Disc Herniations

Disc Resorption & Pickleball Injuries

CF 300: Disc Resorption & Pickleball Injuries Today we’re going to talk about Disc Resorption & Pickleball Injuries.  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!

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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, look down your nose at people 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.  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, drive, smart, 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 educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s 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. 
  • Then go Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com
You have found yourself smack dab in the middle of Episode #300 Now if you missed last week’s episode , we talked about Colorectal Cancer In The Young & AI-Powered Chronic Pain Management. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. So let’s talk about unplanned time off. Because that’s when the he’ll happened to me last week. Holy cow my friends.  I got sick. And when I say sick, I mean really sick. I’m not talking about a man cold thing. I’m talking sick like maybe hospital kind of sick. Last week, I went to work on Wednesday feeling pretty damn poor. It only got worse through the day. By the end of the day, I was done. I was full blown sick and getting messy. I missed Thursday and Friday at work because I was out sick with a stomach bug. I do not cancel a day full of patients. Ever. So you know it’s serious when I cancel. Especially two days. You that are regulars here know that I commonly see 40 or so per day so I had to cancel 80 or so patients and I never take that lightly for personal as well as financial reasons. But let’s back up. When I say ‘stomach bug’, that seems to minimize what I’m now referring to as ‘The Incident’. What I really mean by ‘bug’ is a big alien Chuck Norris bug with a fu man chu and ninja stars that smells of Marlboros and diesel. I haven’t been that sick in 7 or 8 years. I almost went to the ER twice and seriously questioned if I’d ever eat any food at all again. Ever. I was thinking, “So….this is how it ends…I’ve had a good life….it’s been a pretty good run” I’ve had COVID three or four times and would take that over the alien Chuck Norris stomach bug any day. My stomach is still giving me little zingers and reminders of what we went through together every now and then but I’m mostly good to go at this point. Thank God.  I’ll share that an IV up at Creek Stone on Friday with heartburn and nausea meds added to it was very helpful. On a slightly related note; I’ve never had Pedialyte before ‘The Incident’ and, after three  or four gallons, I have to say……it’s actually pretty tasty and low calorie! 😎 So, this my recommendation based on personal first hand experience, if you are approached by an alien Chuck Norris bug with a fu man chu and ninja stars that smells of Marlboros and diesel, my advice is to go to the other side of the street and keep walking with your head down. Oh, and figure out a way to make the clinic run without your presence requires at all times. I’ve tried and I am trying. Trust me. I’m not a solo Chiro on purpose. You hear me advertise for an associate at the top of every show, right? Right. So, still considering hiring. Just have to get the right one. When it’s time, it’ll happen naturally.  Item #1 The first one this week is called “Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-analysis” by Zou et. Al. and published in Clinical Spine Surgery on July 31, 2023, and that’s a zinger! Why They Did It This study aimed to analyze the incidence of spontaneous resorption of lumbar disk herniation (LDH) after conservative treatment. How They Did It
  • We strictly refer to the standard established in the PRISMA (Preferred Reporting Items for a Systematic Review and Meta-analysis) statement, comprehensively searched electronic databases using the terms related to the spontaneous resorption of LDH. 
  • Two reviewers independently evaluated the potential studies, extracted, and analyzed the enrolled data.
  • Thirty-one studies with 2233 patients who received conservative treatment were included for this analysis.
What They Found
  • We found that the pooled overall incidence of disk resorption was 70.39%, 87.77% for disk sequestration, 66.91% for disk extrusion, 37.53% for disk protrusion, and 13.33% for disk bulge, respectively. 
Wrap It Up The existing evidence shows that the overall resorption incidence of LDH was 70.39%, the resorption incidence of ruptured LDH is higher than that of contained LDH. There are significant differences in the resorption incidence among countries. The resorption process mainly occurred within 6 months of conservative treatment. Before getting to the next one, Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office.  When you decide you can’t live without those products, send me an email and I’ll give you the hookup. They will 100% differentiate your clinic from your competitors. I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Item #2 “Pickleball injuries could cost Americans up to $500 million this year, analysis finds” by Megan Cerullo and published in Money Watch and CBS News on June 27, 2023, hot tamale! It’s an article so the high spots we shall hit.  The explosive growth of Pickleball in recent years is contributing to higher injury rates and health care costs, particularly among seniors, according to analysts at UBS. They estimate in a report that injuries related to pickleball could cost Americans between $250 million and $500 million in medical costs this year, mostly related to wrist and leg sprains and fractures. The investment bank was prompted to examine the issue after UnitedHealth Group, whose stocks the Wall Street firm covers, said that health care utilization rates have jumped in recent months among Medicare users. Sounds like a damn insurance company now doesn’t it? Trust me, the know the numbers. Which is stil stunning that they’re not requiring referrals to chiros for non-complicated msk pain. I bet it’s because so many damn chiropractors are crazy and doing non-evidence-based, doctor-centered care still. Just a guess.  Anyway, Over roughly the last three years the number of recreational players around the U.S. has soared 159%, from 3.5 million in 2019 to 8.9 million in 2022, according to data from the Sports and Fitness Industry Association. And the sport is poised for even faster growth. UBS analysts forecast that more than 22 million “Picklers,” as players are known, will be thwacking balls back and forth this year.  Seniors make up a third of the most avid players, according to the firm’s estimate, which defines that as people who whip out their paddles at least eight times per year. UBS analyzed this rapid growth, while also examining common pickleball-related injuries, to come up with its projection of medical costs directly attributable to sport.  Overall, UBS estimates that $377 million worth of medical costs in 2023 will stem from pickleball.  Roughly 80% — or $302 million — of the total relates to outpatient treatment in settings such as emergency rooms and doctor’s offices, the bank said. 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
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 – 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 Zou T, Liu XY, Wang PC, Chen H, Wu PG, Feng XM, Sun HH. Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-analysis. Clin Spine Surg. 2023 Jul 31. doi: 10.1097/BSD.0000000000001490. Epub ahead of print. PMID: 37559207. https://www.cbsnews.com/news/pickleball-injuries-will-cost-americans-up-to-500-million-this-year/    

Discs In Low Back Pain & Unnecessary Surgeries Via COVID

CF 292: Discs In Low Back Pain & Unnecessary Surgeries Via COVID

Today we’re going to talk about Discs In Low Back Pain & Unnecessary Surgeries Via COVID

 

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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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, look down your nose at people 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. 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, drive, smart, 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 educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s 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.
  • Then go Like our Chiropractic Forward Facebook page,
  • Join our private Chiropractic Forward Facebook group, and then
  • Review our podcast on whatever platform you’re listening to
  • Last thing real quick, we also have an evidence-based brochure and poster store at com

You have found yourself smack dab in the middle of Episode #292

Now if you missed last week’s episode, we talked about Racial and Ethnic Disparities In Chronic Low Back Pain & Pregnancy And Cannabis Use . Make sure you don’t miss that info. Keep up with the class.

On the personal end of things…..

Isn’t it funny how things work sometimes? I had something odd happened recently here in the clinic. We found out that our acupuncturist was moving to a different chiropractor’s office. She’s been with us for about eight years. What she’s credentialed through me to see veterans through our VA system.

So the VA randomly called us one day inquiring on her moving to another office and when that is happening, etc. Well, it was news to us. So we reached out to the acupuncturist and she admitted that she had plans to move but had not shared them with us yet. Although Amarillo Texas is about 225,000 people, there are only 3 acupuncturists in the entire area. It’s just not that popular here.

Although, it is definitely gaining in popularity. So the prospects of us being able to bring on another acupuncturist quickly are very slim. However, we went ahead and reached out to the one we really wanted to work with us. I have a good relationship with her, but things have just not worked out to where we could’ve actually worked together before. It turns out that she was tired of her current situation and was interested in making a move.

So she came in for an interview, we talked, and she was on board. We started the credentialing process with the VA that very day, so, while it takes 90 days to get credentialed, at this point, we are already almost a month into the process. That should significantly shorten the waiting period for our veterans to switch to a new acupuncturist and soften the landing.

Oh, in the meantime, if our previous acupuncturist, had any plans of stealing our patients, and taking them to a new place, that is going to be hard for her to accomplish. She hast to get completely re-credentialed, and I promise you were ahead of her on getting that done. In addition, the veterans have to get authorization to see her and she hast to get credentialed before they can even start the process of getting authorized through her. Whereas here in my clinic the machine is already built. The gears are already oiled and greased, and we are at fine-tune the machine. I think there’s no doubt we are going to come out ahead on this transition.

One thing we all know is that the one constant in life is that things are always changing.

Many of us are going through changes with staff. I have 3 CA’s and that third spot. It’s just a constant turnover. I have another one that will start in two weeks. The last one lasted for about two weeks. The one before her lasted about three months. It’s been miserable but when we find the right one I think it will have been worth it anyway, that’s what’s on my mind this morning. Getting acupuncture back up and running and marketed, and getting another new staff member up and going.

It’s a constant churn and, as they say in the military, just embrace the suck and keep trucking. It all pays for your life and for the life of your family members. Might as well enjoy all of it that you can and embrace the parts you feel suck your soul and keep that part in the proper context.

Item #1

 

The first on today is called “Intervertebral disc degeneration and how it leads to low back pain” by Ashish D Diwan, James Melrose and published in Pub Med on Nov14 2022. Dayum. That’s hot.

Why They Did It

  • The purpose of this review was to evaluate data generated by animal models of intervertebral disc (IVD) degeneration published in the last decade.
  • The review aimed to highlight the valuable contributions of these animal models in identifying molecular events associated with pain generation.
  • IVD degeneration is a complex process contributing to spinal pain, and understanding the underlying mechanisms is crucial for developing effective therapeutic strategies to alleviate pain, promote disc repair and regeneration, and prevent associated neuropathic and nociceptive pain.

How They Did It

 

  • The researchers conducted a review of existing studies that employed animal models of IVD degeneration.
  • They likely searched relevant databases, academic journals, and publications from the past decade to gather a comprehensive dataset.

  • The selected studies would have used various animal models and experimental methods to induce IVD degeneration.

  • These animal models mimic certain aspects of human IVD degeneration, allowing researchers to study the molecular events and mechanisms involved in pain generation.

What They Found

  • Through their review, the researchers observed that in degenerated IVDs, there is nerve ingrowth and an increased number of nociceptors (pain-sensing neurons) and mechanoreceptors (sensors of mechanical stimuli).
  • The biomechanically incompetent and abnormally loaded degenerated IVDs experience increased mechanical stimulation, leading to heightened low back pain.
  • This finding helps establish a link between IVD degeneration and pain generation, shedding light on the complexity of the process.

  • The review also highlighted the potential of a specific factor called “growth and differentiation factor 6” in addressing IVD degeneration. Studies using this factor in IVD puncture and multi-level IVD degeneration models, along with a rat xenograft radiculopathy pain model, demonstrated its ability to prevent further deterioration in degenerate IVDs. The factor exhibited regenerative properties that promoted the recovery of normal IVD architectural functional organization and inhibited the generation of inflammatory mediators, which contribute to disc degeneration and low back pain.

Wrap It Up

 

  • The review of animal models of IVD degeneration provided valuable insights into the molecular events underlying pain generation in degenerate IVDs. It emphasized the importance of understanding the complex multifactorial process of IVD degeneration to identify potential therapeutic targets for pain relief and disc repair.

 

  • One promising candidate identified through the review was “growth and differentiation factor 6,” which showed considerable potential in preventing further deterioration of degenerate IVDs, promoting regeneration, and inhibiting the generation of inflammatory mediators.

 

  • The findings from these animal models suggest the need for human clinical trials with this compound to assess its efficacy in treating IVD degeneration and preventing low back pain generation in humans. Overall, this review underscores the significance of animal models in advancing our understanding of IVD degeneration and pain mechanisms, ultimately leading to improved treatment strategies for patients suffering from low back pain.

 

Before getting to the next one,

 

Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office.

 

When you decide you cant live without those products, send me an email and Ill give you the hookup. They will 100% differentiate your clinic from your competitors.

I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it.

Item #2

Our last one this week is called, “100,000 older Americans got unnecessary surgeries during dangerous first year of COVID-19” by Aaron Toleos and published in Lown Institute on May 17, 2022. Hot potato!

Why They Did It

The Lown Institute conducted this analysis to shed light on the issue of overuse of medical procedures in American healthcare, particularly during the COVID-19 pandemic. The aim was to bring attention to the fact that even during a public health crisis, unnecessary procedures were still being performed on vulnerable patients, potentially exposing them to harm and wasting healthcare resources.

How They Did It

The analysis was based on Medicare claims data from January to December 2020. The Lown Institute used the 100% Medicare claims database to evaluate the volume of overuse for eight common low-value procedures. The specific procedures and criteria for overuse were determined based on the institute’s previously published research into the measurement of low-value care at hospitals.

 

 

What They Found

  • The Lown Institute found that a total of 106,474 unnecessary procedures were identified during the analyzed period. The most overused procedure by volume was coronary stents, with 45,176 procedures performed. Other procedures with high rates of overuse included vertebroplasty for osteoporosis, hysterectomy for benign disease, and spinal fusion for back pain.

  • The analysis also revealed that approximately one in five of these low-value procedures met the criteria for overuse across the country. Even some of the nation’s most well-regarded hospitals had rates of overuse above the national average. For example, all of the top 20 hospitals ranked by U.S. News had rates of coronary stent overuse above the national average, with four of them having rates at least double that.

 

Wrap It Up

The analysis conducted by the Lown Institute highlights the persistence of overuse of medical procedures in U.S. hospitals, even during a major public health crisis like the COVID-19 pandemic. Despite previous knowledge that certain procedures, such as coronary stents for stable coronary disease, are of limited clinical benefit, they continue to be performed at high rates. This raises concerns about patient safety, healthcare costs, and the need to address the issue of overuse in the American healthcare system. The findings call for greater attention to evidence-based practices and the promotion of appropriate and necessary medical interventions to ensure better patient outcomes and more efficient use of healthcare resources.

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 cant 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….

Thats 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 cant 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

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

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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

Newer Information On Nonsurgical Spinal Decompression

CF 279: Newer Information On Nonsurgical Spinal Decompression

 

Today we’re going to talk about newer non-surgical decompression information.

 

But first, heres 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

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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, look down your nose at people 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.  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, drive, smart, 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 educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s 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.
  • Then go Like our Chiropractic Forward Facebook page,
  • Join our private Chiropractic Forward Facebook group, and then
  • Review our podcast on whatever platform you’re listening to
  • Last thing real quick, we also have an evidence-based brochure and poster store at com

  You have found yourself smack dab in the middle of Episode #279  

Now if you missed last week’s episode, we talked about SMT and The Low Back & How Much Exercise Is Actually Needed.

Make sure you don’t miss that info. Keep up with the class.  

On the personal end of things…..

Alright, a new week. I want to return back to a topic I have mentioned briefly before and that’s Darcy and Propel. She and they have re-vamped my website SEO. I have to admit, when a solo doc gets too damned busy to babysit a website and he/she is too damned cheap to pay someone to babysit the site, the SEO can sink.  

Now, don’t think I don’t do anything alright. I absolutely do. I write a blog every single week over a different topic. I then take that script and make a Youtube and Facebook video out of it, blah blah blah. I do lots of stuff.   However headings, tags, keywords, etc…..yeah, not my skillset. Nor should it be my skillset.

So, it sank and as a result, so did my new patients that I was getting through Googles.   Many of you know I’m a voice actor and real estate investor, artist, etc and had been putting my extra time into some of the extras I’ve been involved in. Lately, my attention gets drawn away from things I would normally be handling, like checking on Google Analytics from time to time to see how we’re performing.  

Well, since going through Propel’s re-vamp and me making it a priority to do some of the things they suggested, I think we are back on track. I checked my site’s progress over the last 18 days compare to the previous 18 days, the last month to the previous month, etc. And I found that we are indeed on the upswing!

Thank goodness. I would also say that it is reflected directly into the new patient numbers recently. Last year it was nothing for me to have 20-25 new patients in a week. That took a hit as the website took a hit and fell down to 12-14 ish per week. In just the last two weeks we’ve had 17 and then just last week we had 19 so it looks like we are back running in the right direction.   I truly think that is a result of paying more attention to the performance of my website.  

Most of you know that SEO is a slow grow. Nobody can flip a switch and you’ll be number 1 this week. But, early indicators are that Propel and Darcy Sullivan have got some magic up their sleeves.

And no….I don’t get anything at all out of telling you that. I’m just being open and honest with you.  

Alright, let’s dive in.  

 

Item #1   The first on today is called “Effects of non-surgical decompression therapy in addition to routine physical therapy on pain, range of motion, endurance, functional disability and quality of life versus routine physical therapy alone in patients with lumbar radiculopathy; a randomized controlled trial” by Fareeha Amjad, Mohammad A Mohseni-Bandpei, Syed Amir Gilani, Ashfaq Ahmad, Asif Hanif and published in PubMed on March 16 2022. Dayum. That’s hot.    

Why They Did It  

The objective of this study was to determine the effects of decompression therapy in addition to routine physical therapy on pain, lumbar range of motion (ROM), functional disability, back muscle endurance (BME), and quality of life (QOL) in patients with lumbar radiculopathy.    

How They Did It  

  • A total of sixty patients with lumbar radiculopathy were randomly allocated into two groups, an experimental and a control group, through a computer-generated random number table.

 

  • Baseline values were recorded before providing any treatment by using a VAS, Urdu version of Oswestry disability index, modified-modified Schober’s test, prone isometric chest raise test, and SF-36 for measuring the pain at rest, functional disability, lumbar ROM, back muscle endurance, and quality of life, respectively. All patients received twelve treatment sessions over 4 weeks, and then all outcome measures were again recorded.

      What They Found  

  • By using the ANCOVA test, a statistically significant between-group improvement was observed in VAS, Oswestry disability index, back muscle endurance, lumbar ROM, role physical (RP), and bodily pain (BP) domains of SF-36, which was in favour of decompression

 

Wrap It Up  

It was concluded that a combination of non-surgical spinal decompression therapy with routine physical therapy is more effective, statistically and clinically, than routine physical therapy alone in terms of improving pain, lumbar range of motion, back muscle endurance, functional disability, and physical role domain of quality of life, in patients with lumbar radiculopathy, following 4 weeks of treatment.     Before getting to the next one,  

Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office.   When you decide you cant live without those products, send me an email and Ill give you the hookup. They will 100% differentiate your clinic from your competitors.    

I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it.        

Item #2   Our last one this week is called, “Regression of lumbar disc herniation by physiotherapy. Does non-surgical spinal decompression therapy make a difference? Double-blind randomized controlled trial” by Aynur Demirel, Mehmet Yorubulut, Nevin Ergun and published in PubMed on September 17, 2022. Hot potato!      

Why They Did It  

The aim of the study determining whether or not Non-invasive Spinal Decompression Therapy(NSDT) was effective in resorption of herniation, increasing disc height in patients with lumbar disc herniation (LHNP).              

How They Did It  

  • A total of twenty patients diagnosed as lumbar disc herniation and suffering from pain at least 8 weeks were enrolled to the study. Patients were allocated in study (SG) and control groups (CG) randomly.

 

  • Both groups received combination of electrotherapy, deep friction massage and stabilization exercise for fifteen session. The study group received additionally Decompression different from control groups. Numeric Anolog Scale, Straight leg raise test, Oswestry Disability Index (ODI) were applied at baseline and after treatment. Disc height and herniation thickness were measured on Magnetic Resonance Imagination which performed at baseline and three months after therapy.

    What They Found  

  • Both treatments had positive effect for improving pain, functional restoration and reduction in thickness of herniation. Although reduction of herniation size was higher in the study group than control groups, no significant differences were found between groups and any superiority to each other

 

Wrap It Up  

This study showed that patients with lumbar disc herniation received physiotherapy had improvement based on clinical and radiologic evidence. Decompression can be used as assistive agent for other physiotherapy methods in treatment of lumbar disc herniation.    

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 cant 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….

 

Thats 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 cant 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/

 

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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

 

Effectiveness Of Neck Exercise For Disc Herniation and Supine vs. Prone MRIs

CF 242: Effectiveness Of Neck Exercise For Disc Herniation and Supine vs. Prone MRIs Today we’re going to talk about Effectiveness Of Neck Exercise For Disc Herniation and Supine vs. Prone MRIs 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

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

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

You have found yourself smack dab in the middle of Episode #242 Now if you missed last week’s episode , we talked about Does Supplementation Work & Non-Surgical Treatment For Stenosis. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Well, last week was insanity around my office. I personally saw about 196 appointments and our nurse practitioner had his best week since we integrated and brought medical services into our clinic. He saw 38 appointments not counting me.  I say, “Not counting me,” because I got the hormone pellets. If you’re not familiar, go search up BioT or search up Evexipel. We use Evexipel and it’s a hormone balancing or optimization procedure. The provider does some blood work and finds out where you’re at with some key hormones. 

I’m way low on testosterone which makes me insane because I could drop some weight but I’m not nearly as bad as a lot of folks I see. I’m 6’4” and about 272. Yes, I should ideally be about 220 or even less if you listen to the government. However, I was a college offensive lineman and I’ve been a pretty thick dude my whole life.  I have a dad bod but I’m not waddling around and having a hard time getting through doors is what I’m saying. OK? Anyway, I’m not sedentary either. I get lots of activity from 190+ patients in a week to exercise and throw the discus.

I’m a go-getter so the low T thing makes me a little insane but it is what it be and that’s just me.  So, time to do it. We use Evexipel and when I did BioT, it was in the butt cheek and it was pretty freaking sore for about 5-7 days. Evexipel does the pellets in the flank for men and 4 days later, I have had very little to basically zero pain. It’s been amazing. 

The pellets take about 5 days to start being absorbed in the body so I’m looking forward to the benefits. I’ll keep you updated.  For my practice specifically, you’ve heard me mention that we will patch one hole and another leak will spring and I’m always on the lookout for them. Well, I found one just this morning.  We had 1 96 patients on my side last week. I show up for work this morning and look at the schedule and there are only 36 patients on my schedule today.

I guess this issue didn’t register with any of my staff members because when I asked what happened to my schedule this week, they just acted like it’s normal and the week starts filling out on Mondays.  Oh no no no. That’s not how we need to be looking at it. Let’s do a little high-level, global thinking here.  I saw 25 new patients last week. If they’re all on schedule, that’s at least 25 appointments booked on the following Monday. Remember Monday has 36 currently.

Well, 6 of those are new patients. So, let’s throw out those 6 new patients and that leaves us with 30 today. If we remove the new ones from last week, the 25 that should have been guaranteed…..then that just leaves us with 5 established patients.  5. Cinco. Cinco freaking established patients for a Monday.  So, when we’re looking at it in this manner, well, clearly there’s a problem. Patients aren’t on schedule and we’ve had significant fall-off.

This means I’m either not doing my job educating them on why they need to be consistent, or the staff isn’t encouraging the message and supporting the message, or the front desk isn’t getting them rescheduled.  Or all three.  Either way, we basically bled 25 new patients last week. So, that hole has to get plugged, yet again, this week. Another thing to consider is that it’s basically Back To School time and that’s traditionally a slow-down time for us.  So that something else can go stupid next week. Because that’s the way it goes. 

Item #1

This first one is called “Outcomes of active cervical therapeutic exercise on dynamic intervertebral foramen changes in neck pain patients with disc herniation” by Wu et. al. (Wu SK 2022)  and published in BMC Musculoskeletal Disorders on July 30 of 2022. Bam!!! Into the frying pain! It’s hot. 

Why They Did It

To better understand biomechanical factors that affect intervertebral alignment throughout active therapeutic exercise, it is necessary to determine spinal kinematics when subjects perform spinal exercises. This study aims to investigate the outcomes of active cervical therapeutic exercise on intervertebral foramen changes in neck pain patients with disc herniation.

How They Did It

  • Thirty diagnosed C4/5 and/or C5/6 disc-herniated patients
  • 8-week cervical therapeutic exercise program 
  • They were followed up with videofluoroscopic images. 
  • The dynamic changes in the foramen were computed at different timepoints, including the neutral position, end-range positions in cervical flexion-extension, protrusion-retraction, and lateral flexion movements.

What They Found

  • The results showed that the active cervical flexion, retraction, and lateral flexion away from the affected side movements increased the area of the patients’ intervertebral foramen; while the active extension, protrusion, and lateral flexion toward the affected side reduced the areas of intervertebral foramen before treatment. 
  • After the treatment, the active cervical flexion significantly increased the C2/3, C3/4, and C6/7 foramen area by 5.02-8.67%, and the extension exercise significantly reduced the C2/3 and C4/5 area by 5.12-9.18% compared to the baseline. 
  • Active retraction movement significantly increased the foramen area from C2/3 to C6/7 by 3.82-8.66%. 
  • Active lateral flexion away from the affected side significantly increased the foramen by 3.71-6.78%

Wrap It Up

The 8-week therapeutic exercises including repeated cervical retraction, extension, and lateral flexion movements to the lesion led to significant changes and improvements in the intervertebral foramen areas of the patients with disc herniation.

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

Item #2

I saw this one in the Forward Thinking Chiropractic Alliance group on Facebook and it’s pretty darn interesting. It’s called, “Prone Position MRI of the Lumbar Spine in Patients With Low Back Pain and/or Radiculopathy Refractory to Treatment” by Avellanal et. al.  and published in Pain Physician in August of 2022 damnit this Is the first day of August it just doesn’t get any more fire than that heat!

Why They Did It

There are patients with limiting low back pain (LBP) with or without radicular pain in whom conventional supine magnetic resonance imaging (MRI) show no causative pathology. Despite the limitations of dynamic axially loaded MRI examinations, these imaging studies have shown a striking ability to diagnose pathology unrecognized by conventional MRI. The difference in findings between supine and prone MRI with patient symptom correlation has not been studied.

How They Did It

  • Nineteen patients suffering from chronic moderate-to-severe LBP and/or radicular pain 
  • Nonresponsive to conventional therapy or interventional treatment
  • Both supine and prone MRIs were performed and analyzed by a neuroradiologist. 
  • Specific supine and prone measurements were registered, including spinal canal area, lateral recess diameter, foraminal area, and ligamentum flavum thickness. 
  • Three-dimensional MRI reconstructions of varying pathology patterns were created.

What They Found

  • In 52.6% of cases, disc pathology or increased disc pathology was seen only on prone imaging. 
  • They observed significant buckling and increased thickness of the ligamentum flavum in 52.6 % of cases in the prone position that was absent from the supine MRIs. 
  • They also documented varying grades of spondylolisthesis and facet joint subluxation resulting in significant foraminal stenosis in 26.3% of prone cases not seen from supine MRIs.

Wrap It Up

  • Four patterns of pathological findings have been identified by MRI performed in the prone position. 
  • These findings were not observed in the supine position. 
  • Prone MRI can be a significant and useful tool in the diagnosis and treatment of patients with back pain refractory to treatment whose conventional supine MRIs appeared unremarkable.

Which I also take as yet another reason you cannot trust MRI’s for definitive diagnosis of the source of 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 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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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!

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 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  

Bibliography Wu SK, C. H., You JY, Bau JG, Lin YC, Kuo LC (2022). “Outcomes of active cervical therapeutic exercise on dynamic intervertebral foramen changes in neck pain patients with disc herniation.” BMC Musculoskelet Disord 23(1): 728.      

Does Imaging Mean Better Outcomes & Melatonin Slowing Down Disc Degeneration

CF 207: Does Imaging Mean Better Outcomes & Melatonin Slowing Down Disc Degeneration

Today we’re going to talk about….Does Imaging Mean Better Outcomes & Melatonin Slowing Down Disc Degeneration 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

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

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

You have found yourself smack dab in the middle of Episode #207 Now if you missed last week’s episode, we talked about how Vertebral Dysfunction Alters Neuro Function & The Gender Of Your Provider May Matter. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

It’s a bit hectic around here this week being the week after Thanksgiving as of this recording. Being off for 4 days straight was a very welcome respite from the normal day-to-day.  Nothing too crazy around here this week. We are missing our intern who left last week. We’re just re-acclimating to life as it was before we had an extra hand here in the office. But we’re getting there. We’re stretched a little thin because we added the nurse practitioner.

Well, when he has a procedure, he needs an extra set of hands so that takes up one of our CAs. That leaves us short on this end of the business.  But, the NP is not busy enough consistently enough for us to need to hire another set of hands full time. So, we’re in a growth period and growth can stretch you. And it’s stretching us.

But that’s OK. I know it’ll all be worth it eventually.  We started our integrated journey back on August 1st and here we are at almost December 1st. So that’s about 4 months in. We are averaging around 18-20 visits per week for the medical services and just trying to build build build.  Our most common services would probably be trigger point injections, primary visits, and maybe the hormone pellets or IV therapy. It’s a slow grow thing as with any new venture. It takes time to get your message out. And we’re working on it. We start radio ads next week.  Other than that, outside of chiropractic, we are setting up a short term rental/Airbnb, VRBO type of house.

It is a brand new flip so we’re stepping into a basically new place and it’s ready to go. We’ve been buying all of the stuff to outfit it, getting all wireless stuff so we can manage it ourselves remotely, hiring a contractor to build a deck on the back, and are getting our AirBNB and VRBO listings in order and all that good stuff.  It’s a mess for about a month but once you get it set up, it should only take us about 15-30 minutes per week to manage it from an hour and a half away. And, according to AirDNA which is an analysis software for short term rentals, we stand to profit around $30,000+ per year on the thing. That’s pretty exciting. 

I always talk about the exit strategy. This is part of it. Getting more stuff in line outside of your day to day. 30 minutes a week is not completely passive work but it’s damn near passive and gives us a good raise through the year. And $30k is a nice down payment on another house. Especially when you combine it with what I’m doing in voice over industry currently.  Now, if I can just get a rock star associate to come in and take some of the heat off of me on the day to day hands-on chiropractic treatment. THEN….then we might be on our way.  Enough of that, let’s get to it. 

Item #1

The first one this week is called “What are the effects of diagnostic imaging on clinical outcomes in patients with low back pain presenting for chiropractic care: a matched observational study” by Jenkins et. al.  (Jenkins 2021)and published in Chiropractic and Manual Therapies on November 23rd of 2021, aye chi Wawa….it’s so hot. 

Why They Did It

Evidence suggests that diagnostic imaging for low back pain does not improve care in the absence of suspicion of serious pathology. However, the effect of imaging use on clinical outcomes has not been investigated in patients presenting to chiropractors. The aim of this study was to determine if diagnostic imaging affects clinical outcomes in patients with low back pain presenting for chiropractic care.

How They Did It

  • A matched observational study using prospective longitudinal observational data with one year follow up was performed in primary care chiropractic clinics in Denmark. 
  • Data were collected from November 2016 to December 2019. 
  • Participants included low back pain patients presenting for chiropractic care, who were either referred or not referred for diagnostic imaging during their initial visit. 
  • Patients were excluded if they were less than 18 years old, had a diagnosis of underlying pathology, or had previous imaging relevant to their current clinical presentation. 
  • Mixed linear and logistic regression models were used to assess the effect of imaging on back pain intensity and disability at two-weeks, three-months, and one-year, and on global perceived effect and satisfaction with care at two-weeks.
  • 2162 patients were included, with 24.1% referred for imaging. 

What They Found

Participants referred for imaging had slightly higher back pain intensity at two-weeks and one-year, and disability at two-weeks, but the changes are unlikely to be clinically meaningful.  No difference between groups was found for the other outcome measures. Similar results were found when sensitivity analysis, adjusted for age and leg pain intensity, was performed.

Wrap It Up

Diagnostic imaging did not result in better clinical outcomes in patients with low back pain presenting for chiropractic care. These results support that current guideline recommendations against routine imaging apply equally to chiropractic practice. I know some of you will say “I found so and so on a person that would have never been found, etc.” I get it. And some of you just feel better if you’ve seen what’s going on underneath. I get it and I don’t fault that. I really don’t BUT….you MUST acknowledge that the vast majority of your x-rays that you insist on taking on every patient that walks through your doors, ultimately, weren’t absolutely necessary and didn’t change a thing about how you would be treating them.  That is of course unless you’re a technique philosophy wonk and you think you find listings on x-rays. A strategy that I’ve seen little research that can support.  If you follow Choosing Wisely, you are typically in safe and calm waters. 

Item #2

The second one is called “The potential role of melatonin in retarding intervertebral disc ageing and degeneration: A systematic review” by Cheng et. al. (Zhangrong Cheng 2021) and published in Ageing Research Reviews in September of 2021

Why They Did It

They start by setting the stage here.  Low back pain (LBP) is the leading cause of years lived with disability in the world population, which has increased by over 50 % in the past 20 years, mainly due to population ageing Intervertebral disc degeneration (IDD) is a common degenerative disease of the musculoskeletal system that develops with age. It is regarded as the main cause of chronic low back pain in the elderly. IDD has various causes, including ageing, mechanical overloading, and nutritional deficiency.

Melatonin is a pleiotropic indole hormone secreted by the pineal gland and plays an important role in resisting various degenerative diseases.  The serum levels of melatonin decline with age and are reported to be negatively correlated with the symptomatic and histopathological scores of IDD. In vivo studies have shown that exogenous administration of melatonin could maintain the structural integrity of the intervertebral disc and inhibit the development of IDD. Mechanistically, by interacting with its membrane or intracellular receptors, melatonin can promote autophagic flux, scavenge free radicals, inhibit the release of pro-inflammatory factors, and block apoptotic pathways, thereby enhancing anti-stress abilities and matrix anabolism in different types of disc cells.  Several studies have explored the effects of melatonin on IDD.

This was first discovered when surgical removal of the pineal gland in chickens depleted their serum melatonin levels and accelerated IDD onset Therefore, melatonin supplementation may be a promising therapeutic strategy for IDD. This review aimed to summarize the latest findings regarding the therapeutic potential of melatonin in IDD.

Wrap It Up

From the perspective of therapeutic strategies for IDD, the benefits of melatonin are comprehensive. The existing evidence supports melatonin as a potential therapy for the prevention and treatment of IDD 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  Bibliography Jenkins, H. J., Kongsted, A., French, S.D (2021). “What are the effects of diagnostic imaging on clinical outcomes in patients with low back pain presenting for chiropractic care: a matched observational study.” Chiropr Man Therap 29(46).   Zhangrong Cheng, Q. X., Juntan Wang, Yukun Zhang, (2021). “The potential role of melatonin in retarding intervertebral disc ageing and degeneration: A systematic review.” Ageing Research Reviews 70.    

The Case Of The Disappearing Disc & Vitamin D And Back Pain

CF 204: The Case Of The Disappearing Disc & Vitamin D And Back Pain Today we’re going to talk about The Case Of The Disappearing Disc & Vitamin D And Back 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 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 chiropracticforward.com
You have found yourself smack dab in the middle of Episode #204 Now if you missed last week’s episode, we talked about Reduced Access To Chiropractic & The Ideal Diet. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. The clinic numbers have cooled a bit. Still busy but more manageable. Since things have cooled a bit on that end of things, let’s switch focus to side gigs. I see questions about side gigs periodically in the forward-thinking chiropractic alliance group.  We chiros are doing all kinds of different things from being real estate agents and hunting guides to selling stuff on eBay and Etsy.  Here’s some of what I do and why. First, I’m very happy with my income from chiropractic but, as with anything, I don’t like my eggs being in one basket, and let’s face it, we’re in a business where if something were to happen to us, it’s game over. If we are not at work and able to perform, then we can kiss all of those years of hard work goodbye.  In our profession, we are literally on a knife’s edge and it could go good or bad in a heartbeat. Literally.  So, I like other options. Do you know what else I like? Success, freedom, achievement, and wealth. All of that gives you a better chance at happiness. People say you can’t buy happiness. Well, that’s what people with no money tell themselves so they feel better. It’s like someone saying it’s not all about looks. Well….that’s true but looks sure as hell to help land a suitable partner. Wouldn’t you agree? In the say way, wealth helps you have more security and security helps you have a better chance at happiness.  So, for all of those reasons, I do a lot of stuff. I’m an artist as many of you might know. I just finished up a series of several Charlie Chaplin watercolor paintings and a sculpture of a horse and jockey in the middle of a race. They’re flying down the track!  You can see all that stuff on Facebook at Jeff Williams Art.  I have a band and have been a traveling musician in my past. It seems like another life at this point. You can check that out on Facebook at Flying Elbows Perspective. Can you imagine another band would have the band name Flying Elbows? Well they do. It’s a fiddle band from Massachusetts. That’s not us. We’re the ones from Amarillo, TX I created evidence-based posters and brochures for you guys over at chiropracticforward.com Then I create live edge furniture. But I like to be honest, nobody has ever bought any of the pieces but that’s not because they’re not good. It’s because they’re expensive! You can see that on Facebook at Amarillo Furniture – Live Edge and Customs. It’s fun. My office and home are full of these original pieces.  The idea is to be able to retire and still be comfortable. Still have income in retirement. How are you going to accomplish that and what is your exit number? What do you have to have at the end that allows y But here’s where things have freaking gone nuts. It’s in the land of voice-over. Holy cow, y’all. Now, my results are not normal as I’m coming to find out. But, just in the last 10 months, I’ve made about $50,000 I never planned on having in my life. I’ve done over 400 commercials in the last 10 months in about 22% of the countries throughout the world and landed talent agencies that represent California, Texas, Indiana, Ohio, Kentucky, and New Jersey/New York.  How at the age of 49 this voice over thing has just come into my life is a twisted tale but briefly, the drummer for my very first band way back in college in Natchitoches, LA became a Lieutenant Colonel in the Army and we stayed in touch. Well, he became the voice of Hand Unit in the video game called Five Nights At Freddie’s. He got to do a bunch of other really cool stuff too but when the pandemic came along, it got me thinking that I need to have options.  That’s when I hit him up about voice over. A year and a half later, here we are it’s crazy.  Now, what do we do with the extra money? Well, we put it to work. That’s what we do. I’ve also spent the last 6-12 months educating myself on real estate investing. Long-term rentals, multi-plexes, short-term rentals, vacation rentals, flipping, wholesaling, and things like that. So, you may have guessed it, voice over will be funding down payments on investment properties.  What a deal. Right?!? The problem in this market if finding a good deal but we’re on some good ones and are hoping to land them in the next week or two.  Here is a little real estate tip for you. Two tips actually. First, money has always been in real estate and it always will be. Through ups and downs, the money is still there. Secondly, losses in your real estate business can offset gains in your chiropractic business come tax time. That’s if you can qualify as a real estate expert. Well…..they made it really hard to qualify so basically, if you have a job like we all have, you can’t. Your loophole, however, is this; short-term rentals don’t count.  Short-term rentals can offset tax gains without you having to qualify as a real estate expert. So, if you’re a chiropractor, short-term rentals probably make a lot of sense so that real estate losses and depreciation can offset the money you make in your chiropractic business so that you can reduce or eliminate taxes.  As a disclaimer, I am not a lawyer nor a CPA so make sure you run that by them.  OK, just some tips from you Ol’ Uncle Jeffro.  Now to the good stuff.  Item #1 This first one is called “Relationship between Vitamin D and Nonspecific Low Back Pain May Be Mediated by Inflammatory Markers”’ by Xu et al   (Xu HW 2021) and published in Pain Physician in November of 2021 and that’s a steamy as a sizzling sirloin.  I believe I got this one from my esteemed colleague, Dr. David Graber who always always posts great research findings. He’s a fountain of knowledge nuggets so go search him up on Facebook and follow his page. One of the smartest guys you’ll find out there.  Why They Did It To explore the mediating effects of inflammatory markers on the relationship between vitamin D levels and pain outcomes. How They Did It
  • This study was done at the Department of Spinal Surgery of a hospital affiliated to a medical university.
  • It was a cross-sectional study
  • They selected patients with non-specific acute low back pain and non-specific chronic low back pain, 
  • The study included 60 people without Ns-LBP as controls, 
  • The study was done from January 2018 to January 2019. 
  • Serum 25(OH)D and inflammatory marker levels were examined.
  • Regression and causal mediation analysis were used to evaluate the mediating effects of inflammatory markers on the association between vitamin D and pain.
What They Found
  • After adjustment for clinical factors, vitamin D deficiency was associated with Ns-LBP
  • however, when the interleukin 6 (IL-6) level was added to the multivariable models, the association was no longer significant in Ns-CLBP patients
Wrap It Up Patients with Ns-LBP had lower vitamin D and higher inflammatory marker levels. This association between hypovitaminosis D and Ns-CLBP may be mediated by IL-6.  Very interesting findings. They do say there are some limitations to the study. They say a retrospective study may include inevitable bias. More sensitive biomarkers were not investigated in this study. Pain intensity evaluation using the visual analog scale is inevitably subjective. Item #2 Alright, item 2 is called “Clinical and Radiological Follow-Up Results of Patients with Sequestered Lumbar Disc Herniation: A Prospective Cohort Study” by Sucuoglu et. al. (Sucuoğlu H 2021) and published in Medical Principles and Practice in February of 2021 and that’s got my glasses fogged up! Why They Did It The authors wanted to assess radiological changes and clinical outcomes of patients with sequestered lumbar disc herniation (LDH) and evaluate the relationship between them. How They Did It
  • Patients diagnosed with sequestered LDH were followed up in 2 groups: operated (within the 1st month after diagnosis) and nonoperated. 
  • Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores at baseline and 1st , 3rd, and 6th-month visits were used. 
  • Radiological evaluation was performed by measuring the sequestered herniation level and herniation volume using 2 MRIs spaced out between 1st and 4th months
  • After the second MRI, patients in the nonoperated group were divided into 3 groups: non-regression, partial regression, and complete resolution
What They Found
  • Signifi
  • cant improvements were observed in VAS and Oswestry scores at month 2 and month 3 in all groups and at month 4 in partial regression and complete resolution groups. 
  • VAS and Oswestry score improvements at months 2 and 3 were significantly higher in the operated group than in other groups. 
  • At month 4, there were no significant differences in VAS and ODI scores between the operated group and partial regression and complete resolution groups.
Wrap It Up
  • Spontaneous regression was observed in the 6th month post-MRI in most of the nonoperated sequestered herniation patients with conservative treatment.
  • Improvements in pain and disability scores were higher among the operated patients at the early stage, whereas they were not significantly different compared to patients with spontaneous regression at the 6th month.
If you remember, I did a whole episode on disappearing discs. Here’s the deal. You have to know this. The more a disc herniates, protrudes, or extrudes into the spinal canal and migrates either cephalad or caudal, the more likely the body is to recognize it as foreign and gobble it up like the cookie monster.  What I thought was instant surgery several years ago, I now know may be a waiting game that ends up being non-surgical.  Here’s the thing that episode taught me though; the disc material can be dissolved but the symptoms remain. At least for a while while the nerve tissue in the region undergoes the healing process.  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 the 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
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 – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography Sucuoğlu H, B. A. (2021). “Clinical and Radiological Follow-Up Results of Patients with Sequestered Lumbar Disc Herniation: A Prospective Cohort Study.” Med Princ Pract 30(3): 244-252.   Xu HW, Z. S., Yi YY, Chen H, Hu T, Wang SJ, Wu DS, (2021). “Relationship between Vitamin D and Nonspecific Low Back Pain May Be Mediated by Inflammatory Markers.” Pain Physician 24(7): E1015-E1023.      

Extruded Discs – Surgery or No Surgery?

CF 197: Extruded Discs – Surgery or No Surgery? Today we’re going to talk about extruded discs – surgery or no surgery? This one may surprise some of you.  But first, here’s that sweet sweet bumper music

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

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an invaluable resource for your patient education and for you. It can save you time in putting talks together or just staying current on research. It’s categorized into sections so that the information is easy to find and it’s written in a way that is easy to understand for practitioner as well as patient. You have to check it out. 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 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. 

You have found yourself smack dab in the middle of Episode #197 Now if you missed last week’s episode , we talked about How Car Wrecks Contribute To Future Neck and Back Pain. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Alright, I’m feeling pretty good today. Last week was the very first time since February of 2020 that we hit the average weekly visit number that we were doing. I don’t know if that came out right. Before Rona, we were averaging 185 visits per week in 2019.  Rona came along and the best we’ve been able to eke out was about 160. Maybe 165. With the rollercoaster ups and downs of the Rona outbreaks, that number has been down but since February of 2020, it’s never been any higher than that.  Until last week. Last week, by myself, I hit 187. 23 of them were new patients. When you are evidence-based and patient-centered, you don’t hold on to patient unnecessarily for extended visits and treatment schedules so, unfortunately, you live and die by your new patient count. 

Fortunately for me, I’m to a point that new patients aren’t a huge concern. I always have my eye on the count, but it doesn’t give me anxiety these days. We are pretty established here in my community and it tends to mostly take care of itself. Thank my good Lord.  I don’t know if you’ve listened this long but back in February of 2020, the 14th to be exact, my wife and I took a trip to Key Largo. It was amazing.

I left a bustling, busy as hell practice to go on vacation. There was some concern about this COVID stuff but nothing crazy.  In fact, I remember asking my wife on the way to Florida if we should take a mask just in case they told us we needed one. She told me if I brought a mask, that she’d punch me in the nose. Lol. Yes, I have that kind of a wifey. She’s a feisty Texas woman, ya know.  After a week in The Keys, I came back to a ghost town. And then it got worse. I swore I’d never go on vacation again if it was going to tank my practice like that. Well, obviously, it was COVID. And it’s taken a year and a half to start to reclaim our lost business.

But, at 45 patients today as I type this and 5 of them being new patients, this week is looking good too.  Here’s the best news about it all; this is in the midst of a BIG resurgence of COVID here in Amarillo locally. They are adding numbers at the rate they were adding them back in the worst of times. But people are done with it. They just are.  I was one of the first group of providers to be vaccinated here locally. My friends and connections in the medical world here called me when it first came available. They recognized that we work in very close proximity with patients and reached out. Most of my staff and I accepted. I’ve been vaccinated since January 2021. 

I just got the booster on August 26th. It’s a personal thing for each of us but, when you have had a hit on your business like I have, and you’ve had all of the ups and downs, and you’re just now getting back to where you left off after basically losing a year and a half…….well, I’m not about to take a chance on getting sick and being out for 2-4 weeks and watching my business go to crap again.  Including me, I have 12 employees.

That includes 4 CA’s, 3 LMT’s, an NP, an acupuncturist, an esthetician, a billing pro, and I have an intern from Parker College here. These people have families, mortgages, bills, car payments, and gambling debts just to name a few things.  The point is, when you’re the main provider and breadwinner, for me, it’s up to us to be as responsible as we can to make sure we are able to do our jobs.  For example,  here in Amarillo, TX, we are fairly close to the Colorado and New Mexico mountains. About 3 and a half hours to NM and about 5 or so to Colorado. Pretty close. We grew up going skiing in the mountains.

But it dawned on my during my last trip a few years ago; they call them accidents for a reason.  If I fall and break a wrist or twist a knee up, I could be out of a job for up to 6 weeks or more. Well hell, in most cases, that’s more time out than COVID would take you out. I’m the major provider at this time for this clinic. I can’t allow that. So, I gave up snow skiing. It’s not worth it to me.  Why should the pandemic be looked at any differently? For me, it shouldn’t be.  Anyway, I got a little sidetracked there.

Things are going well. I’m hoping business is back to normal and stays normal. For me and for you. We have all fought hard and deserve it.  Now, let’s get some folks to feeling better shall we? Let’s hop into research having to do with large extruded discs.  Once upon a time, I would send them straight to a Neurosurgeon. Not so quickly these days. Knowledge and clinical experience tell me to think twice. Especially in the absence of progressive neurological deficits. 

Item #1

Item one is called “Spontaneous Regression of a Large Lumbar Disc Extrusion” by Ryu et. Al (Ryu Sung-Joo 2010) and published in the Journal of Korean Neurosurgical Society back in 2010. It’s got a little dust on it but not a ton.  

Why They Did It

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

How They Did It

  • It’s a case report so it’s not incredibly impactful but still helpful for something like this. You can see it on one MRI and then 6 months later, it’s gone. 2+2=4 so I’m OK with a case report on something like this here. 
  • A 53-year-old woman was referred to our clinic with a 6-month history of low-back and left lateral leg pain with numbness. Six months earlier, her symptoms had developed suddenly as severe left lateral leg pain. 
  • A neurological examination showed no neurological deficits. The straight leg raise test was negative bilaterally. The lumbar spine MRI performed 6 months earlier revealed a left posterolateral herniated nucleus pulposus which was migrated caudally and compressed the left L5 root
  • She received conservative treatment including pain-relieving medication, physical therapy and spinal anesthetic block therapy due to her poor medical conditions

What They Found

  • After conservative treatment, her clinical symptoms subsided gradually but the numbness of her left lateral leg still remained. A second MRI study performed approximately 6 months after the prior examination reveal almost complete disappearance of the extruded fragment that had been located posterolateral to the L5 vertebral body, and no evidence of compression or displacement of the dural sac or nerve root
  • The height of the L4/5 disc space remained decreased compared to the other levels and was unchanged from the previous MRI examination.

Wrap It Up

  • The precise mechanisms of disc regression are unclear. Three hypotheses have been proposed to explain the process of disc regression. 
  •  
  • The first hypothesis, “retraction of a herniated disc”, proposes that the herniated disc retracts back into the intervertebral space17). Theoretically, this can occur if there is a disc bulge or if the disc material protrudes through the anulus fibrosus but is not separated from it6). However, it would be unlikely in cases of completely extruded or migrated fragments. 
  •  
  • The second explanation, “dehydration of herniated disc”, states that the herniated fragment would disappear due to gradual dehydration and shrinkage16). 
  •  
  • The third hypothesis, “inflammatory reaction and neovascularization”, which is the most compelling and studied hypothesis, states that extruded disc material into the epidural vascular space of spine is recognized as a “foreign body” and induces an inflammatory reaction by the autoimmune system. This would cause neovascularization of the cartilaginous tissue along with infiltration by inflammatory cells, such as macrophages, granulocytes, and lymphocytes7,8,10,11,15). Several histopathology studies from surgical specimens and experimental animal research support this theory
  • Nevertheless, it is possible that all 3 mechanisms play a role in the regression and disappearance of herniated disc tissue.
  • Motor and sensory deficits are present in 50-90% of patients with a herniated lumbar disc18). Surgery can be carried out as an emergency when bladder symptoms or progressive motor weakness are present. In the absence of these symptoms, 75-90% of patients with acute sciatica due to a protruded lumbar disc experience a resolution of symptoms without surgery 
  • Conservative treatment should be considered when cauda equina syndrome or progressive motor weakness are absent in the acute stage of the lumbar herniated disc. Surgical intervention should be considered in cases with neurological deficits or intractable low back and leg pain despite the initial conservative treatment

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Item #2

Our last one is called “Spontaneously disappearing large herniated lumbar disc fragment”’ by Reddy et. al. (Reddy UV 2014) and published in the Journal of Orthopaedics and Allied Sciences in 2014. As impactful as this information is, why do you think there aren’t more studies on it that are recent? Could it because it suggests they shouldn’t be doing surgery on these large extruded discs?

Why They Did It There are reports of spontaneous regression of large extruded disc; however, the exact underlying mechanism and management of such cases remains controversial. We report a 40-year-old female who opted for conservative management for a large extruded lumbar disc. Follow-up magnetic resonance imaging (MRI) showed complete disappearance of the disc fragment; however, there were degenerative changes in the upper and lower adjacent margins of the vertebral body.  Herniated lumbar disc is one of the common causes of low back pain and smaller disc herniations tend to regress over a period of time; and thus, the pain is known to improve with conservative management. 

How They Did It

A 40-year-old female presented with low back pain of 2 year duration. The pain was radiating to lower limbs more to the left side. There was no history of motor or sensory deficits. There was no history of bowel or bladder dysfunction. She was investigated for the similar problem with an MRI 6 months back and it showed a large disc protrusion [Figure 1]. However, she opted for conservative management. On examination, there were no focal motor or sensory deficits. Deep tendon reflexes were normal except bilateral sluggish ankle jerks. Planters were flexor. As the patient was complaining in the severity of the pain with numbness and a repeat magnetic resonance imaging (MRI) was performed. Follow-up MRI showed complete disappearance of the disc fragment;

What They Found

The exact timing for spontaneous regression of the protruded disc material is not known; however, it ranges from few weeks to months. The fastest regression of the fragmented disc material was reported in 2 months.

Wrap It Up

Present case illustrates that a conservative approach can be adopted for a large extruded lumbar disc as it can resolve in a selective group of patients. [24],[38],[39] Spine surgeons should be aware of spontaneous regression of the disc phenomenon as a patient with a large extruded disc who opted for the conservative management initially can have persistence pain, but there may not be an underlying protruded disc. It is important to perform a repeat imaging of the spine to assess the degree and severity of the disc protrusion before making a plan for surgery or any further conservative management.

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 so 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

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About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

  • Reddy UV, A. A., Hegde KV, Suneetha P, Rao MG, (2014). “Spontaneously disappearing large herniated lumbar disc fragment.” J Orthop Allied Sci 2: 26-28.  
  • Ryu Sung-Joo (2010). “Spontaneous Regression of a Large Lumbar Disc Extrusion.” J Korean Neurosurg Soc. 48(3): 285-287.    

Predicting Frailty & A 30-Year Study On Disc Degeneration

CF 184: Predicting Frailty & A 30-Year Study On Disc Degeneration Today we’re going to talk about using bone or musculoskeletal parameters to predict frailty and then we’ll cover a 30-year study on disc degeneration. Sit tight and chew on the morsels of knowledge we’re about to dish up for you.  But first, here’s that sweet sweet bumper music  

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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. We’re the Metallica of chiropractic research……if there is such a thing. 

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. 

You have found yourself smack dab in the middle of Episode #1844

Now if you missed last week’s episode , we talked about the factors leading to surgery for some discs and then we talked about recent information concerning disc innervation and what happens when a disc is injured. 

Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

So for personal happening this week, we are getting the training set up for a nurse practitioner down in Dallas. Our medical Director is good enough that he would like to be trained on what the nurse practitioner is doing as well. That means good things for us. 

When the medical Director is on board with the nurse practitioner, nothing but good happens. 

I’m still promoting and pushing my book. The one I’d love for you to purchase called “‘The Remarkable Truth About Chiropractic: A Unique Journey Into The Research’. It’s on Amazon and you can find the link on my homepage at chiropractscforward.com so go give it a look-see and a purchase. You can get it in paperback and as an ebook. 

This is an amazing resource for you practitioners in the field. Definitely for you content creators. Whether you’re looking for info to post on your social media, whether you’re teaching your patients and need material, or it you’re putting together a speech you need to give to a group……THIS is your resource to make your life easier and to save time. Seriously. Just flip to the topic and pick out the papers you like. BOOM….done. 

I noticed that the forward thinking chiropractic alliance had their fire event this past weekend. With all of the things I’m involved in, I was unable to attend either live or online. 

But, I purchased the online package so will be reviewing it when it is available online. It was all about implementing rehab into your practice and making money doing it. I love rehab and exercise being a part of my every day practice so I’m looking forward to waiting through all of the information. I am still trudging through the forensics fellowship and I have to say, it is not material that I enjoy. In fact, it’s pretty awful. 

But, with the forensics fellowship being a subsidiary of the orthopedics fellowship that I already went through, I only have to do 100 hours rather than 300 so there’s no reason to not do it. So, I am begrudgingly going through it. It feels like I would assume running through quicksand feels. I hate the material but I plan on enjoying The final results. 

Also, as part of the Parker CBI program, I have an intern coming on board. He’s going to move out to Amarillo for a semester and follow us around and work in the office starting in September. 

Throw that in on top of a nurse practitioner starting full-time with us on August 2, and I should have my hands full. This podcast is getting more and more challenging to write produce and record every week. Depending on how all of this goes in the fall, I may be forced to begin releasing an episode every two weeks rather than every week. Stay tuned. That decision is on the horizon. 

Other than all of that, I am involved in all of my extracurricular activities as well.

I am still going to the track and throw in the shot put and discus on the weekends and planning on competing in some masters events next spring and summer. Still trying to lose weight and stay involved in working out and being in the healthy lifestyle. And I’m still busy doing all of my artwork that I’ve been doing all along. 

If you’re interested in any of that you can find it on Facebook at Jeff Williams art. If I was that weren’t enough, I’m busy putting together a new band and music projectWell my voiceover career is also expanding and growing and growing a little bit crazy at the moment. You could say my cup runneth over exponentially. 

For that reason, let’s get on with the research.

Item #1

The first one is called “Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study” by Saaksjarvi et al. (Sääksjärvi S 2020) and published in Spine Journal in October of 2020 which is cooling off but still pretty damn steamy. Hot enough to eat. 

Why They Did It

The aim of this study was to investigate whether early lumbar disc degeneration (DD) in young low back pain (LBP) patients predicts progression of degenerative changes, pain, or disability in a 30-year follow-up

How They Did It

  • A prospective follow-up study.
  • In an earlier study, 75 conscripts aged 20 years with LBP had their lumbar spine examined by MRI. 
  • At a follow-up of 30 years, the subjects were contacted; 
  • 35 of 69 filled a pain and disability questionnaire, 
  • and 26 of 35 were also reexamined clinically and by MRI. 
  • The images were evaluated for decreased signal intensity and other degenerative changes. 
  • Association between decreased signal intensity of a disc at baseline and the presence of more severe degenerative changes in the same disc space at follow-up was analyzed using Fisher exact test. 
  • Association between decreased baseline signal intensity and pain/disability scores from the questionnaire was analyzed with Kruskal-Wallis H test.

What They Found

  • The total number of lumbar discs with decreased signal intensity increased from 23 of 130 to 92 of 130 
  • Distribution of DD changed from being mostly in L4-L5 and L5-S1 discs to being almost even between the four lowermost discs. Discs that had even slightly decreased signal intensity at baseline were more likely to have severely decreased signal intensity at follow-up, compared to healthy discs. 
  • Other degenerative changes were also more common in these discs. 
  • Severity of DD at baseline did not have a significant association with current pain or disability.

Wrap It Up

In young LBP patients, early degeneration in lumbar discs predicts progressive degenerative changes in the respective discs, but not pain, disability, or clinical symptoms.

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Item #2

Our last one today is called “The Predictability of Frailty Associated with Musculoskeletal Deficits: A Longitudinal Study” by Tembo et. al. (Tembo 2021)       and published in Calcified Tissue International in 2021….ouch….don’t touch it…..it sizzles. 

And honestly….who the hell knew there was an entire damn journal called calcified tissue international?? How damn niche can you get?? For reals. And don’t tell me it’s pronounced nish because I’m just going to kick you in the shin if we meet in person. I’m going with niche because there are riches in niches. Not in nishes so don’t do it. 

Why They Did It

How They Did It

  • This longitudinal study included 287 men aged ≥ 50 yr at baseline (2001–2006) from the Geelong Osteoporosis Study
  • Baseline musculoskeletal measures included femoral neck bone mineral density (BMD), appendicular lean mass index (ALMI, kg/m2) and whole-body fat mass index (FMI, kg/m2) and lower-limb strength
  • Frailty at the 15 yr-follow-up (2016–2019) was defined as ≥ 3 and non-frail as < 3, of the following: unintentional weight loss, weakness, low physical activity, exhaustion, and slowness
  • Potential confounders included anthropometry, smoking, alcohol, FMI, socioeconomic status and comorbidities

What They Found

  • Forty-eight (16.7%) men were frail at 15 yr-follow-up.
  • Musculoskeletal models were better predictors of frailty
  • Musculoskeletal parameters improved the predictability model for frailty after 15 years

Wrap It Up

In general, muscle models performed better compared to bone models. Musculoskeletal parameters improved the predictability of frailty of the referent model that included lifestyle factors. Muscle deficits accounted for a greater proportion of the risk for frailty than did bone deficits. Targeting musculoskeletal health could be a possible avenue of intervention in regards to frailty.

And now you know…..the rest of the story….

Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. 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. 

Store

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

 

Purchase Dr. Williams 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

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

Bibliography

Sääksjärvi S, K. L., Luoma K, Paajanen H, Waris E, (2020). “Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study.” Spine (Phila Pa 1976) 45(19): 1341-1347.  

Tembo, M. C., Mohebbi, M., Holloway-Kew, K.L, (2021). “The Predictability of Frailty Associated with Musculoskeletal Deficits: A Longitudinal Study.” Calcified Tissue Int.    

Factors Leading To Surgery For Some Discs & Disc Innervation

CF 183: Factors Leading To Surgery For Some Discs & Disc Innervation

Today we’re going to talk about the innervation of the disc and we’re going to talk about some factors that can lead to surgery for lumbar disc herniations.  But first, here’s that sweet sweet bumper music

 

 

Purchase Dr. Williams 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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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. 

You have found yourself smack dab in the middle of Episode #183 Now if you missed last week’s episode , we talked about Adjustments as immune boosters and we talked about pain. Is it mind or is it matter? Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

It’s been a bit of a whirlwind these last few weeks.  I’ve talked a little more recently about launching my very first book. It’s out. It’s available on Amazon. It’s called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. And I’d love for you to go pick up a copy for yourself. You can get either ebook or a paperback sent to your front door. Your call.  Here’s why I think you need it. All of the research we talk about here and lots before I started the podcast, has been categorized for you into conditions and body regions. So, if you need some research on neck pain, flip to the section and there you go. Migraines? SI joint issues? Go to those sections and there you go.  This comes in handy when you have a talk to give and don’t have the time to go searching through pubmed all day.

Or when a patient asks you a question on something specific. Or a host of any other reasons. It’s a reference for your practice for your education, patient education, and community education.  So go grab that up while you’re thinking about it. 

As mentioned in a previous episode, we visited New Orleans, Then we were home for one weekend. Then the next weekend we were off to Dallas for the Texas Chiropractic Association’s ChiroTexpo event which is our state’s convention basically.  Two board of directors meetings for me plus some networking, classes, and problem-solving. Essentially. 

I have seen him speak before. I went to Forward 19 in St Louis before the Rona came along and saw Brett Winchester talk. We had him in Dallas at this event and he did not disappoint. I was able to better connect with Brett here in Texas. We will absolutely have him on a future podcast and in the meantime, if you want to learn more about Dr. Winchester, check out his podcast at Gestaldt Podcast.  The dude is sharper than a tack, has worked with the St. Louis Cardinals, and is one of those on the top and on the edge so check him out if you’re smart. 

Then, even though Dr. Kevin Christie was already a friend, we really got to hang out and shoot the proverbial shoo shoo in Dallas, along with Dr. Winchester. And it was just a good time had by all. 

I used to be lone wolf, folks. I used to not care about the profession. I just cared about my office, my numbers, my business. Me, me, me. I got a bit shamed into joining the TCA. Then, they had a vacancy on the Board of Directors due to the director in my district having cancer. Well, how can you say no? I was thrown into the fire with no context, no history, no experience, and little idea of what to say or how to act. But I was thrown in with a group of about 20 people that lead the profession and develop leaders from scratch. That’s what they did for me. We got there. We made it happen. 

Fast forward about a decade or so and I was on the Board of Directors for about 5 years, been the Chiropractic Development Initiative Chair, served as the Public Relations Chair, and am now going into the second year as the Department Coordinator for Scientific Affairs. I help steer the speakers we have at our events among other things. 

Associations need your membership dollars and you need to be members. But that’s just a mostly passive notion. The REAL benefit is realized when one becomes active and plugged into the association. Meaning, through being active and involved at just about every step, I have developed a network of close friends and colleagues from around the entire state of Texas that, even though some practice differently than I, would still go to bat for me, support me, and back me. And I them. 

We have developed brothers and sisters, camaraderie, and family with each other. I cannot begin to share with you how many times I’ve had questions or issues that I was able to just call up one of my TCA buddies and get a solid answer for it.  This medical integration I’m going through right now. Do you think I just up and decided to do it and jumped into the fire? Hell no.

I called all of my TCA buddies who have done it previously.  One is now my consultant on it. The attorney that wrote the law that allows for this integration is TCA’s lobby team. He’s the one that has created the paperwork and contracts for me.  Literally, none of what I am today is possible to the degree it’s been possible if not for being active, plugged in, and a solid member of the TCA leadership. 

I don’t say this to brag that I’m active or brag about my positions in the TCA or to boast in any way. I say this to let you know that there is a difference between being a member and being an active member. Between building something larger than yourself and your own practice and doing your own small thing. Between being an influential leader and being a bench warmer.  Get into the game. Raise your hand. You can thank me later.

Our profession needs evidence-based, patient-centered leaders like you. Don’t bitch about our profession if you’re not willing to step in and do something to change it. 

Item #1

This one is called “Factors Associated With Progression to Surgical Intervention for Lumbar Disc Herniation in the Military Health System” by Anderson et. al. [1] and published in Spine Journal on March 15, 2021 which means it’s got the hot spread all over it. 

Why They Did It

To determine surgery-free survival of patients receiving conservative management of lumbar disc herniation (LDH) in the military healthcare system (MHS) and risk factors for surgical intervention

How They Did It

  • The Military Data Repository was queried for all patients diagnosed with lumbar disc herniation from 2011-2018
  • Follow-up time to surgical intervention was defined as the time from diagnosis to first encounter for lumbar microdiscectomy or lumbar decompression in either a military treatment facility or in the civilian sector. 
  • The Military Data Repository was also queried for history of tobacco use at any time during military healthcare system care, age at the time of diagnosis, sex, military healthcare system beneficiary category, and diagnosing facility characteristics. 
  • Multivariable Cox proportional hazards models were used to evaluate the associations of patient and diagnosing facility characteristics with time to surgical intervention.
  • A total of 84,985 military healthcare system beneficiaries including 62,771 active duty service members were diagnosed with lumbar disc herniation in a military treatment facility during the 8-year study period. 
  • A total of 10,532 (12.4%) military healthcare system beneficiaries failed conservative management onto surgical intervention with lumbar microdiscectomy or lumbar decompression. 

What They Found

Among all healthcare beneficiaries, several patient-level (younger age, male sex, and history of tobacco use) and facility-level characteristics (hospital vs. clinic and surgical care vs. primary care clinic) were independently associated with a higher risk of surgical intervention.

Wrap It Up

Lumbar disc herniation compromises military readiness and negatively impacts healthcare costs. military healthcare system beneficiaries with lumbar disc herniation have a good prognosis with approximately 88% of patients successfully completing conservative management. However, strategies to improve outcomes of conservative management in lumbar disc herniation should address risks associated with both patient and facility characteristics.

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Item #2 Our last one today is called “Innervation of the Human Intervertebral Disc: A Scoping Review” by Groh et. al. [2] and published in Pain Medicine in June of 2021 and that’s current hot. As in present-day, burning up the face of the Earth as we speak, hot. 

Why They Did It

Changes to the intervertebral disc (IVD) have been associated with back pain, leading many to postulate that the IVD may be a direct source of pain, typically referred to as discogenic back pain. Yet despite decades of research into the neuroanatomy of the IVD, there is a lack of consensus in the literature as to the distribution and function of neural elements within the tissue. The current scoping review provides a comprehensive systematic overview of studies that document the topography, morphology, and immunoreactivity of neural elements within the IVD in humans.

How They Did It

Articles were retrieved from six separate databases in a three-step systematic search and were independently evaluated by two reviewers.

What They Found

Three categories of neural elements were described within the IVD: perivascular nerves, sensory nerves independent of blood vessels, and mechanoreceptors. Nerves were consistently localized within the outer layers of the annulus fibrosus. Neural ingrowth into the inner annulus fibrosus and nucleus pulposus was found to occur only in degenerative and disease states.

Wrap It Up

While the pattern of innervation within the IVD is clear, the specific topographic arrangement and function of neural elements in the context of back pain remain unclear. I mostly included this because, in our Neuromusculoskeletal Diplomate program, they were clear about the innervation encroaching into a disc injury and how that makes re-injury somewhat easier and sometimes more painful. Because the nerves are further into the structure of the disc once the injury has occurred and then subsequently resolved.  Very interesting stuff.  That’s all I have the time for today folks. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. 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.  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 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 – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

1. Anderson AB, B.M., Pisano AJ, Watson NI, Dickens JF, Helgeson MD, Brooks DI, Wagner SC,, Factors Associated With Progression to Surgical Intervention for Lumbar Disc Herniation in the Military Health System. Spine (Phila Pa 1976), 2021. 46(6): p. E392-E397.

2. Adam M R Groh, M., Dale E Fournier, MSc, Michele C Battié, PhD, Cheryle A Séguin, PhD,, Innervation of the Human Intervertebral Disc: A Scoping Review. Pain Med, 2021. 22(6): p. 1281-1304.

Do Chiropractors Cause Disc Herniations & Family Doctors Still Don’t Get It

CF 178: Do Chiropractors Cause Disc Herniations & Family Doctors Still Don’t Get It

Today we’re going to talk about if chiropractors cause lumbar disc herniations and how primary doctors still don’t understand guidelines that are 4 years old at this point.

But first, here’s that sweet sweet bumper music

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.

You have found yourself smack dab in the middle of Episode #178

Now if you missed last week’s episode, we talked about spinal manipulative therapy effectiveness and chiropractic for colic. Make sure you don’t miss that info. Keep up with the class.

On the personal end of things…..
It’s dragging. Don’t think for a second that you’re going to set up a medical entity in just a week or so. Lol. Goodness gracious. I went through my orthopedic diplomate in 6 months for a reason. It’s not because I’m smarter than anyone else or that I have more extra time than anyone else. Far from it.
I went through it so quickly because I hate stuff just lingering out in the ether unfinished or waiting or on hold or whatever. It drives me crazy to have unfinished ideas or projects. Literally crazy.
So, this new growth thing is making me crazy because it’s still not tied up and we’re in a holding pattern until the papers are signed and we are credentialing. Which we aren’t doing just yet.

But, I think we’re close.

My book will be launching on Tuesday, June the 8th. Be looking for it, y’all! I’m beyond excited about it!

Business is slowly picking back up. Texas is wide open at this point. Its rarer to see someone wearing a mask than it is to see those not wearing masks. Concerts have returned. Crowds have returned. And Texas had the second slowest growth of COVID last month. What does that say exactly?? Hell if I know. But I see the University of Massachusetts penalizing kids for not wearing masks off-campus and I see Texas with little COVID growth yet we’re wide open with basically no masks.

Who’s right? To me, it looks like Texas and states like Texas are right at this point in time. All of the lockdowns were important and needed and effective. Now, it appears to be time to loosen up considerably and proceed with less fear and more science.

I’m not an expert in that field. But there has to be some science coming out of what’s happening and the differences between states still locked down and states that are wide open. Between kids that have been going to school since August of 2020 and kids that just started a week or two ago because their schools have been closed all year.

It’s all interesting. That’s for sure. As for me, in my area, the sense of a return to the old normal is refreshing. In a city area of about 270,000 people, we added 19 new cases yesterday. Again, I’m 100% honest when I tell you there are basically zero masks to be seen with 100% capacity everywhere you go.

You be the judge.

Item #1
This first one is called “Chiropractic care and risk for acute lumbar disc herniation: a population-based self-controlled case series study”’ by Hincapie et. al. [1] and published in European Spine in July of 2018.

Why They Did It
“Our objective was to investigate the association between chiropractic care and acute lumbar disc herniation with early surgical intervention, and contrast this with the association between primary care physician care and acute lumbar disc herniation with early surgery.”

How They Did It
195 cases of acute lumbar disc herniation with early surgery (within 8 weeks) were identified in a population of more than 100 million person-years.
Self-controlled case series design and population-based healthcare databases in Ontario, Canada
They investigated all adults with acute lumbar disc herniation requiring emergency department (ED) visit and early surgical intervention from April 1994 to December 2004.
The relative incidence of acute lumbar disc herniation with early surgery in exposed periods after chiropractic visits relative to unexposed periods was estimated within individuals, and
compared with the relative incidence of acute lumbar disc herniation with early surgery following primary care physician visits.

What They Found
Strong positive associations were found between acute lumbar disc herniation and both chiropractic and primary care physician visits.
The risk for acute lumbar disc herniation with early surgery associated with chiropractic visits was no higher than the risk associated with primary care physician visits.

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

CHIROUP ADVERTISEMENT

Item #2
The last one today is called “Initial Management of Acute and Chronic Low Back Pain: Responses from Brief Interviews of Primary Care Providers” by Roseen et. al. [2] and published in the Journal of Alternative and Complementary Medicine in March of 2021 and we got a hot one folks!

Why They Did It
They say, “In April 2017, the American College of Physicians (ACP) published a clinical practice guideline for low back pain (LBP) [3] recommending nonpharmacologic treatments as first-line therapy for acute, subacute, and chronic LBP.”

Listeners of this Chiropractic Forward Podcast know this because I have been riding that horse nonstop since it came out. I mention damn near every single episode.

The objective here is “To assess primary care provider (PCP)-reported initial treatment recommendations for LBP following guideline release. “

How They Did It
Cross-sectional structured interviews.
Interviews were completed between December 2017 and March 2018.
Convenience sample of 72 primary care providers from 3 community-based outpatient clinics in high- or low-income neighborhoods.
The PCPs were interviewed about their familiarity with the ACP guideline, and how they initially manage patients with acute/subacute and chronic LBP.
PCPs were also asked about their comfort in referring patients to nonpharmacologic treatment providers, and about barriers to referring.

What They Found
Of 72 participating PCPs, over three-fourths indicated being familiar with the ACP guideline
For acute LBP, PCPs typically provided advice to stay active and pharmacologic management (97%; primarily nonsteroidal anti-inflammatory drugs).
For chronic LBP, PCPs were more likely to recommend nonpharmacologic treatments than for acute LBP
The most common nonpharmacologic treatments recommended for chronic LBP were physical therapy (78%), chiropractic care (21%), massage therapy (18%), and acupuncture (17%)
The cost of nonpharmacologic treatments was perceived as a barrier.
However, PCPs working in low-income neighborhood clinics were as likely to recommend nonpharmacologic approaches as those from high-income neighborhood clinics.

Wrap It Up
“While most PCPs indicated they were familiar with the ACP guideline for LBP, nonpharmacologic treatments were not recommended for patients with acute symptoms. Further dissemination and implementation of the ACP guideline are needed.”

So, what’s it going to take? Well, for one, the more fringe and crazy part of our profession needs to cut their crap. No, I don’t want to be a medical doctor or I would have gone to med school.

What I DO want is to be a respected part of an integrated healthcare team. Like it or not, the PCP is the gatekeeper and if the PCPs trust us, we get more patients, and at the end of the day, aren’t more patients the name of the game? Come on, of course, it is.

If our profession moves into the year 2021 instead of 1896 or whatever year Palmer got the idea from the osteopaths, then we can move forward with becoming a part of the community. Rather than separate and distinct. I do like not being under the state medical boards and all that good stuff. That’s necessary while there’s still such a divide.

But we can become more and more of the team if we stop thee more fringe assertions and ideas. Nepute, to my understanding, the chiro out in St. Louis…..the dude that has been, in my view, an absolute lunatic all over social media, is the first person getting nailed under the new covid laws and just happens to be a chiropractor.

Not a good look. In my opinion, he’s done chiropractors zero favors and really bruised us up quite a bit. Why in the hell would a PCP…….or a circus worker…or anyone else in the damn world…..see someone like NePuke and associate them with all other chiropractors and decide they’ll never send a patient or a friend to whackos like chiropractors?

Raise the game folks. Raise the game. Get current. Get smart. Make sure you’re sciencing once or twice per day. It’s not hard to do. Get a Diplomate. Specialize. Raise the game

Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. 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.

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

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

Home

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

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

TuneIn
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About the Author & Host

Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography
1. Hincapie C, Chiropractic care and risk for acute lumbar disc herniation: a population-based self-controlled case series study. European Spine Journal, 2018. 27(7): p. 1526-1537.
2. Roseen EJ, C.F., Atlas SJ, Mehta DH,, Initial Management of Acute and Chronic Low Back Pain: Responses from Brief Interviews of Primary Care Providers. J Altern Complement Med, 2021. 27(S1): p. S106-S114.
3. Qaseem A, Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med, 2017. 4(166): p. 514-530.