CF 238: Benzodiazepines and Mirror Therapy In today’s episode, we cover Benzopdiazapines and Mirror Therapy But first, here’s that sweet sweet bumper music
Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. If you haven’t yet I have a few things you should do.
Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.
Then go Like our Facebook page,
Join our private Facebook group, and then
Review our podcast on whatever platform you’re listening to
Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com
You have found yourself smack dab in the middle of Episode #238 Now if you missed last week’s episode , we talked about Chronic Pain and current thinking. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
I usually type up the podcast ideas and outline on a Monday. Well, we were off this Monday for July 4th so I’m short a day this week which means that this personal happenings part of the podcast has to be short so I can make everything happen in this short week. So here we go. I’m still on the hunt for an associate chiropractor. One who is a go-getter determined to be successful.
One that understands they can go to work for the Joint and get paid more currently. In the now and here. But there will be a cap and they will not be able to exceed that cap. One that understands that there is no cap with me. The more they bring in and grow the clinic and themselves, the more I want to take good care of them. Plain and simple. If that’s you, email me at creekstonecare@gmail.com.
I want to get to know you.
I am getting ready and looking forward to being in Sarasota with the Florida MCM Mastermind for the weekend of July 22nd. It’s a good time of networking with my fellow mastermind people and helping each other build our businesses. Hell yeah. I thrive in masterminds. Even if I don’t necessarily have the time to implement everything I want to implement. I get inspiration, ideas, and actionable steps I can take almost immediately most of the time. Lots of little tips and tricks and I learn as much or more from the Mastermind members outside of the classroom at the hotel bar as I learn in the classroom. If you’re interested in joining, send me a message, and let’s get you connected with Dr. Kevin Christie and hopefully get you plugged into the group ASAP. I mean really, we’re meeting in Sarasota on July 22nd and there’s still room for you but in November, we’re meeting a Playa Largo in Key Largo, FL. Everyone’s bringing their family too so you know you don’t want to miss that one. Reach out and let me help you get plugged in. You have to be grossing $350,000 per year and growth-minded to play so holla. Let’s get started today.
Item #1
Our first one today is called “Association between chiropractic spinal manipulative therapy and benzodiazepine prescription in patients with radicular low back pain: a retrospective cohort study using real-world data from the USA” by Trager et. al. (Trager RJ 2022) and was published in BMJ Open on June 13, 2022. The sizzle…..it’s hot
Why They Did It
Although chiropractic spinal manipulative therapy (CSMT) and prescription benzodiazepines are common treatments for radicular low back pain (rLBP), no research has examined the relationship between these interventions. We hypothesize that utilization of CSMT for newly diagnosed radicular LBP is associated with reduced odds of benzodiazepine prescription through 12 months’ follow-up.
How They Did It Retrospective cohort study. National, multicentre 73-million-patient electronic health records-based network (TriNetX) in the USA 2003 – 2021
What They Found
Odds of receiving a benzodiazepine prescription were significantly lower in the CSMT cohort over all follow-up windows prematching and postmatching (p<0.0001).
Sensitivity analysis suggested a patient preference to avoid prescription medications did not explain the study findings.
Wrap It Up
These findings suggest that receiving CSMT for newly diagnosed rLBP is associated with reduced odds of receiving a benzodiazepine prescription during follow-up.
These results provide real-world evidence of practice guideline-concordance among patients entering this care pathway.
Benzodiazepine prescription for rLBP should be further examined in a randomized trial including patients receiving chiropractic or usual medical care, to reduce residual confounding.
Before getting to the next one, I have to tell you, that Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! It’s life again. Use the code HOTSTUFF upon purchase at droprelease.com to get $50 off your purchase. Y’all, it makes a world of difference. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. My patients love it and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Hear me now and believe me later.
Item #2
The last one today is called “3D augmented reality mirror visual feedback therapy applied to the treatment of persistent, unilateral upper extremity neuropathic pain: a preliminary study” by Mouraux et. Al. (Dominique Mouraux) and published in the Journal of Manual and Manipulative Therapy in 2017.
Why They Did It
The authors assessed whether or not pain relief could be achieved with a new system that combines 3D augmented reality system (3DARS) and the principles of mirror visual feedback.
How They Did It
Twenty-two patients between 18 and 75 years of age All of whom suffered of chronic neuropathic pain. Each patient performed five 3DARS sessions treatment of 20 mins spread over a period of one week. The following pain parameters were assessed:
visual analogic scale after each treatment session
McGill pain scale and DN4 questionnaire were completed before the first session and 24 h after the last session.
What They Found
The mean improvement of VAS per session was 29%.
There was an immediate session effect demonstrating a systematic improvement in pain between the beginning and the end of each session.
They noted that this pain reduction was partially preserved until the next session.
If we compare the pain level at baseline and 24 h after the last session, there was a significant decrease of pain of 37%.
There was a significant decrease on the McGill Pain Questionnaire and DN4 questionnaire.
Wrap It Up
Our results indicate that 3DARS induced a significant pain decrease for patients who presented chronic neuropathic pain in a unilateral upper extremity. While further research is necessary before definitive conclusions can be drawn, clinicians could implement the approach as a preparatory adjunct for providing temporary pain relief aimed at enhancing chronic pain patients’ tolerance of manual therapy and exercise intervention.
You can decide how well-related this is BUT, with phantom limb pain, in addition to cognitive behavioral therapy, they have treated using mirror therapy.
Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.
Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!
The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!
Key Point:
At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!
Contact
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.
Connect
We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
CF 237: Chronic Pain Talk & Thoughts Today we’re going to talk about one of my favorite topics; Chronic Pain. But first, here’s that sweet sweet bumper music
Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. If you haven’t yet I have a few things you should do.
Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.
Then go Like our Facebook page,
Join our private Facebook group, and then
Review our podcast on whatever platform you’re listening to
Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com
You have found yourself smack dab in the middle of Episode #237 Now if you missed last week’s episode , we talked about how You Are What You Eat & Screen Time For Kids. Make sure you don’t miss that info. Keep up with the class.
the personal end of things…..
I just don’t have a lot to report on the personal end of things. We’re a little slower lately. I think it’s because gas prices are sky freaking high and you have to take out a small loan just to fill up your vehicle. I think it’s depressing for a lot of folks. Any time there is confusion or uncertainty with the economy, people pull back. Understandably. Unfortunately, many see chiropractic as an extra and when people are trimming the budget, chiropractic, and healthcare in general, get trimmed and we take a hit. I think that’s what’s up right now.
I’ve talked to a couple of my colleagues in the Dallas area and there are feeling the same dial-back in business. I am used to about 45-50 on a Monday. This week, we have 35. I don’t dig it. Especially when I know I’m marketing and doing the smart stuff. It’s discouraging. But, at the end of the day, there are things out of our control, and rolling with the flow is all we can do. Be moral, ethical, honest, loving, evidence-based, and patient-centered, and treat people right. That’s what good and successful practices should consist of. Those build the base, the foundation of big things in life and in business.
Before getting to the next one, I have to tell you, that Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! It’s live again. Use the code HOTSTUFF upon purchase at droprelease.com to get $50 off your purchase. Y’all, it makes a world of difference. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. My patients love it and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Hear me now and believe me later.
Item #1
This one is called “Manual physical therapy for chronic pain: the complex whole is greater than the sum of its parts” by Coronado et. al. and published in the Journal of Manual and Manipulative Therapy in 2017. They say that “Manual physical therapists can effectively treat patients with chronic pain and other musculoskeletal disorders; however, the field is at a crossroads. The traditional approach to manual therapy assumes that proper technique selection and precise implementation is the primary driver of a successful outcome. In this view, the resultant outcomes are directly attributed to the applied intervention.
They go on, “We propose manual physical therapists will only be recognized as ideal providers for individuals with chronic pain if we accept an updated paradigm acknowledging the complexity of the manual physical therapy experience and accept the robustness of varying contextual elements inherent in our interactions. For some clinicians, this will require a revolutionary shift in their perception of the development, maintenance, and modulation of pain “
You may have heard me say that I’m teaching a 2-hour course called “Chronic Pain And The Upregulated CNS” and this paradigm shift isn’t anywhere near where it will need to be. The information I’m teaching is brand new to 90% of the providers from my experience. “Pain is an experience orchestrated by dynamic sensory, cognitive, and affective processes and is strongly influenced by patient’s expectations (AKA Yellow Flags), mood, desires, and past experiences.
Limiting pain perception to a peripheral impairment is outdated and a more comprehensive, albeit complex, approach to manual therapy accounts for a myriad of interacting factors impacting chronic pain outcomes” “A comprehensive approach acknowledges the impact of patient and therapist factors, which not only include personal and condition-specific patient characteristics, but also the cultural biases, beliefs, and experiences of both the patient and therapist” “Additionally, this view acknowledges the interaction between patient and manual physical therapist, which may yield important outcome contributions, either directly (as in….what techniques we use) or indirectly (like addressing the yellow flags).” “Finally, this approach acknowledges the integration of targeted adjunct interventions such as psychosocial strategies and exercise that may (1) enhance the effectiveness of manual therapy for reducing the impact of pain, and/or (2) promote and maintain positive behavioral change”
We know that when people are sedentary, they have deeper depression, pain, and anxiety. Sleep issues and mood disorders. This is well-researched. On the other hand that movement and exercise reverse these things. Less depression, less anxiety, more fitness, better sleep, and less pain as the CNS becomes more comfortable with the movement and becomes more and more functional.
Pain signals and signals of all sorts run through a filter before they are felt…..or not felt at all. That filter can amplify the signals or dampen them. It’s no longer a straight biomedical view we take. It’s the biopsychosocial construct we use to approach pain now and if we only look at the bio part, we are cheating our patients out of 2/3 of the effectiveness we could have for them. In the end, if your CNS thinks it should hurt, it will. Regardless of whether there is tissue pathology or not. On the other hand, if your tissue is completely jacked up but the CNS determines there is no danger or threat, it will not hurt. Moseley and Butler lay it out straight like that in their book called Explain Pain.
They say it’s as simple and as difficult as that.
Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.
Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!
The Message
I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!
Key Point:
At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!
Contact
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.
Connect
We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
CF 208: Year Four Chiropractic Forward Roundup Today we’re going to re-hash the last 4 years of the Chiropractic Forward podcast on this, the 4 year anniversary of the first episode. But first, here’s that sweet sweet bumper music
Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. If you haven’t yet I have a few things you should do.
Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.
Then go Like our Facebook page,
Join our private Facebook group, and then
Review our podcast on whatever platform you’re listening to
You have found yourself smack dab in the middle of Episode #208 Now if you missed last week’s episode , we talked about Does Imaging Mean Better Outcomes & Melatonin Slowing Down Disc Degeneration. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
On the personal end of things nothing too crazy we’re just scooting right along as usual our new front desk car is coming along swimmingly. In fact, I don’t know what we ever did without her. She is absolutely phenomenal and makes life so much easier for my wife and myself. Which is a lesson to me. You can either hire experienced, or you can train. If you’re going to hire experience it’s going to cost you. Or does it? I had an inexperienced person that I tried to get trained over and over and over, and it ended up costing me around $750,000 over the course of three years. So wouldn’t I have been better off getting somebody who is experienced in billing and coding? And just paying a little more?
The answer is Hell yes.
This girl has been experienced she’s been a coder and a builder and a front desk staff member. And it shows. We couldn’t be happier. If you’ve been listening very long, then you know that my new side gig is investing in real estate. As such, we close on our very first investment property at the end of this week and then starts the task of placing all of the things that we have bought for it over the past two months into the house and getting it all set up and ready for VRBO and Airbnb. The first month of owning a short term rental is a bit tricky from what I’m told. We’re about to find out. But once it’s up and running finally, it’s typically fairly straight forward and somewhat self sustaining. No need to lay someone a 20% property Management fee to run it for you.
They typically take about 15-30 minutes per week to manage and it can all be done from afar since everything in a smart home is WiFi these days. Thermostats, deadbolts, alarms, ring cameras, etc. it’s awesome. I’ll continue to share as we get further into it but as of now, we’ve got about $20,000 or so into above and beyond the down payment.Setting them up and outfitting them for travelers is a chore. For my personal life, my daughter has her first dance this week. If you don’t have any cute kids this age then you probably haven’t thought about it. She’s in eighth grade. I had my first junior high dance when I was in sixth grade. But these kids have had Covid to deal with this entire time and now, in eighth grade, are just now getting their very first dance. Crazy to think about right?
My son happened to be in high school they were the class of 2020. They didn’t get a graduation or a prom. They didn’t get a senior trip or anything like that. His first year in college was anything but normal. Kids in school these days have had a lot of challenges. On top of the regular awkwardness of being a kid. There are a good generation of kids. If nothing else, they are going to be resilient as hell and they were going to understand but the future is not a given. Things can change on a dime and it will serve you well to be adaptable. These kids will know that without a doubt
So let’s get to the top ten all time episodes shall we?
First I want to take a second to say, thank you. If you’ve been with me on this journey for the last 4 years, then we’ve had some fun and you know me a lot better than I know you but that’s totally ok and not creepy at all. Or is it? Anyway, In the last four years, I’ve missed one week back when my dad had a stroke a couple of years ago. I’ve shared my struggles with you and I’ve shared my triumphs with you. I’ve shared my goals, my side gigs, my staff stories, and even my family stories with you. I’m all in. This is all going somewhere, folks.
I want to change this profession. I want it to be better. I want to better myself in the process. Many times, I’m learning right alongside with you. Sometimes, I’m teaching you from what I know. Two Fellowships and 24 years in the trenches will teach you a few things you can then turn around and share with others. Not only that but a book has come of the last 4 + years. Hopefully some speaking, mentorship, and guru-ism will come out of it. Guru-ism in the best sense of the vernacular. Part of making this profession better and raising its game is teaching others and the goal is that that comes about in more and more opportunities in the years to come.
If you need a speaker for your organization or association, send me an email at dr.williams@chiropracticforward.com. Let’s connect and discuss. So, thank you.
Thank you for sharing this podcast and helping us grow. Thank you to those that have had me on your podcasts or promoted me in some way. Thanks to those that sponsored and supported this show in one way or another. My appreciation for your confidence, support, and friendship cannot be put into words. And thank you to all of my mentors and influences along the way. You’ve shown a special interest in me and what I do for some reason and my goal is to consitently validate that. Now, here we go.
#10 – Episode #189 w/ Dr. Brett Winchester: Chiropractic Excellence, Inspiration, & Being The Best Evidence-informed Chiropractor You Can Be
This is a big deal that this episode made it to the top ten because it was just recorded on August 5th. So, in 4 months, it’s cracked the top ten of a list that’s four years in the making. And deservedly so because Dr. Winchester is the tip of the sword when it comes to chiropractic. Dr. Brett Winchester lectures throughout the world, teaching his functional approach to patient care.Combining manual therapy, including joint manipulation and neuromuscular stabilization, with therapeutic exercise, Dr. Winchester effectively treats functional pathologies and acts as a catalyst for patients working to enhance their performance. Dr. Winchester is the founder of Winchester Spine & Sport located outsideSt. Louis, Missouri. He worked with the St Louis Cardinals at the tip top level of what a chiropractor can do for several years. So much can be learned from him. I hope you’ll go find episode 189 and give it a spin. You’ll learn something.
#9 – Episode #118w/ Dr. Stuart McGill – Clinical Jazz, Treating Kids Like Pros, Thoughts On Posture, and Being A Low Back Pain Ninja
What do you say about Dr. McGill other than wow. He’s a master, he’s a gentleman, and he has a moustache that is unrivaled. But seriously, we covered all kinds of topics that included chronic pain, posture, assessing new patients, corrective exercise vs. gamification, multi-sport athletes, and more. This is one of my favorite episodes. Hands down.
#8 – Episode #137 w/ Dr. Aric Frisina-Deyo – Chiropractors In An FQHC Setting & Setting The Bar High Early On
We talked about the ins and outs of working in an FQHC and I have to say that if Dr Frisina-Deyo is the future of chiropractic, then the future is as bright as the sun. Super smart and excellent information.
Not only is Katie one of the brightest rising stars in the chiropractic realmn but she’s also cool and one of my newest besties. I don’t know if she knows we’re long distance besties but I’ve deemed it to be a reality that she’ll just ahve to come to be OK with. She is the head of research at Parker University so we talked about her projects, chiropractic, the future, and all kinds of wonderful and relevant topics. You HAVE to listen to this episode. She’s just a joy and you’re going to love listening to her.
#6 – Episode #113 – w/ Dr. William Lawson – Brand New Guidelines On Neck Pain Treatment
My buddy and the next President of the Texas Chiropractic Association. This episode shot to the top of our top ten almost immediately. It was way back on episode 113 and here we are on 208 and it’s still #6. That’s how popular this one was. We spent the time covering a paper that Dr. Lawson played a part in on guidelines for treating neck pain. What’s appropriate. What’s not appropriate? Are you doing it right or are you an outlier?? That’s what we talked about. Give it a try and see what you think.
#5 – Episode #140 – w/ Dr. Chris Howson:Chiropractors In Hospitals & Drop Release
I love that Dr. Howson is still on our top ten list because he’s been one of the most supportive chiro buddies out there. He’s smart, he’s talented, he invented the Drop Release tool, which we talk about in this episode, and he edited my book. Other than being a Minnesota Vikings fan rather than a fan of my beautiful blue and silver Dallas Cowboys, Dr. Howson is just doign everything about right, folks. Not only that but he’s in a hospital out-patient clinic and is really doing his part to elevate the profession. You can’t go wrong with this wildly popular episode.
#4 – Episode 142 – Nonoperative Disc Treatment, D3 for Depression, & The Biopsychosocial Part Of Chronic Pain
I went through about 4-5 weeks of just killer episodes that people ate up and consumed in big numbers so you’ll notice all of these top episodes all came out pretty close to one week right after the other. This one covered research on treating discs without surgery, Vitamin D3 as a treatment for depression, and the biopsychosocial aspect of treating chronic pain.
#3 – Episode #144 – Common Surgeries Aren’t Well-Researched & Chiropractic Wins Again
Another one of my favorites that I have quoted and used in my day to day practice more than you can imagine. This one is popular for a reason. It shocked me to go through the main paper in this episode. It covered how A very low proportion of the RCTs on the selected procedures compared the procedure to not performing the procedure at all.
64 from the more than 6,735 studies. Less than 1% if you’re keeping track. Is that not stunning? And infuriating?
Of those 64, only 9 were favorable to surgery.
When considering individual surgical procedures, the majority of comparative trials did not favor surgery
None of the studies using patient blinding for any procedure found it to be significantly better than not having the surgery at all.
Wrap It Up
We conclude that many common surgical procedures performed for musculoskeletal conditions causing chronic pain have not been subjected to randomized trials comparing them to not performing the procedure. Based on the observation that when such studies have been performed, only 14% (on average) showed a statistically significant and clinically important benefit to surgery; there is a need to produce such high-quality evidence to determine the effectiveness of many common surgical procedures.Furthermore, the production of high-quality evidence should be a requirement before widespread implementation, funding or professional acceptance of such procedures, rather than the current practice of either performing trials after procedures have become commonplace, or not performing comparative trials at all.”
#2 – New Paper: Spinal Manipulation Has No Effect On Chronic Pain – Our Experts Rebuttal
A paper came out last year in JAMA that basically said that spinal manipulative therapy has not utility in treating chronic pain. I knew that couldn’t be the final answer. Oh hell no. We see this stuff resolve all of the time so what gives? I went to the experts and got their thoughts on the paper and a proper rebuttal in case you’re ever confronted with it. A lot of you took my advice because it’s #2 all time for us. I’m glad to see you found it valuable.
#1 – Lancet Low Back Update & Movement Disorders Mean Pain
For the second year in a row, this paper retains the title as the most listened to of all of our episodes. In 2018 or so, The Lancet released a series of papers on Low Back Pain. It was big and gave us great information and a direction forward for treating it. This episode covered the update to that paper with more current information using the original series as a basis to build on. It’s great information for those striving to be low back ninjas. Learn from the experts. Learn from the best.
So there you have it. Our Chiropractic Forward all time Top Ten most listened to episodes. Pretty cool.
We’ve come a long way from having a handful of listeners to where we are today. It’s been slow but it’s been steady growth.
Let’s face it, chiropractic research isn’t all that sexy and it’s certainly niche-y but for the narrow target audience it’s aimed at, we have a solid listenership regularly tuning in to hear me make stupid jokes and share some educational knowledge nuggets with you. We’re learning together and I’m glad to have you along for the ride. Don’t forget to share with your friends that might find it useful as well. I sure would appreciate it.
Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen.
Let’s get to the message. Same as it is every week.
Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!
The Message
I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!
Key Point:
At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!
Contact
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.
Connect
We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
CF 190: Obesity In Youths With Chronic Pain, The Healing Journey of Pain, and Fibromyalgia Treatment
Today we’re going to talk about obesity in youth and chronic pain, we’ll talk about fibromyalgia and hyperbaric oxygen chambers, and we’ll talk about chronic pain and the healing journey. But first, here’s that sweet sweet bumper music
Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.
I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. If you haven’t yet I have a few things you should do.
Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an invaluable resource for your patient education and for you. It can save you time in putting talks together or just staying current on research. It’s categorized into sections so that the information is easy to find and it’s written in a way that is easy to understand for practitioner as well as patient. You have to check it out. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.
Then go Like our Facebook page,
Join our private Facebook group and interact, and then
go review our podcast on iTunes and other podcast platforms.
While you’re there, join our weekly email newsletter.
You have found yourself smack dab in the middle of Episode #190
Now if you missed last week’s episode , we were joined by the amazing Dr. Brett Winchester from the St. Louis area. This doctor is just phenomenal in everything he does and says and we are all fortunate to have him in this profession. Make sure you don’t miss that info. Keep up with the class.On the personal end of things….. Day 1 of our nurse practitioner starting is today. This morning has, of course, had its hiccups. We have the EHR where we have him set up but he has to have his own login and password and all that good stuff so that’s been one challenge so far. Just getting oriented with where all of the stuff is, lidocaine, lab tubes, swabs, blah blah blah. Still waiting on the autoclave and still getting the malpractice policy in place this morning. What a process that’s been. But we knew there’d be hiccups, and we’re getting them addressed. Then I have my regular life to contend with. I have patients to treat and a podcast to write so here we go. Short and sweet on this one because my cup is running over this morning.Item #1 Our first item today is called “Obesity in Youth with Chronic Pain: Giving It the Seriousness It Deserves” by Hainsworth et. al. (Keri R Hainsworth 2021) and published in Pain Medicine in June of 2021 and day-um…..that’s hot! Why They Did It The aim of this commentary is to review the current science on co-occurring chronic pain and obesity in children and adolescents. In so doing, we also highlight some of the current gaps in knowledge. It is our hope that this commentary will draw attention to an overlooked area of research and clinical endeavors within the field of pediatric pain.
The authors note that it is becoming increasingly clear that we should be familiar with this research. Both chronic pain and obesity have been rising in children for some time and studies are showing that obesity exacerbates the negative outcomes associated with chronic pain. In addition, accumulating research exists on all facets of the co-occurrence of chronic pain and obesity in adults. Given all this, the paucity of research in this area of pediatric chronic pain and obesity is at a minimum, disheartening, and at a maximum, unconscionable.
Ooooweee! That’s like putting a white glove on and smacking some clown around the room a little bit, isn’t it? I like it. It give me a little tickle. Here are their main points:
On average, it can take 2 years longer for youth with obesity to be referred to a pediatric pain clinic than it does for youth with a normal weight
Pediatric patients with CPO have health-related quality of life that is more impaired in every domain than patients with chronic pain and a healthy body mass index percentile
Although systemic inflammation is commonly elevated in youth with obesity, patients with CPO have significantly higher levels of systemic inflammation than those with chronic pain alone or obesity alone
Children with CPO are at increased risk of being treated as though they bear more responsibility for their health (and by extension, their pain) than youth without obesity and are at increased risk of pain dismissal and biased medical care
CPO in children and adolescents is associated with more impaired physical functioning and lower levels of physical activity than youth with chronic pain alone or obesity alone Further, parents report that their children with CPO (particularly girls) have greater functional disability (one of the most important outcomes in our field) than parents of youth with chronic pain and a normal body mass index
While multidisciplinary pain management programs work well for patients with a healthy weight, this is not true for those with comorbid obesity. Patients with a healthy weight improve in functional disability within 3 months of intake, whereas patients with CPO stagnate
First, even though we as clinicians and researchers need to address obesity in the context of chronic pain, we must be extremely thoughtful about how we move forward. Weight is a very sensitive subject, therefore, the call for more research in this area must strongly consider the need for sensitivity. CPO is the co-occurrence of a typically “invisible,” debilitating condition coupled with a condition so visible that it is sadly associated with victimization from important people in the child’s life, including peers, parents, and teachers
Second, we would do well to closely follow the admonitions and advice of our colleagues whose primary clinical and research focus is on obesity and stigma. Suggestions from these experts include first recognizing that weight bias exists even among pediatric health care providers [20]. Additionally, language must be very carefully considered. Puhl et al. [20] offer the practical and sensitive suggestion to ask the patient and family about preferred words or terms in discussions about weight-related health Third, like other health care professionals, we would benefit from a greater understanding of the complexity of obesity and the “potential benefits and disadvantages of introducing weight-management discussions with patients” [14](p865). Certainly, there will be times when weight-related discussions would be contraindicated by the patient’s and/or family’s psychological or emotional state. However, when weight needs to be raised in relation to a child’s chronic pain, it may be best received in the context of health implications. Obesity is a multifactorial disease with strong genetic contributions. It is also associated with systemic inflammation, metabolic syndrome, and increased risk for diabetes and cardiovascular disease, as well as chronic pain. In fact, most are unaware that obesity is a risk factor for migraines in pediatric populations. That said, weight-related health or weight-related pain discussions cannot focus entirely on losing weight. For many, it is a struggle to change their weight status, and even if it is possible, this process takes time. We must not ignore managing pain while we wait for possible weight reduction.
CHIROUP ADVERTISEMENT Item #2 Our second one today is called “Evaluation of a Hyperbaric Oxygen Therapy Intervention in Individuals with Fibromyalgia” by Curtis et. al.(K Curtis 2021)and published in Pain Medicine in June of 2021…….pork chops and apple sauce.Why They Did It To evaluate the feasibility and safety of hyperbaric oxygen therapy (HBOT) in patients with fibromyalgia (FM). How They Did It
A total of 17 patients completed the study
A cohort study with a delayed treatment arm used as a comparator.
Hyperbaric Medicine Unit, Toronto General Hospital, Ontario, Canada.
Eighteen patients diagnosed with FM according to the American College of Rheumatology and a score ≥60 on the Revised Fibromyalgia Impact Questionnaire.
Participants were randomized to receive immediate HBOT intervention (n = 9) or HBOT after a 12-week waiting period
HBOT was delivered at 100% oxygen at 2.0 atmospheres per session, 5 days per week, for 8 weeks
Both groups were assessed at baseline, after HBOT intervention, and at 3 months’ follow-up.
What They Found
HBOT-related adverse events included mild middle-ear barotrauma in three patients and new-onset myopia in four patients
The efficacy of HBOT was evident in most of the outcomes in both groups
This improvement was sustained at 3-month follow-up assessment.
Wrap It Up HBOT appears to be feasible and safe for individuals with FM. It is also associated with improved global functioning, reduced symptoms of anxiety and depression, and improved quality of sleep that was sustained at 3-month follow-up assessment.
I don’ tank about you but I’m not going to go out and buy an oxygen chamber this afternoon but, it’s interesting and I’ve always heard positive things about them so this one peaked my interest a bit. I figured it would with you as well.Item #3 The last one is called “A Healing Journey with Chronic Pain: A Meta-Ethnography Synthesizing 195 Qualitative Studies” by Toye et. al. and also published in Pain Medicine in June of 2021….Smoke show!!
You know, it’s almost like I got an email from Pain Medicine last week highlighting some of their newest research in their June edition. Weird how all of these articles were all in the same month and in the same episode here. Right? Why They Did It There is a large body of research exploring what it means for a person to live with chronic pain. However, existing research does not help us understand what it means to recover. We aimed to identify qualitative research that explored the experience of living with chronic pain published since 2012 and to understand the process of recovery. How They Did It
A synthesis of qualitative research using meta-ethnography.
We used the seven stages of meta-ethnography.
We systematically searched for qualitative research, published since 2012, that explored adults’ experiences of living with, and being treated for, chronic pain.
We used constant comparison to distill the essence of ideas into themes and developed a conceptual model.
We screened 1,328 titles and included 195 studies.
Wrap It Up The innovation of our study is to conceptualize healing as an ongoing and iterating journey rather than a destination. Health interventions for chronic pain would usefully focus on validating pain through meaningful and acceptable explanations; validating patients by listening to and valuing their stories; encouraging patients to connect with a meaningful sense of self, to be kind to themselves, and to explore new possibilities for the future; and facilitating safe reconnection with the social world. This could make a real difference to people living with chronic pain who are on their own healing journeys.
Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus so get active, get involved, and make it happen.
Let’s get to the message. Same as it is every week.Store Remember the evidence-informed brochures and posters at chiropracticforward.com.
Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!
The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few.
It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient.
And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….
That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ TwitterTweets by Chiro_ForwardYouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger Bibliography
K Curtis, P., J Katz, PhD, C Djaiani, BSc, G O’Leary, MD, FRCPC, J Uehling, MS, CCRP, J Carroll, BHA, D Santa Mina, PhD, H Clarke, MD, PhD, FRCPC, M Gofeld, MD, PhD, FRCPC, R Katznelson, MD, FRCPC, (2021). “Evaluation of a Hyperbaric Oxygen Therapy Intervention in Individuals with Fibromyalgia.” Pain Med 22(6): 1324-1332.
Keri R Hainsworth, P., Monica L Gremillion, PhD, W Hobart Davies, PhD, Stacy C Stolzman, PT, MPT, PhD, Steven J Weisman, MD, (2021). “Obesity in Youth with Chronic Pain: Giving It the Seriousness It Deserves.” Pain Med 22(6): 1243-1245.
Today we’re going to talk about Evidence-Based Chiropractic, We talk about the primary spine care model integrated into a primary care setting. What happens when that’s the mode of treatment? Then we’re going to talk about some Frozen Shoulder (adhesive capsulitis) research in JAMA recently. But first, here’s that sweet sweet bumper music
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. If you haven’t yet I have a few things you should do.
Like our Facebook page,
Join our private Facebook group and interact, and then
go review our podcast on iTunes and other podcast platforms.
While you’re there, join our weekly email newsletter.
You have found yourself smack dab in the middle of Episode #158 Now if you missed last week’s episode, we talked about chiropractors that spread misinformation, we talked about patients needing movement, and we talked about love. I’m a softy at heart believe it or not. Make sure you don’t miss that info. Keep up with the class. Evidence-Based Chiropractic is catching on!
On the personal end of things….. We are sitting here on a Monday 12/21 as of the typing up of this episode. Christmas is upon us. Nothing crazy special going on beyond that. There are a couple of things I’ll mention. The first is that I got the Mirror gym you hang on a wall. It’s basically like having a trainer in your living room. Lots of you are already used to this sort of a deal with products like Peloton but it’s new to me and it’s pretty awesome. I’m doing stuff like Tai Chi, yoga, boxing, kickboxing, and stuff like that.
Stuff I’d never do otherwise and it’s pretty darn cool. We turned what used to basically be a dog room into a small gym and it’s been pretty cool so far. I’m enjoying it. I’ve always been a skinny dude stuck in a big dude’s body. So, now that I’m down 33 lbs on weight watchers, and I’ve added the home gym to the mix, I feel like I’m on the way to realizing the skinny dude. Eventually. Lots of work left to do first though.
Secondly, I’m getting the vaccine in a day or two if everything works out. I have mentioned several times on the podcast that I have very positive relationships with a lot of folks in my local medical community. Through that network, my wife and I will be getting ours this week. I’m ready to get that dude and start moving on with life.
No, I’m not worried about it. Understanding I have some level of influence and some level of leadership with my friends, family, and patients, I feel it’s important to get out front and set an example on this deal. Especially being a chiropractor. When you see so many of us disenfranchised because of the vitalists in our profession out there preaching the harms of vaccines when they wouldn’t know how to make it through a research paper on the vaccine to save their lives…..well, wouldn’t it be refreshing to see evidence-based chiropractors stepping up and leading the way on this vaccine? Here’s my stance on it. Maybe it helps you if you’re on the fence. Maybe it doesn’t but here it is anyway. I’m not an epidemiologist or a maker of vaccines. I have researched masks, COVID, the transmission of Covid, and things like that. Not as much on the vaccine on the vaccine itself though.
Scientists understand so much more about that sort of research than I’ll ever know. A Fox Poll says 61% of Americans will get the shots while only 23% are strictly against taking it. There were 16% unsure. Probably the ones waiting to see if everyone does OK with it before they step up. And I don’t think that’s unreasonable. The point is, those getting it like me…..I’m not the minority on it. For me, it’s not only about life or death. I have a 20-something-year-old patient that can’t go back to work because she’s still positive 6 weeks later. I know a nurse that was positive for over nine weeks. I know Patients that had to go to physical therapy for weeks. Long haulers is a real deal. In the end, it’s an easy decision for me. I’m not worried at all really.
There’s risk crossing the road. If I get sick, I have to close my office for at least 2 weeks if not more. That means I lose a lot of money, there will be patients drop off of the schedule, we’ll miss new patients, and I’ll be sick AND anxious the entire time. If COVID doesn’t make me nauseous, the destruction of my business while I’m out sick will. Besides myself, I have 13 or so other employees and their families depending on my presence. My business depends on my presence and does not run when I’m not there. That’s a little different than a lot of other folks. I’m not doing that if I can prevent it. If a vaccine allows me to prevent it, well then, a vaccine it is.
We chiropractors work within inches of people’s faces and in close contact with them. That puts us at more risk than the average Joe and, if we have it, puts our patients at serious risk of getting it from us. If you’re like me, we work with a lot of elderly and immunocompromised patients. I’m not willing to put them at risk like that when all I had to do was trust in science and just get the damn vaccine. They ran human trials on 35000-45000 or so people with no unacceptable issues. That’s a huge sample size. I’ve seen this thought on the FTCA group before. It’s probably a Bobby Maybee special quote but, back before Facebook, people would have just taken the vaccine.
They weren’t worried about this stuff back before Facebook told them to worry about it. No matter what’s out there these days, you have people casting doubt on it for zero reasons. Maybe it’s a call for attention at all costs. Who knows? But it’s to the point now where science and experts are constantly doubted and discounted. And that’s about as dumb and dangerous as can be. It was OK to cure smallpox and polio but COVID……nah bruh.
If there were real questions, would basically the entire medical complex be in line taking it? My guess is that they wouldn’t. What if someone can afford to be out of work or out of their office for 2-4-6 weeks and they want to wait to get it? I think it’s reasonable if someone wants to wait to see if anyone has adverse effects before they take it. I don’t think that’s unreasonable at all. But I think that it’s just delaying the fact that almost everyone is going to do fine with it and most people are going to end up getting it.
They started it in England two weeks ago. Nothing has happened. Because they already did the test trials to make sure nothing would happen. Considering the success of the testing, I think the people not getting it are at far more risk than the people that are getting it. Besides all that, I’m ready to get back in my life. Traveling, doing fun stuff, having a life…..important stuff. Like seeing my mom and step pops and being able to visit my dad in the nursing home for the first time since March.
More power to those that have been doing those things all along but for the above-mentioned reasons, we have not.
So that’s where I’m at. We are all on our own walk and we all need to do what we think is best. Staying healthy, staying open and available, and continuing to provide for my family, my staff, and my patients are what I think is best. So, I’m out front on this. It’ll be good for my patients and family to see a picture of me getting my vaccine on social media. It’ll be good for my patients to see it.
And it’ll be good for those in the medical community that is friends with me to see it. It’ll reaffirm that no….I’m not one of THOSE chiropractors. I encourage you to be out front with it if you get one. Be a leader and blaze the trail. And Merry Christmas, Dammit.
Item #1 The first one today is called “Implementation of the Primary Spine Care Model in a Multi-Clinician Primary Care Setting: An Observational Cohort Study” by Whedon, et. al. (Whedon JM 2020) and published in the Journal of Manipulative and Physiological Therapeutics on September 1, of 2020. And that’s a blistering blast of hotness. If you don’t recognize the Whedon name, he is very prolific in chiropractic research.
Why They Did It
The objective of this investigation was to compare the value of primary spine care with usual care for the management of patients with spine-related disorders within a primary care setting.
How They Did It
They retrospectively examined existing patient encounter data at 3 primary care sites within a multi-clinic health system
Designated clinicians serve in the role as primary spinal care as the initial point of contact for spine patients, they coordinated the care, and they followed up for the duration of the episode of care
A primary spinal care doctor may be a chiropractor, PT, or medical or osteopathic physician trained in primary spinal care for spine-related disorders
They had sites where the primary spinal care was implemented as well as control sites where they just stuck with the usual care model
They examined clinical encounters occurring over a 2 year period from February 2016 to March 2018.
What They Found
Primary spine care was associated with reduced total expenditures compared with usual care for spine-related disorders
At site one, the average per-patient cost was $162 in a year and $186 in year two.
That is compared to site II, a control site, where the cost in year one was $332 and $306 in year two. And in site three, also a control site offering only usual care, where the cost in year one was $467 and year two was $323
Wrap It Up
Among patients with SRDs included in this study, implementation of the PSC model within a conventional primary care setting was associated with a trend toward reduced total expenditures for spine care compared with usual primary care. Implementation of PSC may lead to reduced costs and resource utilization but may be no more effective than usual care regarding clinical outcomes.
CHIROUP ADVERTISEMENT
Item #2
Our second item today is called “Comparison of Treatments for Frozen Shoulder: A Systematic Review and Meta-analysis” by Challoumas, et. al. (Challoumas D 2020) and published in JAMA Open on December 16, of 2020 and it does not get one degree hotter than that people!
Why They Did It
The authors here wanted to know the answer to the question, “Are any treatment modalities for frozen shoulder associated with better outcomes than other treatments?”
How They Did It
It was a meta-analysis of 65 studies with 4097 participants
They searched Medline, EMBASE, Scopus, and CINHAL in February 2020.
Studies with a randomized design of any type that compared treatment modalities for frozen shoulder with other modalities, placebo, or no treatment were included.
Data were independently extracted by 2 individuals
Pain and function were the primary outcomes, and external rotation range of movement (ER ROM) was the secondary outcome
Length of follow-up was divided into short-term (≤12 weeks), mid-term (>12 weeks to ≤12 months), and long-term (>12 months) follow-up.
What They Found
Despite several statistically significant results, only the administration of intra-articular (IA) corticosteroid was associated with statistical and clinical superiority compared with other interventions in the short-term for pain
Subgroup analyses and the network meta-analysis demonstrated that the addition of a home exercise program with simple exercises and stretches and physiotherapy (electrotherapy and/or mobilizations) to the intra-articular corticosteroid may be associated with added benefits in the mid-term
Wrap It Up
The findings of this study suggest that the early use of intra-articular corticosteroid in patients with frozen shoulder of less than 1-year duration is associated with better outcomes. This treatment should be accompanied by a home exercise program to maximize the chance of recovery.
Item #3
Now, on to Evidence-Based Chiropractic. Our third and final one this week is called “Cost comparison of two approaches to chiropractic care for patients with acute and sub-acute low Back pain care episodes: a cohort study” by Whedon et. al. (Whedon JM 2020) and published in the Chiropractic and Manual Therapies on December 14, 2020. Get your red hots right here, get ‘em hot right here. I told you Whedon was prolific. That’s two papers in this one episode that he’s the lead author on and I did not do that on purpose. I didn’t realize who the authors of the papers were until I started typing. He’s on his A-game.
Why They Did It
The abstract for our Evidence-Based Chiropractic talk leads off by saying, “Low back pain (LBP) imposes a costly burden upon patients, healthcare insurers, and society overall. Spinal manipulation as practiced by chiropractors has been found to be cost-effective for the treatment of LBP, but there is wide variation among chiropractors in their approach to clinical care, and the most cost-effective approach to chiropractic care is uncertain. To date, little has been published regarding the cost-effectiveness of different approaches to chiropractic care. Thus, the current study presents a cost comparison between chiropractic approaches for patients with acute or subacute care episodes for low back pain.” How They Did It
It was a retrospective cohort design to examine the costs of chiropractic care among patients diagnosed with acute or subacute low back pain.
The study time period ranged between 07/01/2016 and 12/22/2017
They compared cost outcomes for patients of two cohorts of chiropractors within the health care system: Cohort 1) a general network of providers, and Cohort 2) a network providing conservative evidence-based care for rapid resolution of pain.
They used generalized linear regression modeling to estimate the comparative influence of demographic and clinical factors on expenditures.
A total of 25,621 unique patients were included in the analyses
What They Found
The average cost per patient for Cohort 2 (mean allowed amount $252) was lower compared to Cohort 1 (mean allowed amount $326
Patient and clinician related factors such as health plan, provider region, and sex also significantly influenced costs.
Wrap It Up In general, providers in Cohort 2 were found to be significantly associated with lower costs for patient care as compared to Cohort 1. Utilization of a clinical model characterized by a patient-centered clinic approach and standardized, best-practice clinical protocols may offer lower cost when compared to non-standardized clinical approaches to chiropractic care.
So….just who the hell do you all know that’s been preaching this until his face is about to explode? That’s right, listeners of this podcast. One word, two syllables…..Day-um. Evidence-based and patient-centered care is the future of chiropractic. It is first and foremost, treating our patients with respect and the best care and that’s what they deserve. Secondly, it’s speaking the language of the medical community. Which is the language of research. When you’re using their language, you’re starting to communicate more effectively. I think it’s time for superhero sound effects….boom, pow, snap, kawachow!
Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. 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.
The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!
Key Point:
At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!
Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.
Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website https://www.chiropracticforward.com
Social Media Links https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/
About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Challoumas D, B. M., McLean M, (2020). “Comparison Of Treatments For Frozen Shoulder: A Systematic Review and Meta-Analysis.” JAMA Open 3(12): e2029581.
Whedon JM, B. S., Dennis P, Fischer VA, Russel R, (2020). “Cost comparison of two approaches to chiropractic care for patients with acute and sub-acute low Back pain care episodes: a cohort study.” Chiropr Man Therap 28(68).
Whedon JM, T. A., Bezdijan S, (2020). “Implementation of the Primary Spine Care Model in a Multi-Clinician Primary Care Setting: An Observational Cohort Study.” J Man Physiol Ther 43(7): P667-674.
CF 153: Some Chiropractors Could Be Better Today we’re going to talk about chiropractors, the subluxation – vitalistic group in our profession and we’ll probably make some grumpy vitalistic enemies out of these chiropractors in the process. 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.
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You have found yourself smack dab in the middle of Episode #153 Now if you missed last week’s episode , we talked about spinal instability clinical pearls and we tal ked about degeneration and the facets. That was some good stuff you need to to have in your back pocket. 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
On the personal end of things…..
I’m doing hte same stuff you’re doing for the most part. I’m just struggling through this second wave of COVID. Trying to stay smart and trying to stay healthy. I wish I could say the same for everyone around me. For example, I just had a staff member start this week off by telling me she started working a part time job on the weekends because she got an apartment she thought she could afford but it’s not as easy as she thought. Anyway, at this part time job, her buddy drank out of her drink. She’s like, oh well, it’s just my friend. No big deal. Yeah, no big deal friend called her today…..2 days after that…..and is feeling bad and going to get tested. Now, does that mean my girl has it? Of course not. The friend wasn’t even symptomatic so the chances are low she has it in the first place and if she does have it now, the chances she was shedding the virus then are low.
Still…..come on man. Be smart. My daughter goes to school with 1000 plus kids every day and I don’t let her take a sip of my drink or anything like that. Much less a buddy at my part time job. Hell no. hell no. So those are the things we get to battle with, right? We can control everything about what we personally do but we can’t control our kids at school with their friends. We can’t control my other kid at college and his behavior. We can’t control our staff when they’re not here at work. We just do our best, keep our fingers crossed, and keep working diligently. And hopefully safely. Not because I’m necessarily scared of getting it. Mostly because I don’t want to shut my practice down for 2 weeks minimum. Who can afford that? So let’s get on with pissing people off, shall we?
If you don’t understand by this point that there is a divide in our profession that simply cannot be healed, tied together, or unified, well….I don’t know what to do for you. You just need to pay more attention. If at any point you have thought the two groups could come together, you are fooling yourself. This profession either needs to be split into two completely different degrees and entities or the vitalists need to practice their minimal practice and sit in the back seat and shut the hell up. Yep….shots fired. I know. I’ll explain more as we go. Every now and then I get fired up and this is one of those times. I’m triggered. I’m the grumpy old ‘get the hell off of my lawn’ guy. More specifically, I’m ‘raise your damn game and quit actiing like fools’ guy.
I should tell you why I’m triggered first. As our listeners are well-aware, I am a member of lots of Facebook groups but the most notable would be the Forward Thinking Chiropractic Alliance. Most friends and family would classify me as conservative in finances and life in general but when it comes to my profession, I’m all about progressive change and forward momentum. So this group fits me very well. Anyway, one of the members posted a screenshot of a doctor– trust me – I use that ‘doctor’ term extremely loosely here – it was a post of this guy claiming that with one table, by himself, he treated 99 chiropractic patients and 9 new patient exams all in 3 hours. I did the math for you all. That’s right at 2 minutes per patient.
Well, for many of us, that’s not too far off of the mark for established patients. Some of you are boutique practices and spend 30 minutes to an hour with each patient and charge out the wazoo for that. But, for most of us, we are adjusting, passing off to our staff for therapy and rehab and moving on to the next patient. I want to be fair here. My face to face time is typically 3-5 mintues with an established just depending on what questions I have to answer, if there’s a new complaint popping up that needs evaluated, new patient education, and things like that. Some slightly less than 3 mintues, some quite a bit longer than 5 minutes.
Now, my patients’ whole visit will clock in on average around 20-30 minutes after therapy and/or rehab but that is delegated to the staff. Here’s the real kicker for me on this joke. The new patients. I can not get past the new patients. Now I’ve seen 7 or 8 new patients in a day while juggling another 50 or more established patients. But damn man…that’s over the course of a 7 hour day. And, while I don’t think it makes me particulary any more special than anyone else, I have a Fellowship in neuromusculoskeletal medicine. I can come to a diagnosis somewhat quickly when compared to others. Still, my exam, unless it’s a simple rib complaint or something easy like that, it’s going to take 30-45 mintues. Easy. And that’s with staff doing their history and intake part.
Them filling out OATS takes time on top of that. Plus, I recorded a 7 minute, ‘Welcome to our practice’ video they all watch. Look, there’s no damn way on this damn planet anyone calling themselves doctor works that many new patients through in 3 hours while juggling 99 established patients and claims they’re doing a good job. No way now how. Nope, no, negatory, NO! Worst of all, he’s a vitalist, practice management guru so he’s offering to show other, impressionable knuckleheads how to mistreat patients all on their own.
Solo crappery if you will. Crappy treatment all by themselves. With his crappy guidance. What a crappy deal. I have 34 mutual friends with this person and that’s just disappointing. It truly is. Many of you know who I’m referring to but I see no point in mentioning names because the last thing I want is to bring him even more attention. Especially when I don’t see the reason even one person would pay him any at all. I have no way of knowing how long they’re spending with new patients but let’s just agree that it’s not 30-45 minutes.
There’s no way. I know this because if he spent 30 minutes with each of the 9 new patients, that would be about 4 and a half hours. Much more than the 3 hours he talked about in the post. We are forced to assume it is much less than that. So let’s play with the math. Three hours is 180 minutes. I think we can all agree on that. A former attendee to one of his seminars said he bragged in the seminar that he could adjust a patient top to bottom in just 30 seconds. As a sidenote, he taught how to have the trash can right next to the door so that he could tear the face paper and grap the door knob in one smooth motion so as to have the door open and showing the person out before they’re even off of the table. That way, you don’t have to talk to them. So you don’t have to talk to the patient……you get that?
Good Lord, can you imagine a doctor having to speak to their patient after treatment is provided? The horrors!!! Anyway, let’s say 30 seconds is his record but it actually takes one minute on average per patient. If 30 seconds is the fastest, can’t we assume there will at least be some greeting involved in the appointment? Some questions from time to time? There may be some 30 second appointments in there but there may be some minute and a half and some two minute appointments as well. I think that’s fair.
So, if each of the 99 established takes an average of one minute, which is stillsubstandard care by the way, if they all average one minute, then that leaves 81 minutes to examine and evaluate 9 new patients. That means he has roughly 10-15 minutes for each new patient to do the following if he’s going to adequately assess the patient and have a specific diagnosis outside of subluxation slaying and spine whispering. He’s got to:
Review the history taken by the staff before he came in
Review the range of motion if taken in advance by the staff
Review the vitals
Meet the patient and listen to their story
Assess gait
Assess standing posture
Check yellow flags and discuss any that are present with the patient
Check for red flags – not everyone needs x-rays
Check reflexes
Check dermatomes
Check muscle strength (not freaking AK)
Check neurodynamic positions for radiculopathy
Assess for Ehler-Danlos and hypermobility
Check orthos
Check neuro testing
Check for extension/flexion bias positions in some cases
Come up with an accurate diagnosis
Educate the patient on their diagnosis
If chronic pain is part of the case, he has to educate on CNS upregulation and the biopsychosocial aspect of pain which is at least a 5 mintues conversation.
Teach proper movement and biomechancis to remove the daily pain triggers
He has to answer questions the patient may have
Hell, I wonder if he’s ever had someone lay on their stomachs propped on their elbows for 3 minutes to see if they can identify a home self management strategy for their low back pain? Hell no. Three minutes wouldn’t fit into this doctor-centered model. I have no way of knowing but I’m guessing the exam consists of ‘checking subluxation’ and telling them to lay down.
Pop, pop, pop, the ridiculous power is on, see you tomorrow for you next life-saving adjustment. It’s silly. And it’s insane. And it’s not evidence-based. And it’s not patient-centered. It’s not special. It doesn’t take talent other than being able to sell targets garbage. It’s the lowest common denominator and nothing more.
The point being made here is that one cannot do an adequate, responsible, and appropriate exam in this amount of time. And assuming they average only one minute per patient face to face, that’s substandard as hell. Would you want your kid or brother or sister or mom or dad shuttled through an office like a bullet from a gun? Or would you want them to go to someone that cares, connects with them, slows down a tad and takes their time to listen and work with them? The answer is obvious and if you tell me you’d rather your family go to this guy or anyone like them, then you’re just being obstinate and disagreeable.
It’s obvious which style is superior in healthcare. Maybe working on an assembly line you’d like to see fast, efficient, and little attention given to the specifics. But not in healthcare. This model, I’m sorry to be blunt here….this model is garbage when we are working with the breathing, ever-changing human body. And….oh this guy loves him some of him. Oh my goodness. If someone likes to look in the mirror every morning, it’s probably this guy. Now, he’s selling his unique brand of BS to others. He’s doing a good job of it too. He’s got sycophants all over now learning how to shuttle them out of the office without having to speak to them.
They’re in the comments section of this post proclaiming him a rock star! BS. Rock on! I can’t wait to do this when I get out of school! You’re an inspiration. How awesome!!! Blahditty freaking blah. BS, BS, BS. I would comment, “What an embarrassment to our chiropractic community! What a fool! What about exercise and rehab? What about quality over quantity? You give our profession a bad name. You’re one of the reasons we have zero cultural authority and can’t pass a bill in the legislature because you and your followers are irresponsible!!!” You know….things like that. Now, I’ve been asked why I talk bad about other chiropractors.
Running them down and such. I don’t call it that at all. I call it policing our own and calling out BS when it’s right under your nose. I don’t know about you but I don’t want BS under my nose. It stinks. And not only can I smell it, but everyone else I come into contact with smells it as well. So, basically, these people’s actions reflect on me, my business, and my livelihood. And yours as well. So if you’ve been going along to get along thinking it doesn’t matter, it does matter. It matters to your bottom line.
Can you imagine if we were to have more cultural authority and more integration into a regular healthcare protocol…..can you imagine how full our offices would be? Low back pain is the number one reason for disability globally folks. Yet we only see 10% of the damn population. It’s obvious why and the Palmer Gallup poll laid it out. The biggest reason people don’t go to chiropractors is because they don’t freaking trust us. Because of fools like this. Lots of high volume clinics like this slay subluxations non-stop for weeks and weeks. Some see people every week for life. Think about a self-adjuster. The more they did it, the easier it got to the point they created instability in their neck, they have consistent chronic pain, and now they’re a mess.
Can we see this happen in patients that are adjusted too often for too long? Of course we can!! These spine whipering TORs are many times creating instability and causing chronic pain. Which is the damn thing the knuckleheads are supposed to be treating in the first place. But they were too lazy to get educated beyond college and some continuing education each year about proper documentation and how to adjust an elbow. What if they have a hypermobile EDS patient that really needs weight training but they just keep hammering away at what they call subluxations? This is low quality garbage for people that aren’t taking the time to properly evaluate their patients in the new patient exam. In one of his videos he says, “The patient doesn’t care about anything other than does the doctor care and can he help me?” Again, I use that doctor term exceedingly loosely. I have to just say that he is 100% wrong. Yes, patients do care about those two things but you know what else they care about?
They also care that their doctor is smart. Is on top of his game. Is making decisions in the best interest of the patient and not the clinic or the doctor’s wallet. They care about proper biomechanics so they don’t re-injure their back. They care that if they’re hyper mobile, maybe they shouldn’t be adjusted and should focus on weight training instead. They care that a slight decrease in neck curvature isn’t really the harbinger of death and disease some chiros act like it is. They want to know their doctor is making decisions on their care based on accurate diagnoses. Is making decisions on their care based on research and not philosophy. Trust me, they care about a hell of a lot more than How incredibly arrogant of this supposed doctor to think he has the only answer to what patients care about. They’re not freaking sheep with little to no thought processes.
They’re smart as hell in many cases and they absolutely care about a whole lot of stuff is missing. Saying they don’t is selling them short and it’s unfortunate that he’s going around teaching that. One more example of him being doctor-centered rather than patient-centered. “I….the doctor….knows what the patient really wants and cares about. They can’t think for themselves.” Garbage. Of course patients don’t care about the biopsychosocial aspects of pain. They don’t even know what the hell that is. But we as professionals should absolutely know and absolutely care and leverage it to our advantage. We should know about upregulated CNS and educate patients about it. Because it matters. The question might be, “Why would people keep going back?”
Well a lot don’t but, in general the ones that do have typically had the crap scared out of them based on x-rays that usually shouldn’t have even been taken in the first place. “Looky here, loss of curvature, that is so concerning. I’m really worried about this and what it means for your future if we don’t get that fixed. That’ll be 58 visits this year at a cost of $4800. That’ll be upfront and here’s the contract to hold you to it.” Predatory, unbelievably unethical, astoundingly unprofessional, and embarrassing. Fro every patient referred to a clinic like this, I’d guess they lose one that thinks they and every other chiropractor on the planet is insane.
Thank you vitalists. I really appreciate it. So much. thank you. Clinics like this only see their successes. So they think they’re amazing. I’ll be honest, I see A LOT of patients coming to see me from practices like this because patients can’t stand being shuttled through like cattle, not being listened to, feeling that the care is substandard, being scared by the doctor into treatment, being scared into contracts, and things of that sor They feel taken advantage of and they don’t like it. And I don’t blame them. I just appreciate them for giving me a chance to show them that the majority of chiropractors don’t engage in foolish crap.
That we can play an integral part in resolving their pain. I have heard the most embarrassing stories about chiropractors from patients that escaped clinics like this. A chiropractor can still focus on subluxations but do it in an evidence based, patient-cantered way. Wanna help more people? Hire more docs to handle that patient load and be able to have the time it takes to spend with the patients to do a proper job. Serve more people. Just hire more people to do it. I just want better from this guy and people like him. I want a standard in our profession. I want more from our profession. I want to have a conversation with someone in the medical field or someone that knows very little about chiropractic and not feel the need to apologize for guys like this.
He’s clearly a talented guy and a leader on some level. I just wish the talent was more focused on evidence-based, patient-centered endeavors. Basically, I don’t have a problem with people practicing under the subluxation model when they’re not advising against vaccines. We didn’t learn enough about them to be a damn authority on it. Stay out of the conversation either direction. It is not ours to have. Can you imagine telling a mother not to get a baby vaccinated and then the baby gets measles? Steer clear of that conversation. Anyway, I don’t mind people practicing that model. At the end of the day, we are all moving bones. The adjustment is the cornerstone of my practice but it’s only a piece of my practice. IT’s not the end-all-be-all. IT’s a puzzle piece but the piece is the biggest piece of my puzzle and it’s right in the center of the puzzle. Nothing more nothing less.
It’s not spiritual. It’s just a really big, very effective tool I have. My issue is the thought that a thorough and comprehensive exam is not necessary. That connecting with patients is not important. That talking with them, answering their silly questions, and educating them is not important. It all is very important and all of it, like it or not, takes time. It just does and time is a constant we must all contend with and work within the contraints of. So….that’s me, folks. Raw. And mostly censored because trust me, I cuss like a sailor when I’m not on this podcast. I could make this discussion so much more colorful and it’s deserving of the cuss words. I know many of you know this guy and you think he’s the bees knees and you’ll probably tune out here and think I’m just an awful person because
I’m talking this way about him but here’s the deal, we cannot let quackery and foolishness not only permeat what should be an evidence-based, patient-centered healthcare discipline…..but it is pervasive. Not only is it permeating, but it’s pervasive. You don’t have to look far to find a sycophant. I have 34 nutual friends with this knucklehead afterall. What more do I need to say? So, more akin to the medical field, we should recognize BS, we should call it out, and we should educate against it. And that’s what I’m doing. Every week. It’s not the subluxation-based thing that gets me. I’m used to that. It’s the culture around it that is insane.
Don’t vaccinate, as long as you stay adjusted, don’t worry about COVID, or any other disease, I say a knucklehead guru in school telling me adjstements pushed cancer out of guy’s body. Come on, man. When New Mexico had a shortage of practitioners and allowed chirorpactors to go to two extra years of education to get an advanced practitioner certificate to help prescribe and help handle the patient load, you know who showed up to testify against their own colleagues? Vitalist, subluxation-based, crazy-eyed imbecile chiropractors holding on to green books, the words of BJ, and a philosophy created in the late 1800’s.
Yeah, great look folks. You know who is against the ACA’s push for Medicare parity? Yeah, not just the usual suspects like the AMA. Nope, hell, the AMA’s best teamates against chiropractic are the vitalists. Yeah, I’ve seen the sychophants of Matthew McCoy railing against us being treated equally under Medicare. Explain that for me….someone….please explain that. Again, it’s not the subluxation. I don’t personally use or care for that word or philosophy but that’s not it. IT’s the insane leaders of that cult and the culture surrounding it that makes me want to punt baby bunnies into the damn stratosphere. So, if you’re a subluxation person, my beef is not with you as long as you’re not scaring and taking advantage of your patients. As long as you’re not telling them to see you 80 times this year to keep them healthy and all that. I have no beef with you.
Especially if you’re a Christian. Telling a patient that they were made imperfectly by a God you put every bit of your faith in makes no sense. at all. Y’all I’m a Christian. God makes no mistakes. He didn’t put us on Earth imperfect and in need of a chiropractor every week of our lives or be a miserable wreck of a person just waiting around on death’s doorstep. What a foolish concept for the faith-based models out there. The Body By God group. It’s silly. Sure be faitful, no problem there. But don’t tell people that they need you.
Otherwise, God can’t express himself fully without you. Yes, that is one of their talking points in case you were wondering. Insanity. Current guides tell us to use spinal manipulative therapy for movement dysfunction, use exercise and rehabilitation, use low level laser, use heat, yoga, acupuncture, and soft tissue manual therapy, use balance and proprioceptive training as well. These are all ways of leveraging modalities to great effect in resolving pain. They also teach us to NOT create dependency in the patient upon us.
They shouldn’t depend on us. We should be teaching them ways to self manage ongoing pain at home and see them for periodic flare-ups. That’s evidence-based and that’s patient-centered. 180 degrees opposite of what this practice I’m speaking about is doing. There are so many amazing chiropractors in the world that have raised their games to such a level that they can command respect and money for their opinions and treatment. Then…..there just aren’t. They’re educationally lazy but they can sure talk a great game. I’d like to see eveyrone raising the level. Raising the standard and taking this profession into an era of growth, progress, and respect.
Item #1
It’s called “The disappearance of the primary care physical examination – losing touch” by Dr. Paul Hyman(Hyman P 2020), and MD and it was published in JAMA on August 24, 2020. Damn the sizzle!!
It’s an article so high points we will hit upon He starts out by asking, “What is a physica examination worth?” He says he’s noticed that physical exams seem to be falling by the wayside in recent years and that fact has been highlighted for him since looking at the daily schedule and determining which will be see face to face in the days of COVID. He says that an exam is clearly needed at times for a diagnosis but that he’s realizing other ways he commonly uses exams as well. He says it is a means through which he pauses and physically connects with patients. It’s a way to demonstrate his knowledge and authority to the patient.
He says it’s also a chance to persuade patients and reevaluate their narrative. On the part about demostrating your knowledge, what are you demonstrating when you do a minimal, piss ant exam? Whether you know it or not, you may be demonstrating your lack of knowledge, right? Especially when that patient has had enough of your crap and goes to someone that knows what they’re doing. When the patients say, “This is awesome! The other chiropractor didn’t do any of this,” well, we have a pretty good idea of where you’ve been before getting to us. He goes on to say, “When patients and I disagree on a plan, the physical examination not only provides data, it also acts as an arbiter.”
He makes an excellent point here when he says, “In an admission of my own insecurity, the physical examination remains one of the few domains where I maintain a sense of professional skill and authority. I have never been much of a proceduralist. The mainstay of what I offer to patients is the ability to listen to them, to use critical thinking skills, and to offer my knowledge and experience. But those skills are sometimes challenged in a world where patients research their own health and develop their own medical narratives.
The physical examination remains a place where I offer something of distinct value that is appreciated.” You cannot make a difference in patients’ lives when you don’t know what the hell is wrong with them because you didn’t have the knowledge it takes to be accurate or because you only took 10 minutes to examine them. CHIROUP ADVERTISEMENT
Item #2
This second item is called “Chiropractic, one big unhappy family: better together or apart?” by Leboeuf-Yde et. al. (Leboeuf-Yde C 2020) from February 2019 and published in Chirorpactic and Manual Therapies.
Again, it’s an article so hittin the high spots. They say that the profession has a long history of internal conflict. Today, the division is between the ‘evidence-friendly’ faction that focuses on musculoskeletal problems based on a contemporary and evidence-based paradigm, and the ‘traditional’ group that subscribes to concepts such as ‘subluxation’ and the spine as the centre of good health. This difference is becoming increasingly obvious and problematic from both within and outside of the profession in light of the general acceptance of evidence-based practice as the basis for health care. They argue here that the situation within the chiropractic profession corresponds very much to that of an unhappy couple that stays together for reasons that are unconnected with love or even mutual respect. We also contend that the profession could be conceptualised as existing on a spectrum with the ‘evidence-friendly’ and the ‘traditional’ groups inhabiting the end points, with the majority of chiropractors in the middle. I personally call the ones in the middle agnostics.
They take a little subluxation/innate talk to heart but think evidence-based is the way to go but are not motivated about learning any of the evidence and research. Or just don’t know where to go to find it. They say this middle group does not appear to be greatly concerned with either faction and seems comfortable taking an approach of ‘you never know who and what will respond to spinal manipulation’. We believe that this ‘silent majority’ makes it possible for groups of chiropractors to practice outside the logical framework of today’s scientific concepts. In their conclusion they say, “There is a need to pause and consider if the many reasons for disharmony within the chiropractic profession are, in fact, irreconcilable. It is time to openly debate the issue of a professional split by engaging in formal and courageous discussions.
This item should be prioritised on the agendas of national associations, conferences, teaching institutions, and licensing/registration as well as accreditation bodies. However, for this to happen, the middle group of chiropractors will have to become engaged and consider the benefits and risks of respectively staying together or breaking up.” No matter where you stand on it, it’s though-provoking and I’m sure to find email inbox filling. Lol.
I’m sure I get plenty of hate mail on this episode but I’ll get a lot of support as well. I cannot simply sit by and see BS and sweep it up under the rug. We have to meet it and stand boldly in front of it, and turn it away. For the betterment of ourselves, our profession, and our patients.
Alright, that’s it.
Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. 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.Store Remember the evidence-informed brochures and posters at chiropracticforward.com.
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 https://www.chiropracticforward.com
Social Media Links https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/
About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Hyman P (2020). “The Disappearance of the Primary Care Physical Examination—Losing Touch.” JAMA Internal Med 180(11): 1417-1418.
Leboeuf-Yde C, I. S., Young K, Kauchuk G, Hartvigsen J, (2020). “Chiropractic, one big unhappy family: better together or apart?” Chiropr Man Therap 27(4).
CF 147 w/ Dr. Katie Pohlman – New Research, Upcoming Research, And the Need For It All
Today we’re going to be joined by the one and only, research extraordinaire , Dr. Katie Pohlman. We’re going to talk about all kinds of research-related shenanigans so just you know that you are in the right place at the right time my friend. 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.
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You have found yourself smack dab in the middle of Episode #147.
Now if you missed last week’s episode , we talked about how chiropractic helped the VA cut opioid use among veterans and then we talked about diagnosing lumbar stenosis. 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
On the personal end of things…..
This week we have a guest you’ve heard me talk about plenty of times and I’m excited to have her with us so we won’t dwell on the my personal happenings too long here.
First, we see numbers rising fairly significantly around my neck of the woods. Here in Texas, you can’t get anyone to take it seriously so we have folks walking around everywhere without a mask on. That tends to limit my interaction with people I don’t know. Of course, they’re required here in my clinic but going into a convenience store, that’s a different story.
The last time I did that the clerk and myself were the only ones wearing them out of about 10 people. That’s a little distressing. To say the least. But, it is what it is. Darwinism is a real thing. Of course I don’t wish it on anyone and every loss is tragic. But there’s also the natural progression of Darwinism. Those that go by ‘heart’ and ‘opinion’ rather than science and self-preservation…..well, that’s a more dangerous course and I wish them all luck. In the end, regardless of how many get it, we’re looking at 98% of them coming through alright. No percentage guess on how many survive but suffer ongoing issues though. I haven’t heard numbers on that.
Anyway, as far as the practice goes, we are clicking along and doing well. The new patient count is staying up there where it needs to be and the weekly visits will follow. Still around 145 last week though. I want to see that up around the 185 per week mark. Minimally.
Then we can get back to paying down debt (aka school loans) and investing rather than paying the bills and surviving. Lol. lt’s good to pay the bills and survive but we should have bigger plans shouldn’t we? Investing and being debt free is key to the later part of life and it’s hard to do so when you’re down.
Speaking of, I want to pass along some info to you guys and gals. I just finished up a book and decided I’d order 2 more off of Amazon to give out as gifts. The only other book I’ve ever done that with was one called The Easy Way To Quit Smoking by Alan Carr. I ordered several to loan out to my patients that are smokers.
This book though was about investing. I have read financial books before but, if I’m being honest, getting into symbols and specifics and all…..it’s just not my forte. My wheelhouse exists elsewhere. Which sucks because being financially sound is key to all of our lives.
Anyway, the book is called Quit Like A Millionaire by Kristy Shen and Bryce Leung. They’re a married couple with different last names. I don’t know. Young people these days do stuff different. Lol. Anyway, I am always skeptical about titles like that. Sure sure….quit like a millionaire. Riggghhhtttt. This book is different. When I said young people do things differently, these two really do. There are real, actionable steps here and I have to admit, even at 48 years old, I’m pretty jazzed about getting my numbers back up so I can jump in head first on some of these suggestions.
They retired at 32 years old. She’s got the research and the numbers behind her and I’m impressed. If I can get started on it soon, I’ll talk about it and share my experiences with you as I go along. Until then, you might check her website at https://www.millennial-revolution.com/start-here/
Introduction
Enough of that, let’s get going with our guest today. Welcome to the show, Dr. Pohlman. I appreciate you joining us today.
How are things at Parker University today?
Tell me why you became a chiropractor and then what it was that led you into the research side rather than the treatment side of the profession.
Congratulations on being the ACA Researcher of the Year. Tell me, with all of the amazing researchers doing work in the profession right now, in your opinion, what made you the pick for the award this year.
Let’s talk about your post at Parker University. Can you tell us about your day-to-day? For the research-minded listener out there in podcast land, what does the head of research at Parker do every day when you go into work?
I have a paper here that you were the lead author on called “Assessing Adverse Events After Chiropractic Care at a Chiropractic Teaching Clinic: An Active-Survellance Pilot Study” and published in the Journal of Manipulative and Physiological Therapeutics in August of 2020 so brand new stuff here(Pohlman K 2020). While unfamiliar with the other authors on the paper, I do recognize Dr. Greg Kawchuk. I got to see him speak last September in St. Louis at the Forward ’19 conference and wow….he’s an effective speaker to say the least. He’s a heavy hitter for sure. The stated objective here was to assess the feasibility of implementing an active-surveillance reporting system within a chiropractic teaching clinic and subsequently determining the frequency of adverse events after treatment is administered. Now pilot studies are basically the research before the research, right? So, what is down the road along these lines and why is this paper important to us?
Here is a quote from the conclusion of the paper that I think our listeners would find educational. You say, “Our preliminary findings identified that over 50% of patients had improved symptoms after a chiropractic encounter, whereas 8.9% of patients reported worsening symptoms and 5.0% reported new symptoms. Additionally, results from this study suggest that although most symptoms improve with care, there are symptoms that worsen or are new after care, which may not have been previously known to interns or practitioners.”
Another project you were an author on is called “Chiropractic Care of Adults With Postpartum-Related Low Back, Pelvic Girdle, or Combination Pain: A Systematic Review,” by yourself and Carol Ann Weiss et. al(Weiss C 2020). published again in the Journal of Manipulative and Physiological Therapeutics in again, August of 2020. It was a really busy August for you apparently! The objective of this one was to conduct a systematic review assessing the effectiveness of specific chiropractic care options commonly used for postpartum low back pain, pelvic girdle pain, or a combination of the two.Can you lead us through the paper a little and talk about the abstract’s conclusion which says, “No treatment option was identified as having sufficient evidence to make a clear recommendation.”
The last paper I want to ask you about is one you were on that we covered way back in episode #68 and the paper was called “Change in young people’s spine pain following chiropractic care at a publicly funded healthcare facility in Canada.” It’s amazing how much wonderful research goes on in Canada, BTW. Anyway, it was published in Complementary Therapies in Clinical Practice in March of 2019(Manansala C 2019). This one was interesting to me because it highlighted the fact that spinal pain in young people has been established as a risk factor for pain later in their life. Basically, you all wanted to see how kids respond to chiropractic. I think most chiropractors find this to be obvious given our clinical observations but the conclusion of the paper was “the findings of th epresent study provide evidence that a pragmatic course of chiropractic care, including spinal manipulation, mobilization, soft tissue therapy, acupuncture, and other modalities within the chiropractic scope of practice are a viable conservative pain management treatment option for young people.” What can you tell me about this paper? Did you learn anything new that you didn’t already know going into it?
Do you ever get tired of having a new paper come out? Is it exciting every time?
When I was at Forward ’19, I heard about a program for the first time. I had never heard of CARL before. It turns out that you are very involved. Can you tell us what it is and why it’s important?
What are you and your crew working on now? What’s coming down the line and what big questions are you hoping to get answers to?
Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. 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.
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 https://www.chiropracticforward.com
Social Media Links https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter https://twitter.com/Chiro_Forward
About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Manansala C, P. S., Pohlman K, (2019). “Change in young people’s spine pain following chiropractic care at a publicly funded healthcare facility in Canada.” Complementary Therapies in Clinical Practice.
Pohlman K, F. M., Ndetan H, Hogg-Johnson S, Bodnar P, Kawchuk G, (2020). “Assessing Adverse Events After Chiropractic Care at a Chiropractic Teaching Clinic: An Active-Survellance Pilot Study.” J Man Physiol Ther.
Weiss C, P. K., Draper C, Silva-Oolup S, Stuber K, Hawk C, (2020). “Chiropractic Care of Adults With Postpartum-related Low Back, Pelvic Girdle, or Combination Pain: A Systematic Review.” J Man Physiol Ther.
CF 134: Sleep and Cardiovascular Issues & Can Chiropractic Learn From Podiatry?
Today we’re going to talk aboutSleep and Cardiovascular Issues & Can Chiropractic Learn From Podiatry? But first, here’s that sweet sweet bumper music
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.
I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. If you haven’t yet I have a few things you should do.
Like our Facebook page,
Join our private Facebook group and interact, and then
go review our podcast on iTunes and other podcast platforms.
While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it. You have found yourself smack dab in the middle of Episode #134
Now if you missed last week’s episode, we talked about getting patients back to your office during COVID, shoulder impingement, cervical manipulation, and x-rays and neurodegenerative disease. That one was FULL of great information. Make sure you don’t miss that info. Keep up with the class.On the personal end of things….. I’ve been holding pretty steady at 80-85% of where I’d like to be in my practice. While that’s frustrating, it’s also 100% understandable and patience has to kick in and we must simply wait it out. I am an eternal optimist. Or at least I try to be. I think it’s important. For example, we are making less money BUT we are also spending less money. Not only in my office in overhead but also at home. We’re not taking trips or going and doing. We’re not eating out like we did this time last year. So, not as much money is required. We are more than meeting our monthly bills. If I really take a step back and look at it from a macro view, life is good. I have a bit of extra time to do the things I need to do outside of patient treatment and, due to less spending, a decrease in income isn’t as significant as it would have been. It’s not fun. Don’t get me wrong. Nobody that is an achiever wants to take a step back at any time. For me, it’s pedal to the metal man. Constant and sustained growth. So, even though there are legitimate reasons, it doesn’t matter. It’s still a hit to the heart to see your business shrink. But, again, being an optimist is helpful. It’s going to be alright. I asked for some recommendations in our private Facebook group about how to get your patients to return to your offices during the COVID freakout. Dr. Jerome Fryer with Dynamic Disc Designs had a great suggestion. He said, “Do a walk through video…showing the safety measures exacted. Personalized and live. Share it to your email list and social followers.”
That’s a great suggestion. While I was going through all of the things I am doing on last week’s episode, I mentioned how in marketing, our job is to remove all barriers to saying, ‘Yes.’ Well, COVID is the biggest barrier we face at this time so we have to remove that barrier. We aren’t epidemiologists so we won’t be coming up with any treatments or vaccines of course. So, the way we can remove that barrier as much as possible is to show the safety measure we are taking. Talk about it, video it, demonstrate it. And let your patients see you cleaning while they’re in the office. Those coming to see you already will feel even that much more comfortable with your office when they see you taking steps to keep them and others safe. Remove the barriers to saying yes. Alright, let’s dive in Item #1 Let’s start though with this one here called “Association of Longitudinal Patterns of Habitual Sleep Duration With Risk of Cardiovascular Events and All-Cause Mortality” It was authored by Wang et. al.(Wang Y 2020) and appeared in JAMA on May 22 of 2020 and dammit that’s a blazing barrel of biscuits my friends.Why They Did It The authors wanted to know if there were any longitudinal patterns of habitual sleep duration associated with the subsequent risk of cardiovascular events and all-cause mortality. How They Did It
This was a cohort study that included 52 599 participants
4 distinct sleep duration trajectories reported during a 4-year interval were identified.
Compared with a stable sleep duration of 7.0 to 8.0 hours per night, normal-decreasing and low-increasing patterns were associated with increased risk of first cardiovascular events and all-cause mortality
individuals reporting consistently sleeping less than 5.0 hours per night had the highest risk
Wrap It Up In this study, sleep duration trajectories with lower or unstable patterns were significantly associated with increased risk of subsequent first CVEs and all-cause mortality. Longitudinal sleep duration patterns may assist in more precise identification of different at-risk groups for possible intervention. People reporting consistently sleeping less than 5 hours per night should be regarded as a population at higher risk for CVE and mortality.
Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. If you’re into IASTM also known as instrument-assisted soft tissue manipulation, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend. Drop Release is a revolutionary tool that harnesses the body’s built-in protective systems to make muscles relax quickly and effectively. This greatly reduces the time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day.
Its inventor, Dr. Chris Howson, from the great state of North Dakota has is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase. Go check out Drop Release at droprelease.com and tell Dr. Howson I sent you.Item #2 Item #2 is one I got from Dr. David Wedemeyer who resides out in Costa Mesa, California. I have no idea how I didn’t know about this one already. It’s called “How can chiropractic become a respected mainstream profession? The example of podiatry” by Donald Murphy, et. al.(Murphy D 2008) and published in Chiropractic Osteopathy in 2008.Why They Did It The chiropractic profession has succeeded to remain in existence for over 110 years despite the fact that many other professions that had their start at around the same time as chiropractic has disappeared. Despite chiropractic’s longevity, the profession has not succeeded in establishing cultural authority and respect within mainstream society, and its market share is dwindling. In the meantime, the podiatric medical profession, during approximately the same time period, has been far more successful in developing itself into a respected profession that is well integrated into mainstream health care and society.
The objective here was to present a perspective on the current state of the chiropractic profession and to make recommendations as to how the profession can look to the podiatric medical profession as a model for how a non-allopathic healthcare profession can establish mainstream integration and cultural authority.
We suggest the chiropractic profession consider several questions that speak to the different histories of the chiropractic and podiatric profession. Why are podiatrists better integrated into hospitals and other multidisciplinary facilities than chiropractors? Why are most schools of podiatry integrated into the university system, while chiropractic schools (with very few exceptions) are not? Why did the AMA not try to “contain and eliminate” the podiatric medical profession (despite the several turf battles podiatry has had with the orthopedic specialty)? Why were podiatrists not thrown in jail in the early days for practicing medicine without a license? How did podiatrists gain the level of cultural authority that they currently enjoy, despite having the same duration of existence and a smaller number of practitioners than chiropractic? Discussion One important reason podiatry succeeded in establishing itself in mainstream health care was its traditional dedication to public health. Podiatrists became active members of the American Public Health Association (APHA) as far back as the 1950s, embracing and contributing to the advancement of accepted public health initiatives, in cooperation with others involved in public health. Podiatrists slowly gained an image as proponents of public health, at a time when many chiropractors aggressively (and dogmatically, without evidence opposed many public health measures such as vaccination and water fluoridation. One immediate action step that individual chiropractic physicians can make is to join and become active in the APHA. This would be one of the best ways for chiropractors to have an influence on public health policy. Spinal pain is an enormous public health issue, as the vast majority of Americans will develop a painful back or neck that will require treatment sometime in their lives
It is also vital that those chiropractors who dogmatically oppose common public health practices, such as immunization and public water fluoridation, cease such unfounded activity.
Authors say they are concerned that the common perception (which is well supported, in our experience) that chiropractors are only interested in “selling” a lifetime of chiropractic visits may be one of the primary factors behind our low standing in the minds of members of the public. This is supported by a Canadian study which found that when the public was educated about “subluxation”, the cornerstone of many chiropractors’ “lifetime treatment plans”, members of the public actually developed a negative view, and were more likely to want to consult a medical doctor to see if they had a subluxation prior to seeing a chiropractor They say that we chiropractors must take a critical look at our educational institutions, find what is substandard, and correct those deficiencies. One of the problems that we encounter frequently in our interaction with chiropractic educational institutions is the perpetuation of dogma and unfounded claims. Examples include the concept of spinal subluxation as the cause of a variety of internal diseases and the metaphysical, pseudo-religious idea of “innate intelligence” flowing through spinal nerves, with spinal subluxations impeding this flow. These concepts are lacking in a scientific foundation and should not be permitted to be taught at our chiropractic institutions as part of the standard curriculum. Much of what is passed off as “chiropractic philosophy” is simply dogma, or untested (and, in some cases, untestable) theories which have no place in an institution of higher learning, except perhaps in a historical context. Faculty members who hold to and teach these belief systems should be replaced by instructors who are knowledgeable in the evidence-based approach to spine care and have adequate critical thinking skills that they can pass on to students directly, as well as through teaching by example in the clinic.
They say consideration should also be given to upgrading admission requirements to chiropractic schools. In podiatric medicine, such upgrading, which included the requirement of the Medical College Admission Test (MCAT), a requirement of medical school admission, is considered one of the significant events in the profession’s history, giving the profession legitimacy in its calls for parity with medicine
Continuing with education, they say it is essential that the chiropractic profession establish hospital-based residencies. There is a tremendous void in how chiropractic graduates develop any meaningful hands-on clinical experience with real patients in real-life situations.
Perhaps the most important factor that helped the podiatric medical profession to flourish was the fact that podiatrists had a clear identity and purpose; the podiatric medical profession was founded on the purpose of filling a need in society – the care of problems of the foot. They did not invent a “lesion” and a “philosophy” and try to force it on the public. They certainly did not claim that all disease arose from the foot, without any evidence to support this notion
The podiatric medical profession focused on a particular set of problems for which allopathic medicine had little interest and a limited ability to deal with effectively, i.e., common foot disorders
The chiropractic profession must establish a clear identity and present this to society. In the beginning, DD Palmer invented a lesion, and theory behind this lesion, and developed a profession of individuals who would become champions of that lesion. This is not what credible professions do.
Based on all the evidence regarding chiropractic practice and education, there is only one societal need (but it is a huge one) that chiropractic medicine has the potential to meet: non-surgical spine care. Our education and training is focused on the spine, and clearly, if there is a common bond among all chiropractors, it is spine care
No matter how one looks at it, or what one would like reality to be, chiropractic medicine is about back pain, neck pain, and headache. Instead of fighting that fact (or denying it), we should embrace it fully and focus on becoming society’s go-to profession for disorders in this area.
The World Federation of Chiropractic (WFC) has taken an important step in establishing a clear identity for chiropractors as “The spinal health care experts in the health care system”. It is critical that other state, provincial and national associations follow the lead of the WFC.
Fidelity to the social contract. They say when an individual consults a member of any of the medical professions, it is reasonably expected that the advice and treatment that he or she receives is based in science, not metaphysics or pseudoscience. In addition, it is reasonably expected that the services he or she receives are being provided for the primary purpose of benefiting the patient, and not for any other reason. The financial benefit to the professional is secondary and results from the degree of the clinical benefit received by the patient. Patients place their faith in the professional, and trust that they will not be subject to fraud, abuse, or quackery. This is the social contract as it applies to chiropractic physicians.
Oh, how many times has my audience heard me railing against doctor-centered, clinic-centered practices? Just in the last month or so actually. Lol. We feel it is important here to briefly contrast and compare podiatry and foot reflexology. While the two professions have always been distinct, there is a commonality in that each focuses its treatment efforts on the foot; however, this is where any resemblance between the two professions ends. Podiatric medicine is a science-based profession dedicated to the diagnosis and treatment of foot disorders. Foot reflexology is a metaphysically-based group consisting of non-physicians who believe that many physical disorders arise from the foot. Podiatrists have rejected foot reflexology as an unproven and unscientific practice, and do not consider it part of mainstream podiatric practice. Thus, it would be quite unreasonable to think that podiatry and foot reflexology could ever exist under one professional roof.
Yet, this is the very untenable situation in which we find ourselves in the chiropractic profession. Chiropractic has frequently been described as being two professions masquerading as one, and those two professions have attempted to live under one roof. One profession, the “subluxation-based” profession, occupies the same metaphysical and pseudoscientific space as foot reflexology. The other chiropractic profession – call it “chiropractic medicine” as we do in this commentary – has attempted to occupy the same scientific space as the podiatric profession. Alas, the marriage of convenience between these two chiropractic professions living under one roof has not worked. We find science-based practitioners and organizations alongside quasi-metaphysical, pseudoreligious, pseudoscientific practitioners, and organizations. The result is continually battling with a huge waste of energy and resources, while professional growth stagnates.
We must finally come to the painful realization that the chiropractic concept of spinal subluxation as the cause of “dis-ease” within the human body is an untested hypothesis. It is an albatross around our collective necks that impedes progress. Wrap It Up “The chiropractic profession has great promise in terms of its potential contribution to society and the potential for its members to realize the benefits that come from being involved in a mainstream, respected, and highly utilized professional group. However, there are several changes that must be made within the profession if it is going to fulfill this promise.”
I could add my own thoughts here but listeners of the show know what I think about it. I agree with every word and I bitch and fuss and get in a huff about this stuff all of the time. I don’t know that getting in a huff all of the time is useful or helpful. I think it lessens my outrage if I’m outraged all of the time. So, I’m settling down here lately. I want to make points but not in a truly negative sense. I want to disagree without being disagreeable. That’s not to say I’m not going to lose my marbles here and there. I will. This profession provides so many opportunities for lost marbles, It’s something you can count on. But, I’d like for the lost marbles to be fewer and farther between with more building rather than breaking. If that makes sense. Alright, that’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. 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.Store Remember the evidence-informed brochures and posters at chiropracticforward.com.
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
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ TwitterTweets by Chiro_ForwardYouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Murphy D, S. M., Seaman D, Perle S, Nelson C, (2008). “How can chiropractic become a respected mainstream profession? The example of podiatry.” Chiropr Osteopat 16(10).
Wang Y, W. J., Chen S, (2020). “Association of Longitudinal Patterns of Habitual Sleep Duration With Risk of Cardiovascular Events and All-Cause Mortality.” JAMA Open 3(5).
CF 119: Chiropractic Business Opportunity & How Chiropractic Solves The Opioid Issue
Today we’re going to talk about some recent numbers that came out in JAMA on healthcare spending. Then we’ll talk about how chiropractic has the answer to the healthcare spending issue.
But first, here’s that sweet sweet bumper music
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.
We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.
I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
If you haven’t yet I have a few things you should do.
Like our facebook page,
Join our private facebook group and interact, and then
go review our podcast on iTunes and other podcast platforms.
While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #119
Now if you missed last week’s episode, we had one of our biggest episodes in the history of Chiropractic Forward and than’s because we were joined by the one and only clinical ninja and world-renowned expert himself, Dr. Stu McGill.
I was a bit of a fanboy so I’m still not sure how strong my part of it came out but I can tell you that Stu is ALWAYS strong and this information is a ‘Do Not Miss’ type of thing. 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’m doing the same thing as you’re probably doing. I’m freaking out a little or a lot. OK, some of you aren’t but I have no idea how you’re able to chill out. I’m not a hype type of guy. Hopefully, by now you know I’m a very reasonable kind of guy.
Here’s what I got; I record these podcasts two weeks prior to airing. This pandemic is changing every day so for me to offer opinions, comfort, hope, and things of that nature just seems pointless right now. Because nobody knows what the hell the landscape will be when this goes live. Nobody knows what business is going to look like.
Just know this, if you are a listener, I love you. Even if we’ve never met. I love you. Please be safe. Please listen to the CDC and not chiropractors that think they can end this through adjustments. Please stay in touch with the elderly you are connected to. Encourage them, help them if they need it. They’re scared too. Probably more so than the rest of us.
It’s time to be humans. Not partisans. Not North, South, East, or West. Not even American, Korean, Italian, or Chinese. It’s time to be humans and do our parts to keep this thing from doing any more damage than it has to do.
And, as a Christian myself, if you are a Christian or religious whatsoever, pray. Whether you think it’ll do any good or not. I can promise it won’t hurt.
If you are living day to day financially, I wish I had something amazing to say but, I WILL offer this. The more my business struggles and the more your businesses struggle. The more this goes on, the more you’ll see the system buckle and bend to accommodate you. That may look like no payroll tax, tax relief, tax incentives, extended lease payment options on your office spaces, school loan interest was already waived and it won’t surprise me if there’s a suspension on school loan defaults as well, the government paid leave for employees, and on and on.
What I’m saying is that some things are out of our control. This is out of our control. Hell, by the time this airs, we may all be on mandatory shut down for business and you may be listening from home.
Here’s what you have to know; The country cannot have thousands and thousands and thousands of businesses going under. Landlords cannot have non-leased, empty buildings
The system will figure out how to keep everyone afloat.
Stay strong and stay hopeful. Stay clean and stay separate for a bit and maybe we can get a handle on it.
Alright, enough of that. I’m sure we’re all sick of hearing it by now.
Item #1
Let’s start with this one called “US Health Care Spending by Payer and Health Condition, 1996-2016” by Dieleman et. al(Dieleman J 2020). published in JA<A on March 3, 2020. Yep, it’s hottern’ hell!!
Here’s the deal, this was March 3rd so….just before this mass hysteria started. Healthcare spending may look different now but, this was from 1996-2016 before anyone ever heard of this pandemic.
Why They Did It
They wanted to answer the question, “How does spending on different health conditions vary by payer and how has this spending changed over time?
How They Did It
Information was collected from the following: government budgets, insurance claims, facility records, household surveys, and official US records from 96-2016.
They used the info to estimate spending for 154 health conditions
Spending growth rates were calculated for each type of payer as well as each type of condition.
What They Found
From ’96 to 2016, healthcare spending when up from $1.4 trillion to $3.1 trillion.
For the mathematically challenged, that is up to $1.7 trillion. I was always under the impression that our system and our treatments should get MORE efficient through the year rather than more and more expensive.
In 2016, private insurance paid for 48% of it
Public insurance paid for 42.6% of it
Out-of-pocket was 9.4%
For the stuff that matters to us chiropractors specifically,
In 2016, among the 154 conditions, low back and neck pain had the highest amount of health care spending with an estimated $134.5 billion
57.2% of that was paid by private insurance
33.7% of it was paid by public insurance
9.2% was paid out-of-pocket
Other musculoskeletal conditions cost the system a further $129.8 billion. So if we’re keeping count here peeps, that means the total cost of musculoskeletal system issues cost the system in 2016 and grand total of 264.3 billion dollars.
I’ll have you know that the second most expensive condition was diabetes coming in at a grand total of $111.2 billion. That’s a full $153.1 billion dollars less than m/s issues.
So that we’re not drowning in numbers here….remember this; M/S conditions cost 264.3 billion. The next most expensive was diabetes at $111.2 billion.
Do you smell some business opportunities there? I sure as hell do. You realize they used to be putting a good number of those people on muscle relaxers and opioids but they aren’t anymore. Right? Now, a large number of those people need an alternative and we are uniquely poised and positioned to be that help. To be that alternative.
Mmmmm….when this mess calms, I’ve got some business ideas. You should be cooking up what brew you want to have ready as well.
Item #2
Our second and last item here is called “Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain” by Whedon, et. al(Whedon JM 2020). and published in Pain Medicine on March 6 2020. Smokin plate of whatcha havin!!
Why They Did It
They say that the utilization of nonpharma pain management may prevent unnecessary use of opioids. The objective here was to evaluate the impact of chiropractic utilization on the use of prescription opioids among patients with spinal pain.
How They Did It
This was a retrospective cohort design for analysis of health claims data from three states for the years 2012-2017
They included 101,221 adults from 18-84 yr old that had office visits to a primary or a chiropractor for spinal pain.
They identified two types;
Recipients of both primary and chiropractic care
Non-recipients that got primary care but not chiropractic.
They compared the two groups as far as the risk for filling an opioid prescription.
What They Found
“Patients with spinal pain who saw a chiropractor had half the risk of filling an opioid prescription. Among those who saw a chiropractor within 30 days of diagnosis, the reduction in risk was greater as compared with those with their first visit after the acute phase.”
So, your next social media graphic is this; “patients who saw a chiropractor had half the risk of filling an opioid script.”
Then the next one will be; “Patients that saw a chiropractor in less than 30 days of diagnosis had been more than half as likely to fill an opioid prescription.”
Then the next one will be “US spends $236 billion on musculoskeletal pain but those treating with a chiropractor are less than half as likely to fill an opioid script.” See how I tied that all together for you? Did you see what I did there?
Don’t just listen to this stuff. Turn it into something. I’m trying to help you! Or, you can just join our private Facebook group and I’ll try to start making these more often so you can just share them without going through the effort.
I’m totally cool with that.
Alright, the message is the same every 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 preventativly after initial recovery, we can usually keep it that way while raising the overall level of health!
Key Point:
At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….
That’s Chiropractic!
Contact
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.
Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.
We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.
Connect
We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Dieleman J, C. J., Chapin A, (2020). “US Health Care Spending by Payer and Health Condition, 1996-2016.” JAMA 323(9): 863-884.
Whedon JM, T. A., Kazal L, (2020). “Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain.” Pain Med.
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
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.
We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.
I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
If you haven’t yet I have a few things you should do.
Like our facebook page,
Join our private facebook group and interact, and then
go review our podcast on iTunes and other podcast platforms.
While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #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:
describe adverse events;
report the incidence of adverse events; and
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?
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
There is no place for contracts for your healthcare. Ever.
It is a profession with A LOT of room in the scope. Chiropractic is not a modality. It’s a profession.
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.
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.
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.
I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few.
It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient.
And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health!
Key Point:
At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….
That’s Chiropractic!
Contact
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.
Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.
We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.
Connect
We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
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).
