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Chiropractic Research

Manipulation For Special Forces, Manipulation For Cervical Disc Herniation, Lazy Americans

CF 074: Manipulation For Special Forces, Manipulation For Cervical Disc Herniation, Lazy Americans

Today we’re going to talk about how adjustments affect our special forces – pretty interesting stuff! We’ll talk about manipulation for cervical disc herniations, and we will talk about lazy Americans. It’s a fascinating one today so don’t go anywhere. 

But first, here’s that silky smooth bumper music

Chiropractic evidence-based products

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

You have collapsed into Episode #74. Bing bang boom, knocking ‘em down, one after another. We are doing more and more guest spots lately and have several guests set up to come on the show. You’re going to love them. 

Some are known names, some are not but all are interesting and bring something unique to the table that we are able to learn and grow from. Keep coming back time and time again. You’ll see what I mean. 

Introduction

We’re here to advocate for chiropractic while we also make your life easier using research and some good solid common sense and smart talk. 

F4CP

Just to let you all know – the F4CP will be launching an athletes and opioids eBook toward the end of this month. It’s called A case for chiropractic disrupting the cycle of pain, prescriptions, and addiciton. I’m linking it in the show notes so go get and check it out. 

https://www.f4cp.org/package/home/viewfile/whiathletes-and-opioids-ebook

DACO

We have been in the habit of discussing the DACO program weekly because I’ve been going through it. Well, I’m done with all of the hours so what do I tell you now? Am I supposed to tell you all about how I’m studying? That doesn’t sound very fascinating to me at all. In fact, that may be a cause for blood to leak from your ear holes. 

Today, I’ll just talk very briefly about one of the courses I reviewed yesterday in going back over the material. It’s one I didn’t pick up on very strongly the first time. It had to do with disc herniations that were more up in the T11/12 or L1/2 area and how they can mimic other issues further down the line. It’s really interesting stuff but went into how a hyperreflex on a patellar reflex and numbness in the anterior part of the thigh or calf without associated pain should move our thinking to an upper motor neuron lesion which would mean it’s higher up. 

Remember, the spinal cord ends at L1/2 right? You need to know this stuff because that sort of issue may mean immediate surgical consult. 

Interesting stuff. I got it a little better the second time around. I’m better today than I was yesterday.

Also, in the Chiropractic Forward Group, I posted a graphic from Yokuhashi et al demonstrating common signs and symptoms of Thoracolumbar junction disc herniations. I also added a great Epley maneuver that is easy to perform as well as an easy classification flow chart for reviewing MRIs and classifying herniations. 

It’s a private group so just go over there and request me to add you and, assuming you’re not crazy and curing cancer through your adjustments…..I’m happy to add you to the group. 

Personal Happenings

If you hear something here that you really like and would like it in written form rather than spoken, just hop onto  chiropracticforward.com, find the episode, and just scroll down to copy and paste it. If you’re using it for content or on your website for some reason, just be cool and give us some credit please. I’d sure appreciate it and I’m sure the researchers we discuss would too. 

Item #1

Let’s get it rockin and rolling with a paper that one of my favorites is a co-author on. Lead author on this one is James DeVocht, then Robert Vining, Dean Smith, Cynthia Long, Thomas Jones and a previous guest with us here, yes – one of our favorites, Dr. Christine Goertz[1]. The superwoman of chiropractic research right there and will be a presenter at ChiroTexpo in downtown Dallas, TX June 1-9. I’ll be there, front row, with a smile. And maybe a drink. It depends on how early her talk is. 

Anyway, this one is called “Effect of chiropractic manipulative therapy

on reaction time in special operations forces military personnel: a randomized controlled trial”  This one was in BMC and published this year. 

Why They Did It

Considering that chiropractic manipulative therapy has been reported to improve reaction time in some studies, and considering that reaction time can be vital for special forces military men and women, these authors were interested in if chiropractic treatment could be effective in improving reaction time for this type of patient. 

How They Did It

  • 120 special ops personnel were accepted into the study.
  • This study was a prospective, randomized controlled trial so 60 in one group and 60 in the other.
  • It was conducted at Blanchfield Army Community Hospital, Fort Campbell, KY
  • One group received 4 treatments while the other received none over a two-week trial period. 
  • Assessments used were hand/foot reaction time, choice reaction time, Fitt’s Law, whole-body respponse time, 

What They Found

No between-group statistically significant differences were found for any of the five biomechanical tests, except immediate pre- and post-changes in favor of the CMT group in whole-body response time at both assessment visits.

Wrap Up

The authors’ conclusion was as follows, “A single session of CMT was shown to have an immediate effect of reducing the time required for asymptomatic SOF qualified personnel to complete a complex whole-body motor response task. However, sustained reduction in reaction or response time from five tests compared with a wait-list control group was not observed following three sessions of CMT.”

OK, what’s the take-away and where does that lead research in the future. Here is a question, “We know chiropractic has immediate but somewhat unsustained effectiveness. So, what if they are regularly adjusted? As in 3-5 times a week for 4 weeks when compared to the other non-treatment group? Is it sustained longer then?”

If we know they’re going on a mission, and they are treated once a day, or even twice a day. What about athletes and their reaction times? Good stuff here folks.  

I think there are a lot of interesting questions just waiting for an answer. 

Item #2

Alright, moving on to manipulation for cervical disc herniations. There are two papers here so we will shorten it up and hit the highlights. Just the meat and taters please waiter, thank you. 

The first is called …well, the title is so damn long we’re going to call it manipulation for cervical disc herniations and a comparison between adjustments and nerve root injections. If they want to people to repeat the whole title, they need to make them a touch shorter. 

You can look the full title up in the show notes for this episode. It was published in the Journal of Manipulative and Physiological Therapeutics in 2016 and authored by Cynthia Peterson, et. al.[2] 

Why They Did It

They wanted to assess the outcomes for improvement, pain, and costs between nerve root injections and manipulation for cervical disc herniations. 

How They Did It

104 patients w/ MRI-confirmed symptomatic cervical disc herniations. 

52 had nerve root injections and 52 had spinal manipulative therapy.

Conclusion

Get this, the Improvement for manipulation vs. injection….manipulation in the subacute/chronic population showed 86.5% improvement while injections had 49%. 

Next paper on this topic is from the same author, Cynthia Peterson, et. al, and is called “Outcomes From Magnetic Resonance Imaging–Confirmed Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulative Therapy: A Prospective Cohort Study With 3-Month Follow-Up”[3] It was published in October 2013 in Journal of Manipulative and Physiologics Therapeutics and it goes a sumpin like a this.

Why They Did It

The purpose of this study was to investigate outcomes of patients with cervical radiculopathy from cervical disk herniation who are treated with spinal manipulative therapy.

What They Found

Most patients in this study, including subacute/chronic patients, with symptomatic magnetic resonance imaging–confirmed CDH treated with spinal manipulative therapy, reported significant improvement with no adverse events.

Item #3

Lazy Americans – I’ll admit from the get go here. I’m lazier than I want to be and weigh more than I want to weigh. No doubt. I’m 46, I get to work at 8am and besides a two hour lunch, I leave at about 8pm. Working out doesn’t typically get the attention it deserves. But I can tell you this, it’s not because I’m sitting around idle playing video games so…..I feel better in making that clear. Lol. 

This was an article from AP called “Americans getting more inactive, computers partly to blame[4].” It was written by April 23, 2019 so hot stuff here. 

The highlights of the article are as follows:

  • Americans spend almost 1/3 of their waking hours sitting
  • Sitting time increased over the last 10 years by about an hour per day to the point teens are sitting for 8 hours a day and adults are sitting for 6 1/2 hours per day. 
  • By 2016, 50% of kids and adults spent an hour or more of leisure time on computers
  • TV use was unchanged.
  • U.S. activity guidelines released last fall say adults need at least 150 minutes to 300 minutes of moderate-to-vigorous activity each week, things like brisk walking, jogging, biking or tennis.
  • Muscle strengthening two days weekly is also advised.
  • Kids aged 6 through 17 need 60 minutes of moderate-to-vigorous physical activity daily.

OK, they have convinced me. It’s time to force myself to get busy walking, biking, and lifting some weights. I have everything already. It’s just the time and the energy that I need to figure out. But I’m working on it. 

Do you ever feel like your practice owns you rather than you owning your own practice? Of course you do. It’s all about balance and I feel like I have none. I feel like its all work right now and, while that is a good problem to have, a good problem is still a problem.

April brought us a lot of blessings. It brought us about 80 new patients which is a lot for me. I’m used to about 50-55 new patients but 2019 has been a whole different thing. From December on, it hasn’t been a roller coaster. It’s been straight up and I can’t thank the Lord enough for the blessings but managing to treat them at a high level when it’s just me is most certainly a balancing act. 

Luckily, the DACO course has provided me with some quick ways of evaluating things that I didn’t have before so I can move through new patients with efficiency. Spinal manipulation is a fairly quick and straight forward process. I have staff that walk them through the exercise/rehab portion. It’s not so much the treating. 

I think the time suck is the communicating / connecting part of the deal. The questions, the idle talk that is meaningless but is vital to relationships. That is what takes up so much of the day. For some, coming to our office is the trip of the day or the outing of the week for them. It’s an event. And they want to experience it and chit chat and connect. And we better be on board for it with a smile and kindness. 

Still, it’s time for me to start moving in a direction that lightens my load. That may look like raising prices or it may look like hiring an associate. I’m not sure. But I’ll know when I know. I don’t do anything by accident usually. I do a lot of homework. I ask around. Through my involvement with my state association, my network of advisers is vast and valuable. 

So, I’ll keep you up to date on any happenings as far as all of that goes. 

For now, let’s get to the message. 

Chiropractic evidence-based products
Integrating Chiropractors
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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

1. DeVocht J, V.R., Smith D,, Effect of chiropractic manipulative therapy on reaction time in special operations forces military personnel: a randomized controlled trial. BMC Chiro Man Ther, 2019. 20(5).

2. Peterson C, P.C., Hodler J,, Symptomatic, Magnetic Resonance Imaging–Confirmed Cervical Disk Herniation Patients: A Comparative-Effectiveness Prospective Observational Study of 2 Age- and Sex-Matched Cohorts Treated With Either Imaging-Guided Indirect Cervical Nerve Root Injections or Spinal Manipulative Therapy. J Man Manip Ther, 2016. 39(3): p. 210-217.

3. Peterson C, e.a., Outcomes from magnetic resonance imaging — confirmed symptomatic cervical disk protrusion patients treated with high-velocity, low-amplitude spinal manipulative therapy: a prospective cohort study with 3-month follow-up. J Manipulative Physiol Ther, 2013. 36(8): p. 461-7.

4. Press, A. Americans getting more inactive, computers partly to blame. WTOP, 2019.

w/ Tim Bertelsman – Chiropractic Standards, Chiropractic Specialists, Importance of State Associations

CF 073: w/ Tim Bertelsman – Chiropractic Standards, Chiropractic Specialists, Importance of State Associations

Today we’re going to be talking with Dr. Tim Bertlesman about all kinds of things. Kind of like a discussion amongst friends where anything is really on the table but we’ll hone in a little on chiropractic standardization, chiropractic specialities, and our experiences working on the state levels for our respective state associations. 

It’s going to be another great one that you’ll want to share with your colleagues but first, here’s that syrupy bumper music!

Chiropractic evidence-based products
Integrating Chiropractors
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Introduction

We’re here to advocate for chiropractic while we also make your life easier using research and some good solid common sense and smart talk. 

Store

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

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

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

F4CP

We will be launching an athletes and opioids eBook toward the end of this month. It’s called A case for chiropractic disrupting the cycle of pain, prescriptions, and addiciton. I’m linking it in the show notes so go get and check it out. 

https://www.f4cp.org/package/home/viewfile/whiathletes-and-opioids-ebook

DACO

Let’s talk a bit about the DACO program. Well, our guest today is intimately involved with the DACO here in America and, in fact, is the one that unknowingly got me into this whole thing. 

I finished it. It’s all done. I’m just going ot start studying for the exams now. The first one will be on July 20th. If I come back from that one with my dobber in the dirt, then it didn’t go so well but we don’t plan on that happening. 

Since our guest is a big part of it all, we’re going to leave the DACO talk there and meet him. 

Our guest graduated from Logan College of Chiropractic in 1991. He then went on to get his CCSP there at Logan as well finishing those up in 1994. 

In addition to the CCSP, he is a DACO, a Diplomate of the Academy of Chiropractic Orthopedists and is an instructor for their live hours. So he gets to travel around getting unsusepcting and impressionable docs involved in the DACO. 

He is not only a member of the ACA and the Illinois Chiropractic Society, but is also a former President of the Illinois Chiropractic Society. 

He is also, and maybe most-importantly, the co-founder of ChiroUp which has to be seen to be believed quite honestly. You can do that by going to ChiroUp.com. I’m a member and you probably will want to be as well. 

Let’s get it started here. Welcome to the show Dr. Tim Bertlesman. Thank you for joining me today. 

  1. 300 hours later – I want to thank you for getting me into this mess called the DACO. I’m blaming it all on you and Bill Lawson. 
  2. Tell me about your journey into chiropractic
  3. From your CV, I see that you did the CCSP right out of school. What all have you done through that specific certification?
  4. Can you tell us the most striking difference between the two other than one is more geared toward sports?
  5. Tell me about your practice, what does it look like, who do you see mostly?
  6. Tell me about your journey into the DACO and what benefits you have personally realized from it.
  7. You and your business partner, Dr. Brandon Steele, do a great job at staying on top of the most current research. How do you do that? What are your sources?
  8. I want to hear a little about this friendly rivalry between you and Dr. Steele. 
  9. Did you realize that when I put your name into a Google search to learn a little more about you that Bertlesman Chiropractic pulled up with Dr. Steele’s picture on it? I think his evil plan is beginning to come to fruition. 
  10. When I had Dr. Steele on the show, we talked a bit about Standardization…as in making expectations more uniform for patients visiting chiropractic offices….. and we talked about Specialization such as through the DACO or the CCSP or CSCS. Can you share your thoughts on those two topics for us? 
  11. Tell me about your involvement with your state association and what it has meant to you both personally and professionally
  12. What have you been able to accomplish or have you tried to accomplish legislatively? What struggles are the Illinois and Missouri chiropractors in the middle of these days?
  13. Tell me about chocolate cookies and sushi
  14. I noticed a couple of things from your ‘About Me’ page on your website that I’d love to hear more about. 
    1. The Clinical Internship – Community Health Center
    2. Hospital externship at Deaconess Medical Center
  15. If people want to get more of Tim Bertelsman, what should they do? Where do they need to go to get their ‘fix’? I know you’ll be at ChiroTexpo in downtown Dallas again this year June 7-9. What else?
Chiropractic evidence-based products
Integrating Chiropractors
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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

How To Not Miss A Dissection & De-legitimizing Complementary Medicine

CF 069: How To Not Miss A Dissection & De-legitimizing Complementary Medicine

Today we’re going to talk about a risk vs. benefit assessment strategy to exclude Cervical Artery Dissection and we’ll talk about de-legitimizing complementary medicine.  We’ll have some fun and maybe even get a little worked up. 

Don’t Miss A Dissection!

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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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 crumbled into Episode #69 .I have to tell you that I had a friend razzing me saying I need to change the bumper music. He knows that I’m a musician and that I wrote the music, played all of the parts on the bumper music, and recorded it. It’s nice, if you’re going to create a podcast, if you don’t have to pay someone for the bumper music. Lol. He needs to get used to the bumper music because it’s not going anywhere unless I write and record another one somewhere down the road. 

Introduction

Moving on….We’re here to advocate for chiropractic while we also make your life easier using research and some good solid common sense and smart talk. 

Store

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

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

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

DACO

Let’s talk a bit about the DACO program. I’m down to my last 39 hours and it’s feeling pretty good. The stuff I have learned having to do with the way we communicate with a patient….what effect that has on a person and their tendency for chronic pain is fascinating. I don’t want to nerd out too much on you right now but, as you probably know, we have little muscle spindles (also known as motion detectors) in all parts of our body. They help us know where our limbs are or how we are oriented in the three dimensions. 

OK, so we have 16 little motion detectors per gram of muscle in our fingers. OK, 16 per gram in our fingers. Remember that. We’re pretty good with knowing where our fingers are without paying attention to them right? Think about typing for example. 

We only have 2 motion detectors per gram of muscle in our traps. Not very many. 

Now consider that we have 242 little motion detectors per gram of muscle in the deeper intrinsic muscles of the upper cervical spine. That’s an insane amount when compared to other areas of our body wouldn’t you agree?

There are so many….to the point that anatomists are looking at these upper cervical muscles as a receptor organ as much as they look at them as muscles. When you consider you get your balance, sensorimotor function, all the way down to how your individual vertebrae move atop each other based on how your upper cervical spine takes in proprioceptive information and translates that into subconscious muscle functions like posture……One word……two syllables…..Day-um. Daaaayum. 

Personal Happenings

If you hear something here that you really like and would like it in written form rather than spoken, just hop onto  chiropracticforward.com, find the episode, and just scroll down to copy and paste it. If you’re using it for content or on your website for some reason, just be cool and give us some credit please. I’d sure appreciate it and I’m sure the researchers we discuss would too. 

Item #1

As many of you have probably heard, a very popular yoga instructor was holding an odd pose some time ago and caused herself to suffer a tear in an artery in her neck which led to a stroke. She’s fine now so thank goodness. Her story has been circulated a bit and, unfortunately, ABC’s Good Morning America decided to bring chiropractic into the spotlight on the deal. Which is total and utter BS. 

Anyway, they went into the whole Kate Mae debacle and that the LA coroner laid the blame on the chiropractor for causing it when we know that the most common cause of cervical artery dissections is traumatic onset. And we also know that Katie Mae had a bad fall at a photo shoot before going to the chiropractor. 

From my understanding of the case, the chiropractor didn’t cause that stroke. He didn’t help it but he damn sure didn’t cause it. 

If you want more…..as in a lot more,….please go listen to Episodes #13, 14 and ,15 of this podcast. They will line it all out for you in common sensical, magical, reasoning. You’re going to love it. 

If you don’t know the research that shows the benefits for cervical manipulation vs. the almost zero risk, well then you need to listen to those episodes and I’ll link them in the show notes so you can find them easily. 13, 14, and 15 just go listen to them and learn how to back up your positions if you’re ever questioned. Please. 

That leads us into this first one called “A risk-benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: A comprehensive review” by Aleksander Chaibi and Michael Bjorn Russell[1]. It was published in the Annals of Medicine in the December edition 2018. 

https://www.tandfonline.com/doi/full/10.1080/07853890.2019.1590627

Introduction

They start out by saying.”Cervical artery dissection refers to a tear in the internal carotid or the vertebral artery that results in an intramural hematoma and/or an aneurysmal dilatation. Although cervical artery dissection is thought to occur spontaneously, physical trauma to the neck, especially hyperextension and rotation, has been reported as a trigger.”

Since manual and manipulative therapy are common treatments for headache and neck pain, which just so happen to be the most prevalent symptoms of cervical artery dissection, the authors aim of this review is to provide an updated step-by-step risk-benefit assessment strategy regarding manual therapy and to provide tools for clinicians to exclude cervical artery dissection. It’s so easy to Miss A Dissection

They say that cervical mobilization and/or manipulation have been suspected to trigger artery dissection but this is based on case studies (low level research) that are unable to establish direct causality. 

They relate to the ‘chicken and the egg’ discussion as to what came first; the artery dissection or the manipulation? So, instead or proving a nearly impossible causality hypothesis, this paper aims to provide clinicians an updated step-by-step risk-benefit assessment strategy tool in order to 

  1. raise our understanding of cervical artery dissection
  2. understand the risk and applicability of cervical manual-therapy
  3. give us clinicians tools to better detect and exclude the condition. 

I’m all about this. We almost never…almost never are the actual cause of an artery dissection. Our deficit is not recognizing it when it comes in, adjusting the region and APPEARING that we caused it. THAT’S our big issue. Perception. Not causality. 

This is a fairly lengthy paper so we are going to continue just hitting the highlights and the more interesting aspects of it without getting pulled down into too many stats and minutiae. There’s that word again. Take it. Use it. Love it. 

They say that headache and/or neck pain are the most common initial symptoms while other symptoms are Horner’s syndrome and lower cranial nerve palsy. The headache, understandably, is a new headache. New onset. And it’s unilateral. Why would you have it on both sides when there was only one artery dissection? 

The headache has a sudden onset and the time from headache onset to stroke can be from a few minutes to a few weeks. Which is scary as all hell. That’s what my teenager calls ‘Nightmare Fuel.’

Headaches and neck pain are two of the biggest reasons patients seek out care at our clinics, I think you’ll agree. And, although these are thought to occur spontaneously, physical trauma to the neck (especially traumas involving hyperextension and rotation, are highly suspect for triggering one. 

They say, considering it’s happening and people are coming to us with it happening, it’s sort of really really important that we are able to catch the red flags. Especially considering what can happen if we miss them. 

By the way, this isn’t a ‘Scared Straight’ kind of episode. I hate when gurus try to sell their products by trying to scare the holy hell right out of you. That lights me up every time. If I’m in a seminar and some dope starts a diatribe about how offices that aren’t listening can lose their entire practice and thousands and blah blah blah. If I’m in that class, I get up and show them my backside as I exit. 

The HIPAA gurus are the worst aren’t they? They have to ready to leave and jump off a cliff if you don’t hire them for $10,000. It’s stupid and a good way to slip a vulnerable person into depression. Nope, that’s not what we’re doing here. 

First, I’m not selling anything. Unless you love my office brochures. But that’s just to make life easier. Nothing bad happens if you don’t want them. Lol. 

Second, this is a message of ‘Hey, looky here….we get some scary stuff coming in to our offices here and there, and…..if you’ll just pay attention for a little bit here, we may help you keep people safe and get them the help they really need.”

That’s all

OK, continuing on: One big thing you have to remember is that the World Health Organization regards annual mobilization and/or spinal manipulative treatment conducted by chiropractors to be a safe and effective treatment with few, mild, transient adverse effects. The adverse effects being local soft tissue tenderness and tiredness on treatment day, maybe some muscle soreness, things like that. 

There is no strong evidence at all that spinal manipulative therapy is the culprit. 

When describing the internal carotid artery and the vertebral arteries, this statement about the vertebral arteries really jumped out at me. They said, “the vertebral artery is thought to more susceptible to injury due to extreme rotatory head movements, especially in the transverse foramen of the first cervical vertebra.”

You guys and gals out there using rotation in your cervical adjustments….I think there’s an argument to be made here. Can you get the same effect in your patients by doing away with the rotation-based adjustments and going more to extension/lateral flexion type maneuvers like a Diversified cervical break for example? The answer is yes by the way. You most certainly can get the same effect. 

A big difference from regular neck pain is that when a dissection is present the pain is typically sudden, sharp, severe, steady and described as being different from prior neck pain experiences. In general it’s describes as throbbing (remember – it’s vascular), it can be said that it’s pounding, pulsing, and beating. 

Compared to descriptions for purely musculoskeletal complaints which can be described as aching, sore, heavy, hurting, deep, cramping, or dull. There are pretty stark contrasts between the two. 

Also, in general, musculoskeletal pain can be reproducible or provoked or diminished. You can change it basically. Whereas, with a vascular event, you cannot change it. Vascular events aren’t changed by using analgesics either. In Vertebral Artery Dissection specifically, the pain will often progress to the occipital area and medially along the nuchal line. 

The paper highlights the need for a good History to be taken on the intake. Certainly regarding the time of onset.

  • Any recent trauma? (I added that one)
  • Was there a recent acute respiratory infection?
  • Hyperhomocysteinemia such as Vitamin B6, B9, or 12 deficiency?
  • Is there a low body mass index and low cholesterol history?
  • Is the patient a smoker?
  • Do they have pulsating tinnitus?
  • Any connective tissue disorders like Ehlers-Danlos type IV, Marfan’s, Osteogenesis Imperfecta?

They state that a dissection presents to a chiropractic office at a rate of 1 time per 8.1 million patient encounters. 

The paper mentions an interesting paper we’ll have to look up and cover. They say no serious adverse events were reported in a large prospective national survey conducted in the UK that assessed all adverse events in 28,807 chiropractic treatments which included 50,276 cervical spine manipulations. Hell yeah. 

It’s just nice that the further into research you get, the more and more you find in favor of chiropractic. It is so rare that you see conclusions saying things like, “spinal manipulative therapy had no effect.” You just don’t see it usually. 

As part of their conclusion the authors make a recommendation that I will echo gladly, enthusiastically even. 

They say, “Although the chiropractic profession evolved in the early nineteen hundreds as an art, philosophy, and science, neck manipulation should not resemble a martial art. Thus, when cervical manipulation techniques are being conducted, one must be specific when manipulating a single spinal segment, minimizing the end range in cervical techniques, especially rotational techniques, and minimizing force, all of which have been recommended to reduce the risk of serious AEs.”

Now, with many of your EHR software programs, you can set up your own macros. So I did. About a year ago. If I even sniff a dissection, They get the interrogation. 

Here’s how the interrogations starts, I hammer nails up under each finger nail and ask them why they’re in my country and what are their plans to destroy my government? That’s not true. Nobody would come see me after word got out that I really work for the CIA. Lol

OK, seriously, here’s how it goes in my office. I took these directly off of my macro:

  • First, I check all upper arm strength
  • Then sensation side to side including the face
  • Can they raise their eyebrows?
  • Is there any difference in the size of the pupils?
  • Nice, even smile?
  • Have them stick their tongue out….does it deviate to one side or the other?
  • Cross your hands and grab their hands like a double hand shake and have them grip your hands equally and see if there’s a difference. 
  • Have them shrug both shoulders and resist gentle pressure downward on the shoulders. 
  • Do they have a headache that came on suddenly and can be sharp or throbbing?
  • Do they have a headache that gets worse when they lay down?
  • Do they have difficulty speaking or swallowing?
  • Do they have any visual abnormalities?
  • Do they have unsteadiness or lack of coordination beyond what they would consider normal?
  • Do they have a recent onset of hiccups?
  • Are they having recent onset of pulsing tinnitus?
  • Do they have any nausea and/or vomiting?
  • Does the patient have signs of nystagmus?
  • Are there any other neurological symptoms present?
  • How about light-headedness, fainting, disorientation, or disturbances in ears, tremors, or sweating?

I originally planned on covering four papers this week but the stroke issue is just such a big deal, I chose to go a little more in depth so we’ll put those other papers on the back burner for now but we will get to them. 

I will briefly cover one more very short little finding that ties in to this. It’s called “De‐legitimizing complementary medicine: framings of the Friends of Science in Medicine‐CAM debate in Australian media reports” It was written by Monique Lewis[2] and published on the 21st of February 2019 in Sociology of Health and Illness. 

The abstract starts by saying that complementary and alternative medicine has developed into a a complex and formidable commercial, sociocultural and political force in Australia, and given it’s influence, it is a relevant subject for scholars, health practitioners, health communicators, journalists, policy-makers, and consumers of healthcare products and services. 

This paper considers a newer group in Australia called Friends of Science in Medicine which is an activist group of medical practitioners, researchers, and scientists. 

This paper searched for articles mentioning this group and then measured the patterns and frequencies of media frames, intonation, and sources that are featured in Australian mainstream news. 

The negative headlining and intonation of reports predominated, along with framing Complementary and Alternative Medicine…..AKA….US…as a lucrative, undisciplined, and unethical industry as well as an illegitimate healthcare approach. 

The findings of the paper also offer findings into how journalists respond, replicate, or reconstruct the framings that are provided by an influential and elite group of medical practitioners and scientists, and readdresses issues surrounding the need for more critical health reporting in Australia. 

OK…..let’s give the friends of science in medicine some credit where it is due can we? Are we and other CAM providers lucrative? Good Lord, I sure as hell hope so. I have a family and a couple of knucklehead kids to send through college. That ain’t cheap, folks. I’m sure you’re aware. 

Are we undisciplined? Some of us, absolutely are. No doubt. Too many of us, I’d say. There are people out there on their own islands with crystals and all kinds of potions doing whatever to whoever with no research to back it and no rhyme to the reason but, there are A TON of us who are highly educated and highly disciplined. It seems they’re just looking to lump us all into one group regardless I guess. 

Are we unethical…..well, like any profession, the answer is that there are some predatory chiropractors seeing patients 100 times a year. Shooting a ton of unnecessary x-rays and scaring people into long-term care. Whether that’s unethical or not is up to the individual practitioner to decide but I can sure see how an outsider looking in could determine it unethical. Again, on the other hand, there are a lot of us going by commonly accepted guidelines and probably risking actually UNDERtreating patients out of fear of giving the appearance of being one of ‘those chiropractors.’ There is certainly nothing unethical about that, my friends. 

Are we illegitimate. Well hell no. And if they’re not calling out PTs with all of these labels, then they’re just being complete asses because, like or not, the lines between PTs and DCs are very blurry these days. They cannot pretend chiropractors are bad guys but continue to embrace PTs at the same time. Because, in many cases, there is no difference other than spinal manipulative therapy. Hell, PTs work in DC’s offices. 

This Friends of Science in Medicine is a group of bitchy people that really have little more to do that to form a silly group that makes them feel powerful on some level. Kudos to them. Take it from me. It’s hard as hell to build something that has influence in any sector of life these days. So, whatever. Yay for them. But it’s nothing. They can scream and holler but, at the end of the day, they’ll take care of their patients and we’ll take care of ours. 

There is an ever-expanding market today of patients looking for chiropractic. They no longer want the Friends of Science in Medicine’s pills. They no longer want the visits where you go in, some guy or girl in a white coat pretends to listen to you but cuts you off and then gives you a script for some pill that might, just might make you back end fall out of your body. We’re past that now. But they aren’t. 

We’re past surgery for this and for that. We’re past a pill for this or for that. We tried it. The result is called The Opioid Epidemic and it’s going to claim more lives in America than the Civil War did before too long. Last year claimed more lives than 20 years of counting deaths from the Vietnam War. Are you kidding me that these fools think they have some moral freaking high ground to stand on, behind a big white, glistening podium, and look down on other practitioners that are getting patients better non-invasively, non-pharmacologically, safely, and effectively? 

Are you freaking serious right now with this ball of crapoloa? You can’t make it up. This world gets dumber and dumber by the day and it’s the so-called people in power leading the way. Not those of us in the trenches changing the lives of our patients. It’s the leaders that are the fools. 

That crap makes me want to go kick a kitten and step on a baby rabbit. 

Santa Maria…..makes me want to cuss in Spanish. I swear. 

OK, I’m done. Chiropractors doing things in a patient-centered way are awesome. Here’s the message. 

Chiropractic evidence-based products



Integrating Chiropractors
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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

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About the Author & Host

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

Bibliography

1. Chaibi A, R.M., A risk-benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: A comprehensive review. Annals of Medicine, 2018.

2. Lewis M, De‐legitimising complementary medicine: framings of the Friends of Science in Medicine‐CAM debate in Australian media reports. Sociology of Health & Illness, 2019.


w/ Dr. Christine Goertz – Chiropractic Research, What Does The Science Say, And Where Are We Going?

Today, we have one of the giants of chiropractic research as our guest. I will go further into her background in a moment but we have Dr. Christine Goertz joining us today and, if you do not know who she is, it is time to listen up. Don’t you go anywhere because this is going to be an excellent episode full of great information. 

But first, here’s that “oh how sweet it is” bumper music

Chiropractic evidence-based products
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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 bounced your way into Episode #68 and we are so glad you did. 

Introduction

We’re here to advocate for chiropractic while we also make your life easier. 

Store

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

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

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

Guest Introduction

Christine Goertz, D.C., Ph.D., is the Chief Operating Officer of the Spine Institute for Quality. She is also an Adjunct Associate at the Department of Orthopaedic Surgery, Duke University Medical Center and Adjunct Professor in the Department of Epidemiology, College of Public Health at the University of Iowa. Prior to joining Spine IQ, she was Vice Chancellor of Research and Health Policy at Palmer College of Chiropractic for eleven years. 

Dr. Goertz received her Doctor of Chiropractic (D.C.) degree from Northwestern Health Sciences University in 1991 and her Ph.D. in Health Services Research, Policy and Administration from the School of Public Health at the University of Minnesota in 1999. Her 25-year research career has focused on working with multi-disciplinary teams to design and implement clinical and health services research studies designed to increase knowledge regarding the effectiveness and cost of complementary and integrative healthcare delivery.

She has extensive experience in the administration of Federal grants, both as a PI and as a program official at the National Institutes of Health (NIH). Dr. Goertz has received nearly $32M in federal funding as either principal investigator or co-principal investigator, primarily from NIH and the Department of Defense, and has authored or co-authored more than 100 peer-reviewed papers. Her primary area of focus is the investigation of patient-centered, non-pharmacological treatments for spine-related disorders. Dr. Goertz is a former member of the NIH/NCCIH National Advisory Council and currently serves on the Board of Governors for the Patient Centered Outcomes Research Institute (PCORI), where she has assumed numerous leadership roles. In September 2018 Dr. Goertz was appointed to a 3-year term as Vice Chair of the PCORI Board by the Comptroller General of the United States. 

Welcome to the show Dr. Goertz. I can’t tell you how excited I am to have on our podcast. 

Can I first ask you what was the impetus for your wanting to get into the research end of the profession? How do you come to the decision to dive into research full-time vs. treating patients day-to-day like so many of us do?

I noticed on your CV that you are currently an adjunct professor with the Department of Orthopaedic Surgery at Duke University Medical Center in Durham, North Carolina and also an Adjunct Professor in the Department of Epidemiology, College of Public Health, University of Iowa. All the while, you are working with The Pine Institue for Quality (AKA Spine IQ). Can you tell us what a regular day looks like for you?

Whether you know it or not, you have been a game-changer for this profession. You have, likely unknowingly, played a big part in some of our podcast episodes. I want to start with a paper we covered. I called it The Veterans Paper and it was HUGE. Though I call it the Veterans Paper, you say it was done as part of the Department of Defense. I wonder….did you notice anything BIG after it was published in JAMA? Was it, in your opinion, any more impactful than your other papers?

Here’s what happened as soon as that paper came out from my perspective; almost immediately, we began getting interest from our local VA and, once we completed credentialing, we started seeing referrals. Before that paper…..nothing. No interest. I don’t know if you’re ready to take all of the credit for that but I’m going to give it to your regardless. On behalf of the entire evidence-informed chiropractic profession, thank you for that. 

In emails we have exchanged leading up to our time together today, you mentioned you have a large pragmatic trial funded by the NIH in the VA. Can you tell us anything about that?

In your work called “Insurer Coverage of Nonpharmacological Treatments for Low Back Pain – Time for a Change” published in JAMA October 2015, you say there are no policies emphasizing nonpharma treatment at the forefront of the patient experience, no meaningful levels of coverage for care professionals focussing on nonpharma therapy, and no policies providing financial incentives in favor of nonpharma. I have seen your work make huge differences but have to admit, I’m still seeing reimbursements for chiropractors being a challenge. We have folks out here struggling in practice in spite of everything in our favor. Have you experienced any changes after this came out in JAMA? Can we expect these sentiments you describe to gather steam in the next year or so?

In another piece of yours called “What does research reveal about chiropractic costs?” you say something I want to commend you on. You say, “without a doubt, the most common issues raised by those outside the profession relate to the quality and consistency of chiropractic care delivery.” I think we can all agree that standardization is likely the biggest hurdle our profession faces in regard to integration. Do you believe chiropractic residency training would better prepare chiropractic providers to offer high quality care within medical facilities?

I’m currently over 2/3 of the way through the Diplomate for the Academy of Chiropractic Orthopedists. I see the value every day but, in your opinion, should Board Certification become the norm for chiropractic providers rather than the exception?

In that same paper, when talking about costs for chiropractic care you point out that we are likely equal or less in cost. You say, “In particular, it appears that patients who visit a chiropractor are less likely to undergo hospitalization, resulting in lower global healthcare costs than those who receive medical care only.” Do you feel that the medical field is coming to the point they are seeing our potential in improvement as well as our cost-effectiveness on more of a widespread scale or are there just little pockets here and there? Is the medical field starting to catch on but the insurance companies are still not allowing the change? What are you seeing on your end of things?

You recently were part of a paper that was published just this year, 2019, called, “Effect of chiropractic manipulative therapy on reaction time in special operations forces military personnel: a randomized controlled trial.” I really have to talk to you researchers about trying to shorten the names of these papers. 

Anyway, you all concluded on that one that one session of chiropractic manipulative therapy had immediate effect of reducing the time required for asymptomatic special operations forces to complete a complex whole-body motor response task. Tell me….what are we looking at here? Where is this line of research leading future research?

I personally love it and think it has extremely high value so when I ask you this question, please don’t take it as a negative. Are you responsible for instigating the Palmer-Gallup Poll? What were the main goals for starting it and has it lived up to the original thought process behind its beginning? 

I thought this was an interesting question. A listener and member of our private group on Facebook, Dr. Trent Peng, suggested I ask you which chiropractic adjustment techniques are sufficiently evidence-based in the scientific literature?

In an article by Lisa Rappaport, called “Adding chiropractic to back pain care may reduce disability,” she interviewed you for the article. She had a quote in the article from you that said, “Spinal manipulation (often referred to as chiropractic adjustment) may help heal tissues in your body that form as a result of injury, decreasing pain and improving your body’s ability to move correctly.” 

The other was, “It is also possible that manipulation impacts the way that your body perceives pain through either the brain or the spinal cord and/or decreases pain from muscle strain, inflammation and/or spasm in the muscles next to your spine.” 

The first comment I have on this is that I love the second quote because there is more and more information coming out about what part the central nervous system plays in regard to pain. Pain sensitization, movement dysfunction, joint proprioception and thing of that nature. I thought that quote brought some of that into consideration without getting too complicated for a normal reader. So, kudos on that!

I remember thinking to myself that there are a lot of “may help” and “it is possible” kind of language. I understand that researchers shouldn’t formulate opinions or conclusions in definite terms or absolutes and I completely understand that, but my question to this point is do you ever see a time that all chiropractors can say with a high degree of confidence exactly what happens and exactly why it helps people heal or feel better?

I was sent a paper I believe you have in progress called “Assessment of chiropractic care on strength, balance, and endurance in active-duty US military personnel with low back pain: a protocol for a randomized controlled trial. In the Background section, you all say, Chiropractic care may facilitate the strengthening of trunk muscles, the alteration of sensory and motor signaling, and a reduction in pain sensitivity, which may contribute to improving strength, balance, and endurance for individuals with low back pain.”

As you probably know, here in Texas, we are in a perpetual battle against the Texas Medical Association. Recently, they won a decision that was upheld on appeal to remove the ‘neuro’ snippet from our scope description of treatment the neuromusculoskeletal system. Essentially, they say we only treat the musculoskeletal system. With the research you have done and are currently involved in, what do you say to this?

What has been your favorite project or finding you have been a part of so far?

What has been your favorite paper, project, or finding that a colleague has written but you were not a part of?

What conclusion have you had to draw at the end of a paper that surprised you the most?

How do you see quality research translating into a greater level of inter-professional collaboration and how do you see the future of chiropractic unfolding in terms of integration into the healthcare system?

A tie-in question here, where do you see the profession in 10 years?

I know that low back is one of the biggest reasons for disability worldwide, if not the biggest. It deserves the attention it has received. We have research on low back pain now to the point that even traditional chiropractic detractors can’t really argue all that much with us on low back pain. But we still have a fight on our hands when it comes to cervical manipulation. My question is why do you think we don’t see more research for cervical manipulation and do you see the spotlight ever changing and the research beginning to focus on cervical manipulation and the benefits for neck pain and headache/migraine?

In the private Chiropractic Forward Facebook Group, we are curious….what are you up to right now? What are you working on? 

Apart from what you are working on right now, what are your goals in regard to research in the next 10 years?

Thank you so much for taking time out of your day to join us. I hope our listeners got as much use out of our talk as I did. I truly believe that our profession is where it is and going the direction it’s going in large part because of you an d your efforts. 

And I thank you so much. 

Chiropractic evidence-based products
Integrating Chiropractors
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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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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


Tinnitus & New Guides For Neck-Related Headaches

Today we’re going to talk about a couple of papers touching on tinnitus as well as a paper that just came out on practice guides for persistent headaches associated with neck pain. We’ll have some fun learning some new info if you stick around. 

Chiropractic evidence-based products

But first, here’s that ‘better than a back rub’ bumper music

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

You have drifted into Episode #65. And I don’t mean drifted like a feather or a piece of wood in the ocean. No, I’m talking about dangerous, careless, speedy drifting in the car around a curve, man. That’s the drifting I’m talking about. I talk like I’ve drifted before. I haven’t. Well, at least not intentionally. We won’t talk about that one time down in Alpine, TX. Lol. Hey, I used to be in a touring band. What do you want from me? I used to be on the on’ry side. That’s all I’m saying. 

I’m still a little ornery but age has settled me quite a bit. Which is a good thing. I look at kids these days. My son is a teenager and really, for the most part, he’s just so good. No drugs, no drinking, loving as he can be. I think back to when I was his age. I was legitimately a menace to society. I mean that literally. It’s a wonder I’m alive but, as with most from my generation, we made it didn’t we? In spite of the lead paint, lack of bicycle helmets, and all that stuff. 

I want to take just a few seconds to thank Dr. David Graber. He gave The Chiropractic Forward Podcast a shout-out to a room of about 1000 chiropractors during his talk at the Parker Seminar in Vegas a week or so ago. While that doesn’t seem like that big of a deal, I’ll just say that, when you feel like a lot of times, you’re on your own and everything depends solely on you and your actions or, in-actions, it is a blessing to have others help share the word. When you guys share or help get the message out in any little way, it’s like I breath a little easier if that makes any sense. It’s like I’m part of a team rather than out here on an island shouting through a megaphone hoping a ship passing by hears me. 

Anyway, I know I thanked you in our private Facebook group but wanted to do so here as well. Very much appreciated, Amigo. 

Introduction

Let’s get on with it here. 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.  

Store

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

DACO

Let’s talk a bit about the DACO program. That’s the Diplomate of the Academy of Chiropractic Orthopedists. Why do the DACO? Because, if you want to integrated, you need to certificate. Or more accurately, you need to specialize and get accredited. That’s what the Diplomate is about. Bells, whistles, letters behind your name….yes. More importantly, you’ll be leaps and bounds beyond where you were prior to do it. 

Recent classes have been Tinnitus which we’ll talk about in a moment, carpal tunnel syndrome as part of a double crush syndrome, and managing hip osteoarthritis. Fascinating stuff. 

I saw a chiropractic student upset on Facebook the other day. He was upset because of some video that popped up on social media. It was an anti-vaccination speech and, honestly, it was pretty vile and hateful in the stance against vaccines. Look, you have whatever opinion you want on vaccines, we’re never going to get into that here. That’s not why I mention it. 

The student clearly did not agree with this speech from CalJam and was wondering what kind of profession he’s spending all of this money to be a part of. He was basically questioning what kind of future he’s going to have when you have a profession that is getting continuing education hours for speeches like that. 

I could confidently tell him, and you by the way, that there has never been a better time to be a chiropractor. At least not in the last 35-40 years anyway. We’ve all heard about the Mercedes 80’s. They sound real nice but they’re a pipe dream at this point. 

Right now, there has never been the research backing up what we do. We have it overflowing. Not only in our effectiveness either. We have research on how we’re more effective than PT and MDs. We have research on how our patients are more satisfied with our outcomes than any other practitioner. We have research on how we do all of that while costing less. 

Never before have we had a national epidemic. This little thing we call the opioid epidemic that is driving every healthcare practitioner to look for non-pharma means of treating their patients. That means you and me. 

And never before have we had the capability or opportunities that we have now to integrate with our medical colleagues and become more and more a part of a team of healthcare practitioners. 

We are moving more to the center rather than staying out on the fringes of healthcare like the red-headed step child. 

No offense to red-heads or step-children. 

Anyway, Diplomate programs are more than letters behind a name. They’re about progressing you and your profession. Building knowledge and respect. 

I get nothing for talking about the DACO. I just think certification and professional standardization are important things. Email me at dr.williams@chiropracticforward.com if you have some questions about getting started.

Personal Happenings

And the hunt for a front desk rock star continues. I want to share with you the fact that indeed.com and Facebook work ads are great at netting you about 1.3 million resumes but not good, well-qualified candidates. Every damn time I post a job listing, I’ll get around 150 recipients. Only a very limited few are worth anything. Most aren’t even qualified for the job. 

For instance I got a resume yesterday from a dude that can run a fork lift. Hey, I like forklift drivers fine but that won’t get it done at the front desk of a healthcare facility, right? It’s an insane waste of time going through all of these but, what the hell else are you going to do? you have to have an employee. And I’m not going to my friends to ask if they know of anyone because I don’t want my friends hitting me up for a job. Lol. If that doesn’t work out, not only have you lost an employee but you’ve also lost a friend. 

No thanks!

Item #1

I have had an increase in tinnitus in my left ear after a plane ride I took back from Austin a couple of weeks ago. Bad enough that I went to a specialist for it. Turns out, she said I have, in some frequencies, moderate loss. I said, “What?” Lol. 

Well, I’ve been a touring musician before so, what’s new? I could have told you that. But, it’s been bad in just the past couple of weeks so something changed in that window of time. I started taking some DACO classes and noticed one on tinnitus so jumped to that drill for obvious reasons. 

I don’t want to go into details of the class but I do want to talk about some of the research cited for the class and we’ll start with this one called, “Does multi-modal cervical physical therapy improve tinnitus in patients with cervicogenic somatic tinnitus?” It was authored by S Michiels, P Van de Heyning, and a bunch of other very difficult names and published in Manual Therapy in 2016(Michiels S 2016). 

Why They Did It

Tinnitus can be related to many different etiologies such as hearing loss or a noise trauma, but it can also be related to the somatosensory system of the cervical spine, called cervicogenic somatic tinnitus (CST). Knowing that case studies have suggested a positive effect of cervical spinal treatment on tinnitus, this study wanted to dive a little deeper on it. 

How They Did It

It was a randomized controlled trial of subjects having a combination of tinnitus and neck pain. Like a combo meal, instead of a burger and fries, it was neck ache and ear ringing. Make that two please, thank you. 

Each subject received cervical physical therapy for 6 weeks which equaled 12 sessions. 

What They Found

Cervical physical therapy can have a positive effect on subjective tinnitus complaints in patients with a combination of tinnitus and neck complaints.

Pretty cool stuff there. 

Item #2

Let’s double down with this one from Oostendorp, et. al. called “Cervicogenic somatosensory tinnitus: An indication for manual therapy? Part 1: Theoretical concept” published in 2016 in Manual Therapy(Oosterndorp RA 2016). 

The Big Idea

Tinnitus can be evoked or modulated by input from the somatosensory and somatomotor systems. This means that the loudness or intensity of tinnitus can be changed by sensory or motor stimuli such as muscle contractions, mechanical pressure on myofascial trigger points, transcutaneous electrical stimulation or joint movements.

Interesting yeah? I think so. 

They go on to say, “The neural connections and integration of the auditory and somatosensory systems of the upper cervical region and head have been confirmed by many studies. These connections can give rise to a form of tinnitus known as somatosensory tinnitus. 

Broadening the current understanding of somatosensory tinnitus would represent a first step towards providing therapeutic approaches relevant to manual therapists. Treatment modalities involving the somatosensory systems, and particularly manual therapy, should now be re-assessed in the subgroup of patients with cervicogenic somatosensory tinnitus”

And that’s just what they’re doing. Fascinating stuff considering that you’ve always heard, “you’ll just have to live with it.” Basically, if you can change the intensity, quality, or frequency of the ringing, by moving your jaw or stressing the cervical spine in different directions, there’s more than a solid chance that you can change it completely through cervical manipulative or manual therapy. 

If I remember correctly the guesstimate was around 65% of the cases may be affected by chiropractors for the positive. 

Hell yeah and pass the potatoes people. 

Item #3

Our last thing today is called “Non‐pharmacological Management of Persistent Headaches Associated with Neck Pain: A Clinical Practice Guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration” written by Pierre Cote, Hainan Yu, Heather Shearer, et. al. and published in European Journal of Pain in February 2019(Cote P 2019). 

Hot off the presses and I know you like it served hot like that. Cold or lukewarm education just isn’t as good as piping hot brain nuggets.

Why They Did It

To develop an evidence‐based guideline for the non‐pharmacological management of persistent headaches associated with neck pain (i.e., tension‐type or cervicogenic).

How They Did It

This guideline is based on systematic reviews of high‐quality studies. A multidisciplinary expert panel considered the evidence of clinical benefits, cost‐effectiveness, societal and ethical values, and patient experiences when formulating recommendations.

What They Found

When managing patients with headaches associated with neck pain, clinicians should: 

  1. rule out major structural or other pathologies, or migraine as the cause of headaches; 
  2. classify headaches associated with neck pain as tension‐type headache or cervicogenic headache once other sources of headache pathology has been ruled out; 
  3. provide care in partnership with the patient and involve the patient in care planning and decision‐making; 
  4. provide care in addition to structured patient education; 
  5. consider low load endurance craniocervical and cervicoscapular exercises for tension‐type headaches (episodic or chronic) or cervicogenic headaches >3 months duration; 
  6. consider general exercise, multimodal care (spinal mobilization, craniocervical exercise, and postural correction), or clinical massage for chronic tension‐type headaches; 
  7. do not offer manipulation of the cervical spine as the sole form of treatment for episodic or chronic tension‐type headaches; 
  8. consider manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine for cervicogenic headaches >3 months duration. However, there is no added benefit in combining spinal manipulation, spinal mobilization, and exercises; and 
  9. reassess the patient at every visit to assess outcomes and determine whether a referral is indicated.

All of this is just a part of making us all better day to day. Those paying attention have the leg up. No doubt. 

Here’s the problem with being patient-centered instead of doctor-centered. We have to be OK with watching the high volume practices running through like cattle….we have to be OK watching them make millions while we have an average case treatment of only 7-10 visits. 

So what? Big deal. I always say that I could have a bigger house and more vacations but I sleep very well at night and, being a Christian as I’ve mentioned before, I’m at peace knowing I’m square with my maker and treat people the way they should be treated. 

Religious or not, patient-centered doctors can always take comfort in the fact that they’re doing what is in the best interest of their patients. 

It’s a lovely thing isn’t it? Honesty, ethics, love, cumbaya, and all that tom foolery….. They’re just little bricks that are the building blocks of an excellent life and career. 

Integrating Chiropractors
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Chiropractic evidence-based products

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

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YouTube

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

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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

Cote P, Y. H., Shearer HM, (2019). “Non‐pharmacological Management of Persistent Headaches Associated with Neck Pain: A Clinical Practice Guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.” European Journal of Pain.

Michiels S, V. d. H. P. (2016). “Does multi-modal cervical physical therapy improve tinnitus in patients with cervicogenic somatic tinnitus?” Man Ther: 125-135.

Oosterndorp RA, B. I., Mikolajewska E, (2016). “Cervicogenic somatosensory tinnitus: An indication for manual therapy? Part 1: Theoretical concept.” Man Ther: 120-123.

https://www.chiropracticforward.com/proven-means-to-treat-neck-pain/?v=7516fd43adaa

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








Government-Regulated Rehab, Do Rotator Cuffs Need Repair, Carpal Tunnel

Government-Regulated Rehab, Do Rotator Cuffs Need Repair, Carpal Tunnel

Today we’re going to reach into my bag of papers that have been sitting and gathering a little dust waiting for their time in the sun. We’re talking about government-regulated rehab. Is it any more effective than doctor-regulated? Do you send rotator cuff issues straight to a surgeon and is that the smartest thing? We’ll also skim over some new info on carpal tunnel syndrome. 

But first, here’s that “goes down so smooth” bumper music.

Chiropractic evidence-based productsIntegrating 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 Frankenstein-shuffled into Episode #63 all creepy like

Introduction

Why does this podcast even exist? 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 through your week by giving you confidence in your recommendations and in your treatments. 

This is something I feel confident in guaranteeing you if you listen and stick to it here at the Chiropractic Forward Podcast.  I’m no guru but I do believe I was blessed with some amount of common sense that somehow continues to keep me in the game. You are ABSOLUTELY going to pick up some nuggets that you can use in your own practice. 

Evidence-based Chiropractic Store

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 chiropracticforward.com. My goal is to get enough pre-orders to pay for all of the initial order before the end of March. If you guys will go to chiropracticforward.com…..Just click the STORE link at the top right of the home page and you’ll be off and running. 

https://www.chiropracticforward.com/shop/

We can order any of the posters whenever but, I want to get pre-orders in place for the brochures since they have to be ordered in bulk. With pre-orders helping me do that, I can get them ordered at the end of March, get them to me in about a week and then get them to you in a week so, they’d be in your hands roughly mid-April. So, if you’re team Chiropractic Forward, go check them out and order up. I’ll make it happen for us all. 

I’m getting them for my office as well ya see. I can’t wait to get them. And, I have a ton more I’m working on. But, I’ll be using funds from the first batch, to fund the next batch of these brochures. Rome wasn’t built in a day, folks, cut me some damn slack. Help me out with the first batch and we’ll be up and running. Who knows what we can get done around here together?

DACO

DACO talk, hell yeah. I’m back to rocking and rolling thanks to the guys down under in Australia. They are very intuitive and really do go out of their way to make sure you’re enjoying the courses and getting what you can out of them. 

Recent courses for me have been Acute Torticollis in the Adult and Osteoporotic Compression fractures – Recognizing the Clues. 

I dreaded stepping into the whole idea of 300 hours added to an already full load of work, family, and hobbies. Honestly, I’ve said before, I see 60-70 new patients a month, wife and two kids, I build live edge furniture, I’m a musician many weekends, and a sculptor who’s trying to teach himself to paint and…well…I like to get ornery and have a beer here and there on the weekends too. (you need to grow up)

I don’t say that to brag and say Oh look at me look at me. I’m trying to make the point that, if I can do it, you can do it.

Here’s the deal, I was always learning and adding and reading research papers and all of that stuff anyway. I thought I’d take one live class and get some continuing education hours. Hell, I figured I’d sit in the class for a couple of hours and then go have lunch with my wife. 

Yeah, that didn’t happen. In fact, I’m blaming it all on Dr. Tim Bertlesmen for getting me into it. He and Dr. Brandon Steele are the partners in ChiroUp and he was teaching a class here for the Texas Chiropractic Association’s state convention last summer. I saw him in the expo hall and he told me to come check the class out.

I said I’ll check it out for a bit. He said, “You’ll like it. You’ll stay for the whole thing.” Dammit if he wasn’t right. Lol. Just amazing information that could be used immediately and I literally feel that way about every class I’ve had since then.

So, you see, it hasn’t been stressful. It hasn’t really been any work. It’s just been enjoyable learning that I would have been doing anyway. I might as well get something out of what I was already doing anyway, right?

When the hell do I have time to add 300 hours to my plate? Well, I take off about 2:30 on Tuesday afternoon to do a class. I usually take one on Saturday morning when I’m up before the rest of the family. Sometimes I’ll take another on Sunday. That puts me at about 9 hours a week.

Easy peesy. 

If I can get you started, email me at dr. williams @chiropractic forward.com

Personal Happenings

In personal happenings, it’s been a little crazy around here as you all might can gather if you follow along. If you remember we had a front desk issue back in August and just couldn’t get the position filled. Well, my amazing wife stepped in, got trained on insurance, billing, and all of that lovely mess of crap. She is literally the smartest person I’ve ever met in my life. Some may question her decision to marry me and her intelligence in making that decision but, I think she’s freaking Einstein basically. 

Anyway, that has turned into us getting to work at 8 am and now, because she’s a perfectionist and still maintains her work responsibilities from her other job….which she does from home….we’re literally here until about 8 pm every night and I’m just about done with that people. Being busy is a good problem to have but there is a point where it’s just too much. 

I think a nurse practitioner can take some of the load off and I think maybe bringing in a new young hungry associate would be really nice. But, while I can talk about evidence and research, I’m afraid I’m not particularly skilled at hiring associates or setting up a medical entity but, that’s the direction I’m moving in because this workload is not sustainable for me to have a happy life. It’s just not. Example: on Wednesday of last week, in one day, as a solo practitioner, we had 12 new patients. Now, 6 were just intakes from one car wreck and it went efficiently but, you get the point. 

While it is do-able, for me, it’s not necessarily desirable to have the stress of being piled up on. I’m more like 3 or 4 new patients per day spread evenly throughout the week with some periodic re-exams and a bunch of happy patients just getting better and better every time I see them. THAT’S my idea of a happy workday. That’s not what we have right now. Lol. Good problem to have, admittedly but, still stressful. 

We’re hiring right now to help take some load off of the wife and, before long, I’ll be turning my attention to integrating. You know I’ll be sharing my experience as we go through it all. 

Item #1: Government-regulated Rehab

This first item we’re going to talk about is titled “Is a government-regulated rehabilitation guideline more effective than general practitioner education or preferred-provider rehabilitation in promoting recovery from acute whiplash-associated disorders? A pragmatic randomised controlled trial(Cote P 2019)” written by Pierre Cote, Eleanor Boyle, Heather Shearer, and a plethora of others. It was published in the British Medical Journal Open in 2019 and is cited in our show notes for episode 63. 

Why They Did It

They wanted to evaluate the effectiveness of a government-regulated guidelines line when comparing it to education and activation by general practitioners and to a preferred-provider insurance-based rehab program on self-reported global recovery from acute whiplash-associated disorders Grades 1-2. 

As mentioned in the title of the paper, it was a pragmatic randomized controlled trial. 

What They Found

Here’s what they decided, “Time-to-recovery did not significantly differ across intervention groups. We found no differences between groups with regard to neck-specific outcomes, depression and health-related quality of life.”

Item #2: Rotator Cuffs & Need For Repair

This one is called “What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears(Boorman RS 2018).” Twas written by RS Boorman, KD More, RM Hollinshead, and a gaggle of others. Published in Journal of Shoulder and Elbow Surgery in March of 2018. 

Why They Did It

They wanted to look at the 5-year outcomes in patients enrolled in a nonoperative rotator cuff tear treatment program. What happened with them?

How They Did It

They took patients with chronic, defined as greater than three months, full-thickness rotator cuff tears on MRI that were enrolled in the nonoperative study from 2008-2010. 

They started a nonoperative, home-based treatment program and they were followed up with after different time intervals. 

What They Found

Check this out, at 5 or more years follow-up, approximately 75% of patients remained successfully treated with nonoperative treatment and had a quality of life score of 83 out of 100. 

Between years 2 and 5, only 3 patients thought to have a successful outcome regressed and had surgery

The operative and the nonoperative groups at the 5-year follow-up were not significantly different. 

Wrap It Up

The authors concluded, “Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. While some clinicians may argue that nonoperative treatment delays inevitable surgical repair, our study shows that patients can do very well over time.”

Pow. Snap. Bam. Smash. Kapow!

I don’t know why I take such joy in seeing that surgeons have less reason to do surgery but it give me a tickle in my belly and a warm fuzzy feeling. Who wants a hug, people? I’m feeling the spirit here. 

Item #3: Carpal Tunnel Syndrome

Our last item here is called “The Effect of Manual Therapy Including Neurodynamic Techniques on the Overall Health Status of People With Carpal Tunnel Syndrome: A Randomized Controlled Trial(Wolny T 2018)” and is written by T Wolney, et. al., published in Journal of Manipulative and Physiological Therapeutics in October of 2018. 

Why They Did It

They wanted to check the influence of manual therapy, including neurodynamic techniques, when compared to no treatment on overall health status in those with mild to moderate carpal tunnel syndrome. 

Again, as the title says, it was a randomized controlled trial with 189 subjects. 

They underwent treatment twice weekly. 

What exactly is meant by the term ‘Neurodynamic Technique’? Well, have you ever heard of nerve flossing? That is a type of neurodynamic technique. Gliding or sliding the median nerve in the case of carpal tunnel. Tensioning, relaxing basically. Pull out your Google machine. You’ll find some great YouTube examples of Neurodynamic Techniques to help you with your carpal tunnel patients. 

Now, what did they find?

The authors were able to conclude the following, “Manual therapy, including neurodynamic techniques, had a positive effect on overall health status in this group of individuals with carpal tunnel syndrome.”

Key Takeaways

  • The government doesn’t do a particularly better job than you can do on your own if you’re educated and stay evidence-informed
  • Even full-thickness tears of the rotator cuff do not mean surgical intervention in most patients
  • Carpal Tunnel Surgery doesn’t require surgical intervention in most mild-moderate patients if you learn some take-home exercises and implement neurodynamic techniques
  • Surgeons are going to need to start down-sizing those houses and maybe forego buying that private plane as they will be less and less busy in the years to come. 

Again, before you disappear this week, consider going to chiropracticforward.com and clicking on Store and pre-ordering our spanking brand new evidence-informed brochures. We are looking to gather up pre-orders and ordering all of them in bulk around March 29th. We would appreciate your help in making this happen. Team Chiropractic Forward!

https://www.chiropracticforward.com/shop/

 

Chiropractic evidence-based productsIntegrating Chiropractors

The Evidence-based Chiropractic Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

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About the Author & Host

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

 

Bibliography

  • Boorman RS, M. K., Lollinshead RM, (2018). “What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears.” J Shoulder Elbow Surg 27(3): 444-448.
  • Cote P, S. B., Shearer HM, (2019). “Is a government-regulated rehabilitation guideline more effective than general practitioner education or preferred-provider rehabilitation in promoting recovery from acute whiplash-associated disorders? A pragmatic randomised controlled trial.” BMJ Open 9(e021283).
  • Wolny T (2018). “The Effect of Manual Therapy Including Neurodynamic Techniques on the Overall Health Status of People With Carpal Tunnel Syndrome: A Randomized Controlled Trial.” J Manipulative Physiol Ther 41(8): 641-649.

CF 033: Did You Need Proof That Chiropractors Help Headaches?

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

 

 

 

CF 062: Chiropractic Prevalence, JAMA’s Awful Info on Opioids, & New Info on Screen Time

CF 062: Chiropractic Prevalence, JAMA’s Awful Info on Opioids, & New Info on Screen Time

Today we’re going to talk about chiropractic prevalence, a new article in JAMA with some pretty terrible projections for opioid use and deaths, and new information on kiddos and the time they spend on screens. 

But first, here’s that bumper music

Chiropractic evidence-based productsIntegrating 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 collapsed into Episode #62

Introduction

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 through your week by giving you confidence in your recommendations and in your treatments. This is something I feel confident in guaranteeing you if you listen and stick to it here at the Chiropractic Forward Podcast.  

Evidence-Based Chiropractic Store

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 chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. 

DACO

Let’s talk a bit about the DACO program. Man, this is how it goes with the DACO: just yesterday morning, I had a patient come in, mid-’60s and literally everything hurt. Restless leg syndrome was her main complaint but her GP just yesterday already started her on Vitamin D and iron supplements so she’s going in the right direction there. I have heard of acupuncture being good for it as well but have not seen any research on that so can’t make that claim. 

Anyhooo…literally everything hurt, couldn’t sit down and basically, a general overall look of being unwell for a lack of a better word. She just didn’t look healthy. I started asking her about bone scans and she’d never had one. Well, this guy just gets feelings and when I get a feeling, they get sent out. I sent her out for a bone scan. 

No kidding, that afternoon I sit down for a class. The next one up? Yep, diagnosing osteoporosis. Lol. Wouldn’t you know it? Anyway, had I had this class before the encounter with the new patient, I might not have sent her. I’m not sure.

But, it’s just funny how in tune with clinical practice the classes really are. Also, as a consequence of the class, I have a quick sheet made up that changes the way I deal with potential osteoporosis patients from here on out. Forever and ever amen. 

Personal Happenings

So far, not a lot of blowback on my recent episode covering my thoughts on faith-based practices. Sometimes I’m mouthy, right? I get it. Who the hell cares what I have to say? I don’t know who cares honestly. Lol. But, we’re growing and growing so at least some of you identify with my way of thinking.

I’m religious and I think that’s what makes me feel that I can be credible in critiquing certain things in regard to religion. I just have a hard time with management companies coaching their impressionable doctors how to use the bible to manipulate scared patients looking for answers. When I think about it, it makes my pee hot. 

Anyway, it turns out that you guys agree with me and that makes me like you even more. Before you know it, we’re all going to be besties and share milkshakes with two straws and all of that mumbo jumbo. 

I’m glad you’re here with me today as we dive into the information I have for you this week. Here we go. 

Item #1

I want to start with one that had some conclusions I found surprising and somewhat encouraging……sort of. This new paper from The Journal of Alternative and Complementary Medicine published January 18, 2019, and authored by Stephanie Taylor, Patricia Herman, Nell Marshall, and colleagues called “Use of Complementary and Integrated Health: A Retrospective Analysis of US Veterans with Chronic Musculoskeletal Pain Nationally[1].”

Due to time constraints on me, I didn’t go beyond the abstract here so….freaking sue me. I’ll have it cited in the show notes at chiropracticforward.com so you can go get it and dive in you over-over-achiever you with all that time sitting around. Must be nice pal. 

Why They Did It

The authors say that little is known regarding the use of complementary and integrative health therapies for chronic pain in the VA system which is the nation’s largest integrated healthcare system. We will get into chiropractic prevalence briefly.

In my experience, I can echo this paper’s sentiment that the VA is at the forefront of the movement away from opioids and toward alternative healthcare. 

They researched this paper over 2 years for the use of 9 types of alternative therapies that included meditation, yoga, acupuncture, chiropractic, guided imagery, biofeedback, tai chi, massage, and hypnosis. 

What they found

27% of younger veterans with chronic musculoskeletal pain use alternative healthcare

The most used for was meditation at 15%. I found that surprising. Meditation means slowing down, sitting still, relaxing, and all that good stuff. In this day and age, I just have a hard time seeing that as the most prevalent form of alternative healthcare. 

We all think we’re so busy and, for us chiropractors, a lot of us really ARE too busy to stop and meditate. I may just be taking my own personal experience here and assuming everyone else on the planet is like me and, of course, that’s not true. Still, meditation was the most prevalent in this study. 

Yoga was next at 7%. Again, I guess I haven’t realized how popular yoga is getting these days but, I know the VA is pushing it so that may be playing a part in it. 

Coming in in 3rd place we have acupuncture. Once again, it’s surprising to me but, the VA is directing the recommendations and, in the real world, outside of the VA, acupuncture does not out-pace chiropractic. I do believe the VA is seeing it’s use for PTSD and chronic pain though and is responding appropriately. 

Finally, here comes Chiropractic care coasting in in 4th place for chiropractic prevalence.

Ugh. We know outside the enclosed ecosystem of the VA, chiropractic care is not less prevalent than yoga, meditation, and acupuncture. But, being within the VA, we know that medical doctors, PA’s, and nurse practitioners are making these recommendations and referrals so we still clearly have a lot of work to do. We are still a world away from where we need to be in regard to chiropractic prevalence,

You know what else that means though right? There are incredible potential and opportunity. If the VA is an example of the rest of the allopathic world, we could say that even fewer than 5% of chronics get referred to us from the GPs and orthopedic surgeons. I think that’s fair because most of them are unaware of Dr. Christine Goertz’s work that was published in JAMA not long ago.

If you’re unfamiliar with that, go listen to Episode 25 of this podcast. In short, she showed how veterans with chiropractic care mixed in with their traditional care had better outcomes. That’s when we started seeing the referrals from the VA

Also, you’ll notice that all of the nine therapies tracked here were on the list of first-line therapies that came from the updated recommendations by the American College of Physicians in February of 2016[2]. 

I guess my point on the paper here is that the medical world, or at least the VA part of it, is paying attention to research regardless of whether it goes against their previously held biases. They are absolutely trying to reverse the opioid epidemic. And we have a lot of work to do to gain that trust and get those referrals. When they’re recommending meditation before chiropractic care for chronic pain, then there is a ton of room for us to shine. So go shine it up all you shiny happy people out there. 

Item #2

On to item numero dos, number 2 for our non-Spanish speaking population out there. This one is discouraging and…..well….awful if I’m being honest.

This one is from JAMA called “Prevention of Prescription Opioids Misuse and Projected Overdose Deaths in the United States” published on February 1, 2019, and authored by Quiushi Chen, Marc Larochelle, David Weaver, and colleagues[3].

Why They Did It

In JAMA, they always start with the question being answered here. The authors wanted to answer this one: “what is the projected effect of lowering incident non-medical prescription opioid use on the future trajectory of the opioid overdose crisis in the USA?

I’m just going to cut to the chase on it and leave a bunch of details out. Here’s why. I don’t want us getting bogged down in the details and methods and all that stuff.

I want you to be able to retain just a few numbers and not be distracted by the rest of the minutiae. You like that word? I know you do. Minutiae, You say that to the right fellow nerd and you may just get you a date, people.

It’s a powerful word so take it, use it, enjoy it. I swear I’m undiagnosed ADHD. I swear it. 

Anyway, here’s the deal, although we as a nation, as a world, now see the issues with opioids and are now trying to address the issue, It’s not getting better and it won’t get any better according to this paper. 

Check it out, according to this paper, the annual number of opioid overdose deaths is projected to increase from 33,100 in 2015…..then we know that 72,000 died in 2017….all the way up to 81,700 deaths projected 2025. 

They are projecting from 2016-2025 to lose a total of approximately 700,400 people to opioid deaths. They say about 80% of that will be due to illicit opioids. I don’t know how the hell they can tell that but that may be a little bit of, “yeah it’s happening but it’s not our fault,” BS going on there but who knows? In this paper, they’re assuming that the illegal use of opioids will increase from 61% in 2015 to 80% by 2025. I don’t know. Sounds like fuzzy math to me but I’m not a researcher. 

I think their numbers are fuzzy because we know 2015 saw about 36,000 die, but then 2016 saw around 63,000 die if I remember correctly. Then, 2017 saw 72,000 die. Are you seeing the graph there in your mind? It’s not only up and to the right on this deal, but its up and to the right like it’s climbing Mt. Everest. The numbers have harnesses fastened tightly and ropes and expert climbing guides and they’re going straight up the face like pros! 

These guys are guessing that by 2025, in 9 years, the deaths will only have increased a total of 9,000 per year, so….they’ll only increase an average of 1,000 deaths per year. Do you see why I think they’re crazy? The deaths increased by 9,000 just last year. Do you see what I’m saying? I’m not saying they’re wrong but….they’re wrong. Lol. 

They then say that across all interventions tested, further lowering the incidence of prescription opioid misuse from 2015 levels is projected to decrease overdose deaths by only 3%-5.3%. 

Their quoted conclusion is, “This study’s findings suggest that interventions targeting prescription opioid misuse such as prescription monitoring programs may have a modest effect, at best, on the number of opioid overdose deaths in the near future. Additional policy interventions are urgently needed to change the course of the epidemic.”

So what do we take from this exactly? Here’s my deal. On the surface at least it smells like a steaming pot of shoo shoo caca doody, 

Instead of recognizing the fact that unnecessary surgeries were many times the reason people got addicted in the first place, and that there are amazing opportunities outside the allopathic world to prevent those unnecessary and financially motivated surgeries, they say, “Hey look, a lot of this is done illegally and that’s just going to get worse and our part of this is really very small.

In fact, we can lower the prescriptions of opioids but it’s really not going to do a lot of good and, in fact, we think we should still be able to prescribe them as much as we are right now….blah blah blah poop coming out of the mouth and falling onto the floor with a splat. 

They are making guesses 9 years in the future what addict behaviors will be. I think that’s presumptuous and ultimately impossible. I just thought it was entertaining and that you all might enjoy this group trying to minimize responsibility or what role they can really play on decreasing opioid use.

I could totally be mischaracterizing this and they may have the best intentions in mind. While I trust my GP and I trust the friends of mine that are surgeons personally….I just don’t trust stuff like this. 

Obviously, I don’t agree with them but I’m a bumpkin chiro on the Texas Plains. I wouldn’t listen to me if I were them either. Lol. 

Item #3

OK, last item for this week and it’s something I’m admittedly fascinated with and I think that’s because I have a high schooler and a 5th grader and this stuff hits home any time I see it or read about it. 

This one was in JAMA too and called, “Association Between Screen Time and Children’s Performance on a Developmental Screening Test” written by Sheri Madigan, Dillon Browne, Nicole Racine and colleagues[4] published January 28, 2019. 

Why They Did It

The main question they were trying to answer was this, “Is increased screen time associated with poor performance on children’s developmental screening tests?” Basically, does screen time have a direct effect on child development?

They had 2,441 kiddos in it. A random-intercepts, cross-lagged panel model revealed that higher levels of screen time at 24 and 36 months were significantly associated with poorer performance on developmental screening tests at 36 months and 60 months. 

What They Found

Their conclusion was, “The results of this study support the directional association between screen time and child development. Recommendations include encouraging family media plans, as well as managing screen time, to offset the potential consequences of excess use.”

Yes, it’s easy to just hand them a device and hope they’re quiet long enough to get a nap in. Guilty as charged. Guilty as charged. 

But, turns out as we may have guessed if we really thought about it 8-9 years ago when all of this really started….this isn’t in their best interest in the long run. 

Chiropractic evidence-based productsIntegrating Chiropractors

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

http://www.chiropracticforward.com

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

https://twitter.com/Chiro_Forward

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

 

Bibliography

1. Taylor S, H.P., Marshal N,, Use of Complementary and Integrated Health: A Retrospective Analysis of U.S. Veterans with Chronic Musculoskeletal Pain Nationally. J Altern Complement Med, 2019. 25(1).

2. Qaseem A, Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med, 2017. 4(166): p. 514-530.

3. Chen Q, L.M., Weaver D,, Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States. JAMA Network Open, 2019. 2(2): p. e187621-e187621.

4. Madigan S, Association Between Screen Time and Children’s Performance on a Developmental Screening TestAssociation Between Screen Time and Child DevelopmentAssociation Between Screen Time and Child Development. JAMA Pediatrics, 2019.

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

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

CF 052: Chiropractic Forward Podcast Year One Review

 

 

 

CF 061: Faith-based Chiropractic, Ohio Lawmakers, & Chronic Neck Pain

CF 061: Faith-based Chiropractic, Ohio Lawmakers, & Chronic Neck Pain

Today we’re going to talk about another aspect or group that I find particularly troubling in my profession I call faith-based chiropractic, we’ll talk about some lawmakers in Ohio, and then we’ll gloss over a paper on chronic neck pain and balance. Stick around, it might get interesting. 

But first, here’s that ‘yummy in your tummy’ bumper music


Chiropractic evidence-based productsIntegrating 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 streamed you way into Episode #61

Before I make people mad, let’s talk a bit about the DACO program which is the Diplomate of the Academy of Chiropractic Orthopedists. I’m on it, I’m on it. I’m on it like stink on my teenager’s socks. You know what I’m talking about. I won’t even enter his room. It just has a certain smell that I want no part of. 

Continuing on with the eLearning episodes through the CDI group, I recently wrapped up one on Lateral Epicondylalgia just this morning and a few days ago finished up one on Fibromyalgia. Did you know the literature is pointing to those two conditions as being partly due to the central nervous system and what is termed central sensitization? 

It’s excellent information. If you want some guidance getting started on it, shoot me an email at dr.williams@chiropracticforward.com No, I don’t get a thing out of helping you or out of talking about it. Nothing at all. It’s just something I’m currently doing so it’s top of mind and I see the incredible value daily and am sharing that information with you. That’s about the total of it. 

I want everyone, as soon as you get to a computer, to go to chiropracticforward.com and click on the STORE link. You will find Posters and Brochures. The posters have some of my favorite and often-used sayings from the podcast. The brochures are evidence-based and are something I have been working on for some time now in my spare time. Now, if I can get some pre-orders ready to rock, we’ll get them ordered and sent on their way to you. 

I’d love to get your feedback on them at dr.williams@chiropracticforward.com

Introduction

Everyone on the planet knows there are two things you don’t talk about and they are POLITICS and RELIGION. 

For me, this here, what we’re about to go into….it has very little to do with the nuts and bolts of religion but more to do with the use of it. I’m going to touch on a very touchy subject and I hope that you won’t do the “poor me, I’m offended by everything on the planet” bit and get mad and leave and never return.

Rather, I hope you’ll hear what I have to say and hear it objectively and then, we either agree or disagree and we move on with our days with a common goal of getting people better. In the end, it’s just one dude’s opinion so let’s not get too worked up, OK? 

Faith-based Chiropractic

OK, let’s talk openly and honestly and hope we don’t make everyone mad. Here’s my deal people, I’m a Christian and have been all of my life. In fact, when I was younger as in junior high and high school, typically if the doors were open, I was there. Sunday morning, Sunday evening, and Wednesday night. Yep. Southern Baptist even although, now, I’m non-denominational. I found out I’m not as much of a fan of organized religion as I am of religion in general. When it gets too organized, I get less interested if that makes sense. 

Anyway, I’m a proud Christian but I’m not a loud or a bully Christian at all. If you come to my office, I’m not sure I have one cross in the whole place. That doesn’t mean I frown on you if you have Christian music playing through the speakers and you have scripture written on the walls. I honestly have no problem with that if it’s there for the right reasons. I don’t believe people are coming to my office for religion so it’s not right for me personally. 

I will admit, I’m a sculptor so several of my pieces are here. One of my pieces is called Road To Damascus and is about a story found in the Bible. I’ll post a picture in the show notes at www.chiropracticforward.com and you can just go to episode 61 if you want to check it out and see it. 

 

Damascus apostle paul bronze

saul apostle paul damascus sculpture

 

I feel like, since I AM one, I can talk about other Christians.

Lately, I’m seeing more and more posts and have been hearing more and more about Christian Chiropractors. I think the idea or concept of being a Christian Chiropractor is just fine. Honestly, I do. There are indeed people that would rather go to a like-minded practitioner rather than a Satan-worshipping chiropractor for example. Wouldn’t you agree? ‘Birds of a feather flock together’ is more than just a saying.

Much in the same way that some patients would just as likely AVOID a Christian Chiropractor if they themselves are not Christians. If someone wants to identify themselves as Christian, honestly, I’m cool with that. I don’t but I don’t care if you do. Not at all. 

Fair play to ya. That’s why we have different strokes for different folks and I’m so OK either way. There are Christian MDs, Muslim plumbers, Christian brothers car mechanics, Jewish this, and Buddhist that…. Whatever melts your butter and feathers your fancy. 

My Issue

My issue today isn’t one of religion vs. non-religion in all honestly. My problem lies in practitioners USING their religion to build their businesses and, in a most undesirable move, using religion to manipulate vulnerable patients for the purpose of padding their wallets. 

That’s a next level no-no in my book. Who cares about my book, right? Maybe nobody at all. Maybe around 8,000 people so far though so, it’s possible some actually DO care about my book so let’s keep rolling here. 

I want to make a distinction here. a Christian, according to the New Testament is charged with going and preaching the gospel. Save souls. There are some that truly feel that, if they are not doing that, they’re not fulfilling their mission. 

OK, fair enough. Who am I to argue that you’re wrong and who the hell am I to judge? If I were to say you’re wrong, I’d be arguing against the Bible and I’m certainly not going to do that. I have faults so I do what I can to stay in the good graces when at all possible. 

If it is honest and well-meant and you feel it in your heart to save your patients, rock on brothers and sisters. Amen & Hallelujah. 

But, if you mix religion into your business practices and protocols as a way to build your business by manipulating desperate and many times scared patients into seeing you, that’s where our paths go separately.

I cannot reconcile it in my mind how it would ever be right or permissible. I’ve never in my life gone to church to pick up business. I’m not there for that. It would be disingenuous and would defeat the purpose of being in the building in the first place. 

In the same way, I don’t use it to build my business in my office. I would not feel honest. I wouldn’t feel genuine. At the end of the day, if I’m anything, I’m those two things. Again, we’re all different but for me personally, it just doesn’t feel right. 

Example

Let me give you exhibit #1 for an example so you can see for yourself what I’m talking about. Here is an actual script folk.

“Mary, I’m concerned. I’m really concerned about you. When you don’t continue your plan to remove the subluxations that are interfering with God’s life force allowing it to innately flow from above down through your body in order to heal you, you’re not allowing God to do his part and heal your body. I understand that it’s hard getting here…but I have an opening at 5:30 tonight so we’ll see you then and let’s get you that life-saving adjustment tonight ok?”

That is a script used by a  popular company. They tell their members to say stuff like that. I’m not even kidding and, as I said, that’s some next level BS for me personally, in my practice. 

As a Christian myself I’m telling you, someone says something like that to me while I’m trying to get my issues resolved, the next thing they’re seeing is my ass as I walk out the door. 

First, I’m not there to be preached to. I go to church for that. Second, it’s obvious you’re trying to manipulate me into treatment using my religion and that just straight up pisses me off. Third, if God wants to heal a patient, why on Earth would he need a chiropractor to make that happen? 

Honestly. Think about it honestly. God moved heaven and earth. All-knowing. All powerful. But needs a chiropractor to facilitate your improved health? That’s insane in the membrane to me. 

What If

What if they said, “Mary, I’d never try to tell someone how to spend their money or how to take care of themselves because that’s none of my business. My job is to tell you what I think would be the best for you based on the idea that you live right next door and have no travel concerns, and you have all of the time and money in the world. What would I think would be best for you? Then there’s reality and my job is to be here for you however you want to use me. We don’t hassle our patients about their recommendations. Just do me a favor if you can’t do what I recommend, don’t tell people that chiropractic didn’t work. OK? Tell them you weren’t able to do what the chiropractor recommended. Is that fair?”

And all the people said, Amen. Literally, every single one of them agrees that it is indeed fair. 

Of course, I also tell them that if they love what we do for them and they get to feeling better, we’d love a great review on Google and Facebook but, if you don’t like us, just keep your mouth shut.” Of course, they know I’m kidding. Or am I?…..

The way I see it, I’m a specialist in what I do and that’s why a patient is here to see me and that’s what they will get. They’re not going to get politics and they’re not going to get religion either. 

As I said in episode #56 when I talked about the magical mystical disappearing arthritic osteophytes, although in many areas of the world it’s getting better, we are still in a battle with a medical community that wants to do away with us. We need to ask ourselves an honest question. Does this sort of stuff, put us at risk of continued ridicule? 

I doubt medical doctors are sitting around all over the country saying, “Mary, I’m concerned about you. If you don’t get this chemo followed by months of radiation, God can’t express himself fully in your body and your healing will not be complete, and you’re going to die.” “Mary, if you don’t take this oxcy, God won’t be able to calm down that issue long enough for us to make any progress in your healing.”

And, if you ever DO find one that does (there are always exceptions to the rule right?) if you find an MD that does that, the whole world is going to think he’s a coo coo loco and you might even see him on 60 Minutes one Sunday night. 

God, faith, religion, and spirituality are wonderful things. They’re the #1 things in the lives of so many people including ME. Just don’t dirty them or the profession by using them as marketing and worse of all….tools to work patients and manipulate them. Please….

I love your religion and I love your passion as long as it’s genuine. Once it becomes about business and becomes a tool to work people, you lose me. That’s all I’m saying. 

Hopefully, not too many of you lost the cheese off of your cracker on that. Let’s keep moving. 

Resource #1

I want to cover a recent article I noticed from WSAZ NewsChannel 3 up in Charleston, WV. It was written by Kaitlynn LeBeau called Ohio Lawmakers, doctors suggest chiropractic care instead of opioids(LeBeau 2018) and was posted on March 21, 2018. 

https://www.wsaz.com/content/news/Ohio-lawmakers-doctors-suggest-chiropractic-care-instead-of-opioids-477447883.html

It’s in WV but talking about Ohio and here’s what they had to say. The Ohio Attorney General and lawmakers held a press conference last March to talk about the need for alternatives to pain meds. The Attorney General, Mike DeWine, said: “More and more people are looking for new and innovative ways to treat pain.” 

Yes, we already know this but he also went on to speak about community health centers that include medical, fitness, social and educational services. We’ve already talked about chiropractors getting integrated into the Federally Qualified Health Centers and, yes….you have one near you whether you know it or not. Just Google the term “FQHC” and then the name of your city or region and see what pops up. 

Here’s what I really wanted to point out: we chiropractors have a powerful ally in American soldier, Staff Sergeant Shilo Harris. If you are not familiar with Sgt. Harris, he is located in San Antonio, TX last I heard unless he’s relocated. 

Anyway, on his second deployment to Iraq, he was injured by a roadside bomb. When I say injured, I mean big time. Go do a google search on Shilo Harris and you’ll see immediately what I’m talking about. 

Bless his heart and thank you for your service, Sgt. Harris. Heroes don’t play on a basketball court or football field. They fight selflessly and give of themselves for our freedom. For complete strangers, many of which don’t even like them. They fight for the love of country too, right? Just amazing people. 

He is quoted in the article as saying, “I’m here to tell you that chiropractic care saved my life. I became addicted to my medications, naturally, in a sense because I had had so many back to back surgeries.”

Sgt. Harris has presented at Texas Chiropractic Association’s events and will be at another TCA event in just a couple of weeks down in Austin that I’ll be at. I’m looking forward to hopefully meeting him myself. 

Resource #2

OK, next item: this one called “Evaluation of Postural Balance and Articular Mobility of the Lower Limbs in Chronic Neck Pain Patients by Means of Low-Cost Clinical Tests(Gomes P 2018)” It was authored Amy Pamela Karine Alvino Gomes, et al. and published in October of 2018 in the Journal of Manipulative and Physiological Therapeutics. 

Why They Did It

The purpose of this study was to correlate measurements of chronic neck pain with the balance and mobility of the lower limbs and to compare these variables between individuals with chronic neck pain and asymptomatic participants.

How They Did It

It was a blinded, cross-cross-sectional study

They had chronic neck pain patients as well as asymptomatic people. 

Outcome assessment tools were used to measure the difference in the groups. 

What They Found

“Young adults with chronic neck pain present changes in static balance measured by means of the Functional Reach Test; that is, the higher the intensity of pain, the lower the anteroposterior excursion of the body during the execution of the test.

This week, I want you to go forward with this: again, I’m all for religion. Ultimately, you do you. Just do it proudly, honestly, and genuinely. Always try to be someone your family can be proud of and be above reproach. 

I want you to know that Staff Sgt. Shilo Harris is awesome and he’s on our team so look him up and book him for your next association event or seminar or legislative effort. 

Chiropractic evidence-based productsIntegrating Chiropractors

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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Connect

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

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About the Author & Host

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

Bibliography

Gomes P (2018). “Evaluation of Postural Balance and Articular Mobility of the Lower Limbs in Chronic Neck Pain Patients by Means of Low-Cost Clinical Tests.” Journal of Manipulative and Physiological Therapeutics 41(8): 658-664.

LeBeau, K. (2018). https://www.wsaz.com/content/news/Ohio-lawmakers-doctors-suggest-chiropractic-care-instead-of-opioids-477447883.html. WSAZ News Channel 3.

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