February 2018 - chiropracticforward

Month: February 2018

CF 010: Surprise Unique Information Shows Chiropractic May Work On The Brain Too

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 may work in 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

Bring on the bumper music

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 having to do with the dact that chiropractic may work on the brain itself. 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! And, of course now, we see that chiropractic may work on the brain too!

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:

  1. 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.

 

CF 009: With Dr. Tom Hollingsworth: The Case Against Chiropractic In Texas

We’ll be talking about any and every past attack on chiropractic in Texas and on our profession by the medical field heavyweights…..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.

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 attack on chiropractic in texas and other 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: The 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?

(Discuss VONT, Diagnosis #2, Sublux, and Neuro)

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?

1.   MSK includes “associated” nerves

a. Concerning balance is Ex Parte Halsted

b. Careful to avoid claims toward entirety of nervous system (Hogs get slaughtered.)

2.   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)

3. 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”).

4. 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

1. Had to get out of ear into processing centers

2. (Vestib Nuc and V-spinal tracts)

3. Attempt to utilize MD cultural authority on basic fact

4. 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

  1. 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.
  2. 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.
  3. Yates RG (1988). “Effects of chiropractic treatment on blood pressure and anxiety: a randomized, controlled trial.” Manip Physical Ther 11(6): 484-488.
  4. https://www.chiro.org/Wilk/
  5. https://jamanetwork.com/journals/jama/article-abstract/2616395
  6. https://www.amarillochiropractor.com/healthcare-in-texas-the-battle-against-a-monopoly-a-true-story-about-david-goliath-3/
  7. The Texas Chiropractic Defense From The Texas Medical Association A Timeline.
  8. 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.

 

CF 008: With Dr. Craig Benton – Brand New Information Based on Results Chiropractic Proven Effective For Low Back Pain

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.

For now though, it’s time for bumper music!

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 ,

https://www.thespinejournalonline.com/article/S1529-9430(18)30016-0/fulltext

 

CF 007: Awesome Alternatives To High Blood Pressure Treatment

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

1. Describe the therapeutic modalities commonly used in treating high blood pressure.

2. 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

https://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