Chiropractic Cost-Effectiveness & Early MRIs Lengthen Disability

CF 209: Chiropractic Cost-Effectiveness & Early MRIs Lengthen Disability

Today we’re going to talk about the cost-effectiveness of chiropractic and we cover how getting MRIs too early can lengthen the time of disability a patient goes through. Interesting stuff! But first, here’s that sweet sweet bumper music

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

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

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

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

You have found yourself smack dab in the middle of Episode #209 Now if you missed last week’s episode, it was our 4 year anniversary and round up episode. We covered the top ten all time listened to episodes from the 4 years and it was fun to reminisce. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

So on the personal side of things we are currently getting ready to have our official welcome reception for our nurse practitioner. And I thought I would talk about it briefly just to get your wheels turning about how you do internal marketing. We have done a lot of stuff to try to get the word out about our nurse practitioner. We started by making a list of all of the new services we would be adding and we had fire sitting all around the office. Every time I had a patient come in I would grab one and hand it to them and make sure that they knew what we had come up before he even started his first day.

We send out a weekly email to our patient base. You better believe they heard over and over and over again about the medical integration that was on the horizon. We just started a radio campaign. Somewhere in there we won best of competition in our city which has about a population of 300,000 or so. So that was a pretty big deal. Obviously, anytime I’m working on somebody and we have a conversation I am thinking about whether they need to be seeing our nurse practitioner at the same time.

If they have pesky trigger points I tell them about trigger point injections. If they’re fussing about being tired I tell them about hormone replacement or IV therapy. If I ask them if they have had a bone scan because it’s an older female and they say they don’t have a primary, boom they do now. I think you understand what I’m saying but that is the ultimate in internal marketing. We also have a sign at the front door saying make your appointment for our new medical services today. We also have another one in the lobby. We have hormone replacement banners in the rehab room. This is an ongoing thing. And, slowly, he’s getting busier Last week our nurse practitioner had about 28 to 30 appointments for the week. When he started out in August, obviously it was zero. Two weeks ago it was 18 or 19 appointments for the week. So we are getting there. I am also creating weekly blogs and corresponding YouTube videos and most of them right now I have to do with the Nurse Practitioner and the new services we offer.

And as a side note I have to say, it has been really nice to have another provider in the office. I can’t wait to be able to hire an associate to take over my day to day stuff. But in the meantime, if a case is being particularly pesky, it’s nice to be able to broaden my approach even further than before. If you don’t know much about my clinic, we have me, medical, exercise rehab, three massage therapists, acupuncture, and even an esthetician in the spa side of the building. We are fully integrated and a broad approach is the name of the game Medical was just the next logical step and though it was hard to get set up, we are well on our way now. Let’s be clear.

Still not profitable. But we’re no longer hemorrhaging. Mucho mejor mi amigos Outside of setting up the welcome reception this Friday, we are creating the FB event and inviting doctors and lawyers and any other potential referral source. I am experimenting with creating opt in lead pages with a trickle email campaign and a Google Ads, Facebook Ads, and Instagram ad campaign to lead them there.

Marketing is like treating pain. It’s a broad management type of thing. Hit it from all directions but whatever you do….you have to market. You can’t do business sitting in your ass as Dan Kennedy says. You can’t just be a doer of what you do. You have to be a marketer of what you do. Before we dive in, I want to thank ChiroUp for asking me to guest on their blog and video recently.

I joined Dr. Brandon Steele for a conversation on chronic pain and all the topic entails. It was an excellent talk and Dr. Steele and partner Dr. Tim Bertlesman are just top-notch examples of what chiropractors can be. I can’t say enough about both or them or ChiroUp. They’ve changed our profession for the better.  Alright, let’s get going with the research

Item #1

I first want to thank Dr. David Graber, our esteemed New Jersey-an colleague and contemporary for posting this study in the Forward Thinking Chiropractic Alliance group. He’s got a ton of great research. He’s on top of it all. Go look up Dr. Graber if you get a minute and add his professional page on Facebook. You won’t regret it. 

This first one is called “The association between use of chiropractic care and costs of care among older Medicare patients with chronic low back pain and multiple comorbidities” by Weeks et. al. (Weeks 2016) and published in the Journal of Manipulative Physiological Therapeutics

Why They Did It

The purpose of this study was to determine whether use of chiropractic manipulative treatment (CMT) was associated with lower healthcare costs among multiple-comorbidity Medicare beneficiaries with an episode of chronic low back pain (cLBP).

How They Did It

  • The authors conducted an observational, retrospective study of 2006–2012 Medicare fee-for-service reimbursements
  • The project included 72,326 multiply-comorbid patients aged 66 and older with cLBP episodes and 1 of 4 treatment exposures 
  • The exposures were chiropractic manipulative treatment (CMT) alone, CMT followed or preceded by conventional medical care, or conventional medical care alone. 
  • The researchers used propensity score weighting to address selection bias.

What They Found

  • The total and per-episode Medicare reimbursements during the cLBP treatment episode were lowest for patients who used CMT alone; 
  • These patients had higher rates of healthcare use for low back pain but lower rates of back surgery in the year following the treatment episode.
  • Expenditures were greatest for patients receiving medical care alone; 
  • Patients who used only CMT had the lowest annual growth rates in almost all Medicare expenditure categories. 

Wrap It Up

This study found that older multiple-comorbid patients who used only chiropractic manipulative therapy during their chronic low back pain episodes had lower overall costs of care, shorter episodes, and lower cost of care per episode than patients in the other treatment groups. Further, costs of care per episode were lower for patients who used a combination of chiropractic manipulative therapy and conventional medical care than for patients who did not use any chiropractic manipulative therapy. 

Item #2

Our last one here is called “The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis” by Shraim et. al.  and published in BMC Musculoskeletal Disorders in November of 2021…..sizzle…I can’t touch it. Because it is too hot for me to handle.  Why They Did It They start the abstract by saying that clinical guideline recommendations are against early magnetic resonance imaging  within the first 4 to 6 weeks of conservative management of acute low back pain (LBP) without “clinical suspicion” of serious underlying conditions. Otherwise known as red flags. 

There is some limited evidence that a significant proportion of patients with low back pain receive early MRI non- indicated by clinical guidelines, which could be associated with increased length of disability The aim of this systematic review was to investigate whether early MRI for acute low back pain without red flags is associated with increased length of disability. The length of disability was defined as the number of disability days (absence from work

How They Did It

  • Medline, EMBASE, and CINAHL bibliographic databases were searched from inception until June 5, 2021. 
  • Two reviewers independently assessed the methodological quality of included studies using the Newcastle-Ottawa scale and extracted data for the review. 
  • The search identified 324 records, in which seven studies met the inclusion criteria. 
  • Three of the included studies used the same study population.

What They Found

  • All included studies were of good methodological quality and consistently reported that patients with acute low back pain without red flags who received early magnetic resonance imaging had increased length of disability compared to those who did not receive early magnetic resonance imaging. 
  • Three retrospective cohort studies reported that the early magnetic resonance imaging groups had a higher mean length of disability than the no early magnetic resonance imaging groups ranging from 9.4 days to 13.7 days at the end of 1-year follow-up period. 
  • The remaining studies reported that the early magnetic resonance imaging groups had a higher hazard ratio of work disability when compared to the no early magnetic resonance imaging groups.

Wrap It Up

Early magnetic resonance imaging is associated with increased length of disability in patients with acute low back pain without red flags. Identifying reasons for performing non-indicated early magnetic resonance imaging and addressing them with quality improvement interventions may improve adherence to clinical guidelines and improve disability outcomes among patients with low back pain.

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     

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

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 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!


Send us an email at dr dot williams at 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. 


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.


Social Media Links

Chiropractic Forward Podcast Facebook GROUP




Player FM Link



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  


  • Shraim BA, S. M., Ibrahim AR, Elgamal ME, Al-Omari B, Shraim M (2021). “The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis.” BMC Musculoskelet Disord 22(1):
  • Weeks, W. B., Leininger, B., Whedon, J. M., Lurie, J. D., Tosteson, T. D., Swenson, R., O’Malley, A. J., & Goertz, C. M, (2016). “The Association Between Use of Chiropractic Care and Costs of Care Among Older Medicare Patients With Chronic Low Back Pain and Multiple Comorbidities.” J Manipulative Physiol Ther 39(2): 63-75.