Disc Herniations

The Failure Of Lumbar Fusion Surgery

CF 160: The Failure Of Lumbar Fusion Surgery

Today we’re going to be talking all about lumbar fusion surgery and my growing disdain for the procedure. 

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 #160

Now if you missed last week’s episode, we talked about setting yourself apart in the way you treat migraines. This was an excellent episode that has no choice but to make you better. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I watched an ESPN 30 For 30 the other night. It was on Jim Valvano and his North Carolina State Wolfpack that won the national championship in basketball in 1983 I believe. It was such an unlikely story and some of his techniques were a bit wonky. 

For example, he used to make the team practice cutting down the nets from the goals after winning the championship. Far before it was ever even in the realm of possibility. The players said that was more than a little weird at first but that they came to enjoy it and it was just a part of goal-setting and visualizing. 

Visualization is such a big part of a mental process we can, and should, partake in. I myself forget to think to do it. Even though I know how impactful visualization can be. 

I can give you a personal example where visualization came in handy for me. I was a mediocre discus and shot put thrower in high school. OK, probably above average to be honest but I don’t want to pump my own tires too much. 

I ended up my junior year at 150’. That throw might win district but won’t do a lot for a guy at a regional meet. 

When my senior year came around, in the early Spring, I began getting recruited by a lot of colleges. Mostly DII colleges. One of the coaches recruiting me knew about my discus and shot put throwing. He recommended a book. It was called Peak Performance: Mental Training Techniques Of The world’s Greatest Athletes by Charles A. Garfield. 

This book was about relaxation and visualization techniques of the top athletes in the world. It was like nothing I’d ever read. Now, this was back in 1990. They may have improved visualization and relaxation techniques since then but I’m telling you, this book punted me into a different stratosphere on this stuff. I’ll put a link to it on biblio.com in the show notes for this episode. Go check it out. 

https://www.biblio.com/book/peak-performance-mental-training-techniques-worlds/d/1362768092?aid=frg&currency_id=1&gclid=Cj0KCQiAlsv_BRDtARIsAHMGVSZ40_eKAIMbAHTRPRIUrdGXJN5c6n4SG74XgCEYiPpihaJGbuny2QgaAmgHEALw_wcB

Anyway, while I was throwing in the low 160s in the discus and low 50-foot range in the shot put, when I got this book it was toward the middle of the season so it was a bit rushed. But I dove in immediately. 

Within two weeks I was at 168’ and then at the end of the season, I won state in Texas (not an easy feat with a state of 25 million people)  with a personal meet best of 176’ 4 1/2 inches. I beat my best throw of my junior year by 26’. Not only that but I went to state in the shot put. Most definitely my weak event and threw my personal best there. It was my best throw by about a foot which is a huge jump in that event ending up at 55’. Just a couple of inches from our school record. Not an accomplishment that would have ever happened without this book. 

i apologize. I went out on a tangent a bit there but I’m talking about this book and this visualization topic because it’s real and I know it can make a difference in your life and your practice. 

Listeners of this podcast know I’m not a hippy-dippy kind of dude. This isn’t a hippy-dippy thing. It’s real and I’ve experienced it. This book is meant for business as well. I encourage you to check it out yourself. 

That 30 For 30 is my favorite. It’s very inspiring and he has some great quotes in the show. You can Google his quotes as well to save some time. But, in one part, he was quoting Ralph Waldo Emerson and the quote was, “Nothing great was ever achieved without enthusiasm.”

For many of us, 2020 and COVID stole our enthusiasm. If you take Emerson at his word here, then that would mean that 2020 and COVID also stole our greatness. 

I want to encourage the listeners of the Chiropractic Forward Podcast to get your enthusiasm back. Get your greatness back. Do it right now. Make it a priority. Make it a foundation of your practice this month and let’s see what happens. 

Pass it down to your staff. Keep them pumped up. Even when or if numbers are down. My numbers are down. I’ve made no secret about that. But around here, we’re going to make enthusiasm a key ingredient of our values. Along with honesty, integrity, ethics, love, fun, and being evidence-based and patient-centered. When we add enthusiasm into that mix, I think we have a winning concoction. 

This discussion portion was meant to only deal with enthusiasm but I got to talking about Jimmy V and his visualization efforts and like an ADD guy, I saw a squirrel and just went that direction. Thank you for indulging me. I hope you found something helpful in it all. 

 em today. I first want to say that I am not against surgery for the right person and the right issue. If it’s needed and the last resort, well why the hell not? But a stat I came across a year or so ago said that out of the 56 million back pain sufferers in our country, only about 5% of them actually, truly, clinically need surgery. 

Then, as you’ll see, when you have something as invasive and impactful on life as lumbar fusion being performed so often with no improved overall outcomes on the back end of it all….well, don’t you have to be responsible and step back and take another look at that and ask yourself, what are we as surgeons doing this for, and should we continue?

Item #1

This first one today is called “Is Lumbar Fusion Necessary for Chronic Low Back Pain Associated with Degenerative Disk Disease? A Meta-Analysis” by Xu et. al. (Xu W 2020) and published in World Neurosurgery on November 27, 2020. 

Hot potato, hot potato, get ‘em while they’re good and hot!

Why They Did It

The authors wanted to evaluate the efficacy and safety of lumbar fusion versus nonoperative care for the treatment of chronic low back pain associated with degenerative disk disease.

Remember this is a meta-analysis. It’s right up there at the top of the research pyramid with systematic reviews. Meaning….it’s good stuff.

How They Did It

  • They did a comprehensive duplicate electronic database search that included PubMed, Embase, Cochrane Library, and China National Knowledge Infrastructure. 
  • They took studies published up to June 30, 2020
  • The main outcomes including clinical results, complications, and all-cause additional surgeries were presented in the form of short and long-term follow-up results. 
  • Six prospective studies involving 159 patients for short-term follow-up and 675 for long-term follow-up were included.

What They Found

  • The 2 interventions exhibited little difference in regard to short- and long-term Oswestry Disability Index and visual analog scale scores for back and leg pain, 
  • Lumbar fusion might bring about lower additional surgery rate 
  • Lumbar fusion might bring about a higher complication rate in the long term.

Wrap It Up

“The present meta-analysis determined that fusion surgery was no better than nonoperative treatment in terms of the pain and disability outcomes at either short- or long-term follow-up. It is necessary for clinicians to weigh the risk of complications associated with fusion surgery against additional surgeries after nonoperative treatment. Considering lax patient inclusion criteria in the existing randomized clinical trials, the result needs to be further confirmed by high-quality research with stricter selection criteria in the future.”

So, since we know systematic reviews and meta-analyses are like computers, then we know that they are only as good as the data you put into it. What you put into it determines what you get out of it. If they haven’t done a lot of quality research on low back fusions, well then they won’t have a lot of good quality information to assemble a meta-analysis. Right? 

When we look at 6 studies with 159 patients for the short-term part and we have 675 patients for the long-term…..I’m not a researcher but, to me, that sure doesn’t seem like a huge sample size. Certainly not when you consider the number of lumbar fusions happening around the world every single day. For such an expensive and invasive surgery, you’d sure think there’d be more to go on out there for a project like this. Is it just me?

CHIROUP ADVERTISEMENT

Item #1 was a new paper. Now I want to re-visit a couple of papers we have covered on the podcast before. One in episode 144 and one all the way back in Episode 54. 

Item #2

Item #2 is titled “Lumbar Spine Fusion: What Is The Evidence?” by Harris et. al(Harris I 2018). and published in the Journal of Internal Medicine in 2018. 

Basically, in this paper, they say that lumbar spinal fusion is common and associated with the high cost and a risk of serious adverse events. They state that they aim to summarize systematic reviews on the effectiveness of lumbar spine fusion for most diagnoses. 

Of important note is where they say that they found NO high-quality systematic reviews and the risk of bias of the randomized controlled trials they found was generally high. For something as serious as lumbar fusion surgery. Where they cut into the body, take two vertebrae that usually aren’t unstable on each other, and then drive screws into them and affix hardware to fuse them together forever and ever amen. 

No high-quality systematic reviews for lumbar fusion surgery and the RCTs out there generally carry a high risk of bias. 

Doesn’t that just give you a warm fuzzy feeling inside when a surgery like lumbar fusion doesn’t have a lot backing it?

They go on to say that the available evidence doesn’t support a clinical benefit from lumbar fusion surgery compared to non-operative treatment or stabilization without fusion for thoracolumbar burst fractures. 

They say that surgical intervention for metastatic carcinoma of the spine associated with spinal cord compromise improves mobility and neurological outcome. That was based on a single trial. 

Item #3

This one we covered in episode 144 is called, “Surgery for chronic musculoskeletal pain: the question of evidence” authored by Harris et. al(Harris IA 2020). and published in Pain Journal in September of 2020.

Why They Did It 

They say that globally, the most common reasons surgery is performed relate to the musculoskeletal system, and outside of injury, the most common reasons pertain to arthritis and back or neck pain. AKA – chronic pain. Chronic pain has become a special interest of mine after going through the orthopedic diplomat last year. It’s fascinating. 

They say, “Although the surgical treatment of chronic pain generally relies on attributing pain to objective, often visible changes on imaging studies, the causes of chronic pain are more complex and are strongly influenced by psychosocial factors.” 

Things like Yellow Flags. Go look up yellow flags and Annie O’Connor’s book called World Of Pain please and thank you.  Annie will be speaking at the Texas Chiropractic Association’s Winter Conference on March 5-6. I encourage you to be watching out on www.chirotexas.org for more info because you’ll be able to take this seminar from anywhere in the world. And I recommend you do because my hero, Dr. Anthony Nicholson from Australia will be one of the presenters. Dr. Carlo Amendolia, I will be a speaker at this thing, Dr. Brandon Steele, and Dr. Jay Greenstein as well. This is quite the conference getting put together, folks. So make your plans. 

They say that surgeries like debridement of degenerative joints and things of that nature ignore the complexity of chronic pain. They look at surgery as purely mechanistic in nature with little to no involvement otherwise and the procedures often rely on observational evidence only, rather than rigorous, comparative trials.  

In addition, they say that when the trials have actually been performed for these surgeries have been mostly subjective and measurements are usually not blinded to reduce the bias of the outcomes.  

Who really wants to go under the knife for anything other than having a mole cut off when the procedures have not been thoroughly investigated, researched, and tested? 

Uh hell no. No thank you. 

This paper was written to demonstrate that observational evidence is not adequate when you consider the costs and risks of surgical intervention. They advocate that surgical procedures should undergo randomized controlled trials with blinding and showing statistical and clinically important symptomatic improvement when compared to no surgery at all.  

Well no duh. Who on Earth would put something into widespread use….surgically that is…..without doing their due diligence through research? Well…..evidently everyone in the medical profession from this.  

Ultimately in this paper, the goal here was to quantify what kind of support exists in the literature for some common procedures.  

How They Did It

  • The first thing to do was to identify the common procedures performed for chronic pain
  • Secondly, they had to identify the number of published RCTs comparing each procedure to a control group treated without that procedure
  • They did a search of the Cochrane Central Register of Controlled Trials
  • Each paper was reviewed by two independent authors

What They Found

  • A very low proportion of the RCTs on the selected procedures compared the procedure to not performing the procedure. 64 from the more than 6,735 studies. Less than 1% if you’re keeping track. Is that not stunning? And infuriating?
  • Of those 64, only 9 were favorable to surgery. 
  • When considering individual surgical procedures, the majority of comparative trials did not favor surgery 
  • None of the studies using patient blinding for any procedure found it to be significantly better than not having the surgery at all. 

Wrap It Up We conclude that many common surgical procedures performed for musculoskeletal conditions causing chronic pain have not been subjected to randomized trials comparing them to not performing the procedure. 

Based on the observation that when such studies have been performed, only 14% (on average) showed a statistically significant and clinically important benefit to surgery; there is a need to produce such high-quality evidence to determine the effectiveness of many common surgical procedures.  

Furthermore, the production of high-quality evidence should be a requirement before widespread implementation, funding or professional acceptance of such procedures, rather than the current practice of either performing trials after procedures have become commonplace, or not performing comparative trials at all.” 

Wouldn’t you like to know that your mom’s spinal surgery procedure was fully vetted? It was researched against not doing it at all? They haven’t done that? 

Make memes and/or infographics from the sound bites I’ve given you here. You can use all of this stuff if you have a little imagination. 

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. 

Subscribe Button

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 & Vlogger

 

 

Bibliography

  • Harris I, T. A., Stanford R, (2018). “Lumbar spine fusion: what is the evidence?” Internal Med J.
  • Harris IA, S. V., Mittal R, Adie S, (2020). “Surgery for chronic musculoskeletal pain: the questions of evidence.” Pain 161(9): S95-S103.
  • Xu W, R. B., Luo W, Li Z, Gu R, (2020). “Is Lumbar Fusion Necessary for Chronic Low Back Pain Associated with Degenerative Disk Disease? A Meta-Analysis.” World Neurosurg 146: 298-306.

The Fate Of An OxyContin Producer & The Outdated Use of MRI Diagnosing Cervical Dysfunction

CF 150: The Fate Of An OxyContin Producer & The Outdated Use of MRI Diagnosing Cervical Dysfunction  Today we’re going to talk about the outdated use of MRI to diagnose cervical dysfunction and then the fate of an oxycontin producer.   But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

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

Do it do it do it. 

CF 013: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 1 of 3)

 

You have found yourself smack dab in the middle of Episode #150 Now if you missed last week’s episode, we talked about the costs of preventable disease, and then we’ll talk about whole-body vibration for function and bone mineral density in postmenopausal, osteoporotic women. Make sure you don’t miss that info. Keep up with the class.  While we’re on the topic of being smart, did you know that you can use our website as a resource?

Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function

On the personal end of things…..

On the personal side of things, it’s an alright week. Nothing too crazy other than the rise in the Rona around the nation. We got my biggest week last week since Rona hit us. We had 170 visits last week. Still down from my average of 182 pre-Rona but way up from an average of 135-145 post-Rona.

So progress. Then this week, we’re having three days of snow, ice, and sleet. So….it’s a Texas Two-Step. Two steps forward and one step back. Patience is a virtue. Blah. Such is life.

I thought I’d share a recent experience with you all in an effort to let you know you’re not alone, we can’t make them all happy, and how I handled it.

So last weekend I got an email. It wasn’t positive. In fact, it was a bit combative. Let’s just say it wasn’t flattering. Now, I’d like to be fair to myself here. In 22+ years, I’ve had conflict or whatever you want to call it….let’s call it miscommunication. I’ve had a miscommunication with patients only 3-4 times. Five if I’m pushing it. But this goes to serve as an example, you’re never too old or in practice too long to be above being questioned. In fact, in today’s culture of disrespecting ‘experts’ for lack of a better word, questioning authority, and an overall culture of lacking mutual respect…..well, I think it makes sense that we’re all more likely to have some miscommunication issues here and there. 

Then, online reviews throw a whole other kink into the plan, doesn’t it? So, due to respect for this person and HIPAA, I will be very vague here but in general, this person had significant cervical disc radiculopathy. Sometimes you make a diagnosis and you’re not 100% sure but you’re heading that direction. Not with this one. There was no doubt. They were very upset. Crying. Nauseous. Not feeling well and rating the pain at a 7 out of 10 on the VAS scale. 

We tried some over-the-door traction but it really made the person nauseous so that was out. I tried some retraction/extension exercises and started them on nerve gliding exercises to try to make some headway.  The second treatment comes and we are able to do a little more. Now they’re rating it at a 4 out of 10. Looks like we’re on easy street right? We got this!!

We did very light decompression and the patient said it felt good and they were doing better.  OK. Whew. Another one on the road to avoiding surgery.  Not so fast. For whatever reason, this patient never showed up again. I don’t always think about my patients but I did think about this one because they were so severe on day one. I wondered how they were doing and why I never saw them again. 

Well, this weekend’s email answered that for me. There’s no need to read the whole email just because there’s no need but the sentiment of it was that I had a conversation with them that they characterized as saying that anxiety was causing the pain and that I told them I couldn’t help them. What they took from the conversation was that I should have ordered an MRI on day one basically, that I blamed mental and emotional issues on the part of the patient for their pain and they felt that was unprofessional and uneducated. And potentially ego-driven on top of all of that. They mentioned they sought out an MRI, went to a neurosurgeon, and had a two-level fusion, and are on the road to recovery with the help of PT.

https://www.chiropracticforward.com/giving-maintenance-care-dry-needling-and-vitalism/

 

Oh….you know I’m always honest with you folks because honestly, that’s not flattering stuff. Nobody wants to look into themselves and say, “Does this person have a point? Where did I go wrong and how can I prevent that from happening again with someone else? But here’s the truth, I literally don’t recall that conversation whatsoever. I have a thousand different conversations every week. But I know me. I’ve never in my life told a patient that they have mental or emotional problems and those are the source of their pain. Nor have I ever insinuated that anxiety is the pain source when it’s clear as a bell that it’s radiculopathy secondary to a disc issue. My staff has heard me repeat the same discussions, the same lines, and the same jokes day after day, month after month and they’ll be the first to tell you I’ve never said anything of the sort. 

So, flummoxed as I have been, I slept on that email for the rest of the weekend thinking about it. The last thing you want to do is respond out of anger. You definitely don’t want to respond out of a defensive posture. Especially when you’re reasonably sure you did nothing uneducated or ego-driven. A response like that will only make us look more unprofessional than they already think we are and maybe even potentially provoke. 

So, in short, I did not address the ego comment because I felt it was unnecessary. I’ll just take my lumps on that one. I mentioned how happy I was to hear from them and hear they are recovering. I genuinely was glad. Even if the email was less than flattering.  At least they got some aspect of a resolution. Even if I wasn’t the end solution. I don’t feel there’s any ego on my part in that sentiment. 

I explained that we typically do a trial treatment of a week or two before deciding on advanced imaging and that would have definitely been in the considerations had we treated beyond two appointments. That’s appropriate. Some can make an argument that there was radiculopathy so we could have gotten an MRI on day one. But, if we’re honest, how many patients do you have that have radiculopathies that you are able to clear fairly quickly without resorting to an MRI? My guess is quite a few because that’s my experience. We just don’t have to get very many. But again, we have to have the chance to find out, right?

I discussed briefly that I am very much on top of current research and thinking with regards to pain and neuromusculoskeletal issues and may have been assessing yellow flags. I discussed briefly what the biopsychosocial aspect of treatment entails these days but didn’t want to dwell on it much. Mostly because I never felt it was anxiety, mental, emotional driven thing to start with. It was clearly a disc. But I hope the mention somehow rebuts the idea that I need more education. 

I offered that as a potential reason we may have had some miscommunication.  I also mentioned that there have been very few patients over the years that I would just straight up tell them “I can’t help you.” I told them that I’m typically one of the most stubborn practitioners and will hold on until it’s crystal clear I’m not helping. That, for me, has never happened after only two visits.  In a nutshell, I said that being patient-centered, evidence-based, and having high patient satisfaction was the most important thing to me and that I don’t recall the exact conversation or the wording but that I can learn from the email and can use it to make me better at my job and that I appreciated them taking the time to share their thoughts with me. 

In the end, I was glad to hear about them feeling better and I apologized for any miscommunication on my end.  While that sounds like a very long email, it wasn’t and I took the time to make sure it was hopefully as eloquent as a guy like myself can generate. Without arrogance, ego, combativeness, or being defensive. But WITH being caring, being professional, and being thoughtful. 

Even though it may not be reciprocated, I respect this person and I DO hope they are feeling better. And, whether we feel like these things are our fault or whether we think we did anything wrong or not, we can ALWAYS always learn from stuff like this. We can always be better. I can promise you, I learned to not be lackadaisical when it comes to speaking to patients about central nervous system upregulation or sensitization. Or when discussing the biopsychosocial aspect of pain. 

People don’t know what we know about that stuff and we shouldn’t assume that it’s an easy topic and everyone ‘gets it.’ Or will get it. I really cannot explain what happened there but, I do know it made me step back and think through it though. It made me check my communication. 

Again, I don’t tell you all this stuff because I love it or love to talk about it. I don’t tell you all my patient numbers weekly because I love it. I share this stuff with you because what is happening with me is real. It’s real life. And if it’s happening to me, then it IS happening to many of you. And if it’s not currently happening to you, it CAN or WILL and you may learn from me.  Not as a mentor per se but as that Ol’ Uncle Jeffro.

Alright, enough with the stress talk. Geez. Not very often at all. Maybe once every 5 years or so but when it happens……geesh. I take it personally, I take it home, I dwell on it, and I’m not too proud to admit that it affects me.

I care.

I truly do.

If you get anything from this podcast and all of these episodes, it should be that I care. I care about chiropractic patients, our profession, ethics, morals, professionalism, education, and doing it the right way. 

I care. 

Item #1 Let’s start out with this article that was in CNN Business last week. It’s an article by Chris Isidore called, “OxyContin maker to plead guilty to federal criminal charges, pay $8 billion, and will close the company”(Isidore 2020). It was published on October 21, 2020, it’s cold as hell in Texas but that….that’s hot.  The highlights of the article are that Purdue Pharma, the maker of OxyContin, has agreed to plead guilty and to pay more than $8 billion. Not only pay $8 billion but to also close down the company.  What? Yeah, they say the money will go to opioid treatment and abatement programs. “Purdue Pharma actively thwarted the United States’ efforts to ensure compliance and prevent diversion,” said Drug Enforcement Administration Assistant Administrator Tim McDermott. “The devastating ripple effect of Purdue’s actions left lives lost and others addicted.” They say, “The company doesn’t have $8 billion in cash available to pay the fines. So Purdue will be dissolved as part of the settlement, and its assets will be used to create a new “public benefit company” controlled by a trust or similar entity designed for the benefit of the American public.

Adjusting Disc Herniations and Bulges

 

The Justice Department said it will function entirely in the public interest rather than to maximize profits. Its future earnings will go to paying the fines and penalties, which in turn will be used to combat the opioid crisis.” Maybe it’s just me but that sounds Big Brother as hell to me. Don’t get me wrong, pharma companies, in many instances, are of the devil but to dissolve them, then recreate them and they be basically government run? I don’t know about all that but to me, that’s what this sounds a bit like. 

They go on to say, “That new company will continue to produce painkillers such as OxyContin, as well as drugs to deal with opioid overdose. “The company, which filed for bankruptcy in 2019, pleaded guilty to violating federal anti-kickback laws, as it paid doctors ostensibly to write more opioid prescriptions.” What a-holes. Paid doctors to write more opioid prescriptions. And what a-hole of a doctor do you have to be to take payment to write addicting prescriptions in the first damn place? Honestly.  Meanwhile, we recently crossed the 450,000 dead mark.

Dead from opioid-related overdoses. All the while we evidence-based chiropractors sit and watch stuff we could help treat just spiral out of control. We’re sitting on the bench waiting for the coach to put us in the game but we just rarely get our number called.  If they want to make surgeons the quarterback of the football team, at least we could be the running back or tight end or something. Geez.

We could be a key part of the pain team and research has told the stakeholders several times. But nope. We’re stuck riding the pine.  A little further down in the article, my worries are actually hit on when they say, “So some states are objecting to the settlement. Twenty-five state attorneys general wrote to US Attorney General William Barr last week arguing against the plan to create a government-controlled company out of the assets of Purdue Pharma, arguing that the government should not be in the business of selling OxyContin.”

And I agree with the 25 state attorneys general. That, to me, is not what American was built on.  Again, don’t get me wrong, I’m all about punishing the hell out of a corrupt and evil company like Purdue Pharma. I’m even all about putting them out of business. Hell, the Statler family that runs this business pulled $10 billion out of the company and placed into family trusts before filing bankruptcy. It’s a bad group of people. Lop they’re damn heads off if you think they deserve it…..OK, maybe not to that extent but you get my point. 

But, putting a company out of business and then stepping in as the government to take it over and run it…..no. I don’t like it. But that’s just me. 

CHIROUP ADVERTISEMENT

Item #2

Alright, my last one today is called “Twenty years of ‘insanity’ in diagnosing underlying clinically relevant cervical dysfunction using traditional MRI” by Anton Bowden(Bowden 2018) and published in the Journal of Spine Surgery in September of 2018 and it goes a little sumpin’ like dis. 

Why They Did It

Bowden starts by saying “Studies dating back several decades have failed to show a strong correlation between abnormal MRI scans of the intervertebral discs and clinical symptoms. Which you know if you’ve been following along. This is part of why the patient I mentioned earlier was mad at me for not immediately ordering an MRI. 

He continues, “The recently published 20-year prospective longitudinal study of cervical spine disc degeneration” by Daimon et al.(Daimon K 2019), is perhaps the strongest confirmation to date affirming that intervertebral discs naturally degenerate with age, and that evidence of degeneration alone is insufficient information with which to make a conclusion regarding the root cause of a patient’s symptoms.” We have covered that paper here on the Chiropractic Forward Podcast before.   They discuss the study at length saying, “Daimon et al. found that while MRI signal intensity longitudinally decreases across all cervical disc levels, there is a peak in structural degeneration that occurs at the C5–C6 level, with C4–C5 and C3–C4 having progressively lower degeneration rates. Since the C5–C6 level also corresponds with the highest flexion-extension range of motion of the cervical spine, a mechanical component of the degeneration process appears to be highlighted by the study.

Common Surgeries Aren’t Well-Researched & Chiropractic Wins Again

 

Once the C5–C6 level has been destabilized due to degeneration, sequential acceleration of degeneration at adjacent levels was observed. This insight has relevance to current discussions regarding adjacent-segment disease subsequent to arthrodesis and arthroplasty. The authors also observed that 95% of subjects experienced degenerative progression over the 20-year study period, while only 67% developed clinical symptoms. This observation lends strength to the argument that trying to fight all forms of disc degeneration is an insolvable fight against nature, at least for the foreseeable future.” I was happy to see him mention this, “As a biomechanist, I would be remiss to point out that imaging alone is missing fundamental information regarding the dynamic function of the spine. Spines that look very similar while lying down in the MRI may move very differently while going about activities of daily living—and the consequences can be dramatic for mechanical loading and pain in the discs and adjacent spinal structures “  Here on the show in some of the earlier episodes, we covered the fact that discs that show little to no issues in the supine position can look very different when seated or standing.

Significantly different as a matter of fact. The research has been done on this yet I’ve had discussions with two separate radiologists and both of them guessed there would be little to no change in the disc with position change.  That’s just not the case, is it? I’m happy to see this author recognize the fact.  Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world.

Keep taking care of yourself 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

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

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

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

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

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

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

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

Website 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

  • Bowden, A. (2018). “Twenty years of ‘insanity’ in diagnosing underlying clinically relevant cervical dysfunction using traditional MRI.” J Spine Surg 4(3).
  • Daimon K, F. H., Nishiwaki Y, (2019). “A 20-year prospective longitudinal MRI study on cervical spine after whiplash injury: Follow-up of a cross-sectional study.” J Ortho Science 24(4): 579-583.
  • Isidore, C. (2020) “OxyContin maker to plead guilty to federal criminal charges, pay $8 billion, and will close the company.” CNN Business.

 

Adjusting Disc Herniations and Bulges

CF 135: Adjusting Disc Herniations and Bulges

Today we’re going to talk about Adjusting Disc Herniations and Bulges. Is this a good idea or a bad idea and what does the research have to say about it? But first, here’s that sweet sweet bumper music
Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

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

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

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

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

Do it do it do it. 

You have found yourself smack dab in the middle of Episode #135

Now if you missed last week’s episode , we talked about the impact sleep can have on cardiovascular issues and we talked about what the profession of chiropractic can learn from the podiatry profession. There was a great discussion there I believe and great lessons we can learn. Why did podiatrists start at about the same time as chirorpactic but they’re so much more recognized, respected, and integrated compared to the chirorpactic profession? We talked about it. Make sure you don’t miss that info. Keep up with the class. 

Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper. 

On the personal end of things…..

Keepin on keepin on folks. That’s it. Staying in business. One day at a time. So far so good. I hope you found some use out of our discussion a couple episodes back about tactics myself and others are using to get those patients returning back to your office. I think I was able to share some valuable info in that regard. 

Dr. Blake Bennett posted in our private Facebook group saying, “We mailed a thousand letters to patients who were in in the past couple years and a couple weeks later we mailed another 500 postcards to patients who haven’t been in longer than that. Email every 2-3 weeks to those on the list. He says the response was great and June was a good month.”

Providing value and giving back. Thank you Dr. Bennett. I know others in need appreciate your advice as do I. 

Let’s get on with the reason for the topic today. I saw a post not long ago in the Forward Thinking Chiropractic Alliance where a colleague was asking if it’s OK to adjust segments where there is a confirmed disc herniation or bulge. It was refreshing to see a resounding YES from all of my colleagues. 

My answer was “Yes” as well. I’ve been through this from the back end though and I’ll share some of that story with you. It’s a story I’m not happy about, I’m not proud of, and I’m not happy revisiting. It was a hard time in my life to be honest. But, it’s part of my story regardless so here goes.

Many moons ago I treated A LOT of personal injury cases. We all know some of those patients are better than others. This was not one of the great patients but she was fine. No big issues. She had a disc injury and I diagnosed it appropriately I’ll have you know. 

Now something to know about me; I’m all about gentle motion. I don’t like it when someone cranks my noggin around just looking for that crack sound. I’m not interested in that and I treat people the way I want to be treated. I’m very gentle, non-agressive, use little to zero rotation in the cervical area, and just won’t be rough with it. 

Same went for this lady. And, like so many other patients, she responded well. I tracked her from the beginning where she was having pain 75% of the time down to a much lower rating on the numeric rating scale and only about 25% of the time. She was happy, I was happy and all was gleeful in the land of daily practice. 

Until…..until her daughter attended an appointment with her one day. She came in with her just up in arms and actually screaming at me because I had the audacity to work on her mother when she had a disc herniation and clear mention of the disc herniation on her MRI report. 

I asked her if she’d ever been to a chiropractor before or knew anything about chiropractic. She had not. She knew nothing about what we do or why we do it. So, I tried to explain briefly and tell her how her mother was doing so much better and how she had improved, blah, blah, blah. Didn’t matter. She didn’t know anything but she knew enough to be straight up pissed the hell off that I’d ever work with her mother with that disc herniation. 

It made for an interesting day for sure. But not as interesting as the day I received notice from my state’s governing board that they had received a complaint on me from this patient. While it had this patient’s name on the complaint, it should have had the daughter’s name on it because the patient and I had a good relationship. 

So, no matter how good the notes were, no matter how well I tracked the improvement, guess what? I STILL had to hire an attorney to defend me to my own Board. Now, it’s important to understand that the Board isn’t here for us. They’re stated goal is to protect the interest of the public when it comes to chiropractors. Let’s be fair, they see the worst of the worst. Literally. They can, after some time, become a bit jaded and maybe even start to actually EXPECT the worst when they get a complaint. 

I literally could not believe I had to take two days off of work, fly to Austin, TX, get a hotel, and defend myself against something that was so black and white. But again, let’s be fair, the folks at the TBCE weren’t there. They didn’t witness what I saw. They didn’t see the happiness of the patient with her improvement. They weren’t there when we just did manual mobilization rather than agressive adjustments. I can’t blame them. It was the process and I had to go through it. Right or wrong. And trust me, if you’ve listened to this podcast long enough honesty is big with me. This was wrong. It should have never gotten beyond the initial complaint. But whatever. I went to Austin. 

Now, one of my colleagues and friends was on the enforcement committee and she asked me some straight forward questions with the attorney sitting there. I don’t know why the hell he was even there other than to collect a check because he didn’t say a damn thing or do a damn thing. 

This was before I went through a diplomate but after going through Croft’s Whiplash Biomechanics and Traumatology course. What I’m saying is I’m better today than I was back then but I was far from being a slacker back then. I answered all of the questions, walked out, and the attorney told me what a great job I did and then we waited. 

I ended up getting a warning but nothing on my record. No action taken against me. I was pissed then and am still pissed that I’d get a warning for anything at all. I didn’t deserve a warning. It wasn’t warranted because I didn’t do anything wrong. 

Now, the reason for that story for a couple of reasons. First, I want you to understand the value of documentation. Had I not had the documentation showing the improvement of this patient over her treatment, I would have been absolute toast based solely on the word of a patient’s daughter. A person that has never been to a chiropractor and knows nothing about the profession. That’s number one. So documentation people; don’t just document to remember what you did. Document to protect yourself and your staff. It sucks but you have to do it. 

The second reason I told that story is that this experience led me to start looking up research on discs and adjusting. Was I actually wrong and I just didn’t know it? I went searching for the answers because if I were to keep adjusting people, you damn well better believe that I’m going to be adjusting people with discs that many times are herniated or bulging. That’s either knowingly doing it and most times unknowingly doing it. 

Hell, we know that 60% of patients between the ages of 40 and 50 years old have disc findings that are completely asymptomatic. No pain at all. Still, when you’re adjusting a 40 – 50 year old, you have a 60% chance of adjusting someone with a bulge or herniation. So it made sense to me to protect myself from ever running into this crap again down the road. 

If I had those paper in front of me when I went in there to defend myself, maybe I don’t even get a warning. But, if someone is sitting on the enforcement and questioning concerning adjusting areas with disc issues, they need to be on top of that research as well. And they might have been. I don’t know. All of the folks at the TBCE have become well thought of friends and colleagues now that I’ve been active in the Texas Chiropractic Association for so many years. Not the case at the time though. I only knew one of them back then. Even though there’s been a turnover since this happened many moons ago, I’m still friends with even the new TBCE crew and they’re all highly respected and thought of by me. Good good people just trying to do a good job. 

Anyway, We’re going to go through some papers here for you so you can get a clear picture on this topic. 

Item #1

OK, Item #1 this week is called “Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study” by McMorland, et. al. publshed in the Journal of Manipulative Physiological Therapeutics in October of 2010(McMorland G 2010). 

Why They Did It

The purpose of this study was to compare the clinical efficacy of spinal manipulation against microdiskectomy in patients with sciatica secondary to lumbar disk herniation (LDH).

How They Did It

  • 121 patients were in the study
  • Patients had to have failed at least 3 months of nonoperative management like analgesics, lifestyle modification, physiotherapy, massage, or acupuncture. 
  • They were randomized to either surgical microdiskectomy or standardized chiropractic spinal manipulation
  • Patients could opt to crossover to the other treatment after 3 months

What They Found

Significant improvement in both treatment groups compared to baseline scores over time was observed in all outcome measures. After 1 year, follow-up intent-to-treat analysis did not reveal a difference in outcome based on the original treatment received

Wrap It Up

“Sixty percent of patients with sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention. Of 40% left unsatisfied, subsequent surgical intervention confers excellent outcome. Patients with symptomatic LDH failing medical management should consider spinal manipulation followed by surgery if warranted.”

Who does this not make perfect sense to? Well….besides my patient’s daughter that is? Oh, and just about any medical physician you can find. I just don’t know how they haven’t latched onto this research yet. Honestly. 

Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. If you’re into IASTM also known as instrument assisted soft tissue manipulation, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend. 

Drop Release is a revolutionary tool that harnesses the body’s built-in protective systems to make muscles relax quickly and effectively.  This greatly reduces time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day.

It’s inventor, Dr. Chris Howson, from the great state state of North Dakota has is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase. 

Go check Drop Release at droprelease.com and tell Dr. Howson I sent you.

Item #2

This is a great one here called “Outcomes From Magnetic Resonance Imaging–Confirmed Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulative Therapy: A Prospective Cohort Study With 3-Month Follow-Up” by Peterson et. al. published in the Journal of Manipulative and Physiological Therapeutics in August of 2013(Peterson C 2013). 

Why They Did It

The purpose of this study was to investigate outcomes of patients with cervical radiculopathy from cervical disk herniation (CDH) who are treated with spinal manipulative therapy.

How They Did It

  • 50 Adult Swiss patients with neck pain and dermatomal arm pain; sensory, motor, or reflex changes corresponding to the involved nerve root; and at least 1 positive orthopaedic test for cervical radiculopathy were included.
  • Magnetic resonance imaging–confirmed CDH linked with symptoms was required.
  • Baseline data included 2 pain numeric rating scales (NRSs), for neck and arm, and the Neck Disability Index (NDI). At 2 weeks, 1 month, and 3 months after initial consultation, patients were contacted by telephone, and the NDI, NRSs, and patient’s global impression of change data were collected
  • High-velocity, low-amplitude spinal manipulations were administered by experienced doctors of chiropractic.
  • Acute vs subacute/chronic patients’ NRSs and NDIs were compared using the Mann-Whitney U test.

What They Found

  • At 2 weeks, 55.3% were “improved,” 68.9% at 1 month and 85.7% at 3 months.
  • Statistically significant decreases in neck pain, arm pain, and NDI scores were noted at 1 and 3 months compared with baseline scores
  • Of the subacute/chronic patients, 76.2% were improved at 3 months.

Wrap It Up

Most patients in this study, including subacute/chronic patients, with symptomatic magnetic resonance imaging–confirmed CDH treated with spinal manipulative therapy, reported significant improvement with no adverse events.

Item #3

This one is from Bergmann, et. al. and published in the Journal of Manipulative and Physiological Therapeutics in 1998 called “Manipulative therapy in lower back pain with leg pain and neurological deficit.(Bergmann TF 1998)”

Why They Did It

To discuss a case of sciatica associated with lower back pain that originates in a disc. We discuss the use of manipulative therapy as a conservative approach and compare it with other conservative methods and with surgery.

How They Did It

  • The patient suffered from lower back and left leg pain that had increased in severity over a 6-day period. There was decreased sensation in the dorsum of the left foot and toes. Computed tomography demonstrated the presence of a small, contained disc herniation.
  • The patient was initially treated with ice followed by flexion-distraction therapy. This was used over the course of her first three visits. Once she was in less pain, side posture manipulation was added to her care. Nine treatments were required before she was released from care.

Wrap It Up

“We need a nonsurgical, conservative approach to treat lower back pain with sciatica as an alternative to and before beginning the more aggressive, and potentially hazardous, surgical treatment. There is some support for the idea that lumbar disc herniation with neurological deficit and radicular pain does not contraindicate the judicious use of manipulation. there is ample evidence to suggest that a course of conservative care, including spinal manipulation, should be completed before surgical consult is considered.”

Item #4

The last one we’ll cover here is called “Spinal manipulation in the treatment of patients with MRI-confirmed lumbar disc herniation and sacroiliac joint hypomobility: a quasi-experimental study” by Shokri et. al and published in Chiropractic and Manual Therapies in May of 2018(Shokri E 2018).

Why They Did It

To investigate the effect of lumbar and sacroiliac joint (SIJ) manipulation on pain and functional disability in patients with lumbar disc herniation (LDH) concomitant with SIJ hypomobility.

How They Did It

  • Twenty patients aged between 20 and 50 years with MRI-confirmed LDH who also had SIJ hypomobility participated in the trial in 2010.
  • Patients who had sequestrated disc herniation were excluded
  • All patients received five sessions of spinal manipulative therapy (SMT) for the SIJ and lumbar spine during a 2-week period. 
  • back and leg pain intensity and functional disability level were measured with a numerical rating scale (NRS) and the Oswestry Disability Index (ODI) at baseline, immediately after the 5th session, and 1 month after baseline.

What They Found

A significantly greater mean improvement in back and leg pain was observed in the 5th sessions and 1 month after SMT

Wrap It Up

Five sessions of lumbar and SIJ manipulation can potentially improve pain and functional disability in patients with MRI-confirmed LDH and concomitant SIJ hypomobility.

There are more but I don’t want this episode to be an hour long. If I have a patient with a hot disc, I don’t typically adjust on day one. We focus on getting the patient moving. We sit them on a theraball and have them move their hips in circles, front to back, side to side, figure eights, and whatever other way we can think of. Most have a direction of preference that is in trunk extenstion. If this is right for the patient, we will do extension bias exercises. 

We make sure they are keeping their low back nice and stiff, neutral, and strong in every movement they make. We make sure they know what position to sleep in. We stress the importance of not laying down and hoping it goes away. Rather than that, they really need to be walking and doing the exercises. If they have people that just underwent surgery walking the next day, then doesn’t that same concept make sense for discs? Well of course it does. They typically come back the next day with the pain reduced enough to be able to do some light mobilization on the low back. I am careful to not be agressive and to not put an extreme amount of rotation into the spine. We want movement but we also want the spine as straight, strong, and neurtal as possible. 

Make sure you have schooled them on this concept. Tell them to make sure they behave like they have a long flourescent light bulb taped to their back and their job is to not break it. If you can remove the triggers that caused the pain, it’ll go a long way toward their recovery. 

Alright, that’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.

Let’s get to the message. Same as it is every week. 

Key Takeaways

Store

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

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

Connect

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

Website

Home

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

 

Bibliography

  • Bergmann TF, J. B. (1998). “Manipulative therapy in lower back pain with leg pain and neurological deficit.” J Manipulative Physiol Ther 21(4): 288-294.
  • McMorland G (2010). “Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study.” J Manipulative Physiol Ther 33(8): 576-584.
  • Peterson C, e. a. (2013). “Outcomes from magnetic resonance imaging — confirmed symptomatic cervical disk protrusion patients treated with high-velocity, low-amplitude spinal manipulative therapy: a prospective cohort study with 3-month follow-up.” J Manipulative Physiol Ther 36(8): 461-467.
  • Shokri E, K. F., Sinaei E, Ghafarinejad F, (2018). “Spinal manipulation in the treatment of patients with MRI-confirmed lumbar disc herniation and sacroiliac joint hypomobility: a quasi-experimental study.” Chiropr Man Therap 26(16).

 

 

Tylenol Fails For Back Pain, Cervical Disc Research, & CAM For Headache/Migraine

CF 128: Tylenol Fails For Back Pain, Cervical Disc Research, & CAM For Headache/Migraine Today we’re going to talk about Tylenol Fails For Back Pain, Cervical Disc Research, & complementary and alternative medicine For Headache/Migraine But first, here’s that sweet sweet bumper music  

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

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

Do it do it do it. 

You have found yourself smack dab in the middle of Episode #128 Now if you missed last week’s episode, we were joined on the show by Dr. William Morgan. You wanna hear a truly impressive individual speak and share, this is one of those episodes, my friends. I wouldn’t steer you the wrong way. Go to last week’s episode and give it a listen. We talked about all kinds of good stuff, we talked about excellence, we talked about Parker, we talked about chiropractic in general and Dr. Morgan shared some experiences with us about treating the President of the United States of America. Wow. Make sure you don’t miss that info. Keep up with the class. 

While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.  Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper. 

 

On the personal end of things….. I don’t know how long I’ve been back full force now but it’s been some time. As with anything, you start to adopt new procedures and then those new things become a habit and hardly even noticeable anymore.  I see chiros asking what others are wearing. Some don’t take COVID seriously so they don’t wear anything, to be honest. They just wash hands as if washing your hands takes it out of the air or prevents the coughing from putting it out there for you to breathe.  I wear a mask. I wear glasses so I just wear them for any eye cover. Who knows if that even matters? It probably doesn’t.  I wear gloves. Not because I’m afraid to touch anyone. I started out without gloves but the sanitizer and soap washing all of the time ate my hands up. Bad. So, gloves have solved that problem for me.

Maybe I just need some new soap and I can go back to no gloves.  Now after some unfortunate interactions on Facebook I’m stepping up onto my soapbox for a good old fashioned rant and, when I’m done, I hope we can still be friends.    The more interactions with people I have, even a select few supposedly educated chiropractors, the more I’m aware of how uneducated people can truly be. 

How can you confuse the mask issue? Yes, in the beginning, they said masks weren’t useful. Back when they were trying to prevent a run on N95 masks so the hospitals could have them available.  But for months now, they have recommended them for everyone when social distancing cannot be avoided. AKA; a chiropractor’s office.  Their latest update reiterates it. The best guess estimates are that 40% of COVID cases were due to a ‘healthy’ asymptomatic spreading it.  They also just said last week that up to 35% of positives were in completely asymptomatic cases. That’s excellent news!! That means that a little over 1/3 of people that get it do extremely well and never even know they have it. That’s amazing.  The problem is that that 1/3 is responsible for 40% of the cases because they don’t know they have it and are spreading it. 

How can we be so sure that masks are effective? There are three papers that were done. One in a bus, one in South Korea, and one in Washington State that suggest masks are EXTREMELY effective in stopping COVID in its tracks.  Let’s start with the choir practice(Hammer L 2020)  (https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e6.htm?fbclid=IwAR2iRGtCRNMPhYoxCtQnP1jGYobAhunSqWMH4DSpuga5oKaOHa4VbAH7pNc) 

Following a 2.5 hour choir practice attended by 61 persons, including a symptomatic, 32 confirmed and 20 probably secondary COVID cases occurred. If you’re counting, that’s 52 of the 61 members of the choir.  3 patients were hospitalized and 2 died. The transmission was likely facilitated by close proximity during practice and augmented by the act of singing.  Alright, now, let’s talk about the bus.  In short, scientists in China studied a guy in China who passed it on to 13 others.

On the bus, his germs jumped as far as 4.5 meters to other travelers and it lingered in the air for up to 30 minutes after the guy got off of the bus. 4.5 meters for us Americanos is almost 15 feet.  Now, let’s talk about a new paper that came out on May 13 so it’s recent news.

This paper was in the journal called Respiratory Medicine by Gao, et. al.(Gao M 2020) called ‘A study on infectivity of asymptomatic SARS-CoV-2 carriers’.  This paper follows a case of an asymptomatic spreader and 455 contact encounters to try to assess the infectivity of asymptomatic carriers.  The 455 contacts wore masks, the test subject wore masks. and nobody got sick. They didn’t give COVID to any of the 455. And all wore masks. This included family members.  Medical Express posted an article on May 17th about some research out of Hong Kong where they tested a masking mechanism with hamsters. https://medicalxpress.com/news/2020-05-hamster-masks-coronavirus-scientists.html

The research by the University of Hong Kong is some of the first to specifically investigate whether masks can stop symptomatic and asymptomatic COVID-19 carriers from infecting others. They placed hamsters that were artificially infected with the disease next to healthy animals. Surgical masks were placed between the two cages with airflow traveling from the infected animals to the healthy ones. The researchers found non-contact transmission of the virus could be reduced by more than 75 percent when the masks were used. Two-thirds of the healthy hamsters were infected within a week if no masks were applied. Not only that but, those that did become infected were also found to have less of the virus within their bodies than those infected without a mask. The most effective use of the masks was when the person wearing the mask was the infected one.  

The problem with that is that nobody knows who is infected because up to 35% of people infected don’t have any symptoms or feel sick.  So, you can pass it up to 15 feet away, you can be in close proximity to 61 others and give it to 52 of them, or we can all wear masks and mostly avoid giving it to anybody. Hmmm. Let me do the math, carry the three….and….yep, I’ll wear masks for a little while.

A mask is a small ask, people. That’s the new slogan. Just give me credit. That’s all I ask.  If you don’t require masks in your office as the CDC recommends right now, you’re putting yourself, your staff, and your immunocompromised patients at risk.  You can wash your hands until the skin falls off and think you’re protecting everyone and doing a good job but you’re not taking it out of the air.

The Czechoslovakian government got it right in their slogan, “My mask protects you and yours protects me.”

No, it’s not the damn flu. While the CDC’s latest updates have a lot of good news in it, it’s still clear it’s not the damn flu. If you claim it is, you are simply not very educated on it and you’re probably doing your patients a disservice by saying that it is.  COVID is estimated to have a .4 mortality rate. Flu is estimated at .1 so COVID is FOUR TIMES as deadly. We see that day to day because, in a BAD flu year, between 60k to 80k people die of it. IN A YEAR. 

COVID has killed over 100,000 Americans in just about 3 months or so. It’s not the same as the damn flu.  But, 0.4% is waaaayyy better than it was initially thought. Some other current news from Reuters out of Italy is that it is losing its potency. Meaning, it may have mutated to a less deadly version. That’s awesome news. 

In the beginning, I was worried and stressed and anxious. We all were. It was brand new and nobody knew anything about it. Not even the experts. Hell, when AIDS was brand new, the fear was that mosquitos could infect you. Then we learned more and then we were safer.  As more and more is known about this virus, I’m no longer as worried for myself or my family or even most of my patients. The newest CDC guesstimates show that 96.6% of COVID patients never even have to go to the hospital. That’s a pretty great stat right there. 

However, I AM afraid for my mother. I AM afraid for my Dad who is in a nursing home. I AM afraid for my other family member who is immunocompromised. I AM afraid for my patients that are immunocompromised. I AM going to continue to be safe and be smart for those people. Not out of fear but out of an abundance of education and because it’s not the flu. I hope you’re doing the same. 

While there’s a 96.6% chance none of us ever have to go to the hospital because of it, there’s a 100% chance I’d have to close my office for a bit. I don’t know about you but I can’t afford that. This podcasting gig doesn’t pay anything so I guess I need to mind my p’s and q’s and be smart about my day to day bidniz. 

I know several that say but, but, but….what about….but. All that crap is noise. Uneducated, noise tinged with a healthy dose of arrogance. It really is OK to follow science and evidence. We’ve been preaching it for 3 years now. Why would COVID change that?

Let science guide you. Not Bill Gates, Trump, or Pelosi. What does the science say? Stop listening to Fox and CNN. What does the science say? Stop listening to conservative or Liberal talk show hosts. What does the science say? Stop listening to Uncle Roy, the ranch manager or the warehouse worker. What does the science say? As far as that goes, stop listening to the physician on the hospital steps spouting politically biased crap and tying it into a COVID talk. Who the hell cares? What does the damn science say?

Keep it simple. Don’t let things confuse the topic. How severe, how easily spread, how can you avoid spreading or catching? Simple crap here.

The rest of those people are uneducated and arrogant noise. Noise I tuned out over a month ago. 

Alright, rant over. 

Item #1 Our first Item this week is called “Efficacy and safety of Paracetamol for Spinal Pain and Osteoarthritis: Systematic Review and Meta-Analysis of Randomized Placebo Controlled Trials” by Machado, et. al(Machado G 2015). and published in British Medical Journal in March of 2015. 

Why They Did It They wanted to investigate the efficacy and safety of paracetamol (acetaminophen) aka Tylenol… in the management of spinal pain and osteoarthritis of the hip or knee.

How They Did It

  • Systematic review and meta-analysis
  • Medline, Embase, AMED, CINAHL, Web of Science, LILACS, International Pharmaceutical Abstracts, and Cochrane Central Register of Controlled Trials from inception to December 2014.
  • Paper considered for inclusion were all randomised controlled trials comparing the efficacy and safety of paracetamol with placebo for spinal pain (neck or low back pain) and osteoarthritis of the hip or knee.
  • 13 randomised trials were included

What They Found

  • There was “high quality” evidence that paracetamol is ineffective for reducing pain intensity and disability or improving quality of life in the short term in people with low back pain. 
  • For hip or knee osteoarthritis there was “high quality” evidence that paracetamol provides a significant, although not clinically important, effect on pain and disability in the short term.
  • “High quality” evidence showed that patients taking paracetamol are nearly four times more likely to have abnormal results on liver function tests

Wrap It Up “Paracetamol is ineffective in the treatment of low back pain and provides minimal short term benefit for people with osteoarthritis. These results support the reconsideration of recommendations to use paracetamol for patients with low back pain and osteoarthritis of the hip or knee in clinical practice guidelines.”

Item #2 This one is called “Relationship of Modic Changes, Disk Herniation Morphology, and Axial Location to Outcomes in Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulation: A Prospective Study” by Kressig et. al(Kressig M 2016). and published in Journal of Manipulative Physiology and Therapeutics in October 2016. 

Why They Did It The authors here wanted to evaluate whether cervical disc herniation (CDH) location, morphology, or Modic changes (MCs) are related to treatment outcomes.

How They Did It

  • (MRI) and outcome data from 44 patients with CDH treated with spinal manipulative therapy were evaluated
  • MRI scans were assessed for cervical disc hernation location, morphology, and modic changes
  • Pain and Neck Disability Index data were collected at baseline; 2 weeks; 1, 3, and 6 months; and then again at 1 year

Wrap It Up Although patients who were Modic positive had higher baseline NDI scores, the proportion of these patients improved was higher for all time points up to 6 months. Patients with Modic I changes did worse than patients with Modic II changes at only 2 weeks.

Item #3 Our last one is called, “Complementary and Alternative Medicine Use Among US Adults With Headache or Migraine: Results From the 2012 National Health Interview Survey” by Zhang et. al(Zhang Y 2017). and was published in Headache journal in September of 2017. 

Why They Did It They did this to answer the following questions: (1) Which complementary and alternative (CAM) modalities are used most frequently among migraine/headache sufferers? and (2) What are the self-reported reasons for CAM use among migraine/headache sufferers?

What They Found

The most frequently used CAM modality for headache/migraine was manipulative therapy at only 22%. Herbal supplementation was at 21.7% usage, and mind-body therapy was at 17.9%. The top 3 reasons given for using CAM for headaches were for general wellness, at about 28.7%, improving overall health at about 26.8%, and for reducing stress at about 16.7%. Although CAM is used by many sufferers of headaches and migraines, its use specifically for the headache or migraine is low in the US. 

Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week. 

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

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

Connect

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

Website

Home

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

  • Gao M, Y. L. (2020). “A study on infectivity of asymptomatic SARS-CoV-2 carriers.” Resp Med.
  • Hammer L, D. P., Capron I, Ross A, (2020). “High SARS-CoV-2 Attack Rate Following Exposure at a Choir Practice — Skagit County, Washington, March 2020.” CDC Weekly 69(19): 606-610.
  • Kressig M, P. C., McChurch K, Schmid C, (2016). “Relationship of Modic Changes, Disk Herniation Morphology, and Axial Location to Outcomes in Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulation: A Prospective Study.” J Manipulative Physiol Ther 39(8): 565-575.
  • Machado G, M. C., Ferreira P, Pinheiro M, (2015). “Efficacy and safety of Paracetamol for Spinal Pain and Osteoarthritis: Systematic Review and Meta-Analysis of Randomized Placebo Controlled Trials.” BMJ 350(h1225).
  • Zhang Y (2017). “Complementary and Alternative Medicine Use Among US Adults With Headache or Migraine: Results From the 2012 National Health Interview Survey.” Headache 57(8): 1228-1242.

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

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

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

But first, here’s that sweet sweet bumper music

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

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

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

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

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

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

Do it do it do it. 

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

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

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

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

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

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

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

Now, Dr. Stu McGill

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

10.

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

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

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

14. Tell me about backfitpro.com 

Chiropractic evidence-based products
Integrating Chiropractors
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
Dr. Stuart McGill on low back pain and posture

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

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

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

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

But first, here’s that sweet sweet bumper music

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

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

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

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

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

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

For you older chiros, bunk means bad info. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Item #1

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

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

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

Anyway, here’s Why They Did It

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

How They Did It

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

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

What They Found

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

Wrap It Up

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

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

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

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

The make up of the herniation

The extent of migration

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

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

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

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

Item #2

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

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

Why They Did It

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

What They Found

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

Wrap It Up

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

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

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

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

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

Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions. That’s CFP19, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription.

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

Item #3

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

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

Why They Did IT

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

How They Did It

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

What They Found

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

Wrap It Up

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

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

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

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

Key Takeaways

Store

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

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

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

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

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

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

Multifidus & Disc Degeneration, Opioids & First Provider, Craniocervical Instability

CF 084: Multifidus & Disc Degeneration, Opioids & First Provider, Craniocervical Instability

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

Today, it’s like the olden days here at the Chiropractic Forward Podcast. That’s right. No guests, just moiah. Me. Unfiltered and onery as usual. I’ve had stuff piling up in my archives and we’re going to sprint through some of it and see what sticks. We’re going to talk about the multifidus and some new research on it having to do with disc degeneration, we’ll talk about why what provider you see after low back injury can make all the difference, and we’ll talk about some hint that fibromyalgia and even POTS is theorized to be caused by craniocervical instability. Maybe?

It’s a heaping plate of knowledge noodles so keep your seat, the Italian mama that feeds you too much is in the kitchen. But first, here’s that yummy like a meatball bumper music

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

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have shimmied into Episode #84

Before we get started, 

I’m happy to introduce a new sponsor for the Chiropractic Forward Podcast called GoChiroTV. GoChiroTV is a patient education system for your office that will eliminate the need for running cable TV or the same DVDs over and over again on a loop in your waiting room. The bite-sized videos are specifically made to inform your patients about the importance of chiropractic and healthy living, to encourage referrals, and to present the benefits of the specific and different products and services you offer.

It works by using a tailored-fit video playlist that will only promote the products and services available at your practice, and the videos are replaced automatically on a weekly basis. There’s no need to manually update your playlist or learn any complicated software. With this system, you tcan truly just set it and forget it.

Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions, which also comes with a 45-day free trial to see if it’s right for your practice and…your discounted rate will be locked in for as long as you have a subscription. 

So visit GoChiroMedia.com (that’s g-o-c-h-i-r-o-m-e-d-i-a-.com) to check out the demo reels, and to get started on your free trial. Take your practice to the next level with GoChiroTV.

And thanks to them for being involved in what we’re trying to accomplish here. 

Personal Happenings

If you hear something here that you really like and would like it in written form rather than spoken, just hop onto  chiropracticforward.com, find the episode, and just scroll down to copy and paste it. If you’re using it for content or on your website for some reason, just be cool and give us some credit please. I’d sure appreciate it and I’m sure the researchers we discuss would too. 

Item #1

Our first paper to cover is called “Physical activity attenuates fibrotic alterations to the multifidus muscle associated with intervertebral disc degeneration” and is authored by G. James, D. M. Klyne, et. al. and was published in European Spine Journal in May of 2019(James G 2019). 

Why They Did It

The authors here say that chronic low back pain….chronic…longstanding low back pain literally changes and remodels the multifidus muscles. They go on to say that physical activity reduces the local inflammation that comes before multifidus fibrosis during intervertebral disc degeneration (IDD), but its effect is unknown. This study aimed to assess the development of fibrosis and its underlying genetic network during intervertebral disc degeneration and the impact of physical activity.

How They Did It

This research was actually done on mice. To keep the entertainment value of this podcast as high as possible, I’m not going to get specific here as far as substance P, MMP2, blah blah blah. We’ll just head right to the conclusion of the paper. 

They say “these data reveal the fibrotic networks that promote fibrosis in the multifidus muscel during chronic intervertebral disc degeneration. Furthermore, physical activity is shown to reduce fibrosis and regulate the fibrotic gene network.” 

So they’re saying move it move it move it. 

Item #2

This next paper is called “Initial Provider Specialty Is Associated With Long-term Opiate Use in Patients With Newly Diagnosed Low Back and Lower Extremity Pain” and is authored by TC Azad, D Vail, and J. Bentley et. al. It was published in the esteemed Spine Journal in February of 2019. (Azad TD 2019)

Why They Did It

The authors wanted to determine whether provider specialty influences patterns of opiate utilization long after initial diagnosis. I’d say that’s a great question to be asking these days. When we have 72,000 die in one year from opioid-related causes, that should be up there on the ‘what the hell’ list wouldn’t you agree?

How They Did It

The study was a retrospective longitudinal cohort analysis of patients diagnosed in 2010, with continuous enrollment 6 months prior to and 12 months following the initial visit.

They identified 478,981 newly diagnosed opiate-naive patients. 

They estimated the risk of early opiate prescription and long-term opiate use based on the provider type at initial diagnosis.

What They Found

  • 40.4% of the patients received an opiate prescription within 1 year and 4% met the criteria for long-term use. 
  • The most common provider was family practice. They were associated with 24.4% risk of early opiate prescription and a 2% risk of long-term opiate use. 
  • Risk o freceiving an early opiate prescription was higher among patients initially diagnosed by emergency medicine or at an urgent care. 
  • Risk of Long-term opiate use was highest for aptietns initially diagnosed by pain management doctors or by physical medicine and rehabiliation providers. 

Wrap It Up

Initial provider type influences early opiate prescription and long-term opiate use among opiate-naïve patients with newly diagnosed low back and lower extremity pain.

Looky here ya see, I’m just going to lay it out for you. Zero percent of opiate-naive patients get prescribed OR hooked on opiates from seeing a chiropractor. Zero. 

I’ll even go further than that and say that approximately 70-80% of them get good to excellent results and improvement of their complaint. I know this through the ChiroUp tracking system they use across the country. 

You know what else I know through the ChiroUp tracking? I know that these results happen in only about 7 visits. Kow a Chow!! I know you can’t see it but you can picture that karate chop placed precisely to deliver a virtual coup de grace. 

Alright, Enough silliness. On to out final item here. 

But before we do that –  Let’s take a short break to talk about ChiroUp. If you’re a regular listener of our podcast, you I use it and I’ve told everyone how amazing it is since about June of 2018. Well now they’re a sponsor of our show and we are really excited to have ChiroUp on board the train. 

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

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

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

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

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

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

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

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

Item #3

Item #3 is an article titled “Could Craniocervical Instability Be Causing myalgic encephalomyelitis/chronic fatigue syndrome, Fibromyalgia & POTS?” written by Cort Johnson and published in Health rising.org on February 27, 2019. (Johnson 2019)

This was actually sent to me by a cardiologist friend of mine and I’m really glad he sent it my way because it’s interesting as hell. Follow along. 

I’ll read you the first paragraph here, “Jeff had a typical ME/CFS onset: he was a young, healthy and active individual before being felled by a viral infection and a high temperature. The infection left him with headaches, dizziness, muscle weakness and pain, sound and light sensitivity, and a general sense of being worn down that was exacerbated by exercise – which he soon had to stop altogether. Socializing was the next activity to go as he buckled down to focus on getting through graduate school.”

The article goes on to talk about all of his various visits to specialists and how nothing seemed to work. In fact, he continued to decline in health all of the way to the point that he was essentially bedridden with little to no tolerance for any kind of exertion. We’re talking little energy to chew food and being wheeled into the bathroom to take a shower. Serious stuff. 

Turning his head one way could cause him to nearly lose consciousness and he felt a little like a bobble doll when he walked. His head felt heavy. 

Doing his own homework to try to basically save his own life, he stumbled across craniocervical instability, aka atlantoaxial instability, aka cranial-cervical syndrome and things started to make sense for Jeff. 

Here’s another quoted paragraph from the article, “The strange headaches, the heavy head, the problems turning his head in one direction, the autonomic nervous system issues – they could all be explained by loosened or lax ligaments at the junction between his skull and his vertebrae which kept his head properly situated atop his body. 

With his head destabilized, his spinal column was contacting and compressing his brainstem – throwing his autonomic nervous and sensory systems out of whack. His ANS had become so disturbed that even during sleep when it theoretically should have been mostly at rest – it was oscillating up and down causing bizarre heart rates.”

Craniocervical instability has been associated with conditions like rheumatoid arthritis, Ehlers Danlos Syndrome, Downs Syndrome, and other inflammatory conditions. The doctors were dismissive that, outside of any of these conditions, that he could actually have it. 

Just to expound on Ehlers Danlos a bit, one in 15 of EDS patients have craniocervical instability. 1 in 15 is a pretty good amount. Just another good reason to familiarize yourself with the Beighton scale and see if your EDS patients have other issues like we’re discussing here. 

It seems the correct imaging for CCI is a dynamic CT scan with flexion and extension view but not everyone can get dynamic CTs can they? I believe flexion and extension x-rays can give you a hint as well. 

So, skipping to the end of the story, Jeff had a fusion of the top two vertebrae to his skull and all symptoms poof disappeared. Which is awesome and good for him for diagnosing his issue and for being an advocate for himself. Those medical doctors can be a bit pesky when you go against what they think. 

The article also says there are only a few neurosurgeons in the world that can perform this sort of fusion. I sent the article to another friend of mine who just happens to be a neurosurgeon himself. He said that the whole article was really interesting and he was glad I sent it but he was confused why they think that there are only a few in the world that can do this surgery. He said they have to do it all of the time but, admittedly, it’s because of trauma. Not CCI. 

Still, it seem this is a surgery most neurosurgeons can do if needed. 

Great article, and great story that I’m linking in the show notes for you so click on it and check it out for yourself. There is a ton more with differenct patient stories so give it a read through. It’ll make you better. 


The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Store

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

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

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

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

Azad TD, V. D., Bentley J, (2019). “Initial Provider Specialty Is Associated With Long-term Opiate Use in Patients With Newly Diagnosed Low Back and Lower Extremity Pain.” Spine 44(3): 211-218.

James G, K. D., Millecamps M, (2019). “ISSLS Prize in Basic science 2019: Physical activity attenuates fibrotic alterations to the multifidus muscle associated with intervertebral disc degeneration.” Euro Spine J 28(5): 893-904.

Johnson, C. (2019). “Could Craniocervical Instability Be Causing ME/CFS, Fibromyalgia & POTS? Pt I – The Spinal Series.” Health Rising.

The Evidence For Some Surgeries, Searching for How We Help, and Opioid vs. Non-Opioid

CF 078: The Evidence For Low Back Surgery, Searching for How We Help, and Opioid vs. Non-Opioid

Today we’re going to talk about evidence for low back surgery, we’ll talk about if spinal manipulative therapy is partyly in the brain, opioid information for back, hip, or knee osteoarthritis….what does the research say?

But first, cool like a velvet Elvis, here’s that bumper music

Chiropractic evidence-based products

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


OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have flip flopped into Episode #78

Introduction

We’re here to advocate for chiropractic while we also make your life easier using research and some good solid common sense and smart talk. 

Store

I should have in my first order of the decompression brochures in in just a few days. These dudes are going to look great. I’ll put some pics in the show notes and in the email we send out once a week to our email list. 

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

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

Personal Happenings

I’ve been asked to emcee the Texas Chiropractic Association’s President’s Gala which will be during the ChiroTexpo event in Dallas, TX on June 8th. 

I’m trying to figure out if I need to be making fun of everyone I introduce or not. Maybe I should trip them? You know we chiropractors….some of us can’t take a joke right? We’ll see how it goes. Most of the guys and gals in the TCA are pretty good with having fun. 

I always heard that people don’t join state associations because they think they’re made up of a bunch of old white dudes sitting around bitching. 

Well, not at the TCA, people. We have young people and certainly not all white. That doesn’t happen in Texas these days. We are a pretty mixed state in regard to ethnicity. We are also mixed in respect to gender. Several smart and highly capable women are either on the board or in a position of influence. Heck, we have a female going through the executive chairs starting in June. I’m excited to hear her ideas and see where we go under her direction. This girl is making it happen. She has young ones too. Nothing slows her down it seems. 

Let’s get to the topics today. 

Item #1

The first item we’re talking about is called “Randomised trial support for orthopaedic surgical procedures” authored by Hyeung Lim, Sam Adie, Justine Naylor, and Ian Harris(Lim HC 2014) and published in Plos One in June 13, 2014. 

This is an interesting one because we think that the surgical procedures we undergo have been fully validated. Fully vetted. Hell, you wouldn’t lay someone open unless it’s been researched and proven beyond a doubt to fix the issue would you? One would think so…..but…..let’s dive in a bit. 

Why They Did It

The authors wanted to investigate the proportion of orthopedic procedures supported by evidence from randomized controlled trials. Trials that compared surgical procedures to non-surgical alternatives. 

How They Did It

  • Orthopedic procedures conducted in 2009, 2010 and 2011 across three metropolitan teaching hospitals were identified, grouped and ranked
  • Searches of the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Systematic Reviews (CDSR) and the Database of Abstracts of Reviews of Effects (DARE) were performed to identify RCTs evaluating the most commonly performed orthopaedic procedures
  • A risk of bias analysis was conducted for included studies using the Cochrane Collaboration’s Risk of Bias tool
  • 9,392 orthopedic procedures were performed across the index period

What They Found

Of the 83 RCTs, 23% were classified as supportive of operative intervention.23%. Twenty three percent were supportive of operative intervention. 

Only 37% of the total volume of procedures were supported by at least one RCT showing surgery to be superior to a non-operative alternative. ONLY 37% y’all. 

19.6% of the total volume of procedures were supported by at least one low risk of bias RCT showing surgery to be superior to a non-operative alternative.

Sounds crazy right? 

Of the most common orthopedic surgical interventions….the most common…..of those surgeries, less than 20% of them had a low risk of bias randomized controlled trial backing them up. 

I have some problems with cussing in my personal life but I’m determined to keep this show mostly PG-13 but man. 

That’s just shocking. Cutting people open with no better evidence than that. 

One word – two syllables. Day-um. 

The Conclusion was “The level of RCT support for common orthopaedic procedures compares unfavourably with other fields of medicine.” 

Good Lord I hope the other areas of medicince have more scientific support. 

What procedures are we talking about? Let’s be fair, we’re mostly spine people and the majority of the procedures their taling about here have nothing to do with the back. They’re talking about things like:

  • Knees
  • Hips
  • Intrnal fixation of proximal or shaft fracture of the femur
  • Ankle fracture fixation
  • Shoulder arthroscopy
  • Arthroscopy of the ankle…….no studies at all. Lol

It’s just crazy to think about. If we’re talking about evidence-based practice, is this it? 20% of our profession is about half crazy I think. Well, that’s about the same number of procedures they do that only have one RCT with low bias risk. 

Is it evidence-informed? I don’t know. That still sound awfully low to even consider it evidence-informed. 

I don’t know all of the answers and I don’t pretend to. Do what you do, but…..why they hell do they question spinal manipulation and say we have weak evidence to perform it? What? Stupid. 

Makes me want to cuss in Spanish.

Item #2

This one is just building on what we understand about what a manipulation does. It doesn’t answer any questions definitively but it does lay more groundwork for the future. 

It’s called “Spinal manipulation therapy: is it all about the brain? A current reveiew of the nurophysiological effects of manipulation.” It is authored by Gile Gyer, Jimmy Michael (never trust a guy with two first names. Especially if he’s left handed), Jame INklebarger, and Jaya Tedla. Published in the Journal of Integrative Medicine in May of 2019(Gyer G 2019). 

Hot stuff coming up

Why They Did It

While spinal manipulation has become more and more accepted after being more and more validated by research, the fact remains that we still don’t know exactly HOW it works and according to my interview with Dr. Christine Goertz in Episode 67, we are far away from having that satisfaction. The authors say there are certainly biomechanical and neurophysiological reasons for it’s effectiveness, 

The paper says, “Although both biomechanical and neurophysiological phenomena have been thought to play a role in the observed clinical effects of spinal manipulation, a growing number of recent studies have indicated peripheral, spinal and supraspinal mechanisms of manipulation and suggested that the improved clinical outcomes are largely of neurophysiological origin.”

“The body of literature reviewed herein suggested some clear neurophysiological changes following spinal manipulation, which include neural plastic changes, alteration in motor neuron excitability, increase in cortical drive and many more.” The nerual plastic changes part of that is really fascinating. It was once thought that the brain is the brain and we just start chipping away at brain cells as we age and go stupid stuff. Lol. 

They’re finding out that the brain changes. It can be trained. It can be built sort of like a muscle but in a neural sense. It’s fascinating. But that’s a different episode all together. 

I don’t have access to this full paper but, the point is, they’re trying to find out HOW we are effective through spinal manipulation and they recommend we plan for long-term follow up studies to help us determine the clinical significance of the neural responses that happen from spinal manipulation. 

Pretty interesting stuff there. 

Item #3

Last one for this week. It’s called “Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial.” It was authored by Dr. Erin Krebs, MD et. al(Krebs E 2018). and published in JAMA on March 6 of 2018 so a little over a year ago. 

The question to answer here was, “For patients with moderate to severe chronic back pain or hip or knee osteoarthritis pain despite analgesic use, does opioid medication compared with nonopioid medication result in better pain-related function?”

How They Did It

They had 240 patients and found that the use of opioid vs. nonopioid medication did not result in significantly better pain-related function over 12 months. But they may have gotten some folks addicted in on the way to the conclusion. Lol. 

Basically, this study says stay away from opioids for moderate to severe chronic back pain or hip and knee osteoarthritis. the official conclusions was, “Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months. Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.”

Boom. Pop. Pow.

I feel like I’m preaching to the choir here but you never know who listens. 

Speaking of that, Dr. David Graber shared with me that after his episodes with us, he got an email all the way from Switzerland from a chiropractor that was pretty jazzed by his comments and thoughts and Dr. Graber wanted me to know that we are indeed reaching folks and influencing on some level. 

I can’t tell you how incredibly satisfying that is. Every now and then, I get a little bit of encouraging feedback but honestly, not enough. You never know what the reach is. Are you enjoying the show? Are you listening regularly? Send me an email at dr.williams@chiropracticforward.com and let me know. I love to hear from you guys. I really do. 

Not only is it inspirational like filling up your gas tank…..but feedback can help me direct the show in a direction that I know you guys are interested in or focused on. Feed back only helps me learn more and get better so send me an email won’t you?

Chiropractic evidence-based products

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


The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

  • Gyer G, M. J., Indlebarger J, Tedla JS, (2019). “Spinal manipulation therapy: Is it all about the brain? A current review of the neurophysiological effects of manipulation.” J Integrative Med.
  • Krebs E (2018). “Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain The SPACE Randomized Clinical Trial.” JAMA 319(9): 872-882.
  • Lim HC, A. S., Naylor JM, Harris IA (2014). “Randomised Trial Support for Orthopaedic Surgical Procedures.” PLoS One 9(6).

Manipulation For Special Forces, Manipulation For Cervical Disc Herniation, Lazy Americans

CF 074: Manipulation For Special Forces, Manipulation For Cervical Disc Herniation, Lazy Americans

Today we’re going to talk about how adjustments affect our special forces – pretty interesting stuff! We’ll talk about manipulation for cervical disc herniations, and we will talk about lazy Americans. It’s a fascinating one today so don’t go anywhere. 

But first, here’s that silky smooth bumper music

Chiropractic evidence-based products

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


OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have collapsed into Episode #74. Bing bang boom, knocking ‘em down, one after another. We are doing more and more guest spots lately and have several guests set up to come on the show. You’re going to love them. 

Some are known names, some are not but all are interesting and bring something unique to the table that we are able to learn and grow from. Keep coming back time and time again. You’ll see what I mean. 

Introduction

We’re here to advocate for chiropractic while we also make your life easier using research and some good solid common sense and smart talk. 

F4CP

Just to let you all know – the F4CP will be launching an athletes and opioids eBook toward the end of this month. It’s called A case for chiropractic disrupting the cycle of pain, prescriptions, and addiciton. I’m linking it in the show notes so go get and check it out. 

https://www.f4cp.org/package/home/viewfile/whiathletes-and-opioids-ebook

DACO

We have been in the habit of discussing the DACO program weekly because I’ve been going through it. Well, I’m done with all of the hours so what do I tell you now? Am I supposed to tell you all about how I’m studying? That doesn’t sound very fascinating to me at all. In fact, that may be a cause for blood to leak from your ear holes. 

Today, I’ll just talk very briefly about one of the courses I reviewed yesterday in going back over the material. It’s one I didn’t pick up on very strongly the first time. It had to do with disc herniations that were more up in the T11/12 or L1/2 area and how they can mimic other issues further down the line. It’s really interesting stuff but went into how a hyperreflex on a patellar reflex and numbness in the anterior part of the thigh or calf without associated pain should move our thinking to an upper motor neuron lesion which would mean it’s higher up. 

Remember, the spinal cord ends at L1/2 right? You need to know this stuff because that sort of issue may mean immediate surgical consult. 

Interesting stuff. I got it a little better the second time around. I’m better today than I was yesterday.

Also, in the Chiropractic Forward Group, I posted a graphic from Yokuhashi et al demonstrating common signs and symptoms of Thoracolumbar junction disc herniations. I also added a great Epley maneuver that is easy to perform as well as an easy classification flow chart for reviewing MRIs and classifying herniations. 

It’s a private group so just go over there and request me to add you and, assuming you’re not crazy and curing cancer through your adjustments…..I’m happy to add you to the group. 

Personal Happenings

If you hear something here that you really like and would like it in written form rather than spoken, just hop onto  chiropracticforward.com, find the episode, and just scroll down to copy and paste it. If you’re using it for content or on your website for some reason, just be cool and give us some credit please. I’d sure appreciate it and I’m sure the researchers we discuss would too. 

Item #1

Let’s get it rockin and rolling with a paper that one of my favorites is a co-author on. Lead author on this one is James DeVocht, then Robert Vining, Dean Smith, Cynthia Long, Thomas Jones and a previous guest with us here, yes – one of our favorites, Dr. Christine Goertz[1]. The superwoman of chiropractic research right there and will be a presenter at ChiroTexpo in downtown Dallas, TX June 1-9. I’ll be there, front row, with a smile. And maybe a drink. It depends on how early her talk is. 

Anyway, this one is called “Effect of chiropractic manipulative therapy

on reaction time in special operations forces military personnel: a randomized controlled trial”  This one was in BMC and published this year. 

Why They Did It

Considering that chiropractic manipulative therapy has been reported to improve reaction time in some studies, and considering that reaction time can be vital for special forces military men and women, these authors were interested in if chiropractic treatment could be effective in improving reaction time for this type of patient. 

How They Did It

  • 120 special ops personnel were accepted into the study.
  • This study was a prospective, randomized controlled trial so 60 in one group and 60 in the other.
  • It was conducted at Blanchfield Army Community Hospital, Fort Campbell, KY
  • One group received 4 treatments while the other received none over a two-week trial period. 
  • Assessments used were hand/foot reaction time, choice reaction time, Fitt’s Law, whole-body respponse time, 

What They Found

No between-group statistically significant differences were found for any of the five biomechanical tests, except immediate pre- and post-changes in favor of the CMT group in whole-body response time at both assessment visits.

Wrap Up

The authors’ conclusion was as follows, “A single session of CMT was shown to have an immediate effect of reducing the time required for asymptomatic SOF qualified personnel to complete a complex whole-body motor response task. However, sustained reduction in reaction or response time from five tests compared with a wait-list control group was not observed following three sessions of CMT.”

OK, what’s the take-away and where does that lead research in the future. Here is a question, “We know chiropractic has immediate but somewhat unsustained effectiveness. So, what if they are regularly adjusted? As in 3-5 times a week for 4 weeks when compared to the other non-treatment group? Is it sustained longer then?”

If we know they’re going on a mission, and they are treated once a day, or even twice a day. What about athletes and their reaction times? Good stuff here folks.  

I think there are a lot of interesting questions just waiting for an answer. 

Item #2

Alright, moving on to manipulation for cervical disc herniations. There are two papers here so we will shorten it up and hit the highlights. Just the meat and taters please waiter, thank you. 

The first is called …well, the title is so damn long we’re going to call it manipulation for cervical disc herniations and a comparison between adjustments and nerve root injections. If they want to people to repeat the whole title, they need to make them a touch shorter. 

You can look the full title up in the show notes for this episode. It was published in the Journal of Manipulative and Physiological Therapeutics in 2016 and authored by Cynthia Peterson, et. al.[2] 

Why They Did It

They wanted to assess the outcomes for improvement, pain, and costs between nerve root injections and manipulation for cervical disc herniations. 

How They Did It

104 patients w/ MRI-confirmed symptomatic cervical disc herniations. 

52 had nerve root injections and 52 had spinal manipulative therapy.

Conclusion

Get this, the Improvement for manipulation vs. injection….manipulation in the subacute/chronic population showed 86.5% improvement while injections had 49%. 

Next paper on this topic is from the same author, Cynthia Peterson, et. al, and is called “Outcomes From Magnetic Resonance Imaging–Confirmed Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulative Therapy: A Prospective Cohort Study With 3-Month Follow-Up”[3] It was published in October 2013 in Journal of Manipulative and Physiologics Therapeutics and it goes a sumpin like a this.

Why They Did It

The purpose of this study was to investigate outcomes of patients with cervical radiculopathy from cervical disk herniation who are treated with spinal manipulative therapy.

What They Found

Most patients in this study, including subacute/chronic patients, with symptomatic magnetic resonance imaging–confirmed CDH treated with spinal manipulative therapy, reported significant improvement with no adverse events.

Item #3

Lazy Americans – I’ll admit from the get go here. I’m lazier than I want to be and weigh more than I want to weigh. No doubt. I’m 46, I get to work at 8am and besides a two hour lunch, I leave at about 8pm. Working out doesn’t typically get the attention it deserves. But I can tell you this, it’s not because I’m sitting around idle playing video games so…..I feel better in making that clear. Lol. 

This was an article from AP called “Americans getting more inactive, computers partly to blame[4].” It was written by April 23, 2019 so hot stuff here. 

The highlights of the article are as follows:

  • Americans spend almost 1/3 of their waking hours sitting
  • Sitting time increased over the last 10 years by about an hour per day to the point teens are sitting for 8 hours a day and adults are sitting for 6 1/2 hours per day. 
  • By 2016, 50% of kids and adults spent an hour or more of leisure time on computers
  • TV use was unchanged.
  • U.S. activity guidelines released last fall say adults need at least 150 minutes to 300 minutes of moderate-to-vigorous activity each week, things like brisk walking, jogging, biking or tennis.
  • Muscle strengthening two days weekly is also advised.
  • Kids aged 6 through 17 need 60 minutes of moderate-to-vigorous physical activity daily.

OK, they have convinced me. It’s time to force myself to get busy walking, biking, and lifting some weights. I have everything already. It’s just the time and the energy that I need to figure out. But I’m working on it. 

Do you ever feel like your practice owns you rather than you owning your own practice? Of course you do. It’s all about balance and I feel like I have none. I feel like its all work right now and, while that is a good problem to have, a good problem is still a problem.

April brought us a lot of blessings. It brought us about 80 new patients which is a lot for me. I’m used to about 50-55 new patients but 2019 has been a whole different thing. From December on, it hasn’t been a roller coaster. It’s been straight up and I can’t thank the Lord enough for the blessings but managing to treat them at a high level when it’s just me is most certainly a balancing act. 

Luckily, the DACO course has provided me with some quick ways of evaluating things that I didn’t have before so I can move through new patients with efficiency. Spinal manipulation is a fairly quick and straight forward process. I have staff that walk them through the exercise/rehab portion. It’s not so much the treating. 

I think the time suck is the communicating / connecting part of the deal. The questions, the idle talk that is meaningless but is vital to relationships. That is what takes up so much of the day. For some, coming to our office is the trip of the day or the outing of the week for them. It’s an event. And they want to experience it and chit chat and connect. And we better be on board for it with a smile and kindness. 

Still, it’s time for me to start moving in a direction that lightens my load. That may look like raising prices or it may look like hiring an associate. I’m not sure. But I’ll know when I know. I don’t do anything by accident usually. I do a lot of homework. I ask around. Through my involvement with my state association, my network of advisers is vast and valuable. 

So, I’ll keep you up to date on any happenings as far as all of that goes. 

For now, let’s get to the message. 

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


The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

1. DeVocht J, V.R., Smith D,, Effect of chiropractic manipulative therapy on reaction time in special operations forces military personnel: a randomized controlled trial. BMC Chiro Man Ther, 2019. 20(5).

2. Peterson C, P.C., Hodler J,, Symptomatic, Magnetic Resonance Imaging–Confirmed Cervical Disk Herniation Patients: A Comparative-Effectiveness Prospective Observational Study of 2 Age- and Sex-Matched Cohorts Treated With Either Imaging-Guided Indirect Cervical Nerve Root Injections or Spinal Manipulative Therapy. J Man Manip Ther, 2016. 39(3): p. 210-217.

3. Peterson C, e.a., Outcomes from magnetic resonance imaging — confirmed symptomatic cervical disk protrusion patients treated with high-velocity, low-amplitude spinal manipulative therapy: a prospective cohort study with 3-month follow-up. J Manipulative Physiol Ther, 2013. 36(8): p. 461-7.

4. Press, A. Americans getting more inactive, computers partly to blame. WTOP, 2019.

British Medical Journal Research, Surgeons Against Back Surgery, and Pediatric Chiropractic Under Attack

CF 068: British Medical Journal Research, Surgeons Against Back Surgery, and Pediatric Chiropractic Under Attack

Today we’re going to talk about a BIG new study helping us out in the British Medical Journal, we’ll talk about spinal surgeons against back surgery, and we’ll talk about pediatric chiropractic under attack. That’s a big topic right now. Especially down in Australia. 

But first, get ready to shake your tail feathers……here’s that bumper music

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

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have done the mashed potato right into Episode #68. Just like we were back in the 50’s. Sometimes I wonder if I was born in the wrong generation. Seriously. Speaking of, if you’d like to hear what we listen to in my office all day every day, go to Spotify and get my Old, New, Memphis & Motown Too. My profile is amarillopacc. That’s the amarillo platypus, absinthe, crustacean, crap ton. 

You’re welcome…. I’m here all week. Tip your waitresses. 

Introduction

Now, we’re here to advocate for chiropractic while we also make your life easier. 

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

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

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

DACO

Let’s talk a bit about the DACO program. I went on a short little spring break vacay last week so didn’t get many hours in. I got three hours I believe. The class I took was Class 3 of the Pain In The Frame series. It was over chronic shoulder pain. I have to tell you that the neurology is not something that comes naturally to me but, in the same breath, I want you to know that it is presented in a way that is finally understandable. Even by me and when it comes to hardcore neuro topics, that’s saying a lot, folks. Seriously.

And the concept is repeated repeatedly. That sounds redundant but I know you’re pickin up what I’m throwin down here. 

Dr. Anthony Nicholson who is part of the team that has set up the educational program, and who will also be a guest in the very near future here with us on the podcast, he was a neuro diplomate before getting his DACO so there is plenty of neuro but don’t let that scare you. Had I known that going in, it probably would have scared me a touch but, it’s no biggie. It’s explained very well and though I didn’t completely grasp it the first time or two it was run by me, I got by the 10th time for sure. Lol. 

I’m a slow learner. Lol. I beat myself up. I’m almost done with the whole thing and I have a 95 in the class. Trust me, I’m not a neuro guy. I hate hardcore neuro but it’s excellent stuff that you need to know and if I can do it, I promise you can too. 

Be looking for that interview with Dr. Nicholson all the way from Australia in just a couple of weeks or so.  Maybe sooner. He’s fascinating. 

Personal Happenings

If you hear something here that you really like and would like it in written form rather than spoken, just hop onto  chiropracticforward.com, find the episode, and just scroll down to copy and paste it. If you’re using it for content or on your website for some reason, just be cool and give us some credit please. I’d sure appreciate it and I’m sure the researchers we discuss would too. 

Item #1

Onward we march to the first item here. It’s a biggie and it’s brand new. It’s called “Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials” and authored by Sidney Rubinstein, Annemarie de Zoete, Marienke van Middelkoop, and a herd of others[1]. It was published in the British Medical Journal on March 13th of 2019.  

Hot stuff coming through

The first thing I’ll say here is that there is a pyramid of research hierarchy out there. I’ll post it in the show notes at www.chiropracticforward.com episode #68 so go check it out.

If you look at it, you’ll see that randomized controlled trials and systematic review/meta-analysis studies are at the very top of the hierarchy. 

Well, this paper, for example, as the title says, is a systematic review and meta-analysis of randomized controlled trials. See what I’m saying here? That’s why it’s a biggie. 

Why They Did It

They wanted to assess the benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain. Ah….low back gets all the attention. Still waiting to see them get those cervical pain studies rolling. Anywhoo…..

They did a systematic review on 47 randomized controlled trials including 9,211 participants that all examined the effect of spinal manipulation or mobilization in adults over 18 years old with chronic low back pain with or without referred pain. They did not accept the studies that looked at sciatica exclusively.

What They Found

  • Moderate quality evidence suggests that spinal manipulative therapy has similar effects to other recommended therapies for short term pain relief.
  • The same quality evidence suggests a small, clinically better improvement in function. 
  • High quality evidence suggested that , compared with non-recommended therapies, SMT results in small, not clinically better effects for short term pain relief and small to moderate clinically better improvement in function. 
  • They say about half of the studies examined adverse and serious adverse events. They say most of the observed adverse events were musculoskeletal related, transient in nature, and of mile to moderate severity. 

They concluded, “SMT produces similar effects to recommended therapies for chronic low back pain, whereas SMT seems to be better than non-recommended interventions for improvement in function in the short term. Clinicians should inform their patients of the potential risks of adverse events associated with SMT.”

I have to say, when we dive a bit deeper in, while the study shines brightly on spinal manipulative therapy and its practitioners, we as chiropractors can’t lean on this thing completely for the good OR the bad. That’s because, of the 47 randomized controlled trials accepted, chiropractors were the practitioners delivering the manipulative therapy in only 16 of them. Fourteen were delivered by a PT, 6 by a medical manipulator (whatever the hell that is), 5 by a DO, 2 by a bonesetter…(that’s a real thing?) and on and on. 

So, keep that in mind. This isn’t fully representative of what chiropractors do and how effective we can be. 

Also, the techniques used in the 47 studies ranged from high velocity, low amplitude like a Diversified adjustment, to low velocity, low amplitude passive movement techniques or a combination of both of those. 

Again, not entirely representative of what we chiropractors that move the bones do. In my opinion. 

What they say down deep in the paper that, considering recent systematic reviews and information showing that SMT and massage should be considered cost-effective options for low back pain and then this study showing the effectiveness…..basically….what are we waiting for to get this rocking and rolling. OK, not their words exactly but….yeah, I said that but I said it based on their research speak. 

I am including an infographic the authors generated on this that cuts to the chase and may be something you can use for your waiting room. Go check it out. 

Great paper, very impactful, and it supersedes the recommendations that you heard us talking about from The Lancet Medical Journal back in episodes #16, 17, and 18 of this podcast. 

I’ve said it so many times and it remains a true, considering the forces and powers that have been against us for generations, if we were inherently wrong in what we do, we would have been wiped off the face of the Earth years and years ago. Yet we persist. It is my opinion that we do not persist because of creative sales, influential legislation, and millions and billions in lobbying efforts. It’s because we are right in what we do on the most basic levels. 

Item #2

Our second item this week is an interesting article I came across from painchats.com called “This Spine Surgeon says Avoid Spinal Surgery for Low Back Pain: Stop and Think Carefully about Back Surgery.” the article is written by David Hanscom, MD and linked in our show notes for episode 68 at chiropracticforward.com[2].

His actual website is https://backincontrol.com but this article was in painchats.com.

The article starts off with this, “If you’re considering having spinal surgery as the final fix for your back pain, I’d like to help you to think again about your options.

I’m a spinal surgeon and I want you to know that surgery is not your best option for recovery from low back pain.

Surgery for relieving back pain has never been shown to be effective in a stringent research study. The most careful research paper published in 2006 demonstrated that only 22% of patients were satisfied with the outcomes two years later. Essentially, all research shows consistently poor outcomes for fusion surgery performed for back pain.”

Well….all I have to say is….HALLELUJAH!!!

We are going to look back at x-rays of fusions in 10-15 years and wonder what in the hell the surgeons were thinking. Mark my words people. 

He breaks it down into reasons. I will shorten the article but please, go read the whole thing. It’s really good and makes so much sense. 

Reason #1: Fusion back surgery doesn’t help pain. I love everything about this section but in particular this quote, “We also know that disc degeneration, ruptured discs, bulging discs, arthritis, and narrowed discs have been clearly shown to NOT be the source of chronic back pain.” Thank you for some common sense, man! 

Reason #2: Increased risk of more pain after back surgery. Obviously, people having spinal back surgery want less pain so you can easily see the issue here. He says if you’re already having chronic pain elsewhere, totally unrelated to the surgical issue, you are going to develop chronic pain at the new surgical site up to 60% of the time. 

Day-um… But that ties in so nicely with the neurology I’ve learned in the DACO program. When your CNS is already hyper sensitized or up-regulated, it makes sense that new insult is going to behave this way. He also says that re-operation rates within the first year are as high as 20%. Aren’t you just ecstatic that we don’t have to deal with patients that have had failed spinal surgery from day to day in our offices? Good Lord, the surgeons can have it. I don’t want it. 

Reason #3: Other treatment options are more effective. Praise the Lord and Hallelujah once again. He ties in the new finding in neurology for chronic pain. The stuff I’ve been talking about in the DACO program. He says, “Your brain memorizes pain just like an athlete, artist, or musician learns his or her skill.”

The best example is that of phantom limb pain. There is no limb, yet, the pain persists, right? I’m hoping that in your mind you just agreed with me and said, “Right,” to yourself. 

He says that once a patient understands the neurological nature of chronic pain, it becomes solvable and the key is to shift off the painful and unpleasant circuits onto functional and enjoyable ones or create detours around them. Basically re-wiring the brain to an extent. 

I can’t encourage you all enough to go read this article. Again, I’ve linked it in the show notes so go check it. 

Item #3: Chiropractic used for in infants and pediatrics has become quite the hot topic recently. Especially with the government in Australia looking at restricting any chiropractic treatment to the point where it may not be able to be utilized in patients under the age of 12 years old if I remember correctly. 

In addition, this is expected to be spreading. If my information is correct, it’s already looking to head that way in British Columbia as well as Ontario. So, it’s worth paying attention to. 

My first advice would be this: If you want to film your adjustments and put them on the interwebs, then go for it but, when it comes to hanging newborns upside down and performing manipulations on them that make them cry out and things of that nature…..I would encourage you to do your fellow pediatric chiropractors a favor and NOT put those videos on the internet. 

Not because I think you’re wrong. I don’t mess with babies myself but that’s because I’m not trained in it and am honestly uncomfortable with it. But that doesn’t mean I think it’s wrong either. Regardless, it’s not about right or wrong as much as it is perception. Particularly the perception by people that don’t know anything about or don’t understand chiropractic at all. Especially those ignorant but then also in a seat of power and influence. 

Just don’t freaking do it, OK? That’s what I’m saying. 

With all that in mind let’s get going with this one called “Manual therapy for the pediatric population: a systematic review” authored by Carol Prevost, Brian Gleberzon, Beth Carleo, and others[3]. It was published in BMC Complementary and Alternative Medicine on 24 of July 2018. Remember the research hierarchy pyramid and remember that this is a systematic review of 50 studies. 

What They Found

Moderate-positive overall assessment was found for 3 conditions: low back pain, pulled elbow, and premature infants. Inconclusive unfavorable outcomes were found for 2 conditions: scoliosis (OMT) and torticollis (MT). All other condition’s overall assessments were either inconclusive favorable or unclear. Adverse events were uncommonly reported. More robust clinical trials in this area of healthcare are needed.

This one is called “Utilization of Chiropractic Care in US Children and Adolescents: A Cross-Sectional Study of the 2012 National Health Interview Survey” authored by Dr. Trent Peng, et. al[4]. Dr. Peng is also a member of our Chiropractic Forward private group on Facebook. Congratulations Dr. Peng!

Why They Did It

The purpose of this study was to describe the prevalence of chiropractic utilization and examine sociodemographic characteristics associated with utilization in a representative sample of US children and adolescents aged 4 to 17 years.

How They Did It

They analyzed data from 9,734 respondents to the 2012 National Health Interview Survey and chiropractic utilization in the past 12 months was the targeted outcome. 

What they found

They found that

  • The 12-month prevalence of chiropractic utilization in US children was 3.0%
  • The adjusted odds (95% confidence interval) of chiropractic utilization were higher among 11- to 17-year-olds

That’s just to give you an idea of how underserved the younger population is

Last thing, it’s  titled, “Change in young people’s spine pain following chiropractic care at a publicly funded healthcare facility in Canada” authored by Christian Manansala, Steven Passmore, Katie Pohlman[5], and others and published in Complementary Therapies in Clinical Practice online on March 16, 2019. 

Hot stuff, coming up. 

That’s five articles this week. We are getting some serious schooling here right? The reason for this one was knowing that spinal pain in young people has been established as a risk factor for pain later in life, and considering the fact that recent guidelines recommend spinal manipulation and other modalities for back pain, the authors wanted to begin exploring the response to chiropractic treatment in young people with spinal pain. 

We already know it helps all of us old people but what about the kids?

The study utilized a retrospective analysis of prospectively collected quality assurance data attained from the Mount Carmel Clinic chiropractic program database. 

What they found

Young people 10-24 years old showed statistically and clinically significant improvement on the numeric scale in all four spinal regions following chiropractic management. 

The official conclusions reads as follows, “The findings of the present study provide evidence that a pragmatic course of chiropractic care, including SM, mobilization, soft tissue therapy, acupuncture, and other modalities within the chiropractic scope of practice are a viable conservative pain management treatment option for young people.”

Of course. For us that’s a duh sort of thing but, until it is written in research, you can’t treat it as a duh thing. While we think it’s an obvious conclusion, it’s not so obvious to others so thanks to these fine folks for doing the hard work and allowing all of us to stand on the shoulders of your efforts. 

This week, I want you to go forward with:

  • Big time research in medical journals keep proving you made the right decision to be a chiropractor. I know you didn’t need that validation personally but professionally, it’s a hell of a nice thing to have in our back pockets. 
  • Chronic back pain will never be cured by a surgery-first mentality and we knew that. But, our central nervous system plays as much a part in the resolution of pain as any mechanical factor plays a part in it. 
  • Pediatrics is under attack. Stop filming what you do. You’re not wrong but perception plays as much a part in the problems pediatric chiropractors are having as does any thing else. We get results in kids too but, if you don’t watch it, it’ll get taken away. Be smart. 
Chiropractic evidence-based products
Integrating Chiropractors
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

1. Rubinstein S, d.Z.A., van Middlekoop M,, Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ, 2019. 364(1689).

2. Hanscom D “This Spine Surgeon says Avoid Spinal Surgery for Low Back Pain: Stop and Think Carefully about Back Surgery.”. Pain Chats, 2019.

3. Prevost C, G.B., Carleo B,, Manual therapy for the pediatric population: a systematic review. BMC Comp Altern Med, 2019. 19(60).

4. Peng T, C.B., Gabriel K,, Utilization of Chiropractic Care in US Children and Adolescents: A Cross-Sectional Study of the 2012 National Health Interview Survey. J Manipulative Physiol Ther, 2018. 41(9): p. 725-733.

5. Manansala C, P.S., Pohlman K,, Change in young people’s spine pain following chiropractic care at a publicly funded healthcare facility in Canada. Complementary Therapies in Clinical Practice, 2019.