August 2019 - chiropracticforward August 2019 - chiropracticforward

Month: August 2019

Chiropractic in Active Duty Military, Early Care in Whiplash, Chronic Discs & The Sinuvertebral Nerve

CF 087: Chiropractic in Active Duty Military, Early Care in Whiplash, Chronic Discs & The Sinuvertebral Nerve

Today we’re going to talk about Chiropractic care in Active Duty Military folks, we’ll talk about Early Care in Whiplash victims, and we’ll talk about Chronic Discs & The Sinuvertebral Nerve. What’s the what what on that?

But first, here’s that smooth like chocolate mousse bumper music

Chiropractic evidence-based products
Integrating Chiropractors
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

And away we go..… Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have back flipped into Episode #87. Kind of like the kid at the town swimming pool when you were in school. I could never do that. Pissed me off too. Of course, I never cracked my noggin on the bottom of the pool either so there’s that I suppose. 

We have some pretty cool stuff to talk about this week but, before we get started, let’s talk about GoChiroTV for your lobby. GoChiroTV is a patient education system for your office that will eliminate the need for running cable TV or the same DVDs over and over again in your waiting room. The bite-sized videos are specifically made to inform your patients about the importance of chiropractic and healthy living. To encourage referrals and to present the benefits of all of the different products and services you offer.

It works by using a tailor-fit video playlist that only promotes the products and services available in your practice. Not only that but the videos are replaced automatically on a weekly basis. There’s no need to manually update your playlist or learn any complicated software. You truly can just set it and forget it.

Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions. That’s CFP19, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription and you can’t hardly beat that deal. 

Go visit GoChiroMedia.com to check out the demo reels and get started on your free trial. Take your practice to the next level with GoChiroTV. Introduction

As regular listeners already know, I’m going through the Diplomate of the Academy of Chiropractic Orthopedists and I really don’t have much to share on that end of things. I got past Part I and am studying for Part II which is coming up in November. Overall, it’s been enjoyable. I do a lot of extra continuing education anyway so, might as well get some letters after my name for my effort don’t you think? You know I’ll keep you updated as I go. 

Here and there, when the spirit hits me, I’ll post some interesting stats from the DACO coursework on our Chiropractic Forward facebook page or in the Chiropractic Forward private group so you can be looking in there for that. 

Item #1

We’re going to start with this one. It’s called, “Chiropractic services in the active duty military setting: a scoping review” written by Mior, Sutton, and To, et. al(Mior S 2019). It was published in BMC Chiropractic and Manual Therapies in July 2019. Hot stuff….serving it up fresh folks…

They start by pointing out the obvious and that’s that musculoskeletal injuries are really a big deal to military folks. Hell yeah they are. I’ve had patients that have fallen from helicopters before. That doesn’t typically happen in the civilian population, now does it?

In some countries, recently America was added to the list, chiropractic care is being used more and more to manage these injuries. Which brings to mind….y’all….the VA just sent me a WWII veteran today!! Just this morning. He was in France and Germany from 1944 through the end of the war in 1945. Made my entire month, y’all. Seriously. How fascinating. Imagine the things he’s seen. 

I told him that, when I hear people bitching about Obama or Trump or politics or anything else really….I always think about their generation and that time and wonder what they were thinking about the world. Rationing supplies, sons, brothers, sisters, fathers, and mothers scattered from one end of the globe to the other. What did they think?

You know what he told me? He said, “We didn’t think the world was coming to an end. We just thought one thing and that was putting an end to it and we had to put an end to Germany to do that. That was all we were thinking.”

Pretty interesting. I get to spend time with this dude for several weeks. I’ll report back with any super awesome nuggets he chooses to pass on to me. 

Anyway, sorry for the sidebar there, back to the paper at hand. 

How They Did It

  • They used systematic reviews of relevant databases including military collections and hand searches were conducted from inception up to October 22,2018. 
  • They included peer-reviewed English literature with qualitative and quantitative designs, describing chiropractic practice and services delivered to active duty military worldwide. The data was put into evidence table and sorted by study type. 

Geez….sentences like that make me truly happy I am personally not a researcher myself. How boring. Lol. But thank God some are bent that way and like it. 

Now, What They Found

  • 497 articles were screened and they whittled that down to only 20 that fit the criteria. 
  • Back pain with and without radiculopathy accounted for most complaints. 
  • They identified two recent randomized trials that reported improved pain, disability, and satisfaction when adding chiropractic care to usual medical care compared to usual medical care alone in management of low back pain….I believe Dr. Christine Goertz, one of our previous guests was involved in at least one of those papers. 

Wrap It Up

“Two recent RCTs provide evidence of comparative effectiveness of adding chiropractic care to usual medical care. Despite the reported use of chiropractic services in Australia, Canada, and the US, there is little available published evidence related to the nature, use, and outcomes of chiropractic care in active duty military. Our review suggests the need for further qualitative, descriptive, and clinical trial data worldwide to inform the role and value of chiropractic services in active duty military globally.”

So basically they did a lot of work to say, “Yeah, we’re not sure. We need more research.” Lol. Isn’t that the way it usually goes though?

I’m going to go ahead a anecdote the crap out of you here. As I mentioned before, we see a good number of veterans that the VA sends over. Every single one of them have been in the middle of chronic pain syndrome. I have had more than one of them tell me that they are going to kill themselves if they cannot get something done about their pain. 

The VA is stopping all opioids, as they most certainly should. Veterans don’t like this. The opioids were their safety nets and whether they really helped or not, the vets thought they helped and just like a placebo, that may have been enough to make a difference for them. 

So now it’s other things. They come in still on gabapentin and things of that nature but no more opioids and they’re pissed. But here’s the deal, when you start asking about their service, what years they were in, and where they were sent, you start to see the walls break down a bit. 

That’s when you demonstrate good solid knowledge through your exam and communication. By the time to finish up, if you do it right, you have a new patient and a new friend who’s excited to see where this thing might go. 

Almost all of them have responded positively. Yes, absolutely there are some here or there that don’t get the results we want for them but, without a doubt, the vast majority of them start sleeping better (which is one of the most common complaints), they stop hurting at the levels they previously experienced, and they start becoming more active. They come in laughing and they look forward to being here. 

Researchers can have all of the questions in the world and I’m glad they do and I’m glad they’re trying to answer them but, for me, I don’t have to know exactly how it works physiologically. I just practice good solid evidence-based chiropractic and I have the joy of sitting back and watching what happens. It truly is astounding y’all. 

We’re going to talk about whiplash and early intervention. Good idea or bad idea? It may not be what you think it is. 

First, since we mentioned evidence-based chiropractic, 

Have you heard about the #1 online resource for chiropractors? Well, let me tell you about it. 

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99.

Alright, Item #2

This one is called, “Early aggressive care and delayed recovery from whiplash: isolated finding or reproducible result?” written by Cote, Hogg-Johnson, Cassidy, et. al. and published in Arthritis & Rheumatology in 2007(Cote P 2007). Oldie but a goodie here if you’re doing personal injury work. 

Why They Did It

The stated goal here is to test the reproducibility of the finding that early intensive care for whiplash injuries is associated with delayed recovery. 

How They Did It

  • Data from a cohort study of 1,693 adults suffering whiplash was looked at. 
  • They picked apart 8 different patterns of care between GPs, chiropractors, and specialists
  • And they used Cox models to estimate the association between patterns of care and time to recovery

What They Found

“The observation that intensive health care utilization early after a whiplash injury is associated with slower recovery was reproduced in an independent cohort of patients. The results add to the body of evidence suggesting that early aggressive treatment of whiplash injuries does not promote faster recovery. In particular, the combination of chiropractic and general practitioner care significantly reduces the rate of recovery.”

Well what the hell do we do with that information exactly? What exactly is meant by the term ‘early aggressive’? What is meant by chiropractic care? Does that just mean spinal manipulative therapy? Or does that mean spinal manipulative therapy, exercise/rehab, therapy, and all the good things we use to make people better?

My answer to you is “Hell if I know.” The abstract doesn’t give that information. But what I can tell you is, the more we are able to utilize motion and movement, the faster they heal up. You take that to the bank from your ole pal Uncle Jeffro. 

Item #3

Look, when I read the title of this next one, I don’t want your eyes glossing over and you losing your ability to stay awake. I damn sure don’t want you turning off the podcast or fast forwarding. Just hold on a damn second. 

This one is called “A comprehensive review of the sinuvertebral nerve with clinical applications.” It was written by Brian Shayota, T.L. Wong, and Donald Fru, et. al. and published in Anatomy & Cell Biology in 2019(Shayota B 2019). Hot cakes, servin em fresh. 

When it comes to disc pain, the sinuvertebral nerve is a hot topic amongst anatomists. Bet you didn’t know that, right? Why would that be? Well, they say, “Knowledge of the nerve has been used to design a variety of diagnostic and treatment procedures for chronic discogenic pain. This paper reviews the anatomy and clinical aspects of the sinuvertebral nerve.”

The sinuvertebral nerve, associated with the discogenic type (pain from an injured vertebral disc), accounts for approximately 26%–39% of patients with low back pain. 

Well that’s important now isn’t it?

“Although the sinuvertebral nerve fibers are said to terminate in the outer anulus, it is now widely accepted that this end point is not permanent. Studies of healthy patients normally show neural penetration of the anulus at about 3 mm.” And the plot thickens!!

They continue, “However, degenerative discs have shown penetration of nerve fibers as far as the inner one third in one study [38], and into the nucleus pulposus in another.”

“Discogenic pain is not limited to the lower back. Overactivation of the C1–C3 sinuvertebral nerves is now considered the cause of most cervicogenic headaches.”

Wrap It Up

“Recent studies have shown that the sinuvertebral nerve can be traced as far as the outer three layers of the lamella in healthy patients, but can go as far as the nucleus pulposus in degenerative discs. The nerve has also been implicated in discogenic pain. Yet only recently has its role been extensively studied, providing opportunities for the development of newer diagnostic and treatment techniques to combat the debilitating consequences of its pathology. Provocative discography is still the gold standard for diagnosing discogenic pain. While these procedures have proved advantageous in discogenic pain management, much more work needs to be done to improve their accuracy and efficacy. The sinuvertebral nerve has also been linked to cervicogenic headaches, but more research is needed to clarify its involvement in this condition.

Pretty cool stuff right there folks!!

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. 

Chiropractic evidence-based products
Integrating Chiropractors
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
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

Cote P, H.-J. S., Cassidy JD, (2007). “Early aggressive care and delayed recovery from whiplash: isolated finding or reproducible result?” Arthritis Rheum 57(5): 861-868.

Mior S, S. D., To D, (2019). “Chiropractic services in the active duty military setting: a scoping review.” BMC Chiro Man Ther 27(45).

Shayota B, W. T., Fru D, (2019). “A comprehensive review of the sinuvertebral nerve with clinical applications.” Anat Cell Biol 52(2): 128-133.

Sports Performance / Chiropractic Care Standardization / Proprioception

CF 086: Sports Performance / Chiropractic Care Standardization / Proprioception 

Today we’re going to talk about Sports Performance / Chiropractic Care Standardization / Proprioception 

But first, here’s that arm like a big fuzzy coat bumper music

Chiropractic evidence-based products
Integrating Chiropractors
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have tripped into Episode #86 and when I say tripped, I don’t mean so much the LSD kind of trip but more like the I’m an idiot and fell face first in a room full of people sort of tripped. So, welcome you fools!! Lol. I kid, I joke. I’m honored to have you here today. We have some good stuff to cover. 

Before we get started, let’s talk about GoChiroTV. GoChiroTV is a patient education system for your office that elminates the need for cable TV or looping the same DVDs over and over again in your waiting room. The bite-sized videos are specifically made to inform your patients about the importance of chiropractic and healthy living. To encourage referrals and to present the benefits of all of the different products and services you offer.

It works by using a tailor-fit video playlist that only promotes the products and services available in your practice. Not only that but the videos are replaced automatically on a weekly basis. There’s nothing complicated. You truly can just set it and forget it.

Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions. That’s CFP19, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription and you can’t hardly beat that deal. 

Go visit GoChiroMedia.com to check out the demo reels and get started on your free trial. Take your practice to the next level with GoChiroTV.

Introduction

We’re here to advocate for chiropractic while we also make your life easier using research and some good solid common sense and smart talk. 

Personal Happenings

I always feel that, if I share personal experiences with you guys, first you’ll know me as a person better and I don’t see anything wrong with that. Second, you may identify and sympathize. Third, if you can’t necessarily identify with what I go through, you may be able to learn from it if you get to that point. 

With that I’ll say that 2019 has been quite the year for us around my office. New faces, lots of new patients, and less and less time to do things outside of seeing patients. My work/life balance is out of balance at the moment and I’m afraid my health is starting to show some dents in the armor. 

I think I have an undiagnosed anxiety thing and, typically, I’m very good at managing anxiety and stress and having 4 or 5 balls up in the air at the same time. I’m a juggler people. And I have been for quite a long time. 

But, in January, something clicked. Something changed. I don’t say this to brag. I say this to explain. My practice numbers just started to climb during a time that we are traditionally slow. Really slow. The holidays are usually a time when you just know you’re going to have extra time to catch up on all of those things that have been piling up in front of you. Back to school time as well right? It’s always been a down time for me for one reason or another. 

Yeah, well, not this year. The holidays only got busier. Much busier. The kids go back to school in two weeks and there’s been no slow down this Summer. Which is awesome. But my problem is, I don’t know what I did to cause the influx. If I knew, you better believe I’d be repeating it!! Over and over and over. 

The end story is, growing is great but growing can be stressful. That’s why they call it growing pains right? Think about it: how many staff member do I need to handle the patient load? Am I over staffed or understaffed? Do I need an associate? Which one is the right one? Will they take care of things like it’s their own and they care? Where do I get good contract for one? I have a bathroom that needs tiled and I have an Air conditioner that need’s replaced. My dog pissed on the carpet this morning. Blah blah blah. 

You all know how it goes. Every aspect of practice has stressors. When you’re new in practice and don’t have a heavy load, you’re sitting looking at your watch, playing on the computer, hopegully you’re out marketing, and you’re stressed about how you’re going to provide for your family. 

I’m aware that being too busy is a nice problem to have. I don’t want to come off as a spoiled brat here. I’m just saying that I have been stressed and it’s starting to affect me a bit. We have been blessed and we are going to take blessings and we are going to turn them into more blessings for us and for our patients and staff. 

It’s just getting through some of the mud and muck along the way. I just need to keep my anxiety under the surface a little longer. Lol. So that nobody thinks I’m insane. 

I’ve fooled them this long haven’t I?

On another note, Charlie Manson. Y’all, I was fascinated by their shenanigans when I was in high school but got over it. Every now and then I’ll see something about it and I’ll perk up and listen but I went to see the new movie Once Upon A Time In Hollywood. 

I’ve been seeing where some hate it and some love it and I’ve seen a bunch of ehhh comments but I gotta tell you. I’m firmly in the hell yeah category. Brad Pitt and Leo DiCaprio knocked that sucker straight out of the parking out onto the parking lot. It was funny, it was vintage, it was nostalgic, and no…..of course it didn’t happen that way but it was excellent. 

If you went, shoot me an email at dr.williams@chiropracticforward.com and tell me what you thought. I can share you thoughts next week on the podcast. Or you can get on our Facebook page or our private Facebook group and we can discuss. 

Item #1

Let’s get to our first item here. It’s titled “The effects of spinal manipulation on performance-related outcomes in healthy asymptomatic adult population: a systematic review of best evidence” and written by Meliss Corso, Silvan Mior, Satrah Batley, et. al. It was published in BMC Chiropractic and Manual Therapies in June 2019. Brand new…..hot stuff people. (Corso M 2019)

Why They Did It

The authors wanted to perform a systematic review regarding the effect spinal manipulative therapy has on athletic performance in asymptomatic adults. 

What They Found

They concluded “The preponderance of evidence suggests that SMT in comparison to sham or other interventions does not enhance performance-based outcomes in asymptomatic adult population. All studies are exploratory with immediate effects. In the few studies suggesting a positive immediate effect, the importance of such change is uncertain. Further high-quality performance specific studies are required to confirm these preliminary findings.”

That doesn’t mean we can’t help with pain and discomfort which aids in better performance. But it does suggest that, if a person feels great, getting spinal manipulative therapy isn’t very likely to make any difference in how fast they are or how far they can throw. 

Item #2

This one is called “The Chiropractic Hospital-Based Interventions Research Outcomes Study: Consistency of Outcomes Between Doctors of Chiropractic Treating Patients With Acute Lower Back Pain” by JA Quan, et. al and was published in the Journal of Manipulative and Physiological Therapeutics in June 2015 so 4 years old. (Quon JA 2015)

Why They Did It

The aim of this study was to determine if effectiveness differs between community-based doctors of chiropractic administering standardized evidence-based care that includes high-velocity low-amplitude spinal manipulative therapy (SMT) for acute low back pain (LBP).

How They Did It

  • A secondary analysis of randomized controlled trial and observational pilot study data was performed with nonrandom allocation to 4 DCs. 
  • Patients included those with Quebec Task Force categories less than or equal to 2 and acute LBP of 2 to 4 weeks’ duration. 
  • The intervention included high-velocity low-amplitude SMT. 
  • Outcomes assessed using Roland Disability Questionnaire (RDQ) at 24 weeks. 

What They Found

The findings of this study show that regardless of the treating DC, most patients with acute LBP without radiculopathy appear to experience consistent levels of improvement in terms of BP and general PF after receiving guidelines-based treatment that include s a component of standardized HVLA SMT.

If we dive into the paper, they mention that until now, inconcsistency hasn’t been regarded as a significant barrier to chiropractors getting referrals from the medical realm. Butthere are guarded attitudeds about chiropractors when we’re talking about quality of care and that’s been confirmed in other papers. 

In fact, in a survey of 487 Canadian and American orhtopedic surgeons, they found that about 71% of them held either a neutral or a negative view of chiropractors. That means only 29% of them looked at us in a positive way. 29%. Dammit

Also, when you break down that 71% of neutral or negative….you get 26% were neutral but 45% were in the negative category. Dammit. 

73% of orthopedic surgeons thought chiropractors provided unnecessary treatment. Yeah, they’d probably just do better if you intubated them, knocked them completely out, and drove screws through the bones of their spine to fixate the segments on top of each other and then sewed them back up, and then sent them home with a bunch of pills. That’d probably be much more necessary. Sure thing chief. 

Hell, 52% of them thought chiropractors make their patients dependent on short-term relief. I will say that it feels good to feel good and why wouldn’t a patient want to feel good as often as they can? But putting the shoe on the other foot here, let’s assume they’re right, isn’t being addicted to safe, conservative, non-invasive treatment better than being addicted to opioids or some sort of medication? Our nation’s opioid crisis suggests it is better. 

The paper itself is really a preliminary study and meant to further knowledge and information for other papers down the line but I found it more interesting because of the orthopedic survey discussion. Pretty interesting. And….disappointing I’d add but that was 4 years ago. Maybe those numbers are changed a bit from then to now? Not sure. 

This is a great spot to take a short break to talk about ChiroUp. If you’re a regular listener of our podcast, you I use it and I’ve told everyone how amazing it is since about June of 2018. Well now they’re a sponsor of our show and we are really excited to have ChiroUp on board the train. 

Have you heard about the #1 online resource for chiropractors? Well, let me tell you about it. 

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99

I’m trying to save you people some money here alright?Trust me, you’re not going wrong with ChiroUp. In fact, in studying for the Diplomate of the Academy of Chiropractic Orthopedists part two exam, I’m studying the orthopedic tests and videos from the ChiroUp website. It’s phenomenal. 

Anyway, on to Item #3

It’s called “Neck proprioception compensates for age-related deterioration of vestibular self-motion perception” by G Schweigart, RD Chien, and T. Mergner. It was published in Experimental Brain Research all the way back in 2002. Bringing the old man out of the archives here. (Schweigart G 2002)

Why They Did It

Vestibular functions are known to show some deterioration with age. Vestibular deterioration is often thought to be compensated for by an increase in neck proprioceptive gain. That’s what the authors were studying here….. this presumed compensatory mechanism.

What They Found

Generally, we hold that the transformation of the vestibular signal from the head down to the trunk proceeds further to include the hip and the legs as well as the haptically perceived body support surface; by this, subjects yield a notion of support kinematics in space. 

As a consequence, spatial orientation is impaired by chronic vestibular deterioration only to the extent that the body support is moving in space, while it is unimpaired (determined by proprioception alone) during body motion with respect to a stationary support.

Just to add a little sidebar here: did you know that muscle spindles are our motion detectors? Think about this. There are 16 muscle spindles per gram of muscle in our fingers. Our hands and fingers are highly sensitive with regard to proprioception arent they? Think of a musician playing with their eyes closed. 

You know exactly where your fingers are without looking at them or really even thinking about them. How about typing? You don’t look right?

Now, we only have about 2 muscle spindles per gram of muscle in the traps. Which makes sense. Why do we proprioceptively need to know where our traps are? They’re attached to our axial skeleton. They’re not going anywhere. They’re not out flapping in the wind like our hands right?

Here’s the weird deal though: in our deeper cervical muscles, we have 242 muscle spindles per gram of muscle. That IS our axial skeleton basically so why so many spindles? There’s no flapping out in the wind with the upper cervical muscles either. But, it is the connection between our head and the rest of our body. 

It is to the point that anatomists look at the upper cervical muscles as more of a proprioceptive organ rather than as simply muscles. 

Our three proprioceptive inputs are the eys, the vestibular organ, and the muscles of the upper cervical area. When you do a Romberg’s test and you remove proprioceptive input from the eyes, and the vestibular organ….., part of what you are measuring is the input from the upper cervical region. 

It’s fascinating. Absolutely fascinating when you dive off into it a bit and I encourage to do so.  

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

Chiropractic evidence-based products
Integrating Chiropractors
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
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 & VloggerBibliography

Corso M, M. S., Batley S, (2019). “The effects of spinal manipulation on performance-related outcomes in healthy asymptomatic adult population: a systematic review of best evidence.” BMC Chiro Man Ther 27(25).

Quon JA (2015). “The Chiropractic Hospital-Based Interventions Research Outcomes Study: Consistency of Outcomes Between Doctors of Chiropractic Treating Patients With Acute Lower Back Pain.” J Man Physiol Ther 38(5): 311-323.

Schweigart G, C. R., Mergner T, (2002). “Neck proprioception compensates for age-related deterioration of vestibular self-motion perception.” Exp Brain Res 147(1): 89-97.

Highly Paid Drug Dealers, Keto Diet News, Axial Traction, Stroke Research

CF 085: Highly Paid Drug Dealers, Keto Diet News, Axial Traction, Stroke Research

Today we’re going to talk about Highly Paid Drug Dealers, Keto Diet News, Axial Traction, Stroke Research

But first, here’s that cool like a velvet Elvis bumper music

Chiropractic evidence-based products
Integrating Chiropractors
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

K, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have tip toed into Episode #85

Man, we have a show for you today. I’m still cleaning out some archives. Some papers that have been building up while we have been having guests. Some great guests that we have had more recently have been Dr. Anthony Nicholson from Australia who plays such a big part in the DACO program. The guy is a genius and eveyrone in our profession should know about him. We talked about decoding chronic pain just a few weeks ago so listen. What are you waiting for?

Then we had the chiropractor for Florida State, Dr. John Van Tassel and he is just a wise, accomplished, mentor that you need to go and hear what he has to say. Again, what are you waiting for? Go now!

Speaking of the DACO, I went to Dallas, I drove to the University of Texas in Arlington, TX …..that’s between Dallas and Ft. Worth for you out-of-towners…and I sat in a little cublicle next to some college kid with a bad case of the sniffles and I took my part one exam toward getting my Diplomate of the Academy of Chiropractic Orthopedists. 

I had heard from several sources that it was a hard test and that there really was no way in particular to prepare for the test because it is literally all over the map. And my sources did not tell any fibs people. 

There were the most random, crazy questions on that thing. Things I’d never think to study because we didn’t learn them but, it seems my guessing picker was in order on that day because I passed. Or….they took pity on my and passed me because I’m a swell dude. Either way, I passed. 

Don’t let my experience with this test dissuade you from going through the DACO by the way. The test is being changed and updated for the next round and I suspect it will be more relevant to the course teachings. That’s my guess anyway. 

So, now it’s on to part two in November.  I am taking a two-week break from studying and then I’ll dive back into that rigamarole.  

I’m happy to introduce a new sponsor for the Chiropractic Forward Podcast called GoChiroTV. GoChiroTV is a patient education system for your office that will eliminate the need for running cable TV or the same DVDs over and over again in your waiting room. The bite-sized videos are specifically made to inform your patients about the importance of chiropractic and healthy living, encourage referrals, and present the benefits of all the different products and services you offer.

It works by using a tailored-fit video playlist that will only promote the products and services available at your practice, and the videos are replaced automatically on a weekly basis. There’s no need to manually update your playlist or learn any complicated software. You truly can set it and f orget it.

Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription. 

So visit GoChiroMedia.com (that’s g-o-c-h-i-r-o-m-e-d-i-a-.com) to check out the demo reels, and to get started on your free trial. Take you practice to the next level with GoChiroTV.

Introduction

Let’s get on to the research shall we?

Item #1

Our first paper here is one  from NPR called “Opioid-Maker Insys Admits To Bribing Doctors, Agrees To Pay $225 Million Settlement” and was published in June of 2019. The title leads us….you know where it’s going. (Emanuel G 2019)

Insys Therapeutics, an opioid manufacturer, has agreed to pay $225 million to settle the federal government’s criminal and civil investigations into the company’s marketing practices. As part of the settlement, Insys Therapeutics admitted to bribing doctors to prescribe its opioid painkiller.” Oh my….do tell!

The courts proved that the company set up a fake “speaker program.” The doctors involved were not paid to give speeches, but were paid to write prescriptions of the company’s fentanyl-based medication called Subsys. 

And, you guessed it…..many times the painkiller was prescribed to patients who did not need it.

The founder of Insys Therapeutics, John Kapoor, is among the highest ranking pharmaceutical executives to be convicted amid the opioid epidemic. Sentencing of the former billionaire is scheduled for September.

Highest paid drug dealers in the world right there. 

Item #2 is called “Changes in Spinal Height After Manual Axial Traction or Side Lying: A Clinical Measure of Intervertebral Disc Hydration Using Stadiometry” by Dylan Rubinic, a physical therapist. It was published in the Journal of Manipulative and Physiological Therapeutics in the March/April 2019. Hot stuff right here. (Rubinic D 2019)

Why They Did It

The authors were trying to figure out what effects axial traction have on someone compared to side lying when it comes to increased spine height after sustained loading. 

How They Did It

21 patients with no symptoms were used. 

They either had traction force for 2 rounds of 3 minutes

Or they had sustained side lying for 10 minutes

Spine height was measured with a stadiometer. 

What They Found

There was a significant increase in the height after both manual therapy AND sustained side lying. Well what the hell does that tell us then?

Wrap It Up

This was a preliminary paper to set the stage for futre papers but it’s interesting. They say, “Both manual axial traction force and sustained side-lying position were equally effective for short-term change in spine height after a loaded walking protocol among healthy asymptomatic individuals.” So does that mean that traction is no good? I don’t see that at all here. I say there was little to no difference in asymptomatic, healthy spines when done for three minutes. 

That’s all I see. What about compressed, degenerated, or dehydrated discs with annular fissures and without annular fissures with associate radiculopathy and without associated radiculopathy…..and and and and and. 

Lots of stuff to look at but at least they’re looking at it and I look forward to finding out where it all goes. 

Item #3

Keto diets. The current big thing. Item #3 is called “The Ketogenic Diet for Obesity and Diabetes—Enthusiasm Outpaces Evidence” by Shivam Joshi, MD, Robert Ostfeld, MD, and Michelle McMacken, MD and was published in JAMA Internal Medicine on July 15 2019. Brand spankin new people. (Joshi S 2019)

Before we dive into Keto Diets, let’s take a sec to talk about ChiroUp.

Have you heard about the #1 online resource for chiropractors? Well, let me tell you about it. 

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99

OK, on to the article. 

They start by acknowledging the keto craze but say that the excitement doens’t necessarily equal the effectiveness or the evidence in supporting it. 

The point out that a metanalysis of 13 studies lasting more than a year showed that a keto diet shwoed less than one kilogram of additional weight loss over high carb, low fat diets. Hmmmmm very interesting….

IN addition, a different meta-analysis showed energy expenditure and fat loss was greater with low-fat diets vs. a keto diet. 

I’m going to quote the article directly here because they say it better than I can. They say, “In terms of the risk-benefit balance of the ketogenic diet, the potential adverse effects may give one pause. 

A review of the literature on ketogenic diets for the treatment of pediatric epilepsy reveals multiple adverse effects, ranging from the relatively benign but inconvenient “keto flu,” to less common but deadlier occurrence of cardiac arrhythmias from selenium deficiency. 

Other documented adverse effects include nephrolithiasis, constipation, halitosis, muscle cramps, headaches, diarrhea, restricted growth, bone fractures, pancreatitis, and multiple vitamin and mineral deficiencies.

The greatest risk, however, of the ketogenic diet may be the one most overlooked: the opportunity cost of not eating high-fiber, unrefined carbohydrates. Whole grains, fruits, and legumes are some of the most health-promoting foods on the planet. They are not responsible for the epidemics of type 2 diabetes or obesity, and their avoidance may do harm.”

Item #4

In our continuing series of showing anyone thinking that chiropractors cause strokes that they are the equivalent of archaeic flat Earthers, we go with this paper called, “Effect of cervical manipulation on vertebral artery and cerebral haemodynamics in patients with chronic neck pain: a crossover randomised controlled trial” by Nicholas Moser, Silvano Mior, Michael Noseworthy, et. al. It was published in BMJ Open in 2019.(Moser N 2019) 

Why Thye Did It

Their stated goal in the paper is quoted as, “We aimed to determine whether cervical spine manipulation is associated with changes in vertebral artery and cerebrovascular haemodynamics measured with MRI compared with neutral neck position and maximum neck rotation in patients with chronic neck pain.

They did it at The Imaging Research Centre at St. Joseph’s Hospital in Hamilton, Ontario, Canada. I have to say, I love those damn Canadians. They really do a great job on bringing quality and important research to the table for this profession. 

They used 20 patients here with a mean age of 32 and mean neck pain lasting 5.3 eyars. 

They tested maximal neck rotation followed by cervcial manipulation and/or

Cervical manipulation followed by maximal neck rotation. 

What They Found

“Our results are in accordance with previous work, which has shown a decrease in blood flow and velocity in the contralateral vertebral artery with head rotation. This may explain why we also observed a decrease in blood velocity with manipulation because it involves neck rotation. Our work is the first to show that cervical manipulation does not result in brain perfusion changes compared with a neutral neck position or maximal neck rotation. The changes observed were found to not be clinically meaningful and suggests that cervical manipulation may not increase the risk of cerebrovascular events through a haemodynamic mechanism.”

Chiropractic evidence-based products
Integrating Chiropractors
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
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

Emanuel G (2019). “Opioid-Maker Insys Admits To Bribing Doctors, Agrees To Pay $225 Million Settlement.” NPR.

Joshi S, O. R., McMacken M, (2019). “The Ketogenic Diet for Obesity and Diabetes—Enthusiasm Outpaces Evidence.” JAMA Intern Med.

Moser N, M. S., Noseworthy M, (2019). “Effect of cervical manipulation on vertebral artery and cerebral haemodynamics in patients with chronic neck pain: a crossover randomised controlled trial.” BMJ Open 9(5).

Rubinic D, K. V., Dudley J, Owens SC, (2019). “Changes in Spinal Height After Manual Axial Traction or Side Lying: A Clinical Measure of Intervertebral Disc Hydration Using Stadiometry.” J Manipulative Physiol Ther 42(3): 187-194.