May 2019 - chiropracticforward May 2019 - chiropracticforward

Month: May 2019

w/ Dr. David Graber (Part One) – Chiropractic Technique, Chiropractic Gurus, Teaching

CF 076: w/ Dr. David Graber (Part One) – 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


Chiropractic evidence-based products

Integrating Chiropractors
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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 #76

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 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?

Chiropractic evidence-based products

Integrating Chiropractors
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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

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

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

Chiropractic Residencies, Fat Cat Drug Dealers, Osteoporosis & Yoga, & Pain Science

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

Chiropractic evidence-based products

Integrating Chiropractors
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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 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. 

  1. 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. 
  2. 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.
  3. 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
  4. 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.
  5. 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. 
  6. 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.
  7. 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! 
  8. 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!
  9. 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. 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. 
  11. 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:

  1. Establishing a chiropractic residency program for every school should be priority #1. For the school, the student, the patients, and the profession. 
  2. Drug dealers usually get what they have coming to them. 
  3. Chronic pain is a beast although it IS a fascinating beast. 
  4. Don’t do any crazy yoga if you have osteopenia or osteoporosis.
Chiropractic evidence-based products

Integrating Chiropractors
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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

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

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

1. O’Neill SFD, Establishing a residency program for a chiropractic specialty in a public hospital system: Experiences from Denmark. J Chiropr Educ, 2019.

2. Insys Therapeutics founder John Kapoor convicted in US opioid case. BBC News, 2019.

3. Efthimiou N 11 Important Things To Know About Pain. Integrative Osteopathy, 2018.

4. 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.

Manipulation For Special Forces, Manipulation For Cervical Disc Herniation, Lazy Americans

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 manipulation for cervical disc herniations, 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

Chiropractic evidence-based products

Integrating Chiropractors
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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 #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 manipulation for cervical disc herniations. 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 manipulation for cervical disc herniations 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 manipulation for cervical disc herniations. 

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. 

Chiropractic evidence-based products
Integrating Chiropractors
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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

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

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

1. 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).

2. 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.

3. 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.

4. Press, A. Americans getting more inactive, computers partly to blame. WTOP, 2019.

w/ Tim Bertelsman – Chiropractic Standards, Chiropractic Specialists, Importance of State Associations

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!

Chiropractic evidence-based products
Integrating Chiropractors
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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. 

  1. 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. 
  2. Tell me about your journey into chiropractic
  3. From your CV, I see that you did the CCSP right out of school. What all have you done through that specific certification?
  4. Can you tell us the most striking difference between the two other than one is more geared toward sports?
  5. Tell me about your practice, what does it look like, who do you see mostly?
  6. Tell me about your journey into the DACO and what benefits you have personally realized from it.
  7. 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?
  8. I want to hear a little about this friendly rivalry between you and Dr. Steele. 
  9. 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. 
  10. 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? 
  11. Tell me about your involvement with your state association and what it has meant to you both personally and professionally
  12. 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?
  13. Tell me about chocolate cookies and sushi
  14. I noticed a couple of things from your ‘About Me’ page on your website that I’d love to hear more about. 
    1. The Clinical Internship – Community Health Center
    2. Hospital externship at Deaconess Medical Center
  15. 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?
Chiropractic evidence-based products
Integrating Chiropractors
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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

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

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

Kids Need A Rest, Chiropractic In Europe, & Exercise For Chronic Pain

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

Chiropractic evidence-based products
Integrating Chiropractors
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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 #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 

  1. Use proper mechanics in any sport.
  2. 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. 

Chiropractic evidence-based products
Integrating Chiropractors
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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg


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

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

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.