Chronic Pain

Updated Thinking On Chronic Pain and Exercise

CF 129: Updated Thinking On Chronic Pain and Exercise Today we’re going to talk about chronic pain and exercise.  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 #129 Now if you missed last week’s episode, we talked about Tylenol failures, cervical disc research, and we talked about complementary and alternative treatment for headaches and migraines. What’s the current research and thinking? 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.  Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.  On the personal end of things….. Well, so far, no blowback from my rant on last week’s podcast so sometimes no news is good news. You either all agree with me or you’re not listening.  Rocking and rolling here at work, last week was finally the busiest I have been since late January or early February. It was quite a blessing. I have to admit, I’m not used to working that damned hard anymore but it’s OK. I just need to get back into fighting shape so I can see them all.  Last week we saw about 135 patients. Pre-COVID numbers were anywhere from 185-225 so I’m still significantly down but it’s trending upwards and it’s looking good right now. I cannot and will not fuss about it. Especially when I read that several are just now going back to work and have been closed completely this entire time. We’ve been fully, completely open for more than a month now. It’s hard to imagine being closed down any longer than we were honest. I don’t know how companies survive.  I see reports that the virus may have mutated to a lesser severity. Not only are some doctors claiming that people are getting less severe when they do get sick, but they are not getting sick as easily. That’s some exciting news if it is indeed a fact. Time will tell.  I don’t want to hear anything about ‘new normals’. Once this dude settles down, life will be normal. Not a new normal. It’ll be back to the way it was. I’m guessing August but who knows? It could be in the Fall. Maybe even the Spring. But it will be the old normal. You can count on that.  I hope your businesses are picking back up as well. I hope you’re seeing those old familiar happy faces coming back into the office to greet you. I hope you’re back on track to showing the world how effective and amazing chiropractic can be when practiced by an evidence-based, patient-centered professional. That’s you. That’s who listens to this show and I’m proud of you all. You make this profession better every day and I thank you.  I just hope you get something good from me every week. If you do, I won’t be shy about asking you to share this podcast with your colleagues. We are growing all of the time but it’s never quite fast enough to feel like I’m on a roll. So, with your help in sharing and talking about us, I think we can truly make a big difference and take this thing of ours to another level.  Item #1 This first one this week is called “Exercise Induced Hypoalgesia Is Impaired in Chronic Whiplash Associated Disorders (WAD) With Both Aerobic and Isometric Exercise” by Smith et. al(Smith A 2020). and published in Clinical Journal of Pain in May of 2020. Oy…..that’s smokin’ hot! Why They Did It First, let’s define Exercise Induced Hypolagesia. It is a generalized reduction in pain and pain sensitivity that occurs during exercise and for some time afterward. So, for normal, asymptomatic people, when they exercise, there’s less pain and they feel better and that lasts for a while when they finish exercising.  Exercise induced hypoalgesia can be impaired in patients with chronic pain and may be dependent on exercise type. Factors predictive of Exercise induced hypoalgesia are not known. This study aimed to: 
  1. compare Exercise induced hypoalgesia in participants with chronic whiplash associated disorders to asymptomatic controls, 
  2. determine if exercise induced hypoalgesia differs between aerobic and isometric exercise, 
  3. determine predictors of Exercise induced hypoalgesia.
How They Did It
  • A pre-post study investigated the effect of single sessions of submaximal aerobic treadmill walking and isometric knee extension on exercise induced hypoalgesia in 40 participants with chronic whiplash associated disorders and 30 controls
  • Pressure pain thresholds were measured at the hand, cervical spine and tibialis anterior
  • Appropriate baseline measurements were performed
What They Found Participants with whiplash-associated disorders demonstrated impaired exercise-induced hypoalgesia There was no difference in exercise-induced hypoalgesia between exercise types Wrap It Up “Individuals with chronic whiplash-associated disorders have impaired exercise-induced hypoalgesia with both aerobic and isometric exercise. Higher levels of physical activity and less efficient conditioned pain modulation may be associated with impaired exercise-induced hypoalgesia.” Item #2 This last one is by the great Dr. Craig Liebenson and is called “Pain with Exercise: Is it acceptable & if so how much & for how long?” and was published in First Principles Of Movement on May 20, 2020(Liebenson C 2020). Pow! Hot like a firecracker folks. https://firstprinciplesofmovement.com/pain-with-exercise-is-it-acceptable-if-so-how-much-for-how-long/ For articles, we dispense with our normal outline and we hit the high spots and interesting points.  Craig starts by quoting a paper by Smith, Littlewood where they say “Protocols using painful exercises offer a small but significant benefit over pain-free exercises in the short term, with moderate quality of evidence……Pain during therapeutic exercise for chronic musculoskeletal pain need not be a barrier to successful outcomes.” He also quotes Annie O’Conner’s, author of World of Hurt, where she says we must violate the patient’s expectation that hurt equals harm. Especially with light pain.  Craig also refers to a photograph from Silbernagel’s paper demonstrating a Pain-Monitoring Model where the safe zone on the VAS was 0-2, the Yellow or acceptable zone was 3-5 on the VAS, and the red high-risk zone was 6-10.  Silbernagel says, “Biological plausibility/explanation and reasoning ranks high and then you can individualize. Meaning waiting for the pain to subside does not work because you get weaker and the tissue decreases its tolerance to load. So loading with pain is beneficial to get the structures to improve. However, if it is a fracture it might be very different so know the injury and tissue.” I like this quote of Craig’s from the article: “Many people believe the medical adage – “if it hurts don’t do it”. We know that for some this promotes illness behavior by giving the idea that the body is fragile. Ben Smith & Chris Littlewood’s shoulder paper, Annie O’Conner’s WOH book, some of K Thorberg’s groin work, & you’re tendonopathy paper all show yellow pain is acceptable.  He says the idea of, if it hurts, don’t do it brings about clear yellow flags. Yellow flags such as
  • Hurt = harm
  • activity is harmful
  • if an activity hurts it should be stopped
On the topic of osteoarthritis, he says 
  • The patient decides what’s tolerable, 
  • Above 5 is the red area
  • If pain increases with exercise, that’s OK as long as by the next day it has calmed. 
He goes on to cite a new paper in JAMA by Ben Cormack asking about pain tolerance vs. using the traditional Numeric Rating Scale. They’re suggesting asking if the pain is tolerable is a better way to deal with it.  Cormack says:
  • “The exclusive focus of the numeric rating scale (NRS) on pain intensity reduces the experience of chronic pain to a single dimension.”
  • “This drawback minimizes the complex effects of chronic pain on patients’ lives and the trade-offs that are often involved in analgesic decision-making.”
  • “Furthermore, continually asking patients to rate their pain on a scale that is anchored by a pain-free state (ie, 0) implies that being pain-free is a readily attainable treatment goal, which may contribute to unrealistic expectations for complete relief.”
The modern approach to managing disabling musculoskeletal pain is to shift the focus from chasing symptomatic relief to addressing activity intolerances related to symptoms.
  • “ The overarching goal of chronic pain treatment is to make the pain tolerable for the patient rather than to attain a targeted numeric rating.”
  • “Our findings confirmed the intuitive assumption that most patients with low pain intensity (ie, NRS score, 1-3) find their pain tolerable.”
  • “In contrast, the tolerability of pain rated between 4 and 6 varies substantially among patients.
  • “In this middle range, if a patient describes the pain as tolerable, this might decrease the clinician’s inclination to initiate higher-risk treatments.”
  • “A substantial subgroup of patients with severe pain reported their symptoms as tolerable.”
Dr. Liebenson wraps up the article by saying, “This discussion highlights that hurt does not necessarily equal harm. Nearly all musculoskeletal pain guidelines over the last 30 years have emphasized that pain does not equal tissue damage or impending injury. This study goes a long way to show us better ways to educate people in reassuring ways that will get them back to activity and thus build a mindset that can make them feel less fragile.” Chronic pain is interesting stuff and is a HUGE market where there are lots of opportunities for educated, smart chiropractors to stick their flag in the dirt and stake a claim.  Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Key Takeaways Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   
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 preventativly after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
Home
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/   About the Author & Host Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger   Bibliography
  • Liebenson C (2020). “Pain with Exercise: Is it acceptable & if so how much & for how long?” First Principles Of Movement.
  • Smith A, R. C., Warren J, Sterling M, (2020). “Exercise Induced Hypoalgesia Is Impaired in Chronic Whiplash Associated Disorders (WAD) With Both Aerobic and Isometric Exercise.” Clin J Pain.

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

American Academy of Family Physicians Warming To Chiropractic For Chronic Pain & Evidence Behind Supplements

CF 111: American Academy of Family Physicians Warming To Chiropractic For Chronic Pain & Evidence Behind Supplements

Today we’re going to talk about how the American Family Physicians may be warming up to chiropractic for chronic pain and what supplements actually have some evidence behind them.

But first, here’s that sweet sweet bumper music


Chiropractic evidence-based products
Integrating Chiropractors
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg

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 #111

Now if you missed last week’s episode , we talked about Dry Needling vs. Massage and even more importantly, we talked about the topic of “What is your exit number?”. What are you looking to get out of it all in the end? I feel like there were points made in there that could really get you to contemplating and thinking going forward. So, make sure you don’t miss that info. Keep up with the class. 

That reminds me, did you know that you can use our website as quite a resource? I do it all of the time. If you think I can keep every one of these papers in my noggin and pull them out of my brain files on demand, that’s a big nope. But I can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever I want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points. 

On the personal end of things…..

Rinse and repeat man, rinse and repeat. If you’re friends with me on Facebook, then you know life has been crazy and there’s no slow down in site. 

Some really positive stuff happening though too. For example, I was interviewed for two different articles in Chiropractic Economics recently. They published an article called “Chiropractic for prevention: the latest research on maintenance care” by Michele Wojciechowski. Michele used my comments exclusively in this article and that’s just a big honor. 

I remember when I was new in practice. I remember reading articles in Dynamic Chiropractic and Chiropractic Economics and thinking that would be cool to be in that one of these days. Now…..now…I’ve been fortunate enough to be in Reader’s Digest, on the ACA Blog a couple of times, and now Chiropractic Economics. It’s pretty damn exciting and it’s an honor. 

Thank you Michele for finding value in my comments and sharing them with everyone else. I’ll leave a link to that article at this point in the show notes if you’re interested in giving it a read through. 

Other than that, my family and I took a quick ski-cation to Red River, New Mexico. If you haven’t been, look it up. Here’s why we like Red River, First thing, it’s close. For a Texan to be able to just drive about 4 hours and be in the mountains, that’s pretty exciting. 

Next thing, it’s just gorgeous. And, the ski slope comes right down into the town so you don’t have to drive out to a mountain which is nice. 

Let’s talk about why I retired from skiing myself though shall we? This may make you think a bit about some of the stuff you do in your offtime. Maybe it won’t but it’s important to think about things which is the whole point of me bringing it up.

I used to ski a lot back in high school and junior high. I was pretty decent at it too. Then I went off to play football and be a college kid. Well, Louisiana for a bit and Dallas for a bit…..those areas aren’t very conducive to learning to snow ski. It’s too damn far. Especially when you’re still a kid and broke as hell. Skiing just doesn’t happen at that point in life unless you have parents taking you. I didn’t.

So then you start life and you’re building a business and there’s never time to go then either. 

Well by the time I got back around to going skiing again, I hadn’t done it in about 20 years give or take. So, i got a private coach for a morning just to get me back on that bicycle and rocking and rolling again. I have to tell you, it was hard as hell!! It was NOT like riding a bike. Nothing at all like it as a matter of fact!!

But, I took it slow, I didn’t fall at all, and was fairly happy with my progress over the weekend. HOWEVER, I got to thinking when I got home. I went back to work and had about 45 patients that next day. What if I had twisted a knee, broken and elbow, or dislocated a shoulder while I was skiing? What would I have done?

You know this sounds stupid when you say it but, “They call them accidents because you don’t plan them.” But you can avoid them sometimes. I got to thinking long and hard enough about the risk vs. rewards for continuing to ski and……honestly, on paper, it wasn’t worth the risk. 

So, I retired. Maybe if I had an associate. Maybe I could make more sense of it but, the truth is, I don’t have an associate. It’s just me although I’m thinking of hiring one just as soon as it makes sense. Anyway. I took the kids skiing while the wifey and myself enjoyed the mountains, some brewskis, and some playoff football games. 

What are you involved in as far as physical activity outside of your practice that puts you at risk and puts your ability to earn a living at risk? Do you have disability insurance? Life insurance? Long term care insurance? I have all of that. Do you need it?

Start thinking about these things. Certainly, the more successful you get and the busier your practice gets. Risking an injury just might not be worth it at some point. 

Before we dive into the reason we’re here, it’s good to support the people that support evidence-informed practitioners. Well, ChiroUp certainly does just that. 

If you don’t take advantage of the deal I’m about to offer you, I think you just might be crazy.

Regular listeners know I’ve used ChiroUp for well over a year now. I’m going to tell you want it is and then share a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months. So listen up!

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

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

This saves you so much time – no more explaining & re-explaining your patient’s care because they have access to it right there at their fingertips. 

You can be confident that your patients are getting the best possible care because the reports and exercises are populated based on what the literature recommends and isn’t that reassuring? All of that work has been done FOR you by people that are deep into the research. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice.

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL and, to sweeten the deal, you can use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super saver code is Williams99.

Item #1

Let’s start with this one from American Family Physician. I got this one from one of my amazing colleagues, Dr. Craig Benton down in Lampasas, TX. It’s called “Nonpharmacologic therapies can improve chronic pain outcomes” authored by Michael Devitt and was published in American Academy of Family Physicians on January 15, 2020(Devitt M 2020). Damn it’s hot…..

Not a research paper but more of an article in their publication but has plenty to do with chiropractic. 

They set the stage here by pointing out that chronic pain is something that can cause people to go to extreme measures just to get the pain to go away. Or at least lighten up. They say this includes potentially harmful behaviors like drug and alcohol misuse and/or abuse. 

Then this article in the American Family Physicians journal starts to highlight and promote the nonpharmacologic treatment modalities that are available to family physicians. Honestly, did you think you’d ever see the day? Ever? The battle isn’t over by any stretch of the imagination but research is gradually, inch by inch, turning the tide. 

They say these modalities include simple methods like massage and heat as well as more complex therapy like acupuncture and chiropractic manipulation. They called us ‘complex’ and I’m taking that as a compliment. Lol. What we do can damn sure be complex. 

They say that these nonpharma strategies aren’t only effective for decreasing pain and improving function, but can also be effective for reducing longer-term adverse effects such as substance use disorders and suicide attempts. THAT’S A BIG DAMN DEAL. 

In fact, I got one word, two syllables….day-um. 

One researcher, the lead author from an active-duty US Army service study said “Chronic pain is associated with adverse outcomes such as substance use and suicidal thoughts and behavior,” said Esther Meerwijk, Ph.D., M.S.N., a statistician at the VA Palo Alto Health Care System in California. She added, “It made sense that if nondrug treatments are good at managing pain, their effect would go beyond only pain relief. However, I was surprised that the results of our analyses held, despite our attempts to prove them wrong.”

Despite our attempts to prove them wrong! Haven’t they been trying to prove us wrong for generations now? Lol. I always say that with all of the powers against us, if we were wrong, if we were ineffective, we would have been wiped out years ago. 

In one of her projects, they reviewed the records of more than 275,000 active-duty service members reporting chronic pain.

They combed through their files to determine whether they had received any of 13 nonpharmacologic therapies after their deployment. Those therapies were acupuncture or dry needling, biofeedback, chiropractic care, cold laser therapy, exercise therapy, lumbar supports, massage, osteopathic spinal manipulation, other physical therapy, superficial heat, traction, transcutaneous electrical nerve stimulation, and ultrasonography. 

After crunching all of the numbers and outcomes here’s what they came up with:

Specifically, service members who received nonpharmacologic therapies were

  • 8% less likely to experience new-onset alcohol and/or drug use disorders;
  • 12% less likely to experience suicidal ideation;
  • 17% less likely to experience a self-inflicted injury, including attempted suicide;
  • 18% less likely to intentionally poison themselves with opioids, related narcotics, barbiturates or sedatives; and
  • 35% less likely to accidentally poison themselves with the same types of drugs.

The researchers acknowledged several limitations in their research. For example, although most nonpharmacologic therapies were provided after service members were diagnosed with chronic pain, the authors could not determine whether those nonpharmacologic therapies were used specifically to treat that pain.

In the news release, Meerwijk also explained that her team did not study the effects of individual nonpharmacologic therapies.

“We treated them as one,” she said. “Most likely, only some of the therapies that we included are responsible for the effect that we reported, whereas others may have had no effect at all, assuming there’s no other variable that explains our findings.”

Despite these limits, the authors expressed confidence in their research methods and findings.

“Our results suggest that (nonpharmacologic therapies) provided to active-duty service members with chronic pain may reduce their odds of long-term adverse outcomes,” they concluded in the study. “Given known associations of these adverse outcomes with morbidity and mortality, providing (nonpharmacologic therapies) to service members with chronic pain could potentially save lives.”

I’ve been hearing this crashing tidal wave coming. It’s not here yet. But the roar is approaching and it sounds like sweet sweet music to me ears. 

Item #2

I’m going to do everything I can to boil this sucker down and strip it to the bare bones without it getting too long or boring. This one is called “Evidence-based supplements for the enhancement of the athletic performance” by Peeling, et. al(Peeling P 2017). and published in the International Journal of Sport Nutrition and Exercise Metabolism in 2017. 

The authors wanted to put together a review focusing on the available evidence based for performance supplements commonly used in sports and summarizing the when’s and the how’s around their uses.

The ysay there is robust evidence that the following supplements can enhance sports performance when used according to established protocols. 

So let’s motor through this like poop through a goose, shall we?

  1. Caffeine -There exists a lengthy research history on caffeine supplementation across a range of performance protocols, including endurance-based situations, resistance training exercise, short-term supramaximal efforts, and/or repeat-sprint tasks. Reported benefits of caffeine include benefits include adenosine receptor antagonism, increased endorphin release, enhanced neuromuscular function, improved vigilance and alertness, and a reduced perception of exertion during exercise. Low to moderate doses of caffeine (∼3–6 mg/kg BM), consumed 60 min pre exercise, appear to have the most consistent positive outcomes on sports performance in research situations, although a variety of other protocols (as mentioned above) also appear beneficial, and are practiced in real-life. Of note, athletes who intend to use caffeine as a performance aid should trial their strategies during training or minor competitions, in order to fine-tune a protocol that achieves benefits with minimal side effects.
  2. Creatine – widely-researched supplement, with creatine monohydrate (CM) being the most common form used. Creatine loading can acutely enhance the performance of sports involving repeated high-intensity exercise (e.g., team sports), as well as the chronic outcomes of training programs based on these characteristics (e.g., resistance or interval training), leading to greater gains in lean mass and muscular strength and power. When accepted creatine monohydrate supplementation protocols are followed, the expected increase in intramuscular creatine stores is likely to enhance lean mass, maximal power/strength, and the performance of single and repeated bouts of short-term, high-intensity exercise.
  3. Nitrate –  The authors say Nitrate is a popular supplement initially found to improve oxygen uptake kinetics during prolonged submaximal exercise. Great sources are Leafy green and root vegetables (i.e., spinach, rocket, celery, beetroot, etc.
  4. Beta-Alanine – The paper says this is one of the immediate defenses against the accumulation of protons in the contracting musculature during exercise. I can also tell you that this is just something I never nerded out on. Lol. Not my cup of tea but I like to offer something for everyone here at the Chiropractic Forward Podcast. They say it can improve tolerance for maximal exercise bouts lasting 30 s to 10 min and provide small yet significant benefits in both continuous and intermittent exercise tests. Basically, it’s used in order to augment high-intensity exercise performance ranging from 30 s to 10 min in duration.
  5. Sodium Bicarbonate – benefits are generally seen in short-term, high-intensity sprints lasting ∼60 s in duration, with a diminishing return as the effort duration exceeds ∼10 min. However, greater benefits may be realized (>8% improvement) with a greater number of repeated sprint bouts

Go to our show notes at chiropracticforward.com if you’d like to get dosing information and all the little technical tidbits. It’s really interesting. Even to an orthopedic guy like me although, its technical enough to make my eyes glaze over as well. 

There are several others listed in the paper as well but the authors point out that the evidence for their effectiveness is much less clear. They are Sodium citrate, Phosphates, and Carnitine.

Even though that stuff is not my cup of tea, it’s good to know, it’s good to have as a reference, and it’s good to pass on to you because many of you actually do nerd out on that stuff and thank God for that. That means I can call people like you and ask what the hell. On the other hand, if it’s something I nerd out on like orthopedics, you can call me and say what the hell?

Store

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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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About the Author & Host

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

Bibliography

Devitt M (2020). “Nonpharmacologic Therapies Can Improve Chronic Pain Outcomes Reductions in Drug Misuse, Suicide Attempts Reported.” AAFP.

Peeling P, B. M., Paul S, (2017). “Evidence-based supplements for the enhancement of athletic performance.” IntJ sport Nutrition Exercise Metabolism 28(2): 178-187.

Thoughts on Chiropractic Groupon, Gabapentin, & Weight Loss Research

CF 105: Thoughts on Chiropractic Groupon, Gabapentin, & Weight Loss Research

Today we’re going to talk about some thoughts on Groupon and Chiropractic, if you know me, you probably know where this is going and it’ll probably be fun. We’ll find out. We’ll talk about Gabapentin and we will talk about a couple of papers I encountered recently having to do with metabolism, intermittent fasting, and things of that nature. 

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. So feel free to crack one wide open would you?

Welcome, 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. 

Do it do it do it. 

You have plopped down into Episode #105 just like a comfy easy chair. 

Now if you missed last week’s episode talking about our TWO YEAR wrap up, make sure you don’t miss that episode. It was a lot of fun to put together and to reminisce on some of the amazing episodes we’ve had over the past two years. Good good stuff. 

Something new I found out here…..Did you know that if you have an Alexa product, you can now just say something like, “Alexa, play The Chiropractic Forward Podcast on Apple Podcasts” and kablooey! 

You automatically start to hear the golden throated stylings of yours truly! Lol. You can say skip ahead 30 seconds, play previous episode, and on and on so pretty cool right there. 

On the personal end of things, we just found out that Dad started moving his left leg today for the first time and that’s exciting. It’s the first REAL solid sign of big progress since his first stroke on November 9th. As you can imagine, we are ecstatic about this. Good stuff. Keep on keeping on Pops. Strong like bull!

Before we dive into the reason we’re here, it’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you don’t take advantage of this deal, I just think you might be crazy.

If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!

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

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, 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**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

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

Item #1

Alright let’s dive in. We’ll save Groupon until the last because if I know me, it’ll be what I have the most to say out of all of these. 

Let’s start with Gabapentin shall we? The most recent article I’ve come across was in The Atlantic. It was authored by Olga Khazan and called ‘Chronic Pain Is An Impossible Problem’. It was posted December 9, 2019(Khazan O 2019). 

That’s got some sizzle on it!!

Some key points in the article are that 

  • Chronic pain affects about 1/5 of American adults
  • For years those in the medical field thought it could be treated with painkillers like Oxy but that was proven wrong when basically three planeloads of Americans started dying of opioid-related causes each week
  • Now, they’ve turned to Gabapentin, an anticonvulsant, to help treat it. 
  • From 2012-2016 prescriptions of the medication went up 64%
  • There is emerging information that Gabapentin may not be as safe as previously believed. Certainly when combined with other sedating meds. 
  • When taking it long-term, patients can develop tolerance so more and more is required to reach the desired effect. 
  • There is also a withdrawl effect when trying to get off of gabapentin. 
  • People are now starting to use Gabapentin in combination with Baclofen and benzos like Xanax to increase the intoxicating effect. We can see where that is going can’t we?
  • The article goes on to say, “not only does gabapentin appear to exacerbate or create overdose risk, it also doesn’t work well for chronic pain.” They site a study that we’ll cover in a second. 
  • The paper wraps up by saying they’re essentially out of option when it comes to chronic pain. Which to me says they’ve run out of pills basically. That doesn’t mean they’re out of options though. 
  • Arthur Robin Williams, an assistant professor at Columbia University says “The medical community should take a closer look at non-pill remedies such as physical therapy and psychotherapy…I would add evidence-informed chiropractic… These treatments are often not covered by insurance, take longer to work, and take more of providers’ time. But for many, they might be a better option than yet another pill that has yet another pathway to abuse. “The reality is, a lot of the pills that change how you feel in the next 10 to 30 minutes,” Williams says, “carry addictive liability.”

Well…..no kidding? Who would have ever thought that? Hmmm….let’s see. Oh yeah, every chiropractor and PT that ever lived. 

Let’s combine that with a systematic review and meta-analysis from just last year that was in the Canadian Medical Association Journal called “Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis”(Enke O 2018)

  • Nine trials compared topiramate, gabapentin or pregabalin to placebo in 859 unique participants. Fourteen of 15 comparisons found anticonvulsants were not effective to reduce pain or disability in low back pain or lumbar radicular pain. 
  • There was high-quality evidence of no effect of gabapentinoids vs. placebo on chronic low back pain. 
  • The lack of efficacy is accompanied by increased risk of adverse events from use of gabapentinoids, for which the level of evidence is high.

It is painfully obvious (no pun intended) that pills aren’t cure-alls and aren’t curing the pain problem. And they won’t sure the pain problem so isn’t it time to look elsewhere? In the year 2020?

All of this is cited in the show notes at chiropracticforward.com. Go get the article and the paper. Use it to educate your community on gabapentin. Set yourself as the reasonable alternative to it. 

Item #2

Fasting and weight loss. I want to be right up front on this, I’ve always wanted to make nutrition and weight loss a part of my practice in some shape form or fashion but, if I’m being honest, I’m just straight up a big big dude. Like I’m 6’4” and, depending on the time of year, 280+. I was a college offensive lineman. I played center and i anchored that line pretty well with my overall biggness. Lol. 

Cat-like reflexes people but big as a damn house. So, I’m not going to teach you how to implement weight-loss into your practice here but I am going to give you some interesting research I cam across recently that might make you think a bit. 

The first paper on this is called “Effects of time-restricted feeding on body weight and metabolism. A systematic review and meta-analysis”. It was published in Reviews in Endocrine and Metabolic Disorders, authored by P Marianna, C Iolanda, et. al. and published December 2019. (Marianna P 2019)

Hot to the touch. It’ll burn your  damn finger prints off. 

Why They Did It

Restriction in meal timing has emerged as a promising dietary approach for the management of obesity and dysmetabolic diseases. The present systematic review and meta-analysis summarized the most recent evidence on the effect of time-restricted feeding (TRF) on weight-loss and cardiometabolic variables in comparison with unrestricted-time regimens.

How They Did It

  • A total of 11 studies, 5 randomized controlled trials and 6 observational, were included
  • All selected studies had a control group without time restriction
  • Most studies involved the Ramadan fasting

Wrap It Up

Time restricted feeding regimens achieved a superior effect in promoting weight-loss and reducing fasting glucose compared to approaches with unrestricted time in meal consumption. 

As we’ve covered, systematic reviews and meta-analysis are, ideally, high-level research and, considering the majority of the included studies involved the Ramadan fasting regimen, I went to search it up to see what the what. 

So, what exactly is a Ramadan Fasting Regimen? Well let me tell you. And I’m not going for the fancy stuff because I’m tapped for time here so we’re just going to hit up Wikipedia real quick and Wiki says that the basics are:

  • Fasting from sun up to sun down
  • Abstinence from sex, food, and drink
  • It also means one should refrain from things like
  • violence
  • anger
  • envy
  • greed
  • lust
  • angry/sarcastic retort
  • gossip
  • and you’re supposed to get along with others better than you normally do

In America at least, I’m certain we’ll all just do the food part because everyone’s so busy looking for a reason to be offended that I’m certain being nice and getting along is off the table for now. 

So, if you have any personal experience with intermittent fasting, if you’re an expert on the topic, shoot me an email at dr.williams@chiropracticforward.com Let’s talk about it. Maybe we can set up some guests and do a full episode or two on the topic to educate our community of docs on the matter. Sounds like a great topic so hit me up. 

Now, the last thing I have here I want to talk about is Groupon. 

This one is a bit of a trigger for me honestly. Looky here. I am well aware that people are struggling. I’m well aware that I am fortunate and to sit and judge can seem disconnected and unfair at minimum to some. I definitely get that. 

What I also understand is that a whole bunch of those that are struggling are in a profession they really shouldn’t be in because they’re lazy and want to sit behind their desks and hit a few buttons and be magically transformed into a master chiro with an office stocked full of patients and never ending new patients. 

That’s magic time dreamland stuff. 

There will always be supposed shortcuts. There will always be business hacks or whatever you want to call them. But at the end of the day, shouldn’t you make decisions while keeping several things in mind? Meaning, you have to do what is best for your family. You have to do what is best for your office and your employees. But don’t you feel like you should make decisions based on what is best for your profession and for your colleagues?

I would hate to think that I’ve done something that damages my profession . Obviously I don’t mind calling out BS business practices and unethical chiropractors. If that’s damaging my profession well then, I’m guilty as hell. 

But when you are making the deals some of these guys and gals are making on Groupon, you are demeaning, lessening, and trashing what the rest of us take a great deal of pride in. 

Imagine, you go through chiropractic school, you survive 21+ years in practice while steadily getting more and more education, you take on a Diplomate program and finally complete that, and you are fighting on the state level for your profession and your profession’s image…..and then you open your email. 

Yes, I get emails from Groupon with their best and newest deals. I open it up and BAM….It almost seems like all of that work can just be flushed down the toilet. It’s depressing and it makes me want to club baby seals. 

Before we start talking about the article, I did a quick search for Groupon deals in my area and, right there next to Reflexology deals popped up this:

  • 10% cash back – Sounds like a damn car deal
  • Consultation, exam, x-rays, adjustment, and one full-body vibration plate session for $70. Way to value your services. Great. Way to look awesome. Assuming they actually need vibration plate. Assuming they actually need x-rays, assuming they even need and adjustment. Blah
  • Then this one, it’ll make you tickle – One laser lipo session w/ two vibe plate sessions for $45. See…..in Texas, you can only have laser lipo if you’re trying to increase function. Not just look better. So, that’s not necessarily legal as this implies to me it’s for looks. Unless they have a medical director and I’m here to tell you they do not. 
  • When you go to the bigger cities, it only gets worse. I found a $564 value for only $43.70!!! What a damn deal!!!

It’s all just shady and sketchy. Luckily, there are only two in my area doing this stuff. And if they keep it up, we may have two less competitors here as well. 

Besides the shady, street corner huckster look it so convincingly creates, it’s potentially illegal based on the idea of fee splitting, Medicare inducement, and dual fee schedules and, if the state boards start getting their acts together and going after this stuff, they will be the ones to go down. 

What started me down this path today was an article I came across called “Legal Implications of Chiropractic Groupons.” It was written and posted on the website for Carlson and Jayakumar – attorneys at law. I’ll have the link in the show notes. https://cjattorneys.com/legal-implications-of-chiropractic-groupons/

Highlight of the article include:

  • Each day, numerous chiropractors contract with Groupon and its competitors to sell certificates for adjustments, examinations, x-rays and massages. 
  • Despite the variety of services offered, these programs all have two things in common: (1) the chiropractor is offering a significant discount –92% in some examples, and (2) the chiropractor is sharing the income from each certificate sale – usually around 50% – with the website. While we are unaware of any state board taking action against a licensee for a Groupon-style offering, we believe these programs could create significant civil and criminal liability for chiropractors.
  • most states have rules prohibiting the offer or acceptance by a chiropractor of any commission, discount, or other consideration as compensation or inducement for referring patients, clients, or customers to any person, irrespective of the practitioner’s membership, proprietary interest or co-ownership in or with that person. I was once offered the opportunity to buy in to an imaging center here in town. As badly as I wanted to do it, I made the mistake of hiring two different attorneys for their opinions. BOTH advised against and this is exactly why. 
  • With Groupon, money is paid by the chiropractor to the website in connection with a patient’s referral. The chiropractor essentially, albeit indirectly pays the website per patient that purchases the certificate. At their base, these agreements require the chiropractor to pay the website for soliciting, referring and/or procuring clients not he chiropractor’s behalf. Stuff you’re not supposed to do and can get in a lot of trouble for. 
  • Medicare’s Anti-Kickback Statute criminalized the payment of kickbacks for patient referrals. Subsequent laws expanded it to all federalpay programs. Kickbacks include “any remuneration,” a very broad definition, which includes coupons. The Office of the Inspector General issued a “Special Fraud Alert” regarding advertisements offering “discounts” given to Medicare beneficiaries. Then a “Special Advisory Bulletin” appeared on offering inducements to Medicare beneficiaries. Essentially, it said a provider could not offer a patient anything worth more than $10, and combined $50 in a year for multiple gifts.
  • Groupon-style deals are unadvisable as they may pose problems with insurance companies. Most insurance policies will not pay for any charges that would not have been made in the absence of insurance. Groupon offerings, which almost always charge a lower fee to the purchaser versus insured patients, could be viewed as creating a “dual fee schedule.”  Insurers believe dual fee schedules constitute fraud and over billing. Some argue that Groupons are merely a version of a prompt-payment discount. While California law expressly permits prompt-payment discounts, such discounts must be reasonable. Given the extreme nature of the discounts typically offered by Groupon and its competitors, such certificates likely would not fall under the prompt-pay exception.

They conclude that “Given their widespread use, it seems unlikely that the Board of Chiropractic Examiners would discipline each and every licensee who engages or has engaged in Groupon-style offerings. That said, there may be a rash of “test case” or “example” disciplinary actions that follow. Eventually, we would expect the Board to adopt a regulation, or the Legislature to pass legislation, that explicitly either proscribes or prohibits the use of these deals. In the meantime, we recommend that chiropractors abstain from these types of marketing campaigns….”

I couldn’t agree more with them. 

When I opened up a new place h ere in Amarillo, I printed flyers at Kinko’s and I walked from one business to another knocking on doors and meeting people and telling them about me and my new place. I marketed anyone that could send me business. For more on that, go back about 5 episodes and listen to our episodes called Big Ideas On Marketing Evidence-Based Practices. Link is in the show notes. 

You must know this just isn’t the way to go. Join BNI, join civic clubs, start working out at a gym and get tight with the managers and personal trainers, spend time volunteering, joint a running club if that’s your gig, combine those things with social media and a solid email list that you continue to build and work on. There are so many things you can do that are above the cuff. That are respectable and raise up you and your profession. 

Groupon isn’t one of them. It does exactly the opposite. It identifies those of us who are racing to the bottom of the barrel and dragging the rest of us down with them. 

If you’re doing Groupon, it’s my opinion that it’s time to stand up, stop doing it. Yesterday..if you catch my drift

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
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

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 us that patients can get good to excellent results for headaches, neck pain, back pain, and joint pain just to name just a few.

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

And, if the patient develops a “preventative” mindset going forward from initial recovery, we 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. 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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

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.

Khazan O (2019) “Chronic Pain Is an Impossible Problem A “safe” alternative to opioid painkillers turns out to be not so safe.” The Atlantic.

Marianna P, I. C., Andrea E, Valentina P, Ilaria G, Giovannino C, Ezio G, Simona B, (2019). “Effects of time-restricted feeding on body weight and metabolism. A systematic review and meta-analysis.” Rev Endocr Metab Disord.

Chiropractic Maintenance Care, Corticosteroid Shots, 11 Best Practice Recommendations

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

... continue reading.

w/ Dr. James Lehman (Pt. 2) – National Scope, Chronic vs. High Impact Chronic Pain, Coordinated Care/Medicaid, DACO to DIANM

CF 097: w/ Dr. James Lehman (Pt. 2) – National Scope, Chronic Pain vs. High Impact Chronic Pain , Coordinated Care/Medicaid, DACO to DIANM

Today we’re going to be talking with Dr. James Lehman. This is Part Two of the interview. If you are just now joining us and did not get to hear Part One, make sure you do so. When Dr. Lehman speaks, you don’t want to miss a word. We’re going to cover topics like implementing a national scope of practice, chronic pain vs. high impact chronic pain, and topics like should a chiropractor own rural healthcare clinics and chiropractors working in coordinated care and medicaid integrated settings. 

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 and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. We’re not the stuffy, high-brow kind of research. It’s like we’re talking about research over beers. Which is NOT like talking about research in a classroom or an institution of some sort. Accessible research if you will. I could be more professional but I’m not. 

Welcome, 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. We have a youtube channel and twitter too but those are the main things. 

You have collapsed into Episode #97

I always do a little update on my personal practice and life in the trenches. In the real world if you will. Instead of that, I want to say that last week, I was scrolling through my Facebook page and Dr. Lehman and I are friends on Facebook. 

I noticed a picture he posted laying in a hospital bed watching his beloved St. Louis Cardinals play on TV. 

It turns out that just last week, Dr. Lehman suffered a myocardial infarction. I normally wouldn’t mention this but, I figure if it’s posted on Facebook by the man himself, he’s OK with it. 

Anyway, the main reason I mention it is to ask you all to say a prayer for Dr. Lehman if you are the praying kind, which I most certainly am. If you are not, then please send some positive vibes, energy, or thoughts his way through the ether. Whatever it is, let’s give it to him because Dr. Lehman certainly has given us chiropractors a lot. 

Dr. Lehman, from what I can tell through Facebook and text, Dr. Lehman is doing well and on the mend. From me to Dr. Lehman, you have my prayers and thoughts and please get well my friend. 

Now, before we dive into this interview that we did a couple of weeks ago with Dr. Lehman, we have to pay the bills. 

If you don’t take advantage of this deal, I just think you might be crazy.

If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!

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

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, 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**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

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

Introduction of Dr. James Lehman

Now, let’s go ahead and get on with the reason we’re all here. Before we speak with Dr. James Lehman, I want to go through a little background information on him for you so you are well aware of who he is and where he is coming from. 

Dr. James Lehman is an Associate Professor of Clinical Sciences at the University of Bridgeport/College of Chiropractic and Director of Health Sciences Postgraduate Education (HSPED). 

Dr. James Lehman completed his MBA at the University of New Mexico and a doctorate in chiropractic medicine at the Logan College of Chiropractic in St. Louis, Missouri.

Dr. James Lehman is a board-certified, chiropractic orthopedist. He teaches orthopedic and neurological examination and differential diagnosis of neuromusculoskeletal conditions. In addition, he provides clinical rotations for fourth-year chiropractic students and chiropractic residents in the community health center and a sports medicine rotation in the training facility of the local professional baseball team. 

As Director, Dr. James Lehman developed the three-year, full-time resident training program in chiropractic orthopedics and neuromusculoskeletal medicine. The program offers training within primary care facilities of a Federally Qualified Health Center and Patient-Centered Medical Home. While practicing in New Mexico, he mentored fourth-year, UNM medical students. We could go on and on. 

In your article, you include a section titled “Modernization of Medicare and Medicaid Coverage” which will lead us nicely into one of the main topics of our episode today. In this section you mention how Article 2706 of the Affordable Care Act is supposed to prevent discrimination against chiropractors but, for whatever reason, it hasn’t. I’ve been hollering about this through my position with the Texas Chiropractic Association for years. You talk about this a little in the article but…..why do you think nobody is forcing 2706 down people’s throats and what would it take to take a stand against insurance companies with 2706 as the basis?

OK, coordinated care and Medicaid: a topic you are very knowledgeable. In fact, we have discussed the integration of chiropractors into the FQHC’s around the nation. FQHC, for those that don’t know means Federally Qualified Health Centers. One of our former podcast guests is Dr. Kris Anderson from North Dakota who just happens to be the first in his state to work in an FQHC. 

Can you tell us more about coordinated care and Medicaid and the initiative to get chiropractic care integrated more into that setting?

Alright, last on our list of things we must talk about is the topic you have done a ton of work on. I remember one of the DACO classes I had with you as the instructor. In the class, I recall you mentioning that we as a profession do not diagnose chronic pain syndrome nearly enough. It’s a big problem, and one I’ve become more and more engaged in through the DACO program, so let’s dive into the topic of Chronic Pain Syndrome vs. High Impact Chronic Pain. 

I’m just going to turn it over to you on this. The way I want to start is for you to just tell us what you think we as a profession need to know and we can take it from there.  Chronic pain is a huge topic that really can be it’s own year long topic of chiropractic forward podcasts. Chronic pain affects a huge number of patients.

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
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

w/ Dr. James Lehman (Pt. 1) – National Scope, Chronic vs. High Impact Chronic, Coordinated Care/Medicaid, DACO to DIANM

Today we’re going to be talking with Dr. James Lehman. Yes, THE Dr. James Lehman and we are fortunate to have him with us. The experience and the common sense Dr. Lehman brings to the table is immense and I can’t wait to dive into it today. We’re going to talk about national scope

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun and accessible while we make you and your patients better all the way around. Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have collapsed into Episode #96

Now if you missed last week’s episode on chiropractic and opioids, on anti-inflammatory diets, and on screen time for kiddos…. make sure you don’t miss that info. Go back and listen. I think there were some good information there within so make sure you’re up to date and not falling behind the rest. 

Advertisement

We can’t get started without mentioning the sponsor of the show, 

It’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you’re a regular listener of our podcast, you know I used it since about June of 2018. 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**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

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

Introduction of Dr. James Lehman

Now, let’s go ahead and get on with the reason we’re all here. Before we speak with Dr. James Lehman, I want to go through a little background information on him for you so you are well aware of who he is and where he is coming from. 

Dr. James Lehman is an Associate Professor of Clinical Sciences at the University of Bridgeport/College of Chiropractic and Director of Health Sciences Postgraduate Education (HSPED). 

Dr. James Lehman completed his MBA at the University of New Mexico and a doctorate in chiropractic medicine at the Logan College of Chiropractic in St. Louis, Missouri.

Dr. James Lehman is a board-certified, chiropractic orthopedist. He teaches orthopedic and neurological examination and differential diagnosis of neuromusculoskeletal conditions. In addition, he provides clinical rotations for fourth-year chiropractic students and chiropractic residents in the community health center and a sports medicine rotation in the training facility of the local professional baseball team. 

As Director, Dr. James Lehman developed the three-year, full-time resident training program in chiropractic orthopedics and neuromusculoskeletal medicine. The program offers training within primary care facilities of a Federally Qualified Health Center and Patient-Centered Medical Home. While practicing in New Mexico, he mentored fourth-year, UNM medical students. We could go on and on. 

Welcome to the show Dr. James Lehman, it’s an honor to have you on the Chiropractic Forward Podcast this week. 

Let’s start with the topic that immediately impacts me. I have been telling our listeners for a year or more that I’m going through the DACO program. DACO stands for the Diplomate of the Academy of Chiropractic Orthopedists. Very recently, as in just a few weeks ago, I received notice that the designation has changed to DIANM which stands for the Diplomate of the International Academy of Neuromusculoskeletal Medicine. 

What was the impetus for the change and what all went in to making the decision, deciding on the name, and then moving forward with the decision?

You wrote an article recently that Dynamic Chiropractic published in their September 2019 issue. The title of it was “What Is Chiropractic? We Need A National Practice Act.” We are in a profession that seems to me to bristle at the idea of standardization. How has this article been recieved or is it still a bit too early to tell?

In the article, you say, “Limited Medicare and Medicaid scopes of reimbursement and individual state scope-of-practice restrictions reduce access to chiropractic wervices for patients in pain.” Can you explain how you think limited scopes reduce access and how a broader scope can help us? And how broad of a scope do you advocate for?

I would assume a national scope would be something the ACA would be in the driver’s seat for, which is something you mention in the article as well. Is this something the ACA is looking at? Other than resistance within our own profession, what hurdles would you see in the way of a national scope?

You say it’s not impossible to accomplish and offer 6 essential charactieristics which include:

  1. Chiropractic Physician designation. 
  2. The scope being determined by Doctoral and Post-Doctoral education, trainng and experience 
  3. Full management, referral and prescription authority commensurate with contemporary chiropractic education for patient examination, differential diagnosis, working diagnosis, and health assessment
  4. Full evaulation and management, referral and prescription authority commensurate with contemporary chiropractic education for the care and treatment of neuromusculskeletal and other health conditions or issues. 
  5. Full authority for the delivery of information, advice, recommendations and counseling regarding general health matters, wellness, and health optimization. 
  6. Full authority and adaptable requirements fo the management and training of health care teams and the participation in collaborative or integrative health care groups. 

When I read through that list, does anything jump out at you as being particularly radical or provocative to some chiropractors?

In your article, you include a section titled “Modernization of Medicare and Medicaid Coverage” which will lead us nicely into one of the main topics of our episode today. In this section you mention how Article 2706 of the Affordable Care Act is supposed to prevent discrimination against chiropractors but, for whatever reason, it hasn’t. I’ve been hollering about this through my position with the Texas Chiropractic Association for years. You talk about this a little in the article but…..why do you think nobody is forcing 2706 down people’s throats and what would it take to take a stand against insurance companies with 2706 as the basis?

OK, coordinated care and Medicaid: a topic you are very knowledgeable. In fact, we have discussed the integration of chiropractors into the FQHC’s around the nation. FQHC, for those that don’t know means Federally Qualified Health Centers. One of our former podcast guests is Dr. Kris Anderson from North Dakota who just happens to be the first in his state to work in an FQHC. 

Can you tell us more about coordinated care and Medicaid and the initiative to get chiropractic care integrated more into that setting?

Alright, last on our list of things we must talk about is the topic you have done a ton of work on. I remember one of the DACO classes I had with you as the instructor. In the class, I recall you mentioning that we as a profession do not diagnose chronic pain syndrome nearly enough. It’s a big problem, and one I’ve become more and more engaged in through the DACO program, so let’s dive into the topic of Chronic Pain Syndrome vs. High Impact Chronic Pain. 

I’m just going to turn it over to you on this. The way I want to start is for you to just tell us what you think we as a profession need to know and we can take it from there. 

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
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Big Discs Can Disappear, Chronic Pain & Chiropractic Success, The First Week Says A Lot About The Fourth

CF 093: Big Discs Can Disappear, Chronic Pain & Chiropractic Success, The First Week Says A Lot About The Fourth

Today we’re going to talk about the resorption of lumbar disc herniations (Hint: lots of the big ones don’t need surgery at all!), we’ll talk about chronic low back pain and the success of chiropractic, and we’ll talk about how, after the first visit, you might can tell how well your patient is going to do in the long-term. 

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 and accessible while we make you and your patients better all the way around. Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have tippy-toed quietly into Episode #93 and I do appreciate your keeping it down for me. I’ve been a little tired here lately. 

Now if you missed last week’s episode on the history of chiropractic, you need to  make sure you don’t miss that. It was really fun episode to put together. Especially for a history junkie/nerd like myself. I believe here recently September 18 to be exact, it was the anniversary of DD Palmer inventing chiropractic. We talked a little about whether he invented it or borrowed it or whatever. We talked about that in that episode. Pretty interesting. 

Other more recent episodes you need to be aware of would be the Closing Patients episode. Go learn more about that garbage please. It’s important. 

Also waaaayyyy back (old man river) episode 13 was on Debunking the Myth that chiropractors cause strokes. Enough of that trash. It’s not true and you need to know why, how, when, and how to tell others that it’s bunk info. 

For you older chiros, bunk means bad info. 

One other I think new listeners should go back and find would be about 6-8 weeks ago, episode 90 I believe. It was our mini-class basically on Decoding Chronic Pain. What priceless info. It’s like you went to a seminar and got all of the information for free straight from Dr. Anthony Nicholson. He’s crazy smart. 

Or the way they say it in Boston….he’s wicked smaht. 

I’m currently getting ready to head to St. Louis for the Forward ’19 seminar. It’s all a part of the FTCA Facebook Group and website group. By the time this episode airs, it will already have come and gone but you know I’ll tell you all about it next week. 

I’m looking forward to meeting a lot of the folks from the group that I see interacting with each other all of the time. I’m looking forward to networking and bouncing ideas off each other as well. 

There may be some cocktails in the mix as well so, you know, there’s that too. 

I’m still going through the DACO studying. I have part II coming up on November 9th. Wouldn’t it be nice if you could just get a Diplomate because you took all 300 hours and passed all of the tests and quizzes along the way? 

If you ask the older guys that did the DABCO several years ago, they’ll tell you I’m whining and I need to just shut up because they had it way worse. And you know what? They’d be right. They DID have it way worse. Still, I have a very busy practice, I have a 47 year old brain that doesn’t retain the amount it once did, and I’ve been studying for the part I and the Part II during my free time since probably May. And you know what? I’m tired of studying. Lol. 

I’m ready for it to be over and done with. Geez. Stress, studying, sustained over a long period of time….there’s absolutely a reason that we don’t have a large number of doctors getting the specialization diplomates. It’s carried out over too long of a period. But that’s just fussing. The hours of actual class have been amazing learning. I have stood under the niagara falls of knowledge nuggets people. I swear. 

I’m all in. I’m ten times better than I ever thought I was and for some things, I thought I was pretty put together. I spent a lot of years putting together and taking apart different aspects of a low back exam. I was already coming into it very much up on lumbar differential diagnosis. I’m still better than I was. 

I knew jack squat in regard to the shoulder compared to what I now know. Same goes for the hip, knee, and on down the line. 

If you need some help getting some info and starting down the track of that Ortho Diplomate, let me know. Send me and email at dr.williams@chiropracticforward.com and I’ll be glad to do what I can to get you going. 

We’ll get to the paper on whether discs can resorb in just a sec but first, It’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you’re a regular listener of our podcast, you know I used it since about June of 2018. 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**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

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

Item #1

https://www.ncbi.nlm.nih.gov/pubmed/28072796/

Let’s start the research part of the show with one called “Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis” by M Zhong, JT Liu, H Jiang, et. al(Zhong M 2017). and published in Pain Physician in 2017. Not new enough to play the Hot stuff sound byte and not old enough to sing old man river to you. Just somewhere in between so we’ll just play some random sound byte for you here. Lol. 

You know me…..heavy on the entertainment part here. 

Anyway, here’s Why They Did It

the wanted to analyze the incidence of spontaneous resorption after conservative treatment of low back discs using CT and MRI imaging. 

How They Did It

This paper was a meta-analysis, meaning they took information from a whole bunch of previously done papers and compiled the best information that could be extracted from them to come up with their findings. 

They used a search of the literature from 1990 all the way through 2015. That’s 15 years for those of you that didn’t take mathematics in school. They used very common databases called PubMed, Embase, and the Cochrane Library to find these papers for inclusion. 

What They Found

The overall incidence of spontaneous resorption was 66.66%. Oddly enough they say that the incidence in the UK was a whopping 82% while in Japan it was only 62%. What the hell gives there? I’m not worldly enough to know the significant differences in lifestyles of those two countries to figure out why that would be. Maybe one of you world travelers can offer us some suggestions. Email me. I’d love to hear it. 

Wrap It Up

Wrapping up this paper the authors conclude, “The phenomenon of LDH reabsorption is well recognized. Because its overall incidence is now 66.66% according to our results, conservative treatment may become the first choice of treatment for LDH.”

Now what do I personally know about this? I know that was your next question that was just on the tip of your tongue so I’m going to answer it for you. 

We know, and this comes through the DACO teaching, that a couple of things can give you  clue to whether or not a herniation will eat itself. That sounds like will ferrell doing harry carry on saturday night live. If you were a hot dog….would you eat yourself? I know I would. Lol. 

Anyway….Lord help me. Anyway, a couple of things:

The make up of the herniation

The extent of migration

If there has been endplate damage / modic changes, with that, you might see some trash or garbage inside the herniation on MRI. It may look speckled. When it looks speckled, it is more stubborn and less likely to go away on its own.

On the other hand, if it’s made up of more nuclear material, it’s smoother in appearance and more likely to be able to be reabsorbed. 

On top of that, when a herniation has more than a 4mm migration, it’s further out there and the body is more likely to recognize it as an issue and more likely to do something about it by breaking it down and getting rid of it. 

This is EXCELLENT news for people with these big discs that you may have at one time thought were most certainly surgical. I used to think they were. I think a lot of surgeons probably still think they are. But not all of them are. That’s a researched fact at this point. 

Item #2

https://www.ncbi.nlm.nih.gov/pubmed/12214186/

This one is called “Can patient reactions to the first chiropractic treatment predict early favorable treatment outcome in persistent low back pain?” by I Axen, A Rosenbaum, and T Wren, et. al. and was published in Journal of Manipulative Physiological Therapeutics in 2002(Axen I 2002). Old Man River….

Why They Did It

To investigate whether 3 distinct patterns of reactions to chiropractic care predict early favorable treatment outcomes in patients suffering persistent low back pain. 

What They Found

OF the 115 patients int eh most favorable prognostic group, 84% reported to be definitely improved but the 4th visit vs. 63% of the 384 in the intermediate group, and 30% of the 116 in the least favorable prognostic group. 

Wrap It Up

“Among chiropractic patients with persistent low back pain, it is possible to predict which patients will report definite improvement early in the course of treatment.”

Basically, if you’re getting good response in the first week or so, game on. That patient is likely to have an excellent outcome. 

On to the paper on chronic low back pain patients being referred form a spine surgeon it just a second. Let’s try our best to pay the bills first. 

Let’s talk about GoChiroTV. GoChiroTV is a patient education system for your office that actually saves you money. Instead of spending money on cable TV or looping a DVD over and over in your lobby, the bite-sized videos are specifically made to inform your patients about the importance of chiropractic, healthy living, and to encourage referrals while, at the same time, presenting the benefits of all of the different products and services that you offer. Specific to your office.

That’s right. It works by using a tailor-fit video playlist that only promotes the products and services offered in your specific practice. Not only that but the videos are updated automatically on a weekly basis so there’s no need to manually update your playlist AND you don’t have to learn any complicated software. You get to just set it and forget it. And don’t we busy doctors need just that?

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.

Go visit GoChiroMedia.com to check out the demo reels and get started on your free trial.

Item #3

https://chiromt.biomedcentral.com/articles/10.1186/s12998-018-0225-8

This last item is called “An observational study on trajectories and outcomes of chronic low back pain patients referred from a spine surgery division for chiropractic treatment” by Brigitte Wirth et. al. and it was published in Chiropractic & Manual Therapies in 2019(Wirth B 2019). There it is fresh outta the oven and slapped on your plate for gobblin’ purposes. 

Why They Did IT

The aim of this study was to describe the trajectories and outcomes of patients with chronic LBP referred from the spine surgery division to the chiropractic teaching clinic.

How They Did It

  • The patients filled in an 11-point numeric rating scale (NRS) for pain intensity and the Bournemouth Questionnaire (BQ) (bio-psycho-social measure) at baseline and after 1 week, 1, 3, 6 and 12 months.
  • The Patient’s Global Impression of Change (PGIC) scale was recorded at all time points apart from baseline
  • The data was analyzed using linear mixed model analysis and repeated measures ANOVA

What They Found

  • Between June 2014 and October 2016, 67 participants (31 male, mean age = 46.8 ± 17.6 years) were recruited, of whom 46 had suffered from LBP for > 1 year, the rest for > 3 months
  • At baseline, mean NRS was 5.43 and mean BQ was 39.80 points
  • NRS significantly decreased to 4.05 after 12 months but a significant reduction was not observed BEFORE 6 months after treatment start. So….it took time to see the difference. But don’t a lot of our evidence-informed crowd give you the poo face stink eye if you see patients more than just a couple of weeks? Food for thought judgy judgers!!
  • Now, the Bourneouth Questionnaire – it significantly diminished to 29 points after 12 months and showed a significant reduction in just the first month after treatment started. 
  • Also, the proportion of those showing overall improvement significantly increased from 23% after 1 week of treatment up to 47% after 1 month of treatment. 

Wrap It Up

“Chiropractic treatment is a valuable conservative treatment modality associated with clinically relevant improvement in approximately half of patients with chronic LBP. These findings provide an example of the importance of interdisciplinary collaboration in the treatment of chronic back pain patients.”

That’s some great info right there folks. Ingest it. Roll it around. Not everyone on Facebook has all of the answers. Not even your mentors have ALL of the right answers. We all have to find our own way don’t we? I know I did. 

And we all have to keep learning. Neuroplasticity is real. We keep learning. We keep growing and hopefully we keep altering our perception of what is and what can be. Research helps us do that don’t you agree?

This week, I want you to go forward with…..

Key Takeaways

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. 

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

  • Axen I, R. A., Robech R, Wren T, Leboeuf-Yde C, (2002). “Can patient reactions to the first chiropractic treatment predict early favorable treatment outcome in persistent low back pain?” J Man Physiol Ther 25(7): 450-454.
  • Wirth B (2019). “An observational study on trajectories and outcomes of chronic low back pain patients referred from a spine surgery division for chiropractic treatment.” BMC Chiro Man Ther 6.
  • Zhong M, L. J., Jiang H, (2017). “Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis.” Pain Physician 20(1): E45-E52.

Healthcare Of Old – Days Gone By

CF 090: Healthcare Of Old – Days Gone By

Today we’re going to talk about how healthcare has changed – gone are the days of this and gone are the days of that. And there will be plenty of room for me to spread some personality in there too. If you’re a regular listener, you know I’m never lacking an opinion. 

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 and accessible while we make you and your patients better all the way around. Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have collapsed into Episode #90

We can’t get started without mentioning the sponsor of the first half of our show, 

Let’s talk about GoChiroTV. GoChiroTV is a patient education system for your office that actually saves you money. Instead of spending money on cable TV or looping a DVD over and over in your lobby, the bite-sized videos are specifically made to inform your patients about the importance of chiropractic, healthy living, and to encourage referrals while, at the same time, presenting the benefits of all of the different products and services that you offer. Specific to your office.

That’s right. It works by using a tailor-fit video playlist that only promotes the products and services offered in your specific practice. Not only that but the videos are updated automatically on a weekly basis so there’s no need to manually update your playlist AND you don’t have to learn any complicated software. You get to just set it and forget it. And don’t we busy doctors need just that?

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.

Go visit GoChiroMedia.com to check out the demo reels and get started on your free trial.

We have some great stuff this week. It’s a short week due to Labor Day so this episode may run a little short and that’s OK. I try to not get too long winded. I think I went on about 45 minutes when we talked about Closing Patients two episodes ago.

But, a little gripe session never hurt anyone. If you’ve ever wondered whether Closing patients is right or wrong, get my take by going and listening to episode #88. I lay it out pretty clearly there. 

And don’t forget, last week’s podcast about Fibromyalgia. New info on fibro and treatment. Good stuff there in episode #89

Item #1

I want to start with an article that kind of struck me as…..huh….interesting. It’s called ‘The Old Days of Medicine Are Gone” by Michael Weiss(Weiss M 2019) and it was published in MedPage Today on January 17, 2019. Hot potato, heads up now. 

Weiss is a cardiologist and I have cited this article in the show notes over at chiropracticforward.com. This article refers to medical doctors specifically but there are a lot of parallels that we doctors of chiropractic can relate to. 

The article starts by saying that in the last 5-6 years, physicians have become less and less powerful. So have their patients. This disempowerment is due to a lot of things according to this article. Chief among them are:

  • Health management organizations
  • Managed care and 
  • The insurance exchange

Mr. Weiss says that all of these factors have taken power from the doctors and put the power into the hands of the large insurance companies and in the hands of the government. Well, that’s been going on for at least a generation. 

I remember a pencil pusher with an insurance company several years ago, a person who doesn’t have any kind of degree other than following prompts on a computer…..I remember them telling me how to treat a patient. What they needed. How many times….I was stunned. I will just say that I had a strongly worded conversation that I’m certain went in one ear, bounced around in that dude’s empty noggin, and fell out the other without making any impact. 

But I remember thinking, we are allowing insurance companies, the guys with a financial stake and a financial bias, we are allowing these people to tell us how and when to treat patients when they’ve never seen them in their lives. These patients are just numbers on a page to these companies and they’re going to tell us how to treat them. 

Same goes for the government. Whether it’s a popular opinion or not, makes not one damn to me. I’m going to tell you that when you put all of your healthcare decisions in the hands of one big fat, red-taped fat bureuacratic entity that has already screwed up Medicare and Social Security for no reason at all, due to both sides of a messed up aisle, well, you are once again numbers on a page and sometimes you get what you deserve. Of course that doesn’t mean everything’s peachy and we don’t need some changes to the healthcare system. We most certainly do. Universal healthcare medicare for all though…..I don’t see how that is the solution. Again, one fat, slow, dumb entity that has a history of screwing up big programs isn’t what I personally want making all of the healthcare decisions for me and my family but to each their own. 

Getting back to the article, Mr. Weiss says this physician disempowerment was basically a money grab on the parts of these powers and on the part of the pharmaceutical industry. Well…..of course. I think all that goes without saying doesn’t it? But I’m glad someone is indeed actually saying it. We should be shouting it out loud but, will it change anything? Politicians won’t do anything about it when big pharma is in their pockets and they’re scared of the insurance companies. 

Anyway, he says that doctors’ incomes have been progressively on the decline for years. Can i get an ‘amen’ on that my people. Testify!!  He says this cash-strapped generation of physicians have been forced out of private practice into working for hospitals and huge conglomerates and that gone are the days of Wednesday off for golf, gone are the days of being called a doctor rather than a provider, gone are the days of being respected, gone are the days when patient’s would say “But what does the doctor say?” rather than “Will the insurance pay?”, gone are the days when a physician could direct care they deemed necessary. Even the prescription pad is becoming useless since insurance doesn’t cover a lot of the scripts written these days. 

He says gone are the days when a physician could sit down and perform a detailed and thorough examination. Instead, we have be busted down to being typists, chaotic clerks, mindlessly clucking away at meaningless electronic health records benefiting only large entities. Hallelujah!! 

In order to make money these days, it has to be quantity and, unfortunately, quality many times suffers. For better or worse. When your income goes down, you see more to maintain the income you have built your life around. Quality of care suffers. Not intentionally. Nobody is morally corrupt typically. It’s just a natural consequence. You have bills to pay and you’ll figure out a way. 

Take a radiologist. They used to get about $35 for reading a neck series. Now, after Obamacare, they make $7-$10. I happen to know a radiologist very well so you can trust what I’m telling you. At least here in Texas. Could be different in your area. What happens when you income gets reduced by roughly 2/3 but you still have a big house and some extra toys you have purchased? 

Maybe you have a big garage sale and get rid of the extra fat? Ah hell no, that’s not what happens. Instead of 5 films read in 30 minutes you read 10. Think you might have an elevated risk of missing something? Of course you do. 

Back to the article….I keep getting side-tracked, he says gone are the days when a physician had the luxury of utilizing their skills of observation. He says now there are cookbook guides that have become the puppet masters of the physicians. I’d like to go on record right now, as part of a profession that has no standardization whatsoever…..I’m all for researched and evidence-backed guides. I love it. Give us some guides. Hell, don’t just give them to us, FORCE us to abide by them. Please? Lol. Just make sure they weren’t generated by a damn insurance company. That’s all. 

He says gone are the days of decent hospital stays and the days of when a patient could be cured of infections from a decent stay at the hospital. Now, he claims that patients are kicked out of the hospital early and take the buggies back to their community and spread them which leads to resistant buggies. I’d argue that commonly prescribing antibiotics when it’s a virus was problematic and the cause of a lot of resistance back in the day as well? He left that out oddly enough. 

He hit on a HUGE one when he says gone are the days of reasonable costs for a doctor visit or a drug co-pay. Now, since Obamacare, we see double and triple premiums, up to $100 co-pays, and double or triple deductibles. 

This sucker continues but, before I get to the rest of it, I need to talk about one of our amazing sponsors here at the show. It’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you’re a regular listener of our podcast, you know I used it since about June of 2018. 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**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

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

Back to the article, Mr. Weiss says gone are the days of visiting an ER and getting immediate care as if illness is the priority. Instead, we gotta get that co-pay covered first. 

He claims the days of physicians not having to worry about a patients insurance are gone. But…haven’t those days been gone since the 80’s or so? Honestly? That’s not something new. He says though that the insurance companies have encouraged minute clinics where the nurse pracs, and he says soon the pharmacists, will be giving the medical advice. 

He doesn’t seem to like this idea much but he’s OK with people waiting for hours to see a ‘physician’ because there aren’t enough of them. I’m pretty OK with nurse practitioners for the more mundane stuff. Plus, in my experience, NPs are more likely to refer to chiropractors for whatever reason. 

While Mr. Weiss is right to some extent, a lot of this is just whining in my opinion. The traditional physician doctor had their run with all of the power, the glory, and the golden ticket they cash when they get their medical degree. And, to an extent, they damn well still have a certain amount of power, glory, and golden ticket status. Although to a lesser extent currently. Admittedly. 

It’s one of the last quotes of the article that gets my goat a bit. He says, “Physicians’ voices have been drowned out, their plights buried, leaving their patients helpless,,,,”

Well freaking whaaaa Weiss. Yes, chiropractic has the status it has in healthcare right now because a certain portion of its practitioners refuse to progress. In fact, they work to inhibit any progress and cripple any efforts to expand the profession. Yep, it’s there and it’s undeniable but, when we talk about having voices drowned out, plights buried, and helpless patients, let’s go a little deeper. 

I’ve said it a million times but the medical field is going to look back on spinal fusions in 20 years and wonder what the hell they were thinking. I think I heard where lumbar fusion surgery has gone up 500+% in the last decade or so with little to zero hard stats that show any improvement in outcomes. 

Oh looky there, I see a herniation. Let’s cut that out and you should be good as new. We know so much more now. We know you can’t cut out pain. We know you don’t treat an image. You treat the patient in front of you because most of the time, there is little to no correlation between what you see on an x-ray and what the person’s pain generator is. 

We know now that chronic pain is mostly in the central nervous system. Not out in some peripheral part of the body. You cannot typically get rid of chronic pain by cutting something out. We know more and more now that it just doesn’t work that way. 

Yet, I feel confident promising you that right now, several fusions across the country are taking place. As I type this out. We also know that less than half of those fusion surgeries will be successful, right?

We know this stuff. Yet, they continue. Unabated. So, while I agree that insurance, the government, and the whole managed care concept have screwed up our healthcare system, I would say that physicians have played very key parts in their own downfall. Hello….opioid crisis anyone? Unnecessary surgery? Surgeries for the wrong candidates? Super bugs from overprescribing? Any of this ringing any bells? 

Have you heard the podcast called Dr. Death? Basically, a so called spinal surgeon down in Plano, TX maimed several patients and even killed several and the hospitals protected him and enabled him to keep hurting people over and over and over again. 

It’s not just insurance companies and big pharma that has cause any fall from grace. And let’s be clear, I don’t think there’s been a fall from grace. Go to a hospital and see the interactions. Everyone still defers very clearly to the physician and I don’t see that changing. It’s just now they have to work more, follow rules, and get paid less. I think that’s the big gripe. 

And to that I’d say, welcome to my world friend. Welcome to my world. 

But again, it’s not just the system. Medical doctors have done their part. And, as a chiropractor, I’d argue that part of that is they have largely ignored the American College of Physicians’ recommendations to try spinal manipulative therapy, exercise, massage, acupuncture, yoga, thai chi, and heat first for back pain. 

Those are the first-line recommendations and they are in concert with The Lancet papers on low back pain, the CDC, the FDA, the Joint Commission, The White House, and just about anyone else with any sense at all when it comes to non-complicated musculoskeletal pain. Yet, as I said, fusions are going on all over the country right now. As I speak. That’s when only 5% of back pain sufferers truly need surgery. 

When does someone truly need spinal surgery? When they hurt? Nope. Not usually anyway. Remember, you can’t cut pain out. Outside of an obvious case of a spinal fracture, tumor…..the bad bad stuff….I think it’s commonly accepted that surgery is necessary in a loss of bowel or bladder function, saddle anesthesia – cauda equina- type stuff, or a progressive neural deficits. 

So, if only 5% of back pain sufferers truly need surgery, why are so many still happening every day? After all of the research and after all of the updated recommendations?

Well, I’d say it’s financial. Get this, according to the American Medical Group Association’s Physician Compensation Survey says their research spine surgeons make $688,500 a damn year on average. 

Me personally, I’m doing pretty well in practice. But, it took me 16 years before I really started putting the pedal to the metal. Now part of that was my fault because I was traveling around playing music. Part of it was chiropractic’s fault because we have a system that eats its own. 

Either way, check this out, it took me 16 or so years to really build but, for an orthopedic surgeon, during the first two years of employment, bring in $400k and by their third year, $670k. Allied Physicians reported the maximum orthopedic spine surgeon salary was $1,352,000. 

Crazy. We have some chiropractors that make that kind of money but it’s not many and it’s not very likely. 

Anyway, I agree with some aspects of the article. Other aspects make me chuckle because, although it’s to a much lesser extent, physicians of our day are dealing with some of the things we’ve been dealing with for years and years. 

If we could just communicate with them the fact that we evidence-based chiropractors can play such a big part in helping them treat their patients and getting them back to work and back to life, I probably would have more sympathy. 

Hell, people come to us because we’re experts in what we do, because we are safe, and because we’re effective but, a large part of the medical field looks at us like stumbling idiots playing doctor and hurting our patients. While that may be true for some in our profession as well as for some in THEIR profession (hello Dr. Death), for the most part, we are all highly educated, highly capable doctors getting patients well. 

Maybe when they begin seeing us in that light, we start to see some sort of deeper, more meaningful integration. It’s started here and there in some pockets of awesomeness but not in general. It’s still a goal worth chasing. 

That’s assuming we chiropractors can get our of our own way. Otherwise, if I were a medical doctor, I wouldn’t want any part of something I could only explain as pseudoscience. I WOULD however be interested in a healthcare discipline that had the randomized controlled trials backing the meat of their modality. Count me in on that. 

And that’s the way I see it today. 

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. 

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

Weiss M (2019). “The old days of medicine are gone.” Medpage Today – KevinMD.com.

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**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

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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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

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.