CF 280: Catastrophizing and Proprioception

Today we’re going to talk about catastrophizing and we’ll talk about proprioception in chronic low back pain patients as well.

But first, heres that sweet sweet bumper music


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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.   We’re the fun kind of research. Not the stuffy, high-brow, look down your nose at people kind of research. We’re research talk over a couple of beers.   I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending y  our time with us learning together.   Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, drive, smart, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at   If you haven’t yet I have a few things you should do.

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.
  • Then go Like our Chiropractic Forward Facebook page,
  • Join our private Chiropractic Forward Facebook group, and then
  • Review our podcast on whatever platform you’re listening to
  • Last thing real quick, we also have an evidence-based brochure and poster store at com


You have found yourself smack dab in the middle of Episode #280   Now if you missed last week’s episode, we talked about Newer Information On Nonsurgical Spinal Decompression Make sure you don’t miss that info. Keep up with the class.  

On the personal end of things…..

Things seem to be humming along nicely around my clinic, other than still needing a good, solid, driven associate. But, it is what it is and that’s OK. The right on will come along when they’re supposed to come along. And we’ll take good care of them when they do.  

In other news, I’m still digging on BlueIQ.

I buy a lot of goofy crap and have bought goofy things and services over the years. Always trying to get that competitive advantage.   Some of the more solid investments I’ve made over the years have been ChiroUp, ReviewWave, being in Dr. Kevin Christie’s Mastermind group, and then I think BlueIQ. I think.

I’m still evaluating and using it but I think I really really like it.  

Stats right from my phone if I want them and they’re updated every hour from my EHR, well hell yes. Please and thank you. Thank you, may I have another.  

Also big in the clinic now is that we’ve been using a software called SignPresenter. Now think about it; I have an integrated clinic and that means I have a crap ton of services when you combine all providers.

Well, I got to thinking, why the hell don’t I have a TV in our lobby with all of our services being splashed across the screen and across the brains of all of the people that come through our doors?

Why am I being a dummy?   So I started a little research and came across SignPresenter and signed up muy pronto. There’s a small learning curve on the thing but I think I bout got it handled.   I’ve started making my own graphics, videos, etc, and can now showcase things on it for our lobby-dwelling folks.

Including QR codes for landing pages and more information and things like that.   I think it matters. Our front desk pro, Elexis, tells me that people will just stand in front of the TV watching it. Lol. So that’s a good thing. Can’t be bad!! I’ll let you know how that goes but early signs say that it’s a big, big win.  

OK, enough of the ramblings, let’s get ot the research.    

Item #1  

The first one today is called “Widespread Proprioceptive Acuity Impairment in Chronic Back Pain: A Cross-sectional Study” by Matthias Poesl MSc, Gabriela F. Carvalho Ph.D., Waclaw M. Adamczyk Ph.D., Beate Schüßler MSc, Michael Richter Ph.D., Kerstin Luedtke Ph.D., Tibor M. Szikszay Ph.D. and published in Science Direct on 17 March 2023. Dayum. That’s hot.  

Why They Did It  

To investigate whether proprioceptive accuracy measured with the Joint Position Sense (JPS) in patients with chronic neck and low back pain is impaired exclusively in affected areas or also in distant areas, not affected by pain.  

How They Did It  

  • Patients with chronic neck pain, patients with chronic low back pain, and age- and sex-matched asymptomatic control subjects.
  • One hundred and thirty-three patients with chronic neck and back pain were recruited.
  • Among them, 33 did not meet the inclusion and exclusion criteria or decided not to participate in the study.
  • In total, 30 patients with CLBP, 30 patients with CNP, and 30 pain-free control participants were included.
  • No significant differences were found between all 3 groups regarding sociodemographic and between both patient groups regarding disease-related characteristics.

  What They Found  

  • Both patients with chronic neck pain and patients with chronic low back pain differed significantly from asymptomatic controls in the Joint Position Sense of the cervical spine, lumbar spine and ankle joint, regardless of the painful area.
  • No difference was shown between patient groups.
  • An association of the Joint Position Sense with clinical characteristics, however, could not be shown.


Wrap It Up  

These results suggest widespread impairment of proprioceptive accuracy in patients with chronic and low back pain and a role for central sensorimotor processes in musculoskeletal pain conditions.    


Before getting to the next one,   Next thing, go to That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office.   When you decide you cant live without those products, send me an email and Ill give you the hookup. They will 100% differentiate your clinic from your competitors.   I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. and the discount code is HOTSTUFF. Go do it.  


Item #2   Our last one this week is called, “Level of pain catastrophizing determines if patients with long-standing subacromial impingement benefit from more resistance exercise: predefined secondary analyses from a pragmatic randomized controlled trial (the SExSI Trial)” by Mikkel Bek Clausen, Michael Skovdal, Thomas Graven-Nielsen, Thomas Bandholm, Karl Bang Christensen, Kristian Thorborg and published in British Journal Of Sports Medicine on March 10, 2023. Steamy stack of simmering sausage!  

Why They Did It

The primary aim was to investigate the effectiveness of adding more resistance exercise to usual care on pain mechanisms (including temporal summation, conditioned pain modulation and local pain sensitivity) and pain catastrophizing in people with subacromial impingement at 16 weeks follow-up. Second, to investigate the modifying effect of pain mechanisms and pain catastrophizing on the interventions’ effectiveness in improving shoulder strength and disability  

How They Did It

  • 200 consecutive patients were randomly allocated to usual exercise-based care or the same plus additional elastic band exercise to increase total exercise dose.


  • Completed add-on exercise dose was captured using an elastic band sensor. Outcome measures recorded at baseline, 5 weeks, 10 weeks and 16 (primary end point) weeks included temporal summation of pain (TSP) and conditioned pain modulation assessed at the lower leg, pressure pain threshold at the deltoid muscle (PPT-deltoid), pain catastrophizing and the Shoulder Pain and Disability Index.

  What They Found  

  • Additional elastic band exercise was not superior to usual exercise-based care in improving pain mechanisms or pain catastrophizing after 16 weeks.


  • Interaction analyses showed that pain catastrophizing (median split) modified the effectiveness of additional exerciseswith superior results in the additional exercise group compared with the usual care group in patients with less pain catastrophizing.


Wrap It Up  

Additional resistance exercise added to usual care was not superior to usual care alone in improving pain mechanisms or pain catastrophizing. Additional exercise was, however, superior in improving self-reported disability in patients with lower levels of pain catastrophizing at baseline. Alright, that’s it. Keep on keepin’ on.

Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen.  

Let’s get to the message. Same as it is every week.  


Remember the evidence-informed brochures and posters at  


Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you cant beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots.


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


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


And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!


Key Point:

At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….


Thats Chiropractic!



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We cant 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 – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger



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