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Chiropractic Research

CF 036: A MishMash Of Research on Chiropractic, On Herniation, Trends, and Ineffectiveness

A MishMash Of Research on Chiropractic, On Herniation, Trends, and Ineffectiveness

Integrating Chiropractors

Today we’re going to talk about research on Chiropractic, research on health trends, and research on disc herniation as a result of a visit to your friendly neighborhood chiropractor. Is that real or is that a bunch of hooey? We’ll talk about it so come along. 

But first, here’s that bumper music

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

Now that I have you here, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. Nope, I don’t have some big prize for you if you sign up. Not big offers. No magical marketing tactics with which to get your email address. Just what we hope is a podcast full of value to you and your business. 

Being on the newsletter list just makes it easier to let you know when the newest episode goes live and, maybe in the future we’ll have some cool stuff to offer those on our email list. Also, when someone new signs up it makes my heart leap and wouldn’t you like to be the one responsible for making someone’s heart leap today? 

Upcoming!

We have a lot of great guests lined up to come on the show! Next week I believe we are going to have Dr. Anthony Palumbo from Staten Island, New York. Dr. Palumbo is very active in the New York State Chiropractic Association and practices in a multidisciplinary practice. We’re going to have a good time picking his brain. 

The week after that, I believe we have Dr. Brandon Steele from ChiroUp and from the DACO program joining us. He’s an excellent resource for what is going on in our profession and where we see things heading in the future for chiropractic. I’m really looking forward to that one. 

We have the green light from Dr. Jerry Kennedy of the Black Sheep DC marketing program to come on the show. We just need to get that date lined up. We have Dr. Tim Bertlesman from the DACO program and also the President of the Illinois Chiropractic Association lined up down the road. 

Good stuff on the way so make sure you’re staying tuned into our little corner here in Podcast land. We’re bringing you the best in research on Chiropractic.

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

You have fainted very dramatically into Episode #36 and we’re so glad you did. 

How’s your week been so far? I shared on the last podcast how we have had a rough 2018 but things have leveled off and we up and running. It feels a little like a sprint these days to tell you the truth. Lol. And thank the good Lord for it. 

Speaking of thanking the Good Lord, my 16-year-old son has been raised in the church. Not every single Sunday. I like to sleep sometimes ya know. But, often enough to say he’s been a church-goer as has my 11-year-old daughter. We’ve not pushed anything on him but he has taken it upon himself to an extent to further the church part of his life. 

He’s gone to a church camp in New Mexico the last two summers and this year he returned ready to get baptized. So he did. Last Sunday he went to church and took a bath and we couldn’t be more proud of that little dude. He’s actually not so little anymore but, we worry about our kids don’t we?

We worry about if we’re raising them right. Am I raising him to be a good man? Am I raising him to work hard and be dependable? Will they be ready for the world? Have I somehow enabled him to be weak? Am I raising him to feel entitled instead of working his butt off for things in his life

I think parents have all of these worries. I might argue that if you’re not asking yourself at least some of these questions, you might give them a deeper look. I’m not a parenting expert. That’s just my opinion. 

Anyway, my point is, we got this aspect of his life right so far. We sure love that kiddo and we love the direction we see him headed. Kids can be a game-changer for sure. From conception throughout their entire lives, they consume our mind space without even realizing it. And that’s OK. We wouldn’t have any other way most to the time. 

With school back in session now, what are some of the ways that you keep your practice from slowing down? Back to school is historically a slow time for us and we’re never quite sure how to keep that from happening. Email me at dr.williams@chiropracticforward.com and tell me how you do it. I’ll be glad to share on next week’s podcast if you don’t mind. 

This week, I just want to throw some seemingly random papers having to do with research on Chiropractic at you and we’ll start with one called “Effectiveness of classic physical therapy proposals for non-specific low back pain: a literature review.” It was written by F Cuenca-Martinez[1], et.al. and published in Physical Therapy  Research in March of 2018. This is a group of physical therapists writing this paper just so you are in the know. 

Why They Did It

The authors were hoping to evaluate the effectiveness of classical physiotherapy in the management of non-specific chronic low back pain. 

How They Did It

  • They did a literature search in English electronic databases from November- December in 2015 for only randomized controlled trials
  • They only accepted the studies addressing chronic non-specific low back pain treated by manual therapy and different types of exercise methods. 

What They Found

Back School exercises and McKenzie’s method were both ineffective

Spinal manipulation proved effective when performed on the lower back and on the thoracic region but only immediately after it was received and not in the medium or in the long term. 

Massage proved effective for short-term relief

Wrap It Up

The authors’ conclusion was “Based on the data obtained, classical physiotherapy proposals show ineffectiveness in the treatment of chronic non-specific low back pain. More multidimensional studies are needed in order to achieve a better treatment of this condition, including the biopsychosocial paradigm.”

What do we get from this? First thought is, the papers they cite are, at this point, old and considering the papers we have been covering, are really pretty irrelevant to an extent. I mean, any good information will always be good information but only until better information becomes available. The most recent paper cited for the spinal manipulation portion of this project is over 5 years old. So….what the hell?

Second….it’s a bit discombobulated when you read through the abstract. I’m either bad at following along (which is highly likely) or it’s just worded so oddly. I dove into the full paper to try to make heads or tails of what they have going on here. It sounds like physical therapists are just trying to be cheeky monkeys and throwing poo at spinal manipulation and we’re not having it. Mostly because they’re wrong and because we are better and more cost-effective at treating low back pain than they are. Period over and out. 

The authors, in regards to spinal manipulation, refer to three studies. One by Oliveira, et. al[2]., one by Bronfort et. al[3]. and one by Senna and Machaly[4]. The Bronfort study was done on 300 patients and they found basically no difference between those that had physical therapy vs. chiropractic vs. home exercises. They all ended up the same. But, they didn’t cite the work we covered previously showing that chiropractic combined with exercise is more effective that physical therapy. 

Or the paper from Episode 26 by Korthals-de Bos[5] that concluded: “Manual therapy (spinal mobilization) is more effective and less costly for treating neck pain than physiotherapy or care by a general practitioner.”

There was also no mention of the paper by Blanchette et. al. that we covered in Episode #26 that showed that chiropractic patients experience the shortest duration of compensation, and physical therapists’ patients the longest. Blanchette says in that conclusion, “These differences raise concerns regarding the use of physiotherapists as gatekeepers for the worker’s compensation system.” And all the chiropractors said, “Amen, hallelujah brothers and sisters.”

And the Senna paper they cite actually concluded by saying, “SMT is effective for the treatment of chronic nonspecific LBP. To obtain long-term benefit, this study suggests maintenance SM after the initial intensive manipulative therapy.”

I’m done with that paper. 

Let’s move on from these PTs and their poo-throwing. 

Here’s one more specifically geared toward research on Chiropractic called “Chiropractic care and risk for acute lumbar disc herniation: a population-based self-controlled case series study” by Cesar Hincapie, et. al[6].  

Why They Did It

The objective was to investigate the association between chiropractic care and acute lumbar disc herniation with early surgical intervention and contrast this with the association between primary care physician (PCP) care and acute lumbar disc herniation with early surgery

What They Found

Both chiropractic and primary medical care were associated with an increased risk for acute LDH requiring ED visit and early surgery. Our analysis suggests that patients with prodromal back pain from a developing disc herniation likely seek healthcare from both chiropractors and PCPs before full clinical expression of acute LDH. We found no evidence of excess risk for acute LDH with early surgery associated with chiropractic compared with primary medical care.

This Hincapie fella also had a prior paper published not long ago[7] where he discussed and explored the perception among different medical disciplines and among chiropractors as to whether spinal manipulation causes a lumbar disc herniation. It was an interesting paper. We covered it in episode #27 if you’d like to give it a listen. 

https://www.chiropracticforward.com/cf-027-wanted-safe-nonpharmacological-mean-of-treating-spinal-pain/

Then there’s this research on Chiropractic that came out recently titled “Spine Degenerative Conditions and Their Treatments: National Trends in the United States of America” and published in Global Spine Journal February 2018. It was authored by Buser et. al[8]. 

Why They Did It

The aim of this study was to report the current trends when talking about spine degenerative disorders and their various  treatments.

How They Did It

Patients diagnosed with lumbar or cervical spine conditions within the orthopedic Medicare and Humana databases were included

What They Found

  • Within the Medicare database there were 6 206 578 patients diagnosed with lumbar and 3 156 215 patients diagnosed with cervical degenerative conditions between 2006 and 2012
  • There was an increase of 18.5% in the incidence of fusion among lumbar patients
  • For the Humana data sets there were 1 160 495 patients diagnosed with lumbar and 660 721 patients diagnosed with cervical degenerative disorders from 2008 to 2014
  • There was a 33% (lumbar) and 42% (cervical) increases in the number of diagnosed patients. However, in both lumbar and cervical groups there was a decrease in the number of surgical and nonoperative treatments.

Wrap It Up

The authors wrap it up by saying, “There was an overall increase in both lumbar and cervical conditions, followed by an increase in lumbar fusion procedures within the Medicare database. There is still a burning need to optimize the spine care for the elderly and people in their prime work age to lessen the current national economic burden.”

What do we get from that? I’d say that it’s clear from research on Chiropractic we’ve covered here that neck and back pain is stepping forward for sure. It is being recognized for the problem it really is while treatments available in the medical kingdom continue to show scattered results. Chiropractors are the most uniquely positioned to knock this stuff out of the park. 

Fusion surgeries have gone crazy sky high in the last ten years while the outcomes have remained unchanged. 

Epidural steroid injections have been done at a blistering pace over the last decade with no better outcomes. 

Physical therapists are even starting to question their own effectiveness. Take this article in the journal called Physical Therapy written by Colleen Whiteford et. al[9]. Here is the opening paragraph. Get a load of this:

“We are writing to relay our consternation about the guideline article by Bier et al in the March issue of PTJ. We fully support the increasing emphasis on critical evaluation fo the assessment and intervention models used in physical therapist practice. The long-overdue acknowledgment of research that does not support much of what constitutes the bulk of physical therapist practice is a refreshing and honest introspection that can potentially initiate much-needed change within our profession.”

“Without such change, our profession is destined to continue on our current path of practice that is increasingly shown to be yielding outcomes that are less than desirable. Such exploration inevitably leaves us with gaping holes in practice that can be unsettling. The natural and responsible tendency is to search for alternative measures and interventions to fill this gap.”

I’m going to tell you one of those alternatives they’ll be looking to adopt and are looking to adopt is spinal manipulation. You better listen to me folks. If you’ve listened to our podcast much here then you know they’ve already adopted adjustments and renamed it to translatoric spinal manipulation. 

We can keep monkeying with these chiropractors out on the edge of the ether talking about curing everyone on the planet of everything known to man or we can keep moving in the direction of science and in the direction of evidence. My preference is obvious. 

If you haven’t yet, can you leave us a great review on whatever platform it is that you’re listening to us on? iTunes, Stitcher, or whatever it may be. We sure would appreciate it. 

Integrating Chiropractors

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

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

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

Being the #1 Chiropractic podcast in the world would be pretty darn cool. We’ll keep bringing you Research on chiropractic in the hopes of reaching that goal!

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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Bibliography

1. Cuenca-Martínez F, Effectiveness of classic physical therapy proposals for chronic non-specific low back pain: a literature review. Phys Ther Res, 2018. 21(1): p. 16-22.

2. Oliveira RF, Immediate effects of region-specific and non-region-specific spinal manipulative therapy in patients with chronic low back pain: a randomized controlled trial. Phys Ther Res, 2013. 93(6): p. 748-56.

3. Bronfort G, Supervised exercise, spinal manipulation, and home exercise for chronic low back pain: a randomized clinical trial. Spine, 2011. 11(7): p. 585-98.

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

5. Korthals-de Bos IB, Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. British Medical Journal, 2003. 326(7395): p. 911.

6. Hincapie C, Chiropractic care and risk for acute lumbar disc herniation: a population-based self-controlled case series study. European Spine Journal, 2018. 27(7): p. 1526-1537.

7. Hincapie C, Chiropractic spinal manipulation and the risk for acute lumbar disc herniation: a belief elicitation study. European Spine Journal, 2017.

8. Buser Z, Spine Degenerative Conditions and Their Treatments: National Trends in the United States of America. Global Spine J, 2018. 8(1): p. 57-67.

9. Whiteford C, On “Clinical Practice Guideline for Physical Therapy Assessment and Treatment in Patients With Nonspecific Neck Pain,” Bier JD, Scholten-Peeters WGM, Staal JB, et al. Phys Ther. 2018;98:162–171. Physical Therapy, 2018.

CF 035: Chiropractic & Disc Herniations

Chiropractic and Disc HerniationsIntegrating Chiropractors

Today we’re going to kick around information on disc herniations, disc bulging, and radiculopathy as a result. Is there anything we can do about it? Well, I’m a chiropractic advocate and research backs us on it so I’ll say, “Hell yes.” Come along with us, won’t you?

 

First, I feel some sweet sweet bumper music moving in….

 

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

 

Now that I have you here, I want to ask you to go to chiropracticforward.comand sign up for our newsletter. It makes it easier to let you know when the newest episode goes live and it makes me feel good. Don’t you like to make people feel good? Of course, you do so….do it do it.

 

Also, our group on Facebook. It’s called the Chiropractic Forward Group and I think that’s as appropriate of a name as I could come up with. Lol. Just in case you didn’t know, there’s the page on Facebook. That’s for getting the word out and telling people about the podcast. Then there’s the private group. That’s for interacting with each other, learning from each other, posting new papers when they come out, and maybe organizing into a powerful group someday, somewhere down the line. That sort of deal must grow organically. It can’t be forced so we won’t try to do that.

 

We’ll just let you all know about its existence and hope to start seeing you over there. Let’s start a conversation outside of the podcast!

 

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

 

You have back-flipped head-on into Episode #35

 

Before we talk about all of the disc herniations stuff, I want to tell you all about my weekend. I spent Saturday and part of Sunday morning with my butt firmly planted in a chair in a hotel conference room listening to Dr. Brandon Steele talk about shoulder issues. He was the teacher as his company ChiroUp was a sponsor of the event but he was there teaching as part of the DACO program which is run by the University of Bridgeport.

 

What the heck is DACO right? Well, what used to be called DABCO is now called a DACO which stands for Diplomate of American Chiropractic Orthopedists. I have mentioned before where I sat through the first 10 DACO hours back in June. That was over the low back. These ten were over the shoulder. Topics covered included Scapular Dyskinesis. I knew nothing of this mess and, I already identified and started working with one of these patients the day after I got home. We also covered shoulder impingement, rotator cuff issues, thoracic outlet syndrome, and adhesive capsulitis to name a few.

 

Good stuff all around and, even if I don’t go all the way through the DACO program, I get better and better every time I take a class. And not just better. I get exponentially better.

 

In talking with Dr. Steele this weekend, he agreed to come on to the podcast as a guest. We’ll get that all lined up. I have a ton of questions for him. Some questions about the DACO program, some about ChiroUp (it’s really a game-changer and you better use my name if you sign on!!!), and I want to ask him about practice standardization and some things along those lines. It should be a fun conversation so make sure you keep your eyes out for it in the near future.

 

I encourage you…..a lot of what we talk about here is integrating with the medical community and really stepping up. Part of that is taking the steps to get educated at higher and higher levels. The DACO is in line with that. I have zero association with the people running it other than the fact that I love the product they have created and use it regularly. There is nothing in it as far as reimbursement goes. I just believe in what they’re doing. I encourage you all to look into this DACO program. If you don’t know where to start, just email me at dr.williams@chiropracticforward.com and I’ll get you pointed in the right direction.

 

Now, on to disc herniations

 

Have you ever been told we can’t do anything for discs? Have you been told to not adjust if they have a low back disc issue? Do you know how to recognize a disc issue? What’s the best way to treat it? So many questions!!

Here’s the deal for me today. I’m no guru. I’m going to throw research on you but in the end, a lot of it is just experience. So, don’t take my word as the gold standard. I didn’t expect you to anyway but, I wanted to be sure. Lol.

 

Let’s look first at recognizing disc herniations. There are some simple questions that can get you moving in the right direction on this:

  • Do you have static position irritation meaning, do you have to move around in your chair often to get comfortable?
  • Do you have pain going from seated to standing?
  • Is there a positive Milgram’s
  • How about a positive Modified Slump test?
  • Valsalva’s is part of that but some do it separately.
  • Same with SLR. I was taught that pain on SLR in the first 30 degrees, when the nerve is first tensioned, was indicative of a disc issue but the DACO folks say it’s between 30 and 70 degrees.
  • Worst position is seated
  • Best is lying down
  • Deep buttock pain
  • Pain in the first 1/3 of trunk flexion or trunk extension that cannot be alleviated by bracing or tightening a belt around the waist.
  • Radiating pain into the leg
  • As a general rule of thumb, the further pain radiates beyond the knee, the more likely it is caused by a disc.
  • Sometime you’ll encounter diminished reflexes or differences in sensory or motor information from side to side.

 

When should we get an MRI for disc herniations and other issues? Red flags like the history of cancer, fever, chills, recent unexplained weight loss, immunosuppression, and corticosteroid use give you a reason. Symptoms lasting longer than 6 weeks or symptoms showing progressive neurological deficit also give you a reason to get that MRI.

 

What can we do about it?

Again, that’s going to depend on who you ask. Are we going by The Lancet? Why not go by some chiropractic gurus? We can go by the medical fields recommendation or by physical therapists techniques? I say yes, yes, and yes.

 

I had a neurosurgeon buddy of mine tell me, whatever the hell works without doing surgery…..do that. I agree. That’s why we are friends coincidentally.

 

So, knowing all of that, I’m going to tell you what has been effective for me in my practice. The first thing is something that the insurance companies call experimental and investigational. I think they’re full of it. They don’t seem to be in any hurry to pick up new services to have to pay for, do they? But you know what? I’d rather them NOT cover it so we can actually get paid what it is worth.

 

What I’m talking about here is decompression for disc herniations. This was a game-changer for me in my practice. I have three short stories for you here. They all have to do with guys I tried to send to the surgeon. I’m not going into why we ordered the MRIs or the exam findings. It would take too long for this format so we’re going to jump to the chase in each of their cases.

 

  1. The first is a dude was in town visiting for work and was only going to be here for a few months before returning home. The MRI showed us that his disc herniations was 14 mm caudal migration. I sent him straight to the surgeon. The surgeon set him up for surgery in 6 weeks. The guy was on board with having surgery but couldn’t wait 6 weeks for some kind of relief. Any kind of relief. He begged me to do decompression. I figured that we could go light. In the end, it’s traction and he had no contraindications to decompression so we did it. This guy was back to working and dancing around in the office in about a week and a half y’all. If you want to say it’s placebo, that’s OK, we’re just going to disagree. If you want to say people just like to be touched and I could have pulled on his big toe and it may have had the same effect, I’m going to tell you to jump in a lake.
  2. The second was a guy that was a truck driver. He was in his 70’s and had had heart surgeries and was on blood thinners. He was a physical wreck honestly. When he came in, he was in a wheelchair and unable to work or function. I got an MRI and his herniation was posterior with 18 mm of caudal migration. That used to be a ticket to the surgeon so off he went. Well, his cardiologist would not take him off of the blood thinners so surgery was out of the question. He came back to me just like the other case we discussed. He had no other options and would I please do decompression on him to try to get him some relief. It had been going for quite some time. OK, sure. I’m a nice guy but I told him, I doubt it’s going to help something like you have going on. Yeah, yeah, yeah, hook me up, please. So we did. Guess what? He came in just a time or two later on a walker instead of a wheelchair. Then, a week or so later, he came in without a walker. Then a month or two down the road, he got a new job and was out there telling everyone that would listen about what we were able to do for him. You can take a long walk off a short pier if you’re going to suggest that was anything other than significant effects due to direct intervention.
  3. Last and worst of all disc herniations I’ve ever seen. He is actually a good friend of mine. He came in with numbness and weakness all the way into his foot. Limping, the whole deal. He worked in a warehouse and would have to be forklifted to the second floor where his office is because he couldn’t get there any other way. He thinks it was due to a motorcycle wreck several years ago. Whatever the cause, it was pretty crazy. His MRI showed disc herniations of 23mm of caudal migration. Almost all the way down to the next disc below. I had never seen that before and haven’t seen it since. I, of course, told him he needed to go to the surgeon muy pronto. He agreed but his wife, bless her heart, did not. And thank goodness. She was adamant about him not going to the surgeon. She strongly urged him to not go until he at least gave decompression a try. I told him about the first two cases we just talked about but that he was really in a different ballpark than those guys and I really didn’t know how I could help at all. They understood but decided to give it a go anyway. And thank God they did. Sometimes our patients teach us instead of us teaching them, don’t they? It took a couple of months but he started to turn around and never had that surgery. I just checked with him the other day, 2 years later, and he’s doing great. He said he has a little numbness in the outside of his foot but nothing bad and nothing he can’t handle. All’s well and guess who the hero is? Well….his wife. She’s the hero. Lol. I’m still the buddy and buddies can’t be heroes.

 

These are the worst of the worst disc herniations but what about all of the others that were more minor disc herniations? Think of all of the successes we have had with disc herniations over the years. When I say it’s a game-changer, I damn well mean it and, once again, I care not what insurance companies have to say about it.

 

Let’s look at some papers on it.

 

This one is called “Simple pelvic traction gives inconsistent relief to herniated lumbar disc sufferers” by Edward Eyerman, MD. It was published in the Journal of Neuroimaging in June of 1998[1].

 

Why They Did It

The aim was to do before and after MRIs to correlate improvement in the clinic with MRI evidence in terms of disc herniations repair in the annulus, nucleus, facet joint, or in the foramen as a result of decompression treatment.

 

Eyerman was testing the effectiveness of decompression in a sample of 12 men and 8 women aged 26-74. No, not a big sample.

His MRI finding was as follows:

Disc Herniations: 10 of 14 improved significantly, some globally, some at least locally at the site of the nerve root compression.

Measured improvement in local or general disc herniation size varied in the range of 0% in 2 patients, 20% in 4 patients, 30% to 50% in 4 patients and a remarkable 90 % in 2 patients that did all 40 sessions.

As far as clinical outcomes of the subjects go, he noted that all but 3 patients had very significant pain relief, complete relief of weakness when present, and of immobility and of all numbness except for in 1 patient with herniation and 2 with foraminal stenosis without herniation.

Summed up, he said “Serial MRI imaging of 20 patients treated with the decompression table shows in our study up to 90% reduction of subligamentous nucleus herniation in 10 of 14. Some rehydration occurs detected by T2 and proton density signal increase. Torn annulus repair is seen in all. Transligamentous ruptures show lesser repair. Facet arthrosis can be shown to improve chiefly by pain relief.

Then we have this one by Thomas Gionis, MD published in the Orthopedic Technology Review in December of 2003[2].

They concluded, “Results showed that 86% of the 219 patients who completed the therapy reported immediate resolution of symptoms, while 84% remained pain-free 90 days post-treatment. Physical examination findings showed improvement in 92% of the 219 patients, and remained intact in 89% of these patients 90 days after treatment.”

When is surgery necessary? Well, that’s going to depend on who you ask but a good general rule I follow is that cauda equina syndrome is a quick trip to a surgeon. I personally don’t like foot drop and am likely to send to a surgical consult. I think any progressive worsening of neuro symptoms is cause to pause and reconsider whatever you’re doing. If what you’re doing ain’t fixing it, change directions.

 

But there is this paper I found interesting. It’s from 2010 and called “Spontaneous Regression for a Large Lumbar Disc Extrusion[3]” by Ryu Sung-Joo, MD and was published online for the Journal of Korean Neurosurgical Society. I have no idea what the quality of this journal is or what the impact is but it’s interesting and I’ve seen studies before about spontaneous resolution of disc herniations.

 

The authors say, “Although the spontaneous disappearance or decrease in the size of a herniated disc is well known, that of a large extruded disc has rarely been reported. This paper reports a case of a spontaneous regression of a large lumbar disc extrusion. The disc regressed spontaneously with clinical improvement and was documented on a follow-up MRI study 6 months later.”

 

The case report was on a 53-year-old female after 6 months of low back pain and left lateral leg pain with numbness. Y’all go to the show notes and get the reference to this paper. The MRI images are great.

 

They mention, “After conservative treatment, her clinical symptoms subsided gradually but the numbness of her left lateral leg still remained. A second MRI study performed approximately 6 months after the prior examination reveals almost complete disappearance of the extruded fragment that had been located posterolateral to the L5 vertebral body and no evidence of compression or displacement of the dural sac or nerve root.” Wowza.

 

They go on to explain, “Our patient is an example of the resolution of a large protruded disc without surgery. This phenomenon may be due in part to the fact that larger fragments have a higher water content8) and may regress through dehydration/shrinkage, retraction, and inflammation-mediated resorption.” Meaning….her body ate it and it went bye bye.

 

They finished up the paper by saying, “Even in patients with large lumbar disc extrusion, non-surgical conservative care can be considered as an option for the treatment when radiculopathy is acceptable and neurological deficit is absent.“

That’s pretty cool. I don’t think surgeons are going to want to hear it but it’s cool. If all they can do is surgery on cauda equina or foot drop, they’re going to have a hard time financially.

 

Alright, moving beyond decompression or spontaneous resorption, what else can we do?

 

Here’s one I got from Dr. Tim Bertlesman. It was authored by G McMorland and called “Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study[4].” This one was published in the Journal of Manipulative Physiology and Therapeutics in 2010 and goes like this. The authors concluded, “Sixty percent of patients with sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention. Of the 40% left unsatisfied, subsequent surgical intervention confers excellent outcome. Patients with symptomatic LDH failing medical management should consider spinal manipulation followed by surgery if warranted.“

 

Go check it out in the show notes if you want the nuts and bolts and bells and whistles, please.

 

Then there are your directional preferences exercises. If you have not familiarized yourself with directional preferences, please do so yesterday. They are based upon the idea of centralization and peripheralization. McKenzie’s program uses it, the CRISP protocol uses it, Kennedy’s decompression system uses it, and the DACO program teaches it. Do you see a pattern of some sort emerging here?

 

Other things that are helpful are exercise recommendations like McKenzie or Williams exercises depending on the directional preference, core building.

 

These patients also need strong at-home suggestions like:

  • Get an inversion table for the house.
  • Get back to work as soon as possible
  • Don’t lay up in bed hoping it goes away
  • Sleep correctly
  • Work advice like get up and walk every 45 minutes or so
  • Don’t use catastrophic language and make sure they know it’s not a disease and most disc cases resolve

 

I don’t have all of the answers but, I’m guessing none of you do either. In the end, it’s experience, isn’t it? For example, without experience, I wouldn’t have known that it COULD be possible to help three guys with caudal migration of a disc from 14mm all the way up to 23mm. Nothing but experience can show someone that.

 

While we don’t know it all, we DO find means that are effective and help us get the job done and make a difference in our patients’ lives. That’s for sure.

This week, I want you to go forward with the knowledge that, in case you didn’t already know it, you’re powerful. You can take disc herniations that used to be sent straight to surgery and you can treat that complaint with safe, conservative, non-invasive, and non-pharmacologic means. That’s a hell of a deal right there, folks.

 

We’re not done talking about disc herniations, decompression, and all of that fun stuff. There’s too much left in the tank to be done but, in the interest of time, we’ll get to it on another episode.

 

Integrating Chiropractors

 

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

 

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

 

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

 

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

 

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

 

??Website

http://www.chiropracticforward.com

 

??Social Media Links

 

??iTunes

??Player FM Link

??Stitcher:

??TuneIn

  1. Eyerman E, e.a., MRI Evidence of Nonsurgical, Mechanical Reduction, Rehydration and Repair of the herniated Lumbar Disc.J Neuro Imaging, 1998. 8(2).
  2. Gionis T, Surgical Alternatives: Spinal Decompression.Orthopedic Technology Review, 2003. 6(5).
  3. Ryu Sung-Joo, Spontaneous Regression of a Large Lumbar Disc Extrusion.J Korean Neurosurg Soc., 2010. 48(3): p. 285-287.
  4. McMorland G, Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. J Manipulative Physiol Ther, 2010. 33(8): p. 576-584.

 

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

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

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

https://www.chiropracticforward.com/cf-019-non-opioid-more-effective-while-chiropractic-maintenance-may-be-the-most-effective/ Adolphus Washington Womens Jersey

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

How Evidence-based Chiropractic Can Help Save The Day

Integrating Chiropractors

Today we’re going to talk about our blessing and our America’s curse, opioids. Why would I ever call opioids a blessing? We’ll get to that. Stick around for some updated info on how evidence-based chiropractic can save the day.

But first, here’s that bumper music

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

Now that I have you here, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It makes it easier to let you know when the newest episode goes live, when someone new signs up it makes my heart leap a little, and in the end, it’s just polite and we’re polite in the South.  

We are really starting to pick up some steam. Thank you to you all for tuning in. If you can share us with your network and give us some pretty sweet reviews on iTunes, I’ll be forever grateful. By now, we all know how the interwebs work. You have to share and participate in a page if you are going to see the posts or if the page will be able to grow. 

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

You have Texas two-stepped your way into Episode #32

As I was wondering what the heck I was going to talk about this week, I started looking at having a guest. Well, he was unavailable for a few weeks so now what? 

I started to put some random research papers together for this week’s episode was trying to gather my thoughts on flow, order, and all that good stuff and then…..POOF….it was like divine intervention. In my email box came about 4 or 5 articles on updates having to do with the opioid crisis. ALL IN THE SAME DAY. Pretty much in the same hour if you can believe that!

I’m not one to poo poo blessings or to throw rocks at divine intervention so guess what? We’re going with opioids and the ways evidence-based chiropractic can help save the day by helping our patients avoid them. 

If you have followed the Chiropractic Forward Podcast for any amount of time, or have seen any TV news program, you’ll know that American, and the world, has a bit of an opioid crisis and chiropractic is in the driver’s seat of alternative interventions that have been proven effective in treating the conditions that opioids have been commonly prescribed for. 

I want to start with an article I received from my malpractice carrier and, since I use the largest of chiro malpractice carriers, I’m guessing you all got it too but, if you are like most chiros, just deleted it rather than reading the thing. It turns out that I’m a nerd and I read the thing. It was titled “Opioids Misuse and Addiction: How Chiropractic Can Help(Petrocco-Napuli K)” and written by Kristina Petrocco-Napuli and posted on a site called Clinical Risks on June 13, 2018.

The article started with a story about Megan who was mid 30’s and suffering pain chronic pain four years after being in a wreck. 

As we chiropractors are well-aware of…..evidence based chiropractic care was not offered to her as a viable option for treatment following her car wreck, of course not….right? I mean, the trauma is mechanical in nature so why recommend mechanical solutions? Let’s just go right to the historically ineffective, addictive chemical treatment instead, OK?

So, basically, Megan went through two pregnancies addicted to opioids. She had some success quitting them during different parts of the pregnancies but continued to return to opioids. 

She goes on to cite information from the American Academy of Pain Management that says 100 million Americans suffer from chronic pain. Think about that just a second. Last I remember hearing, there was somewhere around 320 million Americans? That’s about 1/3 of the nation suffering from some form of chronic pain. That’s terrible news but, I’d argue it’s actually great news for chiropractors. Evidence-based chiropractic

It’s like, if we see personal injury patients in our office, we really don’t want people to get in wrecks but, be honest….it’s good for business. It feels dirty just saying that. I know I don’t personally want to see them get hurt but I’m here to help if they need me and that’s how I go about that. Same thing if it’s icy outside. You don’t want people falling and hurting themselves but…….yeah…..it’s good for business. You get my drift. 

We don’t want 1/3 of the nation suffering chronic pain but that also means the opportunities open to evidence-based chiropractic are virtually limitless if we play our cards right.  

I can tell you that we have seen some referrals in my office from a few of the pain doctors in the region that are trying to wean patients off of opioids and can I tell you something? It ain’t pretty. Some are mad at the world. Some are fidgeting all over the place and can’t sit still. Good Lord I’m glad I don’t prescribe and am not getting hit up all of the time for these pain meds. That is a blessing all by itself, isn’t it?

I am an advocate of yours. If you want to practice with adjustment only. Go for it. If you want to integrate…go for it. If you want to further educate yourself, go for it. You should be able to practice and get reimbursed to the extent of your schooling and to the extent of your state’s scope. I’m all for that. 

There was a time I thought it might be cool to prescribe like they do out in New Mexico. Chiropractors over there can go through an extra two years of education and have the ability and right to prescribe some meds to their patients if they feel they need it. I’ve had chiropractors tell me, “That’s not chiropractic.” I get that. That is why it is called an Advanced Practitioner or something of that sort. I don’t recall off the top of my head the official title. Regardless, who am I to hold a brother or sister back that wants to further their education, further their rights, and further their capabilities. You did the work. You deserve the pay-off and I’m on your side. 

However, for me personally, I’m over that. Not only is research showing more and more that that sort of prescription and treatment basically has no more effect than chiropractic, and, on top of all of that research, I don’t want to have to deal with people looking for the meds. I got over that a long time ago. Evidence-based chiropractic

In this article, the author goes on to mention the role of chiropractic which she says are as follows. 

  • Public awareness: Build knowledge on how chiropractic can help with chronic pain as an alternative to medications. We’ve talked about this many times before here on the chiropractic forward podcast
  • Education: Inform other practitioners about chiropractic as a treatment option for patients. This will become increasingly important, given the recent focus on non-pharmacological care. Again, we have screamed this one from the rooftops.
  • Reduce misuse: Help patients locate drug drop boxes for opioid disposal, drug take-back programs, medication lock boxes and testing programs. THIS is one I have not considered. Not at all. I think it’s a great point. If you know how to commonly find these take-back programs and lock boxes, send us an email at dr.williams@chiropracticforward.com and we will be glad to share with others. Right now, without going to Google for more information, I’m assuming a call to your local hospital can probably get this mystery solved for your area. 

Evidence-based chiropractic providers better get off their rears and take action on these points if we’re going to take our place. 

Next, there was this article in the Journal of the American Medical Association titled “The burden of opioid-related mortality in the United States” by Tara Gomes, et. al(Gomes T) and published in JAMA in June of 2018.

Why They Did It

The authors wanted to answer the question, “What has been the burden of opioid-related deaths in the United States over a recent 15-year period?”

How They Did It

  • The study was a cross-sectional design in which cross sections were examined at different time points to investigate deaths from opioid-related causes from January 1, 2001- December 31, 2016. 
  • For the purposes of this study, opioid-related deaths were defined as those in which a prescription or illicit opioid contributed substantially to an individual’s cause of death as determined by death certificates. 

What They Found

Between 2001 and 2016, the number of opioid-related deaths in the United States increased by 345%, from 9489 to 42?245 deaths

Overall, opioid-related deaths resulted in 1?681?359 years of life in 2016

Wrap It Up

Premature death from opioids imposes an enormous and growing public health burden across the United States.

We covered a paper some time ago that mentioned the average age of death has actually decreased in America in the last two years because of opioids. 

Remember the uproar Americans were in when we lost a little over 58,000 soldiers in the Vietnam war? Yeah, another paper we reviewed recently estimates over 64,000 death to opioids just last year. See the issue? But chiropractors have been crazy all these years to offer a sensible, safe, and reasonable alternative for treating these people? Give me a freaking break with that stuff. Now, some chiropractors are crazy OK? It’s the fact but, evidence-based chiropractic care can fix this problem and I have zero doubts about it. 

I want to cover this next one briefly just to highlight how damn tone-deaf these people in the medical kingdom can sometimes be. This one is called “Prescription drug coverage for treatment of low back pain among US Medicaid, Medicare Advantage, and Commercial Insurers.” Written by Dora Lin, MHS and published in JAMA on June 22, 2018(Lin D) this article really highlights the issue we are dealing with in America. 

The question the authors looked to answer here was, “Among US insurers, what are the coverage policies for pharmacologic treatments for low back pain?”

How They Did It

  • A cross-sectional study of health plan documents from 15 Medicaid, 15 Medicare Advantage, and 20 commercial health plans in 2017 from 16 US states representing more than half the US population and 20 interviews with more than 43 senior medical and pharmacy health plan executives from representative plans.
  • Data analysis was conducted from April 2017 to January 2018.
  • Of the 62 products examined, 30 were prescription opioids and 32 were nonopioid analgesics, including 10 nonsteroidal anti-inflammatory drugs, 10 antidepressants, 6 muscle relaxants, 4 anticonvulsants, and 2 topical analgesics.

What They Found

Look who the hell cares what they found, OK? Here’s why NONE of it really matters. All they’re doing here is trying to figure out what drugs insurers carry and how to get drugs to people rather than what is effective, what the current guidelines recommend, what The Lancet papers had to say about opioids and nonopioids, what the American College of Physicians have to say is first-line treatment and what is last line treatment for low back pain. Evidence-based chiropractic

How about they do a little research having to do with….I don’t know…maybe doing away with opioids, and anticonvulsants for low back pain…doing away with steroid shots and surgery for non-complicated low back pain….and knocking down the barriers to patients seeking alternative care. Barriers noted and called out by the White House last year and barriers that were set up by CMS and insurance companies. 

How about we do something effective along those lines instead of wasting more time and paper folks? It could not be more exhausting. 

This week, I want you to go forward with comfort. Comfort in knowing that you are where you need to be and you’re there for the right reasons. You are helping people stay away from these drugs. You saving their lives in many cases whether they….or you….know it. We are saving lives folks. Good on you. Keep it up. Keep making a difference. Stay with evidence-based chiropractic care, be patient-centered rather than doctor driven or numbers driven and the money will take care of itself.

Key Takeaways

  1. Opioids haven’t gone away. Pill pushers haven’t gotten the message yet. The issues are still there and they’re real 
  2. Research doesn’t matter unless we educate the medical professionals around us and educate our patients so spend some extra time talking to your patients about the stuff we go through with you right here. 

Integrating Chiropractors

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

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

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

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

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

??Website

http://www.chiropracticforward.com

??Social Media Links

??iTunes

??Player FM Link

??Stitcher:

??TuneIn

 

Bibliography

Gomes T (2018). “The Burden of Opioid-Related Mortality in the United States.” JAMA Network Open 1(2).

Lin D (2018). “Prescription Drug Coverage for Treatment of Low Back Pain Among US Medicaid, Medicare Advantage, and Commercial Insurers.” JAMA Network Open 1(2).

Petrocco-Napuli K. (2018). “Opioids Misuse and Addiction: How Chiropractic Can Help.” Clincal Risks  Retrieved June 13, 2018, from https://www.ncmic.com/learning-center/articles/risk-management/clinical-risks/opioids-misuse-and-addiction-how-chiropractic-can-help/.

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

CF 020: Chiropractic Evolution or Extinction?

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

evidence-based chiropractic

evidence-based chiropractic

CF 031: No More High Risk & Useless Drugs From Here On – Getting Off Opioids

No More High Risk & Useless Drugs From Here On – Getting Off OpioidsIntegrating Chiropractors

Today we’re going to talk about getting off opioids. Even with the opioid crisis going crazy in our country, every single week, I have patients come in and they’ve been prescribed opioids as knee-jerk reactions right off the bat. We know that ain’t right! It’s time to start getting off opioids. 

But first, here’s that bumper music

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

Before we get started, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It makes it easier to let you know when the newest episode goes live and it’s just nice of you. 

We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. Big goals. It’s a thing, folks… shoot big, and even if you fail, you’re still getting somewhere you weren’t going previously. It’s a win-win. 

You have sashayed all fancy like into Episode #31

I spent the weekend last week in Longview, TX. Folks, I swear if you just looked out to check the weather, your face would fry right up like a pork rind. And pork rinds are gross so, if you’re down South, keep your face in the house. The sun is downright dumb right now, at this point in time. Certainly in the South. 

Now, let’s turn our attention to drugs. Or getting patients off of them. Getting off opioids. This brings to mind an uncle of mine. He’s having some chronic pain. Granted, he’s very elderly but, he’s always been a healthy guy. Always. No seriously bad habits. Nothing like that.  

The doctor said he was going to try taking him off of some of his 16 medications to see if that helped. Lol. Ya think so doc? Holy smokes and save the gravy. Sixteen medications. Imagine the obstacle courses of side effects with every single one of the sixteen medications he was taking? It boggles the mind. Hell yes, he’s sick. When does this mentality change?

We hope with podcasts like this, like evidence-based chiropractic groups on social media. There are people out there like us screaming and hollering to make it happen. 

I had a young lady in my office just two weeks ago. Probably about 24 or 25 years old. She had fairly acute low back pain and had gone to the Urgent Care for it the day before. Guess what they did? Gabapentin was their first-line choice. First line. 

No sir, no ma’am. That is NOT in keeping with every known current recommendation from the medical field. Here it is lined out for you. 

Chiropractic, exercise/rehab, heat, and massage, maybe acupuncture if it’s a chronic issue. Throw in cognitive behavioral therapy and some other therapies I’m not all that familiar with to round it out. Some guides will say aspirin, ibuprofen, etc..

Second line would mostly be the anti-inflammatories like ibuprofen and aspirin. We covered a study some time back on the blog where ibuprofen was shown more effective than Tylenol but, other than that, do as you will. 

Last line would be injections, more serious medications, and very last would be surgery. This is all about getting off of opioids.

That’s the order. You don’t skip everything and go right to Gabapentin. Not anymore anyway. The word isn’t percolating through the ether right now and getting to the physicians seeing this stuff on the front line. It’s all about getting off opioids, folks.

Here’s why. Let’s start with this one called “Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis” by Oliver Enke, et. al. and published in CMAJ(Enke O 2018). CMAJ stands for the Canadian Medical Association Journal so, it’s basically JAMA for Canadians. By making this clear to the listeners here, you know this isn’t chiropractors picking apart medical doctors and medicine. This comes from the authorities in the medical field. 

Why They Did It

There’s scant evidence that an anti-convulsant like gabapentin is effective for low back pain yet the incidence of its use has gained significantly recently. The authors here wanted to find out if there was actually any effectiveness for the medication for low back pain. 

How They Did It

  • 5 databases were used to search for prior info and research on the matter. 
  • The outcomes were self-reported pain, disability, and adverse events
  • Risk of bias was assessed and taken into account
  • Quality of the info was assessed as well
  • The info was gathered and numbers put on the information to make it make sense. 
  • 9 trials compared Topiramate, Gabapentin, or Pregabalin to placebo
  • There were 859 participants

What They Found

  • 14 out of 15 so…..93.3%….found anti-convulsants were not effective to reduce pain or disability in low back pain or lumbar radicular pain
  • There was HIGH-QUALITY evidence of no effect vs. placebo for chronic low back pain in the short term.
  • There was HIGH-QUALITY evidence of no effect for lumbar radicular pain in the immediate term 
  • The lack of effectiveness also comes with HIGH-QUALITY evidence of an increased risk of bad side effects. 

Wrap It Up

The authors wrapped it up by saying, “There is moderate- to high-quality evidence that anticonvulsants are ineffective for treatment of low back pain or lumbar radicular pain. There is high-quality evidence that gabapentinoids have a higher risk for adverse events.”

So, we can close the door on gabapentinoids right? Time shall tell. How are we going to do our part to get the word to the right folks on this? Shoot me your suggestions. Count me in. 

OK, we know now that gabapentinoids are foolish to prescribe for low back pain. What about opioids? If you’ve been listening very long to the Chiropractic Forward Podcast, then you likely already know the answer. But I like to add to the pile so here we do with a new one called “Changes in pain intensity following discontinuation of long-term opioid therapy for chronic non-cancer pain” by McPerson, et. al. and published in the Journal of the International Association for the Study of Pain. This paper was published on June 13 of 2018. (McPherson S 2018)

Why They Did It

The objective of this study was to characterize pain intensity following opioid discontinuation over 12 months.

How They Did it

  • The paper was a retrospective VA administrative data study
  • 551 patients were identified and included.
  • They took data over a 24 month time period which included 12 months before discontinuation and 12 months after discontinuation. 
  • The Numeric Rating Scale for pain was used as an outcome assessment

Wrap It Up

“Pain intensity following discontinuation of LTOT does not, on average, worsen for patients and may slightly improve, particularly for patients with mild-to-moderate pain at the time of discontinuation. Clinicians should consider these findings when discussing risks of opioid therapy and potential benefits of opioid taper with patients.”

Well then, getting off of opioids should be easy. All of the info tells they do no good anyways right? 

I had a new patient come in today. She’s 23. Last year, she had discectomies at three different levels. Can you imagine? Now, to be fair to the surgeon, she tried two months of physical therapy and was still unable to work or function in her daily life. She would intermittently go numb from the waist down. That’s big stuff but, should she have had surgery that quickly?

Does that mean she had cauda equina syndrome? Well….maybe. Numb from the waist down sort of sounds like it but did that include loss of bowel or bladder control? I’m not sure yet. I’m going to find out more about it as we treat. The surgeon may have been correct if it was indeed cauda equina and I’m not one to second-guess the guy right now going off of what I know right now. 

The main point here is that she said she was on all kinds of meds the whole time and afterward and is still on gabapentin and trying to wean herself off of it. I went over the Canadian Medical Journal article we just went over at the start of this podcast and showed her how it’s doing nothing for her. She said she knows that. It doesn’t help her one bit but she has withdrawal issues if she takes less than a certain amount per day. These folks need our help and I hope I’m able to do my part for her. 

We can avoid this stuff. I hate that I’m getting to her afterward though. I have to tell you. What if, on top of physical therapy (which I don’t see doing a ton of good for discs in my experience), what if on top of PT she would have been told to do massage, spinal manipulation, and I would argue spinal decompression and cold laser as well? Did she try an inversion table at all? What about Tai Chi, yoga, cognitive behavior therapy? 

What I’m saying here is that PT is just part of the cocktail. The power is when PT is mixed with the rest. We are getting off opioids, folks.

I have shown you all paper after paper showing evidence-based proof of the effectiveness of chiropractic care but how about some cultural proof? Let’s do it!

What name is more respected by consumers in American than Consumer Reports? Honestly, I remember the name from when I was a kid. Consumer Reports is ingrained in the membrane, isn’t it? I say that it is so it must be so. 

Here is an article from Consumer Reports from May 4, 2017(Carr T 2017). Just over a year ago. 

The article talks about Thomas Sells, a veteran receiving alternative therapies through the VA. Along with chiropractic care, the article mentions alternatives for low back pain treatment like tai chi, yoga, massage, and physical therapy. 

The article says, “Growing research shows that a combination of hands-on therapies and other nondrug measures can be just as effective as more traditional forms of back care, including drugs and surgery. And they’re much safer.”

That feels pretty nice, doesn’t it? Just a little “Awwww yeah…..”

They refer to the updated recommendations from the American College of Physicians that we have mentioned a million times here on the Chiropractic Forward Podcast. Even with only having had 31 episodes, we’ve probably mentioned it that many times. 

They also mention a prior Consumer Report survey of 3,562 back pain sufferers where over 80% of them had tried yoga, tai chi, massage, or chiropractic and said it helped. 

A big kudos to Consumer Report for also saying this, “But here’s the problem: People also told us that their insurers were far more likely to cover visits to doctors than those for non-drug treatments—and that they would have gone for more of that kind of treatment if it had been covered by their health insurance.” 

Remember in the previous episodes where we have talked about the White House report that said clearly that CMS and health insurance policies in general “create barriers” to a patient seeking out effective, but an alternative, means of treatment? The link is in the show notes for your perusal.(2017) 

https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-3-2017.pdf

Well, there you have it. Right there in Consumer Reports. 

They also include a great quote from a woman in St. Charles, Illinois, “Spinal manipulation did me a world of good. My chiropractor had me do a lot of exercises on my own, which I continue to do. I’m so happy to get my active life back.”

We, chiropractors, see and hear this stuff all of the time but, the average Joe reading Consumer Reports or some other popular publication doesn’t usually. 

This week, I want you to go forward with the knowledge that this profession is moving ahead. Not at a snail’s pace either. It’s moving fast right now. Paper after paper is coming out and 99% are in our favor. 

Not only are we moving ahead, we’re moving ahead with help. Help from the big boys. Help from the White House to a certain extent, help from Congress to a certain extent (VA Bills), help from the medical profession to a certain extent, and help from your evidence-based colleagues like this podcast, the Forward Thinking Chiropractor podcast, the Evidence-based chiropractors facebook group, and other groups similar to them. 

This stuff is happening. You can hold onto your ideas whatever they may be but I’m telling you, the door is cracked open and, if we are to bust that sucker down and shatter it into splinters, we will only do it through research and through an integration or merging of our profession with the thoughts and actions of other professions. 

Key Takeaways

  • We can get these folks off useless and harmful drugs and we can help keep more from becoming addicted. The process of getting off opioids has begun.
  • You are educated at a level that you should never be intimidated or nervous to tell a GP that gabapentin is no longer a first-line treatment. Do it for yourself, do it for your patients, and do it for future patients. If not you, then who?

Integrating Chiropractors

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

When you look at the body of literature, it is clear: research and clinical experience show that, in about 80%-90% of headaches, neck, and back pain, patients get good to excellent results with Chiropractic when compared to usual medical care. It’s safe, less expensive, decreases chances of surgery and disability. Chiropractors do it conservatively and non-surgically with little time requirement or hassle for the patient. And, if the patient has a “preventative” mindset going forward, chiropractors can likely keep it that way while raising the general, overall level of health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with your network and help us build this podcast into the #1 Chiropractic podcast in the world. 

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

??iTunes

??Player FM Link

??Stitcher:

??TuneIn

CF 019: Non-Opioid More Effective While Chiropractic Maintenance May Be The Most Effective

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

 

 

Bibliography

(2017). The President’s Commission on Combating Drug Addiction and The Opioid Crisis.

Carr T. (2017). “The Better Way to Get Back Pain Relief: Growing research suggests that drugs and surgery may not be the answer for your bad back.” Consumer Report  Retrieved May 4, 2017, from https://www.consumerreports.org/back-pain/the-better-way-to-get-back-pain-relief/.

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

McPherson S (2018). “Changes in Pain Intensity Following Discontinuation of Long-Term Opioid Therapy for Chronic Non-Cancer Pain.” PAIN.

Getting off opioids

Getting off opioids

Getting off opioids

Getting off opioids

Getting off opioids

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

Episode #30

Integrating Chiropractors – What’s It Going To TakeIntegrating Chiropractors

Today we’re going to talk about what the medical field may be looking for when integrating chiropractors into their referral network. We’ll also talk about a recent article discussing The Lancet papers and whether or not the Chiropractic profession needs to take more care…..or care at all for that matter. 

But first, here’s that bumper music

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

Before we get started, it was brought to my attention by Dr. Ryan Doss out in Lubbock, TX that our Chiropractic Froward episodes in iTunes only go back to Episode 18 or 19 right now. This is a new development that I’m not sure exactly how to fix or what to do about it at this time but, I am trying to figure it out. For now, though, you can go to our website at www.chiropracticforward.com and have access to all of the directly right there. All of them in one place.  

I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It makes it easier to let you know when the newest episode goes live and it’s just nice of you and helps me notify when a new episode is up and ready for you. 

I’m always offering myself up for speaking opportunities or to be a guest on YOUR podcast or at your seminar.  Just send me an email at dr.williams@chiropracticforward.com and we will connect.

I have to tell you that I have recently joined the Facebook group called Forward Thinking Chiropractic Alliance led by Dr. Bobby Maybee who also hosts the Forward Thinking Chiropractic Podcast and I have been a member of the Evidence-Based Chiropractic group over there on Facebook for a while now. That one is led by Dr. Marc Broussard and has several highly respected admins. 

First, I host the Chiropractic Forward podcast and Bobby Maybee hosts the Forward Thinking Chiropractic podcast. Those sound similar right? And….to be fair…in regards to focusing on researched information and draggin’ chiropractic further into the evidence-based realm, we are very similar. OF course, we have different deliveries and Forward Thinking Chiropractic Alliance has been around longer than we have. Integrating chiropractors is a common topic. 

When I was trying to figure out what to name my podcast, I somehow came up with Chiropractic Forward. I Googled it and nothing showed up for Chiropractic Forward and I was so excited and ran with it. It wasn’t until a few months later that I stumbled on Forward Thinking Chiropractic and thought, well hell…. But, though there are similarities in the names, I do my thing and Bobby and his crew do theirs and they are very successful and good at what they are doing. In the end, I hope we are both extremely healthy for chiropractors everywhere a podcast can be heard. 

There is also Dr. Jeff Langmaid known as the Evidence-Based Chiropractor. Jeff has built an amazing brand talking about many of the things we talk about here and he does a great job with it. He’s a great speaker. Clear, concise, and easy to understand. 

So, outside of myself and the Chiropractic Forward Podcast, I hope you will give Dr. Bobby Maybee and the Forward Thinking Chiropractic Podcast a listen as well as Dr. Jeff Langmaid and the Evidence-based Chiropractor Podcast. They are excellent resources for further learning and understanding on all of this stuff. Again, integrating chiropractors is a common topic and you know I love that topic!

The Facebook groups I mentioned are simply priceless when it comes to being an evidence-based chiropractor.

I’ve found myself from time to time feeling a little uncomfortable and surrounded by ideas and philosophies within our profession that I just never got behind or could support. I’ve had to sit through countless speeches that made my eyes roll with disbelief. The Evidence-Based Chiropractic group and the Forward Thinking Chiropractic Alliance groups on Facebook are groups that fit me like a glove. As I said, integrating chiropractors is a topic I’m on board with. I’m not super active in there but really do enjoy reading the threads, opinions, and yes….even some light arguing here and there. But, these groups are very educational and an absolute must if you are evidence-based. 

We have a Chiropractic Forward group as well on Facebook but it’s new and just now getting going. I’d love to invite you all over there to join up with us as well as like our Facebook page itself and maybe even check us out on Twitter at chiro_forward. 

Hey, I’m doing my part to get the word out. You can rest assured on that. 

Enough social media talk, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. That’s a tall order but that is the goal and I’ve never shy-ed away from big goals. You shouldn’t either!

You have collapsed into Episode #30. I can’t believe I started this journey 30 weeks ago. It’s crazy to think. I really can’t tell you how much I have enjoyed it so far. I suppose it takes some amount of hubris to think anyone would care about what you have to say but, in the end, don’t you just have to go where you’re led? That’s what I’m doing and I’m glad you’re coming along with me each week.

We have talked a lot in previous episodes about integrating chiropractors. Whether that means integrating chiropractors into a hospital setting, bringing medical services into your clinic, or some sort of co-treatment/referral sort of set up between the chiropractor and other medical professionals. Regardless, integrating chiropractors is the next step for our profession. 

On that note, let’s start with the article about The Lancet papers on low back pain. This was in Chiropractic & Manual Therapies and Published June 25, 2018. Brand new stuff here folks. This was written by Simon French, et. al. and titled “Low back pain: a major global problem for which the chiropractic profession needs to take more care(French S 2018).” 

The abstract on this article introduces the series of papers published in The Lancet back in March of 2018 which provided the global community with a comprehensive description of low back pain, treatment recommendations based on research, and low back pain going forward from where we are currently. 

They go on to mention what we have been saying over and over here on the podcast. And that is that chiropractic is poised to step in and run the show for non-complicated low back pain. But, according to the authors and according to the Chiropractic Forward podcast, many chiropractors make statements and do things that aren’t supported by robust, contemporary evidence. 

We went through the Lancet papers here on the podcast and you can listen to them by going back to episodes 16, 17, and 18. I encourage you to do so. There really is some excellent information from a multidisciplinary panel of low back pain experts around the world. 

The authors of the Lancet papers, if you follow them on Twitter, have said repeatedly that they don’t want this paper to be profession specific. Meaning, they don’t want to come right out and say, “Hey folks, chiropractors should be the first referral or, we recommend PTs take any and all low back pain patients first and then deal them out where needed for more treatment.” 

I think that’s probably smart on their part but, as a chiropractic advocate, I have no problem throwing our hat in the ring and saying that research has proven several times over that spinal manipulation is superior to the mobilization that PTs perform AND less expensive. If chiropractors are less expensive and more effective, then why in the Hell WOULDN’T we be the first referral for these low back pain patients? Integrating chiropractors makes more sense now than ever before.

This paper goes on to mention that there has been a shift in thinking on low back pain in recent years from the traditional medical approach to a more patient-centered, evidence-based, non-pharma approach putting chiropractors right where they always should have been. 

They also talk about how The Lancet papers say that imaging needs to be reduced significantly. Wouldn’t you agree that may be a challenge for the way many chiropractors practice? You know who you are out there! They also discuss how evidence doesn’t support ongoing passive chiropractic care. This will also be an obstacle for many in my profession. In addition, they state that many chiropractors implement therapy modalities that simply have little to zero good evidence supporting them. 

French says chiropractors are in the right placed but not enough of us are actively involved in research and our research output is small when compared to other healthcare professions. Integrating chiropractors into the medical field will require more research production from our profession that we currently see. 

He also says that the chiropractic profession needs to be more integrated to be a major player if we are to be able to fulfill the role The Lancet papers put us in. And I agree wholeheartedly. If you check out episode #20 called Chiropractic Evolution or Extinction, you’ll hear a robust discussion on this. 

CF 020: Chiropractic Evolution or Extinction?

 

French’s conclusion highlights the reason the Chiropractic Forward podcast exists. It puts a spotlight right on the purpose if you listen close enough. 

He wraps up the article by saying the following: “Our low back pain “call to action” for the chiropractic profession is to get our house in order. In our opinion, nothing is more relevant to chiropractors than people with low back pain, and the evidence clearly shows that we can do a better job for the millions of people who experience this potentially debilitating condition every year. Chiropractors in clinical practice need to provide higher quality care in line with recommendations from evidence-based clinical practice guidelines.

The chiropractic profession is perfectly placed to be a major player in providing a part of the solution to the global challenge of low back pain. But the profession has been shut out of this role in most countries around the world due to, amongst many other things, internal political conflict, a lack of political will, and a minority of chiropractors who provide non-evidence-based approaches. The profession needs to invest heavily to support chiropractors who wish to undertake high-quality research directed at solving this major global problem.”

Amen amen amen. I’ve always wished I knew more about running my own research projects. It’s just not something we were taught. I’m looking at maybe searching out a mentor to help me get my own projects going…..maybe just case reports but something…. and get them published. Although the idea of generating my own research projects makes me want to punch myself in the nose, I know it’s important towards integrating chiropractors.

OK, let’s shift gears a bit. If we are poised and ready for integrating chiropractors and we start following evidence-based protocols, that’s all fine and dandy and moving in the right direction. However, what if there are already perceptions out there in the medical field we’ll be needing to change? I said what it? I meant, of course, there are negative perceptions of us that will have to be battled. It’s a fact. 

Here is a paper from June 22, 2018, by Stacie Salsbury, et. al. called “Be good, communicate, and collaborate: a qualitative analysis of stakeholder perspectives on adding a chiropractor to the multidisciplinary rehabilitation team(Salsbury S).” It would have been more fun if Salsbury would have just titled it “Stop, collaborate and listen if you want to be a good chiropractic physician….. but……she didn’t. We’re obviously not dealing with a Vanilla Ice fan here. It’s probably a good thing that, so far, I’m not responsible for naming research papers. 

Anyway, this paper wanted to explore the qualities preferred in a chiropractor by key stakeholders in a neurorehabilitation setting. 

How They Did It

  • It was a qualitative analysis of a multi-phase, organizational case study
  • It was designed to evaluate the planned integration of a chiropractor into a multidisciplinary rehabilitation team
  • It was a 62-bed rehabilitation specialty hospital
  • Participants were patients, families, community members, and professional staff of administrative, medical, nursing, and therapy departments. 
  • Data collection was from audiotaped, individual interviews and profession-specific focus groups 
  • 60 participants were interviewed in June 2015
  • 48 were staff members, 6 were patients, 4 were family members, and 2 were community members. 
  • The analysis process helped them produce a conceptual model of The Preferred Chiropractor for Multidisciplinary Rehabilitation Settings. 

What They Found

  • The central domain was Patient-Centeredness, meaning the practitioner would be respectful, responsive, and inclusive of the patient’s values, preferences, and needs. This was mentioned in all interviews and linked to all other themes. Of course, I may interject my own opinion here if you don’t mind. Isn’t the lack of patient-centered care the MAIN gripe when it comes to medical doctors too?!? That’s not just a chiropractic issue. 
  • The Professional qualities domain highlighted clinical acumen, efficacious treatment, and being a safe practitioner. Again, something desired of all practitioners regardless of discipline I would think. 
  • Interpersonal Qualities encouraged chiropractors to offer patients their comforting patience, familiar connections, and emotional intelligence
  • Interprofessional Qualities emphasized teamwork, resourcefulness, and openness to feedback as characteristics to enhance the chiropractor’s ability to work within an interdisciplinary setting.
  • Organizational Qualities, including personality fit, institutional compliance, and mission alignment were important attributes for working in a specific healthcare organization.

Wrap It Up

Salsbury ended the article with this conclusion, “Our findings provide an expanded view of the qualities that chiropractors might bring to multidisciplinary healthcare settings. Rather than labeling stakeholder perceptions as good, bad or indifferent as in previous studies, these results highlight specific attributes chiropractors might cultivate to enhance the patient outcomes and the experience of healthcare, influence clinical decision-making and interprofessional teamwork, and impact healthcare organizations.”

Now when you go a little deeper than the abstract you’ll see statements that hint at the fact that, when it comes to chiropractors there is fragmentation, disconnection, boundary skirmishes, and a general failure to communicate. 

In addition, the primary care providers and medical specialists have recognized the ability of some chiropractors to treat some musculoskeletal stuff in some patients but that’s about it right now. Couple that with the fact that most in the medical kingdom report just not knowing much about chiropractic or its treatments. 

Some medical providers express concern about the safety of spinal manipulation and have voiced skepticism over the efficacy of our protocols. Let’s be fair, I have my own concerns and am skeptical of some of their protocols as well so that swings both ways friends. But for evidence-based chiropractors, integrating chiropractors into the field makes perfect sense.

When talking to orthopedic surgeons that had particularly negative attitudes toward chiropractors, they typically cited something a patient told them or would cite aspects of the fringe element of the chiropractic community that allowed the surgeons to question the ethics of some chiropractors, to comment on the inadequacy of educational training, and comment on the sparse scientific basis of chiropractic treatments. 

To all of this, I say…..what the hell rock have these people been living under? Sure question the ethics of some. I question the ethics of A LOT of chiropractors if I’m being honest. I could be a wealthy man right now myself but I wouldn’t be able to sleep knowing I’m taking advantage of people. But, what about laminectomies? What about the fact that outcomes have never improved for lumbar fusion but they incidence of performing fusions has gone sky high. Where are the ethics on that? The epidural shots have shot through the roof without any improved outcomes and proof of zero long-term benefits. Where are the ethics?

If you question our education, know what you’re talking about first. That’s all I’m saying. The admission scale is low admittedly. There are philosophy courses I could do without. There are a few technique classes I think are worthless but, overall, the education of chiropractors is outstanding. Are physical therapists getting the same basic science courses the medical doctors are getting? Is that happening? From a quick search of the Physical Therapist curriculum, it appears that it is not so what on Earth are these people even talking about?

The other comment was the sparse body of research. Let’s just say that I’ve been blogging on chiropractic research since 2009 every single week without repeating research papers. The body of research is absolutely there. They’re just ignorant of it. It’s that simple. And where is the research for some of the garbage they utilize? 

I’m in no way saying chiropractors don’t need to step up. They most certainly do in a big way if integrating chiropractors si to become a reality. I hope the evidence-based guys and gals are starting to find more places they feel comfortable out there in social media and starting to find more of a voice within the profession. I truly believe there are many many more evidence-based chiros than there are others. Let’s be honest here. If you want to fit into healthcare, you damn well better do it based on solid research and evidence backing your profession and protocols. 

If I went through this paper from top to bottom, we’d be here for hours, I would have a red face from defending chiropractic, my blood pressure would be sky high, and my vernacular would probably devolve into meaningless gibberish at some point. So I’m going to leave it there. I gave you some highlights, I have it cited in the show notes. Go and read it and email me your thoughts. I’d love to hear them. 

This week, I want you to go forward with some things a poster in the Evidence-based chiropractic group on facebook the other day that I thought had value when it comes to what we’re talking about. She said:

Chiropractic is not a religion. 

A medical doctor should be able to understand the language coming out of your mouth, if they do not, they need to be able to find it cited in a medical textbook. 

I think chiropractic has a long way to go. It does indeed. But, not as far as we had to go 5 years ago. We still have too many people out there on the fringe. We still have far too many practices that are about numbers instead of being patient-centered. Don’t you think that when your business is patient-centered, your patients know that and the money takes care of itself? 

On the other hand, if you are trying to get 50 visits out of a patient, some will go for it, but many more will be turned off by it and will not return. Not only that but for many patients, you will have ruined the entire profession in their eyes based on your act of hitting numbers rather than making sure you’re doing what is best for the patient. That’s just being as honest as I know how to be. I know some won’t like that much but it’s a fact. 

I can’t tell you how many patients I have gotten from a guy that made patients sign contracts for treatment and when treatment didn’t work, he wouldn’t allow them out of the contract. How in the hell does that fit into healthcare folks? It certainly not patient-centered in any shape form or fashion and you’re fooling yourself if you think otherwise. You will never see us integrating chiropractors into the medical profession with junk like that. 

I told you that I can’t tell you how many patients we got from this guy’s poor ethics but, the bigger question is, “How many patents did he ruin on the idea of chiropractic so now they’re out there thinking they have to suffer in pain when all they had to do was visit a chiropractor better equipped with a high standard of ethics?”

THAT is the real question. 

We have to improve, yes. But, for us to integrate properly, the medical kingdom has to improve as well in regards to musculoskeletal complaints, proper recommendations and treatments, and in their perception and understanding of chiropractic and what we can do for these patients. It’s not all one-sided in my mind. 

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

When you look at the body of literature, it is clear: research and clinical experience show that, in about 80%-90% of headaches, neck, and back pain, patients get good to excellent results with Chiropractic when compared to usual medical care. It’s safe, less expensive, decreases chances of surgery and disability. Chiropractors do it conservatively and non-surgically with little time requirement or hassle for the patient. And, if the patient has a “preventative” mindset going forward, chiropractors can likely keep it that way while raising the general, overall level of health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you heard on integrating chiropractors, be sure to check out www.chiropracticforward.com. We want to ask you to share us with your network and help us build this podcast into the #1 Chiropractic podcast in the world. More people need to hear about integrating chiropractors!

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

??iTunes

??Player FM Link

??Stitcher:

??TuneIn

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

CF 015: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 3 of 3)

 

 

 

French S (2018). “Low back pain: a major global problem for which the chiropractic profession needs to take more care.” Chiropr Man Therap 26(28).

Salsbury S “Be good, communicate, and collaborate a qualitative analysis of stakeholder perspectives on adding a chiropractor to the multidisciplinary rehabilitation team.” Chiropr Man Therap 26(29).

Today’s topic was integrating chiropractors, integrating chiropractors, and integrating chiropractors. : )

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

Episode #29

Is Chiropractic Integration Healthy For The Profession?

Today we have a very special guest and we’re going to be talking about chiropractic integration into a medical based case management or medical team. This one may irritate the holy heck out of the straight chiropractors that preach being separate and distinct but I think evidence-based practitioners will find some good stuff here. 

But first, here’s that bumper music

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

Before we get started, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It makes it easier to let you know when the newest episode goes live and it’s just nice of you. 

Also, I’m alway offering myself up for speaking opportunities or to be a guest on YOUR podcast.  Just send me an email at dr.williams@chiropracticforward.com and we will connect. I always appreciate hearing from my brothers and sisters out there in the profession. 

We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. That’s a tall order but that is the goal and I’ve never shy-ed away from big goals. You shouldn’t either!

You have tip toed ninja style into Episode #29

But first, my week …..I have to say that we started off slow at the start of this Summer season but, now that everyone is settling into the heat, it’s starting to get busy busy and that’s nothing but good good. What are the most effective means you’ve found to get your message out to your communities? Email me and I may just share you suggestions in future episodes. 

This week, I want to welcome a friend of mine and a brother in arms in our battle for Chiropractic here in Texas to come and speak with me about chiropractic integration. He has been involved deeply on the state level leadership for years at this point and has held several posts including the biggest one. Yes, he is currently the big cheese, the head honcho, the el jefe of the Texas Chiropractic Association. Until June of 2019, he will sit as the President of the TCA and we’re honored to have him with us on the Chiropractic Forward Podcast today. 

– I want to welcome Dr. Devin Pettiet of Tomball, TX. Dr. Pettiet, thanks for being here and letting us pick your brain a little today. 

  • When I was coming up with this week’s topic, chiropractic integration, I really couldn’t think of anyone better than you to talk about chiropractic integration with. I know you pretty darn well but our listeners probably do not. Tell us a little bit about your practice. 
  • What originally got you involved in service to your profession? Was there a single incident or experience that flipped a switch in you?

I don’t want to speak for you but, for myself, I’m certainly on the evidence-based aspect of the chiropractic spectrum here. We would like for our thoughts and opinions to be separate from the TCA’s stance on different matters and we should state from the start that our thoughts and opinions are our own and not representative of the TCA. At the same time though, we are the kind of people that want to go to bat for everyone practicing as long as they are within the scope mandated by the State of Texas. 

Now, How do you feel we chiropractors can start making headways into the medical field as spine specialists and….keeping the straights in mind….is it healthy for our profession to seek those avenues for ourselves? Is chiropractic integration a good idea basically?

We know it’s not a lack of research validating our profession but, with your years in practice and with your years of service in the TCA, what things come to mind as the biggest obstacles to chiropractic care fully integrating into medical referral programs or treatment protocols?

Over the years, have you seen any changes in the opinions of chiropractors from those in the medical community or in the way you interact with them?

Let’s go over a couple of papers and you just play Troy Aikman to my Joe Buck and provide commentary wherever you see fit. 

This one is from February 2018 and is called, “Integration of Doctors of Chiropractic Into Private Sector Health Care Facilities in the United States: A Descriptive Survey.” It was written by S Salsbury, et. al. and I see Dr. Goertz listed as an author as well. She has really been a star for the chiropractic profession(Salsbury S 2018). 

Why They Did It

The purpose of this study was to describe the demographic, facility, and practice characteristics of doctors of chiropractic working in private sector health care settings in the United States.

How They Did It

  • The authors did an online, cross-sectional survey. 
  • They were looking for chiropractors already working in integrated health care facilities 
  • They collected demographic details, facility details, and the characteristics of the practice
  • Using descriptive statistics, they analyzed all of the data they collected. 
  • The response rate was 76% which is odd because my email open rate when I email for TCA stuff is like 10%….
  • Most respondents were male with the mean years of experience being 21 years. 

What They Found

  • Doctors of Chiropractic working in hospitals were 40%
  • Multispecialty offices = 21%
  • Ambulatory clinics = 16%
  • Other health care settings = 21%
  • 68% were employees and received a salary
  • Most DCs used the same health record as the medical staff and worked in teh same clinical setting. 
  • Over 60% reported co-management of patients with medical professionals. 
  • In many clinics, the DCs were exclusive providers of spinal manipulation (43%) but most of the clinics saw the DCs receiving and making referrals to the primary, the PT, or to pain and ortho docs. 

Wrap It Up

The authors concluded by saying, “Doctors of chiropractic are working in diverse medical settings within the private sector, in close proximity and collaboration with many provider types, suggesting a diverse role for chiropractors within conventional health care facilities.”

Here’s another by Paskowski et. al.(Paskowski I 2011) Called “A hospital-based standardized spine care pathway: report of multidisciplinary, evidence-based process.”

There were 518 patients and they developed a Spine Care Pathway protocol for their treatment. These patients underwent chiropractic care and physical therapy. 

What They Found

Those that went to a Doctor of Chiropractic treated for about 5.2 visits costing an average of $302.

The pain was 6.2 on intake and 1.9 on exit. 

95% that saw a chiropractic rated their care as excellent. 

Then there’s this one from the Ontario Ministry of Health-commissioned report called The Manga Report which was a comprehensive review of all of the published literature on low back pain(Manga P 1993). 

Some of the things this government-commissioned study had to say are just outstanding. 

  • There was an overwhelming amount of evidence showing the effectiveness of chiropractic in regards to the treatment of low back pain and complaint.
  • They found that it is more cost-effective than traditional medical treatment and management
  • Found that many of the traditional medical therapies used in low back pain are considered questionable invalidity and, although some are very safe, some can lead to other problems being suffered by the patient.
  • They showed that chiropractic is clearly more cost-effective and that there would be highly significant savings if more low back pain management were controlled by chiropractors rather than the medical physicians.
  • The study stated that chiropractic services should be fully insured.
  • The study stated that services should be fully integrated into the overall healthcare system due to the high cost of low back pain and the cost-effectiveness and physical effectiveness of chiropractic.
  • They also stated that a good case could be made for making chiropractors the entry point into the healthcare system for musculoskeletal complaints that presented to hospitals.

They concluded the paper by saying, “Chiropractic should be the treatment of choice for low back pain, even excluding traditional medical care altogether.”

There are a ton of reasons for chiropractic integration into medical protocols that, if we tried to cover them all, we’d be sitting here for a very long time. The point here is that, when you consider these studies, when you consider the low back series in The Lancet that we covered in episodes 16, 17, and 18, when you read the recommendations from the American College of Physicians for acute and chronic low back pain, and you see the recent article in JAMA from Dr. Goertz on Vets and low back pain that we covered in episode 

Dr. Pettiet, where do you see everything going on this??

How do we do our part to ensure chiropractic integration of our profession and move from the fringe toward the center?

Can we do that while still maintaining our identity as chiropractors?

Is the TCA doing anything that we can talk about publicly toward chiropractic integration?

This week, I want you to go forward understanding that you have been and are doing the best thing there is out there for headaches, neck pain, and back pain. There is no other profession with the juice behind them that we have. Be smart, be responsible, and we may just be able to not just have our foot in the door, but to actually knock it down and burst in like a superhero. 

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

When you look at the body of literature, it is clear: research and clinical experience show that, in about 80%-90% of headaches, neck, and back pain, patients get good to excellent results with Chiropractic when compared to usual medical care. It’s safe, less expensive, decreases chances of surgery and disability. Chiropractors do it conservatively and non-surgically with little time requirement or hassle for the patient. And, if the patient has a “preventative” mindset going forward, chiropractors can likely keep it that way while raising the general, overall level of health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic podcast in the world. 

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. 

CF 015: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 3 of 3)

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

CF 020: Chiropractic Evolution or Extinction?

 

 

Bibliography

Manga P, e. a. (1993). “THE MANGA REPORT: THE EFFECTIVENESS AND COST-EFFECTIVENESS OF CHIROPRACTIC MANAGEMENT OF LOW BACK-PAIN.” Funded by the Ontario Ministry of Health.

Paskowski I, e. a. (2011). “A hospital-based standardized spine care pathway: report of multidisciplinary, evidence-based process.” J Manipulative Physiol Ther. 34(2): 98-106.

Salsbury S (2018). “Integration of Doctors of Chiropractic Into Private Sector Health Care Facilities in the United States: A Descriptive Survey.” J Manipulative Physiol Ther 41(2): 149-155.

CF 028: Will Chiropractic First Finally Take Its Place?

 Will Chiropractic First Finally Take Its Place?

Chiropractic First is on the table today.

As they say in Texas, Howdy y’all. You could also say, Hola Amigo in Texas as well, and as I learned last week, it’s How you doin? in New York. Today we’re going to be talking about whether or not Chiropractic should or could be poised to step up and take it rightful spot in healthcare globally. Buckle up, bucko.

But first, here’s that bumper music

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast and today it’s about chiropractic first.  So, glad you’re here with me. In case you are a youngster, the term “bucko” came from a young tike himself named Ritchie Cunningham on Happy Days played by Ron Howard. Yep, that Ron Howard, the famous director and was once a tiny tot named Opie on the Andy Griffith show. No, I’m not THAT old but….I know a little TV trivia here and there. And now it appears that you do too. 

Ritchie, every now and then, would get all worked up into a fuss and call Fonzie or Potsy or whoever a “bucko.” Man…..you wanna talk about fighting words. Fonzie about ended him a time or two but, in the end, Fonzie was way too cool to beat up on Ritchie. OK, enough of that…

I want to ask you to go to http://www.chiropracticforward.com and sign up for our newsletter. We won’t be filling up your inbox and it’s easy to fill you in on all the new stuff. And, in the end, it’s nice of you and it will help keep the wrord circulating if you would like to help us. Likes, shares, and retweets also keep the world turning around and around and that’s really important stuff…..Keeping the world spinning and all….. if we can talk you into it. 

Have you noticed we aren’t selling you anything? That doesn’t mean that we won’t if the right opportunity arises down the road but, I want you to know that I’m doing this podcast for the right reasons. I make furniture, I am a musician, I am a sculptor…..and, Just like anything else I do, I make the things that interest me and that come from my heart. If someone ends up buying what I’ve made down the road, then heck yeah!! Good for me. But, in the meantime, I do what I do because I love it and I guess I have enough ego that I think others may love it as well. I hope you guys and gals love it and find the value like I find in it. 

As with every episode, we are honored to have you with us. We truly are. Now, here we go with some vital information that we think can build confidence and improve your practice which we think will improve your life overall. That’s a tall order but everyone needs goals.

You have Firecircled your way into Episode #28 ala Dr. Strange. My family is full of action movie junkies so just deal with the reference. 

I think a great place to start is by saying that I stumbled upon a heck of a deal this last weekend when I attended the Texas Chiropractic Association’s ChiroTexpo down in Dallas at the Hyatt Regency. I realize the Hyatt Regency holds no meaning to those outside of Dallas but, it’s the hotel with the really cool lit up ball in downtown Dallas. Ah….yes, if you’ve seen the amazing Dallas Cowboys perform inside your TV box, you’ve probably seen the down town rotating restaurant ball on your screen. 

Part of the program had to do with the Lumbar Management portion of the Diplomate of American Chiropractic Orthopedists program. I’m still getting the nuts and bolts of this dude figured out but, basically, it consists of five 10-hour live face-face seminars, 50 hours in total there. Then, 250 of online courses through the University of Bridgeport. After that, you sit for the DACO exam and, assuming you pass it, you now have the honor of being called a DACO and you have the knowledge to back it up. This class was one of the 10-hour sessions.

Now, I have to say, I literally thought I would sit in the class for a couple of hours, my eyes would glaze over, and my butt would start to hurt, and I’d get up and wonder around asking where the nearest trouble could be had because I’m onery on the weekends. I mean really, who the heck wants to sit in a classroom from 1-7pm on a Saturday night and 8-1 on a Sunday morning? Not this guy. Not all in one stretch like that.  

But I did. I sat through all 10 of them. Yep, even surprised myself. Dr. Tim Bertlesman from Illinois was the instructor of the class and he kept it moving, he kept it extremely relevant, and he even kept it pretty funny. Basically, he kept my interest and you know what? I may…..just may…..do the whole program. 

It’s evidence-based for sure and about Chiropractic First

It’s patient-centered without a doubt. And it’s current with the research. If you’ve been paying attention, that’s right in my wheelhouse. If you’d like more information on this program, send me an email at dr.williams@chiropracticforward.com and we’ll connect. As I learn more and more about it all, I’ll be glad to share if you think you’d be interested as well. 

He started off the class with some slides referencing a few studies that I haven’t seen just yet and I a lot of what he was saying is what I’ve been telling all of you for 28 episodes now. All of them. Every single episode. 

The overwhelming sentiment here is that the door is open thanks to opioids. The door to chiropractic first, that is. The chance we have waited for is here. Right now. We may not get it again. People are hungry for what we do and we now have all of the research we need to back ourselves and our profession up, to show complete validation, and thrust us into the mainstream of healthcare for non-complicated musculoskeletal issues. That’s here. 

Let’s look at a little bit of it and see if you agree. 

This is from April 2016 and was published in JAMA. It was authored by Dr. Deborah Dowell, MD, et. al. and was called “CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016(Dowell D 2016).”

Why They Did It

Realizing that opioids are a problem, that there are a limited number of long-term opioid research papers, and that primary care physicians need better, safer ways of managing chronic pain, the authors hoped to make recommendations for when to prescribe opioids outside of cancer treatment, etc….and when to not prescribe them. 

How They Did It

  • The Centers for Disease Control and Prevention (CDC) used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) protocol in order to assess the evidence type and make recommendations from there. 
  • Evidence was made up of observational studies or randomized clinical trials with notable limitations. 
  • No study evaluated long-term (over 1 year) benefit for opioids in chronic pain. 

What They Found

  • There are 12 recommendations
  • Of the most importance was the recommendation that non-opioids is preferred for treatment of chronic pain. That’s where WE fit in folks.
  • Opioids should only be used when benefits for pain and function outweigh risks but risks are use disorder, overdose, and death so….. Pretty much never.
  • Before starting any opioid therapy, practitioners need to set goals and settle on how they will be discontinued if benefits do not outweigh risks.
  • Blah….blah blah….a bunch of other language that does not pertain to us chiropractors. 

Wrap Up

Non-pharmacologic therapy and non-opioid pharmacologic therapy are preferred. Chiropractic first

I think that, before the American College of Physicians finally came right out and said to go see someone that performs spinal manipulation to treat acute and chronic low back pain, this was JAMA’s way of saying, “Hey guys and gals, ummm….we’ve created a bit of a mess and we had better start cleaning it up (cough chiropractic cough) and maybe we should look outside of usual medical care like pills (cough chiropractic cough) and drugs that people get hooked and drugs that kill people (cough Chiropractic).

JAMA has come along slowly but they’ve made great progress. Even since this paper originally came out. 

For the next article, let’s look at this one called “Attorney General Janet Mills Joins 37 States, Territories in Fight Against Opioid Incentives,” released by the Office of the Attorney General on September 18, 2017(Roth-Wells A 2017). 

The Attorney General in Maine, Janet Mills, joined 37 other states in the fight against opioids according to this article. The AG was quoted in the article as saying, “Last year Maine enacted a law limiting opioid prescriptions and that law is beginning to have a positive impact. Now health insurers need to reduce any financial incentives to prescribing these addicting narcotics and offer greater coverage for alternative therapies. As the chief legal officers of our States, we are committed to using all tools at our disposal to combat this epidemic and to protect patients suffering from chronic pain or addiction.”

The attorneys general contend that incentives that promote use of non-opioid therapies will encourage medical providers to consider physical therapy, acupuncture, massage, chiropractic care, and non-opioid medications, instead of narcotic drugs.

The article went on to list all 37 states that were signed on to this initiative but, sadly, my state of Texas was not on the list. That pesky Texas Medical Association really tends to get in the way. I see the other biggest states on the list in regards to the number of chiropractors practicing. Those states are California, New York, and Florida but, no, not Texas.

The next article is called “FDA Education Bluepring for Health Care Providers Involved in the Management or Support of Patients with Pain” and was published in May 2017(FDA 2017). 

On page three, section two, the paper dicusses nonpharmacologic therapies. It states, “A number of nonpharmacologic therapies are available that can play an important role in managing pain, particularly msculoskeletal pain and chronic pain.” 

It then goes on to mention categories. The categories they mention are Psychological approaches, and, while I think our patients look at us as chiropractors, financial advisors, psychologists, and a whole host of other professionals, this paper is speaking to cognitive behavioral therapy and, if I’m honest, I’m simply unfamiliar with that as a treatment regimen. I certainly have more to learn on that topic. They also mention physical therapy, of course. They mention surgical intervention and then they mention complementary therapy underwhich is mentioned acupuncture and chirlpracty. 

I’ve not ever in my life heard the term “chiropracty” but at least we’re in the game, I suppose. 

Then the paper closes the section by saying, “Health care providers should be knowledgeable about the range of available therapies, when they may be helpful, and when they should be used as part of a multidisciplinary approach to pain management.”

Isn’t that interesting? How many practitioners do you think came across this paper and this section of this paper? How many do you suppose have decided to take it upon themselves to get extra information and education in this particular topic? 

Maybe some but, mostly, I would say that it is up to us chiropractors to do our part to educate our medical communities on this sort of information. It’s the FDA for goodness sake. It’s on a government website. It cannot be hard to point them in the right direction and for the medical practitioners to be able to trust the information if it’s coming from this sort of a platform or footing. But, they have to be shown the way. Most of them aren’t simply going to stumble on to it and say, “Oh hey, looky here. Looks like I’ve been wrong my whole life about chiropractic.” 

They need some help and some guidance to find it and then hopefully to receive the information on their own. Regardless of where you start, using sources like the FDA, the Journal of American Medical Association, The Lancet, and the American College of Physicians is always a good idea. They are reputable and they are forms of information that the medical kingdom place a lot of stock and value in. It turns out that they’re on our side on this matter. 

Next, let’s talk about The Joint Commission. “What is The Joint Commission?” you may ask yourself. You may ask yourself that question because that’s the question I asked myself when I first saw the paper so I did some homework for you. 

A quick visit to their website tells us the following:

“An independent, not-for-profit organization, The Joint Commission accredits and certifies nearly 21,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.

 

Our Mission:  To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.

 

Vision Statement:  All people always experience the safest, highest quality, best-value health care across all settings.”

If you really read and understand what is said in that description, you’ll see the terms “improve health care for the public” and “providing safe and effective care of the highest quality and value” and safest, highest quality, best-value health care across all setting.” The vast majority of paper we have covered in the previous 27 episodes argue that chiropractic fits the bill in a lot of different ways.

This article comes from The Joint Commission Online and was published on November 12, 2014 talking about revisions to pain management standards that were to be updated just a couple of months later, January 1, 2015(The Joint Commission Online 2014). I want to give this group credit. They seem to have started to catch on to the need for nonpharma protocols about a year to a year and a half prior to the rest of the medical profession. Kudos to them. 

In the blue box is the Standard PC.01.02.07 which is the code for assessing and managing patients’ pain. The revision states that both nonpharma and pharma play a part in pain management, the non-pharma strategies may include the following: acupuncture therapy, chiropractic therapy, osteopathic manipulative treatment, massage therapy, physical therapy, relaxation therapy, and cognitive behavioral therapy. 

That stuff sounds fairly familiar for the most part doesn’t it? We’ve been talking about it for months by now so it should indeed be familiar. Except for the cognitive behavioral therapy bit. I kid. Cognitive behavioral therapy is geared toward treating depression, anxiety disorders, phobias, and other forms of mental disorders. Certainly the disorders that may exacerbate chronic pain or, at minimum, prevent the patient from moving beyond the pain in any meaningful way.

Continuing on, here’s a paper from the prestigious Spine Journal by Jon Adams, PhD et. al. called, “The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults(Adams J 2017).” 

Why They Did It

Just as the title of the paper indicates, the goal of the authors was to learn more about the prevalence, patterns, and use of chiropractic care in the US. 

How They Did It

  • They took a cross-sectional data from the 2012 National Health Interview Survey. The National Health Interview Survey (NHIS) is the principal and reliable source of comprehensive health care information in the United States, utilizing a nationally rep- resentative sample of the civilian noninstitutionalized popu- lation of the United States
  • They used that information to analyze the lifetime and 12-month prevalence and utilization patterns of chiropractic use. 
  • They determined the profile of chiropractic users. 
  • They determined the predictors of chiropractic consultations.

What They Found

  • Lifetime prevalence of chiropractic use was 24%
  • 12-month prevalence of chiropractic use was 8.4%
  • The use of chiropractic care has grown from 2002 to when the data stopped in 2012
  • Back pain caused people to seek chiropractic care to the tune of 63%
  • Neck pain caused them to go about 30% of the time. 
  • The majority of chiropractic users reported that it helped a great deal with their health problem and improved overal health or well-being. 

Wrap It Up

The authors concluded by saying, “A substantial proportion of US adults utilized chiropractic services during the past 12 months and reported associated positive outcomes for overall well-being and/or specific health problems.”

When we dive a little further past the abstract and get down into this paper, it goes into the specific percentages for different questions:

Chiropractic led to:

  • Better Sleep 42%
  • Reduced Stress 40%
  • Felt better overall and improved health 39%
  • Was seen as very important to the user 48%
  • Helped for a specific health problem 65%
  • Didn’t help at all 4% 
  • 62% went to a chiropractor to treat the cause, not the symptom!

I want to finish up this week’s papers by citing one that came right out of the White House not long ago.

If you go to The President’s Commission On Combating Drug Addiction and The Opioid Crisis report and make your way down to page 57, you will see where the authors say the following, ““A key contributor to the opioid epidemic has been the excess prescribing of opioids for common pain complaints and for postsurgical pain. Although in some conditions, behavioral programs, acupuncture, chiropractic, surgery, as well as FDA-approved multimodal pain strategies have been proven to reduce the use of opioids, while providing effective pain management, current CMS reimbursement policies, as well as health insurance providers and other payers, create barriers to the adoption of these strategies.” That is from the White House. 

If you continue to the very bottom of the page, you’ll see this quote, ““The Commission recommends CMS review and modify rate-setting policies that discourage the use of non-opioid treatments for pain, such as certain bundled payments that make alternative treatment options cost prohibitive for hospitals and doctors, particularly those options for treating immediate post-surgical pain.”

In Episode #11, when I brought this up to my long-time buddy and past TCA President Dr. Tyce Hergert, he said, “You mean like a specialist copay for chiro care and a lower copay for primary care? Or covering surgery 100% and NOT covering non-surgical means.” I couldn’t have said it any better. 

Essentially, the United States Government is admitting there is professional discrimination at the highest levels…..hello Medicare and Health Insurance plans….I’m talking to you….this discrimination creates barriers to doing the smart thing.

The smart thing is seeing a chiropractor for your back pain. The “Big Guys” (AKA: American College of Physicians, The Lancet, the FDA,  and the American Medical Association) recommend it and the government says policies are in place to prevent patients from following those recommendations.

Key Takeaways:

  1. The general population is starving for what we chiropractors do and for what we can offer them. 
  2. All of the important entities in the medical kingdom now recommend what we do but primary practitioners and specialists haven’t caught on just yet.
  3. There are barriers set up within Medicare and insurance in general keeping people from seeking the safest, most cost-effective, non-pharma means to treat themselves.
  4. It’s up to US and nobody else to get the word out in our medical communities. Nobody is going to do it for us and that’s a guarantee. 

I want you to go forward this week with confidence and validation but with the understanding that it is up to every single one of you to figure out how to educate your medical community in an evidence-based, patient-centered way an the first one that does it correctly and effectively may just win a pot of gold and become THE spinal authority in your community. 

I would say that you also need to do your friend Dr. Williams, and all other chiropractors in the world, a big favor. That favor would be to help us get the word out about this podcast. If you find value in it, don’t you think others would too? I’m not sponsored here. I’m doing it because I love it. I don’t have $10,000 to promote the podcast on Facebook or Twitter so I have to keep asking our listeners to please do us a favor and go like our page on Facebook, Like and Share our content EVERY WEEK, FOLLOW us on Twitter, and RETWEET our content on Twitter. 

These are incredibly easy things to do and I truly need your help with them if you would please be kind enough. 

I want you to know with absolute certainty that When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.

When you look at the body of literature, it is clear: research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good to excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic evidence-based podcast in the world. 

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

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

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

 

Social Media Links

iTunes

Bibliography

Adams J (2017). “The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults.” Spine 42(23): 1810-1816.

Dowell D (2016). “CDC Guideline for Prescribing Opioids for Chronic Pain – United States.” MMWR Recomm Rep 65: 1-49.

FDA (2017). “FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain.”

Roth-Wells A (2017). “Attorney General Janet Mills Joins 37 States, Territories in Fight against Opioid Incentives.” Office Of The Maine Attorney General.

The Joint Commission Online (2014). “Revisions to pain management standard effective January 1, 2015 BrightStar Care recognized as Enterprise Champion for Quality for second year New on the Web.” Joint Commission Online.

 

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

WANTED – Safe, Nonpharmacological Means Of Treating Spinal Pain

Today we’re going to talk about treating spinal pain, thoracic manipulation, lumbar manipulation, guidelines from Canada, and perceptions of our profession. Did you know that many people actually think that Chiropractic herniate low back discs all of the time? That’s not our idea of treating spinal pain. That’s for sure!

But first, here’s that bumper music

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast and I am honored to have you join me today.  Thank you to those of you that send emails and like and share our content on Facebook and Twitter. You make it fun. If you haven’t already noticed, we have “Tweetable” quotes from our show notes. All you have to do is click the Tweet button and you’re all set. 

Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. That’s a tall order but that is the goal

You have cavorted your way into Episode #27. Yes, it’s a word. In fact, it’s a synonym of the word dance. Oh how I do love a thesaurus. 

As I’m about to record this episode, it is June 4, 2018 and I am getting ready to head down to the Texas Chiropractic Association’s State Convention. Now, things like that used to make my eyes gloss over but, I wasn’t doing it right or looking at it through the right lens. 

I was a traveling musician for several years and, honestly, chiropractic for me at the time was Plan B while I made a run at music. Well, as usually happens with musicians, it didn’t make me rich. Shock, shock…

During those years, I was a little bit like a guy out on an island all by himself. A lone wolf you might say. I didn’t know anything about research, guidelines, or anything like that. Hell, I was lucky to get to work on time back then. 

Along with being on an island all alone, I thought the idea of being a member of my state association sounded like one to the biggest, best ways to waste my money. Money that I really needed at the time. Well, I was misinformed. Becoming a member of the Texas Chiropractic Association has been one of the best, most rewarding things I have done in my professional life. 

First, I met a ton of people through the TCA. I have a network of colleagues and friends now. If I have a question about ANYTHING, I have an answer! In fact, I was having a hard time with collections for some time and a colleague is the one that came to my rescue. 

Also, the TCA doesn’t just take my money, they take it and use it to help me in my daily life. They have fought some outstanding odds and won several times. They won where, if they had lost, I wouldn’t have the right to diagnose my patients and would be much like a physical therapist depending on referrals from MDs. I’d say that alone is worth my $48 a month wouldn’t you agree?

I went on to serve several years on the Board of Directors for the TCA and am the current chairperson for the Chiropractic Development Initiative fighting to pay for lawsuits, fighting to bolster our profession, and protect it. 

The point here is, I hope you’ll seriously consider joining your state association as well as the American Chiropractic Association. My dues for both combined each month run around $155. It’s just another bill you pay and it goes to securing your job. It’s worth it and I hope you’ll think about doing it. Chiropractic Forward is not just an idea. I walk the walk by being a member and being active. 

Sometimes I end up deviating from research and all that good stuff we do every week but, sometimes, you gotta share what’s on you mind. Thank you for indulging me. 

Let’s get started with the research talk this week with a paper called “Rehabilitative principles in the management of thoracolumbar syndrome: a case report,” by Mathew DiMond who is a DC, DACRB around Bridgeport Connecticut(DiMond M 2017). For those that don’t know what a DACRB is, it stands for Diplomate of the American Chiropractic Rehabilitation Board. To put that into perspective, there are roughly 5,200 chiropractors in Texas and only 5 DACRBs. 

Why They Did It

Dr. DiMond wanted to describe his management of a case where the patient suffered from thoracolumbar syndrome. 

How They Did It

  • The patient was a 33 year old woman. 
  • She had suffered back pain for 3 weeks
  • Nerve tension tests and local tenderness were present
  • Outcome Assessment tools used were the Oswestry Disability Index which was at 62% at baseline, the STarT low back screen tool (6 points total with 2 point subscale), the Numeric Pain Rating Scale (6/10), and the test-retest exercise audits. 
  • 3 treatments rendered to the patient

What They Found

Her scores were substantially improved. Oswestry improved to 8% , STarT (1 point total), Numeric rating scale 1/10.

Wrap It Up

The author concluded by saying, “The patient responded positively to chiropractic care. After a short course of care, the patient reported reduced pain, alleviated symptoms, and improved physical function.” Now that’s treating spinal pain in a nonpharmacological way.

Now onto the next one. We don’t sit still around here. Bam, bam, bam!

This one is titled “Chiropractic spinal manipulation and the risk for acute lumbar disc herniation: a belief elicitation study” by Cesar Hincapie, et. al. and published in the European Spine Journal(Hincapie C 2017). 

Why They Did it

We know low back pain is the number one reason for disability in the world and that chiropractic is moving into the forefront. The author noted that chiropractic has been reported to increase the risk for lumbar disc herniation without any high quality evidence to support the claim. The author wanted to determine the beliefs on this topic going forward.

I have to say all one needs to do is look toward the American College of Physicians new recommendations and The Lancet low back series recommendations for using chiropractic as a first line treatment for low back pain and that should tell you all you need to know on this but, we will go ahead and explore this simply to expand our learning and knowledge. We are the profession best poised for treating spinal pain!

How They Did It

They used a belief elicitation design

They used 47 clinicians made up of 16 chiropractors, 15 family physicians, and 16 spinal surgeons. 

The clinicians estimated how often a chiropractic adjustment could cause a lumbar disc herniation in a hypothetical group of patients with acute low back pain. 

What They Found

  • As one would expect, chiropractors were the most optimistic that the occurrence was rare. In fact chiropractors held the belief that spinal manipulation actually decreases the chance of disc herniation rather than increases it.
  • Family physicians were mostly neutral
  • Spinal surgeons expressed a slightly more pessimistic belief toward the idea

Wrap It Up

The researchers concluded, “Clinicians’ beliefs about the risk for acute LDH associated with chiropractic SMT varied systematically across professions, in spite of a lack of scientific evidence to inform these beliefs.”

My bias is obvious but, the thought of chiropractors going around herniating discs had to have come from someone that either hates chiropractors like the American Medical Association of the 60;s, 70’s, 80’s, and so on…..or it had to come from ignorance. I believe that paper was published just prior to the new updated recommendations putting chiropractic in the driver’s seat for acute and chronic low back pain but geez…. I do get tired of defending the profession. 

Now let’s wrap up the week here with a paper from our chiropractic brethren for the frozen North otherwise known as Canada. The lead author is Dr. Andre Bussieres and the paper is called “Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain: A Guideline From the Canadian Chiropractic Guideline Initiative” and was published in the Journal of Manipulative and Physiological Therapeutics in May of 2018(Bussieres A 2018). 

Why They Did It

The objective of this study was to develop a clinical practice guideline on the management and treating spinal pain of acute and chronic low back pain (LBP) in adults. The aim was to develop a guideline to provide best practice recommendations on the initial assessment and monitoring of people with low back pain and address the use of spinal manipulation therapy (SMT) compared with other commonly used conservative treatments.

How They Did It

  • The authors assessed systematic reviews and randomized controlled trials using A Measurement Tool to Assess Systematic Reviews and Cochrane Back Review Group criteria. 
  • Evidence profiles were used to summarize judgements of the evidence quality. 
  • The Evidence to Decision Framework was used to help the panel to determine the certainty of evidence and strength of the recommendations. 
  • Consensus was achieved through the modified Delphi technique
  • This guideline was peer reviewed by an 8-member multidisciplinary external committee. 

What They Found

  • Acute back pain (0-3 months)

Offer advice on posture and staying active, reassure the patients, education and self-management strategies, chiropractic care, usual medical treatment if deemed beneficial, or a combination of chiropractic care and usual medical treatment. These are effective means of treating spinal pain. 

  • Chronic back pain (3 months and beyond)

When treating spinal pain, offer advice and education chiropractic care or chiropractic care in conjunction with exercise, myofascial, or usual medical care. 

  • Chronic back-related leg pain

Offer advice and education with chiropractic care and home exercise such as positioning and stabilization exercises. Treating spinal pain for chronic patients can be challenging for both the patient and the doctor.

Wrap It Up

The authors concluded by saying, “A multimodal approach including SMT, other commonly used active interventions, self-management advice, and exercise is an effective treatment strategy for acute and chronic back pain, with or without leg pain.” Treating spinal pain is just what we do.

Help us spread the news folks. Go out and get on your roof and start yelling it to the masses. Retweet, like and share and all of the stuff you can help with on your end of it. You can find us on Twitter @chiro_forward and on Facebook. We’re there. We’re just waiting on you to join us so go do that right now

I realize this week was a little here and a little there but the point is that no matter what you’ve heard or been told in the past, those days are over. I believe they’re over for good at this point. We are the #1, non-pharma, safe, conservative, non-invasive, research-backed, evidence-backed, treatment for spinal pain, hands down. And that’s a heck of a place to be coming from wouldn’t you agree?

I want you to know with absolute certainty that When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.

When you look at the body of literature, it is clear: research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good to excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic evidence-based podcast in the world. 

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

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

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

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

 

Social Media Links

iTunes

Bibliography

Bussieres A, e. a. (2018). “Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain: A Guideline From the Canadian Chiropractic Guideline Initiative.” Journal of Manipulative and Physiological Therapeutics 41(4): 265-293.

DiMond M (2017). “Rehabilitative Principles in the Management of Thoracolumbar Syndrome: A Case Report.” Journal of Chiropractic Medicine 16(4): 331-339.

Hincapie C (2017). “Chiropractic spinal manipulation and the risk for acute lumbar disc herniation: a belief elicitation study.” European Spine Journal.

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

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

Today we’re going to talk about our vets with low back pain. We have already shown how chiropractic is backed completely by research for low back pain. For us, that’s not even in question. But, this week, there’s brand new research out in JAMA, yes, THAT JAMA, talking about vets with low back pain and chiropractic.

But first, make way for that bumper music

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

I want to  humbly, with my hat in my hand and puppy dog eyes ask you to go to chiropracticforward.com and sign up for our newsletter. Make it easy on us to update you when a new episode come out. It’s just the nice thing to do folks. 

On another note, do you need an hour or two for your Continuing Education seminar on low back pain guidelines or on Debunking the myth that chiropractors cause strokes? Do you need a guest for YOUR podcast?

Look no further, you have found your man. Just send me an email at dr.williams@chiropracticforward.com and we will get it done. Heck, we’re trying to get the word out about what we’re doing here don’t ya know?

We are honored to have you listening today. Here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. That’s a tall order but that is the goal

You have grooved nice and easy……. 70’s style right into Episode #25

As you may have heard me say several times before, I’m in practice. Day to day, week to week, month to month. In fact, I’ve been in active daily practice for over 20 years. I’ve answered the phones, booked the appointments, been an associate that basically answered to a receptionist. I’ve also been a busy chiropractor having a hard time keeping up with my own head. 

I tell you this because I think it’s important to know that the information you get from me is not only from research journals but is also from daily experience. Twenty years of it at this point! 

When we start discussing active military and veterans, if you’ve been in practice very long at all, you know these men and women are hurting and, many times, are not getting the help they desperately need. I see them every week. I’m actually in the process of signing up for the Choice Program as we speak so I can see more and more of them. Vets with low back painare a priority.

As a side note, you’d think that veterans are among the most honorable of all American citizens wouldn’t you? And wouldn’t you expect that the most honorable of all Americans would be worthy of healthcare that adequately addresses their needs based on current research and knowledge? 

One would think but, as we see over and over, that just isn’t the case, unfortunately. 

Here’s one example, a friend of mine….her father is in the VA hospital right now with several issues. She went to visit and was looking for his room. When she asked a staffer for directions, they directed her through this plywood board attached to a door that kind of opened up all together and allowed passage into the hallway that led to his room. Can you imagine our veterans being in a place that has plywood boarded up on the doors? One door…..any damn door?

Another would be the father of a friend of mine. He died waiting on a referral to a pulmonologist through the Choice Program. He couldn’t just go and make his own appointment. Not if he wanted it covered anyway. The VA system failed this decorated Vietnam Vet whereas medical professionals made it clear to him that his pulmonary hypertension could be treated after seeing a specialist to determine his specific level of PH. Well, the referral didn’t come and time ran out. Doesn’t seem right does it?

Let’s get to the musculoskeletal part of things. Military services leads to a high rate of chronic pain. That is just the facts. Knowing this fact, it is not surprising that veterans succumb to opioid overdose at twice the rate of the general population. That is just astonishing. It’s understandable but astonishing just the same. Not only were they twice as likely to succumb to opioid overdose, but they were twice as likely to be prescribed opioids in the first place!

One would think with the new recommendations from international low back experts published in The Lancet, new recommendations from the American College of Physicians, and the mountains of randomized controlled trials showing the efficacy of Chiropractic Care of low back pain, you’d expect to have an automatic referral from the VA primary care physicians. But, again, common sense doesn’t alway seem to reign in the medical kingdom. Money, politics, group-think, and false dogmatic believes of yesteryear tend to control the thought process. In my opinion, of course. 

If you are unaware of the body of research, I’m sure this just sounds like belly-aching. I’m telling you as straightforward and as honestly as I can, chiropractic’s effectiveness has been proven through research so many times I can’t begin to count. We have been shown to be as effective or more effect than medication including NSAIDS. On top of that, we recently talked about research showing opioids having less effectiveness than NSAIDS. Veterans need a source of treatment for their musculoskeletal pain that is non-pharmacological, cost-effective, and has a high degree of overall effectiveness. 

Everything and everyone already mentioned in this podcast (The Lancet, ACP, etc…) agrees one of those options is Chiropractic specifically. Especially when it comes to vets with low back pain.

With all of that in mind, let’s get into the paper that recently came out in the Journal of the American Medical Association (JAMA). It’s titled “Effect of Usual Medical Care Plus Chiropractic Care vs. Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain,” and authored by Dr. Christine Goetz, DC, PhD. 

It was published in May of 2018(Goertz C 2018). 

Why They Did It

The authors recognized the need for non-pharmacological low back pain treatments and hoped to determine if chiropractic care being added to traditional medical care resulted in a better outcome than if the chiropractic care was left out completely for vets with low back pain. 

How They Did It

  • For you research nerds, the paper was a 3-site pragmatic comparative effectiveness clinical trial using adaptive allocation
  • It was conducted from September 28, 2012 to February 13, 2016
  • The sites studied included 2 large military medical centers and 1 smaller hospital at a military training site. 
  • Active duty aged 18-50 with low back pain originating in the musculoskeletal system were accepted for the study
  • Outcomes used were low back pain intensity measured through the Numerical Rating Scale (NRS) and disability using the Roland Morris Disability Questionnaire. 
  • Secondary outcomes measured were perceived improvement, satisfaction, and medication use. 

What They Found

  • 250 patients at each site were accepted. 
  • 750 total
  • The mean participant age was 30.9
  • 23% were female
  • 32.4% were non-white
  • Adjusted mean differences in scores at the 6-week mark were statistically significant favoring usual medical care PLUS Chiropractic Care. 
  • There were no serious related adverse effects. 

Wrap It Up

The authors concluded, “Chiropractic care, when added to usual medical care, resulted in moderate short-term improvements in low back pain intensity and disability in active-duty military personnel. This trial provides additional support for the inclusion of chiropractic care as a component of multidisciplinary health care for low back pain, as currently recommended in existing guidelines. However, study limitations illustrate that further research is needed to understand longer-term outcomes as well as how patient heterogeneity and intervention variations affect patient responses to chiropractic care.”

I realize this is a brand new paper. I also realize that Dr. Goertz is among the leaders of the body of research when it comes to chiropractic. This is exactly why I question the need for further research to understand longer-term outcomes. We have had longer-term outcomes research. Plenty of them as a matter of fact. 

If you go to this paper’s website and click on the link you’ll find in the show notes, ( https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2680417 ) you’ll notice that you can click on a “Comments” icon just under the “Download PDF” icon. 

If you navigate to that Comment section and click on it, you’ll notice the following quote from May 21, 2018 from Dr. Frederick Rivara, MD, MPH at the University of Washington in Seattle, “As a sufferer myself of chronic low back pain, I was very interested to see the results of this comparative effectiveness trial. To me, it points out the importance of integrated care for the treatment of chronic conditions. What are the likely barriers to implementing this in medical practices in general? Do we really need more research on the right treatments for low back pain?” Here is Dr. Rivara’s stated conflict of interest at the end of the quote: he’s the Editor in Chief of JAMA Network Open. The Editor in Chief made that statement folks. He gets it. Now it’s time for the rest of the medical kingdom to get it.

Key Takeaways

  1. We don’t need any more research into whether low back pain is effectively treated with chiropractic care. It’s been done a hundred times over. What we need is acceptance and a shift in the groupthink of the medical field. When it comes to treating vets with low back pain, there is no better starting point than chiropractic care. 
  2. We also need to chiropractors to step up and take the golden scepter the medical field had dangled out there. It’s ours for the taking. 
  3. We also need more research into the effectiveness of chiropractic care for headaches and neck pain. The research is there supporting our effectiveness. No doubt about it. But, it needs to be there by the hundreds just like you see in low back pain. There needs to be so much of it that the deniers start to look like flat-Earthers in the healthcare world. 

This week, I want you to go forward with doing some of your own research on vets and opioids, on Chiropractic and low back pain, and on the Choice Program through the VA. We can help our active military and our vets. We can help them better than anyone else for their low back pain and that includes physical therapists. There is research showing that exercise/rehab + chiropractic is more effective than exercise/rehab alone(Korthals-de Bos IB 2003, Coulter I 2018). 

Either way you boil it down, we win. We can help these people so help me figure out how we get that message out there and how we’re supposed to reach out and grab it for our profession. 

Subscribe Button

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

I want you to know with absolute certainty that When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.

When you look at the body of literature, it is clear: research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good to excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic evidence-based podcast in the world. 

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

Social Media Links

iTunes

Bibliography

Coulter I (2018). “Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis.” Spine 0(0).

Goertz C (2018). “Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain A Comparative Effectiveness Clinical Trial.” JAMA 1(1): E180105.

Korthals-de Bos IB (2003). “Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial.” British Medical Journal 326(7395): 911.

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

They Laughed When I Said I Could Still Help After Back Surgery

Today, we’re going to talk about people coming into our office after having had back surgery wanting us to perform miracles. Well, why didn’t they come to us BEFORE the surgery would be my big question. We’ll toss all that stuff around today on the Chiropractic Forward Podcast. 

But first, here’s that bumper music!

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

Before we get started, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. On another note, do you need an hour or two for your Continuing Education seminar on low back pain guidelines or on Debunking the myth that chiropractors cause strokes? 

Go no further, you have found your man. Just send me an email at dr.williams@chiropracticforward.com and we will get it done.

We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. That’s a tall order but that is the goal

You have done the electric slide right into Episode #24 and that’s exciting

Now, as I mentioned previously, how many times do chiropractors have new patients come through the doors but they’ve already had back surgery? They’ve had back surgery they hoped would be a quick fix usually. But it wasn’t. 

Now, they’re sitting in your office, looking at you with a very scared and concerned face, and it’s up to you to lead the way and, hopefully, be able to provide them some sort of relief with your magical abilities. 

I can tell you from 20 plus years of experience that it happens all of the time. At least a time or two per month for a busy practice. That’s what I would guess. 

The truth is, sometimes we can help these back surgery people and sometimes we just can’t. I tell patients that surgery, many times, is permanent and anything we do toward trying to get some relief can be a little bit like pushing a wheelbarrow uphill. Depending on the weight in the wheelbarrow, we may get it to the top and we may not get it to the top but we’re sure as hell going to try while making sure we keep them safe from further damage. 

At first glance, when you’re looking at an x-ray of a post-surgical patient, many times I find myself thinking, “What in the heck can I possibly do with this trainwreck.” I’m sure I’m not the only one to ever feel like that. It’s a little bit of a helpless feeling sometimes. Especially when you see parts missing like you’ll see in a laminectomy. Or when you see parts added like boney fusions or fusions with hardware. I get a sinking feeling in my stomach for patients like that. Back surgery is no joke.

Especially when we know for a researched-fact that these patients most likely did not have to endure those procedures. For any reason. If you aren’t sure about that statement, please review our podcast episodes we did no The Lancet low back series. Episodes #16, #17, and #18 dealt with this very issue. 

Back surgery is gaining in popularity while the outcomes show no change. They are no longer recommending surgery for acute or chronic low back pain. Period. Sure, cauda equina syndrome, foot drop, and severe symptoms like that may indicate surgical intervention but, otherwise, they say no shots, no surgery, no bed rest, and no medications. 

We will be hammering these things consistently until we start seeing some change. I can guarantee it. 

OK, but…..what if nobody listened to the experts and they just did the surgery with no relief? Can we do anything about it? 

Let’s look at a couple of possiblities:

  1. The spine was fused years ago and now, due to the immobilization and increased workload on the segments above and below, the segments above and/or below begin to show signs of wear and tear. 
  2. The spine was not fused but the complaint never improved. This may be the case in people that have the microdiscectomies or epidural spinal injections. 

Of course there are a lot of different, very specific outcomes that don’t fit in those two categories but I’d say these are the ones I commonly see. 

Let’s take the first one: a fusion that caused issues above and below the fused segment. If you go through nonsurgical spinal decompression certification through the Kennedy Decompression Technique, you’ll be taught that a fusion with hardware is a hard contraindication. At least it was 6 years ago. 

Assuming these people develop disc issues above or below the fusion, that would mean you can’t do any decompression on the site. An orthopedic surgeon that is familiar with non-surgical decompression however, may tell you that the segment is more solid after the fusion than it ever was before and decompression won’t cause any issues with the fusion itself. 

OK, so, we’re stuck between two worlds on that and, honestly, if you’re an expert on this and you’re listening, email me at dr.williams@chiropracticforward.com and tell me your experience and understanding. 

After bouncing the problem off of several highly trusted colleagues, I think a light pull on decompression is tolerated just fine and does in fact provide relief to fusion patients. No, you cannot pull them at 1/3 or 1/2 of their body weight. We’re talking a LIGHT pull. This combined with gentle McKenzie and Core exercises as well as self-management recommendations at home will go toward getting them back on their feet and getting back after it. 

If any of you disagree, I’d love to talk about it. My first question would be, “What would the alternative be?” 

I am by no means the final and ultimate opinion on this. We have to depend on trusted advice and clinical experience, don’t we? That’s just what I do and what I’ve found is that about 80% of patients just get better. There’s about 10% that gets better but not quite what we hoped for. Then there’s that 10% that …”Hey, we tried and it looks like I’m not your homey on this deal.”

Now, what about the second option? Let’s say that they had a discetomy back surgery but it was a failure (surprise surprise) and now it’s up to us to help the patient and attempt to keep them from enduring any more back surgery or shots. What do you do? Maybe I should say, “What do WE do?”

I say adjust them!! After a certain healing time has passed, of course. 

I say we do all the other stuff I mentioned previously for them as well. We may do decmopression. We may do laser. We certainly do McKenzies, Core Building, McGill’s Big Three, no bed rest, and home self-management.

If you have paid much attention to our previous episodes then you know the American College of Physicians and the global panel of experts on low back pain that published the low back pain papers in The Lancet back in March of 2018 say that spinal mobilization is a researched and recommended first-line therapy for acute and chronic low back pain. 

In my opinion, a discetomy doesn’t change these recommendations much. Sometimes, cases are so specific, that they just don’t get researched in depth for that certain instance. 

However, I CAN offer a case study if you’re willing to listen. 

It was titled, “Chiropractic/Rehabilitative Management of Post-Surgical Disc Herniation: A Retrospective Case Report” and was published in the Journal of Chiropractic Medicine in the Summer edition of 2004(Estadt G 2004).  

Why They Did It

To explore management of lumbar disc herniation following sugery using a regimen of chiropractic manipulation and exercise/rehab. 

How They Did It

  • The patient was a 54 yr old male
  • The patient had a history of acute low back pain with left sciatic pain down the left posterior thigh and lateral calf as well as numbness inthe bottom of the left foot. 
  • The patient previously had steroid anti-inflammatory drugs and lumbar microdiscectomy surgery. 
  • The patient did not recover completely.
  • The patient couldn’t walk without hurting and was unable to return to activities of daily living. 
  • He was antalgic in flexion. 
  • His lumbar range of motion was restricted in flexion as well as in extension. 
  • He had a positive SLR as well as foot drop on the left. 
  • Intervention consisted of patient education on posture, bending, and lifting. 
  • Exercise/Rehab was started in-office progressing to at-home based exercise/rehab. 
  • Active rehab was continued after early improvement (7 visits) in order to return lumbar spinal extensor strength. 
  • The patient was ultimately released to home therapy and supportive chiropractic care and continued to show improvement. 

Wrap It Up

The author concluded, “Management of postsurgical lumbar disc herniation with chiropractic and active rehabilitation is discussed. Spinal deconditioning and weakness of the lumbar spinal extensor muscles appeared to be related to the patient’s symptoms. Patient education on proper posture, proper lifting techniques, core stabilization exercises, active strengthening exercise and chiropractic manipulation appeared effective in this case.”

OK, a case study with one subject. What does that tell us as far as research goes? Very little. What is the impact of the Journal of Chiropractic Medicine? It’s  peer-reviewed and it has an impact factor of 0.74 and has climbed significantly since 0.36 in 2011. 

Although this case study is only one patient’s experience, from my own anecdotal evidence, I would come very close to guaranteeing you and betting the farm that these post back surgery results can be repeated time and time again.

I’ve seen it time and time again. My experience tells me we can help these people. YOU can help these people. Back surgery doesn’t always mean we are helpless to pull out the power of chiropractic. 

I want you to know with absolute certainty that when Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.

When you look at the body of literature, it is clear: research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good to excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic evidence-based podcast in the world. 

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

Social Media Links

iTunes

Bibliography

Estadt G (2004). “Chiropractic/Rehabilitative Management of Post-Surgical Disc Herniation: A Retrospective Case Report.” Journal of Chiropractic Medicine 3(3): 108-115.

CF 020: Chiropractic Evolution or Extinction?

CF 008: With Dr. Craig Benton – Brand New Information Based on Results Chiropractic Proven Effective For Low Back Pain