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CF 040: w/ Dr. Brandon Steele: Chiropractic Standardization & The Future of Chiropractic

w/ Dr. Brandon Steele: Chiropractic Standardization & The Future of Chiropractic

Today we’re going to talk with Dr. Brandon Steele about a lot of stuff but specifically, we’ll talk about Chiropractic standardization, educational advancement, and the future of chiropractic. Stick around for an awesome discussion with an extremely sharp doctor on the forefront of our profession.

Integrating Chiropractors

But first, here’s that bumper music

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

Now that I have you here, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It makes it easier to let you know when the newest episode goes live and if we come up with something pretty cool we need to be telling you about. We won’t use it any more than once per week and that’s about all you need to know. It’s not as big of a deal as most of you have in your mind. Just go do it right now while you’re thinking about it. 

We continue to grow our listenership here. I’m a stats nerd. Trust me, I check them more than what one may consider a healthy amount of times. It’s just who I am. Thank you to you all for tuning in. 

If you can continue to share us with your network, we sure would appreciate it. 

We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

You have passed out and woke up right here in Episode #40

Welcome Dr. Brandon Steele

We have a special guest with us this week. As I said from the top we have Dr. Brandon Steele with us today. He is a very respected speaker and has the awesome chance to travel all over doing just that. 

I first became aware of Dr. Steele when I began taking courses in the DACO program. Dr. Steele is one of the instructors and I got to sit in a classroom for two days listening to him cover everything we needed to know about the shoulder. 

I also much have some full disclosure here I think. Dr. Steele is a co-owner of ChiroUp with Dr. Tim Bertlesman and I’m a user/subscriber of ChiroUp. But, ChiroUp isn’t sponsoring this episode. I haven’t received a thing from them. Not even a free membership. Cough cough… 

Seriously though, I’m having Dr. Steele on today because we think a lot alike from what I can tell, I love what they are doing with the DACO program, and I love where I think ChiroUp can help take our industry down the road in regards to Chiropractic standardization & the future of chiropractic. So, without further adieu…….

Questions for Dr. Brandon Steele

Welcome to the show Dr. Steele. Let’s start off with the obligatory question of, “What made you decide to be a chiropractor?”

In our discussion in Dallas, you told me that you’ve moved around a bit. Where are you from and what led you to St. Louis?

I have seen the terms evidence-based and evidence-informed used for what we do and must admit my ignorance of the subtle differences here. I have assumed that, since I follow research, guidelines, and things like that, that I am indeed what is referred to as an evidence-based chiropractor. Can we assume the same about you? 

When exactly did you decide to start traveling more in the direction of evidence and research rather than the philosophical route in the profession? Was there an aha moment?

Tell me a little bit about your hilarious alter-ego, the wide-lapeled chiropractic huckster we see you play in videos from time to time on the ChiroUp Facebook page. 

Part of the idea of being more into the research and being based or informed with the evidence, I think, is Chiropractic standardization…. to standardize our profession to some extent as well as increasing the level of education of the run of the mill chiropractor. We know we don’t have a low level of education at all so….can you go into that a little bit for us? What do you mean when you speak about Chiropractic standardization & the future of chiropractic?

Tell me everything about the DACO program. What got you involved with the DACO program originally?

Our regular listeners should be well-aware of you, Dr. Tim Bertlesman, and ChiroUp at this point. I’ve been pumping your tires for a bit. How did you and Dr. Bertlesman become acquainted with each other and then decide to go into business together?

Questions About ChiroUp, Chiropractic Standardization, and the Future of Chiropractic

Now, tell us a bit about ChiroUp. It feels like to me that it is really starting to hit its stride. I think ChiroUp is huge for Chiropractic standardization & the future of chiropractic.

Obviously, you want it to be successful for your own financial reasons….we all want to see our businesses to well….. but don’t you see something more than that for the profession coming out of ChiroUp? How do you think ChiroUp can affect or change our profession for the better in the years to come, for the future of chiropractic?

What is in the future for ChiroUp as far as updates, functionality…..things like that?

Questions About Dr. Steele’s Speaking Events

What are some of your upcoming speaking events so people can come to see you do your thing?

How can listeners find you on social media or on the internet and contact you or learn more about you and what you do?

So there you have it folks, Dr. Brandon Steele. There’s no doubt you loved this podcast episode as much as I did. The future is bright for Chiropractic standardization & the future of chiropractic.

Integrating Chiropractors

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio. That’s because spinal pain is a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

Chiropractic Description

The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability.

It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Being the the #1 Chiropractic podcast in the world would be pretty darn cool. 

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

http://www.chiropracticforward.com

▶︎Social Media Links

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

▶︎iTunes

▶︎Player FM Link

▶︎Stitcher:

▶︎TuneIn

About the author:

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

 

 

 

CF 039: Communicating Chiropractic

Communicating Chiropractic 

Integrating Chiropractors

Today we’re going to talk about communicating chiropractic and chiropractic utilization. What am I talking about? Stick around

But first, here’s that bumper music

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

Now that I have you here, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It makes it easier to let you know when the newest episode goes live when someone new signs up it makes my heart leap a little, and in the end, it’s just polite and we’re polite in the South.  

We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

You have potato sack jumped yourself right into Episode #39. In case you are new to the Chiropractic forward podcast, there is a different way to get into this podcast. Moonwalk, do the twist, electric slid, grooved, you get the point. 

We are talking about communicating chiropractic and I want to start the research part of our podcast today with a pretty cool paper that just passed through my email. I have my buddy and colleague, Dr. Craig Benton down in Lampasas, TX to thank for this one. It’s called “Characteristics of Chiropractic Patients Being Treated for Chronic Low Back and Neck Pain.” It was authored by PM Herman, et. al. and published in the Journal of Manipulative Physiology and Therapeutics on August 15th of 2018[1]. Brand spanking new, people. https://www.ncbi.nlm.nih.gov/pubmed/30121129

Why They Did It

Since chronic low back and chronic neck pain dominate our population and since chiropractic is a common approach to the conditions, the authors wanted to explore the characteristics of chiropractic patients suffering the conditions here in the United States. Further knowledge here helps with communicating chiropractic more effectively.

How They Did It

  • They collected information from chiropractic patients with different levels of information that included regions, states, sites, providers and clinics, and patients. 
  • The sites and regions were San Diego, Tampa, Minneapolis, Seneca Falls, and Upstate New York, Portland, and Dallas. 
  • Data was collected through an iPad prescreening questionnaire in the clinic and through emailed links to full screening and baseline online questionnaires

What They Found

  • 518 patients with chronic low back pain only
  • 347 with chronic neck pain only
  • 1159 with both chronic low back pain and chronic neck pain. 
  • In general, most participants were highly educated white females that had been using chiropractic care for years. 
  • Over 90% of the participants reported high satisfaction with their care, few used narcotics, and avoiding surgery was the most important reason they chose chiropractic care.

Wrap It Up

The authors concluded, “Given the prevalence of CLBP and CNP, the need to find effective nonpharmacologic alternatives for chronic pain, and the satisfaction these patients found with their care, further study of these patients is worthwhile.”

As a side note, at the first ChiroTexpo event for the Texas Chiropractic Association state convention, these researchers were there recruiting offices for this paper which is kind of cool. 

How much of the population do chiropractors see on average? At least in American? For years, the number has been from 7% to 11% but there is research out there that suggests the number is actually bigger. We can answer that question a little more accurately thanks to some research from Palmer that was published back in 2015. 

This next paper goes more toward helping us in communicating chiropractic than any other paper in recent memory.

It’s called “Americans’ Perceptions of Chiropractic,” it was performed in conjunction with Palmer and Gallup and was submitted by James O’Connor of Palmer and Joe Daly of Gallup[2]. I have linked it in the show notes for you. 

https://www.palmer.edu/uploadedFiles/Pages/Alumni/gallup-report-palmer-college.pdf

The report states from the get-go that half of the adults in the US have been to a chiropractor as a patient. 

  • 14% of adults say they saw a chiropractic within the last 12 months. 
  • 12% say they saw a chiropractor in the last five years
  • 25% say they saw a chiropractor more than 5 years ago
  • Women are more likely to love and visit their chiropractor regularly
  • Adults under 50 are more likely to say that the chiropractor is their first stop for neck or back pain. 
  • Over 50% of adults strongly agree or agree somewhat that chiropractors are effective at treating neck and back pain. 

All of this is great news, y’all. Great news. In the conclusion of this report from Gallup and Palmer College, they say yes…over half of Americans view chiropractors as effective for neck and back pain but uncertainty about costs and misinformation about potential dangers of chiropractic are potential obstacles to them utilizing our services. 

I addressed the whole stroke issue the medical field has tried to saddle us with in a blog, in a YouTube video, and in a series of three podcasts and highly encourage you to re-visit the information in episodes 13, 14, and 15. I will link them for you in the notes. 

The blog, YouTube video, and podcast series is called “DEBUNKED: The Odd Myth That Chiropractors Cause Strokes.”  You must have this information. If you do anything this week, do that. I laid it all out and I did it in blog form, video form, and podcast form so you could pick your preference and get the information. So do it. This information will go a long way in helping you with communicating chiropractic.

YouTube: https://youtu.be/tRXpG_Ie0Rs

Blog: https://www.chiropracticforward.com/blog-post/debunked-the-odd-myth-that-chiropractors-cause-strokes-revisited/

Podcast Episode #13: https://www.chiropracticforward.com/debunked-the-odd-myth-that-chiropractors-cause-strokes/

Podcast Episode #14: https://www.chiropracticforward.com/cf-episode-14-debunked-the-odd-myth-that-chiropractors-cause-strokes-part-2-of-3/

Podcast Episode #15: https://www.chiropracticforward.com/cf-015-debunked-the-odd-myth-that-chiropractors-cause-strokes-part-3-of-3/

The report suggests we try to be transparent when it comes to the costs of chiropractic which also means providing details on insurance coverage, visits required, etc. Here’s the deal though…..if someone comes up to me on the street and asks me how much it costs to come see me, what the hell am I supposed to say?

Quite literally, I don’t have a single damn clue what it’s going to cost them. I don’t know what kind of insurance they have. How do I know if their issue is acute, chronic, or a combination of issues spanning the acute as well as the chronic? I have no way of knowing if their deductible is met. I can’t know what their co-pay is. How can you tell people any of that crap and I’m sure as hell not going to be having a long enough conversation with them when I’m out and about with friends or family to figure it out either. 

Palmer is crazy on that part of this. I’m all about communicating chiropractic but people are grown-ups. They have a Google machine in their pockets. Figure out what your deductible is and how much you’ve met. Figure out what your co-pay is. Google up the offices in your area and try to get an idea of how they practice. If they’re talking about fixing ear infections, boosting your immunes system, and not getting your kids vaccinated, well….chances are they’re going to want to see you 1.23 million times through your lifetime. 

If they’re talking about exercise/rehab, evidence, research, and things of that nature, then they’re going to address your issue quickly and relatively inexpensively. 

Then get on your Facebook machine and ask your friends which evidence-based chiro in your area you need to be seeing and go do that. It’s easier today than ever before. Palmer doesn’t really need to put that directive on chiropractors in my opinion. 

They go on to say that about 37% of Americans are unsure whether or not chiropractic is dangerous. Palmer suggests we chiropractors try communicating chiropractic more clearly in regards to the level of education we have gone through. I think that’s a great suggestion. I do hate the fact that MDs and DOs aren’t going around having to tell everyone about the classes they took and we DCs obviously do need to do that but, it is what it is. You want that in Espanol? Here it is: “Es lo que es.”

Just trying to spice it up, folks. Go with it alright?

The report had some cool news. What news is that you might say? To that, I’d say this: current users of chiropractic typically see their doc an average of 11 times per year which they say shows a strong commitment to chiropractic care.

If the description is a strong commitment to chiropractic care, then count me in. I’m on board. I’m on that team. 

The last sentence of the report says this, “The chiropractic community would do well to increase awareness among the public about the benefits of chiropractic care and the costs associated with it, including offering flexible methods of payment and assistance with navigating insurance, to ensure potential users have what they need to make an informed decision regarding care.”

OK….where to start here?

Dammit. We all know all too well that chiropractors increasing awareness among the public about the benefits of chiropractic care is a slippery slope. Do I want to encourage a chiropractor that doesn’t believe in vaccinations to be out there talking about the amazing benefits of Chiropractic? Ummmm….nope. Nope, I sure don’t. 

Now, if you have a doc talking about how awesome chiropractic is and how spinal manipulation combined with exercise rehab is a powerful combination and is now recommended by the American College of Physicians, JAMA, The Lancet, the FDA, the CDC, The Joint Commission, the current occupant of The White House, and even Consumer Reports…..well hell….I think you have a winner on your hands. That’s what I’m talking about when I say communicating chiropractic. 

Luckily, the only docs listening to me right now are the ones that are going to be talking about the latter rather than the former. 

So listen up evidence-based men and women…..unfortunately, you have to start telling people more about your education and you have to start telling people more about the research and evidence and support behind what it is we do from day to day. 

I’d like to say that it is super duper big-time double fortunate that you have resources like, oh say, maybe a podcast called the Chiropractic Forward Podcast that does all of the work for you by gathering and talking about research every week that can help you on this. 

Now, onto our last topic this week.

This one is an article from June 19, 2018, that was posted on the ACA Blog and linked in the notes on our website for this episode. 

https://www.acatoday.org/News-Publications/ACA-Blogs/ArtMID/6925/ArticleID/374/Communicating-Chiropractic-An-Algorithm-to-Answer-Difficult-Questions

The title of the article is “Communicating Chiropractic: An Algorithm to Answer Difficult Questions[3].” It was written by Dr. Stephanie Halloran who did an excellent job on this article in my opinion. Dr. Halloran is the chiropractic resident with the VA Connecticut Healthcare System.

Dr. Halloran started the article by covering some common questions that can be asked of chiropractors within an interdisciplinary setting. The questions she mentions are:

  • What are the typical conditions treated by chiropractors and specific treatments utilized?
  • We to know the contraindications for treatment?
  • It’s important to be able to describe the mechanisms of manipulation and/or acupuncture?
  • What adverse events from chiropractic treatment, including post-treatment soreness and cervical manipulation and stroke?

All sound like reasonable questions but think about them for a minute. What would your responses be to them and would your answers really stand up to scrutiny in the medical kingdom?

Dr. Halloran cites her site director, VA Chiropractic Program Director Dr. Anthon Lisi as being key in helping her formulate an approach we can use to guide us to develop our own answers to these questions. She lines out 4 steps we should be looking at. 

  1. Have a great depth of knowledge – She says, “First and foremost, you must have an extensive understanding of what you are being asked. Whether the inquiry is as vague as “What is chiropractic?” or more specific, such as “What is the physiologic mechanism of manipulation?” or more sensitive, such as “Does cervical manipulation cause stroke?” it is imperative to know what the evidence does and doesn’t support. “ My goodness…where on Earth could you ever be educated on research and what the evidence says? Hmm….I’ll just wait here until….yes. You’ve found it right here!
  2. Selectively Present that knowledge – Answer with only the most pertinent information. Sometimes less is more and sometimes more is too much information but, be sure you can expound on the neurophysiological effects if specifics are asked.
  3. Be mindful of an appropriate stopping point – She says, “It is reasonable to assume that an encounter will occur at some point with a specialty physician possessing unwavering negative views of chiropractic treatment, and the reality is some will not be swayed despite the evidence presented. The goal of the interaction is to present the evidence, to meet them where they are, and to leave the door open for further conversation at a later date.” And then you punch them in the face and push them down on the playground while saying nanny boo boo. 
  4. Remain altruistic throughout – She says we need to stay focused on the overall goal of health care which is, according to her “to increase functional outcomes, improve quality of life, and provide the best care for patients.” I can get on board with that description myself. 

All of this goes toward helping you in communicating chiropractic. She wraps it up by saying, “In respect to success in integration, my biggest takeaway from being exposed to interprofessional collaboration on a day-to-day basis in the VA is the need for chiropractors to prepare answers to questions regarding what chiropractic care is, common conditions seen, neurophysiological effects of treatment, and the incidence of adverse events. These answers should be instantaneous and provide evidentiary support. One must also be prepared to hit the brakes when met with substantial resistance and to admit lack of familiarity with a topic, when appropriate.”

Can’t we all agree with this article? It makes perfect sense. If you can’t communicate and relay what it is you do, then what are you doing?

This week, I want you to go forward with the idea that we are not a dying profession. We are, in fact, growing and our utilization is growing. We maintain that growth through communicating chiropractic and better patient education as to our level of education and our cost-effectiveness. In addition, in regards to integration, let’s make sure we are prepared to answer questions and do it in a way that is 100% backed by solid and respected research and evidence. You can’t lose when it’s done that way. 

Integrating Chiropractors

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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

When you are communicating chiropractic, the literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Being the #1 Chiropractic podcast in the world would be pretty darn cool. 

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

http://www.chiropracticforward.com

??Social Media Links

??iTunes

??Player FM Link

??Stitcher:

??TuneIn

Bibliography

1. Herman PM, Characteristics of Chiropractic Patients Being Treated for Chronic Low Back and Neck Pain. J Manipulative Physiol Ther, 2018.

2. O’Connor J, Gallup-Palmer College of Chiropractic Inaugural Report: Americans’ Perceptions of Chiropractic. Palmer College of Chiropractic, 2015.

3. Halloran S, Communicating Chiropractic: An Algorithm to Answer Difficult Questions, in ACA Blog, ACA, Editor. 2018: ACA Blog.

This podcast episode was about communicating chiropractic. Communicating chiropractic effectively is a big part of moving the chiropractic profession forward. Bobby Massie Authentic Jersey

CF 038: w/ Dr. Jerry Kennedy – Chiropractic Marketing Done Right

Chiropractic Marketing Done Right

Integrating Chiropractors

Today we’re going to be talking about Chiropractic marketing done right with The owner of Black Sheep DC, Dr. Jerry Kennedy who describes himself as a Chiropractor, a chiro coach, a podcast host, a relationship marketing nerd, and a chiropractic meme wizard. All great descriptions. Dr. Kennedy sounds as busy as I am.

But first, here’s that bumper music

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.

You have hoofed it into Episode #38

Introduction

We have a great guest that I have become familiar with through a couple of my favorite private Facebook groups. One being the Forward Thinking Chiropractic Alliance and the other being Evidence-Based Chiropractic. We are departing a little from our regular format today and I want to tell you why I asked Dr. Kennedy to be a guest on our podcast today. He’s got it figured out when it comes to Chiropractic marketing.

First, I’m a bit of a nerd myself when it comes to Chiropractic marketing. I didn’t claim to be an amazing marketer but I love it. Just the concept of marketing. The thought of marketing. I love the simple fact that using one color vs. the other can make a complete difference in the success of a campaign. It’s fascinating is what I’m saying.

With that being said, Dr. Kennedy is known for relationship marketing. I admit I hadn’t heard the term before hearing Dr. Kennedy use it but I love it because, from what I can tell, it describes me to a tee.

While Dr. Kennedy is agnostic in regards to whether someone practices in an evidence-based way or practices in a more philosophical based practice, I feel his way of approaching patients and approaching practic-building exactly lines up with my way of building relationships through evidence-based means. Like I said, “Chiropractic marketing done right.”

Disclosure

Dr. Kennedy is not sponsoring this show and I am not a member of Black Sheep. I just like what he’s doing and want you all to know about it. I like the spirit of giving and, down the road, Chiropractic Forward is going to be given opportunities to get our name out there because of it. That’s the way the world works in my experience. Give and ye shall receive.

I think we were both given the gift of gab so this episode should just be a great conversation on Chiropractic and Chiropractic Marketing done the right way.

Welcome Dr. Kennedy

So here we go, “Welcome to the show Dr. Kennedy we are so glad to have you with us today. Where are you coming to us from today?”

I already gave you a so-so intro because I’m not really that interesting overall but, to be comprehensive here, can you tell us more about yourself? I don’t want to leave any high points out like kids and all the really important stuff.

Now, I’ve done my homework and listened to several of your podcasts but still don’t know……why call it Black Sheep DC or Black Sheep Chiropractor?

Relationship-based Chiropractic Marketing

Let’s get into what we’re here for Relationship-based chiropractic marketing. I believe I know what it means to me and I’m pretty sure I know how you mean it but would you describe it for us if you don’t mind?

Would you agree that Relationship Chiropractic marketing works well for those already running a patient-centered practice? By patient-centered, I mean docs that are doing what is best for the patient rather than what is best for their practice goal numbers they’re trying to hit that particular month. For me, those are doctor-centered practices. I just wanted to be clear on my thought process just in case our definitions of patient-centered vs. doctor-centered were different.

Types of marketing

In your program, are you advising on internal and external Chiropractic marketing strategy or is it mostly and in-office and social media thing?

I remember in one of your podcasts, you mentioned how you can’t sit around on your butt expecting things to get better. I’m paraphrasing here but it reminded me of a Dan Kennedy saying he calls YCDBSOYA which stands for You Can’t Do Business Sitting On Your Ass. At the beginning of my chiropractic career, I’d say that was an issue with me. Mostly because I didn’t know what it was I needed to be doing. Ignorance in general when it came to marketing.

Without giving away any of your secrets, those are reserved for your members, what advice do you try to give people to get them involved in the community and basically get them off their butts?

If I remember right, you are a proponent of the newsletter for Chiropractic marketing – How do you keep them fresh? I send weekly emails to an email list but have to admit, it’s hell keeping it new and fresh.

Any solid opinion on Direct Mail – Yea or nay?

Is there a new wave of the future when it comes to marketing that people are missing right now? Things like maybe Periscope or Virtual Marketing…..or something else I don’t know about yet?

Chiropractic Marketing Memes

One thing we have in common, we have a knack for creating memes. I love them and I love making them. It’s an outlet for my sarcastic, smart-aleck side to come out in hopefully a fun way. Two of your more recent ones I loved would be the one with the stunned looking kid and the caption reads, “That moment you realize a successful business is the key to being a successful chiropractor.”

Those of us that have been in the mix a while know this usually through painful experience. What was the impetus for this one?

The other more recent one that cracked me up a little bit was the guy saying Whoa there….if you’re going to tell me how to adjust you, it’s going to cost you extra. I think we’re all familiar with the reason for that one.

Black Sheep DC Podcast

You recently stopped your free podcast after 184 episodes.  Tell us a little about that decision and did you get any pushback on that?

What would be your overriding goal for each person that signs up for your Chiropractic marketing programs?

This is the one somewhat challenging question. It’s been my opinion my whole professional life that patient-centered docs hopefully get their patients over the complaint fairly quickly, effectively, and cost-efficiently while doctor-centered practices are busy trying to hit certain numbers, seeing patients many more times than current guidelines and recommendations allow, and claiming to have effects on conditions there is little to no good research for.

Without getting you to take sides, throw rocks, or any of that…… and without trying to stir the pot too much, how in your opinion, is it possible for a subluxation, philosophical-based, 100 visits a year style of a practitioner to also be patient-centered and relationship-based Chiropractic marketing?

Tell us where listeners can find you and connect with you if they’re interested in relationship marketing and in learning more about Back Sheep DC

Thank you so much for joining us……

Before you all go,

I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It makes it easier to let you know when the newest episode goes live, you’ll never hear from us more than once a week, and in the end, it’s just an email for goodness sakes!

Integrating Chiropractors

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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. We do it conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

We want to hear from you!

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Being the #1 Chiropractic podcast in the world would be pretty darn cool.

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

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CF 004: And Instantly, Treatment of Back Pain Changes Due To Increase In Opioid-Related Deaths

CF 028: Will Chiropractic First Finally Take Its Place?

CF 002: Research Information – Integrating Chiropractors Into Overall Healthcare System

 

CF 037: Stretching Before Playing. What’s the Verdict?

Stretching Before Playing. What’s the Verdict?

Integrating Chiropractors

Today we’re going to talk about stretching before playing. We’ll go through some research and hopefully give you a general idea of what is the right recommendation to make to your patients. 

But first, here’s that bumper music

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

Now that we are locked in and rocking, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It’s just an email. We don’t sell it, we won’t use it any more than once per week when a new episode comes out, and it’s the best way for lots of you to get a reminder when episodes go live. 

Did you know that I literally get more emails from myself than I get from anyone else? It’s true. As soon as I think of something that needs to get done, I send myself an email. Muy pronto. If I don’t, it’ll be gone in the ether. Like a wisp of smoke. It’s there and then swoosh….it’s gone. Lol. That may be just a consequence of aging but it’s been that way for some time now. We just learn how to deal with those things and develop the coping mechanisms that allow life to continue as unimpeded as possible. 

Back to school, yes, we have the knuckleheads back in school and, while they were unhappy, I was all smiles inside. I love being on a schedule and school offers that regimented, timetable type of deal. That’s what I operate best under. When the kids are here, there, and everywhere, I just lose my mind a little honestly so, for my colleagues that have kids…..hell yeah.

We made it through Summer. 

We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

You have high-stepped right into Episode #37

I mentioned some time ago that I really enjoy some of the private groups on Facebook. Specifically, I enjoy the Forward Thinking Chiropractic Alliance and the Evidence-based Chiropractic Facebook groups. I would be crazy to fail to mention our OWN private Facebook group which is called oddly enough the Chiropractic Forward Facebook group. 

??Chiropractic Forward Podcast Facebook GROUP

You can learn so much stuff you weren’t even expecting to find out or didn’t even know you didn’t know. That’s the best kind of learning I think. 

Stretching Before Playing

On that note. In one of those groups, there was a discussion not too long ago on stretching before playing or participating in an athletic event. When I was an athlete from elementary age all the way through college, we stretched. We stretched a lot. 

In playing football in college, I couldn’t tell you whether stretching before playing made any difference in game time performance because there was never an opportunity to NOT stretch. 

However, I actually won state here in Texas in the discus and competed at state in the shot put when I was in high school and I can tell you from personal experience and from knowing my body very well back then…..I always felt weaker when I stretched before an event.

Luckily, we were allowed to kind of do our own thing in track and field when it came to warm-ups and I started avoiding stretching purely based on the way it made me feel weaker. Stretching before playing in my particular case was a no-go.

Peak Performance

I found I got a lot more use out of visualization and relaxing my mind. On that note, I had a college coach recommend a book to me that made all of the difference to me in regards to performance. It was called Peak Performance and authored by Charles A. Garfield.

It is a phenomenal book. Mostly because it didn’t offer general ideas on visualization and relaxation. It gave you specific, easy to use exercises that allowed you to get it and use it immediately. I can’t recommend it highly enough if you can still find it. I’m old now so my copy may one of the few left. But, I did leave a link in the show notes that takes you to a copy at Barnes and Noble if interested. 

https://www.barnesandnoble.com/p/peak-performance-charles-a-garfield/1002544001/2660075437651?st=PLA&sid=BNB_DRS_New+Marketplace+Shopping+Textbooks_00000000&2sid=Google_&sourceId=PLGoP164994&gclid=CjwKCAjw2MTbBRASEiwAdYIpsYwXv0NZHGrUz_0PwqMoqv50DDrvGEyioRTGr44p8jln__5aujnRaxoCKkEQAvD_BwE

Now, was my idea that stretching before playing made me weaker before a throwing event crazy or not? Let’s dive and see what the research has to say on it.

Since there are several papers to run over and our time is limited here, I will not be going very deeply into each paper. We will get the general ideas, I will cite them in the show notes for Episode 37 at chiropracticforward.com and, if you want to learn more, you can find the papers linked there or in our private Chiropractic Forward Facebook group. 

OK, let’s see what we have here. Let’s start with one called “Current concepts in muscle stretching for exercise and rehabilitation” by PT and PhD Phil Page[1]. It was published in the International Journal of Sports Physical Therapy in February of 2012. 

Why They Did It

The purpose of this clinical commentary is to discuss the current concepts of stretching before playing and summarize the evidence related to stretching as used in both exercise and rehabilitation.

There are three muscle stretching techniques frequently described in the literature: Static, Dynamic, and Pre-Contraction stretches. 

Static stretching before playing is the probably the type of stretching we all commonly think of. It’s where you hold a specific position and tension or stretch the muscle or the muscle group. We hold it for 10 or so seconds and usually do that for 3 sets. Traditionally anyway. 

Next is Dynamic stretching before playing, which is characterized by either active or ballistic dynamic stretching. Active dynamic stretching involves moving a limb through its full range of motion to the end range and repeating it several times while Ballistic dynamic stretch involves rapid, alternating movements or “bouncing” at the end-range of the motion. Ballistic dynamic stretching is no longer recommended due to an increased risk of injury. 

The last of the three is Pre-contraction stretching before playing. This involves a contraction of the muscle being stretched or a contraction of its antagonist muscle before stretching. According to Dr. Page’s paper, the most common type of pre-contraction stretching is proprioceptive neuromuscular facilitation (PNF) stretching.

There are several different types of PNF stretching including “contract-relax” (C-R), “hold relax” (H-R), and “contract-relax agonist contract” (CRAC); these are generally performed by having the patient or client contract the muscle being used during the technique at 75 to 100% of maximal contraction, holding for 10 seconds, and then relaxing.

This paper is all about any and all stretching before playing depending on the person and activity so there’s no real specificity in the recommendations but you can derive some generalizations here. 

For warm-up for sports and exercise purposes, Dr. Page says that static stretching is most beneficial for athletes requiring flexibility for their sports like gymnastics, dance, etc. He says that dynamic stretch may be better for athletes that will be running or jumping like basketball players or sprinters. However, he states that stretching has not been shown to reduce the incidence of overall injuries. 

Next, here’s one called “Effects of dynamic and static stretching on vertical jump performance and electromyographic activity” by PA Hough et. al. published in Journal of Strength Conditioning Research in 2009[2].

This was a randomized controlled trial. This one is actually older than the last one but I wanted to cover the last one prior to this one so that you’d know the differences in the types of stretching before playing. So…..on with the show here. 

Why They Did It

The purpose of this study was to assess the effects of static stretching and dynamic stretching on vertical jump performance and electromyographic activity of the vastus medialis.

What They Found

  • There was significantly greater EMG amplitude in the dynamic stretched individuals that the static stretch folks. 
  • The vertical jump was statistically greater in the dynamic stretch group than the static stretch as well. 
  • Static stretch actually has a negative influence on the vertical jump while dynamic has a positive impact. 

Wrap Up

“This investigation provides some physiological basis for the inclusion of DS and exclusion of SS in preparation for activities requiring jumping performance.”

Let’s keep it moving. Here’s one called “Effects of running, static stretching and practice jumps on explosive force production and jumping performance” by W.B. Young et. al. published in Journal of Sports Medicine and Physical Fitness in 2003[3]. 

Why They Did It

The purpose of the study was to compare the effects of running, static stretching of the leg extensors and practice jumps on explosive force production and jumping performance. 

What They Found

The results of this particular study showed that sub-maximum running and practice jumps had a positive effect whereas static stretching before playing had a negative influence on explosive force and jumping performance. It was suggested that an alternative for static stretching should be considered in warm-ups prior to power activities. 

That definitely confirms my personal experience back in track and field in high school. All we really knew back then was the static stretch. 

Right on into the next paper by JC Gergley called “Latent effect of passive static stretching on driver clubbed speed, distance, accuracy, and consistent ball contact in young male competitive golfers” published in Journal of Strength and Conditioning Research in 2010[4]. 

Why They Did It

This investigation was conducted to determine the effect of 2 different warm-up treatments over time on driver clubhead speed, distance, accuracy, and consistent ball contact in young male competitive golfers.

What They Found

The authors concluded, “The results of this inquiry strongly suggest that a total-body passive static stretching routine should be avoided before practice or competition in favor of a gradual active dynamic warmup with the clubs. Athletes with poor mechanics because of lack of flexibility should perform these exercises after a conditioning session, practice, or competition.”

We continue with “The acute effects of static stretching compared to dynamic stretching with and without an active warm-up on anaerobic performance” authored by Bradley Kendall and published in International Journal of Exercise Science in 2017[5].

Why They Did It

“The Wingate Anaerobic Test (WAnT) has been used in many studies to determine anaerobic performance. However, there has been poor reporting of warm-up protocols and limited consistency between warm-up methods that have been used.

With the WAnT being such a commonly-used test, consistency in warm-up methods is essential in order to compare results across studies. Therefore, this study was designed to compare how static stretching, dynamic stretching, and an active warm-up affect WAnT performance.”

It was hypothesized that the dynamic stretching would lead to greater peak power than the static stretching protocol. However, results of post hoc analyses failed to detect a significant difference. For the other measured variables, no significant differences were found.

However, the Bonferroni adjustment is quite stringent and may have failed to detect a significance due to the small sample size in this study. When comparing dynamic stretching to static stretching, Cohen’s effect size suggested that dynamic stretching may have a small to moderate effect on performance.

The comparison between static and dynamic stretching before playing approached significance and had a small to moderate effect, supporting studies that have concluded dynamic stretching before playing to be more beneficial than static stretching prior to anaerobic performance output.”

And here we arrive at our last article called “Injury prevention and management among athletic populations: to stretch or not stretch?” by Kieran O’Sullivan and Sean McAulliffe of Ireland and Gregory Lehman of Canada. This article appeared in Aspetar Sports Medicine Journal in 2014[6]. 

Since this article is long, we won’t get too detailed here. We will hit the high spots and link it in the show notes for episode #37 at ChiropracticForward.com and hopefully, you can read it in depth 

http://www.aspetar.com/journal/upload/PDF/201412891228.pdf

Why They Wrote It

The authors wanted to discuss whether there is evidence that static stretch is worth including in athlete management.

I found it interesting to see a quote at the beginning of this article that said, “There is consistent evidence that SS increases flexibility in the short-term, although the gains in flexibility decrease relatively quickly, such that they are lost within 30 minutes.” 

They summarized static stretch as follows:

  • SS increases flexibility in both the short- and long-term
  • Flexibility is also increased by strength training, especially eccentric training.
  • Interestingly, strength training appears to increase both tendon stiffness and overall MTU stiffness, while simultaneously increasing ROM
  • Neither SS nor strength training appears to consistently decrease the stiffness of the joints.
  • none of the reviews showed a beneficial effect of SS on performance
  • Maximal strength appears to be more commonly negatively affected by SS than explosive muscular performance or power
  • Sustained SS does not appear to enhance running or walking efficiency even when ROM is increased. Results are equivocal with SS and endurance performance. In contrast, strength training consistently improves endurance performance
  • Acute SS for greater than 45 seconds should be avoided immediately before participation in activities where strength or power are important
  • Shorter durations of SS are also hard to justify immediately before participation in activities where strength or power are important
  • In endurance activities, acute SS is hard to justify immediately before participation as performance may be reduced
  • SS is far less effective than strength training in enhancing strength and power and it’s unclear whether adding SS might reduce the strength gains achieved, so why do it?
  • There is not sufficient evidence to endorse or discontinue routine stretching before or after exercise to prevent injury among competitive or recreational athletes
  • In terms of injury prevention, it appears SS has very little to offer and should not be used.
  • Alternatively, a meta- analysis showed that strength training reduced incidence of sports injuries to less than one third

They summarized the article by saying, “the only area in which SS might seem to offer a specific advantage is in the area of increasing flexibility. There may be times when the most important goal is enhancing flexibility (e.g. ballet) and in these isolated circumstances SS may be justifiable.

However, there remains a lack of evidence that gains are superior to those of a strength training programme. Even if strength training is eventually confirmed as being inferior to SS at increasing flexibility, the fact that strength training improves performance, pain, disability, injury and return to sports rates mean strength training must be a mainstay of athletic development and training, in contrast to SS.”

What a fascinating article. We only touched on a few of the larger ideas in the article but it’s FULL of information and learning. If sports and stretching are a part of your focus, the article is a must. Everything they talk about is cited properly so you can really dive in face first if you want. 

Great stuff folks. 

I’m going to say that my notion in high school, in my mind, has been confirmed. I just felt weaker if I performed static stretch for more than just a few seconds. Like the stretching just took the wind out of my sails. 

I’ve learned a ton through putting this podcast and I hope you have too! Hell, that’s what we’re here for right?

Go forward this week with more confidence in your recommendations for stretching before athletic activity. If we didn’t hit enough here for you, dive into the show notes and the citations at chiropracticforward.com Episode #37 and do some of your own homework. You’ll be better for it. I promise. 

Integrating Chiropractors

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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability.

It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Being the #1 Chiropractic podcast in the world would be pretty darn cool. 

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

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http://www.chiropracticforward.com

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Enjoy other episodes of our Chiropractic Forward Podcast!

CF 020: Chiropractic Evolution or Extinction?

CF 030: Integrating Chiropractors – What’s It Going To Take?

CF 034: Chiropractic Information To Help You Form Your Practice

 

Bibliography

1. Page P, CURRENT CONCEPTS IN MUSCLE STRETCHING FOR EXERCISE AND REHABILITATION. Int J Sports Phys Ther, 2012. 7(1): p. 109-119.

2. Hough PA, Effects of dynamic and static stretching on vertical jump performance and electromyographic activity. J Strength Cond Res, 2009. 23(2): p. 507-12.

3. Young WB, Effects of running, static stretching and practice jumps on explosive force production and jumping performance. J Sports Med Phys Fitness, 2003. 43: p. 21-7.

4. Gergley JC, Latent effect of passive static stretching on driver clubhead speed, distance, accuracy, and consistent ball contact in young male competitive golfers. J Strength Cond Res, 2010. 24(12): p. 3326-33.

5. Kendall B, The Acute Effects of Static Stretching Compared to Dynamic Stretching with and without an Active Warm up on Anaerobic Performance. Int J Exerc Sci, 2017. 10(1): p. 53-61.

6. O’Sullivan K, Injury prevention and management among athletic populations: To stretch or not stretch. Aspetar Sports Medicne Journal, 2014. 3(3): p. 624-628.

CF 036: A MishMash Of Research on Chiropractic, On Herniation, Trends, and Ineffectiveness

A MishMash Of Research on Chiropractic, On Herniation, Trends, and Ineffectiveness

Integrating Chiropractors

Today we’re going to talk about research on Chiropractic, research on health trends, and research on disc herniation as a result of a visit to your friendly neighborhood chiropractor. Is that real or is that a bunch of hooey? We’ll talk about it so come along. 

But first, here’s that bumper music

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

Now that I have you here, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. Nope, I don’t have some big prize for you if you sign up. Not big offers. No magical marketing tactics with which to get your email address. Just what we hope is a podcast full of value to you and your business. 

Being on the newsletter list just makes it easier to let you know when the newest episode goes live and, maybe in the future we’ll have some cool stuff to offer those on our email list. Also, when someone new signs up it makes my heart leap and wouldn’t you like to be the one responsible for making someone’s heart leap today? 

Upcoming!

We have a lot of great guests lined up to come on the show! Next week I believe we are going to have Dr. Anthony Palumbo from Staten Island, New York. Dr. Palumbo is very active in the New York State Chiropractic Association and practices in a multidisciplinary practice. We’re going to have a good time picking his brain. 

The week after that, I believe we have Dr. Brandon Steele from ChiroUp and from the DACO program joining us. He’s an excellent resource for what is going on in our profession and where we see things heading in the future for chiropractic. I’m really looking forward to that one. 

We have the green light from Dr. Jerry Kennedy of the Black Sheep DC marketing program to come on the show. We just need to get that date lined up. We have Dr. Tim Bertlesman from the DACO program and also the President of the Illinois Chiropractic Association lined up down the road. 

Good stuff on the way so make sure you’re staying tuned into our little corner here in Podcast land. We’re bringing you the best in research on Chiropractic.

We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

You have fainted very dramatically into Episode #36 and we’re so glad you did. 

How’s your week been so far? I shared on the last podcast how we have had a rough 2018 but things have leveled off and we up and running. It feels a little like a sprint these days to tell you the truth. Lol. And thank the good Lord for it. 

Speaking of thanking the Good Lord, my 16-year-old son has been raised in the church. Not every single Sunday. I like to sleep sometimes ya know. But, often enough to say he’s been a church-goer as has my 11-year-old daughter. We’ve not pushed anything on him but he has taken it upon himself to an extent to further the church part of his life. 

He’s gone to a church camp in New Mexico the last two summers and this year he returned ready to get baptized. So he did. Last Sunday he went to church and took a bath and we couldn’t be more proud of that little dude. He’s actually not so little anymore but, we worry about our kids don’t we?

We worry about if we’re raising them right. Am I raising him to be a good man? Am I raising him to work hard and be dependable? Will they be ready for the world? Have I somehow enabled him to be weak? Am I raising him to feel entitled instead of working his butt off for things in his life

I think parents have all of these worries. I might argue that if you’re not asking yourself at least some of these questions, you might give them a deeper look. I’m not a parenting expert. That’s just my opinion. 

Anyway, my point is, we got this aspect of his life right so far. We sure love that kiddo and we love the direction we see him headed. Kids can be a game-changer for sure. From conception throughout their entire lives, they consume our mind space without even realizing it. And that’s OK. We wouldn’t have any other way most to the time. 

With school back in session now, what are some of the ways that you keep your practice from slowing down? Back to school is historically a slow time for us and we’re never quite sure how to keep that from happening. Email me at dr.williams@chiropracticforward.com and tell me how you do it. I’ll be glad to share on next week’s podcast if you don’t mind. 

This week, I just want to throw some seemingly random papers having to do with research on Chiropractic at you and we’ll start with one called “Effectiveness of classic physical therapy proposals for non-specific low back pain: a literature review.” It was written by F Cuenca-Martinez[1], et.al. and published in Physical Therapy  Research in March of 2018. This is a group of physical therapists writing this paper just so you are in the know. 

Why They Did It

The authors were hoping to evaluate the effectiveness of classical physiotherapy in the management of non-specific chronic low back pain. 

How They Did It

  • They did a literature search in English electronic databases from November- December in 2015 for only randomized controlled trials
  • They only accepted the studies addressing chronic non-specific low back pain treated by manual therapy and different types of exercise methods. 

What They Found

Back School exercises and McKenzie’s method were both ineffective

Spinal manipulation proved effective when performed on the lower back and on the thoracic region but only immediately after it was received and not in the medium or in the long term. 

Massage proved effective for short-term relief

Wrap It Up

The authors’ conclusion was “Based on the data obtained, classical physiotherapy proposals show ineffectiveness in the treatment of chronic non-specific low back pain. More multidimensional studies are needed in order to achieve a better treatment of this condition, including the biopsychosocial paradigm.”

What do we get from this? First thought is, the papers they cite are, at this point, old and considering the papers we have been covering, are really pretty irrelevant to an extent. I mean, any good information will always be good information but only until better information becomes available. The most recent paper cited for the spinal manipulation portion of this project is over 5 years old. So….what the hell?

Second….it’s a bit discombobulated when you read through the abstract. I’m either bad at following along (which is highly likely) or it’s just worded so oddly. I dove into the full paper to try to make heads or tails of what they have going on here. It sounds like physical therapists are just trying to be cheeky monkeys and throwing poo at spinal manipulation and we’re not having it. Mostly because they’re wrong and because we are better and more cost-effective at treating low back pain than they are. Period over and out. 

The authors, in regards to spinal manipulation, refer to three studies. One by Oliveira, et. al[2]., one by Bronfort et. al[3]. and one by Senna and Machaly[4]. The Bronfort study was done on 300 patients and they found basically no difference between those that had physical therapy vs. chiropractic vs. home exercises. They all ended up the same. But, they didn’t cite the work we covered previously showing that chiropractic combined with exercise is more effective that physical therapy. 

Or the paper from Episode 26 by Korthals-de Bos[5] that concluded: “Manual therapy (spinal mobilization) is more effective and less costly for treating neck pain than physiotherapy or care by a general practitioner.”

There was also no mention of the paper by Blanchette et. al. that we covered in Episode #26 that showed that chiropractic patients experience the shortest duration of compensation, and physical therapists’ patients the longest. Blanchette says in that conclusion, “These differences raise concerns regarding the use of physiotherapists as gatekeepers for the worker’s compensation system.” And all the chiropractors said, “Amen, hallelujah brothers and sisters.”

And the Senna paper they cite actually concluded by saying, “SMT is effective for the treatment of chronic nonspecific LBP. To obtain long-term benefit, this study suggests maintenance SM after the initial intensive manipulative therapy.”

I’m done with that paper. 

Let’s move on from these PTs and their poo-throwing. 

Here’s one more specifically geared toward research on Chiropractic called “Chiropractic care and risk for acute lumbar disc herniation: a population-based self-controlled case series study” by Cesar Hincapie, et. al[6].  

Why They Did It

The objective was to investigate the association between chiropractic care and acute lumbar disc herniation with early surgical intervention and contrast this with the association between primary care physician (PCP) care and acute lumbar disc herniation with early surgery

What They Found

Both chiropractic and primary medical care were associated with an increased risk for acute LDH requiring ED visit and early surgery. Our analysis suggests that patients with prodromal back pain from a developing disc herniation likely seek healthcare from both chiropractors and PCPs before full clinical expression of acute LDH. We found no evidence of excess risk for acute LDH with early surgery associated with chiropractic compared with primary medical care.

This Hincapie fella also had a prior paper published not long ago[7] where he discussed and explored the perception among different medical disciplines and among chiropractors as to whether spinal manipulation causes a lumbar disc herniation. It was an interesting paper. We covered it in episode #27 if you’d like to give it a listen. 

https://www.chiropracticforward.com/cf-027-wanted-safe-nonpharmacological-mean-of-treating-spinal-pain/

Then there’s this research on Chiropractic that came out recently titled “Spine Degenerative Conditions and Their Treatments: National Trends in the United States of America” and published in Global Spine Journal February 2018. It was authored by Buser et. al[8]. 

Why They Did It

The aim of this study was to report the current trends when talking about spine degenerative disorders and their various  treatments.

How They Did It

Patients diagnosed with lumbar or cervical spine conditions within the orthopedic Medicare and Humana databases were included

What They Found

  • Within the Medicare database there were 6 206 578 patients diagnosed with lumbar and 3 156 215 patients diagnosed with cervical degenerative conditions between 2006 and 2012
  • There was an increase of 18.5% in the incidence of fusion among lumbar patients
  • For the Humana data sets there were 1 160 495 patients diagnosed with lumbar and 660 721 patients diagnosed with cervical degenerative disorders from 2008 to 2014
  • There was a 33% (lumbar) and 42% (cervical) increases in the number of diagnosed patients. However, in both lumbar and cervical groups there was a decrease in the number of surgical and nonoperative treatments.

Wrap It Up

The authors wrap it up by saying, “There was an overall increase in both lumbar and cervical conditions, followed by an increase in lumbar fusion procedures within the Medicare database. There is still a burning need to optimize the spine care for the elderly and people in their prime work age to lessen the current national economic burden.”

What do we get from that? I’d say that it’s clear from research on Chiropractic we’ve covered here that neck and back pain is stepping forward for sure. It is being recognized for the problem it really is while treatments available in the medical kingdom continue to show scattered results. Chiropractors are the most uniquely positioned to knock this stuff out of the park. 

Fusion surgeries have gone crazy sky high in the last ten years while the outcomes have remained unchanged. 

Epidural steroid injections have been done at a blistering pace over the last decade with no better outcomes. 

Physical therapists are even starting to question their own effectiveness. Take this article in the journal called Physical Therapy written by Colleen Whiteford et. al[9]. Here is the opening paragraph. Get a load of this:

“We are writing to relay our consternation about the guideline article by Bier et al in the March issue of PTJ. We fully support the increasing emphasis on critical evaluation fo the assessment and intervention models used in physical therapist practice. The long-overdue acknowledgment of research that does not support much of what constitutes the bulk of physical therapist practice is a refreshing and honest introspection that can potentially initiate much-needed change within our profession.”

“Without such change, our profession is destined to continue on our current path of practice that is increasingly shown to be yielding outcomes that are less than desirable. Such exploration inevitably leaves us with gaping holes in practice that can be unsettling. The natural and responsible tendency is to search for alternative measures and interventions to fill this gap.”

I’m going to tell you one of those alternatives they’ll be looking to adopt and are looking to adopt is spinal manipulation. You better listen to me folks. If you’ve listened to our podcast much here then you know they’ve already adopted adjustments and renamed it to translatoric spinal manipulation. 

We can keep monkeying with these chiropractors out on the edge of the ether talking about curing everyone on the planet of everything known to man or we can keep moving in the direction of science and in the direction of evidence. My preference is obvious. 

If you haven’t yet, can you leave us a great review on whatever platform it is that you’re listening to us on? iTunes, Stitcher, or whatever it may be. We sure would appreciate it. 

Integrating Chiropractors

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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments. Research on chiropractic shows this clearly.

The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks. Again, research on chiropractic shows this clearly.

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Being the #1 Chiropractic podcast in the world would be pretty darn cool. We’ll keep bringing you Research on chiropractic in the hopes of reaching that goal!

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

http://www.chiropracticforward.com

??Social Media Links

??iTunes

??Player FM Link

??Stitcher:

??TuneIn

Bibliography

1. Cuenca-Martínez F, Effectiveness of classic physical therapy proposals for chronic non-specific low back pain: a literature review. Phys Ther Res, 2018. 21(1): p. 16-22.

2. Oliveira RF, Immediate effects of region-specific and non-region-specific spinal manipulative therapy in patients with chronic low back pain: a randomized controlled trial. Phys Ther Res, 2013. 93(6): p. 748-56.

3. Bronfort G, Supervised exercise, spinal manipulation, and home exercise for chronic low back pain: a randomized clinical trial. Spine, 2011. 11(7): p. 585-98.

4. Senna MK, Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome? Spine (Phila Pa 1976), 2011. Aug 15; 36(18): p. 1427-37.

5. Korthals-de Bos IB, Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. British Medical Journal, 2003. 326(7395): p. 911.

6. Hincapie C, Chiropractic care and risk for acute lumbar disc herniation: a population-based self-controlled case series study. European Spine Journal, 2018. 27(7): p. 1526-1537.

7. Hincapie C, Chiropractic spinal manipulation and the risk for acute lumbar disc herniation: a belief elicitation study. European Spine Journal, 2017.

8. Buser Z, Spine Degenerative Conditions and Their Treatments: National Trends in the United States of America. Global Spine J, 2018. 8(1): p. 57-67.

9. Whiteford C, On “Clinical Practice Guideline for Physical Therapy Assessment and Treatment in Patients With Nonspecific Neck Pain,” Bier JD, Scholten-Peeters WGM, Staal JB, et al. Phys Ther. 2018;98:162–171. Physical Therapy, 2018.

CF 034: Chiropractic Information To Help You Form Your Practice

Chiropractic Information To Help You Form Your Practice

Integrating Chiropractors

Today we’re going to talk about a couple of interesting articles that have come out recently touching on some chiropractic information and it’s all good in the neighborhood for chiropractors. 

But first, here’s that bumper music

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  That’s this one…you’re listening to it right now so you don’t have to do anything else at this point. Just listen and chill out. 

Since you’re here, I might as well ask you to go to chiropracticforward.com and sign up for our newsletter. It makes it easier to let you know when the newest episode goes live, when someone new signs up it makes my heart leap a little and in the end, wouldn’t you just like to know when new episodes come out and, what if we end up compiling a team and coming up with some great ideas? Heck yeah, you want to know about that stuff so make sure you’re on the newsletter. It’s just an email guys. Not diamonds or gold. Lol. 

I want to share with you all the fact that our downloads on this podcast have almost DOUBLED from last month. We’ve picked up that much steam in just one month. Thank you to you all for tuning in. If you can continue to share us with your network and give us some pretty sweet reviews on iTunes, I’ll be forever grateful. 

If all you do is listen, that’s awesome and I’m glad you’re a part of this thing. But, if you can take the extra few seconds to share the episode with buddies on Facebook or wherever, THAT’S the real difference.  

We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

You have bee-bopped right into Episode #34

Before we get into it too far, I’m going to be honest with you all. 2018 has been a challenging year for me both business wise as well as personally. For several reasons really. 

When your attention is taken away from where it needs to be, things tend to fall apart little by little and then finally, you go into a mode where you are all hands on deck and really focused on righting the ship. 

Well, that happened to me at the end of 2017 and through a lot of 2018 as well. I’m only sharing this with you because I want listeners to understand that we’re in this dude together. Issues I deal with and are ultimately able to solve…..if I share those experiences with our listeners, I believe it serves to help you in your practice. 

Here’s the deal, an evidence-based chiropractor, whether I like it or not, is somewhat dependent on a steady stream of new patients. That is due to the fact that we don’t try to see our patients a hundred times, right? We don’t develop the reputation of seeing how many times we can run our patients through the door. Do we? Hopefully, this is chiropractic information you can use.

Oh looky here….your insurance allows you to have 27 visits in a year and….what dya know….your specific condition requires exactly 27 visits to resolve. Ugh. That stuff makes me crazy and, unfortunately, chiropractors are notorious for it. I am hoping some updated, reasonable chiropractic information can sway them to the light. 

Just so chiros don’t think I’m bashing too hard here, medical doctors do useless surgeries just because they can do it and get paid for it with little to zero concern about the person it was done to. It’s rampant in all fields. I just notice the chiropractic side of it more than the others because I’m in it. No chiropractor holds on to 100% of their patients. It just doesn’t happen. 

But, if those NUMBERS DOCTORS – the ones hitting certain stats and the ones that are doctor-centered rather than patient-centered….those guys and gals…..I wonder if they have any idea how many patients they drive away by having that kind of model. And I don’t mean drive away from just their practice. I’m also talking about the number of people they drive away from ANY chiropractor because they assume we’re all the same. It all gives me a rash when I think about it. The public doesn’t have the kind of chiropractic information the rest of us have. 

Anyway, new patients: we depend on a steady stream of them. Now, last year, I would average 55-65 new patients a month but, while we started having issues with billing/collections department, I really got down, I got stressed, and honestly, for a bit, doubted the future of my practice remaining in its current state. That leads to self-doubt too. Where you had a ton of confidence, there remains only a shred after having your foundation shaken, right?

As much as you’d like to avoid it, business gets brought home. Especially when it’s an all-consuming feeling of self-doubt and potential impending doom. Lol. Maybe I’m being a little dramatic looking back on it but, when you’re in it, it’s intense. 

As a result of my focus being altered, my new patient count went to 38 here, 42 there. We’re talking 20+ less new patients per month there for a little while. Without changing anything to my knowledge. 

I spoke with a colleague here in town and his numbers have been down as well so maybe it’s not just me. Who knows?

Here’s what I DO know though. As soon as things lined out in the billing/collections department, guess what, the new patient stream started to line out.

How’s that exactly? I don’t know. I’m guessing an increase in confidence in regards to finances leads to an increase in self-confidence and, when all of my focus isn’t on billing/collections, I have the freedom to work on and consider other aspects of the business. And let’s face it, I’m just a much more pleasant person to be around when I’m not worried about the financial health of my company. I’m going to guess you all are the same way. 

Seriously, once we made a change in the billing/collections department (as badly as I did not want to do it), my billing and collections turned around immediately. I mean immediately. Front desk staff became more confident. I became more confident. Patients started paying what they were supposed to pay. Outdated balances got current. THAT’s some good chiropractic information!

Long story short, what started out as a slow 2018 has become a little bit crazy for me and, if it continues, I’m going to have to hire an associate so I can come up for air. Just getting the podcast written up and produced has started to become a real chore in the last several weeks but I’m committed folks. I’m here for the long haul. 

I hope you are too. 

Let’s start our research talk with one from Chiropractic & Manual Therapies dated 17th of July, 2018 called “Chiropractic in global health and wellbeing: a white paper describing the public health agenda of the World Federation of Chiropractic[1]. This was authored by Michele Maiers, et. al. 

The article begins by saying, “The World Federation of Chiropractic supports the involvement of chiropractors in public health initiatives, particularly as it relates to musculoskeletal health.” I noticed there is no neuro before the musculoskeletal description. Curious. 

The authors then say there are three topics that require out focus as chiropractors and they are

  1. Healthy aging
  2. Opioid misuse
  3. Women, children, and adolescents’ health

I guess the men in the crowd are either built heartier or we’re just not quite as important. Lol. 

The WFC want to help us in participating in these areas and promote chiropractic as partners in the broader healthcare system. That’s certainly something I can get on board with. 

Now, this article is pretty darn long so we’re just going to hit some of the more interesting spots. I will have it linked in the show notes so you can go hop online and read the whole thing word for word should you feel the desire. 

In the background section of the article, they say, “In an era where both medical costs and years lived with chronic disease are increasing, calls have been made for closer collaboration between public health officials and healthcare providers. The potential contribution of many providers, including chiropractors and other health care professionals, is often overlooked.”

But then they go on to say our profession needs to identify priority areas of focus and have plans for our engagement in public health based on these areas of focus. 

I am wondering why they feel that men engaged in manual labor activities having chronic low back pain are not worthy of being a focus group here? We’ve talked so much about how low back pain is such a global epidemic and how so much work is missed as a result blah blah blah. 

Maybe I’m just old school. I don’t have any stats to prove my thoughts here but, I would assume the majority of manual labor is on the backs of men. If I’m not right about that, please email me and show me the stats at dr.williams@chiropracticforward.com. If I’m wrong, I need to be educated. 

Still, what gives on this? I want to be positive so let’s get back to the paper. 

In the area of Healthy Aging, they state the world’s population is getting older and older with the number of folks over the age of 60 years old expected to double in the first half of this century. 

That’s assuming they get control of opioids right? We covered an article some time back that said the US expected lifespan has actually decreased in the last two years rather than increased because of opioids so there is that to keep in mind. 

They mention that “Musculoskeletal conditions are a leading contributor to non-communicable burden of disease, predominantly low-back pain and osteoarthritis.” 

And…”Physical activity is key in the prevention, treatment, and management of most chronic conditions affecting older adults, including musculoskeletal complaints. Chiropractors should consider prescribing exercise, with or without manual therapy, for spine care in older adults. Such approaches are supported by an evidence-based framework, which includes clinical practice guidelines.” Great chiropractic information.

Isn’t it nice to see the WFC using evidence-based terminology and approaching things from an evidence-based platform? Everything mentioned in this article has resources that are cited. It feels good and it gives me a warm fuzzy feeling all over. 

They also talk about how falling is a major concern among the older crowd and how exercises and physical activity helping to maintain strength and balance can help prevent them. 

They mention potential barriers to older folks getting chiropractic care. If you are a regular listener of our podcast, you know about the White House report that actually said CMS creates barriers to patients seeking care under a chiropractor[2]. I just linked that in the show notes if you want to look at it. It’s on page 57 so you can avoid reading the whole thing just to get that snippet.

https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-3-2017.pdf

How does that get resolved exactly? I think that’s what happens when we have government-run healthcare in my opinion. They have to cut costs and the services they feel are of the least value will go away in terms of coverage. 

I think that’s what is going on with Medicare. Research shows it’s effective but we can’t get anything other than an adjustment covered. What other reason would there be? Pass on any of your chiropractic information you can share with us on this.

Onto focus area #2: Opioid misuse. 

Boy we’ve covered this one. Like….a lot. Let’s see if they have anything new here for us to chew on. 

Here’s a new stat I haven’t seen before, “Opioids account for 70% of the negative health impact associated with drug use disorders globally, and are considered the most harmful drug type .” They also say, “Approximately 69,000 people worldwide die from opioid overdose each year, with a large toll of overdose deaths in the United States and Canada.”

Then they say something I completely agree with, “The opioid misuse crisis creates an impetus for chiropractors and chiropractic organizations to collaborate with other healthcare providers, decision makers, and stakeholders. Patient-centered, inter-professional collaboration should be expanded for the treatment of musculoskeletal pain, with chiropractors playing a larger role on multidisciplinary pain management teams.”

Notice they say “Patient-centered.” Not “Doctor-centered.” Not offices and doctors that do things to hit numbers. Not doctors that see a patient 80 visits. Not those guys. Patient-centered, evidence-based chiropractors are in the right spot right now folks. 

OK, priority #3: Women’s, Children’s, and Adolescents’ Health. 

When covering some of the relevant issues for this group, they cite pregnancy-related back pain and pelvic pain and post-partum spinal disorders which may impede recovery. 

The second issue cited is hormonal changes, dietary factors, and physical inactivity are all factors for osteoporosis. 

The third is violence against women and girls causing injury. I’m just not sure how in the year 2018 we still have violence against women and girls or children in general. Human beings can be cretins, can’t we? Lack of parenting? Inherent evil in the offenders? Who knows? It’s hard to postulate on something you understand nothing about. 

Here’s something in the article I can agree with 100% they say that women are the major decision maker for their families. If you are marketing men…..in most markets, you are wasting your money. 

I can’t tell you how many men come in here and when we ask how they found us or what brings them here today, they say, “My wife. This is where my wife told me to be. I didn’t want to come. I don’t like doctors but my wife is tired of my griping about my back.”

Market the ladies and you market effectively. End of story. 

To summarize the article, the WFC says they are developing tools with the goal of empowering chiropractors and WFC member organizations to engage in public health activities in the three identified priority areas. I’m looking forward to seeing what they’re going to come up with. Exciting stuff here. Great chiropractic information.

The next article I want to cover quickly is one written by Dr. Christine Goertz called “What Does Research Reveal About Chiropractic Costs?” and it was published on the ACA Blog on July 10, 2018[3]. 

Dr. Goertz by saying something ALL evidence-based chiros can yell, “Amen,” at and that is where she says, “Without a doubt, the most common issues raised by those outside the profession relate to the quality and consistency of chiropractic care delivery. The second most commonly asked question invariably pertains to the costs associated with chiropractic care.”

So….AMEN! 

Another amen quote would be this one: “(Evidence) consistently shows that patients with low back and neck pain who are treated by chiropractors have either similar or lower costs than those seeking care from other providers. In particular, it appears that patients who visit a chiropractor are less likely to undergo hospitalization, resulting in lower global healthcare costs than those who receive medical care only.”

Hallelujah. If you love this chiropractic information you need to share this chiropractic information.

When addressing the cost of chiropractic care, Dr. Goertz mentions a paper we have covered here by Hurwitz[4] that concluded that found that health care expenditures for patients with low back pain, neck pain, and headaches were all lower in those who received chiropractic care alone when compared to any other combination of healthcare providers. 

Well, that’s some sexy chiropractic information, isn’t it? Of course it is. You realize you can use articles like this and the information you get from podcasts like this to help you educate your population and your area’s Medical professionals right? Are you listening or are you listening and utilizing? That’s a good question to think about. I have cited the Hurwitz paper in the show notes for your own independent review. 

She then covers a paper by Martin et. al. that we will be covering soon. Over 12,000 patients with 4,300 or so using alternative healthcare. 75% of the alternative users (3,225) were treated with chiropractic. This is big for chiropractic since those treating with alternative means had $424 less in spinal care and $796 less in total healthcare costs. Average healthcare spending for alternative care users was on average $526 lower. 

Huge, absolutely huge folks. If that doesn’t put a grin on your face, you’re dead. You need a defibrillator muy pronto, amigo. Share this chiropractic information won’t you?

This week, I want you to go forward with this: Don’t you understand that if we chiropractors were wrong, we’d have been wiped out by now? We are right. We have been right and we will continue to be right. What we do is so powerful that our profession has persisted and, in fact, prospered in spite of the non-evidence-based people out there on the fringe giving the rest of bad names. The hucksters and profiteers have not even been able to destroy it. They’ve held us back, no doubt. But they haven’t been able to extinguish us and that’s pretty powerful. We are right. Keep on keeping on with confidence. 

Integrating Chiropractors

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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Being the #1 Chiropractic podcast in the world would be pretty darn cool. 

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

http://www.chiropracticforward.com

??Social Media Links

??iTunes

??Player FM Link

??Stitcher:

??TuneIn

Bibliography

1. Maiers M, Chiropractic in Global Health and wellbeing: a white paper describing the public health agenda of the World Federation of Chiropractic. Chiropr Man Therap, 2018. 26(26).

2. The President’s Commission on Combating Drug Addiction and The Opioid Crisis. 2017.

3. Goertz C, What Does Research Reveal About Chiropractic Costs?, in ACA Blog. 2018: ACA Blog.

4. Hurwitz EL, e.a., Variations in Patterns of Utilization and Charges for the Care of Neck Pain in North Carolina, 2000 to 2009: A Statewide Claims’ Data Analysis. J Manipulative Physiol Ther, 2016. May 39(4): p. 240-51.

Relevant Links

CF 021: Crazy Update On Run-Away Healthcare Spending in America

 

CF 005: Valuable & Reliable Expert Advice On Clinical Guides For Your Practice

 

CF 032: How Evidence-Based Chiropractic Can Help Save The Day

How Evidence-based Chiropractic Can Help Save The Day

Integrating Chiropractors

Today we’re going to talk about our blessing and our America’s curse, opioids. Why would I ever call opioids a blessing? We’ll get to that. Stick around for some updated info on how evidence-based chiropractic can save the day.

But first, here’s that bumper music

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

Now that I have you here, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It makes it easier to let you know when the newest episode goes live, when someone new signs up it makes my heart leap a little, and in the end, it’s just polite and we’re polite in the South.  

We are really starting to pick up some steam. Thank you to you all for tuning in. If you can share us with your network and give us some pretty sweet reviews on iTunes, I’ll be forever grateful. By now, we all know how the interwebs work. You have to share and participate in a page if you are going to see the posts or if the page will be able to grow. 

We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

You have Texas two-stepped your way into Episode #32

As I was wondering what the heck I was going to talk about this week, I started looking at having a guest. Well, he was unavailable for a few weeks so now what? 

I started to put some random research papers together for this week’s episode was trying to gather my thoughts on flow, order, and all that good stuff and then…..POOF….it was like divine intervention. In my email box came about 4 or 5 articles on updates having to do with the opioid crisis. ALL IN THE SAME DAY. Pretty much in the same hour if you can believe that!

I’m not one to poo poo blessings or to throw rocks at divine intervention so guess what? We’re going with opioids and the ways evidence-based chiropractic can help save the day by helping our patients avoid them. 

If you have followed the Chiropractic Forward Podcast for any amount of time, or have seen any TV news program, you’ll know that American, and the world, has a bit of an opioid crisis and chiropractic is in the driver’s seat of alternative interventions that have been proven effective in treating the conditions that opioids have been commonly prescribed for. 

I want to start with an article I received from my malpractice carrier and, since I use the largest of chiro malpractice carriers, I’m guessing you all got it too but, if you are like most chiros, just deleted it rather than reading the thing. It turns out that I’m a nerd and I read the thing. It was titled “Opioids Misuse and Addiction: How Chiropractic Can Help(Petrocco-Napuli K)” and written by Kristina Petrocco-Napuli and posted on a site called Clinical Risks on June 13, 2018.

The article started with a story about Megan who was mid 30’s and suffering pain chronic pain four years after being in a wreck. 

As we chiropractors are well-aware of…..evidence based chiropractic care was not offered to her as a viable option for treatment following her car wreck, of course not….right? I mean, the trauma is mechanical in nature so why recommend mechanical solutions? Let’s just go right to the historically ineffective, addictive chemical treatment instead, OK?

So, basically, Megan went through two pregnancies addicted to opioids. She had some success quitting them during different parts of the pregnancies but continued to return to opioids. 

She goes on to cite information from the American Academy of Pain Management that says 100 million Americans suffer from chronic pain. Think about that just a second. Last I remember hearing, there was somewhere around 320 million Americans? That’s about 1/3 of the nation suffering from some form of chronic pain. That’s terrible news but, I’d argue it’s actually great news for chiropractors. Evidence-based chiropractic

It’s like, if we see personal injury patients in our office, we really don’t want people to get in wrecks but, be honest….it’s good for business. It feels dirty just saying that. I know I don’t personally want to see them get hurt but I’m here to help if they need me and that’s how I go about that. Same thing if it’s icy outside. You don’t want people falling and hurting themselves but…….yeah…..it’s good for business. You get my drift. 

We don’t want 1/3 of the nation suffering chronic pain but that also means the opportunities open to evidence-based chiropractic are virtually limitless if we play our cards right.  

I can tell you that we have seen some referrals in my office from a few of the pain doctors in the region that are trying to wean patients off of opioids and can I tell you something? It ain’t pretty. Some are mad at the world. Some are fidgeting all over the place and can’t sit still. Good Lord I’m glad I don’t prescribe and am not getting hit up all of the time for these pain meds. That is a blessing all by itself, isn’t it?

I am an advocate of yours. If you want to practice with adjustment only. Go for it. If you want to integrate…go for it. If you want to further educate yourself, go for it. You should be able to practice and get reimbursed to the extent of your schooling and to the extent of your state’s scope. I’m all for that. 

There was a time I thought it might be cool to prescribe like they do out in New Mexico. Chiropractors over there can go through an extra two years of education and have the ability and right to prescribe some meds to their patients if they feel they need it. I’ve had chiropractors tell me, “That’s not chiropractic.” I get that. That is why it is called an Advanced Practitioner or something of that sort. I don’t recall off the top of my head the official title. Regardless, who am I to hold a brother or sister back that wants to further their education, further their rights, and further their capabilities. You did the work. You deserve the pay-off and I’m on your side. 

However, for me personally, I’m over that. Not only is research showing more and more that that sort of prescription and treatment basically has no more effect than chiropractic, and, on top of all of that research, I don’t want to have to deal with people looking for the meds. I got over that a long time ago. Evidence-based chiropractic

In this article, the author goes on to mention the role of chiropractic which she says are as follows. 

  • Public awareness: Build knowledge on how chiropractic can help with chronic pain as an alternative to medications. We’ve talked about this many times before here on the chiropractic forward podcast
  • Education: Inform other practitioners about chiropractic as a treatment option for patients. This will become increasingly important, given the recent focus on non-pharmacological care. Again, we have screamed this one from the rooftops.
  • Reduce misuse: Help patients locate drug drop boxes for opioid disposal, drug take-back programs, medication lock boxes and testing programs. THIS is one I have not considered. Not at all. I think it’s a great point. If you know how to commonly find these take-back programs and lock boxes, send us an email at dr.williams@chiropracticforward.com and we will be glad to share with others. Right now, without going to Google for more information, I’m assuming a call to your local hospital can probably get this mystery solved for your area. 

Evidence-based chiropractic providers better get off their rears and take action on these points if we’re going to take our place. 

Next, there was this article in the Journal of the American Medical Association titled “The burden of opioid-related mortality in the United States” by Tara Gomes, et. al(Gomes T) and published in JAMA in June of 2018.

Why They Did It

The authors wanted to answer the question, “What has been the burden of opioid-related deaths in the United States over a recent 15-year period?”

How They Did It

  • The study was a cross-sectional design in which cross sections were examined at different time points to investigate deaths from opioid-related causes from January 1, 2001- December 31, 2016. 
  • For the purposes of this study, opioid-related deaths were defined as those in which a prescription or illicit opioid contributed substantially to an individual’s cause of death as determined by death certificates. 

What They Found

Between 2001 and 2016, the number of opioid-related deaths in the United States increased by 345%, from 9489 to 42?245 deaths

Overall, opioid-related deaths resulted in 1?681?359 years of life in 2016

Wrap It Up

Premature death from opioids imposes an enormous and growing public health burden across the United States.

We covered a paper some time ago that mentioned the average age of death has actually decreased in America in the last two years because of opioids. 

Remember the uproar Americans were in when we lost a little over 58,000 soldiers in the Vietnam war? Yeah, another paper we reviewed recently estimates over 64,000 death to opioids just last year. See the issue? But chiropractors have been crazy all these years to offer a sensible, safe, and reasonable alternative for treating these people? Give me a freaking break with that stuff. Now, some chiropractors are crazy OK? It’s the fact but, evidence-based chiropractic care can fix this problem and I have zero doubts about it. 

I want to cover this next one briefly just to highlight how damn tone-deaf these people in the medical kingdom can sometimes be. This one is called “Prescription drug coverage for treatment of low back pain among US Medicaid, Medicare Advantage, and Commercial Insurers.” Written by Dora Lin, MHS and published in JAMA on June 22, 2018(Lin D) this article really highlights the issue we are dealing with in America. 

The question the authors looked to answer here was, “Among US insurers, what are the coverage policies for pharmacologic treatments for low back pain?”

How They Did It

  • A cross-sectional study of health plan documents from 15 Medicaid, 15 Medicare Advantage, and 20 commercial health plans in 2017 from 16 US states representing more than half the US population and 20 interviews with more than 43 senior medical and pharmacy health plan executives from representative plans.
  • Data analysis was conducted from April 2017 to January 2018.
  • Of the 62 products examined, 30 were prescription opioids and 32 were nonopioid analgesics, including 10 nonsteroidal anti-inflammatory drugs, 10 antidepressants, 6 muscle relaxants, 4 anticonvulsants, and 2 topical analgesics.

What They Found

Look who the hell cares what they found, OK? Here’s why NONE of it really matters. All they’re doing here is trying to figure out what drugs insurers carry and how to get drugs to people rather than what is effective, what the current guidelines recommend, what The Lancet papers had to say about opioids and nonopioids, what the American College of Physicians have to say is first-line treatment and what is last line treatment for low back pain. Evidence-based chiropractic

How about they do a little research having to do with….I don’t know…maybe doing away with opioids, and anticonvulsants for low back pain…doing away with steroid shots and surgery for non-complicated low back pain….and knocking down the barriers to patients seeking alternative care. Barriers noted and called out by the White House last year and barriers that were set up by CMS and insurance companies. 

How about we do something effective along those lines instead of wasting more time and paper folks? It could not be more exhausting. 

This week, I want you to go forward with comfort. Comfort in knowing that you are where you need to be and you’re there for the right reasons. You are helping people stay away from these drugs. You saving their lives in many cases whether they….or you….know it. We are saving lives folks. Good on you. Keep it up. Keep making a difference. Stay with evidence-based chiropractic care, be patient-centered rather than doctor driven or numbers driven and the money will take care of itself.

Key Takeaways

  1. Opioids haven’t gone away. Pill pushers haven’t gotten the message yet. The issues are still there and they’re real 
  2. Research doesn’t matter unless we educate the medical professionals around us and educate our patients so spend some extra time talking to your patients about the stuff we go through with you right here. 

Integrating Chiropractors

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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Being the #1 Chiropractic podcast in the world would be pretty darn cool. 

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

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http://www.chiropracticforward.com

??Social Media Links

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??TuneIn

 

Bibliography

Gomes T (2018). “The Burden of Opioid-Related Mortality in the United States.” JAMA Network Open 1(2).

Lin D (2018). “Prescription Drug Coverage for Treatment of Low Back Pain Among US Medicaid, Medicare Advantage, and Commercial Insurers.” JAMA Network Open 1(2).

Petrocco-Napuli K. (2018). “Opioids Misuse and Addiction: How Chiropractic Can Help.” Clincal Risks  Retrieved June 13, 2018, from https://www.ncmic.com/learning-center/articles/risk-management/clinical-risks/opioids-misuse-and-addiction-how-chiropractic-can-help/.

CF 025: Vets With Low Back Pain. Usual Care + Chiropractic vs. Usual Care Alone

CF 020: Chiropractic Evolution or Extinction?

CF 026: Chiropractic Better Than Physical Therapy and Usual Medical Care For Musculoskeletal Issues

evidence-based chiropractic

evidence-based chiropractic

CF 030: Integrating Chiropractors – What’s It Going To Take?

Episode #30

Integrating Chiropractors – What’s It Going To TakeIntegrating Chiropractors

Today we’re going to talk about what the medical field may be looking for when integrating chiropractors into their referral network. We’ll also talk about a recent article discussing The Lancet papers and whether or not the Chiropractic profession needs to take more care…..or care at all for that matter. 

But first, here’s that bumper music

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

Before we get started, it was brought to my attention by Dr. Ryan Doss out in Lubbock, TX that our Chiropractic Froward episodes in iTunes only go back to Episode 18 or 19 right now. This is a new development that I’m not sure exactly how to fix or what to do about it at this time but, I am trying to figure it out. For now, though, you can go to our website at www.chiropracticforward.com and have access to all of the directly right there. All of them in one place.  

I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It makes it easier to let you know when the newest episode goes live and it’s just nice of you and helps me notify when a new episode is up and ready for you. 

I’m always offering myself up for speaking opportunities or to be a guest on YOUR podcast or at your seminar.  Just send me an email at dr.williams@chiropracticforward.com and we will connect.

I have to tell you that I have recently joined the Facebook group called Forward Thinking Chiropractic Alliance led by Dr. Bobby Maybee who also hosts the Forward Thinking Chiropractic Podcast and I have been a member of the Evidence-Based Chiropractic group over there on Facebook for a while now. That one is led by Dr. Marc Broussard and has several highly respected admins. 

First, I host the Chiropractic Forward podcast and Bobby Maybee hosts the Forward Thinking Chiropractic podcast. Those sound similar right? And….to be fair…in regards to focusing on researched information and draggin’ chiropractic further into the evidence-based realm, we are very similar. OF course, we have different deliveries and Forward Thinking Chiropractic Alliance has been around longer than we have. Integrating chiropractors is a common topic. 

When I was trying to figure out what to name my podcast, I somehow came up with Chiropractic Forward. I Googled it and nothing showed up for Chiropractic Forward and I was so excited and ran with it. It wasn’t until a few months later that I stumbled on Forward Thinking Chiropractic and thought, well hell…. But, though there are similarities in the names, I do my thing and Bobby and his crew do theirs and they are very successful and good at what they are doing. In the end, I hope we are both extremely healthy for chiropractors everywhere a podcast can be heard. 

There is also Dr. Jeff Langmaid known as the Evidence-Based Chiropractor. Jeff has built an amazing brand talking about many of the things we talk about here and he does a great job with it. He’s a great speaker. Clear, concise, and easy to understand. 

So, outside of myself and the Chiropractic Forward Podcast, I hope you will give Dr. Bobby Maybee and the Forward Thinking Chiropractic Podcast a listen as well as Dr. Jeff Langmaid and the Evidence-based Chiropractor Podcast. They are excellent resources for further learning and understanding on all of this stuff. Again, integrating chiropractors is a common topic and you know I love that topic!

The Facebook groups I mentioned are simply priceless when it comes to being an evidence-based chiropractor.

I’ve found myself from time to time feeling a little uncomfortable and surrounded by ideas and philosophies within our profession that I just never got behind or could support. I’ve had to sit through countless speeches that made my eyes roll with disbelief. The Evidence-Based Chiropractic group and the Forward Thinking Chiropractic Alliance groups on Facebook are groups that fit me like a glove. As I said, integrating chiropractors is a topic I’m on board with. I’m not super active in there but really do enjoy reading the threads, opinions, and yes….even some light arguing here and there. But, these groups are very educational and an absolute must if you are evidence-based. 

We have a Chiropractic Forward group as well on Facebook but it’s new and just now getting going. I’d love to invite you all over there to join up with us as well as like our Facebook page itself and maybe even check us out on Twitter at chiro_forward. 

Hey, I’m doing my part to get the word out. You can rest assured on that. 

Enough social media talk, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. That’s a tall order but that is the goal and I’ve never shy-ed away from big goals. You shouldn’t either!

You have collapsed into Episode #30. I can’t believe I started this journey 30 weeks ago. It’s crazy to think. I really can’t tell you how much I have enjoyed it so far. I suppose it takes some amount of hubris to think anyone would care about what you have to say but, in the end, don’t you just have to go where you’re led? That’s what I’m doing and I’m glad you’re coming along with me each week.

We have talked a lot in previous episodes about integrating chiropractors. Whether that means integrating chiropractors into a hospital setting, bringing medical services into your clinic, or some sort of co-treatment/referral sort of set up between the chiropractor and other medical professionals. Regardless, integrating chiropractors is the next step for our profession. 

On that note, let’s start with the article about The Lancet papers on low back pain. This was in Chiropractic & Manual Therapies and Published June 25, 2018. Brand new stuff here folks. This was written by Simon French, et. al. and titled “Low back pain: a major global problem for which the chiropractic profession needs to take more care(French S 2018).” 

The abstract on this article introduces the series of papers published in The Lancet back in March of 2018 which provided the global community with a comprehensive description of low back pain, treatment recommendations based on research, and low back pain going forward from where we are currently. 

They go on to mention what we have been saying over and over here on the podcast. And that is that chiropractic is poised to step in and run the show for non-complicated low back pain. But, according to the authors and according to the Chiropractic Forward podcast, many chiropractors make statements and do things that aren’t supported by robust, contemporary evidence. 

We went through the Lancet papers here on the podcast and you can listen to them by going back to episodes 16, 17, and 18. I encourage you to do so. There really is some excellent information from a multidisciplinary panel of low back pain experts around the world. 

The authors of the Lancet papers, if you follow them on Twitter, have said repeatedly that they don’t want this paper to be profession specific. Meaning, they don’t want to come right out and say, “Hey folks, chiropractors should be the first referral or, we recommend PTs take any and all low back pain patients first and then deal them out where needed for more treatment.” 

I think that’s probably smart on their part but, as a chiropractic advocate, I have no problem throwing our hat in the ring and saying that research has proven several times over that spinal manipulation is superior to the mobilization that PTs perform AND less expensive. If chiropractors are less expensive and more effective, then why in the Hell WOULDN’T we be the first referral for these low back pain patients? Integrating chiropractors makes more sense now than ever before.

This paper goes on to mention that there has been a shift in thinking on low back pain in recent years from the traditional medical approach to a more patient-centered, evidence-based, non-pharma approach putting chiropractors right where they always should have been. 

They also talk about how The Lancet papers say that imaging needs to be reduced significantly. Wouldn’t you agree that may be a challenge for the way many chiropractors practice? You know who you are out there! They also discuss how evidence doesn’t support ongoing passive chiropractic care. This will also be an obstacle for many in my profession. In addition, they state that many chiropractors implement therapy modalities that simply have little to zero good evidence supporting them. 

French says chiropractors are in the right placed but not enough of us are actively involved in research and our research output is small when compared to other healthcare professions. Integrating chiropractors into the medical field will require more research production from our profession that we currently see. 

He also says that the chiropractic profession needs to be more integrated to be a major player if we are to be able to fulfill the role The Lancet papers put us in. And I agree wholeheartedly. If you check out episode #20 called Chiropractic Evolution or Extinction, you’ll hear a robust discussion on this. 

CF 020: Chiropractic Evolution or Extinction?

 

French’s conclusion highlights the reason the Chiropractic Forward podcast exists. It puts a spotlight right on the purpose if you listen close enough. 

He wraps up the article by saying the following: “Our low back pain “call to action” for the chiropractic profession is to get our house in order. In our opinion, nothing is more relevant to chiropractors than people with low back pain, and the evidence clearly shows that we can do a better job for the millions of people who experience this potentially debilitating condition every year. Chiropractors in clinical practice need to provide higher quality care in line with recommendations from evidence-based clinical practice guidelines.

The chiropractic profession is perfectly placed to be a major player in providing a part of the solution to the global challenge of low back pain. But the profession has been shut out of this role in most countries around the world due to, amongst many other things, internal political conflict, a lack of political will, and a minority of chiropractors who provide non-evidence-based approaches. The profession needs to invest heavily to support chiropractors who wish to undertake high-quality research directed at solving this major global problem.”

Amen amen amen. I’ve always wished I knew more about running my own research projects. It’s just not something we were taught. I’m looking at maybe searching out a mentor to help me get my own projects going…..maybe just case reports but something…. and get them published. Although the idea of generating my own research projects makes me want to punch myself in the nose, I know it’s important towards integrating chiropractors.

OK, let’s shift gears a bit. If we are poised and ready for integrating chiropractors and we start following evidence-based protocols, that’s all fine and dandy and moving in the right direction. However, what if there are already perceptions out there in the medical field we’ll be needing to change? I said what it? I meant, of course, there are negative perceptions of us that will have to be battled. It’s a fact. 

Here is a paper from June 22, 2018, by Stacie Salsbury, et. al. called “Be good, communicate, and collaborate: a qualitative analysis of stakeholder perspectives on adding a chiropractor to the multidisciplinary rehabilitation team(Salsbury S).” It would have been more fun if Salsbury would have just titled it “Stop, collaborate and listen if you want to be a good chiropractic physician….. but……she didn’t. We’re obviously not dealing with a Vanilla Ice fan here. It’s probably a good thing that, so far, I’m not responsible for naming research papers. 

Anyway, this paper wanted to explore the qualities preferred in a chiropractor by key stakeholders in a neurorehabilitation setting. 

How They Did It

  • It was a qualitative analysis of a multi-phase, organizational case study
  • It was designed to evaluate the planned integration of a chiropractor into a multidisciplinary rehabilitation team
  • It was a 62-bed rehabilitation specialty hospital
  • Participants were patients, families, community members, and professional staff of administrative, medical, nursing, and therapy departments. 
  • Data collection was from audiotaped, individual interviews and profession-specific focus groups 
  • 60 participants were interviewed in June 2015
  • 48 were staff members, 6 were patients, 4 were family members, and 2 were community members. 
  • The analysis process helped them produce a conceptual model of The Preferred Chiropractor for Multidisciplinary Rehabilitation Settings. 

What They Found

  • The central domain was Patient-Centeredness, meaning the practitioner would be respectful, responsive, and inclusive of the patient’s values, preferences, and needs. This was mentioned in all interviews and linked to all other themes. Of course, I may interject my own opinion here if you don’t mind. Isn’t the lack of patient-centered care the MAIN gripe when it comes to medical doctors too?!? That’s not just a chiropractic issue. 
  • The Professional qualities domain highlighted clinical acumen, efficacious treatment, and being a safe practitioner. Again, something desired of all practitioners regardless of discipline I would think. 
  • Interpersonal Qualities encouraged chiropractors to offer patients their comforting patience, familiar connections, and emotional intelligence
  • Interprofessional Qualities emphasized teamwork, resourcefulness, and openness to feedback as characteristics to enhance the chiropractor’s ability to work within an interdisciplinary setting.
  • Organizational Qualities, including personality fit, institutional compliance, and mission alignment were important attributes for working in a specific healthcare organization.

Wrap It Up

Salsbury ended the article with this conclusion, “Our findings provide an expanded view of the qualities that chiropractors might bring to multidisciplinary healthcare settings. Rather than labeling stakeholder perceptions as good, bad or indifferent as in previous studies, these results highlight specific attributes chiropractors might cultivate to enhance the patient outcomes and the experience of healthcare, influence clinical decision-making and interprofessional teamwork, and impact healthcare organizations.”

Now when you go a little deeper than the abstract you’ll see statements that hint at the fact that, when it comes to chiropractors there is fragmentation, disconnection, boundary skirmishes, and a general failure to communicate. 

In addition, the primary care providers and medical specialists have recognized the ability of some chiropractors to treat some musculoskeletal stuff in some patients but that’s about it right now. Couple that with the fact that most in the medical kingdom report just not knowing much about chiropractic or its treatments. 

Some medical providers express concern about the safety of spinal manipulation and have voiced skepticism over the efficacy of our protocols. Let’s be fair, I have my own concerns and am skeptical of some of their protocols as well so that swings both ways friends. But for evidence-based chiropractors, integrating chiropractors into the field makes perfect sense.

When talking to orthopedic surgeons that had particularly negative attitudes toward chiropractors, they typically cited something a patient told them or would cite aspects of the fringe element of the chiropractic community that allowed the surgeons to question the ethics of some chiropractors, to comment on the inadequacy of educational training, and comment on the sparse scientific basis of chiropractic treatments. 

To all of this, I say…..what the hell rock have these people been living under? Sure question the ethics of some. I question the ethics of A LOT of chiropractors if I’m being honest. I could be a wealthy man right now myself but I wouldn’t be able to sleep knowing I’m taking advantage of people. But, what about laminectomies? What about the fact that outcomes have never improved for lumbar fusion but they incidence of performing fusions has gone sky high. Where are the ethics on that? The epidural shots have shot through the roof without any improved outcomes and proof of zero long-term benefits. Where are the ethics?

If you question our education, know what you’re talking about first. That’s all I’m saying. The admission scale is low admittedly. There are philosophy courses I could do without. There are a few technique classes I think are worthless but, overall, the education of chiropractors is outstanding. Are physical therapists getting the same basic science courses the medical doctors are getting? Is that happening? From a quick search of the Physical Therapist curriculum, it appears that it is not so what on Earth are these people even talking about?

The other comment was the sparse body of research. Let’s just say that I’ve been blogging on chiropractic research since 2009 every single week without repeating research papers. The body of research is absolutely there. They’re just ignorant of it. It’s that simple. And where is the research for some of the garbage they utilize? 

I’m in no way saying chiropractors don’t need to step up. They most certainly do in a big way if integrating chiropractors si to become a reality. I hope the evidence-based guys and gals are starting to find more places they feel comfortable out there in social media and starting to find more of a voice within the profession. I truly believe there are many many more evidence-based chiros than there are others. Let’s be honest here. If you want to fit into healthcare, you damn well better do it based on solid research and evidence backing your profession and protocols. 

If I went through this paper from top to bottom, we’d be here for hours, I would have a red face from defending chiropractic, my blood pressure would be sky high, and my vernacular would probably devolve into meaningless gibberish at some point. So I’m going to leave it there. I gave you some highlights, I have it cited in the show notes. Go and read it and email me your thoughts. I’d love to hear them. 

This week, I want you to go forward with some things a poster in the Evidence-based chiropractic group on facebook the other day that I thought had value when it comes to what we’re talking about. She said:

Chiropractic is not a religion. 

A medical doctor should be able to understand the language coming out of your mouth, if they do not, they need to be able to find it cited in a medical textbook. 

I think chiropractic has a long way to go. It does indeed. But, not as far as we had to go 5 years ago. We still have too many people out there on the fringe. We still have far too many practices that are about numbers instead of being patient-centered. Don’t you think that when your business is patient-centered, your patients know that and the money takes care of itself? 

On the other hand, if you are trying to get 50 visits out of a patient, some will go for it, but many more will be turned off by it and will not return. Not only that but for many patients, you will have ruined the entire profession in their eyes based on your act of hitting numbers rather than making sure you’re doing what is best for the patient. That’s just being as honest as I know how to be. I know some won’t like that much but it’s a fact. 

I can’t tell you how many patients I have gotten from a guy that made patients sign contracts for treatment and when treatment didn’t work, he wouldn’t allow them out of the contract. How in the hell does that fit into healthcare folks? It certainly not patient-centered in any shape form or fashion and you’re fooling yourself if you think otherwise. You will never see us integrating chiropractors into the medical profession with junk like that. 

I told you that I can’t tell you how many patients we got from this guy’s poor ethics but, the bigger question is, “How many patents did he ruin on the idea of chiropractic so now they’re out there thinking they have to suffer in pain when all they had to do was visit a chiropractor better equipped with a high standard of ethics?”

THAT is the real question. 

We have to improve, yes. But, for us to integrate properly, the medical kingdom has to improve as well in regards to musculoskeletal complaints, proper recommendations and treatments, and in their perception and understanding of chiropractic and what we can do for these patients. It’s not all one-sided in my mind. 

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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments. Integrating chiropractors makes perfect sense here.

When you look at the body of literature, it is clear: research and clinical experience show that, in about 80%-90% of headaches, neck, and back pain, patients get good to excellent results with Chiropractic when compared to usual medical care. It’s safe, less expensive, decreases chances of surgery and disability. Chiropractors do it conservatively and non-surgically with little time requirement or hassle for the patient. And, if the patient has a “preventative” mindset going forward, chiropractors can likely keep it that way while raising the general, overall level of health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you heard on integrating chiropractors, be sure to check out www.chiropracticforward.com. We want to ask you to share us with your network and help us build this podcast into the #1 Chiropractic podcast in the world. More people need to hear about integrating chiropractors!

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

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http://www.chiropracticforward.com

??Social Media Links

??iTunes

??Player FM Link

??Stitcher:

??TuneIn

CF 026: Chiropractic Better Than Physical Therapy and Usual Medical Care For Musculoskeletal Issues

CF 015: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 3 of 3)

 

 

 

French S (2018). “Low back pain: a major global problem for which the chiropractic profession needs to take more care.” Chiropr Man Therap 26(28).

Salsbury S “Be good, communicate, and collaborate a qualitative analysis of stakeholder perspectives on adding a chiropractor to the multidisciplinary rehabilitation team.” Chiropr Man Therap 26(29).

Today’s topic was integrating chiropractors, integrating chiropractors, and integrating chiropractors. : )

CF 029: w/ Dr. Devin Pettiet – Is Chiropractic Integration Healthy For The Profession?

Episode #29

Is Chiropractic Integration Healthy For The Profession?

Today we have a very special guest and we’re going to be talking about chiropractic integration into a medical based case management or medical team. This one may irritate the holy heck out of the straight chiropractors that preach being separate and distinct but I think evidence-based practitioners will find some good stuff here. 

But first, here’s that bumper music

OK, we are back. Welcome back to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

Before we get started, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It makes it easier to let you know when the newest episode goes live and it’s just nice of you. 

Also, I’m alway offering myself up for speaking opportunities or to be a guest on YOUR podcast.  Just send me an email at dr.williams@chiropracticforward.com and we will connect. I always appreciate hearing from my brothers and sisters out there in the profession. 

We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. That’s a tall order but that is the goal and I’ve never shy-ed away from big goals. You shouldn’t either!

You have tip toed ninja style into Episode #29

But first, my week …..I have to say that we started off slow at the start of this Summer season but, now that everyone is settling into the heat, it’s starting to get busy busy and that’s nothing but good good. What are the most effective means you’ve found to get your message out to your communities? Email me and I may just share you suggestions in future episodes. 

This week, I want to welcome a friend of mine and a brother in arms in our battle for Chiropractic here in Texas to come and speak with me about chiropractic integration. He has been involved deeply on the state level leadership for years at this point and has held several posts including the biggest one. Yes, he is currently the big cheese, the head honcho, the el jefe of the Texas Chiropractic Association. Until June of 2019, he will sit as the President of the TCA and we’re honored to have him with us on the Chiropractic Forward Podcast today. 

– I want to welcome Dr. Devin Pettiet of Tomball, TX. Dr. Pettiet, thanks for being here and letting us pick your brain a little today. 

  • When I was coming up with this week’s topic, chiropractic integration, I really couldn’t think of anyone better than you to talk about chiropractic integration with. I know you pretty darn well but our listeners probably do not. Tell us a little bit about your practice. 
  • What originally got you involved in service to your profession? Was there a single incident or experience that flipped a switch in you?

I don’t want to speak for you but, for myself, I’m certainly on the evidence-based aspect of the chiropractic spectrum here. We would like for our thoughts and opinions to be separate from the TCA’s stance on different matters and we should state from the start that our thoughts and opinions are our own and not representative of the TCA. At the same time though, we are the kind of people that want to go to bat for everyone practicing as long as they are within the scope mandated by the State of Texas. 

Now, How do you feel we chiropractors can start making headways into the medical field as spine specialists and….keeping the straights in mind….is it healthy for our profession to seek those avenues for ourselves? Is chiropractic integration a good idea basically?

We know it’s not a lack of research validating our profession but, with your years in practice and with your years of service in the TCA, what things come to mind as the biggest obstacles to chiropractic care fully integrating into medical referral programs or treatment protocols?

Over the years, have you seen any changes in the opinions of chiropractors from those in the medical community or in the way you interact with them?

Let’s go over a couple of papers and you just play Troy Aikman to my Joe Buck and provide commentary wherever you see fit. 

This one is from February 2018 and is called, “Integration of Doctors of Chiropractic Into Private Sector Health Care Facilities in the United States: A Descriptive Survey.” It was written by S Salsbury, et. al. and I see Dr. Goertz listed as an author as well. She has really been a star for the chiropractic profession(Salsbury S 2018). 

Why They Did It

The purpose of this study was to describe the demographic, facility, and practice characteristics of doctors of chiropractic working in private sector health care settings in the United States.

How They Did It

  • The authors did an online, cross-sectional survey. 
  • They were looking for chiropractors already working in integrated health care facilities 
  • They collected demographic details, facility details, and the characteristics of the practice
  • Using descriptive statistics, they analyzed all of the data they collected. 
  • The response rate was 76% which is odd because my email open rate when I email for TCA stuff is like 10%….
  • Most respondents were male with the mean years of experience being 21 years. 

What They Found

  • Doctors of Chiropractic working in hospitals were 40%
  • Multispecialty offices = 21%
  • Ambulatory clinics = 16%
  • Other health care settings = 21%
  • 68% were employees and received a salary
  • Most DCs used the same health record as the medical staff and worked in teh same clinical setting. 
  • Over 60% reported co-management of patients with medical professionals. 
  • In many clinics, the DCs were exclusive providers of spinal manipulation (43%) but most of the clinics saw the DCs receiving and making referrals to the primary, the PT, or to pain and ortho docs. 

Wrap It Up

The authors concluded by saying, “Doctors of chiropractic are working in diverse medical settings within the private sector, in close proximity and collaboration with many provider types, suggesting a diverse role for chiropractors within conventional health care facilities.”

Here’s another by Paskowski et. al.(Paskowski I 2011) Called “A hospital-based standardized spine care pathway: report of multidisciplinary, evidence-based process.”

There were 518 patients and they developed a Spine Care Pathway protocol for their treatment. These patients underwent chiropractic care and physical therapy. 

What They Found

Those that went to a Doctor of Chiropractic treated for about 5.2 visits costing an average of $302.

The pain was 6.2 on intake and 1.9 on exit. 

95% that saw a chiropractic rated their care as excellent. 

Then there’s this one from the Ontario Ministry of Health-commissioned report called The Manga Report which was a comprehensive review of all of the published literature on low back pain(Manga P 1993). 

Some of the things this government-commissioned study had to say are just outstanding. 

  • There was an overwhelming amount of evidence showing the effectiveness of chiropractic in regards to the treatment of low back pain and complaint.
  • They found that it is more cost-effective than traditional medical treatment and management
  • Found that many of the traditional medical therapies used in low back pain are considered questionable invalidity and, although some are very safe, some can lead to other problems being suffered by the patient.
  • They showed that chiropractic is clearly more cost-effective and that there would be highly significant savings if more low back pain management were controlled by chiropractors rather than the medical physicians.
  • The study stated that chiropractic services should be fully insured.
  • The study stated that services should be fully integrated into the overall healthcare system due to the high cost of low back pain and the cost-effectiveness and physical effectiveness of chiropractic.
  • They also stated that a good case could be made for making chiropractors the entry point into the healthcare system for musculoskeletal complaints that presented to hospitals.

They concluded the paper by saying, “Chiropractic should be the treatment of choice for low back pain, even excluding traditional medical care altogether.”

There are a ton of reasons for chiropractic integration into medical protocols that, if we tried to cover them all, we’d be sitting here for a very long time. The point here is that, when you consider these studies, when you consider the low back series in The Lancet that we covered in episodes 16, 17, and 18, when you read the recommendations from the American College of Physicians for acute and chronic low back pain, and you see the recent article in JAMA from Dr. Goertz on Vets and low back pain that we covered in episode 

Dr. Pettiet, where do you see everything going on this??

How do we do our part to ensure chiropractic integration of our profession and move from the fringe toward the center?

Can we do that while still maintaining our identity as chiropractors?

Is the TCA doing anything that we can talk about publicly toward chiropractic integration?

This week, I want you to go forward understanding that you have been and are doing the best thing there is out there for headaches, neck pain, and back pain. There is no other profession with the juice behind them that we have. Be smart, be responsible, and we may just be able to not just have our foot in the door, but to actually knock it down and burst in like a superhero. 

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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

When you look at the body of literature, it is clear: research and clinical experience show that, in about 80%-90% of headaches, neck, and back pain, patients get good to excellent results with Chiropractic when compared to usual medical care. It’s safe, less expensive, decreases chances of surgery and disability. Chiropractors do it conservatively and non-surgically with little time requirement or hassle for the patient. And, if the patient has a “preventative” mindset going forward, chiropractors can likely keep it that way while raising the general, overall level of health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic podcast in the world. 

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. 

CF 015: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 3 of 3)

CF 011: With Dr. Tyce Hergert: It’s Here. New Guides For Low Back Pain That Medical Doctors Are Ignoring

CF 020: Chiropractic Evolution or Extinction?

 

 

Bibliography

Manga P, e. a. (1993). “THE MANGA REPORT: THE EFFECTIVENESS AND COST-EFFECTIVENESS OF CHIROPRACTIC MANAGEMENT OF LOW BACK-PAIN.” Funded by the Ontario Ministry of Health.

Paskowski I, e. a. (2011). “A hospital-based standardized spine care pathway: report of multidisciplinary, evidence-based process.” J Manipulative Physiol Ther. 34(2): 98-106.

Salsbury S (2018). “Integration of Doctors of Chiropractic Into Private Sector Health Care Facilities in the United States: A Descriptive Survey.” J Manipulative Physiol Ther 41(2): 149-155.

CF 028: Will Chiropractic First Finally Take Its Place?

 Will Chiropractic First Finally Take Its Place?

Chiropractic First is on the table today.

As they say in Texas, Howdy y’all. You could also say, Hola Amigo in Texas as well, and as I learned last week, it’s How you doin? in New York. Today we’re going to be talking about whether or not Chiropractic should or could be poised to step up and take it rightful spot in healthcare globally. Buckle up, bucko.

But first, here’s that bumper music

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast and today it’s about chiropractic first.  So, glad you’re here with me. In case you are a youngster, the term “bucko” came from a young tike himself named Ritchie Cunningham on Happy Days played by Ron Howard. Yep, that Ron Howard, the famous director and was once a tiny tot named Opie on the Andy Griffith show. No, I’m not THAT old but….I know a little TV trivia here and there. And now it appears that you do too. 

Ritchie, every now and then, would get all worked up into a fuss and call Fonzie or Potsy or whoever a “bucko.” Man…..you wanna talk about fighting words. Fonzie about ended him a time or two but, in the end, Fonzie was way too cool to beat up on Ritchie. OK, enough of that…

I want to ask you to go to http://www.chiropracticforward.com and sign up for our newsletter. We won’t be filling up your inbox and it’s easy to fill you in on all the new stuff. And, in the end, it’s nice of you and it will help keep the wrord circulating if you would like to help us. Likes, shares, and retweets also keep the world turning around and around and that’s really important stuff…..Keeping the world spinning and all….. if we can talk you into it. 

Have you noticed we aren’t selling you anything? That doesn’t mean that we won’t if the right opportunity arises down the road but, I want you to know that I’m doing this podcast for the right reasons. I make furniture, I am a musician, I am a sculptor…..and, Just like anything else I do, I make the things that interest me and that come from my heart. If someone ends up buying what I’ve made down the road, then heck yeah!! Good for me. But, in the meantime, I do what I do because I love it and I guess I have enough ego that I think others may love it as well. I hope you guys and gals love it and find the value like I find in it. 

As with every episode, we are honored to have you with us. We truly are. Now, here we go with some vital information that we think can build confidence and improve your practice which we think will improve your life overall. That’s a tall order but everyone needs goals.

You have Firecircled your way into Episode #28 ala Dr. Strange. My family is full of action movie junkies so just deal with the reference. 

I think a great place to start is by saying that I stumbled upon a heck of a deal this last weekend when I attended the Texas Chiropractic Association’s ChiroTexpo down in Dallas at the Hyatt Regency. I realize the Hyatt Regency holds no meaning to those outside of Dallas but, it’s the hotel with the really cool lit up ball in downtown Dallas. Ah….yes, if you’ve seen the amazing Dallas Cowboys perform inside your TV box, you’ve probably seen the down town rotating restaurant ball on your screen. 

Part of the program had to do with the Lumbar Management portion of the Diplomate of American Chiropractic Orthopedists program. I’m still getting the nuts and bolts of this dude figured out but, basically, it consists of five 10-hour live face-face seminars, 50 hours in total there. Then, 250 of online courses through the University of Bridgeport. After that, you sit for the DACO exam and, assuming you pass it, you now have the honor of being called a DACO and you have the knowledge to back it up. This class was one of the 10-hour sessions.

Now, I have to say, I literally thought I would sit in the class for a couple of hours, my eyes would glaze over, and my butt would start to hurt, and I’d get up and wonder around asking where the nearest trouble could be had because I’m onery on the weekends. I mean really, who the heck wants to sit in a classroom from 1-7pm on a Saturday night and 8-1 on a Sunday morning? Not this guy. Not all in one stretch like that.  

But I did. I sat through all 10 of them. Yep, even surprised myself. Dr. Tim Bertlesman from Illinois was the instructor of the class and he kept it moving, he kept it extremely relevant, and he even kept it pretty funny. Basically, he kept my interest and you know what? I may…..just may…..do the whole program. 

It’s evidence-based for sure and about Chiropractic First

It’s patient-centered without a doubt. And it’s current with the research. If you’ve been paying attention, that’s right in my wheelhouse. If you’d like more information on this program, send me an email at dr.williams@chiropracticforward.com and we’ll connect. As I learn more and more about it all, I’ll be glad to share if you think you’d be interested as well. 

He started off the class with some slides referencing a few studies that I haven’t seen just yet and I a lot of what he was saying is what I’ve been telling all of you for 28 episodes now. All of them. Every single episode. 

The overwhelming sentiment here is that the door is open thanks to opioids. The door to chiropractic first, that is. The chance we have waited for is here. Right now. We may not get it again. People are hungry for what we do and we now have all of the research we need to back ourselves and our profession up, to show complete validation, and thrust us into the mainstream of healthcare for non-complicated musculoskeletal issues. That’s here. 

Let’s look at a little bit of it and see if you agree. 

This is from April 2016 and was published in JAMA. It was authored by Dr. Deborah Dowell, MD, et. al. and was called “CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016(Dowell D 2016).”

Why They Did It

Realizing that opioids are a problem, that there are a limited number of long-term opioid research papers, and that primary care physicians need better, safer ways of managing chronic pain, the authors hoped to make recommendations for when to prescribe opioids outside of cancer treatment, etc….and when to not prescribe them. 

How They Did It

  • The Centers for Disease Control and Prevention (CDC) used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) protocol in order to assess the evidence type and make recommendations from there. 
  • Evidence was made up of observational studies or randomized clinical trials with notable limitations. 
  • No study evaluated long-term (over 1 year) benefit for opioids in chronic pain. 

What They Found

  • There are 12 recommendations
  • Of the most importance was the recommendation that non-opioids is preferred for treatment of chronic pain. That’s where WE fit in folks.
  • Opioids should only be used when benefits for pain and function outweigh risks but risks are use disorder, overdose, and death so….. Pretty much never.
  • Before starting any opioid therapy, practitioners need to set goals and settle on how they will be discontinued if benefits do not outweigh risks.
  • Blah….blah blah….a bunch of other language that does not pertain to us chiropractors. 

Wrap Up

Non-pharmacologic therapy and non-opioid pharmacologic therapy are preferred. Chiropractic first

I think that, before the American College of Physicians finally came right out and said to go see someone that performs spinal manipulation to treat acute and chronic low back pain, this was JAMA’s way of saying, “Hey guys and gals, ummm….we’ve created a bit of a mess and we had better start cleaning it up (cough chiropractic cough) and maybe we should look outside of usual medical care like pills (cough chiropractic cough) and drugs that people get hooked and drugs that kill people (cough Chiropractic).

JAMA has come along slowly but they’ve made great progress. Even since this paper originally came out. 

For the next article, let’s look at this one called “Attorney General Janet Mills Joins 37 States, Territories in Fight Against Opioid Incentives,” released by the Office of the Attorney General on September 18, 2017(Roth-Wells A 2017). 

The Attorney General in Maine, Janet Mills, joined 37 other states in the fight against opioids according to this article. The AG was quoted in the article as saying, “Last year Maine enacted a law limiting opioid prescriptions and that law is beginning to have a positive impact. Now health insurers need to reduce any financial incentives to prescribing these addicting narcotics and offer greater coverage for alternative therapies. As the chief legal officers of our States, we are committed to using all tools at our disposal to combat this epidemic and to protect patients suffering from chronic pain or addiction.”

The attorneys general contend that incentives that promote use of non-opioid therapies will encourage medical providers to consider physical therapy, acupuncture, massage, chiropractic care, and non-opioid medications, instead of narcotic drugs.

The article went on to list all 37 states that were signed on to this initiative but, sadly, my state of Texas was not on the list. That pesky Texas Medical Association really tends to get in the way. I see the other biggest states on the list in regards to the number of chiropractors practicing. Those states are California, New York, and Florida but, no, not Texas.

The next article is called “FDA Education Bluepring for Health Care Providers Involved in the Management or Support of Patients with Pain” and was published in May 2017(FDA 2017). 

On page three, section two, the paper dicusses nonpharmacologic therapies. It states, “A number of nonpharmacologic therapies are available that can play an important role in managing pain, particularly msculoskeletal pain and chronic pain.” 

It then goes on to mention categories. The categories they mention are Psychological approaches, and, while I think our patients look at us as chiropractors, financial advisors, psychologists, and a whole host of other professionals, this paper is speaking to cognitive behavioral therapy and, if I’m honest, I’m simply unfamiliar with that as a treatment regimen. I certainly have more to learn on that topic. They also mention physical therapy, of course. They mention surgical intervention and then they mention complementary therapy underwhich is mentioned acupuncture and chirlpracty. 

I’ve not ever in my life heard the term “chiropracty” but at least we’re in the game, I suppose. 

Then the paper closes the section by saying, “Health care providers should be knowledgeable about the range of available therapies, when they may be helpful, and when they should be used as part of a multidisciplinary approach to pain management.”

Isn’t that interesting? How many practitioners do you think came across this paper and this section of this paper? How many do you suppose have decided to take it upon themselves to get extra information and education in this particular topic? 

Maybe some but, mostly, I would say that it is up to us chiropractors to do our part to educate our medical communities on this sort of information. It’s the FDA for goodness sake. It’s on a government website. It cannot be hard to point them in the right direction and for the medical practitioners to be able to trust the information if it’s coming from this sort of a platform or footing. But, they have to be shown the way. Most of them aren’t simply going to stumble on to it and say, “Oh hey, looky here. Looks like I’ve been wrong my whole life about chiropractic.” 

They need some help and some guidance to find it and then hopefully to receive the information on their own. Regardless of where you start, using sources like the FDA, the Journal of American Medical Association, The Lancet, and the American College of Physicians is always a good idea. They are reputable and they are forms of information that the medical kingdom place a lot of stock and value in. It turns out that they’re on our side on this matter. 

Next, let’s talk about The Joint Commission. “What is The Joint Commission?” you may ask yourself. You may ask yourself that question because that’s the question I asked myself when I first saw the paper so I did some homework for you. 

A quick visit to their website tells us the following:

“An independent, not-for-profit organization, The Joint Commission accredits and certifies nearly 21,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.

 

Our Mission:  To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.

 

Vision Statement:  All people always experience the safest, highest quality, best-value health care across all settings.”

If you really read and understand what is said in that description, you’ll see the terms “improve health care for the public” and “providing safe and effective care of the highest quality and value” and safest, highest quality, best-value health care across all setting.” The vast majority of paper we have covered in the previous 27 episodes argue that chiropractic fits the bill in a lot of different ways.

This article comes from The Joint Commission Online and was published on November 12, 2014 talking about revisions to pain management standards that were to be updated just a couple of months later, January 1, 2015(The Joint Commission Online 2014). I want to give this group credit. They seem to have started to catch on to the need for nonpharma protocols about a year to a year and a half prior to the rest of the medical profession. Kudos to them. 

In the blue box is the Standard PC.01.02.07 which is the code for assessing and managing patients’ pain. The revision states that both nonpharma and pharma play a part in pain management, the non-pharma strategies may include the following: acupuncture therapy, chiropractic therapy, osteopathic manipulative treatment, massage therapy, physical therapy, relaxation therapy, and cognitive behavioral therapy. 

That stuff sounds fairly familiar for the most part doesn’t it? We’ve been talking about it for months by now so it should indeed be familiar. Except for the cognitive behavioral therapy bit. I kid. Cognitive behavioral therapy is geared toward treating depression, anxiety disorders, phobias, and other forms of mental disorders. Certainly the disorders that may exacerbate chronic pain or, at minimum, prevent the patient from moving beyond the pain in any meaningful way.

Continuing on, here’s a paper from the prestigious Spine Journal by Jon Adams, PhD et. al. called, “The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults(Adams J 2017).” 

Why They Did It

Just as the title of the paper indicates, the goal of the authors was to learn more about the prevalence, patterns, and use of chiropractic care in the US. 

How They Did It

  • They took a cross-sectional data from the 2012 National Health Interview Survey. The National Health Interview Survey (NHIS) is the principal and reliable source of comprehensive health care information in the United States, utilizing a nationally rep- resentative sample of the civilian noninstitutionalized popu- lation of the United States
  • They used that information to analyze the lifetime and 12-month prevalence and utilization patterns of chiropractic use. 
  • They determined the profile of chiropractic users. 
  • They determined the predictors of chiropractic consultations.

What They Found

  • Lifetime prevalence of chiropractic use was 24%
  • 12-month prevalence of chiropractic use was 8.4%
  • The use of chiropractic care has grown from 2002 to when the data stopped in 2012
  • Back pain caused people to seek chiropractic care to the tune of 63%
  • Neck pain caused them to go about 30% of the time. 
  • The majority of chiropractic users reported that it helped a great deal with their health problem and improved overal health or well-being. 

Wrap It Up

The authors concluded by saying, “A substantial proportion of US adults utilized chiropractic services during the past 12 months and reported associated positive outcomes for overall well-being and/or specific health problems.”

When we dive a little further past the abstract and get down into this paper, it goes into the specific percentages for different questions:

Chiropractic led to:

  • Better Sleep 42%
  • Reduced Stress 40%
  • Felt better overall and improved health 39%
  • Was seen as very important to the user 48%
  • Helped for a specific health problem 65%
  • Didn’t help at all 4% 
  • 62% went to a chiropractor to treat the cause, not the symptom!

I want to finish up this week’s papers by citing one that came right out of the White House not long ago.

If you go to The President’s Commission On Combating Drug Addiction and The Opioid Crisis report and make your way down to page 57, you will see where the authors say the following, ““A key contributor to the opioid epidemic has been the excess prescribing of opioids for common pain complaints and for postsurgical pain. Although in some conditions, behavioral programs, acupuncture, chiropractic, surgery, as well as FDA-approved multimodal pain strategies have been proven to reduce the use of opioids, while providing effective pain management, current CMS reimbursement policies, as well as health insurance providers and other payers, create barriers to the adoption of these strategies.” That is from the White House. 

If you continue to the very bottom of the page, you’ll see this quote, ““The Commission recommends CMS review and modify rate-setting policies that discourage the use of non-opioid treatments for pain, such as certain bundled payments that make alternative treatment options cost prohibitive for hospitals and doctors, particularly those options for treating immediate post-surgical pain.”

In Episode #11, when I brought this up to my long-time buddy and past TCA President Dr. Tyce Hergert, he said, “You mean like a specialist copay for chiro care and a lower copay for primary care? Or covering surgery 100% and NOT covering non-surgical means.” I couldn’t have said it any better. 

Essentially, the United States Government is admitting there is professional discrimination at the highest levels…..hello Medicare and Health Insurance plans….I’m talking to you….this discrimination creates barriers to doing the smart thing.

The smart thing is seeing a chiropractor for your back pain. The “Big Guys” (AKA: American College of Physicians, The Lancet, the FDA,  and the American Medical Association) recommend it and the government says policies are in place to prevent patients from following those recommendations.

Key Takeaways:

  1. The general population is starving for what we chiropractors do and for what we can offer them. 
  2. All of the important entities in the medical kingdom now recommend what we do but primary practitioners and specialists haven’t caught on just yet.
  3. There are barriers set up within Medicare and insurance in general keeping people from seeking the safest, most cost-effective, non-pharma means to treat themselves.
  4. It’s up to US and nobody else to get the word out in our medical communities. Nobody is going to do it for us and that’s a guarantee. 

I want you to go forward this week with confidence and validation but with the understanding that it is up to every single one of you to figure out how to educate your medical community in an evidence-based, patient-centered way an the first one that does it correctly and effectively may just win a pot of gold and become THE spinal authority in your community. 

I would say that you also need to do your friend Dr. Williams, and all other chiropractors in the world, a big favor. That favor would be to help us get the word out about this podcast. If you find value in it, don’t you think others would too? I’m not sponsored here. I’m doing it because I love it. I don’t have $10,000 to promote the podcast on Facebook or Twitter so I have to keep asking our listeners to please do us a favor and go like our page on Facebook, Like and Share our content EVERY WEEK, FOLLOW us on Twitter, and RETWEET our content on Twitter. 

These are incredibly easy things to do and I truly need your help with them if you would please be kind enough. 

I want you to know with absolute certainty that When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.

When you look at the body of literature, it is clear: research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good to excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic evidence-based podcast in the world. 

We cannot wait to connect again with you next week. From Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

CF 013: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 1 of 3)

CF 011: With Dr. Tyce Hergert: It’s Here. New Guides For Low Back Pain That Medical Doctors Are Ignoring

 

Social Media Links

iTunes

Bibliography

Adams J (2017). “The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults.” Spine 42(23): 1810-1816.

Dowell D (2016). “CDC Guideline for Prescribing Opioids for Chronic Pain – United States.” MMWR Recomm Rep 65: 1-49.

FDA (2017). “FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain.”

Roth-Wells A (2017). “Attorney General Janet Mills Joins 37 States, Territories in Fight against Opioid Incentives.” Office Of The Maine Attorney General.

The Joint Commission Online (2014). “Revisions to pain management standard effective January 1, 2015 BrightStar Care recognized as Enterprise Champion for Quality for second year New on the Web.” Joint Commission Online.