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CF 058: The Patient Experience, Lumbar Stenosis, & Fibromyalgia 

CF 058: The Patient Experience, Lumbar Stenosis, & Fibromyalgia 

Today we’re going to talk about the patient experience being more important than your marketing, we’ll talk about some research from JAMA on lumbar stenosis, and some research on upper cervical manipulative therapy on fibromyalgia. 

But first, here’s that bumper music

Integrating Chiropractors

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 clumsily stumbled into Episode #58 knocking lamps off of the end tables and generally making a mess of the place.

DACO

As with every week, let’s talk a bit about the DACO program and my progress. I was doing the Communication Drills but they kept referring to eLearning Episodes. So let’s break that down a bit real quick for those interested in the program. The bulk is made up of 40 Diagnostic Drills, 46 Communication Drills, and 17 eLearning Episodes. 

You get 2 hrs credit for each Diagnostic or Communication Drill and you get 3 hours credits for each eLearning Episode. 

Now, since Communication Drills kept referring to eLearning Episodes, I figured I would switch focus and go through them and then return to the Communication Drills. Still with me?

The eLearning Episodes are very much video based on a downloadable worksheet to take notes on. I take notes digitally though so I’m still getting my angle of attack down on these and how I want to best tackle them and have great notes I’m getting it figured out. 

DACO Classes

So far, I’ve taken classes on Adjusting locally and thinking globally about how a cervical adjustment can affect even the low back. The neurology is amazing. A class on blurry vision from a pain in the neck. Again, the neurology people. I don’t know how I made it day to day before this stuff. Then last weekend I took one on making sense of a headache. 

Outstanding information and all lined up to make you better, make you wiser in your decision-making, and making you a better communicator with your patients and colleagues. 

If you’re waiting to get started on the DACO, get started. I’ll be glad to help you if you’ll email me at dr.williams@chiropracticforward.com

I’m about wrapped up with some cool stuff that you all may be interested in on our website at chiropracticforward.com. If you’ll go there and sign up for our newsletter on our home page, I’ll be able to let you know all about it when it’s ready to roll out.   

Great week for listens Y’all. Thank you for tuning in. Everyone loved Dr. James Lehman’s episode. That was a big one for us! If you missed it, it’s episode #55. Candy for your ears. I see that sucker being the number one listened to podcast pretty quickly. 

Onto the Discussion

Let’s get to trying to make your practice better. This first one we’ll discuss is titled, “Patient experience five times as likely to drive consumer loyalty as marketing” by Christopher Cheney with HealthLeaders(Cheney C 2018). It was published on December 28, 2018. Once again, I know you dig the new stuff. 

If you’re getting after it. If you’re hustling, then you’re marketing. Marketing isn’t something you do once, is it? Oh no, it isn’t. It’s something you do every damn day if you’re doing it effectively. It’s exhausting, isn’t it? But it can be fun too. 

Marketing

Isn’t it fascinating that just changing the color of the border on your marketing material has the potential to elicit a different behavior from the recipient? Or changing the color of the shirt that the person in the ad is wearing affects the response rate? It’s amazing. But, it’s also exhausting to contemplate all of the different combinations of possibilities of words, colors, placements, and all of that crap. 

Good grief. You could make yourself crazy and how many chiropractors usually have the budget to hire a full-time marketing person that actually had a marketing degree? Not many would be the answer you’re looking for if you were confused on that. It was more rhetorical than anything. 

Here in this article, Mr. Cheney says that the patient experience while in your office is the primary driver of patients’ consumer loyalty at health systems, hospitals, and physician practices. He based this information on a recent Press Ganey report I would normally link for you in the show notes but it looks like a bit of click bate. As in leave your email and get the report crapola and I’m not doing that to my peeps. Ain’t nobody got time for that. 

Hell, I can hardly get you guys to give ME your email address and most of you are loyal listeners! Lol. 

Consumer Loyalty

Anyway, he says that consumer loyalty is vital for not only your profit at the end of the month but also helps you take better care of long-term patients with multiple chronic illnesses. 

Hell, that’s why we got into this business; taking care of people. I have to say that if you got into this business to get rich, you’re taking the long way around buddy. Lol. Most of us got into this business to take care of people when nobody else was able to get results with them. And then hopefully keep them that way!

Here’s what raised my antennae straight up, he said, “Patient experience is FIVE TIMES more likely to influence brand loyalty than conventional marketing tools such as billboards, or television, print, or radio ads.”

WHAT?

What was that? Let me repeat that just in case my DACO talk put you to sleep. Hey, wake the hell up and listen to this. “Patient experience is FIVE TIMES more likely to influence brand loyalty than conventional marketing tools such as billboards, or television, print, or radio ads.”

That is astounding. Of course, some of you already had this figured out and being 20 + years into this dealio, I have it figured out to an extent as well but FIVE TIMES more effective than billboards, TV, print, or radio?

I did NOT have that much figured out. Do you know how I know I didn’t have all of that figured out? Well, it’s because I am spending too much damn money on all that crapola. They interviewed over 1,000 adults on this survey. 

I do have it figured out to the extent that I tell my staff that we are certainly in the healthcare business but they’re fools if they think we are not also in the customer service business. You better believe it. I tell them that I’d much rather a patient leave feeling the same but feeling great about the people they met and the experience they had here and feeling hopeful about what we can accomplish with them as opposed to them leaving my office sore because I either rushed through the appointment or thought we’d equate appointment success with a popping noise and pushed so hard that I finally got a pop sound but ended up making the patient feel worse. 

That goes for the front desk too, doesn’t it? They’re the first point of contact and the last point of contact. If they’re not friendly when people come in and greet them warmly and are very welcoming, well….we’re already behind the 8-ball there and had better make up some ground in the back of the office. And when they leave…..oh nobody likes to pay their own money out of their own pocket and they damn sure don’t like to pay it to someone they don’t like personally. 

Here is a quote from the report, “Healthcare organizations can tap the power of patient experience, the report says. “To harness that influence, providers should capitalize on the power of word-of-mouth marketing by viewing the patient experience as an essential part of their acquisition strategy. By gaining a deep understanding of what gets people talking about positive patient experiences, identifying opportunities to advance the conversation and disseminating key information, healthcare systems can naturally align the mission of delivering safe, high-quality, patient-centered care with the business of acquiring and retaining consumers.”

The Big 4

They went on to line our 4 Big One’s that should be a part of any healthcare facility’s strategy for getting and keeping patients. They were:

  1. Give every patient a voice – They’re not just talking about listening to them when they visit your office and tell you about their conditions. They describe delivering surveys via text and email as well as the standard outreach protocols. 
  2. Identify factors that drive and erode patient loyalty. They say to really know where you can improve, you gotta know positive loyalty metrics on things like the likelihood to refer or recommend your office to their network of people. Imagine man, being a former member of BNI, they teach that each person, whether they know it or not, has a network of 250 people in their lives. I get 55-65 new patients per month. That’s 13,750-16,250 potential work of mouth contacts that can either hear the good about our office or, if we allow them to catch us on bad days….that’s up to 16,250 people that can hear bad things about us. You can see why it’s so important to have positive patient experiences in your office just as often as you possibly can. Especially in the days of social media. There is no room for ego, for talking down to your patients or scolding your patients, or any of that crap. Patient-centered is more than an idea, it’s how you’d better be carrying yourself. 
  3. Use natural language processing to analyze comments. What the hell does that mean? Well, they say that it is language that allows aggregation of comments into clear brand equities and liabilities, allowing for proactive management of both experience and brand. That sounds like an overly wordy and annoying resume if I’m being honest. Basically, it’s using computers to analyze emails, customer feedback forms, surveys and things like that to identify the root cause of customer dissatisfaction or, we hope, customer satisfaction. I’d like to lead you further down this path but, obviously, I have more to learn on it myself. 
  4. Post ratings and reviews in physician profiles. Ensure that future patients have the most convenient access to all information they seek by including comments – both positive and negative. I can’t deal with negative comments. They hurt. Lol. 

Reviews

They also say that you need to be earning quality reviews online for Yelp, Google, Facebook, and all that good stuff. If you don’t know the value of reviews at this point, you just might be a lost cause. Lol. 

They also say you must address negative reviews online in a professional way while understanding that negative reviews are an opportunity to learn and improve. 

But, when it’s not right and borderline illegal, I believe it’s OK to have your attorney contact the person leaving that negative review. Here’s what happened. We offer a service. Not chiropractic but a service that a girl that treated here for some time decided she would begin offering here in town without being certified in any way to perform. 

OK, annoying for sure but then she, one of her little buddies and her boyfriend go online and leave us bad reviews for the exact same service. So there we were with 80 or so 5-star reviews. Not one negative review. And then three 1 star reviews popping up out of nowhere. Nope, she got a call from my attorney and they went away very quickly. 

Ain’t nobody got time for that crap, right? I know I don’t and I have little tolerance for people that want to try to tear down something others have built just to try to further themselves. 

Before my face gets too red and I start to stutter, let’s move onto the next topic. 

Next Paper

This next paper is called, “The addition of upper cervical manipulative therapy in the treatment of patients with fibromyalgia: a randomized controlled trial.” The lead author on this one is Ibrahim Moustafa and it was published in Rheumatology International in July of 2015(Moustafa I 2015). 

And can we just stop a second appreciate the last name Moustafa? Can we do that? Holy cow, if I had a good head of hair and a last name like Moustafa, I’d have the world on a leash ya know. But I don’t have good hair and my name is Williams (so boring) so let’s move on. 

Why They Did It

The aim of this study was to investigate the immediate and long-term effects of a one-year multimodal program, with the addition of upper cervical manipulative therapy, on fibromyalgia management outcomes in addition to three-dimensional (3D) postural measures.

It was a randomized controlled trial with a one-year follow-up. 

What They Found

The addition of the upper cervical manipulative therapy to a multimodal program is beneficial in treating patients with fibro.

I threw that one in for you Upper Cervical guys. You’re getting some love when it comes to treating fibro and I know fibro sufferers will appreciate that. 

I think, after learning more about the upper cervical spine in the DACO course, that it’s fascinating to think about. There is so much going on in the upper three segments in terms of sensorimotor and proprioception that it just blows your mind. 

Last Paper

OK, on to the last paper. This one is called “Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial(Schneider M 2019)”. It was authored by Michael Schneider, DC, Ph.D., Carlo Ammendolia, DC (who we have covered here before for stenosis), and Donald Murphy, DC et. al. It appeared in JAMA on January 4, 2019, and here’s how it goes. 

Why They Did It

The question to answer for them was, “What is the comparative effectiveness of 3 types of nonsurgical treatment options for patients with lumbar spinal stenosis?”

Now the 3 types of protocols they tested were medical care, group exercise, and manual therapy/individualized exercise. 

The medical care consisted of medications and/or epidural injections. 

The group exercise classes were supervised by fitness instructors in senior community centers. 

The manual therapy/individualized exercise consisted of spinal mobilization (because it works and is awesome I assume), stretches, and strength training provided by chiropractors and PTs. 

A combination of manual therapy/individualized exercise provides greater short-term improvement in symptoms and physical function and walking capacity than medical care or group exercises, although all 3 interventions were associated with improvements in long-term walking capacity.

Integrating Chiropractors

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

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

Help us get to the top of podcasts in our industry. That’s how we get the message out.

Connect

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

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About the Author & Host

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

 

Bibliography

  • Cheney C (2018) “PATIENT EXPERIENCE FIVE TIMES AS LIKELY TO DRIVE CONSUMER LOYALTY AS MARKETING.” HealthLeaders.
  • Moustafa I (2015). “The addition of upper cervical manipulative therapy in the treatment of patients with fibromyalgia: a randomized controlled trial.” Rheum Inter 35(7): 1163-1174.
  • Schneider M, A. C., Murphy D, (2019). “Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis A Randomized Clinical Trial.” JAMA Network Open 2(1): e186828.

CF 045: Harvard Health, Low Back Stenosis, Allergy Autism

CF 016: Review of The Lancet Article on Low Back Pain (Pt. 1)

 

CF 056: What Does A Spinal Manipulation Do In Medical Terms & What I Despise About My Profession

Today we’re going to talk about what a chiropractic spinal manipulation is, we’ll talk about what it does and what happens there. We’re also going to talk about what I sincerely despise about our great profession. Depending on how fired up I get here, this one should be a good episode.

CF 055: w/ Dr. James Lehman – The Future Of Chiropractic, Chiropractic Specialization, & Chiropractic Integration

CF 055: w/ Dr. James Lehman – The Future Of Chiropractic, Chiropractic Specialization, & Chiropractic Integration  

Today we’re going to talk to one of the giants in our profession, Dr. James Lehman. We will be talking to Dr. James Lehman all about all sorts of things but mostly about the future of chiropractic. What is it looking like for those of us in the profession over the course of the next 15-30 years?

Dr. James Lehman, FACO - University of Bridgeport Connecticut

But first, here’s that delicious bumper music

Integrating Chiropractors

 

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  We will get to Dr. James Lehman soon. 

Introduction

You have fluttered into Episode #55 kind of like the feather on Forrest Gump. Come on, you know the feather from literally one of the best movies of all time. Yes, that feather. 

Diplomate of the Academy of Chiropractic Orthopedists

This is normally the point in the program where I mention the DACO program and how I am progressing through it but, for reasons that will become obvious fairly quickly, we are going to save that talk for just a little later in our program. 

However, I will tell you I have 80 online hours at this point and some of my more recent classes have been Why does my shoulder keep hurting and how to diagnose a tension-type headache. If you recall from a week or so ago, two classes on migraines were among the classes so, after this last week, I’m getting a handle on the headache mystery. 

I have just about completed all of the Diagnostic Drills. There are 40 of them and I’ve finished 39 of them. The last one is on ankle sprain and what we really need to know about them. Then, we move on to Communication Drills that reinforce these Diagnostic Drills and help you write to your colleagues in an effective and professional way to describe your findings. I’m looking forward to those!

Introduction of Dr. James Lehman

Now, let’s go ahead and get on with the reason we’re all here. Before we speak with Dr. James Lehman, I want to go through a little background information on him for you so you are well aware of who he is and where he is coming from. 

Dr. James Lehman is an Associate Professor of Clinical Sciences at the University of Bridgeport/College of Chiropractic and Director of Health Sciences Postgraduate Education (HSPED). 

Dr. James Lehman completed his MBA at the University of New Mexico and a doctorate in chiropractic medicine at the Logan College of Chiropractic in St. Louis, Missouri.

Dr. James Lehman is a board-certified, chiropractic orthopedist. He teaches orthopedic and neurological examination and differential diagnosis of neuromusculoskeletal conditions. In addition, he provides clinical rotations for fourth-year chiropractic students and chiropractic residents in the community health center and a sports medicine rotation in the training facility of the local professional baseball team. 

As Director, Dr. James Lehman developed the three-year, full-time resident training program in chiropractic orthopedics and neuromusculoskeletal medicine. The program offers training within primary care facilities of a Federally Qualified Health Center and Patient-Centered Medical Home. While practicing in New Mexico, he mentored fourth-year, UNM medical students. 

Welcome to the show Dr. James Lehman, it’s an honor to have you on the Chiropractic Forward Podcast this week. 

Questions for Dr. Lehman

How did the job at UofB become a reality for you? How did you make that happen or even make it a possibility?

Can you tell me about your position at UofB? 

What are your responsibilities? 

What does a regular day for you look like? 

Dr. Lehman and I became acquainted with each other through the DACO program. In case you have been hiding under a rock, zoning off during our podcasts, or maybe this is the very first podcast you’ve listened to of ours, DACO stands for Diplomate of American Chiropractic Orthopedists. 

What got you so interested in the Orthopedic side of our profession? 

What was it that made you want to specialize originally?

Can you tell us a little about your experience with chiropractic integration over the years? 

Have you had some battles to fight internally against medical practitioners?

What are some of the pitfalls and what are some of the rewards beyond seeing the patients recover?

Can you tell us about FQHCs? I had no idea they existed, especially in my city, until you showed me. Integrating into an FQHC was something that was never on my radar until we talked in Dallas.

At this point in our discussion, I need to tell you, the audience, that Dr. Lehman has played a vital role in furthering the DACO program. Through his position at the University of Bridgeport Connecticut, and through a partnership of sorts with online education through Chiropractic Development International out of Australia, obtaining the DACO has become very do-able and very attainable for all that may be so inclined. 

Dr. Lehman, can you tell us a little about how you and the University of Bridgeport got involved in the DACO and how it’s going so far? How did you identify the need and then go about filling that need?

Can you tell us why you feel like specialization like the DACO is so important to doctors of chiropractic these days? 

Why has this become your mission?

Through email, you suggested to me that, for the chiropractic profession to gain the respect of the healthcare system, a reasonable definition of chiropractic would be a good starting point. You offered a definition that doesn’t restrict providers nor does it highlight ‘subluxation.’ That definition is as follows:

“The evidence-based practice of differential diagnosis, patient-centered treatment, and prevention of pain and human disease as taught by CCE-approved chiropractic colleges, institutions, or schools.”

Tell me how you came up with this definition. 

Just to tell a quick personal experience, I have been introduced before by one neurosurgeon to another neurosurgeon using a disclaimer. He said, “He’s not one of THOSE chiropractors. He’s one of the good guys.” Which, I have to say that I appreciated the vote of confidence but at the same time it made me think, “With such a prevailing sentiment toward our profession, how will we ever integrate successfully or is it even possible?”

Do you think that even those of us that are specializing are going to be forever introduced with a disclaimer? I personally don’t see how a profession as split as ours progresses and integrates successfully. Is there a solution to this or are we just stuck with the split and the internal fighting?

With the knowledge that PTs are now utilizing spinal manipulative therapy, what do you feel is going to happen with our profession in the next 15-30 years?

In the two classes I’ve sat through with you as a speaker, you were adamant about Informed Consent. I read your paper on that topic after I got back from Dallas and thought it was pretty interesting. Informed Consent doesn’t sound like a particularly interesting or sexy topic to the general population so, would you mind telling us about that and what interested you enough in a topic like Informed Consent to actually publish a paper on it?

We covered the vast divide in our profession, what are some other big obstacles you see on the horizon for our profession right now?

In our private Chiropractic Forward Group, when we discussed you episode coming on the show, Dr. Brandon Steele said I need to ask you this question, “What can students do right now to prepare for current trends in Healthcare? Are there residencies, certifications, internships or other equivalents they should be considering going through to prepare for their future after graduation?”

Also in the private group, Dr. William Lawson, who has been a guest with us before, told me to ask you about rural healthcare centers and how a chiropractor can work in or own a rural healthcare center. 

 being with us and taking time out of your day. I really appreciate you and what you are doing for our profession. I don’t know where we would be without folks like you and others just like you. 

Integrating Chiropractors

 

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

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

Help us get to the top of podcasts in our industry. That’s how we get the message out.

Connect

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

Website

Home

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

About the Author & Host

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

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

CF 039: Communicating Chiropractic

CF 046: Chiropractic Effectiveness – Chiropractic Integration – Chiropractic Future

CF 054: Lumbar Fusion Surgery and Its Evidence Or Lack Of

CF 054: Lumbar Fusion Surgery and Its Evidence Or Lack Of

Today we’re going to talk about a great new paper coming to us from Internal Medicine Journal on Lumbar fusion surgery and it’s evidence or lack of. What’s the word on lumbar fusion surgery? We’ll tell you.

But first, here’s that silky smooth Chiropractic Forward bumper music

Integrating Chiropractors

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 glided all fast and furiously into Episode #54 and we’re happy to have you here smokin tires and all. Kill the engine and take a chill pill, won’t you?

DACO

Let’s talk a bit about the Diplomate of the Academy of Chiropractic Orthopedics program quickly. I’m sitting at around 76 of my online hours and I have to get 250 of those. Yes, if you were wondering, it is going by slowly here lately but I’m going to have a little time this week and weekend to put the pedal to the metal and get after it. 

Some classes from this past week were migraines, migraines in children, thoracolumbar junction difficulties, and chronically injured hamstrings. 

Spelling Issues

These courses come from a group in Australia and they really take the long road when it comes to spelling. Did you guys know that? The first thing that’s crazy about the Aussies is that they use esses instead of z’s. For example, recognize is spelled with an s rather than a “z”.

When you see the word orthopedic spelled orthopaedic, it’s because of them and the English. We take the shortcuts and say, hey, recognize has a z sound in it so let’s spell it with a z. Hey, orthopedic has an e sound in the middle of it so let’s drop the dumb a since we don’t need it and let’s just spell it orthopedic. 

Here’s another one. Behavior. These goofy people spell it behaviour. They snuck in au right there at the very end of the word like they thought they were going to get away with it or something. Uh uh. Nope. We Americans don’t need the u at the end so we just end it in or. Because we’re cool and ain’t nobody got time for that crap. 

The most annoying one is probably edema or estrogen. They start both of those words with an O. Who the hell would ever spell estrogen Oestrogen? Or edema spelled oedema? That’s absolutely uncalled for and I’d appreciate them re-evaluating their use of the English language in this manner. 

Absolute ridiculosity. 

I am currently designing some really cool stuff all based in research and current evidence that I think you will all be interested in. At least I hope you are because, from what I’ve seen in researching, it’s like nothing else out there. 

Go to chiropracticforward.com right now while you’re thinking about it, just under this week’s episode, you’ll see an area where you can sign up for the newsletter. It’s only once a week and it’ll help us tell you about what we’re working on when we get it ready to go live!!

Now, let’s get to the reason for the season here. 

The is titled “Lumbar Spine Fusion: What Is The Evidence(Harris I 2018)?” and it was written by Ian Harris, Adrian Traeger, Ralph Stanford, Christopher Maher, and Rachelle Buchbinder. I recognize at least two of these names from the low back pain series published in The Lancet earlier this year. 

If you have not been through those papers, please listen to episodes #16, 17, and 18 of this Chiropractic Forward podcast for all the info you need on that. 

Basically, in this paper, they say that lumbar spinal fusion is common and associated with high cost and a risk of serious adverse events. They state that they aim to summarize systematic reviews on the effectiveness of lumbar spine fusion for most diagnoses. 

Of important note is where they say that they found NO high-quality systematic reviews and the risk of bias of the randomized controlled trials they found was generally high. For something as serious as lumbar fusion surgery. Where they cut into the body, take two vertebrae that usually aren’t unstable on each other, and then drive screws into them and affix hardware to fuse them together forever and ever amen. 

No high-quality systematic reviews for lumbar fusion surgery and the RCTs out there generally carry a high risk of bias. Great. Duly noted. Awesome. Lumbar fusion surgery

They go on to say that the available evidence doesn’t support a clinical benefit from lumbar fusion surgery compared to non-operative treatment or stabilization without fusion for thoracolumbar burst fractures. 

They say that surgical intervention for metastatic carcinoma of the spine associated with spinal cord compromise improves mobility and neurological outcome. That was based on a single trial. 

That was the high points of the abstract but let’s move in a little more and get on the micro level of this thing. 

This study takes info from Australia and, in the land down under, lumbar spine fusion is the fourth most costly surgical procedure, behind knee replacement, hip replacement, and C-sections. For a procedure with no high-quality systemic reviews. The first word that comes to mind for me here is, “Damn.”

The most common reasons used for lumbar spine fusion procedures would be intervertebral disc disease (which nearly everyone beyond 50-60yrs old has), degenerative scoliosis, and spinal canal stenosis. 

The main purpose here was to compare lumbar spinal fusion to non-operative means. Not to compare it to other surgical procedures. 

Conclusion

As part of the conclusion, the authors say, “The available evidence does not support the hypothesis that lumbar fusion surgery confers a clinical benefit compared to non‐operative alternatives for low back pain associated with degeneration. Similarly, the available evidence does not support the hypothesis that spine fusion confers a clinical benefit compared to non‐operative treatment or stabilization without fusion for thoracolumbar burst fractures. 

Benefits of lumbar fusion surgery compared to non‐operative treatment for isthmic spondylolisthesis are unclear (one trial at high risk of bias). Surgical intervention for metastatic carcinoma of the spine associated with spinal cord compromise improves mobility and neurological outcome (based on a single trial).

Ideally, lumbar fusion surgery for spondylolisthesis, burst fractures, back pain or degenerative conditions (degenerative scoliosis, spinal stenosis, recurrent disc herniation or instability), should only be performed in the context of high-quality clinical trials until the true value for each of these conditions is established. 

Until better quality evidence is available, treatment will continue to be guided by expert clinical opinion based on evidence at high risk of bias. Patients contemplating lumbar fusion surgery should be fully informed about the evidence base for their particular problem, including the relative potential benefits and harms of fusion compared with non‐operative treatments.

When Surgery Is OK

Let’s transition from that to an excellent guideline called When Surgery is OK and this comes from the legendary Dr. Stu McGill. 

To keep this episode from getting too long and out of hand, let’s hit the highlights. This is a 3-page document so we’ll shorten it to the extent that makes sense while still squeezing the good stuff out of it. Use these thoughts and ideas when deciding if surgery is indicated. 

Stu says to try the virtual surgery game and consider surgery only when it fails. Meaning pretend you had surgery today and tomorrow is the first day of recovery. It is characterized by gentle movements and activities but mostly a forced day of rest. The days following a typical post-surgical progression involves restricted activity. If this helps, no surgery at this time. 

Consider surgery when neurological issues are substantial, such as loss of bowel and bladder control. Note: that does not include radiating symptoms like sciatica, peripheral numbness, atrophy, etc….

Consider surgery in cases of trauma. When structures are unstable and need to be stabilized. 

Consider surgery only when the pain has been unrelenting and severe for a substantial period of time. Pain can be a terrible and misleading reason to get surgery. 

Select the surgeon. Dr. McGill says everyone likes to state that they had the best surgeon. He has found that asking the nurses and physical therapists at the hospital which surgeon has the best results is a wise way to go. 

Discuss the pain with the surgeon. Ask what the pain generator is and if they can cut it out. IF there are several tissues involved, chances of success are getting worse. Also if there is damage at several levels. 

Clarify what the success rate is. What does success even mean in your case? Does that mean you survived or does it mean you did OK for a bit before relapsing into pain? You want long-term success to any and all other options available. 

Beware of new treatments. That one should really go without any further discussion. Don’t be a pioneer on the patient side of surgical procedures. 

Beware of disc replacement – Dr. McGill states in this paper that he has not seen a successful case as of the writing of the article. 

Always exhaust the conservative options – He says you may believe that since you tried physical therapy and it didn’t help that only surgery remains. It just may be that the exact therapy tried was not the right one for your specific condition. 

FREE MRI Review

Beware of institutes that offer to view medical images and, with no other information, advise patients on surgery. Pictures are not linked to pain. He argues that a thorough clinical assessment is absolutely essential. I want to butt in on this one. The laser institute and orthopedic surgeons are all over the commercials on TV with this one. 

I will take this time to admit because they’re doing these free MRI reviews, I’m offering the same in my region but here’s why. It’s evidently enticing or they would not offer it and I KNOW for a fact they have a higher-paid marketing department that has decided it is indeed effective. 

That’s one of the reasons I’m doing it but the real reason is because I know that the majority of these people, if they get a free MRI review at the osteopath or the laser spine institute, they’re very likely to be lined up for surgery whereas I, after a thorough exam, will be lining them up for conservative, non-invasive therapy and I can usually keep these people from surgery and useless shots. 

There’s a difference. My free MRI review is to prevent them from surgery. Their free MRI review, in my opinion, is to QUALIFY them for surgery. 

Wrap Up

In wrapping this article or paper up, Dr. McGill says the following, “Tissues in the back become irritated with repeated loading. Consider accidentally stuffing a toe or biting the lip repeatedly – eventually, the slightest touch causes pain. This is symptom magnification because the tissues are hypersensitized. Reduction of the hypersensitivity in the toe or lip only occurs following a substantial amount of time after the accidental stub or bite has stopped.”

Dr. McGill goes on to say, “For example, people with flexion bending intolerance of the spine may replicate this every time they rise from a chair. Correcting this movement fault, metaphorically taking the hits away, results in less sensitized tissues, an increased repertoire of pain-free tasks, and a return of motion. Motion returns once the pain goes away.”

Boom. Snap. Pow. Shazam. KaBAM!! Superhero abilities via the chiropractor and ZERO surgery. How clever. 

Opinion

I don’t care what your chiropractic practice looks like. OK….I lie. As long as it doesn’t make mine look hokey or bad, then I don’t care what your practice looks like. Some are geared toward getting people out of pain. Some are geared to some wellness protocol. Some are floundering because they don’t know where they belong or exactly what they’re trying to accomplish. 

I’ll admit that, at one point in time, I was one of them. 

But, one common thread through all sorts of practices is this, we keep people from surgery. Maybe not 100% of the time but we do a hell of a job with the tools we’ve been given and I love the direction that opioids and lumbar fusion surgery failures are pushing our profession. 

Sometimes even in spite of ourselves. 

Integrating Chiropractors

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

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

Help us get to the top of podcasts in our industry. That’s how we get the message out.

Connect

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

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TuneIn

About the Author & Host

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

 

Bibliography

Harris I, T. A., Stanford R, (2018). “Lumbar spine fusion: what is the evidence?” Internal Med J.

 

 

CF 024: They Laughed When I Said I Could Still Help After Back Surgery

CF 020: Chiropractic Evolution or Extinction?

 

 

 

CF 053: Healthy New Ideas For Physical Activity

CF 053: Healthy New Ideas For Physical Activity

Today we’re going to talk about updated guidelines for physical activity as well as some research that the more vitalistic in the profession may not dig too much. Don’t kill the messenger people. 

But first, here’s that delicious bumper music

Integrating Chiropractors

Introduction

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 toppled into Episode #53, the first episode of year #2. I am committing to doing a second year as long as we show continued growth. If we stop growing, I may change my approach at some point but, I absolutely want to do a second year to see where this thing of ours can go. 

Talking DACO

Let’s talk a bit about the Diplomate of American Chiropractic Orthopedist program also known as the DACO. I’m just keeping you apprised of my progress. At this point, I have 68 online hours down and 40 live hours done. So, I’m 108 hours into the 300 I need. 

I have literally knocked out 24 hours online in the last two weeks. That’s a gob of information. It is literally changing how I practice every single week. It’s almost indescribable but, I see patients coming in every day now that have something I would have missed without having gone this far into the DACO. 

The more recent classes I’ve been through include plantar heel pain, Diagnosing idiopathic scoliosis and assessing the risk of progression, anterior knee pain in an adolescent, lateral knee pain and th IT band, as well as recognizing meniscus tears and essential of reading knee MRIs. 

I honestly wonder how on Earth I’ve gotten anyone well over my 20 years in practice without the knowledge that I’m gaining here. In the end, I guess doing SOMETHING is always going to trump doing nothing and, it’s not like I’ve been a dummy for 20 years. 

CEs

I’ve always been a big proponent of continuing education and have consistently gotten 30-50 CEs every year rather than the 16 required so, I’m not going to beat myself up over it but, sincerely here, this information you get in the DACO program is beyond anything I’ve gotten in any seminar anywhere. 

Now, with that being said, I haven’t been to one of McGill’s or Liebenson’s talks so I need to make that clear. By the way, both of those giants will be at Parker Vegas in February if you are ready for some learning of the highest caliber. 

Newsletter

Right now, while you’re thinking about it, go to chiropracticforward.com and sign up for the weekly newsletter. It’s just once per week, it’s easy and fast and I’m in the process of making some pretty cool stuff that I think can be useful in helping you in practice. 

When it’s ready to roll out, you’ll save because you were cool enough to be on the list, cool enough to be an early adopter, and cool enough to basically be a founder of what we’re trying to build here. I’ve never believed that I can build it by myself. It has to be a team of like-minded, motivated individuals. 

If you are evidence-based I’d love to have you on the team. Reach out and let’s talk about what we can do to build build build. 

Meat n’ Taters

Alright, onto the meat n taters today. Let’s start with this paper that just came out in the Journal of the American Medical Association. It’s authored by Dr. Katrina Piercy et. al[1]. and is called The Physical Activity Guidelines for Americans. It was published on November 20, 2018. It doesn’t get a whole lot more recent than that does it?

The 2018 Physical Activity Guidelines Advisory Committee conducted a systematic review of the science supporting physical activity and health. They came up with recommendations strictly based on evidence graded as strong or moderate. 

Here’s what they decided:

  • Preschool-aged children from 3-5 need to be active throughout the day
  • Children and adolescents from 6-17 should do 60 minutes or more of moderate to vigorous activity daily. 
  • Adults should do at least 2 1/2 hrs to 5 hrs per week of moderate intensity, or 1 hr 15 minutes to 2.5 hours per week of vigorous aerobic activity, or an equivalent combination of the two. 
  • Adults should also do muscle-strengthening activity on 2 or more days per week. 
  • Older adults need a multicomponent physical activity that includes balance training as well as aerobic and muscle-strengthening. 
  • Pregnant and postpartum females need at least 2.5 hrs of moderate activity a week. 
  • Basically moving more and sitting less will benefit nearly everyone. 

See? And you didn’t even need a trainer to figure it out. You’re welcome. You are so welcome, folks. It’s what I do. I give give give. 

Walking Paper

Let’s move on to a paper that was in Spine Journal in November 2018 called Walking more than 90 minutes/week was associated with a lower risk of self-reported low back pain in persons over 50 years of age: A cross-cross-sectional study using the Korean National Health and Nutrition Examination Surveys[2]. 

Again, very new stuff. Only a month or so old. 

They did this one because, while strengthening and aerobic exercise is well-documented and well-founded, there isn’t a lot of information on walking and it effects for low back pain. 

This was a cross-sectional study which means they looked at people differing on one specific characteristic at one specific point in time. The data they collected was from the Korea National Health and Nutrition Examination Surveys from 2010-2015. 

What They Found

The authors wrapped it up by saying, “Our study showed that longer walking duration was associated with a lower risk of LBP. Regular walking with a longer duration for more than 3 days/week is significantly associated with a lower risk of LBP in the general population aged over 50 years.”

Social Prescribing

I wanted to discuss a pretty neat article I came across last week from the Smithsonian. This article is called British Doctors May Soon Prescribe Art, Music, Dance, Singing Lessons and it was written by Meilan Solly[3] published November 8, 2018. Yet again….the newest stuff here this week. 

The article discusses a new initiative on the part of British Health Secretary Matt Hancock and they’re wanting to allow the country’s doctors to prescribe art or hobby based treatment for all sorts of issues. From dementia and psychosis to lung complaints and mental health complications. 

They’re calling it “social prescriptions” and I have to say that I’m a big fan of the idea. For instance, just listening to Otis Redding sing Sittin’ On The Dock of the Bay does something good to me inside and out. One of my all time favorites and you all clearly have good taste because you’re listening to our little podcast here so I’m sure it’s one of your favorites too. If it’s not one of your favorites then you clearly haven’t listened to it yet. 

The health secretary has an excellent quote here when he says, “We’ve been fostering a culture that’s popping pills and Prozac when what we should be doing is more prevention and perspiration.” “Social prescribing can help us combat over-medicalizing people.”

And the heavens opened up and all God’s people said, “Amen.”

The only problem I have with the idea is that they’re not looking at having it up and running until 2023. Which, honestly, isn’t as far away as it once seemed is it? 

Still, you’d think they have that rocking and rolling quicker but look who’s griping? We’re still here in America where our medical profession is still trying to figure out how to get more people on medication and into surgery rather than think out of the box just a tad for a second or two. 

But, back to the point, I think it’s an amazing idea. Music, singing, creating art, and experiencing art in whatever form possible is good for the body and soul. Not one or the other but all of it. Every inch. Laughing too. Laughing is so good for you. 

Richard Pryor, Rodney Dangerfield, and Eddie Murphy for children of the 80’s such as myself. Dane Cook and Kevin Hart for the 2000’s kids. Laughing your butt off fixes a lot of stuff. 

‘Principled’ May Not Be So Principled

And to our last paper by Guillaume Goncalves, et. al. published in Biomed Central on April 5, 2018 called “Effect of chiropractic treatment on primary or early secondary prevention: a systematic review with a pedagogic approach[4].”

The authors start out by saying that the chiropractic vitalistic approach to the concept of ‘subluxation’ as a cause of disease lacks any validity nevertheless, some in our profession still claim to prevent disease in general through continuous chiropractic care. 

Don’t send me crappy emails. That’s what the authors said here. 

They go on to say that, if some are going to continue with this model of practice, there must be evidence that it is effective and that’s the reason for the research here. 

How They Did It

They searched PubMed, Embase, Index to Chiropractic Literature, and some specialized chiropractic journals, from inception to October 2017.

They scrutinized 13 articles. 8 were clinical studies and 5 were population studies

They dealt with various disorders of public health importance like blood pressure, blood test immunological markers, and mortality. 

Wrap It Up

The authors concluded the paper by saying, “We found no evidence in the literature of an effect of chiropractic treatment in the scope of primary prevention or early secondary prevention for disease in general. Chiropractors have to assume their role as evidence-based clinicians and the leaders of the profession must accept that it is harmful to the profession to imply a public health importance in relation to the prevention of such diseases through manipulative therapy/chiropractic treatment.”

Now look, don’t kill the messenger. I know that some of you are just going to do what you want to do and what you believe no matter what is thrown in front of you. I know that. Honestly, those people probably aren’t listening to an evidence-based podcast to start with because we won’t confirm that bias. We’ll challenge it from time to time. 

People don’t typically like that. In fact, they may attack those that challenge their bias. 

The information is more useful to confirm the bias of evidence-based chiropractors and to further educate those that are being fed information to the contrary whether it’s by friends or even at school. 

Regardless, for every chiropractor and patient, it’s food for thought. 

Integrating Chiropractors

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point: Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

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

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

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

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TuneIn

About the author:

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

https://www.smithsonianmag.com/smart-news/british-doctors-may-soon-prescribe-art-music-dance-singing-lessons-180970750/?utm_source=facebook.com&utm_medium=socialmedia&fbclid=IwAR1etMZiV8oe-JbUwgUYmP2gxR5pinJcbLS2W1u1QlMBNISVIxTpFBRmubc

https://jamanetwork.com/journals/jama/fullarticle/2712935?utm_source=silverchair&utm_campaign=jama_network&utm_content=weekly_highlights&cmp=1&utm_medium=email

https://chiromt.biomedcentral.com/articles/10.1186/s12998-018-0179-x?fbclid=IwAR3aJGZBcmMSscPoibtAzIRHok9_RpsMvJDbvx76MnzRJY9YU0x_JMY5FK0

https://www.ncbi.nlm.nih.gov/m/pubmed/30448632/

 

Bibliography

1. Piercy K, T.R., Ballard R,, The Physical Activity Guidelines for Americans. JAMA, 2018. 320(19): p. 2020-2028.

2. Park SM, Walking more than 90 minutes/week was associated with a lower risk of self-reported low back pain in persons over 50 years of age: A cross-sectional study using the Korean National Health and Nutrition Examination Surveys. Spine J, 2018. 18: p. S1529.

3. Meilan Solly, British Doctors May Soon Prescribe Art, Music, Dance, Singing Lessons. Smithsonian.com, 2018.

4. Gonclaves G, Effect of chiropractic treatment on primary or early secondary prevention: a systematic review with a pedagogic approach. BMC Chiro Man Ther, 2018. 26(10).

 

CF 052: Chiropractic Forward Podcast Year One Review

CF 052: Chiropractic Forward Podcast Year One Review

One year. I started this podcast exactly one year ago. 52 weeks. 52 episodes. We’re going to talk about the highlights of the first year. We’re going to talk about chiropractic today vs. chiropractic when I started a year ago. Has anything changed? The short answer is yes. Quite a bit has changed in just a year. 

But first, here’s that sweet like honey bumper music

Integrating Chiropractors

Welcome

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 collapsed into Episode #52 and it feels good to say that. To be able to do anything consistently for a year straight, every single week, it’s an accomplishment for sure and it sure as hell feels good folks. 

DACO Program

Before we get into the highlights. let’s talk a bit about the DACO program. For those new to the Chiropractic Forward Podcast, I have been going through the Diplomate of American Chiropractic Orthopedists. I’m 92 hours into a 300-hour course. Ugh…that hurts just to say it. Lol. I don’t even feel close to being done. 

I figured it out that at the rate I’m going now, which is about 8 hours per week, I can be done around May I believe. While it seems way off, you know what? I’d be learning and educating myself anyway. Why not get something out of it, right? That’s the idea and May will be here before you know it. 

Hell, it seems like it was Summer just a couple of weeks ago. Lol. 

Products

I have been fast at work preparing some new options for you. I have noticed  a lack of what I would want in my office when it talks 

One-Year Anniversary

Let’s get on to talking about our one-year anniversary. I want to start by talking listen out our top 10 episodes so far and what we talked about that made everyone listen to each of them. I’m linking them all for quick reference in the show notes. So away we go!

Number 10

Episode #30 – Integrating Chiropractors – What’s It Going To Take? We discussed the medical field and what they are looking for in a chiropractor in regard to integrating that individual into the system. We went over The Lancet papers as well. Great episode to check out. 

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

 

Number 9

Episode #25 – Vets With Low Back Pain. Usual Care + Chiropractic vs. Usual Care Alone. This episode revolved around a paper in JAMA from Dr. Christine Goertz where she and her co-authors showed additional support for including chiropractic as part of a multidisciplinary team for treating low back pain. Great paper by a great asset for chiropractic. 

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

Number 8

Episode #28 – Will Chiropractic First Finally Take Its Place? In this installment, we went through a paper that showed non-pharma and non-opioid therapies are now the preference. Well, that’s chiropractic, right? We talked about some GREAT resources in this episode including the President’s Commission on Combating Drug Addiction and The Opioid Crisis report as well as a great paper by Jon Adams Ph called The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults. That one had some marketing nuggets for the nugget pouch.

CF 028: Will Chiropractic First Finally Take Its Place?

 

Number 7

Episode #27 – Wanted – Safe, Nonpharmacological Means of Treating Spinal Pain. This episode went through treating spinal pain, thoracic manipulation, lumbar manipulation, guidelines from Canada, and the perceptions of our profession. We discussed a paper about how some in the medical profession think chiropractors go around herniating discs all the time. Pfft… 

CF 027: WANTED – Safe, Nonpharmacological Means Of Treating Spinal Pain

 

Number 6

Episode #9 – With Dr. Tom Hollingsworth of Corpus Christi, TX called The Case Against Chiropractic In Texas. We talked with Dr. Hollingsworth about the Texas Medical Association’s attacks on Texas Chiropractors and our rights. We talked about the latest in the current court case and the appeal process. 

Just a couple of weeks ago, in fact, this case had a decision that was reached and it wasn’t good for chiropractors. And I’m talking about chiropractors nationwide. We’ll have to do an updated episode with Dr. Hollingsworth because what may be on its way down the pike for all chiropractors…..well….let’s just say it’s no bueno. 

CF 009: With Dr. Tom Hollingsworth: The Case Against Chiropractic In Texas

 

Number 5

Episode #26 – Chiropractic Better Than Physical Therapy and Usual Medical Care For Musculoskeletal Issues. The title is accurate. And researched fact. There are some that don’t like that language. Can’t we all get along? That type of deal and yes, we can all get along. Most certainly. My issue is with PTs being the first referral for non-complicated musculoskeletal issues when research shows they have decreased effectiveness when compared to chiropractic care. 

They have less patient satisfaction when compared to chiropractic care as well. In addition, research shows chiropractic care to be a lot less expensive. So why in the hell is a practitioner that is exponentially more expensive, much less effective on their outcomes, and patients don’t like as much…..why the hell are they the first referral? That still makes my pee hot when I really really think about it. It’s dumb. 

I don’t think we should be doing post-surgical rehab unless we take specific training in that. I think PTs and DCs can work very well together but there should be lanes and I don’t think PTs stay in their lane. Not when they’re out there taking a weekend course on adjusting. It’s BS and that doesn’t stand for Bad Students. 

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

 

Number 4

Episode #29 – With Dr. Devin Pettiet of Tomball, TX, still the President of the Texas Chiropractic Association. This episode was titled Is Chiropractic Integration Healthy For the Profession? We talked with Dr. Pettiet all about chiropractic integration into a medical based case management or medical team. 

This one was one of my favorites too. For sure. Devin is a great resource and a great personality. He’s all energy and has an awesome amount of information and experience.

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

 

Number 3

Episode #6 with Dr. Tyce Hergert from Southlake, TX. This episode is called Astounding expert Information on Immediate Headache Relief. This one was all about headaches and highlighted one service that was dressed up and parading around as another. Yes, those pesky PTs are moving in on us and this episode talked about little bit about that along with some great papers showing chiropractic’s effectiveness with treating headaches. Fun episode. 

CF 006: With Dr. Tyce Hergert: Astounding Expert Information On Immediate Headache Relief

 

Number 2

Episode #13 – DEBUNKED: The Odd Myth That Chiropractors Cause Strokes. My favorite episode and my favorite endeavor as far as really putting together information to stick a fork in an anti-chiropractic idea or myth. This is actually a three-part series consisting of #13, 14, and 15. All three episodes really paint a picture of foolishness on the part of the medical field and a coordinated attack that is easily put to rest through common sense, correct context, and research. 

It’s really so simple when you take the time to listen, learn, and just think about it for a minute. They are the three episodes I encourage you to share the very most out of all of them I have created. 

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

 

Number 1

Episode #11 – called It’s Here. New Guides For Low Back Pain That Medical Doctors Are Ignoring.

The most listened-to episode for our first year was Episode #11 once again with my old friend and colleague Dr. Tyce Hergert down in Southlake, TX. He has TWO episodes in the top 10 from our first year. That’s because he’s smart, he’s the ex-President of the Texas Chiropractic Association, and he’s entertaining if he’s had his coffee. 

In this one, we talked about current healthcare guidelines, why they matter to chiropractic patients and even non-patients, and whether MDs are getting it or not. Guess what? They’re still ignoring these guides!

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

 

Wrap Up

So….there you have it, folks. That’s our Top 10 in a nutshell with all of the links in the show notes. We have had a great first year. We hope you have enjoyed the content we have been bringing to you as much as we have enjoyed gathering it for you. 

There is so much going on in our profession. Both good and bad. It’s important to stay plugged in now more than ever. We’ll talk about it in a future episode but the Texas Chiropractors lost their appeal and the medical kingdom will bring their dog and pony show to your state before you know it. Believe me. 

But, for evidence-based chiropractors, there’s still no better time than today to be a doctor of chiropractic. I firmly believe that to be the truth.

Integrating Chiropractors

 

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point: 

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

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

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

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

Chiropractic Forward Podcast Facebook GROUP

Twitter

YouTube

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 051: Necks, Integrity of the Cervical Spine, and the CDC on Opioids

CF 051: Necks, Integrity of the Cervical Spine, and the CDC on Opioids

Today we’re going to talk about the reliability of clinical tests assessing the cervical spine, what is happening when adjusting a neck as far as the integrity of the cervical spine, and what the CDC says about opioids. It’s all fascinating all the time here at the Chiropractic Forward Podcast 

But first, here’s that bumper music

Integrating Chiropractors

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 drifted all slow and gently into Episode #51

DACO

As has become the tradition, let’s talk a bit about the DACO program. DACO stands for Diplomate of American Chiropractic Orthopedist. Trudging along. I’m up to I believe 84 of the required 300. Classes this last week were on frozen shoulder, piriformis syndrome, Important aspects of lumbar MRI, and inguinal pain. 

This stuff is just invaluable, folks. I’m an organizational freak but at the end of each course, I’ll make myself a quick sheet that I can reference when something like that comes through the door. I think making these little quick sheets will really help to get some of the more rare or difficult cases figured out quickly. 

I’ve already put the lumbar differential diagnosis sheet to use a few times as well as the dizziness quick sheet I created. I have shared several times here that I don’t sit around a lot either at work or at home. I’m a busy bee. 

Vacation & Hobbies

Going on vacation, don’t even try to take me to a beach. If my wife wants to go to the beach, that’s all her. I’ll tag along and I’ll check in on her out there reading a book from time to time but, for the most part, I’ll be off doing, seeing, and experiencing. The ability to sit still and just relax…..that’s an ability I did not receive in this lifetime. 

As a result, I make live edge furniture. Go to Facebook and look up Amarillo live edge and custom furniture. I am a sculpture and charcoal artist. Go back to Facebook now and look up River Horse Art Gallery. I’m in the process of teaching myself to paint right now too. I also am a singer/songwriter. Go back to Facebook once again. Yes, once again and look up Flying Elbows Perspective.

Crazy name indeed. 

So, here’s the point. It’s not to brag or pump my tires. The point is that this is how important I’ve found the DACO program to be. While I haven’t completely put everything else on hold, the DACO has taken priority of my time. One reason is that I want to motor through it quickly and efficiently. The next reason would be that I’ll be the only DACO in all of Texas West of the Dallas/Ft. Worth metroplex. 

What does that get me? Maybe a pat on the back. Maybe a part time or full-time gig on staff at an FQHC. As we have mentioned in previous episodes, there are reports of DCs on FQHC staffs making as little as $120/visit up to $300/visit on even Medicaid visits. Unbelievable. But you have a better shot at getting into the system when you are specialized AKA – a Diplomate. 

Just a part of making us all better. You guys and gals need to be looking at this stuff. 

Before we hop into the papers for the week, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. I think I have some pretty cool stuff coming down the pike you’ll be interested in. That’s in you enjoy evidence-based education.

Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

Paper #1

The first paper here is called “Reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders: Part 1—A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration” It was done my Madege Lemurnier et. al. and published in the European Spine Journal in September 2017[1]. 

Why They Did It

With a title as long as that one, what the heck are they doing here? They say they were hoping to determine the reliability of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders. 

How They Did It

They updated the systematic review of the 2000-2010 Bone and Joint Decade Task Forst on Neck Pain and Associated Disorders. 

They searched the literature for studies on the reliability and validity of Doppler velocimetry to evaluate the cervical arteries. 

They had two independent evaluators look through it all

What They Found

  • Preliminary evidence showed that the extension-rotation test may be reliable and has adequate validity to rule out pain arising from facet joint. Or rule in I suppose. Just in case you are unaware of the cervical extension-rotation test, it’s exactly as it sounds. Have the patient extend and then rotate toward the side you’re testing. When you combine this maneuver with palpation you can typically get a good idea of whether the patient is suffering from a facet issue. You need to know that this test is also effective in sniffing out a low back facet issue as well. Lumbar extension and then rotation can give you some good clues sometimes.
  • The evidence suggests variable reliability and preliminary validity for the evaluation of cervical radiculopathy including neurological examination (manual motor testing, dermatomal sensory testing, deep tendon reflexes, and pathological reflex testing), Spurling’s and the upper limb neurodynamic tests.
  • No evidence found for doppler velocimetry. 

Wrap It Up

Little evidence exists to support the use of clinical tests to evaluate the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders. We found preliminary evidence to support the use of the extension–rotation test, neurological examination, Spurling’s and the upper limb neurodynamic tests.

Paper#2

On to our second paper. This one is called “Intervertebral kinematics of the cervical spine before, during, and after high-velocity low-amplitude manipulation” and appeared in Spine Journal in August of 2018 and was authored by Dr. William J. Anderst, et. al[2].

Why They Did It

Since cervical manipulation is such a common intervention for neck pain, the authors wanted to characterize the forces involved and the facet gapping that takes place during manipulation. 

How They Did It

It was a laboratory-based prospective observational study

It included 12 patients 

Each patient had acute mechanical neck pain

One of the outcome measurements was the neck pain rating scale (NPRS)

Other measurements were taken for amount and rate of cervical facet joint gapping 

What They Found

The authors concluded, “This study is the first to measure facet gapping during cervical manipulation on live humans. The results demonstrate that target and adjacent motion segments undergo facet joint gapping during manipulation and that intervertebral ROM is increased in all three planes of motion after manipulation. The results suggest that clinical and functional improvement after manipulation may occur as a result of small increases in intervertebral ROM across multiple motion segments.”

Pretty cool stuff. 

Paper #3

Our last paper for this episode is called, “CDC: Drug overdoses hit new record.” It’s an article on thehill.com written by Nathaniel Weixel and was published on August 15th of this year, 2018[3]. 

The article leads off saying that 72,000 Americans died from drug overdoses in 2017 and that’s based on information provided by the Centers for Disease Control and Prevention. That is a new record folks and we have our friends in the medical realm to thank for it. 

Who’s To Blame?

Now, that, of course, doesn’t mean pharmacists and medical doctors are bad and there was a mass conspiracy to cause this deal. But it does mean that SOME of them are bad. SOME doctors are doing time in an orange outfit right now because they knew better but the dollar was mightier than common sense and common decency. 

There were pharmacies dispensing 100x more than their population could ever consume but they want to not refer to us and talk about the integrity of the cervical spine. That kind of crap is what got us here.

But, it’s also what has brought chiropractors from the shadows into the light. When you have the mess the medical field has created, then you have to start looking for the non-pharma solutions and we are it. 

Comparison

72,000 deaths. You ever heard of the Vietnam War? Of course, you have. We all have. Some either remember or have seen what a big deal it was. The deaths, the protests, the loss. I’ve been to the Vietnam Wall in Washington DC several times. It’s profound. It’s stunning to see all of those names. 

Just to compare, the total number of those lost in Vietnam stands at 58,220. Now keep in mind, that takes into account deaths from as early as 1956 all the way up to as late as 2006 and comes from Defense Casualty Analysis System Extract Files from The Vietnam Conflict Extract Data File. 

I did my homework. I’m not giving you fake numbers here. 

Essentially, 13,780 more deaths happened because of opioids, In just one year. In just 2017. That doesn’t even begin to scratch the surface when you start totaling up 2016, 2015, and further back. Unbelievable isn’t it? 

If we look at it, 2014 had 28,647 deaths, 2015 had 33,100 deaths, 2016 saw 63,632 deaths…..and then 72,000 in 2017. 

I’m guessing you can see the trend. Hell yes, it’s an epidemic.

The Math

I’ll do the math for you because I love you and I’m glad you’re here and I don’t want you to have to think too hard while you’re giving me your time. Over the last 4 years, that’s approximately 200,000 opioid-related deaths. 197,379 to be more specific. 

The genie seems to be out of the bottle.

While we can’t put the genie back in, we can offer solutions for the future. Many of those addicted to opioids became addicted due to spinal surgery. Many of those surgeries were unnecessary. One paper I reviewed showed that approximately 5% of lumbar fusions are necessary making about 95% of the unnecessary. Yeah….95%. 

The Answer

We have the answer people. The American College of Physicians, The White House, The Lancet, 2 papers in JAMA, Consumer Report surveys, The Joint Commission, The FDA…..seriously, there is not one reason that we aren’t inundated by spinal pain referrals at this very moment. No reason at all. It actually makes me mad as hell that we are not. 

Exactly what the hell does it take to make general practitioners, neurosurgeons, orthopedic surgeons, nurse practitioners, and physician assistants understand that an evidence-based chiropractor is best situated to help these people as a first-line therapy?

Integrating Chiropractors

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

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

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

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

Website

http://www.chiropracticforward.com

Social Media Links

Chiropractic Forward Podcast Facebook GROUP

Twitter

YouTube

iTunes

Player FM Link

Stitcher:

TuneIn

About the Author and Host:

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

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

CF 012: Proven Means To Treat Neck Pain

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

CF 050: Chiropractic Care – Text Neck, Headaches, Migraines

 

 

 

Bibliography

1. Lemeunier N, Reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders: Part 1—A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration. Euro Spine J, 2017. 26(9): p. 2225-2241.

2. Anderst W, Intervertebral kinematics of the cervical spine before, during, and after high-velocity low-amplitude manipulation. Spine (Phila Pa 1976), 2018. 0(0).

3. Weixel N. CDC: Drug overdoses hit new record. The Hill 2018  5 August 2018]; Available from: https://thehill.com/policy/healthcare/401961-cdc-drug-overdoses-hit-new-high-in-2017.

 

 

CF 049: The Palmer/Gallup Poll 2018 Discussion On Chiropractic Marketing

CF 049: The Palmer/Gallup Poll 2018 Discussion On Chiropractic Marketing

Today we’re going to talk about the 2018 version of the Palmer Gallup poll that has some great info including some chiropractic marketing nuggets for your nugget pouch so stick around as we get into the details

But first, make way for that sweet sweet bumper music

Integrating Chiropractors

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

Introduction

You have crumpled into Episode #49. Info to help with your chiropractic marketing. We are moving in on a solid year of Chiropractic Forward episodes and that feels good. Every single week. We haven’t missed one week this past year. There is most certainly a sense of accomplishment and doesn’t it feel good to feel good? Of course, it does. 

The Diplomate of American Chiropractic Orthopedists (DACO)

Let’s talk a bit about the DACO program – Same as last week. Just trudging along. Last week I took classes on benign paroxysmal positional vertigo, poster canal, anterior and horizontal canals, Epley’s maneuver and all that goes along with that. I also had a class on Lumbar spinal stenosis that I learned some new tidbits on. Great stuff. My offer stands, if any of you want to start looking at it, I’d be glad to give you a little guidance in getting yourself started. 

Newsletter

How’s about youse guys head over to chiropracticforward.com and get yourself on our newsletter. I have some cool stuff coming down the pike and I want you to be the first to know about it and I want you to save money because you were cool enough to be on our email list. No more than once a week. That’s my guarantee. It’s just an email address folks. Not a big deal. 

Personal happenings

You have heard my woes and my front desk worries over the past month or two. I told you last week that it appears my wife has herself a new full-time gig and guess what? With her help, we had not only one of the best Octobers we have ever had, but we also had one of the best months (numbers-wise) that we have ever had in 20 years. 

I believe there’s something to this “wife working the front desk” idea people. Something to think about for sure. If you can work with your wife or husband that is. You may have to pee strategically around the office just to mark your territory and let it be known this is your domain but, nobody will work as hard for the office as someone that has a vested interest in it. I’m a firm believer in that. 

Into The Information

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.

This week I want to talk about the Palmer/Gallup poll that has been coming out annually for a couple of years now. I think it’s two years but cannot recall off the top of my head. 

Regardless, let’s talk about the 2018 version. I look forward to its release every year because you can get some chiropractic marketing ideas from it if you’re looking at it the right way. 

The Ideal Patient

Any time you start a new generic chiropractic marketing program, they have you create your ideal avatar or your ideal customer. The customer that not only comes in and you love to see them come through the door but the customer that is coming in and paying good money to see a good doctor. The people that love you and go out into the world to tell everyone every good thing they can about you and the ones that are the first to leave you a great Google review. 

THAT’S the ideal patient, isn’t it? If we could only fill up our offices with that specific, amazing person all day every day. We’d never even think about giving up our practices and moving to an exotic place with umbrellas and funny drinks. Chiropractic marketing would be non-existent. 

Well, we may still think about doing that but it wouldn’t occupy as much brain space if these people were all that ever came through our door. 

Don’t we just love seeing these perfect patients? Smiles, good vibes, and excitement. And sometimes food!! I have one bring us pumpkin spiced cake and sugar cookies last week. We need to work on a nutritional talk for sure but you get the point. 

On To The Poll

I am linking the poll in the show notes so go check it out Episode 49 at chiropracticforward.com

http://www.palmer.edu/uploadedFiles/Pages/Alumni/gallup/palmer-gallop-annual-report-2018.pdf

The first thing we really get into here is the Summary and I think that’s really where we are going to stay instead of going too deep in because we’ll wind up with a 4 hour episode and I don’t want that any more than you do so let’s hit the high spots and call it good. 

  1. Neck and back pain is common among adults in the US – yes, we knew that now didn’t we? They say about 2/3 of US adults (62% to be specific) have had neck or back pain that was significant enough that they saw a healthcare professional for care at some point in their lifetime, including 25% who did so in the last 12 months. 
  • 25% of the population sought care in the last year for pain. I bet 25% did not seek care for wellness. 

2. 80% of American adults prefer to see an expert in spine care for neck and back conditions rather than a general medicine professional who treats anything and everything. I think we all know who the experts are right? It’s us….

He’s a problem though, 67% of them prefer to see someone that can prescribe medication or surgery to treat neck or back pain.  Only 28% want to see someone that does not use prescription medication or surgery. That one is a bit of a kick to the nether region. I thought we were making more progress on that front. 

I can’t tell if the next point contradicts the previous one or not. You decide. They say that prescription pain meds aren’t preferred as first-line care for about 79%. I can only guess they are preferring a practitioner that can prescribe just in case it declines to the point of needing it but they don’t necessarily want to start with pills? Maybe…..

3. When it comes to healthcare providers, people say that chiropractic doctors and medical doctors are the top choices for neck or back pain care. In the last year, 62% say a medical doctor while 53% saw a chiropractic doctor. 

Peel Back The Layers

Going a little deeper there, 34% say a PT and 34% visited a massage therapist. 

I think it’s of important note here that half of the people that went to the chiropractor went because they said that chiropractors provide the most effective treatment for their pain. That’s pretty damn awesome right there. We’ll get to the other half here in just a minute. 

The overwhelming feeling in this subsection is the keyword is “EFFECTIVENESS.” Can you say, “Chiropractic Marketing Nugget?” How effectively can you relay your effectiveness? 

I would offer to you the idea that this podcast is an EXCELLENT way to speak about your effectiveness as well as to back up your effectiveness. You just have to listen and you have to take what you learn and turn that into kick-butt content and marketing material. 

Since not everyone is particularly gifted at chiropractic marketing or creating content, we are working on helping you out in that aspect. Stick with us. It’ll happen. Just go to  chiropracticforward.com and get on the email list to stay on top of that. 

Outside of ‘effectiveness,’ SAFETY was another reason people chose chiropractors and PTs for their back and neck pain. In fact, about half of those coming to the chiropractor said safety was why they chose chiropractic.

So, we have the big TWO reasons. Only two. That people go to chiropractors nationwide. They are Effectiveness and Safety. That should be useful information for you guys and gals to take and run with. Chiropractic marketing at its best. 

Next point

4. The fourth point of the summary was types of care. They found a lot of people utilizing self-management at home, as they should. They say 53% of American adults went to get massages to control pain. They say 47% had chiropractic care for their pain. And 42% went to a PT. 

That means we have a lot of people doing more than one thing right? It would make perfect sense to not be a one-trick pony in your practice. For instance, the subluxation guys and gals only adjust. They’ll see a patient 100 times a year and only adjust. Nothing else.

Oh wait, I lie. There’s a local guy here that will pray over each one before using the activator on them all so I guess it’s a little more than just the adjustment. 

I don’t want to make light of prayer. I’m a Christian and am well aware of the power of prayer but when it’s done after joining Body By God type management programs, well, it just seems a bit disingenuous doesn’t it? If we’re being honest?

Anyway, if you have to see someone that many times a year, you’re probably a terrible chiropractor and you’re probably doing more damage than you are doing good.

Diversifying

Back to doing more than one thing: it’s clear that patients are not looking for just an adjustment. It appears they’re looking for chiropractic, they’re looking for massage, they’re looking for some exercise/rehab considering 72% were looking into yoga. 

Although it’s not in this article, I believe many are looking for acupuncture these days. As discussed earlier, they may potentially be looking for meds so why couldn’t you offer anti-inflammatories like turmeric or Boswellia just to name a few. I say this because this poll showed that 73% of people took an over the counter medications like acetaminophen or ibuprofen. Definitely food for thought. 

5. Patient Experiences

Patients that visited a chiropractor, a PT, or an MD over the last year said they received a high level of care. That’s good news. 

For chiropractors specifically, 9 out of 10 patients said

  • The chiropractor listened to them
  • DCs provided convenient and quick care
  • We demonstrated caring and compassion
  • The chiropractor explained things well
  • And they spent the right amount of time with them

Approximately 90% of patients had all of that to say about chiropractic doctors. That’s outstanding news, folks. That means that we can fight amongst ourselves and, while I would argue the straights are keeping us from full integration, in the eyes of patients, almost ALL of us are doing a good job!

For Physical Therapists, overall, they were hitting around the 83%-86% area. 

For MD’s, they didn’t do too well honestly. But didn’t we expect that? Here’s how they fared:

  • 72% say their MD listens
  • 67% said they often explain things well
  • 66% said they demonstrate care and compassion
  • 53% said they have quick access and are convenient

No surprise there. In fact, the surprise comes when we see that so many are still going to the GP for non-complicated musculoskeletal pains. That’s the real surprise. 

Point 5 Discussion

When you consider that chiropractors hit around 90% for all of those and you see MDs around 64% for the same metrics, well…..that’s not so good, right?

I see A LOT of opportunities here. If you are of the marketing mind, I’m sure you see the same!

This podcast isn’t just for listening to some mindless drivel folks. I am trying to give you stuff that you can use immediately after you listen. If you pay attention to what I’m telling you every week, you can turn around and communicate FACTS to your patients, your staff, and to those in the medical field in your region. 

I’m friends with a neurosurgeon and a vascular surgeon because I’m not freaking crazy. I can communicate research to them in an effective way that they understand. I’ve taught them a ton they didn’t already know. Plus we all like a Cerveza here and there so that works out well for us. 

Research helps you communicate

What I’m saying is that you should be listening to this podcast to learn for sure. But you should also be listening to it with the mindset of, “How am I going to take this information and use it in either my marketing or in my communication with my community?”

Believe me or don’t. I hope you believe me. The information I am bringing to you is the information you should be using. Not the subluxation stuff. Not the philosophy stuff. Literally, straights in our profession are the only people on this Earth that give a damn about that stuff. 

Nobody else knows or cares. Nobody. 

But research, safety, and effectiveness, well…..when you’re talking in those terms, then you are getting somewhere. 

Integrating Chiropractors

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is 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.

Contact

Send us an email at dr.williams@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

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

http://www.palmer.edu/uploadedFiles/Pages/Alumni/gallup/palmer-gallop-annual-report-2018.pdf

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

 

CF 034: Chiropractic Information To Help You Form Your Practice

 

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

 

CF 048: Do Disc Herniations On An MRI Worsen When Sitting Or Standing (PART TWO)?

CF 048: Do Disc Herniations On An MRI Worsen When Sitting Or Standing (Part TWO)?

Today we’re going to continue our talk from last week on whether or not a disc herniations change as you sit up, stand up, or move around. We went over some pretty good research last week. This week, it’s time for the cherry on the top. 

But first, here’s that bumper music

Integrating Chiropractors

 

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 scampered into Episode #48. I use scamper this week because, as my son was playing with his aunt and uncle’s dog named Rowdy down in Dallas last weekend, that was the way he described when the dog would take off after the tennis ball every time. Scamper. Great word that I plan on using more from here on out where appropriate. 

Diplomate of Chiropractic Orthopedists

The DACO this weekend down in Dallas. The class was with James Lehman. Dr. Lehman, in case you do not know, is with the University of Bridgeport Connecticut. His official title from their website is Associate Professor of Clinical Sciences, Health Sciences, College of Chiropractic. 

Dr. Lehman is also one of the main drivers of this DACO program. Through Univ. of Bridgeport Connecticut, he has teamed up with CDI out of Australia and their courses in neuromusculoskeletal online education. It is VERY well done. Very professional and very worthwhile. You can find that at https://cdi.edu.au

We talked a lot about some stuff that I want you to hear straight from him so we’ll do an interview with him very soon but the gist of it all is this: get certified in something other than simply having your doctor of chiropractic degree. 

FQHC

I’ve heard a couple of opinions. I’ve heard the Diplomate programs are worthless now and that people are moving away from them. But, I think that’s coming from people that don’t want to take the time or put in the effort. The real story is most likely that our system, for good or bad, is moving away from private practice and TOWARD integrating through the group offices and through the Federally Qualified Health Centers. 

There are chiropractors being reimbursed in the system up to $300 for a Medicaid visit and around $150 on the lower end. 

I have to thank Dr. Craig Benton once again for bringing this to my attention. Did you guys know that, given the right positioning, you could make that much per appointment from freaking Medicaid?

Here’s the deal though: you have to be a specialist. A Diplomate. So, is it really useless? I say it most certainly is not. 

Whiplash Section

Now the course, the course this weekend was on whiplash. I’ve been through Art Croft’s 4 part Advanced Certification on Whiplash Biomechanics and Traumatology so I can say with a lot of honesty that a good portion of the course was a refresher for me. 

But, I absolutely learned a solid amount of new stuff as well. Such as Axillary compression. Axillary compression was not a condition of the shoulder that was on my radar screen prior to this course. 

That is one simple little example but there was a gob of nuggets for the nugget pouch and as always, I really walked away feeling that I will be better at my job on Monday. But it’s always that way. Even after just a 2-hour online course. It’s phenomenal.

Personal

Continuing the ongoing saga of hiring a front desk staff member in the year 2018. Here’s what all I’m going to say about it. Looks like my wife has found a new full-time job. Lol. Get the picture?

It looks like I may have a cool speaking gig coming up in February. Nothing solid but, if I were to come to your state convention or to some sort of event you are at, what topic along the vein of Chiropractic Forward’s typical content would you like to learn more about? 

If you are a regular listener and familiar with what we have been doing here this last year, I’d really appreciate it if you would take just a minute and email me at dr.williams@chiropracticforward.com and give me a little guidance. What topics would you want to see in a presentation?

I’m glad you’re here and hopefully, I didn’t ramble too much before getting to the meat and taters. Here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

On To The Research

Picking up from last week, we want to start in on the changes disc herniations undergo when axial pressure is placed on them. In other words, what happens to disc herniations from the time the MRI is taken laying down to the point where the person sits up. 

I have to preface it all by saying go listen to last week’s episode which is #47, please. It tells you how it is very common in the medical field amongst even radiologists to assume or guess that there is no change in the disc or in the herniation when axial pressure is applied. Research tells us differently. 

This week we want to start with a paper called “Evaluation of intervertebral disc herniation and hypermobile intersegmental instability in symptomatic adult patients undergoing recumbent and upright MRI of the cervical or lumbosacral spines.” It was done by Ferreiro Perez, et. al[1]. and published in the European Journal of Radiology

How they did it

  • 89 Patients studied
  • 45 of them had their low back imaged
  • 44 patients had their necks imaged
  • The images were done in both the lying down position as well as the sitting.

What They Found

  • The overall combined recumbent (lying down) miss rate in cases of pathology was 15%
  • Overall combined recumbent underestimation rate in cases of pathology was 62%
  • Overall combined upright-seated underestimation in cases of pathology was 16%.

Wrap It Up

Upright-seated MRIs were seen to be superior to recumbent MRIs in 52 of the patients studied for conditions of posterior disc herniations and spondylolisthesis. Recumbent MRIs were only superior in 12% of the patients.

Next, this one is titled, “Effect of intervertebral disk degeneration on spinal stenosis during magnetic resonance imaging with axial loading” by Ahn et al[2].

Why They Did It

The authors in this paper were wanting to determine if disc degeneration will increase the severity of spinal stenosis when the spine is loaded with axial pressure. 

How They Did It

They had 51 patients with symptoms of neurogenic intermittent claudication and/or sciatica that had their MRIs loaded as well as non-loaded. 

The foramen involved were all measured for changes in sizes.

Wrap It Up

Here’s what they found, “More accurate diagnosis of stenosis can be achieved using MR imaging with axial loading, especially if grade 2-4 disc degeneration is present.”

AKA:” Seated or loaded MRIs are superior for assessing lumbar stenosis. 

Next, this one is by Willen[3] and it’s called “Dynamic effects on the lumbar spinal canal: axially loaded CT-myelography and MRI in patients with sciatica and/or neurogenic claudication.” It appeared in Spine Journal in 1997. 

They had 50 people with CTs, 34 were imaged with MRI, the imaging was performed laying down as well as axially loaded. 

They closed it up by saying, “Axial loading of the lumbar spine in computed tomographic scanning and magnetic resonance imaging is recommended in patients with sciatica or neurogenic claudication when the dural sac cross-sectional area at any disc location is below 130 mm2 in conventional psoas-relaxed position and when there is a suspected narrowing of the dural sac or the nerve roots, especially in the ventrolateral part of the spinal canal in psoas-relaxed position”

Next Paper

This one is by Kanno, et. al[4]. called “Axial loading during magnetic resonance imaging in patients with lumbar spinal canal stenosis: does it reproduce the positional change of the dural sac detected by upright myelography?” It appeared in Spine Journal in 2012. 

44 patients, with imaging in the supine position and then with axial load added. The dural sack was measured 

“The size of the sack was significantly reduced in the axially loaded imaging and the axial loaded MRI detected severe constriction with a higher sensitivity (96.4%) and specificity (98%) than the conventional MRI.”

Next paper

This one is by Danielson et. al. from 2001 called, “Axially loaded magnetic resonance image of the lumbar spine in asymptomatic individuals.” This paper appeared in Spine Journal in 2001 as well. 

MRIs were performed lying down as well as with axial load on the participants. The axial loading was performed lying down, face up with a compression device built for this study specifically. The diameter of the dural sack was measured to check for the differences. 

The authors said, “A significant decrease in dural cross-sectional area from psoas-relaxed position to axial compression in extension was found in 24 individuals (56%), most frequently at L4-L5, and increasingly with age.”

Pretty cool stuff right there people. 

I want you to go forward this week knowing what you get from listening to this podcast every week. You get things you can absolutely use and implement immediately. Some of you may gain confidence now that you know some research that you maybe didn’t know previously. Some of you may now be able to tell a patient that has a 5mm central posterior herniation that 5mm isn’t telling us the whole story. 

It’s telling us part of the puzzle but that discs respond to positioning and various stresses we put on the discs through our activities. 

Use it or lose it

This can give you some extra guidance in your recommendations when you consider disc herniations change and get worse, stenosis gets worse when the patient sits up or bends forward. 

If you aren’t up on directional preference exercises, McKenzie, and CRISP protocols, it’s time to get there folks. It’s time to get there. The anatomy absolutely responds to movement and positioning. 

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.

Contact Us!

I want to ask you to go to chiropracticforward.com and sign up for our newsletter. We love to stay in touch and want to offer you discount specials when we get our educational products up and rolling. 

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

Chiropractic Forward Podcast Facebook GROUP

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 047: Do Disc Herniations On An MRI Worsen When Sitting Or Standing (PART ONE)?

CF 035: Chiropractic & Disc Herniations

Bibliography

1. Ferreiro P, e.a., Evaluation of intervertebral disc herniation and hypermobile intersegmental instability in symptomatic adult patients undergoing recumbent and upright MRI of the cervical or lumbosacral spines. Eur J Radiol, 2007. 62(3): p. 444-8.

2. Ahn TJ, e.a., Effect of intervertebral disk degeneration on spinal stenosis during magnetic resonance imaging with axial loading. Neurol Med Chir (Tokyo), 2009. 49(6): p. 242-7.

3. Willen J, e.a., Dynamic effects on the lumbar spinal canal: axially loaded CT-myelography and MRI in patients with sciatica and/or neurogenic claudication. Spine (Phila Pa 1976), 1997. 22(24): p. 2968-76.

4. Kanno H, e.a., Axial loading during magnetic resonance imaging in patients with lumbar spinal canal stenosis: does it reproduce the positional change of the dural sac detected by upright myelography? Spine (Phila Pa 1976), 2012. 37(16): p. E985-92.

CF 045: Harvard Health, Low Back Stenosis, Allergy Autism

CF 045: Harvard Health, Low Back Stenosis, Allergy Autism

As the title this week indicates, I’ve taken some files that have been gathering a little bit of dust in the dark corner and I’m bringing them out into the light.

Today we’ll talk about an article in Harvard Health, we’ll talk about low back stenosis research (something that doesn’t get a lot of attention), we’ll talk about a JAMA article on allergies and autism, and we’ll hit on a paper attempting to explain why some patients respond while others do not. 

Integrating Chiropractors

 

But first, you know what’s up, I wrote and recorded our jingle so you might as well just sit back and enjoy this candy for your ears. When you do create something, it’s going to be in EVERY show don’t ya know!! 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 collapsed into Episode #45

OK, first thing, we should probably talk about the Texas vs. Oklahoma game that just happened this last weekend. By the time this posts, it’ll be two weeks ago but, still need to brag. What a game that was. I’m a Texas boy but either way would have been fine since most of OU’s players are from Texas anyway. I go for all of the Texas teams. 

I want to thank Kyle Swanson for the shout out on the Forward Thinking Chiropractic Alliance group a couple weeks ago. He’s a Texas A&M Aggie. Look, like I said, I root for A&M too so we would probably be buddies in the real world if I’m guessing out loud. 

Front Desk Staffing

Let’s get to the ongoing saga of hiring a new front desk staff. If you’ve been following along, you’ll remember that hiring a new front desk staff member has been nothing but a soup sandwich. 

Messy. Gloppy, Unreal and confusing. Those are just some words I’m laying on you. I have more words for what we’ve been through on this deal but then my podcast would have an explicit designation and I try to keep it clean around here. 

But, I believe progress has been made. We seem to have a new one that seems to be on top of her game. If she’s a “sticker,” then the search may very well be over. Of course, she’s not young which is probably why she’s a sticker so far. She’s closer to my age than any of the others have been. I’m not saying that young people have no work ethic…..I’m just saying that all of the young people that we interviewed for this job have no work ethic. 

That sounds like I’m against young people, millennials, blah blah blah. I’m not. I have had some VERY intelligent and capable young people come through here as employees over the years. There are very smart, very talented young folks out there. We just didn’t encounter any of them for this round of hiring. That’s all I’m saying. 

Moving on

October has really taken off in terms of listens for the podcast. I can only guess you’re sharing episodes here and there with your network. To that, I say thank you. If I ever see you somewhere and you tell me you have been sharing my stuff, and hold your hands out like, “bring it in big boy,” well then…you’re getting a hug my friend.

I’m a hugger. Which can probably be scary if you don’t know me. I’m 6’4” and like 280 so….big guy coming through! But, those that know me know that I’m a teddy bear. Unless you try to steal my food. Then it’s pretty much on at that point. 

On to the research

Let’s get on with trying to make your practice better. When your practice is better, your life is better. 

Let’s start with the Harvard Article. It was published in November 2017. I have it linked at chiropracticforward.com for you all in the show notes for episode 45. The name of the article is “Where to turn for low back pain relief[1]” and I couldn’t find the name of the author so there ya go. 

https://www.health.harvard.edu/pain/where-to-turn-for-low-back-pain-relief

The subtitle of this Harvard Medical journal….medical journal……is this: in most cases, a primary care doctor or chiropractor can help you resolve the problem. What the hell??? It seriously says that in a Harvard Medical article. I’m trying to catch my breath here. Sorry…..

It was published in November of 2017. The article says that there are many causes of low back pain and some of the most common is an injury to muscles or tendon which we know is called a strain and then injury to back ligaments which we call a sprain. And then there are herniated or bulging discs. 

Going through the DACO program tells me that the prevalence between disc, facet, and SI joint pain stands at 40% for the disc, 30% for the facet, and 22.5% for the SI joint pain. BUT….over the age of 50 years old, it flips a little and the Facet joint gains prevalence over disc or SI pain. Just some nuggets to tuck away in your nugget pouch. 

This article just blows me away when it gets to the “Where to Turn” subtitle. Beneath this subheader, it says, “Since you shouldn’t try to diagnose your own back pain, make your first call to a professional who can assess your problems, such as a primary care physician or a chiropractor.”

Both can serve as the entry point for back pain says Dr. Matthew Kowalski who serves as a chiropractor with the Other Clinical Center for Integrative Medicine at the Harvard-affiliated Brigham and Women’s Hospital. 

What the hell is happening here? Am I in the Twilight Zone where everything is flipped and the medical world finally gets it?

The article goes on to say “A well-trained chiropractor will sort out whether you should be in their care or the care of a physical therapist or medical doctor.”

And here’s the difference between evidence-based/patient-centered chiropractors and those that are not. 

The more not evidence-based amongst us, the ones that drive a billion people through their doors for everything from allergies to whatever…..they will not typically be turning those patients over to the medical doctor or the PT. 

Moving to the next paper, it’s called “Comprehensive Nonsurgical Treatment Versus Self-directed Care to Improve Walking Ability in Lumbar Spinal Stenosis: A Randomized Trial” authored by Carlo Ammendolia, et. al. It’s all about low back stenosis. This paper is co-authored by DCs, AND MDs. It was published in the Archives of Physical Medicine and Rehabilitation on October 27, 2017[2]. 

Why They Did It

They wanted to the effectiveness of a comprehensive nonsurgical training program to a self-directed approach in improving walking ability in low back stenosis.

How They Did It

  • It was a randomized controlled trial
  • It was done in an Academic hospital outpatient clinic
  • Participants suffered neurogenic claudication
  • MRI confirmed lumbar spinal stenosis
  • Subjects were suffering low back stenosis and randomized

What They Found

The conclusion stated, “A comprehensive conservative program demonstrated superior, large, and sustained improvements in walking ability and can be a safe nonsurgical treatment option for patients with neurogenic claudication due to LSS”

Low back stenosis can be helped

Dr. Ammendola has an amazing lumbar spinal stenosis program and training course. I have not personally taken it just yet but, it’s on my list after I finish up the DACO program. It comes HIGHLY recommended and this paper shows us why. 

Trucking on, this one is called “Do participants with low back pain who respond to spinal manipulative therapy differ biomechanically from nonresponders, untreated controls or asymptomatic controls?” It was published in Spine Journal in September of 2015 and authored by Wong, et. al. [3]

Why They Did It

To determine whether patients with low back pain (LBP) who respond to spinal manipulative therapy (SMT) differ biomechanically from nonresponders, untreated. Some, but not all patients with low back pain report improvement after a visit to the chiropractor. Why does that happen?

What They Found

After the first SMT, SMT responders displayed statistically significant decreases in spinal stiffness and increases in multifidus thickness ratio sustained for more than 7 days; these findings were not observed in other groups.

Wrap It Up

Quote, “Those reporting post-SMT improvement in disability demonstrated simultaneous changes between self-reported and objective measures of spinal function. This coherence did not exist for asymptomatic controls or no-treatment controls. These data imply that SMT impacts biomechanical characteristics within SMT responders not present in all patients with LBP.”

And our last one this week comes to us from JAMA, also known as the Journal of the American Medical Association. This one is called, “Association of Food Allergy and Other Allergic Conditions With Autism Spectrum Disorder in Children.[4]” It was authored by Guifeng, et. al. and published in 2018. Again, these papers are cited in the show notes at chiropracticforward.com under episode 45 so check them out yourself please. 

The question they attempt to answer here is, “What are the associations of food allergy and other allergic conditions with autism spectrum disorder (ASD) in children?”

They say in the paper that Common allergic conditions, in particular, food allergy, are associated with autism among US children, but the underlying mechanism for this association needs further study.

The study was a population-based, cross-sectional study used data from the National Health Interview Survey collected between 1997 and 2016

The conclusion was quote, “In a nationally representative sample of US children, a significant and positive association of common allergic conditions, in particular, food allergy, with ASD was found.”

They now need to find out the cause and underlying mechanisms so they can attempt to reverse the upswing of autism here in America. 

So….it appears maybe it’s not all due to vaccines after all. 

Integrating Chiropractors

That wraps it up for us this week. I hope you enjoyed it. Research can be boring but, it can be fascinating too when you allow it to help guide your thought process when you are approaching your daily tasks and deciding on treatment options for your patients. 

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

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

 

Bibliography

1. School, H.M., Where to turn for low back pain relief. Harvard Health Publishing, 2017.

2. Ammendolia C, Comprehensive Nonsurgical Treatment Versus Self-directed Care to Improve Walking Ability in Lumbar Spinal Stenosis: A Randomized Trial, in North American Spine Society Meeting. 2017, Archives of Physical Medicine and Rehabiliation: Orlando, FL.

3. Wong AY, Do participants with low back pain who respond to spinal manipulative therapy differ biomechanically from nonresponders, untreated controls or asymptomatic controls? Spine, 2015. 40(17): p. 1329-37.

4. Guifeng X, Association of Food Allergy and Other Allergic Conditions With Autism Spectrum Disorder in Children. JAMA, 2018. 1(2).

 

CF 016: Review of The Lancet Article on Low Back Pain (Pt. 1)