Carpal Tunnel Syndrome

Government-Regulated Rehab, Do Rotator Cuffs Need Repair, Carpal Tunnel

Today we’re going to reach into my bag of papers that have been sitting and gathering a little dust waiting for their time in the sun. We’re talking about government-regulated rehab. Is it any more effective than doctor-regulated? Do you send rotator cuff issues straight to a surgeon and is that the smartest thing? We’ll also skim over some new info on carpal tunnel syndrome. 

But first, here’s that “goes down so smooth” bumper music.

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 Frankenstein-shuffled into Episode #63 all creepy like

Introduction

Why does this podcast even exist? We’re here to advocate for chiropractic and to give you some awesome information to make your life easier from day-to-day. We’re going to keep you from wasting time through your week by giving you confidence in your recommendations and in your treatments. 

This is something I feel confident in guaranteeing you if you listen and stick to it here at the Chiropractic Forward Podcast.  I’m no guru but I do believe I was blessed with some amount of common sense that somehow continues to keep me in the game. You are ABSOLUTELY going to pick up some nuggets that you can use in your own practice. 

Evidence-based Chiropractic Store

Part of saving you time and effort is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. My goal is to get enough pre-orders to pay for all of the initial order before the end of March. If you guys will go to chiropracticforward.com…..Just click the STORE link at the top right of the home page and you’ll be off and running. 

https://www.chiropracticforward.com/shop/

We can order any of the posters whenever but, I want to get pre-orders in place for the brochures since they have to be ordered in bulk. With pre-orders helping me do that, I can get them ordered at the end of March, get them to me in about a week and then get them to you in a week so, they’d be in your hands roughly mid-April. So, if you’re team Chiropractic Forward, go check them out and order up. I’ll make it happen for us all. 

I’m getting them for my office as well ya see. I can’t wait to get them. And, I have a ton more I’m working on. But, I’ll be using funds from the first batch, to fund the next batch of these brochures. Rome wasn’t built in a day, folks, cut me some damn slack. Help me out with the first batch and we’ll be up and running. Who knows what we can get done around here together?

DACO

DACO talk, hell yeah. I’m back to rocking and rolling thanks to the guys down under in Australia. They are very intuitive and really do go out of their way to make sure you’re enjoying the courses and getting what you can out of them. 

Recent courses for me have been Acute Torticollis in the Adult and Osteoporotic Compression fractures – Recognizing the Clues. 

I dreaded stepping into the whole idea of 300 hours added to an already full load of work, family, and hobbies. Honestly, I’ve said before, I see 60-70 new patients a month, wife and two kids, I build live edge furniture, I’m a musician many weekends, and a sculptor who’s trying to teach himself to paint and…well…I like to get ornery and have a beer here and there on the weekends too. (you need to grow up)

I don’t say that to brag and say Oh look at me look at me. I’m trying to make the point that, if I can do it, you can do it.

Here’s the deal, I was always learning and adding and reading research papers and all of that stuff anyway. I thought I’d take one live class and get some continuing education hours. Hell, I figured I’d sit in the class for a couple of hours and then go have lunch with my wife. 

Yeah, that didn’t happen. In fact, I’m blaming it all on Dr. Tim Bertlesmen for getting me into it. He and Dr. Brandon Steele are the partners in ChiroUp and he was teaching a class here for the Texas Chiropractic Association’s state convention last summer. I saw him in the expo hall and he told me to come check the class out.

I said I’ll check it out for a bit. He said, “You’ll like it. You’ll stay for the whole thing.” Dammit if he wasn’t right. Lol. Just amazing information that could be used immediately and I literally feel that way about every class I’ve had since then.

So, you see, it hasn’t been stressful. It hasn’t really been any work. It’s just been enjoyable learning that I would have been doing anyway. I might as well get something out of what I was already doing anyway, right?

When the hell do I have time to add 300 hours to my plate? Well, I take off about 2:30 on Tuesday afternoon to do a class. I usually take one on Saturday morning when I’m up before the rest of the family. Sometimes I’ll take another on Sunday. That puts me at about 9 hours a week.

Easy peesy. 

If I can get you started, email me at dr. williams @chiropractic forward.com

Personal Happenings

In personal happenings, it’s been a little crazy around here as you all might can gather if you follow along. If you remember we had a front desk issue back in August and just couldn’t get the position filled. Well, my amazing wife stepped in, got trained on insurance, billing, and all of that lovely mess of crap. She is literally the smartest person I’ve ever met in my life. Some may question her decision to marry me and her intelligence in making that decision but, I think she’s freaking Einstein basically. 

Anyway, that has turned into us getting to work at 8 am and now, because she’s a perfectionist and still maintains her work responsibilities from her other job….which she does from home….we’re literally here until about 8 pm every night and I’m just about done with that people. Being busy is a good problem to have but there is a point where it’s just too much. 

I think a nurse practitioner can take some of the load off and I think maybe bringing in a new young hungry associate would be really nice. But, while I can talk about evidence and research, I’m afraid I’m not particularly skilled at hiring associates or setting up a medical entity but, that’s the direction I’m moving in because this workload is not sustainable for me to have a happy life. It’s just not. Example: on Wednesday of last week, in one day, as a solo practitioner, we had 12 new patients. Now, 6 were just intakes from one car wreck and it went efficiently but, you get the point. 

While it is do-able, for me, it’s not necessarily desirable to have the stress of being piled up on. I’m more like 3 or 4 new patients per day spread evenly throughout the week with some periodic re-exams and a bunch of happy patients just getting better and better every time I see them. THAT’S my idea of a happy workday. That’s not what we have right now. Lol. Good problem to have, admittedly but, still stressful. 

We’re hiring right now to help take some load off of the wife and, before long, I’ll be turning my attention to integrating. You know I’ll be sharing my experience as we go through it all. 

Item #1: Government-regulated Rehab

This first item we’re going to talk about is titled “Is a government-regulated rehabilitation guideline more effective than general practitioner education or preferred-provider rehabilitation in promoting recovery from acute whiplash-associated disorders? A pragmatic randomised controlled trial(Cote P 2019)” written by Pierre Cote, Eleanor Boyle, Heather Shearer, and a plethora of others. It was published in the British Medical Journal Open in 2019 and is cited in our show notes for episode 63. 

Why They Did It

They wanted to evaluate the effectiveness of a government-regulated guidelines line when comparing it to education and activation by general practitioners and to a preferred-provider insurance-based rehab program on self-reported global recovery from acute whiplash-associated disorders Grades 1-2. 

As mentioned in the title of the paper, it was a pragmatic randomized controlled trial. 

What They Found

Here’s what they decided, “Time-to-recovery did not significantly differ across intervention groups. We found no differences between groups with regard to neck-specific outcomes, depression and health-related quality of life.”

Item #2: Rotator Cuffs & Need For Repair

This one is called “What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears(Boorman RS 2018).” Twas written by RS Boorman, KD More, RM Hollinshead, and a gaggle of others. Published in Journal of Shoulder and Elbow Surgery in March of 2018. 

Why They Did It

They wanted to look at the 5-year outcomes in patients enrolled in a nonoperative rotator cuff tear treatment program. What happened with them?

How They Did It

They took patients with chronic, defined as greater than three months, full-thickness rotator cuff tears on MRI that were enrolled in the nonoperative study from 2008-2010. 

They started a nonoperative, home-based treatment program and they were followed up with after different time intervals. 

What They Found

Check this out, at 5 or more years follow-up, approximately 75% of patients remained successfully treated with nonoperative treatment and had a quality of life score of 83 out of 100. 

Between years 2 and 5, only 3 patients thought to have a successful outcome regressed and had surgery

The operative and the nonoperative groups at the 5-year follow-up were not significantly different. 

Wrap It Up

The authors concluded, “Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. While some clinicians may argue that nonoperative treatment delays inevitable surgical repair, our study shows that patients can do very well over time.”

Pow. Snap. Bam. Smash. Kapow!

I don’t know why I take such joy in seeing that surgeons have less reason to do surgery but it give me a tickle in my belly and a warm fuzzy feeling. Who wants a hug, people? I’m feeling the spirit here. 

Item #3: Carpal Tunnel Syndrome

Our last item here is called “The Effect of Manual Therapy Including Neurodynamic Techniques on the Overall Health Status of People With Carpal Tunnel Syndrome: A Randomized Controlled Trial(Wolny T 2018)” and is written by T Wolney, et. al., published in Journal of Manipulative and Physiological Therapeutics in October of 2018. 

Why They Did It

They wanted to check the influence of manual therapy, including neurodynamic techniques, when compared to no treatment on overall health status in those with mild to moderate carpal tunnel syndrome. 

Again, as the title says, it was a randomized controlled trial with 189 subjects. 

They underwent treatment twice weekly. 

What exactly is meant by the term ‘Neurodynamic Technique’? Well, have you ever heard of nerve flossing? That is a type of neurodynamic technique. Gliding or sliding the median nerve in the case of carpal tunnel. Tensioning, relaxing basically. Pull out your Google machine. You’ll find some great YouTube examples of Neurodynamic Techniques to help you with your carpal tunnel patients. 

Now, what did they find?

The authors were able to conclude the following, “Manual therapy, including neurodynamic techniques, had a positive effect on overall health status in this group of individuals with carpal tunnel syndrome.”

Key Takeaways

• The government doesn’t do a particularly better job than you can do on your own if you’re educated and stay evidence-informed
• Even full-thickness tears of the rotator cuff do not mean surgical intervention in most patients
• Carpal Tunnel Surgery doesn’t require surgical intervention in most mild-moderate patients if you learn some take-home exercises and implement neurodynamic techniques
• Surgeons are going to need to start down-sizing those houses and maybe forego buying that private plane as they will be less and less busy in the years to come. 

Again, before you disappear this week, consider going to chiropracticforward.com and clicking on Store and pre-ordering our spanking brand new evidence-informed brochures. We are looking to gather up pre-orders and ordering all of them in bulk around March 29th. We would appreciate your help in making this happen. Team Chiropractic Forward!

https://www.chiropracticforward.com/shop/

The Evidence-based Chiropractic 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

• Boorman RS, M. K., Lollinshead RM, (2018). “What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears.” J Shoulder Elbow Surg 27(3): 444-448.
• Cote P, S. B., Shearer HM, (2019). “Is a government-regulated rehabilitation guideline more effective than general practitioner education or preferred-provider rehabilitation in promoting recovery from acute whiplash-associated disorders? A pragmatic randomised controlled trial.” BMJ Open 9(e021283).
• Wolny T (2018). “The Effect of Manual Therapy Including Neurodynamic Techniques on the Overall Health Status of People With Carpal Tunnel Syndrome: A Randomized Controlled Trial.” J Manipulative Physiol Ther 41(8): 641-649.

CF 033: Did You Need Proof That Chiropractors Help Headaches?

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