chiropracticforward

CF 061: Faith-based Chiropractic, Ohio Lawmakers, & Chronic Neck Pain

CF 061: Faith-based Chiropractic, Ohio Lawmakers, & Chronic Neck Pain

Today we’re going to talk about another aspect or group that I find particularly troubling in my profession I call faith-based chiropractic, we’ll talk about some lawmakers in Ohio, and then we’ll gloss over a paper on chronic neck pain and balance. Stick around, it might get interesting. 

But first, here’s that ‘yummy in your tummy’ bumper music


Chiropractic evidence-based productsIntegrating Chiropractors

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

You have streamed you way into Episode #61

Before I make people mad, let’s talk a bit about the DACO program which is the Diplomate of the Academy of Chiropractic Orthopedists. I’m on it, I’m on it. I’m on it like stink on my teenager’s socks. You know what I’m talking about. I won’t even enter his room. It just has a certain smell that I want no part of. 

Continuing on with the eLearning episodes through the CDI group, I recently wrapped up one on Lateral Epicondylalgia just this morning and a few days ago finished up one on Fibromyalgia. Did you know the literature is pointing to those two conditions as being partly due to the central nervous system and what is termed central sensitization? 

It’s excellent information. If you want some guidance getting started on it, shoot me an email at dr.williams@chiropracticforward.com No, I don’t get a thing out of helping you or out of talking about it. Nothing at all. It’s just something I’m currently doing so it’s top of mind and I see the incredible value daily and am sharing that information with you. That’s about the total of it. 

I want everyone, as soon as you get to a computer, to go to chiropracticforward.com and click on the STORE link. You will find Posters and Brochures. The posters have some of my favorite and often-used sayings from the podcast. The brochures are evidence-based and are something I have been working on for some time now in my spare time. Now, if I can get some pre-orders ready to rock, we’ll get them ordered and sent on their way to you. 

I’d love to get your feedback on them at dr.williams@chiropracticforward.com

Introduction

Everyone on the planet knows there are two things you don’t talk about and they are POLITICS and RELIGION. 

For me, this here, what we’re about to go into….it has very little to do with the nuts and bolts of religion but more to do with the use of it. I’m going to touch on a very touchy subject and I hope that you won’t do the “poor me, I’m offended by everything on the planet” bit and get mad and leave and never return.

Rather, I hope you’ll hear what I have to say and hear it objectively and then, we either agree or disagree and we move on with our days with a common goal of getting people better. In the end, it’s just one dude’s opinion so let’s not get too worked up, OK? 

Faith-based Chiropractic

OK, let’s talk openly and honestly and hope we don’t make everyone mad. Here’s my deal people, I’m a Christian and have been all of my life. In fact, when I was younger as in junior high and high school, typically if the doors were open, I was there. Sunday morning, Sunday evening, and Wednesday night. Yep. Southern Baptist even although, now, I’m non-denominational. I found out I’m not as much of a fan of organized religion as I am of religion in general. When it gets too organized, I get less interested if that makes sense. 

Anyway, I’m a proud Christian but I’m not a loud or a bully Christian at all. If you come to my office, I’m not sure I have one cross in the whole place. That doesn’t mean I frown on you if you have Christian music playing through the speakers and you have scripture written on the walls. I honestly have no problem with that if it’s there for the right reasons. I don’t believe people are coming to my office for religion so it’s not right for me personally. 

I will admit, I’m a sculptor so several of my pieces are here. One of my pieces is called Road To Damascus and is about a story found in the Bible. I’ll post a picture in the show notes at www.chiropracticforward.com and you can just go to episode 61 if you want to check it out and see it. 

 

Damascus apostle paul bronze

saul apostle paul damascus sculpture

 

I feel like, since I AM one, I can talk about other Christians.

Lately, I’m seeing more and more posts and have been hearing more and more about Christian Chiropractors. I think the idea or concept of being a Christian Chiropractor is just fine. Honestly, I do. There are indeed people that would rather go to a like-minded practitioner rather than a Satan-worshipping chiropractor for example. Wouldn’t you agree? ‘Birds of a feather flock together’ is more than just a saying.

Much in the same way that some patients would just as likely AVOID a Christian Chiropractor if they themselves are not Christians. If someone wants to identify themselves as Christian, honestly, I’m cool with that. I don’t but I don’t care if you do. Not at all. 

Fair play to ya. That’s why we have different strokes for different folks and I’m so OK either way. There are Christian MDs, Muslim plumbers, Christian brothers car mechanics, Jewish this, and Buddhist that…. Whatever melts your butter and feathers your fancy. 

My Issue

My issue today isn’t one of religion vs. non-religion in all honestly. My problem lies in practitioners USING their religion to build their businesses and, in a most undesirable move, using religion to manipulate vulnerable patients for the purpose of padding their wallets. 

That’s a next level no-no in my book. Who cares about my book, right? Maybe nobody at all. Maybe around 8,000 people so far though so, it’s possible some actually DO care about my book so let’s keep rolling here. 

I want to make a distinction here. a Christian, according to the New Testament is charged with going and preaching the gospel. Save souls. There are some that truly feel that, if they are not doing that, they’re not fulfilling their mission. 

OK, fair enough. Who am I to argue that you’re wrong and who the hell am I to judge? If I were to say you’re wrong, I’d be arguing against the Bible and I’m certainly not going to do that. I have faults so I do what I can to stay in the good graces when at all possible. 

If it is honest and well-meant and you feel it in your heart to save your patients, rock on brothers and sisters. Amen & Hallelujah. 

But, if you mix religion into your business practices and protocols as a way to build your business by manipulating desperate and many times scared patients into seeing you, that’s where our paths go separately.

I cannot reconcile it in my mind how it would ever be right or permissible. I’ve never in my life gone to church to pick up business. I’m not there for that. It would be disingenuous and would defeat the purpose of being in the building in the first place. 

In the same way, I don’t use it to build my business in my office. I would not feel honest. I wouldn’t feel genuine. At the end of the day, if I’m anything, I’m those two things. Again, we’re all different but for me personally, it just doesn’t feel right. 

Example

Let me give you exhibit #1 for an example so you can see for yourself what I’m talking about. Here is an actual script folk.

“Mary, I’m concerned. I’m really concerned about you. When you don’t continue your plan to remove the subluxations that are interfering with God’s life force allowing it to innately flow from above down through your body in order to heal you, you’re not allowing God to do his part and heal your body. I understand that it’s hard getting here…but I have an opening at 5:30 tonight so we’ll see you then and let’s get you that life-saving adjustment tonight ok?”

That is a script used by a  popular company. They tell their members to say stuff like that. I’m not even kidding and, as I said, that’s some next level BS for me personally, in my practice. 

As a Christian myself I’m telling you, someone says something like that to me while I’m trying to get my issues resolved, the next thing they’re seeing is my ass as I walk out the door. 

First, I’m not there to be preached to. I go to church for that. Second, it’s obvious you’re trying to manipulate me into treatment using my religion and that just straight up pisses me off. Third, if God wants to heal a patient, why on Earth would he need a chiropractor to make that happen? 

Honestly. Think about it honestly. God moved heaven and earth. All-knowing. All powerful. But needs a chiropractor to facilitate your improved health? That’s insane in the membrane to me. 

What If

What if they said, “Mary, I’d never try to tell someone how to spend their money or how to take care of themselves because that’s none of my business. My job is to tell you what I think would be the best for you based on the idea that you live right next door and have no travel concerns, and you have all of the time and money in the world. What would I think would be best for you? Then there’s reality and my job is to be here for you however you want to use me. We don’t hassle our patients about their recommendations. Just do me a favor if you can’t do what I recommend, don’t tell people that chiropractic didn’t work. OK? Tell them you weren’t able to do what the chiropractor recommended. Is that fair?”

And all the people said, Amen. Literally, every single one of them agrees that it is indeed fair. 

Of course, I also tell them that if they love what we do for them and they get to feeling better, we’d love a great review on Google and Facebook but, if you don’t like us, just keep your mouth shut.” Of course, they know I’m kidding. Or am I?…..

The way I see it, I’m a specialist in what I do and that’s why a patient is here to see me and that’s what they will get. They’re not going to get politics and they’re not going to get religion either. 

As I said in episode #56 when I talked about the magical mystical disappearing arthritic osteophytes, although in many areas of the world it’s getting better, we are still in a battle with a medical community that wants to do away with us. We need to ask ourselves an honest question. Does this sort of stuff, put us at risk of continued ridicule? 

I doubt medical doctors are sitting around all over the country saying, “Mary, I’m concerned about you. If you don’t get this chemo followed by months of radiation, God can’t express himself fully in your body and your healing will not be complete, and you’re going to die.” “Mary, if you don’t take this oxcy, God won’t be able to calm down that issue long enough for us to make any progress in your healing.”

And, if you ever DO find one that does (there are always exceptions to the rule right?) if you find an MD that does that, the whole world is going to think he’s a coo coo loco and you might even see him on 60 Minutes one Sunday night. 

God, faith, religion, and spirituality are wonderful things. They’re the #1 things in the lives of so many people including ME. Just don’t dirty them or the profession by using them as marketing and worse of all….tools to work patients and manipulate them. Please….

I love your religion and I love your passion as long as it’s genuine. Once it becomes about business and becomes a tool to work people, you lose me. That’s all I’m saying. 

Hopefully, not too many of you lost the cheese off of your cracker on that. Let’s keep moving. 

Resource #1

I want to cover a recent article I noticed from WSAZ NewsChannel 3 up in Charleston, WV. It was written by Kaitlynn LeBeau called Ohio Lawmakers, doctors suggest chiropractic care instead of opioids(LeBeau 2018) and was posted on March 21, 2018. 

https://www.wsaz.com/content/news/Ohio-lawmakers-doctors-suggest-chiropractic-care-instead-of-opioids-477447883.html

It’s in WV but talking about Ohio and here’s what they had to say. The Ohio Attorney General and lawmakers held a press conference last March to talk about the need for alternatives to pain meds. The Attorney General, Mike DeWine, said: “More and more people are looking for new and innovative ways to treat pain.” 

Yes, we already know this but he also went on to speak about community health centers that include medical, fitness, social and educational services. We’ve already talked about chiropractors getting integrated into the Federally Qualified Health Centers and, yes….you have one near you whether you know it or not. Just Google the term “FQHC” and then the name of your city or region and see what pops up. 

Here’s what I really wanted to point out: we chiropractors have a powerful ally in American soldier, Staff Sergeant Shilo Harris. If you are not familiar with Sgt. Harris, he is located in San Antonio, TX last I heard unless he’s relocated. 

Anyway, on his second deployment to Iraq, he was injured by a roadside bomb. When I say injured, I mean big time. Go do a google search on Shilo Harris and you’ll see immediately what I’m talking about. 

Bless his heart and thank you for your service, Sgt. Harris. Heroes don’t play on a basketball court or football field. They fight selflessly and give of themselves for our freedom. For complete strangers, many of which don’t even like them. They fight for the love of country too, right? Just amazing people. 

He is quoted in the article as saying, “I’m here to tell you that chiropractic care saved my life. I became addicted to my medications, naturally, in a sense because I had had so many back to back surgeries.”

Sgt. Harris has presented at Texas Chiropractic Association’s events and will be at another TCA event in just a couple of weeks down in Austin that I’ll be at. I’m looking forward to hopefully meeting him myself. 

Resource #2

OK, next item: this one called “Evaluation of Postural Balance and Articular Mobility of the Lower Limbs in Chronic Neck Pain Patients by Means of Low-Cost Clinical Tests(Gomes P 2018)” It was authored Amy Pamela Karine Alvino Gomes, et al. and published in October of 2018 in the Journal of Manipulative and Physiological Therapeutics. 

Why They Did It

The purpose of this study was to correlate measurements of chronic neck pain with the balance and mobility of the lower limbs and to compare these variables between individuals with chronic neck pain and asymptomatic participants.

How They Did It

It was a blinded, cross-cross-sectional study

They had chronic neck pain patients as well as asymptomatic people. 

Outcome assessment tools were used to measure the difference in the groups. 

What They Found

“Young adults with chronic neck pain present changes in static balance measured by means of the Functional Reach Test; that is, the higher the intensity of pain, the lower the anteroposterior excursion of the body during the execution of the test.

This week, I want you to go forward with this: again, I’m all for religion. Ultimately, you do you. Just do it proudly, honestly, and genuinely. Always try to be someone your family can be proud of and be above reproach. 

I want you to know that Staff Sgt. Shilo Harris is awesome and he’s on our team so look him up and book him for your next association event or seminar or legislative effort. 

Chiropractic evidence-based productsIntegrating Chiropractors

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

Gomes P (2018). “Evaluation of Postural Balance and Articular Mobility of the Lower Limbs in Chronic Neck Pain Patients by Means of Low-Cost Clinical Tests.” Journal of Manipulative and Physiological Therapeutics 41(8): 658-664.

LeBeau, K. (2018). https://www.wsaz.com/content/news/Ohio-lawmakers-doctors-suggest-chiropractic-care-instead-of-opioids-477447883.html. WSAZ News Channel 3.

CF 052: Chiropractic Forward Podcast Year One Review

CF 014: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 2 of 3)

CF 046: Chiropractic Effectiveness – Chiropractic Integration – Chiropractic Future

 

 

 

CF 060: Medical Marketing & Integration Care Expectations

CF 060: Medical Marketing & Integration Care Expectations

Today we’re going to talk about medical marketing scoundrels and about what the multidisciplinary world expects of us chiropractors. 

But first, here’s that ‘goes down so smooth’ bumper music

Integrating Chiropractors

And we’re back. .Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  We are honored you’re spending some time with us and we hope we give some entertainment and some value in return. 

Introduction

You have disco’ed your way into Episode #60 just like John Travolta in Saturday Night Live. Kids, go Google that. It was cool back then. You could walk down the street in a Staying Alive strut man. Travolta was the bee’s knees back then wasn’t he? From Mr. Kotter, to Grease, to Staying Alive. Then turned kookoo wacko on everyone. He got so open-minded that his brain fell out and went splat. 

Let’s talk a bit about the diplomate of the Academy of chiropractic orthopedists quickly. That’s also known as the DACO program that I’m currently going through. I’ve officially hit the halfway point for the online hours and only have one class left for the live hours which I’ll get in less than a month down in Austin. Basically, out of 300 hours, I have about 125 left and have just been serious about this thing since October. Recent classes have been A Neurological Approach to Scoliosis, and the Neck and a Sense of Well-Being. 

I feel like it’s scooting fairly quickly at this point. It’s funny to watch my staff when I’m performing an exam these days. They’re familiar with the way I do exams and have done them for years. Just about every week, including this week, I’m adding or taking away from what I normally do. They don’t really know how to handle it. Lol. These classes really do change what you do almost immediately. 

If I can help you get started and rocking and rolling on your DACO, shoot me an email at dr.williams@chiropracticforward.com and I’ll be glad to point you in the right direction. 

New Year

How’s your new year starting? By the time this episode goes live, we’ll have been in it for a little over a month. I have to say that I’m confused this year. This is typically our slowest time of year. But, it’s going a little crazy this year for whatever reason. I have literally had 35 new patients in the last two weeks. It’s all I can do to get this podcast written each week, to be honest, but I’m committed. 

I actually had to come in on a Saturday to record the last episode because I just didn’t have the time available during the week to get it done. I’m not trying to brag. I think if you have a good staff, which I do, and you have them spaced appropriately, which I do, you can make your way through them while giving them the best care possible. Especially when you’re using post-graduate educations like the DACO to guide your exam and diagnosis. 

Crazy Busy

And, 35 new patients for my practice looks different than it may in a lot of clinics. I don’t see how many times we can run them through the doors. I don’t convince them their lives are at stake if they don’t see me 50 times this year. 

I used ChiroUp for all of my patients which I highly recommend. An additional $150/month seems like a lot. I know. But this programs is worth even more than that and they’re not paying me anything at all to say that. One of the things it does is track your patients through follow up emails. 

That’s how I know my case average, which is the number of times I typically see a person, stands at around 8 times while their national average stands at about 7 times. 

I know that my average improvement rating is 79.43% for ALL cases and that included everything from cervical radiculopathy and lumbar stenosis to cervicogenic headache and greater trochanteric bursitis. Their national average for improvement is 71.8% so I’m doing good there. If I’m getting 80% of my patients well, I’m happy. 

They have also tracked me at having a 98.6% likely to refer from my patients. Meaning, our patients are 98% happy to refer us to their family and friends and that makes me feel warm and fuzzy inside. I’d still like to know what I can do to make that other 1.4% happy but I think some people cannot be made happy at all. 

Even if you get them well and gave them free ice cream. They’d still gripe because the ice cream didn’t have chocolate syrup on it. You know those people. You know who I’m talking about, don’t you?

Anyway, the point was….I hope your 2019 has started off like my 2019. If it sustains, I’m going to have to get me some help in here! Including a nurse practitioner. Ahhhhh, the day I finally make that leap I may have a few hundred beers. Lol. 

Paper #1

The first item of research I want to get to is on medical marketing. Why do we care what the medical field is doing for marketing? Well, because they’re the main stakeholders in healthcare and it’s important to know what they’re doing. Either we can copy it or we can go 180 degrees from it depending on what we’re talking about. 

This paper we’ll talk about was in the Journal of the American Medical Association also known as JAMA on January 1, 2019, so it’s hot off of the press. It is called “Medical Marketing in the United States, 1997-2016” and was written by Lisa Schwartz, MD and Steven Woloshin, MD[1].  Please remember, if you’d like to see the paper, the methods, and that good hulabaloo….I always cite the papers at the end of the show notes over at chiropracticforward.com. This show is episode 60 just so’s you’s knows. 

Why They Did It

They wanted to answer the question, “How has the marketing of prescription drugs, disease awareness, health services, and laboratory tests in the United States changed from 1997 through 2016?” I think that’s a great question. 

Let’s find out, shall we? I say hell yes we shall!

As far as medical marketing goes, they say, “From 1997 through 2016, medical marketing expanded substantially, and spending increased from $17.7 to $29.9 billion, with direct-to-consumer advertising for prescription drugs and health services accounting for the most rapid growth, and pharmaceutical marketing to health professionals accounting for most promotional spending.”

Let’s dial down into that just a bit. 

As you are probably already guessing because you see this trash on TV every time you turn it on but the most rapid, crazy increase in medical marketing advertising was in the direct-to-consumer advertising. It went from $2.1 billion in 1997, which was 11.9% of the total marketing….it went from $2.1 billion all the way up to $9.6 billion and now, marketing meds directly to the consumer now make up 32% of the total spending. I say NOW….that was 2016’s numbers. Probably worse now.

They broke it down even further and highlighted the prescriptions that are marketed directly. The drugs you need a prescription for ….ads for them went from $1.3 billion in ’97 which was 79,000 ads, all the way up to $6 billion dollars and 663,000 ads in 2016. 

All I have to say here is, “Dayum.”

Then, I’m not done yet….hold my beer and watch this….Lol. That’s what I feel like here. Then, they say that medical marketing straight to healthcare providers like the MDs, DOs, etc….that marketing went up from $15.6 billion to 20.3 billion in 2016 but here’s what’s crazy when you think about it, folks, $13.5 billion of that was for free samples….OK, whatever. Then $979 million went to payments to physicians for speaking fees, meals, and things like that that were related to specific products. So they paid almost a billion damn dollars to MDs to go around medical marketing & touting their drugs.  

It’s insane. You cannot tell me no way no how that with that much money in the hopper, that we don’t have some nefarious skunky smelly dirty crap snaking around and messing with people for the worse. You can’t convince me of it and I’m not a conspiracy guy either. 

Like, when they say we didn’t land on the moon, it was shot in a studio in Hollywood? Yeah, they need a kick in the nuggets. Really? The Earth is flat? Are you sure? I’ve seen a lot of pics from outers space and round is what I’m getting people!! 

You see what I mean here but I also know people and I know what greed does to people. It’s insane, honestly. 

Pharmaceutical Commercials

Let’s talk about those medical marketing commercials for a minute. Let’s make up a name that sounds a little like a prescription. How about Killyametrix? Yeah, sounds good. OK, here’s how it usually goes, “Have you been having a hard time getting into your life? Are you just tired? No energy, no drive, no ambition anymore? Wouldn’t you like to have more energy? You’re too young for this. Killyametrix has been shown to increase energy and get patients back to enjoying their lives quicker and faster than any medication in the history of man that was ever made. There are some side effects. You’ll want to talk to your doctor if you experience any of the following symptoms: gout, liver failure, tumors coming out of your eyeballs, if your foot falls right off in mid-stride, high blood pressure, going cross-eyed, bleeding from the ears and fingernails, if your hair curls, if all of your hair falls out, or if your knee cap pops right off as you sit down and shoots straight across the room knocking someone out. Other than those issues, it’s a great drug. Try Killyametrix. Ask your doctor about Killyametrix and if it might be right for you.”

Here’s the deal, when I was growing up, did you realize whiskey, bourbon, scotch, …..the hard stuff…..it was never advertised on TV because they knew it was damaging to the population so why promote it nationally. I believe it was actually illegal to advertise the hard stuff but I’m not 100% on that. 

But, now, or at least in 2016, it’s OK to advertise prescription drugs straight to the consumer to the tune of 663,000 ads at a cost of $6 billion dollars. It’s lunacy. 

How about you go to your doctor with no preconceived idea of what’s wrong with you and he or she plays doctor, figures out what’s going on with you, and the DOCTOR, the actual doctor, decides what medication you need if any at all. 

Why don’t we try that crap out in America for a change? 

If I were an MD or DO, I’d be livid every time I saw one of those stupid commercials on TV. Hell, I’m a DC and I’m livid when I see them. 

Make me a crazy person. Makes me want to go live in a rubber room for a couple of weeks to decompress.

Paper #2

Let’s get to the last thing here. This one is called “Stakeholder expectations from the integration of chiropractic care into a rehabilitation setting: a qualitative study” by Zacariah Shannon, et. al[2]. published in BMC Complementary and Alternative Medicine in December 2018. 

Why They Did It

They say that few studies exist on what the expectations of chiropractic care really are within a multidisciplinary setting so they wanted to add to the literature on this topic. 

What They Found

They found that expectations for the chiropractic program in this study were mostly positive. Good news. The idea of the patients making progress was the overriding theme for the group. They expected the addition of chiropractic to help patients progress by improving pain management and physical functioning. 

In addition, they also expected indirect effects of chiropractic on healthcare integration. Things like increasing the patient participation in other providers’ treatments which would lead to improved care for the patient across the board. 

I wonder if those other providers were or will be helping increase the chiropractor’s load as well? That’s a good question to ask. 

Wrap It Up

They summed it up by saying, “Stakeholders expected the addition of chiropractic care to a rehabilitation specialty hospital to benefit patients through pain management and functional improvements leading to whole person healing. They also expected chiropractic to benefit the healthcare team by facilitating other therapies in pursuit of the hospital mission, that is, moving patients towards discharge.”

Not bad, not bad. It’s a helluva lot better than we had going on for us before the opioid crisis. I’ll give them that. I think the only part of this I really don’t like is their expectation of the chiropractor helping feed the rest of them while, in my biased opinion, they should be feeding the chiropractor first in an effort to keep people off of meds. 

Their stated goals are pain management and physical function. Well…that’s sort of right in our wheelhouse so why wouldn’t we be getting those first? I think the stakeholders have been fed quite enough. They’re fat as hell and slobbering. 

Bring the evidence-informed chiropractors in and watch your patients shine with happiness, leave amazing reviews, and go out and tell your city about all of the good things your clinic is doing. 

If they get the right evidence-based chiropractor in there, that’s the way I see it playing out because the research we covered several weeks ago shows us that chiropractors have the highest patient outcome satisfaction when compared to MD and DO’s, in fact, we wipe the floor with those people in regard to musculoskeletal issues. Not only that but we beat out the PTs as well on outcome measures. 

But we should feed them, right? They should be thankful to have us. 

Integrating Chiropractors 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

http://www.chiropracticforward.com

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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

1. Schwartz L, W.S., Medical Marketing in the United States, 1997-2016. JAMA, 2019. 321(1): p. 80-96.

2. Shannon Z, S.S., , Gosselin D, Vining R,, Stakeholder expectations from the integration of chiropractic care into a rehabilitation setting: a qualitative study. BMC Comp Altern Med, 2018. 18(316).

 

https://www.chiropracticforward.com/cf-025-vets-with-low-back-pain-usual-care-chiropractic-vs-usual-care-alone/

https://www.chiropracticforward.com/cf-032-how-evidence-based-chiropractic-can-help-save-the-day/

 

CF 027: WANTED – Safe, Nonpharmacological Means Of Treating Spinal Pain

 

 

CF 059: Don’t Be Dumb on Cervicogenic Headache

CF 059: Don’t Be Dumb on Cervicogenic Headache

Today we’re going to talk about headaches. More specifically, we’re going to talk about cervicogenic headaches. How can we recognize cervicogenic headache, and get better at diagnosing and treating cervicogenic headache?

But first, here’s that delicious bumper music

Integrating Chiropractors

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

You have crashed into Episode #59 like a bull in a china cabinet. You know, I’ve been told before that I’m a little like a bull in a china cabinet. That what I don’t break I poo on. Was that more palatable than some of the other words I could have used? I certainly hope so because me saying it that way just doesn’t sound very Jeff-like but I try to keep it mostly high brow and not too profanity-laced. 

DACO

As always, let’s talk a bit about the DACO program. I decided I kind of dread the eLearning episodes. Although the information is excellent, I’m one of those that doesn’t want to miss a word in the notes. These can be somewhat complex topics and, I’m afraid that if I miss something, it’ll be important and I’ll have trouble making sense of it all when I re-visit it. 

That could be my undiagnosed anxiety issue at play. Who the hell knows but it’s a fact so that means that I have to transcribe the entire 20-40 minutes of video or I’m not happy with the final result of the class. There are notes on these classes. A worksheet that helps organize it all but, there is a lot on the videos that is not on the worksheet so transcribe I must and I’m starting to despise that process. 

It’s admittedly a quirk of mine and probably won’t be your experience on the deal if you give it a try. As a result, I have started combining the Communication Drills. So I’ll take an eLearning episode and then I’ll take a Communication Drill and basically alternate them to keep me from getting burned out and to keep me moving forward efficiently. I’m averaging 8 or so hours a week so we’re still clicking along like a tired locomotive. 

Recent classes have been Managing Migraine Headaches, Diagnosing Cervicogenic Headaches, A Neurological Approach to Scoliosis, and Thinking Laterally With The Disc Patient. 

Coming Up

I gotta tell you, you all really liked the episode we did with Dr. James Lehman, episode 55, and the one we did on what I despise about this profession, episode 56. We are up over 7,200 downloads and that’s pretty exciting Y’all. This little thing of ours is rocking and rolling and shows no signs of slowing down either. 

That’s because THE Dr. Christine Goertz is coming on the show in late February. Wow! That’s a biggie! I’m going to let you in on a little secret. You’d already know this if you were in our private Chiropractic Forward Group on Facebook. You would have even had the chance to suggest questions for me to ask her when she comes on the show. You should probably go ahead and become a member. 

Speaking of the episode where we talked about the magical disappearing osteophytes, I was a little worried if I’m being honest about that one. I hated being negative like that and I was a bit concerned some of you would have a problem with that. Oh contrare, I think I had more feedback on that one than any of our episodes. 

It appears you guys agree and there is indeed no room for that mystical hunk o junk in our great profession. Of course, there isn’t. We knew that. Sometimes you just have to blow off a little steam and be the old guy saying, “get off my lawn ya punks!”

That was episode 56 for me. “Get off my lawn and stop driving so fast in a 30 mph zone yeah steampunk loving jackasses! And quit looking at my daughter like that before I shoot you in the nose hole!” We’re in Texas and all. lol. 

Cervicogenic Headache

Alright, let’s tackle cervicogenic headache a bit here. The first thing I want to say here is that, prior to the DACO classes, I had assumed that cervicogenic headache had a much higher prevalence than it does in reality. In your clinic, it really doesn’t show up all that much compared to the other forms of headaches. 

Breaking that down a little, tension-type headaches are the most prevalent at 38% of cases, migraines are next at 10%, and cervicogenic headache brings up the rear-end of the group at about 4% of cases. 

If it only makes up 4% of cases, why the heck are we covering it this week you may ask. Well, let me answer that since you’re so damn inquisitive today. 

Because it still makes up your patient base, you need to be able to notice it, and it’s one of the forms we can be fairly effective in treating. 

The first thing we gotta do is rule out a pathological headache by testing 

  • Steady gait over a normal base
  • Normal vital signs
  • Normal Romberg’s test
  • Quick screen of cranial nerves looking for extra-ocular movements, nystagmus, symmetrical pupils with normal reaction to light, normal facial muscle tone, and things like that. 
  • And then a basic screen of tendon reflexes, motor power and pathological reflexes like Babinski’s and Hoffman reflexes

 

What Does It Look Like?

So, what does a cervicogenic headache typically look like? Well, the first thing is that it is technically a secondary headache which means it is the symptom of something else that’s going on. 

Cervicogenic headache is usually 

  • Unilateral, side-consistent pain referred from a source in the neck. In fact, many times, you can elicit the head pain by pressing on the facets of the C2/3 region. 
  • Usually, the pain starts in the upper cervical region and then spreads toward the front of the head, orbital region, temples, vertex, or ears.
  • The pain may also spread to the ipsilateral shoulder or arm
  • Also, the pain is precipitated or aggravated by special neck movements or sustained neck posture. 
  • It’s mostly in the adult population with females being four times more affected than men. 
  • Sufferers can have suboccipital neck pain, dizziness, and even lightheadedness 

Paper #1

Let’s look at this paper called “Cervical musculoskeletal impairment in frequent intermittent headache. Part 1: subjects with single headaches” authored by G. Jull and published in 2007 in the International Headache Society[1]. 

They were testing musculoskeletal function in headache types like tension-type, migraine, and cervicogenic.

In all but one measure (kinesthetic sense), the cervicogenic headache group were significantly different from the migraine, tension-type headache and control groups. 

They found that collectively, restricted movement, in association with palpable upper cervical joint dysfunction and impairment in the cranio-cervical flexion test, had 100% sensitivity and 94% specificity to identify cervicogenic headache. 

They found that collectively, restricted movement, in association with palpable upper cervical joint dysfunction and impairment in the cranio-cervical flexion test, had 100% sensitivity and 94% specificity to identify cervicogenic headache.

It doesn’t get much more sensitive and specific than that does it? 100% and 94%. Bam, you got a cervicogenic headache Patient Jones and I have pretty much zero doubt about that. Yes…that feels good to be that confident. 

Paper #2

This next paper is called “Upper cervical and upper thoracic manipulation vs. mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial[2].” It was authored by James Dunning, and what looks like about 30 others and published in BMC Musculoskeletal Disorders in 2016. 

In the beginning here the authors say that no studies have directly compared the effectiveness of cervical and thoracic manipulation to mobilization and exercise in individuals with cervicogenic headache. Thus the reason for the study. 

They had 110 participants here that were randomized to receive both cervical and thoracic manipulation or mobilization and exercise. 

What They Found

“Six to eight sessions of upper cervical and upper thoracic manipulation were shown to be more effective than mobilization and exercise in patients with CH, and the effects were maintained at 3 months.”

Time for superhero sound effects….Bam, snap, pow, shazam!

One of these days, I’m really going to incorporate sound effects into my efforts here but until then, you’re stuck with my ridiculous superhero effects. Lol. 

Paper #3

Moving on, this next paper is called “Dose-response for chiropractic care of chronic cervicogenic headache and associated neck pain: a randomized pilot study.” It was authored by M Haas, et. al. and published in the Journal of Manipulative and Physiological Therapeutics[3]. 

Why They Did It

To acquire information for designing a large clinical trial and determining its feasibility and to make preliminary estimates of the relationship between headache outcomes and the number of visits to a chiropractor.

What They Found

There was substantial benefit in pain relief for 9 and 12 treatments compared with 3 visits.

The authors concluded, “A large clinical trial on the relationship between pain relief and the number of chiropractic treatments is feasible. Findings give preliminary support for the benefit of larger doses, 9 to 12 treatments, of chiropractic care for the treatment of cervicogenic headache.”

Paper #4

Roughly that same group led by M.  Haas, et. al. later published this one in 2018, just last year, called “Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial.” It was published in Spine Journal[4]. 

They were looking to settle in on the optimal number of visits for the care of cervicogenic headache with spinal manipulative therapy. 

It was a two-site, open-open-table randomized controlled trial with 256 participants. 

What They Found

There was a linear dose-response relationship between spinal manipulative therapy visits and days with cervicogenic headache. For the highest and most effective dose of 18 treatments, days suffering from cervicogenic headache were reduced by half and about 3 more days per month than for the light-massage control group. 

And there you have it people, more information than you probably expected to get on Cervicogenic headache today. 

This week, I want you to go forward knowing more about cervicogenic headache than you did before you listened to this podcast. I want you to see it, test for it, recognize it, and fix it!

Integrating Chiropractors

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

Home

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

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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

1. Jull G, Cervical Musculoskeletal Impairment in Frequent Intermittent Headache. Part 1: Subjects With Single Headaches. International Headache Society, 2007. 27(7).

2. J, D., Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC Musculoskelet Disord, 2016. 17(1): p. 1.

3. Haas M, Conservative physical therapy management for the treatment of cervicogenic headache: a systematic review. J Man Manip Ther, 2013. 21(2): p. 113-24.

4. Haas M, Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial. Spine, 2018: p. S1529-9430.

CF 006: With Dr. Tyce Hergert: Astounding Expert Information On Immediate Headache Relief

CF 050: Chiropractic Care – Text Neck, Headaches, Migraines

CF 041: w/ Dr. William Lawson – Research For Neck Pain

 

 

CF 058: The Patient Experience, Lumbar Stenosis, & Fibromyalgia 

CF 058: The Patient Experience, Lumbar Stenosis, & Fibromyalgia 

Today we’re going to talk about the patient experience being more important than your marketing, we’ll talk about some research from JAMA on lumbar stenosis, and some research on upper cervical manipulative therapy on fibromyalgia. 

But first, here’s that bumper music

Integrating Chiropractors

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

You have clumsily stumbled into Episode #58 knocking lamps off of the end tables and generally making a mess of the place.

DACO

As with every week, let’s talk a bit about the DACO program and my progress. I was doing the Communication Drills but they kept referring to eLearning Episodes. So let’s break that down a bit real quick for those interested in the program. The bulk is made up of 40 Diagnostic Drills, 46 Communication Drills, and 17 eLearning Episodes. 

You get 2 hrs credit for each Diagnostic or Communication Drill and you get 3 hours credits for each eLearning Episode. 

Now, since Communication Drills kept referring to eLearning Episodes, I figured I would switch focus and go through them and then return to the Communication Drills. Still with me?

The eLearning Episodes are very much video based on a downloadable worksheet to take notes on. I take notes digitally though so I’m still getting my angle of attack down on these and how I want to best tackle them and have great notes I’m getting it figured out. 

DACO Classes

So far, I’ve taken classes on Adjusting locally and thinking globally about how a cervical adjustment can affect even the low back. The neurology is amazing. A class on blurry vision from a pain in the neck. Again, the neurology people. I don’t know how I made it day to day before this stuff. Then last weekend I took one on making sense of a headache. 

Outstanding information and all lined up to make you better, make you wiser in your decision-making, and making you a better communicator with your patients and colleagues. 

If you’re waiting to get started on the DACO, get started. I’ll be glad to help you if you’ll email me at dr.williams@chiropracticforward.com

I’m about wrapped up with some cool stuff that you all may be interested in on our website at chiropracticforward.com. If you’ll go there and sign up for our newsletter on our home page, I’ll be able to let you know all about it when it’s ready to roll out.   

Great week for listens Y’all. Thank you for tuning in. Everyone loved Dr. James Lehman’s episode. That was a big one for us! If you missed it, it’s episode #55. Candy for your ears. I see that sucker being the number one listened to podcast pretty quickly. 

Onto the Discussion

Let’s get to trying to make your practice better. This first one we’ll discuss is titled, “Patient experience five times as likely to drive consumer loyalty as marketing” by Christopher Cheney with HealthLeaders(Cheney C 2018). It was published on December 28, 2018. Once again, I know you dig the new stuff. 

If you’re getting after it. If you’re hustling, then you’re marketing. Marketing isn’t something you do once, is it? Oh no, it isn’t. It’s something you do every damn day if you’re doing it effectively. It’s exhausting, isn’t it? But it can be fun too. 

Marketing

Isn’t it fascinating that just changing the color of the border on your marketing material has the potential to elicit a different behavior from the recipient? Or changing the color of the shirt that the person in the ad is wearing affects the response rate? It’s amazing. But, it’s also exhausting to contemplate all of the different combinations of possibilities of words, colors, placements, and all of that crap. 

Good grief. You could make yourself crazy and how many chiropractors usually have the budget to hire a full-time marketing person that actually had a marketing degree? Not many would be the answer you’re looking for if you were confused on that. It was more rhetorical than anything. 

Here in this article, Mr. Cheney says that the patient experience while in your office is the primary driver of patients’ consumer loyalty at health systems, hospitals, and physician practices. He based this information on a recent Press Ganey report I would normally link for you in the show notes but it looks like a bit of click bate. As in leave your email and get the report crapola and I’m not doing that to my peeps. Ain’t nobody got time for that. 

Hell, I can hardly get you guys to give ME your email address and most of you are loyal listeners! Lol. 

Consumer Loyalty

Anyway, he says that consumer loyalty is vital for not only your profit at the end of the month but also helps you take better care of long-term patients with multiple chronic illnesses. 

Hell, that’s why we got into this business; taking care of people. I have to say that if you got into this business to get rich, you’re taking the long way around buddy. Lol. Most of us got into this business to take care of people when nobody else was able to get results with them. And then hopefully keep them that way!

Here’s what raised my antennae straight up, he said, “Patient experience is FIVE TIMES more likely to influence brand loyalty than conventional marketing tools such as billboards, or television, print, or radio ads.”

WHAT?

What was that? Let me repeat that just in case my DACO talk put you to sleep. Hey, wake the hell up and listen to this. “Patient experience is FIVE TIMES more likely to influence brand loyalty than conventional marketing tools such as billboards, or television, print, or radio ads.”

That is astounding. Of course, some of you already had this figured out and being 20 + years into this dealio, I have it figured out to an extent as well but FIVE TIMES more effective than billboards, TV, print, or radio?

I did NOT have that much figured out. Do you know how I know I didn’t have all of that figured out? Well, it’s because I am spending too much damn money on all that crapola. They interviewed over 1,000 adults on this survey. 

I do have it figured out to the extent that I tell my staff that we are certainly in the healthcare business but they’re fools if they think we are not also in the customer service business. You better believe it. I tell them that I’d much rather a patient leave feeling the same but feeling great about the people they met and the experience they had here and feeling hopeful about what we can accomplish with them as opposed to them leaving my office sore because I either rushed through the appointment or thought we’d equate appointment success with a popping noise and pushed so hard that I finally got a pop sound but ended up making the patient feel worse. 

That goes for the front desk too, doesn’t it? They’re the first point of contact and the last point of contact. If they’re not friendly when people come in and greet them warmly and are very welcoming, well….we’re already behind the 8-ball there and had better make up some ground in the back of the office. And when they leave…..oh nobody likes to pay their own money out of their own pocket and they damn sure don’t like to pay it to someone they don’t like personally. 

Here is a quote from the report, “Healthcare organizations can tap the power of patient experience, the report says. “To harness that influence, providers should capitalize on the power of word-of-mouth marketing by viewing the patient experience as an essential part of their acquisition strategy. By gaining a deep understanding of what gets people talking about positive patient experiences, identifying opportunities to advance the conversation and disseminating key information, healthcare systems can naturally align the mission of delivering safe, high-quality, patient-centered care with the business of acquiring and retaining consumers.”

The Big 4

They went on to line our 4 Big One’s that should be a part of any healthcare facility’s strategy for getting and keeping patients. They were:

  1. Give every patient a voice – They’re not just talking about listening to them when they visit your office and tell you about their conditions. They describe delivering surveys via text and email as well as the standard outreach protocols. 
  2. Identify factors that drive and erode patient loyalty. They say to really know where you can improve, you gotta know positive loyalty metrics on things like the likelihood to refer or recommend your office to their network of people. Imagine man, being a former member of BNI, they teach that each person, whether they know it or not, has a network of 250 people in their lives. I get 55-65 new patients per month. That’s 13,750-16,250 potential work of mouth contacts that can either hear the good about our office or, if we allow them to catch us on bad days….that’s up to 16,250 people that can hear bad things about us. You can see why it’s so important to have positive patient experiences in your office just as often as you possibly can. Especially in the days of social media. There is no room for ego, for talking down to your patients or scolding your patients, or any of that crap. Patient-centered is more than an idea, it’s how you’d better be carrying yourself. 
  3. Use natural language processing to analyze comments. What the hell does that mean? Well, they say that it is language that allows aggregation of comments into clear brand equities and liabilities, allowing for proactive management of both experience and brand. That sounds like an overly wordy and annoying resume if I’m being honest. Basically, it’s using computers to analyze emails, customer feedback forms, surveys and things like that to identify the root cause of customer dissatisfaction or, we hope, customer satisfaction. I’d like to lead you further down this path but, obviously, I have more to learn on it myself. 
  4. Post ratings and reviews in physician profiles. Ensure that future patients have the most convenient access to all information they seek by including comments – both positive and negative. I can’t deal with negative comments. They hurt. Lol. 

Reviews

They also say that you need to be earning quality reviews online for Yelp, Google, Facebook, and all that good stuff. If you don’t know the value of reviews at this point, you just might be a lost cause. Lol. 

They also say you must address negative reviews online in a professional way while understanding that negative reviews are an opportunity to learn and improve. 

But, when it’s not right and borderline illegal, I believe it’s OK to have your attorney contact the person leaving that negative review. Here’s what happened. We offer a service. Not chiropractic but a service that a girl that treated here for some time decided she would begin offering here in town without being certified in any way to perform. 

OK, annoying for sure but then she, one of her little buddies and her boyfriend go online and leave us bad reviews for the exact same service. So there we were with 80 or so 5-star reviews. Not one negative review. And then three 1 star reviews popping up out of nowhere. Nope, she got a call from my attorney and they went away very quickly. 

Ain’t nobody got time for that crap, right? I know I don’t and I have little tolerance for people that want to try to tear down something others have built just to try to further themselves. 

Before my face gets too red and I start to stutter, let’s move onto the next topic. 

Next Paper

This next paper is called, “The addition of upper cervical manipulative therapy in the treatment of patients with fibromyalgia: a randomized controlled trial.” The lead author on this one is Ibrahim Moustafa and it was published in Rheumatology International in July of 2015(Moustafa I 2015). 

And can we just stop a second appreciate the last name Moustafa? Can we do that? Holy cow, if I had a good head of hair and a last name like Moustafa, I’d have the world on a leash ya know. But I don’t have good hair and my name is Williams (so boring) so let’s move on. 

Why They Did It

The aim of this study was to investigate the immediate and long-term effects of a one-year multimodal program, with the addition of upper cervical manipulative therapy, on fibromyalgia management outcomes in addition to three-dimensional (3D) postural measures.

It was a randomized controlled trial with a one-year follow-up. 

What They Found

The addition of the upper cervical manipulative therapy to a multimodal program is beneficial in treating patients with fibro.

I threw that one in for you Upper Cervical guys. You’re getting some love when it comes to treating fibro and I know fibro sufferers will appreciate that. 

I think, after learning more about the upper cervical spine in the DACO course, that it’s fascinating to think about. There is so much going on in the upper three segments in terms of sensorimotor and proprioception that it just blows your mind. 

Last Paper

OK, on to the last paper. This one is called “Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial(Schneider M 2019)”. It was authored by Michael Schneider, DC, Ph.D., Carlo Ammendolia, DC (who we have covered here before for stenosis), and Donald Murphy, DC et. al. It appeared in JAMA on January 4, 2019, and here’s how it goes. 

Why They Did It

The question to answer for them was, “What is the comparative effectiveness of 3 types of nonsurgical treatment options for patients with lumbar spinal stenosis?”

Now the 3 types of protocols they tested were medical care, group exercise, and manual therapy/individualized exercise. 

The medical care consisted of medications and/or epidural injections. 

The group exercise classes were supervised by fitness instructors in senior community centers. 

The manual therapy/individualized exercise consisted of spinal mobilization (because it works and is awesome I assume), stretches, and strength training provided by chiropractors and PTs. 

A combination of manual therapy/individualized exercise provides greater short-term improvement in symptoms and physical function and walking capacity than medical care or group exercises, although all 3 interventions were associated with improvements in long-term walking capacity.

Integrating Chiropractors

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

Home

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

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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

  • Cheney C (2018) “PATIENT EXPERIENCE FIVE TIMES AS LIKELY TO DRIVE CONSUMER LOYALTY AS MARKETING.” HealthLeaders.
  • Moustafa I (2015). “The addition of upper cervical manipulative therapy in the treatment of patients with fibromyalgia: a randomized controlled trial.” Rheum Inter 35(7): 1163-1174.
  • Schneider M, A. C., Murphy D, (2019). “Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis A Randomized Clinical Trial.” JAMA Network Open 2(1): e186828.

CF 045: Harvard Health, Low Back Stenosis, Allergy Autism

CF 016: Review of The Lancet Article on Low Back Pain (Pt. 1)

 

CF 057: What Is Contributing To Low Back Pain And More Opioid Bashing

CF 057: What Is Contributing To Low Back Pain And More Opioid Bashing

Today we’re going to talk about What Is Contributing To Low Back Pain And More Opioid Bashing from us. We hate them and they don’t do any good anyway so why did 72,000 people have to die at their hands last year in America?

But first, here’s that bumper music.

Integrating Chiropractors

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

You have fumbled your way into Episode #57

Junk I Say

Let’s first talk a bit about junk I say. I drive myself crazy and here’s why; I get flustered sometimes. I don’t know why. Honestly, I’d like to eventually go on the speaking circuit but I think I’ll be terrible at it. Lol. I get flustered. 

I always listen to the episodes after they post. For a couple of reasons but it’s kind of like why a football team will watch game tape the day and week after a game. I do the same thing. I want to identify where I can improve and how I can make myself and the show better from week to week. 

Well, I invariably catch myself saying stuff that makes no sense. Like in the recent episode where I discussed the lack of research for lumbar fusion, I referred to an orthopedic surgeon as an osteopath. What? Trust me…..I know the damn difference so things like that make me want to punch myself in the nose a little. 

Another is that, without thinking, I’ve been calling it the diplomate of American chiropractic orthopedists. Yeah….that’s not what it is and I know that. Lol. It’s the Diplomate of the Academy of Chiropractic Orthopedists and those folks can be a member of the American Chiropractic Orthopedists. You see the confusion, right?

Anyway….I’m not a dummy people. Well, most days anyway. I still have my brain farts but I’m usually fairly put together. Or at least I like to think I am. Reminds me of a comedian I heard when I was a kid. He said, “I may look dumb, but that doesn’t mean I’m not!” Yeah….so you just think about that for a bit. 

The DACO

Speaking of the DACO program, “What’s the latest?”, you may ask. To that I would answer that a lot is going on actually. I slowed down for a bit but picked it back up during the holidays with the spare time I had. 

More communication drills including ideas and instruction on how to tactfully disagree with our medical counterparts. For instance, if they diagnose a patient with a disc and we are CERTAIN it’s an SI, how are you going to let them down softly and keep them from going away mad ala Motley Crue…girl….don’t go away mad. Just go away. 

You know we all have egos and you know damn well that “king ego” exists in the medical world. How do you tell those people they’re at odds with the research? I’m afraid there are some of them that would rather be wrong than be corrected. 

How do you tell them that they diagnosed a tension-type headache when, in reality, the symptoms are more in line with a cervicogenic headache? And then, how do you tell a GP that probably doesn’t like cervical manipulation that you recommend just that?

Things that make you go “Hmmmm….”

At the end of each of the Communication Drills, they give you a script to help you in the future should the need pop up for you to artfully and tactfully slap around Mr. King Ego without them really knowing you payahed them across the face with a glove. 

Short Show 

Alright, it’s a crazy week. I’m trying to close out 2018 as far as stats go and all that good stuff so this episode ain’t gonna be a big one. 

Before we get to it though, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It’s just an email. We’ll send you one once a week when a new episode pops up and, if we have something cool to tell you about, I’ll include it in that email. No extra emails. Don’t be so stingy with that damn email address. 

Don’t be like a college kid with the last piece of pizza. Don’t be that kid. 

Onto the Research

Let’s get to the goodies, folks. Let’s start with this one from BMC Musculoskeletal Disorders by Shanthi Ramanathan, Peter Hibbert, Louise Wiles, Christopher Maher, and William Runicman called “What is the association between the presence of comorbidities and the appropriateness of care for low back pain? A population-based medical record review study[1].”

 

First thing here is that Chris Maher is a busy guy, y’all. Seriously. He is a Physical Therapist and I believe lives in Australia if I remember correctly. He was on a paper we discussed recently having to do with lumbar fusion as well as being on The Lancet series of papers for low back pain. He’s a mover and shaker

Why They Did It

Knowing that low back pain is non-specific in 90% of cases, low back pain is treated as an independent entity even though we know other conditions exist with it or contribute to it. What comorbidities? Things like obesity, diabetes, heart disease, high blood pressure, arthritis, etc…

What They Found

One hundred and sixty-four LBP patients were included in the analysis. Over 60% of adults with LBP in Australia had one of 17 comorbidities documented, with females being more likely than males to have comorbid conditions.

Wrap Up

This study established that the presence of comorbidities is associated with poorer care for LBP. Understanding why this is so is an important direction for future research.

Paper #2

Onward we march…. This one is called “Chiropractors’ views on the use of patient-reported outcome measures in clinical practice; a qualitative study.” It was written with Michelle Holmes as the lead author followed by Felicity Bishop, David Newell, Jonathan Field, and George Lewith and it was published in Chiropractic and Manual Therapies in December of 2018[2]. 

I know you people like the new stuff. 

Why They Did It

Patient-reported outcome measures (also known as OATS in my office and probably your office as well. OATS meaning Outcome Assessments)

Anyway, OATS are widely available for use in musculoskeletal care there’s not much research exploring the implementation of OATS in clinical practice. They wanted to see what chiropractors’ views were on OATS to identify any barriers and facilitators to implementing OATS in chiropractic care.

What They Found

“Chiropractors are increasingly using OATS in their clinical practice. The aim of this qualitative study was to examine the views of chiropractors on using OATS. Exploring chiropractors’ experience of using OATS, this study identified how clinician knowledge and engagement and organizational barriers and facilitators affect implementing OATS in chiropractic care, such as choosing the appropriate OATS and systems to use in their practice. Chiropractors also identified possible training needs of chiropractors regarding OATS, with training including the process and benefits of using OATS in clinical practice.”

Opioids

Now, in our “beating a dead horse” segment, let’s bash the hell out of opioids, shall we? Well, don’t mind if I do!

This one is by Jason Busse, a Chiropractor by the way, and associate professor in the department of anesthesia at McMaster University’s school of medicine in Ontario, Canada……. Canada has it going on, folks. Seriously.

Here’s a chiropractor in the department of anesthesia at a school of medicine. We need to get that guy on our podcast don’t you think?

The paper was also written by Li Wang, Ph.D., and Mostafa Kamaleldin. Easy for you to say. 

It’s called “Opioids for Chronic Noncancer Pain; A systematic review and meta-analysis[3]” and appeared in JAMA in December of 2018. 

Why They Did It

They wanted to find out if the use of opioids to treat chronic noncancer pain was associated with greater benefits or harms compared with placebo and alternative analgesics.

Wrap It Up

In this meta-analysis of RCTs of patients with chronic noncancer pain, evidence from high-quality studies showed that opioid use was associated with statistically significant but small improvements in pain and physical functioning, and increased risk of vomiting compared with placebo. Comparisons of opioids with nonopioid alternatives suggested that the benefit for pain and functioning may be similar, although the evidence was from studies of only low to moderate quality.

CNN’s Spin 

CNN actually did an article by Michael Nedelman[4], on this paper where they get a little deeper saying the following, “For adults with chronic pain, opioids offer narrow improvements over placebo for pain and physical functioning, on average, according to a new analysis published Tuesday. And the majority of patients will experience no meaningful benefit.”

Subgroups of the studies included in the analysis suggest that non-opioid alternatives — such as NSAIDs, certain antidepressants and medical cannabis — may offer similar benefits to opioids on average. But the evidence for that is less strong, Busse said.

Question

Here’s my question for Dr. Busse, “Considering the fact that the American College of Physicians and The Lancet promote spinal manipulative therapy for acute and chronic low back pain as an alternative to opioids, and considering you are a chiropractor, why did your research not include spinal manipulative therapy as one of the alternative treatments?”

My guess is that maybe there were not enough randomized controlled trials comparing spinal manipulative therapy directly to opioids? I’m not sure why, to be honest. 

What We Know

But, we do know from JAMA that a current review found that spinal manipulation therapy is associated with moderate improvements in pain and function in patients with acute low back pain[5].

We know from Keeney et al that there “Reduced odds of surgery were observed for…those whose first provider was a chiropractor. 42.7% of workers [with back injuries] who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor[6].”

From Haas et. al[7]., we know “Acute and chronic chiropractic patients experienced better outcomes in pain, functional disability, and patient satisfaction; clinically important differences in pain and disability improvement were found for chronic patients.”

There are so many others that I just don’t have the time to get into right now but, I’m certainly interested in papers comparing the two directly to each other. I bet I already know the answer and I bet you do too. 

Integrating Chiropractors

The Message

Here’s why you know the answer already……it’s because we know 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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TuneIn

About the Author & Host

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

 

Bibliography

1. Ramanthan S, H.P., Wiles L, Maher C, Runicman W,, What is the association between the presence of comorbidities and the appropriateness of care for low back pain? A population-based medical record review study. BMC Musculoskelet Disord, 2018. 19(391).

2. Holmes M, B.F., Newell D, Field J, Lewith G,, Chiropractors’ views on the use of patient-reported outcome measures in clinical practice: a qualitative study. Chiropr Man Therap, 2018. 26(50).

3. Busse J, W.L., Kamaleldin M,, Opioids for Chronic Noncancer Pain: A Systematic Review and Meta-analysis. JAMA, 2018. 320(23): p. 2448-2460.

4. Nedelman, M., Opioids offer little chronic pain benefit and wane over time, study says, in CNN. 2018: CNN Online.

5. Page N, Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain. Journal of American Medical Association (JAMA), 2107. 317(14): p. 1451-1460.

6. Keeney BJ, Early predictors of lumbar spine surgery after occupational back injury: results from a prospective study of workers in Washington State. Spine (Phila Pa 1976), 2013. May 15(38): p. 11.

7. Haas M, A practice-based study of patients with acute and chronic low back pain attending primary care and chiropractic physicians: two-week to 48-month follow-up. J Manipulative Physiol Ther, 2004. Mar-Apr;27(3): p. 160-9.

CF 025: Vets With Low Back Pain. Usual Care + Chiropractic vs. Usual Care Alone

CF 027: WANTED – Safe, Nonpharmacological Means Of Treating Spinal Pain

CF 031: No More High Risk & Useless Drugs From Here On – Getting Off Opioids

CF 026: Chiropractic Better Than Physical Therapy and Usual Medical Care For Musculoskeletal Issues

 

 

 

CF 056: What Does A Spinal Manipulation Do In Medical Terms & What I Despise About My Profession

Today we’re going to talk about what a chiropractic spinal manipulation is, we’ll talk about what it does and what happens there. We’re also going to talk about what I sincerely despise about our great profession. Depending on how fired up I get here, this one should be a good episode.

CF 055: w/ Dr. James Lehman – The Future Of Chiropractic, Chiropractic Specialization, & Chiropractic Integration

CF 055: w/ Dr. James Lehman – The Future Of Chiropractic, Chiropractic Specialization, & Chiropractic Integration  

Today we’re going to talk to one of the giants in our profession, Dr. James Lehman. We will be talking to Dr. James Lehman all about all sorts of things but mostly about the future of chiropractic. What is it looking like for those of us in the profession over the course of the next 15-30 years?

Dr. James Lehman, FACO - University of Bridgeport Connecticut

But first, here’s that delicious bumper music

Integrating Chiropractors

 

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  We will get to Dr. James Lehman soon. 

Introduction

You have fluttered into Episode #55 kind of like the feather on Forrest Gump. Come on, you know the feather from literally one of the best movies of all time. Yes, that feather. 

Diplomate of the Academy of Chiropractic Orthopedists

This is normally the point in the program where I mention the DACO program and how I am progressing through it but, for reasons that will become obvious fairly quickly, we are going to save that talk for just a little later in our program. 

However, I will tell you I have 80 online hours at this point and some of my more recent classes have been Why does my shoulder keep hurting and how to diagnose a tension-type headache. If you recall from a week or so ago, two classes on migraines were among the classes so, after this last week, I’m getting a handle on the headache mystery. 

I have just about completed all of the Diagnostic Drills. There are 40 of them and I’ve finished 39 of them. The last one is on ankle sprain and what we really need to know about them. Then, we move on to Communication Drills that reinforce these Diagnostic Drills and help you write to your colleagues in an effective and professional way to describe your findings. I’m looking forward to those!

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. 

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

Questions for Dr. Lehman

How did the job at UofB become a reality for you? How did you make that happen or even make it a possibility?

Can you tell me about your position at UofB? 

What are your responsibilities? 

What does a regular day for you look like? 

Dr. Lehman and I became acquainted with each other through the DACO program. In case you have been hiding under a rock, zoning off during our podcasts, or maybe this is the very first podcast you’ve listened to of ours, DACO stands for Diplomate of American Chiropractic Orthopedists. 

What got you so interested in the Orthopedic side of our profession? 

What was it that made you want to specialize originally?

Can you tell us a little about your experience with chiropractic integration over the years? 

Have you had some battles to fight internally against medical practitioners?

What are some of the pitfalls and what are some of the rewards beyond seeing the patients recover?

Can you tell us about FQHCs? I had no idea they existed, especially in my city, until you showed me. Integrating into an FQHC was something that was never on my radar until we talked in Dallas.

At this point in our discussion, I need to tell you, the audience, that Dr. Lehman has played a vital role in furthering the DACO program. Through his position at the University of Bridgeport Connecticut, and through a partnership of sorts with online education through Chiropractic Development International out of Australia, obtaining the DACO has become very do-able and very attainable for all that may be so inclined. 

Dr. Lehman, can you tell us a little about how you and the University of Bridgeport got involved in the DACO and how it’s going so far? How did you identify the need and then go about filling that need?

Can you tell us why you feel like specialization like the DACO is so important to doctors of chiropractic these days? 

Why has this become your mission?

Through email, you suggested to me that, for the chiropractic profession to gain the respect of the healthcare system, a reasonable definition of chiropractic would be a good starting point. You offered a definition that doesn’t restrict providers nor does it highlight ‘subluxation.’ That definition is as follows:

“The evidence-based practice of differential diagnosis, patient-centered treatment, and prevention of pain and human disease as taught by CCE-approved chiropractic colleges, institutions, or schools.”

Tell me how you came up with this definition. 

Just to tell a quick personal experience, I have been introduced before by one neurosurgeon to another neurosurgeon using a disclaimer. He said, “He’s not one of THOSE chiropractors. He’s one of the good guys.” Which, I have to say that I appreciated the vote of confidence but at the same time it made me think, “With such a prevailing sentiment toward our profession, how will we ever integrate successfully or is it even possible?”

Do you think that even those of us that are specializing are going to be forever introduced with a disclaimer? I personally don’t see how a profession as split as ours progresses and integrates successfully. Is there a solution to this or are we just stuck with the split and the internal fighting?

With the knowledge that PTs are now utilizing spinal manipulative therapy, what do you feel is going to happen with our profession in the next 15-30 years?

In the two classes I’ve sat through with you as a speaker, you were adamant about Informed Consent. I read your paper on that topic after I got back from Dallas and thought it was pretty interesting. Informed Consent doesn’t sound like a particularly interesting or sexy topic to the general population so, would you mind telling us about that and what interested you enough in a topic like Informed Consent to actually publish a paper on it?

We covered the vast divide in our profession, what are some other big obstacles you see on the horizon for our profession right now?

In our private Chiropractic Forward Group, when we discussed you episode coming on the show, Dr. Brandon Steele said I need to ask you this question, “What can students do right now to prepare for current trends in Healthcare? Are there residencies, certifications, internships or other equivalents they should be considering going through to prepare for their future after graduation?”

Also in the private group, Dr. William Lawson, who has been a guest with us before, told me to ask you about rural healthcare centers and how a chiropractor can work in or own a rural healthcare center. 

 being with us and taking time out of your day. I really appreciate you and what you are doing for our profession. I don’t know where we would be without folks like you and others just like you. 

Integrating Chiropractors

 

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

Home

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

About the Author & Host

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

CF 029: w/ Dr. Devin Pettiet – Is Chiropractic Integration Healthy For The Profession?

CF 039: Communicating Chiropractic

CF 046: Chiropractic Effectiveness – Chiropractic Integration – Chiropractic Future

CF 054: Lumbar Fusion Surgery and Its Evidence Or Lack Of

CF 054: Lumbar Fusion Surgery and Its Evidence Or Lack Of

Today we’re going to talk about a great new paper coming to us from Internal Medicine Journal on Lumbar fusion surgery and it’s evidence or lack of. What’s the word on lumbar fusion surgery? We’ll tell you.

But first, here’s that silky smooth Chiropractic Forward bumper music

Integrating Chiropractors

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

You have glided all fast and furiously into Episode #54 and we’re happy to have you here smokin tires and all. Kill the engine and take a chill pill, won’t you?

DACO

Let’s talk a bit about the Diplomate of the Academy of Chiropractic Orthopedics program quickly. I’m sitting at around 76 of my online hours and I have to get 250 of those. Yes, if you were wondering, it is going by slowly here lately but I’m going to have a little time this week and weekend to put the pedal to the metal and get after it. 

Some classes from this past week were migraines, migraines in children, thoracolumbar junction difficulties, and chronically injured hamstrings. 

Spelling Issues

These courses come from a group in Australia and they really take the long road when it comes to spelling. Did you guys know that? The first thing that’s crazy about the Aussies is that they use esses instead of z’s. For example, recognize is spelled with an s rather than a “z”.

When you see the word orthopedic spelled orthopaedic, it’s because of them and the English. We take the shortcuts and say, hey, recognize has a z sound in it so let’s spell it with a z. Hey, orthopedic has an e sound in the middle of it so let’s drop the dumb a since we don’t need it and let’s just spell it orthopedic. 

Here’s another one. Behavior. These goofy people spell it behaviour. They snuck in au right there at the very end of the word like they thought they were going to get away with it or something. Uh uh. Nope. We Americans don’t need the u at the end so we just end it in or. Because we’re cool and ain’t nobody got time for that crap. 

The most annoying one is probably edema or estrogen. They start both of those words with an O. Who the hell would ever spell estrogen Oestrogen? Or edema spelled oedema? That’s absolutely uncalled for and I’d appreciate them re-evaluating their use of the English language in this manner. 

Absolute ridiculosity. 

I am currently designing some really cool stuff all based in research and current evidence that I think you will all be interested in. At least I hope you are because, from what I’ve seen in researching, it’s like nothing else out there. 

Go to chiropracticforward.com right now while you’re thinking about it, just under this week’s episode, you’ll see an area where you can sign up for the newsletter. It’s only once a week and it’ll help us tell you about what we’re working on when we get it ready to go live!!

Now, let’s get to the reason for the season here. 

The is titled “Lumbar Spine Fusion: What Is The Evidence(Harris I 2018)?” and it was written by Ian Harris, Adrian Traeger, Ralph Stanford, Christopher Maher, and Rachelle Buchbinder. I recognize at least two of these names from the low back pain series published in The Lancet earlier this year. 

If you have not been through those papers, please listen to episodes #16, 17, and 18 of this Chiropractic Forward podcast for all the info you need on that. 

Basically, in this paper, they say that lumbar spinal fusion is common and associated with high cost and a risk of serious adverse events. They state that they aim to summarize systematic reviews on the effectiveness of lumbar spine fusion for most diagnoses. 

Of important note is where they say that they found NO high-quality systematic reviews and the risk of bias of the randomized controlled trials they found was generally high. For something as serious as lumbar fusion surgery. Where they cut into the body, take two vertebrae that usually aren’t unstable on each other, and then drive screws into them and affix hardware to fuse them together forever and ever amen. 

No high-quality systematic reviews for lumbar fusion surgery and the RCTs out there generally carry a high risk of bias. Great. Duly noted. Awesome. Lumbar fusion surgery

They go on to say that the available evidence doesn’t support a clinical benefit from lumbar fusion surgery compared to non-operative treatment or stabilization without fusion for thoracolumbar burst fractures. 

They say that surgical intervention for metastatic carcinoma of the spine associated with spinal cord compromise improves mobility and neurological outcome. That was based on a single trial. 

That was the high points of the abstract but let’s move in a little more and get on the micro level of this thing. 

This study takes info from Australia and, in the land down under, lumbar spine fusion is the fourth most costly surgical procedure, behind knee replacement, hip replacement, and C-sections. For a procedure with no high-quality systemic reviews. The first word that comes to mind for me here is, “Damn.”

The most common reasons used for lumbar spine fusion procedures would be intervertebral disc disease (which nearly everyone beyond 50-60yrs old has), degenerative scoliosis, and spinal canal stenosis. 

The main purpose here was to compare lumbar spinal fusion to non-operative means. Not to compare it to other surgical procedures. 

Conclusion

As part of the conclusion, the authors say, “The available evidence does not support the hypothesis that lumbar fusion surgery confers a clinical benefit compared to non‐operative alternatives for low back pain associated with degeneration. Similarly, the available evidence does not support the hypothesis that spine fusion confers a clinical benefit compared to non‐operative treatment or stabilization without fusion for thoracolumbar burst fractures. 

Benefits of lumbar fusion surgery compared to non‐operative treatment for isthmic spondylolisthesis are unclear (one trial at high risk of bias). Surgical intervention for metastatic carcinoma of the spine associated with spinal cord compromise improves mobility and neurological outcome (based on a single trial).

Ideally, lumbar fusion surgery for spondylolisthesis, burst fractures, back pain or degenerative conditions (degenerative scoliosis, spinal stenosis, recurrent disc herniation or instability), should only be performed in the context of high-quality clinical trials until the true value for each of these conditions is established. 

Until better quality evidence is available, treatment will continue to be guided by expert clinical opinion based on evidence at high risk of bias. Patients contemplating lumbar fusion surgery should be fully informed about the evidence base for their particular problem, including the relative potential benefits and harms of fusion compared with non‐operative treatments.

When Surgery Is OK

Let’s transition from that to an excellent guideline called When Surgery is OK and this comes from the legendary Dr. Stu McGill. 

To keep this episode from getting too long and out of hand, let’s hit the highlights. This is a 3-page document so we’ll shorten it to the extent that makes sense while still squeezing the good stuff out of it. Use these thoughts and ideas when deciding if surgery is indicated. 

Stu says to try the virtual surgery game and consider surgery only when it fails. Meaning pretend you had surgery today and tomorrow is the first day of recovery. It is characterized by gentle movements and activities but mostly a forced day of rest. The days following a typical post-surgical progression involves restricted activity. If this helps, no surgery at this time. 

Consider surgery when neurological issues are substantial, such as loss of bowel and bladder control. Note: that does not include radiating symptoms like sciatica, peripheral numbness, atrophy, etc….

Consider surgery in cases of trauma. When structures are unstable and need to be stabilized. 

Consider surgery only when the pain has been unrelenting and severe for a substantial period of time. Pain can be a terrible and misleading reason to get surgery. 

Select the surgeon. Dr. McGill says everyone likes to state that they had the best surgeon. He has found that asking the nurses and physical therapists at the hospital which surgeon has the best results is a wise way to go. 

Discuss the pain with the surgeon. Ask what the pain generator is and if they can cut it out. IF there are several tissues involved, chances of success are getting worse. Also if there is damage at several levels. 

Clarify what the success rate is. What does success even mean in your case? Does that mean you survived or does it mean you did OK for a bit before relapsing into pain? You want long-term success to any and all other options available. 

Beware of new treatments. That one should really go without any further discussion. Don’t be a pioneer on the patient side of surgical procedures. 

Beware of disc replacement – Dr. McGill states in this paper that he has not seen a successful case as of the writing of the article. 

Always exhaust the conservative options – He says you may believe that since you tried physical therapy and it didn’t help that only surgery remains. It just may be that the exact therapy tried was not the right one for your specific condition. 

FREE MRI Review

Beware of institutes that offer to view medical images and, with no other information, advise patients on surgery. Pictures are not linked to pain. He argues that a thorough clinical assessment is absolutely essential. I want to butt in on this one. The laser institute and orthopedic surgeons are all over the commercials on TV with this one. 

I will take this time to admit because they’re doing these free MRI reviews, I’m offering the same in my region but here’s why. It’s evidently enticing or they would not offer it and I KNOW for a fact they have a higher-paid marketing department that has decided it is indeed effective. 

That’s one of the reasons I’m doing it but the real reason is because I know that the majority of these people, if they get a free MRI review at the osteopath or the laser spine institute, they’re very likely to be lined up for surgery whereas I, after a thorough exam, will be lining them up for conservative, non-invasive therapy and I can usually keep these people from surgery and useless shots. 

There’s a difference. My free MRI review is to prevent them from surgery. Their free MRI review, in my opinion, is to QUALIFY them for surgery. 

Wrap Up

In wrapping this article or paper up, Dr. McGill says the following, “Tissues in the back become irritated with repeated loading. Consider accidentally stuffing a toe or biting the lip repeatedly – eventually, the slightest touch causes pain. This is symptom magnification because the tissues are hypersensitized. Reduction of the hypersensitivity in the toe or lip only occurs following a substantial amount of time after the accidental stub or bite has stopped.”

Dr. McGill goes on to say, “For example, people with flexion bending intolerance of the spine may replicate this every time they rise from a chair. Correcting this movement fault, metaphorically taking the hits away, results in less sensitized tissues, an increased repertoire of pain-free tasks, and a return of motion. Motion returns once the pain goes away.”

Boom. Snap. Pow. Shazam. KaBAM!! Superhero abilities via the chiropractor and ZERO surgery. How clever. 

Opinion

I don’t care what your chiropractic practice looks like. OK….I lie. As long as it doesn’t make mine look hokey or bad, then I don’t care what your practice looks like. Some are geared toward getting people out of pain. Some are geared to some wellness protocol. Some are floundering because they don’t know where they belong or exactly what they’re trying to accomplish. 

I’ll admit that, at one point in time, I was one of them. 

But, one common thread through all sorts of practices is this, we keep people from surgery. Maybe not 100% of the time but we do a hell of a job with the tools we’ve been given and I love the direction that opioids and lumbar fusion surgery failures are pushing our profession. 

Sometimes even in spite of ourselves. 

Integrating Chiropractors

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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TuneIn

About the Author & Host

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

 

Bibliography

Harris I, T. A., Stanford R, (2018). “Lumbar spine fusion: what is the evidence?” Internal Med J.

 

 

CF 024: They Laughed When I Said I Could Still Help After Back Surgery

CF 020: Chiropractic Evolution or Extinction?

 

 

 

CF 053: Healthy New Ideas For Physical Activity

CF 053: Healthy New Ideas For Physical Activity

Today we’re going to talk about updated guidelines for physical activity as well as some research that the more vitalistic in the profession may not dig too much. Don’t kill the messenger people. 

But first, here’s that delicious bumper music

Integrating Chiropractors

Introduction

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

You have toppled into Episode #53, the first episode of year #2. I am committing to doing a second year as long as we show continued growth. If we stop growing, I may change my approach at some point but, I absolutely want to do a second year to see where this thing of ours can go. 

Talking DACO

Let’s talk a bit about the Diplomate of American Chiropractic Orthopedist program also known as the DACO. I’m just keeping you apprised of my progress. At this point, I have 68 online hours down and 40 live hours done. So, I’m 108 hours into the 300 I need. 

I have literally knocked out 24 hours online in the last two weeks. That’s a gob of information. It is literally changing how I practice every single week. It’s almost indescribable but, I see patients coming in every day now that have something I would have missed without having gone this far into the DACO. 

The more recent classes I’ve been through include plantar heel pain, Diagnosing idiopathic scoliosis and assessing the risk of progression, anterior knee pain in an adolescent, lateral knee pain and th IT band, as well as recognizing meniscus tears and essential of reading knee MRIs. 

I honestly wonder how on Earth I’ve gotten anyone well over my 20 years in practice without the knowledge that I’m gaining here. In the end, I guess doing SOMETHING is always going to trump doing nothing and, it’s not like I’ve been a dummy for 20 years. 

CEs

I’ve always been a big proponent of continuing education and have consistently gotten 30-50 CEs every year rather than the 16 required so, I’m not going to beat myself up over it but, sincerely here, this information you get in the DACO program is beyond anything I’ve gotten in any seminar anywhere. 

Now, with that being said, I haven’t been to one of McGill’s or Liebenson’s talks so I need to make that clear. By the way, both of those giants will be at Parker Vegas in February if you are ready for some learning of the highest caliber. 

Newsletter

Right now, while you’re thinking about it, go to chiropracticforward.com and sign up for the weekly newsletter. It’s just once per week, it’s easy and fast and I’m in the process of making some pretty cool stuff that I think can be useful in helping you in practice. 

When it’s ready to roll out, you’ll save because you were cool enough to be on the list, cool enough to be an early adopter, and cool enough to basically be a founder of what we’re trying to build here. I’ve never believed that I can build it by myself. It has to be a team of like-minded, motivated individuals. 

If you are evidence-based I’d love to have you on the team. Reach out and let’s talk about what we can do to build build build. 

Meat n’ Taters

Alright, onto the meat n taters today. Let’s start with this paper that just came out in the Journal of the American Medical Association. It’s authored by Dr. Katrina Piercy et. al[1]. and is called The Physical Activity Guidelines for Americans. It was published on November 20, 2018. It doesn’t get a whole lot more recent than that does it?

The 2018 Physical Activity Guidelines Advisory Committee conducted a systematic review of the science supporting physical activity and health. They came up with recommendations strictly based on evidence graded as strong or moderate. 

Here’s what they decided:

  • Preschool-aged children from 3-5 need to be active throughout the day
  • Children and adolescents from 6-17 should do 60 minutes or more of moderate to vigorous activity daily. 
  • Adults should do at least 2 1/2 hrs to 5 hrs per week of moderate intensity, or 1 hr 15 minutes to 2.5 hours per week of vigorous aerobic activity, or an equivalent combination of the two. 
  • Adults should also do muscle-strengthening activity on 2 or more days per week. 
  • Older adults need a multicomponent physical activity that includes balance training as well as aerobic and muscle-strengthening. 
  • Pregnant and postpartum females need at least 2.5 hrs of moderate activity a week. 
  • Basically moving more and sitting less will benefit nearly everyone. 

See? And you didn’t even need a trainer to figure it out. You’re welcome. You are so welcome, folks. It’s what I do. I give give give. 

Walking Paper

Let’s move on to a paper that was in Spine Journal in November 2018 called Walking more than 90 minutes/week was associated with a lower risk of self-reported low back pain in persons over 50 years of age: A cross-cross-sectional study using the Korean National Health and Nutrition Examination Surveys[2]. 

Again, very new stuff. Only a month or so old. 

They did this one because, while strengthening and aerobic exercise is well-documented and well-founded, there isn’t a lot of information on walking and it effects for low back pain. 

This was a cross-sectional study which means they looked at people differing on one specific characteristic at one specific point in time. The data they collected was from the Korea National Health and Nutrition Examination Surveys from 2010-2015. 

What They Found

The authors wrapped it up by saying, “Our study showed that longer walking duration was associated with a lower risk of LBP. Regular walking with a longer duration for more than 3 days/week is significantly associated with a lower risk of LBP in the general population aged over 50 years.”

Social Prescribing

I wanted to discuss a pretty neat article I came across last week from the Smithsonian. This article is called British Doctors May Soon Prescribe Art, Music, Dance, Singing Lessons and it was written by Meilan Solly[3] published November 8, 2018. Yet again….the newest stuff here this week. 

The article discusses a new initiative on the part of British Health Secretary Matt Hancock and they’re wanting to allow the country’s doctors to prescribe art or hobby based treatment for all sorts of issues. From dementia and psychosis to lung complaints and mental health complications. 

They’re calling it “social prescriptions” and I have to say that I’m a big fan of the idea. For instance, just listening to Otis Redding sing Sittin’ On The Dock of the Bay does something good to me inside and out. One of my all time favorites and you all clearly have good taste because you’re listening to our little podcast here so I’m sure it’s one of your favorites too. If it’s not one of your favorites then you clearly haven’t listened to it yet. 

The health secretary has an excellent quote here when he says, “We’ve been fostering a culture that’s popping pills and Prozac when what we should be doing is more prevention and perspiration.” “Social prescribing can help us combat over-medicalizing people.”

And the heavens opened up and all God’s people said, “Amen.”

The only problem I have with the idea is that they’re not looking at having it up and running until 2023. Which, honestly, isn’t as far away as it once seemed is it? 

Still, you’d think they have that rocking and rolling quicker but look who’s griping? We’re still here in America where our medical profession is still trying to figure out how to get more people on medication and into surgery rather than think out of the box just a tad for a second or two. 

But, back to the point, I think it’s an amazing idea. Music, singing, creating art, and experiencing art in whatever form possible is good for the body and soul. Not one or the other but all of it. Every inch. Laughing too. Laughing is so good for you. 

Richard Pryor, Rodney Dangerfield, and Eddie Murphy for children of the 80’s such as myself. Dane Cook and Kevin Hart for the 2000’s kids. Laughing your butt off fixes a lot of stuff. 

‘Principled’ May Not Be So Principled

And to our last paper by Guillaume Goncalves, et. al. published in Biomed Central on April 5, 2018 called “Effect of chiropractic treatment on primary or early secondary prevention: a systematic review with a pedagogic approach[4].”

The authors start out by saying that the chiropractic vitalistic approach to the concept of ‘subluxation’ as a cause of disease lacks any validity nevertheless, some in our profession still claim to prevent disease in general through continuous chiropractic care. 

Don’t send me crappy emails. That’s what the authors said here. 

They go on to say that, if some are going to continue with this model of practice, there must be evidence that it is effective and that’s the reason for the research here. 

How They Did It

They searched PubMed, Embase, Index to Chiropractic Literature, and some specialized chiropractic journals, from inception to October 2017.

They scrutinized 13 articles. 8 were clinical studies and 5 were population studies

They dealt with various disorders of public health importance like blood pressure, blood test immunological markers, and mortality. 

Wrap It Up

The authors concluded the paper by saying, “We found no evidence in the literature of an effect of chiropractic treatment in the scope of primary prevention or early secondary prevention for disease in general. Chiropractors have to assume their role as evidence-based clinicians and the leaders of the profession must accept that it is harmful to the profession to imply a public health importance in relation to the prevention of such diseases through manipulative therapy/chiropractic treatment.”

Now look, don’t kill the messenger. I know that some of you are just going to do what you want to do and what you believe no matter what is thrown in front of you. I know that. Honestly, those people probably aren’t listening to an evidence-based podcast to start with because we won’t confirm that bias. We’ll challenge it from time to time. 

People don’t typically like that. In fact, they may attack those that challenge their bias. 

The information is more useful to confirm the bias of evidence-based chiropractors and to further educate those that are being fed information to the contrary whether it’s by friends or even at school. 

Regardless, for every chiropractor and patient, it’s food for thought. 

Integrating Chiropractors

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!

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. 

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

http://www.chiropracticforward.com

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TuneIn

About the author:

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

https://www.smithsonianmag.com/smart-news/british-doctors-may-soon-prescribe-art-music-dance-singing-lessons-180970750/?utm_source=facebook.com&utm_medium=socialmedia&fbclid=IwAR1etMZiV8oe-JbUwgUYmP2gxR5pinJcbLS2W1u1QlMBNISVIxTpFBRmubc

https://jamanetwork.com/journals/jama/fullarticle/2712935?utm_source=silverchair&utm_campaign=jama_network&utm_content=weekly_highlights&cmp=1&utm_medium=email

https://chiromt.biomedcentral.com/articles/10.1186/s12998-018-0179-x?fbclid=IwAR3aJGZBcmMSscPoibtAzIRHok9_RpsMvJDbvx76MnzRJY9YU0x_JMY5FK0

https://www.ncbi.nlm.nih.gov/m/pubmed/30448632/

 

Bibliography

1. Piercy K, T.R., Ballard R,, The Physical Activity Guidelines for Americans. JAMA, 2018. 320(19): p. 2020-2028.

2. Park SM, Walking more than 90 minutes/week was associated with a lower risk of self-reported low back pain in persons over 50 years of age: A cross-sectional study using the Korean National Health and Nutrition Examination Surveys. Spine J, 2018. 18: p. S1529.

3. Meilan Solly, British Doctors May Soon Prescribe Art, Music, Dance, Singing Lessons. Smithsonian.com, 2018.

4. Gonclaves G, Effect of chiropractic treatment on primary or early secondary prevention: a systematic review with a pedagogic approach. BMC Chiro Man Ther, 2018. 26(10).

 

CF 052: Chiropractic Forward Podcast Year One Review

CF 052: Chiropractic Forward Podcast Year One Review

One year. I started this podcast exactly one year ago. 52 weeks. 52 episodes. We’re going to talk about the highlights of the first year. We’re going to talk about chiropractic today vs. chiropractic when I started a year ago. Has anything changed? The short answer is yes. Quite a bit has changed in just a year. 

But first, here’s that sweet like honey bumper music

Integrating Chiropractors

Welcome

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

You have collapsed into Episode #52 and it feels good to say that. To be able to do anything consistently for a year straight, every single week, it’s an accomplishment for sure and it sure as hell feels good folks. 

DACO Program

Before we get into the highlights. let’s talk a bit about the DACO program. For those new to the Chiropractic Forward Podcast, I have been going through the Diplomate of American Chiropractic Orthopedists. I’m 92 hours into a 300-hour course. Ugh…that hurts just to say it. Lol. I don’t even feel close to being done. 

I figured it out that at the rate I’m going now, which is about 8 hours per week, I can be done around May I believe. While it seems way off, you know what? I’d be learning and educating myself anyway. Why not get something out of it, right? That’s the idea and May will be here before you know it. 

Hell, it seems like it was Summer just a couple of weeks ago. Lol. 

Products

I have been fast at work preparing some new options for you. I have noticed  a lack of what I would want in my office when it talks 

One-Year Anniversary

Let’s get on to talking about our one-year anniversary. I want to start by talking listen out our top 10 episodes so far and what we talked about that made everyone listen to each of them. I’m linking them all for quick reference in the show notes. So away we go!

Number 10

Episode #30 – Integrating Chiropractors – What’s It Going To Take? We discussed the medical field and what they are looking for in a chiropractor in regard to integrating that individual into the system. We went over The Lancet papers as well. Great episode to check out. 

CF 030: Integrating Chiropractors – What’s It Going To Take?

 

Number 9

Episode #25 – Vets With Low Back Pain. Usual Care + Chiropractic vs. Usual Care Alone. This episode revolved around a paper in JAMA from Dr. Christine Goertz where she and her co-authors showed additional support for including chiropractic as part of a multidisciplinary team for treating low back pain. Great paper by a great asset for chiropractic. 

CF 025: Vets With Low Back Pain. Usual Care + Chiropractic vs. Usual Care Alone

Number 8

Episode #28 – Will Chiropractic First Finally Take Its Place? In this installment, we went through a paper that showed non-pharma and non-opioid therapies are now the preference. Well, that’s chiropractic, right? We talked about some GREAT resources in this episode including the President’s Commission on Combating Drug Addiction and The Opioid Crisis report as well as a great paper by Jon Adams Ph called The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults. That one had some marketing nuggets for the nugget pouch.

CF 028: Will Chiropractic First Finally Take Its Place?

 

Number 7

Episode #27 – Wanted – Safe, Nonpharmacological Means of Treating Spinal Pain. This episode went through treating spinal pain, thoracic manipulation, lumbar manipulation, guidelines from Canada, and the perceptions of our profession. We discussed a paper about how some in the medical profession think chiropractors go around herniating discs all the time. Pfft… 

CF 027: WANTED – Safe, Nonpharmacological Means Of Treating Spinal Pain

 

Number 6

Episode #9 – With Dr. Tom Hollingsworth of Corpus Christi, TX called The Case Against Chiropractic In Texas. We talked with Dr. Hollingsworth about the Texas Medical Association’s attacks on Texas Chiropractors and our rights. We talked about the latest in the current court case and the appeal process. 

Just a couple of weeks ago, in fact, this case had a decision that was reached and it wasn’t good for chiropractors. And I’m talking about chiropractors nationwide. We’ll have to do an updated episode with Dr. Hollingsworth because what may be on its way down the pike for all chiropractors…..well….let’s just say it’s no bueno. 

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

 

Number 5

Episode #26 – Chiropractic Better Than Physical Therapy and Usual Medical Care For Musculoskeletal Issues. The title is accurate. And researched fact. There are some that don’t like that language. Can’t we all get along? That type of deal and yes, we can all get along. Most certainly. My issue is with PTs being the first referral for non-complicated musculoskeletal issues when research shows they have decreased effectiveness when compared to chiropractic care. 

They have less patient satisfaction when compared to chiropractic care as well. In addition, research shows chiropractic care to be a lot less expensive. So why in the hell is a practitioner that is exponentially more expensive, much less effective on their outcomes, and patients don’t like as much…..why the hell are they the first referral? That still makes my pee hot when I really really think about it. It’s dumb. 

I don’t think we should be doing post-surgical rehab unless we take specific training in that. I think PTs and DCs can work very well together but there should be lanes and I don’t think PTs stay in their lane. Not when they’re out there taking a weekend course on adjusting. It’s BS and that doesn’t stand for Bad Students. 

CF 026: Chiropractic Better Than Physical Therapy and Usual Medical Care For Musculoskeletal Issues

 

Number 4

Episode #29 – With Dr. Devin Pettiet of Tomball, TX, still the President of the Texas Chiropractic Association. This episode was titled Is Chiropractic Integration Healthy For the Profession? We talked with Dr. Pettiet all about chiropractic integration into a medical based case management or medical team. 

This one was one of my favorites too. For sure. Devin is a great resource and a great personality. He’s all energy and has an awesome amount of information and experience.

CF 029: w/ Dr. Devin Pettiet – Is Chiropractic Integration Healthy For The Profession?

 

Number 3

Episode #6 with Dr. Tyce Hergert from Southlake, TX. This episode is called Astounding expert Information on Immediate Headache Relief. This one was all about headaches and highlighted one service that was dressed up and parading around as another. Yes, those pesky PTs are moving in on us and this episode talked about little bit about that along with some great papers showing chiropractic’s effectiveness with treating headaches. Fun episode. 

CF 006: With Dr. Tyce Hergert: Astounding Expert Information On Immediate Headache Relief

 

Number 2

Episode #13 – DEBUNKED: The Odd Myth That Chiropractors Cause Strokes. My favorite episode and my favorite endeavor as far as really putting together information to stick a fork in an anti-chiropractic idea or myth. This is actually a three-part series consisting of #13, 14, and 15. All three episodes really paint a picture of foolishness on the part of the medical field and a coordinated attack that is easily put to rest through common sense, correct context, and research. 

It’s really so simple when you take the time to listen, learn, and just think about it for a minute. They are the three episodes I encourage you to share the very most out of all of them I have created. 

CF 013: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 1 of 3)

 

Number 1

Episode #11 – called It’s Here. New Guides For Low Back Pain That Medical Doctors Are Ignoring.

The most listened-to episode for our first year was Episode #11 once again with my old friend and colleague Dr. Tyce Hergert down in Southlake, TX. He has TWO episodes in the top 10 from our first year. That’s because he’s smart, he’s the ex-President of the Texas Chiropractic Association, and he’s entertaining if he’s had his coffee. 

In this one, we talked about current healthcare guidelines, why they matter to chiropractic patients and even non-patients, and whether MDs are getting it or not. Guess what? They’re still ignoring these guides!

CF 011: With Dr. Tyce Hergert: It’s Here. New Guides For Low Back Pain That Medical Doctors Are Ignoring

 

Wrap Up

So….there you have it, folks. That’s our Top 10 in a nutshell with all of the links in the show notes. We have had a great first year. We hope you have enjoyed the content we have been bringing to you as much as we have enjoyed gathering it for you. 

There is so much going on in our profession. Both good and bad. It’s important to stay plugged in now more than ever. We’ll talk about it in a future episode but the Texas Chiropractors lost their appeal and the medical kingdom will bring their dog and pony show to your state before you know it. Believe me. 

But, for evidence-based chiropractors, there’s still no better time than today to be a doctor of chiropractic. I firmly believe that to be the truth.

Integrating Chiropractors

 

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!

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. 

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:

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