chiropracticforward

10 Back Facts & How Does Chiropractic Perform When Integrated?

Jordan Hospital Spine Care demonstrated the quality and value of care rendered to a population of patients. This was accomplished with a relatively low cost and with high patient satisfaction.

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Are MRI’s On The Outs? & The Ease of The Arm Squeeze

CF 108: Are MRI’s On The Outs? & The Ease of The Arm Squeeze

Today we’re going to talk about why MRI’s in the early going are out and we’ll talk about how easy and useful the Arm Squeeze Test is for differentiating arm pain from cervical radiculopathy pain. 

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers so feel free to crack one open because we’re off and running. 

Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

If you haven’t yet I have a few things you should do. 

  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. 

Do it do it do it. 

You have collapsed into Episode #108

Now if you missed last week’s episode, we talked about how insurance may be warming up to chiropractic in the coming year and years and we covered research behind chiropractic treatment for sciatica. Make sure you don’t miss that info. 

On the personal end of things. I don’t even want to tell you how my life’s been going lately to be honest because it hasn’t been a lot of fun. 

We put my Dad in a nursing home this weekend because insurance is done paying for him to continue to stay at a rehabilitation hospital. My stepdad had his appendix out on Christmas day. I have a pre-teen daughter that I’m trying to figure out. I had someone throw a rock through my office’s front door glass just yesterday and steal our cash box. Luckily they only got about $500. Then, later that night I got a nail in my tire picking up food for the family, get it home, hear my tire hissing, get my son to follow me to drop my truck off at the tire store for the next morning, then get back home only to find out that the only sandwich left out of the damn take-home order……yes…it was my freaking sandwich. 

So, that’s my life lately and I don’t want to talk about it. I want to talk about research. Lol. So let’s get to it. –

Before we dive into the reason we’re here though, it’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you don’t take advantage of this deal, I just think you might be crazy.

If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!

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

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

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

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

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

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

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

Item #1

Let’s start with an orthopedic test that came up on a post on the Forward Thinking Chiropractic group. I had actually learned about the Arm Squeeze Test from the DACO/DIANM program and through Tim Bertelsman and Brandon Steele with ChiroUp but for whatever reason, have been inconsistent in using the test. I forget about it is what I’m saying to you right here right now. But no more I say!

This paper we’re using today is called “Arm Squeeze Test: a new clinical test to distinguish neck from shoulder pain” by Gumina, et. al. and published in European Spine Journal in 2013(Gumina S 2013). 

Now, look, what if you could find the fastest, easiest way to distinguish pain in the arm either coming from the shoulder or arm or whether it’s coming from the neck? What if it was so easy that you could just reach out and grab someone’s arm? Like…..really….that easy. The ease of the arm squeeze. That just rolls off of the tongue. Don’t you agree? The Ease Of The Arm Squeeze. Lol

Well, it is that easy so listen up friends, family,……loved ones. 

Why They Did It

They wanted to evaluate the diagnostic values of the Arm Squeeze Test where the clinician basically grabs the middle third of the arm and gives it a bit of a squeeze. 

How They Did It

  • There were 1,567 patients included in the study. 
  • DX of cervical root compression or shoulder disease was clinically formulated and confirmed with imaging
  • 350 healthy volunteers were used as the control group
  • The test was positive when the score on the VAS scale was 3 points or higher on squeezing the middle third of the upper arm 

What They Found

  • The test was positive in 295 out of 305 patients with cervical nerve root compression. 
  • The test had a sensitivity of 96% and a specificity of 91%. 

Wrap Up

The conclusion states, “The Arm Squeeze Test may be useful to distinguish cervical nerve root compression from shoulder disease in case of doubtful diagnosis. A positive result to this test may lead to cervical etiology of the shoulder pain.”

From reaching out and grabbing someone’s arm. You’re welcome folks. You’re welcome. Making you better every damn day. 

Item #2

Being in an evidence-based practice and being aware of updated guides and recommendations, you know that healthcare is moving away from MRI’s as a knee-jerk reaction. Why would that be, you may ask… Well, because they’ve found it leads to an escalation of care. 

When a surgeon sees a bulge or herniation, if he or she isn’t quite up to snuff on research, they may just think they can cut that out and the person will be off and running again. When many times, that little bulge isn’t what is causing the pain. 

Did you know that a perfect surgery performed on a person in chronic pain syndrome puts them at a 60% chance of developing new chronic pain at the new site of injury? That’s when everything goes perfectly. 

What I’m saying is that you can’t always just cut out pain and MRI’s many times lead doctors to think that they actually can so care gets escalated. 

I tell patients to be careful what they’re looking for because they sure as hell just might find it. If you go barking up the surgery tree, you just might get some of that tree on you. 

So this article is by Paul Ingraham and is called “MRI and X-Ray Often Worse than Useless for Back Pain” and it was published on PainScience.com on February 16, 2019(Ingraham P 2019). 

Not piping hot but hot enough for this!!!

We’ll just hit the highlights here. 

One of the first interesting statements is when he says, “Premature MRI is actually often worse than useless.” Look, let’s be honest, healthcare is a profit-driven profession for the most part. It’s not very patient-centered in my experience. Especially when we’re talking about our medical counterparts. 

Want proof? Is charging $15-$20 for an ibuprofen or Tylenol patient-centered? Hell no it’s not but hospitals do that crap all day every day. Well, MRI centers are the same. $550 cash but $2500 for insurance payors. Lol. I mentioned not long ago on the podcast that I had the opportunity to buy into an imaging facility but two different lawyers told me to stay far far away because I don’t look good in orange. 

However, the imaging center acted like it was as legal as could possibly be. 

Anyway, back to the actual usage of MRI…..The American College of Physicians recommended in a paper all the way back in 2007 that “Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain (strong recommendation, moderate-quality evidence).(Chou R 2007)”

For the WHEN part, they recommended: “Clinicians should perform diagnostic imaging and testing for patients with low back pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination (strong recommendation, moderate-quality evidence).”

In this same ACP paper from way back in 2007, they made the recommendation “For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits—for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation”

Now we know they updated that recommendation in 2016(Qaseem A 2017) to a strong recommendation for those alternative therapies but I was this many days old when I found out they were talking about spinal manipulative therapy way back in 2007. 

Another interesting statement from Mr. Ingraham was this one: “Consider the results of a major 2015 review by Brinjikji et al: signs of degeneration are present in very high percentages of healthy people with no problem at all. “Many imaging-based degenerative features are likely part of normal aging and unassociated with pain.” 

Well, we know this. We can even put rough numbers to it. We know that 40-50-year-olds with no pain at all can get an MRI and 60% of them are going to have degenerative changes, disc findings like herniations or disc bulges, and/or facet hypertrophy. It’s just a given. 

They’re going to find disc findings in about 30% of freaking 20-year-olds. 

So, he says, let’s assume we understand some MRI findings are red herrings. OK, so what’s the harm in getting them then? Well, because findings on MRI’s freak people the hell out and not all practitioners have a firm handle on how to actually communicate with people in a productive way when they give the report. 

If the doctor says well there’s this degeneration and we see a narrowing of this hole here where the nerves run that will probably get worse in the next decade so you’re going to really want to be careful and keep an eye on that……well hell….. Take a person already on the verge of chronic pain syndrome, that doctor just pushed them off the cliff. A patient already in chronic pain syndrome just got pushed in deeper. It’s like taking someone that’s having a hard time keeping afloat in the water and tossing them a bag that weighs 20lbs. Not helpful. 

He says, “There’s expert consensus on this topic because the evidence is quite clear. Consider the hair-raising 2016 experiment that sent the same woman with back pain and sciatica to ten different MRI facilities, producing such a variety of conflicting diagnoses that it would be laughable if it weren’t so tragic.”

The bottom line: Typically, no imaging outside of red flags. If you think something ominous may be going on, of course you do imaging. Without question. If there are no red flags, how about a two-week treatment trial to see how the patient progresses before sending out for imaging?

That’s patient-centered. That’s evidence-based. 

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
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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 us that patient results for headaches, neck pain, back pain, and joint pain just to name just a few.

It’s safe and cost-effective. It can decrease surgeries & disability and we normally do it through conservative, non-surgical means with minimal hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm. When it comes to non-complicated musculoskeletal complaints….

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Website

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TuneIn

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About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

  • Chou R, Q. A., Snow V, Casey D, (2007). “Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society.” Annals of Internal Medicine 147(7): 478-491.
  • Gumina S, C. S., Postacchini F, (2013). “Arm Squeeze Test: a new clinical test to distinguish neck from shoulder pain.” Eur Spine J 22(7): 1558-1563.
  • Ingraham P (2019) “MRI and X-Ray Often Worse than Useless for Back Pain Medical guidelines “strongly” discourage the use of MRI and X-ray in diagnosing low back pain, because they produce so many false alarms.” PainScience.com.
  • Qaseem A (2017). “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians.” Ann Intern Med 4(166): 514-530.

Insurance Warming To Chiropractic in 2020 & Chiropractic For Lumbar Herniation and Sciatica

CF 107: Insurance Warming To Chiropractic in 2020 & Chiropractic For Lumbar Herniation and Sciatica

Today we’re going to talk about what to expect with Insurance coverage in 2020 and we’ll talk about some thoughts on chiropractic, lumbar herniation, and sciatica according to what the research tells us. 

But first, here’s that sweet sweet bumper music

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

OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.

Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

If you haven’t yet I have a few things you should do. 

  • Like our facebook page, 
  • Join our private facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. 

Do it do it do it. 

You have collapsed into Episode #107

Now if you missed last week’s episode on joint replacement life spans, spinal infections, and vitamin D w/ calcium supplementation, then make sure you don’t miss that info. 

I think there were some good solid knowledge nuggets found there within so make sure you’re up to date and not falling behind the rest. Keep up with the class won’t you?

On the personal end of things I have to say that this has been one of the more challenging of Christmases if I’m being honest.  Beyond the disruption of normal schedules and normal business that goes on with the holidays…..we expect those things. The disruption stinks and it can make us lose money. That is frustrating. 

However this one was a bit different for me. If you’re a regular listener then you know that my Dad had a stroke on November 9th so that’s still a daily deal. Going out to the rehab hospital, working with his hand and wrist, elbow, and shoulder to see if I can spark any kind of sensation or movement. 

Then on Christmas Eve, my stepdad needs to go to the ER so I drive over to their house and drive my mom and Fred to the VA ER at about 10pm. 

Well, we end up sitting there until about 5am. Turns out he has appendicitis but no surgeons until the morning. We had a little time to go home and get a few hours of sleep before having to be back up at the hospital for surgery at about noon on Christmas Day. 

So, I got a few hours of sleep in, went by the rehab hospital to check on Dad, went back to pick my mom and family up, then off to the hospital. It only took them about 45 minutes and here’s the amazing thing. 

Fred had his appendix out at about 12:45 in the afternoon and was out of the hospital and at his house by 6:30pm. 

Outstanding!! And he’s done great. Hell, he said the worst part is where they shaved him and the hairs growing back in are wanting to catch on his clothing. Lol. 

So, as you can guess, it was a bit of a miserable Christmas. Back in my rascally days, 5am was nothing to me. In fact, I saw 5:00am pretty regularly after having been up all night hooting and hollering and acting a fool. But at 47, 5:00am is some mystical thing that I only hear about sometimes from my health freak friends that get up to work out in the mornings. 

I hope you holidays were more amazing than mine. I hope you got to spend some quality time with your loved ones and I hope the best for all of us in this new year. Upward onward and forward. 

Before we dive into the reason we’re here, it’s good to support the people that support you don’t you think? I’m about to throw you a deal and if you don’t take advantage of this deal, I just think you might be crazy.

If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!

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

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

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

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

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

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

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

Item #1

Our first item of interest today is called “More Payers Backing Chiropractic Care in 2020” by Sherry McAllister(McCallister S 2019). It was published in the Managed Healthcare Executive on December 23, 2019. 

Hot potato, coming through….

Just taking this article point by interesting point:

She says research has shown private and government health plans may inadvertently be steering their members toward opioids by not covering, restricting benefits, or charging higher co-pays for chiropractic care. 

Indeed and we’ve covered that here as well. This was laid out particularly well in a White House report from 2017 or so I believe. They were actually very clear in pointing out that current Medicare and healthcare policies actually create barriers to conservative management rather than pharmaceutical modalities. 

Think about it; when a prescription of opioids cost $10-$20 but a visit to a PT or chiropractor can bust the bank…..well, what you going to pick if you’re not very educated on all of the options available?

She points out a recent study from Boston University showing that patients with a deductible greater than $1500 were less likely to choose a doctor of chiropractic as their entry-point provider. 

However, as she points out, United Healthcare has announced a certain employer-sponsored medical plan that will have zero out-of-pocket spending, which will include their deductible….if they opt to go to a chiropractor for treatment of low back pain first. Hell yeah. Hell yeah is what I have to say about that. 

We’ve been sitting here at the end of the tunnel waiting on this train that has been delayed for decades. I’m getting old waiting on this stupid POS but it looks like we might be seeing the light coming down the way and hearing the rumbling on the line. 

Medical doctors will never lead the charge when it comes to sending these patients to chiropractors. It must come from the payers and maybe we’re starting to see the push. Hell, we know we save the system money so why on Earth would they NOT lead the charge?

UHC estimates that by 2021 this design can reduce imaging by 22%…..good luck getting some chiros to scale back on x-rays UHC….good luck. They estimate it can reduce spinal surgeries by 21%….I’d guess more than that, reduce opioid use by 19%…..more than that I’d guess, and reduce total cost for members and employers. Agreed and agreed. 

McAllister goes on to discuss how other healthcare plans are coming on board by expanding or emphasizing coverage in 2020 for chiropractic including Tricare which handles the military folks here in America. Instead of just active duty troops, Tricare is expected to approve extending chiropractic coverage to family members, retirees, and family members!! 

Kowapow, people. Sha-freaking-zam to the bamalam. 

She points out this is most likely in response to a 10-year study of military members through 3 different clinical trials showing chiropractic was instrumental in increasing strength, endurance, and response time among service members with lower back pain. Again, we have covered these here on The Chiropractic Forward podcast if you’ve been following along. 

Chiropractic’s own Dr. Christine Goertz has been instrumental in some of those clinical trials. 

Mrs. McAllister points out that even non-military seniors in some part of America could be getting upgraded access to chiropractic through benefit expansions of Medicare Advantage plans. 

We know that insurance plans do not like wellness care because they’re stupid and short-sighted but Anthem Blue Cross in California expanded wellness benefits for its Medicare Advantage plans to include up to 24 visits per year with a chiropractor, massage therapist, and/or acupuncturist at no extra cost. Same goes for folks in Philadelphia. Good stuff here people. 

When you hear veteran chiropractors such as myself say there’s not been a better time to be a chiropractor in the last 30 years, since the Mercedes 80’s,  now you are seeing why. It’s happening before your eyes I believe. 

This is all excellent news for chiropractors, massage therapists, and acupuncturists. Now, when can we expect things to really change and translate into more patients in your doors and more money in the bank? Well, who the hell knows? But, I can tell you that the American College of Physicians started recommending spinal manipulation for back pain in 2016, the Journal of the American Medical Association supported that recommendation in a 2017 article, The Lancet’s series on Low Back Pain supported the recommendations in 2017, The White House Report we mentioned backed it all up, Consumer Reports, The Joint Commission, CDC, NIH, and the FDA all came in line with this new thinking. 

So, you see the more of these organizations and voices of authority that come on board, the more we’re going to see in our offices. But it is a snowball and the ball has just started rolling at the top of the hill. 

The trick is going to be to take advantage of it all by following research and evidence. By expanding and bringing chiropractic closer to the medical community rather than leaving it in some archaic form from 100+ years ago. 

Stick with it. It’s moving the right direction and it’s going to be OK. 

Item #2

The second paper is an older one. It’s from way back in 2006. Old man river…. that old man river…

It’s called “Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations.” It was authored by V Santilli et. al. and published in Spine Journal(Santilli V 2006). If it’s in Spine, it’s prolly muy bueno amigo. 

Why They Did It

The stated goal here was to assess the short and long-term effects of spinal manipulation on acute back pain and sciatica WITH disc protrusion. 

How They Did It

  • It was a randomized double-blind trial comparing active and simulated manipulations in rehabilitation medical centers in Rome and its suburbs
  • They had 102 ambulatory patients with at least moderate pain on a visual analog scale for local pain and/or radiating pain. 
  • They implemented appropriate outcome measurements
  • Manipulations or simulated manipulations were performed five days per week by chiropractors with a number of sessions which depended on pain relief or up to a max of 20 
  • They used a rapid thrust technique which I’m assuming is high-velocity low amplitude such as diversified 

What They Found

  • Manipulations appeared more effective on the basis of the percentage of 
  • pain-free cases
  • number of days with pain
  • number of days with moderate or severe pain
  • Patient receiving manipulations had a lower mean VAS score
  • There were no adverse events

Wrap It Up

“Active manipulations have more effect than simulated manipulations on pain relief for acute back pain and sciatica with disc protrusion.”

Pawya!!

Item #3

Our last one today is called “Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study” authored by McMorland et al and published in the Journal of Manipulative Physiological Therapeutics in October of 2010. Old man river….not quite that old though. 10 years isn’t fresh in the research world but that’s OK, it’s still a good one we should all know about. 

Why They Did It

They wanted to compare the clinical efficacy of spinal manipulation against microdiskectomy in patients with sciatica secondary to lumbar herniation

How They Did It

  • It was a randomized clinical study
  • 120 patients were included all of which were referred by a primary to neurosurgeons for lumbar herniation
  • All had unilateral lumbar radiculopathy secondary to lumbar disc her4niation 
  • The herniations were present at L3/4, L4/5, or L5/S1

What They Found

Significant improvement in both treatment groups compared to baseline scores over time was observed in all outcome measure

Wrap Up

“Sixty percent of patients with sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention. 

Of 40% left unsatisfied, subsequent surgical intervention confers excellent outcomes. 

Patients with symptomatic lumbar herniation failing medical management should consider spinal manipulation followed by surgery if warranted.

Three syllables….one word, folks. Bamalam. Bam-a-lam, people….

It’s happening. It’s coming. Stay the course, make smart decisions. Be the expert. Use research and the Chiropractic Forward Podcast to do it. 

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 us that patients can get good to excellent results for headaches, neck pain, back pain, and joint pain just to name just a few.

It’s safe and cost-effective. It can decrease surgeries & disability and we normally do it through conservative, non-surgical means with minimal hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm. When it comes to non-complicated musculoskeletal complaints….

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Website

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

McCallister S (2019) “More Payers Backing Chiropractic Care in 2020.” Managed Healthcare Executing.

Santilli V, B. E., Finucci S, (2006). “Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations.” Spine J 6(2): 131-137.

Joint Replacement Expectations, Spinal Infections, & Vitamin D with Calcium

CF 106: Joint Replacement Expectations, Spinal Infections, & Vitamin  D with Calcium

Today we’re going to talk about Joint Replacement Expectations how long can you expect a joint replacement to actually last, we’ll talk about Spinal Infections – what are some of the signs and symptoms according to research, and they we’ll cover a paper in JAMA on supplementation with Vit D alone vs. Vitamin D with Calcium. Stick around for a great show. 

But first, here’s that sweet like a Christmas candy cane bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. So go get one and crack it open because we’re off and running. 

Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

If you haven’t yet I have a few things you should do. 

  • Like our facebook page, 
  • Join our private facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. 

Do it do it do it. 

You have ping ponged into Episode #106. And my Parker alums will remember all of the ping pong that went on there at the student rec room. Pretty heated matches right there!

Now if you missed last week’s episode on Groupon deals, Gabapentin, and on Weight Loss…. make sure you don’t miss that info. As I tend to do, I got a little red in the face and probably got a bit dramatic and opinionated but I felt better by the time it was over with. 

Did you know that if you have an Alexa product, you can now just say something like, “Alexa, play The Chiropractic Forward Podcast on Apple Podcasts” and kablooey! You here the golden throated stylings of yours truly! Lol. You can say skip ahead 30 seconds, play previous episode, and on and on so pretty cool right there. 

On the personal end of things the Holidays are always stressful and this season has been a bit extra with my Dad having the stroke and being in the rehab hospital. That and whatever other daily trials and tribulations that come along with raising teenagers. 

It’s been journey but isn’t life just like that? Whack a mole every day. Whackin whacking whacking. Sometimes it’s exhausting. Obviously, I have a little turmoil poking it’s head up here and there lately but I’m a good swimmer. 

What I mean is, this world is full of sinkers and swimmers. Very rarely do you find simple water treaders. We’re sinking or we’re swimming. The sinkers let life happen to them rather than happening to life. 

They either make things happen, let things happen, or wonder what the hell just happen. 

On the other hand, swimmers are making things happen every day. Things keep coming at them and they keep batting them away and they stay above water. Hell, some of them make a game out of it and adapt to have the best breaststroke or back stroke you’ve ever seen. 

Those are the ones that just act like they’re indestructible. Well, I’m not indestructible. At all. I’ve been going through a season lately for sure. Nothing about business. All about my dad and other family stuff here and there. Luckily, I have an amazing wife and support structure. Good support allows swimmers to swim. She allows me to be a swimmer. No doubt. 

Enough about all that. Again, I share personal aspects because I know many of you will either relate on some level and ideally maybe even draw some inspiration. Others can learn from it I think. At least that’s my hope. 

By the time this airs, Christmas will have come and gone. I hope you had the merriest of Christmases. Being a Christian myself, I can’t tell you how much I love the season, the music, the magic of giving. Even with all of the hustle and bustle and pain in the butt it brings, it’s a special time of year and I try to keep it special for me and the family. 

Before we dive into the reason we’re here, it’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you don’t take advantage of this deal, I just think you might be crazy.

If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!

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

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

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

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

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

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

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

Item #1

This one is called “Vitamin D and Calcium for the Prevention of Fracture. A Systematic Review and Meta-Analysis” it was authored by Yao, et. al. and published in JAMA Open on December 20, 2019(Yao P 2019). 

Hot hot hot like Texas in the Summer.

Why They Did It

Considering that vitamin D and calcium are recommended for prevention of fracture but prior RCTs have reported conflicting results, the authors wanted to assess the risks of fracture associated with differences in concentrations of 25-hydroxyvitamin D in observational studies and the risks of fracture associated with supplementation with Vitamin D alone or in combination with calcium in RCTs

How They Did It

  • Systematic review and meta-analyses. 
  • 34,243 participants. 
  • They mined data from PubMed, EMBASE, Cochrane Library and other RCT databases
  • Observational studies involving at least 200 fracture cases and RCTs enrolling at least 500 participants and reporting at least 10 incident fractures were included
  • RCTs compared Vit D or Vit D with calcium with control
  • Two researchers independently extracted the data and assessed possible bias

Wrap It Up

The authors concluded “In this systematic review and meta-analysis, neither intermittent nor daily dosing with standard doses of vitamin D ALONE was associated with reduced risk of fracture, BUT daily supplementation with both vitamin D and calcium was a more promising strategy.” To the tune of a 16% reduced risk of hip fracture. I’d sure as hell take that reduced risk if it’s my mom, wife, sister, or if it’s a patient. 

So, if you have a patient with osteoporosis and I know that you absolutely do…..it looks evidence-based to tell them to supplement with Vitamin D but only if they add Calcium to the mix. 

I love getting smarter and better. This is a nugget that does just that for us. 

Item #2

Joints!! 

How many knee replacements do you check reflexes on during the month? We average around 70-80 new patients per month so the answer in my office is, ‘several’. 

You probably already know that surgeons don’t like to do knee or hip replacements on younger folks because they don’t want the replacement to wear out before the patient dies. They don’t want the patient to have to go through the damn thing twice basically. 

The Lancet medical journal recently published two papers on the topic. One on the hip and one on the knee. One was called “How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up” and the other was called oddly enough “How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.” They were both authored by the same group led by Jonathan Evans and were published in The Lancet on February 16, 2019. Not hot off the press but not room temperature either. Very luke warm, folks. (Evans J 2019, Evans J 2019)

Why They Did It

For both papers, it’s pretty obvious why they did it. They want to know how long hips and knees last when replaced. Easy peesy. 

How They Did It

  • The papers were systematic reviews and meta-analyses 
  • Medline and Embase were used from Sept 12, 2017 to current
  • They used 140 eligible articles
  • They also reviewed reports of national joint replacement registries

Wrap It Up

On the hip paper, they concluded “Assuming that estimates from national registries are less likely to be biased, patients and surgeons can expect a hip replacement to last 25 years in around 58% of patients.”

On the knee paper, they concluded “Approximately 82% of total knee replacements last 25 years and 70% of unicondylar knee replacements last 25 years.”

Isn’t good to have a solid number you can confidently tell your patients when they’re thinking about making that appointment with the orthopedic surgeon?

Item #3

Our last paper this week is on spinal infection. It’s called “Red flags for the early detection of spinal infection in back pain patients” authored by Yusuf et. al. and published in BMC Musculoskeletal Disorders in December of 2019. (Yusuf M 2019)

Sizzlin’ hot like a Summer sidewalk come on.

Why They Did It

The aim was to conduct a systematic review specifically reporting on studies that evaluated the diagnostic accuracy of red flags for Spinal Infection in patients with low back pain.

How They Did It

  • Again they mined the biggies like Medline, Cochrane, and EMBASE,  but also Pedro, Web of Science, OpenGrey, and Grey Literature Report
  • 40 papers were accepted
  • A total of 2224 cases of spinal infection were identified

What They Found

  • Spinal pain and fever were the most common clinical features
  • Diabetes and IV drug use were the most occurring determinants
  • MRI was the most used imaging and 
  • Staphylococcus aureus and mycobacterium tuberculosis were the most common microorganisms detected. 

Wrap It Up

The authors wrapped it up saying, “The current evidence surrounding red flags for spinal infection remains small, it was not possible to assess the diagnostic accuracy of red flags for spinal infection…..the most frequently reported clinical feature was the classic triad of spinal pain, fever and neurological dysfunction.”

Key Takeaways

Store

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

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

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

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 us that patients can get good to excellent results for headaches, neck pain, back pain, and joint pain just to name just a few.

It’s safe and cost-effective. It can decrease surgeries & disability and we normally do it through conservative, non-surgical means with minimal hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm. When it comes to non-complicated musculoskeletal complaints….

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Website

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

  • Evans J, E. J., Walker R, Blom A, Whitehouse M, Sayers A, (2019). “How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.” The Lancet 393(10172): 647-654.
  • Evans J, W. R., Evans J, Blom A, Sayers A, Whitehouse M, (2019). “How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.” The Lancet 393(10172): 655-663.
  • Yao P, B. D., Mafham M, (2019). “Vitamin D and Calcium for the Prevention of Fracture. A Systematic Review and Meta-analysis.” JAMA Open 2(12).
  • Yusuf M, F. L., Selfe J, (2019). “Red flags for the early detection of spinal infection in back pain patients.” BMC Musculoskelet Disord 20.

Thoughts on Chiropractic Groupon, Gabapentin, & Weight Loss Research

CF 105: Thoughts on Chiropractic Groupon, Gabapentin, & Weight Loss Research

Today we’re going to talk about some thoughts on Groupon and Chiropractic, if you know me, you probably know where this is going and it’ll probably be fun. We’ll find out. We’ll talk about Gabapentin and we will talk about a couple of papers I encountered recently having to do with metabolism, intermittent fasting, and things of that nature. 

But first, here’s that sweet sweet bumper music

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-10.23.33-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 and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. So feel free to crack one wide open would you?

Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

If you haven’t yet I have a few things you should do. 

  • Like our facebook page, 
  • Join our private facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. 

Do it do it do it. 

You have plopped down into Episode #105 just like a comfy easy chair. 

Now if you missed last week’s episode talking about our TWO YEAR wrap up, make sure you don’t miss that episode. It was a lot of fun to put together and to reminisce on some of the amazing episodes we’ve had over the past two years. Good good stuff. 

Something new I found out here…..Did you know that if you have an Alexa product, you can now just say something like, “Alexa, play The Chiropractic Forward Podcast on Apple Podcasts” and kablooey! 

You automatically start to hear the golden throated stylings of yours truly! Lol. You can say skip ahead 30 seconds, play previous episode, and on and on so pretty cool right there. 

On the personal end of things, we just found out that Dad started moving his left leg today for the first time and that’s exciting. It’s the first REAL solid sign of big progress since his first stroke on November 9th. As you can imagine, we are ecstatic about this. Good stuff. Keep on keeping on Pops. Strong like bull!

Before we dive into the reason we’re here, it’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you don’t take advantage of this deal, I just think you might be crazy.

If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!

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

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

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

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

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

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

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

Item #1

Alright let’s dive in. We’ll save Groupon until the last because if I know me, it’ll be what I have the most to say out of all of these. 

Let’s start with Gabapentin shall we? The most recent article I’ve come across was in The Atlantic. It was authored by Olga Khazan and called ‘Chronic Pain Is An Impossible Problem’. It was posted December 9, 2019(Khazan O 2019). 

That’s got some sizzle on it!!

Some key points in the article are that 

  • Chronic pain affects about 1/5 of American adults
  • For years those in the medical field thought it could be treated with painkillers like Oxy but that was proven wrong when basically three planeloads of Americans started dying of opioid-related causes each week
  • Now, they’ve turned to Gabapentin, an anticonvulsant, to help treat it. 
  • From 2012-2016 prescriptions of the medication went up 64%
  • There is emerging information that Gabapentin may not be as safe as previously believed. Certainly when combined with other sedating meds. 
  • When taking it long-term, patients can develop tolerance so more and more is required to reach the desired effect. 
  • There is also a withdrawl effect when trying to get off of gabapentin. 
  • People are now starting to use Gabapentin in combination with Baclofen and benzos like Xanax to increase the intoxicating effect. We can see where that is going can’t we?
  • The article goes on to say, “not only does gabapentin appear to exacerbate or create overdose risk, it also doesn’t work well for chronic pain.” They site a study that we’ll cover in a second. 
  • The paper wraps up by saying they’re essentially out of option when it comes to chronic pain. Which to me says they’ve run out of pills basically. That doesn’t mean they’re out of options though. 
  • Arthur Robin Williams, an assistant professor at Columbia University says “The medical community should take a closer look at non-pill remedies such as physical therapy and psychotherapy…I would add evidence-informed chiropractic… These treatments are often not covered by insurance, take longer to work, and take more of providers’ time. But for many, they might be a better option than yet another pill that has yet another pathway to abuse. “The reality is, a lot of the pills that change how you feel in the next 10 to 30 minutes,” Williams says, “carry addictive liability.”

Well…..no kidding? Who would have ever thought that? Hmmm….let’s see. Oh yeah, every chiropractor and PT that ever lived. 

Let’s combine that with a systematic review and meta-analysis from just last year that was in the Canadian Medical Association Journal called “Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis”(Enke O 2018)

  • Nine trials compared topiramate, gabapentin or pregabalin to placebo in 859 unique participants. Fourteen of 15 comparisons found anticonvulsants were not effective to reduce pain or disability in low back pain or lumbar radicular pain. 
  • There was high-quality evidence of no effect of gabapentinoids vs. placebo on chronic low back pain. 
  • The lack of efficacy is accompanied by increased risk of adverse events from use of gabapentinoids, for which the level of evidence is high.

It is painfully obvious (no pun intended) that pills aren’t cure-alls and aren’t curing the pain problem. And they won’t sure the pain problem so isn’t it time to look elsewhere? In the year 2020?

All of this is cited in the show notes at chiropracticforward.com. Go get the article and the paper. Use it to educate your community on gabapentin. Set yourself as the reasonable alternative to it. 

Item #2

Fasting and weight loss. I want to be right up front on this, I’ve always wanted to make nutrition and weight loss a part of my practice in some shape form or fashion but, if I’m being honest, I’m just straight up a big big dude. Like I’m 6’4” and, depending on the time of year, 280+. I was a college offensive lineman. I played center and i anchored that line pretty well with my overall biggness. Lol. 

Cat-like reflexes people but big as a damn house. So, I’m not going to teach you how to implement weight-loss into your practice here but I am going to give you some interesting research I cam across recently that might make you think a bit. 

The first paper on this is called “Effects of time-restricted feeding on body weight and metabolism. A systematic review and meta-analysis”. It was published in Reviews in Endocrine and Metabolic Disorders, authored by P Marianna, C Iolanda, et. al. and published December 2019. (Marianna P 2019)

Hot to the touch. It’ll burn your  damn finger prints off. 

Why They Did It

Restriction in meal timing has emerged as a promising dietary approach for the management of obesity and dysmetabolic diseases. The present systematic review and meta-analysis summarized the most recent evidence on the effect of time-restricted feeding (TRF) on weight-loss and cardiometabolic variables in comparison with unrestricted-time regimens.

How They Did It

  • A total of 11 studies, 5 randomized controlled trials and 6 observational, were included
  • All selected studies had a control group without time restriction
  • Most studies involved the Ramadan fasting

Wrap It Up

Time restricted feeding regimens achieved a superior effect in promoting weight-loss and reducing fasting glucose compared to approaches with unrestricted time in meal consumption. 

As we’ve covered, systematic reviews and meta-analysis are, ideally, high-level research and, considering the majority of the included studies involved the Ramadan fasting regimen, I went to search it up to see what the what. 

So, what exactly is a Ramadan Fasting Regimen? Well let me tell you. And I’m not going for the fancy stuff because I’m tapped for time here so we’re just going to hit up Wikipedia real quick and Wiki says that the basics are:

  • Fasting from sun up to sun down
  • Abstinence from sex, food, and drink
  • It also means one should refrain from things like
  • violence
  • anger
  • envy
  • greed
  • lust
  • angry/sarcastic retort
  • gossip
  • and you’re supposed to get along with others better than you normally do

In America at least, I’m certain we’ll all just do the food part because everyone’s so busy looking for a reason to be offended that I’m certain being nice and getting along is off the table for now. 

So, if you have any personal experience with intermittent fasting, if you’re an expert on the topic, shoot me an email at dr.williams@chiropracticforward.com Let’s talk about it. Maybe we can set up some guests and do a full episode or two on the topic to educate our community of docs on the matter. Sounds like a great topic so hit me up. 

Now, the last thing I have here I want to talk about is Groupon. 

This one is a bit of a trigger for me honestly. Looky here. I am well aware that people are struggling. I’m well aware that I am fortunate and to sit and judge can seem disconnected and unfair at minimum to some. I definitely get that. 

What I also understand is that a whole bunch of those that are struggling are in a profession they really shouldn’t be in because they’re lazy and want to sit behind their desks and hit a few buttons and be magically transformed into a master chiro with an office stocked full of patients and never ending new patients. 

That’s magic time dreamland stuff. 

There will always be supposed shortcuts. There will always be business hacks or whatever you want to call them. But at the end of the day, shouldn’t you make decisions while keeping several things in mind? Meaning, you have to do what is best for your family. You have to do what is best for your office and your employees. But don’t you feel like you should make decisions based on what is best for your profession and for your colleagues?

I would hate to think that I’ve done something that damages my profession . Obviously I don’t mind calling out BS business practices and unethical chiropractors. If that’s damaging my profession well then, I’m guilty as hell. 

But when you are making the deals some of these guys and gals are making on Groupon, you are demeaning, lessening, and trashing what the rest of us take a great deal of pride in. 

Imagine, you go through chiropractic school, you survive 21+ years in practice while steadily getting more and more education, you take on a Diplomate program and finally complete that, and you are fighting on the state level for your profession and your profession’s image…..and then you open your email. 

Yes, I get emails from Groupon with their best and newest deals. I open it up and BAM….It almost seems like all of that work can just be flushed down the toilet. It’s depressing and it makes me want to club baby seals. 

Before we start talking about the article, I did a quick search for Groupon deals in my area and, right there next to Reflexology deals popped up this:

  • 10% cash back – Sounds like a damn car deal
  • Consultation, exam, x-rays, adjustment, and one full-body vibration plate session for $70. Way to value your services. Great. Way to look awesome. Assuming they actually need vibration plate. Assuming they actually need x-rays, assuming they even need and adjustment. Blah
  • Then this one, it’ll make you tickle – One laser lipo session w/ two vibe plate sessions for $45. See…..in Texas, you can only have laser lipo if you’re trying to increase function. Not just look better. So, that’s not necessarily legal as this implies to me it’s for looks. Unless they have a medical director and I’m here to tell you they do not. 
  • When you go to the bigger cities, it only gets worse. I found a $564 value for only $43.70!!! What a damn deal!!!

It’s all just shady and sketchy. Luckily, there are only two in my area doing this stuff. And if they keep it up, we may have two less competitors here as well. 

Besides the shady, street corner huckster look it so convincingly creates, it’s potentially illegal based on the idea of fee splitting, Medicare inducement, and dual fee schedules and, if the state boards start getting their acts together and going after this stuff, they will be the ones to go down. 

What started me down this path today was an article I came across called “Legal Implications of Chiropractic Groupons.” It was written and posted on the website for Carlson and Jayakumar – attorneys at law. I’ll have the link in the show notes. https://cjattorneys.com/legal-implications-of-chiropractic-groupons/

Highlight of the article include:

  • Each day, numerous chiropractors contract with Groupon and its competitors to sell certificates for adjustments, examinations, x-rays and massages. 
  • Despite the variety of services offered, these programs all have two things in common: (1) the chiropractor is offering a significant discount –92% in some examples, and (2) the chiropractor is sharing the income from each certificate sale – usually around 50% – with the website. While we are unaware of any state board taking action against a licensee for a Groupon-style offering, we believe these programs could create significant civil and criminal liability for chiropractors.
  • most states have rules prohibiting the offer or acceptance by a chiropractor of any commission, discount, or other consideration as compensation or inducement for referring patients, clients, or customers to any person, irrespective of the practitioner’s membership, proprietary interest or co-ownership in or with that person. I was once offered the opportunity to buy in to an imaging center here in town. As badly as I wanted to do it, I made the mistake of hiring two different attorneys for their opinions. BOTH advised against and this is exactly why. 
  • With Groupon, money is paid by the chiropractor to the website in connection with a patient’s referral. The chiropractor essentially, albeit indirectly pays the website per patient that purchases the certificate. At their base, these agreements require the chiropractor to pay the website for soliciting, referring and/or procuring clients not he chiropractor’s behalf. Stuff you’re not supposed to do and can get in a lot of trouble for. 
  • Medicare’s Anti-Kickback Statute criminalized the payment of kickbacks for patient referrals. Subsequent laws expanded it to all federalpay programs. Kickbacks include “any remuneration,” a very broad definition, which includes coupons. The Office of the Inspector General issued a “Special Fraud Alert” regarding advertisements offering “discounts” given to Medicare beneficiaries. Then a “Special Advisory Bulletin” appeared on offering inducements to Medicare beneficiaries. Essentially, it said a provider could not offer a patient anything worth more than $10, and combined $50 in a year for multiple gifts.
  • Groupon-style deals are unadvisable as they may pose problems with insurance companies. Most insurance policies will not pay for any charges that would not have been made in the absence of insurance. Groupon offerings, which almost always charge a lower fee to the purchaser versus insured patients, could be viewed as creating a “dual fee schedule.”  Insurers believe dual fee schedules constitute fraud and over billing. Some argue that Groupons are merely a version of a prompt-payment discount. While California law expressly permits prompt-payment discounts, such discounts must be reasonable. Given the extreme nature of the discounts typically offered by Groupon and its competitors, such certificates likely would not fall under the prompt-pay exception.

They conclude that “Given their widespread use, it seems unlikely that the Board of Chiropractic Examiners would discipline each and every licensee who engages or has engaged in Groupon-style offerings. That said, there may be a rash of “test case” or “example” disciplinary actions that follow. Eventually, we would expect the Board to adopt a regulation, or the Legislature to pass legislation, that explicitly either proscribes or prohibits the use of these deals. In the meantime, we recommend that chiropractors abstain from these types of marketing campaigns….”

I couldn’t agree more with them. 

When I opened up a new place h ere in Amarillo, I printed flyers at Kinko’s and I walked from one business to another knocking on doors and meeting people and telling them about me and my new place. I marketed anyone that could send me business. For more on that, go back about 5 episodes and listen to our episodes called Big Ideas On Marketing Evidence-Based Practices. Link is in the show notes. 

You must know this just isn’t the way to go. Join BNI, join civic clubs, start working out at a gym and get tight with the managers and personal trainers, spend time volunteering, joint a running club if that’s your gig, combine those things with social media and a solid email list that you continue to build and work on. There are so many things you can do that are above the cuff. That are respectable and raise up you and your profession. 

Groupon isn’t one of them. It does exactly the opposite. It identifies those of us who are racing to the bottom of the barrel and dragging the rest of us down with them. 

If you’re doing Groupon, it’s my opinion that it’s time to stand up, stop doing it. Yesterday..if you catch my drift

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
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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 us that patients can get good to excellent results for headaches, neck pain, back pain, and joint pain just to name just a few.

It’s safe and cost-effective. It can decrease surgeries & disability and we normally do it through conservative, non-surgical means with minimal hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm. When it comes to non-complicated musculoskeletal complaints….

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Website

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

Enke O (2018). “Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis.” CMAJ(190): E786-793.

Khazan O (2019) “Chronic Pain Is an Impossible Problem A “safe” alternative to opioid painkillers turns out to be not so safe.” The Atlantic.

Marianna P, I. C., Andrea E, Valentina P, Ilaria G, Giovannino C, Ezio G, Simona B, (2019). “Effects of time-restricted feeding on body weight and metabolism. A systematic review and meta-analysis.” Rev Endocr Metab Disord.

Year Two ‘Big Hits’ Wrap Up

CF 104: Year Two Big Hits Wrap Up For The Chiropractic Forward Podcast

This is chiropractic forward podcast episode #104. Fifty two times two = 104. That means two solid years of pumping out the Chiropractic Forward Podcast religiously. Pumping it out like a damn piston people. Dependable and powerful. 

BAM, kowapow!!! We’re going to talk about the most listened to episodes from the previous two years and we’ll talk about why they continue to be so darn popular. 

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.

Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

If you haven’t yet I have a few things you should do. 

  • Like our facebook page, 
  • join our private facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com

Do it do it do it. 

You have done the electric slide into Episode #104. The two-year anniversary party is engaged. Yaya!! If you know me, doing really anything at all dependably for two straight years every single week is pretty good. 

I’m high maintenance people. In some ways anyway. I can’t be bothered with this and sometime that. I don’t seem to have time for some of the simplest tasks. You know how it is. 

I don’t go camping either. Nope. I need plumbing. I need central heat and air. And I need a decent bed. None of that camping foolishness unless it’s in a bus of some sort. Then……prolly. Otherwise, I’m too high maintenance and I’m not ashamed. I’m good with hanging out by a rocky mountain river for a bit. Maybe even hiking in the forest a bit. But then, back to the hotel. Come on now. 

Also, the beach. Am I the only one that can’t lay around on a damn beach all freaking day long? It’s not even remotely possible. It’s insane actually. I’m the kind, I hate sand all up on me everywhere. That’s the worst feeling. 

And then, after sitting around and soaking up the beauty for about 30 mintues…..maybe an hour…..it’s time to look around for something else to do. I can’t sit around and drink all day. Not unless I want to be out of commission the next day. Maybe two days. See…..I’m a little high maintenance. But don’t tell anyone. It’s our little secret. 

Now if you missed last week’s episode on spinal manipulation’s effect on the brain, on forward head posture and if it’s really related to neck pain, and we talked about how smoking is related to pain throughout the body,  make sure you don’t miss that info. It was good stuff and very well-listened to!

On the personal end of things, my Pops is back in the hospital. He had a mini stroke, TIA sort of thing that spooked the folks at the rehab hospital that they sent him over to the big hospital to be sure everything is A-OK. 

He’s looking and talking roughly the same as before he spooked everyone so I’m hoping we are back on track. Maybe he was just feeling a little extra on that day. He called his wife and his neighbor at around 2am last night so his brain still has some confusion but he’s doing OK overall. A lot of folks have been in a lot worse shape from strokes. Still not sensory or motor in the left upper and lower extremities. Unfortunately. 

Before we dive into the biggest episodes in Chiropractic Forward Podcast History, it’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you don’t take advantage of this deal, I just think you might be crazy.

If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!

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

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

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

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

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

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

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

First thing you gotta know is that as I list these off, the link to the specific show will be in the show notes so that you can have quick access to the episodes that sound the most interesting to you. 

OK, let’s start with #10 – 

#10

Our tenth ranked episode was Episode #68 and was called “British Medical Journal Research, Surgeons Against Back Surgery, and Pediatric Chiropractic Under Attack”

Any time the British Medical Journal is going to come out and say that moderate quality evidence suggests that SMT has effect on short term pain relief and increased function, we’re going to talk about it and we did. 

We also talked about Dr. David Hanscom, MD who wrote a book called Back In Control and who is also on the war path against chronic pain and surgery for the wrong candidate. Sounds like a guy I can get on board with right there. He’s well-versed in upregulated, sensitized CNS and I highly recommend his book to any practitioner or chronic pain sufferer. 

#9

Number nine all time is actually Episode #9 oddly enough and that was when I had my good friend and colleague, Dr. Tom Hollingsworth of Corpus Christi, TX join me to discuss the Case Against Chiropractic in Texas. Evidently that episode is still riging true for chiropractors because it’s still getting downloaded. The thing is, the Texas Medical Association is still suing us here. This case is still going. The episode aired on February 15 of 2018 so moving in on two years ago and the case is to the point where the TMA has won and we are waiting to see if the TX Supremes will hear the case. 

Keep your fingers crossed and go listen if you don’t know what it’s about because whatever happens here in TX can, and probably will, happen anywhere. 

#8

It was very recent. Episode #98 and it was called “Big Ideas On Marketing Evidence-Informed Practices.” This episode and it’s part II episode were listened to in big numbers and well-received. Which is exciting. I’ve always seen myself as a marketerpersonally but, primarily for the podcast, a voice of reason, responsibility, honesty, ethics, and yes….of course, research. 

But, I’m a marketer as well and how the heck do you market an Evidence-based practice? Well, there’s Jeff Langmaid with the Evidence-based Chiropractor material. There’s Dr. Kevin Christie with The Modern Chiropractic Marketer material. There’s Dr. Christie teaming up with Dr. Bobby Maybee and the Chiropractic Success Academy. And then there’s myself and the Chiropractic Forward Podcast. 

That’s it as far as I know. We are the outlets to help you market responsibly and ethically. There are a million other programs but A LOT of them are questionable at minimum. So, I have to say that I was pleased to see that so many found those marketing episodes to have value. 

#7

“How To Not Miss A Dissection & De-legitizing Complementary Medicine” This was episode #69. Well this one hit it big because people don’t want to get in trouble!! We are here to help people. Certainly not hurt people. That’s not what we’re built for. I went over a lot of policies I have here in my office that have so far helped me avoid and crazy situtations. 

I think every practitioner that is in practice for 21 plus years will have a couple little adverse things here and there like a patient actually getting a little worse in the short term and things like that but, I’ve been fortunate enough to avoid anything scary or serious. I think mostly because I’m very cognizent and aware of the research and do eveyrthing I can to avoid anything scary. Now I’m going to knock on wood and you should go get this episode because there was some real solid, immediate useful information in it. 

#6

“National Scope, Chronic vs. High Impact Chronic Pain, Coordinated Care/Medicaid, and DACO to DIANM”

Episode #96 – For this episode, which again was very recent, we were fortunate enough to be joined again….for the second time…by Dr. James Lehman of the University of Bridgeport and a key driver of the DACO/DIANM program and a frequent author of articles in Dynamic Chiropractic. 

This one shot right up to the top of our most listened to episodes because Dr. Lehman is a legend first of all and second it’s because he gives some amazing, profitable, and entrepreneurial ideas about the future of coordinated care. He also taught us about the difference between chronic pain and high impact chronic pain. 

I’d say the main thing though was his push for a modernized, national scope rather than 50 different scopes of practice in the US. Fascinating stuff from Dr. Lehman in this one. Don’t miss it. 

#5

Our fifth most listened to episode was episode #80 with Dr. Anthony Nicholson called “Decoding Chronic Pain” and I’m here to tell you that if anyone can help you decode chronic pain, it’s Anthony Nicholson. 

This episode, you get to hear it for free but I’m telling you, it’s a master class in chronic pain. Have you ever wondered about central nervous system sensitization or upregulation? Have you wondered what centralized pain vs. peripheral pain is? And no….I’m not talking about McKenzie protocols. 

I have covered a lot of material on chronic pain over the last two years but THIS is typically the source of my information. Dr. Anthony Nicholson si a neuro diplomate as well as an ortho diplomate. He is a genius and when he speaks, you need to be listening. So go listen. Don’t you dare miss that one. 

#4

This one was episode #55 and I told you all Dr. James Lehman was a legen y’all. Well here he is for the second time in our top ten most listened to episodes. 

This one was called “The Future of Chiropractic, Chirorpactic Specialization, & Chiropractic Integration.” Again, Dr. Lehman shared information that can make the entrepreneurial mind start swooning and swimming. Seriously. Knowledge nuggets raining down like manna from heaven people. 

#3

Our third most listened to is Episode #6 done with Dr. Tyce Hergert of Southlake Texas as our guest. The episode was called “Expert Information on Immediate Headache Relief”. Dr. Hergert and I covered several papers on how chiropractic helps knock those dudes out. Tyce is a pretty entertaining individual typically and is most certainly one of the smartest your going to find. 

#2

Our second most listened to episode is still probably my favorite personally. It was episode #13 and is called “DEBUNKED: The Odd Myth That Chiropractors Cause Strokes.” 

This was a lot of fun for me because it was part brain dump, part entertainment, and part educational. 

I said in a recent episode that there are few things in the world more satisfying than being able to slap someone straight across the face metaphorically by saying, “I can get that research paper for you if you like.” Well, this is THAT episode. 

I cover literally everything I could think of. From the risks vs. benefits, the research behind SMT for the neck. The research behind SMT for headache. The research AGAINST SMT causing strokes. The issues the medical field should REALLY be worried about when it comes to adverse effects. Man, I covered it all and while I’m aware it’s not very humble of me to say, I just don’t understand how a hater can really go through it and still be convinced chiropractors cause strokes. 

I just don’t. I feel like the information is just that thorough. Go listen to episodes #13, #14, and #15 and see what you think by the time you hear it all. 

#1

Well looky there, Dr. Tyce Hergert makes two appearances in our top five….not even the top ten….no, the top five. Only the best for Dr. Hergert. Which that’s fine. All those folks down in Southlake Texas think they should only get the best anyway. Lol. It’s jokes I make jokes. 

We go way back. Like….to 3rd or 4th grade basically. For real. Grew up in the same neighborhood in Perryton, TX – look it up – we were in Parker Chiropractic College at the same time and we’ve been serving in the Texas Chiropractic Association together for years. He’s actually an ex-President of the TCA so definitely worth listening to. 

This particular episode was called New Guides For Low Back Pain That Medical Doctors Are Ignoring. 

Surprise surprise, they’re STILL ignoring guides set forth by their own damn organizations and associations. 

We talked about Section 2706 of Obamacare. We covered a lot of ground and people have responded by making Episode 11 our #1 listened to episode of the first 2 years of the Chiropractic Forward Podcast. 

It’s been fun and we’re still rocking and rolling and whatnot. Don’t you go anywhere. You keep coming back every Thursday for the new episodes. 

Keep sharing us on Facebook and Twitter. Keep writing reviews on podcast platforms. Keep stoppign by the shop at chiropracticforward.com and let’s keep seeing where this here train will lead. 

I’m hoping it leads to more evidence-informed practitioners comign out of college each and every semester. More and more and more until some of the garbage we see right now becomes the exception rather than the rule. 

Together, with your involvement here and with your help, we can make it happen. 

Store

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

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

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

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 us that patients can get good to excellent results for headaches, neck pain, back pain, and joint pain just to name just a few.

It’s safe and cost-effective. It can decrease surgeries & disability and we normally do it through conservative, non-surgical means with minimal hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm. When it comes to non-complicated musculoskeletal complaints….

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Website

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 & The Brain, Forward Head Posture Hurts, & Smoking Hurts Worse

CF 103: Chiropractic & The Brain, Forward Head Posture Hurts, & Smoking Hurts Worse

Today we’re going to talk about spinal manipulation’s effect on the brain, forward head posture and neck pain, and we’ll talk about how smoking is related to pain throughout the body. 

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.

Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

If you haven’t yet I have a few things you should do. 

  • Like our facebook page, 
  • join our private facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com

Do it do it do it. 

You have collapsed into Episode #103

Now if you missed last week’s episode on headaches, contraindications to adjusting, and more info on maintenance care, then make sure you don’t miss that info. Go listen when you get done with this one. 

Just a quick re-cap, some of the more recent very popular episodes have been when we had Dr. James Lehman on ths show for episodes 96 and 97. Those were huge for listeners. 

Then, right after those, we had a couple of shows on Marketing Evidence Based practices. Those were big shows for us too. 

Our all time biggest episodes though have been #13, 14, and 15. They were early in our existence. They’re called Debunked: The Odd Myth That Chiropractors Cause Stroke. And then there was episode 80 with Dr. Anthony Nicholson on Decoding Chronic Pain. That was amazing. It was a mini-course on chronic pain and I promise, it’s one you don’t want to miss. 

Anyway, for those that are newer to our podcast, you’ll have to check those out and see what you think.

On the personal end of things, Dad is still in a struggle for independence. If you’ve been around stroke victims in the early weeks, it’s tough stuff. I don’t wish it on a single soul. Well, there’s this one attorney I used to know. Lol. 

Kidding. I Kid….

When it’s my time, man….I just want it to go lights out. BAM. Seeya! It’s been nice but I gotta go hang with Jesus and my family I haven’t seen in a while. Buh bye. 

We don’t get to choose but I sure hope that’s the way it goes. I never want to be a burden on anyone just so I can keep breathing. I want to check out and say adios amigos, hasta luego. 

As far as practice goes, all days are not created equally are they? This was one of those days. Where to even start really?

I had to get after staff members for not doing rehab long enough. I don’t like repeating myself 100 times but I also don’t like getting after the staff members. I hate it. But it has to be done from time to time. 

Then a PT told one my new patients not to go to the chiropractor until after he is done working with them because the patient is ‘gummy’ and an adjustment wouldn’t stick. Now, what the hell does that mean exactly? We don’t take bones from one place and put them into another. Adjustments don’t need to stick. They need to create movement. And alignment isn’t a real thing. Son of a mother, people. 

I’ve never had a PT directing my patient’s treatment in my office before so that was a fun surprise. 

Then a re-exam patient shows up 5 mintues before lunch. Talk about wanting to choke a patient. In a loving way of course because I love my patients but choke indeed. 

Then an attorney on a case on a patient that I’ve seen just three freaking times calls the office. He wants to get me and the insurance adjustor on the phone at the same time. He wants to know what my bill is going to be, how many times I’m going to see the patient, etc… Yeah no. Not happening. 

You have a question? Email me and tag the insurance adjustor. Want a specific answer, yeah…no. Everyone is different, every injury is different, and everyone heals at a different rate. I can give you a very rough estimate at best. Suck it Mr. Attorney, aka Mr. Waste My Freaking Time. 

Then I have a new car wreck patient that doesn’t want me to see his previous radiology reports because they told him nothing was wrong and he doesn’t want me making up my mind about him based on radiology reports. Are you serious? You can’t make this crap up y’all. 

Then, there’s some inner office fussing going on. It’s not a big deal but just un-needed on top of the rest of it while I’m trying to switch CPAs, balance and close out the month of November, and just keep my crap together long enough to go out to the rehab hospital to see my Dad. 

Lol. Wow, what a brain dump I just laid on you all. I apologize but again, I share personal aspects of what’s going on day to day because I know many of you will 100% identify and if you don’t, you can probably learn from my experiences. If you don’t learn how to handle them, then maybe you can learn how to NOT handle them. Lol. 

I’m OK with that too. 

I can’t remember if I shared on the last episode but did you know the new slang for 100% is hundo p? It’s true. So, I hundo p guarantee that tomorrow will be a better day because I played whack a mole all day today and those little bastards are going to have headaches and will lay a bit lower tomorrow. 

At least I hundo p hope so. 

Before we dive into the reason we’re here, it’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you don’t take advantage of this deal, I just think you might be crazy.

If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!

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

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

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

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

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

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

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

Item #1

Our first item is titled “Smoking Is Associated with Pain in All Body Regions, with Greatest Influence on Spinal Pain”, published in Pain Medicine Journal in October of 2019, and authored by Smuck, Scheider, and Ehsanian, et. al(Smuck M 2019). 

Why They Did It

The authors wanted to examine the interrleationship between smoking and pain the US

How They Did It

It was a cross-sectional population-based study

It was done nation-wide

They collected related demographicsin 2,307 subjects from 2003-2004

What They Found

Smoking is most strongly associated with spine pain, followed by headaches, then trunk pain, then limb pain. 

Wrap It Up

The conclusions is, “Current smoking is associated with pain in every region of the body. This association is strongest for spine and head pain. Given that pain is a strong motivator and that current smoking was associated with pain in all body regions, we recommend that these results be used to further raise public awareness about the potential harms of smoking.”

So we already knew that smoking was related to low back pain and disc issues from research we’ve covered here before. Now we know it goes beyond that. It’s everything everywhere basically. 

Honestly, can you think of anything that could actually be good about regularly inhale smoke all day every day? Like….anything at all? Of course not. And you know what’s going to piss some of you off? Other than some touted ideas on stress and pain relief, can you tell me what on Earth could be good about inhaling marijuana smoke regularly into one’s lungs. All day every day. Wake and bake is no better than smoking folks. I promise. When all the research shakes loose, you simply cannot inhale substances regularly and it be OK. 

As a side note I just want to throw some personal commentary in here. I had a conversation with a patient this week about another chiropractor here in my town and some of the beliefs and ideas that was laid on them on their visits with them. 

You know…..the things that push patients away and makes them come see other chiropractors. Things like don’t vaccinate your kids (regardless of your stance on the matter, don’t be a bully about it to your patients. It’s gross and unprofessional), things like don’t use cell phones because of radiation, things like pushing supplements more than an actual adjustment with exercises, things like we need 70 visits and $4000 from you this year to fix that loss of curve in your neck. Things like pushing the newest thing like CBD, multi-level marketing like supercharged water. 

From a patient’s perspective, if you went to your medical doctor and they’re pushing a ton of stuff from out of the blue….stuff beyond normal and customary medication. Things supplements that cost A LOT of money. They’re pushing CBD and selling if from their office, etc etc….

Well, those people look like snake oil salespeople. It’s not a good look, it’s off-putting, and we should hold ourselves to a higher standard. You can make plenty of money in this profession without selling your dignity and continually jumping on the hot new bandwagon. 

The golden oldies are still the best ROI, folks. Spinal manipulative therapy, exercise/rehab, physiotherapy, massage and manual therapy, acupuncture, and honest and high ethics. 

That’s your winning formula, y’all. Not CBD, special magical water, oils, and stuff like that. 

It’s just not. 

I swear I feel like I’m being controversial today but I’m not trying to be. I’m just speaking my mind and in the US at least these days, that is not a popular thing to do. We are at the point where 50% of the country hates the other 50% and anything you say, even when backed with facts, is taken as offesive material by half the country. 

Random thought just now. If kid slang for 100% is hundo p, for 50%, is it fitty p? Just a question I have. That’s all. 

Item #2

Now, item 2. This one is called “The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis” published in Current Reviews in Musculoskeletal Medicine in November of 2019 and authored by Mahmoud, Hassan, Abdelimajeed, Moustafa, and Silva, et. al(Mahmoud N 2019). 

November 2019 – hot stuff. fog your glasses up steaming plate. 

And can I just say Oh how I wish my last name was Moustafa? Powerful – elegant – a little bit of hell yeah there. 

Why They Did It

Despite claims that FHP may be related to neck pain, this relation seems to be controversial. Thus, our purpose is to determine whether FHP differs between asymptomatic subjects and those with neck pain and to investigate if there is a relationship between head posture and neck pain.

How They Did It

15 cross-sectional studies were eligible for inclusion

It was a systematic review and meta-analysis – so basically high-level information and research

What They Found

The conclusion of the project was “This systematic review found that age played an important role as a confounding factor in the relation between FHP and neck pain. Also, the results showed that adults with neck pain show increased FHP when compared to asymptomatic adults and that FHP is significantly correlated with neck pain measures in adults and older adults. No association was found between FHP and most of neck pain measures in adolescents.”

Now, you curve people don’t start getting our of hand. Can’t we see a world where a person does not have Forward HEad Posture but still has a loss of a curve. However, that loss of curve doesn’t cause a lot of issues? Of course we can. Because we have recent research that shows loss of a curve isn’t that big of a damn deal long-term. 

This paper is on forward head posture specifically and it doesn’t take a research paper to envision sitting with consistent bad posture and developing upper cross syndrome is going to set a person up for some chronic pain issues. I can easily make that leap with you. And with these authors. Count me in. 

Item #3

This one is called “The effect of spinal manipulation on brain neurometabolites in chronic nonspecific low back pain patients: a randomized clinical trial” it was published in Irish Journal of Medical Science in November of 2019  and authored by Didehdar, Kamali, Yoosefinejad, Lotfi, et. al(Didehdar d 2019). 

November 2019 – Pow- firecracker hot right here. Watch your fingers

Why They Did It

In patients with chronic nonspecific low back pain (NCLBP), brain function changes due to the neuroplastic changes in different regions. They wanted to evaluate the brain metabolite changes after spinal manipulation, using proton magnetic resonance spectroscopy

How They Did It

  • 25 patients enrolled
  • They were randomly assigned to lumbopelvic mainpulation or sham manipulation
  • They were evaluated befre the study begain and at 5 weeks after treatment. 
  • The Numerical Rating Scale and the Oswestry Disability Index and the H-MRS outcome assessments were used to quantify the results

What They Found

After treatment, pain and functional disability were significantly reduced in the treatment group vs. the sham group. 

This paper gets heavy into the neurology so, in order to keep you on board here, we’ll straight to the conclusion. 

Wrap It Up

The authors concluded, “In the patient with low back pain, spinal manipulation affects the central nervous system and changes the brain metabolites. Consequently, pain and functional disability are reduced.”

We did an episode on what an adjustment does way back on episode #56. That was also the episode where I talked about a popular group of millennial chiropractors that pour on the theatrics and sales talk and teach other impressionable chiropractors to do the same. 

And then claimed to make degenerative arthritic spurs disappear after adjusting 3 or 4 times a day for like 2 or 3 weeks. I can’t recall exactly now but go back and listen to episode 56. It was a fun brain dump and is probably something you’ll enjoy if I’m guessing. I’m putting the link right here at this point in the show notes at chiropracticforward.com so go give it a looksee. 

How do you describe a manipulation? If you were on an airplane sitting next to a neurosurgeon and he asked you exactly how manipulation works and affects the body and pain, what would you tell him? Have you thought about it?

The folks at ChiroUp have thought about it and probably because they’re DACOs, the DACO program also has an interesting description to offer. 

Dr. Brandon Steele with ChiroUp offered a good explanation for cavitation back in October on their blog. I’ll leave the link for you in the show notes. 

He described the need for better communication with the patients regarding cavitation and whether something “goes” or pops. Too many times, patients equate a successful treatment with cavitation. You know what we’re saying here. 

To quote Dr. Steele’s blog, he says, “Joint manipulation improves range of motion across individual and multiple vertebral segments.  A recent paper by Anderstt et al. (2018) confirmed that cervical manipulation results in facet gaping.  This force also improves regional motion across multiple spinal levels during and post-manipulation.

“This study is the first to measure facet gapping during cervical manipulation on live humans. The results demonstrate that target and adjacent motion segments undergo facet joint gapping during manipulation and that intervertebral range of motion is increased in all three planes of motion after manipulation. The results suggest that clinical and functional improvement after manipulation may occur as a result of small increases in intervertebral ROM across multiple motion segments.” 

Evidence-based chiropractors can bridge the patient education knowledge gap by incorporating current research into simple explanations.”

The DACO program I’ve been discussing put it all into an excellent description. Check this out and let me know what you think about it. 

“Chiropractic adjustments exert their effects upon the nervous system in a variety of ways. 

In recent years the neuroscience community has taken great strides in uncovering the mechanisms at play. These include analgesic responses at the dorsal horn level, as well as activation of the descending inhibitory pathways from brainstem regions such as the periaqueductal gray. 

There is also a compelling body of research that suggests profound changes in sensorimotor integration within the cortex. 

It appears that manipulation relies upon signaling properties of the muscle spindles that lie embedded in the paraspinal tissues. As the spindle registers rapid lengthening of the muscle it transduces this into a large proprioceptive barrage. 

The unique nature of a manipulation seems to alter the responsiveness of second-order neurons in the dorsal horn and make them less sensitive to incoming nociceptive signals from injured tissues.”

Good stuff. The more you know, the better you are. The better you are, the more you stand out and the busier you are. 

The right kind of busy. Not busy because you scared people into treating with you. Not busy because you made a big deal out of something insignificant. 

Busy because you’re freaking smart as hell, make good reasonable recommendations. Busy because you took the time to get the extra education to be able to help your patients beyond what your local competitors can do. Busy because you’re honest and you know that treatment should have a start and it should have a finish. 

Busy because you’re an evidence-informed, evidence-based chiropractor and high level research backs everything you say and everything you do. 

There are few things more satisfying than saying, “Would you like for me to send you the research paper on that?”

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
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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 us that patients can get good to excellent results for headaches, neck pain, back pain, and joint pain just to name just a few.

It’s safe and cost-effective. It can decrease surgeries & disability and we normally do it through conservative, non-surgical means with minimal hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm. When it comes to non-complicated musculoskeletal complaints….

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Website

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About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

Didehdar d, K. F., Yoosefinejad AK, Lotfi M, (2019). “The effect of spinal manipulation on brain neurometabolites in chronic nonspecific low back pain patients: a randomized clinical trial.” Ir J Med Sci.

Mahmoud N, H. K., Abdelmajeed S, Moustafa I, Silva A, (2019). “The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis.” Curr Rev Musculoskelet Med: 1-16.

Smuck M, S. B., Ehsanian R, Martin E, Kao MJ, (2019). “Smoking Is Associated with Pain in All Body Regions, with Greatest Influence on Spinal Pain.” Pain Med.

Headaches and the Neck, Absolute Contraindications, More Maintenance Care

CF 102: Headaches and the Neck, Absolute Contraindications, More Maintenance Care

Today we’re going to talk about new information on how working on the neck could help headaches of all kinds. Who woulda thunk it? We’ll talk about absolute contraindications to spinal manipulative therapy. Do you remember them all? I’ll give you a refresher to be sure. We’ll wrap up the episode with another paper on maintenance care. Is it evidence-based?

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.

Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

If you haven’t yet I have a few things you should do. 

  • Like our facebook page, 
  • join our private facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com

Do it do it do it. 

You have sauntered into Episode #102

Now if you missed last week’s episode, it was episode #101 and it covered 9 characteristics that make up a good chiropractor,  make sure you don’t miss that info. Put that one on your listen-to list muy pronto, mi amigo. 

On the personal end of things that whole DACO thing you’ve heard me talk about since June of 2018…..well, I got word last week that I passed the part II exam. That also happens to be the FINAL exam I’ll have you know which means……yes, it means I’m now officially a Diplomate or Fellow of the International Academy of Neuromusculoskeletal Medicine. 

It turns out that we can choose whether to go by Diplomate or Fellow and I choose Fellow. So, when it comes to adding alphabet soup to the end of my signature, I now get to add FIANM(us). 

Besides graduating with a doctorate, this is the biggest thing I’ve done and I can’t really express how excited I am to join the amazing group of doctors in this specialization. 

Did you know that only 2% of chiropractors go on to specialize? We really really need to change that. I want to be honest here: the hours were absolutely, 100%, without a single doubt one of the most enjoyable and most rewarding things I’ve done. WAaaaaayyyy better than chiropractic school. 

The course was current with research. It was smart. It was professionally done. It was just amazing. 

The testing process……welll…..that was a different story for me. I felt that the material in Part I was just irrelevant to the course. In fact, had little to nothing to do with what we learned. BUT – the good news is that they’ve created a new test now and it should be more relevant. 

Part II was amazing, imaginative, and well-put together and conducted. But, I believe there were doctors making the questions that had never undergone the current course load so, once again, there were questions that were a bit random and just seemed out of place to a person that had all of those hours. 

Again, the good news is that they are consistently adding updated questions and I have no doubt they will get more and more focused in regard to what was actually covered in the course. 

So, I in short, doctors should undertake this Diplomate. The hours are so rewarding. You literally cover a topic in the course and then it shows up in your clinic. It’s scary as hell how that works. 

The testing part is cumbersome and clunky but they’re working on lining it out. Even if that part didn’t get any smoother or any better, it is still 100% absolutely worth every dime spent and every hour spent achieving the goal. 

Trust me, I’d tell you straight up if it weren’t. If you have the money, do it. Don’t give me that excuse about time. I didn’t have time either. I just made time. I did it while I watched football. I did it with coffee on Saturday and Sunday mornings. I took off early on Tuesdays just to study. It can be done and YOU can do it. 

Send me an email at dr.williams@chiropracticforward.com if I can help point you in the right direction and get you started. I’d be happy to help you. 

More chiropractors need to specialize. Just think about it. 

My Dad…..well….If you listened to previous episodes, you know he had a stroke a couple of weeks ago. I can’t tell you how emotionally challenging this has been. To work and still get out there to spend time every day…..it’s a process and it’s a commitment. 

But that’s it. He’s my Dad and I’m committed to being there to help and do whatever I can to help him get restored to whatever level we can get. 

We are both guitar players so I brought my guitar up to the rehab facility last night and played for him for a while. We are both sculptors. We make bronzes. Check riverhorseart.com and we have a Facebook page as well. 

So, I bought him some new sculpting tools and some clay and took them up to him today at lunch. He can only use is dominant hand, his right hand, but he was pretty excited. He started sculpting before I even left. 

Fingers crossed that we see some improvement in a hurry. Thank you to each of you that sent me emails and messages through Facebook offering prayers and good wishes. I value each of them as much as I value you. Thank you. 

Before we dive into the reason we’re here, it’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you don’t take advantage of this deal, I just think you might be crazy.

If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!

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

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

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

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

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

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

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

Item #1

Let’s start with absolute contraindications shall we? This comes from the WHO Guidelines(Sweaney J 2004). That’s right the World Health Organization. The actual name of the document is WHO guidelines on basic training and safety in chiropractic. 

I literally never knew this existed until I saw it in a Facebook group last week. Some kind hearted individual shared it. I can’t recall whether it was the Forward Thinking Chiropractic Alliance group or if it was the Evidence Based Chiropractic group. Either way, I found it interesting and here we are. 

I’m going to leave a link to the document at this point in the show notes so just go to chiropracticforward.com and episode 102. You’ll find it and you’ll be happy. 

https://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf

If we go down to page 21, we find a list of Absolute contraindications to spinal manipulative therapy. Many of them, you already know but let’s just stroll through them for a refresher just in case. 

1. anomalies such as dens hypoplasia, unstable os odontoideum, etc.

2. acute fracture

3. spinal cord tumor

4. acute infection such as osteomyelitis, septic discitis, and tuberculosis of the spine

5. meningeal tumor

6. hematomas

7. malignancy of the spine

8. frank disc herniation with accompanying signs of progressive

neurological deficit

9. basilar invagination of the upper cervical spine

10. Arnold‐Chiari malformation of the upper cervical spine

11. dislocation of a vertebra

12. aggressive types of benign tumors, such as an aneurysmal bone cyst, giant cell tumor, osteoblastoma, or osteoid osteoma

13. internal fixation/stabilization devices – metal hardware such as after a surgical fusion

14. neoplastic disease of muscle or other soft tissue

15. positive Kernig’s or Lhermitte’s signs – these are orthopedic meningitis signs. Go look up Kernig’s and Lhermitte’s if you don’t know them please.

16. congenital, generalized hypermobility – Are you using the Beighton Scale for hyper mobility? Are you adjusting chronic pain, hyper mobile people? Sometimes, even if they like the popping sounds, that’s not best. Sometimes, strengthening and support exercises are better than mobilizing joints that are already too mobile. 

17. signs or patterns of instability

18. syringomyelia

19. hydrocephalus of unknown etiology

20. diastematomyelia – a congenital disorder in which a part of the spinal cord is split, usually at the level of the upper lumbar vertebra. Fortunately, we almost never see this.

21. cauda equina syndrome – I caught one not long ago in my office. A new patient who had been to the ER 3 times already and they never even took the time to do any imaging. A young guy in his 30’s on a walker, difficulty controlling bowel and bladder function, saddle anesthesia. I told him to go directly back to the ER and tell them you are concerned you are suffering from cauda equina and tell them you have saddle anesthesia. 

As soon as he did that, boom, imaging, and emergency surgery. He says I saved his life. While that’s not true specifically, it sure as hell feels good to hear. 

Alright. I hope you enjoyed that brief refresher and it gave you a little food for thought. You can go to the show notes and get the document or just go to get the list if you like. 

Item #2

This one is pretty cool. It’s called “A neuroscience perspective of physical treatment of headache and neck pain,” by Rene Castien and Willem De Hertogh and published in Front Neurology in March of 2019(Castien R 2019). 

This one is probably going to tell you what you instinctively already knew but it’s going to lay some scienc-ing in on the top there for you. 

Just like a warm blanket, a layer of scienc-ing is all warm and fuzzy and makes you feel good. Can’t get enough of scienc-ing can we?

OK, we know that the most prevalent headache is tension type headache. In fact, about 40% of those presenting in your clinic are TTH. Not migraine, not cervicogenic…..TTH. In fact, only about 10% of the headaches that present to your office are actually migraines. That’s not very many is it? 

Which is a good thing because migraine is more of an issue in the brainstem – in the descending pain inhibitory complex. In the words of Dr. Anthony Nicholson and Dr. Matthew Long from the CDI coursework – The experience of head pain requires activation of the trigeminal nucleus. After all, this is where the neurons that sense the head and neck are located.

Adjustments don’t always knock out a migraine issue right? It’s wired into the brain. However, adjustments tend to show more success when we’re dealing with a TTH. 

Now, the TTH is also an issue with impaired inhibition. It’s on the same spectrum….the same continuum as is migraine. Migraine way off to the right and TTH way off to the left. But there’s a lot of middle ground in there where their symptoms can overlap into each other a bit. 

But, in general, we are able to be more effective with TTH than we are with migraine. 

They mention in this paper that physical treatment is a frequently applied treatment for headaches. They say that although physical treatment is often applied to the neck, the neurophysiological background…..how it works or helps…..is unclear. 

So, the authors had the goal of taking more recent knowledge from neuroscience and enhancing clinical reasoning in using physical treatment for headaches and to understand why it’s so common for headaches and neck pain to exist together so oftenly.

Some of the highlight quotes from this article are as follows:

“Headache (migraine, tension-type headache, cervicogenic headache), neck pain, and cervical musculoskeletal dysfunctions seem to be related in case-control studies, although the strength, significance and explanation of this relation varies per type of headache.”

“It is a great challenge for clinicians and researchers to develop effective treatment strategies for headache targeted on modulation of cervical afferent input in order to decrease the excitability of first- to second order neurons at the level of the TCC. Experimental studies of the neurophysiological effect of physical treatment and randomized clinical trial on this topic are scarce and urgently warranted. Meanwhile, there is no standard recipe for physical treatment on the neck for different types of headache. But clinicians may be encouraged by recent evidence and new insights on headache and neck pain and may use this knowledge in clinical reasoning to provide a tailored and evidence based neuro-physiological approach for patients with headache and neck pain.”

“The relation between brainstem nuclei and the (upper) neck and trigeminal nerve has to be incorporated in development of physical treatment for headache targeted at the cervical spine, especially the upper cervical region. 

According to the ‘gate-control’ hypothesis, the relative high amount of proprioceptive muscular input from the upper cervical segments particularly C1-3….. to the central nervous system may alter nociceptive input. 

Stimulation of proprioceptive input by active exercises for neck muscles may decrease the excitability of second order neurons at the trigemino-cervical complex and activation of the supraspinal diffuse noxious inhibitory control system by stimulation of myofascial fibers through manual pressure techniques at the upper cervical spine can be of added value.”

Pretty cool stuff. Physical treatment is effective for different kinds of headache through the trigemino-cervical complex via proprioceptive stimulation of the upper cervical region. 

You’re welcome. This is something covered extensively in the coursework we did for our Neuromusculoskeletal Fellowship/Diplomate. 

Like I said, it’s absolutely worth going through the course. 

Item #3

Our last paper here is paper #3 in the last year on Chiropractic Maintenance. It’s called, “Chiropractic maintenance care – what’s new? A systematic review of the literature”. It was published in Chiropractic and Manual Therapies and authored by Iben Axen, Lise Hestbaek, and Charlotte Leboeuf-Yde in November 2019(Axen I 2019) – Hot steamin’ greasy plate of enchiladas here. 

If you notice the name Iben Axen, then you will remember he is the one that authored the paper on how a patient’s improvement in the first visit or two can really help you know how they will do through the course of the treatment. He’s pretty active in research and we appreciate him here at the Chiropractic Forward Podcast. 

Why They Did It

Here’s why they did this one: knowing that maintenance care is an age old tradition with chiropractors, and knowing that systematic reviews in ’96 and in /08 both found evidence lacking for maintenance care, and then considering Andreas Eklund’s Nordic papers on maintenance care recently (we’ve covered them both here), these authors decided it was time to review the newest evidence on the matter. 

How They Did It

Knowledge of chiropractic Maintenance Care has advanced. There is reasonable consensus among chiropractors on what Maintenance Care is, how it should be used, and its indications. Presently, Maintenance Care can be considered an evidence-based method to perform secondary or tertiary prevention in patients with previous episodes of low back pain, who report a good outcome from the initial treatments. However, these results should not be interpreted as an indication for Maintenance Care on all patients, who receive chiropractic treatment.

You know it feels good when a paper can conclusively say ‘presently, maintenance care can be considered an evidence-based method.” It reminds me of Jim Carrey in the Ace Ventura movies saying, “Can you feel that? Huh?” Lol. 

Good stuff there. I love slapping people with research. It’s a warm feeling going down kind of like Bailey’s and coffee. You know what I’m saying. 

Key Takeaways

  • Be smart and know your absolute contraindications
  • Treating the neck for headaches is evidence-based
  • Chiropractic maintenance is evidence-based

Speaking of evidence-based, make sure you go to chiropracticforward.com and go to the store link to check out our evidence-based brochures and posters. You’ll like them. 

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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 us that patients can get good to excellent results for headaches, neck pain, back pain, and joint pain just to name just a few.

It’s safe and cost-effective. It can decrease surgeries & disability and we normally do it through conservative, non-surgical means with minimal hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm. When it comes to non-complicated musculoskeletal complaints….

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Website

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Twitter

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About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

  • Axen I, H. L., Leboeuf-Yde C, (2019). “Chiropractic maintenance care – what’s new? A systematic review of the literature.” Chiropr Man Therap 27(63).
  • Castien R, D. H. W. (2019). “A Neuroscience Perspective of Physical Treatment of Headache and Neck Pain.” Front Neurol 10: 276.
  • Sweaney J (2004). WHO guidlines on basic training and safety in chiropractic. WHO: 44.

What Makes A Good Chiropractor – 9 Characteristics

CF 101: What Makes A Good Chiropractor – 9 Characteristics

Today we’re going to talk about going to a chiropractor and how to tell your out-of-town loved ones how to choose a good one on their own. Without your help even! We’re also going to talk about being the kind of chiropractor that your colleagues are happy to send their family to. 

But first, here’s that sweet sweet bumper music

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. We’re not the stuffy, high-brow kind of research oh no…. we’re talking about research over beers.

Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  If you haven’t yet I have a few things you should do, like our facebook page, join our private facebook group and interact, and then go to chiropracticforward.com and check out the store link. Sign up for our weekly newsletter there too.

No spam there, just reminders when we post a new episode so you don’t miss any!

You have collapsed into Episode #101

Now if you missed last week’s episode, we covered a lot of research. It was Episode 100 so make sure you don’t miss that info. 

I know there were some good solid knowledge nuggets found there within so make sure you’re up to date and not falling behind the rest. Keep up with the class, man! 

On the personal end of things I cannot tell you what a trying and what an emotional week it’s been. These episodes are recorded a week or two ahead of time so you’ll note the time difference of when this happened and when it’s making its way live. 

On Saturday November 9th, my dad had a stroke. He got out of bed that morning and said he’s got a tall bed so he always has to sort of find his footing before he gets out and walks. He said on this day, he got out of bed and got out a bit awkward and fell. 

He hit his head on the end table and cut his head open. From there, he went to the garage to get rags to clean up the bloody mess. Well, from the garage he goes to talk to his wife in the kitchen and there he falls again….hitting his head once again. 

At this point, his wife calls the ambulance and off to the hospital they go. My wife and I were in Dallas TX, about a 6 hour drive away. So, I get the call. Take care of my business in Dallas and head back to Amarillo as quickly as we can. 

Now, never having been around a stroke victim in the first week or so, I have little experience in this arena. I had no idea what to expect. When we got to the hospital, he was awake and talking to me. Telling me all kinds of stories, basically doing decent but there was weakness on the left side arm and leg. 

Now, here’s where it got A LOT more interesting. On day two in the hospital, after taking a walk on the walker, he was sitting and eating and just relaxing when he had stroke #2. This was the more severe stroke. They put him on heparin, a blood thinner, and took him to the critical care unit to keep a closer eye on everything. 

Now complete loss of sensation and motor in the left leg and arm and hand. He was very out of it and confused in the CCU. 

So that was touch and go for a bit as you can imagine. Very emotional. Very stressful for everyone. Certainly for my dad. 

Now, let’s fast forward to today, Monday November 18th, we are now 9 days out from the first stroke and 7 days out from the second stroke. He’s out of the hospital and in a rehab facility where they are trying to teach him to regain his life if possible. At this point, nobody knows where this train is going to take us and when it will get there but, we are hopeful and we are praying. If this reaches you and you hear it, I would appreciate your prayers, your good vibes, or whatever you are willing to send this way. 

He could use it and, honestly, his family could too. It’s been a challenge to try to see patients and then spend time at the hospital. It’s hard to be present for your patients when your mind is fixated on your personal problems. I’m sure it goes that way for doctors going through divorces and life changing events like that as well. Mine just happens to be my Dad’s stroke. 

So, I’ve usually got at least something to share with you on the personal side of things. This one was a whole new thing for me. I’ll probably giving updates as we go along. 

Before we dive into the reason we’re here, it’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you don’t take advantage of this deal, I just think you might be crazy.

If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!

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

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

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

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

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

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

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

Item #1

Now, the reason for this week’s topic: I saw a question on one of the Facebook groups the other day about what are the qualities we look for in other chiropractors before we’ll recommend them to a family member or to a friend. 

Quite honestly, I get phone calls, text messages, Facebook messages, and emails from friends and associates that live out of town asking me if I know a good chiropractor where they live all of the time. Literally almost every week. And if I don’t know one, then what is the best way to choose a chiropractor? I’d say my first knee-jerk response is to go to forwardthinkingchiro.com and check the Member Map they have. 

Now that still doesn’t guarantee it’s the best referral in the world but it’s a damn good start in whittling out the crazies right off the bat. But, that map unfortunately doesn’t represent every area of every city and it certainly doesn’t get you a good referral in BFE, Wyoming. 

So, that’s what we’re talking about here. How do you find someone then if that FTCA map fails us?

I think that any time one decides that they’re going to go to a new doctor….even for you and for me…..If we change doctors, there is a certain amount of apprehension. In choosing a chiropractor, this apprehension can be escalated to a certain extent because all chiropractors are vastly different. In short, there is literally zero standardization. It’s like the wild wild West out there. If you have an ear infection and you go to the ER, you know it’s going to be a pretty standard treatment, right?

Not with chiropractic. You can go in for a little tweak in your back and walk out $3500 lighter with a year long plan. Or you can walk in with a little tweak in your back and get some completely normal, repsonible recommendation. 

There are some chiropractors that focus on weight loss. There are some chiropractors that only use an instrument to adjust rather than manual adjusting. 

There are some chiropractors that are more driven by philosophy than other chiropractors. There are some chiropractors that use therapy and extra equipment, while other chiropractors only adjust.

So let’s dive into 9 characteristics I feel are important in a good chiropractor. 

  1. 1. Honesty 

Other than the first topic and the last topic, I have not put these qualities in any specific order. But I put honesty at the top of the pile because I feel that strongly about it. 

I feel that honesty is of utmost importance in any profession. Especially in the healthcare field. People are literally putting their lives and their livlihoods in our hands. You would like to think our family is putting their lives in the hands of an honest person, don’t you think?

We’ve heard it said time and time again that if a person doesn’t have his word, then he doesn’t have anything. It so so true. 

How do you know if a chiropractor is honest when you first visit their office? That’s a hard one to answer. It may simply be a “gut” sort of thing. But usually, if we trust our “gut”, then we don’t get steered off of the right track.

You may not be able to develop a “gut” feeling until the second or third visit but you will most likely get a good idea by then. I would say that, in general, if it takes 3 visits to get your recommendations and really start treating, they may be using sales tactics on you. 

If they talk about having to see them once a week for a year or for a lifetime, they may not necessarily be dishonest but they are most certainly unaware of current guidelines and evidence-based protocols. 

If they talk about fixing everything in your body based on a subluxation model, I’d say you should save your money and leave. That’s just me. Again, that doesn’t mean dishonesty but it does mean they may not be evidence-based. 

  1. 2.Evidence-based/Evidence Informed 

OK, this one is admittedly a sticky one here. As most chiropractors are well-aware, there is this huge chasm in our profession between those that believe in only adjusting the spine and nothing else and those that are evidence-based or evidence-informed. 

Between those that follow a philosophy and those that follow research. Between those that do not believe in the profession progressing and growing and those that believe our profession can and should grow and expand. 

There are some research papers that the philosophy group will point to saying these papers prove their theories and minimal treatment but, in truth, from what I’ve seen, they are low quality and no profession worth anything would rest their entire reputation on them. 

However, there are TONS of papers, many of which we have covered here on the Chiropractic Forward Podcast, that proves and validates evidence-based chiropractic every day in almost every way. 

In general, it is my recommendation that you BE the chiropractor or refer your family TO the chiropractor that follows research, follows the expanding knowledge within, and pushes to move the profession more and more into the current century. 

  1. 3.Network. 

To me, “Network” means, “how plugged in is the doctor as far as his associations, his colleagues, and the profession as a whole?”

On the surface, that may sound like a silly suggestion and to be somewhat inconsequential to you. But I have found that there is an extreme amount of value in being active with fellow chiropractors and state and national associations. 

We are able to bounce ideas and questions off of each other whereas someone with no colleague interaction or support system merely has their own knowledge and is sort of on an island of their own making.

Trust me, this is coming from a dude that was on that self-made island years and years ago. I had my basic knowledge from going to chiropractic school but I wasn’t particularly skilled in anything extra. Just basic white paint in a world of oranges, purple, fuschia, lilac, or whatever color you can think of. Sitting here today, I wouldn’t send anyone to me then. 

Being active in the Texas Chiropractic Association has allowed me the opportunity to stay plugged in with rules and regulations, new treatments, changes in insurance plans, and options that I would have likely never known about were I not being active in my profession.

  1. 4. Knowledge & Experience of Doctor and Staff

I think this qualification really goes without saying. And again, knowledge and experience is of extreme importance in ANY profession. Even an experienced comedian is usually going put on a better show than a rookie.

For instance, I attend a chiropractic conference one weekend out of every month. Chiropractors are required 16 hours of continuing education every year. Some chiropractors will only go to a continuing education seminar one weekend out of every year. I should know, I used to be one of those chiropractors. 

But with age comes wisdom and the desire for more wisdom. I would do my best to figure out the chiropractor’s knowledge and their level of experience. This could certainly end up being a “gut” thing as we previously discussed but it’s usually something they’re proud of and something they market. 

Trust me, when I finally get that Fellowship of the International Academy of Neuromusculoskeletal Medicine, you better believe it’s going to be on the website and will probably look like some sign right out of Las Vegas.

If there’s no sign on the website of extra certification and acheivement, your money is probably best spent elsewhere. I’m ten times the doctor I was when I began the Diplomate program. Or more….exponentially better. 

  1. 5. Good listener 

You’re not going to be able to get this off of a doctor’s website so don’t even try but we can strive to be better ourselves in this department. Myself included. I’ve been at a point where I didn’t feel I could get everyone worked through in one day and I can guarantee you I cut some patients off in the middle of their explanation. 

I think that it is very important that a doctor has a good bedside manner. Meaning, that they need to be able to listen, focus on the patient, and fully understand what the patient is saying and what their concerns are. There are those days where we are just doing everything we can to stay above water but in general, don’t be uninterested and think you have the problem solved before they’ve said anything. 

Open your ears. 

  1. 6. Office Presentation. 

This may seem like a silly one and I’m sorry if it’s just not important to you, but if I am going to a doctor’s office, I expect the office to be mostly clean and fairly sharp looking. 

GASP….what if they went over the top and it looks amazing? 

I think that if a healthcare provider takes pride in their office and in their staff, then they’re going to take pride in their results and their expertise. Maybe I’m wrong. You can find those that don’t give a squat about anything in their office. No good pictures, old this, smelly that..yet they’re able to get the best results. 

Let’s face it though, is that the exception or the rule? I argue it’s the exception.

An an ideal office, they try to have a welcoming feeling, the staff is dressed neatly, there is as little dirt or dust is on the floor and furniture as is possible, there is no trash on the floor next to the trash can, everything is as nice, as sharp, and as clean as possible. 

If the doctor and the staff do not portray an acceptable image, then that may not be the place for you.

  1. 7. A sense of purpose. 

Have you ever gone to a doctor’s office and felt that they were simply going through the motions and collecting money? I have absolutely felt that way a time or two. I think that the better doctor is genuinely concerned about his patients’ well-being, and how he can help them in the best way possible.

Someone that you can just feel is a little extra. Someone that is knowledgeable and can relate things to you in relate-able terms. Not chiropractic jargon. Someone that you can instantly tell is not there to get into your pocket or to max your insurance. You know what I’m talking about. Someone that is there to get you results as quickly as possible. That’s purpose. 

Even on top of that though, it would be nice to find a chiropractor that you felt had the community’s best interests in mind. When you see them donating and giving back to their community, why wouldn’t you want to do business with that person instead of a taker. Takers kind of suck. Takers just make profit but are narcissistic. They don’t get involved with their state or national associations at all. They don’t give anything back to their profession, their school, or their community. 

They take that money and spend it only on themselves because that’s all they care about. I don’t want to do business with that person. I want to do business with a giver. Any day all day. Gimme a giver. Thank you, i’ll have another please. 

I want a chiropractor that got into the profession of chiropractic in order to heal people. And to heal as many people as he could possibly reach. 

Someone that thinks and works on a higher level rather than someone that just shows up to work and does their job. A doctor that is excited and jazzed to be doing what they’re doing in the place where they are doing it. 

THAT’S the guy I want to go to!

  1. 8. Know when to refer. 

Tell me you know when to refer. Tell me you don’t think you can fix everything. Please tell me!!

When we talk about referrals, we can get way off track in the chiropractic profession. Some chiropractors feel they can solve any problem walking through their doors. Ear infection? Pop ya bones? Asthma? Pop ya bones. Cancer? Pop ya bones. Diverticulitis? Pop ya bones? 

You know the ones. Yeah you know them. They’re the reason people in the medical field look at all of us like we’re crazy. And if that’s the measuring stick for crazy, then they’re right. Fortunately, most of aren’t like that. But the loud minority is still winning the day in our profession I’m afraid. 

As I said before, I am interested in the chiropractor that is plugged in to his profession and to his colleagues. I’m interested in the chiropractor that is plugged in to the healthcare field as a whole. And I’m damn sure interested in the chiropractor who is plugged into research and current, accepted guidelines. 

If a doctor gives me a sense that they feel that they are the only one that can handle any condition, or that there is never any need to look outside of their office for additional help, then I am likely going to find another chiropractor. I think it is extremely important to go to a chiropractor that is not afraid to admit when additional treatment should be reasonably looked at.

I for one, look forward to each and every time that I have the opportunity to work in conjunction with a medical provider. I feel that it is a very complete treatment plan when you are able to address all symptoms thoroughly.

Patients have to take into consideration whether they  want a chiropractor that is deeply versed in chiropractic philosophy or want a chiropractor that is open to working with the medical community. 

  1. 9. Love. 

I like to throw curveballs here and there. I like to add things you don’t see in most lists. This is one of those things and I saved this one for last because I hope that, after you’re done reading this, this is the one that will resonate the longest with you. 

I strongly feel that when you visit a health care provider,  things like caring, genuineness, focus, listening, and all of those other things that we’ve talked about above…..they can all be wrapped up into one thing. 

And I think that that one thing is love. If the doctor and the staff love what they do, they love their patients, and they love being where they are, when they are there, then people can feel that.

If you walk into an office and it’s cold, there’s no personality, and it feels stiff and stale, then that’s just no fun at all. Where’s the love? How do you show it to your patients? 

I want an office that I love to go to and if the doctor and the staff have love as the primary driver of their office and their purpose and it’s something palpable that you can feel….., then I think that all of the other eight qualifications pretty much take care of themselves.

That’s it. I’m sure if I didn’t have so much on my plate I could come up with about 20 more things that are important. Maybe a 100 but I have to get to the hospital to see my dad. 

I enjoyed sitting and throwing some random thoughts on the page. I hope you liked it and make sure you come back next week. 

Our podcasts post every Thursday. Typically in the morning unless I’

Store

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

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

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

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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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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 Maintenance Care, Corticosteroid Shots, 11 Best Practice Recommendations

WOW!! Our 100th episode. That feels great to say. We made it to 100 and we should celebrate!! I feel like we should do what got me started which is cover some great research that advocates and validates what we do every single day of our working lives.

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