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Evidence Based Chiropractic

w/ Dr. Kris Anderson – FQHC, Chiropractic Research, and Professionalism

CF 079: w/ Dr. Kris Anderson – FQHC, Chiropractic Research, and Professionalism

Today we’re going to be joined by a special guest Dr. Kris Anderson from North Dakota. Yes, North Dakota’s finest is here to tell us about some of the stuff he’s got shaking and there’s a lot of stuff shaking thanks to this amazing guy. 

But first, here’s that silky satiny bumper music

Chiropractic evidence-based products

Integrating Chiropractors
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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 #79

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

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. I just got in my first box. I started with the non-surgical spinal decompression brochures. I wanted them for myself and ordered enough to send you some too!

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’m still studying. Nothing sexy there. I will say that the second time through the material is really really valuable. At least for me it is. I forget so much. Especially being 46. Not only am I older and I don’t remember things at the level I once did, but I also think I’m undiagnosed ADD. 

If I see anything shiny, man, I’m off in a completely different direction. When you have computers and phones dinging at you all the damn time, it’s tough. I have tried to minimize my notifications on the electronics. I’ve tried to keep my phone turned to do not disturb and all that good stuff. I can’t deal with all the racket when I’m trying to focus on something. 

So, yes, the second time through, for me, is of high value. 

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. 

Now, let’s get ot our guest today. 

Sometimes, we have doctors on as guests that not everyone knows. I think that if you do not know our next guest, you either should or will know him in due time. He is a mover and shaker in our profession and is really just getting started. Some people cannot be ignored and I think our guest is one of those. Without a doubt. 

He is the current President of the North Dakota Chiropractic Association and was voted Chriopractor of the Year last year for the NDCA. That’s a pretty big deal. 

He has worked on behalf of the State of North Dakota with payers, legislatyors, government agencies, and other healthcare and community stakeholders. We’ll be finding out more about that in a bit. 

He has helped conduct research on safety as well on a smoking cessation pilot study.  

He was part of a study team whose systematic review of manual therapy for pediatric patients was published in BMC Complementary and Alternative Medicine. 

He treats part time as an employee of his local FQHC. Which stands for Federally Qualified Health Center. He’s their first chiropractor so I can’t wait to learn more about how that is progressing and what challenges he is encountering as he goes. 

If all of that were not enough, he is currently the AMA RUC HCPAC ACA Alternate Advisor. Don’t feel bad if you don’t know what that is because I had to ask too. We’ll tell you about it. Some of it is super double top secret but interesting for sure. 

He is also in the middle of a North Dakota Department of Health grant to help expand detection and management of hypertension within our profession. 

Now….now do you see why we have him here with us today? You may or may not know the name Kris Anderson but I feel confident the entire profession is going to know who he is by the time he’s done leaving his dent on our profession. 

We are happy to welcome Dr. Kris Anderson to the Chiropractic Forward Podcast today. Thank you for joining us today Dr. Anderson. 

My first question for you is, “When the hell do you ever sleep?” You have a ton of stuff going on.

I noticed on your CV that you worked as a barista at Starbuck’s during your time at Palmer. I’m not sure how anyone can hold a job while going through chiropractic college but, is this a skill that has paid off for you? Do you have an espresso machine in your office?

When I go through your information, you are involved in so many things. For example, I see your are District 4’s representative for Clinical Compass, Delphi Panelist, Grantee from ND Dept. of Health, Committee member for Notrh Dakota State Board of Chiropractic Examiners, ACA, and on and on. Where does all of this stem from? I’ve never even considered district representative for Clinical Compass was even a thing. Lol. 

We covered a paper you were part of back in Episode #68. In fact, that may be how we became familiar with each other. The paper was callled “Manual therapy for the pediatric population: a systematic review. It was in the BMC Complementary and Alternative Medicine(Prevost C 2019) just this year. I want to know all about it. How did you get involved with the team? Tell us a little about the process. 

This study came out at just about the same time as the Australians and certain spots in Canada started dealing with attacks on their rights to treat pediatric patients woith chiropractic care. What amazing timing. First, are pediatric patients a significant part of your practice and secondly, what has been the reception globally in regards to the paper’s findings?

As you probably well know, Texas has been in quite a battle with our state medical association. You are clearly as deeply involved in your state’s association. What challenges are the North Dakota chiropractors facing in 2019?

Do you have any specific goals to work on as President of the North Dakota Chiropractic Association?

Tell me about the gig with the FQHC? Dr. James Lehman was on our podcast in episode #55 and he was discussing the FQHC’s and integrating. He felt integration into them would be helped by completing a specialization like the DACO or something like that. What is your opinion on that? How did you get involved? 

What does your day at the FQHC look like?

Being the FQHC’s first chiropractor, what biases or other issues are you finding yourself having to address and navigate?

Tell us more about the grant you are in the middle of for the North Dakota Department of Health? How did it come about? What is the mission?

Let’s talk about alphabet soup….. AMA RUC HCPAC ACA Alternate Advisor. I promise, almost no person alive knows what all of that stands for so do us a favor and break it down for us and tell me what the purpose is. What’s the goal and how does it help chiropractors?

Those of us that have been active know the difference between being a member and being an active member. What has it meant to you both personally and professionally to not only be a member of your state association but to also be active in it? 

When we are sitting in our offices in Amarillo, TX or in Grand Forks, North Dakota, Washington DC and the ACA seems far away and somewhat out of reach. What have you seen is an effective way to become active with the ACA on a national level?

What’s coming down the pike for you in the next 5 years and in the next 10 years? Where do you see all of your efforts headed. Or where do you hope they’re headed?

Thanks for joining us

Chiropractic evidence-based products

Integrating Chiropractors
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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

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

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
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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
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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

  • 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).

w/ Dr. David Graber (Part Two) – Chiropractic Technique, Chiropractic Gurus, Teaching

CF 077: w/ Dr. David Graber (Part Two) – Chiropractic Technique, Chiropractic Gurus, Teaching

Today we’re going to be talking with Dr. David Graber from New Jersey. Parsippany, NJ to be specific. 

But first, here’s that bumper music

Chiropractic evidence-based products

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


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

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

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. 

F4CP

We 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

Let’s talk a bit about the DACO program

Let’s get to our guest today. As I mentioned at the top of the show, we have Dr. DavidCF ep. 76 Graber with us today. 

  • Dr. Graber graduated from New York Chiropractic College in 1985 and got his Sports Diplomate in 1996. 
  • He is a fromer NYCC assistant instructor of diagnosis and technique. 
  • He developed and taught over 20 different post-graduate courses in Chiropractic technique and theory, and rehabilitation. 
  • He was voted chiropractor of the year in 2012 by the Association of New Jersey Chiropractors
  • He is the charman of the ANJC council on technique and clinical excellence. 
  • And he’s here with us today. 
  1. I can’t think of anyone better than you to ask this question of. I see so many polar opinions concerning this: with the rising popularity of the YouTube folks like Cipriano and Gregory Johnson, AKA – Ring Dinger – what is you opinion of the Y-axis adjustment? Is it as dangerous as some think?
  2. You were a speaker at Parker Vegas this year so some of our listeners may be already very aware of you. Tell me a little about your presentation and the whole experience. I saw a lot of very positive vibes on Facebook coming from evidence-based chiropractors. 
  3. You have been teaching chiropractors for some time now. One of the power points I have is called Contextual healing in Chiropractic: The Roles of Placebo, Nocebo, and Intension. I’m not too proud to admit that there is information here that I’m not 100% up on. It looks fascinating. Can you give us a summary of what is in the course. The big ideas essentially. 
  4. You are very visible in the evidence-based facebook groups like the Chiropractic Practice Research group and the Forward Thinking Chiropractic Alliance and others that are very similar in regard to being based on science and evidence-based practice. You are particularly prolific in posting research papers of all kinds. First, where do you typically get your research? Secondly, what avenue of research seems to be your area of the most interest?
  5. You say that Evidence-based Chiropractic doesn’t exist in actual practice. OK, what you talkin’ ‘bout, Willis?
  6. I have to give you some serious props. Going through your power point from Parker Vegas….let’s just say that I just finished 300 hours of education to sit for the DACO testing to get the Diplomate for Orthopedics. So much of what we learned in that course, you are already on top of. It’s already in this power point. Things like downregulation of central faciliatation, vestibular effects, neuroplasticity, mechanoreceptor stimulation, release of entrapped synovial folds of the facet joints – I know where I learned all of this stuff. Assuming you haven’t gone through the DACO yet, where did you pick it up? Was it the Sports Diplomate?
  7. When you discuss some of the unsupported and ‘Unfavorable’ testing like manual muscle testing, paraspinal skin temperature readings, surface EMG, or x-rays to localize a site of care…..how much push back do you typically encounter and how do you go about handling that? We both know there are people that will argue these things until their last breath. 
  8. Tell me…..how does one practice non-subluxation based Chiropractic that’s not considered the same thing as a PT
  9. I wrote an article for my blog at one time called “Back Alignment: Useful Terminology Or Outdated Idea?” I noticed one of your slides that made me want to jump and cheer because we are definitly on the same page. It said “Adjustments Improve Motion, Not Alignment.” I’d love for chiropractors to hear more on* that. Can I get you to elaborate briefly on that for us? 
  10. 10.When it comes to what we do as chiropractors, in general, it can be a concept, a therapy we’re not utilizing….whatever you think…..but, what is the biggest thing we are missing as a profession? From our email exchanges, it may have to do with just getting better at what we do?
  11. 11.I’ve heard chiropractic in New York is not so good but do not know specifics on that. Being right next door to New York, can you tell me about chiropractic in New Jersey? What are your State Association’s battles?
  12. 12.After going through your Parker Vegas power point, you have a fan in me. Where will you be in the future? How do we keep up with you and hopefully catch you at a seminar and hear all of this awesome information?
Chiropractic evidence-based products

Integrating Chiropractors
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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

w/ Dr. David Graber (Part One) – Chiropractic Technique, Chiropractic Gurus, Teaching

CF 076: w/ Dr. David Graber (Part One) – Chiropractic Technique, Chiropractic Gurus, Teaching

Today we’re going to be talking with Dr. David Graber from New Jersey. Parsippany, NJ to be specific. 

But first, here’s that bumper music


Chiropractic evidence-based products

Integrating Chiropractors
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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 #76

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

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. 

F4CP

We 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

Let’s get to our guest today. As I mentioned at the top of the show, we have Dr. DavidCF ep. 76 Graber with us today. 

  • Dr. Graber graduated from New York Chiropractic College in 1985 and got his Sports Diplomate in 1996. 
  • He is a fromer NYCC assistant instructor of diagnosis and technique. 
  • He developed and taught over 20 different post-graduate courses in Chiropractic technique and theory, and rehabilitation. 
  • He was voted chiropractor of the year in 2012 by the Association of New Jersey Chiropractors
  • He is the charman of the ANJC council on technique and clinical excellence. 
  • And he’s here with us today. 
  • Welcome to the show
  • Tell me about your journey into chiropractic
  • Tell me about your journey into evidence-based chiropractic
  • When did you start getting into speaking and giving presentations? How did that come about?
  • I noticed a powerpoint where you taught cervical adjusting. After going through the powerpoint, how many ways are there to adjust a neck?  Minus the techniques Rambo and Chuck Norris use of course : )
  • You say you know how to suck at a technique. I don’t know anyone that wants to suck but, in order to avoiding sucking, you must explain. 
  • You mention the people that are publishing research and teaching courses on Chiropractic technique and how to approach them as if they were a financial planner. Can you explain that a little further for us?
  • I can’t think of anyone better than you to ask this question of. I see so many polar opinions concerning this: with the rising popularity of the YouTube folks like Cipriano and Gregory Johnson, AKA – Ring Dinger – what is you opinion of the Y-axis adjustment? Is it as dangerous as some think?

Chiropractic evidence-based products

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


The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Chiropractic Residencies, Fat Cat Drug Dealers, Osteoporosis & Yoga, & Pain Science

CF 075: Chiropractic Residencies, Fat Cat Drug Dealers, Osteoporosis & Yoga, & Pain Science

Today we’re going to talk about chiropractic residencies, fat cat drug dealers, Osteoporosis and Yoga, and we’ll talk a bit about some pain facts. You’ll find something for everyone in this episode so just sit back and enjoy a cornucopia of tasty knowledge nuggets won’t you?

But first, here’s that bubbalicious bumper music

Chiropractic evidence-based products

Integrating Chiropractors
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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 skipped gleefully into Episode #75

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

We has launched an athletes and opioids eBook 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

Let’s talk a bit about the DACO program. I freshened up my info on BPPV recently while going back through the drills and reviewing the material. Did you know that 85%-90% of BPPV is caused by the particles drifting off into the posterior canal? Epley maneuver is the best technique to take care of it when in the posterior canal. 

As a side note: If you want to sound smart, those particles are actually called otoliths until they move into a semicircular canal. When they do that, they become canaliths. Probably because they’re in a canal? Makes sense to me. 

Epley Maneuver knocks out BPPV of the posterior canal in about 85% of cases. However, if it does not knock it out, start looking at the horizontal canal, 10% of the time, or check for the anterior canal. There are other head maneuvers to try for those different instances so you’ll have to get smarter at that point or refer to a specialist. When they’re in a different canal, they can get a bit nasty. 

Personal Happenings

I have to tell you all that 2019 has been a bit of a freak year for growth around here. Absolutely crazy. April was a record-breaking month for me as you’ve probably heard me talk about in past episodes. We are looking at bringing on an associate to help us with the load. The thing you worry about is, “Is it a fluke and we slow down to the point that we don’t need the extra help and now I’m stuck with an associate?” 

I don’t move into anything quickly without a lot of thought. But, even if it did slow up a bit, an associate should be there to help grow the practice rather than just take some heat off the owner, right? These are the thoughts keeping me busy at the moment. I’m sure I’m not the only one out there thinking them either. 

If you have any comments or suggestions, shoot them to me at dr.williams@chiropracticforward.com and I’ll probably share them in a future podcast. That may be an interesting topic. 

Let’s get to the good stuff

Item #1

Our first item is called “Establishing a residency program for a chiropractic specialty in a public hospital system: Experiences from Denmark” by O’Neill, et. al. and published in Journal of Chiropractic Education in April of 2019[1]. 

As you may guess, this one has to do with establishing a residency program for chiropractors in Denmark. Just as the title mentions. The paper describes experiences and lessons from a 5-year postgraduate, hospital-based residency program. 5 Years. 

One word – two syllables – Day-um

Three pilot programs were done between 2009 and 2016. What they decided so far is that there needs some improvement to structure and content that they’re on the right track for sure. And…..wouldn’t you agree?

How much better would we be individually and as a group if we had a year or two of residency in a hospital setting? Our profession would be in a completely different space right now. That’s a guarantee I don’t mind making. 

While I’m sure students aren’t quick to jump on the idea, just imagine the network you’d build while doing your residency. The connections. The learning going forward. The benefits of residency programs throughout the globe are endless. 

I’d love to see our profession move in that direction sooner rather than later. I know a couple of schools have started this in American and I believe Canada but I’m not sure which ones and to what extent just yet. If you have that info, shoot it to me. I’d love to hear more about it. 

Item #2

Let’s move on to a Fat Cat Drug Dealer – aka John Kapoor, the owner of Insys Therapeutics. His claim to fame? The first pharmaceutical boss to be convicted in a case linked to the US opioid crisis according to an article in BBC News[2]. 

“A Boston jury found Kapoor and four colleagues conspired to bribe doctors to prescribe addictive painkillers, often to patients who didn’t need them. The former billionaire was found guilty of racketeering conspiracy for his role in a scheme which also misled insurers.”

“The court heard that Kapoor – who was arrested in 2017 on the same day President Donald Trump declared the opioid crisis a “national emergency” – ran a scheme that paid bribes to doctors to speak at fake marketing events to promote Subsys.”

Alright, there is more to the article but that’s good enough for our purposes. I have to say that it’s hard for me to get excited about someone going to jail for up to 20 years but I have to say, in this case, gimme a hell yeah, and amen, and why didn’t he get more time? Really, when you consider this dude contributed to over 72,000 opioid related deaths in one freaking year…..why isn’t he getting life in prison?

And this dude looks like a fat crypt-keeper. Like an unsavory Mr. Scrooge. He fits the part perfectly. I don’t know how anyone can get in this dude’s corner. Seriously. Terrible. Good riddance and if someone ever deserved to be worth 1.8 billion and then lose it and go to prison, it’s someone like this knucklehead. 

I’m not against medication. Hell, I’m not even against opioids when absolutely necessary and with close oversight. Medication certainly has its place. But not when it’s done like this guy did it. 

Good riddance and take out the garbage. 

Item #3

This next item is called “11 Important Things To Know About Pain” written by Nick Efthimiou who is an osteopath. It was published on April 30, 2018 so just a little over a year ago….published in Integrative Osteopathy and cited in the show notes[3]. 

I mentioned a week or so ago that pain has really started to move into my head space in a way that it never did prior to going through the DACO program. Pain plays a big part in the DACO and, as a result, I find myself more and more fascinated with the topic. 

I love the way the article suggests that we know more about pain typically than our patients know and it is hard to convey that information effectively so they suggest we use concrete language rather than abstract language, we use examples that relate well to us or the patient, and we repeat the key concepts until they stick with the patient so there’s no misunderstanding. 

  1. Pain doesn’t equal tissue damage – He says this is the most important thing to understand about pain. He says there are countless examples of people experiencing tissue damage and not feeling any pain at all and vice versa. 
  2. Pain is protective – Whether it is protective of an injured body part or protective of a threat to our brain’s concept of self pain is a biological process that is meant to keep us safe.
  3. Pain is produced by the brain and localized to the body – Our brains produce a conscious experience based on input from the sensory nerves. Nociception is “noise” from the body. Sensory nerves that respond to thermal, mechanical or chemical stimulation are constantly sending signals to the spinal cord. Most of this is blocked, because it is just that – noise. However, when when those nerves are stimulated to a greater degree – think an injury, or contacting a hot surface – then your brain becomes aware of the change to the noise levels. Your brain, not knowing exactly what is going on, will respond by producing pain, and will decide to protect the area where the increased nociception is coming from. To make matters even more complex, we can have pain in the absence of nociception – think of amputees with phantom limb pain
  4. Chronic Pain is Different To Acute Pain – Acute pain is usually a response to either a tissue injury or other immediate threat, it subsides as the injury or threat does. Chronic pain is the result of changes to the nervous system which make it more sensitive. This means the nervous system and brain become “hyper protective”, generating pain with little or no provoking stimulus. If something is wrong with the central control room, then everything linked to it (which is everything), can be affected.
  5. Recurrent pain and multisite pain are both forms of chronic pain – Both recurrent pain and multisite pain are forms of chronic pain, and need to be managed as such. Often multisite pain starts as a single site, and progresses to multisite, chronic pain. 
  6. Pain is never simple, even when it seems so – Pain is not linear, as in this happened and now this hurts. It is emergent. An emergent process is when two or more things combine to form something that doesn’t share the properties of the things that make it up. Because of this, and all the invisible and unconscious factors that contribute to us experiencing pain, we can never say that pain is simple.
  7. Pain is not caused by “poor posture” weak muscles or being “out of alignment.” – It actually, many time, just the reverse. Poor posture is more likely caused by pain and poor posture is adopted as a defensive mechanism. Bam. That’s where I see minds exploding across our listenership. Kapow! 
  8. Osteopaths (and other practitioners) don’t “fix” pain – When it comes to pain, the resolution lies within your own body and brain. Even pain relieving drugs can only work if you are in the right context – morphine doesn’t always help, while sometimes a placebo pill works better than the real thing. Pow. Snap. Kabam!
  9. Everything can “work” –  There are claims from therapists, doctors and other kinds of healers about all kinds of treatments for all kinds of pain. It’s likely all of these people have numerous success stories to confirm that what they do works. This is not a bad thing at all. It is actually the goal of many therapies. The problem comes, when interventions are sold in misleading ways, i.e. they are sold as doing something unrealistic or impossible. Uhuh. I know some pretty whacky chiropractors. Of course let’s be fair. I know some wacky medical physicians as well. 
  10. 10.Inflammation is a good thing – Inflammation is the body’s way of healing.Yes, it can be painful, but pain is a protective response. And you know what needs protecting? Injured tissues. That is not to say you need to completely rest an injured tissue by the way. It is simply saying that suppressing inflammation (particularly with drugs) can impair and delay healing. Stop with the ice. They also say though, chronic inflammation is not a good thing and should be managed differently than acute inflammation. 
  11. How you live is more important than what you do – What is most important, particularly for sufferers of chronic pain, is living well, despite your pain. Healthy lifestyle habits contribute to healthy bodies and brains.

This stuff lines up with the DACO, it’s crazy. The folks that generated the DACO information, Dr. Anthony Nicholson and Matthew Long could have written this article. Word for word. In fact, before I got the end of the article and finally saw the name of the author, I emailed the article to Dr. Nicholson asking him if it was him that wrote it. Lol. 

Item #4

One more very short one. This one is called “Soft tissue and bony injuries attributed to the practice of yoga: a biomechanics analysis and implications for management.” It was authored by Lee, et. al. and published in Mayo Clinic Proceedings in March of 2019[4]. 

Here’s the conclusion, “Yoga potentially has many benefits, but care must be taken when performing positions with extreme spinal flexion and extension. Patients with osteopenia or osteoporosis may have higher risk of compression fractures or deformities and would benefit from avoiding extreme spinal flexion. Physicians should consider this risk when discussing yoga as exercise.”

News you can use people. I do hope you enjoy the show as much as I enjoy bringing it to you. It’s a blast. Do us a favor and tell someone won’t you?

This week, I want you to go forward with these points:

  1. Establishing a chiropractic residency program for every school should be priority #1. For the school, the student, the patients, and the profession. 
  2. Drug dealers usually get what they have coming to them. 
  3. Chronic pain is a beast although it IS a fascinating beast. 
  4. Don’t do any crazy yoga if you have osteopenia or osteoporosis.
Chiropractic evidence-based products

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


The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

1. O’Neill SFD, Establishing a residency program for a chiropractic specialty in a public hospital system: Experiences from Denmark. J Chiropr Educ, 2019.

2. Insys Therapeutics founder John Kapoor convicted in US opioid case. BBC News, 2019.

3. Efthimiou N 11 Important Things To Know About Pain. Integrative Osteopathy, 2018.

4. Lee M, Soft Tissue and Bony Injuries Attributed to the Practice of Yoga: A Biomechanical Analysis and Implications for Management. Mayo Clin Proc, 2019. 94(3): p. 424-431.

w/ Tim Bertelsman – Chiropractic Standards, Chiropractic Specialists, Importance of State Associations

CF 073: w/ Tim Bertelsman – Chiropractic Standards, Chiropractic Specialists, Importance of State Associations

Today we’re going to be talking with Dr. Tim Bertlesman about all kinds of things. Kind of like a discussion amongst friends where anything is really on the table but we’ll hone in a little on chiropractic standardization, chiropractic specialities, and our experiences working on the state levels for our respective state associations. 

It’s going to be another great one that you’ll want to share with your colleagues but first, here’s that syrupy bumper music!

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


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

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. 

F4CP

We 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

Let’s talk a bit about the DACO program. Well, our guest today is intimately involved with the DACO here in America and, in fact, is the one that unknowingly got me into this whole thing. 

I finished it. It’s all done. I’m just going ot start studying for the exams now. The first one will be on July 20th. If I come back from that one with my dobber in the dirt, then it didn’t go so well but we don’t plan on that happening. 

Since our guest is a big part of it all, we’re going to leave the DACO talk there and meet him. 

Our guest graduated from Logan College of Chiropractic in 1991. He then went on to get his CCSP there at Logan as well finishing those up in 1994. 

In addition to the CCSP, he is a DACO, a Diplomate of the Academy of Chiropractic Orthopedists and is an instructor for their live hours. So he gets to travel around getting unsusepcting and impressionable docs involved in the DACO. 

He is not only a member of the ACA and the Illinois Chiropractic Society, but is also a former President of the Illinois Chiropractic Society. 

He is also, and maybe most-importantly, the co-founder of ChiroUp which has to be seen to be believed quite honestly. You can do that by going to ChiroUp.com. I’m a member and you probably will want to be as well. 

Let’s get it started here. Welcome to the show Dr. Tim Bertlesman. Thank you for joining me today. 

  1. 300 hours later – I want to thank you for getting me into this mess called the DACO. I’m blaming it all on you and Bill Lawson. 
  2. Tell me about your journey into chiropractic
  3. From your CV, I see that you did the CCSP right out of school. What all have you done through that specific certification?
  4. Can you tell us the most striking difference between the two other than one is more geared toward sports?
  5. Tell me about your practice, what does it look like, who do you see mostly?
  6. Tell me about your journey into the DACO and what benefits you have personally realized from it.
  7. You and your business partner, Dr. Brandon Steele, do a great job at staying on top of the most current research. How do you do that? What are your sources?
  8. I want to hear a little about this friendly rivalry between you and Dr. Steele. 
  9. Did you realize that when I put your name into a Google search to learn a little more about you that Bertlesman Chiropractic pulled up with Dr. Steele’s picture on it? I think his evil plan is beginning to come to fruition. 
  10. When I had Dr. Steele on the show, we talked a bit about Standardization…as in making expectations more uniform for patients visiting chiropractic offices….. and we talked about Specialization such as through the DACO or the CCSP or CSCS. Can you share your thoughts on those two topics for us? 
  11. Tell me about your involvement with your state association and what it has meant to you both personally and professionally
  12. What have you been able to accomplish or have you tried to accomplish legislatively? What struggles are the Illinois and Missouri chiropractors in the middle of these days?
  13. Tell me about chocolate cookies and sushi
  14. I noticed a couple of things from your ‘About Me’ page on your website that I’d love to hear more about. 
    1. The Clinical Internship – Community Health Center
    2. Hospital externship at Deaconess Medical Center
  15. If people want to get more of Tim Bertelsman, what should they do? Where do they need to go to get their ‘fix’? I know you’ll be at ChiroTexpo in downtown Dallas again this year June 7-9. What else?
Chiropractic evidence-based products
Integrating Chiropractors
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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Kids Need A Rest, Chiropractic In Europe, & Exercise For Chronic Pain

CF 072: Kids Need A Rest, Chiropractic In Europe, & Exercise For Chronic Pain.

Today we’re going to talk about a surgeon that says let kids slow down, the shape of chiropractic in Europe, how exercise affects chronic pain.       

But first, here’s that bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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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 #72

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

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. 

F4CP

We 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

Let’s talk a bit about the DACO program

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

“Noted surgeon Dr. James Andrews wants your young athlete to stay healthy by playing less” by Dennis Manoloff of the The Plain Dealer(Manoloff D 2013). It was posted back in February of 2013 so a little old but has been making the rounds here lately in the private groups and with several colleagues. And it’s right up our alley when you consider we are also trying to keep kids out of surgery. 

Some highlights are when Dr. Andrews says they have worried for too long about patching people up rather than preventing the injury in the first place. Amen brothers and sisters. 

When asked why kids are getting hurt more and more these days, he says there are really two factors. One being that kids specialize too much now and what he calls professionalism. 

Specialization means kids are just playing one sport these days instead of being well-rounded athletes with a wide array of different activities and skills. When they’re only doing one thing and they’re doing it over and over and over…..well, that’s a recipe for surgery due to overuse.

He says ‘professionalism’ is taking these young kids that are 12 or 13 and working them like they are professional athletes with year-round training and activity. 

Advice he would give parents that can help us guide our conversations with patients and parents was 

  1. Use proper mechanics in any sport.
  2. Don’t play year round. Their kiddo needs at least two months off each year to recover from a specific sport. Ideally, 3-4 months. 

Basically, sometimes we have to look at mom and dad and say, cut it out or a surgeon will be cutting something out. 

I just made that up but you can use it if you like it. You don’t even have to give me credit for it unless you make money from it. Lol. 

Alright, Item #2, comin’ through.

Before the DACO course, chronic pain (while it should have been) was not on my radar at ALL as far as something I was interested in and something I wanted to learn to solve. It sure it now though and this next paper fits right in. 

It’s called “Exercise-induced hypoalgesia: A meta-analysis of exercise dosing for the treatment of chronic pain” by Anne Polaski, Amy Phelps, Matthew Kosted, and more(Polaski A 2019). It was published in January 2019 and I’ve cited it in the show notes. 

Why They Did It

As more and more studies are showing the effects of exercise as a first-line treatment for “nearly all forms of chronic pain,” things like dosing for different treatment modalities has not been explored just yet. 

What They Found

As you can deduce from the title, this was a meta-analysis. 

They say in the abstract, “increasing the frequency of exercise sessions per week is most likely to have a positive effect on chronic pain patients.”

In the end, as is always a part of the conclusion, more research is needed but there is a modest effect. 

Item #3

This one was in BMC Chiropractic & Manual Therapies in April of 2019. Hot stuff….comin up! It’s called “The shape of chiropractic in Europe: a corss-setional survey of chiropractor’s beliefs and practice(Gislason H 2019).” It was written by Halldor Gislason, Jari Salminen, Linn Sandhaugen, and other names I refuse to attempt at this time. 

Why They Did It

Considering the ongoing split in the profession, the authors were looking to report an adherence to unorthodox descriptiions of chiropractic and the types of chiropractic practice in Europe. 

How They Did It

They sent out an online survey amongst European chiropractors in 2017. They sent it out through social media and through the different membership associations. 

What They Found

  • They got back 1,322 responses back representing about 17.2% fo the profession. 
  • The responses were boiled down to fit into 2 different groups of practices. 
  • The two groups were categorized as orthodox and unorthodox. 
  • The orthodox group made up 80% of practitioners
  • The unorthodox group made up 20% 

Some Key Differences

  • 23% of the unorthodox chiropractors x-rayed over 50% of their new patients while the orthodox chiropractors x-rayed only 5% of theirs. 
  • The amount of unorthodox chiropractors seeing over 150 visits per week was more than double the amount seen by the orthodox chiropractor. 
  • Then, of course, there’s info demonstrating how unorthodox hates vaccines while orthodox chiros are fine with them. 

Wrap Up

They concluded by saying, “in parallel with other research, this survey suggests that key practice characteristics in contravention of national radiation guidelines or opposition to evidence based public health policy are significantly more associated with non-orthodox chiropractic paradigms.”

Now, what does that mean exactly? Well, for those of us on the evidence-informed end of the spectrum, it means that we are in concert with 80% of the profession in Canada and in Europe. From what I recall, about 80% of the profession in America is either evidence-informed or somewhere in the middle. Basically, agnostic. 

It’s not my place to argue if subluxation is a real thing or is not a real thing because I believe people define it differently. My opinion, not research because there is none to my knowledge….but my opinion is that if one defines a subluxation as something that can be removed thus fixing cancer, infections, and things like that…..well, my opinion is that that definition puts you in the unorthodox category and puts you in the 20%. 

That’s my opinion anyway and that’s worth diddly squat in the unorthodox community so, take as you may. 

We can also discuss the x-rays. I honestly have no problems with initial x-rays. I realize that flies in the face of a lot of newer guidelines but I believe that we get gut feelings that don’t fit into the definition of a ‘red flag’ per se. You damn well better get x-rays on those deals. 

I’d also say, if you have a history of x-raying every single patient that comes through the doors, that’s also putting you in the 20% that is defined as unorthodox and it’s also meaning that you’re considered an outlier. 

Outliers MUST keep an eye out if you have contracts with insurance companies. If you’re going to be an outlier, you’d best be a cash practice. Whether it be right or wrong in your opinion, insurance companies do NOT like outliers and unorthodox practitioners. And, honestly, who can blame them?

If I’m writing a bunch of checks and I have 80% of the profession over here mostly following guidelines, seeing people a reasonable amount of visits, I’m going to be cool with that 80%. If I have 20% of guys and girls over here seeing people 100 times per year when they have absolutely zero pain and taking repeated x-rays through the year, well…..if I’m writing those checks, I’m going to have a problem with that 20% at least 100% of the time. 

Do whatever you’re going to do but you should give at least SOME consideration to what I’m saying. 

Chiropractic evidence-based products
Integrating Chiropractors
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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

Gislason H, S. J., Sandhaugen L, (2019). “The shape of chiropractic in Europe: a cross sectional survey of chiropractor’s beliefs and practice.” BMC Chiro Man Ther 27(16).

Manoloff D (2013). “Noted surgeon Dr. James Andrews wants your young athlete to stay healthy by playing less.” The Plain Dealer.

Polaski A, P. A., Kostek M, (2019). “Exercise-induced hypoalgesia: A meta-analysis of exercise dosing for the treatment of chronic pain.” PLoS One.

How To Not Miss A Dissection & De-legitimizing Complementary Medicine

CF 069: How To Not Miss A Dissection & De-legitimizing Complementary Medicine

Today we’re going to talk about a risk vs. benefit assessment strategy to exclude Cervical Artery Dissection and we’ll talk about de-legitimizing complementary medicine.  We’ll have some fun and maybe even get a little worked up. 

Don’t Miss A Dissection!

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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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 crumbled into Episode #69 .I have to tell you that I had a friend razzing me saying I need to change the bumper music. He knows that I’m a musician and that I wrote the music, played all of the parts on the bumper music, and recorded it. It’s nice, if you’re going to create a podcast, if you don’t have to pay someone for the bumper music. Lol. He needs to get used to the bumper music because it’s not going anywhere unless I write and record another one somewhere down the road. 

Introduction

Moving on….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

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. 

DACO

Let’s talk a bit about the DACO program. I’m down to my last 39 hours and it’s feeling pretty good. The stuff I have learned having to do with the way we communicate with a patient….what effect that has on a person and their tendency for chronic pain is fascinating. I don’t want to nerd out too much on you right now but, as you probably know, we have little muscle spindles (also known as motion detectors) in all parts of our body. They help us know where our limbs are or how we are oriented in the three dimensions. 

OK, so we have 16 little motion detectors per gram of muscle in our fingers. OK, 16 per gram in our fingers. Remember that. We’re pretty good with knowing where our fingers are without paying attention to them right? Think about typing for example. 

We only have 2 motion detectors per gram of muscle in our traps. Not very many. 

Now consider that we have 242 little motion detectors per gram of muscle in the deeper intrinsic muscles of the upper cervical spine. That’s an insane amount when compared to other areas of our body wouldn’t you agree?

There are so many….to the point that anatomists are looking at these upper cervical muscles as a receptor organ as much as they look at them as muscles. When you consider you get your balance, sensorimotor function, all the way down to how your individual vertebrae move atop each other based on how your upper cervical spine takes in proprioceptive information and translates that into subconscious muscle functions like posture……One word……two syllables…..Day-um. Daaaayum. 

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

As many of you have probably heard, a very popular yoga instructor was holding an odd pose some time ago and caused herself to suffer a tear in an artery in her neck which led to a stroke. She’s fine now so thank goodness. Her story has been circulated a bit and, unfortunately, ABC’s Good Morning America decided to bring chiropractic into the spotlight on the deal. Which is total and utter BS. 

Anyway, they went into the whole Kate Mae debacle and that the LA coroner laid the blame on the chiropractor for causing it when we know that the most common cause of cervical artery dissections is traumatic onset. And we also know that Katie Mae had a bad fall at a photo shoot before going to the chiropractor. 

From my understanding of the case, the chiropractor didn’t cause that stroke. He didn’t help it but he damn sure didn’t cause it. 

If you want more…..as in a lot more,….please go listen to Episodes #13, 14 and ,15 of this podcast. They will line it all out for you in common sensical, magical, reasoning. You’re going to love it. 

If you don’t know the research that shows the benefits for cervical manipulation vs. the almost zero risk, well then you need to listen to those episodes and I’ll link them in the show notes so you can find them easily. 13, 14, and 15 just go listen to them and learn how to back up your positions if you’re ever questioned. Please. 

That leads us into this first one called “A risk-benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: A comprehensive review” by Aleksander Chaibi and Michael Bjorn Russell[1]. It was published in the Annals of Medicine in the December edition 2018. 

https://www.tandfonline.com/doi/full/10.1080/07853890.2019.1590627

Introduction

They start out by saying.”Cervical artery dissection refers to a tear in the internal carotid or the vertebral artery that results in an intramural hematoma and/or an aneurysmal dilatation. Although cervical artery dissection is thought to occur spontaneously, physical trauma to the neck, especially hyperextension and rotation, has been reported as a trigger.”

Since manual and manipulative therapy are common treatments for headache and neck pain, which just so happen to be the most prevalent symptoms of cervical artery dissection, the authors aim of this review is to provide an updated step-by-step risk-benefit assessment strategy regarding manual therapy and to provide tools for clinicians to exclude cervical artery dissection. It’s so easy to Miss A Dissection

They say that cervical mobilization and/or manipulation have been suspected to trigger artery dissection but this is based on case studies (low level research) that are unable to establish direct causality. 

They relate to the ‘chicken and the egg’ discussion as to what came first; the artery dissection or the manipulation? So, instead or proving a nearly impossible causality hypothesis, this paper aims to provide clinicians an updated step-by-step risk-benefit assessment strategy tool in order to 

  1. raise our understanding of cervical artery dissection
  2. understand the risk and applicability of cervical manual-therapy
  3. give us clinicians tools to better detect and exclude the condition. 

I’m all about this. We almost never…almost never are the actual cause of an artery dissection. Our deficit is not recognizing it when it comes in, adjusting the region and APPEARING that we caused it. THAT’S our big issue. Perception. Not causality. 

This is a fairly lengthy paper so we are going to continue just hitting the highlights and the more interesting aspects of it without getting pulled down into too many stats and minutiae. There’s that word again. Take it. Use it. Love it. 

They say that headache and/or neck pain are the most common initial symptoms while other symptoms are Horner’s syndrome and lower cranial nerve palsy. The headache, understandably, is a new headache. New onset. And it’s unilateral. Why would you have it on both sides when there was only one artery dissection? 

The headache has a sudden onset and the time from headache onset to stroke can be from a few minutes to a few weeks. Which is scary as all hell. That’s what my teenager calls ‘Nightmare Fuel.’

Headaches and neck pain are two of the biggest reasons patients seek out care at our clinics, I think you’ll agree. And, although these are thought to occur spontaneously, physical trauma to the neck (especially traumas involving hyperextension and rotation, are highly suspect for triggering one. 

They say, considering it’s happening and people are coming to us with it happening, it’s sort of really really important that we are able to catch the red flags. Especially considering what can happen if we miss them. 

By the way, this isn’t a ‘Scared Straight’ kind of episode. I hate when gurus try to sell their products by trying to scare the holy hell right out of you. That lights me up every time. If I’m in a seminar and some dope starts a diatribe about how offices that aren’t listening can lose their entire practice and thousands and blah blah blah. If I’m in that class, I get up and show them my backside as I exit. 

The HIPAA gurus are the worst aren’t they? They have to ready to leave and jump off a cliff if you don’t hire them for $10,000. It’s stupid and a good way to slip a vulnerable person into depression. Nope, that’s not what we’re doing here. 

First, I’m not selling anything. Unless you love my office brochures. But that’s just to make life easier. Nothing bad happens if you don’t want them. Lol. 

Second, this is a message of ‘Hey, looky here….we get some scary stuff coming in to our offices here and there, and…..if you’ll just pay attention for a little bit here, we may help you keep people safe and get them the help they really need.”

That’s all

OK, continuing on: One big thing you have to remember is that the World Health Organization regards annual mobilization and/or spinal manipulative treatment conducted by chiropractors to be a safe and effective treatment with few, mild, transient adverse effects. The adverse effects being local soft tissue tenderness and tiredness on treatment day, maybe some muscle soreness, things like that. 

There is no strong evidence at all that spinal manipulative therapy is the culprit. 

When describing the internal carotid artery and the vertebral arteries, this statement about the vertebral arteries really jumped out at me. They said, “the vertebral artery is thought to more susceptible to injury due to extreme rotatory head movements, especially in the transverse foramen of the first cervical vertebra.”

You guys and gals out there using rotation in your cervical adjustments….I think there’s an argument to be made here. Can you get the same effect in your patients by doing away with the rotation-based adjustments and going more to extension/lateral flexion type maneuvers like a Diversified cervical break for example? The answer is yes by the way. You most certainly can get the same effect. 

A big difference from regular neck pain is that when a dissection is present the pain is typically sudden, sharp, severe, steady and described as being different from prior neck pain experiences. In general it’s describes as throbbing (remember – it’s vascular), it can be said that it’s pounding, pulsing, and beating. 

Compared to descriptions for purely musculoskeletal complaints which can be described as aching, sore, heavy, hurting, deep, cramping, or dull. There are pretty stark contrasts between the two. 

Also, in general, musculoskeletal pain can be reproducible or provoked or diminished. You can change it basically. Whereas, with a vascular event, you cannot change it. Vascular events aren’t changed by using analgesics either. In Vertebral Artery Dissection specifically, the pain will often progress to the occipital area and medially along the nuchal line. 

The paper highlights the need for a good History to be taken on the intake. Certainly regarding the time of onset.

  • Any recent trauma? (I added that one)
  • Was there a recent acute respiratory infection?
  • Hyperhomocysteinemia such as Vitamin B6, B9, or 12 deficiency?
  • Is there a low body mass index and low cholesterol history?
  • Is the patient a smoker?
  • Do they have pulsating tinnitus?
  • Any connective tissue disorders like Ehlers-Danlos type IV, Marfan’s, Osteogenesis Imperfecta?

They state that a dissection presents to a chiropractic office at a rate of 1 time per 8.1 million patient encounters. 

The paper mentions an interesting paper we’ll have to look up and cover. They say no serious adverse events were reported in a large prospective national survey conducted in the UK that assessed all adverse events in 28,807 chiropractic treatments which included 50,276 cervical spine manipulations. Hell yeah. 

It’s just nice that the further into research you get, the more and more you find in favor of chiropractic. It is so rare that you see conclusions saying things like, “spinal manipulative therapy had no effect.” You just don’t see it usually. 

As part of their conclusion the authors make a recommendation that I will echo gladly, enthusiastically even. 

They say, “Although the chiropractic profession evolved in the early nineteen hundreds as an art, philosophy, and science, neck manipulation should not resemble a martial art. Thus, when cervical manipulation techniques are being conducted, one must be specific when manipulating a single spinal segment, minimizing the end range in cervical techniques, especially rotational techniques, and minimizing force, all of which have been recommended to reduce the risk of serious AEs.”

Now, with many of your EHR software programs, you can set up your own macros. So I did. About a year ago. If I even sniff a dissection, They get the interrogation. 

Here’s how the interrogations starts, I hammer nails up under each finger nail and ask them why they’re in my country and what are their plans to destroy my government? That’s not true. Nobody would come see me after word got out that I really work for the CIA. Lol

OK, seriously, here’s how it goes in my office. I took these directly off of my macro:

  • First, I check all upper arm strength
  • Then sensation side to side including the face
  • Can they raise their eyebrows?
  • Is there any difference in the size of the pupils?
  • Nice, even smile?
  • Have them stick their tongue out….does it deviate to one side or the other?
  • Cross your hands and grab their hands like a double hand shake and have them grip your hands equally and see if there’s a difference. 
  • Have them shrug both shoulders and resist gentle pressure downward on the shoulders. 
  • Do they have a headache that came on suddenly and can be sharp or throbbing?
  • Do they have a headache that gets worse when they lay down?
  • Do they have difficulty speaking or swallowing?
  • Do they have any visual abnormalities?
  • Do they have unsteadiness or lack of coordination beyond what they would consider normal?
  • Do they have a recent onset of hiccups?
  • Are they having recent onset of pulsing tinnitus?
  • Do they have any nausea and/or vomiting?
  • Does the patient have signs of nystagmus?
  • Are there any other neurological symptoms present?
  • How about light-headedness, fainting, disorientation, or disturbances in ears, tremors, or sweating?

I originally planned on covering four papers this week but the stroke issue is just such a big deal, I chose to go a little more in depth so we’ll put those other papers on the back burner for now but we will get to them. 

I will briefly cover one more very short little finding that ties in to this. It’s called “De‐legitimizing complementary medicine: framings of the Friends of Science in Medicine‐CAM debate in Australian media reports” It was written by Monique Lewis[2] and published on the 21st of February 2019 in Sociology of Health and Illness. 

The abstract starts by saying that complementary and alternative medicine has developed into a a complex and formidable commercial, sociocultural and political force in Australia, and given it’s influence, it is a relevant subject for scholars, health practitioners, health communicators, journalists, policy-makers, and consumers of healthcare products and services. 

This paper considers a newer group in Australia called Friends of Science in Medicine which is an activist group of medical practitioners, researchers, and scientists. 

This paper searched for articles mentioning this group and then measured the patterns and frequencies of media frames, intonation, and sources that are featured in Australian mainstream news. 

The negative headlining and intonation of reports predominated, along with framing Complementary and Alternative Medicine…..AKA….US…as a lucrative, undisciplined, and unethical industry as well as an illegitimate healthcare approach. 

The findings of the paper also offer findings into how journalists respond, replicate, or reconstruct the framings that are provided by an influential and elite group of medical practitioners and scientists, and readdresses issues surrounding the need for more critical health reporting in Australia. 

OK…..let’s give the friends of science in medicine some credit where it is due can we? Are we and other CAM providers lucrative? Good Lord, I sure as hell hope so. I have a family and a couple of knucklehead kids to send through college. That ain’t cheap, folks. I’m sure you’re aware. 

Are we undisciplined? Some of us, absolutely are. No doubt. Too many of us, I’d say. There are people out there on their own islands with crystals and all kinds of potions doing whatever to whoever with no research to back it and no rhyme to the reason but, there are A TON of us who are highly educated and highly disciplined. It seems they’re just looking to lump us all into one group regardless I guess. 

Are we unethical…..well, like any profession, the answer is that there are some predatory chiropractors seeing patients 100 times a year. Shooting a ton of unnecessary x-rays and scaring people into long-term care. Whether that’s unethical or not is up to the individual practitioner to decide but I can sure see how an outsider looking in could determine it unethical. Again, on the other hand, there are a lot of us going by commonly accepted guidelines and probably risking actually UNDERtreating patients out of fear of giving the appearance of being one of ‘those chiropractors.’ There is certainly nothing unethical about that, my friends. 

Are we illegitimate. Well hell no. And if they’re not calling out PTs with all of these labels, then they’re just being complete asses because, like or not, the lines between PTs and DCs are very blurry these days. They cannot pretend chiropractors are bad guys but continue to embrace PTs at the same time. Because, in many cases, there is no difference other than spinal manipulative therapy. Hell, PTs work in DC’s offices. 

This Friends of Science in Medicine is a group of bitchy people that really have little more to do that to form a silly group that makes them feel powerful on some level. Kudos to them. Take it from me. It’s hard as hell to build something that has influence in any sector of life these days. So, whatever. Yay for them. But it’s nothing. They can scream and holler but, at the end of the day, they’ll take care of their patients and we’ll take care of ours. 

There is an ever-expanding market today of patients looking for chiropractic. They no longer want the Friends of Science in Medicine’s pills. They no longer want the visits where you go in, some guy or girl in a white coat pretends to listen to you but cuts you off and then gives you a script for some pill that might, just might make you back end fall out of your body. We’re past that now. But they aren’t. 

We’re past surgery for this and for that. We’re past a pill for this or for that. We tried it. The result is called The Opioid Epidemic and it’s going to claim more lives in America than the Civil War did before too long. Last year claimed more lives than 20 years of counting deaths from the Vietnam War. Are you kidding me that these fools think they have some moral freaking high ground to stand on, behind a big white, glistening podium, and look down on other practitioners that are getting patients better non-invasively, non-pharmacologically, safely, and effectively? 

Are you freaking serious right now with this ball of crapoloa? You can’t make it up. This world gets dumber and dumber by the day and it’s the so-called people in power leading the way. Not those of us in the trenches changing the lives of our patients. It’s the leaders that are the fools. 

That crap makes me want to go kick a kitten and step on a baby rabbit. 

Santa Maria…..makes me want to cuss in Spanish. I swear. 

OK, I’m done. Chiropractors doing things in a patient-centered way are awesome. Here’s the message. 

Chiropractic evidence-based products



Integrating Chiropractors
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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

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About the Author & Host

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

Bibliography

1. Chaibi A, R.M., A risk-benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: A comprehensive review. Annals of Medicine, 2018.

2. Lewis M, De‐legitimising complementary medicine: framings of the Friends of Science in Medicine‐CAM debate in Australian media reports. Sociology of Health & Illness, 2019.