Exercise

Dry Needling, Types of Exercise Count, Motor Skills For Chronic Back, and Blood Pressure & Dementi

CF 166: Dry Needling, Types of Exercise Count, Motor Skills For Chronic Back, and Blood Pressure & Dementia

Today we’re going to talk about Dry Needling, how the types of exercising count in the long run, we talk about Motor Skills For Chronic Back Pain, and we wrap it up with a paper on Blood Pressure & Dementia

But first, here’s that sweet sweet bumper music

 

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

We’re the fun kind of research. The AC/DC, Motley Crew, Metallica kind of research. 

Not the stuffy, high-brow, Beethoven and Mozart kind of research. 

We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

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

  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #166 

Now if you missed last week’s episode, we talked about chiropractors working on kids. A controversial topic in some areas of the land and some professions don’t like chiropractors doing so. We talk about it. Check it out. You might learn something

Keep up with the class.  

On the personal end of things…..

Alright, if you listen regularly, you know I just lost my office manager of over 11 years to a little higher paying job. 

You know that my main computer that contains my whole life decided to take a dirt nap. It’s dead now. 

You know I have been up on the ropes a little here lately with slower numbers and all so let’s get into the nitty gritty here and see if we can make lemonade our of a crappy bunch of lemons, shall we?

Let’s start with the manager taking an exit. We can make these things positive or negative. I choose to make it a positive. Think about it; after 11 years, this person was by far my most highly paid employee. Probably overpaid honestly because I was trying to keep her happy. 

She had some difficulties financially at one point a couple of years ago so my wife and I created a marketing position for her so that we could justify paying her quite a bit more money per month while getting some marketing benefit out of it as well. 

So, not only was she highly paid for the office work, in addition, she made a good amount with the marketing side too. So, her leaving is an impact for sure. Not to mention the fact that she’s my buddy. She’s basically family. So it was an impact professionally but a bit personally. 

Here’s the thing though; do we let that paralyze us or do we make it positive? I make things positive when I can. Where are the positives here? 

Well, first thing is….I’m going to save a TON of money. Even when I get her replacement hired, I’m still getting about $1800 raise every month. Who the hell doesn’t want that kind of raise in their lives? Yes please, may I have another?

Also, with her having been out a bunch marketing, the other girls know how to do everything around the office that she used to do. That’s a big benefit. 

So, do we sit on that money or do we invest it? I invest. Remember, my ultimate goal is growth to the point I can remove myself and we do that be integrating and replacing me while making sure there are enough of alternatives to provide a comfortable retirement. 

Investing that money means it’s time to get off my tookus and integrate my practice. I’ve talked about it for years but never pulled the trigger. It’s time now and that’s what I’m doing. 

There is also the option of owning a Rural Health Clinic. That is on the table as well and I’ve got a call set up on Thursday to explore that option as well. 

Let’s say the RHC isn’t viable in Texas. OK, integration with the nurse prac is the path. I have an attorney in place and waiting on my to set it all up and I have a consulting company set up to help me get there. 

Here’s what I love about how life has created me. The best way to make sure I do something is to tell me that I can’t. The best way to see what I can do is to underestimate me or put me on the ropes and throw a few jabs. That’s when I tend to come out firing. 

I think we have to approach life like that every day but most definitely when life takes its jabs at our rib cage or our nethers. 

Instead of taking it, absorbing it, and letting it work us, come out firing on all cylinders. Prove yourself worthy of the things you really really desire 

Now, that doesn’t mean be stupid and financially dangerous. I take measured risks. I never jump off of cliffs. But, I have a pile of PPP money to pay employees and I just got an unexpected raise so now is the time to pounce. I may not have a chance quite like this again so let’s make it happen. And I will. 

The new computer will be here tomorrow. I’ve been without it for a couple of weeks now but, overall it hasn’t been too miserable. Macs have this cool thing called iCloud and a lot of my info including browser book marks and anything I had moved over just to my desktop screen….they’re all in iCloud so I started bringing my MacBook laptop to work and signed in and BAM….it was all there. I’m missing some important stuff but overall, I’ve been able to do the things I need to do. Including keeping up with this podcast. 

The big thing I’m behind on right now is keeping stats because it’s all in my computer memory. I’m working on a solution for that. For me and for you so keep your eyes and ears on the lookout for that in the coming months. You’ll see what I mean when I get it ready for you. That’s another good reason to be in our private Facebook group. I’ll be announcing it and the need for some beta testers and I’ll only make that available in the private group so make sure you’re in there for that special opportunity. 

In other big news, I got a call from Dr. James Lehman and he shared with me the existence of a Diplomate program called Forensics. I have to admit I’d never heard of it. He told me it’s a subspecialty of the Neuromusculoskeletal Diplomate. Which I already have. And he said that since I already have it, then to get the Forensics Diplomate, all I’d need to do is get 100 additional hours. It would break down into 60 hours online through ChiroCredit, 20 hours taking the AMA’s Impairment Rating course, and 20 hours in a conference in Chicago. 

Once completed, I would have the Diplomate in Forensics as well as the Neuromusculoskeletal Diplomate and I’d be able to command some hefty prices serving as a court expert and consultant. 

Well, that fit into the retirement plan doesn’t it? It’s not exactly retiring but it is getting our of the day to day, in-person tasks of daily patient treatment. Which is the goal eventually. And it fits that path. 

So, as you guessed, I’m signed up and have already knocked out about 2 hours of the 60. If you’ve been a listener since the start, you know that I gave you updates on the Neuromusculoskeletal Diplomate as I went through it. I told you all about it and what I was working on and learning. 

I plan on doing some of the same here for you on the Forensics thing. That way you’ll be able to learn more about it and might consider it for yourself. Plus, I’ll have Dr. Lehman come on in a future podcast and share more about it. 

The goal for the profession is to eventually get more and more chiropractors exploring the Diplomates and specializing. Raising the game of this profession one chiropractor at a time. 

CHIROUP 

Item #1

This first one is called “Is Dry Needling Effective for the Management of Spasticity, Pain, and Motor Function in Post-Stroke Patients? A Systematic Review and Meta-Analysis” by Fernandez-de-las-Penas et. al. (1) and published in Pain Medicine on December 18, 2020 and that’s a lot hot in the pot!

Why They Did It

To evaluate the effects of muscle dry needling alone or combined with other interventions on post-stroke spasticity (muscle tone), related pain, motor function, and pressure sensitivity.

How They Did It

  • Electronic databases were searched for randomized controlled trials including post-stroke patients where at least one group received dry needling and outcomes were collected on spasticity and related pain
  • Secondary outcomes included motor function and pressure pain sensitivity
  • Data were extracted by two reviewers
  • 7 studies were included

What They Found

  • The meta-analysis found significantly large effect sizes of dry needling for reducing spasticity, post-stroke pain, and pressure pain sensitivity as compared with a comparative group at short-term follow-up
  • The effect on spasticity was found mainly in the lower extremity
  • No effect on spasticity was seen at 4 weeks
  • No significant effect on motor function
  • The risk of bias was generally low, but the imprecision of the results downgraded the level of evidence.

Wrap It Up

The authors ended it by saying, “Moderate evidence suggests a positive effect of dry needling on spasticity (muscle tone) in the lower extremity in post-stroke patients. The effects on related pain and motor function are inconclusive.”

Item #2

Our second on today is called “Effect of Motor Skill Training in Functional Activities vs Strength and Flexibility Exercise on Function in People With Chronic Low Back Pain: A Randomized Clinical Trial” by Van Dillen, et. Al (2) and published in JAMA Neurology on December 28, 2020 and it’s a lot hot in the pot as well. 

Why They Did It

For people with chronic, nonspecific low back pain, does person-specific motor skill training in functional activities result in better short-term and long-term outcomes than strength and flexibility exercise? You all know I love me some chronic pain research! I gobble it up like meat lover’s pizza. 

How They Did It

  • Single-blind, randomized clinical trial of people with chronic, nonspecific LBP
  • 149 participants
  • 12-month follow-up
  • Recruitment spanned December 2013 to August 2016
  • Testing and treatment were performed at an academic medical center
  • Participants received 6 weekly 1-hour sessions of motor skill training in functional activity performance or strength and flexibility exercise of the trunk and lower limbs
  • Half of the participants in each group received up to 3 booster treatments 6 months following treatment.
  • The primary outcome was the modified Oswestry Disability Questionnaire (MODQ) score (0%-100%) evaluated immediately, 6 months, and 12 months following treatment.

Wrap It Up

“People with chronic low back pain who received motor skill training had greater short-term and long-term improvements in function than those who received strength and flexibility exercise. 

Person-specific motor skill training in functional activities limited owing to low back pain should be considered in the treatment of people with chronic low back pain”

Item #3

Item 3 is called “Association of Physical Activity Intensity With Mortality A National Cohort Study of 403 681 US Adults” by Wang et. al. (3) and published in JAMA Internal Medicine on November 23, of 2020. It’s a skootch steamy, Sir!

Why They Did It

They asked the question, “Is vigorous physical activity associated with additional mortality risk reduction compared with moderate physical activity?” Great question. I’ve been working out but wouldn’t it be nice if moderate was just as effective as rigorous? I say it would be. So let’s see how it plays out. 

How They Did It

  • Cohort study
  • 403,681 adults from the National Health Interview Survey 1997-2013. Hello big, large sample size!
  • provided data on self-reported physical activity and were linked to the National Death Index records through December 31, 2015.
  • Statistical analysis was performed from May 15, 2018, to August 15, 2020.

Wrap It Up

“This study suggests that, for the same volume of moderate physical activity, a higher proportion of vigorous physical activity to total physical activity was associated with lower all-cause mortality. Clinicians and public health interventions should recommend 150 minutes or more per week of moderate physical activity but also advise on the potential benefits associated with vigorous physical activity to maximize population health.”

Dammit, looks like it’s as I feared. Vigorous is superior. Which honestly is pretty obvious but I was hoping for the keys to the kingdom with as little work as possible. 

Item #4

The last one is called “Association of Blood Pressure Lowering With Incident Dementia or Cognitive Impairment A Systematic Review and Meta-analysis” by Hughes, et. al. (4) and published in JAMA on May 19, of 2020 and I say it’s hot enough, fools. Stand back!

Why They Did It

The authors asked the question, “Is there an association between blood pressure lowering with antihypertensive therapy and the incidence of dementia or cognitive impairment?” 

We are answering so many good questions today, people!!

How They Did It

  • Meta-analysis 
  • Search of PubMed, EMBASE, and CENTRAL for randomized clinical trials published from database inception through December 31, 2019, that evaluated the association of blood pressure lowering on cognitive outcomes
  • The control groups consisted of either placebo, alternative antihypertensive agents, or higher blood pressure targets.
  • Data were screened and extracted independently by 2 authors
  • The primary outcome was dementia or cognitive impairment. 
  • The secondary outcomes were cognitive decline and changes in cognitive test scores.

Wrap It Up

“In this meta-analysis of randomized clinical trials, blood pressure lowering with antihypertensive agents compared with control was significantly associated with a lower risk of incident dementia or cognitive impairment.”

So, besides stroke and other similar dangers, add dementia and cognitive abilities to the list of reasons to keep blood pressure in check. 

Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week. 

Store 

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

The Message 

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

Key Point: 

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

Contact 

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

Connect 

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

Website 

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

TuneIn 

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About the Author & Host 

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

 

Bibliography

  1. César Fernández-de-las-Peñas, PT, PhD, Albert Pérez-Bellmunt, PT, PhD, Luis Llurda-Almuzara, PhD, Gustavo Plaza-Manzano, PT, PhD, Ana I De-la-Llave-Rincón, PT, PhD, Marcos J Navarro-Santana, PT, MSc, Is Dry Needling Effective for the Management of Spasticity, Pain, and Motor Function in Post-Stroke Patients? A Systematic Review and Meta-Analysis, Pain Medicine, Volume 22, Issue 1, January 2021, Pages 131–141, https://doi.org/10.1093/pm/pnaa392
  2. van Dillen LR, Lanier VM, Steger-May K, et al. Effect of Motor Skill Training in Functional Activities vs Strength and Flexibility Exercise on Function in People With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Neurol. Published online December 28, 2020. doi:10.1001/jamaneurol.2020.4821
  3. Wang Y, Nie J, Ferrari G, Rey-Lopez JP, Rezende LFM. Association of Physical Activity Intensity With Mortality: A National Cohort Study of 403 681 US Adults. JAMA Intern Med. 2021;181(2):203–211. doi:10.1001/jamainternmed.2020.6331
  4. Hughes D, Judge C, Murphy R, et al. Association of Blood Pressure Lowering With Incident Dementia or Cognitive Impairment: A Systematic Review and Meta-analysis. JAMA. 2020;323(19):1934–1944. doi:10.1001/jama.2020.4249

Chiropractic Misinformation, Patients Need Movement & Love

CF 157: Chiropractic Misinformation, Patients Need Movement & Love

Today we’re going to talk about misinformation on the part of chiropractors during the COVID pandemic, we’ll talk about three papers covering pain and how patients need a little love while they also need movement and physical activity. 

But first, here’s that sweet sweet bumper music

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

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

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

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

  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #157. The first episode to kick off our 4th year in the podcasting business. To be 100% honest, it doesn’t seem like I’ve been doing this for that long. It’s crazy to think about. 

Now if you missed last week’s episode , we talked about our Top Ten episodes over the previous 3 years. It was our 3rd Year Anniversary episode. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I had a pretty decent weekend. Still just staying in and being smart. We drove around and looked at lights with the kiddos. More just to get outta the damn house and do something different. The wifey, myself, and the two kiddos are about ready to give each other the People’s Elbow from time to time. People are all like….COVID is a time we get to slow down and reconnect with our families. 

I’m all like, I’d like to connect with some of them. Physically. With my hands and tinged with some level of aggression. Lol. It’s hard as a parent to watch your kids waste away into boredom and just allow it to happen. I’m a big believer in doing things. Creating things. Being busy on some level. I believe an idle mind is a dangerous thing. So, I’m the parent telling them to get the hell up and make something of themselves. Maybe it’s me or maybe it’s my generation. Generation X is a generation of do-ers I believe. 

Either way, they get tired of me urging them to do, to make, or just to freaking be. Be something! No, you can’t lie on your bed reading fictional books all day long. Maybe for an hour or so at night before bed instead of the xbox. That’s a good time to read don’t you think? Not for hours smack dab in the middle of the day. 

I’m a big believer in art of all forms. So they get pushed to play the guitar, the piano, draw something, paint something. Write a story or a poem. Freaking create something. ANYTHING! Just don’t lay or sit around like a lump on a log all day. I won’t have it. I won’t create lazy bums to put out into the world. I just won’t. Yeah, it probably sucks to be my kid. I know. I admit it. My daughter is a 7th grader and I’ve already got her learning the discus. Pumping my own tires for a second here, I won state here in Texas in the discus and went to state in the shot put so I love re-visiting those days by coaching others. My son had no interest but Joss….she’s in and she’s doing great! My son, I’ve got him on the guitar and piano and he’s doing great too. All I ask for is activity and some progress. That’s all. 

It actually snowed in Amarillo this weekend. Yes, we get snow somewhat regularly in my part of TX. We’re in the northern plains of Texas. We are flat and there are really no trees unless someone planted them. But we do have the nation’s second largest canyon called Palo Duro canyon and it’s awesome! If you’re ever close to Amarillo, you gotta check it out. Well worth it.

I’m typing this up on Monday morning 12/14. I saw on the news this morning that the first healthcare workers are getting the vaccine today. That’s pretty dang exciting. I already called my doctor buddies here in town and told them that when they feel it’s appropriate for us to have one, my wife and I would love to be on their list. I know a lot of folks are freaky about the vaccine and here’s my deal; by the time it’s my turn, any adverse events will already be well-known. They started in the UK las week. Adverse events are pretty much sorted out in about 8 weeks. 

I’m tired of it. I’m over it. I’ve said it before here but, if I get the Rona, I have to shutter my clinic for 2-4 weeks. I can’t afford that. Well, technically, I can afford it but it would drain resources that don’t need to be drained if I just try to stay smart and healthy. So why wouldn’t I do everything I can? Besides that, I’m ready to get back to my life. Traveling, building things, and moving forward instead of this stagnate state we’ve all been in for 8 or more months. The vaccine is the first real step out of it. 

I am so over other chiropractors out there. One of the vitalists I talked about and was ashamed of in Episode 153 called Some Chiropractors Could Be Better…..well that Flat-Earther has been on his Facebook railing against the vaccines and acting like he is an epidemiologist and trained in the safety and efficacy of vaccines. 

He wasn’t. I went through chiropractic school. Other than chiro philosophy, no real education on vaccines was had and certainly not enough to pretend to be an authority on them. One way or another. For or against them. So why the hell are so many wading out into those waters? Just stay the hell out of the discussion. It’s so dumb. It really is. 

Can  you imagine telling a young mother their baby doesn’t need the measles vaccine because your magical powers of subluxation slaying will protect them by boosting their immune system? And then the baby actually gets measles?

Why in the hell would you want to put yourself or that mother and baby in that position. Just shut up. Back off. Stay in your lane, pal. You’re not that cool. Same goes for COVID. Do you really want to be in the position of telling your patient they really shouldn’t take that vaccine because you’re a spine whisperer and detecting subluxations protects from viruses if they’ll just come to see you every week for the rest of their lives? First you create dependency on YOU. That’s not right and it’s damn sure not evidence-based. Good for the ol’ wallet though isn’t it?

Second, you weren’t trained on it. So back off. 

Third, can you imagine that patient getting it anyway and, God forbid, dying from it. What if that patient mentioned to their family members that they weren’t getting the vaccine because Dr. Jackhole told them they didn’t need it and shouldn’t take it. Would the family have a legal claim against you? My opinion is hell yes they do and you should be calling your malpractice carrier to see how to handle it. 

The point being. Just remove all of that by keeping your mouth closed and staying out of vaccine discussions. It’s completely appropriate to say that getting it is an individual choice and they should talk to their doctor about the risks vs. the benefits and take it from there. Because that really is what they should be doing. 

This vitalist and others like him are going to get more people killed because they love themselves on a level that leads them to believe they have all of the answers. They don’t. In fact, when they’re recording selfie videos of themselves walking around their offices or sitting and driving in their cars, they look insane. Crazy-eyed insane people. 

Enough of that. I made my point. Some of you listen enough or we’re friends on Facebook so you know that I’m an artist of sorts. Guitar singer songwriter, charcoal drawing and portraits and sculpting. I’ve been sculpting a race horse lately and I did the bridle and saddle this weekend. Looking back on it, I may rather take a swift kick in the cajones then repeat that. Geez. Straps, buckles, loops, cuss words. But, it’s shining up finally. If you want to follow some of my artistic escapades on Facebook, go like and follow River Horse Art. It’s fun. If nothing else, I’m keeping life interesting at the very least.

Another thing totally unrelated to chiropractic is Hot chocolate bombs. Here’s a tip from your Ol’ Uncle Jeffro. Be damned careful what you put on FB during the holidays people. My wife Meg and daughter Bitsy… her real name is Joss….they were making these things and I shared it in FB just to brag on them a bit. They were just making them for family and friends and they are pretty cool.I’m on Weight Watchers…down 33 pounds now…and so I can’t indulge but I did share one with my wife and they are absolutely sinful, people. Holy cow. They’ll make your hair stand up. 

Anyway, now it’s an overnight success business sort of thing. Geez. She has orders for about $300 worth of these things and a guy that may order around $1500 worth of them for his business connections and marketing purposes. What in the holy chocolate hell? So now I have a factory in my kitchen with two bumblebees buzzing all over it. 

In business, you have probably heard me mention that we have been down since the second spike hit. Down quite a bit. I used to gripe that my new norm was 145 a week rather than my pre-COVID average of about 190 per week. Well, turns out it could get worse. We’ve been averaging about 125 a week since the second spike came on BUT…..but….this week is starting off right with 41 and four new patients today. Fingers crossed. 

I told you we did a radio run and, believe it or not, people are starting to tell me they’ve been hearing our ads. Which is encouraging. It’s still too early for me to share what we’ve done and it that’s why this week is better. I’m not sure the powers at play just yet. I’m going to keep monitoring it and will let you know.

Enough, let’s get to the research, shall we?

Item #1

This first one is new and it goes with one of my talking points in the intro section. It’s called “Misinformation, chiropractic, and the COVID-19 pandemic” by Iben Axen, et. al. and published in Chiropractic & Manual Therapies in November of 2020. Hopping jalapeños that’s hot!

Why They Did It

Before we get to why they did it, I think we all know. Yes, we know. If fact, look, I knew people were crazy before COVID. There are just crazy people out there in the world. That’s a given. But I had no idea how many truly crazy and impressionable people there really are until this pandemic. Holy huge balls of insanity, people. I have seen the most disappointing stuff coming from people. Not just chiropractors but definitely some chiropractor as well. No doubt. They crazier than bed bugs. Crazier than a craphouse rat. 

They begin by saying, “During this time of crisis, some chiropractors made claims on social media that chiropractic treatment can prevent or impact COVID-19. The rationale for these claims is that spinal manipulation can impact the nervous system and thus improve immunity. These beliefs often stem from nineteenth-century chiropractic concepts. We are aware of no clinically relevant scientific evidence to support such statements.

We explored the internet and social media to collect examples of misinformation from Europe, North America, Australia and New Zealand regarding the impact of chiropractic treatment on immune function. We discuss the potential harm resulting from these claims and explore the role of chiropractors, teaching institutions, accrediting agencies, and legislative bodies.”

Despite this grave situation, some chiropractors have advocated a misbelief that spinal manipulative therapy (SMT) or “adjustments” can boost immunity and thus should be offered as a preventive measure for viral infections. The World Federation of Chiropractic (WFC) noted this development on March 17th 2020 and refuted this in a public statement: “… .there is no credible scientific evidence to support this notion and to suggest otherwise is potentially dangerous to public health” . Nevertheless, some chiropractors continue promoting misinformation on social media putting the chiropractic profession at odds with scientific evidence.

The chiropractor (and I use that term loosely) I discussed is 100% one of these people. Geez, he’s embarrassing. But he takes videos of his huge pool and big backyard he got from seemingly bilking the holy crap out of impressionable patients and young dumb chiropractors but whatever.… 

Anyway…they say that the estimate is that 20% of the chiropractic profession has the vitalist, faith-based, philosophy, I’m going to pop this and protect you from virus approach to taking advantage of patients. I mean….going about their business. 

They say, “Misinformation about adjustments and immunity taints public understanding of viral prevention, undermines the coordinated efforts of health authorities, and has become a cause for concern among researchers and public health authorities”

Wrap It Up

Members of the chiropractic profession share a collective responsibility to act in the best interests of patients and public health. We hope that all chiropractic stakeholders will view the COVID-19 pandemic as a call to action to eliminate the unethical and potentially dangerous claims made by chiropractors who practise outside the boundaries of scientific evidence.

CHIROUP ADVERTISEMENT

Item #2

This one is called “Effect of Physical Exercise Programs on Myofascial Trigger Points–Related Dysfunctions: A Systematic Review and Meta-analysis” by Guzman-Pavon, et. al. (Guzman-Pavon MJ 2020) and published in Pain Medicine on October 4, of 2020. Sizzlin’ succotash! It’s hot!

Why They Did It

Remember, this is a systematic review and meta-analysis and those are at the top of the research pyramid. They’re mostly reliable. 

They say, “Myofascial pain syndrome is one of the primary causes of health care visits. In recent years, physical exercise programs have been developed for the treatment of myofascial trigger points, but their effect on different outcomes has not been clarified. Thus, this study aimed to assess the effect of physical exercise programs on myofascial trigger points.”

How They Did It

  • A systematic search was conducted in Pubmed, Web of Science, and Scopus.
  • Articles analyzing the effect of physical exercise programs on pain intensity, pressure pain threshold, range of motion, and disability were included
  • 24 randomized controlled trials were included

Wrap It Up

Physical exercise programs may be an effective approach in the treatment of pain intensity, pressure pain threshold, and range of motion among patients with myofascial trigger points.

Let me just tell you that physical exercise programs are absolutely effective. Not just in the physical sense but in the biopsychosocial aspect as well. When people are gradually moving more and gradually building their confidence in movement and their abilities, the brain, or the centralized part of the pain experience is affected in for the positive which brings the pain level down overall. It’s just fascinating but in short, moving means more than just physical activity when we’re talking about pain. 

Item #3

Item #3 here is called “Excess Body Mass and Leisure Time Physical Activity in the Incidence and Persistence of Chronic Pain” by Shiri, et. al (Shiri R 2020) and published in Pain Medicine on November 11, 2020. Which makes hotter than a habanero. And that’s real hot. 

Why They Did It

To estimate the effects of excess body mass and leisure time physical activity on the incidence and persistence of chronic pain.

How They Did It

A prospective cohort study.

three cohorts of employees of the City of Helsinki (18,562 observations) and defined incident chronic pain as having pain in any part of the body for more than three months at follow-up in participants without chronic pain at baseline. This was a great sample size. 

Persistent chronic pain was defined as having pain for more than three months at both baseline and follow-up

Wrap It Up

As if we didn’t know this already, they say, “Obesity not only increases the risk of developing chronic pain, but also increases the risk of persistent pain, while leisure time physical activity reduces the risk of developing chronic pain.”

Now consider the obesity issue in America today. 

Item #4

And finally, our last one is called “Perceived Injustice Helps Explain the Association Between Chronic Pain Stigma and Movement-Evoked Pain in Adults with Nonspecific Chronic Low Back Pain” by Penn et. al. (Penn T 2020) and published in Pain Medicine on April 24, 2020 which is hot enough because it just came out in the November 2020 issue. It’s not steaming but it is indeed very hot. 

Why They Did It

For most patients with chronic low back pain (cLBP), the cause is “nonspecific,” meaning there is no clear association between pain and identifiable pathology of the spine or associated tissues. Just for the record here, Dr. Stuart McGill and his mustache would call total BS on the idea that nonspecific back pain exists. He’s say you just aren’t looking hard enough. 

Anyway, they go on to say, “Laypersons and providers alike are less inclined to help, feel less sympathy, dislike patients more, suspect deception, and attribute lower pain severity to patients whose pain does not have an objective basis in tissue pathology. Because of these stigmatizing responses from others, patients with cLBP may feel that their pain is particularly unjust and unfair. These pain-related injustice perceptions may subsequently contribute to greater cLBP severity. The purpose of this study was to examine whether perceived injustice helps explain the relationship between chronic pain stigma and movement-evoked pain severity among individuals with cLBP.”

And honestly, these are things I haven’t considered before and I think it’s interesting as hell. 

How They Did It

Participants included 105 patients with cLBP who completed questionnaires assessing chronic pain stigma and pain-related injustice perception, as well as a short physical performance battery for the assessment of movement-evoked pain and physical function.

What They Found

  • Findings revealed that perceived injustice significantly mediated the association between chronic pain stigma and cLBP severity and physical function. 
  • Greater chronic pain stigma was associated with greater perceived injustice, which in turn was associated with greater movement-evoked pain severity. 

Wrap It Up

“These results suggest that perceived injustice may be a means through which chronic pain stigma impacts nonspecific cLBP severity and physical function.”

So, today’s take-aways…..

  • Be a science driven healthcare leader and practitioner. Don’t be crazy because you look insane and you make everyone else in your profession appear to be insane as well. That’s just rude as hell. Especially when you’re proving Parento’s Law by just 20% of you making the rest of us look like crazy people. We don’t appreciate it. Stop it now, dammit. 
  • Love your patients and if you worry about the outcomes, you won’t have to worry about the income
  • And get them moving. 

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

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

Store

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

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

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

Connect

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

Website

Home

Social Media Links

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Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

  • Guzman-Pavon MJ, C.-R. I., Martinez-Vizcaino V, (2020). “Effect of Physical Exercise Programs on Myofascial Trigger Points–Related Dysfunctions: A Systematic Review and Meta-analysis.” Pain Med 21(11): 2986-2996.
  • Penn T, O. D., Aroke E, (2020). “Perceived Injustice Helps Explain the Association Between Chronic Pain Stigma and Movement-Evoked Pain in Adults with Nonspecific Chronic Low Back Pain.” Pain Med 21(11): 3161-3171.
  • Shiri R, L. T., RAhkonen O, Leino-Arjas P, (2020). “Excess Body Mass and Leisure Time Physical Activity in the Incidence and Persistence of Chronic Pain.” Pan Med 21(11): 3092-3101.

Vegans & Broken Bones, Daily Step Count, Medical Cannabis

CF 155: Vegans & Broken Bones, Daily Step Count, Medical Cannabis

Today we’re going to talk about new research for vegans and the risk of broken bones, we’ll cover new information pertaining to a patient’s daily step count, and we’ll talk about a study on medical cannabis and it’s effectiveness in treating chronic pain. Good stuff today, folks.  But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products

Integrating Chiropractors

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

  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #155 Now if you missed last week’s episode , we talked about the shake up with the World Federation of Chiropractic and all of the goings on that went on with that. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

As of the typing of this, it is the Monday following Thanksgiving. I hope you all had a good one. I have a nice back patio, outdoor kitchen area with a fireplace and quite a bit of room to move around.  I have my mom and my stepdad over as well as my brother and his wife. With the four of my regular crew, that made 8 of us. Nobody went inside. We all just gathered outside on the patio and ate outside. It was great. It was safe. And we still got to have Thanksgiving. 

We had two separate tables. One for my crew and one for the other four. We had my crew at one table because I work with 140 or so appointments per week, my son goes to a high infection rate college, and my daughter goes to junior high with over 1,000 kids every day. So, my crew was the wildcard in that crowd. So we sat separated just a bit to be sure we were protecting the others from any asymptomatic hoo ha.  It seemed to work very well. Again, I hope you all did well and stayed safe and happy and healthy.

It was different for sure, right? Definitely one to remember. No doubt.

Think of all of the things we took for granted before this mess. I know many of you have but I haven’t taken a trip or vacation or anything since February when we went to Key Largo.  I’m used to going on little vacays about once per quarter just to preserve my sanity. I think that’s important. Getting out of the office and getting some sea air or some mountain air in your face.

But we haven’t been able to do any of that in the last 9 to 10 months and I’m missing it. I’m a traveler.  This has really taught us what we do and what we do not have control over. We do not have control over nature from what I can tell. Certainly not this virus. At least not yet we don’t.  This second spike has been severe where I live. Over 1,000 new cases in one day on the last count, over 750 FEMA staffers here helping our healthcare system keep up with the hospitalized patients. I haven’t seen this week’s numbers yet but we lost 24 residents to COVID in just two days last week. 24 deaths in two days. That was unheard of just a couple of months ago. I have lost a couple of patients to it.

Fortunately, I haven’t lost any friends as of yet. I hope your friends are all staying safe and weathering the storm the same.  PRactice is just there. Nothing special going on right now. We are running a radio spot for this holiday season but I’m not sure how smart that is. Luckily, they gave us a killer deal on the run so we couldn’t resist. They made us a deal we couldn’t refuse. I’m not sure all of the ads in the world will get everyone out of the mental and financial funk any time in the next several months.  But I’ll report back. If it works, I’ll share what we did so you can do the same.

On the other hand, if you’re doing something that is working for your clinic and getting people back in the numbers you want to see, send me an email at [email protected] and let us know so we can let others know and help everyone out with getting their numbers back closer to normal. 

Item #1

Let’s start with one called “Medical Cannabis for the Management of Pain and Quality of Life in Chronic Pain Patients: A Prospective Observational Study” by Safakish, et. al. (Safakish R 2020) published in Pain Medicine in November of 2020. And it sizzles and steams as it sits.  

Why They Did It

To evaluate the short-term and long-term effects of plant-based medical cannabis in a chronic pain population over the course of one year.

How They Did It

  • 751 chronic pain patients initiating medical cannabis treatment.
  • A longitudinal, prospective, 12-month observational study.
  • Study participants completed the Brief Pain Inventory and the 12-item Short Form Survey (SF-12), as well as surveys on opioid medication use and adverse events, at baseline and once a month for 12 months.

What They Found

  • Medical cannabis treatment was associated with improvements in pain severity and interference (P < 0.001) observed at one month and maintained over the 12-month observation period.
  • Significant improvements were also observed in the SF-12 physical and mental health domains (P < 0.002) starting at three months.
  • Significant decreases in headaches, fatigue, anxiety, and nausea were observed after initiation of treatment
  • In patients who reported opioid medication use at baseline, there were significant reductions in oral morphine equivalent doses (P < 0.0001), while correlates of pain were significantly improved by the end of the study observation period.

Wrap It Up

Taken together, the findings of this study add to the cumulative evidence in support of plant-based medical cannabis as a safe and effective treatment option and potential opioid medication substitute or augmentation therapy for the management of symptoms and quality of life in chronic pain patients. Alright, I’ll be upfront; I don’t like marijuana. I know some of you love the sweet sweet weed. I’ll never understand it. Trust me, I’ve been around it so many times I can’t count. I’m a former traveling muscian. For 10 years I traveled the circuit so you can only imagine.  I’ve been against its legalization from Day 1.

I’ve seen it turn famiily members into lazy, unmotivated bums. I hate it. I hate the smell. I hate what it does to people and I hate the culture surrounding it.  But, I can’t argue with research and this says it helps. I’ve seen other reports that it works. Regardless, I’m for pill form, chewables, or gels. I will never before inhaling it. There is no amount of evidence on the planet that will make me think it’s OK to take smoke into your lungs. Especially when there are other options for it’s utilization.  So, this is encouraging.

I hope its medical use becomes more widespread and more common because it sure as hell looks like it works for chronic pain and, at the end of the day, that’s what we’re here for. 

CHIROUP ADVERTISEMENT

Item #2 This second one is called, “Association of Daily Step Count and Step Intensity With Mortality Among US Adults” by Saint-Maurice et. al. (Saint-Maurice P 2020) and published in JAMA in March of 2020. Dammit it’s hot enough. 

Why They Did It

Describe the dose-response relationship between step count and intensity and mortality.

How They Did It

  • Representative sample of US adults aged at least 40 years in the National Health and Nutrition Examination Survey who wore an accelerometer for up to 7 days ( from 2003-2006). 
  • Mortality was ascertained through December 2015.
  • Accelerometer-measured number of steps per day and 3 step intensity measures 
  • Accelerometer data were based on measurements obtained during a 7-day period at baseline.
  • They adjusted for for age; sex; race/ethnicity; education; diet; smoking status; body mass index; self-reported health; mobility limitations; and diagnoses of diabetes, stroke, heart disease, heart failure, cancer, chronic bronchitis, and emphysema.

Wrap It Up

Based on a representative sample of US adults, a greater number of daily steps was significantly associated with lower all-cause mortality. There was no significant association between step intensity and mortality after adjusting for total steps per day. I personally found it interesting that they found no big association between step intensity and mortality. Very interesting. So, let’s make sure we’re all moving. No matter the age. 

Item #3

This one is an article by Rupert Steiner(Steiner R 2020) called “Vegans and non–meat eaters are more likely to suffer broken bones, Oxford University research show” and it was published in Market Watch on November 24, 2020 and it’s it’s hotter than the burning sun!

  • We just hit the highlights for the articles so here we go:
  • They start right off getting into the meat and taters by saying, “Non–meat eaters, especially vegans, are at higher risk of breaking their bones due to lower intakes of calcium and protein, according to new research by the University of Oxford published on Monday
  • The EPIC-Oxford study, which involved almost 55,000 British people, concluded: “Non–meat eaters, especially vegans, had higher risks of either total or some site-specific fractures, particularly hip fractures
  • Participants were categorized into four diet groups composed of 29,380 meat eaters, 8,037 fish eaters, 15,499 vegetarians and 1,982 vegans.
  • The results showed over an average of 17.6 years of follow-up, researchers observed 3,941 cases of total fractures.

Food for thought and the damn pun was absolutely intended. Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few.

It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health!

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

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

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

Website https://www.chiropracticforward.com

Social Media Links https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter https://twitter.com/Chiro_Forward

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

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

Player FM Link https://player.fm/series/2291021

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

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

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

Bibliography

  • Safakish R, K. G., Salimpour V, Hendin B, Shoanpal I, (2020). “Medical Cannabis for the Management of Pain and Quality of Life in Chronic Pain Patients: A Prospective Observational Study.” Pain Med 21(11): 3073-3086.
  • Saint-Maurice P, T. R., Bassett D, (2020). “Association of Daily Step Count and Step Intensity With Mortality Among US Adults.” JAMA 323(12): 1151-1160.
  • Steiner R (2020). “Vegans and non–meat eaters are more likely to suffer broken bones, Oxford University research show.” MarketWatch.

 

Preventable Disease And the Impact & Whole Body Vibration For Function and Bone Density

CF 149: Preventable Disease And the Impact & Whole Body Vibration For Function and Bone Density Today we’re going to talk about the costs of preventable disease and then we’ll talk about whole body vibration for function and bone mineral density in postmenopausal, osteoporotic women.   But first, here’s that sweet sweet bumper music
Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 
  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.  You have found yourself smack dab in the middle of Episode #149 Now if you missed last week’s episode , we talked about manipulation for concussion, sleep and cognitive decline, and we talked aobut demential predictors and prevention. Super interesting stuff. Make sure you don’t miss that info. Keep up with the class.  While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function On the personal end of things….. We were busier last week. If you’ve listened for very long, I’ve tried to be open and honest about my numbers each week so that listeners will know where they stand. They’re either doing better or they’re doing about the same. Some will be doing worse. Either way, maybe I can be a measuring stick of some sort.  The best I have done since COVID reared it’s stupid face is 145 visits in one week. That’s down from an average of 182 per week in 2019. So, that’s quite a difference. I keep immacualte stats so I know that in 2020, I have averaged 117 per week but that includes when we were closed and then when we were emergency only.  Since we finally got up and running full steam back in May, I have averaged 136 per week. That puts me at about 75% of my pre-COVID point. So, I just need to average about 46 more visits per week to get back to 100%. No big deal right? Lol. That’s a solid jump but I’m a do-er and I have positive energy and a healthy amount of confidence.  And, we got a good start last week. Last week for the first time, I beat the 145 mark that I had been limited to and saw 158. Just in time for the Rona to start surging back and freaking people out again. Lol. Such is my luck. We shall keep trudging, keep being smart, and keep doing what we can to stay healthy.  If it all works out, we should be back to 100% by the end of the year. That’s my goal at least. As I type this out, we have 48 on the books today which is about 10-12 more than we’ve been seeing on Mondays. So things are looking up.  Be safe folks, we’re not out of the crap yet. In fact, as of the time I’m typing this, it’s worse than it has been for a while. Just keep being safe, keep working, and do what you can to take care or yourself and those around you.  Item #1 The first one we’re going to talk about today is called, “The cost of preventable disease in the USA” by Galea, et. al(Galea S 2020). published in The Lancet on October 1, 2020. Aye chiuaua. es too mucho caliente.  https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30204-8/fulltext?fbclid=IwAR3VMx1p1cZZTdT9o3_b6GkgSzfbImiOPPKLJFElqMKaHN5Vi-3OpkqwDTg This is more article and discussion so as usual when we cover stuff like this, we’ll just hit the high points and summarize it for you.  They start by stating that a substantial proportion of poor health in populations is preventable and cite the Global Burden of Diseases, INjuries, and Risk FActors Study that suggests nearly half of all health burdern in the US is attributable to a list of 84 modifiable risk factors.  They say that globally, up to half of all deaths fall into the category of preventable deaths. They estimate that more than 1/4 of health-care spending was due to these preventable illnesses. Not only that but the US heatlhcare spending is notoriously expensive spending 16.9% of its GDP on healthcare which is TWICE as much as the average of other similar countries.  In fact, our spending is mroe than the 2019 GDP of 171 coutnries in the world. All but the 19 wealthiest.  They ask a wonderful question, “Why do we continue to accept such a high burden of preventable disease, even when the cost of it is known?” Great question. Especially when you’re looking at it from a chiropractor’s point of view. Fusion surgeries run around $50,000 each, are basically useless, and put the patient at signficant risk of additional, expensive surgery. Epidural injections are useless as well. We have plenty of studies showing how we save money and cost much less than traditional medical care for back pain. We have surveys and research showing that our patient outcomes and satisfaction are superior to PT and general practitoners. We have the American College of Physicians, The Joint Commission, and The Lancet recommending spinal manipulation and exercise as first-line treatments. Yet, we are not inundated with referrals for chronic and acute low back pain.  We should be absolutely flooded with referrals. We should be emptying out lobbies of furniture so we have more room in the corner to put a new referral. But nope. Hell no. My opinion is because we have vitalist chiropractors trying to convince patients they have to see them every week for the rest of ever…..as long as ye shall live….forever and ever amen. Taking x-rays and convincing them they’re going to die if they don’t fix that decreased curvature. Telling patients they’re going to pop their back and fix their gall bladder issue.  THAT’S why we can’t have nice things. You have these evidence-based, patient-centered chiropractors over here going, “What they hell? We can help these people so much!” But we’ll never get the chance because vitalists don’t know how to stay in their lane. To be fair, they were taught their lane was much larger than research suggests it is. We do what we’re taught. The difference is, some of us are better at smelling BS than others.  Too many chiropractors have a stopped up nose and can’t seem to smell very well. Which is unfortunate.  Back to the article, they say, “The high burden and cost of preventable disease should push us to think differently about health at a foundational level.” And to that I say, “Indeed, Sir.” They also say that we should embrace the notion that no amoutn of preventable death or illness is acceptable and that about $730 billion could be repurposed. Like to pay our debt…..just a suggestion.  They conclude by saying, “high body-mass index, high systolic blood pressure, high fasting plasma glucose, dietary risks, and tobacco smoke exposure account for most of the spending on preventable illness.  Preventing these risk factors would require an engagement with subsidising the availability of nutritious foods, disincentivising the commercial production of harmful products, investing in early childhood education that leads to healthy exercise and dietary habits, and creating cities that encourage healthy behaviours.” For example, why does healthy food cost more than garbage food? That’s exactly reverse of what it should be. If we really care about lower socioeconomic folks and you want to fight for universal healthcare and things of that sort, wouldn’t it make sense to protest stuff like that? Why aren’t we seeing picket lines outside of Tyson food factories or in front of grocery stores. They could be carrying signs that say, “Stop keeping our poor fat” or “make healthy affordable” or stuff like that. I’ll keep watching the TV. I’m not holding my breath though. Making healthy food affordable isn’t quite as sexy as all of the other reasons people are finding to stay outraged these days.  Don’t get me wrong, I’m not making light of peaceful and respectful protest. That’s what Amercia is built on. I’m less understanding of the destruction, riots, and death that have come with so many of the more recent activities.  Anyway, it’s a great article and I’ve linked it in the show notes at chiropracticforward.com if you’d like to go a little further in depth in the thing. Chiropractors can help this issue though. The research is there. They just have to start giving it a try. I think they’d be surprised with the results. Unless they referred to a vitalist. Then, when the patient reported back to the MD, the MD would probably never make another referral to a chiropractor as long as they lived once they realize that their referral made them look like an idiot. Just a guess.  CHIROUP ADVERTISEMENT Item #2 This one is called “Effect of Whole-Body Vibration Exercise on Power Profile and Bone Mineral Density in Postmenopausal Women With Osteoporosis: A Randomized Controlled Trial” by ElDeeb, et. al(ElDeeb A 2020). published in the Journal of Manipulative and Physiological Therapeutics in May of 2020…..eh….it’s not fresh from the fire but it’s still steaming out of the microwave.  https://www.jmptonline.org/article/S0161-4754(20)30044-0/fulltext Why They Did It To investigate the effect of whole-body vibration (WBV) on muscle work and bone mineral density (BMD) of the lumbar vertebrae and femur in postmenopausal women. How They Did It
  • 43 postmenopausal women with low bone mineral density
  • randomly assigned to WBV and control groups
  • Both groups got calcium and Vit D supplementation once per day
  • The WBV group additionally got WBV exercises 2x/week for 24 weeks
  • Hip power generation and absorption, knee power absorption and generation, ankle power generation adn absoprtion were all measured. 
  • Dual-energy X-ray absorptiometry was used to measure bone mineral density of the lumbar spine and femor before and after intervention
What They Found
  • There were significant increases in the hip muscle work, knee muscle work, ankle musle work during gait in the WBV group.
  • Bone mineral densityof the lumbar spine and femur were significantly increased in the WBV group. 
  • However, there were no significant changes in teh control group 
  • The posttreatment values of the hip, knee, and ankle muscle work and the bone mineral density of the WBV group were significantly higher htan the posttreatment values of the control group. 
Wrap It Up The conclusion states, “Whole-body vibration training improved the leg muscle work and lumbar and femoral bone mineral density in postmenopausal women with low bone mineral density.” Pretty interesting stuff, folks. Is this definitive proof? No. The sample size is small but it is randomized which is good. Would I advertise that I’m going to increase osteoporotic BMC? Nope. If my mom had osteoporosis, would I have her on the WBV? You bet your sweet bippy I would.  Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   
Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
Home
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger Bibliography
  • ElDeeb A, A.-A. A. (2020). “Effect of Whole-Body Vibration Exercise on Power Profile and Bone Mineral Density in Postmenopausal Women With Osteoporosis: A Randomized Controlled Trial.” J Manipulative Physiol Ther 43(4): P384-393.
  • Galea S, M. N. (2020). “The cost of preventable disease in the USA.” The Lancet 5(10): E513-E514.

Chiropractic’s Effect On Strength and More, Status of Muscle Relaxers, And The Best Recovery Posture

CF 136 Chiropractic’s Effect On Strength and More, Status of Muscle Relaxers, And The Best Recovery Posture

Today we’re going to talk about Chiropractic’s Effect On Strength and More, Status of Muscle Relaxers, And The Best Recovery Posture But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products

Integrating Chiropractors

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

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

Check your JUNK folder!! Do it do it do it. You have found yourself smack dab in the middle of Episode #135 Now if you missed last week’s episode, we talked about adjusting in the areas of known disc complications, bulges, herniations..things of that sort. Make sure you don’t miss that info. Keep up with the class. While we’re on the topic of being smart, did you know that you can use our website as a resource?

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

On the personal end of things….. Nothing new to report really. We aren’t growing in our visit count week to week but, at the same time, we aren’t shrinking either. We’re holding steady at about 80% of where we were before the COVID train wreck and here’s what I’ve sort of decided. I’m just going to be OK with 80%.

Like I said last week, while we’re billing out less and collecting less, we’re also spending less both in the practice as well as in my personal life. Some of you aren’t. Some of you think it’s a hoax and all that stuff. You’re going out and traveling and vacationing and all that jazz. We aren’t. We are not afraid but we also do want to be smart and be diligent. I’ve come to the mindset that if I wind up getting it, I’ll probably do just fine with some time but regardless of how severe or mild symptoms are, I’ll STILL have to shut my office down.

Now, how many of us can afford to just shut the doors for 2-4 weeks without any issues? Honestly, I’m a saver so I could actually do it and survive but I damn sure don’t want to. I have other plans for that money don’t you know. It wasn’t saved so that I could cover my practice financially if I get sick for a month. Hell no. It was saved to invest. So, we are being smart, we are wearing our masks and no….I don’t give one damn what anyone thinks about masks. Honestly. This has been the most disappointing aspect of human observation in recent memory.

The mask debate or debacle. Absolutely a waste of time and energy talking or listening to people on that deal. Anyway, we are wearing our masks. Our patients are wearing their masks. We are still cleaning and having our lobby closed. We are still not allowing visitors in with our patients. We are still using our UV air scrubbers in each room. We are still doing it to keep my most fragile patients safe and confident in us as a clinic, we doing it all to protect the staff, and we’re doing it to protect me as much as possible so we don’t all have to shut down for a month.

Makes perfect sense to me.

We know some things that increase your chances of having a hard time with COVID. Or at least there is some research to back up that low vitamin D puts you at risk. Obesity, underlying conditions like diabetes, low testosterone, smoking, and being of the blood type A. These are just a few things I recall off the top of my head. My question to you is, “What factors under your control are you bolstering or addressing?” I am overweight. I’m naturally a big guy but I’ve gotten a little lazy in the last 5 years. OK…..A LOT lazy.

I started the Couch to 5K program a few weeks ago and am slowly trudging through that. My knees are super pissed at me about it but I’m still doing it. I have addressed any hormone issues I needed to look at. I have gotten on a Vitamin D replacement regimen. I am trying to get more sleep more consistently. I don’t smoke.

Of course, there’s nothing you can do about what type of blood you are but….my point is, what steps are you taking to lower your risk of complications should you wind up with it? I’d love to hear if you’ve changed anything at all or if you’re just like the Russian boxer Drago in Rocky 4…..If he dies, he dies.

Item #1 Let’s get to it. This first one is not sexy. I’m saving the better ones for here in just a minute. Let’s start off nice and simple here with one called “Effects of Two Different Recovery Postures during High-Intensity Interval Training” by Michaelson, et. al(Michaelson J 2019). and published in Translational Journal of the ACSM in February of 2019. Hmmmmmm…..yep… Hot enough. Out of the way.

Why They Did It The purpose of this study was to examine the effects of two different recovery postures, hands on head (HH) and hands on knees (HK), as a form of immediate recovery from high-intensity interval training (HIIT).

How They Did It Twenty female Division II varsity soccer players completed two experimental trials in a randomized, counterbalanced order. Each trial consisted of four intervals on a motorized treadmill consisting of 4 min of running at 90%–95% max heart rate with 3 minutes of passive recovery between each interval. Heart rate recovery was collected during the first 60 seconds of each recovery, where the volume of carbon dioxide and tidal volume were recorded each minute during the 3-min recovery period.

What They Found Results showed an improved heart rate recovery, greater tidal volume, and increased volume of carbon dioxide, with hands on the knees when compared with hands on the head.

Wrap It Up “These data indicate that HK posture may be more beneficial than the advocated HH posture as a form of immediate recovery from high-intensity interval training.”

Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. If you’re into IASTM also known as instrument-assisted soft tissue manipulation, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend. Drop Release is a revolutionary tool that harnesses the body’s built-in protective systems to make muscles relax quickly and effectively.  This greatly reduces time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day. Its inventor, Dr. Chris Howson, from the great state of North Dakota has is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase. Go check Drop Release at droprelease.com and tell Dr. Howson I sent you.

Item #2 Item 2 is called “Assessment of Physician Prescribing of Muscle Relaxants in the United States, 2005-2016” by Soprano et. al(Soprano S 2020). and published in JAMA Open on June 24, 2020 and that’s damn sure a steaming heaping helping right there.

Why They Did It They wanted to measure national trends in muscle relaxant prescribing over a 12-year period. 2005-2016

How They Did It It was a cross-sectional study It used data from the National Ambulatory Medical Care Survey The study included those with ambulatory care visits with non-federally funded, office-based physicians in the US Included almost 315,000,000 office visits.

What They Found Get this y’all – During the study period, office visits with a prescribed muscle relaxer nearly doubled from 15.5 million in 2005 to 30.7 million in 2016 Although visits for new muscle relaxer prescriptions remained stable, office visits with continued muscle relaxer drug therapy tripled from 8.5 million visits in 2005 to 24.7 million visits in 2016 Older adults accounted for 22.2% of visits with a muscle relaxer prescription. Concomitant use of an opioid was recorded in 67.2% of all visits with a continuing muscle relaxer prescription.

Wrap It Up “This study found that SMR use increased rapidly between 2005 and 2016, which is a concern given the prominent adverse effects and limited long-term efficacy data associated with their use. These findings suggest that approaches are needed to limit the long-term use of SMRs, especially in older adults, similar to approaches to limit the long-term use of opioids and benzodiazepines.” And we wonder how we ended up with an opioid and pill problem. Cheese ’n’ rice people. Godzilla it’s just clear as day but nobody’s listening. Are you inundated with referrals from physicians in 2020? Some of you are. Most of you, the large very vast majority of you are not at all and it’s a shame because we can prevent so much of this garbage.

Item #3 Alright, the last item and my favorite one this week. It’s called “Effects of Chiropractic Care on Strength, Balance, and Endurance in Active-Duty U.S. Military Personnel with Low Back Pain: A Randomized Controlled Trial” by Vining et. al(Vining R 2020). published in the Journal of Alternative and Complementary Medicine in July of 2020. Another helping of boiling thought nuggets for you to feast upon.

Why They Did It They wanted to investigate whether chiropractic care influences strength, balance, and/or endurance in the active-duty United States military personnel with low back pain

How They Did It It was a prospective randomized controlled trial using a pragmatic treatment approach Participants were randomly allocated to 4 weeks of chiropractic care or to a wait-list control Chiropractic care consisted of spinal manipulation, education, advice, and reassurance Naval Air Technical Training Center branch clinic at the Naval Hospital Pensacola Florida One hundred ten active-duty military personnel 18-40 years of age with self-reported LBP Outcome measurements included Isometric pulling strength from a semi-squat position was the primary outcome. Secondary outcomes were single-leg balance with eyes open and eyes closed, and trunk muscle endurance using the Biering-Sorensen test. Patient-reported outcomes such as pain severity and disability were also measured. Outcomes were measured at baseline and 4 weeks. Linear mixed-effects regression models over baseline and 4 weeks were used for analysis.

What They Found Participants had a mean age of 30 years, 17% were female, 33% were non-white, and 86% reported chronic LBP. Mean maximum pulling strength in the chiropractic group increased by 5.08 kgs and decreased by 7.43 kgs in the wait-list group, with a statistically significant difference in mean change between groups Statistically significant differences in mean change between groups were also observed in trunk muscle endurance and balance with eyes closed, but not in balance with eyes open Differences in mean change between groups were statistically significant in favor of chiropractic for LBP-related disability, pain intensity and interference, and fear-avoidance behavior.

Wrap It Up “Active-duty military personnel receiving chiropractic care exhibited improved strength and endurance, as well as reduced LBP intensity and disability, compared with a wait-list control.”

Alright, that’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week. Store Remember the evidence-informed brochures and posters at chiropracticforward.com.

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

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

That’s Chiropractic!

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

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

Social Media Links

https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/ Twitter https://twitter.com/Chiro_Forward YouTube

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

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

Michaelson J, B. L., Suprak D, McLaughlin W, Dahlquist D, (2019). “Effects of Two Different Recovery Postures during High-Intensity Interval Training.” Translational J ACSM 4(4): 23-27.

Soprano S, H. S., Bilker W, (2020). “Assessment of Physician Prescribing of Muscle Relaxants in the United States, 2005-2016.” JAMA Open 3(6).

Vining R, L. C., Minkalis A, Gudavalli MR, Xia T, Walter J, Coulter I, Goertz C, (2020). “Effects of Chiropractic Care on Strength, Balance, and Endurance in Active-Duty U.S. Military Personnel with Low Back Pain: A Randomized Controlled Trial.” J Altern Complement Med 26(7): 592-601.

Updated Thinking On Chronic Pain and Exercise

CF 129: Updated Thinking On Chronic Pain and Exercise Today we’re going to talk about chronic pain and exercise.  But first, here’s that sweet sweet bumper music
Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 
  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.  You have found yourself smack dab in the middle of Episode #129 Now if you missed last week’s episode, we talked about Tylenol failures, cervical disc research, and we talked about complementary and alternative treatment for headaches and migraines. What’s the current research and thinking? Make sure you don’t miss that info. Keep up with the class.  While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.  Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.  On the personal end of things….. Well, so far, no blowback from my rant on last week’s podcast so sometimes no news is good news. You either all agree with me or you’re not listening.  Rocking and rolling here at work, last week was finally the busiest I have been since late January or early February. It was quite a blessing. I have to admit, I’m not used to working that damned hard anymore but it’s OK. I just need to get back into fighting shape so I can see them all.  Last week we saw about 135 patients. Pre-COVID numbers were anywhere from 185-225 so I’m still significantly down but it’s trending upwards and it’s looking good right now. I cannot and will not fuss about it. Especially when I read that several are just now going back to work and have been closed completely this entire time. We’ve been fully, completely open for more than a month now. It’s hard to imagine being closed down any longer than we were honest. I don’t know how companies survive.  I see reports that the virus may have mutated to a lesser severity. Not only are some doctors claiming that people are getting less severe when they do get sick, but they are not getting sick as easily. That’s some exciting news if it is indeed a fact. Time will tell.  I don’t want to hear anything about ‘new normals’. Once this dude settles down, life will be normal. Not a new normal. It’ll be back to the way it was. I’m guessing August but who knows? It could be in the Fall. Maybe even the Spring. But it will be the old normal. You can count on that.  I hope your businesses are picking back up as well. I hope you’re seeing those old familiar happy faces coming back into the office to greet you. I hope you’re back on track to showing the world how effective and amazing chiropractic can be when practiced by an evidence-based, patient-centered professional. That’s you. That’s who listens to this show and I’m proud of you all. You make this profession better every day and I thank you.  I just hope you get something good from me every week. If you do, I won’t be shy about asking you to share this podcast with your colleagues. We are growing all of the time but it’s never quite fast enough to feel like I’m on a roll. So, with your help in sharing and talking about us, I think we can truly make a big difference and take this thing of ours to another level.  Item #1 This first one this week is called “Exercise Induced Hypoalgesia Is Impaired in Chronic Whiplash Associated Disorders (WAD) With Both Aerobic and Isometric Exercise” by Smith et. al(Smith A 2020). and published in Clinical Journal of Pain in May of 2020. Oy…..that’s smokin’ hot! Why They Did It First, let’s define Exercise Induced Hypolagesia. It is a generalized reduction in pain and pain sensitivity that occurs during exercise and for some time afterward. So, for normal, asymptomatic people, when they exercise, there’s less pain and they feel better and that lasts for a while when they finish exercising.  Exercise induced hypoalgesia can be impaired in patients with chronic pain and may be dependent on exercise type. Factors predictive of Exercise induced hypoalgesia are not known. This study aimed to: 
  1. compare Exercise induced hypoalgesia in participants with chronic whiplash associated disorders to asymptomatic controls, 
  2. determine if exercise induced hypoalgesia differs between aerobic and isometric exercise, 
  3. determine predictors of Exercise induced hypoalgesia.
How They Did It
  • A pre-post study investigated the effect of single sessions of submaximal aerobic treadmill walking and isometric knee extension on exercise induced hypoalgesia in 40 participants with chronic whiplash associated disorders and 30 controls
  • Pressure pain thresholds were measured at the hand, cervical spine and tibialis anterior
  • Appropriate baseline measurements were performed
What They Found Participants with whiplash-associated disorders demonstrated impaired exercise-induced hypoalgesia There was no difference in exercise-induced hypoalgesia between exercise types Wrap It Up “Individuals with chronic whiplash-associated disorders have impaired exercise-induced hypoalgesia with both aerobic and isometric exercise. Higher levels of physical activity and less efficient conditioned pain modulation may be associated with impaired exercise-induced hypoalgesia.” Item #2 This last one is by the great Dr. Craig Liebenson and is called “Pain with Exercise: Is it acceptable & if so how much & for how long?” and was published in First Principles Of Movement on May 20, 2020(Liebenson C 2020). Pow! Hot like a firecracker folks. https://firstprinciplesofmovement.com/pain-with-exercise-is-it-acceptable-if-so-how-much-for-how-long/ For articles, we dispense with our normal outline and we hit the high spots and interesting points.  Craig starts by quoting a paper by Smith, Littlewood where they say “Protocols using painful exercises offer a small but significant benefit over pain-free exercises in the short term, with moderate quality of evidence……Pain during therapeutic exercise for chronic musculoskeletal pain need not be a barrier to successful outcomes.” He also quotes Annie O’Conner’s, author of World of Hurt, where she says we must violate the patient’s expectation that hurt equals harm. Especially with light pain.  Craig also refers to a photograph from Silbernagel’s paper demonstrating a Pain-Monitoring Model where the safe zone on the VAS was 0-2, the Yellow or acceptable zone was 3-5 on the VAS, and the red high-risk zone was 6-10.  Silbernagel says, “Biological plausibility/explanation and reasoning ranks high and then you can individualize. Meaning waiting for the pain to subside does not work because you get weaker and the tissue decreases its tolerance to load. So loading with pain is beneficial to get the structures to improve. However, if it is a fracture it might be very different so know the injury and tissue.” I like this quote of Craig’s from the article: “Many people believe the medical adage – “if it hurts don’t do it”. We know that for some this promotes illness behavior by giving the idea that the body is fragile. Ben Smith & Chris Littlewood’s shoulder paper, Annie O’Conner’s WOH book, some of K Thorberg’s groin work, & you’re tendonopathy paper all show yellow pain is acceptable.  He says the idea of, if it hurts, don’t do it brings about clear yellow flags. Yellow flags such as
  • Hurt = harm
  • activity is harmful
  • if an activity hurts it should be stopped
On the topic of osteoarthritis, he says 
  • The patient decides what’s tolerable, 
  • Above 5 is the red area
  • If pain increases with exercise, that’s OK as long as by the next day it has calmed. 
He goes on to cite a new paper in JAMA by Ben Cormack asking about pain tolerance vs. using the traditional Numeric Rating Scale. They’re suggesting asking if the pain is tolerable is a better way to deal with it.  Cormack says:
  • “The exclusive focus of the numeric rating scale (NRS) on pain intensity reduces the experience of chronic pain to a single dimension.”
  • “This drawback minimizes the complex effects of chronic pain on patients’ lives and the trade-offs that are often involved in analgesic decision-making.”
  • “Furthermore, continually asking patients to rate their pain on a scale that is anchored by a pain-free state (ie, 0) implies that being pain-free is a readily attainable treatment goal, which may contribute to unrealistic expectations for complete relief.”
The modern approach to managing disabling musculoskeletal pain is to shift the focus from chasing symptomatic relief to addressing activity intolerances related to symptoms.
  • “ The overarching goal of chronic pain treatment is to make the pain tolerable for the patient rather than to attain a targeted numeric rating.”
  • “Our findings confirmed the intuitive assumption that most patients with low pain intensity (ie, NRS score, 1-3) find their pain tolerable.”
  • “In contrast, the tolerability of pain rated between 4 and 6 varies substantially among patients.
  • “In this middle range, if a patient describes the pain as tolerable, this might decrease the clinician’s inclination to initiate higher-risk treatments.”
  • “A substantial subgroup of patients with severe pain reported their symptoms as tolerable.”
Dr. Liebenson wraps up the article by saying, “This discussion highlights that hurt does not necessarily equal harm. Nearly all musculoskeletal pain guidelines over the last 30 years have emphasized that pain does not equal tissue damage or impending injury. This study goes a long way to show us better ways to educate people in reassuring ways that will get them back to activity and thus build a mindset that can make them feel less fragile.” Chronic pain is interesting stuff and is a HUGE market where there are lots of opportunities for educated, smart chiropractors to stick their flag in the dirt and stake a claim.  Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Key Takeaways Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   
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  The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
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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
  • Liebenson C (2020). “Pain with Exercise: Is it acceptable & if so how much & for how long?” First Principles Of Movement.
  • Smith A, R. C., Warren J, Sterling M, (2020). “Exercise Induced Hypoalgesia Is Impaired in Chronic Whiplash Associated Disorders (WAD) With Both Aerobic and Isometric Exercise.” Clin J Pain.