Chiropractic Maintenance

Chiropractic Maintenance Care, Corticosteroid Shots, 11 Best Practice Recommendations

WOW!! Our 100th episode. That feels great to say. We made it to 100 and we should celebrate!! I feel like we should do what got me started which is cover some great research that advocates and validates what we do every single day of our working lives.

Chiropractic Wins Again, Push Ups Say A Lot, Low Iron & The Disc

CF 064: Chiropractic Wins Again, Push Ups Say A Lot, Low Iron & The Disc

Today we’re going to talk about how chiropractic and spinal manipulative therapy win again, we’ll talk about how push ups may tell us more than what you see on the surface, we’ll discuss some new information on low back discs and how they’re affected by low iron, and then we’ll gloss over a paper on physical therapy to toss you some thought nuggets. 

Chiropractic evidence-based products

But first, jsut for my friend and collegue, Dr. Michael Henry down in Austin, here’s that ‘you know you love it’ bumper music. He’s a big fan. 

Integrating Chiropractors

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

You have shimmied all 60’s like into Episode #64


We’re here to advocate for chiropractic and to give you some awesome information to make your life easier from day-to-day. We’re going to keep you from wasting time in your week and give you confidence in your recommendations and treatments. And I feel confident in guaranteeing that to you if you listen and stick to it here at the Chiropractic Forward Podcast.  


Part of saving you time and effort is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at I noticed an error on the shipping charge. That has been corrected now. 

Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at if somehting is out of sorts or isn’t working correctly. 


Let’s talk a bit about the Diplomate of the Academy of Chiropractic Orthopedists probgram also known as the DACO. I finished up all 50 of the required live hours this weekend down in Austin, TX during the Texas Chiropractic Association’s legislative seminar. 

Not only did I get all of the hours wrapped up but I also got to see a lot of colleagues I have been doing battle along side with for the last 8 years or so. You may or may not know that the Texas Medical Association is particularly aggressive and attacks at will for anything and everything. Which means we have to constantly raise funds to defend the attacks. 

It’s this cute thing we do with each other from year to year. It’s really a special relationship chiropractors have with the TMA. I keep thinking one day they’ll start listening to their own profession and leave us the hell alone but nope. Not so far. Not until they have full and complete control of chiropractic care in Texas. Which is not going to happen. Just so you know.. 

They sued us because 2 docs in texas who were Neuro Diplomates were doing VONT testing. I’d never even heard of VONT until this last time we got sued by TMA. IF you can give me a good reason why a neuro diplomate cannot do VONT testing, I’ll send you a candy bar or some chicklets or something like that. 

It’s enough to make a guy crazy. I got to meet a lot of bright new people ready to help the TCA fight and overcome. Andrea Ohmann recently moved to Texas from Minnesota. She is in a hospital setting if I understood correctly. She’s a bright star to keep an eye on. I also need to thank Dr. Jamie Marshall for listening to us down in Conroe, TX. I really appreciate it!

I got to see Staff Sergeant Shilo Harris speak. I mentioned him a couple of episodes ago but I have to tell you, this man is a hell of a speaker and he’s in our corner specifically. He gives chiropractic care all of the credit for helping him get through all of his injuries and surgeries. He was blown up by an IED in Iraq and has been through absolute hell to get to where he is now and chiropractic was key to getting him there. 

Very emotional and very impactful. I can’t imagine a legislator being confronted by him and his story and not being forced to see it our way. It’s powerful. Thanks to Shilo for eveything he’s doing for this profession. I hope you’ll go to and see what he’s about. 

Beyond that our DACO hours were taught by Jeffrey Miller who is a chiropractor on staff at the University of Missouri medical school. He’s not as sharp as a tack. He’s actually sharper than a tack and told me he’d love to join us on the podcast so I’m going to do us all a favor and get that set up. We also have Dr. Christine Goertz’s episode coming up quickly so keep your eyes peeled for that one too. 

This get on with this deal here. 

Item #1

Our first item here is called “Manipulative Therapies: What Works” and is authored by Dr. Michael Smith, an MD, and his herd of collegues. It was published in American Family Physician on Febraury 15, 2019(Smith M 2019). I got this one from Dr. William Lawson in Austin, TX who is a DABCO and a swell dude on top of that. 

In case you missed it, this herd of authors are medical doctors. They start by saying that manipulative therapies include things like osteopathic manipulative treatment which is the same as chiropractic manipulative treatment. 

They say that, when you compare manipulative therapy to oral analgesics, cervcial manipulation and/or mobilization appears to provide better short-term pain relief and improved funciton in patietns with neck pain. 

They go on to say that manipulative therapy may be as effective as amitriptyline for treating migraine headaches and can reduce the frequency and intesity of pain. 

While there is some evidence showing that manipulative therapy can reduce length of hospital stays for preterm infants, there is ZERO research for some of the other reasons we see chiropractors treating infants. Things like otitis media, colic, allergies, and respiratory conditions. 

That was all in the abstract. That’s the medical world starting to take note. Can you hear it? When do the insurance companies start to take note as well?

THAT’S REALLY when our lives start changing. Oh happy day….I have a dream. A dream where we are no longer pursecuted for being right all the damn time. A dream that chiropractors don’t go around saying crazy crap and making the rest of us look bad. I have a dream people. I’m not going to pretend to be as good of an orator as Martin Luther King Jr. but you get the point. 

You know that the more of these articles that come out, the more they have to start gathering steam. Turn on a light bulb at night in South Texas and see what happens. The bugs start swarming. Turn on this kind of light and you’ll see these articles begin catching more and more attention until we finally have a consensus in the medical field. A consensus that says, “Hell, looks like they’ve been onto something this whole time. We better take another look at it.”

This is an excellent paper. And we need to keep seeing this more and more. Even if they’re talking specifically about osteopathic manipulative therapy, we know that chiropractors do it too and, in fact, chiropractors do almost all of it these days. DO’s have moved almost completely to medicine. We are the ones moving joints. Make no mistake about it. 

Item #2

Pushups…what can they tell us? Well, it appears they can tell us quite a lot from an article in StudyFinds called “Men Who Can Do More Than 40 Push-ups Far Less Likely To Develop Heart Disease.(Finds 2019)”

This article covers a new study that showed that men posessing the ability to perform 40 push-ups in one attempt are much less likely to suffer from heart disease wihtin the next 10 years. 

They showed where middle-aged men who can put in more than 40 in a single try have a 96% less chance of having heart disease when compared to those who could complete no more than 10 push-ups. 

So, it appears, to me…..that it’s time to start doing some push-ups muy pronto. 

Item #3

This one comes to us from the American Journal of Translational Research and is called “Iron defficiency accelerates intervertebral disc degeneration through affectring the stability of DNA polymerase epsilon complex(Zhang C 2015).” 

It was published in November of 2015 and appears to be mostly Chinese researchers. Could be Japanese, Korean, or Vietnamese but the name of the lead author is Chungiang Zhang and whole host of names that appear to be just as difficult to pronounce. 

We will not get deep into the details here because I’m not too proud to admit that the information here goes far above my head in many ways. I’ve said it before, I’m no guru. I’m like Alex Trebec on Jeopardy. He delivers the info but I promise he’s no expert on every question coming across his lips. Lol. 

But, when we stick with the basics, we see that iron serves as an important cofactor of iron-containging proteins that play critical roles in the maintenance of DNA stability and cell cycle progression. They say that disturbed iron homeostasis gives rise to things like cancer and anemia. 

In addition, they say that they found clear correlation between iron deficiency and intervertebral disc degeneration. 

They wrapped up their paper by saying, “In summary, our study suggests that iron deficiency is an important factor in the aggravation of IDD. Proper iron supplementation may be an effective strategy to alleviate the symptoms of patients with intervertebral disc degeneration.”

Item #4

Our last on the list, it has to do with PTs and is called “Minimal physical therapy utilization compared with higher physical therapy utilization for patients with low back pain: a systematic review,” authored by Heidi Ojha and a gaggle of others and published in Physiotherapy Theory and Practice in February 2019(Ojha H 2019).

This was a systematic review to compare the effects of minimal physical therapy utilization (two visits or less) vs. typical physical therapy utilization consisting of 3 or more visits on patient-important outcomes for patients with low back pain. 

They say this research is needed because there is such variation in physical therapy use for those with low back pain. 

Interestingly, they found that, when compared with minimal utilization, higher utilization demonstrated no significant differences on pain, disability, or quality of life at the 1-year follow-up.

Even more interesting was that the conclusion of the paper said the following, “While higher utilization may not result in significant improvements in patient-important outcomes, it may be more cost-effective for patients with chronic or complex LBP conditions when compared to minimal utilization.”

So, what the hell is that? It’s not going to make you any difference to see us a lot but the price point is agreeable so, by all means, we’d like to see you a crap load. Which isn’t as much as a crap ton. By the way. But I think you see what I mean. 

I have noticed so many papers that basically cast a lot of doubt on PT in general while all we seem to find in regards to manipulative therapy are positive reaffirmation of the chiropractic profession. 

It just makes me wonder where the tipping point is to be honest. When does the medical industry start to look at chiropractic as being more effective for these conditions that PT and making those referrals accordingly? I had some insight on a PT private group on Facebook a couple of weeks ago. 

The PTs were piling on a chiropractor’s advertisement techniques. Let’s be fair, the DC was a knucklehead and wasn’t being honest and identifying himself as a chiropractor in his marketing but, for discussion purposes here, that’s beside the point. 

They were bashing not only on that chiropractor but our profession as a whole. I bash on aspects of my profession as well but, where the rubber hits the road, we average better patient outcomes, we are safe, we are effective, and we average higher patient satisfaction. Even if some in our profession would win a county craziness competition. 

Don’t believe me? Go listen to Episode #49 of this podcast where we go over the Parker-Gallup poll. Very interesting episode and there are some valuable marketing nuggets in that one for you as well. Definitely worth the listen. 

Also Episode #26 talks about PTs and DCs. The age old grudge match. Go check them out and see what you think. 

Some in our profession are simply imbeciles. That sounds harsh but for a time after graduating, I held no interest in furthering my education. I wanted to coast. I’d done the hard work, right? I was so smart already after all those years of college. Well, you don’t know what you don’t know. And, I can admit that for a few years there, I was an imbecile. 

They learned enough to pass but that doesn’t make them smart or ethical and that’s sad. But again, when said and done, our profession consistently proves itself and is proven by insurance companies, governments, polls, surveys, and universities. 

From what I’ve seen recently, I can’t say the same for them and I just can’t see where they feel they have some moral high ground or platform to stand on and spout a bunch of denigrating thoughts at us. 

I thought it’d be a good idea once to refer to a PT. I had a car wreck patient and thought they could use PT and at that time, I wasn’t equipped to do much rehab. So onto the PT they went. In two damn weeks, the PT ran up a bill that would have literally taken me 4 months to run up. I was astounded. And, in that two week period, there was little to no improvement for the patient. 

On a separate occasion, I had a disc patient finally settled down and doing great. She was very active and very much into working out. I had her disc settled down to a point that she thought she’d go get PT on top of what I was doing. She did not talk to me about it. She just did it. Her thought process was that it would just be that much better to combine the two. Chiropractic and PT. Honestly, that’s not bad thinking in theory. 

She came back after one visit almost unable to walk or function. We tried and tried to get it to settle back down but she ended up taking herself to a surgeon to get our of pain. Sorry PTs. Quit talking smack and work with us instead of against us.

Ideally, PTs and chiropractors work hand in hand and complement each other. Many offices can and should operate in this manner. In reality though, I see PTs as great for post-operative rehab and rehab after certain types of injury. When it comes to joints and spines in general though, they can’t touch us. They talk bad about us, they steal services from us, they think they have the moral ground on us, but they can’t touch us.

Those of us practicing in an evidence-informed manner anyway. Those not practicing evidence-informed actually continue to provide them with whatever moral ground they believe they have. 

I for one would like to move on from the beginnings and progress our profession much like the MDs have done over the last 150 years. They went from blood-letting, leeches, and labotomies to what they can do now. Yet, there’s still a part of our profession wanting to hold on dearly to our originations of 100+ years ago. 

Chiropractors, let go. Progress. Practice current, in the current day and age. Practice evidence-informed. It’ll help you and it’ll help the profession in general. 

That’s my opinion anyway. Take it or leave it. 

This week, I want you to go forward with

  1. Chiropractic wins and wins and wins again. We made the right decision. We just need to only use our powers for the good. 
  2. Push-ups….let’s get to doing them!
  3. Iron deficiency for disc degeneration is something worth looking at. 
  4. When we are practicing evidence-informed chiropractic care, PTs only wish they could get the results we can get.

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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!


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

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


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


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About the Author & Host

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


Finds, S. (2019) “Men Who Can Do More Than 40 Push-Ups Far Less Likely To Develop Heart Disease.” StudyFinds.

Ojha H, M. M., Johnston M, (2019). “Minimal physical therapy utilization compared with higher physical therapy utilization for patients with low back pain: a systematic review.” Physio Theory Practice.

Smith M (2019). “Manipulative Therapies: What Works.” AMerican Family Physician 99(4): 248-252.

Zhang C (2015). “Iron deficiency accelerates intervertebral disc degeneration through affecting the stability of DNA polymerase epsilon complex.” Am J Transl Res 10(11): 3430-3442.

CF 042: w/ Dr. Tyce Hergert – Chiropractic Maintenance Care / Chiropractic Preventative Care

CF 042: w/ Dr. Tyce Hergert – Chiropractic Maintenance Care / Chiropractic Preventative Care

Tyce hergert chiropractor southlake

Integrating Chiropractors

Today we have a special return appearance from a friend of the show and we’re going to talk about chiropractic maintenance care also known as chiropractic preventative care. Chiropractors have recommended a regular schedule to their patients for generations but it was mostly as a result of experience and intuition. But what about research on the matter? We’ll get to it.

But first, here’s that bumper music

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

Be sure you have signed up for our newsletter slash email. You can do that at and it lets us keep you updated on new episodes and new evidence-based products when they come out. Yes, eventually there will be some pretty cool things available through us. We won’t email any more than once per week and the value outweighs the risk. Kind of like in cervical manipulation. So just go get that done while we’re thinking about it. 

You have confidently strutted right into Episode #42 and we are so glad you did. 

I would really like to just turn this mic on and automatically be the #1 chiropractic podcast in the world but that’s not the real world, right? But I have to say that we continue to grow. I’m impatient and it’s never quite fast enough but we are continually growing and that’s always exciting. When you see the growth chart consistently going up and to the right, then hell yeah. Ka-bam shazam. 

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

My Week

But first, my week has been nuts. When was the last time you tried to hire someone? It’s absolutely stupid these days. Honestly, I posted a job on I got literally 175 resumes, scheduled 15 interviews, only 7 showed up for the interview, and we have one really good prospect. 

This is the second round by the way. We tried to hire for the front desk position a few weeks ago and went through 120 resumes. We actually hired a girl but then her dad got sick and after thinking it over, decided we weren’t a good fit. Lol. Can you imagine? 

I don’t know if you can tell from this podcast or not but….I’m generally a pretty darn good guy and really care about my staff and care about people and care about making connections with others. 

I don’t yell, I don’t fuss a lot. Even when they’re wrong. That’s just not my style. I don’t think I stink or anything having to do with body functions so, I can’t figure it out other than people have just changed. Or has it always been hard to find good help? All I know is that I’m having a hell of a time finding the right front desk personnel and it’s making me more than a little crazy. 

Welcome Dr. Tyce Hergert from Southlake, TX

Now that we have all of that out of the way, I want to welcome our guest today. You could say we sort of know each other. In fact, we grew up in the same neighborhood from elementary school all the way through high school. Even though I was a couple years older, we definitely knew each other. He lived right next door to my best friend and we played football in his front yard pretty often. 

We were at the University of North Texas at the same time living in Denton, TX and then we were down at Parker College of Chiropractic at the same time as well. If that weren’t enough, we have both served in statewide leadership positions for the Texas Chiropractic Association. In fact, Tyce is part of the reason I got involved in the first place. 

He took it a step further than me though. Dr. Hergert actually served as the President of the TCA two terms ago and helped steer the profession to a historic 4 chiro-friendly bills passed in the state legislature that year. This is important because the bills that were passed in our favor prior to that would be basically zero, none, nada, goose-egg, zilch. 

About an Integrated Practice

Dr. Hergert also runs an integrated practice down in Southlake, TX so he’s an excellent resource for our kind of podcast. 

Some people kind of think he’s a big deal and there’s a good argument to be made for that but I’m not going to be the one making it because I’ve known him way too long. 

Not only is he an ex-Pres for the TCA, but he also has the bragging rights of being a guest on 2 of our top five most popular episodes of all times here at the Chiropractic Forward Podcast. Those are episodes 6 and 11 with 11 actually being our most listened to episode of all time so congrats to Dr. Hergert on that. 

If you enjoy his guest appearance on this episode, although I’d be a bit flabbergasted as to why you enjoyed it….you can always get more of Tyce on those. Again, I’m not sure why you’d ever want to do that. Lol. 

Welcome to the show Dr. Hergert. Thank you for taking the time to join us. 

Tell us a little bit about Southlake, TX for the ones unfamiliar with the Dallas/Ft. Worth area. 

Tell us a little bit about running an integrated practice. What’s it like? Have you become more of an owner/administrator or are your elbow deep in treatment and the physical aspects of seeing patients all day every day still?

Getting To The Research

This first paper….I alluded to back in episode #36 but very briefly. We covered a little more in depth back in Episode #19 as well which posted back in April of this year. I think in light of a brand new paper that just came out, it’s worth covering this one again if you do not mind. It’s all about chiropractic maintenance and chiropractic preventative treatment.

It’s called “Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome?” and was published in the prestigious Spine journal[1]. 

For the purpose of this study, keep in mind that SMT stands for spinal manipulation therapy. Also of special note is that chiropractors perform over 90% of SMTs in America so I commonly interchange SMT or spinal manipulation therapy with the term “Chiropractic Adjustment.”

Why They Did It

The authors of this paper wanted to check how effective spinal manipulation, also known as chiropractic adjustments, would be for chronic nonspecific low back pain and if chiropractic maintenance and chiropractic preventative treatment adjustments were effective over the long-term in regards to pain levels and disability levels after the initial phase of treatment ended.

How They Did It

  • 60 patients having chronic low back pain of at least six months duration
  • Randomized into three different groups:
  • They included 12 treatments of fake treatment for one month
  • One group had 12 treatments of chiropractic adjustments for a month only
  • They also had a group with 12 treatments for a month with maintenance adjustments added every 2 weeks for the following 9 months.
  • Outcome assessments measured for pain and disability, generic health status, and back-specific patient satisfaction at the beginning of treatment

What They Found

  • Patients in groups 2 and 3 had a significant reduction in pain and disability scores.
  • ONLY group 3, the group that had chiropractic maintenance and chiropractic preventative treatment adjustments added, had more reduction in pain and disability scores at the ten-month time interval.
  • The groups not having chiropractic maintenance and chiropractic preventative treatment adjustments, pain and disability scores returned close to the levels experienced prior to treatment.

Wrap It Up

The authors’ conclusion is quoted as saying, “SMT is effective for the treatment of chronic nonspecific LBP. To obtain long-term benefit, this study suggests maintenance SM after the initial intensive manipulative therapy.”

Dr. Hergert, what do you have to say on this one? I’m not sure what there is to say except, “Told you so!”

What do you typically recommend to your patients as far as chiropractic maintenance and chiropractic preventative treatment care goes?

Paper #2:

Actually, this one is a webpage linked in the show notes for you at in episode #42.

This article was compiled by Dr. Anthony Rosner, Ph.D and called Documentation Supporting Maintenance Care[2]. 

The article starts by saying that the RAND Corporation studied a subpopulation of patients who were under chiropractic care compared to those who were NOT and found that the individuals under continuing chiropractic care were:

  • Less likely to be in a nursing home
  • Were less likely to have been in the hospital the previous 23 years
  • They were more likely to report better health status
  • Most were more likely to exercise vigorously

Although it is impossible to clearly establish causality, it is clear that continuing chiropractic care is among the attributes of the cohort of patients experiencing substantially fewer costly healthcare interventions[3]. 

The next paper on chiropractic maintenance and chiropractic preventative treatment is by Dr. Rosner and talks about was a review of a larger cohort of elderly patients under chiropractic care and those not under chiropractic care. Basically, comparing monies spent on hospitals, doctor visits, and nursing homes[4] They found the following: Those under chiropractic care saved almost three times the money those NOT under chiropractic care spent for healthcare. 

  • $3,105 vs. $10,041

How’s it looking so far, Tyce?

Tyce, you’re going to like this one. Chances are, you’re probably going to want to tell people all about this one. 

Let’s get to the newer paper I mentioned before. It’s called The Nordic Maintenance Career program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain – pragmatic randomized controlled trial and it was compiled by Andreas Eklund, et. al[5]. 

Why They Did It

The authors wanted to explore chiropractic maintenance and chiropractic preventative treatment in the chiropractic profession. What is the effectiveness for prevention of pain in patients with recurrent or persistent non-specific low back pain?

How They Did It

  • 328 patients
  • Pragmatic, investigator-blinded. Pragmatic. What does that mean exactly? According to Califf and Sugarman 2015, It means it is “Designed for the primary purpose of informing decision-makers regarding the comparative balance of benefits, burdens and risks of a biomedical or behavioral health intervention at the individual or population level” Meaning they are attempting to run a trial to inform decision-makers of responsible guidelines going forward. That’s it for the dummies like me in the room. 
  • Two arm randomized controlled trial
  • Included patients 18-65 w/ non-specific low back pain
  • The patients all experienced an early favorable result with chiropractic care. 
  • After an initial course of treatment ended, the patients were randomized into either a maintenance care group or a control group. 
  • The control group still received chiropractic care but on a symptom-related basis. 
  • The main outcome measured was the number of days with bothersome low back pain during a 1 year period. 
  • The info was collected weekly through text messaging. 

What They Found

  • Maintenance care showed a reduction in the number of days per week having low back pain
  • During the year-long study, the chiropractic maintenance and chiropractic preventative treatment group showed 12.8 fewer days. 
  • The chiropractic maintenance and chiropractic preventative treatment received 1.7 more treatments than the symptom-related group. 

Wrap It Up

The authors wrap it up by saying, “Maintenance care was more effective than symptom-guided treatment in reducing the total number of days over 52 weeks with bothersome non-specific LBP but it resulted in a higher number of treatments. For selected patients with recurrent or persistent non-specific LBP who respond well to an initial course of chiropractic care, MC should be considered an option for tertiary prevention.”

Basically, both groups still underwent chiropractic maintenance and chiropractic preventative treatment. It’s like we tell people, stay on a schedule and you’ll do well. Wait until you hurt and the chances are good that you’ll spend the same amount getting over that complaint anyway. 

This study showed that exactly except, over the course of just one year, the maintenance chiropractic care (preventative chiropractic care) people had 1.7 more visits but suffered pain almost 13 days less. 

Bring it home

Are two appointments extra worth almost 2 weeks less of having pain in a year’s time? I say hell yes. 

Dr. Hergert…what say you?

Lay some sage-like wisdom on us here and bring it all home for us won’t you please?

This week, I want you to go forward with the knowledge that, when you write “patient recommended preventative chiropractic care schedule going forward” you can do so confidently knowing your are right and there is research showing it. 

You don’t have to recommend chiropractic maintenance and chiropractic preventative treatment simply because you heard to do that at school or because your old boss always did it. 

You can make those recommendations because it’s best for your patients. 

Dr. Hergert, do you have anything to add, this is probably your last time on the podcast after all. 

Thank you so much for hanging out with us today, I was kidding of course. We will make time and do it again down the road. 

Integrating Chiropractors


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

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


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

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

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


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About the author:

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



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

2. Rosner A. Documentation Supporting Maintenance Care. 2016; Available from:

3. Coulter ID, Chiropractic Patients in a Comprehensive Home-Based Geriatric Assessment, Follow-up and Health Promotion Program. Topic in Clinical Chiropractic, 1996. 3(2): p. 46-55.

4. Rupert R, Maintenance Care: Health Promotion Services Administered to US Chiropractic Patients Aged 65 and Older, Part II. J Manipulative Physiol Ther, 2000. 23(1): p. 10-19.

5. Eklund A, The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain—A pragmatic randomized controlled trial. PLoS One, 2018. 13(9).

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