Chronic Disc

Change Your Mind About Pain

CF 239: Change Your Mind About Pain Today we’re going to talk about changing your mind when it comes to pain and how looking at it differently can help our patients get in control of it. But first, here’s that sweet sweet bumper music

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #239 Now if you missed last week’s episode , we talked about Benzopdiazapines and Mirror Therapy. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Folks, not a lot going on right now in practice. It seems like I’m just in a holding pattern of sorts at the moment. You’ve probably heard me mention that we’ve been slower lately. For whatever reason. That’s true. I’m not sure why. The economy, gas prices, who knows?

This week though, sitting here on a Monday morning, and counting, I have 162 patients set up for the week and we know more will jump in as the week progresses. That’s 17 new patients set up so far this week as well. That will usually bump up to about 23-25 if I’m guessing.  Whack-a-mole people. So, now that numbers are back on the rise, another hole will appear in the bucket. Another mole will pop up and have to be whacked on the noggin with my oversize sledgehammer. 

So what’s it going to be?

Patients failing to stay on their schedules because we didn’t have the time available to educate them about the schedule? Not chasing A/R with any real intention? Where’s it going to be? Who knows? It’s always a great mystery but, as one thing improves, the pipes start busting elsewhere. 

You better believe I have my eyes out too. At the ChiroTexpo event in Frisco a few weeks ago, I met a vendor that does billing, chases A/R, and things of that nature. They’re spending this week auditing our EHR billing records to make sure we’re up to speed and on target.  I’m paying particular attention to the report of findings. I don’t do anything elaborate but when I get in a hurry, I tend to simply gloss right over it and keep scooting.

Not this time. Being in the Florida Mastermind has helped me slow down and give it the importance it deserves.  And patient care will not take a step back regardless so….. We’ll see where the next a-hole mole comes popping up but believe me, I’m waiting and ready with binoculars!! Alright, let’s dive in

Item #1

Our first one this week is called, “A clinical perspective on a pain neuroscience education approach to manual therapy” by Louw et. al. (Adriaan Louw 2017)and published in the Journal of Manual and Manipulative Therapy on May 22, 2017 It’s 5 years old but I included it because it’s relevant to a lot of what I teach and talk about here on the podcast.

Before we get into these two papers today, I want you to understand that I don’t for a second discount the biomedical aspect of pain and I fully believe hands-on chiropractors are in an amazing spot and well-placed to handle the biopsychosocial pain model. But only if we understand it and know how to leverage our tools in our favor.  Otherwise, we make it worse. 

Why They Did It

In recent years, there has been an increased interest in pain neuroscience education (PNE) in physical therapy. There is growing evidence for the efficacy of PNE to decrease pain, disability, fear-avoidance, pain catastrophization, limited movement, and health care utilization in people struggling with pain. So what is PNE? PNE teaches people in pain more about the biology and physiology of their pain experience including processes such as central sensitization, peripheral sensitization, allodynia, inhibition, facilitation, neuroplasticity and more. 

PNE’s neurobiological model often finds itself at odds with traditional biomedical models used in physical therapy.  Traditional biomedical models, focusing on anatomy, pathoanatomy, and biomechanics have been shown to have limited efficacy in helping people understand their pain, especially chronic pain, and may in fact even increase a person’s pain experience by increasing fear-avoidance and pain catastrophization.  Trust me, from the stories I get from my patients, the traditional bio-medical model doesn’t just cause catastrophization, it causes downright fear and terror in some patients.  An area of physical therapy where the biomedical model is used a lot is manual therapy. I would add chiropractic to the discussion here as well. 

This contrast between PNE and manual therapy has seemingly polarized followers from each approach to see PNE as a ‘hands-off’ approach even having clinicians categorize patients as either in need of receiving PNE (with no hands-on), or hands-on with no PNE. In this paper, the authors explored the notion of PNE and manual therapy co-existing. 

PNE research has shown to have immediate effects of various clinical signs and symptoms associated with central sensitization. Using a model of sensitization, they argue that PNE can be used in a manual therapy model, especially treating someone where the nervous system has become increasingly hypervigilant. You guys and gals….if you have chronic pain patients, you have to start listening and paying attention to central sensitization, upregulated central nervous systems, cognitive behavioral therapy, mindfulness, yellow flags, fear avoidance, catastrophization, oh my.

Seriously, if these terms are unfamiliar to you, please do yourself and your patients a favor and go get the smarts. You can start the smarts right here in our podcast episodes. I talk about this stuff non-stop and have been for years here so dive in. 

It’s not one thing over the other. Either….or. It’s a broad management protocol that includes PNE, SMT, exercise, massage, yoga, tai chi, low level laser, and some other stuff all piled on top. Oh, and a good provider that communicates in a hopeful and encouraging manner.  Put the puzzle together. Start by getting the smarts. And quit being confusion as the kids would say. Do research about it. Lol. 

 

Before getting to the next one, I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! It’s live again. Use the code HOTSTUFF upon purchase at droprelease.com to get $50 off your purchase. Y’all, it makes a world of difference. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. My patients love it and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Hear me now and believe me later.

 

Item #2

The second one is called “Changes in psychosocial well-being after mindfulness-based stress reduction: a prospective cohort study” by Hill et. al. (Renee J. Hill 2017) and also published in The Journal of Manual and Manipulative Therapy on May 4, 2017.  Again, yes, old man river here as far as research goes but relevant 

Why They Did It

The primary purpose of the current study was to assess the effects of a mindfulness-based stress reduction (MBSR) program, facilitated by non-psychologist clinicians, for improving psychosocial well-being.  A secondary purpose of the current study was to explore the role of self-compassion as a potential underlying factor for improvements in emotional distress.

How They Did It

  • 130 participants with a variety of medical complaints completed an eight-week mindfulness-based stress reduction program at Vanderbilt. 
  • Before treatment and at the 8-week time point, participants completed measures for emotional distress, stress, mindfulness, and self-compassion. 
  • Linear model estimation using ordinary least squares was used to evaluate the association between changes in self-compassion with changes in emotional distress.
  • I’m not going to lie….I’m ignorant of that last part. Made be feel stupid. Which, of course, isn’t hard to do. 

What They Found

  • Following mindfulness-based stress reduction, participants reported significant reductions in emotional distress. 
  • Additionally, participants reported improvements in mindfulness and self-compassion. 
  • Linear regression model revealed that changes in self-compassion were significantly associated with changes in emotional distress.

Start getting the smarts. Research at least once per day. 

Alright, that’s it.

Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point:

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

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 

Connect

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

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Home

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TuneIn

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About the Author & Host

Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

Adriaan Louw, J. N. E. J. P. (2017). “A clinical perspective on a pain neuroscience education approach to manual therapy.” Journal of Manual & Manipulative Therapy 25(3): 160-168.

Renee J. Hill, L. C. M., Li Wang & Rogelio A. Coronado, (2017). “Changes in psychosocial well-being after mindfulness-based stress reduction: a prospective cohort study.” Journal of Manual & Manipulative Therapy 25(3): 128-136.      

w/ Dr. Stuart McGill – Clinical Jazz, Treating Kids Like Pros, Thoughts On Posture, and Being A Low Back Pain Ninja

CF 118: w/ Dr. Stuart McGill – Clinical Jazz, Treating Kids Like Pros, Thoughts On Posture, and Being A Low Back Pain Ninja 

Today we’re going to be talking with the low back ninja himself, Dr. Stu McGill. What an honor. If you know anything about Dr. McGill, then you truly know what a big deal it is to have him as a guest. 

But first, here’s that sweet sweet bumper music

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

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

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

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

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

Do it do it do it. 

You have found yourself smack dab in the middle of Episode #118

Now if you missed last week’s episode #117, we talked about spinal manipulation with and without myofascial release added to the mix and we discussed the research behind vitamin d3 to help for migraine headaches. Really interesting stuff. Make sure you don’t miss that info. Keep up with the class. 

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

No personal disaster stories this week. I want to dive right in. 

Before we get to Dr. McGill, I want to briefly mention ChiroUp.com. Look folks, if you haven’t heard of this program, you just don’t know what you’re missing. ChiroUp has solved almost all of my biggest issues in practice. Not only with a gap in knowledge initially in rehab but with time management. 

It saves time, it educates patients on exercise, activities of daily living, and your recommendations, it encourages Google reviews, it tracks your patients’ success, it gives you all kinds of marketing templates and ideas, if you don’t know a particular exam or treatment protocol for a certain body region, it has videos to show you – in short….it’s amazing. 

If you’d like a free trial period followed by 6 months at only $99/month, go to chiroup.com and use the code Williams99 That way you get the discount and they know who’s greasing the wheels. 

Now, Dr. Stu McGill

Dr. Stuart M. McGill is a professor emeritus, University of Waterloo, where he was a professor for 30 years. His laboratory and experimental research clinic investigated issues related to the causal mechanisms of back pain, how to rehabilitate back-pained people and enhance both injury resilience and performance. 

His advice is often sought by governments, corporations, legal experts, medical groups and elite athletes and teams from around the world.

His work produced over 240 peer-reviewed scientific journal papers, 5 books, and many international awards. He mentored over 37 graduate students during this scientific journey.

During this time he taught thousands of clinicians and practitioners in professional development and continuing education courses around the world.

He continues as the Chief Scientific Officer for Backfitpro Inc. Difficult back cases are regularly referred to Dr. McGill for consultation. 

I went through his CV on the Backfitpro website and I’d be here for an hour if I read it all out to you. It’s truly impressive as is Dr. McGill himself. 

What an honor it is for us to welcome Dr. McGill on the show today. Dr. McGill, thank you so much for taking the time. Where are you as we speak and how’s the weather treating you?

1. In the book, “Back Mechanic’, you seem to minimize the psychosocial aspect of chronic back pain and instead focus on removing the physical pain triggers. More and more emerges about the psychosocial aspect. Do you think it’s a fad or have you changed your mind any on it as it’s popularity seems to be rising?

2. For those few that are relatively unfamiliar with your work, what would be your best summary? What are your key points or takeaways? Things like flexion is mostly bad, it depends, and strength building doesn’t mean pain improvement….

3. You say that disc injuries often resolve in about two weeks. In your experience, is there a specific kind of disc injury that tends to stick around and be pesky for longer than that?

4. Here is a question from our private Facebook group. If trunk flexion is not generally advisable, how does one go about building ab muscles just purely for aesthetics….to get a six-pack essentially? What’s the best way to advise our active patients on this?

5. Let’s say you have a patient that has had chronic low back pain for years. Just general, dull chronic pain. Let’s say you diagnose and treat and they come out of it. Now they feel great and they want to go a step further and start getting active in the gym. Now I suspect your answer will include, “It depends,” and to avoid the triggers or movements that once hurt but, in general, how do you counsel them on the best way to start without taking a step back? 

6. Recent recommendations came out about posture from what I believe was the primary chiropractic association in Canada. They said there really is no bad posture but what is important is the frequent change in postures. Taking out pain triggers, what is your opinion on this idea of no bad postures?

7. In reviewing your certification process, I see live hours for Level 1 and they’re in amazing places like Australia, Brazil, The Netherlands, Toronto, and on and on. My question is, are there any plans to offer some of this online for the practitioner that is unable to travel in the manner required? Or is it more of a hands-on class and live hours are vital?

8. I realize this is a big question and there can be a lot of stuff to unpack here but I think it’s worth asking. So that those of us in the field can know where we stand as far as how we go about assessing a new patient…..To adequately assess a patient and generate a diagnosis, how long should it take on average to do a good job and be accurate? I understand you evaluate a new patient for 3 hours or more.

9. Here’s probably another huge question but, what comes first for you: Corrective exercise or Gamification?

10.

11. With low back pain being the #1 reason for disability globally, and with all of the research you’ve been involved with, are we gaining on it? Why do I still get patients in my clinic with stories that make it clear that the medical profession is still not really paying attention?

12. We are seeing more and more information emerges suggesting it’s good for young athletes to be multi-sport athletes rather than specializing and being essentially treated like a professional athlete while still very young and developing. On a podcast interview, I listened to with you as the featured guest, you say you just can’t be good at everything because your spine basically needs to be tailored the specialty. Can you go into this a little bit and is there a way to find the balance between the idea that you can’t be good at it all but that you also should look at being a multi-sport athlete? At least at a young age. 

13. Also from our private facebook group, what are some assumptions you made 5 years ago (or some other time) that you no longer agree with? If any.

14. Tell me about backfitpro.com 

Chiropractic evidence-based products
Integrating Chiropractors
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Dr. Stuart McGill on low back pain and posture

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Chiropractic in Active Duty Military, Early Care in Whiplash, Chronic Discs & The Sinuvertebral Nerve

CF 087: Chiropractic in Active Duty Military, Early Care in Whiplash, Chronic Discs & The Sinuvertebral Nerve

Today we’re going to talk about Chiropractic care in Active Duty Military folks, we’ll talk about Early Care in Whiplash victims, and we’ll talk about Chronic Discs & The Sinuvertebral Nerve. What’s the what what on that?

But first, here’s that smooth like chocolate mousse bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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And away we go..… Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have back flipped into Episode #87. Kind of like the kid at the town swimming pool when you were in school. I could never do that. Pissed me off too. Of course, I never cracked my noggin on the bottom of the pool either so there’s that I suppose. 

We have some pretty cool stuff to talk about this week but, before we get started, let’s talk about GoChiroTV for your lobby. GoChiroTV is a patient education system for your office that will eliminate the need for running cable TV or the same DVDs over and over again in your waiting room. The bite-sized videos are specifically made to inform your patients about the importance of chiropractic and healthy living. To encourage referrals and to present the benefits of all of the different products and services you offer.

It works by using a tailor-fit video playlist that only promotes the products and services available in your practice. Not only that but the videos are replaced automatically on a weekly basis. There’s no need to manually update your playlist or learn any complicated software. You truly can just set it and forget it.

Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions. That’s CFP19, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription and you can’t hardly beat that deal. 

Go visit GoChiroMedia.com to check out the demo reels and get started on your free trial. Take your practice to the next level with GoChiroTV. Introduction

As regular listeners already know, I’m going through the Diplomate of the Academy of Chiropractic Orthopedists and I really don’t have much to share on that end of things. I got past Part I and am studying for Part II which is coming up in November. Overall, it’s been enjoyable. I do a lot of extra continuing education anyway so, might as well get some letters after my name for my effort don’t you think? You know I’ll keep you updated as I go. 

Here and there, when the spirit hits me, I’ll post some interesting stats from the DACO coursework on our Chiropractic Forward facebook page or in the Chiropractic Forward private group so you can be looking in there for that. 

Item #1

We’re going to start with this one. It’s called, “Chiropractic services in the active duty military setting: a scoping review” written by Mior, Sutton, and To, et. al(Mior S 2019). It was published in BMC Chiropractic and Manual Therapies in July 2019. Hot stuff….serving it up fresh folks…

They start by pointing out the obvious and that’s that musculoskeletal injuries are really a big deal to military folks. Hell yeah they are. I’ve had patients that have fallen from helicopters before. That doesn’t typically happen in the civilian population, now does it?

In some countries, recently America was added to the list, chiropractic care is being used more and more to manage these injuries. Which brings to mind….y’all….the VA just sent me a WWII veteran today!! Just this morning. He was in France and Germany from 1944 through the end of the war in 1945. Made my entire month, y’all. Seriously. How fascinating. Imagine the things he’s seen. 

I told him that, when I hear people bitching about Obama or Trump or politics or anything else really….I always think about their generation and that time and wonder what they were thinking about the world. Rationing supplies, sons, brothers, sisters, fathers, and mothers scattered from one end of the globe to the other. What did they think?

You know what he told me? He said, “We didn’t think the world was coming to an end. We just thought one thing and that was putting an end to it and we had to put an end to Germany to do that. That was all we were thinking.”

Pretty interesting. I get to spend time with this dude for several weeks. I’ll report back with any super awesome nuggets he chooses to pass on to me. 

Anyway, sorry for the sidebar there, back to the paper at hand. 

How They Did It

  • They used systematic reviews of relevant databases including military collections and hand searches were conducted from inception up to October 22,2018. 
  • They included peer-reviewed English literature with qualitative and quantitative designs, describing chiropractic practice and services delivered to active duty military worldwide. The data was put into evidence table and sorted by study type. 

Geez….sentences like that make me truly happy I am personally not a researcher myself. How boring. Lol. But thank God some are bent that way and like it. 

Now, What They Found

  • 497 articles were screened and they whittled that down to only 20 that fit the criteria. 
  • Back pain with and without radiculopathy accounted for most complaints. 
  • They identified two recent randomized trials that reported improved pain, disability, and satisfaction when adding chiropractic care to usual medical care compared to usual medical care alone in management of low back pain….I believe Dr. Christine Goertz, one of our previous guests was involved in at least one of those papers. 

Wrap It Up

“Two recent RCTs provide evidence of comparative effectiveness of adding chiropractic care to usual medical care. Despite the reported use of chiropractic services in Australia, Canada, and the US, there is little available published evidence related to the nature, use, and outcomes of chiropractic care in active duty military. Our review suggests the need for further qualitative, descriptive, and clinical trial data worldwide to inform the role and value of chiropractic services in active duty military globally.”

So basically they did a lot of work to say, “Yeah, we’re not sure. We need more research.” Lol. Isn’t that the way it usually goes though?

I’m going to go ahead a anecdote the crap out of you here. As I mentioned before, we see a good number of veterans that the VA sends over. Every single one of them have been in the middle of chronic pain syndrome. I have had more than one of them tell me that they are going to kill themselves if they cannot get something done about their pain. 

The VA is stopping all opioids, as they most certainly should. Veterans don’t like this. The opioids were their safety nets and whether they really helped or not, the vets thought they helped and just like a placebo, that may have been enough to make a difference for them. 

So now it’s other things. They come in still on gabapentin and things of that nature but no more opioids and they’re pissed. But here’s the deal, when you start asking about their service, what years they were in, and where they were sent, you start to see the walls break down a bit. 

That’s when you demonstrate good solid knowledge through your exam and communication. By the time to finish up, if you do it right, you have a new patient and a new friend who’s excited to see where this thing might go. 

Almost all of them have responded positively. Yes, absolutely there are some here or there that don’t get the results we want for them but, without a doubt, the vast majority of them start sleeping better (which is one of the most common complaints), they stop hurting at the levels they previously experienced, and they start becoming more active. They come in laughing and they look forward to being here. 

Researchers can have all of the questions in the world and I’m glad they do and I’m glad they’re trying to answer them but, for me, I don’t have to know exactly how it works physiologically. I just practice good solid evidence-based chiropractic and I have the joy of sitting back and watching what happens. It truly is astounding y’all. 

We’re going to talk about whiplash and early intervention. Good idea or bad idea? It may not be what you think it is. 

First, since we mentioned evidence-based chiropractic, 

Have you heard about the #1 online resource for chiropractors? Well, let me tell you about it. 

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

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

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

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

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

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

Alright, Item #2

This one is called, “Early aggressive care and delayed recovery from whiplash: isolated finding or reproducible result?” written by Cote, Hogg-Johnson, Cassidy, et. al. and published in Arthritis & Rheumatology in 2007(Cote P 2007). Oldie but a goodie here if you’re doing personal injury work. 

Why They Did It

The stated goal here is to test the reproducibility of the finding that early intensive care for whiplash injuries is associated with delayed recovery. 

How They Did It

  • Data from a cohort study of 1,693 adults suffering whiplash was looked at. 
  • They picked apart 8 different patterns of care between GPs, chiropractors, and specialists
  • And they used Cox models to estimate the association between patterns of care and time to recovery

What They Found

“The observation that intensive health care utilization early after a whiplash injury is associated with slower recovery was reproduced in an independent cohort of patients. The results add to the body of evidence suggesting that early aggressive treatment of whiplash injuries does not promote faster recovery. In particular, the combination of chiropractic and general practitioner care significantly reduces the rate of recovery.”

Well what the hell do we do with that information exactly? What exactly is meant by the term ‘early aggressive’? What is meant by chiropractic care? Does that just mean spinal manipulative therapy? Or does that mean spinal manipulative therapy, exercise/rehab, therapy, and all the good things we use to make people better?

My answer to you is “Hell if I know.” The abstract doesn’t give that information. But what I can tell you is, the more we are able to utilize motion and movement, the faster they heal up. You take that to the bank from your ole pal Uncle Jeffro. 

Item #3

Look, when I read the title of this next one, I don’t want your eyes glossing over and you losing your ability to stay awake. I damn sure don’t want you turning off the podcast or fast forwarding. Just hold on a damn second. 

This one is called “A comprehensive review of the sinuvertebral nerve with clinical applications.” It was written by Brian Shayota, T.L. Wong, and Donald Fru, et. al. and published in Anatomy & Cell Biology in 2019(Shayota B 2019). Hot cakes, servin em fresh. 

When it comes to disc pain, the sinuvertebral nerve is a hot topic amongst anatomists. Bet you didn’t know that, right? Why would that be? Well, they say, “Knowledge of the nerve has been used to design a variety of diagnostic and treatment procedures for chronic discogenic pain. This paper reviews the anatomy and clinical aspects of the sinuvertebral nerve.”

The sinuvertebral nerve, associated with the discogenic type (pain from an injured vertebral disc), accounts for approximately 26%–39% of patients with low back pain. 

Well that’s important now isn’t it?

“Although the sinuvertebral nerve fibers are said to terminate in the outer anulus, it is now widely accepted that this end point is not permanent. Studies of healthy patients normally show neural penetration of the anulus at about 3 mm.” And the plot thickens!!

They continue, “However, degenerative discs have shown penetration of nerve fibers as far as the inner one third in one study [38], and into the nucleus pulposus in another.”

“Discogenic pain is not limited to the lower back. Overactivation of the C1–C3 sinuvertebral nerves is now considered the cause of most cervicogenic headaches.”

Wrap It Up

“Recent studies have shown that the sinuvertebral nerve can be traced as far as the outer three layers of the lamella in healthy patients, but can go as far as the nucleus pulposus in degenerative discs. The nerve has also been implicated in discogenic pain. Yet only recently has its role been extensively studied, providing opportunities for the development of newer diagnostic and treatment techniques to combat the debilitating consequences of its pathology. Provocative discography is still the gold standard for diagnosing discogenic pain. While these procedures have proved advantageous in discogenic pain management, much more work needs to be done to improve their accuracy and efficacy. The sinuvertebral nerve has also been linked to cervicogenic headaches, but more research is needed to clarify its involvement in this condition.

Pretty cool stuff right there folks!!

Store

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

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

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

Chiropractic evidence-based products
Integrating Chiropractors
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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

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About the Author & Host

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

Bibliography

Cote P, H.-J. S., Cassidy JD, (2007). “Early aggressive care and delayed recovery from whiplash: isolated finding or reproducible result?” Arthritis Rheum 57(5): 861-868.

Mior S, S. D., To D, (2019). “Chiropractic services in the active duty military setting: a scoping review.” BMC Chiro Man Ther 27(45).

Shayota B, W. T., Fru D, (2019). “A comprehensive review of the sinuvertebral nerve with clinical applications.” Anat Cell Biol 52(2): 128-133.