CF 259: Cervical Curvature & Lumbar MRI Findings In Asymptomatics – New Stuff
Today we’re going to talk about Cervical Curvature & Lumbar MRI Findings In Asymptomatics – New Stuff
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!
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 #259
Now if you missed last week’s episode , we were joined by Dr. Anthony Houssain and had an amazing discussion on how to choose a good practice location, on the clinic/gym hybrid model, and one why masterminds are so important for you growth. Make sure you don’t miss that info. Keep up with the class.On the personal end of things….. First thing, if you haven’t had enough of my podcast, or you just want to hear my thoughts in a different context and setting, Dr. Jay Greenstein and Brad Cost interviewed me for their podcast called TechTalk and we had a great chat about life, practice, and all things in between. Go check it out. It aired just a week or two ago so it’s one of their newest episodes. So, if you’ve been listening lately, you know I’ve been in a slump. I’m not a slump type of guy. I don’t know what ‘take a step back’ even looks like. It’s not in my vocabulary. All I know is progress, growth, win, win, win. I’m an old college football player and won state here in Texas in the discus. Competition, initiative, and growth are engrained in the very fabric of my being. It’s just how I’m built. So, being slower here in the clinic this year has been challenging for me. A bit financially but also big time mentally. I don’t have mental health issues. That’s now what we’re talking about. Mentally as far as trying to figure it out. Putting the puzzle together so that I can fix it and get back to growing. Part of that has been fixing my outlook day to day. Embracing the suck. Meaning, when I show up on a Monday morning and there’s 48 on the schedule and there are 5 in the lobby before we even open…..instead of being defeated before I even get into my office space, my personal area, instead of being defeated, I need to embrace the stress and anxiety, thank God for our blessings, and get to work making people feel better. So, I wanted to fix that first. Then, what else could be the issue. Well, I used to be #1 on the google search. For years I was the top one because nobody else had figured out the importance at that time so I had a step ahead. But, an internet company I was with screwed up my site, Google changed their algorithms, and boom, I started dropping. So I switched companies. They set up a great site but no real SEO. So I started blogging every single week. New, fresh, completely original content. Guess what, no help at all. Not even a little. I was falling like a rock. So I think website SEO is a big issue so I’m addressing that now too. You all know I’m in the Florida Mastermind with Dr. Kevin Christie. Well Kevin works with Darcy Sullivan of Propel. So, I contacted Darcy and she’s taking me on as a client and a big project I can only assume. Lol. I’m going to be talking every week or so about my experience so you’ll know how it’s going in real time and we’ll be able to see where I started and where I end up with Darcy’s help. It’ll be a learning project we’ll do together. Stick with me for the next 4-6 months on the website SEO thing because this should be interesting. If all works out well, you may be contacting Darcy and Propel as well. Time will tell. Alright, let’s get to the research shall we? Item #1 Our first on his called, “Lumbar spine MRI findings in asymptomatic elite male academy footballers: a case series: by Carmody et. Al. (Carmody S 2022) and published in BMC Sports Science Medical Rehabilitation on October 24th, 2022 and that’s brand new and it’s hot too! Why They Did It
Understanding common MRI findings may allow clinicians to appreciate the sport-specific effects on the lumbar spine, and to discern clinically significant pathology.
Prevalence data regarding radiological abnormalities seen during the surveillance of asymptomatic elite footballers is, therefore, important to help understand injury mechanisms and to prevent associated injuries.
The purpose of this study was to evaluate the magnetic resonance imaging (MRI) findings in the lumbar spines of asymptomatic elite male adolescent footballers.
How They Did It
A prospective case-series study was carried out.
MRI was performed in 18 asymptomatic male elite adolescent footballers recruited from a professional academy in England
The images were independently reported by two consultant musculoskeletal radiologists to achieve consensus opinion.
What They Found
Fifteen players (83%) showed one or more abnormalities, that included facet degeneration, synovial cysts, disc degeneration, disc herniation, and pars injury.
One player had mild (Grade 1) facet joint arthropathy at L4/L5
3/18 showed evidence of bilateral facet joint effusions.
Three synovial cysts were identified in 2 players,
4 presented asymptomatic pars injuries,
4 had a grade 2 subtotal stress fracture and
1 player had a grade 4 chronic stress fracture
Disc degeneration at one or more levels was demonstrated in 7 fo the 18.
Disc herniation was present in 5 or 27% of the players.
Wrap It Up A range of unsuspected findings on MRI of the lumbar spine are common in elite adolescent footballers.
Folks, all of those scary words used to send my patients straight to a surgeon for a second evaluation. Now I know better. These are all asymptomatic. No clinical issue whatsoever and these players ranged from 17 years old to almost 19 years old. No pain and almost 30% of them had disc herniations. We can manage these cases. If there is no progressive neurological deficit with regard to bowel and bladder function, DTRs, dermatomes, or motor function, why are you sending them anywhere?
Don’t do it. Pain is not a reason for surgery and we can manage them if you are educated and know what to do. If you do not know, get smart and get educated. Good starting points are:
Stu McGill’s book called Back Mechanic
Craig Liebensen
McKenzie Certifications
FMS/SFMA
DNS
Donal Murphy’s Spine Practitioner program and his CRISP Protocol books.
Just that group of stuff right there will put you heads and shoulders beyond what the majority of your colleagues and yes…competitors are able to do. You immediately differentiate yourself and then you lengthen the road between yourself and the others more and more with each cert you get. Then look at Diplomates to solidify a canyon between yourself and the rest. Stop sitting on your ass if you don’t know anything about this stuff. Get on it and make this profession what it should be. Bam. Pow. Smack. Kachunga, Slap! Wowza! Tough talk and tough love. But hopefully motivating works from you Ol’ Uncle Jeffro. You’re welcome. 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 next one is called, “Does Improvement towards a Normal Cervical Sagittal Configuration Aid in the Management of Lumbosacral Radiculopathy: A Randomized Controlled Trial” by Moustafa et. al. (Moustafa IM 2022)published in Journal of Clinical Medicine on September 29, 2022 and that’s a hot tamale with jalapeños atop of it. And as a side note, I’m still trying to figure out how I got stuck with a boring name like Williams while you got guys walking the Earth with the last name Moustafa. It’s just not fair.Why They Did It
to investigate the effects of sagittal head posture correction on 3D spinal posture parameters, back and leg pain, disability, and S1 nerve root function in patients with chronic discogenic lumbosacral radiculopathy
How They Did It
A randomized controlled study with a six-month follow-up
80 (35 female) patients between 40 and 55 years experiencing chronic discogenic lumbosacral radiculopathy with a definite hypolordotic cervical spine and forward head posture (FHP) and were randomly assigned a comparative treatment control group and a study group
Both groups received TENS therapy and hot packs, additionally, the study group received the Denneroll cervical traction orthotic.
Interventions were applied at a frequency of 3 x per week for 10 weeks and groups were followed for an additional 6-months.
Radiographic measures included cervical lordosis (CL) from C2-C7 and FHP; postural measurements included: lumbar lordosis, thoracic kyphosis, trunk inclination, lateral deviation, trunk imbalance, surface rotation, and pelvic inclination.
Leg and back pain scores, Oswestry Disability Index (ODI), and H-reflex latency and amplitude were measured
What They Found
Statistically significant differences between the groups at 10 weeks were found: for all postural measures,
No significant difference for back pain, leg pain and ODI at 10 weeks were identified.
Only the study group’s improvements were maintained at the 6-month follow up while the control groups values regressed back to baseline.
At the 6-month follow-up, it was identified in the study group that improved cervical lordosis and reduction of FHP were found to have a positive impact on 3D posture parameters, leg and back pain scores, ODI, and H-reflex latency and amplitude.
OK….a dude who sells the Denneroll did this paper. It’s funny how other researchers find no big deal when it comes to the cervical curve. However, literally ALL of this guy’s ‘papers’ somehow make a big deal out of C-sp decreased curvature. Hinky, huh? It’s so odd. It’s like Firestone doing research and finding out how amazing their tires are. Hey everyone….McDonald’s did a research project and they found out how yummy their food is!! Yay McDonald’s you’re so amazing and thank you for doing your own research on your own company for the rest of us dumbasses. Thank you for being so awesome and kind. Blah. 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!
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
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ TwitterTweets by Chiro_ForwardYouTube 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 Carmody S, R. G., Mitchell A, Kryger KO, Ahmad I, Gill M, Rushton A, (2022). “Lumbar spine MRI findings in asymptomatic elite male academy footballers: a case series.” BMC Sports Sci Med Rehabil 14(1): 184.
Moustafa IM, D. A., Harrison DE (2022). “Does Improvement towards a Normal Cervical Sagittal Configuration Aid in the Management of Lumbosacral Radiculopathy: A Randomized Controlled Trial.” J Clin Med 11(19): 5768.
CF Ep. 213: Easy, Cheap Way To Fix Cervical Curvature & SMT For Chronic Neck Pain Today we’re going to talk about Easy, Cheap Way To Fix Cervical Curvature & SMT For Chronic Neck Pain 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!
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 intosections 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 #213 Now if you missed last week’s episode , we talked about Intermittent Fasting & Dementia And Your Level Of Activity. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
Alright, no…it’s not just you….I’m a little slower than normal right now. For most of us, that’s the nature of the beast. We just slow down in January because most of us take insurance and most of those plans re-set in January. People haven’t met their deductibles. They don’t like to spend their own money. And that’s OK. Speaking from 24 years of experience, it’s normal and you’ll start seeing it pick back up around mid to late February. Definitely by March. Like I sadi last week, this is the time that we start playing catch up and taking care of all of the stuff that’s been sitting on the back burner.So start dusting off that stack on your desk and working through it while you have the time. I want to be honest. Which I always am. I think I’m in a mid-life crisis. I’m tired of replacing employees. Re-hiring, etc. I’m tired of the same old questions we get from patients. I’m tired of dealing with the day-to-day stuff I’ve dealt with. Some of you will love what you’re doing so much that you’ll want to die in your office at 84 years old working on someone.
And wouldn’t that be an awful experience for the patient? Just as a side thought. Lol.
Anyway, that’s not me. When I’m answering the question about why someone’s neck is hurting for the umpteenth time, the call for more freedom of time gets stronger.And stronger and stronger. That’s the reason that over the last few years I have started cultivating the side gigs. The exit strategy. Looky here; I write and perform music, I paint, I draw, I play the guitar, I build furniture, I sculpt, I throw the discus and want to compete in old man track meets, and I love spending time with my family and traveling. So…how the hell do you do all of that while you’re in a clinic all day every day your entire life? The answer is….you don’t. You don’t do the things that feed your soul. You either don’t do them at all, or you don’t do them very often.
Until you’re 65 or so for most people. Well, I don’t plan on being most, folks. So, how do you own the practice instead of the practice owning you? Great question. I don’t know but here are some of the avenues I’m using to try to walk the path.
In fact, I have a big presentation coming up at the Texas Chiropractic Association’s MidWinter Conference in Lubbock, TX on February 18th. It’s called Chronic Pain And The Upregulated Central Nervous System. I’m in the process of building that talk as we speak. If that sounds like something your group or association could use, email me at dr.williams@chiropracticforward.com and let’s connect.
I’d love to come present for you and your peeps.
So, anyway, I do all kinds of things. But those are the biggies. Get your exit number in place. Even if you’re brand new. You gotta have your loans paid. You gotta have your retirement finances in the process. You gotta have investments working. Once that’s handled, what is the exit number that would make you secure to make your exit. Or to make a Hybrid Exit. What’s that exactly? A Hybrid Exit would look different for different folks. For one person that might mean treating patients 2 days per week. For others, it might mean strictly being the owner but exiting patient treatment completely. It could mean a million things but, at the price point some of us make per year, it can be difficult to build enough side gig to replace that income. For me, just looking at the numbers and potential, while keeping risk mitigation in mind, real estate seems the quickest way when you combine that with the clinic integration and hiring an associate chiro. Combining these three may get me there. Then you throw in this voice-over blessing that I started last year…..wow. That was out of nowhere, was a complete surprise, and an amazing blessing. Voice over, by itself, has more than funded the down payment and the furnishing of our very first short-term rental house and investment I’ve been mentioning more and more recently.
Let’s be honest though, you don’t have to be in voice-over to invest. You just have to keep the overhead down and save up enough for a downpayment. The rest will take care of itself. And the earlier you start, the faster you get there. I’m 49 and wish I’d had this mentality at 29. Damnit.
But it’s never too late to start taking better care of your future, your physical health, and your mental health. That’s where I’m at. I’ll keep updating you.
Item #1
This first one is called “The Effects of Osteopathic Manipulative Treatment on Pain and Disability in Patients with Chronic Neck Pain: A Single-Blinded Randomized Controlled Trial” by Cholewicki et. al. (Cholewicki J 2021) and published in PM&R on October 31, 2021.
Aye chiwawa!
Why They Did It
Neck pain (NP) affects as much as 70% of individuals at some point in their lives. Systematic reviews indicate that manual treatments can be moderately effective in the management of chronic, nonspecific NP. However, there is a paucity of studies specifically evaluating the efficacy of osteopathic manipulative treatment (OMT). The authors wanted to evaluate the efficacy of OMT in reducing pain and disability in patients with chronic NP. And I’m glad they are because they’re right, there is a paucity of research on neck pain. Low back gets all the attention while neck pain…..treating neck pain is the main thing we chiros get beat up over. So why the hell not knock out a ton of high-level research on chiro, manipulation, and neck pain while continuing to highlight the low risk of adverse effects for its treatment? Can we finally get past this chiropractors cause strokes issue? Is there increased risk? Sure. But that doesn’t mean we go arounnd causing them. There are bad patients that shouldn’t be worked on and there are bad chiros that are far too rouugh. But for the most part, its not dangerous whatsoever. Take the UFC for example
University-based, osteopathic manipulative medicine outpatient clinic.
97 participants, 21-65 years old, with chronic, nonspecific NP
Participants were randomized to two trial arms: immediate OMT intervention or waiting period first.
The intervention consisted of 3-4 OMT sessions over 4-6 weeks, after which the participants switched groups.
Primary outcome measures were pain intensity (average and current) on the numerical rating scale and Neck Disability Index.
38 and 37 participants were available for the analysis in the OMT and waiting period groups, respectively
What They Found
The results showed significantly better primary outcomes in the immediate OMT group for reductions in average pain, current pain, disability, and improved secondary outcomes related to sleep, fatigue, and depression.
No study-related serious adverse events were reported.
Wrap It Up
OMT is relatively safe and effective in reducing pain and disability along with improving sleep, fatigue, and depression in patients with chronic NP immediately following treatment delivered over approximately 4-6 weeks. One big thing here, this improvement was seen with 3-4 visits over 4-6 weeks. Shouldn’t that have been standardized and consistent from patient to patient? Like 4 visits over 6 weeks for example. Not a range. Next thing, this is about chronic pain. Is 3-4 visits over 4-6 weeks really enough to start addressing the issue of chronic pain? To introduce proprioception, movement, function, and all that good stuff?? No is the answer but, they still showed improvement. I’d love to see the outcomes in a design like this with a more robust and appropriate treatment schedule or frequency.
Item #2 Thsi one is called “You don’t need expensive CBP BS protocols with biased research done by the stakeholders to entice the 9 out of 10 patients that naturally have a decreased cervical curvature into a 70 visit $5,000 treatment plan to fix a lack of cervical curve that a 20 year research project proved is no big deal anyway. Oh wait….sorry….check that. The actual title is “Efficacy of Modified Cervical and Shoulder Retraction Exercise in Patients With Loss of Cervical Lordosis and Neck Pain” by Lee et. al. (Lee 2020) and published in Annals of Rehabilitation Medicine on May 29 2020 and it’s hot enough! Sorry for the mistake. I’ll try to pay more attention to the research paper titles. I’m undiagnosed ADD like that. I take the eye off the ball every here and there. I’ll try to tighten that up a bit.
Anyway
Why They Did It
This research was done by medical doctors so there is no chiropractic bias to this lack of curvature research information.
The authors say they wanted to explore if the modified cervical and shoulder retraction exercise program restores cervical lordosis and reduces neck pain in patients with loss of cervical lordosis.
How They Did It
This study was a retrospective analysis of prospectively collected data.
Eighty-three patients with loss of cervical lordosis were eligible.
The eligible patients were trained to perform the modified cervical and shoulder retraction exercise program by a physiatrist, and were scheduled for a follow-up 6 to 8 weeks later to check the post-exercise pain intensity and lateral radiograph of the cervical spine in a comfortable position.
The parameters of cervical alignment (4-line Cobb’s angle, posterior tangent method, and sagittal vertical axis) were measured from the lateral radiograph.
Forty-seven patients were included.
The mean age was 48.29±14.47 years
What They Found
Cervical alignment and neck pain significantly improved after undergoing the modified cervical and shoulder retraction exercise program.
The upper cervical lordotic angle also significantly improved.
In a subgroup analysis, which involved dividing the patients into two age groups (<50 years and ≥50 years), the change of the sagittal vertical axis was significantly greater in the <50 years group
Wrap It Up
The modified cervical and shoulder retraction exercise program tends to improve cervical lordosis and neck pain in patients with loss of cervical lordosis. So……if we’re evidence-based and patient-centered, we are not taking advantage of others. We don’t see patients as sales targets. We aren’t seeing them as targets to close on. We aren’t seeing them with dollar signs in our eyes. Rather, we are seeing them as human beings that are in our clinic to place full faith, trust, body, mind, physical well-being, and their entire futures in our hands.
If we are honoring this idea and honoring our patients, we are teaching them about this, we are teaching them about moving, we are teaching them how to self-manage at home, and we are doing what we can within a responsible and appropriate 2-4 treatment plan….give or take. You know…..being a doctor and doing doctor stuff instead of doing street corner huckster stuff like I see so many fellow chiropractors doing. It’s sad. We don’t have to put up with it in our profession. We just have to stop ignoring it and start calling it out and not putting up with it. We can run this behavior out of our profession. If we choose to. 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.
Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!
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/
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
Cholewicki J, P. J., Reeves NP, DeStefano L, (2021). “The Effects of Osteopathic Manipulative Treatment on Pain and Disability in Patients with Chronic Neck Pain: A Single-Blinded Randomized Controlled Trial.”
PM R. Lee, M., Jeon H, Choi J, Park Y, (2020). “Efficacy of Modified Cervical and Shoulder Retraction Exercise in Patients With Loss of Cervical Lordosis and Neck Pain.” ARM 44: 3.
Today we’re going to talk about the primary spinal practitioner program, research on gabapentin and its use in low back pain and radiculopathy, and we’ll talk about cervical curvature…what’s the research?
But first, here’s that sweet sweet bumper music
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.
Like our facebook page,
Join our private facebook group and interact, and then
go review our podcast on iTunes and other podcast platforms.
While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #123
Now if you missed last week’s episode , we talked about chiropractic primary prevention research, we talked about TENS use for migraines in the ER, and we talked about research for acupuncture with chronic pain. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.
On the personal end of things…..
Well another pandemic week in the books. I’m recording this on April the 29th, 2020 and it’s quite a mess still. We have states that are still climbing in cases dramatically but still opening up businesses.
I’ve been telling people that I’m in the middle on this deal. We have to get out. We can’t stay in our cocoons and watch our businesses die. I was that way for a bit honestly. But we just can’t do that. At the same time, it’s not time to open wide and let ‘er rip either. We have to have a measured opening keeping a watch on the cases.
The great news emerging is the number of asymptomatics they are identifying. It really does all come down to testing. You don’t know what you’re dealing with if you can’t tell who the heck has it. Wouldn’t it be amazing if we are blessed enough to be one of those asymptomatics that simply have no symptoms and no idea we even had the damn thing?
The problem is that at least for now, we have to go about as if we are asymptomatic carriers basically. The last thing I’d ever want is to unknowingly give it to my 74-year-old mother or my 80-year-old stepdad. That’s not my idea of being a good person at all. Lol.
I also have a dad in a nursing home and that’s been tough for sure. I know they do what they can to entertain them but they’re basically forced to keep all of the residents separated in case the bug is lurking about. So, they end up in their rooms most if not all of the day I think.
We haven’t been allowed in to see him since middle March or so. Which is frustrating. He had a stroke so he’s not always all there and can be a bit confused about why people aren’t visiting. Getting him on the phone has been a challenge as well but we’re making due.
It’s a tough time for everyone right now. But I’m a glass half-full guy. This too shall pass. We’re going to be OK. People are going to eventually get out and about. People are going to eventually start re-engaging in the economy. Until then, financial institutes and the government will continue to make accommodations for business owners.
Keep the faith brothers and sisters. The general curve in our country right now is downward. I believe there’s light at the tunnel. Just stay smart and stay safe until we reach that light.
Before we get started, I did a thing
I’ve always wanted to help others with their message and how they’re getting it out there. Keeping that in mind, during this lull in business due to the pandemic, I decided to try something different and invest my time instead of waste it. I’ve certainly had the time to invest as have most of us.
I did two episodes on marketing an evidence-based practice a few months ago and both of those episodes are among our most listened to, most popular episodes so I know there is value there and I know there’s an interest in the topic.
Over the years, if I wanted to learn more about excel, I’d take a course over at udemy.com. If I wanted to learn more about marketing, udemy proved to be a valuable resource. If you’re not familiar with sites like Udemy or Teachable, you should go check it out.
I haven’t really looked into what other chiropractors are using it for but I thought, if I wanted to offer a course, Udemy would be a good place to start. While I’m still building the course and adding content every week, it’s live and ready to go for those interested. If it’s not, it will be live in only a day or two.
If you’re interested, I created, basically, my playbook for marketing and my thoughts on each topic or technique. I also have created downloads, checklists, and examples to show what my stuff looks like.
Just go to udemy.com and do a search on Marketing An Evidence Based Chiropractic Practice and check it out. See what you think. It’s my first online course to create so any feedback is appreciated. Over time, I’ll be updating the content and adding graphics, and things like that as I finish the initial bulk of the work and am able to revisit and re-work parts that could use it. Plus, I plan on responding to feedback and make any needed changes from there as well.
This one is not a research paper as much as it is an article. It is from way back in 2011 but is as relevant or more relevant than it’s ever been today. This one is called, “The establishment of a primary spine care practitioner and its benefits to health care reform in the United States” by Donald Murphy et al(Murphy D 2011) and published in Chiropractic and Manual Therapies journal. I have the citation in the show notes if you’d like to look deeper at this
Why They Did It
They highlight the issue with spine-related treatments, the costs, the lack of any real effectiveness to justify the rising costs and make the argument that a key answer to theses issues includes having a group of practitioners trained to function as primary care practitioners for the spine.
Let’s hit some of the highlights here:
Spine-related disorders (SRDs) are among the most common, costly and disabling problems in Western society. For the purpose of this commentary, we define SRDs as the group of conditions that include back pain, neck pain, many types of headache, radiculopathy, and other symptoms directly related to the spine. Virtually 100% of the population is affected by this group of disorders at some time in life.
A variety of physicians and other providers have traditionally been involved with the diagnosis and treatment of these patients. This includes primary care physicians, chiropractic physicians, orthopedic surgeons, neurosurgeons, physiatrists, osteopathic physicians, physical therapists, psychologists, massage therapists, kinesiologists, naprapaths and acupuncturists. This has resulted in what has been termed the “supermarket approach” to the management of SRDs [19]. That is, the SRD patient is faced with an environment in which there is a large number of practitioners, each offering a solution to SRDs, with the patient left to sort out which of these disparate approaches is best for his or her particular problem. Oftentimes this determination is based more on salesmanship and marketing than on science, clinical benefit and cost-effectiveness. Lawd don’t we know some surgeons and some chiropractors that are salesmen? And scare care tacticians?
Treatment for SRDs has become increasingly specialist-focused, imaging-oriented, invasive and expensive.
One approach to health care reform would designate primary care physicians (PCPs) or groups of PCPs as “patient homes”, responsible for the comprehensive care and management of a designated patient population under a risk-sharing agreement
In their book Redefining Health Care [26], Porter and Teisberg state that for health care reform to be successful, it must incentivize competition based on value, i.e., outcome per dollar spent. To maximize value in health care, they recommend physicians and other health care providers organize themselves around conditions in which they have maximal expertise and experience (chronic kidney disease, diabetes, SRDs) rather than around medical specialties (orthopedics, internal medicine, neurology, etc.) and compete on the level of providing the best health outcomes for these conditions at the best possible cost (i.e., providing value). Ohhhh, that sounds fun because the Palmer/Gallup surveys show chiropractors get patients better for less money and patients are happier with chiropractors than PTs and GPs. I think the good chiropractors would fair particularly well in this scenario.
We think that the health care system needs an appropriately trained and skilled clinician who can fill the role of a primary care provider for the diagnosis and non-surgical management of SRDs; a “primary care physician for the spine”.
The primary spine care practitioner will require a particular skill set that includes the ability to apply evidence-based procedures, appropriately educate and motivate patients and effectively prevent and manage disability related to SRDs. The benefits in terms of improved outcomes of care for SRDs, improved patient satisfaction, and reduced costs (i.e., the value of care for SRDs) would be well worth the effort of grooming practitioners toward filling this role.
Dr. Murphy and his crew have established the Primary Spine Practitioner Certification Program through the University of Pittsburgh. I’ve provided their link in the show notes. If I were 10 years younger, I’d probably do it now that I’ve completed the Ortho Diplomate.
https://www.psp.pitt.edu
Item #2
On to item #2 called “Anticonvulsants in the Treatment of Low Back Pain and Lumbar Radicular Pain: A Systematic Review and Meta-Analysis” by Enke et. al.(Enke O 2018) published in the Canadian Medical Association Journal in July 2018.
Why They Did It
The use of anticonvulsants (e.g., gabapentin, pregabalin) to treat low back pain has increased substantially in recent years despite limited supporting evidence. We aimed to determine the efficacy and tolerability of anticonvulsants in the treatment of low back pain and lumbar radicular pain compared with placebo.
How They Did It
A search was conducted in 5 databases for studies comparing an anticonvulsant to placebo in patients with nonspecific low back pain, sciatica or neurogenic claudication of any duration.
The outcomes were self-reported pain, disability and adverse events.
Risk of bias was assessed using the Physiotherapy Evidence Database (PEDro) scale
Quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE)
Nine trials compared topiramate, gabapentin or pregabalin to placebo in 859 unique participants.
What They Found
Fourteen of 15 comparisons found anticonvulsants were not effective to reduce pain or disability in low back pain or lumbar radicular pain;
For example, there was high-quality evidence of no effect of gabapentinoids versus placebo on chronic low back pain in the short term or for lumbar radicular pain in the immediate term
The lack of efficacy is accompanied by increased risk of adverse events from use of gabapentinoids, for which the level of evidence is high.
Wrap It Up
“There is moderate- to high-quality evidence that anticonvulsants are ineffective for treatment of low back pain or lumbar radicular pain. There is high-quality evidence that gabapentinoids have a higher risk for adverse events.”
Item #3
Our last one is called “Cervical lordosis in asymptomatic individuals: a meta-analysis” by Guo et. al(Guo G 2018). and published in the Journal of Orthopedic Surgery and Research in 2018.
Why They Did It
Cervical lordosis has important clinical and surgical implications. Cervical spine curvature is reported with considerable variability in individual studies. The aim of this study was to examine the existence and extent of cervical lordosis in asymptomatic individuals and to evaluate its relationship with age and gender.
How They Did It
A comprehensive literature search was conducted in several electronic databases
Random effects meta-analyses were performed to estimate the proportion of asymptomatic individuals with lordosis and the effect size of cervical lordotic curvature in these individuals which followed metaregression analysis to examine the factors affecting cervical lordosis
Data from 21 studies were used in the study.
15,364 asymptomatic individuals, age 42.30 years
What They Found
64% individuals possessed lordotic curvature
Degree of lordotic curvature differed by method of measurement
Lordotic curvature was not significantly different between symptomatic and asymptomatic individuals but was significantly higher in males in comparison with females
Age was not significantly associated with lordotic cervical curvature
Wrap It Up
Majority of the asymptomatic individuals possesses lordotic cervical curvature which is higher in males than in females but have no relationship with age or symptoms.
There are a lot more papers out there on cervical curves and the meaning and impact of hypolordosis. Here’s the deal, I’m standing strong that hypolordosis is minimally impactful and is not anywhere near important enough to to sell $6,000, 70 visit annual plans to correct it.
It’s just not. And I don’t care what the owner of a curvature correction system says about it or what biased BS research they try their best to pump out there. It’s Just NOT.
It’s a hell of a marketing scare tactic and it’ll put money in your pockets but it won’t give you respect and it might even keep you up at night if you allow your conscience to have a seat at the table.
Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, belive it, count on it.
Let’s get to the message. Same as it is every week.
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 preventativly 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.
Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Enke O (2018). “Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis.” CMAJ(190): E786-793.
Guo G, L. J., Diao Q, (2018). “Cervical lordosis in asymptomatic individuals: a meta-analysis.” J Orthop Surg Res 13(147).
Murphy D, J. B., Paskowski I, Perle S, Schneider M, (2011). “The establishment of a primary spine care practitioner and its benefits to health care reform in the United States.” Chiropr Man Therap 17.