chiropracticforward

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
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 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. 

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

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Twitter

YouTube

https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

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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

  • 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. 

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

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

iTunes

https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

Player FM Link

https://player.fm/series/2291021

Stitcher:

https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

About the Author & Host

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

Chiropractic 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.

... continue reading.

Big Ideas On Marketing Evidence-Based Practices (Part Two)

CF 099: Big Ideas On Marketing Evidence-Based Practices (Part Two)

Today, you’re going to hear Part Two of our two-part series about marketing. Specifically, marketing an evidence-based chiropractic practice. How do you do it and do it right?

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. We’re not the stuffy, high-brow kind of research. It’s like we’re talking about research over beers. Which is NOT like talking about research in a classroom or an institution of some sort. Accessible research if you will. I could be more professional but I’m not. 

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, and go to our Store link at chiropracticforward.com and check out the goods. That’s it. Not bad right?

You have shimmied into Episode #99 and I hope you’re enjoying the Marketing series. 

Now, if you missed last week’s episode, it was Part I of this marketing an evidence-informed practice series. Stop now and go back and listen to Part I first. Then come back here and devour Part II. 

Because….make no mistake…..we’re serving it up hot and fresh here people. 

On a personal note, nothing special is going on around the office or in my work life balance. It’s just been business as usual. We’ve had a bit of a fall off from the Summer but it’s still busier than this time last year and we’re staying busy busy busy. 

So, nothing of signifigance to report here but, before we get too deep, 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.

OK….now, back to Part II of our marketing series. We covered some general marketing thoughts and we covered internal marketing last week. We were just about to get into External Marketing and the idea of the first big three means of external marketing which can be thought of as shotgun marketing. 

So, let’s pick back up where we left off last week. Here we go. 

#2 External Marketing

Now, let’s move on to External Marketing. This is the traditional marketing we think of. Things like:

  • TV
  • Radio
  • Billboards

Let’s talk about those three first. We can call that shotgun marketing because you are hitting random people with random pebbles. You can’t laser focus marketing with a cannonball this way. You can only hope that someone that would be interested in you happens to see your message. Some will. Most probably won’t. 

Don’t worry if you’ve fallen for some of this crap. I spent $19k one year to have the front page corner of the yellow pages. Now, that was years ago when everyone actually used the yellow pages but, trust me, I’ve done stupid crap too. 

Back to TV, no matter how smooth the sales reps are, more and more are unplugging. They’re using streaming services like Netflix or Amazon. Disney and Apple are jumping in with both feet too so sooner rather than later, I think the majority will not see a message on traditional TV. 

Same goes for radio. Hello, every heard of Sirius radio? Or, if you’re like me, I’m listening to a podcast as soon as I get in my truck to go anywhere. I don’t even listen to traditional radio anymore. If you do, I think you’re quickly becoming the minority. 

Billboards may make sense if you’re right off the highway and it leads people to your front door. Otherwise, I think it’s probably mostly a waste of money. Don’t get too tied up in whether or not you see your face or your name up on a big board or up on TV. It’s not real. It didn’t happen organically because you’re awesome. You put it there with your money. And you may have just wasted that money. 

Shotgun marketing can make sense but only after all of the base coat has been painted and now you’re just going for exposure and saturation of the market. I really don’t care what the sales reps say and how many graphs they show you. Those are manipulated to take your money. 

Another negative about shotgun marketing is that it is hard to track. Marketing needs to be traced and tracked. Either through computerized means or on a simple spreadsheet. Better believe I know where every single new patient comes from, who to thank, and where my bread and butter lies. 

Unless you’re really tracking well, many times you won’t know if someone comes in from a billboard, TV, or radio. Sometimes they’ll tell you straight up but sometimes they just don’t remember. 

But what about other means of external marketing?

What about things like:

  • BNI
  • Chamber of Commerce
  • Charity and philanthropy. 
  • Social Media
  • Sponsoring teams and events
  • If you want to do personal injury, wouldn’t you figure out how to attract and market that demographic?
  • If you wanted more pain patients, where do they hang out? Where do they go? Wouldn’t you want to figure out how and who to market for those people?
  • Direct mail – yes, it can still work and you can target it like a laser
  • Brochures
  • Marketing representative
  • Creating authority – talks, appearances, book, podcast, content creation, etc…

I have so much on external marketing. The options are endless and we could talk about them for ever. I’ve tried them all. Trust me. 

Something I forgot to mention in the beginning is the fact that marketing is always changing. It’s not a set it and forget it endeavor. You have to be on it all of the time. Yellow Pages anyone? Hello….Bueller. 

#3 Who You Are

As I said before I add this third one because we are in a personal business. You’re not a big brand like Coca Cola. Coca Cola doesn’t have a face. It doesn’t have a name behind the brand. While some would argue that it does, in the context I mean it in, Coca Cola does not have a personality and it damn sure doesn’t have a relationship with it’s drinkers. 

You could say that #3 really has more to do with internal marketing but I think it’s a cross-over thing. Who you are, your vibe, how you carry yourself….that all goes into making your business what it is and makes your reputation what it is. 

For a smaller community, this is even more vital. For a city, still vital. You are attracting people or you are repelling them. It’s not very often that you have not effect or neutral effect on people. Right? Do you ever leave a conversation or a personal encounter with someone with absolutely zero feel about it? You get the point. 

So, what if you spent on average $150 per each new patient that gets on your schedule? There are some pretty good stats you can keep on this stuff. What if you invested $150, they come to your door, you’re having a bad day, rush through their exam, are a bit of a jerk about them doing exactly what you recommend, and then maybe there’s a snafu at the front desk when they pay out because you were too lazy to get the staff trained appropriately?

You may have made the $150 back up but you’re probably not going to profit on that patient because of YOU. Your vibe was crap. You didn’t want to be there. You didn’t want that patient there. You didn’t train your front desk right. And now YOU probably won’t have another visit with that patient. 

What if you are at an event, you woke up that morning and stepped in dog crap, and that just set the tone for the day. Now you’re at this event you don’t really feel like being at and everyone can tell. Mr. Sourpuss chiropractor over there sucking on a whiskey sour with his sour face. 

These are dumb simple little examples but who you are, how you are able to talk and communicate to people, and communicate what you do can make all of the difference in the world. If you’re positive, energetic, smart, and capable…..Boom. The battle is won. 

Eyore from Winnie The Poo on the other hand gets no patients. Only your mom is coming to see you. #66 in town, #1 in mama’s heart. 

More than personality though, you MUST be a real person. Don’t pretend. Don’t sell. Patients smell that garbage a mile away. Be AUTHENTIC. That’s a key concept in marketing. 

It’s the stuff you learned in kindergarten. Treat others the way you want to be treated. Honesty, ethics, forthright, stand up, and gentlemanly or lady like. Professional. These are so important. What about loving? Of course. You better love your patients and you better love your staff. 

Our practices are made up of lots of relationships and if you aren’t interested in people and relationship building, I’m afraid no amount of marketing will make it OK or will make you succeed. No amount of money. 

When you’re providing quality care with responsible recommendations, and you salt and pepper that delicious brew with a little love and personality, you got a winning recipe on your hands. I like cajun food so I add even more personality to my spicey brew!!

Boom snap pow!

I mentioned this earlier but, I think the biggest key to anything business related is keeping and tracking stats effectively. Do you know the exact number of new patients you got last month from Google or Facebook or Instagram or from referrals from your existing patients? Do you know how many new patients you got from your own staff referring people to you?

Do you know your PVA? Do you know how much you make per patient encounter on average and how much it costs you in marketing dollars to get a new patient in your doors? Do you know what your average profit per patient visit is each month or what it averages over the course of the year?

If you can’t answer these questions, you have to figure out how to answer them and you need to do it yesterday if you get my drift. 

These numbers and metrics aren’t only important to your marketing efforts. They’re important to your business in general. How can you possibly know your return on investment for anything you do in your business? It sounds crazy to say it, right? For so many of us, record keeping and stats are just second nature. But, I wasn’t always there. I had no idea where I’d been and not a clue where I was going.

I was like a drunk pin balling off of the walls trying to get somewhere and falling down every so often. 

I’m not just trying to relate to you on some level. That’s real talk. I was on an island for so many years. No colleagues to bounce ideas off of or to ask for help. No association involvement, no network. No real continuing education. I came late to the party. But, with knowing I was coming late to the party, I jumped in with both feet, man. 

Gimme the bottle of tequila, the bottle of vodka, and throw in some fireball on top of that. Let’s get there as fast as possible. 

That’s what I did with being a chiropractor. 

Now, as far as the stats keeping, I’m working on a solution for those of you that might be interested in getting some help with keeping stats. Something that will make it easy and fast. Yes, it’ll have a monthly cost but it won’t be ridiculous and you can only pay for what you think you need. Different levels…that type of deal. But, it’s in the works and I’ll let you know more about it when we get it up and running. You numbers nerds will love it. 

Some other random thoughts and musings:

  • Having something to talk about is always important. Especially on social media. If you’re talking, people are typically listening. Even when you think they aren’t
  • Make sure your website is doing what it’s supposed to do for you. IF you can’t do it, hire it out. It really is that important. 
  • IF you can learn YouTube videos, learn it and do it. Even if you think you suck on screen. It’s important. 
  • Eliminate the risk. Do what you can to remove any and all obstacles to coming to see you. Is your insurance staff making the payment process a little bumpy? Fix it. Are people wanting to fill out paper work online but you don’t have that? Fix it. Does the majority of your population want to come in from 5-6 and you’re closed at 5? Fix it. Not for just one or two people but if the majority needs that time block, give it to them. Just remove the obstacles. 
  • Be the expert that you are and be the expert everywhere your market will allow you to be the expert. Clubs, associations, boards, etc…
  • The secret to referrals is the difference between satisfaction and enthusiasm. 

Things NOT to do pretty please for the love of all that’s holy. 

  • Do not put your office and profits above your patients for any reason ever. 
  • Do not scare patients into care. It’s rude and it’s unethical
  • Do not use curve correction as a reason to manipulate patients into setting up 70 visits. It’s rude, it’s borderline unethical, it makes all of us look bad, your actions really do reflect on the rest of us, and there’s no good, non-biased research backing the notion that curve correction matters at all. 
  • Don’t do dinner with the doctor unless you truly are simply trying to build authority in your community. If you are using them as bait and switches where you get someone in for a $29 initial treatment and then scare the crap out of them to make them sign a contract for $3500 over the course of a year, then YOU are the problem with this profession. 
  • Oh yeah, contracts between doctors and patients do not belong in healthcare. It’s embarrassing. Please stop if you do it and never start if you don’t. 

Just be honest, ethical, put the patient first, behave in a manner that would make the chiropractor next door be proud to be a chiropractor, and take care of your patients by following industry standards for treatment. Keep learning and expanding your knowledge. Be the smartest in your town. The more real, research-backed education you get the better you’ll understand things in the profession and the better you’ll understand how to carry yourself. CCSP, Diplomates, etc. 

Basically, have a moral compass which sums it up.  

So, there’s the quick form of a marketing seminar.  We could spend an hour on each one of these little nuances to marketing and could go on and on and on. 

Again, if any of you want me to put together a more robust marketing talk and have me present it for your group or association, let me know and we can see how we can make it work. 

If you have any questions or ideas, shoot me an email at dr.williams@chiropracticforward.com

I hope you’ve enjoyed my marketing talk. I literally sat down and just started typing. Yes, I’m sure I didn’t cover everything as thoroughly as you’d like but, if you’re really paying attention, I gave you some good solid cement to build a base out of. 

Key Takeaways

  • Have a USP
  • Have a marketing meeting regularly
  • Set goals
  • Be honest, ethical, loving, authentic, and don’t sell people
  • Don’t push people and scare care is crap care. 
  • If it takes you 100 visits to help someone, you could get better at what you do
  • Internal marketing means as much as external marketing which means as much as who you are and how you communicate and carry yourself. 
  • Track EVERYTHING

Store

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

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

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

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

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

iTunes

https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

Player FM Link

https://player.fm/series/2291021

Stitcher:

https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

About the Author & Host

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

Big Ideas On Marketing Evidence-Based Practices (Part One)

CF 098: Big Ideas On Marketing Evidence-Based Practices (Part One)

Today we’re going to talk about marketing. Specifically, marketing an evidence-informed chiropractic practice. How do you do it and do it right?

But first, here’s that sweet sweet bumper music

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

OK, we are back 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. It’s like we’re talking about research over beers. Which is NOT like talking about research in a classroom or an institution of some sort. Accessible research if you will. I could be more professional but I’m not. 

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, and go to our Store link at chiropracticforward.com and check out the goods. That’s it. Not bad right?

You have collapsed into Episode #98 which means I’ve been doing this thang of ours for a r solid 98 weeks now without missing a single one. It hasn’t always been easy to pull off either but I’m committed. I hope you are committed to listening and helping grow this thing as well. 

Now, if you missed last week’s episode, it was Part II with Dr. James Lehman and, if his episodes didn’t get you to thinking and didn’t get your wheels turning, you just don’t have the entrepreneur mindset about you and that’s OK. But, if you do, you need to make sure you don’t miss those two episodes!

make sure you don’t miss that info. Go listen now. Keep up with the rest of the class won’t you?

I usually do a personal section here but I’m just going to say that our topic today is huge. Marketing is absolutely multifaceted and they have college degrees on the topic so it’s big and we’re just going to dive right in. 

ChiroUp.com

Before we get too deep 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 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.

Marketing Authority

OK….marketing evidence-based practices. Where to even start? Isn’t it fascinating that just changing the color of a girl’s shirt from black to red to blue can get more attention and can invoke different emotion in a potential buyer? Blue is healing. Red is emergency and urgent. Green is money. Black is executive. Orange is just stupid. Lol. 

Let’s start with authority. What on Earth makes me a person that is qualified to talk about marketing. Well, most people that actually know me or have watched me over my career probably don’t have that question in their minds. They’ve seen what I do day to day. It’s pretty obvious. 

For those that don’t know me or my practice, let me say these things in an attempt to show authority and NOT in an attempt to sound like a big shot or to brag. That’s not the intention here. 

I’ve been at it almost 22 years and, to an extent, I gave everyone else a 7 year head start. If you are more than just a casual listener of the show, you probably know that I was a traveling musician for the first 7-8 years of my time in practice. I didn’t market. Learning more and educating myself was off the table. I didn’t pour my heart and soul into chiropractic and building my practice. I made all I could Monday – Thursday and then hit the road with the band to go play music. Where energy goes, attention flows. 

It’s a fact. So, while I gave everyone a big head start on me, I believe I have caught up and passed a whole bunch of them. On average, as a solo practitioner, I get about 80+ new patients per month. That’s vital to practice health. If I’m not going to scare care people into a million visits, then I’d better have a steady stream of new ones. 

If you like the stat we call PVA, patient visit average, mine is about 9 or 10. Which means, on average, I see patients over the course of their lifetimes about 9 or 10 times. To put that into perspective, the more philosophy, subluxation based, vitalistic, holistic practitioners will see PVA’s of 40, 50, even 100 in some offices. 

That is probably the key difference between evidence-based and philosophy-based practice. If you get people better and back to their lives honestly and ethically and in 10 visits, and research doesn’t support the construct of correcting curves and seeing people 100 times, then why on Earth would you do that? Other than for financial means, of course?

Now, marketing….yes….I see roughly 80+ new patients per month and that turns into about 180-220 patient encounters per week. Yes it can be done because I do it. Yes you have to have a big, well-trained staff to pull it off. That’s a whole other episode. The point is, for an evidence-based practice, I think we can agree that we’re doing something right in regard to marketing in order to make it all happen. OK? OK….

Seminar

Now I have considered putting together a short weekend seminar on this so, this may just form the framework to it. If any of you have an organization or association that you’d like me to build this talk for, shoot me an email at dr.williams@chiropracticforward.com I’d love to see how we can work together on it. 

Introduction To Marketing and Patient Expectation

Let’s dive in. First thing you have to know is that, in your marketplace, trust is #1. How do we build trust? I’d argue you build trust through a consistent history and track record of making smart, factual posts on Facebook. Pumping out marketing, talks, or material that sets you up as the authority when it comes to smart, responsible, reasonable options and alternatives to what your patients see everywhere else. 

Patients are not dumb for the most part. They do not want to be sold to. Let me repeat that. They do not want to be sold to. Trust me, they smell a snake from a mile away. Outside of scaring the crap out of them, you cannot get them to see you a million times. They didn’t come to you for that, they don’t want that, and you can’t talk them into it either without making a fool of yourself and out of other chiropractors. 

So, the 50-100 PVA……throw that out the window. That’s not real world stuff if you are doing what is real, reasonable, and responsible. Most of the docs using that out-dated construct use information from one or two guys that is over a century old or they’re using questionable research done to prove a system. A system that the ‘researcher’ sells and makes money from. Bias maybe? Um….yes. Muy biased as they say in Texas. 

So, for me, that practice construct is out the window. I focus on pain, disfunction, movement, and strengthening. If I were Joe Blow off the street that hurt like hell, what would I find more appealing and more respectable? Would it be ‘let’s correct that curve through 50-100 visits or you’ll be in pain and be sick your whole life, especially in 30 years’? 

Or would it be “research shows we can usually do something about that pain you’ve been having and we can usually do it in anywhere from 3-20 visits or so depending on the patient. We’ll use strengthening, exercise, we’ll use chiropractic adjustments, we may use some massage and muscle work, we could use some balance training, and maybe acupuncture to accomplish it but we can usually either make it better or get it knocked out completely.”

Well, my money is on the last one and I’d be bold enough so suggest that your marketing should reflect this way of practicing. Yes, it’s focused on pain. And isn’t that OK? Pain affects almost everyone in the world so why on Earth would focusing on pain limit our reach and limit the pool of potential patients? Hell, I think there are more worried about getting our of pain than are interested in wellness care honestly. With that  being said though, you can treat patients for their pain but you can certainly market and treat wellness patients as well. The more lures you have in the water, the more fish you catch. No doubt. They’re not mutually exclusive. 

Dan Kennedy

One of my all time favorite marketing sayings is from Dan Kennedy. He calls it “YCDBSOYA” and that stands for ‘you can’t do business sitting on your ass.” So, if you think you’re going to sit behind your desk and post a couple things a week on your Facebook page that has like 250 likes on it and that’s going to make the difference for you…..I have some disappointing news for you. You’re wasting your time. 

I think the next steps in marketing would be to define your market and your demographic. Get very clear on who they are and how you should best communicate with them. 

For example, if you’re a sports chiro, you better be marketing athletic trainers, coaches, PTs, soccer moms, off-campus sports programs, and other sports experts in your market that may be sources of referrals. 

But, make sure you REALLY are a sports chiro. Go get your CCSP or your CSCS or a Diplomate in Chiropractic Sports. Don’t just have a passing interest in sports so you decide to call yourself a sports chiro. Otherwise, your house of cards WILL fall and it’ll fall in a way that embarrasses you and gives other chiropractors a bad name. 

Market what you are. Not what you’d like to be someday. Now that you know who you’re marketing, where do they hang out? What do they do? How do they think?  How would their lives be easier if you’re in it? what makes you the best option above and beyond anyone else in your market? When you answer these questions, you have a head start on finding these people and getting your message to them. 

Now that you’ve defined your market and where they hang out, you need to define your service. You need to be crystal clear on what it is you do and how you want to communicate that message. No confusion. No chiro speak. Simple, relatable terms. It’s called a unique selling proposition or USP for short. 

USP

A USP could be something similar to ‘We help everyone from Moms to top-notch athletes solve short term and long term pain in as few visits as possible, based on what the research shows is effective and safe, so that they can live their lives with less complication and more enjoyment.”

Bam snap pow

Could that use a little work? Well hell yeah but what do you expect for something that I just took 3 seconds to think up and type down? Come on man. Cut a brutha some slack. 

But that’s a quick example of a USP and that should be the over riding message that you are communicating to your chosen target demographic. 

The next thing that’s important is goal setting. What is the goal of your marketing? New patients? long-term treatment plans? Pain resolution? Mom’s this month? Sports people this month? 

Not just goal setting but mostly meetings with either yourself or with your marketing representative. Did we accomplish our goals? Why did we or why did we not? What could we have done better? What are we going to focus on this month? 

If you are not setting time aside to evaluate goals and you are not tracking your marketing efforts as well as your marketing results, you are driving in the fog without a map people. 

The old saying will hold true until the end of time. If you can measure it, you can improve upon it. When things are quantified and recorded, you now have a number. A number to chase and a number to improve. A more quantified goal if you will. 

Now tools that are important to disperse and build on that message…. My view of marketing may differ a touch than some other. I believe You need a three-pronged approach to marketing. Most focus on #1 and on #2 but I think there are three points to be made here. They are:

  1. Internal marketing – inside your practice
  2. External marketing – billboards, in the public
  3. Your vibe – who you are – everywhere

Let’s start with #1

Internal marketing. Did you know that people that have already done business with you before, assuming you treated them right and they’re happy, those people are the cheapest and most fulfilling to market to? 

They’re easy to reach because you already have their info. People like this are more eager to help you. They’re happy to refer but most of us just don’t ask. If they don’t know you need their referrals, they won’t think about it. It’s nothing against us. We’re just all busy and, many times, if we’re not told, we just don’t think about it or know about it. 

Most of the really really busy practices are so busy because they are actively marketing internally as much as externally. 

Some of the most effective internal marketing techniques consist of simple things like:

  • The first and most important aspect of internal marketing is patient experience. What does your office look like when they come in and when they walk around the place? How do you treat patients? What are they thinking when you’re explaining things to them? What are they thinking when they’re walking back to their cars? I’ve had patients that I could have been meaner to just to give them that pop that we all love but, would they be walking to their cars feeling like they just got crapkicked in the alleyway? Shouldn’t a visit be something a patient looks forward to rather than a visit they are happy they survived? Did you greet them with a smile and a handshake? Did your front desk staff greet them by their first name? Was your rehab staff knowledgeable and understanding of their specific challenges? Were you a pushy jerk about your recommendations or were you firm with recommendations but understanding of finances, travel concerns, and things like that? The real world does exist ya know. All of these things go into a patient’s experience and you better believe they make up their mind VERY quickly whether they like you and your place or not and, if not, you start behind the 8 ball and had better put on your charming pants if you want to turn that tide around. 
  • An email list – cheap and easy. And yes…..still effective. Just ask Kevin Christie with the Modern Chiropractic Marketing podcast. He just did an episode on it. 
  • A testimonial book in the lobby – Think that’s an out-dated idea? Go read Influence by Cialdini and check out the section on group think or peer influence. 
  • What about office flyers for some new information you just discovered?
  • Brochures? Well, you know I’ve created evidence-based brochures for my office and for yours if you want to purchase some. So you know I’m all about brochures. 
  • Music
  • Smell
  • In-house events – talks, patient education
  • What about encouraging online reviews and Facebook check-ins? Patients don’t think of these things so you can’t be shy about telling them what you need from them. 
  • How about thank you letters to your patients when appropriate. What if one leaves you a Google Review? Wouldn’t it set you apart if you sent them a handwritten note? Of course it would and I promise a lot of you have plenty of time to do it. 

These are just a few of the things you can do with internal marketing but there are a lot more things. We could dive into specific tactics on each of these but, again, that could be its own seminar down the road and doesn’t necessarily fit into the podcast format. 

Store

I will hopefully have something in place to help you track metrics soon enough. Also 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 that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

iTunes

https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

Player FM Link

https://player.fm/series/2291021

Stitcher:

https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

About the Author & Host

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

w/ Dr. James Lehman (Pt. 2) – National Scope, Chronic vs. High Impact Chronic Pain, Coordinated Care/Medicaid, DACO to DIANM

CF 097: w/ Dr. James Lehman (Pt. 2) – National Scope, Chronic Pain vs. High Impact Chronic Pain , Coordinated Care/Medicaid, DACO to DIANM

Today we’re going to be talking with Dr. James Lehman. This is Part Two of the interview. If you are just now joining us and did not get to hear Part One, make sure you do so. When Dr. Lehman speaks, you don’t want to miss a word. We’re going to cover topics like implementing a national scope of practice, chronic pain vs. high impact chronic pain, and topics like should a chiropractor own rural healthcare clinics and chiropractors working in coordinated care and medicaid integrated settings. 

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 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. It’s like we’re talking about research over beers. Which is NOT like talking about research in a classroom or an institution of some sort. Accessible research if you will. I could be more professional but I’m not. 

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. We have a youtube channel and twitter too but those are the main things. 

You have collapsed into Episode #97

I always do a little update on my personal practice and life in the trenches. In the real world if you will. Instead of that, I want to say that last week, I was scrolling through my Facebook page and Dr. Lehman and I are friends on Facebook. 

I noticed a picture he posted laying in a hospital bed watching his beloved St. Louis Cardinals play on TV. 

It turns out that just last week, Dr. Lehman suffered a myocardial infarction. I normally wouldn’t mention this but, I figure if it’s posted on Facebook by the man himself, he’s OK with it. 

Anyway, the main reason I mention it is to ask you all to say a prayer for Dr. Lehman if you are the praying kind, which I most certainly am. If you are not, then please send some positive vibes, energy, or thoughts his way through the ether. Whatever it is, let’s give it to him because Dr. Lehman certainly has given us chiropractors a lot. 

Dr. Lehman, from what I can tell through Facebook and text, Dr. Lehman is doing well and on the mend. From me to Dr. Lehman, you have my prayers and thoughts and please get well my friend. 

Now, before we dive into this interview that we did a couple of weeks ago with Dr. Lehman, we have to pay the bills. 

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

Introduction of Dr. James Lehman

Now, let’s go ahead and get on with the reason we’re all here. Before we speak with Dr. James Lehman, I want to go through a little background information on him for you so you are well aware of who he is and where he is coming from. 

Dr. James Lehman is an Associate Professor of Clinical Sciences at the University of Bridgeport/College of Chiropractic and Director of Health Sciences Postgraduate Education (HSPED). 

Dr. James Lehman completed his MBA at the University of New Mexico and a doctorate in chiropractic medicine at the Logan College of Chiropractic in St. Louis, Missouri.

Dr. James Lehman is a board-certified, chiropractic orthopedist. He teaches orthopedic and neurological examination and differential diagnosis of neuromusculoskeletal conditions. In addition, he provides clinical rotations for fourth-year chiropractic students and chiropractic residents in the community health center and a sports medicine rotation in the training facility of the local professional baseball team. 

As Director, Dr. James Lehman developed the three-year, full-time resident training program in chiropractic orthopedics and neuromusculoskeletal medicine. The program offers training within primary care facilities of a Federally Qualified Health Center and Patient-Centered Medical Home. While practicing in New Mexico, he mentored fourth-year, UNM medical students. We could go on and on. 

In your article, you include a section titled “Modernization of Medicare and Medicaid Coverage” which will lead us nicely into one of the main topics of our episode today. In this section you mention how Article 2706 of the Affordable Care Act is supposed to prevent discrimination against chiropractors but, for whatever reason, it hasn’t. I’ve been hollering about this through my position with the Texas Chiropractic Association for years. You talk about this a little in the article but…..why do you think nobody is forcing 2706 down people’s throats and what would it take to take a stand against insurance companies with 2706 as the basis?

OK, coordinated care and Medicaid: a topic you are very knowledgeable. In fact, we have discussed the integration of chiropractors into the FQHC’s around the nation. FQHC, for those that don’t know means Federally Qualified Health Centers. One of our former podcast guests is Dr. Kris Anderson from North Dakota who just happens to be the first in his state to work in an FQHC. 

Can you tell us more about coordinated care and Medicaid and the initiative to get chiropractic care integrated more into that setting?

Alright, last on our list of things we must talk about is the topic you have done a ton of work on. I remember one of the DACO classes I had with you as the instructor. In the class, I recall you mentioning that we as a profession do not diagnose chronic pain syndrome nearly enough. It’s a big problem, and one I’ve become more and more engaged in through the DACO program, so let’s dive into the topic of Chronic Pain Syndrome vs. High Impact Chronic Pain. 

I’m just going to turn it over to you on this. The way I want to start is for you to just tell us what you think we as a profession need to know and we can take it from there.  Chronic pain is a huge topic that really can be it’s own year long topic of chiropractic forward podcasts. Chronic pain affects a huge number of patients.

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 that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

iTunes

https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

Player FM Link

https://player.fm/series/2291021

Stitcher:

https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

About the Author & Host

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

w/ Dr. James Lehman (Pt. 1) – National Scope, Chronic vs. High Impact Chronic, Coordinated Care/Medicaid, DACO to DIANM

Today we’re going to be talking with Dr. James Lehman. Yes, THE Dr. James Lehman and we are fortunate to have him with us. The experience and the common sense Dr. Lehman brings to the table is immense and I can’t wait to dive into it today. We’re going to talk about national scope

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 and accessible while we make you and your patients better all the way around. Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have collapsed into Episode #96

Now if you missed last week’s episode on chiropractic and opioids, on anti-inflammatory diets, and on screen time for kiddos…. make sure you don’t miss that info. Go back and listen. I think there were some good information there within so make sure you’re up to date and not falling behind the rest. 

Advertisement

We can’t get started without mentioning the sponsor of the show, 

It’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you’re a regular listener of our podcast, you know I used it since about June of 2018. Let me tell you about it. 

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

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

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

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

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

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

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

Introduction of Dr. James Lehman

Now, let’s go ahead and get on with the reason we’re all here. Before we speak with Dr. James Lehman, I want to go through a little background information on him for you so you are well aware of who he is and where he is coming from. 

Dr. James Lehman is an Associate Professor of Clinical Sciences at the University of Bridgeport/College of Chiropractic and Director of Health Sciences Postgraduate Education (HSPED). 

Dr. James Lehman completed his MBA at the University of New Mexico and a doctorate in chiropractic medicine at the Logan College of Chiropractic in St. Louis, Missouri.

Dr. James Lehman is a board-certified, chiropractic orthopedist. He teaches orthopedic and neurological examination and differential diagnosis of neuromusculoskeletal conditions. In addition, he provides clinical rotations for fourth-year chiropractic students and chiropractic residents in the community health center and a sports medicine rotation in the training facility of the local professional baseball team. 

As Director, Dr. James Lehman developed the three-year, full-time resident training program in chiropractic orthopedics and neuromusculoskeletal medicine. The program offers training within primary care facilities of a Federally Qualified Health Center and Patient-Centered Medical Home. While practicing in New Mexico, he mentored fourth-year, UNM medical students. We could go on and on. 

Welcome to the show Dr. James Lehman, it’s an honor to have you on the Chiropractic Forward Podcast this week. 

Let’s start with the topic that immediately impacts me. I have been telling our listeners for a year or more that I’m going through the DACO program. DACO stands for the Diplomate of the Academy of Chiropractic Orthopedists. Very recently, as in just a few weeks ago, I received notice that the designation has changed to DIANM which stands for the Diplomate of the International Academy of Neuromusculoskeletal Medicine. 

What was the impetus for the change and what all went in to making the decision, deciding on the name, and then moving forward with the decision?

You wrote an article recently that Dynamic Chiropractic published in their September 2019 issue. The title of it was “What Is Chiropractic? We Need A National Practice Act.” We are in a profession that seems to me to bristle at the idea of standardization. How has this article been recieved or is it still a bit too early to tell?

In the article, you say, “Limited Medicare and Medicaid scopes of reimbursement and individual state scope-of-practice restrictions reduce access to chiropractic wervices for patients in pain.” Can you explain how you think limited scopes reduce access and how a broader scope can help us? And how broad of a scope do you advocate for?

I would assume a national scope would be something the ACA would be in the driver’s seat for, which is something you mention in the article as well. Is this something the ACA is looking at? Other than resistance within our own profession, what hurdles would you see in the way of a national scope?

You say it’s not impossible to accomplish and offer 6 essential charactieristics which include:

  1. Chiropractic Physician designation. 
  2. The scope being determined by Doctoral and Post-Doctoral education, trainng and experience 
  3. Full management, referral and prescription authority commensurate with contemporary chiropractic education for patient examination, differential diagnosis, working diagnosis, and health assessment
  4. Full evaulation and management, referral and prescription authority commensurate with contemporary chiropractic education for the care and treatment of neuromusculskeletal and other health conditions or issues. 
  5. Full authority for the delivery of information, advice, recommendations and counseling regarding general health matters, wellness, and health optimization. 
  6. Full authority and adaptable requirements fo the management and training of health care teams and the participation in collaborative or integrative health care groups. 

When I read through that list, does anything jump out at you as being particularly radical or provocative to some chiropractors?

In your article, you include a section titled “Modernization of Medicare and Medicaid Coverage” which will lead us nicely into one of the main topics of our episode today. In this section you mention how Article 2706 of the Affordable Care Act is supposed to prevent discrimination against chiropractors but, for whatever reason, it hasn’t. I’ve been hollering about this through my position with the Texas Chiropractic Association for years. You talk about this a little in the article but…..why do you think nobody is forcing 2706 down people’s throats and what would it take to take a stand against insurance companies with 2706 as the basis?

OK, coordinated care and Medicaid: a topic you are very knowledgeable. In fact, we have discussed the integration of chiropractors into the FQHC’s around the nation. FQHC, for those that don’t know means Federally Qualified Health Centers. One of our former podcast guests is Dr. Kris Anderson from North Dakota who just happens to be the first in his state to work in an FQHC. 

Can you tell us more about coordinated care and Medicaid and the initiative to get chiropractic care integrated more into that setting?

Alright, last on our list of things we must talk about is the topic you have done a ton of work on. I remember one of the DACO classes I had with you as the instructor. In the class, I recall you mentioning that we as a profession do not diagnose chronic pain syndrome nearly enough. It’s a big problem, and one I’ve become more and more engaged in through the DACO program, so let’s dive into the topic of Chronic Pain Syndrome vs. High Impact Chronic Pain. 

I’m just going to turn it over to you on this. The way I want to start is for you to just tell us what you think we as a profession need to know and we can take it from there. 

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 that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

iTunes

https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

Player FM Link

https://player.fm/series/2291021

Stitcher:

https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

About the Author & Host

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

An Inverse Relationship With Chiropractic & Opioids, Anti-Inflammatory Diets, & Screen Time Might Make Dummies

CF 095: An Inverse Relationship With Chiropractic & Opioids, Anti-Inflammatory Diets, & Screen Time Might Make Dummies

Today we’re going to talk about the relationship between chiropractic and opioids, we’ll talk about anti-inflammatory diet ideas, and a little ditty about screen time and dumb butts. 

But first, here’s that sweet sweet bumper music

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 and accessible while we make you and your patients better all the way around. Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have slinkied into Episode #95

Now i you missed last week’s episode on my trip to St. Louis for the Forward ’19 seminar, decompression research, and young baseball pitchers, make sure you don’t miss that info. I’d like to think that all of our episodes are such that you walk away better than before you hit the play button. That’s my goal anyway. 

I usually am not at a lack of words when it comes to the personal side of what’s been going on lately. I have to say though, not much is going on around the office these days. It’s slower this week but not much slower. I’m just trying to get everything done. 

For a chiropractor, what exactly does that mean? Well, I’ve created two or three new graphics for social media posts and loaded them into the hopper for realease later this week. 

I proofread two blog articles my writer sent to me for two websites. I’ve gotten those posted after making corrections. 

I’ll be proofreading and scheduling my patient weekly email as soon as my staff member finishes it. 

I met with our marketing staff member to go over what marketing we are doing and want to do before she headed out onto the town this morning. 

It’s 1 pm and I’ve already seen two new patients and my fair share of established patients. 

I’ve dealt with a roof leak, a staff member that ended up with a migraine that required us to take her to be treated. Taht’sAn Inverse Relationship With Chiropractic & Opioids, Anti-Inflammatory Diets, & Screen Time Might Make Dummies a whole different crazy story. 

I get off early on Tuesdays to go home and study for the DACO part II test so I’ve got that going for me today. 

So…..my point is, even when we are a bit slower, we don’t slow down. Hell, that’s when we are actually able to ramp it up. 

If you are not doing external AND internal marketing consistently, you are behind your colleagues. Wake up. Dan Kennedy has a saying I follow. It’s YCDBSOYA. That stands for you can’t do business sitting on your ass. 

I hate a liar but I love a hustler. I mean that in the ethical manner. Not hustling someone as in lying and cheating for financial gain. I mean hustling as in constantly busy getting the word out about how amazing your office is. The more you hustle in that manner, the more business you see. It’s magical like that. 

You want a slow practice, sit on your butt in your office playing games on the computer. That’s exactly how you can accomplish that. 

You would have a hard time coming up with any form of marketing that I either have not tried or am not currently doing. I’m probably doing some marketing you’ve never even thought of. 

So, here’s your pro tip. When things get a little slower in the fall when the kids get back to school, that’s when you have the time it takes to really market effectively. So do it. 

I may end up doing a marketing epsiode. I should totally do that. If I forget in the next several weeks, y’all send me an email or two and I’ll do it. 

The first paper we’ll breeze across is a brand new one about the association between chiropractic use and opioid use. 

First, It’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you’re a regular listener of our podcast, you know I used it since about June of 2018. Let me tell you about it. 

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

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

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

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

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

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

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

Item #1

OK, back to the research. As I mentioned, this first paper is called “Association Between Chiropractic Use and Opioid Receipt Among Patients with Spinal Pain: A Systematic Review and Meta-analysis” Now remember, systematic reviews and meta-analyses are at the top of the research pyramid. It was authored by Corcoran, et. al(K 2019). and published in Pain Medicine on September 27, 2019…whoa….that’s like last week. Scorching hot off the presses, watch out, don’t burn your finger prints off….

Why They Did It

They wanted to investigate the current evidence to determine if there is an association between chiropractic use and opioid receipt. 

How They Did It

  • The study was as systematic review and meta-analysis
  • The databases mined for information were Medline, pubmed, embase, amed, cinahl, and web of science.
  • The search was through April 18 of 2018
  • They identified 874 articels 
  • Those were whittled down to 6 articles
  • 5 studies focused on back pain while one focused on neck pain

What They Found

In a random-effects analysis, chiropractic users had a 64% lower odds of receiving an opioid prescription than nonusers. 

Bam pop snap!

Come on MDs, DOs, and all of your flock. It’s time to start turning the back and neck pain folks over to the profession that continually proves, through research I might add, that we can get them better safely, effectively, non-invasively, non-pharmaceutically, with better outcomes assessments, and better patient satisfaction than any other healthcare practitioner in the world. 

If it’s really all about the patient, and you all REALLY mean that, then start referring these patients to evidence-informed chiropractors. Like yesterday. 

If you want to try PT first, OK. Do that. Then, when PT isn’t as effective as the patient was hoping it to be, send them to an evidence-informed chiropractor. 

That’s if it really is all about the patient. 

Item #2

Item 2 is from Harvard Health Publishing from Harvard Medical School and is called “Foods that fight inflammation.” (2014)They published it in June of 2014. It’s an older study. Old Man River, that old man river….

They start by asking what does an anti-inflammatory diet do? Your body creates inflammation in response to anything it recognizes as foreign. Things like microbes, plant pollens, and chemicals. That’s great obviously but sometimes inflammation persists right? The article goes on to state that many major diseases like cancer, heart disease, diabetes, arthritis, depression, and even Alzheimer’s have been linked to long-standing, chronic inflammation. 

Dr. Frank Hu, professor of nutrition and epidemiology in the Dept. of Nutrition at Harvard School of Public Health says, “Many experiemental studies have shown that components of foods or beverages may have anti-inflammatory effects.”

Wouldn’t it be nice if we can reduce our risk of these deadly serious diseases just by eating more of the right stuff?

First they list foods they have identified as CAUSING inflammation so that you can stay away from them. Take a deep breath, this is going to hurt a little bit. OK, it’s going to hurt a lot. 

  • Refined carbohydrates – yes, white breads, pastries, noodles, yep I know
  • French Fries – no real loss there. 
  • Soda and other sugar-sweetened drinks. Honestly, if you’re still drinking soda as an adult, you’re behind the curve. 
  • Red Meat – like burgers, steaks, and processed meat like hot dogs and sausage. Although I saw a report this morning that red meat isn’t as bad as they thought. 
  • Margarine – shortening, and lard

The anti-inflammatory foods they highlight are:

  • Tomatoes
  • Olive oil
  • Green leafy vegetables – spinach, kale, and collards
  • Nuts – almonds and walnuts
  • Fatty Fish – like salmon, mackerel, tune, and sardines
  • Fruits – strawberries, blueberries, cherries, and oranges. 

That would be a brief overview of the article but I’d encourage you all to go read the whole thing. Very interesting stuff. I just wanted to give you the short version of it. 

Store

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

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

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

Item #3

On to our last item here. It doesn’t have anything to do with musculoskeletal issues but might be a little something you could print up and put in your lobby for your patients to look over and think – Dayum. 

It’s called “Association Between Screen Media Use and Academic Performance Among Children and Adolescents A Systematic Review and Meta-analysis” by Adelantado-Renau, et al and published in JAMA Pediatrics on September 23, 2019(Adelantado-Renau M 2019). 

Why They Did It

They were trying to find out if there was any association between screen-based activites and academic performance areas among children and adolescents. 

How They did It

  • They took 58 cross-sectional studies, television viewing and video game playing were inversely associated with academic performance. 
  • In addition, it was more profound in adolescents than it was for the smaller children. 

Wrap It Up

  • Television and video games were the worst of the screen time culprits. 
  • This study suggests that education and public health professionals should consider screen media use supervision and reduction as strategies to improve the academic success of children and adolescents.
Chiropractic evidence-based products
Integrating Chiropractors
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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

iTunes

https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

Player FM Link

https://player.fm/series/2291021

Stitcher:

https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

About the Author & Host

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

Bibliography

  • (2014). “Foods that fight inflammation.” Harvard Health Publishing https://www.health.harvard.edu/staying-healthy/foods-that-fight-inflammation.
  • Adelantado-Renau M, M.-U. D., Cavero-Redondo, (2019). “Association Between Screen Media Use and Academic Performance Among Children and Adolescents A Systematic Review and Meta-analysis.” JAMA Pediatr.
  • K, C. (2019). “Association Between Chiropractic Use and Opioid Receipt Among Patients with Spinal Pain: A Systematic Review and Meta-analysis.” Pain Med.

Forward ’19, Decompression Research, Curveball or Pitch Count?

CF 094: Forward ’19, Decompression Research, Curveball or Pitch Count?

Today we’re going to talk about my Forward ’19 experience, we’ll talk about decompression research, and we’ll cover some new research on whether it’s the curveball or the pitch count that injures young players on the baseball diamond. 

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 and accessible while we make you and your patients better all the way around. Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have rattled and rolled into Episode #94

Now if you missed last week’s episode on the bigger the disc the better and what early improvement in treatment tells you, make sure you don’t miss that info. Every episode offers some good take-aways so make sure you’re up to date and not falling behind the rest. 

I like to look at this podcast as an ongoing, fun way of learning and making each other just a little bit better every week so don’t just hop in for one episode. Stack them up one after another and, before you know it, you’re going to start retaining the info and you’re going to start recalling something we talked about down the road when you’re interacting with a patient and they ask you a question. 

You’ll see. Even though I’m the host, it happens to me. Someone will ask me a question and I’ll remember an episode we did on that topic and BOOM!! Pow!! There it is, the answer comes to me. Pretty cool. 

Forward ’19 – For you newbies here you’re probably wondering what the hell Forward ’19 is. A quick rundown is that it is a yearly seminar/conference that was born from an online Facebook group called the Forward Thinking Chiropractic Alliance aka FTCA. They have a website as well. 

The group is very much evidence-based or evidence-informed. Whichever is your preferred verbiage. The group has about 7800 or so doctors in it and they are interacting on a daily basis mostly to try and make each other better. Overall, it’s a good group. I’ve heard people griping because they see griping here and there in the group but, in general, it’s a very positive, very smart, and very helpful group. I encourage you joining it if you’re a doctor or student. 

Anyway, Forward 19 – What an event. The group puts on several events through the year but this is the key event put on by the FTCA every year. This is year #2. It was in St Louis at the campus of Logan Chiropractic College.

First thing is, holy smokes what a campus man. I bet they pay a fortune just to mow the grass. Just wow. The landscaping, the tower in the middle, and Purcer Center where it was all held. Just gorgeous. Having gone to Parker, that was the Chiro campus I’d been on and don’t get me wrong, Parker is impressive. I’d say Logan most definitely is as well. Kudos.

Speakers:

Gray Cook SFMA – SFMA stands for Selective Functional Movement Assessment – I have to admit that this was my first exposure to Gray Cook but it won’t be my last. I had heard of SFMA but was not all that familiar with it. I really enjoyed his talk and some of the concepts he puts forward. I can’t wait until I get through with my Diplomate program – hopefully in November – so that I can dive into Gray Cook’s stuff and just keep building on the knowledge pile. 

Greg Kawchuk – He is the Research Chair for the World Federation of Chiropractic. 

So, outside of the FTCA, I had little knowledge of Greg Kawchuk. But, Greg gave a speech at the World Federation of Chiropractic last year in Berlin that got some people a little fussy and some people elated. It definitely got the attention of chiropractors around the world to say the least. He gave the same speech last weekend in St. Louis and it had people on the edge of their seats. 

Backing up a bit, Greg is a dynamic speaker. One of the more humorous and engaging speakers I’ve seen in maybe forever. He’s immediately like-able and that make for a good speech from the top. The talk was all about putting the ACT back in Chiropractic. A play on the way the philosophy guys use the TOR and the TIC garbage. You know….the principled vs. un-principled hoohah. 

I happened to think that evidence-informed docs are the principled ones and if you need more info on why I think that, just go back about 3-4 episodes and listen to my podcast on the topic of Closing Patients. A principled, ethical person doesn’t carry themselves in that manner and the philosophy folks are much more likely to be out there closing patients than offering responsible treatment plans that are based on commonly accepted guidelines. In my experience at least. It’s always made me a bit hot under the collar when someone asks whether another chiropractor is principled or not. 

Makes me want to principle them in the forehead…..with a mighty slap. 

Anyway, putting the ACT back in chiropractic: he asked what are we doing right now? What are you doing right now to move the needle forward? To bring chiropractic into this current century we are in? He suggests we do a lot of sciencing and consume at least 1 science per day and I agree with him. 

Hell, here at the Chiropractic Forward podcast, we distribute about 3-4 sciences per episode so we almost got you covered for the whole week if you’re a regular listener. 

I think the part of his presentation that some took exception to was the part where he feels the evidence group may, at some point, consider a divorce from the philosophy geared group. He said it may not be an official divorce but could be very much a divorce in the way we act, carry ourselves, communicate with our patients, and things of that nature. 

He says, at the end of the day, it could be something similar to….. we went out for a pack of smokes and…..just never came back. 

Now, as you sit in your car or truck or your office hearing me say that, you can take that all in as you will. I’m going to tell you that, as a doctor that considers himself very much on the research end of things and very little on the philosophy end of it, and as a doctor that does everything he can to be ethical, honest, and all that…..it is so hard to sit and hear patients talking to me about being forced to sign of on a contract for thousands of dollars for a year long schedule for umpteen visits based on a curve correction that research suggests isn’t that big of a deal. 

It’s hard to hear about the knuckleheads in Oakland claiming they can reverse degenerative spurring by seeing someone 3x/per day for 3 weeks. It’s hard to watch Mr. man bun top not from the coffee house talking about fixing kids with no research to back his claims. 

It’s hard to hear about chiropractors scaring the crap out of patients with x-rays and convincing them that they are somehow damaged and in a dire circumstance unless they undergo 60 visits and another 3 sets of x-rays….

These are just a few of the stories. There are so so so many of them and at some point, I just don’t want to be associated with that anymore. At all. If that’s not understandable and that makes no sense to you and that makes you mad at me, well….I’d say I’m sorry but I’m just….I’m just not. 

Even though I don’t smoke in the physical meaning of the word, I think I went out for a pack of smokes and never came back about 15 years ago. 

Christine Goertz – If you are a regular listener of our podcast, you know Dr. Goertz has been on our show before and you know I’m a nerdy fan of her and her contribution to our profession. Any chance to listen to Dr. Goertz is a chance that should be seized upon. She’s a giant in our industry. 

Annie O’Connor – World Of Hurt – OK, I’m admitting something again. I wasn’t familiar with Annie O’Connor. Annie is fun and vivacious and really another very dynamic speaker but she is full of knowledge nuggets. The kind that you can really put to use. She spoke on how words can harm so how key communication can be for some patients. She talked about yellow flags and she talked about classifying pain patients so that we can help them with more efficiency. You can believe that World Of Hurt is on my reading list after Forward ’19. 

Greg Friedman – documentation  documentation. Greg is Greg. Smart, laid back, fun, and just likable immediately. It was great to get to meet him in person and share a good discussion prior to his documentation class. He’s full of excellent information and not just on documentation so, if you get a chance and you need the hours, search out a class. He’s flying all over the nation every weekend. 

Mike Massey – he shared teaching duties with Greg on the documentation class. He told me he’s a listener of our podcast and he’s an active member of the FTCA so I’ve been a fan of his for a while now. It’s always a cool deal to put the online world into a 3D context and it was sure nice to meet Dr. Massey. Hopefully next time I’ll get to sit and speak a while with him. I think our personalities probably match up pretty closely from what I can tell. 

Some of the others I got to see and speak with are Brandon Steele

Kevin Christie

Jon Morrison

Robert Jones, President Of The ACA was there the whole weekend sitting in on the classes himself. What a super guy.

Budweiser tour

Meeting people

Kris Anderson

Chris Howson

Rob Pape

Bobby Maybee

Bobby Mozafari

Mike Massey

Greg Friedman

Dale Thompson

Kevin Christie

Anne Maurer

My biggest regret is that I didn’t get any real one on one time with very many of these folks but That’s OK. All’s well.

If I didn’t come up and speak with you but you saw me there, please don’t take it personally, believe it or not, I have a bit of a shy streak. Once I’ve had a conversation with someone, it’s all good. But, if I don’t know you yet….ugh….I have a podcast. I was a traveling musicians for 7 years. Why would a guy like me be shy at all? Yeah I don’t know. I’m in control in those other situations. Maybe it’s when I’m not in control or I’m a newbie….who knows?

Anyway, if you ever see me at an event, regardless of the event, please come say hi. I’d love to meet you.

We are about to get to our two articles. One is new research on traction/decompression information for low back discs and the other is on young baseball pitchers and how the curveball isn’t the culprit. 

First though, we have backed off and rather than having two show sponsors, we have one and it’s a company you all know how much I love. 

If you’re a regular listener of our podcast, you know I used it since about June of 2018. Let me tell you about it. 

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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. 

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Item #1

The first article today is called “The effect of mechanical traction on low back pain in patients with herniated intervertebral disks: a systemic review and meta-analysis” by Cheng, et. al(Cheng Y 2019). and published in Clinical Rehabilitation in August 28, 2019. Smoking hot folks. Stand back. Watch your eyebrows!

First thing, recognize in the title there, this is a systematic review and meta-analysis. That’s at the top of the research pyramid. 

Why They Did It

To evaluate the effectiveness of traction in improving low back pain, functional outcome, and disk morphology in patients with herniated intervertebral disks.

How They Did It

  • They did a big time search PubMed, Scopus, Embase, and the Cochrane Library and they did this search from the earliest record all the way up to July 2019. 
  • They included RCTs that involved adult patients with low back pain associated with herniated disc confirmed by MRI or CT
  • RCTs that compared lumbar traction to sham or no traction
  • RCTs that provided quantitative measurements of pain and function before and after intervention. 
  • The initial search came up with 3,015 records which they whittled down to 7 involving 403 patients.

What They Found

Compared to the control group, the patients that had traction showed significantly greater improvements in pain and function in the short term

The differences were not significant enough to support the long-term effects on pain and function, nor the effects on herniated disc size. 

Wrap It Up

Compared with sham or no traction, lumbar traction exhibited significantly more pain reduction and functional improvements in the short term, but not in the long term. There is insufficient evidence to support the effect of lumbar traction on herniated disk size reduction.

Here’s where I’m at on that. I use decompression. I just need to know more about this study. Did they do simple traction? Did they do a cycling pull phase from a pull to a rest phase? How much weight was the pull? How long did they do each treatment and how many treatments did they do?

There’s also patient preference and clinical experience factoring into using decompression.

Reading down through this sucker, it’s just too varied to make any assumptions. The intervention programs differed among the studies from 10 sessions to 60. The treatment protocols varied from 2 weeks to 10 weeks. Some of the studies included had no information on the weight of the pull while a handful went up to 50% of the body weight. Some of the studies used continued traction while others had intermittent traction. Some even used self-suspended, inversion table type traction. 

Are you getting a whiff of what I’m dumping here? 

Out of the 7 studies they included, only 2 measure the disc height and one measured the disc ratio. 

Overall, when you read through the paper, these authors freely admit, this is a tough one but they wanted to start somewhere. They suggest several ways to go forward and say that there are a couple of studies out there that show a trend toward long-term decompression reducing the size of a disc herniation but no longer papers have been done to investigate it. 

It’s anecdotal as hell but I’m going to go ahead and anecdote the hell of you. Right to your face. Or….to your ears as it may be. I’ve been doing decompression for about 7 years and I’ve yet to see anything as effective. Including exercises, McKenzie, all of it. In some cases, it has absolutely amazed me. But, like I said, that is anecdotal but I hope some of these really super smart researchers out there in the profession start to dial down into it and figure it out. Mostly because I know it works. I’ve just seen it too many times. 

Item #2

This last item is called “Effects of a Simulated Game on Upper Extremity Pitching Mechanics and Muscle Activations Among Various Pitch Types in Youth Baseball Pitchers” by Oliver et. al(Oliver G 2019). and was published in Journal of Pediatric Orthopedics in September of 2019. Wait, it’s September of 2019 right now right? Steaming pile of fresh knowledge nuggets, big platter, sizzling. 

Why They Did It

The purpose of this study was to examine differences in pelvis, torso, and upper extremity pitching mechanics and muscle activations between the fastball, change-up, and curveball pitches in youth baseball pitchers following a simulated game.

How They did It

  • 14 youth baseball pitchers with no history of injury were included
  • All major muscles and mechanics were measured
  • The pitchers were instructed to throw with max effort during a simulated game that provided random game situations
  • They were limited to 85 pitches
  • Data from 3 fastballs, curveballs, and change-ups thrown in the first and last innings were selected for analysis

Wrap it up

The principle findings of this study revealed that pitching to the age-restricted pitch count limit did not result in altered pitching mechanics or muscle activations, and no differences occurred between the 3 pitches. These results support previous research that indicate the curveball pitch is no more dangerous for youth than the other pitches commonly thrown. This is supported by the pitcher’s ability to maintain a proper arm slot during all 3 pitches and indicates that they are obtaining the spin on the ball from their grip and not by altering upper extremity mechanics.

So….it is not the curveball it seems but, rather, it’s the pitch count in young pitchers, it’s treating them like professionals when they’re still developing, it’s that they tend to play only one sport aka specialize, and that they need to be treated like developing children and human beings rather than the Dad’s lost glory or a future paycheck for the whole family. 

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
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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

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About the Author & Host

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

Bibliography

  • Cheng Y, H. C., Lin Y, (2019). “The effect of mechanical traction on low back pain in patients with herniated intervertebral disks: a systemic review and meta-analysis.” Clin Rehabil.
  • Oliver G, P. H., Henning L, (2019). “Effects of a Simulated Game on Upper Extremity Pitching Mechanics and Muscle Activations Among Various Pitch Types in Youth Baseball Pitchers.” J Pediatr Orthop 39(8): 387-393.