Cervical Artery Dissection

Tensile Force On Vertebral Artery During Adjustments & Exercising For Pain

CF 257: Tensile Force On Vertebral Artery During Adjustments & Exercising For Pain Today we’re going to talk about Tensile Force On Vertebral Artery During Adjustments & Exercising For 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 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 chiropracticforward.com

You have found yourself smack dab in the middle of Episode #257 Now if you missed last week’s episode , we talked about Aspirin And Fall Risk & Caffeine And Child Growth. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things….. What’s going on with me lately? Well, still riding some inflation and recession stuff here these last two months and working on marketing and my customer experience to right the ship as quickly as possible. My trip to Florida and Thanksgiving are playing hell with some of the recoveries but that is what it is and that’s OK. That’s life. 

One of the things we started last week was ‘Your benefits re-start in January so use them while you have them.” Also, am I in too big of a hurry with patients?

Do they feel my need to be in and out or do they each feel special in some way? I am trying to slow down and be more present with each patient. More interested in them and in their story.  We can always blame outward forces when our practices slow up a bit. And that’s legit. You have to consider all aspects. Is it the economy? My website SEO? Inflation? What is the outward cause?

But also, what are the potential in-house causes? Am I too rushed? Am I no longer focused on the customer experience and only focusing on all of my stuff that has to be done instead? Is there something going on with our new patient process and our booking procedures?  Internally, have we changed anything about how we are functioning and doing things? Let’s review how we’re doing things and let’s figure it out. That’s what I’m looking at right now.

No coach or mastermind has all of the answers to a slowdown. It is up to us as business owners to diagnose the cause and the effect. At least to the best of our abilities.  I’m not dramatically slower than in August but September and October and November have been slow enough compared to my regular load that it’s past time to get it fixed and headed back in the right direction. 

And that includes looking in the mirror. We should all do that. A good leader doesn’t ask where the staff failed, but asks, where have I failed.  That’s what I’m doing. 

Also, I’m looking at where I can delegate tasks that have put me in a hurry most days. When I can’t keep up with stuff, it’s time to figure out how to farm out stuff so that I don’t feel rushed and overwhelmed all day every day.  I’m an immaculate stat keeper. That’s about to change. I have an excellent virtual assistant in Nigeria that is helping me figure out how to automate and delegate balancing bank statements, which I still do myself and stat keeping.

This will save A LOT of time on Mondays, Tuesdays, and Wednesdays freeing my brain up to work on more productive tasks like the customer experience.  Alright, enough introspective discovery for this week. Onto the research. 

Item #1

The first on today is called, “Vertebral arteries do not experience tensile force during manual cervical spine manipulation applied to human cadavers” by Gorrell et. al. (Gorrell LM 2022) and published in Journal of Manual Manipulativer Therapy on November 15, 2022. Dayum. That’s hot. 

Why They Did It The vertebral artery (VA) may be stretched and subsequently damaged during manual cervical spine manipulation. The objective of this study was to measure vertebral artery length changes that occur during cervical spine manipulation and to compare these to the vertebral artery failure length.

How They Did It

  • Piezoelectric ultrasound crystals were implanted along the length of the VA (C1 to C7) and were used to measure length changes during cervical spine manipulation of seven un-embalmed, post-rigor human cadavers. 
  • Arteries were then excised, and elongation from arbitrary in-situ head/neck positions to first force (0.1 N) was measured. Following this, vertebral arteries were stretched (8.33 mm/s) to mechanical failure. 
  • Failure was defined as the instance when VA elongation resulted in a decrease in force.

What They Found

  • From arbitrary in-situ head/neck positions, the greatest average vertebral artery length change during spinal manipulation was 5.1%. 
  • From arbitrary in-situ head/neck positions, arteries were elongated on average 33.5% prior to first force occurrence and 51.3% to failure. 
  • Average failure forces were 3.4 N

Wrap It Up

Measured in arbitrary in-situ head/neck positions, vertebral arteries were slack. It appears that this slack must be taken up prior to vertebral arteries experiencing tensile force.  During cervical spine manipulations (using cervical spine extension and rotation), arterial length changes remained below that slack length, suggesting that VA elongated but were not stretched during the manipulation.  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 can’t live without those products, send me an email and I’ll 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, “The Relationship Between Physical Activity and Pain in U.S. Adults” by Ray et. al. (Ray 2022) and published in Medicine and Science in Sports and Exercise on October 26, 2022. Hot potato!

Why They Did It The authors wanted to assess the relationship between physical activity (PA) and pain within the available sample, with secondary aims to assess prevalence of pain, physical activity levels, healthcare seeking behaviors, and impact of pain on daily activities and work.

How They Did It They conducted an epidemiological cross-sectional observational study utilizing National Health Interview Survey (NHIS) data from 2020.  They examined the self-reported adherence to current physical activity guidelines and the prevalence of pain.  They hypothesized those dealing with pain were less likely to meet physical activity guidelines. physical activity levels, pain prevalence, frequency, and intensity were assessed via the survey and relationships explored via modeling.

What They Found

  • 31,568, subjects
  • 12,429 (39.37%) reported pain on some days, 2,761 (8.75%) on most days, and 4,661 (14.76%) every day. 
  • The odds of engaging in physical activity decreased in a stepwise fashion based on frequency and intensity of pain reporting when compared to no pain. 
  • Importantly, physical activity is a significant correlate affecting pain reporting, with individuals engaging in physical activity (strength and aerobic) demonstrating 2 times lower odds of reporting pain when compared to those not meeting the physical activity guidelines.

Wrap It Up

There is a significant correlation between meeting physical activity guidelines and pain. Meeting both criteria of physical activity guidelines resulted in lower odds of reporting pain. Additionally, the odds of participating in physical activity decreased based on pain frequency reporting.

These are important findings for clinicians, highlighting the need for assessing physical activity not only for those dealing with pain but as a potential risk factor for minimizing the development of chronic pain. Get ‘em moving folks!

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  

Bibliography

Gorrell LM, S. A., Edwards WB, Herzog W., (2022). “Vertebral arteries do not experience tensile force during manual cervical spine manipulation applied to human cadavers.” J Man Manip Ther.  

Ray, B. M. K., Kyle J.; Eubanks, James E.; Nan, Nan; Ma, Changxing; Miles, Derek, (2022). “The Relationship Between Physical Activity and Pain in U.S. Adults.” Medicine & Science in Sports & Exercise.          

Recognizing Cervical Artery Dissection

 CF 244: Recognizing Cervical Artery Dissection Today we’re going to talk about Recognizing Cervical Artery Dissection 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 excellent education for you AND your patients. It saves you time in 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 chiropracticforward.com

You have found yourself smack dab in the middle of Episode #244 Now if you missed last week’s episode , we talked about Chiropractic Adjustments To Avoid Other Procedures & we talked about Male Vets With Chronic Pain. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Well, I just turned the big 50 people. It hurt a little. I’m not going to lie. I’ve always been one to really value and enjoy being young. I didn’t just go through it without appreciating my abilities and what I could do and accomplish.  I loved being an athlete and running and all of that good stuff. They say it’s just a number but that number is engrained in my joints and I feel it. Part of it is a weight thing.

Being 6’ 4” and 275 or so isn’t great for joints of the body so I’m on it. We’ll get that down. I’m determined.  So, 50 is blah for me but it’s over and it’s onward ho. I have too many irons in the file to be worrying about birthdays and all of that stuff. 

Business is pretty solid for back-to-school. It’s pretty steady. Which is surprising. I’m changing up some marketing in the near future and will share some of my experience on that. I’m a little nervous to dive more into marketing because if I’m honest, I’m at capacity as it is.  I saw 27 new patients last week. Just me. We had a total of about 180 visits and that’s just about as much as I can do. But with the type of marketing, we’re going to be trying, we’ll be more likely to only get the patients in here that we want to work with that are already fully committed and motivated.  We shall see. But for now, let’s get on with the research. We have some fun ones this week. 

Before I do that though, I have to tell you, that 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 #1

This first and only one this week is getting some attention due to a recent artery dissection suffered by a woman in Georgia. Unfortunate for sure. I don’t know the particulars so we won’t go into that specifically but, when things like this happen, we start seeing more and more about the chiropractors cause stroke thing.  Typically, this isn’t true and there is a lot of research backing that up. I want to cover an article today that just came out called, “How to Recognize A Cervical Artery Dissection’ by James Demetrious, DC, DABCO (DABCO 2022) and published in PostGrad DC on July 18, 2022. Kaplowy! 

That’s hot!

Since this is an article, we’ll dispense with the traditional format and hit the high notes.  The arrticle highlights an excellent paper that came out not long ago that we covered here on the podcast. It’s by Chaibi et al (Chaibi A 2018) and was in the Annals of Medicine in 2019. In their paper, they cited high-quality research that affirms 

  • Manual therapy doesn’t no result in an increased risk of CAD
  • There is no strong evidence that manual therapy provokes CAD. 

Chaibi and Russell cite high-quality research to support these conclusions:

  • The rarity of CAD also makes the provision of epidemiological evidence challenging.
  • However, several extensive cohort studies and meta-analyses have found no excess risk of CAD resulting in secondary ischaemic stroke for chiropractic SMT compared to primary care. [2, 3, 4]
  • Similarly, retrospective cohort studies have reported no association with traumatic injury to the head or neck after SMT for neuromusculoskeletal pain.
  • Studies have disproven any misconception about whether SMT strains exceed failure strains.
  • No changes in blood flow or velocity in the VA of healthy young male adults were found in various head positions and during a cervical SMT.
  • Thus, these studies support the evidence of spontaneous causality or minimally suggest very low risk for serious AEs following SMT.

For my office, I try my best to minimize the risk to as close to zero as possible. If there is a young person in the office with unilateral neck pain for no reason, especially combined with a severe headache, they’re getting the inquisition, folks. I’m a research nerd and through my years of doing this podcast, I have compiled 19 questions that I feel can give us the best possible screen for CAD. Feel free to use them for yourself. They are as follows:

  • Is there any difference in upper arm strength from side to side?
  • Is there pain or numbness in one side of the face?
  • Can the patient raise both eyebrows equally?
  • Is there any difference in the size of the pupils?
  • Does the patient have an even smile?
  • Is the tongue straight when you have the patient stick it out?
  • Do they have a mostly even grip bilaterally?
  • Can they perform a resisted shoulder shrug evenly bilaterally?
  • Do you have a head pain or headache that developed suddenly and can be sharp or throbbing?
  • Do you have a headache that is worse when laying down?
  • Do you have difficulty speaking or swallowing?
  • Do you have any visual abnormalities?
  • Do you have unsteadiness or lack of coordination beyond what you consider normal?
  • Are you having any recent onset hiccups?
  • Are you having any hearing loss or pulsing tinnitus?
  • Are you having any nausea or vomiting?
  • Signs of nystagmus?
  • Any other neurological symptoms?
  • Do they have any light-headedness or fainting, disorientation, unexplained anxiety, disturbances in the ears, tremors, or sweating?

Now, if after all of those questions, you have accurately documented this complaint and should have a good direction forward. Most of the time, after the screen, I’m comfortable moving on. I’ve done my due diligence. However, I’m sure I’ve lost some patients over the years because if some of these are answered yes with no clear explanation for them, they’re getting an MR-A or a CT-A or I’m not working on them. Plain and simple.  I tell them my first job is to do no harm. My second job is to make them better.  Most appreciate it and are happy to do the imaging. 

So, there you go. If you’d like more information on why chiropractors are almost never solely responsible for CAD, I put together a very comprehensive and, I think, entertaining rundown of the information and I did it in various forms so that you could get the info however you like.  I put it in a blog on my website at chiropracticforward.com. The blog is called Debunked; The Odd Myth That Chiropractors Cause Strokes. The link can be found in the show notes right here at this point in the episode.  https://www.chiropracticforward.com/blog-post/debunked-the-odd-myth-that-chiropractors-cause-strokes-revisited/

I also have it in video form on YouTube with the same title   And just to be sure you could get the information in your preferred format, I made podcast episodes covering the same information in depth. The episodes of this podcast are Episodes 13, 14, and 15

I invite you to dive in a bit so you can be on top of it all. 

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  

Bibliography

  • Chaibi A, R. M. (2018). “A risk-benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: A comprehensive review.” Annals of Medicine.
  • DABCO, J. D. D. (2022). “How to Recognize a Cervical Artery Dissection?” PostGradDC.