Catastrophizing

Young Athletes With CTE & Catastrophizing, Fear Avoidance, and Pain

CF 322: Young Athletes With CTE & Catastrophizing, Fear Avoidance, and Pain

Today we’re going to talk about Young Athletes With CTE & Catastrophizing, Fear Avoidance, and Pain But first, here’s that sweet sweet bumper music  

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OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com 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 resource for you and is 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. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #322 Now if you missed last week’s episode, we talked about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 9).  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things….. I’m recording on a Monday and we have the big West Texas Conference coming up this Friday for the Texas Chiropractic Association. It’ll be in Lubbock, TX so about an hour and 45 minutes south of where I’m at here in Amarillo.  I’ve paid for our Parker intern, Dontae, to come with. I think it’s up to the older folks to get the younger folks engaged in our state associations. If you listen long enough, in every podcast, at the end, I say that the ACA and our state associations need bus in the leadership positions if this profession is ever going to continue gaining integration into the system as a whole. If we’re ever going to achieve 1st or 2nd referral status for a non-complicated msk issue, we damn well better start behaving like part of the team instead of part of a fringe cult from outer space. 

Here’s a thought, hey clinic owners and lead doctors with associates, if you don’t require your associates to be a part of their state associations, you are absolutely, undeniably part of the problem. It’s as much Your responsibility to bring them up correctly as it is theirs to start getting involved in their profession.  Oh, I’m getting fired up this morning, damnit!! I’ve held enough positions in the TCA at this point that I’ve lost count and ever since my first year of involvement, our membership has been the issue. We have about 25% of our licensed DCs in the state of TX as actual members in the TCA. So, if we have 6,500 DC in the state, then about 1600 or so are members. Not active members. Just dues-paying members.

Minimal effort members, you might say. 

Consider that the state of TX has around 70,000 physicians and the vast majority are required to be paying members of their predatory state association. The official name is Texas Medical Association but we call them the Evil Empire.  Tell me…..how in the hell are 1600 chiropractors, of which only about 50 are actually active, supposed to turn the tide or battle effectively against an Evil Empire of approximately 60,000 or more? Then throw in lead chiropractors and clinic owners that are sitting on their asses not giving a squirt one way or another and not showing their associates how to give back to their profession and how to protect their rights?

Come on…..it’s almost too ridiculous to even talk about. Why do we have to say this stuff?  it’s disappointing and astonishing.  I sat in a Board Of Directors meeting many years ago. It cost us money to be there and cost us money to be out of our clinics to be there. Fighting an uphill battle that the majority of the DCs in the state don’t care about. It’s self-defeating. But one of my colleagues and friends said, “If not us, then who?” And then it’s OK. Fight the battles nobody else is willing to fight.

Get in, impose your will. Make sure evidence-based, patient-centered practice models are at the forefront of your state association’s initiatives and influence and get the crazy aliens off of the stages at your states continuing education conferences. 

Literally, about 20 people run your associations at any point in time. Hop in. One person can make a world of difference.  Raise your hand. Send an email. Just show up and be there. 

Item #1 Our first one this week is called “Neuropathologic and Clinical Findings in Young Contact Sport Athletes Exposed to Repetitive Head Impacts” by McKee et. Al and published in JAMA Neurology on August 28, 2023 and that’s blisterin’ hot!! Remember, the citations can be found at chiropracticforward.com under this episode. 

McKee AC, Mez J, Abdolmohammadi B, et al. Neuropathologic and Clinical Findings in Young Contact Sport Athletes Exposed to Repetitive Head Impacts. JAMA Neurol. 2023;80(10):1037–1050. doi:10.1001/jamaneurol.2023.2907

Why They Did It Young contact sport athletes may be at risk for long-term neuropathologic disorders, including chronic traumatic encephalopathy (CTE). They wanted to characterize the neuropathologic and clinical symptoms of young brain donors who were contact sport athletes.

How They Did It This case series analyzes findings from 152 of 156 brain donors younger than 30 years identified through the Understanding Neurologic Injury and Traumatic Encephalopathy (UNITE) Brain Bank who donated their brains from February 1, 2008, to September 31, 2022.  Neuropathologic evaluations, retrospective telephone clinical assessments, and online questionnaires with informants were performed blinded. Data analysis was conducted between August 2021 and June 2023.

Exposures  Repetitive head impacts from contact sports.

Main Outcomes and Measures  Gross and microscopic neuropathologic assessment, including diagnosis of CTE, based on defined diagnostic criteria; and informant-reported athletic history and informant-completed scales that assess cognitive symptoms, mood disturbances, and neurobehavioral dysregulation.

What They Found Among the 152 deceased contact sports participants included in the study, CTE was diagnosed in 63 (median age, 26 years).  Of the 63 brain donors diagnosed with CTE, 60 were diagnosed with mild CTE (stages I or II).  Brain donors who had CTE were more likely to be older  Of the 63 athletes with CTE, 45 were men who played amateur sports, including American football, ice hockey, soccer, rugby, and wrestling; 1 woman with CTE played collegiate soccer.  For those who played football, duration of playing career was significantly longer in those with vs without CTE  Athletes with CTE had more ventricular dilatation, cavum septum pellucidum, thalamic notching, and perivascular pigment-laden macrophages in the frontal white matter than those without CTE. 

Cognitive and neurobehavioral symptoms were frequent among all brain donors.  Suicide was the most common cause of death, followed by unintentional overdose; there were no differences in cause of death or clinical symptoms based on CTE status.

Wrap It Up This case series found that young brain donors exposed to repetitive head impacts were highly symptomatic regardless of CTE status, and the causes of symptoms in this sample are likely multifactorial. 

Item #2 Our second one this week is called, “Changes in pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy mediate changes in pain intensity on disability in the treatment of chronic low back pain” by Ryum et al and published in Pain Reports in September of 2023 and it’s hot to the touch!

Ryum T, Stiles TC. Changes in pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy mediate changes in pain intensity on disability in the treatment of chronic low back pain. Pain Rep. 2023 Sep 13;8(5):e1092. doi: 10.1097/PR9.0000000000001092. PMID: 37719924; PMCID: PMC10501475.

Why They Did It Treatment of chronic low back pain (CLBP) based on the fear-avoidance model (FAM) has received support in randomized controlled trials, but few studies have examined treatment processes associated with treatment outcome.  This study examined changes in pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy as mediators of the relation between changes in pain intensity and disability in exposure-based treatment of CLBP.

How They Did It Data from a randomized controlled trial with 2 treatment arms (which were the fear avoidance model with/without in-session exposure)  Change scores (pre to booster session) were computed for all variables, and the indirect effect of change in pain intensity on change in 3 measures of disability, through change in the proposed mediators, was tested in parallel mediation analyses.

What They Found Decreases in pain catastrophizing and fear-avoidance beliefs, as well as increases in pain self-efficacy, mediated a unique proportion of the relation between changes in pain intensity and disability, depending on the outcome measure.  The direct relation between changes in pain intensity and disability was absent when indirect effects were controlled.

Wrap It Up The results suggest that the way pain is interpreted (pain catastrophizing, fear-avoidance beliefs), as well as pain self-efficacy, are all more critical for reducing disability in exposure-based treatment of CLBP than symptom relief per se. You’ve been hearing this from you Ol’ Uncle Jeffro since about 2019 now. Since I went through the Diplomate of the Neuromusculoskeletal Medicine program. Which used to be called the DACO or the ortho diplomate.

It was the DACO when I started and changed in the middle of my education.  I wondered why but it became quickly apparent. There was as much Neuro in the process as there was ortho and yellow flags, upregulated CNS, fear avoidance and all kinds of Neuro tidbits were front stage. So, an ortho diplomate no longer adequately described what we were learning. 

Anyway, pay attention to this stuff. It will absolutely get your patients better when you understand it! 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. 

Store Remember the evidence-informed brochures and posters at chiropracticforward.com. 

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 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 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…. 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 and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  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 https://www.chiropracticforward.com Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter https://twitter.com/Chiro_Forward YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – 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  

New Dietary Ideas & The Doctor’s Words Matter

CF 282: New Dietary Ideas & The Doctor’s Words Matter

Today we’re going to talk about new dietary ideas and the doctor’s words matter.

But first, heres that sweet sweet bumper music

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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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 your 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 creekstonecare@gmail.com

 

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 #282

 

Now if you missed last week’s episode, we were joined by Dr. Lindsay Mumma and talked about clinical excellence and pelvic floors.

Make sure you don’t miss that info. Keep up with the class.

 

On the personal end of things…..

What’s going on in my world these days? It’s interesting always. To say the least.

 

The biggest on our radars at the moment are three things actually.

  1. We have always leased our space and I would love to own the property for obvious reasons. But prices are just ridiculous, honestly. So it’s been a challenge when we’re looking at property. We still have one year on our current lease but just had this building come open that is looking pretty good both size-wise and price-wise. So it has to be looked at. We know our current space is going to go up in a year and our monthly nut on the building will probably be about the same so, why not? But there’s still the process of moving everything, the IT stuff, the making it all work stuff, setting up a clinic/gym hybrid and all that gobbled gook. Geez. It’s daunting.
  2. The second thing we’re looking at is hiring an associate. But can both of these be done at the same time? Hiring an associate and moving into a new building. I don’t think they can be done simultaneously without putting us in a precarious position financially. The extra info on that thought is that it doesn’t seem to matter because associates are getting out of school and they’re going to work for a franchise and aren’t really doing associate-ships anymore. Every chiro I know out in the world that is looking for an associate tells me they’re not to be found and in the last 7 months or so that I’ve been looking, they’re exactly right. Plus, living in Amarillo, TX isn’t as appealing as living in Dallas or Houston or wherever. A person has to almost be from the Texas Panhandle to see my job offering as a blessing. So, if the associate situation continues the way it is, it’ll be no question. We’ll just move into the new building. Lol.
  3. The third thing is that there is a company out of the Houston, TX area that is an investment gropu and they’re buying 60% of practices that qualify within their metrics and they take over all of the soul-crushing parts of your clinic. They do the HR, the billing, and the collecting. The clinics keep their name and nobody but the owner and the staff will ever even know that part of the practice was sold. Dentists have been doing this model for years. Clinic owners make a solid salary and make their 40% commission. They can bill on the medical E&M scale and get paid at a higher level than we could on our own DC codes so the same work for more money. Plus they help bring in medical if you want and they help bring in PT if you want. And they’ll help bring in associates as well. My colleagues working with the company tell me they’re working less and making more and it was the best decision they ever made. So, I’m looking at seriously. With a little side eye but the wife is on board, which is the most important thing. I just need to get the price I’m looking for. Then we shall see.

 

So, there are 3 biggies that are weighing me down because not a one of those are small decisions. They’re actually monumental decisions and they’re all sitting on my plate currently. I’ll let you know how it unfolds as it unfolds.

 

Stay tuned. For now, let’s dive into the research.

 

 

Item #1

 

The first one today is called “Dietary recommendations for cardiovascular health challenged by new evidence on saturated fatty acids’ effects on LDL-C and Lp(a) levels” by Dr. Chinta Sidharthan and published in News Medical Life Sciences on May 15, 2023. Dayum. That’s hot.

 

 

 

Why They Did It

 

The study was conducted to investigate the effects of dietary modifications on cardiovascular health, specifically focusing on the impact of reducing saturated fatty acid intake on lipid profiles and the risk of cardiovascular diseases.

 

 

How They Did It

 

  • The research on the relationship between dietary modifications, lipoprotein A, and cardiovascular disease risk is based on a review of existing scientific literature and studies.

 

  • The research involved analyzing and synthesizing data from multiple studies that investigated the effects of dietary modifications, particularly the reduction of saturated fatty acids, on lipoprotein A and LDL-C levels.

 

  • To assess the impact of dietary modifications on lipoprotein A and LDL-C levels, the researchers collected and analyzed data from participants, including their dietary intake, lipoprotein A and LDL-C levels, and potentially other relevant markers or risk factors for cardiovascular disease. Statistical was performed to determine the associations between different variables and to assess the significance of the findings.

 

 

 

What They Found

 

  • Despite the lack of data for conclusive inferences, it appears that the risk of cardiovascular disease depends on a relative balance between the levels of the two lipoproteins — LDL-C and lipoprotein A — and the baseline values of both in each individual.

 

  • Furthermore, while reducing cardiovascular risk due to high LDL-C levels through the modulation of saturated fatty acid intake remains important, the clinical LDL-C measurements also include the cholesterol component from lipoprotein A.

 

 

Wrap It Up

 

  • Overall, the evidence indicated that the standard recommendations for a heart-healthy diet which includes reduced consumption of saturated fatty acids, might have a negative impact by increasing the lipoprotein A levels despite lowering the LDL-C levels.

 

  • Since dietary changes are the most prevalent non-pharmacological form of disease prevention, tailored recommendations for dietary changes after considering individual lipid profiles might be required.

 

  • Furthermore, additional cardiac health markers such as lipoprotein A cholesterol content are necessary to assess cardiovascular disease risk accurately.

 

 

Before getting to the next one,

 

Next thing, go to https://www.tecnobody.com/en/products 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 droprelease.com & 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. drop-release.com and the discount code is HOTSTUFF. Go do it.

 

 

 

 

Item #2

 

Our last one this week is called, The enduring impact of what clinicians say to people with low back pain” by Ben Darlow, Anthony Dowell, G David Baxter, Fiona Mathieson, Meredith Perry, Sarah Dean published in PubMed on December 11, 2013. Hot potato!

 

 

Why They Did It

 

The purpose of this study was to explore the formation and impact of attitudes and beliefs among people experiencing acute and chronic low back pain.

 

How They Did It

 

Semistructured qualitative interviews were conducted with 12 participants with acute low back pain (less than 6 weeks’ duration) and 11 participants with chronic low back pain (more than 3 months’ duration) from 1 geographical region within New Zealand. Data were analyzed using an Interpretive Description framework.

 

 

What They Found

 

  • Participants’ underlying beliefs about low back pain were influenced by a range of sources. Participants experiencing acute low back pain faced considerable uncertainty and consequently sought more information and understanding.

 

  • Although participants searched the Internet and looked to family and friends, health care professionals had the strongest influence upon their attitudes and beliefs. Clinicians influenced their patients’ understanding of the source and meaning of symptoms, as well as their prognostic expectations. Such information and advice could continue to influence the beliefs of patients for many years.

 

  • Many messages from clinicians were interpreted as meaning the back needed to be protected.

 

  • These messages could result in increased vigilance, worry, guilt when adherence was inadequate, or frustration when protection strategies failed.

 

  • Clinicians could also provide reassurance, which increased confidence, and advice, which positively influenced the approach to movement and activity.

 

 

Wrap It Up

 

Health care professionals have a considerable and enduring influence upon the attitudes and beliefs of people with low back pain. It is important that this opportunity is used to positively influence attitudes and beliefs.

 

When a patient is standing on the ledge of chronic pain, we can push them in or pull them back literally based on what we say and how we behave. If you make a big deal out of ddd, they’re gone, echoing as they fall into the pit. If you tell them that everyone has ddd at some point and usually zero pain associated with it, you start pulling them back. Certainly after you encourage them to move, go for a walk, hurt doesn’t mean harm, and you get some pain free movement wins through your treatment and exercises…..well then we’re having two completely different outcomes altogether now, aren’t we?

 

Be smart with your words and your behavior. It’ll make you look like you’re up on your research and education and it’ll make all the difference in the world in your patients.

 

 

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.

 

 

Store

Remember the evidence-informed brochures and posters at chiropracticforward.com.

 

 

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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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

 

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you 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!

 

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.

 

Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.

 

We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.

 

Connect

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.

 

Website

 

Social Media Links

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

 

Chiropractic Forward Podcast Facebook GROUP

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

 

Twitter

 

YouTube

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

 

iTunes

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

 

Player FM Link

https://player.fm/series/2291021

 

Stitcher:

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

 

TuneIn

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

 

About the Author & Host

Dr. Jeff Williams – 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

 

 

Catastrophizing and Proprioception

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

 

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

This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg

This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg

This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.   We’re the fun kind of research. 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 creekstonecare@gmail.com   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 https://www.tecnobody.com/en/products 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 droprelease.com & 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. droprelease.com 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.  

Store

Remember the evidence-informed brochures and posters at chiropracticforward.com.  

 

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!

 

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.

 

Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.

 

We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.

 

Connect

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.

 

Website

 

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

 

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https://player.fm/series/2291021

 

Stitcher:

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

 

TuneIn

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

 

About the Author & Host

Dr. Jeff Williams – 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

 

 

Nerve Flossing Carpal Tunnel & Catastrophizing

CF 227: Nerve Flossing Carpal Tunnel & Catastrophizing Today we’re going to talk about Nerve Flossing Carpal Tunnel & Catastrophizing But first, here’s that sweet sweet bumper music    

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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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private 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 chiropracticforward.com

You have found yourself smack dab in the middle of Episode #227 Now if you missed last week’s episode , we talked about Cognitive Behavioral Therapy & Restless Leg Syndrome. Make sure you don’t miss that info. Keep up with the class. 

 

On the personal end of things…..

Well if you listened to me last week, then you heard me struggling through an episode. My voice was a straight up mess, I felt pretty dang rough, and really just wanted to be at home in my bed. That business went on for a few more days. I finally figured out that I had COVID. What the hell. Isn’t COVID over? Apparently not.  At this point, I’m 8 days out from the first day I felt crummy. I just have a stuffy nose and coughing some stuff out of my chest here and there but doing pretty good overall.  I’m just glad I got the omicron brand rather than the DeltaVID or the OG-VID I was beginning to think I was immune.

I had an employee that had the antibodies but never got sick. I figured that was me. I guess not. So, I should be good to go with the Rona for like six months before I get it again. Lol So last week was a bust and I have a short week this week as I head to Florida to meet my buddies in St Augustine fir the MCM Mastermind that Kevin Christie began.  It’s an outstanding group of providers. I don’t know if there are any seats left in the group but if you’d like to join the group, gimme a holler.

The next trip and meeting is July 22 in Sarasota. Let’s get to it. Before we do though, I recently connected with a dude.  we all know that the number one type of case that we want is a personal injury case – they are gold because the clients are more compliant, and we get paid at rates far above insurance or Medicare or Medicaid. The patient’s attorney tells them to go for treatment as doing so enhances their legal case and gets them more money. That’s on their end of it but we know less medical providers will accept their cases and they need treatment. And we can help. 

The problem is, how do we get PI cases?  Attorneys don’t generally respond to your invitation for lunch. And let’s face it, they’re a touch bunch. I have the answer. An attorney I know has put together a system, that is both in written and video form, that shares how to approach attorneys and get them to send their PI clients to you. This is the real deal. Attorney Paul Samakow’s system costs $997 and he guarantees satisfaction or your money back. You have to check this out.  Even if you only get one case, you’ve made at least 4 or 5 times the investment. Go to gettingpicases.com/cs That’s gettingpicases.com/cs One more time so you get it right:   gettingpicases.com/cs 

Item #1

The first one is called “Peripheral and Central Adaptations After a Median Nerve Neruomobilization Program Completed by Individuals With Carpal Tunnel Syndrome: An Exploratory mechanistic Study using Musculoskeletal Ultrasound Imaging and Transcranial Magnetic Stimulation” by Paquette et. al. (Paquette P 2020) and published in the Journal Of Manipulative and Physiological Therapeutics on August of 2020. It’s just steamy….not too enfuego on this day.  Why They Did It The authors say, “This exploratory and mechanistic study aims to evaluate the potential peripheral and central adaptations that may result in individuals with CTS who have completed a neuromobilization program.” How They Did It

  • Fourteen individuals with CTS were evaluated 
  • Evaluation were before and 1 week after the completion of a 4-week neuromobilization program that incorporated median nerve sliding exercises. 
  • Pain and upper limb functional abilities were assessed using standardized questionnaires. 
  • The biological integrity and mechanical properties of the median nerve and the corticospinal excitability were quantified using musculoskeletal ultrasound imaging and transcranial magnetic stimulation, respectively.

What They Found

  • Upon completion of the program, participants reported both large and moderate improvements in pain and upper limb functional abilities, respectively. 
  • The biological integrity and mechanical properties of the median nerve remained unchanged, whereas a small significant increase in corticospinal excitability was observed.

Wrap It Up The proposed neuromobilization program appears promising to improve pain and upper limb functional abilities in individuals with CTS. These improvements may be preferentially mediated via central, rather than peripheral, adaptations. Before getting to the next one, I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! It’s live again. Use the code HOTSTUFF upon purchase at droprelease.com to get $50 off your purchase. Y’all, it makes a world of difference. 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. My patients love it and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Hear me now and believe me later.

Item #2

The last one today is called, “Pain Catastrophizing and Pain Self-Efficacy Mediate Interdisciplinary Pain Rehabilitation Program Outcomes at Posttreatment and Follow-Up” by Schumann et. al. (Matthew E Schumann 2021) and published in Pain Medicine in September of 2021 and THAT one is enfuego today. 

Why They Did It

“To prospectively evaluate interdisciplinary pain rehabilitation outcomes, as well as to evaluate the mediating effects of both pain catastrophizing and pain self-efficacy on outcome.”

How They Did It

  • 315 patients with chronic pain participated
  • They completed a 3-week interdisciplinary pain rehabilitation program. 
  • Pain severity, pain interference, pain catastrophizing, pain self-efficacy, quality of life, depressive symptom questionnaires, and measures of physical performance were assessed before and after treatment. 
  • Follow-up questionnaires were returned by 163 participants. 
  • Effect size and reliable change analyses were conducted from pre- to posttreatment and from pretreatment to 6-month follow-up. 
  • Mediation analyses were conducted to determine the mediating effect of pain catastrophizing and pain self-efficacy on pain outcome.

What They Found

  • Significant improvements from pre- to posttreatment in pain outcomes were observed, and more than 80% evidenced a reliable change in at least one pain-relevant measure. 
  • Pain catastrophizing and pain self-efficacy mediated the relationship between changes in pain outcomes.

Wrap It Up

Interdisciplinary pain rehabilitation is an effective treatment, and decreasing pain catastrophizing and increasing pain self-efficacy can influence maintenance of treatment gains. So when you’re managing your words and managing the patients’ yellow flags as much as you’re managing the bio aspect of the condition, then you’re on the right track.  If you only manage the bio part and ignore the psychosocial parts, you only get 1/3 of the equation and potentially only 1/3 of the improvement.

Of course boundaries are much more fluid than that with it comes to healthcare and pain but you get my point.  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. 

 

Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

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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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment 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…. 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 and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 

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 https://www.chiropracticforward.com

Social Media Links https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/

Twitter https://twitter.com/Chiro_Forward

YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

Player FM Link https://player.fm/series/2291021

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

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

About the Author & Host Dr. Jeff Williams – 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  

Bibliography

Matthew E Schumann, P., Brandon J Coombes, PhD, Keith E Gascho, Jr., Jennifer R Geske, Mary C McDermott, APRN, CNP, DNP, MS, Eleshia J Morrison, PhD, Andrea L Reynolds, PT, Jessica L Bernau, RN, Wesley P Gilliam, PhD, (2021). “Pain Catastrophizing and Pain Self-Efficacy Mediate Interdisciplinary Pain Rehabilitation Program Outcomes at Posttreatment and Follow-Up.” Pain Med 23(4): 697-706.  

Paquette P, H. J., Gagnon D, (2020). “Peripheral and Central Adaptations After a Median Nerve Neuromobilization Program Completed by Individuals With Carpal Tunnel Syndrome: An Exploratory Mechanistic Study Using Musculoskeletal Ultrasound Imaging and Transcranial Magnetic Stimulation.” J Man Physiol Ther 43(6): P566-578.