on this issue. The same type of thing is currently happening with the chiropractic industry as well. We are being reimbursed at smaller and smaller rates. We are seeing our covered patients being turned into cash patients whether we like it or not. The co-pays and deductibles are so high, the could just as easily be cash patients for our purposes. For this very reason, you are seeing more and more chiropractors in America begin to look at changing over to a cash-based practice model and drop insurance contracts all together.
I’m not certain every bit of this discussion is completely on topic but let me tie it up and bring it home through the use of this research paper. This paper appeared in the Journal of the American Medical Association (JAMA) on March 23, 2018. It was titled “Health Care Spending in the United States and Other High-Income Countries” and was authored by Irene Papanicolas, PhD (Papanicolas I 2018).
Why They Did It
Healthcare spending in America is a long-time hot topic and issue that has never been adequately addressed. Part of the problem is that we Americans spend more than other high-income countries with little information that shows that any efforts to control expenses has done anything to help the problem.
These authors attempted to compare the big ticket items in healthcare in America with the same items in ten other high-income countries in an attempt to learn where improvement might be made here at home.
How They Did It
Information was mostly gained from the Organization for Economic Cooperation and Development (OECD) from 2013-16. The OECD is an international organization comparing underlying differences in structural features, types of health care and social spending, and performance for several high-income countries.
What They Found
- In 2016, America spent 17.8% of its gross domestic product on healthcare while the other 10 nations spent from 9.6%-12.4%.
- Surprise, surprise….pharmaceutical costs spending per capita in American was $1443 vs. from $466-$939 in the other 10 countries. American doctors and patients love those pills.
- 90% of Americans are insured while 99%-100% were insured in the other 10 countries.
- The U.S. has the highest proportion of private insurance when compared to the other 10 countries, which is 55.3%.
- When it comes to smoking, Americans actually have the second lowest rate sitting at 11.4%
- When we talk about obesity, the US has the highest proportion at 70.1%. Others range from 23.8%-63.4% for comparison purposes.
- The US life expectancy was the lowest at 78.8 years.
- US infant mortality was the highest rate of the 11 countries.
- There was no real difference in the American physician workforce, nurse workforce, etc., when compared to the other 10 countries.
- America has comparable numbers of hospital beds
- Americans use MRIs and CTs when compared to the other 10 countries.
- The US had similar rates of utilization for acute myocardial infarction, pneumonia, chronic obstructive pulmonary disease, hip replacements, knee replacements, and coronary artery bypass graft surgery.
- Administrative costs of care in American stood at 8% while the same measure in the other 10 countries ranged from 1%-3%.
- Salaries of physicians and nurses were higher in the US; for example, generalist physicians salaries were $218 173 in the US compared with a range of $86 607 to $154 126 in the other countries.
Wrap It Up
The authors of the paper concluded that, “The United States spent approximately twice as much as other high-income countries on medical care, yet utilization rates in the United States were largely similar to those in other nations. Prices of labor and goods, including pharmaceuticals, and administrative costs appeared to be the major drivers of the difference in overall cost between the United States and other high-income countries"
My own wrap up would be that America spends twice as much money on healthcare while we have the highest rate of obesity, double the mount of pharmaceuticals, lower life expectancy, higher infant mortality, and higher administrative costs when we are compared to 10 other countries of similar income.
That’s not good, folks. Not good at all. When do the pharmaceutical companies stop controlling the medical profession and the medical profession turn it around to control the pharmaceutical companies? When does that happen exactly?
Did you know that, from 1948 until 1996, there was a TV ban on running liquor ads? You may see beer or wine ads but you would never see Jim Beam running a commercial between Alf and Different Strokes. But, how often do we see pharmaceutical ads on TV these days? It’s a shame to be honest. Shouldn’t the doctor be the one that is informed on medications rather than a 320 million people that are almost completely uneducated on pharmaceuticals? Should patients be going into doctors’ offices ready to pressure them into a certain medication because they saw it on TV?
It is absolutely insane and should have been stopped at the first mention of it. To make it fair or legal or whatever may be the case, they state a long laundry list of all of the things that may happen to you if you take it. But, the information is delivered and people are influenced.
If a patient goes in for something like erectile dysfunction, the doctor tells them what they need. They don’t tell the doctor!! Do you see the problem here? If the patient goes in for potential blood clots, the doctor should be telling them they need a certain type of thinner. That is not the patient’s place in any country on the entire planet.
Not only do the pharma companies control patient mentality in this way but they attempt control of the physicians. Pharma reps are skilled at what they do. They are highly trained and very well-paid to effect influence in their market’s physicians. They take them on dinners, bring the office lunches, pay for trips, etc. You can spot them at any doctor’s office you go to. Just look for the well-dressed person in the waiting room with a clip board and a bag of goodies. That’s them!
I had a general practitioner that I had to finally fire. I had been living a bit unhealthy for several months when I went for a yearly checkup. My blood pressure was high. He immediately tried to put me on life-long meds. I was overweight and drank a 12-pack of Bud Light here and there while traveling in a band playing music. You might say that I used to be a little bit ornery. Again, I was admittedly behaving badly. His diagnosis was that I was depressed and needed an anti-depressant. Really?
Instead of trying some behavior modification, according to him, I needed life-long blood pressure meds and life-long antidepressant meds. Where does this mentality come from? What if we treat the CAUSE rather than the SYMPTOM?
First, I lost weight and started to behave. Guess what? My blood pressure returned to normal. As a result of ceasing traveling in a band, I basically quit drinking beer outside of social events. Boom! I was no longer depressed according to his definition.
This may seem like an extreme example to some but, it is my estimation that this sort of “doctoring” and “pill pushing” is far more common than one may even dream.
I am in no way against the medical field or against surgery or against medicine. I am against simple pill fixes. I’m against long-term meds when not needed. There are some conditions like diabetes or genetic high blood pressure that require long-term meds but, in many cases, they should be avoided. I’m against the medical field performing shots and surgeries and using opioids for musculoskeletal pains when the research is clear when it recommends chiropractic, massage, etc.. for those pains.
Basically, the medical field needs to stop thinking the pills are the be all - end all of healthcare and start looking more to the cause rather than just treating the symptoms. The physicians need to take the reins of their profession away from the pharmaceutical companies and wield the power over pharma that they attempt to wield over chiropractic and other alternative means of healthcare.
Enough about them for this episode. I want you to know with absolute certainty that When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.
When you look at the body of literature, it is clear: research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good to excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.
Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!
If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic evidence-based podcast in the world.
We cannot wait to connect again with you next week. From Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Bibliography
Papanicolas I (2018). "Health Care Spending in the United States and Other High-Income Countries." JAMA 319(10): 1024-1039.
Chiropractic: Evolution or Extinction?
This week on the Chiropractic Forward Podcast, I want to continue with discussions on low back pain (LBP) because that is the topic that is on fire at the moment. Not only that but I will go into some of the inter-professional feuding we find in the chiropractic industry and we will touch on some admittedly uncomfortable topics for some chiropractors.
First, bring on that bumper music!
Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast where we talk about issues related to health, chiropractic, evidence, chiropractic advocacy, and research. Thank you for taking time out of your day I know your time is valuable and I want to fill it with value so here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.
You have shimmied right into Episode #20. It’s hard to believe all of this craziness started 20 weeks ago. It feels like I’m still trying to get it figured out. That’s for sure.
I just returned from a trip to New Orleans. Did you know that New Orleans is actually good for you?
The momentum low back pain has picked up recently is a once in a lifetime re-booting of an entire thought process, of long-held clinical pathways, and of stubborn practitioner mentality and dogmatic beliefs.
I blame the national emergency we know as the “Opioid Crisis” for starting a more focused attack on low back pain. The statistics on low back pain are some incredible numbers. It’s the number one reason for disability in the world. That is truly impressive. However, low back pain as a global issue did not crop up in only the last several years. Granted, due to an older, aging population, it has increased but low back pain has been a serious concern for many years at this point.
Yet, there were no global papers on low back pain. There were no articles in the journals for the American Medical Association and for the American College of Physicians recommending spinal manipulation (chiropractic adjustments) as an effective, first-line treatment for low back pain. We have simply never seen the attention based on the research that we have seen since the onset of the opioid crisis.
One must give kudos to the medical field in the sense that they recognize they have been partly the cause of the opioid crisis and, in turn, are taking steps to address the problem through new thinking and alternative means. Even if that means going against old dogmatic beliefs and against the common grain. I applaud the new directions. Although, there is still a very clear gap that will take time to fill in regards to what the practitioner is doing and what they SHOULDbe doing.
We recently discussed a series of papers in The Lancet from March 21, 2018 that dealt with low back pain. The Lancet is one of the oldest and most respected medical journals in the world dating back to 1823 and the series of papers was compiled by an international, interdisciplinary group of experts. It is considered the best current information we have dealing with low back pain, it’s prevention, and going forward. I highly encourage you to read through the papers.
Since it would get a little boring going over the same three papers over and over, I am going to move along with other research and other information concerning low back pain.
I want to start with a paper that echoes the sentiments of The Lancet series in regards to the gap in what the evidence suggests and in what is actually happening in the real world. In all actuality, from here forward, I believe most of what we discuss on the topic of low back pain will somewhat echo the sentiments found in the recent Lancet papers.
Moving on, the papers we will discuss are arranged strategically and tell a story if you follow along.
To start, here is a paper from 2010 titled “Managing low back pain in the primary care setting: the know-do gap.” It was published in Pain Research & Management and authored by NA Scott, et. al. with the Institute of Health Economics in Edmonton, Alberta, Canada.
Why They Did It
The goal for these authors were to identify gaps in knowledge in regards to diagnosis of acute and chronic low back pain in a primary care clinical setting for primary practitioners in Alberta, Canada in order to further determine what barriers lie in the way of the primary practitioners adopting a multidisciplinary approach in the treatment process.
How They Did It
- The authors accepted papers from 1996-2008
- The papers compared clinical pathway patterns found in the primary practices and in the guides and recommendations found through searching literature databases, websites of various health technology assessment agencies, and libraries.
- The data was organized qualitatively.
What They Found
The search for quality papers yielded 14 that were considered relevant.
Knowledge gaps were identified in the primary practices for red flags, imaging use, advice for bed rest and sick leave for low back pain, medications, and recommendations of alternative treatment means such as chiropractic, acupuncture, physiotherapy, etc.)
Wrap It Up
The authors stated that a “know-do” gap certainly exists. Meaning, there is a difference in what the research is telling primary practices to do for low back pain and in what they are actually doing in the real world. The authors plan to use this information to develop a plan to implement more multidisciplinary protocols for low back pain by educating the primary practitioners on the guides and recommendations[1].
If we are to talk about the “Know-do” gap, what a common result of there being a gap in knowledge of diagnosis and treatment when compared to actual researched guides?
To help shed some light on this, let us look at a paper from March of 2018 by Richard Deyo, et. al. at the Department of Family Medicine at Oregon Health Science University in Portland, Oregon. This paper is titled “Use of prescription opioids before and after an operation for chronic pain (lumbar fusion surgery)”
Why They Did It
Considering low back fusion surgery is typically performed to treat chronic low back pain, and considering that patients have the expectation of no longer needing opioids after a surgery, the authors were looking to discover three things:
- What amount of patients having long-term preoperative opioid use discontinued or reduced dosage after surgery?
- What amount of patients having had a smaller amount of preoperative opioid use initiated long-term use?
- What predicts whether a patient goes on to use opioids in the long-term after surgery?
How They Did It
- This was a retrospective cohort study
- There were 2491 participants that had undergone lumbar fusion surgery to treat degenerative conditions.
- The researchers used Oregon’s prescription drug monitoring program to determine pre-op and post-op use of opioids by the test subjects.
- Long-term use was defined as more than 4 prescription refills 7 months after hospitalization. At least 3 occurring more than 30 days after hospitalization.
What They Found
- 1045 patients were identified as having long-term opioid use PRE-operatively
- 1094 were determined to have had long-term opioid us POST-operatively.
- From the long-term PRE-op patients, 71% continued long-term in POST-op use and 13.8% experienced episodic opioid use.
- A mere 9.1% of the long-term PRE-op patients had short-term use POST-op.
- In the group of patients that received no preoperative opioids, 12.8% went on to use opioids long-term.
Wrap It Up
This paper suggests that the strongest predictor of whether a patient would use opioids long-term was the cumulative effect of PRE-op opioid doses. The paper also suggests that lumbar fusion surgery commonly had no effect on eliminating long-term opioid use so patients that are unaware of the risks of opioid use run a risk of long-term use[2].
While I’m no orthopedic surgeon, I would ask, “Why are they doing lumbar fusions on stable segments in the first place considering the research showing that it should be a treatment of last resort?”
It should come after spinal manipulation, acupuncture, massage, exercise rehab, physiotherapy, cognitive behavior therapy, yoga, etc….. That is A LOT any sort of surgery should typically follow so why? Of course, I’m not making the money those folks make so, that may be the decision maker for some of them at least.
Moving from things going wrong to ways they can go right, there is this paper from the journal Pain from March 27, 2018 titled, “Spinal Manipulation and Exercise for Low Back Pain in Adolescents: A Randomized Trial by R. Evans, et. al. with the University of Minnesota’s Integrative Health and Wellbeing Research Program. As a side note, Gert Bronfort was also listed as an author in this paper. If you are unfamiliar with Bronfort, he has authored several key papers previously.
Why They Did It
The authors state that there is a “paucity” in high quality research on the matter of exercise vs. spinal manipulative therapy in the treatment of low back pain.
How They Did It
- The research was a multicenter, randomized trial
- 185 adolescent were included
- The participants ranged in age from 12-18 years old
- All had chronic low back pain
- Outcome assessments were measured at 12 weeks, 26 weeks, and at 52 weeks
What They Found
- The inclusion of spinal manipulative therapy (chiropractic adjustments) to exercise therapy had a greater effect on the reduction of low back pain severity over the course of a year.
- At the 26-week mark, the spinal manipulative therapy with exercise group had better effectiveness for disability and improvement over the exercise alone group.
Wrap It Up
The spinal manipulative therapy with exercise group had a significantly greater satisfaction with care at all time points. “There were no serious treatment-related adverse events. For adolescents with chronic LBP, spinal manipulation combined with exercise was more effective than exercise alone over a one-year period, with the largest differences occurring at six months. These findings warrant replication and evaluation of cost-effectiveness[3].”
We chiropractors have to love that paper now, don’t we?
Next, let’s look at a different level of recovery that deals with the way patients think as much as the treatment they undergo. Here is an article that appeared in HealthDay called “Overcoming Fear of Back Pain May Spur Recovery” by Steven Reinberg. The article was based on a recent paper that appeared in JAMA Neurology in April 16, 2018 published by lead researcher Anneleen Malfliet. It is usually wise to at least listen up when it’s in journals such as The Lancet or in the Journal of American Medical Association.
The research paper being cited once again echoes much of the sentiment laid forth in The Lancet low back series. Basically, their recommendations were as follows:
- We need to help patients think differently about their pain.
- We need to encourage patients to move in ways they had been afraid of.
- We need to teach patients with neck and back pain to remain active and/or increase their activity level gradually.
- We should avoid the use of scary or un-reassuring labels or diagnoses.
- We should not use pain levels as a reliable symptom or guideline to limit activity.
In short, research proved that patients following these guidelines showed less disability, a reduced fear of moving, and improvement in mental and physical outlook.
“Pain neuroscience education aims to change patients' beliefs about pain, to increase their knowledge of pain and to decrease its threat,” Malfliet said[4].
Be sure to read the full article at: https://consumer.healthday.com/bone-and-joint-information-4/backache-news-53/overcoming-fear-of-back-pain-may-spur-recovery-732970.html
Now that we chiropractors are taking the step more and more into the spotlight as the experts in the treatment of biomechanical issues, what can we do on our end to ensure our colleagues can confidently refer to us and see us as peers for these issues?
I can tell you that, being in the ER one night as a result of a viral infection, not only was the virus running crazy through me but my neck was killing me as well. I thought I would ask the ER doc if he had any orthopedic exam up his sleeve that could determine what on Earth was hurting me so bad. Between you, me, and the light post, I already had a good idea but was curious as to what he knew and I thought it may be something that both of us could learn from.
It was. He did a Spurling’s move and that was about it before he gave up and said, “Honestly man, you probably know what’s going on better than I do.” And he was right. I did. But, it showed me that he was honest and that he saw me as an expert in my field and I appreciated it. Of course, he’s more of an expert in his field which is why I was there in the first place. We all have our part to play in the treatment of patients. Don’t we?
Back to my original point: how do we increase our profile as spinal, biomechanical experts. How do we increase interdisciplinary, inter-professional trust in who we are and what we can do for our patients?
I can tell you what NOT to do if that helps anything. I do not see any use chiropractic terminology that our colleagues do not understand. I personally do not use the term subluxation. In the dictionary, it is described as a partial dislocation. What does that mean in the medical mentality? It means a shoulder that was almost dislocated but reduced naturally. It means something along those lines. It does not mean a slight misalignment of a vertebra that causes cancer or whatever other conditions some describe.
I understand chiropractors wanting to stay separate and distinct. I get it. But, there is a difference between being separate and distinct and putting yourself in a category nobody understands, that everyone thinks is out on the fringe, and that nobody knows exactly how to utilize.
If our profession is not careful, it will separate itself into oblivion now that physical therapist, physiotherapists, and the medical world in general have discovered something we have known all along. That is that spinal manipulation and mobilization is one of the best and most effective means of treating neck and back pain.
What has kept us safe from them taking our business all of these years is that they all thought we were crazy! For some, they were right but the basic principle our profession is based on was one that evidence eventually backed up and proved. Now we are in danger of losing it if we do not learn that separate and distinct may not be the most effective means of conducting our business.
The last paper I want to discuss is one called “How frequent are non-evidence-based health care beliefs in chiropractic students and do they vary across the pre-professional educational years” by Stanley Innes, et. al. It was published in Chiropractic & Manual Therapies in March 15, 2018.
Why They Did It
The authors wanted to determine what proportion of chiropractic students in Australia hold non-evidence-based beliefs from the start and what their beliefs are in the treatment of non-musculoskeletal health condition. In addition, the authors wanted to determine if the beliefs changed any over the course of their education.
How They Did It
- The study was performed in 2016
- The information was taken from two chiropractic schools in Australia
- The students answered a questionnaire with the following questions
- How often would they give advice on five common health conditions in their future practices
- What was their opinion about if chiropractic spinal adjustments could prevent or help seven health-related conditions.
- There were 444 responses to the questionnaire
What They Found
- Students were highly likely to offer advice on non-musculoskeletal health conditions.
- The chances of a student doing so rose to the highest level in the last year of their education.
- High numbers of students held non-evidence-based ideas of the capabilities of chiropractic spinal adjustments in beginning which then tended to decrease in proportion until the last year. In the last year, the pattern reversed.
Wrap It Up
The authors were quoted as saying, “New strategies are required for chiropractic educators if they are to produce graduates who understand and deliver evidence-based health care and able to be part of the mainstream health care system[5].”
I want you to know that I am a chiropractic advocate. I want chiropractors to practice how they wish. I want the minimal practices to be comfortable and be as stripped down and as effective as they can be. I want the interdisciplinary doctors to do everything they can do to get people well and make a difference in lives. But I want them to do things in a way that is backed by science, that brings us to the center of healthcare rather than the fringes, I want us using terminology and ideas that garner confidence and respect rather than ridicule and scorn, and I want us all to thrive and prosper while we grow our incredible profession.
There will always be an internal feud amongst chiropractors. Likely, some of my close colleagues whom I respect immensely will take offense to what I am saying and to them, I can only say, “I’m sorry but it’s the way I feel about it and it’s the way I see it.” Thank God we are all different. The same would be boring.
A colleague of mine told me he feels that philosophy and science can live hand in hand. I want to believe that too. I hope it is true. But, what I do know for a fact is that, if we do not take this once-in-a-lifetime opportunity that opioids and low back pain has presented us, and move toward better integrating ourselves with the medical profession, I fully believe we will have our techniques and treatment stolen from us and we will cease to exist in our current form.
One constant you can always count on in life is change. I hope the inner-professional feuding does not keep change from happening quickly and in the right direction.
When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.
Did you know that research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic? Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health!
Please feel free to send us an email at dr dot williams at chiropracticforward.comand let us know what you think or what suggestions you may have for us for future episodes.
If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic evidence-based podcast in the world.
We cannot wait to connect again with you next week. From Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
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https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
References
- Scott NA, Managing low back pain in the primary care setting: the know-do gap.Pain Res Manag, 2010. 15(6): p. 392-400.
- Deyo R, Use of prescription opioids before and after an operation for chronic pain (lumbar fusion surgery).Pain, 2018.
- Evans R, Spinal Manipulation and Exercise for Low Back Pain in Adolescents: A Randomized Trial.Pain, 2018.
- Malfliet A, Effect of Pain Neuroscience Education Combined With Cognition-Targeted Motor Control Training on Chronic Spinal Pain
A Randomized Clinical Trial.JAMA Neurology, 2018.
- Innes S, How frequent are non-evidence-based health care beliefs in chiropractic students and do they vary across the pre-professional educational years.Chiropr Man Therap, 2018. 26(8).
Podcast Episode #19
Non-Opioid More Effective While Chiropractic Maintenance May Be The Most Effective
This Chiropractic Forward podcast this week is a bit of a mishmash of a couple studies that will ultimately intertwine into a valid discussion. The papers we will go over cover Chiropractic preventative care ideas and what research has to say about it and then we’ll talk about opioids vs. non-opioids research out of Minnesota and I’m going to issue a warning and maybe even a challenge as we go through it all.
Right now though, it’s time for bumper music!
Music
Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast where we talk about issues related to health, chiropractic, evidence, chiropractic advocacy, and research. Thank you for taking time out of your day I know your time is valuable and I want to fill it with value so here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.
Before we get started, I want to draw your attention our website at chiropracticforward.com. Just below the area where you can listen to the latest episode, you’ll see an area where you can sign up for our newsletter. I’d like to encourage you to sign up. It’s just an email about once a week to let you know when the episode is updated and what it’s about. Also, if something brand new pops up, we’ll be able to tell you about it quickly and easily.
You have moonwalked into episode #19. I hope you have enjoyed the previous episodes. Particularly the last six which were a part of a series all debunking the “Chiropractors Cause Strokes” myth and then another series of podcasts reviewing the lancet articles on low back pain. The Chiropractic profession NEEDS you to share those 6 episodes in particular
Now, since we have covered the impact of the opioid crisis exhaustively, I will cover it only briefly for reference purposes.
- Low back pain is the single leading cause of disability worldwide.
- 8 out of every ten people will experience back pain. I will admit that I have never met anyone in 45 years of life on this Earth that fits into the 20% that apparently never suffers from any low back pain.
- Back pain is the second most common reason for visits to the doctor’s office right behind upper-respiratory infections.
- With such gains and leaps in the medical industry as far as treatment goes, low back pain is stubbornly on the rise.
- More than half of Americans who experience low back pain spend the majority of the work day sitting. 54% to be exact.
- Did you know that an equal number of patients first seek help with a chiropractor as seek help with a medical practitioner for back pain?
- Back pain in general costs $100 billion dollars every year when you factor in lost wages and productivity, as well as legal and insurance overheads.
Should there be any doubting the necessity of non-pharmacologic treatments for low back pain at this point, then a person is simply beyond help. We can only refer you to a report from the Executive Office of the President of the United States’ report titled “The Underestimated Cost of the Opioid Crisis” put forth by the Council of Economic Advisers in November of 2017[1].
That reminds me, that paper citation as well as any others we talk about here will be in the show notes so always check out www.chiropracticforward.comfor those show notes.
The report paints a fairly complete picture of this national crisis. The medical field helped create the national crisis. Now, will they help put the fire out? It seems the answer to that question is, “Yes!”
Now that the nation and the medical field understand the danger of opioids, we are certainly starting to see an increase in research having to do with opioids. A brand new paper of particular note was published March 6, 2018 in JAMA, performed by Dr. Erin Krebs, MD, et. al. and is titled “Effect of Opioid vs. Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain. The SPACE Randomized Clinical Trial [2].”
Why They Did It
The authors of this paper wanted to test opioids vs. nonopioids over a time span of twelve months for function, pain intensity, and adverse effects.
How They Did It
- 240 subjects
- 12-month trial
- Randomized with masked outcome assessments
- Test subjects experienced moderate to severe chronic back, hip, or knee osteoarthritis pain despite analgesic use.
- Interventions tested were opioids and nonopioids
- The first step of the opioid group included immediate-release morphine, oxycodone, or hydrocodone/acetaminophen
- The nonopioid group’s first step was acetaminophen or a nonsteroidal anti-inflammatory drug.
- Medication was changed and/or adjusted within each group according to patient response.
- The main outcome assessment used was Brief Pain Inventory (BPI) scale.
What They Found
- 240 subjects completed the trial
- There was little difference between the two groups in terms of function over the course of the 12 months of testing.
- Pain intensity was actually much more improved (statistically significant) in the NONopioid group.
- Adverse harms (bad side-effects) were significantly greater in the opioid group.
Wrap It Up
The authors’ conclusion was, “Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months. Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.”
Again, I don’t wish to belabor a point we have covered several times but, for the purpose of this discussion, we must mention them. The medical field is stepping up to the challenge slowly but, I would argue significantly. The American College of Physiciansupdated their treatment recommendations for chronic and acute low back pain just last year. In the report[3]they recommended spinal manipulation prior to taking ibuprofen or other over-the-counter NSAIDs for low back pain. One month later, in JAMA (the journal for the American Medical Association) there was a paper demonstrating the effectiveness of spinal manipulative therapy[4]. IN JAMA!!The significance of this cannot be overstated.
Next, let us talk a little bit about chiropractic treatment for low back pain, what it looks like, and whether maintenance care really makes any sense. that recommend preventative (AKA Wellness Care) to their patient bases.
Let me start by stating my opinion and the opinion of most evidence-based chiropractors I would assume: active, complaint-focused treatment should have a start and it should have an end. Plain and simple, cut and dry.
If a patient is coming in for a complaint such as neck pain, the practitioner should decide whether the pain is acute, subacute, or chronic and, based on history and exam findings, be able to give some good, responsible recommendations for the treatment of the complaint. Typically, the acute schedule will be shorter in terms of treatments and time vs. a chronic condition. A chronic condition is more difficult to treat and one would reasonably expect the schedule for a chronic condition to be longer and more intense. The CCGPP guides[5]can be useful for this sort of decision-making.
Treatment recommendations aren’t always dependent on the date of injury. For example, Medicare has broken down how they value diagnosis codes into groups A-D. In their system, the secondary diagnosis codes can be the difference between seeing a patient only 12 times or as much as 30 visits for a specific complaint. A simple low back pain diagnosis or muscle spasm diagnosis garners 12 visits from Medicare while degeneration of lumbar intervertebral disk or lumbar spinal stenosis will indicate up to 30 visits for treatment.
In the personal injury world, according to the Quebec Taskforce on Whiplash Associated Disorders, if a patient is assessed with a Grade III whiplash, assuming complications, they can be treated up to 76 visits over 56 weeks. That’s a lot of treatment but the length of treatment reflects the severity of injury as a Grade III whiplash is associated with ligament tearing and/or neurological findings.
For more information on general guides for practice protocol, please reference a previous blog of ours on the topic at https://www.amarillochiropractor.com/valuable-reliable-expert-advice-clinical-guides-practice/or listen to our podcast at http://www.chiropracticforward.com. The guides can be found in Episode #5 which can be found at this link: http://www.chiropracticforward.com/2018/01/18/cf-episode-5-valuable-reliable-expert-advice-on-clinical-guides-for-your-practice/
What does all of that have to do with wellness care? The point being made is that there are a lot of different chiropractors. Seventy thousand plus in America alone and, although there are guidelines out there, chiropractors do not typically seem to have a general overall desire to implement them. One chiropractor may tell you that they will need to see a chronic neck pain patient 50 visits a year to clear it up while another may see the same condition for 18-20 visits. This is not only frustrating for chiropractors, it’s highly frustrating for patients as well.
Then consider that there is a common chiropractic misconception by potential patients out there in the world that, if you go to a chiropractor, you will always have to go. For the rest of your life!
Of course, this is not true but, don’t chiropractors commonly recommend preventative or wellness care that may resemble “rest of your life” care? It’s my opinion that once a complaint resolves, patients should see their chiropractor once a month. Minimally, they should be seen once every two months. That is my opinion. I will find more than a handful of chiropractors that will disagree with me on both ends of the spectrum but the key to the idea is “preventative wellness” care in some sort of ongoing fashion.
There is research for preventative/wellness care. Take a paper from 2011 for example. It is by MK Senna, it’s titled “Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome?”and was published in the prestigious Spine journal[6]. For the purpose of this study, keep in mind that SMT stands for spinal manipulation therapy. Also of special note is that chiropractors perform over 90% of SMTs in America so I commonly interchange SMT or spinal manipulation therapy with the term “Chiropractic Adjustment.”
Why They Did It
The authors of this paper wanted to check how effective spinal manipulation, also known as chiropractic adjustments, would be for chronic nonspecific low back pain and if maintenance chiropractic adjustments were effective over the long-term in regards to pain levels and disability levels after the initial phase of treatment ended.
How They Did It
- 60 patients having chronic low back pain of at least six months duration
- Randomized into three different groups:
- 12 treatments of fake treatment for one month
- 12 treatments of chiropractic adjustments for a month only
- 12 treatments for a month with maintenance adjustments added every 2 weeks for the following 9 months.
- Outcome assessments measured for pain and disability, generic health status, and back-specific patient satisfaction at the beginning of treatment,
What They Found
- Patients in groups 2 and 3 had significant reduction in pain and disability scores.
- ONLY group 3, the group that had maintenance adjustments added, had more reduction in pain and disability scores at the ten-month time interval.
- The groups not having maintenance adjustments, pain and disability scores returned close to the levels experienced prior to treatment.
Wrap It Up
The authors conclusion is quoted as saying, “SMT is effective for the treatment of chronic nonspecific LBP. To obtain long-term benefit, this study suggests maintenance SM after the initial intensive manipulative therapy.”
Considering this research, it appears plausible, if not obvious, that chiropractic care in a long-term maintenance use, is indeed effective in treating patients with chronic low back pain.
For my own wrap up this week I would say simply this:
- Low back pain is a significant issue for Americans
- It is one of the biggest reasons people get hooked on opioids
- As shown above, opioids are no more effective than non-opioids so why would anyone use them?
- Chiropractic has been shown superior to nonopioids (specifically Diclofenac[7])
- The big boys of the medical field (ACP and AMA) and the White House itself are recommending chiropractic for the treatment of low back pain before using even NSAIDs
So, why is this even in the discussionphase rather than the implementationphase? Why are we not inundated with low back pain patients at this very minute?
We have to go back to a different White House report that came out recently discussing the fact on page 57 of the report that although chiropractic has been proven effective, barriers to chiropractic treatment have been put in place by CMS and health insurance providers[8].
The specific wording is as follows: “A key contributor to the opioid epidemic has been the excess prescribing of opioids for common pain complaints and for postsurgical pain. Although in some conditions, behavioral programs, acupuncture, chiropractic, surgery, as well as FDA-approved multimodal pain strategies have been proven to reduce the use of opioids, while providing effective pain management, current CMS reimbursement policies, as well as health insurance providers and other payers, create barriers to the adoption of these strategies.” “The Commission recommends CMS review and modify rate-setting policies that discourage the use of non-opioid treatments for pain, such as certain bundled payments that make alternative treatment options cost prohibitive for hospitals and doctors, particularly those options for treating immediate post-surgical pain.”
It’s all there. It’s simple. All we can do is continue to tell everyone and beg for your help in telling everyone as well.
It is up to us to spread the good news and all it takes is hitting the Share button on social media. Retweet,
I challenge youto tell your people. It’s so easy but it takes a little initiative on your part. You actually have to do something now. Your profession is poised on the edge of stepping into a role it is uniquely able to fulfill and excel in but NOT unless we reach out and take that role and hold onto it.
Our effectiveness is proven. It’s time. Help us help you. I’m not asking for donations. I don’t want your money. I want your influence. So do us a favor if you will and share this information and, if it didn’t get the response you hoped for, share it again. Print out the parts of this article you find particularly effective and send it to medical practices in your area.
Make a difference.
Did you know that research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic? Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.
Please feel free to send us an email at dr dot williams at chiropracticforward.comand let us know what you think or what suggestions you may have for us for future episodes.
If you love what you hear, be sure to check out www.chiropracticforward.com. As this podcast builds, so will the website with more content, products, and chances to learn.
We cannot wait to connect again with you next week. From Creek Stone, my office here in Amarillo, TX, home of the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Source Material
- The Council of Economic Advisers, The Underestimated Cost of the Opioid Crisis. 2017: The Executive Office of the President of the United States of America.
- Krebs E, Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain
The SPACE Randomized Clinical Trial.JAMA, 2018. 319(9): p. 872-882.
- Qaseem A, Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians.Ann Intern Med, 2017. 4(166): p. 514-530.
- Page N, Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain.Journal of American Medical Association (JAMA), 2107. 317(14): p. 1451-1460.
- Baker G, Algorithms for the Chiropractic Management of Acute and Chronic Spine-Related Pain.Topics in Integrative Health Care, 2012. 3(4).
- Senna MK, Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome?Spine (Phila Pa 1976), 2011. Aug 15; 36(18): p. 1427-37.
- Wolfgang J, e.a., Spinal HVLA-Manipulation in Acute Nonspecific LBP: A Double Blinded Randomized Controlled Trial in Comparison With Diclofenac and Placebo.Spine, 2012. 38(7).
- The President's Commission on Combating Drug Addiction and The Opioid Crisis. 2017.
Review of The Lancet Article: Low back pain: a call to action (Part Three)
On the Chiropractic Forward podcast this week, we are going continue a review of a recent paper published on low back pain that we hope will have a powerful impact in the months and years to follow. This week it will be a review of paper #3 from the Lancet series.
Before we get started, I want to draw your attention our website at chiropracticforward.com. Just below the area where you can listen to the latest episode, you’ll see an area where you can sign up for our newsletter. I’d like to encourage you to sign up. It’s just an email about once a week to let you know when the episode is updated and what it’s about. Also, if something brand new pops up, we’ll be able to tell you about it quickly and easily.
Right now though, it’s time for bumper music!
Music
Welcome to the podcast today, you have strolled right into episode 17. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast where we talk about issues related to health, chiropractic, evidence, chiropractic advocacy, and research. Thank you for taking time out of your day I know your time is valuable and I want to fill it with value so here we go.
As I mentioned at the top of the show, this week, I want to continue with the series published in The Lancet on March 21, 2018. For a quick re-cap this week…. The Lancet is one of the oldest and most respected medical journals in the world. It has been around since 1823. In addition to the credibility of the journal, this series of papers dealing with Low Back Pain was compiled and authored by the leading experts on the matter globally. On top of that, the experts were a group of interdisciplinary practitioners which meant they ranged from medical doctors and PhD’s, to physical therapists and chiropractors.
Essentially, EVERYONE had a seat at the table so, it is the general consensus at this point that this series of papers is as current, as credible, and as accurate as can be had at this point in time and in our understanding of Low Back Pain.
The three papers were broken down as follows:
- What low back pain is and why we need to pay attention.
- Prevention and treatment of low back pain: evidence, challenges, and promising directions.
- Low back pain: a call for action.
Last week, we reviewed the first of the three papers which was titled, “What low back pain is and why we need to pay attention.” We went through it note by note and section by section trying to strip away the embellishments to simply boil it down to a leisure read and, hopefully, an enjoyable learning process.
We will do the same this week with the second paper of the series titled, “Prevention and treatment of low back pain: evidence, challenges, and promising directions.”
I want to start this week in the same way we started last week: by discussing how the papers were accomplished.
How They Did It
For this paper, again titled “What low back pain is and why we need to pay attention,” the researchers identified scientific studies through searches of databases:
•MEDLINE (PubMed)
•Scopus
•Google Scholar
•African Index Medicus Database
In order to ensure a high-quality standard, systematic reviews were shown preference for inclusion.
This week, we’re going to review the last of the three papers from a recent series published in The Lancet on March 21, 2018. If you don’t know the impact or why this series is so important, please review the last two episodes of the Chiropractic Forward Podcast at www.chiropracticforward.com or the last two articles of my blog over at amarillochiropractor.com/blog. That will get you up to speed. In short, the series on low back pain was compiled and authored by an international panel of experts on the matter. Essentially, the best of the best. This series is as up to date, as current, and as reliable as can be had at this point in our understanding for low back pain so it is worth your time and attention.
This last of the three papers is titled “Low Back Pain: A Call To Action.”
Summary
We have already covered several times that low back pain is now the leading cause of disability globally and is only growing in significance because the global population is living longer. The issue may be more profound in low to middle-income countries. In addition, most low back pain doesn’t even appear to be directly related to any specific trigger or origin. Some of the key areas for improvement for the treatment of low back pain are in health & workplace policies as well as disability benefits and payments. They claim they are wasteful and can certainly stand a re-boot. In many cases, patients are being restricted from attempting resolution of the back pain via conservative approaches such as self-management support, specialized interventions like spinal manipulations (I added that part) and multidisciplinary rehab.
The panel suggests the following:
- Address the political aspect. They recommend calling on the World Health Organization to make low back pain one of its priorities by putting it on the target list in an effort to increase attention and decrease treatment that is not recommended initially. They recommend calling on political, medical, and social leaders to make sure public health initiatives are properly funded and geared toward the prevention of low back pain and treatment.
- Change priorities - Make low back pain a priority. Create and implement ways to prevent it and combine these strategies with other strategies that are chronic and somewhat related. Strategies such as weighing the right amount, being active physically, and maintaining good mental health as well. These tactics treat more than simply low back pain. The panel also recommends strategies that can modify the factors putting the population at risk of developing low back pain.
- Change systems and change practice - Provide early recommendations for maintaining work load as much as possible and/or return to work as quickly as possible. Attempt to ensure early ID of people that are at risk of developing long-term, chronic disability as a result of low back pain. Address co-morbidities raising a person’s risk of developing low back pain and promote a healthier lifestyle in addition to altering disability benefits and get people back to work as soon as possible. And lastly, address low back pain through multidisciplinary rehabilitation in an effort to return the patient to work quickly.
- Public health challenge.
-
Healthcare challenge -
-
Change culture - The panel appears to me to be promoting the use of a Public Relations campaign to focus and promote living well with low back pain, self-management, staying healthy, and to change the public perception of low back pain.
- Change clinician behavior - The recommendation is to place effort and finances into finding out the best way to change the way clinicians recommend care for low back pain and to fill the evidence/real world gap. After developing the best evidence-based systems, there will be a need togged everyone on the same team in regards to the way clinicians refer and treat, the patients, as well as the professional journals.
- Change systems - There is a need to develop and implement systems allowing a patient to receive the right care at the right time. Clinical pathways will need a re-boot and will need to become consistent across interdisciplinary lines and differing clinical settings.
- Tackle Vested Interests - The panel discusses the fact that governments and insurance companies need to regulate in a manner consistent with evidence-based treatment for low back pain and eliminate conflicts of interest. Regulation through contracts, and payment schedules for treatments with little to no evidence for effectiveness.
The idea that a healthy weight and regular physical activity will help reduce low back pain must enter the global subconscious through public programs, especially in low to middle-income countries.
An assertion I fully agree with the authors on is that, thus far, healthcare dollars have been wasted on treatments that are ineffective and, many times, downright dangerous. The risk vs. reward ration just doesn’t make sense more times than not currently. No too mention the issue of opioid addiction which we all should know the stats on by now.
Boiling it down, the panel aims to get rid of practices that harm and create waste while, at the same time, opening the door to effective and affordable means of treating low back pain to patients in need. The authors are quoted here as saying,”Protection of the public from unproven or harmful approaches to managing low back pain requires that governments and health-care leaders tackle entrenched and counterproductive reimbursement strategies, vested interests, and financial and professional incentives that maintain the status quo.”
The authors promote the idea of implementing a positive health concept as the umbrella idea aiming for prevention of long-term disability. This includes alternative to treatments and cures and promotes more meaningful lives.
Another great quote from this third paper is as follows, “Improved training and support of primary care doctors and other professionals engaged in activity and lifestyle facilitation, such as physiotherapists, chiropractors, nurses, and community workers, could minimize the use of unnecessary medical care.”
The panel also calls for an active monitoring system in order to assess and keep an eye on the recommendations implementation as well as the outcomes of the changes.
To read more for yourself, follow this link to the third paper:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30488-4/fulltext
If access is unavailable, just simply register at The Lancet. It is completely free of charge.
If you are research minded, if you are a low back pain patient, or if you are a practitioner regularly coming in contact with low back pain patients, it is my opinion that taking the time to read these three papers yourself is of utmost importance.
Please find the links to the papers in the “References” section and get it done. Together, we can make a big, big difference in the lives of our low back pain patients. Without a doubt.
For this week’s next step, go register with The Lancet and get this paper for free! You just have to register. That’s it.
Next week we will review the third and final paper of this three paper series. Next week’s paper is called “Low back pain: a call to action.” We’ll go through it bit by bit and hit the highlights for those of you that aren’t into reading research papers and things of that sort. Don’t miss it!
If you love what you hear, be sure to check out www.chiropracticforward.com. As this podcast builds, so will the website with more content, products, and chances to learn.
We cannot wait to connect again with you next week. From Creek Stone, my office here in Amarillo, TX, home of the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
References:
Paper 1 - “What low back pain is and why we need to pay attention: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30480-X/fulltext
Paper 2 “Prevention and treatment of low back pain: evidence, challenges, and promising directions.”: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30489-6/fulltext
Paper 3 - “Low back pain: a call for action”: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30488-4/fulltext
Review of The Lancet Article: Prevention and treatment of low back pain: evidence, challenges, and promising directions (Part Two)
On the Chiropractic Forward podcast this week, we are going continue a review of a recent paper published on low back pain that we hope will have a powerful impact in the months and years to follow. This week it will be a review of paper #2 from the Lancet series called Prevention and treatment of low back pain: evidence, challenges, and promising directions.
Before we get started, I want to draw your attention our website at chiropracticforward.com. Just below the area where you can listen to the latest episode, you’ll see an area where you can sign up for our newsletter. I’d like to encourage you to sign up. It’s just an email about once a week to let you know when the episode is updated and what it’s about. Also, if something brand new pops up, we’ll be able to tell you about it quickly and easily.
Right now though, it’s time for bumper music!
Music
Welcome to the podcast today, you have strolled right into episode 17. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast where we talk about issues related to health, chiropractic, evidence, chiropractic advocacy, and research. Thank you for taking time out of your day I know your time is valuable and I want to fill it with value so here we go.
As I mentioned at the top of the show, this week, I want to continue with the series published in The Lancet on March 21, 2018. For a quick re-cap this week…. The Lancet is one of the oldest and most respected medical journals in the world. It has been around since 1823. In addition to the credibility of the journal, this series of papers dealing with Low Back Pain was compiled and authored by the leading experts on the matter globally. On top of that, the experts were a group of interdisciplinary practitioners which meant they ranged from medical doctors and PhD’s, to physical therapists and chiropractors.
Essentially, EVERYONE had a seat at the table so, it is the general consensus at this point that this series of papers is as current, as credible, and as accurate as can be had at this point in time and in our understanding of Low Back Pain.
The three papers were broken down as follows:
- What low back pain is and why we need to pay attention.
- Prevention and treatment of low back pain: evidence, challenges, and promising directions.
- Low back pain: a call for action.
Last week, we reviewed the first of the three papers which was titled, “What low back pain is and why we need to pay attention.” We went through it note by note and section by section trying to strip away the embellishments to simply boil it down to a leisure read and, hopefully, an enjoyable learning process.
We will do the same this week with the second paper of the series titled, “Prevention and treatment of low back pain: evidence, challenges, and promising directions.”
I want to start this week in the same way we started last week: by discussing how the papers were accomplished.
How They Did It
For this paper, again titled “What low back pain is and why we need to pay attention,” the researchers identified scientific studies through searches of databases:
•MEDLINE (PubMed)
•Scopus
•Google Scholar
•African Index Medicus Database
In order to ensure a high-quality standard, systematic reviews were shown preference for inclusion.
Paper 2 Summary:
Recommendations commonly offered for those with low back pain include:
- Pharmacologic implementation is not typically a first line choice
- Education supporting self-management
- Resumption of regular daily activities
- Resumption of exercise
- Psychological programs for those with low back pain that tends to linger
- Limited or non-use of medication
- Limited or non-use of imaging
- Limited or non-use of surgery
The authors state that these recommendations are derived from high-income countries and that they are concentrated on treatment rather than preventative recommendations.
The authors state there is an inappropriate high usage of the following treatments for low back pain:
- Spinal injections
- Imaging
- Opioids
- Surgery
- Rest
The authors also say that doing a lot of the same will get us the same results so, in going further, the treatments should be more in line with what evidence suggests is effective. Things like exercise and getting back to work as soon as possible. Makes sense to us!
In the rest of the paper, the authors identify some promising directions and solutions for low back pain including the redesign of clinical pathways, an integrated health partnership, and occupational interventions to get workers back when possible.
Prevention
- A 2016 systematic review with 30,850 adults showed that there was moderate quality evidence that exercise alone, or in combination with education, is effective for prevention of low back pain.
- However, the review was mainly for secondary prevention and the exercise program required an intense schedule of twenty 1-hour supervised sessions.
- A 2014 systematic review with 2700 children that found moderate quality evidence that education is not effective. They also found that ergonomic furniture was likely no more help in preventing low back pain than regular furniture.
Some key messages for Prevention were to self-management, physical and psychological regimens, and some forms of complementary medicine. In regards to Treatment, there should be less emphasis on pharmacologic protocols and less instances of surgical intervention. Also, the authors write that, although their popularity in healthcare has been steadily on the rise, there should be less utilization of imaging, opioids, and spinal injections.
Treatment
The authors cite three studies. The studies come from Denmark, the UK, and the USA.
- All three of the studies (Danish, UK and USA) recommend spinal manipulation as an effective regimen for low back pain. The UK study specifically recommends spinal manipulation in conjunction with an exercise protocol.
- As my own side note, in America, chiropractors perform 90% of all spinal manipulations. When we are discussing spinal manipulation and it’s role in treating low back pain, it is important to keep in mind which profession is the one being recommended. Although the authors do not come out and recommend chiropractic specifically, when spinal manipulations are recommended, it is a well-known fact that chiropractors are the doctors that are best-equipped to perform the treatment.
- Also in the US guidelines, there is a recommendations for the marked reduction of pharmacologic care.
- Some key advice coming from these updated recommendations (besides the use of spinal manipulation) is to assure patients they are not suffering from serious disease, that they will indeed improve in time, that they should continue as much movement and exercise as can be tolerated, they should avoid bed rest, and they should get back to work as soon as possible.
- The authors recommend physical treatments. Certainly for chronic low back pain which refers to pain lasting longer than 12 weeks. Physical treatments included exercise programs targeting the patients’ abilities, preferences, etc.
- The authors stated that passive therapies such as electric stim, interferential, traction, diathermy, and back supports seem to be ineffective. As a side note, it’s strictly anecdotal but this panel of experts are going to have a hard time convincing me traction, when done correctly, is not effective. I’ve seen patients avoid surgery from traction therapy alone.
- They say new recommendations encourage doctors consider psychological therapies such as cognitive behavior therapies, progressive relaxation therapy, and mindfulness-based stress reduction alone or in combination with other physical and psychological treatment for chronic low back pain with or without radiculopathy having not responded to other treatments.
- If the condition persists and the patient is functionally disabled, the authors then recommend multidisciplinary rehab with supervised exercise, cognitive behavior, and medication.
- Of course, routine use of opioids is not advised.
- Recommend no spinal epidural injections or facet joint injections for low back pain
- Do recommend epidural injections of local anesthetic & steroid for radicular pain, however, as we have discussed before, epidural steroid injections show short-term effectiveness only if they are effective at all and have no influence at all on long-term disability or future need for surgery. In my own research, epidural steroid injections have shown to increase risk of spinal fracture up to 21% after each subsequent injection.
- Surgery - the benefits for spinal fusion when the back pain was thought to be due to degenerated discs were about equal to the results gained with intensive multidisciplinary rehab and only a modest improvement over non-surgical treatment. In addition, surgery has obvious downsides like expense, recovery, medication, and the risk of adverse events. However, surgery may be indicated when the patient is suffering severe or progressive neurological symptoms and surgery may be indicated when patients suffer radicular pain, have failed first line treatment, and the symptoms can be traced to via imaging to a disc or stenosis origin.
- Ultimately, the authors say, low back pain patients have a tendency to resolve with out without surgical intervention so waiting and trying to avoid surgery is certainly appropriate.
- Research dealing with low back pain in children or in low and middle income countries is limited so a lot is unknown for those categories, however, the two studies that actually have been done in low and middle income countries (Brazil and Philippines) have similar results as those in high income countries.
The global gap between evidence and practice
This section masterfully demonstrates the difference between evidence-based medicine and what is really happening in the real world. When it comes to low back pain, the medical field is not adhering to research globally as they “overuse low-value care and underuse high-value care.”
- They start by stating that low back pain should be managed by primary care practitioners and then go on to list studies showing how it is being managed, in many cases, by emergency rooms, hospitals, and surgeons.
- Their next directive is to provide low back pain patients with education and advice on self management and then show how, in the real world, roughly only 20%-23% of practitioners seem to actually do so.
- The next directive is for low back pain patients to stay active and get to work or stay at work if possible. They go on to cite research showing how, in the real world, medical professionals are recommending rest and time off work. In India, for example, 46% of physiotherapists recommended rest to low back pain patients and in Brazil, rheumatologist recommended rest.
- The next comparison was for the guideline that imaging should only be ordered if the practitioner suspects a specific cause that would guide treatment and case management differing from normal care recommendations. In the USA, for example, from 2010-2013 the rate of imaging the low back with no red flags stayed consistent at 53.7%. If we thought that was excessive, the authors go on to cite information from India showing 100% of chronic low back pain patients in an orthopedic clinic underwent imaging for non-specific low back pain. Similar results were found through the other studies cited for low and middle income countries.
- The next comparison was for the guideline that the first line treatments should be non-pharmacologic. They found that this guideline is not commonly followed citing research for high income countries demonstrating that 64.5% of low back pain patients in Australia from 2000-2010 were prescribed meds on the first visit and, on a personal note, I had a patient here in the USA just this morning with acute low back pain that was prescribed pain meds on the first day. To be fair, his pain is severe but, they are not following guidelines and the meds have had no impact on his level of pain still he continues to take them as ordered. Medication for no effect essentially. In the lower and middle-income countries, the authors cite research showing that in South Africa, 90% of the low back pain patients going to a primary care physician received medication.
- The next guideline was that many times, there was advice to avoid electrical physical modalities such as diathermy, etc. In the high-income setting, Swedish physiotherapists recommend transcutaneous stim for low back pain to the tune of 38%, 75% of American PTs use lumbar traction, and a Spanish National Health Service study suggested 38.6% of physical therapy costs were for treatments known to have no effectiveness.
- The next guide comparison was that the use of opioids is discouraged. The authors go on to cite prescription rates from 2004-2009 and, to be honest, I think the opioid epidemic has likely caused the numbers cited to actually drop. Although opioid addiction is on the rise, it’s my opinion that it is now at the forefront of the national story. With the sort of attention it has demanded, I cannot imagine the numbers staying the same. That is my opinion, of course.
- Next guide was that surgery and interventional treatment should be very limited or possibly eliminated for low back pain. In the real world, this is not occurring. In the USA in 2011, spinal fusion was the reason for the most costs of any surgical procedure in the nation. US Medicare covered 2,023,481 epidural injections (a substantial increase from 2000-2011), 990,449 lumbar or sacral facet injections as well as 406,378 lumbar or sacral facet neurotomy treatments, Medicare funded 252,654 sacroiliac joint injections. Two-thirds of Dutch spinal surgeons perform spinal fusion surgeries.
- The next guide comparison was that exercise is now recommended for the treatment of chronic low back pain. A 2009 paper the authors cited showed that 54% of Americans with chronic low back pain were not prescribed any exercise as treatment.
- The final guide comparison was done for the recommendation that a biopsychosocial framework guide the management for low back pain patients. In the USA, only 12% of chronic low back pain patients had been treated for their diagnosed depression in the year prior and only 8.4% were recommended cognitive behavioral treatment.
Promising Directions
implementation of the best available evidence
The authors state here that some of the biggest issues toward implementation of new low back guidelines may be short consultation times, the practitioners having a decreased amount of knowledge on the guides, fear of being sued if missing serious pathology, and an effort to appease patients’ desires and, in my opinion, be the “good guy” in the patients’ eyes. However, the authors explain that there are some examples of successful implementation and that widespread use may be achieved through dispelling existing established practice patterns, repetition of the guides, and finding out what is the most effective and cost-effective treatments.
The authors suggest integrated education of health-care professionals surmising that such a thing could not only educate & innovate but also break through professional barriers that exist. Professional barriers such as exist between many in the medical field and the chiropractic field.
Clinical systems and pathways
The authors say that one solution could be a radical departure from current procedure and move toward a stratified primary care model known as STarT Back. This model is a two-part model with the first part consisting of a questionnaire to help the practitioner identify the patient’s risk of persistent disabling pain. The second part consists of treatments tailored to the patients level of risk according to the first part questionnaire.
Another option along these lines would be to redesign the entire case management paths from first contact all the way through to the specialized care practitioner. They argue that a current barrier to doing this is the fact that healthcare reimbursements are currently geared toward quantity rather than quality. Two programs the authors cited for examples of promising pathways are Canada’s Saskatchewan Spine Pathway as well as NHS England’s program.
Integrate health and occupational interventions
The authors argue in this section that healthcare and occupational health interventions need to be considered simultaneously when it comes to patients with low back pain and work disability issues. Return to work commonly happens before the absence of pain. Even hurting, people can still return to work. The authors tend to have a very strong recommendation on never leaving work or returning as quickly as possible.
Due to very specific examples, I have admittedly glossed over this section to avoid inaccuracies and unintended generalizations. I highly encourage your reading the paper on your own time for accuracy.
Public health interventions
In this section, the authors are discussing public relations: how to get the word out. How to change public perception of back pain. They cite a successful campaign in Australia that used television ads with prominent public figures serving as the spokespeople. They felt it was well-funded and was successful in part due to the proper messaging but also due to laws and public policies that supported the campaign.
Conclusions
There is a large gap between what evidence suggests and what practitioners are actually doing in their day to day practice and in the recommendations they commonly make. The authors admit that even the solutions put forth in this paper are based on relatively limited evidence. The following are quotes from the conclusion:
- “Focusing on key principles, such as the need to reduce unnecessary health care for low back pain, support people to be active and stay at work, and reform unhelpful patient clinical pathways and reimbursement models, could guide next steps.”
- “No single solution will be effective, and a collective, global effort will take time, determination, and organization. Without the collaborative efforts of people with low back pain, policy makers, clinicians, and researchers necessary to develop and implement effective solutions, disability rates, and expenditure for low back pain will continue to rise.”
Key Takeaways:
A paper of this size and of this magnitude, and with the level of education of contributors honestly cannot be done complete justice by a review such as this. I admittedly hit the high spots. I am more focused in some areas than in others. More specific for some topics and more general in others. That is the nature of a summarization and I hope I am allowed that latitude.
If you are research minded, if you are a low back pain patient, or if you are a practitioner regularly coming in contact with low back pain patients, it is my opinion that taking the time to read these three papers yourself is of utmost importance.
Please find the links to the papers in the “References” section and get it done. Together, we can make a big, big difference in the lives of our low back pain patients. Without a doubt.
For this week’s next step, go register with The Lancet and get this paper for free! You just have to register. That’s it.
Next week we will review the third and final paper of this three paper series. Next week’s paper is called “Low back pain: a call to action.” We’ll go through it bit by bit and hit the highlights for those of you that aren’t into reading research papers and things of that sort. Don’t miss it!
If you love what you hear, be sure to check out www.chiropracticforward.com. As this podcast builds, so will the website with more content, products, and chances to learn.
We cannot wait to connect again with you next week. From Creek Stone, my office here in Amarillo, TX, home of the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
References:
Paper 1 - “What low back pain is and why we need to pay attention: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30480-X/fulltext
Paper 2 “Prevention and treatment of low back pain: evidence, challenges, and promising directions.”: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30489-6/fulltext
Paper 3 - “Low back pain: a call for action”: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30488-4/fulltext
Podcast Episode #16
Review of The Lancet Article: Low Back Pain: A Major Global Challenge (Part One)
On the Chiropractic Forward podcast this week, we are going do a review of a recent paper published on low back pain that we hope will have a powerful impact in the months and years to follow.
Before we get started, I want to draw your attention our website at chiropracticforward.com. Just below the area where you can listen to the latest episode, you’ll see an area where you can sign up for our newsletter. I’d like to encourage you to sign up. It’s just an email about once a week to let you know when the episode is updated and what it’s about. Also, if something brand new pops up, we’ll be able to tell you about it quickly and easily.
Right now though, it’s time for bumper music!
Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast where we talk about issues related to health, chiropractic, evidence, chiropractic advocacy, and research. Thank you for taking time out of your day I know your time is valuable and I want to fill it with value so here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.
You have illegally u-turned into Episode #16 and crimals are welcome so make yourself at home.
I’ve been battling a head cold and depending on the day, the head cold is winning. I hope you’ll excuse my graveled voice and my nasal presentation. I’ll do my best.
Those of us that are hungry for new research and the recommendations that arise from the body of literature being constantly created were excited last week about the release of significant reports coming out in a highly respected research journal called The Lancet.
Founded in 1823, The Lancet is published weekly is is one of the oldest, most respected, and most well-known medical journals in the world so when it was announced a series of papers were to be published in The Lancet having to do with low back pain, as you may imagine, those of us interested in the research world and musculoskeletal complaints were all ears.
Not only was the article noteworthy due to its being published in The Lancet, but it was also exciting for those of us in the so-called alternative healthcare world because there were several Doctors of Chiropractic sitting on the steering committee for the series of reports. For some reason, chiropractors are still considered by many to be alternative while this group of papers suggest chiropractic may be a lot more than simply “alternative.”
We chiropractors are typically not sitting at the table when the bigger discussions or decisions are made so, thanks to research that has been done prior to this, we are in the thick of it it seems. And that is exciting to say the least.
There are a couple of things in my mind that stand out as reasons for such a series of papers. The first being that low back pain has become a major problem globally and show no sign of stopping the growth of it impact. The second reason would be the ineffectiveness of the treatments commonly used or recommended. This includes surgery, epidural steroid injections, and, the most notable of failed treatments, opioids.
The series of Low Back Pain papers were compiled by a team of leading experts on back pain. The team was made up of an international spectrum of varied backgrounds. They met for a workshop in Buxton, UK, in June, 2016, to start the journey and the process of setting the outline and some sort of structure for each paper.
It was quite an undertaking from quite the group of experts. This is not a group of papers to be ignored since these authors and researchers are among the best of the best globally.
The papers were broken down as follows:
- What low back pain is and why we need to pay attention.
- Prevention and treatment of low back pain: evidence, challenges, and promising directions.
- Low back pain: a call for action
In this article, I will cover the first of the three papers with plans to highlight the next two papers in the coming weeks so be sure to return for those important discussions.
How They Did It
For this paper, again titled “What low back pain is and why we need to pay attention,” the researchers identified scientific studies through searches of databases:
- MEDLINE (PubMed)
- Scopus.
- Google Scholar
- African Index Medicus Database
In order to ensure a high-quality standard, systematic reviews were shown preference for inclusion.
Summary of the introduction of the first paper.
- Low back pain is now the leading cause of disability worldwide.
- Only a small percentage have a well-understood, definite cause for their low back pain. Examples of well-known and udnerstood causes are things like a vertebral fracture, malignancy, or infection.
- Things that seem to raise the risk of having low back pain complaints would be populations that smoke regulary, people that have physically demanding jobs or routine jobs or jobs that keep them mostly sedentary throughout the day and throughout the work week, people with physical and mental issues that add to a low back complaint or contribute to a low back complaint, and overweight/obese people. These populations are all at risk for developing low back pain.
- 540 million people were affected at any one time globally.
- A systematic review (3097 participants) found several MRI findings had a reasonably strong association with low back pain, including Modic type 1 change, disc bulge, disc extrusion, and spondylolysis. To futher define Modic 1 changes, in regular vertebral endplate bone, the trabeculae shoud be like a type of scaffolding. Within the trabeculae there is red bone marrow producing blood cells. In a Modic type 1, the trabeculae are fractured intermittently and the patterns are more erratic and the marrow is absent. In the marrow’s place now is serum which is the same substance one can find in a blister.
Symptoms associated with low back pain
Radicular Pain and Radiculopathy
- Radiculopathy is usually called sciatica and mostly occurs when there is involvement where the nerve root exits the spine.
- The authors noted that the term sciatica is used inconsistently by doctors and the public in general and should probably be avoided all together.
- The diagnosis of radicular pain relies on clinical findings, such as history of dermatomal leg pain, leg pain that is actually worse than the back pain, aggravation of the symptom when bearing down such as in coughing, sneezing, lying on your back and raising heels off of the table or in going from seated to standing, and straight leg raise test. General rule of thumb for an SLR is that pain in the first 30 degrees of leg elevation hints at a disc origin since that is the movement that first starts to tension the nerve at the root.
- Radiculopathy is not just the feeling of pain. Radiculopathy can also be weakness, decreased sensation, decreased relexes, or all of those combined. In addition they can be identified with, or without, the presence of pain.
- Patients presenting with low back pain in addition to radicular pain or radiculopathy tend to have worse outcomes than those presenting with low back pain alone.
Lumbar Spinal Stenosis
- I tell my patients that the simplest way to explain stenosis is to say that a hole that nerves run through has become smaller and, as a result, the nerves sometimes have pressure on them that can cause them to be somewhat dysfunctional.
- Lumbar spinal stenosis is clinically characterized by pain or discomfort with walking or standing that radiates into one or both legs and can be eased resting and almost always by lumbar flexion (neurogenic claudication). They call this the shopping cart sign. Meaning, if a person gets relief from leaning on a shopping cart, it sure may be stenosis. If it is aggravated by leaning back or by inducing a “swayback” type of movement, that sure may be stenosis. As a sidenote and from my own studies, if lumbar extension (or swayback) does not hurt, but then rotation in either direction at the endpoint of lumbar extenstion actually does increase the pain, then the patient is likely suffering from a lumbar facet complaint.
- Lumbar stenosis is commonly caused by narrowing of the spinal canal or intervertebral foramina as a result of a combination of degeneration such as facet osteoarthritis, ligamentum flavum hypertrophy, and bulging discs. Two or three of these factors can combine to reduce the size and space available for the neural structures to pass through. Obviously that can create issues.
- Experts tend to agree that the diagnosis of stenosis requires both the presence of the symptoms in addition to imaging findings demonstrating stenosis.
Other causes of Low Back Pain
- Vertebral fracture, inflammatory disorders, malignancy, infections, intra-abdominal causes.
- The US guideline for imaging advises deferral of imaging pending a trial of therapy when there are weak risk factors for cancer or axial spondyloarthritis. What does that mean exactly? That means a trial of conservative care. The authors will delve further into this in the second paper from the Lancet series but I will butt my head in here with the opinion of the American College of Physicians. Their updated recommendations from February of 2017 reflect that doctors should be recommending Chiropractic, massage, and/or ice for acute low back pain and should recommend Chirorpactic, acupuncture, and/or exercise/rehab for chronic low back pain. These recommendations are to precede taking even ibuprofen.
Prevalence
- Approximately 40% of 9-18-year olds in high-income, medium-income, and low-income countries report having had low back pain.
- Low back pain prevalence increased 54% since 1990.
- It is the number one cause of disability globally
Work Disability
- Jobs are less-regulated in lower and middle income countries. Many times employers and companies are unwilling to modify the job duties or the workload. As a result, having low back pain can be particularly concerning or difficult for an employee in these circumstances.
- To go along with jobs that are poorly regulated, heavy manual labor has no regulation or proper safety instruction adding to low back pain injury instances.
- In Europe, low back pain is the most common cause of medically certified sick leave and early retirement.
- In the USA, low back pain accounts for more lost workdays than any other occupational musculoskeletal condition
Social Identity & Inequality
- MacNeela and colleagues reviewed 38 separate qualitative studies in high-income countries. They showed found common traits, including: worry and fear about the social consequences of chronic low back pain, hopelessness, family strain, social withdrawal, loss of job and lack of money, disappointment with health-care encounters (in particular with general practitioners), coming to terms with the pain, and learning self-management strategies.
- Froud and colleagues reviewed 42 qualitative studies from high-income countries, and found that many people living with low back pain struggled to meet their social expectations and obligations and that achieving them might then threaten the credibility of their suffering, with disability claims being endangered. Sometimes we have to almost force low back patients back into the workforce and, did you know that studies show in general that the sooner people are returned to work, the better they tend to recover from the low back pain complaint?
- Schofield and colleagues found that individuals who exit the workforce early as a result of their low back pain have substantially less wealth by age 65 years, even after adjustment for education. This is just an obvious statement. It makes sense that people that quit working earlier than 65 end up making less money by the time they reach 65. You can also throw the expense of dealing with a back pain complaint in on top of the loss of wages.
- Globally, low back pain contributes to inequality. At first, when I read this, it struck me as being silly. Everything’s about inequality these days isn’t it? Certainlly in America it seems. But, this is a little different when you read through the explanation. The authors go on to say that in low-income and middle-income countries, poverty and inequality might increase as participation in work is affected. In addition, regulations on how to properly re-introduce a person into the workforce are absent, and workers are likely to be placed right back into the job they were originally injured without proper re-introduction. The authors felt this might place more strain on family and community livelihoods.
Cost of Low Back Pain
- Costs associated with low back pain are commonly tallied as direct medical costs, meaning the cost of the doctor’s bill. They are also tallied in terms of indirect costs; meaning the cost of being out of work and the loss of productivity at the work place.
- Most studies underestimate the total costs of low back pain
- Although we do not think of low back pain in these terms yet, the truth is that low back pain, in terms of a real problem as far at the cost to treat and the overall indirect costs, are right up there with the biggest issues the global pupulation faces. Issues such as cardiovascular disease, cancer, mental health, and autoimmune diseases. That’s huge.
- In the USA, 44% of the population used at least one complementary or alternative health-care therapy in 1997; and the most common reason was low back pain. with 70,000 plus chiropractors in the United States, I can tell you with some confidence the profession most associated with alternative treatment for low back pain or spinal pain of any sort is chiropractic care.
- The USA has the highest costs, attributable to a more medically intensive approach as well as higher rates of surgery compared with other high-income countries. We see patients every week that have gone through needless surgeries. Surgeries for which there is plenty of high-level research proving its ineffectiveness yet you see the popularity for these surgeries continuing to rise.
Natural History
- A systematic review (33 cohorts; 11 166 participants) provides strong evidence that most episodes of low back pain improve substantially within 6 weeks, and by 12 months average pain levels are low. However, two-thirds of patients still report some pain at 3 months and 12 months
- The best evidence suggests around 33% of people will have a recurrence within 1 year of recovering from a previous episode.
Risk Factors and Triggers for Low Back Pain Episodes
- A systematic review (5165 participants) found consistent evidence that people who have had previous episodes of low back pain are at increased risk of a new episode. Likewise, people with other chronic conditions, including asthma, headache, and diabetes, are more likely to report low back pain than people in good health
- a UK cohort study found psychological distress at age 23 years predicted incident low back pain 10 years later. The Canadian National Population Health Survey with 9909 participants found that pain-free individuals with depression were more likely to develop low back pain within 2 years than were people without depression
- systematic reviews of cohort studies indicate that lifestyle factors such as smoking, obesity, and low levels of physical activity that relate to poorer general health are also associated with occurrence of low back pain episodes. We know that obesity and lack of exercise has become an American trait that needs to be reversed.
- A systematic review found the genetic influence on the liability to develop low back pain ranged from 21% to 67%, with the genetic component being higher for more chronic and disabling low back pain than for inconsequential low back pain.Don’t we all have patients that present to us claimng that their bad back just runs in the family? Mom and Grandma had a bad back so that must be why they have a bad back is the common sentiment. It seems there may be a bit of validity there.
- An Australian case-crossover study (999 participants) showed that awkward postures, heavy manual tasks, feeling tired, or being distracted during an activity were all associated with increased risk of a new episode of low back pain. Similarly, work exposures of lifting, bending, awkward postures, and tasks considered physically demanding were also associated with an increased risk of developing low back pain in low-income and middle-income countries
Psychological Factors
The presence of psychological factors in people who present with low back pain is associated with increased risk of developing disability even though the mechanisms are not fully understood
Social and Societal Factors
- Cross-sectional data from the USA (National Health Interview Survey 2009–10, 5103 people) found that those with persistent low back pain were more likely to have had less than high-school education and had an annual household income of less than US$20,000.
- Suggested mechanisms for the effect of low education on back pain include environmental and lifestyle exposures in lower socioeconomic groups, lower health literacy, and health care not being available or adequately targeted to people with low education.
- To go along with lower wages, the lower socioeconomic groups are commonly in routine and manual occupations and ahve increased physical workloads is associated with disabling low back pain
Conclusion
“Low back pain is now the number one cause of disability globally. The burden from low back pain is increasing, particularly in low-income and middle-income countries, which is straining health-care and social systems that are already overburdened. Low back pain is most prevalent and burdensome in working populations, and in older people low back pain is associated with increased activity limitation. Most cases of low back pain are short-lasting and a specific nociceptive source cannot be identified. Recurrences are, however, common and a few people end up with persistent disabling pain affected by a range of biophysical, psychological, and social factors. Costs associated with health care and work disability attributed to low back pain are enormous but vary substantially between countries, and are related to social norms, health-care approaches, and legislation. Although there are several global initiatives to address the global burden of low back pain as a public health problem, there is a need to identify cost-effective and context-specific strategies for managing low back pain to mitigate the consequences of the current and projected future burden.”
Key Takeaway:
Obviously, low back pain is an issue that must be addressed in a more effective way globally and irregardless of national ranking in terms of the economy. Just because it’s musculoskeletal doesn’t mean it can be ignored and kicked to the curb while the big stuff like heart disease, diabetes, and cancer are treated. The research for the big stuff is adequately funded but, honestly, in general, most general practitioners don’t have the first clue of what to do for low back pain. I personally suggest they turn to their own American College of Physicians for updated recommendations on chronic and acute low back conditions if I were them.
Authors
Steering Committee
Rachelle Buchbinder - Australia
Jan Hartvigsen - Denmark
Dan Cherkin - United States
Nadine Foster - UK
Chris Maher - Australia
Martin Underwood - UK
Maruits van Tulder - Netherlands
For this week’s Next Steps, be sure to send us an email at dr.williams@chiropracticforward.com and let us know what you thought or contribute to the show for next week. We love hearing from you all. Also, go and follow Jan Hartvigsen https://twitter.com/JanHartvigsen, and Chris Maher https://twitter.com/CGMMaher on Twitter.
Next week we will review the second paper of this three paper series. Next week’s paper is called “Prevention and treatment of low back pain: evidence, challenges, and promising directions.” We’ll go through it bit by bit and hit the highlights for those of you that aren’t into reading research papers and things of that sort. Don’t miss it!
If you love what you hear, be sure to check out www.chiropracticforward.com. As this podcast builds, so will the website with more content, products, and chances to learn.
We cannot wait to connect again with you next week. From Creek Stone, my office here in Amarillo, TX, home of the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
References:
- The Lancet article on low back pain: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30480-X/fulltext
- Jan Hartvigsen Twitter: https://twitter.com/JanHartvigsen
- Chris Maher Twitter: https://twitter.com/CGMMaher
- Chiropractic Preventative Treatment: https://www.amarillochiropractor.com/non-opioid-more-effective-while-chiropractic-maintenance-may-be-the-most-effective/
This week, we are in Episode #3 of the 3 part series where we systematically debunk the odd myth that chiropractors cause strokes. I’m almost done with this y’all. In this final episode of this series, we will discuss risky interventions, papers having to do with the risk, or lack thereof, of chiropractic adjustments to the cervical region specifically, and then a wrap up of the information.
Before we get started, I want to draw your attention to the reviews over at iTunes. If you would be kind enough to leave us a great review we sure would appreciate you! This is a new podcast and we need all the help we can get!
Right now though, it’s time for bumper music!
Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast where we talk about issues related to health, chiropractic, evidence, chiropractic advocacy, and research. Thank you for taking time out of your day I know your time is valuable and I want to fill it with value so here we go.
Let’s begin by thanking those of you that sent even more emails to me after this series kicked off and after the second episode of the stroke series came out last week. It’s good to know you’re listening and finding the value. Again, the best way you can help is to share these three stroke episodes with as many people as you can. We can get this myth debunked and we can put it to rest right here, right now. But, obviously and once again, I can’t do it myself. I need your help to do it. You have to actively, hit a share button, hit a like button, copy and paste a link into an email, whatever the action may be….you have to actively do it. And I thank you in advance.
I also want to remind you that this is part 3 of a three part series on the stroke myth. Last week was part 2 where we discussed research papers demonstrating and validating benefits of having cervical manipulation treatments. Or chiropractic adjustments to the neck. We talked about the benefits, according to research, for neck pain as well as for headaches. And we talked a little about where this myth came from and why it perpetuates to this day.
In part one of this stroke series, we discussed some risky odds, some case specific discussion, some signs and symptoms of vertebral artery dissection, and some research dealing with common treatments within the medical profession.
Be sure to go back and listen to it if you have not. It’s essential in getting the full picture of the chiropractors cause strokes issue.
Now…off into this episode we go.
I find it interesting and helpful to put ideas into medical terms. Many times, when one is learning about topics they are unfamiliar with, it helps to familiarize the material by relating it in terms they better understand. Have you ever watched a commercial for a new medicine or pill and, at the end of the commercial, the narrator runs through an obstacle course of side effects and possible harms?
Prescription medication can be scary and risky but what about more benign, over-the-counter medications?
Briefly, let us discuss some of the other treatment risks patients commonly face with traditional medical interventions.
- Data obtained from the U.S. Centers for Disease Control and Prevention show that more than 300 people die annually as a result of acetaminophen poisoning.
- Beginning in 2006, according to the CDC, the number of people who died after accidentally taking too much acetaminophen surpassed the number who died from intentionally overdosing to commit suicide.
- NSAIDS such as Ibuprofen and Acetaminophen cause at least 16,000 deaths per year and send 100,000 people to the ER in the United States every year.
It is clear that there is risk with ANY sort of intervention when it comes to the living, breathing, constantly changing, human body. There is risk when one chooses to cross the street, walk in a rainstorm, or climb a ladder. Most do not let these minimal risks control their decisions or instill fear into their hearts so that they refuse to take an action. The majority of the population subconsciously realizes a risk, understands minimal odds, and takes action accordingly.
What follows is a listing of the papers exploring the RISKS of adverse events as a result of cervical manipulation. Each paper mentioned includes a short description of the conclusion for each paper cited. Each of these papers is referenced in the citation section at the end of this article and can be reviewed independently.
- Cassidy JD, et. al. – Spanning over a nine year time period and 109,020,875 person-years, the researchers included visits to chiropractors AND primary practitioners. There was no statistical difference between the likelihood of vertebral artery dissection after having seen a primary medical doctor vs. after having seen a chiropractor. The only possible conclusions are 1) Chiropractors and medical doctors are causing strokes on rare occasion. 2) Patients are presenting to the offices of chiropractors and medical doctors seeking relief from symptoms of a vertebral arterial dissection already in progress. Obviously the medical professionals are not manipulating the cervical region so option number one makes the least sense. Cassidy’s conclusion was as follows, “This suggests that patients with undiagnosed vertebral artery dissection are seeking clinical care for headache and neck pain before having a VBA stroke.”
- Cassidy JD, Pronfort G, Hartvigsen J, et. al. – This article appeared in the British Medical Journal in 2012. “The effectiveness of manipulation for neck pain has been examined in several high quality systematic reviews, evidence based clinical guidelines, and health technology assessment reports. When combined with recent randomized trial results, this evidence supports including manipulation as a treatment option for neck pain,…..We say no to abandoning manipulation and yes to more rigorous research on the benefits and harms of this and other common interventions for neck pain[1].”
- Kosloff TM, et. al. – “We found no significant association between exposure to chiropractic care and the risk of VBA (vertebrobasilar artery system) stroke. We conclude that manipulation is an unlikely cause of VBA stroke. The positive association between PCP visits and VBA stroke is most likely due to patient decisions to seek care for the symptoms (headache and neck pain) of arterial dissection. We further conclude that using chiropractic visits as a measure of exposure to manipulation may result in unreliable estimates of the strength of association with the occurrence of VBA stroke[2].”
- Buzzatti L, et. al. – “….the displacement induced with the present technique seems not to be able to endanger vital structure on the Spinal Cord and the Vertebral Artery. This study also adds to a better comprehension of the kinematic of the atlanto-axial segment during the performance of HVLA manipulation[3].”
- Whedon JM, et. al. – “Among Medicare B beneficiaries aged 66 to 99 years with neck pain, incidence of vertebrobasilar stroke was extremely low. Small differences in risk between patients who saw a chiropractor and those who saw a primary care physician are probably not clinically significant[4].”
- Achalandabaso A, et. al. – “Our data show no changes in any of the studied damage markers. Although this study examined the outcomes in an asymptomatic population, lower cervical and thoracic manipulative techniques seem to be safe manual therapies techniques which cause no harm to the health of the subject. These data may be used as evidence of the safe application of spinal manipulation to healthy subjects. Further studies with a large sample size and a patient population are needed to corroborate the innocuous effects of spinal manipulation[5].”
- Quesnele JJ, et. al. – “There were no significant changes in blood flow or velocity in the vertebral arteries of healthy young male adults after various head positions and cervical spine manipulations[6].”
- Tuchin P, et. al. – “The evidence for causality of vertebral artery dissection from chiropractic is weak[7].”
- Symons BP, et. al. – “We conclude that under normal circumstances, a single typical (high-velocity/low-amplitude) SMT thrust is very unlikely to mechanically disrupt the VA[8].”
- Church EW, et. al. – “Our analysis shows a small association between chiropractic neck manipulation and cervical artery dissection (CAD). This relationship may be explained by the high risk of bias and confounding in the available studies, and in particular by the known association of neck pain with CAD and with chiropractic manipulation. There is no convincing evidence to support a causal link between chiropractic manipulation and CAD. Belief in a causal link may have significant negative consequences such as numerous episodes of litigation[9].”
A methodical, logical, and systematic stroll through the body of literature shows without a doubt there is indeed incredible benefit in the use of cervical manipulative treatments for neck pain and headaches & migraine complaints while there is no more risk of stroke from treating with a chiropractor vs. treating with a medical profession.
I want this article to be the final word on this myth. I want it to be the “end all, be al l” on the topic but I have lived long enough to know better and experienced twenty years within the chiropractic profession. I know this information will not change the attitudes of many. But, if this article can be a reference point for learning more about the topic and can be a tool for educating others about this myth, then I will have fulfilled my function.
In conclusion, the benefit and effectiveness has been proven, the risks have been disproven, and the “Chiropractors Cause Strokes” myth is ONCE AND FOR ALL officially and completely DEBUNKED.
- Cassidy, e.a., Should we abandon cervical spine manipulation for mechanical neck pain? No. BMJ, 2012.
- Kosloff T, e.a., Chiropractic care and the risk of vertebrobasilar stroke: results of a case–control study in U.S. commercial and Medicare Advantage populations. Chiropractic & Manual Therapies, 2015. 23(19).
- Buzzatti L, e.a., Atlanto-axial facet displacement during rotational high-velocity low-amplitude thrust: An in vitro 3D kinematic analysis. Man Ther, 2015. 20(6): p. 783-9.
- Whedon JM, e.a., Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66 to 99 years. Spine (Phila Pa 1976), 2015. 40(4): p. 264-270.
- Achalandabaso A, e.a., Tissue damage markers after a spinal manipulation in healthy subjects: a preliminary report of a randomized controlled trial. Dis Markers, 2014.
- Quesnele JJ, e.a., Changes in vertebral artery blood flow following various head positions and cervical spine manipulation. J Manipulative Physiol Ther, 2014. 37(1): p. 22-31.
- Tuchin PJ, e.a., Chiropractic and stroke: association or causation? Int J Clin Pract, 2013. 67(9): p. 825-833.
- Symons BP, Internal forces sustained by the vertebral artery during spinal manipulative therapy. Science Direct, 2002. 25(8): p. 504-510.
- Church E, e.a., Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation. Cureus 2016. 8(2): p. e498.
DEBUNKED: The Odd Myth That Chiropractors Cause Strokes Revisited
Part 2 of 3
This week we are in Episode #2 of the 3 episodes where we are systematically debunking the odd myth that chiropractors cause strokes. I’m not having it folks. In this episode, we will discuss research papers demonstrating and validating benefits of having cervical manipulation treatments. Or chiropractic adjustments to the neck. We will talk about the benefits, according to research, for neck pain as well as for headaches. And we’ll also talk a little about where this myth came from and why it perpetuates to this day.
Before we get started, I want to draw your attention to the reviews over at iTunes. If you would be kind enough to leave us a great review we sure would appreciate you! This is a new podcast and we need all the help we can get!
Right now though, it’s time for bumper music!
Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast where we talk about issues related to health, chiropractic, evidence, chiropractic advocacy, and research. Thank you for taking time out of your day I know your time is valuable and I want to fill it with value so here we go.
Let’s begin this episode by thanking those of you that sent emails to me after this series kicked off last week. You guys are great. The best way you can help is to share these episodes with as many people as you can. We can get this myth debunked and we can put it to rest right here, right now. But, obviously, I can’t do it myself. I need your help to do it.
I also want to remind you that this is part 2 of a three part series on the stroke myth. Last week was part one where we discussed some risky odds, some case specific discussion, some signs and symptoms of vertebral artery dissection, and some research dealing with common treatments within the medical profession.
Be sure to go back and listen to it if you have not. It’s essential.
Then next week we will discuss other risky interventions, papers having to do with the risk, or lack thereof, of chiropractic adjustments to the cervical region specifically, and then a wrap up of the information.
Don’t miss it folks.
Now, let’s get on with our risk vs. reward discussion with the BENEFITS of cervical manipulation therapy.
If we talk about danger with an intervention, then don’t we have to talk about the risk vs. reward ratio?
I want to start off with the benefits of cervical manipulation for neck pain specifically. Each paper mentioned includes a short description of the conclusion for each paper cited. Also each of these papers is referenced in the show notes and can be very easily reviewed independently. You have to know that I am going to absolutely murder some of these names and I don’t even care. I’m small town South y’all. I’m not fancy at all. All I can is do my best but I assure you I’m not going to do backflips trying to figure out the correct pronunciation of each of these names. Be sure though, the days of Dr. Smith or Dr. Jones doing all of the research are no longer Take this first name as an example.
- Korthalis-de Bos IB, et. al. – “Manual therapy (spinal mobilization) is more effective and less costly for treating neck pain than physiotherapy or care by a general practitioner[1].”
- Dewitte V, et. al. – “Based on key features in subjective and clinical examination, patients with mechanical nociceptive pain probably arising from articular structures can be categorized into specific articular dysfunction patterns. Pending on these patterns, specific mobilization and manipulation techniques are warranted. The proposed patterns are illustrated in 3 case studies. This clinical algorithm is the corollary of empirical expertise and is complemented by in-depth discussions and knowledge exchange with international colleagues. Consequently, it is intended that a carefully targeted approach contributes to an increase in specificity and safety in the use of cervical mobilizations and manipulation techniques as valuable adjuncts to other manual therapy modalities[2].”
- Dunning JR, et. al. – “The combination of upper cervical and upper thoracic HVLA thrust manipulation is appreciably more effective in the short term than nonthrust mobilization in patients with mechanical neck pain[3].”
- Brontfort G, et. al. – “For participants with acute and subacute neck pain, SMT was more effective than medication in both the short and long term. However, a few instructional sessions of HEA resulted in similar outcomes at most time points[4].”
- Puentedura EJ, et. al. – The objective of the paper was as follows: “Thrust joint manipulation to the cervical spine has been shown to be effective in patients presenting with a primary report of neck pain. It would be useful for clinicians to have a decision-making tool, such as a clinical prediction rule, that could accurately identify which subgroup of patients would respond positively to cervical thrust joint manipulation.” In the results, they showed if 3 or more of the 4 attributes were present,” the probability of experiencing a successful outcome improved from 39% to 90%[5].”
- Yu H, et. al. – “Chiropractic management of atlantoaxial osteoarthritis yielded favorable outcomes for these 10 patients[6].”
- Puentedura EJ, et. al. – “Patients with neck pain who met 4 of 6 of the CPR criteria for successful treatment of neck pain with a thoracic spine thrust joint manipulation demonstrated a more favorable response when the thrust joint manipulation was directed to the cervical spine rather than the thoracic spine. Patients receiving cervical thrust joint manipulation also demonstrated fewer transient side-effects[7].”
- Miller J, et. al. – “Moderate quality evidence supports this treatment combination (cervical manual therapy combined with exercise) for pain reduction and improved quality of life over manual therapy alone for chronic neck pain; and suggests greater short-term pain reduction when compared to traditional care for acute whiplash[8].”
- Hurwitz EL, et. al. – “Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain[9].”
- Muller R, et. al. – “In patients with chronic spinal pain syndromes, spinal manipulation, if not contraindicated, may be the only treatment modality of the assessed regimens that provides broad and significant long-term benefit[10].”
- Zhu L, et. al. – “There was moderate level evidence to support the immediate effectiveness of cervical spine manipulation in treating people with cervical radiculopathy[11].”
- Giles LG, et. al. – “The consistency of the results provides, despite some discussed shortcomings of this study, evidence that in patients with chronic spinal pain, manipulation, if not contraindicated, results in greater short-term improvement than acupuncture or medication[12].”
- Bronfort G, et. al. – “Our data synthesis suggests that recommendations can be made with some confidence regarding the use of spinal manipulative therapy and/or mobilization as a viable option for the treatment of both low back pain and neck pain[13].”
There you have a fairly thick list of research papers demonstrating the effectiveness of chiropractic adjustments for uncomplicated neck pain but neck pain is not the only reason to have a chiropractic adjustment delivered to the cervical region. Another very common reason for neck adjustments would be for the treatment of acute and chronic headaches.
Chiropractors see headache patients in their offices daily and research shows us those patients are in the right place for the best, non-pharmacological treatment of the complaint. In fact, I have an episode of this podcast that dealt with a paper showing the effectiveness of chiropractic for headaches. Episode #6 to be exact.
Here is a listing of papers demonstrating the benefits of cervical manipulation for headaches. Each paper mentioned includes a short description of the conclusion for each paper cited. Also each of these papers is referenced in the show notes and can be very easily reviewed independently
- Malo-Urries M, et. al. - “Upper cervical translatoric spinal mobilization intervention increased upper, and exhibited a tendency to improve general, cervical range of motion and induce immediate headache relief in subjects with cervicogenic headache[14].”
- Espi-Lopez GV, et. al. – “In short, manual therapy techniques and manipulation applied to the suboccipital region for four weeks or more showed great improvement and in effectiveness for several aspects that measure the quality of life of a patient having suffered from tension type headaches[15].”
- Dunning J, et. al. - “Six to eight sessions of upper cervical and upper thoracic manipulation were shown to be more effective than mobilization and exercise in patients with cervicogenic headache, and the effects were maintained at 3 months[3].”
- Hurwitz EL, et. al. – “Utilization and expenditures for headache treatment increased from 2000 to 2009 across all provider groups. MD care represented the majority of total allowed charges in this study. MD care and DC care, alone or in combination, were overall the least expensive patterns of headache care. Risk-adjusted charges were significantly less for DC-only care[16].”
- Bronfort G, et. al. – “SMT appears to have a better effect than massage for cervicogenic headache. It also appears that SMT has an effect comparable to commonly used first-line prophylactic prescription medications for tension-type headache and migraine headache[17].”
- Bronfort G, et. al. – “Chiropractic is effective in acute, subacute, and chronic low back pain, migraines and headaches originating from the neck, for the treatment of some forms of dizziness, extremity and joint issues, as well as mid back and acute and subacute neck pain[18].
- Tuchin PJ, et. al. - “The results of this study support previous results showing that some people report significant improvement in migraines after chiropractic spinal manipulative therapy. A high percentage (>80%) of participants reported stress as a major factor for their migraines. It appears probable that chiropractic care has an effect on the physical conditions related to stress and that in these people the effects of the migraine are reduced[19].”
- McCrory D, et. al. – “Cervical spinal manipulation was associated with improvement in headache outcomes in two trials involving patients with neck pain and/or neck dysfunction and headache. Manipulation appeared to result in immediate improvement in headache severity when used to treat episodes of cervicogenic headache when compared with an attention-placebo control. Furthermore, when compared to soft-tissue therapies (massage), a course of manipulation treatments resulted in sustained improvement in headache frequency and severity[20].”
Many headache patients present to chiropractors after a considerable amount of time spent taking headache and migraine medications. Medications do not come without consequences. Certainly when taking long-term. Not only have they spent a considerable amount of time on medication, they often have had botox injections, steroid injections, and worse before finally going to the chiropractor.
It is a fact that patients should have the GUARANTEED of the best treatment that does the LEAST amount of harm. In that spirit, and considering that chiropractic is safe, effective, and non-pharmacologic, it makes sense that the medical field should actually PROMOTE chiropractic as a viable and valuable treatment for headaches and migraines rather than dismiss it as ineffectual and dangerous.
Having demonstrated study upon study validating the effectiveness and benefit of cervical manipulation for neck pain (acute, subacute, and chronic) and headaches (chronic, acute, subacute, tension-type, cervicogenic, and migraines), we can now focus attention on research papers and abstracts having to do with the risk of stroke instance (lack of risk) as a direct result of cervical chiropractic adjustments.
But first, where would you think the idea of chiropractors running around stroking everyone out might come from? I believe there are at least a few root sources.
- You guessed it: our old friend the American Medical Association and their state association underlings. This group deemed it unethical to refer to chiropractors or accept referrals FROM They tried to run us out of business by conducting conferences about chiropractic and generating literature that was anti-chiropractic. They then dispersed the misinformation down through the channels of the state medical associations all the way out to the medical doctors, nurses, and medical field profession out in the field, and then ultimately to their patient bases. The “Chiropractors Cause Strokes” myth was well within their ability to propagate. When your initiative is to rid the Earth of the chiropractic profession, you take advantage of what you can. The Federal Court decision in Wilk vs. AMA shows the AMA did just that.
- The other likely culprit in my estimation would be patients visiting medical professionals after having been to a chiropractor and having suffering a stroke sometime afterward. I did not say chiropractors “causing” strokes. Research shows us that people are going to chiropractors already suffering arterial tears that are sometimes spontaneous in nature. While chiropractors have a high level of education, there are many out there that are simply untrained at catching red flags and making the proper referral. Other times, patients present with very common symptoms and there are no red flags present whatsoever. The chiropractor treats the patient thinking they are going to help improve a neck complaint or a headache while in reality they may be exacerbating a tear. When the patient reaches the medical professional, the link is easy to make for the uninformed: chiropractor causes stroke.
- Ignorance – The simple lack of knowledge regarding the body of evidence and research that is available on the topic perpetuates the myth. It is clear the benefits are present. It is clear the risks are not. End of story. But if one is ignorant of the literature,
This is where we are going to stop for this second episode of the Chiropractors cause strokes series. Remember, it is a three part series.
Be sure to tune in next week for the third and final part of the three part series. Next week, we will discuss risky interventions, papers having to do with the risk, or lack thereof, of chiropractic adjustments to the cervical region specifically, and then a wrap up of the information.
Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes.
If you love what you hear, be sure to check out www.chiropracticforward.com. As this podcast builds, so will the website with more content, products, and chances to learn.
We cannot wait to connect again with you next week. From Creek Stone, my office here in Amarillo, TX, home of the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
- Korthals-de Bos IB, Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. British Medical Journal, 2003. 326(7395): p. 911.
- Dewitte V, Articular dysfunction patterns in patients with mechanical neck pain: a clinical algorithm to guide specific mobilization and manipulation techniques. Man Ther, 2014. 19(2-9).
- Dunning J, Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC Musculoskeletal Disorders, 2016. 16(64).
- Bronfort G, Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain: A Randomized Trial. Annals of Internal Medicine 2012. Ann Intern Med, 2012. 156(1): p. 1-10.
- Puentedura EJ, Development of a clinical prediction rule to identify patients with neck pain likely to benefit from thrust joint manipulation to the cervical spine. J Orthop Sports Phys Ther, 2012. 42(7): p. 577-92.
- Yu H, Upper cervical manipulation combined with mobilization for the treatment of atlantoaxial osteoarthritis: a report of 10 cases. J Manipulative Physiol Ther, 2011. 34(2): p. 131-7.
- Puentedura EJ, Thoracic spine thrust manipulation versus cervical spine thrust manipulation in patients with acute neck pain: a randomized clinical trial. J Orthop Sports Phys Ther, 2011. 41(4): p. 208-20.
- Miller J, Manual therapy and exercise for neck pain: a systematic review. Man Ther, 2010. 15(4): p. 334-54.
- Hurwitz EL, e.a., Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine, 2008. 33(4 Suppl): p. S123-52.
- Muller R, G.L., Long-term follow-up of a randomized clinical trial assessing the efficacy of medication, acupuncture, and spinal manipulation for chronic mechanical spinal pain syndromes. J Manipulative Physiol Ther., 2005. 28(1): p. 3-11.
- Zhu L, Does cervical spine manipulation reduce pain in people with degenerative cervical radiculopathy? A systematic review of the evidence, and a meta-analysis. Clin Rehabil, 2015.
- Giles LGF, M.R., Chronic spinal pain syndromes: a clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation. J Manipulative Physiol Ther, 1999. 22(6): p. 376-81.
- Bronfort G, Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. Spine, 2004. May-Jun 4(3): p. 335-56.
- Malo-Urries M, Immediate Effects of Upper Cervical Translatoric Mobilization on Cervical Mobility and Pressure Pain Threshold in Patients With Cervicogenic Headache: A Randomized Controlled Trial. J Manipulative Physiol Ther, 2017. 40(9): p. 649-658.
- Espi-Lopez G, e.a., Do manual therapy techniques have a positive effect on quality of life in people with tension-type headache? A randomized controlled trial. Eur J Phys Rehabil Med, 2016. 13(1): p. 4-13.
- Hurwitz EL, e.a., Variations in Patterns of Utilization and Charges for the Care of Neck Pain in North Carolina, 2000 to 2009: A Statewide Claims’ Data Analysis. J Manipulative Physiol Ther, 2016. May 39(4): p. 240-51.
- Bronfort G, Efficacy of spinal manipulation for chronic headache: a systematic review. J Manipulative Physiol Ther, 2001. 24(7): p. 457-466.
- Bronfort G, Effectiveness of manual therapies: The UK evidence report. Chiropr Osteopat, 2010. 18(3).
- Tuchin PJ, e.a., A randomized controlled trial of chiropractic spinal manipulative therapy for migraine. J Manipulative Physiol Ther, 2000. 23(2): p. 91-95.
- McCrory D, Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache. Duke University Evidence-based Practice Center, Center for Clinical Health Policy Research.
DEBUNKED: The Odd Myth That Chiropractors Cause Strokes Revisited
Part 1 of 3
This week, we are going to start tackling a myth that has run rampant for years and I hope to once and for all dispel it. The myth is that Chiropractors Cause Strokes. The information could not be clearer on this and we’re gonna to show it to you in a way that you can understand and in a way that allows you to show it to others. I’m done with this myth, folks!
Before we get started, I want to draw your attention to the reviews over at iTunes. If you would be kind enough to leave us a great review we sure would appreciate you! This is a new podcast and we need all the help we can get!
Right now though, it’s time for bumper music!
Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast where we talk about issues related to health, chiropractic, evidence, chiropractic advocacy, and research. Thank you for taking time out of your day I know your time is valuable and I want to fill it with value so here we go.
Unfortunately, you often read, watch, or hear me complaining about how our profession has been historically attacked by those organizations in charge of the medical profession. I hope those paying attention understand it is not just sour grapes.
It is education.
It has been proven in the courts that medical associations and organizations aligned together to force Chiropractic out of business. When we talk about profession validation, the history of our invalidation is incredibly important.
I continually bring these facts up in my articles, videos, and podcast because many of the things we talk about have their roots in our history, in the attacks our profession has sustained, and in the attacks our profession is currently battling.
From the start, let me state that research simply does NOT support the “Chiropractors Cause Strokes” myth.
If you have seen the TV series called “Mythbusters,” then you know the smart red-headed guy and the bald bespectacled serious guy both, along with their rascally cohorts, took a common myth and tested its validity.
Some of the myths were outrageous and some seemed like they may actually be plausible. The show, whenever I watched it was highly entertaining and extremely educational. The entertaining part always came toward the end of the show when they would blow something to smithereens. That’s the part where the inner child in me would leap with glee. Internally of course, not externally.
This mythbusting process has already been carried out for the “Chiropractors Cause Strokes” myth. Several times, in fact. Without the show-ending explosion of course. Although, at the end of this Mythbusting series, I may walk away with a mic drop if you’re all OK with that.
I say mythbusting series because there is SO MUCH information here that I have to split it into 3 different episodes for the podcast. I’m pumping my own tires and I am completely full of myself on what I’m about to say here and I’m well-aware of the fact but, from what I have seen out there on the interwebs, I feel like this is, or at least CAN be, the definitive article, the definitive podcast, the definitive gathering of the information for this topic. If that is indeed the lofty goal I’m aiming for, it has to be comprehensive and somewhat exhaustive and I don’t think I can maintain your focus and interest for the entire amount of the information to be compiled into one super long episode.
I have split it into three episodes that will break up like this
The first episode, the one you’re currently listening to will include some risky odds, some case specific discussion, some signs and symptoms of vertebral artery dissection, and some research dealing with common treatments within the medical profession.
In the second episode coming next Thursday we will discuss research papers demonstrating and validating benefits of having cervical manipulation treatments. Or chiropractic adjustments to the neck. We will talk about the benefits, according to research, for neck pain as well as for headaches. And we’ll also talk a little about where this myth came from and why it perpetuates to this day.
In the third and final episode we will discuss risky interventions, papers having to do with the risk, or lack thereof, of chiropractic adjustments to the cervical region specifically, and then a wrap up of the information.
Stick with us on this. If you are a chiropractor, a chiropractic advocate, patient, or an open-minded professional in the field of healthcare, I am absolutely certain you are going to learn stuff that you never knew you did not know. It’s a guarantee.
Now, let’s dive into this first episode of the “Chiropractors Cause Stroke” series.
Through the RAND institute, it is estimated that a serious, adverse reaction (such as stroke as a result to a chiropractic adjustment alone) happens in approximately 1 out of every 1 million treatments?
Let’s put that finding into perspective by comparing it to some other odds.
- The odds of being struck and killed by lightning is 1 in 174,426 according to the National Safety Council.
- The odds of being told to “Come on down,” on The Price Is Right is 1 in 36!
- The odds of being born with 11 fingers or toes is 1 in 500.
- The odds of dying from a firearms assault is 1 in 113.
- How about this one: the odds of winning an Oscars are 1 in 11,500.
I think it’s time to move to LA!
The simple message is that there is very little (to absolutely almost zero) risk at all of a chiropractic adjustment being the sole cause for a person having suffered a stroke.
Consider that there are 70,000+ chiropractors in the United States of America. If Doctors of Chiropractic were out in the world causing strokes “all of the time,” it would be apparent, it would be obvious, and our malpractice insurance would reflect the fact that a visit to the chiropractor comes with a considerable amount of risk. To the contrary, we chiropractors have malpractice insurance that costs chiropractors approximately 1/10th of what it costs our medical counterparts.
Before we start diving off into the research too deeply, I want to talk about a case that happened within the last couple of years (February 2016) that brought the “Chiropractors Cause Stroke” myth back to the forefront. It had to do with the “Queen of Snapchat” Katie May. Katie died of a stroke at the age of 34 and, by many, it was immediately assumed the stroke was caused by her two visits to a chiropractor to treat her recent onset of neck pain.
I actually wrote about this case shortly after it originally happened. Initial reports stated that she had a horrible fall while on the set of a photoshoot, which resulted in her neck pain. Then, for some reason, this fact seemed to disappear from further reports.
Also, initial reports stated that Katie visited either the ER or a medical professional prior to her visits with a chiropractor. The family later denies this so, admittedly, there is some confusion on the matter. With this information brought back into the reporting, let’s begin breaking it all down.
Katie posted this message to Twitter: “Pinched a nerve in my neck on a photoshoot and got adjusted this morning. It really hurts! Any home remedy suggestions loves? XOXO.”
Keep that in mind as we run through things that can cause a vertebral artery dissection such as Katie May suffered. They are as follows:
- Physical Trauma (direct blow to the neck, traffic collision, etc.)
- Strangulation
- Spontaneous (from underlying connective tissue disorder)
According to one paper by Debette et. al., “Trauma has been reported to have occurred within a month of dissection in 40% with nearly 90% of this time the trauma being minor[1]. “
Vertebral artery dissection (VAD) can be particularly difficult to diagnose without the use of a CT Angiogram. For instance, some common symptoms of VAD are as follows:
- Pain and/or numbness in the same side of the face.
- Head pain/Headache that develops gradually and can be dull or throbbing
- In less than 1/5th of the cases of VAD, people suffer difficulty speaking or swallowing.
- Possible unsteadiness or lack of coordination
- Visual abnormalities
- Hiccups
- Nausea/Vomiting
- Hearing loss
When one reads this list, it is easy to diagnose a VAD, right?
It rarely presents with these classic signs. VAD commonly presents as a healthy patient that shows up with a headache or neck pain and sometimes both. In fact, it is estimated that more than 80% of VAD cases present with neck pain and headache alone.
Is a medical professional or chiropractor going to refer every single one of these patients for a CT Angiogram? Not very likely. It is simply not economically feasible to do so and good luck getting insurance companies to cover the costs of the CT Angiograms!
If Katie did indeed visit a medical professional after her fall, they missed it. Unfortunately, it seems obvious that the chiropractor missed it as well. That does not, however, mean the two professionals are inept. As the website for emedicine.com states, “The focal signs may not appear until after a latent period lasting as long as three days, however, and delays of weeks and years also have been reported[2].”
A study that we will discuss later shows that people commonly present to a chiropractor or a primary practitioner (medical doctor) already suffering an artery dissection before even walking into their offices but assuming the pain is a result of something innocent and simple.
With that being said, I don’t want to be completely biased here. If a healthy person shows up with a headache and neck pain BUT has a history of recent trauma, more exploration is advised, without question. Knowing this, I can relay countless stories of medical doctors having made bad decisions as well. I have heard countless stories throughout my twenty years of practice. Ultimately, we are all human which is why chiropractors and medical doctors both carry malpractice insurance. But, as I mentioned before, chiropractors’ malpractice is approximately 1/10th that of their medical counterparts because, basically, we do not typically cause any harms in our patients.
As we go through more and more papers, it should be clear that Katie likely suffered the VAD as a result of the fall during the photo shoot and the VAD was missed by the medical professionals (if she did indeed go) and then certainly missed by the chiropractor BUT, the chiropractor almost certainly did not CAUSE the VAD. There’s no we he helped it and could have even potentially exacerbated it, but it is highly doubtful and exceedingly rare that he could have been the CAUSE of it.
Some time later, the Los Angeles coroner reported that the chiropractor was responsible for Katie’s death. This finding really opened the door to all of the chiropractic haters to bash away at the profession.
The LA coroner’s office is an appointed position that, in some states, requires little training, to be quite honest. While I am unaware of this particular coroner’s level of training and expertise, this coroner has been under scrutiny for being understaffed and underfunded to mention just a couple of issues. In addition, I would argue that simply because a man or a woman is a county coroner, does not mean they are above being affected by bias or by their profession’s long-held beliefs and teachings. I would say they most certainly are not above influence and, in my opinion, are highly likely to be affected by them.
I would also argue that the coroner likely has little to zero knowledge of the current body of research regarding cervical manipulation and the instance of stroke. How could an educated person aware of the body of literature on the matter decide otherwise?
For years, I have experienced nurses, physician assistants, medical doctors, and others in an online setting claiming that chiropractic adjustments are dangerous and ineffective. A common theme amongst them is, “It happens all of the time.” We see it “all of the time.” Research proves the notion is a lie.
To put it in plain and simple terms, they wonder why someone would undergo a treatment that is so dangerous for absolutely no improvement. Again, this simply shows ignorance in regards to the available research. I would like to be less dramatic or inflammatory in my wording but I do not know of another way to describe it.
Let’s assume that this myth has its base rooted in some sort of fact. Let us be clear. It does not. But, for argument sake, let us say that it does. At that point, we would need to assess the benefits of chiropractic treatment vs. the risks of chiropractic treatment.
In Southern terms, “Is the squeeze worth the push?”
Is there a return on the investment?
Again, this is purely for argument sake because the “Chiropractors Cause Strokes” myth is not real to start with but playing the devil’s advocate can be of use and is almost always entertaining.
Before we step into deeper water with the research papers, let us discuss benefits & effectiveness vs. risk for some common treatments for spinal complaints in the medical world. If the discussion is focused on doing away with cervical adjustments, what then would be the alternatives and how effective are they? Basically, if the medical field is looking in OUR backyard, maybe we should take a peek into theirs as well.
Keep in mind that all of the research we discuss will be cited in the show notes so that those of you that wish can easily research these independently on your own.
- The opioid crisis cost the US economy $504 billion dollars in 2015 and a total of $221 billion to $431 billion in lost economic output due to there being 33,000 opioid-related deaths in 2015[3].
- There were 63,600 opioid-related deaths in 2016, which was an increase of 21% from the 2015.[4].
- Chou R, et. al. – Although the steroid injections for radiculopathy showed some short-term relief in pain and short-term increase in function, the benefits seen in the patients were only small and short-term only. There was no effect long-term and no affect on whether or not the person had surgery eventually. The evidence in this paper suggested there was no effectiveness at all for the treatment of spinal stenosis[5].
- Epstein N, et. al. – “Although not approved by the Food and Drug Administration (FDA), injections are being performed with an increased frequency (160%), are typically short-acting and ineffectiveover the longer-term, while exposing patients to major risks/complications[6].”
- Peterson CK, et. al. – ““Subacute/chronic patients treated with SMT (spinal manipulative therapy) were significantly more likely to report relevant “improvement” compared with CNRI (CERVICAL NERVE ROOT INJECTION) patients.There was no difference in outcomes when comparing acute patients only[7].”
- Chou R, et. al. – “Epidural corticosteroid injections for radiculopathy were associated with immediate improvements in pain and might be associated with immediate improvements in function, but benefits were small and not sustained, and there was no effect on long-term risk of surgery. Evidence did not suggest that effectiveness varies based on injection technique, corticosteroid, dose, or comparator. Limited evidence suggested that epidural corticosteroid injections are not effective for spinal stenosis or nonradicular back pain and that facet joint corticosteroid injections are not effective for presumed facet joint pain[5].”
- Chou R, et. al – “Surgery for radiculopathy with herniated lumbar disc and symptomatic spinal stenosis is associated with short-term benefits compared to nonsurgical therapy, though benefits diminish with long-term follow-up in some trials. For nonradicular back pain with common degenerative changes, fusion is no more effective than intensive rehabilitation, but associated with small to moderate benefits compared to standard nonsurgical therapy[8].”
- Maghout J, et. al. – “Use of intervertebral fusion devices rose rapidly after their introduction in 1996. This increased use was associated with an increased complication risk without improving disability or reoperation rates[9].”
At this point, it is clear the medical field has its own issues to concentrate on and improve upon when it comes to spinal pain and the treatment of it. It is my opinion these facts are but only a few of the concerns in the medical field and, if taken individually, are much more concerning than any one single issue that can be found within the chiropractic profession.
The biggest yoke they try to put on our necks is stroke and, considering the research, their concerns should be focused in their own playground.
This is where we are going to stop for this first episode of the Chiropractors cause strokes series. Remember, it is a three part series.
Be sure to tune in next week for the second part of the three part series. Next week, we will be talking about the benefits, according to research, for neck pain as well as for headaches. And we’ll also talk a little about where this myth came from and why it perpetuates to this day.
Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes.
If you love what you hear, be sure to check out www.chiropracticforward.com. As this podcast builds, so will the website with more content, products, and chances to learn.
We cannot wait to connect again with you next week. From Creek Stone, my office here in Amarillo, TX, home of the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
References
- Debette S, "Pathophysiology and risk factors of cervical artery dissection: what have we learnt from large hospital-based cohorts?". . Current Opinion in Neurology, 2014. 27(1): p. 20-8.
- Lang E. Vertebral Artery Dissection. Emergency Medicine 2017 January 18]; Available from: https://emedicine.medscape.com/article/761451-overview.
- Mutikani L. Opioid crisis cost U.S. economy $504 billion in 2015: White House. 2017; Available from: https://www.reuters.com/article/legal-us-usa-opioids-cost/opioid-crisis-cost-u-s-economy-504-billion-in-2015-white-house-idUSKBN1DL2Q0.
- Glenza J. Life expectancy in US down for second year in a row as opioid crisis deepens. 2017 December 21; Available from: https://www.theguardian.com/us-news/2017/dec/21/us-life-expectancy-down-for-second-year-in-a-row-amid-opioid-crisis.
- Chou R, Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis: A Systematic Review and Meta-analysis. Ann Intern Med, 2015. 163(5): p. 373-81.
- Epstein N, The risks of epidural and transforaminal steroid injections in the Spine: Commentary and a comprehensive review of the literature. Surg Neurol Int, 2013. 4(Suppl 2): p. S74-93.
- Peterson CK, Symptomatic, Magnetic Resonance Imaging-Confirmed Cervical Disk Herniation Patients: A Comparative-Effectiveness Prospective Observational Study of 2 Age- and Sex-Matched Cohorts Treated With Either Imaging-Guided Indirect Cervical Nerve Root Injections or Spinal Manipulative Therapy. J Manipulative Physiol Ther, 2016. 39(3): p. 210-7.
- Chou R, Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline. Spine, 2009. 34(10): p. 1094-109.
- Maghout J, e.e., Lumbar fusion outcomes in Washington State workers' compensation. Spine (Phila Pa 1976), 2006. 31(23): p. 2715-23.
Podcast Script Episode #12
Proven Means To Treat Neck Pain
In today’s podcast, we are going to talk about research but hopefully in a fun way. We like to have fun on the Chiropractic Forward podcast. Let’s face it, research can be a bit boring so why not try to have some fun with it?
Before we get started, I want to draw your attention to the reviews over at iTunes. If you would be kind enough to leave us a great review, that tells iTunes that people are finding value in what we are sharing and it will help us grow this podcast. We sure would appreciate you!
Right now though, it’s time for bumper music!
Music
Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast where we talk about issues related to health, chiropractic, evidence, and research and how those things all fit into a comprehensive approach for treating different conditions. Thank you for taking time out of your day to give us a listen. I know your time is valuable and I will always try hard to fill our time with valuable content.
In the words of Chris Berman, you have back back back backed into Episode #12 and this week we’re going to have more fun than having your teenage son spank you in video games that you’ve always beat him at. Yes, this recently happened to yours truly. Not only that but he did it with a pistol and I’m asham ed. Call of Duty was my safe space y’all…..
So, I’ll just bury myself into my work, stuff it deep down inside to explode at a later date.
Now, If you have spent any significant amount of time with our videos, podcasts, or blogs, you are probably aware that there is an excess of research regarding chiropractic’s effectiveness in patients suffering from low back pain.
Although there are some excellent research papers having to do with chiropractic and neck pain, I would argue that it demands more attention. Without question. The first reason being that neck pain is as important or more so than low back pain. In the paper we will be discussing this week, they cite research suggesting that neck pain is responsible for up to 25% of the patients seen in outpatient orthopedic practices and 50% of the general population will have neck pain at some point in their lives.
The second reason I believe neck pain demands more attention from our industry is that we have been unfairly labeled as the profession out there in the world causing strokes every day. There needs to be a clear, factual representation of the risk vs. reward ratio and, if there is a small body of evidence, our case doesn’t stand up quite as strongly.
To be more clear, there is an abundance of evidence that Chiropractic is not linked to strokes any more than going to the primary practitioner. However, there is scant evidence of Chiropractic’s effectiveness for neck pain when compared to low back pain.
This does not mean there isn’t great research in our favor. That is not what I’m saying at all. It just means we have not documented it through research in the amounts that we have for the low back pain and I would like to see more. If I were a researcher myself, it is the condition I would be targeting without question.
Now, with that being said, this week’s paper is titled “The Immediate Effects of Upper Thoracic Translatoric Spinal Manipulation on Cervical Pain and Range of Motion: A Randomized Clinical Trial” published in the Journal of Manual Manipulative Therapeutics in 2008 that shows the effectiveness of spinal manipulative therapy. Here’s the catch, it was performed by physical therapists, not chiropractors. It was done by John Krauss, PT, PhD, OCS, FAAOMPT, et. al. Look at all of those letters.
At this point, I would like to diverge from the original path for a few moments. If chiropractors are unaware, along with research validating the chiropractic adjustment comes more competition for the service. Physical therapists were restricted to muscles and exercise essentially. Now, they are adjusting. This is going to become a turf war between chiropractors doing what we have always done and physical therapists adopting our treatments as their own. Of course, physical therapists can’t call what they do “chiropractic adjustments” so they have changed the term to “translatoric spinal manipulation.” It’s irritating to the chiropractic profession but it is a fact the profession will be facing more and more in the years to come so be prepared for it. It is particularly irritating when you consider that physical therapists have been part of the medical machine that have torn down the chiropractic profession for generations prior to adopting its techniques as their own.
Now, back to the research paper.
Why They Did It
The authors of the paper wanted to determine the effectiveness of thoracic (upper back) adjustments on neck pain and neck range of motion.
How They Did It
- The active range of motion of the neck in each subject was measured before and after the manipulation. The term “active range of motion” means the patient turned their neck as far as possible in rotation both ways without the assistance of the researcher.
- The range of motion was measured with a cervical inclinometer.
- The patient’s neck pain was measured prior to and after treatment with the Faces Pain Scale. A quick trip to Wikipedia tells us that the Wong-Baker Faces Pain Rating Scale is a pain scale that was developed by Donna Wong and Connie Baker. The scale shows a series of faces ranging from a happy face at 0 which represents "no hurt" to a crying face at 10 which represents "hurts worst.”
- The study included 32 patients having pain in the cervical region and limited range of motion.
- 22 of these were randomly split into an experimental group while the other ten were randomly placed into a control group.
- The evaluator measuring the pre- and post-manipulation outcomes was a blinded evaluator to reduce risk of bias.
- The experimental (treatment) group received the manipulation treatment to the areas of the upper back region that had been determined to be hypomobile. In simpler terms, they delivered the adjustment to the areas of the upper back that were stiff or not moving like they should.
- The control group had no treatment.
- Paired t-tests were used to determine the changes within the group for cervical rotation and pain. A paired t-test is used to compare two population means where you have two samples in which observations in one sample can be paired with observations in the other sample.
- A 2-way repeated-measure ANOVA was used to analyze between-group differences in cervical rotation and pain. A two-way repeated measures ANOVA is often used in studies where you have measured a dependent variable over two or more time points, or when subjects have undergone two or more conditions. The primary purpose of a two-way repeated measures ANOVA is to understand if there is an interaction between these two factors on the dependent variable.
What They Found
- Significant changes were found for neck rotation within the group as well as between the groups.
- The translatoric spinal manipulative group showed more range of motion in right rotation as well as in left rotation.
- The levels of pain the subjects experienced after the manipulation were significantly reduced.
Wrap It Up
The authors of the paper concluded by saying, “This study supports the hypothesis that spinal manipulation applied to the upper thoracic spine (T1-T4 motion segments) significantly increases cervical rotation ROM and may reduce cervical pain at end range rotation for patients experiencing pain during bilateral cervical rotation.”
When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.
Did you know that research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good to excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health!
Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. If you love what you hear, be sure to check out www.chiropracticforward.com. As this podcast builds, so will the website as we add more content, educational products, and a little further down the road, webinars, seminars, and speaking dates as they get added.
We cannot wait to connect again with you next week. From Creek Stone here in Amarillo, TX, home of the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Source Material
Krauss J, et. al., “The Immediate Effects of Upper Thoracic Translatoric Spinal Manipulation on Cervical Pain and Range of Motion: A Randomized Clinical Trial.” J Man Manip Ther. 2008; 16(2): 93–99.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565124/
It's Here: New Guides For Chiropractic That Doctors Are Ignoring
Welcome to Chiropractic Forward. This week, we are talking about acute and non-acute low back pain. What are current healthcare guidelines? Why does it matter to chiropractic patients and non-chiropractic patients and are those in the medical field getting (and implementing) the information?
Again, welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast where we talk about issues related to health, chiropractic, evidence, and research and how those things all fit into a comprehensive approach for treating different conditions. Thank you for taking time out of your day to give us a listen. I know your time is valuable and I will always try hard to fill our time with valuable content.
We’re going to have more fun this week than stepping on a nail. Which I have done.
Before we dive in, it was so nice we had to do it twice. What am I talking about? I’m talking about bringing on Tyce. Tyce Hergert that is down in Southlake, TX. Owner and operator of Chiropractic Care Center of Southlake as well as Southlake Physical Medicine where he oversees an integrated practice. Dr. hergert is also the immediate former President of the Texas Chiropractic Association so now he can say what he really thinks. He was the big cheese, the illustrious potentate of chiropractic in Texas.
Although it’s highly unlikely, should you enjoy what Tyce shares with us here today, go and listen to his other guest spot which can be found in Episode #6.
Welcome to the show Tyce. Nice to have you back.
I would say that a chiropractor would be completely oblivious to not understand that Chiropractic is considered to be on the fringe of healthcare by many to most in the medical field. It’s just a fact and chiropractors deal with this daily. We Chiropractors are used to feeling like the black sheep of the healthcare family off in a corner keeping all to ourselves.
In other articles, podcasts, and videos of mine, you’ll notice I have covered the Wilk vs. AMA case. I’ve covered the Doctored film by Jeff Hayes spotlighting mistreatment of chiropractors. I’ve also covered current attacks on Texas Chiropractors by the Texas Medical Association. It is all very well-documented at this point.
Chiropractic is currently undergoing an amazing renaissance. This is due to a couple of key factors. The first being the need to develop non-pharmacological treatment recommendations in the midst of a national opioid addiction crisis. A crisis that has killed thousands and thousands in the last several years. The second reason being the body of high-quality research that is consistently coming to light almost every month showing the effectiveness of Chiropractic and evidence-based chiropractors.
Do you feel this renaissance, Tyce, or is it just me living inside my head
With all of the new information and new healthcare laws emerging, the questions going forward SHOULD be, “Is the medical field and is the insurance industry listening and implementing?” We shall see. So far, the answer is, “Absolutely not.” In fact, it’s almost defiant.
Is that an accurate statement Tyce? You’re my checks and balance guy on everything.
Let’s begin with the most glaring denial of Federal Law by the insurance companies right now. It has to do with Section 2706 of the Patient Protection and Affordable Care Act. Also commonly known as “Obamacare.” Section 2706 of the PPACA is entitled the nondiscrimination In Health Care section of the Federal Law and is intended to keep insurance companies and health plans from keeping chiropractors and the services they provide out of the system.
It reads as follows, “A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law. This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures.”
On the American Chiropractic Association’s FAQ site for 2706, they state, “It is important to understand that Section 2706 and its assurance of non-discrimination in terms of participation and coverage requires that doctors of chiropractic not be discriminated against in the provision of any “essential benefit” that is within their scope of practice.”
Here’s the rub on 2706: part of its purpose is to reimburse chiropractors performing the same services under their scope and license at the same level financially as any other profession that provides that service.
For instance, under the PPACA Section 2706 Federal Law, chiropractors are to be paid the exact same for an 99203 exam code as a doctor of medicine or osteopathy is paid.
Would you agree with that assessment Dr. Hergert? Is this your understanding of the law?
Plain and simple. This is not happening. With so many chiropractors now integrating their practices with medical directors, physician assistants, nurse practitioners, and physical therapists like Dr. Hergert has in Southlake, it’s painfully clear that doctors of chiropractic are being discriminated against when it comes to reimbursements for the same codes performed.
In fact, chiropractors are integrating with these other professions just so that they can finally GET the reimbursements that the other practitioners are allowed! It is madness and clearly violates Section 2706 of PPACA.
Dr. Hergert, you are a great resource here since you’re in the middle of the two professions. What is your experience on this?
Tyce: The carriers will come right out and tell you they don’t think they have to play by this rule.
Also, there is violation of the law if an insurer does something such as applying caps on specific services provided by one healthcare provider whereas the cap does not apply to another type of provider. It is my understanding that United Healthcare has moved to a $65 visit cap on chiropractic care here in Texas.
Am I misinformed here Tyce? Does United Healthcare only put caps on Chiropractors or are they capping services with all providers?
Tyce: That gets very frustrating for those patients with a $50-70 copay.
It is the American Chiropractic Association’s opinion that a violation exists if the insurer or plan denies specific forms of care that is otherwise covered if it is a chiropractor providing the service and it is within their scope and licensing. I would suggest that a medical doctor probably gets services such as non-surgical decompression covered under insurance but chiropractors are routinely denied coverage.
Are there any better examples of this disparity, Tyce, since I don’t know any medical doctors that have their patients perform decompression?
There is also a possible violation when doctors of Chiropractic are denied inclusion into a plan or group purely based on the profession. For example, it is my understanding that FirstCare won’t cover Chiropractic. Is that a violation? I suppose I could offer an opinion if I were a lawyer. I’m not sure why exactly other providers are allowed coverage while chiropractors are left out in the cold. Here is a great example though that I’m aware of here locally. there is a local insurance network that will remained un-named that charges $200 per year for chiropractors to be included for coverage however, medical professionals pay nothing to be included. Could that be a violation of the nondiscrimination law? I would say it smells a little fishy.
In my opinion, Federal Law is being violated all over the place in regards to Section 2706 of PPACA. I’m not sure how it can be perceived any other way.
What can you add here Tyce that I may have left out?
Tyce: What this means for patients is you can’t use that shiny new insurance policy that is costing you more than a $250k house payment would. You have to fork over the more money to pay for your chiropractic care.
Moving on from Section 2706…..I love talking about the New Recommendations For Acute and Chronic Low Back Pain.
It is becoming more and more aggravating that we chiropractors are not seeing a flood of acute and chronic low back pain patients. If you read my articles, watch my videos, or listen to my podcast with any regularity, you have no doubt been informed several times over of these new recommendations which, at this point aren’t that new anymore. They have been around for about a year now.
It is my opinion that no long-held beliefs or protocols will change if new information isn’t continually pounded and yelled about from the top of the roofs with megaphones. In marketing, experts have said that it takes a target 7 times of being exposed to information before it is finally received and, hopefully, acted upon.
I know that the medical field has NOT been exposed to this information at least 7 times because of two factors:
- I have spoken to several medical practitioners here locally and not a single one of them has heard of or were aware of these new recommendations.
- I am not seeing an incredible, overwhelming influx of acute and chronic low back pain new patients coming through my doors as a result of medical referrals.
Tyce, are you seeing an incredible influx of new low back patients from the medical field these days?
Is this willful disregard for the changing recommendations and a “clinging on” to old dogmatic beliefs passed down from the AMA years ago? I think some of it most certainly is.
Is it that a few bad seeds in the Chiropractic profession are giving the rest of us a bad image? I would say some of it most certainly is.
What I think it is mostly based on, however, is the fact that medical professionals are busy, they’re stressed, and many times over-worked and they simply don’t always have the time or opportunity to stay completely up on every new recommendation or updated protocol.
What do you think about it, Tyce?
Tyce: “You’re not down with, what you’re not up on.” Most don’t know. They didn’t get this info in school, and the pharma reps aren’t out spreading the good news.
With that being said, let’s be clear; the issues of low back pain, its economic impact, and the national opioid epidemic crisis in America combine to make these new recommendations that much more important.
Let’s start with the American College of Physicians. Remember, the American College of Physicians was proven in the Wilk vs. AMA case to have played a part in collaborating with the AMA in an attempt to rid the Earth of Chiropractic. I think that’s important to note as we go through the information because the ACP is historically known as a detractor or the chiropractic profession to put it mildly.
In response to the opioid epidemic gripping the nation currently, the American College of Physicians developed new recommendations for treating acute and chronic low back pain.
Why They Did It
- The American College of Physicians developed this guideline in order to provide updated recommendations on treatment of low back pain.
- With these recommendations, the ACP hoped to influence clinicians AND patients to make the correct decision for care in acute, subacute, or chronic low back pain conditions.
How They Did It
- They based their recommendations on a systematic review of randomized controlled trials and other systematic reviews.
- The research they reviewed included those papers available through April of 2015.
- The research included only those on noninvasive pharmacologic and nonpharmacologic treatments.
What They Found
- Recommendation #1: patients with subacute or acute low back pain should seek nonpharmacologic treatments such as Chiropractic, Massage, Acupuncture, and superficial heat BEFORE resorting to non-steroidal anti-inflammatories such as Ibuprofen, Tylenol, Aleve, etc… (Graded as a strong recommendation)
- Recommendation #2: patients with chronic low back pain should seek nonpharmacologic treatments such as Chiropractic, Exercise/Rehabilitation, Acupuncture, & Cold Laser Therapy BEFORE resorting to non-steroidal anti-inflammatories such as Ibuprofen, Tylenol, Aleve, etc… (Graded as a strong recommendation)
- Recommendation #3: In patients with chronic low back pain that have had no relief from nonpharmacological means, the first line of treatment would consist of NSAIDs like Aleve, Tylenol, Ibuprofen, etc.. As a second-line treatment, the clinician may consider tramadol or duloxetine. Opioids would be a last option and only if all other treatments have been exhausted and failed and even then with lengthy discussion with the patient in regards to the risks and benefits of using opioids. (Graded as weak recommendation)
Let’s recap: in February of 2017, the American College of Physicians, historically a Chiropractic profession detractor and attacker, now recommends Chiropractic as a first-line treatment for acute and chronic low back pain.
Dr. Hergert, does that make you feel warm and fuzzy inside because it does me?
Next, let us discuss the American Medical Association. If you thought the American College of Physicians was guilty of Chiropractic-hating, the American Medical Association is, or was, “Pablo Escobar” or the “El Chapo” of the attacks on the Chiropractic profession. The “El Jefe” of the Chiropractic haters, and the group that not only sat in the driver’s seat but also OWNED the entire truck of destruction back before Wilk vs. AMA came along. I believe I have been watching too much Netflix.
As a side note, I have realized that I have a wife, a daughter, and an all female staff at my office and…..I’m not the El Chapo or El Jefe of really anything. My son and I just walk around following orders pretty much. Tyce, you’re married with two daughters right?
On April 11, 2017, the Journal of the American Medical Association published a study on their website titled “Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain Systematic Review and Meta-analysis,” authored by Neil Page, MD et. al. In the format of this research paper, they refer to chiropractic treatment as spinal manipulative treatment or SMT. But, because spinal manipulative therapy is what we chiropractors do the most and what we are most identified with, I’m replacing the term “SMT” with “chiropractic adjustment.”
Is that fair, Tyce? I think it’s fair.
Why They Did It
Considering that spinal manipulation, or the chiropractic adjustment, is a treatment option for acute low back pain, and that acute low back pain is one of the most common reasons for visits to the doctor’s office, the authors wanted to systematically review the studies that have been done in the past dealing with the effectiveness as well as the harms of chiropractic adjustments in the treatment of acute low back pain.
How They Did It
- The researchers used searches of MEDLINE, Cochrane Database of Systematic Reviews, EMBASE, and Current Nursing and Allied Health Literature.
- The search spanned 6 years from January 2011 through February 2017 for randomized controlled trials of adults with low back pain comparing spinal manipulative therapy with no treatment or with alternative treatments.
- The accepted papers also had to measure pain or functional outcomes for up to 6 weeks.
- The data extraction was done in duplicate.
- The quality of the study was assessed through use of the Cochrane Back and Neck Risk of Bias tool.
- Finally, the evidence was assessed using the GRADE criteria which stands for Grading of Recommendations Assessment, Development, and Evaluation.
- 26 eligible randomized controlled trials were identified and accepted
What They Found
- 15 of the RCTs, totaling 1699 patients, showed moderate-quality evidence that chiropractic adjustments had a statistically significant association with improvements in PAIN.
- 12 of the RCTs, totaling 1381 patients, showed moderate-quality evidence that chiropractic adjustments have a statistically significant association with improvements in FUNCTION.
- NO RCTs reported any serious harms or adverse event as a result of undergoing chiropractic adjustments.
- There were only minor events reported like some increased pain, muscle stiffness, and headache in roughly 50%-67% of those treated in the large case series. I would be interested to hear more about this statement by the authors. That is not what we commonly see in our practice. Sometimes, if the patient is new and is not accustomed to chiropractic adjustments, they may experience some soreness or stiffness the next day which is to be expected following a change in the body.
- I want to be as thorough as I can here….Tyce, do you see 50%-67% minor harms in your daily practice?
Wrap It Up
In true AMA fashion, instead of just coming out and saying, “Chiropractic adjustments showed moderate quality evidence for effectiveness in pain as well as in function,” the authors instead stated in conclusion, “Among patients with acute low back pain, spinal manipulative therapy was associated with modest improvements in pain and function at up to 6 weeks, with transient minor musculoskeletal harms. However, heterogeneity in study results was large.” Heterogeneity is defined as, “The quality or state of being diverse in character or content.” In my opinion, this is to give themselves and “out” by implying there was not enough focus to the RCTs to truly state their findings as fact.
Nonetheless, when the AMA comes even remotely close to endorsing anything having to do with Chiropractic, I’ll take it. And so should those in the medical field that commonly come in contact with those seeking help for their acute and chronic low back pain.
So…….We Should Be All Set For Success Now Right? Maybe they’re about to open up a chiropractic low back pain wing of the hospital, right?
That is what you’ think but there is new information from the White House that this simply is not the case despite the obvious ramifications. You can find the link in the show notes but on page 57 of The President’s Commission On Combating Drug Addiction and The Opioid Crisis report, the authors say, “A key contributor to the opioid epidemic has been the excess prescribing of opioids for common pain complaints and for postsurgical pain. Although in some conditions, behavioral programs, acupuncture, chiropractic, surgery, as well as FDA-approved multimodal pain strategies have been proven to reduce the use of opioids, while providing effective pain management, current CMS reimbursement policies, as well as health insurance providers and other payers, create barriers to the adoption of these strategies.” This is straight from the White House.
At the bottom of page 57, you will also see that it says, “The Commission recommends CMS review and modify rate-setting policies that discourage the use of non-opioid treatments for pain, such as certain bundled payments that make alternative treatment options cost prohibitive for hospitals and doctors, particularly those options for treating immediate post-surgical pain.”
What say you Tyce?
Tyce: You mean like a specialist copay for chiro care and a lower copay for primary care? Or covering surgery 100% and NOT covering non-surgical means.
Essentially, the United States Government is admitting there is professional discrimination at the highest levels…..hello Medicare and Health Insurance plans….I’m talking to you….this discrimination creates barriers to doing the smart thing.
The smart thing is seeing a chiropractor for your back pain. The “Big Guys” (AKA: American College of Physicians and the American Medical Association) recommend it and the government says policies are in place to prevent patients from following those recommendations.
In addition, policies that discriminate against chiropractic or chiropractors run in violation of Section 2706 of PPACA. It comes full circle.
I know you have something good to say here Tyce…
Tyce: The beautiful thing we get to see in our office, since we have both medicine and chiropractic working together, is the end of the story…people getting off the mind altering drugs, healing, and getting their lives back. All we do is follow these simple guidelines.
I have a question to pose to the entire Chiropractic profession: How in the heck do we deal with this?
It has to be through either the legislature at the state and federal levels or it has to be through the legal system. A guarantee I feel comfortable making is that the insurance companies won’t begin enforcing it on their own.
Mobilization and unification of the Chiropractic profession is probably where it starts.
Some steps toward that end include:
- Join or get involved with your state association. They’re the only ones effectively fighting for you and your rights on the state level.
- Join or get involved with your national association. They’re the only ones effectively fighting for you and your rights on the national level.
- If possible, build relationships with your state and national legislators.
- Donate to all of the above in the largest amounts you are comfortable with.
- Tell your friends and your colleagues about what is going on and help them get involved if they’re so inclined.
- Follow the news of your industry closely and stay knowledgeable about your profession. Both the good AND the bad.
Tyce, you have served for years and you’re still serving your profession. What you got on this?
Tyce: “Be part of the solution. You don’t have to dedicate 24/7 to the crusade….but you could do a little more. Right?”
A Chiropractic profession that is unified and playing offense instead of defense is powerful and is one of the worst nightmares of some folks I know out there in the world. Personally, as a side note, I like to see people like that squirm just a little don’t you? It just feels good. Makes what’s left of my hair stand up.
So won’t you consider helping if you haven’t before? If you don’t know where to start, email me at dr.williams@chiropracticforward.com and I will help you get on your way.
Tyce, I want to thank you for taking the time to come on the podcast and share your genius with us. With our history, I’m sure that Chiropractic Forward podcast listeners can count on your being a guest many many times. And, the next time will be the third time and I can say something like, “It was so nice, we had to do it thrice, with Tyce….or something stupid but entertaining like that.” Thanks for joining us today.
When Chiropractic is at its best, you cannot beat the risk vs reward ratio.
Did you know that research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic? Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health!
Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. If you love what you hear, be sure to check out www.chiropracticforward.com. As this podcast builds, so will the website as we add more content, educational products, and a little further down the road, webinars, seminars, and speaking dates as they get added.
We cannot wait to connect again with you next week. From Creek Stone here in Amarillo, TX, home of the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
References and Source Material
- https://www.amarillochiropractor.com/startling-medical-professional-attacks-chiropractic/
- https://www.amarillochiropractor.com/healthcare-in-texas-the-battle-against-a-monopoly-a-true-story-about-david-goliath-3/
- https://www.whitehouse.gov/sites/whitehouse.gov/files/images/The%20Underestimated%20Cost%20of%20the%20Opioid%20Crisis.pdf
- https://www.acatoday.org/Portals/60/Docs/Advocacy%20and%20Reimbursement/2706/2706-FAQs.pdf?ver=2015-12-23-125425-503
- http://annals.org/aim/fullarticle/2603228/noninvasive-treatments-acute-subacute-chronic-low-back-pain-clinical-practice
- https://jamanetwork.com/journals/jama/article-abstract/2616395?widget=personalizedcontent&previousarticle=2616379
- https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-3-2017.pdf
Surprise Unique Information Shows Chiropractic May Work On The Brain Too
Welcome to the Chiropractic Forward podcast. I am your host Dr. Jeff Williams and we’re exctied to have you along for the ride. In today's show, we’re going to talk about how chiropractic affects the brain itself rather than how it affects just the musculoskeletal system. We include some intriguing stuff from New Zealand that will make you think, hmmmm, that’s interesting, and we’ll have a little fun along the way
Again, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast This is where we talk about issues related to health, chiropractic, evidence, and research and how those things all fit into a comprehensive approach for treating different conditions. Thank you for taking time out of your day to give us a listen. I know your time is valuable and I will always try hard to fill our time with valuable content.
You have bobbed and weaved your way into episode #9 of the Chiropractic Forward podcast.
Before we get started, I want to draw your attention to the reviews over at iTunes. If you would be kind enough to leave us a great review, that tells iTunes that people are finding value in what we are sharing and it will help us grow this podcast. We sure would appreciate you!
For anyone that has paid any amount of attention to chiropractic, it's clear that chiropractic treats muscles, bones, and the biomechanics overall. But what some people don't commonly consider is the fact that chiropractic is effective when treating the nerves that make it all work together.
For instance, what do you think about when you think of chiropractic? More than likely, you think about back pain, neck pain, athletes, and headaches and migraines. It is unlikely that phrases like “cortical drive” or “movement related cortical potential” comes to mind.
According to the author of the paper we’re going to be talking about today, "Scientists use to believe spinal manipulation was a biomechanical treatment option for spinal pain conditions. However, the growing basic science evidence suggests there may be more of a neurophysiological effect following spinal manipulation than previously realized.”
When we begin to talk about the brain, physiology, neurology, and neurological processes, you can get into some highly complicated terms and ideas. I'm going to do everything I can to put it into terms that anyone and everyone can easily process without having a year of neurology classes.
And let's be crystal clear, I'm not a neurologist or a chiropractic neurology diplomate either with tons of extra education on the brain and nervous system specifically. Many of these terms go above MOST of our heads and MOST of the heads in the medical field as well. That is just a matter of fact. But that doesn’t mean we can’t read, comprehend, and relay the overall pertinent information, which is what we are doing here.
Basically, “What’s the big idea?” That’s what I’m trying to bring to you here without making your eyes glaze over and making you fall into a deep state of hibernation.
Now, with all of that being said, there is some potentially fascinating research coming out of New Zealand we’re going to be talking about here. We are going to talk about two papers that have been done by roughly the same group at the Centre for Chiropractic Research at the New Zealand College of Chiropractic in Auckland New Zealand. Just the name “Auckland” makes me want to go visit. I hear New Zealand is fantastic and the Lord Of The Rings was filmed there so you know it’s stunning. If an epic is filmed in your country, then you know it must be truly epic.
Here is a bit of a disclaimer to start off with. I have seen some dispute from other evidence-based chiropractors online of a different study from Dr. Haavick so I want you to understand that this sort of research cannot be accepted as the gospel. Not just yet anyway. I’d say it’s promising to an extent but there needs to be A LOT more exploration here before we hold it up as the gospel truth. Today’s podcast is more of a, “Hey, look what they’re studying, look what their findings are, and look what the potential for this sort of study could be.” rather than drawing any firm conclusions at this time.
The first study is titled, “Impact of Spinal Manipulation on Cortical Drive to Upper and lower Limb Muscles,” and was published in the journal ‘Brain Sciences’ in December of 2016(1).
Why They Did It
The researcher wanted to find out whether chiropractic care changes motor control. Motor control is basically the messages your brain sends your body in order make it move. Bending your arm, writing on a piece of paper, kicking your leg, or walking are examples of motor control. They assessed whether chiropractic care affected motor control for the arms as well as the legs and tried to find out if the changes may partly happen in the cortical part of the brain, which is the part that issues motor commands. Although the researchers couldn’t completely rule out the idea that chiropractic adjustments can help motor function at the actual spinal level manipulated, the theory was that some of the changes must happen in the brain itself. Basically, do chiropractors change how the brain controls muscles(2)?
How They Did It
- They conducted two experiments to test their theory. One for the arm and one for the leg.
- In the first, transcranial magnetic stimulation input-output curves for an upper limb muscle known as the abductor pollicis brevis were recorded.
- They also recorded F-waves before and after spinal manipulation or the control intervention for the control group on the same subjects on two different days.
- The researchers did the same in a separate experiment for the lower limb using the tibialis anterior muscle.
What They Found
Before getting into what they found, let’s define the term “motor evoked potential.” According to Medscape, the definition is, “Single- or repetitive-pulse stimulation of the brain causes the spinal cord and peripheral muscles to produce neuroelectrical signals known as motor evoked potentia ls. Clinical uses of motor evoked potential include as a tool for the diagnosis and evaluation of multiple sclerosis and as a prognostic indicator for stroke motor recovery(3).”
With that knowledge the following was noted:
- Spinal manipulation caused an increase in maximum motor evoked potential in both muscles tested.
Wrap It Up
In a quote from the research abstract, the authors conclude, “Spinal manipulation may therefore be indicated for the patients who have lost tonus of their muscle and or are recovering from muscle degrading dysfunctions such as stroke or orthopaedic operations. These results may also be of interest to sports performers. We suggest these findings should be followed up in the relevant populations.”
In another quote from the lead author, she said, “This research has big implications,” says an enthusiastic Heidi Haavik. “It is possible that patients who have lost muscle tonus and/or are recovering from muscle degrading dysfunctions such as stroke or orthopaedic operations could also benefit from chiropractic care. These findings are also very relevant to sports performers (although this too must also be followed up with more research), because it indicates that chiropractic care may help their brains to more efficiently produce greater outputs. So all in all a very exciting study!”
Guess what? They took their own advice in their conclusion and followed up this paper with another similar paper focused more specifically on athletic performance. Here’s the last paper we will discuss called, “The Effects of a Single Session of Spinal Manipulation on Strength and Cortical Drive in Athletes” published in the European Journal of Applied Physiology in January of 2018. Brand new information(5).
Why The Did It
Of course, they did it because they suggested the need for the paper in the conclusion of the previous study but more specifically, they did it because they wanted to test if a single chiropractic adjustment could change things in the muscles of the lower leg for an elite Taekwondo athlete.
How They Did It
- The muscle measured was the soleus muscle, which lies just under what is commonly known as the calf muscle or the gastrocnemius.
- Soleus evoked V-waves, H-reflex and maximum voluntary contraction of the plantar flexors were recorded from 11 elite Taekwondo athletes
- A randomized controlled crossover design was utilized.
- Treatments used consisted of either spinal manipulation in the treatment group or passive movement control in the control group.
- Outcome measurements were noted prior to treatment, immediately after treatment, 30 minutes after treatment, and an hour after treatment.
What They Found
- Spinal manipulation was responsible for increasing each factor measured when compared to the control group.
- The differences were considered significant through each time interval.
Wrap It Up
The authors are quoted in the conclusion of the paper as saying, “A single session of spinal manipulation increased muscle strength and corticospinal excitability to ankle plantar flexor muscles in elite Taekwondo athletes. The increased maximum voluntary contraction force lasted for 30 minutes and the corticospinal excitability increase persisted for at least 60 minutes.“
As I said in the beginning, I feel that this sort of research is really just beginning and consider it in its infancy but I also think that the results are enough to demand more exploration into this area of how chiropractic can affect neurology.
There is actually a court case in Texas this very minute. The appeals argument starts on February 28th down in Austin. The Texas Medical Association is attacking Texas Chiropractors’ rights to treat the “neuromusculoskeletal” system. They argue that chiropractors do not (and cannot) treat anything further than the “musculoskeletal”system. Certainly, NOT the “neuromusculoskeletal” system.
Regardless of the opinions held by those in the leadership of the Texas Medical Association and their legal team, both of these papers (and many other by the way), in my opinion, render their arguments ignorant, nit-picky, archaic, and obsolete. It’s not a question of what research is out there. It’s a question of if they can understand it or will let their pride go. My guess is, “No.” They have to prevent Chiropractic from moving into their territory at any and all costs. It is NOT about patient safety. It never has been and it never will be. It’s purely based on power and the threat of losing it.
What’s your opinion. We would love to hear it.
Research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good or excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically and do it with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health!
Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. If you love what you hear, be sure to check out www.chiropracticforward.com. As this podcast builds, so will the website as we add more content, educational products, and a little further down the road, webinars, seminars, and speaking dates as they get added.
We cannot wait to connect again with you next week. From Creek Stone here in Amarillo, TX, home of the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Sources:
- Haavik H, Niazi IK, Jochumsen M, Sherwin D, Flavel S, Türker KS. Impact of Spinal Manipulation on Cortical Drive to Upper and Lower Limb Muscles. Brain Sci. 2016 Dec 23;7(1).https://chiropracticscience.com/increase-cortical-drive-following-spinal-manipulation/
2) https://spinalresearch.com.au/new-study-reveals-impact-spinal-manipulation-cortical-drive-limb-muscles/
3) https://emedicine.medscape.com/article/1139085-overview
4) https://www.researchgate.net/publication/322199907_The_Effects_of_a_Single_Session_of_Spinal_Manipulation_on_Strength_and_Cortical_Drive_in_Athletes
5) Christiansen L, et. al. (2018). The Effects of a Single Session of Spinal Manipulation on Strength and Cortical Drive in Athletes. European Journal of Applied Physiology. . 10.1007/s00421-018-3799-x/fulltext.html.
You’ve smacked into episode #9 of the Chiropractic Forward podcast. In today’s podcast, we have a special guest with us and we’ll be talking all about current and past attacks on our profession by the medical field heavy weights…..what’s at risk and why. In addition, we’ll be sharing some personal opinions, some facts, some research….and we’ll be discussing what you all can do to help if you are an active person that wants to pitch in.
Right now though, it’s time for some bumper music!
Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast where we talk about issues related to health, chiropractic, evidence, and research and how those things all fit into a comprehensive approach for treating different conditions. Thank you for taking time out of your day to give us a listen. I know your time is valuable and I will always try hard to fill our time with valuable content.
Right off the top today, I want to welcome a good friend and colleague of mine, Dr. Tom Hollingsworth originally from Brady, TX and now living in Corpus Christi, TX. Dr. Hollingsworth is a master of linguistics and he’s a master of the material when it comes to what we’ve been through and what we are going through currently. In fact, Tom has helped prepare the court drafts so he has intimate knowledge and it’s a special treat to have Dr. Hollingsworth here to walk us through it all.
Welcome to the Chiropractic Forward podcast Dr. Hollingsworth. We’re so glad to have you with us today…
Have you ever heard the song “Corpus Christi Bay” by Robert Earl Keen and is it indeed hard to stay sober on the Corpus Christi Bay?
Tell me a little about your background and your family.
We have both been highly active in the Texas Chiropractic Association over the years. Everyone fits a certain function for sure. What have been your functions in the past on the Statewide level?
With this being an evidence-based podcast, can you offer some thoughts on whether or not there is room in an evidence-based model for chiropractic philosophy to maintain any sort of footprint in it?
There is so much material here, I want you to know that you have free-reign to interrupt, stop me, correct me, and keep me on track here. I encourage any and all participation from you on this.
When Chiropractors start talking about the attacks we’ve endured and are enduring, we can go on for hours. We are going to try to convey a very serious and meaningful message about it all right here today but without getting into a three hour conversation.
I can only hope that all chiropractors in practice are well-aware of the trials and tribulations this amazing professions have, not only been through, but overcome and grew as a result. It is profound. The unfortunate reality is that most do not know and, if they do, they normally lack any important details to truly place their knowledge in the correct context.
I believe that Dr. Hollingsworth will agree with me that, in our experience, lots of folks don’t know what’s going on with their profession….is that correct sir?
As a former board member of the Texas Chiropractic Association myself and a current member of the leadership statewide, we are intimately aware of many of the issues, both current and historically.
And I think, from the top here, it’s important to say that, even though Dr. Hollingsworth and myself are TCA members and leaders, our opinions may or may not represent the opinions of the TCA but we are NOT representing the TCA as we go through this podcast and in this capacity.
Anything you’d like to add to that disclaimer Dr. Hollingsworth?
We have all heard the stories of chiropractors being jailed for practicing. I remember a story from a documentary by Jeff Hayes called Doctored where a chiropractor is recalling how his father, who was also a chiropractor was in a bowling league. There was a medical doctor on the other team that refused to bowl against his father’s team simply because the team had a chiropractor on it.
Now, let’s run through the BIG ATTACK first. Folks, if you don’t know about Wilk vs. AMA, please do yourself, and all other chiropractors, a big favor and go check it out. To put it into a very brief blurb, basically, after 11 years of court proceedings, Dr. Chester Wilk and four other chiropractors, led by attorney George McAndrews, ultimately prevailed in proving the American Medical Association guilty of violating the Sherman anti-trust act. Meaning the AMA and several other medical institutions like the American Hospital Association, the American College of Surgeons, the American College of Physicians, and the Joint Commission on Accreditation of Hospitals were found guilty of conspiring to eliminate chiropractic from the Earth. According to Chiro.org….”the suit claimed that the defendants had participated for years in an illegal conspiracy to destroy chiropractic. On August 24, 1987, after endless wrangling in the courts, U.S. District Court judge Susan Getzendanner ruled that the AMA and its officials were guilty, as charged, of attempting to eliminate the chiropractic profession. “
Does that about sum it up, Dr. Hollingsworth, and would you like to add to any of that?
Basically the AMA and others were proven guilty of the following acts against Chiropractic:
- Encourage ethical complaints against doctors of chiropractic
- Oppose chiropractic inroads into workmen’s comp
- Oppose chiropractic inroads into health insurance and make it difficult for patients to get covered for chiropractic care
- Oppose inroads into hospitals
- Contain or eliminate Chiropractic schools
- They conducted nationwide conferences on Chiropractic
- Distributed anti-Chiropractic publications and propaganda
- Helped other organizations prepare anti-chiropractic literature
- Deemed it unethical for medical doctors to refer to, or accept referrals from, chiropractors.
- And, they discouraged colleges, universities, and faculty from cooperating with chiropractic schools.
Can you believe that things have progressed to the point now that two of those organizations came out last year in support of Chiropractic for the treatment of acute and chronic and low back pain?
In referencing a blog of mine from November 11th, 2015 called Healthcare in Texas: Th Battle Against a Monopoly. A True Story About David & Goliath,” I reminded myself of some more recent minor attacks. I’ll put the link in the show notes.
- The Texas Medical Association attempted to remove Doctors of Chiropractic from the high school concussion oversight teams. They wanted to allow simple high school trainers but not chiropractors.
- The same year, the TMA attempted to remove Chiropractors’ ability to perform physical exams on school bus drivers.
- Same year, they tried to introduce legislation to remove our ability to perform high school exams on athletes. A function chiropractors have been performing for generations.
Now Dr. Hollingsworth, you’d think this would have put the battle to rest right? Can you go ahead and run through TMA #1 one for us please? The when, why, and what happened
Before we get any further, how about we define Chiropractic. At least as far as the State of Texas is concerned, Tom.
I’d like to take just a second to direct everyone to an excellent video on YouTube that the Texas Chiropractic Association published about a year and a half ago concerning a lot of this. The link will be in the show notes but you can also find it by going to YouTube and searching the term “The Texas Chiropractic Defense From The Texas Medical Association A Timeline.” This ten minute video sums up what kind of constant attacks our profession is still enduring today.
So, we have Wilk vs. AMA that Chiropractic ultimately won, and we prevailed in the TMA #1 diagnosis case for the diagnosis issue…….now, surely, when the TBCE and the TCA triumphed in that one, that had to have killed any further attacks from the TMA right, Dr. Hollingsworth?
Tom, what is the current status on this case? It’s about to be go time right?
What kind of research is the TCA and TBCE team looking at using to bolster the case and why are we using these particular papers?
- MSK includes “associated” nerves
a. Concerning balance is Ex Parte Halsted
b. Careful to avoid claims toward entirety of nervous system (Hogs get slaughtered.)
- TMA depended greatly on UT Med School’s Leonard Cleary, PhD.’s deposition
a. Understandably supported TMA position MSK is not neuro
b. Heavily focused on structure considerations only in isolation from function
c. Ivory Tower challenged
i. by TBCE presenting Grays, and
ii. TCA presenting simpler TEA authors defining elements of muscle.
d. PRE-TRIAL appeal allowed for exam outside of MSK if it will lead to opinion of bio-mechanical condition of MSK. So…
i. Neurotrophic effects on muscle
ii. Neurotrophic effects on bone (Deposition Ex. 10)
- Subluxation Complex
a. TBCE presented definitions of WHO, Dorland’s and compared them to TBCE’s. Can you expound on the different definitions for us please?
b. TCA presented Texts by Strang, Leach, King & Janig , and
i. AMA’s CPT definitions,
ii. Bakris/Dickholtz NUCCA BP study
Now This is a paper we covered in podcast episode #7 but we also cited a couple others by AP Wong and by Yates, et. al. There’s no doubt we’re on solid ground here.
c. TMA offered no witness qualified to opine on subluxation complex
i. However, a letter from them to TBCE when adding “subluxation” stated they preferred TBCE choosing the WHO definition (that includes “nerve”).
- Vestibular-Ocular-Nystagmus Testing (VONT)
a. TMA offered a NeurOtologist (ENT subspecialty) and a PT
i. Argued training length (residency, etc.)
ii. Mostly Fair witness
iii. One key was distinguishing Vestib Apparatus from Vestib System
-
Had to get out of ear into processing centers
-
(Vestib Nuc and V-spinal tracts)
-
Attempt to utilize MD cultural authority on basic fact
-
Build on basic facts later.
iv. After hours of testimony from TMA’s vestibular experts, trial judge asked: “When are we going to hear about VONT?”
Well, I suppose all we can do at this point is to continue to raise money from chiropractors that want to pitch in. We know that an appeals process is expensive. We also know that what happens in a state with over 5,000 chiropractors in it, usually tends to happen in other states down the line so it’s likely in every American chiropractor’s interest to get on board with this issue and contribute to its success.
If you would like to donate to this victory, I would direct you to the TCA since they are leading the way on this. Go to www.chirotexas.org/cdi
Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. If you love what you hear, be sure to check out www.chiropracticforward.com. As this podcast builds, so will the website as we add more content, educational products, and a little further down the road, webinars, seminars, and speaking dates as they get added. Also, find our Facebook page where we’ll be sharing all kinds of good stuff from the shows and from our guests.
Reviews….folks, we need reviews over at the iTunes Chiropractic Forward page. That’s what tells iTunes that people are finding value in what we’re doing. We sure would appreciate it.
We cannot wait to connect again with you next week. From Creek Stone here in Amarillo, TX, home of the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Show Note resources
- Bakris G. (2007). "Special chiropractic adjustment lowers blood pressure among hypertensive patients with misaligned C-1 vertebra." Retrieved February 7, 2018, from http://www.uchospitals.edu/news/2007/20070314-atlas.html.
- Wong AP (2018). "Review: Beyond conventional therapies: Complementary and alternative medicine in the management of hypertension: An evidence-based review." Pak J Pharm Sci 31(1): 237-244.
- Yates RG (1988). "Effects of chiropractic treatment on blood pressure and anxiety: a randomized, controlled trial." Manip Physical Ther 11(6): 484-488.
- http://www.chiro.org/Wilk/
- https://jamanetwork.com/journals/jama/article-abstract/2616395
- https://www.amarillochiropractor.com/healthcare-in-texas-the-battle-against-a-monopoly-a-true-story-about-david-goliath-3/
- The Texas Chiropractic Defense From The Texas Medical Association A Timeline.
- https://youtu.be/XHGfAQwIqNo
Bibliography
Bakris G. (2007). "Special chiropractic adjustment lowers blood pressure among hypertensive patients with misaligned C-1 vertebra." Retrieved February 7, 2018, from http://www.uchospitals.edu/news/2007/20070314-atlas.html.
Wong AP (2018). "Review: Beyond conventional therapies: Complementary and alternative medicine in the management of hypertension: An evidence-based review." Pak J Pharm Sci 31(1): 237-244.
Yates RG (1988). "Effects of chiropractic treatment on blood pressure and anxiety: a randomized, controlled trial." Manip Physical Ther 11(6): 484-488.
Today’s episode is all about chronic low back pain and some great, brand new research. By now, as I’ve said in the past, even traditional Chiropractor-hating, torch-wielding, quasi-scholastic chiropractic detractors are admitting that, yes, Chiropractic is indeed helpful for low back pain.
If you love what you hear, be sure to check out www.chiropracticforward.com. As the podcast builds, so too will the website content, educational products, webinars, seminars, and speaking dates as they get added.
We will dive into the research in a few minutes but first, I have to introduce my guest this week. His name is Dr. Craig Benton. Dr. Benton is the owner/operator of Benton Chiropractic down in Lampassas, Texas but that’s not where the intro stops. Dr. Benton is the chair of Scientific Affairs for the Texas Chiropractic Association. He is where I have found a healthy percentage of the material that I have covered over the years for my blog, my YouTube videos, and now for the Chiropractic Forward podcast. Dr. Benton has been unknowingly instrumental in keeping me in business and making my life easier.
Welcome to the show Dr. Benton, how is life in Lampassas this week? My first question today is, have you been playing any guitar lately?
Dr. Benton and I are both in active practice. In fact, there’s a chance we may both have a patient show up at any time. That’s how actively we are practicing. I think that’s incredibly important to note because, so many times, you hear podcasts and attend seminars where the guys and gals speaking don’t really know a thing about actively practicing for 20 plus years. I’ve always felt that experience matters. Even when I was young and green. I was well-aware that I didn’t know it all and I’m even more aware of that today than ever.
So Dr. Benton, I’m looking forward to hearing your opinions and insight today.
Since the podcast today is about chronic pain, I think we should begin with a definition of what Chronic really is. When we define “chronic” in the context of neuromusculoskeletal complaints, we define it as being a complaint that is greater than 12 weeks in duration. Right at 3 months. Some patients will come into the office having had a condition for 15-20 years. I tell them that they are more than a little stubborn to have put up with something for so long.
It is common sense that a condition that is chronic will be more difficult to treat. Also, most chronic conditions can be traced back to a biomechanical, neuromusculoskeletal origin. One of my favorite quotes is from Dr. Lee Green, Professor of Family Medicine at the University of Michigan. He said, “Neck pain is a mechanical problem, and it makes sense that mechanical treatment works better than a chemical one.” Although Dr. Green is referring to neck pain in this instance, “low back pain” can easily be substituted. What he says could not make more sense. It’s an easy and very concise way to understand why Chiropractic, manipulation, mobilization is so incredibly effective above and beyond anything else for this sort or issue, including medication.
Do you have a quote or quotes that you love sharing that make sense to you and that help you boil down what it is we chiropractors are doing to help our patients?
I have overhead medical doctors (more than once) talking about having back pain and just injecting themselves with something to try to get over it. If they asked me, I’d tell them that they’re just covering up an underlying trigger or cause and ignoring it is to their detriment.
A good metaphor I came across for using medication for neuromusculoskeletal complaints is that it’s like unplugging a smoke alarm because you don’t like the noise. But, the fire is still slowly growing. What have they done to treat anything in a responsible and effective way? Nothing at all. We tend to live in a society that wants a pill for this and a potion for that so they can get over it and get on with life. But it doesn’t work that way.
Dr. Benton, has this been your experience as well?
Dr. Benton, don’t you treat soldiers through the VA program? Can you tell us all a little bit about that?
Let’s go over some low back pain statistics just we can try to stress the importance of what we’re talking about here. Dr. Benton, please feel free to jump in with anything you’d like to add:
- Low back pain is the single leading cause of disability worldwide.
- 8 out of every ten people will experience back pain. I will admit that I have never met anyone in 45 years of life on this Earth that fit’s into the 20% that apparently never suffers from any low back pain. Dr. Benton….have you ever met anyone that has never had back pain? Is it just me?
- Back pain is the second most common reason for visits to the doctor’s office right behind upper-respiratory infections.
- With such gains and leaps in the medical industry as far as treatment goes, low back pain is stubbornly on the rise.
- More than half of Americans who experience low back pain spend the majority of the work day sitting. 54% to be exact. It’s good to be a chiropractor I guess. Our patients keep us up and moving most of the day.
- Dr. Benton, did you know that….now…an equal number of patients seek help with a chiropractor first as seek help with a medical practitioner first for back pain? That’s new information to me that I found interesting.
- Back pain in general costs $100 billion dollars every year when you factor in lost wages, productivity as well as legal and insurance overheads.
Now that we all know more about low back pain, let’s go through some things that may put you at greater risk of suffering from the condition. Dr. Benton, with your experience on the research, stop me if you have anything to add to any of these:
- Age: as the spine and supporting structures begin to age and decline, the rate of low back pain will understandably increase.
- Fitness Level: physically active people do not suffer low back pain to at the rate inactive people suffer. A healthy exercise and core building protocol can help reduce symptoms or instances of low back pain.
- Weight Gain: Being overweight or obese and gaining weight quickly places increased strain on the low back.
- Pregnancy: This one goes without saying. Pelvic changes and weight gain both contribute.
- Genetics: Some forms of arthritis or other systemic conditions are genetic in nature
- Work: Jobs that include heavy labor and or twisting or expose people to vibration consistently can be problematic. Jobs that require long periods of sitting in a chair can be equally problematic.
- Mental health factors: Many people are able to deal with chronic pain but anxiety and depression are conditions that can cause a person to focus on the pain which tends to raise the perceived severity and significance for the person suffering from the condition. Dr. Benton, have you come across any patients that fit this description in your practice?
- Improper backpack use: Kids suffer back pain needlessly since they are not traditionally in an age range we would consider to be a risk factor. However, backpacks used improperly are a common culprit. A backpack should never be more than 15%-20% of a child’s weight and should be carried on both shoulders with the bottom being at or about waste level.
What does the research say?
As I’m sure Dr. Benton will agree…..the research says a lot, to be honest. In fact, I’d say that there’s more research for the effectiveness of manipulation/mobilization in low back pain than for any other conditions chiropractors commonly treat. Am I out of bounds here Dr. Benton?
The research shows Chiropractic beating general practitioners in effectiveness as well as cost. The research shows Chiropractic beating common medications prescribed for low back pain. The research shows Chiropractic beating physical therapy and exercise alone. The research shows Chiropractic beating epidural spinal injections for low back pain. And the two of us can point you to randomized controlled trials proving it. Basically, the research is clear.
In January of 2018, a brand new research paper dealing with manipulation and mobilization was published in Spine Journal by Ian Coulter, PhD et. al. titled “Manipulation and mobilization for treating chronic low back pain: a systematic review” and funded by the National Center for Complementary and Integrative Health.
Now, to be clear, Spine Journal sounds a little bit like it may be a Chiropractic publication for those of you that don’t commonly read research abstracts…… but it is not.
Dr. Benton, can you describe Spine Journal for us?
Here’s why the authors took this project on.
The authors of the paper stated that there remained questions about manipulation and mobilization efficacy, the proper dosing of the techniques, how safe they are, as well as how they compare to other treatment protocols commonly used for chronic low back pain.
I have to say that I had no remaining questions regarding really ANY of those topics but it seems that these authors did.
Dr. Benton, again, please feel free to jump in anywhere you’d like as we go through the hows, why’s and the what’s here.
Here’s How They Did It
- This paper was a systematic review and meta-analysis.
- They searched databases for relevant studies from January 2000-March 2017
- They chose randomized controlled trials that compared manipulation or mobilization to sham treatment, no treatment, other therapies, and multimodal therapeutic approaches.
- They assessed the risk of bias using the Scottish Intercollegiate Guidelines Network.
- Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was applied to determine the confidence in effect estimates.
- 51 trials were included
What They Found
- Within 7 of those trials on manipulation and/or mobilization there was reduction of disability when compared to other forms of therapy.
- Further analyses showed that manipulation specifically was responsible for significant reduction in pain and disability when put up against therapies such as exercise and physical therapy.
- Mobilization was also was significantly more effective when compared to exercise regimens for pain reduction but not for disability.
Wrap It Up
In the conclusion of the paper abstract, the authors say, “There is moderate-quality evidence that manipulation and mobilization are likely to reduce pain and improve function for patients with chronic low back pain; manipulation appears to produce a larger effect than mobilization. Both therapies appear safe.”
As I’ve said many times, “a lot of research in your favor becomes fact.” Chiropractic has A LOT of research in its favor.
Dr. Benton, would you like to add any final thoughts?
I’d like to thank Dr. Benton for taking the time to be with us today. He really is one of the guys out here in the real world trying his best to help change things for Chiropractors in Texas and in the world.
I want to finish off by saying that when Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple.
Just another reason to call a chiropractor TODAY!
Research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good or excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically and do it with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health!
Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Please remember, we need your help to spread the word and grow this podcast. If you would help us out by sharing our podcast information, our website, and social media entities, we would greatly appreciate your help.
We cannot wait to connect again with you next week. From Creek Stone here in Amarillo, TX, home of the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Research Citation:
Coulter I, et. al. “Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis” The Spine Journal, Volume 0 , Issue 0 ,
http://www.thespinejournalonline.com/article/S1529-9430(18)30016-0/fulltext
Astounding Expert Information On Immediate Headache Relief
Episode #6
Welcome back to the Chiropractic Forward podcast. This is your host, Dr. Jeff Williams from Amarillo, TX. You have tripped right into episode #6 of our new podcast and I hope you’re enjoying what we’re offering. Or, as the kids say, we hope you’re picking up what we’re throwing down. Or scooping what I’m shoveling. However you choose to put it, you get what I mean.
This episode is all about headaches, it highlights one service dressed up and parading around as another sort of like it’s Halloween or something, and we’ll tell some personal stories about what we have seen in practice during our years of service to our patients. It should be a good one.
We are excited to welcome Dr. Tyce Hergert to the Chiropractic Forward podcast. Dr. Hergert has the distinct privilege of being the very first guest that we’ve ever had. Dr. Hergert was the Texas Chiropractic Association President, the head honcho, for 2016/2017 and, under his leadership the TCA was able to get 5 Chiropractic friendly bills through the legislation whereas we had failed to get even one through in all the years prior to that as far back as I had paid any attention so that was quite a feat.
Dr. Hergert is the owner/operator of Chiropractic Care Center of Southlake as well as the owner/operator of Southlake Physical Medicine in Southlake, TX
In addition, Dr. Hergert and myself both grew up in Perryton, TX. He was a couple of years younger than myself but we grew up on the same neighborhood, went to chiropractic school at the same time roughly, and have both served in the Texas Chiropractic Association at the same time. You could say that we know each other.
Welcome to the Chiropractic Forward Podcast Dr. Hergert. How do you feel about being the very first guest that we have ever had?
In this episode, I promise that we’re going to have more fun than being on the receiving end of a purple nurple.
This week, I want to discuss headaches and conservative, alternative headache treatment. It’s common for people to look at chiropractors as “spine people” and “back doctors”.
Is that your experience as well, Dr. Hergert?
What people don’t commonly know is that chiropractors can knock it straight out of the park when it comes to treating headaches. Yes, I said, “Knock it out of the park.” That’s an old metaphor comparing baseball players hitting home runs and I’m telling you, chiropractors mostly hit home runs on headache cases.
I have to admit that I was a terrible baseball player. I played college football and I’m Texan born and raised where football is King so I should probably put it in football terms. In football terms, you might say that we chiropractors have a record of 80-yd touchdown passes when it comes to headaches. We return headache punts for a score almost every time. We pick-six those suckers. That’s probably enough to drive the point home.
Not every single headache of course. I’ve met my match several times over my 20 years in practice. But I don’t think it’s too bold to say that about 80%-90% of headache patients just improve. And not just improve, but DRAMATICALLY improve.
Before we get into the research, let me take a minute to give you just a couple of personal experiences in treating headache patients in my practice here in Amarillo.
Case #1: We will call this patient Andy McFuddlesticks just because I’m feeling a little goofy today. That sounds a little like a Harry Potter character, doesn’t it?
Andy had experienced migraines his whole life and was around 40 years old at the time we crossed paths. He had been to all of the medical doctors. He had endured injections if his suboccipital region. I don’t recall what the injection was exactly because this was about 18 years ago. I don’t believe they did botox for migraines at that point in time. He had gone through nuclear bones scans as well. Andy McFuddlesticks had been through it you might say.
He came to see me only a few times. It was frustrating that he didn’t finish his treatment plan but the reason he didn’t finish is satisfying. Andy only came a handful of times because the headaches were gone. After all of the years and procedures, just a few visits to a very new and green chiropractor made them vanish. How do I know? Well, I was in a civic organization with his brother who confirmed months later that his brother was doing great and had not had a headaches since seeing me. How is Andy 18 years later? I have no idea. I switched towns but I know he did great for a long time and we are putting that one in the “win” column.
Dr. Hergert, would you like to share one of your more memorable headache case stories with us?
Case #2: Sally McGullicutty I believe was her name. Red hair. Irish. Anyway, Sally had migraines for years. I actually knew Sally personally and had been friends for some time. Evidently I was not skilled at getting my message out on how successfully we can deal with headaches because it took Sally way longer than it should have taken her to make an appointment with us.
Sally shared with me that she had migraines, on average, several times a week and once or twice every month would find herself in a dark bathroom floor sitting my the toilet throwing up. How awful of an existence is that? I cannot even imagine being forced to live that way. I say it often but it bears repeating, “Pain can absolutely change a person.” Not only the person but it can change everyone around the person that is consistently in and out of contact with them.
After approximately 2-4 weeks of working with Sally, she just started to not have the migraines anymore! I would say she “magically” recovered but chiropractors know this isn’t accurate. We got the right joints moving, we got the right muscles to relax, and we got out of the way and let the body do the rest. There’s no magic in that. It’s just common sense to chiropractors.
Fast forward a few years and Sally is still a patient and Sally comes here for other reasons and conditions from time to time but she doesn’t visit because of migraines anymore. She just doesn’t have them.
How about one more story Dr. Hergert?
I’m pretty sure we could both absolutely go on and on with examples from personal experience in practice. I have 20 years of dealing with headaches and I can tell you, Chiropractors are modern day headache whisperers.
Let’s dive into a little research just to show you what I’m talking about. There are more we will go over in the future episodes but I want to touch on two this week. One new study and one older.
The first one is the more recent research paper and comes to us from a group in Spain. The lead author was Miguel Malo-Urries, PT, PhD with the University of Zaragoza Aragon Spain and it was published in Journal of Manipulative and Physiological Therapeutics in the November-December 2017 issue, Volume 40, Issue 9, Pages 649-658. The study was titled “Immediate Effects of Upper Cervical Translatoric Mobilization on Cervical Mobility and Pressure Pain Threshold in Patients With Cervicogenic Headache: A Randomized Controlled Trial.” What a name.
Did you catch that word, “Translatoric?” Dr. Hergert, have you run across this term prior to this interview?
I’m going to define that word for everyone. Translatoric is not commonly in the Chiropractic verbiage or vernacular. At least I don’t recall it from my education at Parker University in Dallas but that was eons ago. I have gray sideburns now. It has been a while. The authors of the paper all have PT behind their names so we have physical therapists setting the terms for the research project. Understanding this, then the use of translatoric makes more sense.
I found a site that gives a pretty good definition of Translatoric Spinal Manipulation. The term Translatoric Spinal Manipulation or TSM “consists of a series of high and low-velocity manipulative spinal techniques, which emphasize the use of small amplitude, straight-line (or translatoric) traction and gliding impulses delivered parallel or perpendicular to an individual vertebral joint or movement segment. Furthermore, TSM emphasizes the use of either direct manual stabilization or the use of spinal pre-positioning to restrict the amount of motion occurring at adjacent spinal segments during the translatoric impulse.” The website goes on to say, “Delivering translatoric impulses (in the form of disc traction, disc glides, facet traction and facet gliding) to an individual joint or spinal motion segment while using stabilization provides the manual therapist with a manipulative tool that has a predictable effect in terms of pain reduction and motion restoration with minimal potential risk of patient injury.”
Do you know what that sounds like to me? Dr. Hergert, what does it sound like it’s describing to you?
It sounds like a “Chiropractic Adjustment.” Another term it sounds like is “Spinal Manipulative Treatment/Therapy.” Something we chiropractors have been doing for over 100 years and have been called crazies and quacks for doing. It sounds like the exact thing that the medical world has touted as being responsible for strokes for years and years. Of course, research proves that they don’t have a clue what they’re talking about on the storke issue but translatoric spinal manipulation is nothing more than a Chiropractic Adjustment.
Now that that is clear, let’s get back into the research.
Why They Did It
The good folks in Spain performing Translatoric Spinal Manipulation rather than Chiropractic Adjustments wished to assess the response in terms of range of motion and pain in patients suffering cervicogenic headaches.
How They Did It
- It was a randomized controlled trial
- The paper included 82 patients.
- The patients ranged in age from about 25-55 or so.
- All patients suffered from cervicogenic headaches.
- The patients were randomly split up into two groups. One was a control group and one was a treatment group.
- The treatment group received Chiropractic Adjustments…..I’m sorry…Translatoric Spinal Manipulation.
- The control group received no treatment or sham treatment.
- The researchers tested Cervical range of motion, they tested the pressure pain thresholds over the upper trapezius muscles, the C2-3 zygapophyseal joints and sub occipital muscles were tested, and the current headache intensity were all measured on the Visual Analog Scale prior to the Chiropractic adjustment and right after.
- The testing was done by two blinded investigators
What They Found
- Afterward, the Chiropractic Adjustment group had significantly increased range of motion in the neck region overall as well as in the flexion-rotation test.
- And, while there was no changes in the pain thresholds, patients reported significantly lower intensity in their headaches!
Wrap It Up
The quote from the authors themselves reads as follows, “Upper cervical translatoric spinal mobilization intervention increased upper, and exhibited a tendency to improve general, cervical range of motion and induce immediate headache relief in subjects with cervicogenic headache.”
Dr. Hergert….do the findings in the study surprise you at all?
What are your initial impressions of the study?
I’d say that, if you have issues with chiropractors, now you can just take it straight from physical therapists with PhD’s that are performing chiropractic adjustments but calling it something else.
I want to be honest here: the frustrating part of this for me isn’t necessarily the fact that PTs are doing cervical chiropractic adjustments. Heck, chiropractors have been doing PT for years but the physical therapists claim ownership of the term so the chiropractic industry just call it exercise rehab.
Although, their doing adjustments may be irritating on some level, the most irritating thing is that a certain aspect of the physical therapy community and a larger aspect of the medical community have spent years ridiculing, mocking, and belittling generations of chiropractors. And now, doctors of osteopathy and physical therapists are trying to do the exact same thing without going through any chiropractic training. You would think they would at least release a statement saying, “You know, we have thrown rocks at chiropractors for years but it turns out they were right all along so, since we can’t beat them, we’re going to just join them.”
Wouldn’t that be refreshing?
Can I get an amen on that Dr. Hergert? Do you have any other thoughts on that?
I’m geting all bothered over here so let’s go over the older study before I start getting too ugly about the whole deal.
This one is by GV Espi-Lopez et. al. and is called, “Do manual therapy techniques have a positive effect on quality of life in people with tension-type headache? A randomized controlled trial.” It was published in the European Journal of Physical and Rehabilitation Medicine on February 29th of 2016.
Why They Did It
Although there have been lots of studies that prove the impact of manual therapy and spinal mobilization for frequency and intensity of pain suffered from tension type headaches, there have been no studies in regards to the effectiveness of the same therapies for the quality of life for the people suffering from them.
The authors of this paper wished to focus on patient quality of life.
How They Did It
•The study was again, a randomized, single blinded, controlled clinical trial.
•Comprised of 62 women and 14 men.
•Aged between 65 years old all the way down to 18 years old.
•All subjects suffered from chronic tension type headaches or episodic tension type headaches.
•The subjects were categorized into four separate groups: suboccipital inhibitory pressure, suboccipital spinal manipulation, a combination of the two together, and then a control group.
•An SF–12 questionnaire was used to help assess the subjects’ quality of life at both the beginning of treatment, the ending of the treatment, as well as at the one month follow-up.
What They Found
•The suboccipital inhibition group improved significantly in their quality of life at the one month mark as well as improvements in moderate physical activities.
•Not the control group, but all other treatment groups had an improvement in physical activities, pain, and social functioning at the one month mark.
•After treatment, as well as that the one month mark, the combined treatment category had improved vitality.
•Following treatment and at the one-month mark, both groups that had manipulation to the sub occipital region also showed improved mental health.
Wrap It Up
All three therapy approaches showed significant effectiveness toward improving the quality of life, however the combined treatment therapy had the most dramatic change for the good.
In short, manual therapy techniques and manipulation applied to the sub occipital region for four weeks or more showed great improvement and in effectiveness for several aspects that measure the quality of life of a patient having suffered from tension type headaches.
Dr. Hergert…you like apples? Lol Do these findings reflect what you have seen over the years there in Southlake, TX?
These are just a couple of studies to get us started off on the right foot for headache discussions on the Chiropractic Forward Podcast. There are several more I will be sharing in the future so stay tuned.
When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.
I mentioned this in episode #1 but Dr. Hergert and myself spend some time trying to generate a concise, responsible statement regarding chiropractic care in general. A statement that could easily be shared. An elevator speech for the profession if you will. You will find it at the end of every blog, every video, and every chiropractic forward podcast. It is as follows:
Research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic. Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health!
Thank you to Dr. Hergert for spending his valuable time with us today. We look forward to many more guest appearances.
Please feel free to send us an email at dr.williams@chiropracticforward.com and let us know what you think or if you have any suggestions for future episodes.
From Creek Stone in Amarillo, TX and the flight deck of the Chiropractic Forward podcast, this is Dr. Jeff Williams saying upward, onward, & forward.
http://www.jmptonline.org/article/S0161-4754(16)30281-0/fulltext?elsca1=etoc&elsca2=email&elsca3=0161-4754_201711_40_9_&elsca4=Physical%20Medicine%20and%20Rehabilitation%7CHealth%20Professions
https://www.optp.com/Translatoric-Spinal-Manipulation-for-Physical-Therapists-Book-and-DVD
https://www.amarillochiropractor.com/get-rid-of-migraines-and-headaches-once-and-for-all/
In today’s podcast, we are going to talk about high blood pressure, what happens, how many people it affects, and what we may be able to do to help it. Today is all about high blood pressure and I’m going to admit to you….in researching for this week’s podcast, even I learned new things about high blood pressure and I’m betting you will too. If you love what you hear, be sure to check out www.chiropracticforward.com. As this podcast builds, so will the website as we add more content, educational products, and a little further down the road, webinars, seminars, and speaking dates as they get added.
Welcome to the podcast today, Dr. Jeff Williams here with Creek Stone here in Amarillo, TX and I’m your host for the Chiropractic Forward podcast where we talk about issues related to health, chiropractic, evidence, and research and how those things all fit into a comprehensive approach for treating different conditions. Thank you for taking time out of your day to give us a listen. I know your time is valuable and I will always try hard to fill our time with valuable content.
You have fallen head first into episode #7 this week and I want to welcome you. We are going to have more fun that headbutting an i-beam..which I actually did on accident one time when I was a kid. I was running away from someone while playing tag and was looking over my shoulder wrhen smack…now I have a scare on the side of my noggin 35-40 years later. This is how I am certain we will have more fun with this episode.
Speaking of fun, with this being a brand new podcast, I can’t tell you how much fun it is to check the stats of the show and see people tuning in and finding value in our ideas and in information we have to share with you.
I think it is responsible to start off with a disclaimer: I am not a cardiologist. I am a research-minded, evidence-based Doctor of Chiropractic that has seen a jillion people with high blood pressure throughout a 20-year career. The ideas and discussion to follow will be based on information derived from the Centers for Disease Control and Prevention, from the American Heart Institute, and from information shared through Dr. Stephen Sinatra of New York, who is a cardiologist and founder of the New England Heart Center. Ultimately, your blood pressure and heart health is something your primary practitioner and/or cardiologist should be monitoring consistently. Our intent here is not to “treat” anyone through the internet but to simply raise awareness and encourage you to pay attention and take steps to protect yourself if needed. Do not simply depend on information from the internet or Dr. Google as I call it. If you are suffering from high blood pressure (or think you might be) make an appointment with your primary today.
Now that we’ve taken care of that, let’s get going with an easy definition of high blood pressure. According to the American Heart Association, high blood pressure is when your blood pressure, the force of the blood flowing through your blood vessels, is consistently too high.
I want to tell you all why, at times, I should have high blood pressure. It’s because I have a teenager. Yes, I have a 15 year old high school kid and he’s why. Lol. Not really, as far as teenagers go, he could be soooo much worse. Other than his need to be right conflicting with my need to be right, he’s a sweetheart.
Other reasons may be a busted pipe in the pool house when we had a major freeze. I know I know…first world problems… I happen to be the owner of a european great dane…..enough said. That girl can tear some stuff up when she gets bored.
I also have a huge Leonberger dog. Look it up. They’re beautiful but the hair…I’m telling you, it’s a job to stay clean. I could make cushions out of the amount of hair that dog generates.
The animals at my house at this point would include two dogs, a cat (not my choice), two guineas, and two turtles..and that doesn’t even include my 10 year old daughter and my teenage son… I probably have some mice too if I’m guessing right.
Not to mention I’m an actively practicing chiropractor running a busy practice and all of the stressors that come with it. Own your own business they said, be your own boss they said….you’ll be able to do whatever you want. Heck, I don’t have time to think twice and I certainly don’t have a lot of time to sit around and generate content. I’m busy humpin it and making a living. I’m not out on the lecture circuit just yet and having dinner and a drink in the hotel bar. Lol. I’m at work all day every day. I have stress people!! That’s all I’m saying.
But seriously, I have actually been very fortunate and have not had to battle with high blood pressure yet. Thank the good Lord. I am just lucky I think.
From personal experience in treating patients, I have seen new patients having blood pressure counts of 200 over 110 before and they had NO IDEA their blood pressure was high. What does a chiropractor do in that instance? You may get different ideas from different chiropractors but I can tell you what THIS chiropractor does in those cases. I send them either directly to their primary practitioner or the urgent care, whichever they prefer. I won’t touch them as far as chiropractic treatment until the blood pressure is under control.
There is research we will discuss in a minute showing chiropractic is effective in controlling high blood pressure but I will not be the one trying to get it down when it is at that level. I’ll be the one trying to help once it’s normalized. That is simply my opinion and the way I choose to go about things in my practice. As I said, other chiropractors likely have other opinions and protocols.
Next, let’s discuss some high blood pressure facts from the Centers for Disease Control & Prevention that you may not already know about concerning WHO is commonly affected:
- Did you know that about 75 million Americans suffer from high blood pressure? That’s about a third of the population. Another way of saying that is that 1 in every 3 people have high blood pressure.
- Unfortunately, only about half of the people with high blood pressure have the condition under control.
- About 11 million adults in America have high blood pressure and don’t even know it.
- High blood pressure costs America around $46 Billion every year when you account for the cost of health care services, medications, and days out of work.
- High blood pressure affects women about as much as it affects men overall but under the age of 45, more men are affected. Over the age of 65, more women have the condition.
- When we look at race, more black people have high blood pressure than do whites and Hispanics, and of the black people having it, more women are affected than men.
- Women having high blood pressure that then become pregnant are more likely to have complications.
- Uncontrolled high blood pressure during the midlife phase (45-65) seems to be linked to higher risks of dementia later in life.
Here are some of those random facts that you may be able to use in a game of Trivial Pursuit somewhere down the line:
- Did you know that too little salt can contribute to high blood pressure? We commonly associate an excess of salt with high blood pressure but too little is an issue as well. According to Dr. Stephen Sinatra, a cardiologist from New York, it seems a good mix is keeping more than 1.8 grams of salt a day in your body while keeping sodium below 2.8 mg/day while keeping a close eye on hidden salts that can be found in canned soups, pickles, salted nuts, etc.
- Potassium plays a part in healthy blood pressure so it’s likely a good idea to foods like eggplant, squash, bananas, coconut water, and baked potatoes.
- It’s a good idea to have the blood pressure taken in both arms since the numbers are often different from one arm to the other.
- Cardio is great but weight training can RAISE blood pressure. If you like to lift weights but suffer from high blood pressure, it would probably be a great idea to lift much lighter with higher reps in an attempt to bring down those numbers.
Now let’s talk about some of the causes of high blood pressure in patients:
- Emotional stress
- Being overweight
- Environmental toxins
- Smoking
- Lack of exercise
- Too much salt as well as too little salt
- More than one or two drinks of alcohol per day.
- Age
- Genetics
What risks do you run when leaving your high blood pressure untreated or uncontrolled? As unpleasant as it may be to discuss, it can be as serious as you may have imagined. Here are the potential outcomes of untreated high blood pressure:
- The CDC states that over 360,000 U.S. citizens died of high blood pressure in 2013 which totals about 1,000 deaths every single day.
- High blood pressure increases your risk of having a heart attack, of having a stroke, of having long-lasting heart failure, and of having kidney disease.
Here’s brand new and very interesting research paper I wanted to take the time to discuss. It’s by AP Wong and is titled “Review: Beyond conventional therapies: Complementary and alternative medicine in the management of hypertension: An evidence-based review(1).”
Why They Did It
The authors state that high blood pressure is responsible for about 12.8% of all deaths globally. Considering that staggering fact, the World Health Organization has targeted a 25% reduction in high blood pressure by the year 2025 and has encouraged more evidence and research into non-conventional methods of controlling high blood pressure.
How They Did It
-
The authors of the paper had two main objectives
-
Describe the therapeutic modalities commonly used in treating high blood pressure.
-
Review the current level of evidence that has been attained for each.
-
The researchers used a search from 2005-2013 of the databses MEDLINE, The Cochrane Library, PUBMED, and EMBASE.
- 23 papers were found and accepted.
- Modalities identified in the 23 papers were fish oil, qigong, yoga, coenzyme Q10, melatonin, meditation, vitamin D, vitamin C, monounsaturated fatty acids, dietary amino-acids, chiropractic, osteopathy, folate, inorganic nitrate, beetroot juice, beetroot bread, magnesium, and L-arginine.
What They Found
The following therapies had weak to no evidence for effectiveness in treating high blood pressure:
- Fish oil
- Yoga
- Vitamin D
- Monounsaturated fatty acid
- Dietary amino-acids
- Osteopathy
The following therapies showed significant reduction in blood pressure:
- Chiropractic
- Magnesium
- Qigong
- Melatonin
- Meditation
- Vitamin C
- Folate
- Inorganic nitrate
- Beetroot juice
- L-arginine
Coenzyme Q10 has differing results. Some studies showed it had weak to no effectiveness while other studies showed it to have significant effect on the reduction of high blood pressure.
Wrap It Up
In a quote from the authors conclusion, they said, “Results from this review suggest that certain non-conventional therapies may be effective in treating hypertension and improving cardiac function and therefore considered as part of an evidence-based approach.”
With all of the information combined from the articles used as source material, including the research paper, the Alternative means of treating high blood pressure may include:
- CHIROPRACTIC - we will talk more about this in just a moment
- Coenzyme Q10 - More discussion on Coenzyme Q10 later.
- Magnesium
- Ribose
- L-arginine
- RestricT carbohydrates
- Use olive oil - consider adopting the use of the Mediterranean Pan-Asian diet which is a non-inflammatory diet.
- Cutting sugar out of your diet is crucial for those suffering from high blood pressure.
- Less alcohol is best but a glass of wine a day has shown benefits.
- No processed juices from the grocery store. They’re packed full of useless and damaging sugars.
- Exercise protocols
- Lose weight - only a five pound reduction can make a difference
- Stop smoking!
- Qigong
- Melatonin
- Meditation
- Vitamin C
- Folate
- Inorganic nitrate
- Beetroot juice
Besides this study, there are several other suggesting Chiropractic plays an important role in reducing or controlling blood pressure.
In one from 1988 by Yates, et. al. called “Effects of chiropractic treatment on blood pressure and anxiety: a randomized, controlled trial,” they showed how anxiety and blood pressure were significantly reduced following chiropractic treatment(2).
In another very interesting study through the University of Chicago Medicine from March 14, 2007, and led by George Bakris, MD (director of the hypertension center at the University of Chicago Medical Center, researchers did the following:
- They took 50 Chicago-area citizens having high blood pressure.
- All had misaligned C1 vertebrae measured on x-ray
- They were randomly divided into a treatment group consisting of a chiropractic adjustment and a sham group where no treatment was actually performed.
- The participants were assessed at the beginning of treatment, after the chiropractic adjustment, and at the end of eight weeks.
What They Found
The authors stated that the improvement in blood pressure for both systolic and diastolic were similar to that seen when giving patients two different blood pressure medications at the same time. Not only that, but the reduction in the blood pressure continued in the eighth week!
Wow!!!
When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.
Just another reason to call a chiropractor TODAY!
Research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic. Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health!
Please feel free to send us an email at dr.williams@chiropracticforward.com and let us
know what you think or if you have any suggestions for future episodes. And remember
to help us spread the word by sharing our podcast with your colleagues, your friends,
and your family.
From Creek Stone in Amarillo, TX and the flight deck of the Chiropractic Forward
podcast, this is Dr. Jeff Williams saying upward, onward, & forward.
Research Citations
(1) Wong AP, et al. “Review: Beyond conventional therapies: Complementary and alternative medicine in the management of hypertension: An evidence-based review.” Pak J Pharm Sci. 2018 Jan;31(1):237-244.
https://www.ncbi.nlm.nih.gov/m/pubmed/29348109/
(2) Yates RG, et. al. “Effects of chiropractic treatment on blood pressure and anxiety: a randomized, controlled trial.” J Manip Physical Ther. 1988 Dec;11(6):484-8.
https://www.ncbi.nlm.nih.gov/pubmed/3075649
(3) Bakris, G. Journal of Human Hypertension, advance online publication, March 2, 2007. Grassi, G. Journal of Human Hypertension, advance online publication, January 25, 2007.George Bakris, MD, director, hypertension center, University of Chicago. Marshall Dickholtz Sr., DC, Chiropractic Health Center, Chicago.
http://www.uchospitals.edu/news/2007/20070314-atlas.html
Other Source Material:
https://www.cdc.gov/bloodpressure/facts.htm
https://www.cdc.gov/features/highbloodpressure/index.html
http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/GettheFactsAboutHighBloodPressure/The-Facts-About-High-Blood-Pressure_UCM_002050_Article.jsp#.WmYUYyOZNBw
https://www.drsinatra.com/6-surprising-blood-pressure-facts-everyone-should-know
Hello, hello, Dr. Jeff Williams here with Creek Stone here in beautiful Amarillo, TX and I’m your host for the Chiropractic Forward podcast. You have bumped right into episode #4 and we could not be any happier to welcome you.
Before we get too far into this week’s podcast, we are brand new of course but we are ready I believe to start search for sponsorships for the podcast as well as some affiliate marketing relationships. We want to make sure you have awesome information without having to search it out but, being in active practice like I am, it takes time and energy to do the show every week and seeing some opportunity for return on it would make it even more sweet.
This week we’re going to discuss some attacks on the profession in the not-so-distant past, we’ll talk about the current state of the opioid epidemic, and we’ll talk about why right now is such a good time for what is going on with Chiropractic research.
Before we get to the meat of the subject this week, I want to say that I hope you all had a Merry Christmas and a Happy New Year. My family brought it in sitting on the couch drinking decaf coffee. It was very uneventful but pleasant. I used to be a traveling musician in what seems like a former life now and…if you’d have told me 10 years ago that I’d be bringing in the new year sitting on the couch drinking coffee, I would have laughed at you in a dismissive way and probably had given you a look that you would not have taken as being positive. But, jobs and kids and family have a way of forcing the needed changes and that’s OK with me. It’s all a part of life and you better believe I’m living it.
Here’s wishing you all a happy and prosperous 2018.
Now, back to our regularly scheduled programming. This week, we’re going to have more fun that Chinese algebra. Just sit back and watch. I tell you the truth.
Seriously though, this is the place where we talk about some pretty cool stuff going on in the Chiropractic field that is based on research and evidence. How cool is that? When you can just sit back and let all the super smart guys and gals validate everything you do? What a blessing. Of course, we chiropractors have always known we were right about how to go about treating our patients. Think about it. Think about the generations of attacks this profession has endured through the years from extremely powerful people in the legislative and in the healthcare world. The American Medical Association. I’m not sure it gets more powerful than that. Heck, they even lost an anti-trust case in the Supreme Court when chiropractors sued them. In short, chiropractors proved in Federal Court that the American Medical Association did the following or encouraged their members in the following manner:
- They encouraged ethical complaints against doctors of chiropractic;
- They opposed chiropractic inroads in health insurance;
- They Opposed chiropractic inroads in workmen’s compensation;
- They opposed chiropractic inroads into labor unions;
- They opposed chiropractic inroads into hospitals; and
- They attempted to contain chiropractic schools.
- They conducted nationwide conferences on chiropractic;
- They distributed publications critical of chiropractic;
- They assisted others in preparation of anti-chiropractic literature;
- They warned medical doctors and their underlings that professional association between medical physicians and chiropractors was unethical; and
- They discouraged colleges, universities and faculty from cooperating with chiropractic schools.
If you hear all of this ridiculousness and you say to yourself, “There’s no way that’s true,” then please do us both a big favor and Google the term Wilk vs. AMA and that should tell you all you need to know about the matter.
Anyway, to my original point, if we weren’t right, we would have been destroyed years ago by the machine. I want you to listen to me here. Let me say it again, if we chiropractors were not right, we would have been wiped off the map years ago. It certainly wasn’t from a lack of effort on the part of the powers that be.
The best part about the blogs and podcasts and videos I share every week is that most everything we talk about has its roots in research. How do you generate facts? I’d argue it’s through research. I hear it all the time: “I believe in chiropractics.” My response is pretty simple. We’re not a church. You don’t have to believe. We have mountains of research. The problem is, few people know about it.
Mountains of research, after some time, begins to look a lot like facts don’t ya think? And facts are pesky things. A person doesn’t have to like them. They just are….like it or not.
I don’t like the fact that our national debt and deficit is what it is. But, they’re just facts and we have to learn to live with it. Well, the medical field is starting to learn to live with some new facts. In fact, they’re getting smacked down like a red-headed step kid by these facts!
Facts like this…the opioid crisis cost the US economy $504 billion dollars in 2015 according to an article from Reuters this year written by Lucia Mutikani and Ginger Gibson. There authors of the article were relaying information taken from the White House Council of Economic Advisers (CEA).
There is no reason to expect this number to improve any time soon either. If indicators are correct, as numbers become more available for 2016 and 2017, you’ll see this amount explode.
The opioid crisis has reached the point that President Trump was forced to declare it a public health emergency.
The article goes on to discuss the fact that there was a total of $221 billion to $431 billion in lost economic output due to there being 33,000 opioid-related deaths in 2015. The wide range in dollar amounts is to take into account the fact that there are several different models but, I think you get the idea. It’s incredibly significant.
“The crisis has worsened, especially in terms of overdose deaths which have doubled in the past ten years,” the CEA said. Wow. And, if I’m correct, yo u can compare the crisis to a fire. While it may have taken 10 years to double (which is bad), I believe the rate of expansion of the problem has increased exponentially.
The article wraps up by citing the U.S. Centers for Disease Control and Prevention as saying more than 100 Americans die daily from related overdoses. On top of that, new information is out that opioid-related deaths have now surpassed breast cancer. I love that the NFL does the pink uniforms during October which is Breast Cancer Awareness Month but I’m wondering if now we’ll start seeing a specific color and more awareness for the Opioid Addiction Awareness Month or something of that nature. It’s bad, y’all.
https://www.reuters.com/article/legal-us-usa-opioids-cost/opioid-crisis-cost-u-s-economy-504-billion-in-2015-white-house-idUSKBN1DL2Q0
How bad is it? It’s so bad that a recent article in The Guardian says that overall life expectancy in the US has declined for the second year in a row as a result of the opioid crisis. Can you imagine? It’s the first time in 50 years that the US life expectancy has gone down for 2 years in a row. The last time was the year of our Lord, nineteen hundred and sixty-three!
The article in The Guardian was written by Jessica Glenza and was published on December 21, 2017. In the article, she shares that there were 63,600 opioid-related deaths in 2016 which was an increase of 21% from the 2015. These numbers came from the National Center for Health Statistics.
As I hinted in the beginning of this blog, early indications for 2017 aren’t looking very bright. Robert Anderson of the National Center for Health Statistics says of 2017, “It doesn’t look any better.” Anderson goes on to say, “We haven’t seen more than two years in a row in declining life expectancy since the Spanish flu – 100 years ago,” said Anderson. “We would be entering that sort of territory, which is extremely concerning.”
There are guesstimates that this crisis is going to take a good 10-20 years to turn around now that multiple generations are already hooked.
https://www.theguardian.com/us-news/2017/dec/21/us-life-expectancy-down-for-second-year-in-a-row-amid-opioid-crisis
Realizing that the first phase of the opioid crisis was started by physicians over-prescribing these opioids, the American Medical Association and the American College of Physicians have really stepped up in a way that I would believe most alternative caregivers would describe as rather unexpected considering the history of these organizations. They have consistently and constantly attacked - verbally, in the courts, and legislatively - just about any and all alternative healthcare protocols up to this point in history.
However, in new recommendations put out in February of 2017, the American College of Physicians have now started recommending Chiropractic, Massage, and/or Acupuncture as first-line treatment for acute and chronic low back pain before even taking an over-the-counter anti-inflammatory such as Aspirin, Tylenol, or Ibuprofen.
Quickly thereafter (2 months), the American Medical Association published an article in its journal called Journal of the American Medical Association (JAMA) in support of the updated recommendations made by the American College of Physicians.
It took a national emergency of epic proportions started in part by the medical profession itself but, now, finally, we have some realistic and responsible recommendations coming from the medical field on safe and conservative means of treating uncomplicated musculoskeletal conditions. I would say they need to go ahead and expand it to the entire musculoskeletal system but acute and chronic low back pain is a good starting point I suppose.
In the end, it is my firm belief that patients are entitled to the best treatments that do the least harm. There is nothing out there safer and more effective than chiropractic, massage, and/or acupuncture.
Through the years, I have carried with me a wonderful quote by Dr. Lee Green, a Professor of Family Medicine at the University of Michigan. He said, ”Neck pain is a mechanical problem, and it makes sense that mechanical treatment works better than a chemical one.”
Doesn’t it?
Just another reason to call a chiropractor TODAY!
- Research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic. Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health!
https://www.amarillochiropractor.com/evidence-backed-reason-add-chiropractic/
Outro/Offer:
I want you to be sure you know all about our blog and our YouTube channel. Currently, we have these entities set up under Creek Stone Integrated Care. Now, with the building of the Chiropractic Forward podcast site, how’s that going to change and how’s that going to look? I haven’t figured that part out just yet but know this, you can get your fix on all things chiropractically researched by going to amarillochiropractor.com and clicking on the blog button. Or, you can visit our youtube channel by searching Creek Stone Integrated Care in the YouTube search
Be looking for our upcoming website at chiropracticforward.com. It is not ready but it will be soon enough. It’s closer every week. I don’t know if you know this but I am all over social media in a whole bunch of areas. For a list of links, see the show notes and we’ll see you somewhere in that list I hope.
Thank you for listening. You know, sharing is caring and that’s how we get to more and more ears. If you like what you hear and you know other chiropractors or medical field professionals…..or even potential chiropractic patients….make sure you share our podcast with them. Together we can make a difference and help people get off of medication, get out of pain, and get healthier overall.
I’m Dr. Jeff Williams from the Chiropractic Forward Flight deck saying upward, onward, and forward .
Great News: Chiropractic Outpaces Muscle Relaxants
Hey hey, Dr. Jeff Williams with the Chiropractic Forward podcast coming to you directly from the flight deck at Creek Stone Care in icey Amarillo, TX and you have stumbled head first into Episode numero 3.
Welcome welcome, this week we’re going to be talking about people that I believe may be related to unicorns because I can’t hardly believe they exist, we’ll talk about something I pondered while in the shower, and we’ll talk about what research has to say about low back pain, muscle relaxants, and chiropractic care.
I like to be an honest person so I’m just going to speak directly here and say that….I have yet to get the hang of the whole podcast thing but, I’m at least screwing it up regularly and consistency is half the battle I’m told. We’re going to have more fun than chopping wood and I firmly believe it. If you believe it, it must be true. What’s the saying? Perception is reality? I sometimes enjoy living in my own reality to tell the truth. Who doesn’t?
Speaking of unbelievable, Did yo u know that you are 75% to 85% likely to experience low back pain in your lifetime? Those are some pretty good odds. Or, bad, odds depending on how you look at it. That’s where the unicorn reference comes in here. I have a hard time believing these people exist.
By the way, I’d like to meet the 15%-25% that don’t have back pain. Wouldn’t you? Maybe these folks have been marked by God for greatness that just can’t be achieved if they’re suffering from back pain. They’re the ones looking at everyone else like, “What the heck is wrong with you people?”
How do you make it through a lifetime without back pain? That just doesn’t seem right to me. Someday, I plan on having a talk with God about this deal. I’m kind of mad about it.
Believe it or not, I remember life without back pain. I specifically remember being a kid, taking a hot shower, and thinking about adults that always gripe about back pain. I had recently heard an adult talking about how standing in a hot shower made their back feel better so that’s what made me think about it.
I thought, “That must really stink to always be hurting like that.” Well then I was smart enough to play college football and go to chiropractic school where chiropractors get to use each other as guinea pigs to learn how to help others. Yes, you could say I donated my body to science in a way. Regardless of the reasons, I am well-acquainted with the occasional back pain. It has been intense a few times. To the point of crawling to the bathroom because I couldn’t walk to get there. It’s been years since that was the case but I certainly have empathy for my patients that come through the doors like that. It can be pure misery and it’s no wonder at all why people would look to medication for a quick fix for such intense, non-stop pain. If I’m being honest, when I remember that pain, I would be be looking for anything and everything to make it stop too.
Here’s the problem though: there arebut a few things that can help immediately. The good news here is that Chiropractic is one of the very BEST answers for this issue. The even better news is that the American Medical Association and the American College of Physicians now agree with me on this as of 2017.
That leads us into this article’s source material which is a research paper by KT Hoiriis called “A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain.” It was published in the Journal of Manipulative Physiological Therapeutics in July-August issue in 2004 and can be found on pages 388-398.
Why They Did It
Considering the fact that we are almost all going to suffer from low back pain at some point in our lives and considering the fact that acute pain will generally resolve and chronic pain is tough to treat, the authors of this paper were interested in trying to assess the reponsiveness of SUBacute low back pain to different treatments available. The treatment the authors chose to compare were Chiropractic treatments vs. muscle relaxants and placebo.
How They Did It
- The platform chosen by the researchers was a randomized, double-blind clinical trial. It is high-quality information when done with this sort of design.
- They chose 192 patients that had suffered low back pain for a time period of between 2 and 6 weeks in duration.
- The patients were randomly split into three different groups for the purpose of the project.
- They each underwent 2 weeks of treatment. One group with Chiropractic, one with muscle relaxants, and one with placebo.
- The Outcome Assessments were performed through the use of the Visual Analog Scale (VAS), the Oswestry Disability Questionnaire, and the Modified Zung Depression Scale.
- These assessments were performed at the beginning of treatment (baseline), at two weeks, and at the conclusion of the treatment which was at the four week mark.
- In addition to the Assessments previously mentioned, Schobers’s flexibility test, acetaminophen usage, and the Global Impression of Severity Scale (GIS) were assessed at the 2 week mark and at the 4 week mark.
What They Found
- The baselines were essentially the same in all of the Outcome Assessments except for in the Global Impression of Severity Scale.
- The subjects that actually finished the trial, 146 in all, had their data combined revealing pain, disability, depression, and the Global Impression of Severity Scale had ALL decreased significantly while flexibility for the low back was not altered.
- Statistical differences through the groups showed that the chiropractic patients improved more than the control group and in terms of the Global Impression of Severity Scale, the chiropractic patients also improved more than the placebo group AS WELL AS the muscle relaxants group.
Wrap It Up
Chiropractic was more beneficial than placebo in reducing pain and more beneficial than either placebo or muscle relaxants in reducing GIS.
While this is good news from 2004, there are studies subsequent to this one showing how Chiropractic outpaces medication in the treatment of low back pain. These are part of the reason that they American Medical Association and the American College of Physicians recently published articles and papers recommending Chiropractic as first-line treatment for acute and chronic low back pain before even taking acetaminophen or aspirin. That’s huge folks.
Source Material
Hoiriis KT, et. al., “A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain.” J Manip Physiol Ther. 2004 Jul-Aug;27(6):388-98.
https://www.ncbi.nlm.nih.gov/pubmed/15319761
Just another reason to call a chiropractor TODAY!
•Research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic. Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health!
https://www.amarillochiropractor.com/evidence-backed-reason-add-chiropractic/
Outro/Offer:
I want you to be sure you know all about our blog and our YouTube channel. Currently, we have these entities set up under Creek Stone Integrated Care. Now, with the building of the Chiropractic Forward podcast site, how’s that going to change and how’s that going to look? I haven’t figured that part out just yet but know this, you can get your fix on all things chiropractically researched by going to amarillochiropractor.com and clicking on the blog button. Or, you can visit our youtube channel by searching Creek Stone Integrated Care in the YouTube search
Be looking for our upcoming website at chiropracticforward.com. It is not ready but it will be soon enough.
Thank you for listening. You know, sharing is caring and that’s how we get to more and more ears. If you like what you hear and you know other chiropractors or medical field professionals…..or even potential chiropractic patients….make sure you share our podcast with them. Together we can make a difference and help people get off of medication, get out of pain, and get healthier overall.
I’m Dr. Jeff Williams from the Chiropractic Forward Flight deck saying upward, onward, and forward .