Chiropractic

New Information On 5 Actions To Change Clinical Practice

CF 131: New Information On 5 Actions To Change Clinical Practice Today we’re going to talk about moving toward being patient-centered. There are 5 actions recommended. What does it even mean? I might just ruffle some feathers here but a damn I do not giveth. But first, here’s that sweet sweet bumper music  
Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 
  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.  You have found yourself smack dab in the middle of Episode #131 Now if you missed last week’s episode , we were joined by Dr. Kevin Christie with The Modern Chiropractic Marketing podcast and author of a new book that’s coming out on chiropractic marketing. Kevin is a rising star in chiropractic and is a must-not-miss. Make sure you don’t miss that info. Keep up with the class.  While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.  Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.  On the personal end of things….. Still climbing in the patient numbers. Where I’m located here in Amarillo, TX, there is a population of approximately 280,000 people. Last week, on Thursday and Friday we added 3 total cases of COVID on Thursday and only 2 cases on Friday. Then the following Monday, we added 11.  So, as you can see, the numbers here are no longer high. People are sort of ‘over it’ and you can see that and hear it when you talk to the patients. Hell, I’m sort of over it but still being smart. I’m having friends to the house again but we stay outside by the pool and have a couple of adult beverages.  I have a friend that is a musician. Last weekend, he played a rodeo on Woodward, OK. He said there were probably 1,000+ people at the event and it was indoors. So, in Woodward, OK at least, they are REALLY over it. No way in hell I’m grouping up with that many people indoor or outdoor right now. It just doesn’t make sense to me for now.  I guess if I were 28 and at the top of my game physically it wouldn’t make any difference to me either. But going to an event where people are yelling and cheering right behind, beside, and in front of me….big nopers right now. Ain’t happnin’ I noticed that while cases seem to be leveling off across America, they’re not increasing or decreasing as much as you’d like but, what I noticed is that the deaths are going down. Fairly signficantly. So wouldn’t that fit with the news that started coming out a couple weaks ago about the virus losing some potency?  People are still getting it but not as many dying from it. Another explanation could be that we’ve gotten better at treating it. Either way, that’s not my lane so I’m not going to act like the expert. I’ll just say hell yay-us and keep the good news coming so we can all get back to life as it was meant to be lived.  I hope you’re all well and staying healthy. As always, if you care about the kind of information I share every week and you listen consistently, I’m proud of you. I think you care about the right stuff and even though I don’t know you all, I consider you my friend.  Item #1 Let’s kick this week’s research reviews off with this one called ‘It is time to move beyond body region silos to manage musculoskeletal pain; five actinos to change clinical practice’ by Caneiro et. al(Caneiro JP 2020). published in British Journal of Sports Medicine in 2020. We got a hot one over here!! This paper actually has a lot of big names in the industry like Caneiro, O’Sullivan, O’Sullivan and Jan Hartvigsen. If you don’t know Jan’s name, you just haven’t been a regular listener.  Why They Did It They say that current clinical research, education, and practice approaches musculoskeletal pain and conditions in silos. Basically it’s a focus on body regions like the knee, hip, neck, shoulder, etc.  But current thinking actually shows that the pain disorders are frequently comorbid and share common biopsychosocial risk profiles for pain and disability.  They say that a shift to focusing on the person is what is needed and that this would encourage the doctors to:
  1. focus on the patients’ context and modifiable biopsychosocial factors that influence their pain and disability
  2. Use education to facilitate active management approaches (targeted exercise therapy, physical activity, and healthy lifestyle habits) thus reducing reliance on passive interventions
  3. Consider evidence-based surgical procedures only for those with a clear indication and where guideline-based non-surgical approaches have been rigorously adhered to. 
Well who the hell can’t get behind all of that? Honestly, it’s odd when you think about it that in the year 2020, we’re still saying that surgery should be evidence-based and follow certain guides and that conservative treatment should be first basically. How’s that not just common sense and common procedure in 2020? We’re supposed to have freaking flying cars by now but the medical field doesn’t have this stuff down they way they should just yet?  It’s money. I know. I understand it. But it’s frustrating as hell all the same.  In this paper, the authors say to be truly patient-centered, they have five actions they recommend for managing a person with musculoskeletal pain, irrespective of body region. 
  1. Screen for biopsychosocial factors and health comorbidities. Notice this is #1 on their recommendations. If you’re just getting them in a pop a crack a lack and sending them on without this step, your results are going to be less than you or the patient desires. They say we need to communicate clearly with the patient to identify potential biopsychosocial drivers of the pain and then provide the therapy to fill that gap. These things include pain beliefs, emotional and coping responses to pain, social contest, physical and lifestyle factors and the presence of comorbidities. They recommend using the Orebro Musculoskeletal Pain Questionnaire. 
  2. Embrace patient-centered communication. This one is huge and this is one of the key things we learned in the Fellowship training for the neuromusculoskeletal medicine program. Clinicians should use open and reflective questioning to elicit the patient’s understanding of factors, which include the pain experience (tell me your story), causation beliefs (what do they think is the cause of the pain?), coping (what do you do when the pain increases?), impact (Tell me how your symptoms affect your ability to move and function), concerns (do your symptoms worry you?), beliefs (why do you think you shouldn’t bend/lift, or run?), social factors (tell me about your home life or work life), goals (what are you rgoals?), and expectations. Yes, to an extent, updated research and thinking has us behaving a bit like a psychologist I think. It’s not my favorite stuff. But, when you learn and consider how much pain is held in the brain due to these yellow flag indicators, then you start to realize that pain, certainly chronic pain, cannot just be treated at a peripheral source. You have to address the pain from a central sensitization perspective at least equally or you risk never being able to help these patients. 
  3. Educate beyond words using active learning approaches. doctors have to embrace education as a central part of patient care if we are going to change behavior. We have to dispel myths about pain, imaging findings, and activity engagement (for example, hurt does not equal harm). They say that behavioral learning like exercise therapy can be used to bust myths that are unhelpful. Myths and beliefs that lead to things like fear avoidance. 
  4. Coach towards self-management. A large portion of the chiropractic profession wants and desires patients to depend on them week after week, month after month and that’s just not real world stuff. And it’s not helpful for the patient’s recovery either. We should be empowering patients to engage in exercise, valued activities and a healthy lifestyle with confidence. Can you feel the difference here? “Mary, I know you’re only 35 but you already have some degenerative discs in your neck and I’m so concerned about it. This should be considered urgent and I’m going to need to see you 5 million times for the rest of your life.” Is that helpful or is this helpful? “Mary, I know you read on your rad report here that there is a finding of a degenerative disc in your neck but the truth is, that’s very common and not something you should be concerned with. Certainly not over-concerned with. I actually prefer the word ‘deconditioned’ over ‘degenerative.’ A good percentage of 30-40 year old patients have some mildly deconditioned discs but these rarely ever cause any issues. You’re young, you’re strong, and you’re healthy. We’re going to get everything moving correctly and then I’m going to give you some excellent exercises to really focus on the region and build plenty of support. You’re going to do great.” When you stack those two next to each other, it’s easy to see how harmful one is as opposed to the other more positive, more hopeful one. I got a little side tracked there, the point is, help them take control and self manage. Active amnagement relieves pain and improves function across pain conditions and health comorbidities. 
  5. Address comorbid health factors. They say clinicians should refer for co-care in teh presence of comorbid mental and physical health complaints like high levels of emotional distress, eating disorders, and type 2 diabetes. The authors say they contend that multidisciplinary care needs to be integrated, with consistent messages across the team to prevent care fragmentation and patient distress. 
Wrapping up the paper, the authors say Patient-centered care will optimize the value of healthcare provided. Shifting funding to support high-value evidence-based care options and educating society will be critical to enable this transition and will likely be cost-effective. Integrated cross-discipline clinical networds are required for effective co-care. We believe clinicians are ready to change, but they require the support of health systems and payers.  One word….two syllables. Day-um. You day-um right. But, health systems and payers are stuck on the part of our profession that doesn’t care about movement, function, yellow flags, exercise, or proper patient-centered practice. They’re stuck on the portion of our profession that is TIC or TOR or principled or whatever the hell useless drivel they’re using this week.  The hardcore, philosophy, doctor-centered, faith-based rather than evidence-based group of chiropractors are smaller but they’re so much louder. And dangerous. They’re flat-earthers. They’re the reason the evidence-based group will never reach any kind of cultural authority.  You can have a GROUP of guys and girls go through years of continuing education and maybe get a couple of diplomats in neuro or orthopedics or rehab….wahtever….and they can be the smartest chiropractor on the planet and almost 100% of their patients get well.  And then you have just ONE lowsy-ass guy or girl go and bait and switch just ONE patient into 80 visits in a year with a contract and all of the bells and stupid whistles of a doctor-centered practice, and that group that worked so so hard loses every ounce of legitimacy. Because of ONE jackhole that refuses to understand or read research or refuses to sacrifice some money in the interest of their patients well-being.  It’s gross. It’s awful. But it’s chiropractic. We are already looked at with a side-glance untrusting gaze. So any deviance of behavior that would be widely considered normal is magnified. Just one ruins the batch for all of us.  I remember a preacher once saying that you gain trust in drops but you lose it in buckets. The reality in chiropractic is that just one faith-based, doctor-centered jackhole loses trust in ALL chiropractors in buckets. For ALL of us.  My plea is to start sharing this podcast with your subluxation friends. Especially the young students that haven’t yet decided to be ‘principled.’ Maybe we can help lead them down the right path from the very start. The more people are exposed to the research and to the idea of being patient-centered, the more they’ll latch onto it. They have to. One is borderline evil, and the other is not. It’s backed by science. One destroys reputations for the sake of the dollar. One builds reputations and respect. One is built on ideas and theories over a century old that cannot or have not been proven while the other is backed by science and progress. How is it even a damn choice to begin with? We’re either a healthcare profession. Or we are a faith. True healthcare professions do research and then they do more and they change according to what works well and they drop the stuff that doesn’t, and on and on to the point of really being on the cutting edge of the science and on the health of our patients.  I’ll never understand how such a percentage of our profession can’t get on board with that. Whatever the answer to that question might be, it’s that answer that keeps us at the bottom of the cultural authority ladder.  Unfortunately, I don’t see if changing any time soon. Not until the governing boards decided it’s time to change once and for all.   Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Key Takeaways Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   
Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 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 https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger   Bibliography Caneiro JP, R. E., Baron CJ, et. al., (2020). “It is time to move beyond ‘body region silos’ to manage musculoskeletal pain: five actions to change clinical practice.” Br J Sports Med 54: 435-443.

Current Knowledge On A Robust Low Back Pain Diagnosis

CF 125: Current Knowledge On A Robust Low Back Pain Diagnosis Today we’re going to talk about picking apart a Lumbar pain diagnosis. What’s the latest information according to research? But first, here’s that sweet sweet bumper music    
Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   Today, I want to use a current paper from November on low back pain and diagnosing it correctly. I’m going to use the paper as the main source of info here but I’m going to be peppering in my own learning as a Fellow of the International Academy of Neuromusculoskeletal Medicine. I’m a nerd when it comes to the low back for whatever reason. Maybe because its the best researched of the conditions we treat. I don’t know. But I nerd out of this stuff and, if you follow along, by the end of today’s episode, you should be able to raise your low back diagnosis game considerably.    Item #1 This one is called “Current evidence for the diagnosis of common conditions causing low back pain; systematic review and standardized terminology recommendations” by Robert Vining, et. al(Vining R 2019). and published in Journal of Manipulative and Physiological Therapeutics in November of 2019……hot enough, here we go.  Why They Did It The purpose of this systematic review was to evaluate and summarize current evidence for the diagnosis of common conditions causing low back pain and to propose standardized terminology use. How They Did It
  • A systematic review of the scientific literature was conducted from inception through December 2018
  • Electronic databases searched included PubMed, MEDLINE, CINAHL, Cochrane, and Index to Chiropractic Literature
  • Of the 3995 articles screened, 36 (8 systematic reviews and 28 individual studies) met final eligibility criteria
  • Diagnostic criteria for identifying likely discogenic, sacroiliac joint, and zygapophyseal (facet) joint pain are supported by clinical studies using injection-confirmed tissue provocation or anesthetic procedures
  • Diagnostic criteria for myofascial pain, sensitization (central and peripheral), and radicular pain are supported by expert consensus–level evidence
  • Criteria for radiculopathy and neurogenic claudication are supported by studies using combined expert-level consensus and imaging findings.
What They Found
  • The absence of high-quality, objective, gold-standard diagnostic methods limits the accuracy of current evidence-based criteria and results in few high-quality studies with a low risk of bias
  • These limitations suggest practitioners should use evidence-based criteria to inform working diagnoses rather than definitive diagnoses for low back pain
Let’s dive in a bit, shall we? Discogenic pain, they say provocation discography is the diagnostic reference standard test used to confirm discogenic pain but it costs a lot, it’s not well standardized and there are some pretty significant risks of adverse effects. So the authors are recommending the centralization phenomenon as an office-based test to try to confirm discogenic pain. I’d add a few other signs of the pain being disc in nature. Here are a few off the top of my head:
  • The patient locates their pain axially and at L5 or above, not laterally
  • You cannot typically provoke the pain when pressing P to A on the segment
  • Walking helps
  • The Slump Test is highly useful here
  • Pain on coughing or sneezing or going from seated to standing
  • Pain that is worse sitting and better when lying down
  • Pain that can be centralized or peripheralized
  • Diminished motor, sensory, or reflexes
  • About 40% of low back pain patients under the age of 50 are discs
  • And pain that radiates beyond the knee
Myofascial Pain – They recommend myofascial pain be defined as nociceptive signaling from within muscle or fascial tissues that may or may not include referred pain or the presence of trigger points. Diagnostic criteria consistent with this definition include tenderness within a muscle with or without referred pain and reproduction of familiar pain with palpation or use. SI Joint Pain – Despite the existence of numerous provocation tests designed to identify SI joint pain, current scientific evidence does not support the diagnostic utility of individual tests. I can agree with that. Therefore, they say that SI anesthetic injections or blocks are the current diagnostic standard but of course, we don’t do that do we? No, we test the SI joints in several different ways and try to have a consensus. 
  • SI joint pain prevalence is about 22.5% of your low back patients
  • Fortin’s finger test raises your suspicion considerably
  • Walking hurts
  • Seated to standing usually hurts
  • For a robust diagnosis of SI, you should have 3 of the following 5 positive tests. 
  • Sacroiliac compression test
  • Distraction / gapping test
  • FABER test
  • Gaenslen’s test
  • Thigh thrust
Facet Joint Pain – They point out a study by Laslett et. al. saying a reporting of 3 out of 5 findings is sufficient to make a facet dx. They are:
  • Patient over 50
  • Paraspinal pain
  • Relieved with walking
  • Relieved with sitting
  • Positive extension/rotation
I will add to that list that facet joints constitute roughly 30% of your low back patients. The extension/rotation test is important. If it’s positive, it can still be something other than facets. But, if it’s negative, it’s almost certainly NOT a facet. Get that again, if extension/rotation is NOT positive, it’s almost certainly NOT facet.  In addition, you can push paraspinal on the patient and provoke the pain whereas, as mentioned, with a disc, you cannot provoke it by palpation.  Typically, long-lever activities are bothersome. Things like vacuuming, doing the dishes, or folding laundry. Anything that involves being slightly bent forward for a period of time.  Stenosis – They say “Neurogenic claudication occurs when spinal stenosis is severe enough to cause symptoms from intermittent neural compression or ischemia, most commonly from degenerative changes within the spine.” They say they “recommend diagnostic criteria reported by Nadeau et al. Which are symptoms triggered with standing, relieved by sitting, symptoms above the knees, and positive shopping cart sign.” For me here in my clinic, I use the protocol Carmen Amendolia created and validated through research. It’s been highly effective for us and our patients.  Piriformis Syndrome Current diagnostic criteria are available only through a systematic review of clinical features reported in the scientific literature: 
  1. ipsilateral leg radiation, 
  2. (2) greater sciatic notch tenderness, 
  3. (3) buttock pain, 
  4. (4) positive SLR, and 
  5. (5) pain with sitting
I would add that resisted external rotation could give you a hint. Put your hands on the lateral sides of the patient’s knees bilaterally. Then tell the patient to try to spread their legs while you resist. It’s painful, you have another very simple hint that you may be dealing with a piriformis issue.  So there you have it with my own learning from the neuromusculoskeletal diplomate program salted and peppered in for a good robust discussion. Yes, there are other considerations like lumbar sprain strain and things like that but these are the biggies.  If you weren’t before, you should be well-equipped after this episode to kill it on a low back diagnosis.  Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Key Takeaways Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   
Chiropractic evidence-based products

Integrating Chiropractors

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  The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
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 https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography Vining R, S. Z., Minkalis A, (2019). “Current evidence for diagnosis of common conditions causing low back pain; systematic review and standardized terminology recommendations.” J Man Manip Ther 42(9): P651-654.

w/ Dr. Michael Massey – Doing Things Right, Medicolegal Thoughts, and How We Better Protect Ourselves

CF 124: w/ Dr. Michael Massey – Doing Thing Right, Medicolegal Thoughts, and How We Better Protect Ourselves Today we’re joined by Dr. Michael Massey. We’re going to talk about What We chiropractors Are Doing Wrong, we’ll talk about Medicolegal things, and we’ll talk about How chiropractors can go about Better Protecting Ourselves But first, here’s that sweet sweet bumper music  
Chiropractic evidence-based products

Integrating Chiropractors

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  OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 
  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.  You have found yourself smack dab in the middle of Episode #124 Now if you missed last week’s episode, we talked about the primary spinal practitioner program, gabapentin, and cervical curvatures. Make sure you don’t miss that info. Keep up with the class.  While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.  Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.  On the personal end of things….. Before we get to our guest this week, I did a thing Being an evidence-informed practitioner can present a set of problems at times. Mostly problems with regard to patient volume because we don’t typically treat a patient with long-term recommendations. So we see them come and go depending on if they hurt or not. It can lead to lulls, disappointment, and boredom if there’s not a steady stream of new patients coming through your pearly gates each and every month. I have taken various courses over the years at Udemy so when I decided to create a course, I immediately thought Udemy would be a good place to start.  While I’m still building the course and adding content every week, it’s live and ready to go for those interested in getting started. I’m putting the link to the course at this point in the show notes. https://www.udemy.com/course/marketing-evidence-based-chiropractic/?referralCode=36A4D91C66B48300360B Over the last two years or so, I’ve averaged almost 80 new patients every month as a solo practitioner. If you’re interested, I created, basically, my playbook for marketing and my thoughts on each topic or technique. I also have created downloads, checklists, and examples to show what my stuff looks like.  Just go to udemy.com and do a search on Marketing An Evidence-Based Chiropractic Practice and check it out. It will grow and expand in the coming months and if you get just one patient from the ideas shared in it, it paid for itself. Now imagine if you get a bunch….well then it’s priceless. udemy.com and the course is called Marketing and Evidence-based Chiropractic Practice.  I usually drop some personal thoughts and updates on the clinic and things like that. When we have a guest join me on the show, I typically drop that section and just get on with it. It’s no different today. So, let’s get on with it.  Today we are joined by Dr. Michael Massey who hails from the great state of Tennessee. Athens, TN to be exact with is just Northeast of Chattanooga.  Dr. Michael Massey has been in private practice for nearly 30 years and is no stranger to the inner workings of insurance companies or the creation and administration of regulations.  He has worked in and around commercial and federal insurance carriers for most of his time in practice, serving as a liaison, a consultant, and a contracted employee.   He is also a certified coder, a certified healthcare quality manager, and a quality assurance/utilization review diplomate.  He has additionally served as the president of his state chiropractic association, a delegate to the American Chiropractic Association, the chairman of the ACA Coding and Reimbursement Committee, and as a 10-year member of his state Board of Chiropractic Examiners, while simultaneously serving as a delegate to both the Federation of Chiropractic Licensing Boards and the National Board of Chiropractic Examiners.   He also regularly serves as a nationally-sought expert witness for malpractice and insurance fraud cases.  This diverse experience offers him a unique perspective and a comprehensive skill set to speak on insurance matters, coding, documentation, HIPAA, Medicare, compliance, personal injury, and risk management. Welcome to the show Dr. Massey. May I call you Mike or Michael? Now, first question is, how are you enjoying this grand global pandemic we’re currently blessed with? I have been to Nashville a few times but only recall going through Chattanooga one time when I was on a family vacation back when I was a freshman in high school. I recall it being one of the most beautiful areas I’d ever seen and, from what I remember, I’d probably still classify it that way. I did a little research on Athens, TN. It appears the population is 13,458 hoomans. My region is about 280,000 for comparison sake. What’s it like practicing in a small-town setting where you only have that many to draw from for new patients? Or are you close enough to Chattanooga that you can draw off of their population as well? We met through the miracles of the private Facebook group called the Forward Thinking Chiropractic Alliance. You are typically pretty active in the group and then we met face to face at the Forward ’19 event out in St. Louis back in September. You were teaching a class on Documentation with Dr. Greg Friedman.  I love the group. I’m active here and there, I’ve joined the membership, I support the group. I see the value for sure. While I’m minimally active, I have learned a lot from others just by lurking a little. OK….lurking a lot. What would you say you’ve found to be your biggest takeaway from the FTCA group? What’s been the big bang for the buck for you with it? Documentation is not typically something finds much fascination in but you guys did a good job taking a dry subject and communicating the information in a way that was interesting.  Coding and documentation, for me, can be like pouring salt or maybe hot sauce in my eyeballs. I find it displeasing in general. So, what on Earth got you into coding and documentation? Why is that, of all things, your wheelhouse? From a procedural coding perspective, what are the most common mistakes made by chiropractors?  How about from a diagnostic coding perspective? I don’t know how other states are but here in TX, we have to have 4 hours of medicare, ethics, and documentation every year. Required hours. I think it’s insane to force grown professionals to do this when we could be learning how to take better care of our patients. I can see maybe every other year or every 5 years as a refresher. But I’m not down with every year. What’s your view on this? Relative to clinical documentation, what are the top two or three nuggets of advice you’d offer to both newer doctors as well as those who have been in practice for a while? You’ve had a good bit of experience working with insurance companies, can you offer some insight into their perception of our profession?  Where do they seem to believe we fit best in the system?  What are their primary concerns or frustrations with us? Now we collaborated briefly on a case you were working on recently having to do with stroke. I believe you were defending a chiro if I’m not mistaken. How’d it turn out? Did the good guys win the day? When we’re talking about risk management, as we just mentioned, you have experience doing expert witness work for malpractice cases. Is there any consistency in the types of lawsuits you’re seeing?  Are the allegations typically similar?  Are there specific things chiropractors do/don’t do that seem to trigger lawsuits? How did you get into the med/legal work?  How do you prepare to be a good witness? What are a few critical risk management tips you wish every chiropractor knew? Let’s talk about something I know is near and dear to you and you’ve been putting together for a while now. Pretty much since we first traded private messages through Facebook. It’s called Practice Mechanics and it’s something you’ve put together with Dr. Rob Pape out in California.  Rob is another very active member and moderator with the FTCA group. I talk a lot about FTCA on this podcast. I should push my private group as much as I push FTCA. Lol. But there are less in my private group and the FTCA members are way more active.  Anyway, Rob is like the jedi ninja dude in there and always has an interesting take on whatever the post of the day happens to be. Tell me about Practice Mechanics, tell me about teaming up with Rob on this project, and give us some clue of who it would be good for, where it’s at, and where it’s going? What’s the big picture? We’re going to link the Practice Mechanics website at this point in the show notes at chiropracticforward.com so you can go find out more about it. https://www.practice-mechanics.com Thanks for coming on the show with us, Dr. Massey.  Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, belive it, count on it. Let’s get to the message. Same as it is every week.  Key Takeaways Store Remember the evidence-informed brochures and posters at chiropracticforward.com. 
Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
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Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Chiropractic Scoundrels, Chiropractic Safety In Kids & What Is Chiropractic?

CF 116: Chiropractic Scoundrels, Chiropractic Safety In Kids & What Is Chiropractic? 

Today we’re going to talk about chiropractic safety for kids and then we’ll spend some time talking about a paper attempting to define what chiropractic is. 

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

If you haven’t yet I have a few things you should do. 

  • Like our facebook page, 
  • Join our private facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!

Do it do it do it. 

You have found yourself smack dab in the middle of Episode #116

Now if you missed last week’s episode , we talked about epiduran steroid injections and why to give them the heave ho, asap, mi amigo. Make sure you don’t miss that info. Keep up with the class. 

While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points. 

On the personal end of things…..

I’ve had some wah wah news to share with you guys since my Dad’s stroke in November and issues with my office getting broken into, and my bonus dad having his hospitalizations and all that. I’ll just get to it. 

I lost two friends this week. One on Monday and one on Tuesday. While I can’t consider them my inner circle friends, they were friends over a course of many years and it’s never fun. More importantly, when they’re your age, it makes you consider your own mortality and honestly, who the hell wants to consider their own mortality?

Certainly not me so we’re going to keep trucking. 

The week of recording this episode, my interview with Dr. Jerry Kennedy on RocketChiro’s podcast went live. Other than there being video where you can see my ugly face, I thought it was a lot of fun and we covered all kinds of topics most of you would probably find interesting. You can find that at rocketchiro.com and click on podcasts.

This week, I also spent an hour and a half on the witness stand testifying in court in regard to a car wreck patient of mine. I haven’t seen him in a couple of years. I haven’t had to testify in a few years. 

The idea of testifying once mortified me. Absolutely petrifying. Lol. Some of you can relate because it probably scares the crap out of you too. 

The thought of having your notes up on the big screen….ugh. You better be a good note-taker!! When you’re teaching staff to take good SOAP notes, tell them that their notes can be up on a big huge screen with your name underneath them!

Anyway, it was weird, the friendly attorney, the one that asked me to come testify, he asked me questions for roughly an hour and a half. When it was the bad guy’s turn, he asked me like 3 little simple, insignificant questions. Like, he had nothing. Nothing to ask me. Lol. 

I don’t know if it’s because I was doing a good job throwing out research findings and whiplash injury factoids that he wanted me to shut up and get off of the stand……or…..if I was as insignificant as a fly and he had no use for me. Lol. 

For my own sanity and mentality….I’m going with option #1. I’m sure you understand. 

This podcast folks, it’s really started to take flight in the last few months. More and more people are starting to latch on and I couldn’t be more pleased to see that hard work does actually pay off with consistency. 

And that’s what I’ve tried to provide you all consistent, high-level information tainted with a bit of personality and entertainment. Maybe….just maybe it’s an effective combination. I’m not where I’d like to be but we are certainly moving in the right direction. About 30,000 downloads for a nichey little podcast like this just isn’t bad, folks. 

If you have helped me along the way, I want to tell you thank you. If I see you at an event, I hope you’ll come to introduce yourself and we can hug it out. I’m a friendly dude. What can I say?

All I can ask is, if you know someone that would be interested in the information you find here, please share us with them. Pump our tires a little bit and show them how to find us and connect. That’s all. That’s it. And thank you. 

Before we dive into the reason we’re here, it’s good to support the people that support evidence-informed practitioners. Well, ChiroUp certainly does just that. 

If you don’t take advantage of the deal I’m about to offer you, I think you just might be crazy.

Regular listeners know I’ve used ChiroUp since for well over a year now. I’m going to tell you want it is and then share a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months. So listen up!

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, activities of daily living, & for their exercises. 

This save you so much time – no more explaining & re-explaining your patient’s care, because they have access to it right there at their fingertips. 

You can be confident that your patients are getting the best possible care because the reports and exercises are populated based on what the literature recommends and isn’t that reassuring? All of that work has been done FOR you by people that are deep into the research. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice.

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL and, to sweeten the deal, you can use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super saver code is Williams99.

Item #1

This first one is called “The safety of spinal manipulative therapy in children under 10 years: a rapid review” by Corso, et. al(Corso M 2020). and published in Chiropractic & Manual Therapies in February – dammit that’s some hot fresh smart biscuits, people…

Why They Did It

“The safety of spinal manipulative therapy (SMT) in children is controversial. We were mandated by the College of Chiropractors of British Columbia to review the evidence on this issue.”

How They Did It

  • They conducted a rapid review of the safety of SMT in children (< 10 years). 
  • They aimed to: 
  1. describe adverse events; 
  2. report the incidence of adverse events; and 
  3. determine whether SMT increases the risk of adverse events compared to other interventions.
  • They searched commonly used databases like MEDLINE, CINAHL, and Index to Chiropractic Literature
  • They searched from 1990 to 2019 – That’s a pretty large search I think most would agree. 
  • They used rapid review methodology recommended by World Health Organization

What They Found

  • Most adverse events are mild (e.g., increased crying, soreness).
  • One case report describes a severe adverse event (rib fracture in a 21-day-old) and another an indirect harm in a 4-month-old
  • Whether SMT increases the risk of adverse events in children is unknown.

Wrap It Up

The risk of moderate and severe adverse events is unknown in children treated with SMT. It is unclear whether SMT increases the risk of adverse events in children < 10 years.

OK – looky here. I may be a country bumpkin. I may just be a Texas Flatland dipstick but here’s my take. Even in politics…..it’s all about the kids, isn’t it? Haven’t you noticed that? If you can bring the kids into it, BAM!!! You have an instant impact statement, don’t you?

Chiropractic

So, with the powers that have waged war on the profession of chiropractic for generations, don’t you think that if there were indeed any real, consistent, and common adverse effects from chiropractors working on kids, that we’d damn sure know about it by now?

Honestly, they searched almost 30 years of records. Are you stepping in what I’m tossing down? Let’s be honest, some goofy stuff happens here and there but this paper doesn’t ell me it’s unclear. Knowing this profession and the medical profession and the history of conflict there, this paper tells me there’s nothing to see here. Keep on trucking and getting the kiddos to feeling better if they need it. 

Don’t work them over for no damn reason but if they have a complaint, by all means, help them. Please. 

Item #2

This second one is called “So, what is chiropractic? Summary and reflections on a series of papers in Chiropractic and Manual Therapies” by Jan Hartvigsen and Simon French(Hartvigsen J 2020). Published in Chiropractic & Manual Therapies on January 30, 2020 

Nothing but steamy plates of fresh filets of brain food, folks!

The authors start the abstract by saying, “This commentary brings the 2017–2019 thematic series What is Chiropractic? to a close. The 18 papers published in the series contribute to a better understanding of what chiropractic is, where chiropractors practice and function, who seeks their care, what chiropractors do, and how they interact with other healthcare professionals. “

Several papers in the series highlighted deeply rooted disagreements within chiropractic about fundamental issues pertaining to ideology, acceptance of scientific evidence as the basis for clinical practice and the future of chiropractic. 

If the chiropractic profession is to remain relevant in today’s evidence-based healthcare environment, there is an urgent for the profession to undertake further research to describe what chiropractic is, what chiropractors do, and provide evidence for the value of these activities to patients and healthcare decision-makers.”

Boy is that an understatement…..

They close out the body of the paper with what struck me as some powerful thoughts.  

“Papers in this series have again revealed deeply rooted disagreements within the chiropractic profession about what chiropractic is, and what it should be, as a profession, as well as disagreements and variation in relation to the education of chiropractors and chiropractic clinical practice.” 

In our opinion, it is ironic that while chiropractic has a strong presence in large parts of the world, is taking on increasingly important roles in disability prevention [6, 7, 17], in the military [5] and in interprofessional care [8] as well as growing research capacity [16], discussions about fundamental values and direction of the profession are unresolved. 

This unresolved issue creates confusion for stakeholders and threatens to impede professionalization and cultural authority. If chiropractors are to remain relevant in today’s evidence-based healthcare environment, there is an urgent need to agree on, and further describe, what chiropractic is, what chiropractors do and importantly to provide evidence for the value of these activities to patients and societies.”

Dr. Hartvigsen and Dr. French are dead on target here but it’s 100% pointless. You will never unite this profession until the old guard changes or dies out. Some say, ‘what does it matter as long as we’re getting people better?”

Here’s why it matters. Many of us have worked our asses off raising our game and there are knuckleheads out there parading around as experts, scaring patients into long-term contracts, and making us all look like straight-up idiots and I don’t appreciate it. I don’t like to walk into a room of medical doctors and see the way they look at me when someone tells them I’m a chiropractor and know the reason is because of these knuckleheads. 

So, if you’re a go along to get along type of person…..THAT’s why it matters 

I happened to be on Reddit kicking around the Chiropractic subReddit and came across a girl who was a patient of a chiropractic clinic on the West side of St. Louis. Saint Charles to be specific. 

The issue started out because this office was leaning HARD on her to market them to her friends and family and get her to get patients into their office. 

OK let’s start there. I am not afraid to ask a patient every now and then if they have remembered to tell everyone they ever met about this amazing new office and the results they got here. I do it in a non-pushy, comical way but at the same time, I am encouraging some word of the mouth stuff to happen. Make sense? I hope so because it makes sense to me. 

Now, that’s OK. But what she was describing was the doctors on her at every visit and coming close to harassing her about it. 

OK, not cool but not a deal-breaker but then she started to go into more of her story with these knuckleheads. Here’s what she said. 

I signed a one year contract with what they call a “wellness center.” 

Two chiropractors run it. I have already received 5 months of treatment and have 7 to go. 

The payments are due over a 10 month period of time, but I will receive 12 months of treatment in total when it’s done. 

Anyways, my chiropractor every day pushes his clients to refer to other clients. I am new to the area and I’ve told him that I’m new. 

Also, I’m not his marketing team. Like sheesh. Well, today he said to me “you’ve lived here long enough, you have someone by now you can send in here and save their life with chiropractic.” I’m started to feel harassed.

Save their life with chiropractic. Look folks…..I’m all about valuing chiropractic and what we do for our patients but ‘Save their life?” That and turn the power on type stuff makes me want to throw up in my mouth a bit. I’d rather run a cheese grader on my legs than hear that crap. 

Anyway – she continued

But here’s my main issue: 

When I signed the contract, they said the RETAIL for 12 months of care is over $5k. Since you will be signing a contract it will be taken down to $3,350 

So I pay $335 every month for ten months. I’ve already paid 5 months. They said if this contract is broken early, you will then owe the difference for each visit you have received of what the “retail fee” would have been since you are being discounted for having a long term contract. 

I believe their “retail fee” is $55/visit and my “discounted fee” is $36 per visit. I’ve probably had close to 40-50 visits so I’d back owe close to $1,000. 

She concluded by saying, “Please help me! I was snaked by these people because I just wanted pain relief!”

If you agree with the tactics this clinic is using against this woman, just stop listening to me. Put your phone down now. I can’t with you or anyone like you. It’s shameful and it pisses me off. 

To scare them into a contract, to make them feel they’re locked into the contract and they’ll owe a fortune if they try to get out, and to carry on as a healthcare practitioner or to carry on as anything other than a snake oil salesman out on the street corner…..I just can’t. 

So here’s what she’s going to do. Or what I hope she’s going to do. I hope and am encouraging her to contact the state board of examiners for Missouri and tell them her story. If there is an issue there, they’ll open a complaint. If there is not an issue, I’m going to open up a complaint with the Board of Chiropractic Examiners in Missouri. Lol

I’m fortunate enough to be in Texas. Texas chiropractors can’t pull this crap anymore. Thank God. 

I’ll repeat what I’ve said countless times on this podcast

  1. There is no place for contracts for your healthcare. Ever. 
  2. It is a profession with A LOT of room in the scope. Chiropractic is not a modality. It’s a profession. 
  3. It is not a church. It’s not a faith-based system. It is a scientifically validated profession but only when you’re using evidence-based research. Not piddly case studies that fit your bias or studies performed by the stakeholder of the system they’re selling. 
  4. Professions have a birth. Then they have learning and progress into the current state and construct you see. They do not have a birth and then remain in the same place with the same amount of information and techniques for over 100 years. The medical field doesn’t do that. Physical Therapy doesn’t do that. Chiropractic shouldn’t do that. 
  5. Be a doctor. Don’t be a salesperson. It’s gross and, even if nobody says it to your face, it’s embarrassing to you and to the rest of us. 

Well, how many enemies have I made right there? Lol. Honestly, I don’t care at this point. Let’s be honest with each other can’t we? We’re all mostly grownups I hope. 

Be an a-hole, take advantage of people, scare people, bully people, and screw people and you’ll find that maybe you make a lot of money but that doesn’t come without consequence. Whether it’s turning your soul a shade of blackish/gray or whether it’s the snickers, sneers, and giggles behind your back as you walk by, or maybe whether it’s the eventual realization of what you’ve done to the reputations of not only your family and friends but also to your colleagues. Whatever forms it takes, there are consequences to living and behaving like that. 

On the other hand, be a good person. Be smart. Be ethical and have a moral compass. Then good things happen. You can walk upright and proud.

Always. 

Store

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

Chiropractic evidence-based products
Integrating Chiropractors
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The Message

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

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

It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. 

And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point:

At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….

That’s Chiropractic!

Contact

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

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

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

Connect

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

Website

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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

  • Corso M, C. C., Mior S, Taylor-Vaisey A, Cote P, (2020). “The safety of spinal manipulative therapy in children under 10 years: a rapid review.” Chiropr Man Therap 28(12).
  • Hartvigsen J, F. S. (2020). “So, what is chiropractic? Summary and reflections on a series of papers in Chiropractic and Manual Therapies.” Chiropr Man Therap 28(4).

TEN Keys To Chiropractic Success

CF 114: TEN Keys To Chiropractic Success

Today we’re going to talk about some of the things I would tell myself about chiropractic success if I were just starting out. How would I mentor myself at this point in my life? How would I counsel and mentor ANY doctor? I believe old dogs certainly can learn new tricks because 22 years into practice and I’m learning new tricks. Better believe it. 

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

If you haven’t yet I have a few things you should do. 

  • Like our facebook page, 
  • Join our private facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!

Do it do it do it. 

You have found yourself smack dab in the middle of Episode #114

Now if you missed last week’s episode, we were joined by Dr. William Lawson of Austin, TX and we talked about a paper he participated in that was concerned with setting treatment guidelines for neck pain. Newer paper and newer information so make sure you don’t miss that info. Keep up with the class. 

While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points. 

On the personal end of things…..

Alright, nothing blew up this week. We had some snow last week so that was nice. Kids stayed home from school and I stayed home in the morning but made it to work that afternoon. It was a nice change in the schedule.

I’m actually headed to the Florida Keys on Thursday morning. I’ve never been and that’s exciting! My wife has massages and facials booked and when I put an s on the end of those words, I’m serious. Every day starts with either a massage or a facial and that’s the stuff that makes me feel warm and fuzzy inside. Count me in. 

Here at the office, I have 5-6 massage therapists. I pay for my own massages. I don’t take advantage of them. But I try to get at least one per month and more when time allows. I’m a junkie. So it should be a great long weekend there in Florida. Plus it’s not too hot this time of year. I’d probably meltdown there in the Summer.

I got the news last week that the legendary Stu McGill will be joining us on the show in March. That’s some cool news right there. How do you ask someone like Stu questions that he doesn’t normally get that are still thoughtful and insightful?

The short answer is I don’t know but I’m listening to some past interviews and trying to be prepared for the back Jedi. The ninja, if you will.

I’ve been a little lazy about getting guests lately but I really enjoyed having Bill Lawson last week, I’m looking forward to Stu, and I think more guests are in order! I’m sure you get tired of hearing me ramble on so I’m making a resolution here and now more guests! 

This week, I’ll be recording a podcast with Dr. Jerry Kennedy of Rocket Chiro, previously called BlackSheepDC. He has been kind enough to invite me to speak with him on his podcast about marketing and promoting chiropractic through research. Using research to communicate what we do and why and what to expect in the results according to research. I’m looking forward to that so be looking for it. I’ve only been a guest once before on a podcast called Health Nuts but it was fun. This one should be too. Dr. Kennedy and I line up very well in how we see things. 

Before we dive into the reason we’re here, it’s good to support the people that support evidence-informed practitioners. Well, ChiroUp certainly does just that. 

If you don’t take advantage of the deal I’m about to offer you, I think you just might be crazy.

Regular listeners know I’ve used ChiroUp for well over a year now. I’m going to tell you whant it is and then share a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months. So listen up!

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, activities of daily living, & for their exercises. 

This saves you so much time – no more explaining & re-explaining your patient’s care because they have access to it right there at their fingertips. 

You can be confident that your patients are getting the best possible care because the reports and exercises are populated based on what the literature recommends and isn’t that reassuring? All of that work has been done FOR you by people that are deep into the research. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice.

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL and, to sweeten the deal, you can use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super saver code is Williams99.

Ten Keys To Chiropractic Success

For today, I want to cover something outside if our norm here. This is more of a mentor post if I may be so bold. If you’re new to the podcast listenership, we typically cover some personal points over the previous week and then jump right into covering 2-4 research papers having to do with the activities we are involved in every day in our offices. 

I happened to see a post by Dr. Kevin Christie with  The Modern Chiropractic Marketing Facebook group last week. He asked the group, “What is your one piece of advice to the younger Docs that you wish you knew or followed in the earlier years of practice?”

This one post of Kevin’s demanded over 90 comments the last I checked. Some of the recommendations were goofy of course. It’s a fun group. You expect so of that. Some serious, some were fairly irrelevant and off-target. 

It got me to thinking; if I have done this for over 22 years and I been successful at it, are there any words of wisdom I could share that you would find valuable? I hope I’ve not been sampling my own brew too much but, I have to say I think I can pass on some nuggets to you. 

First thing is, you can learn something from ANYONE. Even if it’s learning what NOT to do. Lol. Sometimes you can learn both of those from the same person and I think I certainly fit that bill. I’ve made mistakes, people. Mistakes that are hard to admit. 

Next, I don’t own multiple clinics. I haven’t franchised. Hell, I don’t even have an associate; even though I should have had one year ago. So, let’s keep it in context and let’s be honest about it. I hate people that inflate their numbers. It’s obnoxious and gross. If I’m anything, I’m honest. Sometimes to a fault. My wife calls me a damn boy scout. She means it to tease but I’m kind of OK with that. I am not comfortable with lying and have alway liked ethics and high morals so in that spirit, here we go. 

This is purely meant to demonstrate why I probably have some good stuff to share. Although January and February always bring a bit of a slowdown, on average I see about 18-23 new patients per week. Over the course of 2019, I averaged 73.4 new patients per month and 726 visits per month. My PVA was about 9.8 visits. And then you have to understand that I have massage and acupuncture thrown in on top of that stuff. 

We’re doing alright. It’s a BIG overhead and super busy office. I’m one of those guys. Not necessarily on purpose either. It’s by necessity. I know some docs that can see 6 patients in a day, command and outstanding fee, and do just as well. All I can say to that is…..freaking teach me. Please. Lol. I’m busy as hell at almost all points during the day and it can be exhausting. But that’ll be covered a little more later. 

Now, standing where I now stand, what would I tell new docs? What advice would I pass down to myself if I were just starting out in business? Here we go, let’s work through it:

#1 – Value Yourself & Value What You Do

What is the #1 reason you are a chiropractor? Maybe it’s to help people. A very noble reason and I would guess the reason most of us got into the business. But let’s not make any mistakes, it’s called a business for a reason. You didn’t getting into the business to help people and starve. If you did, you’re a knucklehead. Straight up. 

Now, I have issues with money. I didn’t come from a lot of money so I guess on some level, I’ve always felt guilty about making it or prospering in a big way. I’ve traditionally had a hard time giving recommendations for treatment. Even when I know for a damn fact that they are going to help address long-standing pain. I’m telling you, it’s a mental game. 

Because I struggled with money early in the game, I automatically allow my experiences to paint my handling of others when it comes to money or finances. 

Not as much 22 years into the game but I still struggle to an extent if I’m being honest. But I came to really begin to value my service, my office, my employees, my family, and I began to value my patients. This was a profound turnaround for me that happened when I started really immersing myself in the available research. 

How in the hell can you sell something you’re not sure the value of to start with? Look, it’s different now but, when I came out of Parker in ’98, it was a philosophy mill and I never fit that mold. From day #1. I was not a chiropractic philosophy guy. I didn’t fit anywhere and felt I had probably made a big mistake. 

It wasn’t until I started to seek out and find chiropractors like me and started paying attention to all of the high-level research that I started to see firm value in what I did and how I could help others. THAT’s when things started to click for me. 

OK, I finally see a clear path that makes sense, I start walking that path and I’m rocking and rolling. In fact, I start killing it. Conviction in your words really does matter it turns out. Now, what’s the most important thing?

#2 – Take Care Of Business

Remember I said it’s a business so that means you must take care of business. I saw the value and started killing it but I wasn’t trained in matters of the office. I did a lot of PI in the early days. A LOT of PI. If you’ve done it before then you know that you have to settle with the attorneys all the damn time. Frustrating, yes….indeed. But part of the game. 

Anyway, because of settling all of the time, Accounts Receivable was not necessarily an accurate stat. I kept an insane amount of stats but I was missing ONE KEY stat. It was the one that tells you your profit per appointment. Man oh, man. Missing that one stat taught me a very very expensive lesson several years ago. 

You’ve probably heard me say in previous episodes that I lost almost a million dollars over the course of about 3 years. This happened for several reasons. It makes a guy feel like an idiot to admit it but, it happened. It’s part of my life. I had an employee that I trusted, that I trained, and then trained, and then got trained more, and then provided resources for so she could ask any questions. I even got the training to come here to my office and work with her. 

I want to be clear, nobody was stealing. She just wasn’t disputing denials, re-billing, some of the billing just wasn’t done at all but she never said a word, even though I’d made it clear to tell me if she needed help or had questions, etc. Well…..she didn’t so I was dumb enough to think it was all taking care of itself. Once the timely filing deadlines have passed, that’s it. Done deal. That money is bye by. 

Hell, my stats showed me that I was seeing a ton of folks and getting a ton of folks better. I was killing it! So I thought. You could fall prey to the same mistake. That’s why I’m sharing my sheer stupidity with you. I’m not a proud man. 

I knew things weren’t jiving so I brought in an internal auditor to sort the mess and oh hell what a mess it was. I had no idea. One month, for example, I lost $40.00 per visit and another month I lost $21.00 per visit. LOST. 

So, my fault was in buying into my employees and rooting too hard for them. Getting personally invested in their success and fighting for them. That’s just who I am and that’s how it came about. I’m still that person today. I’m just a hell of a lot smarter about what I will and will not tolerate. That’s the difference now. 

I’m not a smart man but I know when my bank account is getting closer and closer to zero. Lol. 

At the end of the day, when I say take care of business, I mean that your business ultimately depends on the billing and collections. If you’re not billing or collecting, you’re not in business. Period. Either make damn sure your billing/collections person is a rockstar or outsource it to a professional and experienced company. 

Without question. Just do it and don’t second guess it. And never pay an outsourced business a flat fee. They should be on a percentage of collections. That way they have the motivation to get your AR to zero. 

You can use the profit per visit stat to help you determine where you are as far as collections. It’s the one stat out of all of them that could have saved me at least half a million dollars. That’s important enough to cover it real quick. 

You find your Profit Per Visit (PPV) by subtracting your Cost Per Visit (CosPV) from your Collected Per Visit (ColPV. 

ColPVCosPV = PPV

I’m going to tell you how to find those right quick so get out your pens and pencils ladies and gentlemen. 

Let’s start with the Collected Per Visit number. Find that by dividing your Total Collection Amount (TCA) by your Total Number of Visits (TNV). 

TCA / TNV = ColPV

So let’s say we’re doing last January for example. I want my collected per visit number so I’m going to look and divide my total collections in January by the number of visits I saw in January. Bam, there you go. One number down. 

Now we need to find our Cost Per Visit number. For that one, we just divide our Overhead (OH) in January by our Total Number of Visits. You should see how it all revolves around your Total Number of Visits right? Because it does. 

OH / TNV = CosPV

Anyway, it’s simple, you just have to be told how to do it. Now, subtract Cost Per Visit from Collected Per Visit and you will have your Profit Per Visit number. That number tells you whether you’re knocking it out of the park or sucking the dirt of all of those others that really are knocking it out of the park. 

I’d say if you’re Profit Per Visit is around $40-$60, you’re where you want to be. Some are more and some are less but that will all come down to where you are as far as your overhead. KEEP AN EYE ON IT. 

These equations are illustrated a little clearer for you in the show notes at chiropracticforward.com so go there and check it out. 

#3 – Chiropractic Statistics

The easiest way you can say it is like this; how can you know where you’re going if you don’t know where you’ve been? Honestly, it wasn’t until I joined a practice consulting group that I learned the value of keeping stats. Unfortunately, that group didn’t keep the profit per visit stat. Ugh. Anyway, moving on…..

It’s vital to be able to compare your current situation from past performance. Have you ever had a month where you were in the dumps because you thought your practice was slower than normal? And maybe you were ready to just go ahead and jump off the cliff or drive your car into a tree? Or something equally self-harming?

Well, I have too. But, because I keep stats so thoroughly, I’m able to pull them up and compare now to last year at this time. Not only that but I can compare to the 10 years prior to that and see the growth and then I don’t panic and I don’t feel like all hope is gone. It’s really nice to know where I’ve been. Plus, it can help you plan where you want to go and set realistic, reachable goals. 

Outside of valuing my services, keeping stats has probably been the most important change I’ve made over the years. It’s that big of a deal. 

#4 – Chiropractic Marketing

If you’ve listened to my podcast any time at all, then you know what I think of marketing. And it can be summed up in these words, “You must be a marketer of what you do. Not just a do-er of what you do. 

The names you most associate with a particular industry aren’t usually the best. They were just better at telling people how good they are. Put it this way, do you really think McDonald’s makes the best hamburger? Hell no they don’t. Yet, there they are. Around the world, absolutely killing the burger industry. 

Also, a Dan Kennedy classic you’ve heard from me before. It’s YCDBSOYA which stands for You can’t do business sitting on your ass. You better be someone that becomes a mover and a shaker because the success will not belong fo the meek and the mild in this story. It will belong to the ones that aren’t afraid to tell people what they do in an honest and ethical way. 

If you’d like some great thoughts and ideas on marketing an evidence-based practice, check out the two-part series we did on it. They were episodes 98 and 99 and are linked in the show notes. They were called Big Ideas On Marketing Evidence-Based Practices and published on October 31st of 2019 and part two was published on November 8 of 2019 so go find them and get to work. 

Part I

Part II

#5 – Control Chiropractic Overhead

Here’s the honest truth, I suck at this one. I like toys and I like having extra hands to help. Here’s the deal, when you have an office of employees, none of them…..NONE OF THEM cares about your business as much as you do. Even my most valued employee doesn’t value it as I do and she’s amazing. 

They find reasons to be gone. They wake up with a cough, their belly hurts, blah blah blah. I’ve heard them all. And on a side note, I do it as schools do it. If you have a fever, keep your butt at home. If you do not have a fever, get your butt in gear. If you miss work, you better have a doctor’s note. Plain and simple. Remember it’s a business and you have to take care of business. 

Anyway, I am usually one person over-staffed because I got tired of being short-handed all the damn time. I saw someone on Dr. Christie’s post say that people need to remember that overhead walks on two legs. Meaning, employees are the biggest aspect of your overhead. And it can get out of hand fast. I used to think a $42,000 per month overhead was the most ridiculous thing I’d ever heard of. A colleague of mine told me that was his overhead and I was about half of that at the time. Now, I’m around $5k-$10,000 beyond that on average every month. 

It sneaks up on you so keep an eye on it. Protect it. When a salesperson calls me, I tell them straight up, “I’m not just out looking for more reasons to raise my overhead so if it doesn’t blow my shorts off, it’s a no from me.” Pretty simple. 

#6 – Background Checks

Speaking of employees, I about pulled a dummy a year or two ago. I hired a girl with front office healthcare experience. Hell, she worked at a cardiologist’s office for quite a while! I was so excited. I hired her and she was just killing it at the front desk. I mean killing it when we’d been through several that were just awful. i was so excited. Then, one of my other employees told me she’s pretty sure this new girl has a mugshot out there somewhere so she went looking. 

Dammit if she didn’t find a damn mugshot. So, I called up one of my besties who happens to be a copper copper crime stopper and guess what? This girl working my front desk for the last two or three weeks….turns out she was just in jail for stealing from a cardiologist’s office. At about the same time, a friend of mine that works at that cardiologist’s office called me to see if I’d hired their ex-employee….Lol. I felt like an idiot but, we caught it in time and we went ahead and let her go before she could do any damage. 

But the lesson was learned. Do background checks. They may be so good and capable and smart so that they can figure out how to manipulate your system to steal from you. Just a thought. 

#7 Never Stop Learning

We never know it all, folks. If we ever get to a point that we can stop learning, then we should be traveling the world lecturing and teaching other doctors to be clinical ninjas. 

I’m not there and I’m betting only about .05% of chiropractors are there. Always learn. I just finished the ortho diplomate and now I’m on to Stu McGill, Donald Murphy, and the latest research that is continually coming out. 

I can’t remember where I heard this quote but, “be a learn it all, not a know it all.” This also means to always be taking advice. Be quick to take advice! Seek it out. I remember when I was growing up and my Dad saying, “Son, just remember, no matter how big and bad and strong you get, there’s always someone out there that can beat your ass to a pulp.” This is true. Lol. 

But what else is true is that no matter how smart any of us think we are, there is always someone smarter and more capable. The best part about that is that we can learn from them! Without them beating our asses to a pulp, by the way. Lol

Dr. Greg Kawchuk says we should consume at least one science per day. Meaning, find the papers and consume them. If you have the time to go beyond the abstract, please do. But consume at least one science per day. It’s good for your brain, your soul, your profession, and your patients. 

I just told my wife the other night….I’m going through Stu McGill’s ‘Back Mechanic’ book right now. I told her it’s amazing that I’ve been through Murphy’s CRISP protocol book and I’ve been the through the ortho diplomate program and it’s amazing and so cool that even in the first 30 pages of Dr. McGill’s book, I’m learning even more stuff to stick in the toolbox. 

It’s exhilarating. Keep the foot on the gas pedal folks. Never stop soaking up material at the quickest pace possible. 

#8 – Chiropractic Mentorship

I waited for 11 years or so. I tried to do it on my own. Hell, I didn’t have the money to get a mentor in the first place anyway. But, if I were advising my new doc self, I’d say get a mentor…..as in yesterday. 

I can tell you that I don’t see the value in long-term contracts with them though. There is really only so much you can learn from a mentor so why would we pay thousands more when we exhaust the learning potential. Our chiropractic success is not typically going to lie in the hands of one person and, even if it does, you’ll learn what you need from them in a year or two. Anything beyond that is probably a waste.

At some point, you cease being the student and the group starts learning from you. This is the point that you should graduate into being a member at no charge because you are contributing as much or more than you are extracting. If that makes sense. 

I have had about 2 and a half mentors. One was outstanding and I damn sure paid a high price financially for it. The other was very philosophy minded and we just didn’t jive. I didn’t know how philosophy minded in the beginning but I got out once I figured it out. 

That doesn’t mean I didn’t learn from him though. I got a great hiring process out of that group. I got some great marketing techniques that I could tailor to my own evidence-based means. 

I always treated mentors or practice management groups like buffets. I took what looked good to me and worked for me and I left what I didn’t like and what didn’t fit me. 

I think buying into one person or one system and diving in 100% usually isn’t the best way to do things. Hell, I’m a Christian and I think that way about preachers too. People rallying around one personality and devoting everything and all energy to it……yeah….not my style. 

Just treat them like a buffet and you’ll be fine. I like the idea of a mentor or practice management group that lines up with your way of practicing and I like them mostly because they can keep you focused and keep you accountable for your stats and your practice goals. 

I’m in a great spot in practice and I’ve still considered jumping into a new one just to see if I can get some new, fresh ideas. You should too. Just don’t make an egomaniac more and more rick while they are actively in the process of propagating garbage and ruining our chances of getting this profession where it belongs. Please. 

Good ways to get started for an evidence-based chiropractor would be joining the Chiropractic Success Academy, joining the Chiropractic Forward Facebook group, joining the Forward Thinking Chiropractic Alliance Facebook page, and joining the Evidence-Based Chiropractor Facebook page. 

Look, I get that this next one isn’t a popular topic but hear me out before you tune me out.

#9 – Join Your Associations

What you get out of your involvement is directly equal to what you put into it. By sitting on the Board of Directors for the Texas Chiropractic Association, I made more connections and friends than I could ever count for you or explain to you. It was a dramatic turning point for me personally and professionally. 

These doctors I was on the Board with became life-long friends to me. They’ve helped me solve countless problems over the years when I needed them the most. When I had the billing debacle I mentioned earlier, guess who gave me the way out? A Board member that I called asking for suggestions on billing/collections companies. 

If I’m thinking about ideas for my business, for expanding, for integrating or making any sort of changes, who do you think I ask?I have a network of about 15-20 high level, successful doctors here in Texas and we help each other. We pass advice and information back and forth. 

It was never that way before I became a TCA member and got active. I was by myself making it up by myself with poor information to go on. 

My involvement in the TCA got me into getting a Diplomate. Connections through the TCA is what setting me up for the next 5 years. 

Yes, your association needs you and your talents but more importantly, YOU need your state association. In ways you don’t realize or ever thought of. I thought it would be a time suck and a money suck. I couldn’t have been more wrong. 

Something on this point that I can promise is that if you just join and continue to sit in your office and do nothing, you’ll be helping your association but you’ll get little out of it. At least in regard to what I just described. 

BUT, if you hop in and volunteer, you’ll be exposed to a whole slew of other chiros that will eventually become your comrades in the battle. Your connections will be deep. It’ll happen. Trust me. And you’ll appreciate it. 

Besides all of the things I just mentioned, our state and national associations NEED to have more and more evidence-based practitioners helping steer and advise this profession as we proceed into the next 10, 20, 30 years and beyond. 

Just do it. It’s worth it. 

#10 Don’t Forget About YOU

It’s easy to get caught up in practice. It’s easy to feel like your practice owns you rather than you owning your practice. Hell, I feel that way right now. It happens to everyone. But what I’m trying to do these days is to learn to set aside more time for me and my family. 

Burnout is very real and it doesn’t do you, your family, your employees, or your patients any favors at all. I’ve been burned out at various times so many times. It’s miserable. And it can get to the point that even a long weekend doesn’t make any damn difference. Because all the stuff piles up and you have to wade through it when you get back. It sucks. 

To battle back, I try to have a trip planned at least once per quarter. That way, there is always something to look forward to and plan for. Something on the horizon. 

Now, there is a big difference between taking some time for yourself and being a lazy ass bum. Nobody likes a lazy ass. Everyone respects a worker and a giver so don’t take this one to the extreme. It just means to fit yourself in some time too. That’s all. 

Remember that nobody will be on the death bed and will be thinking, “You know, I really wish I had spent more time at work.” It’s the truth. 

Some trips are big and you can write off as your yearly shareholder’s meeting. Some are just 5-6 hour drives to Dallas or up into Colorado Springs or the New Mexico mountains. The point is, get out of your office. See no patients. 

See your family. That’s the point. 

Certainly, there are more things an old wolf like me can share. There are a lot of things I have yet to learn but I’m seeking. I’m searching it out and soaking it all up. Every single damn day. 

If you have anything to add to the conversation, hop into the private group called the Chiropractic Forward Facebook group and share with the group. We’d love to hear from you. What would you tell a new doc going into practice?

I asked this question in the Chiropractic Forward group and asked the docs to share some of their recommendations:

Dr. Kenneth Chillson over in Cologne Germany says, “The number one cause of failure is the fear of failure. So, stop focusing on fear and start focusing on what you think needs to be done right now. Believe in yourself, because you are the only one that will. 

Dr. Craig Benton in Lampasas, TX says, “Have no fear we can help a ton of people that don’t even know it yet. Get your message out there.” I would add….but be responsible about what you’re putting out there as you message. Remember to be the doctor that you are and what you say and do reflects on the rest of us. Don’t make me or any of the rest of us look bad. We don’t deserve it. Be cool. 

Dr. Don White down in Ft. Worth says, “Never be afraid to say no to a “Good deal” for a contract as an associate if it isn’t a good deal. Better yet ask for more when you get the first offer. Have other people that know more than you do look at any and all contracts before you agree and sign anything. (Contracts for employment, a buildout, a lease, management group, etc)” He also said having a business plan is key for him. 

That’s it. That’s my top 10. I hope you enjoyed the show this week as much as I enjoyed the brain dump you go through when you start pulling out all of the old files in your noggin and searching through them. 

I hope you found value in it and found some things you can use to help you better, make your family better, make your practice better, and make your patients better. 

The best news is that there’s never been a better time to be a chiropractor in the last 30 years. You’re where you are for a reason and chiropractic success is more a certainty than it was 5-10 years ago. Just go out, grab it, knock it out, and take it back home! Lol.  

Key Takeaways

Store

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

Chiropractic evidence-based products
Integrating Chiropractors
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The Message

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

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

It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. 

And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point:

At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….

That’s Chiropractic!

Contact

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

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

w/ Dr. William Lawson – Brand New Guidelines On Neck Pain Treatment

CF 113: w/ Dr. William Lawson –  Brand New Guidelines On Neck Pain Treatment

Today we’re going to be joined by Dr. William Lawson to talk about some brand new guidelines that came out in December regarding neck pain and the treatment of neck pain for chiropractors. Be sure and listen so you’re up on the latest and you’re not doing it wrong!

But first, here’s that sweet sweet bumper music

OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

If you haven’t yet I have a few things you should do. 

  • Like our facebook page, 
  • Join our private facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!

Do it do it do it. 

You have found yourself smack dab in the middle of Episode #113

Now if you missed last week’s episode, we talked about what effect lifestyle might have on dementia and we talked about whether or not the feeling of having a stiff back actually means that you have a stiff back. Make sure you don’t miss that info. Keep up with the class. 

While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. 

I swear to you, I see chiropractors always asking about research papers and what research is there on this or that. I want to yell at the top of my lungs to go and check my damn website. But, you don’t want to look like you’re self-serving and pumping your own tires so…..I say nothing. It IS called social media for a reason. It’s not called to get online and sell your stuff to everyone all the time. So I don’t. 

With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points. 

It just makes sense to be but hell, I used it all of the time because I can’t remember everything off the top of my head. I’m old now. My brain doesn’t brain like that anymore. 

On the personal end of things…..

Guys and girls…..you wouldn’t believe me if I told you. That’s if you’ve been listening regularly over the last 3 months. Now, remember, there’s a two-week delay on these podcasts so keep that in mind but, yesterday afternoon my step-dad went to the ER with heart issues. He’s 80 and he’s the one that had the appendectomy on Christmas day. 

Keep in mind that my biological dad is still in a nursing home at 76 years old after he suffered a stroke back on November 9th. 

Lots of other stuff is going on with other members of my family as well but those are the biggies for now. 

Anyway, it looks like he’ll be getting a heart cath today. I’ll keep you updated. 

On the bright side, I got my certificate to get in a big fancy frame. It’s the one that says I’m a Diplomate of the International Academy of Neuromusculoskeletal Medicine and I have to be honest, I remember being brand new in practice and really admiring the fact that some would go to the lengths of getting a Diplomate. 

I never considered that I would ever be one to do it though. When I got out of college, I didn’t want to see another book or class. I would say I was a bit of a lazy student back in the college days. I learned better from studying notes than I learned from listening to some boring teacher drones on and on day after day. 

Other than the lab classes, it was torture for me. I learn better by having words in front of me and studying them over and over. That’s why the school was so damn difficult for me. Especially histology. Lordy lordy. We had a 98-year-old with a monotone voice teaching us histology at Parker in Dallas. Can you imagine a more dry subject and it was taught by the driest person with the dry-est delivery. Hell no, folks. Hell no. If I had them, I would have given up the nuclear codes just to get him to shut up. It was awful. 

Anyway, the thought of my undergoing another 2-year course of study to get a Diplomate just wasn’t on the radar. And it stayed that way for about 20 years. Until one day. One day I was walking through the exhibit hall at ChiroTexpo ’18 in Dallas, TX and I met one Dr. Tim Bertelsman. He was pumping the tires on ChiroUp. BTW, if you want to go to chiroup.com and sign up with the code Williams99, you can get the first six months for only $99/month. You won’t regret it. 

Anyway, once he went through all of the amazing stuff that ChiroUp can do for me and my patients, he looked up at me…..I’m a pretty tall dude….and he said I should come to his lecture on back pain later that day. He said that it counts as 10 hours toward the 50 live hours needed toward the Orthopedic Diplomate. He said very confidently, “Come check it out. You’ll like it. You’ll stay.”

He got a chuckle out of me on that. I had other things I wanted to do for the weekend. Ten hours in a classroom wasn’t in the plans. Hell, being in TCA leadership, I already get about 40 or more hours a year anyway. 

Plus, The Diplomate was not on my radar so that didn’t mean anything to me but I was intrigued by the idea of focusing my knowledge and thoughts on the low back so I made sure I sat in on his class. At least for a bit just to check it out. 

Well, it’s obvious at this point, but I sat through the whole weekend. Dr. Bertelsman just nailed it. He’s engaging and interesting and extremely knowledgeable. He’s a star on the speaking circuit. 

So, I finished that class and thought, if that information was so good, what could I learn from the next one and on and on? Plus, I’d already knocked out 10 of the 50 live hours. Makes sense to at least look at it as a possibility. 

The more I looked at it, the more I realized that the Academy, Dr. James Lehman with the University of Bridgeport, and the Australian group with Dr. Anthony Nicholson and Dr. Matthew Long called Chiropractic Development International have all really really gone to great lengths to make getting that Diplomate easily accessible. They are working together to create a new culture of chiropractors. Chiropractic practitioners that are on a different level – a different plane from your regular run of the mill general chiropractor. 

I would have to say they have done just that. With only 5 live hour weekends required over the course of a year and half to 2 years, and the ability to take all of the other 250 hours in the comfort of you home…..well, it made sense. I get a ton of hours every year anyway so….why not?

I put the pedal to the metal and got the hours knocked out in about 6 months and spent the rest of my time just studying and reviewing the material. It worked out. Here we are, about the frame a certificate. 

The point is, it’s more convenient than it’s ever been and you can and should do it. If for now other reason than to be the best in your community at assessing, diagnosing, and treating. I mean really, who the hell doesn’t want that?

We are joined on the podcast today by the doctor that made it more convenient for folks in Texas to take on the Diplomate program.  Dr. William Lawson is our guest today. 

Dr. Lawson is located down in Austin, TX

He has a diplomate in Chiropractic Orthopedics as well as a Diplomate in Integrative Medicine college of pain management. 

He has a masters degree in Health Care Administration

He is certified in acupuncture

He is heavily involved in the Texas Chiropractic Association

He is an Air Force veteran

He does Designated Doctor work as well as medicolegal work

Let’s welcome Dr. William Lawson to the show. Thanks for taking some time out to come on the show today, Bill. Welcome!

This is actually your second time on The Chiropractic Forward show. The last time was September 27, of 2018 and it was episode #41. Here we are in episode 113 so it’s been a bit. Tell me what all has been going on in the life of Dr. Lawson since then

A quick review at chiropracticforward.com tells me that the last time you were on, we spent the episode discussing research targetting the cervical region. I remember fussing because we have so much research-based around the lumbar region and low back pain but nothing near as robust for the cervical region. Then, you got involved in research paper having to do with neck pain and treatment. Tell us how that came about and tell us what part you played in it. What was your contribution to it? 

So it turns out, all I have to do is raise a fuss to get neck pain some attention and voila…..here we are. : )

I noticed in the Acknowledgements section, some of our other friends were also involved in contributing. Drs Kris Anderson up in North Dakota, Dr. Craig Benton in Lampasas, TX, your name of course, and Dr. Dean Smith who is active with the Evidence-Based Chiropractor group. It looks like an excellent group. 

Let’s go ahead and give it this paper the Chiropractic Forward treatment if that’s OK

This paper you were involved in is called “Best-Practice Recommendations for Chiropractic Management of Patients With Neck Pain” authored by Wayne Whalen, Ronald Farabaugh, Cheryl Hawk and a slew of others. It was published in the Journal of Manipulative and Physiological Therapeutics on December 20, 2019 – Hot potato…

Why They Did It

Dr. Lawson, since you were involved in it, walk us through their reasoning for doing the paper if you will. 

How They Did It

I must admit to only reading the abstract so far so lead us a little deeper into how they go about formulating these guidelines and recommendations?

For those that don’t know or don’t really get deep into research, can you give us a layman’s explanation of what exactly a Delphi Panel is?

What They Found/Wrap Up

Tell us what they came up with. At the end of the day and after all of the effort, what do we have going forward?

(This is a good point to go beyond the abstract and cover the 16 points made in the Best-Practice Recommendations For Chiropractic Management of Neck Pain section of the paper)

  1. Begin care management with a thorough history.
  2. Follow the history with a condition-specific examination. It is the duty of the provider to perform an examination consistent with the complexity of the case, based initially on history, which includes the mechanism of injury.
  3. Evaluate patients with complaints of neck pain for potentially serious red flags.
  4. Consider referral for diagnostic imaging or other studies based on established clinical practice guidelines (see “Diagnostic Imaging” later).
  5. Develop a care plan based on history and examination. The care plan includes appropriate diagnostic tests. Sometimes referred to as a report of findings, the history, examination findings, plan of care, and prognosis should be reviewed with the patient through a process of shared decision-making and with their consent to proceed obtained.17
  6. Document factors that may delay recovery. (Yellow Flags?)
  7. Develop a working diagnosis and, when clinically indicated, consider differential diagnoses.
  8. Reassure the patient regarding the generally benign nature of minor neck pain and encourage activity and movement. With moderate to severe neck pain, emphasize the importance of treatment plan compliance.
  9. Determine whether to (a) manage the patient exclusively, (b) co-manage, or (c) refer to another provider.
  10. Begin treatment with a brief trial of care, 6 to 12 visits, followed by evaluation for treatment effectiveness. The initial trial is not the same as a limit or cap on care.
  11. Evaluate the patient briefly during each encounter, pre- and post-treatment. Conduct a more focused condition-specific evaluation after each benchmark in the treatment plan. Examples: Every 6 to 12 visits, or in 30-60-90-day intervals.
  12. Some patients’ responses to treatment may not follow a predictable pattern, or they may not respond. In this case, consider a modification to the treatment plan that may include, but may not be limited to (a) change in technique and/or modality, (b) referral to another provider within the same discipline for a second opinion, (c) referral to another provider outside the discipline for a second opinion and consideration of other treatment approaches, or (d) referral for diagnostic tests (eg, X-ray, magnetic resonance imaging [MRI], computed tomography scan, neurodiagnostic or blood studies)
  13. Refer patients with new or worsening symptoms or evidence of psychological issues to providers with expertise in those areas (eg, behavioral health).
  14. Determine at each visit and/or evaluation if the patient is improving, is worsening, or has plateaued, and discharge if appropriate.
  15. Encourage and provide home and self-care approaches.
  16. Document the history, clinical examination, treatments performed, the rationale for and response to care, and any referrals.

In the paper, just after the section we just covered, they recognize that not all patients recover fully. Unfortunately, we’re all well-aware. Tell me a bit about what they have to say about that. 

For patients who have reached MTB, the question then becomes: What is the best course of care to help control the ongoing pain? In general, patients unable to reach full recovery fall into one of these categories:

  • 1. No physician/provider intervention is necessary. The patient has residual minor neck pain but can manage it with self-care strategies: ice, nonsteroidal anti-inflammatory drugs, home-based exercise.
    2.
    Physician/provider intervention is necessary in periodic episodes of care. The patient experiences pain that exceeds his or her ability to self-manage and must return for care in an episodic fashion.
    3.
    Physician/provider intervention is necessary on an ongoing basis. The patient experiences pain that exceeds his or her ability to self-manage, and in the absence of care the condition deteriorates. These patients often benefit from 1 to 2 visits per month to providers of nonpharmacologic conservative care who use spinal manipulation, to be reevaluated every 6 to 12 visits.

Now, I have been seeing this paper being shared and discussed all over the Forward Thinking Chiropractic Alliance Facebook page as well as the Evidence-based Chiropractor Facebook group. Those are all very like-minded docs in there and we all love practice guidelines, the idea of professional standardization, a certain level of standards within that construct, and those sorts of things. 

So it’s no surprise that a paper putting guidelines into the profession is well-accepted by those groups. I wonder if you’ve seen or noticed any thoughts or opinions elsewhere? Basically, what is the paper’s reception as far as the rest of the profession is concerned? Or do you know? A lot of chiropractors don’t know a thing about research or new research and may not even know it exists. 

Let’s start wrapping it up a bit, do we have any more research papers you’re contributing to? What is next on your horizon? 

Thanks for coming on the show this week


The Message

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

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

It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. 

And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point:

At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….

That’s Chiropractic!

Contact

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

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Lifestyle Effect On Dementia & Feeling A Stiff Back May Not Mean A Stiff Back

CF 112: Lifestyle Effect on Dementia & Feeling A Stiff Back May Not Mean A Stiff Back

Today we’re going to talk about Lifestyle and Dementia and Does the feeling of a stiff back really mean your back is actually stiff?

But first, here’s that sweet sweet  bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

If you haven’t yet I have a few things you should do. 

  • Like our facebook page, 
  • Join our private facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!

Do it do it do it. 

You have found yourself smack dab in the middle of Episode #112

Now if you missed last week’s episode , we talked about how the American Family Physicians my be warming up to chiropractic and what supplements actually have some evidence behind them. Make sure you don’t miss that info. Keep up with the class. 

While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points. 

On the personal end of things…..

You remember how I mentioned that my life has been a bit of a soup sandwich lately? Yeah, well, I had my front door glass broken out yet again. That’s twice in about 3 weeks. We’ve not had any issue whatsoever with our building or break-ins in over 10 years in the same locations. All of the sudden, bam…. here we are about $500 lighter in deductible fees and about to be a lot lighter in the bank account because now I have to invest in some security cameras. 

Because I’m done folks. Luckily, they caught the little a-holes and they’re sitting in the Randall County Jail. I’m hoping that’ll be their new home for a while. Hopefully long enough for them to learn their lessons. 

Other than than, life is motoring a long. Wrapped up January in fine fashion. My goals are always 10% better. If you can do better than that, then heck yeah. But for me, 10% better is a minimum for me each year. In each category. Are you keeping stats? I mean accurate, robust stats. 

I keep them for just about everything I can think of. And you should too. I hit my numbers big time in 2019. Now, I’m getting with my main marketing girl and trying to see how we’re going to improve 10% over what was already a big big year for us. 

That’s another question I have; without getting into politics, I’m going to tell you that all was well up through 2014 or so. But then 2015 and 2016 came along. We dropped off. Not dangerous numbers but I’d classify it as a significant dropoff for sure. 

Then came 2017 through 2019 and we saw tremendous growth and numbers. So, my question, if we look at what was happening in the USA around that time, we had the winding down of the Obama Presidency and the election of a different President. 

Now, anyone can say anything they want about the White House’s current occupant but I don’t think anyone can deny that the economy has been hitting on all cylinders. 

So back to the question at hand; does it matter at all which President is in office? Which party holds the office at The White House? Does it matter?

I may get some blow back here but I’m trying to look at it in a non-partisan, non-political way and say, that in my expereince, it has mattered and my business has done much better since the 2016 election than the years prior to. 

Now let’s be fair, a lot of research has emerged in that time. The American College of Physicians recommended spinal manipulation, the White House recommended spinal manipulation, The Lancet Papers came out, Dr. Goertz kicked the VA doors down with her research…..basically, I don’t think it’s one thing like which party is in the Presidency. 

But, can we deny that when the economy is killing it like right now, that patients seem more willing and more confident to spend money? My uneducated but experienced guess is that yes, the economy has an effect on our businesses and the party in power affects the economy. 

Alright, those of you that disagree, go fire up my email inbox. I’m always all ears and willing to learn so feel free to tell me all about it. 

I want to talk about some much much cooler stuff than that right now though. I want to discuss some papers on lifestyle and genetics in regard to dementia as well as if feeling back stiffness actually means you have a stiff back. Pretty interesting stuff there. 

Before we dive into the reason we’re here, it’s good to support the people that support evidence-informed practitioners. Well, ChiroUp certainly does just that. 

If you don’t take advantage of the deal I’m about to offer you, I think you just might be crazy.

Regular listeners know I’ve used ChiroUp since for well over a year now. I’m going to tell you want it is and then share a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months. So listen up!

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, activities of daily living, & for their exercises. 

This save you so much time – no more explaining & re-explaining your patient’s care, because they have access to it right there at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports and exercises are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you by people that are deep into the research. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice.

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL and, to sweeten the deal, you can use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super saver code is Williams99.

Item #1

Let’s start out with this one in JAMA called “Association of Lifestyle and Genetic Risk With Incidence of Dementia” by Lourida, et. al. and published on July 14, 2019(Lourida I 2019)….it’s not sizzlin but it’s steamy folks. 

Why They Did It

The authors objective was to investigate whether a healthy lifestyle is associated with lower risk of dementia regardless of genetic risk. 

How They Did It

  • The study included 196,383 subjects
  • They were followed up for 1,545,433 person-years
  • This paper was a retrospective cohort study i
  • It included adults of European ancestry aged at least 60 years 
  • The subjects had no cognitive impairment or dementia at baseline. 
  • They joined the UK Biobank study from 2006-2010 and were followed until 2016 or 2017
  • They scored for dementia
  • and paid close attention to lifestyle factors such as smoking, physical activity, diet, and moderate alcohol consumption

Wrap Up

The authors concluded the following, “Among older adults without cognitive impairment or dementia, both an unfavorable lifestyle and high genetic risk were significantly associated with higher dementia risk. A favorable lifestyle was associated with lower dementia risk among participants with high genetic risk.”

So, just to keep you all smart, in summary, no matter where you fall on the genetic risk continuum, don’t smoke, eat healthily, drink in moderation, and get some exercise. And tell your patients to do the same. 

OK, Item #2 

This one is called “Feeling stiffness in the back: a protective perceptual inference in chronic back pain” by Stanton, et. al. and was published in Scientific Reports in August of 2017(Stanton TR 2017). Not smoking hot but only a couple years or so old. 

Why They Did It

The authors were looking to test the idea or notion that have a back that FEELS stiff actually means you have a stiff back. They wanted to propose a new hypothesis and that is that feelings of back stiffness are a protective perceptual construct, rather than reflecting biomechanical properties of the back. This new theory, if proven, would have far-reaching implications for the treatment of pain and stiffness going forward. 

How They Did It

They used three different experiments to challenge the view by demonstrating that feeling stiff doesn’t actually relate to the objective measure of actually being stiff. In addition, objective back stiffness doesn’t differ any between those who report FEELING stiff vs those who do not. 

What They Found

Those reporting a feeling of stiffness actually are showing self-protective responses and they significantly overestimate force applied to their spine. 

Wrap It Up

Here we show that conscious experience of feeling stiff does not reflect true biomechanical back stiffness, but may rather represent a protective perceptual inference that may serve to reduce movement and re-injury. By showing that feelings of stiffness do not relate to biomechanical stiffness measures and that biomechanical measures of stiffness do not differ between those with and without feelings of stiffness, this suggests that information other than actual joint stiffness is influencing this perceptual inference

Correct me if I’m wrong but, to an extent that sounds similar to what we commonly hear called ‘fear-avoidance’. What would you say is a common way to deal with fear-avoidance? I would be bold enough to suggest that an effective means is a concept of ‘hurt vs harm.’ 

Fear-avoidance can keep patients in chronic pain syndrome but if they start moving and start exercising, they start trusting their bodies more and more. We are clear to them that some movements may hurt a little bit and that’s OK. It’s part of the process. But, if the movements feel ‘harmful’, they should stop and let’s take a closer look at what’s going on. 

We all know that most exercises for most people are not actually harmful. Once they get moving and making progress, they get excited, don’t they? Fear-avoidance goes down, activity level goes up, and health gets a boost. 

The patient is a winner and the doctor is a winner. Hell, the patient’s family is a winner. Have you ever had to be around a chronically painful or ill patient? It’s misery for all involved. Plus, what if the person in chronic pain typically cooks for the family? Obviously, everyone here is the winner because I like some biscuits. 

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

The Message

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

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

It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. 

And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point:

At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….

That’s Chiropractic!

Contact

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

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Lourida I, H. E., Littlejohns TJ, (2019). “Association of Lifestyle and Genetic Risk With Incidence of Dementia.” JAMA 322(5): 430-437.

Stanton TR, M. G., Wong AYL, Kawchuk G, (2017). “Feeling stiffness in the back: a protective perceptual inference in chronic back pain.” Sci Rep 7(9681).

10 Back Facts & How Does Chiropractic Perform When Integrated?

Jordan Hospital Spine Care demonstrated the quality and value of care rendered to a population of patients. This was accomplished with a relatively low cost and with high patient satisfaction.

... continue reading.

Joint Replacement Expectations, Spinal Infections, & Vitamin D with Calcium

CF 106: Joint Replacement Expectations, Spinal Infections, & Vitamin  D with Calcium

Today we’re going to talk about Joint Replacement Expectations how long can you expect a joint replacement to actually last, we’ll talk about Spinal Infections – what are some of the signs and symptoms according to research, and they we’ll cover a paper in JAMA on supplementation with Vit D alone vs. Vitamin D with Calcium. Stick around for a great show. 

But first, here’s that sweet like a Christmas candy cane bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. So go get one and crack it open because we’re off and running. 

Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

If you haven’t yet I have a few things you should do. 

  • Like our facebook page, 
  • Join our private facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. 

Do it do it do it. 

You have ping ponged into Episode #106. And my Parker alums will remember all of the ping pong that went on there at the student rec room. Pretty heated matches right there!

Now if you missed last week’s episode on Groupon deals, Gabapentin, and on Weight Loss…. make sure you don’t miss that info. As I tend to do, I got a little red in the face and probably got a bit dramatic and opinionated but I felt better by the time it was over with. 

Did you know that if you have an Alexa product, you can now just say something like, “Alexa, play The Chiropractic Forward Podcast on Apple Podcasts” and kablooey! You here the golden throated stylings of yours truly! Lol. You can say skip ahead 30 seconds, play previous episode, and on and on so pretty cool right there. 

On the personal end of things the Holidays are always stressful and this season has been a bit extra with my Dad having the stroke and being in the rehab hospital. That and whatever other daily trials and tribulations that come along with raising teenagers. 

It’s been journey but isn’t life just like that? Whack a mole every day. Whackin whacking whacking. Sometimes it’s exhausting. Obviously, I have a little turmoil poking it’s head up here and there lately but I’m a good swimmer. 

What I mean is, this world is full of sinkers and swimmers. Very rarely do you find simple water treaders. We’re sinking or we’re swimming. The sinkers let life happen to them rather than happening to life. 

They either make things happen, let things happen, or wonder what the hell just happen. 

On the other hand, swimmers are making things happen every day. Things keep coming at them and they keep batting them away and they stay above water. Hell, some of them make a game out of it and adapt to have the best breaststroke or back stroke you’ve ever seen. 

Those are the ones that just act like they’re indestructible. Well, I’m not indestructible. At all. I’ve been going through a season lately for sure. Nothing about business. All about my dad and other family stuff here and there. Luckily, I have an amazing wife and support structure. Good support allows swimmers to swim. She allows me to be a swimmer. No doubt. 

Enough about all that. Again, I share personal aspects because I know many of you will either relate on some level and ideally maybe even draw some inspiration. Others can learn from it I think. At least that’s my hope. 

By the time this airs, Christmas will have come and gone. I hope you had the merriest of Christmases. Being a Christian myself, I can’t tell you how much I love the season, the music, the magic of giving. Even with all of the hustle and bustle and pain in the butt it brings, it’s a special time of year and I try to keep it special for me and the family. 

Before we dive into the reason we’re here, it’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you don’t take advantage of this deal, I just think you might be crazy.

If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99.

Item #1

This one is called “Vitamin D and Calcium for the Prevention of Fracture. A Systematic Review and Meta-Analysis” it was authored by Yao, et. al. and published in JAMA Open on December 20, 2019(Yao P 2019). 

Hot hot hot like Texas in the Summer.

Why They Did It

Considering that vitamin D and calcium are recommended for prevention of fracture but prior RCTs have reported conflicting results, the authors wanted to assess the risks of fracture associated with differences in concentrations of 25-hydroxyvitamin D in observational studies and the risks of fracture associated with supplementation with Vitamin D alone or in combination with calcium in RCTs

How They Did It

  • Systematic review and meta-analyses. 
  • 34,243 participants. 
  • They mined data from PubMed, EMBASE, Cochrane Library and other RCT databases
  • Observational studies involving at least 200 fracture cases and RCTs enrolling at least 500 participants and reporting at least 10 incident fractures were included
  • RCTs compared Vit D or Vit D with calcium with control
  • Two researchers independently extracted the data and assessed possible bias

Wrap It Up

The authors concluded “In this systematic review and meta-analysis, neither intermittent nor daily dosing with standard doses of vitamin D ALONE was associated with reduced risk of fracture, BUT daily supplementation with both vitamin D and calcium was a more promising strategy.” To the tune of a 16% reduced risk of hip fracture. I’d sure as hell take that reduced risk if it’s my mom, wife, sister, or if it’s a patient. 

So, if you have a patient with osteoporosis and I know that you absolutely do…..it looks evidence-based to tell them to supplement with Vitamin D but only if they add Calcium to the mix. 

I love getting smarter and better. This is a nugget that does just that for us. 

Item #2

Joints!! 

How many knee replacements do you check reflexes on during the month? We average around 70-80 new patients per month so the answer in my office is, ‘several’. 

You probably already know that surgeons don’t like to do knee or hip replacements on younger folks because they don’t want the replacement to wear out before the patient dies. They don’t want the patient to have to go through the damn thing twice basically. 

The Lancet medical journal recently published two papers on the topic. One on the hip and one on the knee. One was called “How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up” and the other was called oddly enough “How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.” They were both authored by the same group led by Jonathan Evans and were published in The Lancet on February 16, 2019. Not hot off the press but not room temperature either. Very luke warm, folks. (Evans J 2019, Evans J 2019)

Why They Did It

For both papers, it’s pretty obvious why they did it. They want to know how long hips and knees last when replaced. Easy peesy. 

How They Did It

  • The papers were systematic reviews and meta-analyses 
  • Medline and Embase were used from Sept 12, 2017 to current
  • They used 140 eligible articles
  • They also reviewed reports of national joint replacement registries

Wrap It Up

On the hip paper, they concluded “Assuming that estimates from national registries are less likely to be biased, patients and surgeons can expect a hip replacement to last 25 years in around 58% of patients.”

On the knee paper, they concluded “Approximately 82% of total knee replacements last 25 years and 70% of unicondylar knee replacements last 25 years.”

Isn’t good to have a solid number you can confidently tell your patients when they’re thinking about making that appointment with the orthopedic surgeon?

Item #3

Our last paper this week is on spinal infection. It’s called “Red flags for the early detection of spinal infection in back pain patients” authored by Yusuf et. al. and published in BMC Musculoskeletal Disorders in December of 2019. (Yusuf M 2019)

Sizzlin’ hot like a Summer sidewalk come on.

Why They Did It

The aim was to conduct a systematic review specifically reporting on studies that evaluated the diagnostic accuracy of red flags for Spinal Infection in patients with low back pain.

How They Did It

  • Again they mined the biggies like Medline, Cochrane, and EMBASE,  but also Pedro, Web of Science, OpenGrey, and Grey Literature Report
  • 40 papers were accepted
  • A total of 2224 cases of spinal infection were identified

What They Found

  • Spinal pain and fever were the most common clinical features
  • Diabetes and IV drug use were the most occurring determinants
  • MRI was the most used imaging and 
  • Staphylococcus aureus and mycobacterium tuberculosis were the most common microorganisms detected. 

Wrap It Up

The authors wrapped it up saying, “The current evidence surrounding red flags for spinal infection remains small, it was not possible to assess the diagnostic accuracy of red flags for spinal infection…..the most frequently reported clinical feature was the classic triad of spinal pain, fever and neurological dysfunction.”

Key Takeaways

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

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

The Message

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

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

It’s safe and cost-effective. It can decrease surgeries & disability and we normally do it through conservative, non-surgical means with minimal hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, we 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. When it comes to non-complicated musculoskeletal complaints….

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show 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

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

  • Evans J, E. J., Walker R, Blom A, Whitehouse M, Sayers A, (2019). “How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.” The Lancet 393(10172): 647-654.
  • Evans J, W. R., Evans J, Blom A, Sayers A, Whitehouse M, (2019). “How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.” The Lancet 393(10172): 655-663.
  • Yao P, B. D., Mafham M, (2019). “Vitamin D and Calcium for the Prevention of Fracture. A Systematic Review and Meta-analysis.” JAMA Open 2(12).
  • Yusuf M, F. L., Selfe J, (2019). “Red flags for the early detection of spinal infection in back pain patients.” BMC Musculoskelet Disord 20.

Thoughts on Chiropractic Groupon, Gabapentin, & Weight Loss Research

CF 105: Thoughts on Chiropractic Groupon, Gabapentin, & Weight Loss Research

Today we’re going to talk about some thoughts on Groupon and Chiropractic, if you know me, you probably know where this is going and it’ll probably be fun. We’ll find out. We’ll talk about Gabapentin and we will talk about a couple of papers I encountered recently having to do with metabolism, intermittent fasting, and things of that nature. 

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. So feel free to crack one wide open would you?

Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

If you haven’t yet I have a few things you should do. 

  • Like our facebook page, 
  • Join our private facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. 

Do it do it do it. 

You have plopped down into Episode #105 just like a comfy easy chair. 

Now if you missed last week’s episode talking about our TWO YEAR wrap up, make sure you don’t miss that episode. It was a lot of fun to put together and to reminisce on some of the amazing episodes we’ve had over the past two years. Good good stuff. 

Something new I found out here…..Did you know that if you have an Alexa product, you can now just say something like, “Alexa, play The Chiropractic Forward Podcast on Apple Podcasts” and kablooey! 

You automatically start to hear the golden throated stylings of yours truly! Lol. You can say skip ahead 30 seconds, play previous episode, and on and on so pretty cool right there. 

On the personal end of things, we just found out that Dad started moving his left leg today for the first time and that’s exciting. It’s the first REAL solid sign of big progress since his first stroke on November 9th. As you can imagine, we are ecstatic about this. Good stuff. Keep on keeping on Pops. Strong like bull!

Before we dive into the reason we’re here, it’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you don’t take advantage of this deal, I just think you might be crazy.

If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99.

Item #1

Alright let’s dive in. We’ll save Groupon until the last because if I know me, it’ll be what I have the most to say out of all of these. 

Let’s start with Gabapentin shall we? The most recent article I’ve come across was in The Atlantic. It was authored by Olga Khazan and called ‘Chronic Pain Is An Impossible Problem’. It was posted December 9, 2019(Khazan O 2019). 

That’s got some sizzle on it!!

Some key points in the article are that 

  • Chronic pain affects about 1/5 of American adults
  • For years those in the medical field thought it could be treated with painkillers like Oxy but that was proven wrong when basically three planeloads of Americans started dying of opioid-related causes each week
  • Now, they’ve turned to Gabapentin, an anticonvulsant, to help treat it. 
  • From 2012-2016 prescriptions of the medication went up 64%
  • There is emerging information that Gabapentin may not be as safe as previously believed. Certainly when combined with other sedating meds. 
  • When taking it long-term, patients can develop tolerance so more and more is required to reach the desired effect. 
  • There is also a withdrawl effect when trying to get off of gabapentin. 
  • People are now starting to use Gabapentin in combination with Baclofen and benzos like Xanax to increase the intoxicating effect. We can see where that is going can’t we?
  • The article goes on to say, “not only does gabapentin appear to exacerbate or create overdose risk, it also doesn’t work well for chronic pain.” They site a study that we’ll cover in a second. 
  • The paper wraps up by saying they’re essentially out of option when it comes to chronic pain. Which to me says they’ve run out of pills basically. That doesn’t mean they’re out of options though. 
  • Arthur Robin Williams, an assistant professor at Columbia University says “The medical community should take a closer look at non-pill remedies such as physical therapy and psychotherapy…I would add evidence-informed chiropractic… These treatments are often not covered by insurance, take longer to work, and take more of providers’ time. But for many, they might be a better option than yet another pill that has yet another pathway to abuse. “The reality is, a lot of the pills that change how you feel in the next 10 to 30 minutes,” Williams says, “carry addictive liability.”

Well…..no kidding? Who would have ever thought that? Hmmm….let’s see. Oh yeah, every chiropractor and PT that ever lived. 

Let’s combine that with a systematic review and meta-analysis from just last year that was in the Canadian Medical Association Journal called “Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis”(Enke O 2018)

  • Nine trials compared topiramate, gabapentin or pregabalin to placebo in 859 unique participants. Fourteen of 15 comparisons found anticonvulsants were not effective to reduce pain or disability in low back pain or lumbar radicular pain. 
  • There was high-quality evidence of no effect of gabapentinoids vs. placebo on chronic low back pain. 
  • The lack of efficacy is accompanied by increased risk of adverse events from use of gabapentinoids, for which the level of evidence is high.

It is painfully obvious (no pun intended) that pills aren’t cure-alls and aren’t curing the pain problem. And they won’t sure the pain problem so isn’t it time to look elsewhere? In the year 2020?

All of this is cited in the show notes at chiropracticforward.com. Go get the article and the paper. Use it to educate your community on gabapentin. Set yourself as the reasonable alternative to it. 

Item #2

Fasting and weight loss. I want to be right up front on this, I’ve always wanted to make nutrition and weight loss a part of my practice in some shape form or fashion but, if I’m being honest, I’m just straight up a big big dude. Like I’m 6’4” and, depending on the time of year, 280+. I was a college offensive lineman. I played center and i anchored that line pretty well with my overall biggness. Lol. 

Cat-like reflexes people but big as a damn house. So, I’m not going to teach you how to implement weight-loss into your practice here but I am going to give you some interesting research I cam across recently that might make you think a bit. 

The first paper on this is called “Effects of time-restricted feeding on body weight and metabolism. A systematic review and meta-analysis”. It was published in Reviews in Endocrine and Metabolic Disorders, authored by P Marianna, C Iolanda, et. al. and published December 2019. (Marianna P 2019)

Hot to the touch. It’ll burn your  damn finger prints off. 

Why They Did It

Restriction in meal timing has emerged as a promising dietary approach for the management of obesity and dysmetabolic diseases. The present systematic review and meta-analysis summarized the most recent evidence on the effect of time-restricted feeding (TRF) on weight-loss and cardiometabolic variables in comparison with unrestricted-time regimens.

How They Did It

  • A total of 11 studies, 5 randomized controlled trials and 6 observational, were included
  • All selected studies had a control group without time restriction
  • Most studies involved the Ramadan fasting

Wrap It Up

Time restricted feeding regimens achieved a superior effect in promoting weight-loss and reducing fasting glucose compared to approaches with unrestricted time in meal consumption. 

As we’ve covered, systematic reviews and meta-analysis are, ideally, high-level research and, considering the majority of the included studies involved the Ramadan fasting regimen, I went to search it up to see what the what. 

So, what exactly is a Ramadan Fasting Regimen? Well let me tell you. And I’m not going for the fancy stuff because I’m tapped for time here so we’re just going to hit up Wikipedia real quick and Wiki says that the basics are:

  • Fasting from sun up to sun down
  • Abstinence from sex, food, and drink
  • It also means one should refrain from things like
  • violence
  • anger
  • envy
  • greed
  • lust
  • angry/sarcastic retort
  • gossip
  • and you’re supposed to get along with others better than you normally do

In America at least, I’m certain we’ll all just do the food part because everyone’s so busy looking for a reason to be offended that I’m certain being nice and getting along is off the table for now. 

So, if you have any personal experience with intermittent fasting, if you’re an expert on the topic, shoot me an email at dr.williams@chiropracticforward.com Let’s talk about it. Maybe we can set up some guests and do a full episode or two on the topic to educate our community of docs on the matter. Sounds like a great topic so hit me up. 

Now, the last thing I have here I want to talk about is Groupon. 

This one is a bit of a trigger for me honestly. Looky here. I am well aware that people are struggling. I’m well aware that I am fortunate and to sit and judge can seem disconnected and unfair at minimum to some. I definitely get that. 

What I also understand is that a whole bunch of those that are struggling are in a profession they really shouldn’t be in because they’re lazy and want to sit behind their desks and hit a few buttons and be magically transformed into a master chiro with an office stocked full of patients and never ending new patients. 

That’s magic time dreamland stuff. 

There will always be supposed shortcuts. There will always be business hacks or whatever you want to call them. But at the end of the day, shouldn’t you make decisions while keeping several things in mind? Meaning, you have to do what is best for your family. You have to do what is best for your office and your employees. But don’t you feel like you should make decisions based on what is best for your profession and for your colleagues?

I would hate to think that I’ve done something that damages my profession . Obviously I don’t mind calling out BS business practices and unethical chiropractors. If that’s damaging my profession well then, I’m guilty as hell. 

But when you are making the deals some of these guys and gals are making on Groupon, you are demeaning, lessening, and trashing what the rest of us take a great deal of pride in. 

Imagine, you go through chiropractic school, you survive 21+ years in practice while steadily getting more and more education, you take on a Diplomate program and finally complete that, and you are fighting on the state level for your profession and your profession’s image…..and then you open your email. 

Yes, I get emails from Groupon with their best and newest deals. I open it up and BAM….It almost seems like all of that work can just be flushed down the toilet. It’s depressing and it makes me want to club baby seals. 

Before we start talking about the article, I did a quick search for Groupon deals in my area and, right there next to Reflexology deals popped up this:

  • 10% cash back – Sounds like a damn car deal
  • Consultation, exam, x-rays, adjustment, and one full-body vibration plate session for $70. Way to value your services. Great. Way to look awesome. Assuming they actually need vibration plate. Assuming they actually need x-rays, assuming they even need and adjustment. Blah
  • Then this one, it’ll make you tickle – One laser lipo session w/ two vibe plate sessions for $45. See…..in Texas, you can only have laser lipo if you’re trying to increase function. Not just look better. So, that’s not necessarily legal as this implies to me it’s for looks. Unless they have a medical director and I’m here to tell you they do not. 
  • When you go to the bigger cities, it only gets worse. I found a $564 value for only $43.70!!! What a damn deal!!!

It’s all just shady and sketchy. Luckily, there are only two in my area doing this stuff. And if they keep it up, we may have two less competitors here as well. 

Besides the shady, street corner huckster look it so convincingly creates, it’s potentially illegal based on the idea of fee splitting, Medicare inducement, and dual fee schedules and, if the state boards start getting their acts together and going after this stuff, they will be the ones to go down. 

What started me down this path today was an article I came across called “Legal Implications of Chiropractic Groupons.” It was written and posted on the website for Carlson and Jayakumar – attorneys at law. I’ll have the link in the show notes. https://cjattorneys.com/legal-implications-of-chiropractic-groupons/

Highlight of the article include:

  • Each day, numerous chiropractors contract with Groupon and its competitors to sell certificates for adjustments, examinations, x-rays and massages. 
  • Despite the variety of services offered, these programs all have two things in common: (1) the chiropractor is offering a significant discount –92% in some examples, and (2) the chiropractor is sharing the income from each certificate sale – usually around 50% – with the website. While we are unaware of any state board taking action against a licensee for a Groupon-style offering, we believe these programs could create significant civil and criminal liability for chiropractors.
  • most states have rules prohibiting the offer or acceptance by a chiropractor of any commission, discount, or other consideration as compensation or inducement for referring patients, clients, or customers to any person, irrespective of the practitioner’s membership, proprietary interest or co-ownership in or with that person. I was once offered the opportunity to buy in to an imaging center here in town. As badly as I wanted to do it, I made the mistake of hiring two different attorneys for their opinions. BOTH advised against and this is exactly why. 
  • With Groupon, money is paid by the chiropractor to the website in connection with a patient’s referral. The chiropractor essentially, albeit indirectly pays the website per patient that purchases the certificate. At their base, these agreements require the chiropractor to pay the website for soliciting, referring and/or procuring clients not he chiropractor’s behalf. Stuff you’re not supposed to do and can get in a lot of trouble for. 
  • Medicare’s Anti-Kickback Statute criminalized the payment of kickbacks for patient referrals. Subsequent laws expanded it to all federalpay programs. Kickbacks include “any remuneration,” a very broad definition, which includes coupons. The Office of the Inspector General issued a “Special Fraud Alert” regarding advertisements offering “discounts” given to Medicare beneficiaries. Then a “Special Advisory Bulletin” appeared on offering inducements to Medicare beneficiaries. Essentially, it said a provider could not offer a patient anything worth more than $10, and combined $50 in a year for multiple gifts.
  • Groupon-style deals are unadvisable as they may pose problems with insurance companies. Most insurance policies will not pay for any charges that would not have been made in the absence of insurance. Groupon offerings, which almost always charge a lower fee to the purchaser versus insured patients, could be viewed as creating a “dual fee schedule.”  Insurers believe dual fee schedules constitute fraud and over billing. Some argue that Groupons are merely a version of a prompt-payment discount. While California law expressly permits prompt-payment discounts, such discounts must be reasonable. Given the extreme nature of the discounts typically offered by Groupon and its competitors, such certificates likely would not fall under the prompt-pay exception.

They conclude that “Given their widespread use, it seems unlikely that the Board of Chiropractic Examiners would discipline each and every licensee who engages or has engaged in Groupon-style offerings. That said, there may be a rash of “test case” or “example” disciplinary actions that follow. Eventually, we would expect the Board to adopt a regulation, or the Legislature to pass legislation, that explicitly either proscribes or prohibits the use of these deals. In the meantime, we recommend that chiropractors abstain from these types of marketing campaigns….”

I couldn’t agree more with them. 

When I opened up a new place h ere in Amarillo, I printed flyers at Kinko’s and I walked from one business to another knocking on doors and meeting people and telling them about me and my new place. I marketed anyone that could send me business. For more on that, go back about 5 episodes and listen to our episodes called Big Ideas On Marketing Evidence-Based Practices. Link is in the show notes. 

You must know this just isn’t the way to go. Join BNI, join civic clubs, start working out at a gym and get tight with the managers and personal trainers, spend time volunteering, joint a running club if that’s your gig, combine those things with social media and a solid email list that you continue to build and work on. There are so many things you can do that are above the cuff. That are respectable and raise up you and your profession. 

Groupon isn’t one of them. It does exactly the opposite. It identifies those of us who are racing to the bottom of the barrel and dragging the rest of us down with them. 

If you’re doing Groupon, it’s my opinion that it’s time to stand up, stop doing it. Yesterday..if you catch my drift

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

Chiropractic evidence-based products
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The Message

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

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

It’s safe and cost-effective. It can decrease surgeries & disability and we normally do it through conservative, non-surgical means with minimal hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, we 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. When it comes to non-complicated musculoskeletal complaints….

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show 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

Enke O (2018). “Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis.” CMAJ(190): E786-793.

Khazan O (2019) “Chronic Pain Is an Impossible Problem A “safe” alternative to opioid painkillers turns out to be not so safe.” The Atlantic.

Marianna P, I. C., Andrea E, Valentina P, Ilaria G, Giovannino C, Ezio G, Simona B, (2019). “Effects of time-restricted feeding on body weight and metabolism. A systematic review and meta-analysis.” Rev Endocr Metab Disord.