Chronic Traumatic Encephalopathy (CTE)

Young Athletes With CTE & Catastrophizing, Fear Avoidance, and Pain

CF 322: Young Athletes With CTE & Catastrophizing, Fear Avoidance, and Pain

Today we’re going to talk about Young Athletes With CTE & Catastrophizing, Fear Avoidance, and Pain 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 giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
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You have found yourself smack dab in the middle of Episode #322 Now if you missed last week’s episode, we talked about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 9).  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things….. I’m recording on a Monday and we have the big West Texas Conference coming up this Friday for the Texas Chiropractic Association. It’ll be in Lubbock, TX so about an hour and 45 minutes south of where I’m at here in Amarillo.  I’ve paid for our Parker intern, Dontae, to come with. I think it’s up to the older folks to get the younger folks engaged in our state associations. If you listen long enough, in every podcast, at the end, I say that the ACA and our state associations need bus in the leadership positions if this profession is ever going to continue gaining integration into the system as a whole. If we’re ever going to achieve 1st or 2nd referral status for a non-complicated msk issue, we damn well better start behaving like part of the team instead of part of a fringe cult from outer space. 

Here’s a thought, hey clinic owners and lead doctors with associates, if you don’t require your associates to be a part of their state associations, you are absolutely, undeniably part of the problem. It’s as much Your responsibility to bring them up correctly as it is theirs to start getting involved in their profession.  Oh, I’m getting fired up this morning, damnit!! I’ve held enough positions in the TCA at this point that I’ve lost count and ever since my first year of involvement, our membership has been the issue. We have about 25% of our licensed DCs in the state of TX as actual members in the TCA. So, if we have 6,500 DC in the state, then about 1600 or so are members. Not active members. Just dues-paying members.

Minimal effort members, you might say. 

Consider that the state of TX has around 70,000 physicians and the vast majority are required to be paying members of their predatory state association. The official name is Texas Medical Association but we call them the Evil Empire.  Tell me…..how in the hell are 1600 chiropractors, of which only about 50 are actually active, supposed to turn the tide or battle effectively against an Evil Empire of approximately 60,000 or more? Then throw in lead chiropractors and clinic owners that are sitting on their asses not giving a squirt one way or another and not showing their associates how to give back to their profession and how to protect their rights?

Come on…..it’s almost too ridiculous to even talk about. Why do we have to say this stuff?  it’s disappointing and astonishing.  I sat in a Board Of Directors meeting many years ago. It cost us money to be there and cost us money to be out of our clinics to be there. Fighting an uphill battle that the majority of the DCs in the state don’t care about. It’s self-defeating. But one of my colleagues and friends said, “If not us, then who?” And then it’s OK. Fight the battles nobody else is willing to fight.

Get in, impose your will. Make sure evidence-based, patient-centered practice models are at the forefront of your state association’s initiatives and influence and get the crazy aliens off of the stages at your states continuing education conferences. 

Literally, about 20 people run your associations at any point in time. Hop in. One person can make a world of difference.  Raise your hand. Send an email. Just show up and be there. 

Item #1 Our first one this week is called “Neuropathologic and Clinical Findings in Young Contact Sport Athletes Exposed to Repetitive Head Impacts” by McKee et. Al and published in JAMA Neurology on August 28, 2023 and that’s blisterin’ hot!! Remember, the citations can be found at chiropracticforward.com under this episode. 

McKee AC, Mez J, Abdolmohammadi B, et al. Neuropathologic and Clinical Findings in Young Contact Sport Athletes Exposed to Repetitive Head Impacts. JAMA Neurol. 2023;80(10):1037–1050. doi:10.1001/jamaneurol.2023.2907

Why They Did It Young contact sport athletes may be at risk for long-term neuropathologic disorders, including chronic traumatic encephalopathy (CTE). They wanted to characterize the neuropathologic and clinical symptoms of young brain donors who were contact sport athletes.

How They Did It This case series analyzes findings from 152 of 156 brain donors younger than 30 years identified through the Understanding Neurologic Injury and Traumatic Encephalopathy (UNITE) Brain Bank who donated their brains from February 1, 2008, to September 31, 2022.  Neuropathologic evaluations, retrospective telephone clinical assessments, and online questionnaires with informants were performed blinded. Data analysis was conducted between August 2021 and June 2023.

Exposures  Repetitive head impacts from contact sports.

Main Outcomes and Measures  Gross and microscopic neuropathologic assessment, including diagnosis of CTE, based on defined diagnostic criteria; and informant-reported athletic history and informant-completed scales that assess cognitive symptoms, mood disturbances, and neurobehavioral dysregulation.

What They Found Among the 152 deceased contact sports participants included in the study, CTE was diagnosed in 63 (median age, 26 years).  Of the 63 brain donors diagnosed with CTE, 60 were diagnosed with mild CTE (stages I or II).  Brain donors who had CTE were more likely to be older  Of the 63 athletes with CTE, 45 were men who played amateur sports, including American football, ice hockey, soccer, rugby, and wrestling; 1 woman with CTE played collegiate soccer.  For those who played football, duration of playing career was significantly longer in those with vs without CTE  Athletes with CTE had more ventricular dilatation, cavum septum pellucidum, thalamic notching, and perivascular pigment-laden macrophages in the frontal white matter than those without CTE. 

Cognitive and neurobehavioral symptoms were frequent among all brain donors.  Suicide was the most common cause of death, followed by unintentional overdose; there were no differences in cause of death or clinical symptoms based on CTE status.

Wrap It Up This case series found that young brain donors exposed to repetitive head impacts were highly symptomatic regardless of CTE status, and the causes of symptoms in this sample are likely multifactorial. 

Item #2 Our second one this week is called, “Changes in pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy mediate changes in pain intensity on disability in the treatment of chronic low back pain” by Ryum et al and published in Pain Reports in September of 2023 and it’s hot to the touch!

Ryum T, Stiles TC. Changes in pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy mediate changes in pain intensity on disability in the treatment of chronic low back pain. Pain Rep. 2023 Sep 13;8(5):e1092. doi: 10.1097/PR9.0000000000001092. PMID: 37719924; PMCID: PMC10501475.

Why They Did It Treatment of chronic low back pain (CLBP) based on the fear-avoidance model (FAM) has received support in randomized controlled trials, but few studies have examined treatment processes associated with treatment outcome.  This study examined changes in pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy as mediators of the relation between changes in pain intensity and disability in exposure-based treatment of CLBP.

How They Did It Data from a randomized controlled trial with 2 treatment arms (which were the fear avoidance model with/without in-session exposure)  Change scores (pre to booster session) were computed for all variables, and the indirect effect of change in pain intensity on change in 3 measures of disability, through change in the proposed mediators, was tested in parallel mediation analyses.

What They Found Decreases in pain catastrophizing and fear-avoidance beliefs, as well as increases in pain self-efficacy, mediated a unique proportion of the relation between changes in pain intensity and disability, depending on the outcome measure.  The direct relation between changes in pain intensity and disability was absent when indirect effects were controlled.

Wrap It Up The results suggest that the way pain is interpreted (pain catastrophizing, fear-avoidance beliefs), as well as pain self-efficacy, are all more critical for reducing disability in exposure-based treatment of CLBP than symptom relief per se. You’ve been hearing this from you Ol’ Uncle Jeffro since about 2019 now. Since I went through the Diplomate of the Neuromusculoskeletal Medicine program. Which used to be called the DACO or the ortho diplomate.

It was the DACO when I started and changed in the middle of my education.  I wondered why but it became quickly apparent. There was as much Neuro in the process as there was ortho and yellow flags, upregulated CNS, fear avoidance and all kinds of Neuro tidbits were front stage. So, an ortho diplomate no longer adequately described what we were learning. 

Anyway, pay attention to this stuff. It will absolutely get your patients better when you understand it! Alright, that’s it.

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

Store Remember the evidence-informed brochures and posters at chiropracticforward.com. 

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website https://www.chiropracticforward.com Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter https://twitter.com/Chiro_Forward YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger