Forward Head Posture

Breathing Through The Pain, Need For Rehab, & Forward Head Posture And Shoulder Pain

CF 164: Breathing Through The Pain, Need For Rehab, & Forward Head Posture And Shoulder Pain

Today we’re going to talk about the impact of chiropractic care on opioid use and then we’ll talk about garbage marketing in the chiropractic profession. I go off a bit. I can’t help it. They make me nuts. 

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.  If this episode has a different type of sound quality when compared to previous episodes, my main computer died. It choked a little and held it’s belly and rolled around in agony for about a month and then…..sadly, it straight up and died. 

So, I have another ordered and in the meantime, I’m figuring out how to do this through my MacBook Pro. Where there’s a will, there’s a way. We’ll make it happen.  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 #164 Now if you missed last week’s episode, we talked about opioids and spinal pain and then we talked about vitalists’ scripts. That was about the point that I lost my mind momentarily. Because they make me crazy and all.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Wow, what a week I had last week, y’all. And I’m not talking in a good way. Oh hell no. This was one of those kick you in the face and in the backside. And when you’re falling to the ground, putting a boot in your ribs for good measure.  One word, two syllables. Day-um.  For patients that I’m comfortable with, it’s common for them to ask me how my day’s going and my go-to answer is usually something similar to, “Ah you know….pissing excellence. As usual. It becomes a habit after a while.” Yeah, not last week. I wasn’t the windshield. I was the bug. 

First thing’s first, on last Tuesday, my longest tenured employee and office manager turned in her resignation. Over 11 years, down the drain. She’s not just a staff member. She’s become my little buddy. She’s hilarious. She was also our marketing girl. Definitely a boot to the face. Pow.  But there are a lot of positives there as well. Being my longest employed staffer, she was also my highest paid so we will save a good chunk of money. We just need to make some adjustments on the marketing and things of that nature.  Then, on Wednesday, as mentioned previously, we joined the Wealthability program and we had a meeting with our new accountants they matched us with. They’re out in St. Louis. Well, they found that our previous CPA was wrong and now we have to pay a gob in taxes we weren’t expecting to pay. We can spread it out over an amount of time and it’s fixable but day-um…..

Come on man.

When you hire professionals, you expect a professional job that will prevent you from getting into trouble. Don’t you? That was a kick to the nether regions. Smack.  Then, later that afternoon, my main computer that has my entire life on it straight up died. Luckily, it had slowed a bit and I called my computer guy to come in and back it up so it can be replicated on another computer. Still, that computer won’t be here for 2 damn weeks.  Kick to the shin. Thunk. 

Then, two of my girls got the second vaccine shot and both got sicker than dogs. One missed work on Wednesday. Not that big of a deal. Just kind of sucked.  Then I got a visit from a connection that works in my Dad’s nursing home. She came to my house on Thursday night after work to tell me my Dad is being mistreated and is withering away.  Stomp to the noggin while I’m down. Snap.  There were some other little things here and there but you get the picture. Rough week. But we’re on the mend.

We’re heading the right direction this week I think. We have some good ideas and I think we are going to make some changes.  So, as a learning lesson, bad things can be used for an impetus to change course and go in a positive direction. For example, I’ve begun going down the path of fully integrating. I’m saving enough money with the departure of my manager that I can use that money toward integrating and hiring a nurse practitioner. 

This would fit my long term plan of being able to remove myself from my day to day practice. It’s a piece of the puzzle. The final piece of the puzzle would be hiring an associate. At that point, I believe my time begins to get freed up a bit.  Hopefully in five years, I’m mentoring my colleagues and teaching them how to accomplish what I’ve accomplished. I’m sharing wisdom with hungry evidence-based chiros and spreading the good news about evidence-based, patient-centered chiropractic care.  We’re going to get there.  In other news, last week wasn’t a total loss. You may have seen where the Texas Chiropractors, after a ten-year battle, put the smackdown on the Texas Medical Association. People’s elbow, Kabam!!

The biggest bully of bullies got slapped the hell around by the Texas Chiropractic Association and the Texas Board of Chiropractic Examiners at the Texas Supreme Court level.  Just briefly, the TMA had sued the TCA and the TBCE approximately 10 years ago over our right to perform the VONT testing. Also known as vestibulo-ocular nystagmus test. Then that morphed into attacking our rights to diagnose and our rights to treat the Neuromusculoskeletal system rather than just the musculoskeletal system. Seemingly silly little things but, if they had won, technically, we couldn’t treat anything having to do with ‘nerve’ and we couldn’t have diagnosed our own patients so we’d depend on referrals from medical professionals……and how do you think that would have turned out in the long run?

Not good for an chiropractor on the planet because other medical associations would have precedence and would have repeated the process. Those of us in leadership positions for the TCA have been well-aware for the last decade that if we lost this case, we would be the first domino and it would effect every other chiropractor.  We lost, then we lost the appeal, then the Texas Supreme Court gave us the win. And the Texas Medical Association, the most predatory state medical association in the United States, has to cover the court costs. Oh, and on top of that, they can suck it.  We are going to have an entire episode where I’ll be joined by my fellow TCA members. Folks that have been the deepest in the trenches on this case and know every in and out of the entire process.  It’s going to be a good one so keep a lookout for that one.  Alright, let’s get to the good stuff shall we?

Item #1

This first one is called, “Can Slow Deep Breathing Reduce Pain? An Experimental Study Exploring Mechanisms” by Jafari, et. al. (1) and published in the Journal Of Pain in September/October of 2020. It’s not a lot hot but hot enough!

Why They Did It

This study sought to investigate effects of instructed breathing patterns on experimental heat pain and to explore possible mechanisms of action

How They Did It

  • In a within-subject experimental design, 48 healthy volunteers performed 4 breathing patterns: 
      1. Unpaced breathing, 
      2. Paced breathing (PB) at the participant’s spontaneous breathing frequency, 
      3. Slow deep breathing at 6 breaths per minute with a high inspiration/expiration ratio (SDB-H), and 
      4. Slow deep breathing at 6 breaths per minute with a low inspiration/expiration ratio (SDB-L)
  • During presentation of each breathing pattern, participants received painful heat stimuli of 3 different temperatures and rated each stimulus on pain intensity
  • Respiration, heart rate, and blood pressure were recorded.

What They Found

Compared to unpaced breathing, participants reported less intense pain during each of the 3 instructed breathing patterns.

Wrap It Up

Slow deep breathing is more efficacious to attenuate pain when breathing is paced at a slow rhythm with an expiration that is long relative to inspiration, but the underlying mechanisms remain to be elucidated. Oh…..elucidated. That’s a $5 word for the research crew there. Congrats on elucidated, folks. 

CHIROUP ADVERTISEMENT

Item #2

This one is called, “Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019” by Cieza, et. al.  (2) and published in The Lancet on December 19, 2020. Smokin’, sizzlin’, steamy pot of chili pie.  I have learned, by the way, that Frito Pies are not an American thing.  It’s just mostly a Texan thing. I have eaten Frito pies my whole damn life and didn’t figure this factoid out until just a few years ago. I play Call Of Duty here and there on xbox.

I know….I’m a nerd but I’m a killing’ nerd on occasion! I can kill real people in a fake way right there with the best of them when I want to. And I have my glasses on. And I haven’t had any more than a few beers. Lol.  Anyway, I play with a dude from Louisville, KY and he’d never heard of Frito pies. Holy cow people. There are some things you need to get tuned into if you’re not from Texas. They are as follows:

    • Frito Pie
    • Fried Okra
    • Fried squash. 

Yes, all are terrible for you so…..as a priest told me at the bar back when I went to college in Louisiana and was asking him how this whole ‘priest being in a bar’ worked out….he said, “Everything in moderation, Brother.” We should probably get back to the paper, Y’all. 

Why They Did It

Rehabilitation has often been seen as a disability-specific service needed by only few of the population. Despite its individual and societal benefits, rehabilitation has not been prioritized in countries and is under-resourced. We present global, regional, and country data for the number of people who would benefit from rehabilitation at least once during the course of their disabling illness or injury.

How They Did It

To estimate the need for rehabilitation, data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 were used to calculate the prevalence and years of life lived with disability of 25 diseases, impairments, etc. 

What They Found

  • Globally, in 2019, 2.41 billion individuals had conditions that would benefit from rehabilitation, contributing to 310 million years of life lived with disability
  • This number had increased by 63% from 1990 to 2019
  • The disease area that contributed most to prevalence was musculoskeletal disorders with low back pain being the most prevalent condition in 134 of the 204 countries analyzed.

Wrap It Up

The authors wrap up their thoughts with this, “To our knowledge, this is the first study to produce a global estimate of the need for rehabilitation services and to show that at least one in every three people in the world needs rehabilitation at some point in the course of their illness or injury. This number counters the common view of rehabilitation as a service required by only few people. We argue that rehabilitation needs to be brought close to communities as an integral part of primary health care to reach more people in need.”

I will add that the vitalists that think they can only adjust their way out of every damn condition or complaint need to get in the back of the line and just keep quiet. If you are going to be current rather than look like a dumb dumb, then you need to understand that a good, learned chiropractor knows that we do not only mobilize with adjustments, stretching, and things of that nature. But we also much know when to stabilize through strengthening activities.  If you’re just hitting the high spots on all of your patients, you need to be better and raise you game. Mr. Vitalist…..I’m talking to you. 

Item #3

The last one today is called, “Does forward head posture change subacromial space in active or passive arm elevation?” By Dehqan, et. al. (3) and published in the Journal of Manual and Manipulative Therapy on November 30, of 2020 and that’s about the right amount of hot Why They Did It Forward head posture (FHP) is one of the most common musculoskeletal disorders that appears to affect the shoulder joint through the shared muscles between the head and neck area and the shoulder girdle. The present study compared the acromiohumeral distance between individuals with normal head and neck alignment and those with moderate and severe FHP in active and passive arm elevation.

How They Did It

  • Based on the craniovertebral angle, 60 volunteers were selected and equally distributed among three groups, including group one with normal head and neck alignment, group two with moderate FHP and group three with severe FHP
  • The space between the humeral head and the acromion was measured in 10°, 45° and 60° of active and passive arm elevation as the acromiohumeral distance.

What They Found

  • The acromiohumeral distance was only different between the three groups at 45° arm elevation angle, and this difference was significant between groups one and three
  • In active and passive arm elevation, increased arm elevation angle reduced the subacromial space significantly
  • Also, in each arm elevation angle, the subacromial space differed significantly between the active and passive arm elevations.

Wrap It Up

They concluded, “The acromiohumeral distance was significantly lower in the severe FHP group than the group with normal head and neck alignment in the 45° active arm elevation angle, which could be due to the changed tension in tissues between active and passive arm elevation and also the maximum muscle activity in the 45° active arm elevation angle.”

Shoulder impingement folks.

I didn’t know anything about it until I went through he DACO program. Which is now the Neuromusculoskeletal Diplomate. It’s a real estate issue and when you have an upper cross type setup, forward head posture, you decrease the real estate.  Increase the real estate, decrease the issue in this sort of a setup.  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.

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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. Hassan Jafari, Ali Gholamrezaei, Mathijs Franssen, Lukas Van Oudenhove, Qasim Aziz, Omer Van den Bergh, Johan W.S. Vlaeyen, Ilse Van Diest, Can Slow Deep Breathing Reduce Pain? An Experimental Study Exploring Mechanisms, The Journal of Pain, Volume 21, Issues 9–10, 2020, 1018-1030
  2. Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vox T, Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. 396 (10267), P2006-2017, December 19, 2020.
  3. Behdokht Dehqan, Cyrus Taghizadeh Delkhoush, Majid Mirmohammadkhani & Fatemeh Ehsani (2020) Does forward head posture change subacromial space in active or passive arm elevation?, Journal of Manual & Manipulative Therapy, DOI: 10.1080/10669817.2020.1854010

 

Chiropractic & The Brain, Forward Head Posture Hurts, & Smoking Hurts Worse

CF 103: Chiropractic & The Brain, Forward Head Posture Hurts, & Smoking Hurts Worse

Today we’re going to talk about spinal manipulation’s effect on the brain, forward head posture and neck pain, and we’ll talk about how smoking is related to pain throughout the body. 

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.

Welcome, 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

Do it do it do it. 

You have collapsed into Episode #103

Now if you missed last week’s episode on headaches, contraindications to adjusting, and more info on maintenance care, then make sure you don’t miss that info. Go listen when you get done with this one. 

Just a quick re-cap, some of the more recent very popular episodes have been when we had Dr. James Lehman on ths show for episodes 96 and 97. Those were huge for listeners. 

Then, right after those, we had a couple of shows on Marketing Evidence Based practices. Those were big shows for us too. 

Our all time biggest episodes though have been #13, 14, and 15. They were early in our existence. They’re called Debunked: The Odd Myth That Chiropractors Cause Stroke. And then there was episode 80 with Dr. Anthony Nicholson on Decoding Chronic Pain. That was amazing. It was a mini-course on chronic pain and I promise, it’s one you don’t want to miss. 

Anyway, for those that are newer to our podcast, you’ll have to check those out and see what you think.

On the personal end of things, Dad is still in a struggle for independence. If you’ve been around stroke victims in the early weeks, it’s tough stuff. I don’t wish it on a single soul. Well, there’s this one attorney I used to know. Lol. 

Kidding. I Kid….

When it’s my time, man….I just want it to go lights out. BAM. Seeya! It’s been nice but I gotta go hang with Jesus and my family I haven’t seen in a while. Buh bye. 

We don’t get to choose but I sure hope that’s the way it goes. I never want to be a burden on anyone just so I can keep breathing. I want to check out and say adios amigos, hasta luego. 

As far as practice goes, all days are not created equally are they? This was one of those days. Where to even start really?

I had to get after staff members for not doing rehab long enough. I don’t like repeating myself 100 times but I also don’t like getting after the staff members. I hate it. But it has to be done from time to time. 

Then a PT told one my new patients not to go to the chiropractor until after he is done working with them because the patient is ‘gummy’ and an adjustment wouldn’t stick. Now, what the hell does that mean exactly? We don’t take bones from one place and put them into another. Adjustments don’t need to stick. They need to create movement. And alignment isn’t a real thing. Son of a mother, people. 

I’ve never had a PT directing my patient’s treatment in my office before so that was a fun surprise. 

Then a re-exam patient shows up 5 mintues before lunch. Talk about wanting to choke a patient. In a loving way of course because I love my patients but choke indeed. 

Then an attorney on a case on a patient that I’ve seen just three freaking times calls the office. He wants to get me and the insurance adjustor on the phone at the same time. He wants to know what my bill is going to be, how many times I’m going to see the patient, etc… Yeah no. Not happening. 

You have a question? Email me and tag the insurance adjustor. Want a specific answer, yeah…no. Everyone is different, every injury is different, and everyone heals at a different rate. I can give you a very rough estimate at best. Suck it Mr. Attorney, aka Mr. Waste My Freaking Time. 

Then I have a new car wreck patient that doesn’t want me to see his previous radiology reports because they told him nothing was wrong and he doesn’t want me making up my mind about him based on radiology reports. Are you serious? You can’t make this crap up y’all. 

Then, there’s some inner office fussing going on. It’s not a big deal but just un-needed on top of the rest of it while I’m trying to switch CPAs, balance and close out the month of November, and just keep my crap together long enough to go out to the rehab hospital to see my Dad. 

Lol. Wow, what a brain dump I just laid on you all. I apologize but again, I share personal aspects of what’s going on day to day because I know many of you will 100% identify and if you don’t, you can probably learn from my experiences. If you don’t learn how to handle them, then maybe you can learn how to NOT handle them. Lol. 

I’m OK with that too. 

I can’t remember if I shared on the last episode but did you know the new slang for 100% is hundo p? It’s true. So, I hundo p guarantee that tomorrow will be a better day because I played whack a mole all day today and those little bastards are going to have headaches and will lay a bit lower tomorrow. 

At least I hundo p hope so. 

Before we dive into the reason we’re here, it’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you don’t take advantage of this deal, I just think you might be crazy.

If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!

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

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

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

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

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

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

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

Item #1

Our first item is titled “Smoking Is Associated with Pain in All Body Regions, with Greatest Influence on Spinal Pain”, published in Pain Medicine Journal in October of 2019, and authored by Smuck, Scheider, and Ehsanian, et. al(Smuck M 2019). 

Why They Did It

The authors wanted to examine the interrleationship between smoking and pain the US

How They Did It

It was a cross-sectional population-based study

It was done nation-wide

They collected related demographicsin 2,307 subjects from 2003-2004

What They Found

Smoking is most strongly associated with spine pain, followed by headaches, then trunk pain, then limb pain. 

Wrap It Up

The conclusions is, “Current smoking is associated with pain in every region of the body. This association is strongest for spine and head pain. Given that pain is a strong motivator and that current smoking was associated with pain in all body regions, we recommend that these results be used to further raise public awareness about the potential harms of smoking.”

So we already knew that smoking was related to low back pain and disc issues from research we’ve covered here before. Now we know it goes beyond that. It’s everything everywhere basically. 

Honestly, can you think of anything that could actually be good about regularly inhale smoke all day every day? Like….anything at all? Of course not. And you know what’s going to piss some of you off? Other than some touted ideas on stress and pain relief, can you tell me what on Earth could be good about inhaling marijuana smoke regularly into one’s lungs. All day every day. Wake and bake is no better than smoking folks. I promise. When all the research shakes loose, you simply cannot inhale substances regularly and it be OK. 

As a side note I just want to throw some personal commentary in here. I had a conversation with a patient this week about another chiropractor here in my town and some of the beliefs and ideas that was laid on them on their visits with them. 

You know…..the things that push patients away and makes them come see other chiropractors. Things like don’t vaccinate your kids (regardless of your stance on the matter, don’t be a bully about it to your patients. It’s gross and unprofessional), things like don’t use cell phones because of radiation, things like pushing supplements more than an actual adjustment with exercises, things like we need 70 visits and $4000 from you this year to fix that loss of curve in your neck. Things like pushing the newest thing like CBD, multi-level marketing like supercharged water. 

From a patient’s perspective, if you went to your medical doctor and they’re pushing a ton of stuff from out of the blue….stuff beyond normal and customary medication. Things supplements that cost A LOT of money. They’re pushing CBD and selling if from their office, etc etc….

Well, those people look like snake oil salespeople. It’s not a good look, it’s off-putting, and we should hold ourselves to a higher standard. You can make plenty of money in this profession without selling your dignity and continually jumping on the hot new bandwagon. 

The golden oldies are still the best ROI, folks. Spinal manipulative therapy, exercise/rehab, physiotherapy, massage and manual therapy, acupuncture, and honest and high ethics. 

That’s your winning formula, y’all. Not CBD, special magical water, oils, and stuff like that. 

It’s just not. 

I swear I feel like I’m being controversial today but I’m not trying to be. I’m just speaking my mind and in the US at least these days, that is not a popular thing to do. We are at the point where 50% of the country hates the other 50% and anything you say, even when backed with facts, is taken as offesive material by half the country. 

Random thought just now. If kid slang for 100% is hundo p, for 50%, is it fitty p? Just a question I have. That’s all. 

Item #2

Now, item 2. This one is called “The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis” published in Current Reviews in Musculoskeletal Medicine in November of 2019 and authored by Mahmoud, Hassan, Abdelimajeed, Moustafa, and Silva, et. al(Mahmoud N 2019). 

November 2019 – hot stuff. fog your glasses up steaming plate. 

And can I just say Oh how I wish my last name was Moustafa? Powerful – elegant – a little bit of hell yeah there. 

Why They Did It

Despite claims that FHP may be related to neck pain, this relation seems to be controversial. Thus, our purpose is to determine whether FHP differs between asymptomatic subjects and those with neck pain and to investigate if there is a relationship between head posture and neck pain.

How They Did It

15 cross-sectional studies were eligible for inclusion

It was a systematic review and meta-analysis – so basically high-level information and research

What They Found

The conclusion of the project was “This systematic review found that age played an important role as a confounding factor in the relation between FHP and neck pain. Also, the results showed that adults with neck pain show increased FHP when compared to asymptomatic adults and that FHP is significantly correlated with neck pain measures in adults and older adults. No association was found between FHP and most of neck pain measures in adolescents.”

Now, you curve people don’t start getting our of hand. Can’t we see a world where a person does not have Forward HEad Posture but still has a loss of a curve. However, that loss of curve doesn’t cause a lot of issues? Of course we can. Because we have recent research that shows loss of a curve isn’t that big of a damn deal long-term. 

This paper is on forward head posture specifically and it doesn’t take a research paper to envision sitting with consistent bad posture and developing upper cross syndrome is going to set a person up for some chronic pain issues. I can easily make that leap with you. And with these authors. Count me in. 

Item #3

This one is called “The effect of spinal manipulation on brain neurometabolites in chronic nonspecific low back pain patients: a randomized clinical trial” it was published in Irish Journal of Medical Science in November of 2019  and authored by Didehdar, Kamali, Yoosefinejad, Lotfi, et. al(Didehdar d 2019). 

November 2019 – Pow- firecracker hot right here. Watch your fingers

Why They Did It

In patients with chronic nonspecific low back pain (NCLBP), brain function changes due to the neuroplastic changes in different regions. They wanted to evaluate the brain metabolite changes after spinal manipulation, using proton magnetic resonance spectroscopy

How They Did It

  • 25 patients enrolled
  • They were randomly assigned to lumbopelvic mainpulation or sham manipulation
  • They were evaluated befre the study begain and at 5 weeks after treatment. 
  • The Numerical Rating Scale and the Oswestry Disability Index and the H-MRS outcome assessments were used to quantify the results

What They Found

After treatment, pain and functional disability were significantly reduced in the treatment group vs. the sham group. 

This paper gets heavy into the neurology so, in order to keep you on board here, we’ll straight to the conclusion. 

Wrap It Up

The authors concluded, “In the patient with low back pain, spinal manipulation affects the central nervous system and changes the brain metabolites. Consequently, pain and functional disability are reduced.”

We did an episode on what an adjustment does way back on episode #56. That was also the episode where I talked about a popular group of millennial chiropractors that pour on the theatrics and sales talk and teach other impressionable chiropractors to do the same. 

And then claimed to make degenerative arthritic spurs disappear after adjusting 3 or 4 times a day for like 2 or 3 weeks. I can’t recall exactly now but go back and listen to episode 56. It was a fun brain dump and is probably something you’ll enjoy if I’m guessing. I’m putting the link right here at this point in the show notes at chiropracticforward.com so go give it a looksee. 

How do you describe a manipulation? If you were on an airplane sitting next to a neurosurgeon and he asked you exactly how manipulation works and affects the body and pain, what would you tell him? Have you thought about it?

The folks at ChiroUp have thought about it and probably because they’re DACOs, the DACO program also has an interesting description to offer. 

Dr. Brandon Steele with ChiroUp offered a good explanation for cavitation back in October on their blog. I’ll leave the link for you in the show notes. 

He described the need for better communication with the patients regarding cavitation and whether something “goes” or pops. Too many times, patients equate a successful treatment with cavitation. You know what we’re saying here. 

To quote Dr. Steele’s blog, he says, “Joint manipulation improves range of motion across individual and multiple vertebral segments.  A recent paper by Anderstt et al. (2018) confirmed that cervical manipulation results in facet gaping.  This force also improves regional motion across multiple spinal levels during and post-manipulation.

“This study is the first to measure facet gapping during cervical manipulation on live humans. The results demonstrate that target and adjacent motion segments undergo facet joint gapping during manipulation and that intervertebral range of motion is increased in all three planes of motion after manipulation. The results suggest that clinical and functional improvement after manipulation may occur as a result of small increases in intervertebral ROM across multiple motion segments.” 

Evidence-based chiropractors can bridge the patient education knowledge gap by incorporating current research into simple explanations.”

The DACO program I’ve been discussing put it all into an excellent description. Check this out and let me know what you think about it. 

“Chiropractic adjustments exert their effects upon the nervous system in a variety of ways. 

In recent years the neuroscience community has taken great strides in uncovering the mechanisms at play. These include analgesic responses at the dorsal horn level, as well as activation of the descending inhibitory pathways from brainstem regions such as the periaqueductal gray. 

There is also a compelling body of research that suggests profound changes in sensorimotor integration within the cortex. 

It appears that manipulation relies upon signaling properties of the muscle spindles that lie embedded in the paraspinal tissues. As the spindle registers rapid lengthening of the muscle it transduces this into a large proprioceptive barrage. 

The unique nature of a manipulation seems to alter the responsiveness of second-order neurons in the dorsal horn and make them less sensitive to incoming nociceptive signals from injured tissues.”

Good stuff. The more you know, the better you are. The better you are, the more you stand out and the busier you are. 

The right kind of busy. Not busy because you scared people into treating with you. Not busy because you made a big deal out of something insignificant. 

Busy because you’re freaking smart as hell, make good reasonable recommendations. Busy because you took the time to get the extra education to be able to help your patients beyond what your local competitors can do. Busy because you’re honest and you know that treatment should have a start and it should have a finish. 

Busy because you’re an evidence-informed, evidence-based chiropractor and high level research backs everything you say and everything you do. 

There are few things more satisfying than saying, “Would you like for me to send you the research paper on that?”

Store

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

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

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

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The Message

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

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

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

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

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm. 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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

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

Connect

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

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About the Author & Host

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

Bibliography

Didehdar d, K. F., Yoosefinejad AK, Lotfi M, (2019). “The effect of spinal manipulation on brain neurometabolites in chronic nonspecific low back pain patients: a randomized clinical trial.” Ir J Med Sci.

Mahmoud N, H. K., Abdelmajeed S, Moustafa I, Silva A, (2019). “The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis.” Curr Rev Musculoskelet Med: 1-16.

Smuck M, S. B., Ehsanian R, Martin E, Kao MJ, (2019). “Smoking Is Associated with Pain in All Body Regions, with Greatest Influence on Spinal Pain.” Pain Med.