Headache

Headaches In Kids & Multiple Myeloma Research

CF 290: Headaches In Kids & Multiple Myeloma Research

 

Today we’re going to talk about Headaches In Kids & Multiple Myeloma Research

 

But first, here’s that sweet sweet bumper music

 

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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

 

We’re the fun kind of research. Not the stuffy, high-brow, look down your nose at people kind of research. We’re research talk over a couple of beers.

 

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. I’m so glad you’re spending your time with us learning together.

 

Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, drive, smart, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com

 

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

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

 

You have found yourself smack dab in the middle of Episode #290

 

Now if you missed last week’s episode, we talked about motor control stiffening and spinal manipulation and the vertebral artery. Make sure you don’t miss that info. Keep up with the class.

 

On the personal end of things…..

Hey, hey, everyone! Welcome – we’ve got a rather interesting topic to dive into, and it’s a bit personal, I must admit.

 

You see, in the world of chiropractic, we have our colleagues we love and then we have the ones we love to gripe about. But what happens when a fellow chiropractor goes completely off the rails and starts attacking others not only professionally, but personally as well? Strap in, folks, because today we’re talking about hate and about handling professional turbulence and keeping your cool in the face of what I perceive to be a sheer craziness.

 

So, picture this – there I am one night at home, minding my own business after a long hard day at work, scrolling on Facebook when I get tagged in a post. It’s brought to my attention out of nowhere that another chiropractor that will go unnamed here, got some hurt feelings by something I said somewhere in almost 300 podcast episodes and posted a hit piece on me that was full of absolute vitriol and hate. It was disgusting. Especially from someone that wants desperately to be a leader for the profession.

 

Certainly considering that I’ve never met the dude in my life. Never shared an email exchange, text, wave, no contact in my 25 years of being in the profession. These really seemed to be some hurt feelings here. This guy decided to unleash a barrage of attacks directly on me that came out of left field because I have never, nor will I ever, attack him, or one of his sycophants, directly by name, place, or person.

 

When I have ever discussed anti-vitalism, it’s in broad terms with no names or identifying factors. That’s intentional. I think it’s important to talk about ideas and why I support them or do not support them or why the evidence supports them or does not support them. But I have never found value in the idea of going after someone by name directly. That’s rude, hateful, it doesn’t demonstrate leadership, and it’s not the way I want to handle things personally.

 

This particular person doesn’t like when someone doesn’t support his brand of chiropractic. If someone says something against it, that person, so it seems, must be destroyed. There are lots of examples in his tabloid. It’s like he woke up and thought, “You know what would be a great idea? I’d like to try ruining someone’s reputation and potentially their license because they don’t agree with me!”

 

Regardless of the work people have put into their careers. Trust me, I’m not the first nor will I be the last to suffer these attacks from this tabloid. This person is on a mission that he thinks is vital at all costs. Regardless.

Now, I’m all for spirited debates and discussions within our profession. It’s healthy, it keeps us sharp, and ultimately benefits our patients and the profession. But attacking someone personally and professionally? Come on, man! We’re supposed to be helping people live better lives and making better doctors of chiropractic, not creating chaos! I mean honestly, it’s astonishing the depths that he went on this deal.

 

I’ve had my moments of frustration, just like anyone else. But I firmly believe that the best way to handle situations like these is with grace and professionalism. Let’s face it, we’re human – emotions can run high. But when someone goes “off the rails” as I like to put it, well, that’s a whole other level of… shall we say, “interesting.”

 

So, what did I do in the face of this unprovoked direct attack? Well, I took a step back, breathed deeply, and reminded myself why I got into this field in the first place. It’s all about helping people lead healthier, happier lives. And if I let someone else’s negativity derail me, then I’m not doing justice to my calling. Then, I called my lawyer who, after reading it, simply couldn’t believe someone would have the gall to write that hit piece but then recommended I let it go for now unless I suffer a personal or professional loss.

 

Because, without one single doubt, several points made at my cost in the hit piece were taken out of context and sensationalized for shock value and to, in my opinion, do nothing more than make me look like a fool and try to discredit me at every turn and on every level. And trust me, there are plenty of our colleagues that are sycophants of this guy that will think just that and believe every word. For example, it was claimed that I advertised I was the best chiropractor in Amarillo when you cannot advertise superiority. Even included a screenshot of a video I posted. But failed to mention that the video was announcing that I was voted Best Chiropractor in Amarillo. Two years in a row as a matter of fact. An accomplishment I’m very proud of.

 

Which I am more than able to post about winning. As many times as I damn well want to post about it. That context was absent from the hit job. When things are deliberately taken out of context and sensationalized in such a manner to attack and result in a personal or professional loss…..well then…legally…..the game changes, doesn’t it?

 

Getting back to it….It’s not always easy to maintain composure when you’re faced with such attacks. But I realized that responding in kind would only perpetuate the negativity. So, I’m choosing a different path – I’ve continued to focus on my patients, on my podcast, on my leadership duties, and on improving myself and my message. I do not plan on having a tick for tat running discussion going on this. He done his damage and I suspect it’ll end right there. I certainly recommend that it does.

 

As they say, ultimately, the best revenge is success. While this unnamed individual may be busy spewing negativity and trying to destroy anyone that disagrees with his brand of chiropractic, I’m busy promoting my brand of chiropractic without the personal and direct attacks on my colleagues. It seems like the ones that want to convince others that they aren’t somehow crazy and maniacal, are always the ones out there doing the crazy things. The crazy things that just go to prove everyone’s point.

 

So, what’s the takeaway from all of this? Well, first and foremost, keep your cool when faced with attacks, whether they’re personal or professional. Do what you can to get effective counsel and rise above the chaos and stay true to yourself and your purpose. I know who I am and I know damn well what I stand for – as do any of you who listen regularly or know me personally. And, Hey….I’m a big boy. Literally and figuratively. I can take it and I suppose if you’re going to take a stance and fight for the things you believe in, you have to be ready for the punches from the trolls. I wasn’t expecting it. But I am now.

 

And secondly, let’s all remember that in the grand scheme of things, we’re here to make a positive impact on the world, not engage in hate or destroying someone personally just because we happen to not agree with them. It’s shameful, desperate, and embarrassing. Hate is going to hate and we can’t change that so we might as well get busy living and doing what we can to be a positive change and a positive force for those around us that love us and have faith in our ideas and in our leadership.

 

 

Item #1

 

The first on today is called “Potential effect modifiers for treatment with chiropractic manipulation versus sham manipulation for recurrent headaches in children aged 7–14 years: development of and results from a secondary analysis of a randomised clinical trial” by Susanne Lynge, Werner Vach, Kristina Boe Dissing & Lise Hestbaek and published in Chiropractic & Manual Therapies and on 11 July 2023. Dayum. That’s hot.

 

Why They Did It

 

A recent randomized controlled trial (RCT) investigating the effect of chiropractic manipulation in 199 children aged 7–14 years with recurrent headaches demonstrated a significant reduction of number of days with headache and a better global perceived effect (GPE) in the chiropractic manipulation group compared to a sham manipulation group. However, potential modifiers for the effectiveness of chiropractic manipulation of children with recurrent headaches have never been identified.

 

The present study is a secondary analysis of data from that RCT and will investigate potential effect modifiers for the benefit of chiropractic manipulation for children with headache.

 

How They Did It

 

Sixteen potential effect modifiers were identified from the literature and a summary index was prespecified based on clinical experience. Relevant variables were extracted from baseline questionnaires, and outcomes were obtained by means of short text messages. The modifying effect of the candidate variables was assessed by fitting interaction models to the data of the RCT. In addition, an attempt to define a new summary index was made.

 

 

What They Found

 

The prespecified index showed no modifying effect. Four single variables demonstrated a treatment effect difference of more than 1 day with headache per week between the lower and the upper end of the spectrum: intensity of headache (p = 0.122), Frequency of headache (p = 0.031), sleep duration (p = 0.243), and Socioeconomic status (p = 0.082).

 

Five variables had a treatment effect difference of more than 0.7 points on the GPE scale between the lower and the upper end of the spectrum: Frequency of headache (p = 0.056),

Sport activity (p = 0.110),

Sleep duration (p = 0.080),

History of neck pain (p = 0.011), and

 Headache in the family (0.050).

 

A new summary index could be constructed giving highest weight to History of neck pain and Headache in the family and Frequency of headache. The index suggests a difference of about 1 point in GPE between low and high values of the index.

 

 

Wrap It Up

 

Chiropractic manipulation offers a moderate benefit for a broad spectrum of children. However, it cannot be excluded that specific headache characteristics, family factors, or a history of neck pain may modify the effect. This question must be addressed in future studies.

 

 

Before getting to the next one,

 

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

 

When you decide you can’t live without those products, send me an email and I’ll give you the hookup. They will 100% differentiate your clinic from your competitors.

 

 

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

 

 

Item #2

 

Our last one this week is called, “An experimental treatment developed at Israel’s Hadassah-University Medical Center has a 90% success rate at bringing patients with multiple myeloma into remission.” by Judy Siegel-Itzkovich and published in The Jerusalem Post on MAY 29, 2023. Hot potato!

 

Why They Did It

 

The researchers and medical professionals at Hadassah-University Medical Center in Jerusalem’s Ein Kerem developed the innovative treatment for multiple myeloma cancer because it is a significant medical challenge. Multiple myeloma is the second-most common hematological disease and has long been considered incurable, with a poor life expectancy for patients. The motivation behind this research was to find a groundbreaking solution that could improve the prognosis and quality of life for patients suffering from this type of cancer.

 

How They Did It

 

The treatment is based on genetic engineering technology known as CAR-T (Chimeric Antigen Receptor T-Cell Therapy). The process involves the following steps:

 

Apheresis: Blood components are collected from the patient, and the T cells (active cells in the immune system that can fight tumors) are isolated.

 

Genetic Engineering: A genetic segment that encodes a receptor against cancer cells is added to the T cells using a virus.

 

Injection: The engineered T cells are then injected back into the patient’s body.

 

Targeting and Destruction: The engineered T cells target the tumors and destroy the cancer.

 

 

What They Found

 

According to the article, more than 90% of the 74 patients treated at Hadassah with the CAR-T therapy went into complete remission. This represents a highly successful response rate and a significant improvement in the prognosis for patients with multiple myeloma. The treatment also showed minimal side effects, making it even more promising for patients’ well-being.

 

 

Wrap It Up

 

The researchers and medical professionals at Hadassah-University Medical Center have achieved an unprecedented breakthrough in the treatment of multiple myeloma cancer using CAR-T therapy. This innovative approach, based on genetic engineering technology, has shown remarkable success in achieving complete remission for the majority of patients treated.

 

The treatment offers hope to those suffering from a disease that was once considered incurable, greatly improving their life expectancy and quality of life. Moreover, by significantly reducing the cost of the treatment, Hadassah has made it more affordable and accessible to a larger number of patients in Israel and around the world.

 

The success of this treatment could pave the way for the development of future treatments using CAR T cells for other types of cancer as well. The researchers’ efforts represent a major achievement in the field of oncology and immunotherapy, with the potential to revolutionize cancer treatment worldwide.

 

 

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

 

 

Store

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

 

 

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

 

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

 

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

 

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

 

Key Point:

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

 

That’s Chiropractic!

 

Contact

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

 

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

 

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

 

Connect

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

 

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About the Author & Host

Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Thoracic Adjustments For Neck, Not Headache & Physical Activity In Children

CF 229: Thoracic Adjustments For Neck, Not Headache & Physical Activity In Children Today we’re going to talk about T-sp Adjustments For Neck, Not Headache & Physical Activity In Children But first, here’s that sweet sweet bumper music  

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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

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

You have found yourself smack dab in the middle of Episode #229 Now if you missed last week’s episode , we talked about Exercise For Depression & Manipulation For Tendinopathy. Make sure you don’t miss that info. Keep up with the class. 

 

On the personal end of things…..

I’ll be honest with you all…..I always am anyway…..I feel like I’m as busy as I’ve ever been but when I look at the numbers, they’re down a bit still. I’m not fully recovered to the numbers that we saw prior to the pandemic setting in in 2020. I know many of you are. I’m not yet. I’m not far off. But I’m not there dependably month after month yet.  As a result of my involvement in Dr. Kevin Christie’s Florida Mastermind that you’ve heard me mention, and at Kevin’s suggestion, I read a book called Who Not How by Dan Sullivan and Ben Hardy. I highly suggest it. This book is telling us to quit looking for how you do things and start looking for WHO can help you accomplish your goal.  This isn’t really a new concept but really sheds some light on the topic.

We need a team. We need helpers. We cannot ever hope to do it all ourselves and do it a high level. To start looking at bringing on team members as investments rather than costs.  It’s eye-opening for sure. Give it a try and see what you think. As a result, I’m looking for Whos. I have some Whos already. I make good use of virtual assisstants. I have one in Pakistan, one in Nigeria, and one in India.

They help me with marketing voice over, with my Chiropractic Forward website, with a website I’m trying to build for another business, and with stat keeping and monthly balancing and close outs in my chiro business.  But I’m still doing a lot of tasks weekly that can be farmed out to a Who. What daily and weekly worker bee tasks are you doing yourself that can be farmed out while investing in a new Who? My biggest one is an associate. I’m on the hunt. If you or someone you know is interested in interviewing with me for a potential position here in my clinic, I’d love to speak with you.

The Texas Panhandle has pros and cons like everywhere else but I will say that one of our biggest draws is our incredible people. We are kind, friendly, and helpful. That, and hey, we have the second largest canyon in the nation called Palo Duro Canyon. It’ll knock your socks and your shoes off.  Anyway, send me an email at creekstonecare@gmail.com if you’re intersted and we’ll connect. 

Before we get to the research, I recently connected with a personal injury attorney and as a result, I have a gift for you!  I’m going to turn you on to a system that will result in your getting tons of PI cases from attorneys.   Yes, getting these referrals can be done. Paul Samakow, a veteran PI attorney, put this system together.  He knows what attorneys want to hear – inviting them to lunch doesn’t work, folks.   His system, delivered to you in both written and video form, is insightful and hits the mark. 

Over 25 concepts on how you can not only get attorneys to refer to you, but endear yourself to them. Samakow’s system costs $997 and he guarantees satisfaction or your money back. You have to check this out.  Even if you only get one case, you’ve made at least 4 or 5 times the investment. Go to gettingpicases.com/cs That’s gettingpicases.com/cs One more time so you get it right:   gettingpicases.com/cs

Item #1

The first one today is called, Thoracic spine thrust manipulation for individuals with cervicogenic headache: a crossover randomized clinical trial by McDevitt et. al. (Amy W. McDevitt 2022) and published in the Journal of Manual and Manipulative Therapy July of 2021. Shazam….it’s steamy. 

Why They Did It

To determine if thoracic spine manipulation (TSM) improves pain and disability in individuals with cervicogenic headache (CeH). Now, let’s take a step back just a bit and I’ll share some knowledge from the Neuromusculoskeletal Diplomate program about where Cervicogenic headaches lie in terms of prevalence.  Tension-type headaches are the overwhelming winners.

They make up about 40% or more of the headaches that present to just about any clinic.  Second place goes to migraines. True migraines make up only about 10%. Not nearly as much as you might expect. Since Tension type and migraine live on the same continuum of headaches, they can share some characteristics of each other so, many times, a tension type can behave like a migraine and vice versa.  True migraines, however, are only about 10% of cases.  Then comes cervicgenic headaches at only about 4% of the cases of headaches you see in clinic.  The good news is that tension type and cervicogenic are the ones we really have a lot of success with since they typically come from the suboccipital and/or neck region and that’s our bread and cinnamon butter, baby. That’s hero territory right there because we can turn someone’s life around muy pronto, mi amigo. 

How They Did It

  • It was a randomized controlled crossover trial 
  • It was conducted on 48 participants with cervicogenic symptoms. 
  • Participants were randomized to 6 sessions of thoracic spine manipulation or no treatment and after 4-weeks, groups crossed over. 
  • Outcomes were collected at 4, 8 and 12 weeks and included: headache disability inventory (HDI), neck disability index (NDI), and the global rating of change (GRC). 

What They Found

  • Comparing no-treatment group to the active treatment group, the Headache Disability Index outcomes were not significantly different between groups at any timepoint; 
  • The Neck Disability Index outcome, however, was significant at 4 weeks.

Wrap It Up

Thoracic spine manipulation had no effect on headache-related disability but resulted in significant improvements in neck-related disability and participant reported perceived improvement. Muy bueno, muy bueno. Don’t forget to adjust the T-spine for the neck pain.  Before getting to the next one, I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! It’s live again.

Use the code HOTSTUFF upon purchase at droprelease.com to get $50 off your purchase. Y’all, it makes a world of difference. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. My patients love it and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Hear me now and believe me later.

Item #2

This one is called, “Physical Activity In Children” by Michel et. al. (Michel J 2022) published on April 25, 2022….brand spankin new in the skillet. It’s burns! This is an article really rather than a research project so lets summarize this bad boy. 

They start by saying “The US received an overall grade of D− for physical activity in children, with only about 1 in 4 children meeting the daily recommendation of 60 minutes or more per day.

With the recent COVID-19 pandemic, this has worsened because children are even less active, missing out on daily activities and group sports, and increasing screen time.” “Being inactive has numerous harmful effects on health and well-being. It is linked to many chronic diseases and conditions, such as obesity, diabetes, high blood pressure, heart disease, cancers, and early death. In contrast, there are numerous benefits to physical activity for children, including decreased risk for developing all of these diseases and conditions.

Physical activity can also help to decrease stress and improve school performance, sleep, and mental health.” “US physical activity guidelines recommend that children aged 3 to 5 years be physically active throughout most of the day and that children aged 6 to 17 years have at least 60 minutes of moderate to vigorous physical activity daily. Moderate to vigorous activity means the heart rate is raised higher than the normal resting range and is associated with sweating and deeper breathing.” “How can you help your child meet these goals? First, be an example.

Children copy you, so if you make exercise a part of your routine, they are more likely to follow in your footsteps. You can also help by making physical activity a part of your whole family’s daily routine by setting a time every day, especially when your children are young. In addition, try to make activity fun. If your child enjoys physical activity from an early age, this will likely continue as they grow older.

It can also be helpful to make a list of physical activity options, both for outside and indoors for when the weather is not appropriate. “ These are recommendations for us as parents but also as providers that can guide and encourage out younger patients toward more activity.

Do you do anything outside of your office to encourage your patients to get active? What if one of your staff members wanted to host a walk in the park? A hike in nature? Or something similar?  Good for your patients and good for practice building.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

Store

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

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

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

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

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

Website https://www.chiropracticforward.com

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About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  

CF 159: Set Yourself Apart In Your Chiropractic Care For Migraines

CF 159: Set Yourself Apart In Your Chiropractic Care For Migraines Today we’re going to talk about chiropractic care for migraines. What does new research tell us.  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 #159 Now if you missed last week’s episode , we talked about chiropractors within a primary spine care model, we talked about frozen shoulder treatments, and we talked about how evidence-based care is more cost-effective. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Alright alright alright. Christmas is over and as of the typing of this episode we are staring down New Year’s. No big deal for me. I’m not going anywhere so there’s nothing to get too excited or worked up about.  I guess the biggest news for me is that my wife and I got vaccinated last week. We got the Moderna version of the vaccine. Didn’t hurt a bit. I was one of the fortunate ones. I had absolutely zero reaction. No sore arm, no fever, no aches…..nothing. I guess if you poked on my arm fairly hard it would have been a bit sore but really, nothing at all.  If I had been in the research trial, I would think I got the placebo. That’s how uneventful it was for me.

My wife though, she felt a little crummy. No fever but maybe a little bit of overall achey-ness. Sore arm for a few days. But that’s about it. Nothing severe at all and she recovered quickly.  I’ve had several ask me online how we got ours so quickly. The first thing I’d say is that I have a network of providers here locally that I refer to, they refer to me, and on some level, we are friends. They know how closely we work with our patients. They don’t want us getting it and they don’t want us giving it to others.  So, when the vaccine came to town, they called and told us to come down and get ours. So we did. Here’s the cool part; they told me to reach out to fellow chiropractors and tell them to come to get vaccinated if they want one.

I thought to myself, “Can you imagine if this pandemic were just 10 years ago? Would the medical community have extended that offer to chiropractors then?” My guess is probably not.  Here’s the not-so-cool part. I reached out to about 40 in the area and only ONE of them accepted the offer. So, we gots some work to do in making chiropractors more evidence-science-based. Though I do want to be fair. I don’t think it’s unreasonable at all to wait 4-6 weeks just to make sure everyone does OK with this thing. even though the proper trials were done….it’s not unreasonable.  It’s just delaying the fact that people are going to do fine and everyone will end up getting it anyway but whatever. 

What I do think is unreasonable is continuing to refuse it beyond the 4-6 week mark. This thing is far beyond the flu both in transmissibility and in the risks of death and or disability. Sometimes that disability is short-term and sometimes it’s long-term. Don’t think of this as a death vs. living thing. Long-haulers is a real thing.  We don’t need to be out of work that long. We don’t need to have to figure out how to keep our employees paid while we are out sick for 2-4-6 weeks or however long we have to be out.  We don’t need to think we just have a sniffle or allergies and then spread this to our elderly or immunocompromised patients.  Being out of work for far too long or passing this onto risky patients….when all we had to do was just get the damn shot.

So….I got the damn shot and so far, so good. 

In other news, I have formed a collection of all of my research blogs from 2007 onward. I’ve organized them into categories so they can be easily found so now I have a book. I’m in the process of getting the book cover made. This dude is about 220 pages or so. It could be much longer but I’m trying to make it skinnier on purpose.  It is called “The Remarkable Truth About Chiropractic: A Unique Journey Into The Research”. We still have a lot of steps and hoops to jump through to get to the finished product but we are well on our way. Of course I’ll keep you updated on the progress.  Happy New Year folks. Let’s get on with the research today. 

Item #1

This one is called “Association of drinking water and migraine headache severity” by Khorsha, et. al. (Khorsha F 2020) and was published in the Journal of Clinical Neuroscience in July of 2020 and that’s still a steaming pile of sizzle! Before we get into chiropractic care for migraines, let’s cover a little headache primer here for you. First thing, the history of the headache is key. In general, a headache is considered dangerous if there is any recent change in a headache’s character. Some have a long history with headaches but if that history changes, further exploration is needed. Recent onset of less than 6 months is more worrisome. Focal neurological signs. And lastly, cognitive changes. Changes in behavior for example. 

Getting back to headache types, 38% of headaches seen in a clinical setting are tension-type headaches right off the bat. Only about 10% are actual migraines. Only 4% of headaches are actually classified as true cervicogenic headaches. Then cluster headaches, and on and on….those are very rare. Here’s the fine print though. Tension-type and migraine headaches exist on the same continuum. Meaning, they share characteristics. I suppose you could even say that tension-type is a very very mild form of migraine while migraine is a very very extreme tension-type.

That may be overstating it a bit but there is a relationship between the two and they can share characteristics with each other.  According to Dr. Anthony Nicholson and Dr. Matthew Long with the CDI learning from the Diplomate in Neuromusculoskeletal Medicine, “It is a pervasive neurological condition with genetic underpinnings. Indeed, when you look more closely you will soon realize that migraineurs do not function normally in between headache episodes either (the interictal period). In other words, the headache symptoms are simply a feature of what might be described as a chronic neurological ‘disorder’ or ‘illness’. As we shall explore in this Drill, migraine is the manifestation of an abnormally excitable brain that is capable of over-activating the trigeminal system in genetically susceptible individuals.

The result is not only nasty headaches but also a host of other autonomic, cognitive, emotional and musculoskeletal disturbances. Furthermore, these can occur both during the headache or outside of the acute pain episode. It is therefore important that we immediately recognize a patient as a migraineur because it should influence the way we interpret their entire case. Not only that, but we certainly need to approach a migraine sufferer a little differently when it comes to dispensing manual treatment. “

If you think that makes a ton of sense, Dr. Anthony Nicholson just signed on to be a presenter for the Texas Chiropractic Association’s Winter Conference, which will be online for ALL OF YOU to enjoy. It’ll be march 5-6 and will also include myself, Annie O’Connor, Jay Greenstein, Brandon Steele, and Carlo Ammendolia as presenters. Don’t miss it folks! That’s huge. So, getting back to Dr. Nicholson’s description, we wouldn’t describe a tension-type headaches that way, would we? As you have probably experienced or at least guessed, migraines are much more difficult to address or treat than are the other types of headaches. 

I don’t have the time or space to go into the full treatment of migraines here but I do want to highlight some studies that we might leverage to our advantage and we can go that extra mile to help our patients with the issues of headaches and migraines.  Many times, they’re at the bottom of their rope when we get them. If we succeed where everyone else failed, well then, don’t we always enjoy being that practitioner? Hell yeah, we do.  Just remember 3 important questions:

  • Do you have recurrent headaches that interfere with work, family, or social functions?
  • Do your headaches last at least 4 hours?
  • Have you had a new or different headache in the last 6 months?

These should give you some guidance considering migraines typically last 4-72 hours and interfere with work, family, and social functions. Patients cannot simply muscle through migraines. It’s a nope. 

Why They Did It

“Based on evidence dehydration is closely related to promoting migraine headache frequency and severity. The Water intake is the best intervention to reduce or prevent headache pain. water intake in migraine patients has rarely been studied. the present study aimed to evaluate the relation between water intake and headache properties in migraine.”

How They Did It

  • It was a cross-sectional design with 256 women
  • They were aged 18–45 years old
  • They had all been referred to neurology clinics for the first time
  • The diagnosis of migraine by a neurologist according to ICHD3 criteria
  • To assess migraine severity the Migraine disability assessment questionnaire (MIDAS), visual analog scale (VAS), and a 30-day headache diary were used.
  • Pearson correlation analysis was used to evaluate the relationship between the number of days and duration of headache with daily water intake.

What They Found

The results showed that the severity of migraine disability, pain severity, headaches frequency, and duration of headaches were significantly lower in those who consumed more water or total water. Wrap It Up “The present study found a significant negative correlation between daily water intake and migraine headache characteristics but further clinical trials are needed to interpret the causal relationship.”

CHIROUP ADVERTISEMENT

Item #2 This second one is called “Endogenous Melatonin Levels and Therapeutic Use of Exogenous Melatonin in Migraine: Systematic Review and Meta‐Analysis” by Liampas L, et. al. (Liampas L 2020) and published in the Journal of Head and Face Pain on April 30 2020 schizza it’s hot.  Why They Did It The aim of this study was to review the existing evidence for the deployment of melatonin in migraine prophylaxis.  How They Did It

  • MEDLINE EMBASE, CENTRAL, PsycINFO, trial registries, Google Scholar, and OpenGrey were comprehensively searched
  • The quality of studies was assessed according to the Newcastle‐Ottawa Scale (case‐control studies) and the Risk‐of‐Bias Cochrane tool (RCTs)
  • Random‐effects (RE) or fixed‐effects (FE) model was used based on heterogeneity among studies 
  • Publication bias was assessed by funnel plots.
  • Literature search provided 11 case‐control studies
  • Regarding the treatment‐prevention of migraine, 7 RCTs and 9 non‐randomized studies were retrieved
  • Overall, melatonin was more efficacious and equally safe with placebo in the prevention of migraine in adults (3 of 4 RCTs provided superior efficacy results for melatonin

Wrap It Up

“Melatonin may be of potential benefit in the treatment‐prevention of migraine in adults, but complementary evidence from high‐quality RCTs is required.”

Item #3

Next up is “Integrating Chiropractic Care Into the Treatment of Migraine Headaches in a Tertiary Care Hospital: A Case Series” by Bernstein et. al. (Bernstein C 2019) and published in Global Advances in Health And Medicine” in 2019. Not hot but definitely not cold. 

Why They Did It

They ran a case series to illustrate an integrated model of care for migraine that combines standard neurological care with chiropractic treatment.

How They Did It

  • For each patient, we describe the rationale for referral, diagnosis by both the neurologist and chiropractor, the coordinated care plan, communication between the neurologist and chiropractor based on direct face-to-face “hallway” interaction, medical notes, team meetings, and clinical outcomes.
  • Findings are evaluated within the broader context of the multicause nature of migraine and the impact of integrative chiropractic. 

They highlighted 3 cases that we’ll touch on briefly.  Case 1

  • She was 40 when she first went to the neurologist for daily migraines. 
  • She started integrative care at 42 years old. 
  • She had had migraines since she was 29 years old. 
  • After seeing the neuro, the frequency went down to 3-4 times per week
  • She also had some TMJ issues and neck pain and stiffness. with some radicular symptoms that were only a few months in duration
  • Upon going to the chiro, they found trigger points that would stimulate the headache on compression, abnormal tracking of the TMJ, and tenderness over the right C2/3 facet joint. 
  • After spinal manipulative therapy, the patient experienced almost immediate reduction in headache and neck pain and a reduced headache frequency of 1 per month. 

Shazam! Pop! Smack. KaPow! Case 2

  • She was 31 at the start, 34 when integrating treatment. 
  • She had been having them since 12 years old that she managed with Excedrin for years. But they got more out of hand after her 2 pregnancies
  • 2 of the headaches even sent her to the ER
  • Associated symptoms included unilateral neck pain, nausea, and vomiting
  • She tried multiple trials of different medications with limited relief
  • Once making her way to the chiropractor, they found trigger points in the suboccipitals, temporalis, and masseters. Weakness in the deep neck flexor muscles, and substantial postural faults, forward head carriage, and rounded shoulders. 
  • Where her headaches had been rated from 7-8, after 9 months of treatment with admittedly poor adherence to the at-home exercises, she rated them at a 3 out of 10 and after 10 months experienced her first headache-free month. 

Pow! Zap! Slap! Case 3

  • 27 years old when first going to the neuro and 29 when she made it to the chiro
  • Migraines started when she was 13
  • Pounding and throbbing with aura. The whole nine yards. 
  • Migraines were nearly daily, disabling and interfering with life to the point she could only take 1-2 college classes each semester. 
  • Multiple medication trials
  • She underwent botox treatments that helped her have as many as 8 pain free days in a month. Which means she still had about 22 days of headaches in a month. How miserable. 
  • Fortunately the botox helped the severity dampen by about 50% but she still complained of the disabling neck pain. 
  • The chiropractor found trigger points in the sub occipital area and the traps and could reproduce the pain on compression. The chiro also noted substantial segmental mobility restriction in the upper cervical spine. 
  • After seeing the chiropractor, there was a nearly immediate positive response to initial care in headache and neck pain intensity and frequency. with a reported 50% reduction in the intensity. The average headache dropped to 3.5 out of 10. 

Zowey, Kapowey, Thunk! 

Wrap It Up

“Our case series highlights the promise of and the need to further evaluate integrated models of chiropractic and neurologic care. Although we observed improvement in patient outcomes in this small case series, rigorously designed studies with adequate control groups are needed to determine the efficacy and safety of chiropractic care for migraine patients.”

Item #4

Yep, it’s a longer podcast today but I can’t leave you without doing this paper real quick! It’s called “The Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta‐Analysis” by Rist et. al. and published in the Journal of Head and Face Pain on March 14, of 2019. Again, not hot but damn sure not cold.  Why They Did It They wanted to perform a systematic review and meta‐analysis of published randomized clinical trials (RCTs) to evaluate the evidence regarding spinal manipulation as an alternative or integrative therapy in reducing migraine pain and disability.

How They Did It

  • PubMed and the Cochrane Library databases were searched for clinical trials that evaluated spinal manipulation and migraine‐related outcomes through April 2017
  • The methodological quality of retrieved studies was examined following the Cochrane Risk of Bias Tool.

What They Found

  • The search identified 6 randomized controlled trials eligible for meta‐analysis.
  • Intervention duration ranged from 2 to 6 months
  • Outcomes included measures of migraine days (primary outcome), migraine pain/intensity, and migraine disability
  • They observed that spinal manipulation reduced migraine days with an overall small effect size as well as migraine pain/intensity.

Wrap It Up

The authors concluded, “Spinal manipulation may be an effective therapeutic technique to reduce migraine days and pain/intensity. However, given the limitations to studies included in this meta‐analysis, we consider these results to be preliminary. Methodologically rigorous, large‐scale RCTs are warranted to better inform the evidence base for spinal manipulation as a treatment for migraine.” It’s like a computer. It only spits out information that is based on the information that was put into it. Same with a meta-analysis. If the studies going into it are few, your output won’t be too robust.

Of course, we know that the effect we have on migraines is much more than small. In the 3rd study we covered today, do you think any of those 3 case study patients thought that the relief they got from the chiropractor was small? Nope, they thought the results were worthy of superhero sound effects. At least if they had a brain like mine that’s what they’d think.  So, for our research community, there are your marching orders. We have research on the low back in spades. Let’s prove neck pain and headache/migraine now please? I’ve been asking for 3 years now. Please?

Besides the claims of the vitalists in our profession, those are the things that keep us from really stepping up. Lack of proof for neck pain effectiveness, headache/migraine effectiveness, and the lack of risk for spinal manipulation in the cervical region.  I feel the stroke risk has been debunked and handled. Now if we can get the other two firmly under our belts, we’ll be good to go.  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

  • Bernstein C, W. P., Rist P, Osypiuk K, Hernandez A, Kowalski M, (2019). “Integrating Chiropractic Care Into the Treatment of Migraine Headaches in a Tertiary Care Hospital: A Case Series.” Glob Adv Health Med 8.
  • Khorsha F, M. A., Togha M, Mirzaei K, (2020). “Association of drinking water and migraine headache severity.” J Clin Neuroscience 77: 81-84.
  • Liampas L, S. V., Brotis A, Vikelis M, Dardiotis E, (2020). “Endogenous Melatonin Levels and Therapeutic Use of Exogenous Melatonin in Migraine: Systematic Review and Meta‐Analysis.” J Head Face Pain 60(7): 1273-1299.

 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Alright, rant over. 

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

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

How They Did It

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

What They Found

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

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

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

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

How They Did It

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

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

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

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

What They Found

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

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

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

Connect

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

Website

Home

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

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

Spinal Manipulation With & Without Myofascial Release and Vitamin D3 and Headaches

CF 117: Spinal Manipulation With & Without Myofascial Release and Vitamin D3 and Headaches

Today we’re going to talk about manipulation with and without myofascial release added and we’ll cover a cool paper on vitamin D3 and headaches. Good stuff today in regard to smarts being handed out for free. 

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 #117

Now if you missed last week’s episode , we talked about the safety for chiropractic care in kiddos and we talked a little about an excellent article by Jan Hartvigsen called “What Is Chiropractic’. Definitely some food for thought. 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. 

On the personal end of things…..

Let’s talk about ebbs and flows, shall we? Here’s the thing; our practices ebb and flow. If someone tells you their practice looks like a business chart where it’s only up and to the right, they’re all hat and no cattle if you catch my drift. 

I told you all in the 10 Keys To Success episode recently that last year, I saw an average of 73.4 new patients every month last year. But in February of this year……I haven’t gotten the exact numbers as of the recording here but I believe it’s only somewhere around 30. 

Now, many of you would be jumping with joy to have 30 new patients in a month and I apologize if my displeasure is a put-off. It’s not meant that way. You must admit that if you love having 25 in a month, only having 8 or so is disappointing. Agreed?

So please keep the discussion in context. Now, what happened? Did I take a piss on someone’s dog and everyone found out? Of course not. I may do that to a cat but never a dog!!! Lol. 

Here’s what I think. I took four working days to go on vacation. Then, snow and ice messed with about another 2 and a half days or so. Essentially, I lost about 6 working days in February. Partly because of me. Partly not because of me. 

Then, for a hybrid insurance practice like mine, we have to battle with the fact that insurance plans reset in January. So, January and February are typically slower months to begin with. We basically took an already slower month and they made it worse by missing a little over a week of it. 

That’s a recipe for disaster. Dammit. I haven’t been in an amazing place since my dad’s health went south back in November but February was just a good way to put the cherry on the top. 

Here’s the deal though. Is it time to cash in the chips, throw my hands in the air, and say screw this. I’m out!!!????

Of course not. I’ve been around the game long enough to understand practice, understand life, and understand that I’m sitting on a cash cow of a practice and we just had a crap month. This too shall pass. 

Yes, I’m going to feel it in a couple of months. But that too will be short-lived. For example, I’m typing this on a Wednesday in the first week of March and for this week, we already have 11 new patients on the books and I expect more. Plus the re-exams are up there too. 

So, my practice is starting to level off again and get back to what I’m used to seeing. Hell yes, it’s stressful when numbers aren’t where you want them. Hell yes, it’s easy to get in the dumps and I do get in the dumps. But you can’t even imagine how productive I’ve been with the extra free time. Organizing marketing campaigns with our marketing manager, social media and website content, and basically TCB – taking care of business, man!!!

The marketers say don’t wait until it’s slow and then bust your butt marketing. Market like that year round. Yeah, I like that and it sounds great but that’s really fairytale land crap when you’re busting your butt like we did last year. There was no time. Literally. 

When people say they don’t have time, to me, that means it wasn’t a priority because we make time for the things that are priorities. Except when you literally do not have the time. And we didn’t. 

Now we do and we’re on it. I’ll keep you updated with how we proceed. I absolutely expect this coronavirus freak out to affect all of us. If people aren’t going to Las Vegas or Seattle, you can damn sure bet they don’t go to our offices as well. But, it’ll pass. 

You’ll stop seeing it on the news so much, deductibles will get met, and practices will fill up. At least…..mine will. Lol. And if you’re making good use of any extra time and being a marketer of what you do rather than a do-er of what you do, then yours will fill up too. 

If you’re playing video games at work on your computer, I can almost guarantee yours will not fill up. 

Before we dive into the reason we’re here, it’s good to support the people that support evidence-informed practitioners. Well, ChiroUp certainly does just that. 

If you don’t take advantage of the deal I’m about to offer you, I think you just might be crazy.

Regular listeners know I’ve used ChiroUp since for well over a year now. I’m going to tell you want it is and then share a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months. 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, activities of daily living, & for their exercises. 

This save you so much time – no more explaining & re-explaining your patient’s care, because they have access to it right there at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports and exercises are populated based on what the literature recommends and isn’t that reassuring? All of that work has been done FOR you by people that are deep into the research. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice.

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 and, to sweeten the deal, you can use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super saver code is Williams99.

Item #1

Let’s start with a paper called “Effectiveness of Spinal Manipulation and Myofascial Release Compared With Spinal Manipulation Alone on Health-Related Outcomes in Individuals With Non-Specific Low Back Pain: Randomized Controlled Trial” by Boff et al (Boff TA 2019)and published in Physiotherapy in Nov. of 2019 that’s only 3 months ago and it’s……Hot

Why They Did It

They wanted to investigate the effectiveness of spinal manipulation combined with myofascial release compared with spinal manipulation alone in individuals with chronic non-specific low back pain. 

How They Did It

  • It was a randomized controlled trial
  • There was a 3-month follow up. 
  • 72 patients between 18 and 50 years old participated
  • They were placed in two different groups
  1. Spinal manipulation
  2. Spinal manipulation + myofascial release
  • They were treated twice a week for three weeks
  • Assessments were performed at baseline, three weeks post-treatment, and at three months after treatment. 

What They Found

  • No significant differences were found between the two groups for pain intensity and disability 
  • They found an overall significant difference between-groups for CNLBP disability, though this effect was not clinically important and was not sustained at follow-up. Stay tuned for my thoughts on this please…..

Wrap It Up

They concluded, “We demonstrated that spinal manipulation combined with the myofascial release was not more effective compared to spinal manipulation alone for patients with chronic non-specific low back pain.”

OK, fair enough. Nothing was found. But, what about that treatment frequency? 2x/week for 3 weeks…..only four visits in 2 weeks. We ARE talking about chronic pain guys and gals. 

What about 3x/week for 3 weeks for starters? Some of these people will never get out of pain completely and we’re trying to reduce the frequency and reduce the intensity. 

Basically, I absolutely buy into the fact they didn’t see a lot of difference. But I also don’t think they gave it very long. What do you think? Shoot me an email at dr.williams@chiropracticforward.com and let me know or jump into our private Facebook group and start a discussion. 

Item #2

This one is called “Vitamin D3 might improve headache characteristics and protect against inflammation in migraine: a randomized clinical trial”  by Ghorbani, et. al(Ghorbani Z 2020). and published in Neurological Sciences in January of 2020 – Dammitt – I burned myself. The heat and all…

Why They Did It

Due to the anti-inflammatory effects of vitamin D3, they aimed to explore the effects of supplementation with this vitamin on headache characteristics and serum levels of pro and anti-inflammatory markers in migraineurs.

How They Did It

  • It was a placebo-controlled, double-blind study
  • It included 80 episodic migraineurs who randomly assigned into two equal groups to receive either daily dose of vitamin D3 2000 IU (50 μg) or placebo for 12 weeks.
  • At baseline and after the trial, headache characteristics were determined using diaries and serum levels of interleukin (IL)-10, IL-6, inducible nitric oxide synthase (iNOS), and cyclooxygenase-2 (Cox-2) were assessed via ELISA method

What They Found

At the end of trial, analysis revealed that vitamin D3 supplemented group experienced significantly lower headache days per month

reduced attacks duration

less severe headaches

and lower analgesics use per month

This was all when compared to the placebo

Wrap It Up

The authors concluded, “Based on the results of this study, we found that 2000 IU (50 μg)/day vitamin D3 supplementation for 12 weeks could improve headache characteristics and might reduce neuro-inflammation in episodic migraine.”

If all of you tell me that you get 100% of your headaches patients completely headache free, I’m going to raise my eyebrow at you in the skeptical posture and deep deep deep down inside, I’m going to think you’re full of horse hockey. Plain and simple. 

This paper can give us some insight into other avenues to explore. I’m not saying go put all of your headache patients on Vitamin D3 but, if you have some that are not responding, it makes sense to read through this paper and decide for yourself about recommending it. Or, alternatively, collaborate with their primary on the matter. 

That’s it for this week. I’m outties, Hope you enjoyed the show. I humbly ask you, if you know a colleague that would enjoy this material every week, please share the show with them. There’s only one way we make a difference in the chiropractic profession and that is through your help. 

Thanks in advance!

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

The Message

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

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

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

And, if the patient treats 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

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

  • Boff TA, P. F., Ben AJ, Bosmans J, (2019). “Effectiveness of Spinal Manipulation and Myofascial Release Compared With Spinal Manipulation Alone on Health-Related Outcomes in Individuals With Non-Specific Low Back Pain: Randomized Controlled Trial.” Pysiotherapy 107: 71-80.
  • Ghorbani Z, T. M., Rafiee P, (2020). “Vitamin D3 might improve headache characteristics and protect against inflammation in migraine: a randomized clinical trial.” Neuro Sciences.

Headaches and the Neck, Absolute Contraindications, More Maintenance Care

CF 102: Headaches and the Neck, Absolute Contraindications, More Maintenance Care

Today we’re going to talk about new information on how working on the neck could help headaches of all kinds. Who woulda thunk it? We’ll talk about absolute contraindications to spinal manipulative therapy. Do you remember them all? I’ll give you a refresher to be sure. We’ll wrap up the episode with another paper on maintenance care. Is it evidence-based?

But first, here’s that sweet sweet bumper music

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

OK, we are back 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 sauntered into Episode #102

Now if you missed last week’s episode, it was episode #101 and it covered 9 characteristics that make up a good chiropractor,  make sure you don’t miss that info. Put that one on your listen-to list muy pronto, mi amigo. 

On the personal end of things that whole DACO thing you’ve heard me talk about since June of 2018…..well, I got word last week that I passed the part II exam. That also happens to be the FINAL exam I’ll have you know which means……yes, it means I’m now officially a Diplomate or Fellow of the International Academy of Neuromusculoskeletal Medicine. 

It turns out that we can choose whether to go by Diplomate or Fellow and I choose Fellow. So, when it comes to adding alphabet soup to the end of my signature, I now get to add FIANM(us). 

Besides graduating with a doctorate, this is the biggest thing I’ve done and I can’t really express how excited I am to join the amazing group of doctors in this specialization. 

Did you know that only 2% of chiropractors go on to specialize? We really really need to change that. I want to be honest here: the hours were absolutely, 100%, without a single doubt one of the most enjoyable and most rewarding things I’ve done. WAaaaaayyyy better than chiropractic school. 

The course was current with research. It was smart. It was professionally done. It was just amazing. 

The testing process……welll…..that was a different story for me. I felt that the material in Part I was just irrelevant to the course. In fact, had little to nothing to do with what we learned. BUT – the good news is that they’ve created a new test now and it should be more relevant. 

Part II was amazing, imaginative, and well-put together and conducted. But, I believe there were doctors making the questions that had never undergone the current course load so, once again, there were questions that were a bit random and just seemed out of place to a person that had all of those hours. 

Again, the good news is that they are consistently adding updated questions and I have no doubt they will get more and more focused in regard to what was actually covered in the course. 

So, I in short, doctors should undertake this Diplomate. The hours are so rewarding. You literally cover a topic in the course and then it shows up in your clinic. It’s scary as hell how that works. 

The testing part is cumbersome and clunky but they’re working on lining it out. Even if that part didn’t get any smoother or any better, it is still 100% absolutely worth every dime spent and every hour spent achieving the goal. 

Trust me, I’d tell you straight up if it weren’t. If you have the money, do it. Don’t give me that excuse about time. I didn’t have time either. I just made time. I did it while I watched football. I did it with coffee on Saturday and Sunday mornings. I took off early on Tuesdays just to study. It can be done and YOU can do it. 

Send me an email at dr.williams@chiropracticforward.com if I can help point you in the right direction and get you started. I’d be happy to help you. 

More chiropractors need to specialize. Just think about it. 

My Dad…..well….If you listened to previous episodes, you know he had a stroke a couple of weeks ago. I can’t tell you how emotionally challenging this has been. To work and still get out there to spend time every day…..it’s a process and it’s a commitment. 

But that’s it. He’s my Dad and I’m committed to being there to help and do whatever I can to help him get restored to whatever level we can get. 

We are both guitar players so I brought my guitar up to the rehab facility last night and played for him for a while. We are both sculptors. We make bronzes. Check riverhorseart.com and we have a Facebook page as well. 

So, I bought him some new sculpting tools and some clay and took them up to him today at lunch. He can only use is dominant hand, his right hand, but he was pretty excited. He started sculpting before I even left. 

Fingers crossed that we see some improvement in a hurry. Thank you to each of you that sent me emails and messages through Facebook offering prayers and good wishes. I value each of them as much as I value you. Thank you. 

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

Let’s start with absolute contraindications shall we? This comes from the WHO Guidelines(Sweaney J 2004). That’s right the World Health Organization. The actual name of the document is WHO guidelines on basic training and safety in chiropractic. 

I literally never knew this existed until I saw it in a Facebook group last week. Some kind hearted individual shared it. I can’t recall whether it was the Forward Thinking Chiropractic Alliance group or if it was the Evidence Based Chiropractic group. Either way, I found it interesting and here we are. 

I’m going to leave a link to the document at this point in the show notes so just go to chiropracticforward.com and episode 102. You’ll find it and you’ll be happy. 

https://www.who.int/medicines/areas/traditional/Chiro-Guidelines.pdf

If we go down to page 21, we find a list of Absolute contraindications to spinal manipulative therapy. Many of them, you already know but let’s just stroll through them for a refresher just in case. 

1. anomalies such as dens hypoplasia, unstable os odontoideum, etc.

2. acute fracture

3. spinal cord tumor

4. acute infection such as osteomyelitis, septic discitis, and tuberculosis of the spine

5. meningeal tumor

6. hematomas

7. malignancy of the spine

8. frank disc herniation with accompanying signs of progressive

neurological deficit

9. basilar invagination of the upper cervical spine

10. Arnold‐Chiari malformation of the upper cervical spine

11. dislocation of a vertebra

12. aggressive types of benign tumors, such as an aneurysmal bone cyst, giant cell tumor, osteoblastoma, or osteoid osteoma

13. internal fixation/stabilization devices – metal hardware such as after a surgical fusion

14. neoplastic disease of muscle or other soft tissue

15. positive Kernig’s or Lhermitte’s signs – these are orthopedic meningitis signs. Go look up Kernig’s and Lhermitte’s if you don’t know them please.

16. congenital, generalized hypermobility – Are you using the Beighton Scale for hyper mobility? Are you adjusting chronic pain, hyper mobile people? Sometimes, even if they like the popping sounds, that’s not best. Sometimes, strengthening and support exercises are better than mobilizing joints that are already too mobile. 

17. signs or patterns of instability

18. syringomyelia

19. hydrocephalus of unknown etiology

20. diastematomyelia – a congenital disorder in which a part of the spinal cord is split, usually at the level of the upper lumbar vertebra. Fortunately, we almost never see this.

21. cauda equina syndrome – I caught one not long ago in my office. A new patient who had been to the ER 3 times already and they never even took the time to do any imaging. A young guy in his 30’s on a walker, difficulty controlling bowel and bladder function, saddle anesthesia. I told him to go directly back to the ER and tell them you are concerned you are suffering from cauda equina and tell them you have saddle anesthesia. 

As soon as he did that, boom, imaging, and emergency surgery. He says I saved his life. While that’s not true specifically, it sure as hell feels good to hear. 

Alright. I hope you enjoyed that brief refresher and it gave you a little food for thought. You can go to the show notes and get the document or just go to get the list if you like. 

Item #2

This one is pretty cool. It’s called “A neuroscience perspective of physical treatment of headache and neck pain,” by Rene Castien and Willem De Hertogh and published in Front Neurology in March of 2019(Castien R 2019). 

This one is probably going to tell you what you instinctively already knew but it’s going to lay some scienc-ing in on the top there for you. 

Just like a warm blanket, a layer of scienc-ing is all warm and fuzzy and makes you feel good. Can’t get enough of scienc-ing can we?

OK, we know that the most prevalent headache is tension type headache. In fact, about 40% of those presenting in your clinic are TTH. Not migraine, not cervicogenic…..TTH. In fact, only about 10% of the headaches that present to your office are actually migraines. That’s not very many is it? 

Which is a good thing because migraine is more of an issue in the brainstem – in the descending pain inhibitory complex. In the words of Dr. Anthony Nicholson and Dr. Matthew Long from the CDI coursework – The experience of head pain requires activation of the trigeminal nucleus. After all, this is where the neurons that sense the head and neck are located.

Adjustments don’t always knock out a migraine issue right? It’s wired into the brain. However, adjustments tend to show more success when we’re dealing with a TTH. 

Now, the TTH is also an issue with impaired inhibition. It’s on the same spectrum….the same continuum as is migraine. Migraine way off to the right and TTH way off to the left. But there’s a lot of middle ground in there where their symptoms can overlap into each other a bit. 

But, in general, we are able to be more effective with TTH than we are with migraine. 

They mention in this paper that physical treatment is a frequently applied treatment for headaches. They say that although physical treatment is often applied to the neck, the neurophysiological background…..how it works or helps…..is unclear. 

So, the authors had the goal of taking more recent knowledge from neuroscience and enhancing clinical reasoning in using physical treatment for headaches and to understand why it’s so common for headaches and neck pain to exist together so oftenly.

Some of the highlight quotes from this article are as follows:

“Headache (migraine, tension-type headache, cervicogenic headache), neck pain, and cervical musculoskeletal dysfunctions seem to be related in case-control studies, although the strength, significance and explanation of this relation varies per type of headache.”

“It is a great challenge for clinicians and researchers to develop effective treatment strategies for headache targeted on modulation of cervical afferent input in order to decrease the excitability of first- to second order neurons at the level of the TCC. Experimental studies of the neurophysiological effect of physical treatment and randomized clinical trial on this topic are scarce and urgently warranted. Meanwhile, there is no standard recipe for physical treatment on the neck for different types of headache. But clinicians may be encouraged by recent evidence and new insights on headache and neck pain and may use this knowledge in clinical reasoning to provide a tailored and evidence based neuro-physiological approach for patients with headache and neck pain.”

“The relation between brainstem nuclei and the (upper) neck and trigeminal nerve has to be incorporated in development of physical treatment for headache targeted at the cervical spine, especially the upper cervical region. 

According to the ‘gate-control’ hypothesis, the relative high amount of proprioceptive muscular input from the upper cervical segments particularly C1-3….. to the central nervous system may alter nociceptive input. 

Stimulation of proprioceptive input by active exercises for neck muscles may decrease the excitability of second order neurons at the trigemino-cervical complex and activation of the supraspinal diffuse noxious inhibitory control system by stimulation of myofascial fibers through manual pressure techniques at the upper cervical spine can be of added value.”

Pretty cool stuff. Physical treatment is effective for different kinds of headache through the trigemino-cervical complex via proprioceptive stimulation of the upper cervical region. 

You’re welcome. This is something covered extensively in the coursework we did for our Neuromusculoskeletal Fellowship/Diplomate. 

Like I said, it’s absolutely worth going through the course. 

Item #3

Our last paper here is paper #3 in the last year on Chiropractic Maintenance. It’s called, “Chiropractic maintenance care – what’s new? A systematic review of the literature”. It was published in Chiropractic and Manual Therapies and authored by Iben Axen, Lise Hestbaek, and Charlotte Leboeuf-Yde in November 2019(Axen I 2019) – Hot steamin’ greasy plate of enchiladas here. 

If you notice the name Iben Axen, then you will remember he is the one that authored the paper on how a patient’s improvement in the first visit or two can really help you know how they will do through the course of the treatment. He’s pretty active in research and we appreciate him here at the Chiropractic Forward Podcast. 

Why They Did It

Here’s why they did this one: knowing that maintenance care is an age old tradition with chiropractors, and knowing that systematic reviews in ’96 and in /08 both found evidence lacking for maintenance care, and then considering Andreas Eklund’s Nordic papers on maintenance care recently (we’ve covered them both here), these authors decided it was time to review the newest evidence on the matter. 

How They Did It

Knowledge of chiropractic Maintenance Care has advanced. There is reasonable consensus among chiropractors on what Maintenance Care is, how it should be used, and its indications. Presently, Maintenance Care can be considered an evidence-based method to perform secondary or tertiary prevention in patients with previous episodes of low back pain, who report a good outcome from the initial treatments. However, these results should not be interpreted as an indication for Maintenance Care on all patients, who receive chiropractic treatment.

You know it feels good when a paper can conclusively say ‘presently, maintenance care can be considered an evidence-based method.” It reminds me of Jim Carrey in the Ace Ventura movies saying, “Can you feel that? Huh?” Lol. 

Good stuff there. I love slapping people with research. It’s a warm feeling going down kind of like Bailey’s and coffee. You know what I’m saying. 

Key Takeaways

  • Be smart and know your absolute contraindications
  • Treating the neck for headaches is evidence-based
  • Chiropractic maintenance is evidence-based

Speaking of evidence-based, make sure you go to chiropracticforward.com and go to the store link to check out our evidence-based brochures and posters. You’ll like them. 

Chiropractic evidence-based products
Integrating Chiropractors
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The Message

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

When compared to the traditional medical model, research and clinical experience show 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. 

Website

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

Chiropractic Forward Podcast Facebook GROUP

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Twitter

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

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TuneIn

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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

  • Axen I, H. L., Leboeuf-Yde C, (2019). “Chiropractic maintenance care – what’s new? A systematic review of the literature.” Chiropr Man Therap 27(63).
  • Castien R, D. H. W. (2019). “A Neuroscience Perspective of Physical Treatment of Headache and Neck Pain.” Front Neurol 10: 276.
  • Sweaney J (2004). WHO guidlines on basic training and safety in chiropractic. WHO: 44.

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

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

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

Don’t Miss A Dissection!

But first, here’s that sweet sweet bumper music

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

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

Introduction

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

Store

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

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

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

DACO

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

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

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

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

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

Personal Happenings

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

Item #1

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

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

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

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

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

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

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

Introduction

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

That’s all

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Chiropractic evidence-based products



Integrating Chiropractors
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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

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

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


Tinnitus & New Guides For Neck-Related Headaches

Today we’re going to talk about a couple of papers touching on tinnitus as well as a paper that just came out on practice guides for persistent headaches associated with neck pain. We’ll have some fun learning some new info if you stick around. 

Chiropractic evidence-based products

But first, here’s that ‘better than a back rub’ bumper music

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

You have drifted into Episode #65. And I don’t mean drifted like a feather or a piece of wood in the ocean. No, I’m talking about dangerous, careless, speedy drifting in the car around a curve, man. That’s the drifting I’m talking about. I talk like I’ve drifted before. I haven’t. Well, at least not intentionally. We won’t talk about that one time down in Alpine, TX. Lol. Hey, I used to be in a touring band. What do you want from me? I used to be on the on’ry side. That’s all I’m saying. 

I’m still a little ornery but age has settled me quite a bit. Which is a good thing. I look at kids these days. My son is a teenager and really, for the most part, he’s just so good. No drugs, no drinking, loving as he can be. I think back to when I was his age. I was legitimately a menace to society. I mean that literally. It’s a wonder I’m alive but, as with most from my generation, we made it didn’t we? In spite of the lead paint, lack of bicycle helmets, and all that stuff. 

I want to take just a few seconds to thank Dr. David Graber. He gave The Chiropractic Forward Podcast a shout-out to a room of about 1000 chiropractors during his talk at the Parker Seminar in Vegas a week or so ago. While that doesn’t seem like that big of a deal, I’ll just say that, when you feel like a lot of times, you’re on your own and everything depends solely on you and your actions or, in-actions, it is a blessing to have others help share the word. When you guys share or help get the message out in any little way, it’s like I breath a little easier if that makes any sense. It’s like I’m part of a team rather than out here on an island shouting through a megaphone hoping a ship passing by hears me. 

Anyway, I know I thanked you in our private Facebook group but wanted to do so here as well. Very much appreciated, Amigo. 

Introduction

Let’s get on with it here. We’re here to advocate for chiropractic and to give you some awesome information to make your life easier from day-to-day. We’re going to keep you from wasting time in your week and give you confidence in your recommendations and treatments. And I feel confident in guaranteeing that to you if you listen and stick to it here at the Chiropractic Forward Podcast.  

Store

Part of saving you time and effort 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.

DACO

Let’s talk a bit about the DACO program. That’s the Diplomate of the Academy of Chiropractic Orthopedists. Why do the DACO? Because, if you want to integrated, you need to certificate. Or more accurately, you need to specialize and get accredited. That’s what the Diplomate is about. Bells, whistles, letters behind your name….yes. More importantly, you’ll be leaps and bounds beyond where you were prior to do it. 

Recent classes have been Tinnitus which we’ll talk about in a moment, carpal tunnel syndrome as part of a double crush syndrome, and managing hip osteoarthritis. Fascinating stuff. 

I saw a chiropractic student upset on Facebook the other day. He was upset because of some video that popped up on social media. It was an anti-vaccination speech and, honestly, it was pretty vile and hateful in the stance against vaccines. Look, you have whatever opinion you want on vaccines, we’re never going to get into that here. That’s not why I mention it. 

The student clearly did not agree with this speech from CalJam and was wondering what kind of profession he’s spending all of this money to be a part of. He was basically questioning what kind of future he’s going to have when you have a profession that is getting continuing education hours for speeches like that. 

I could confidently tell him, and you by the way, that there has never been a better time to be a chiropractor. At least not in the last 35-40 years anyway. We’ve all heard about the Mercedes 80’s. They sound real nice but they’re a pipe dream at this point. 

Right now, there has never been the research backing up what we do. We have it overflowing. Not only in our effectiveness either. We have research on how we’re more effective than PT and MDs. We have research on how our patients are more satisfied with our outcomes than any other practitioner. We have research on how we do all of that while costing less. 

Never before have we had a national epidemic. This little thing we call the opioid epidemic that is driving every healthcare practitioner to look for non-pharma means of treating their patients. That means you and me. 

And never before have we had the capability or opportunities that we have now to integrate with our medical colleagues and become more and more a part of a team of healthcare practitioners. 

We are moving more to the center rather than staying out on the fringes of healthcare like the red-headed step child. 

No offense to red-heads or step-children. 

Anyway, Diplomate programs are more than letters behind a name. They’re about progressing you and your profession. Building knowledge and respect. 

I get nothing for talking about the DACO. I just think certification and professional standardization are important things. Email me at dr.williams@chiropracticforward.com if you have some questions about getting started.

Personal Happenings

And the hunt for a front desk rock star continues. I want to share with you the fact that indeed.com and Facebook work ads are great at netting you about 1.3 million resumes but not good, well-qualified candidates. Every damn time I post a job listing, I’ll get around 150 recipients. Only a very limited few are worth anything. Most aren’t even qualified for the job. 

For instance I got a resume yesterday from a dude that can run a fork lift. Hey, I like forklift drivers fine but that won’t get it done at the front desk of a healthcare facility, right? It’s an insane waste of time going through all of these but, what the hell else are you going to do? you have to have an employee. And I’m not going to my friends to ask if they know of anyone because I don’t want my friends hitting me up for a job. Lol. If that doesn’t work out, not only have you lost an employee but you’ve also lost a friend. 

No thanks!

Item #1

I have had an increase in tinnitus in my left ear after a plane ride I took back from Austin a couple of weeks ago. Bad enough that I went to a specialist for it. Turns out, she said I have, in some frequencies, moderate loss. I said, “What?” Lol. 

Well, I’ve been a touring musician before so, what’s new? I could have told you that. But, it’s been bad in just the past couple of weeks so something changed in that window of time. I started taking some DACO classes and noticed one on tinnitus so jumped to that drill for obvious reasons. 

I don’t want to go into details of the class but I do want to talk about some of the research cited for the class and we’ll start with this one called, “Does multi-modal cervical physical therapy improve tinnitus in patients with cervicogenic somatic tinnitus?” It was authored by S Michiels, P Van de Heyning, and a bunch of other very difficult names and published in Manual Therapy in 2016(Michiels S 2016). 

Why They Did It

Tinnitus can be related to many different etiologies such as hearing loss or a noise trauma, but it can also be related to the somatosensory system of the cervical spine, called cervicogenic somatic tinnitus (CST). Knowing that case studies have suggested a positive effect of cervical spinal treatment on tinnitus, this study wanted to dive a little deeper on it. 

How They Did It

It was a randomized controlled trial of subjects having a combination of tinnitus and neck pain. Like a combo meal, instead of a burger and fries, it was neck ache and ear ringing. Make that two please, thank you. 

Each subject received cervical physical therapy for 6 weeks which equaled 12 sessions. 

What They Found

Cervical physical therapy can have a positive effect on subjective tinnitus complaints in patients with a combination of tinnitus and neck complaints.

Pretty cool stuff there. 

Item #2

Let’s double down with this one from Oostendorp, et. al. called “Cervicogenic somatosensory tinnitus: An indication for manual therapy? Part 1: Theoretical concept” published in 2016 in Manual Therapy(Oosterndorp RA 2016). 

The Big Idea

Tinnitus can be evoked or modulated by input from the somatosensory and somatomotor systems. This means that the loudness or intensity of tinnitus can be changed by sensory or motor stimuli such as muscle contractions, mechanical pressure on myofascial trigger points, transcutaneous electrical stimulation or joint movements.

Interesting yeah? I think so. 

They go on to say, “The neural connections and integration of the auditory and somatosensory systems of the upper cervical region and head have been confirmed by many studies. These connections can give rise to a form of tinnitus known as somatosensory tinnitus. 

Broadening the current understanding of somatosensory tinnitus would represent a first step towards providing therapeutic approaches relevant to manual therapists. Treatment modalities involving the somatosensory systems, and particularly manual therapy, should now be re-assessed in the subgroup of patients with cervicogenic somatosensory tinnitus”

And that’s just what they’re doing. Fascinating stuff considering that you’ve always heard, “you’ll just have to live with it.” Basically, if you can change the intensity, quality, or frequency of the ringing, by moving your jaw or stressing the cervical spine in different directions, there’s more than a solid chance that you can change it completely through cervical manipulative or manual therapy. 

If I remember correctly the guesstimate was around 65% of the cases may be affected by chiropractors for the positive. 

Hell yeah and pass the potatoes people. 

Item #3

Our last thing today is called “Non‐pharmacological Management of Persistent Headaches Associated with Neck Pain: A Clinical Practice Guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration” written by Pierre Cote, Hainan Yu, Heather Shearer, et. al. and published in European Journal of Pain in February 2019(Cote P 2019). 

Hot off the presses and I know you like it served hot like that. Cold or lukewarm education just isn’t as good as piping hot brain nuggets.

Why They Did It

To develop an evidence‐based guideline for the non‐pharmacological management of persistent headaches associated with neck pain (i.e., tension‐type or cervicogenic).

How They Did It

This guideline is based on systematic reviews of high‐quality studies. A multidisciplinary expert panel considered the evidence of clinical benefits, cost‐effectiveness, societal and ethical values, and patient experiences when formulating recommendations.

What They Found

When managing patients with headaches associated with neck pain, clinicians should: 

  1. rule out major structural or other pathologies, or migraine as the cause of headaches; 
  2. classify headaches associated with neck pain as tension‐type headache or cervicogenic headache once other sources of headache pathology has been ruled out; 
  3. provide care in partnership with the patient and involve the patient in care planning and decision‐making; 
  4. provide care in addition to structured patient education; 
  5. consider low load endurance craniocervical and cervicoscapular exercises for tension‐type headaches (episodic or chronic) or cervicogenic headaches >3 months duration; 
  6. consider general exercise, multimodal care (spinal mobilization, craniocervical exercise, and postural correction), or clinical massage for chronic tension‐type headaches; 
  7. do not offer manipulation of the cervical spine as the sole form of treatment for episodic or chronic tension‐type headaches; 
  8. consider manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine for cervicogenic headaches >3 months duration. However, there is no added benefit in combining spinal manipulation, spinal mobilization, and exercises; and 
  9. reassess the patient at every visit to assess outcomes and determine whether a referral is indicated.

All of this is just a part of making us all better day to day. Those paying attention have the leg up. No doubt. 

Here’s the problem with being patient-centered instead of doctor-centered. We have to be OK with watching the high volume practices running through like cattle….we have to be OK watching them make millions while we have an average case treatment of only 7-10 visits. 

So what? Big deal. I always say that I could have a bigger house and more vacations but I sleep very well at night and, being a Christian as I’ve mentioned before, I’m at peace knowing I’m square with my maker and treat people the way they should be treated. 

Religious or not, patient-centered doctors can always take comfort in the fact that they’re doing what is in the best interest of their patients. 

It’s a lovely thing isn’t it? Honesty, ethics, love, cumbaya, and all that tom foolery….. They’re just little bricks that are the building blocks of an excellent life and career. 

Integrating Chiropractors
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Chiropractic evidence-based products

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

Cote P, Y. H., Shearer HM, (2019). “Non‐pharmacological Management of Persistent Headaches Associated with Neck Pain: A Clinical Practice Guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.” European Journal of Pain.

Michiels S, V. d. H. P. (2016). “Does multi-modal cervical physical therapy improve tinnitus in patients with cervicogenic somatic tinnitus?” Man Ther: 125-135.

Oosterndorp RA, B. I., Mikolajewska E, (2016). “Cervicogenic somatosensory tinnitus: An indication for manual therapy? Part 1: Theoretical concept.” Man Ther: 120-123.

https://www.chiropracticforward.com/proven-means-to-treat-neck-pain/?v=7516fd43adaa

https://www.chiropracticforward.com/debunked-the-odd-myth-that-chiropractors-cause-strokes/








CF 050: Chiropractic Care – Text Neck, Headaches, Migraines

CF 050: Chiropractic Care – Text Neck, Headaches, Migraines

Today we’re going to talk about headaches, migraines, neck pain, and our favorite topic here at the Chiropractic Forward Podcast, yes….we’ll talk about Chiropractic care. Specifically, chiropractic care for the headaches, migraines, and neck pain. 

Hold on though, make way, get in the Soul Train dance line because here’s that bumper music

Integrating Chiropractors

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

You have skidded all fast and furiously into Episode #50

Let’s talk a bit about the DACO program. For those that don’t know, that’s the Diplomate of American Chiropractic Orthopedists program I’m slowly trudging through. 

I say slowly. You have 3 years to finish. But, I’m a doer if you can’t tell. I’m a worker bee if you will. When I start something, I want to finish. I don’t like unfinished bidness. I don’t like things flapping out in the wind. I want to start it and then I want to finish it quickly and move on to the next thing. 

Getting 300 hours is never going to get done quickly. Especially when you are the sole doctor in a busy practice not getting home until 7 pm or even later sometimes. Such is my life. A curse and a blessing depending on the day and my outlook on that particular day. 

However, I believe I’m on a path to finish it up in about a year from when I started. Probably much sooner. For example, I knocked out 12 hours last week. That’s pretty solid but, we had a snow day and I took advantage of being stuck at home. 

I crawled down into my basement man cave, got in my blankie and jammies with an iPad on my belly, leaned the recliner back and got some education. 

So far, I have 40 hours of the 250 online hours done and 40 hours of the 50 live hours required. In total, I’m 80 hours into a 300-hour course. Rocking and rolling folks. Rocking and rolling. 

Some of the more recent courses I’ve completed were hip pain in children, joint hypermobility disorders, TMJ, and thoracic outlet syndrome. These courses are fascinating. 

The offer is there. If you need help getting started on yours, send me an email at dr.williams@chiropracticforward.com I’ll be glad to get you on your way. 

Speaking of getting in touch, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It makes everything easier. 

Now onto a discussion that took place on our Facebook page a couple of weeks ago that I thought was particularly interesting. 

I will put it in the show notes for you if you’d like to see the meme….funny word. My son loves it when we mispronounce it. You should try it with your kids if they’re old enough to get embarrassed by their parents.  

Anyway, the picture I posted was of a contemplative Kermit the Frog and it said, “Me when a patient tells me another chiropractor wanted 5 sets of x-rays over 9 months of treatment to correct something research doesn’t support.”

Now, let me set the stage here. The impetus for this was that one of my patients moved down to Georgia. Her daughter started having some headaches and pain so she went and got an MRI. 

The results of the MRI showed the issue to be out of the scope of chiropractic. Regardless, you guessed it, she got a recommendation for 5 sets of x-rays over 9 months of treatment. 

Absolute scare care riduculosity. 

Here’s where it got a little sticky. A colleague got on that post and expressed some dissatisfaction that I would post something like that. I guess he didn’t like my airing dirty laundry. Which is cool. I don’t mind at all but here’s what happened for me on the deal. 

I sat down and crafted a very PC response I think and in doing so, I had an opportunity to reflect on the podcast, the reason for it, and what we’ve done in just the past year. 

Here are some highlights that came to mind for me:

  1. You don’t make an omelet without cracking some eggs and I think some difference of opinion is to be expected and it’s something I just need to get used to. 
  2. I think I created this podcast to do whatever I could to move this profession forward. 
  3. Forward to me means providing research like we do every week but also to educate others, to suggest new research avenues, to encourage specialization and higher education, to push for integration, and to call out and discourage the behavior I feel holds us back from moving forward. 

If you aren’t active on our Facebook page, I’d encourage you to stop in and say, “Hi.” Tell us if you’re digging the podcast. Share some research you’ve found. Maybe give us a suggestion for a future podcast. We’re here. We also have a private Facebook group if you’d like to join the private group. 

OK, research for this week, here we go with paper #1

This one is called “Characteristics of Chiropractic Patients Being Treated For Chronic Low Back and Neck Pain[1].” The lead author is PM Herman and the paper was published in August of 2018 in the Journal of Manipulative Physiological Therapeutics. 

https://www.ncbi.nlm.nih.gov/pubmed/30121129

Get your marketing hat on for this one people. 

Why They Did It

Since chronic low back and neck pain are so prevalent, and since spinal manipulation is a common non-pharma treatment for them, the authors wanted to determine the characteristics of the type of patient that visits the chiropractor. 

How They Did It

  • They collected data from chiropractic patients in regard to regions and states, sites, providers and clinics, and patients. 
  • The data was collected through an iPad questionnaire given at the chosen sites. 
  • They had 518 chronic low back pain patients complete it while 347 chronic neck pain patients finished theirs. They also had 1159 do both. 

What They Found

  • Most of the sample were highly-educated
  • Most were non-hispanic
  • White females were the dominant demographic for race and gender
  • Few used narcotics
  • Avoiding surgery was the most important reason they chose chiropractic care 
  • Over 90% of the patients reported high satisfaction with their care

That should give you some good ideas when trying to figure out who you should be marketing to. I can lead the horse to water but I cannot show the snout into the pond and make the horse drink it up. 

Text Neck

I picked this one out because I saw a discussion on Facebook last week about Text Neck. The question posed was, isn’t text neck just a new term for an old problem? Is text neck just a scare tactic?

That was the general gist of the post. 

While I did not respond, I do have an opinion on text neck. I do not think it’s an old problem. I mean, let’s back up a bit. Poor posture is most certainly an age-old problem. No doubt about it. 

However, at no other point in our time in history that I’m aware of, have little bitty children all the way up to mid-aged and elderly people had a reason to be sitting in one spot for hours with their head flexed forward, bent down almost into their laps. It pains me to see some of the kids these days. 

My poor son. Not so much my daughter right now but my son….my goodness. That kid…I’ll look at him sometimes and he has somehow balled himself up into what I can only describe as something resembling a roly-poly or an armadillo. His head bent at 90 degrees looking at his phone in his lap. Basically, the epitome of text neck.

It must really suck being a chiropractor’s kid. I’ve taken pictures of it before when he wasn’t looking. As you probably know, you can draw on pictures on your phones. So I took that picture then drew big red marks exploding out of his neck. Then, while he’s sitting there on his phone, he gets the picture in a text. 

It’s awesome. You all should try it sometime if for no other reason than to give yourselves a laugh. 

Next Paper

This paper is called, “Cervical Proprioception in a Young Population Who Spend Long Periods on Mobile Devices: A 2-Group Comparative Observational Study” and it was published in the Journal of Manipulative and Physiological Therapeutics as well[2]. The lead author was Andrew Portelli and it was published in February of 2018. 

https://www.jmptonline.org/article/S0161-4754(17)30010-6/fulltext?elsca1=etoc&elsca2=email&elsca3=0161-4754_201802_41_2_&elsca4=Physical%20Medicine%20and%20Rehabilitation%7CHealth%20Professions

Why They Did It

The purpose of this study was to evaluate if young people with insidious-onset neck pain who spend long periods on mobile electronic devices (known as “text neck”) have impaired cervical proprioception and if this is related to time on devices.

What They Found

“The participants with text neck had a greater proprioceptive error during cervical flexion compared with controls. This could be related to neck pain and time spent on electronic devices.”

This message has been brought to you by an uncool parent of a teenager. 

Paper #3

This one is called, “Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial[3].” and it was published in Spine journal in February of 2018. 

https://www.ncbi.nlm.nih.gov/pubmed/29481979/

Why They Did It

The optimal number of visits for the care of cervicogenic headache with spinal manipulative therapy is unknown so the authors hoped to identify the dose-response relationship between visits and chronic headache outcomes…. and to evaluate the efficacy of chiropractic by comparison with a light-massage control.

What They Found

The authors’ conclusion was as follows, “There was a linear dose-response relationship between SMT visits and days with CGH. For the highest and most effective dose of 18 SMT visits, CGH days were reduced by half and about 3 more days per month than for the light-massage control.”

So, you guys and gals that want to take evidence-based to the extreme and get people out of your office in only 3 or 4 visits, you may not be hitting the number of visits that work the best. Everyone is different right? Everyone heals differently. Here we have 18 visits being the most effective for chronic cervicogenic headache. 

Good info to keep in mind. 

Integrating Chiropractors

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

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

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

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

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

That’s Chiropractic!

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. 

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

Chiropractic Forward Podcast Facebook GROUP

Twitter

YouTube

iTunes

Player FM Link

Stitcher:

TuneIn

About the author:

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

Bibliography

1. Herman PM, Characteristics of Chiropractic Patients Being Treated for Chronic Low Back and Neck Pain. J Manipulative Physiol Ther, 2018.

2. Portelli A, Cervical Proprioception in a Young Population Who Spend Long Periods on Mobile Devices: A 2-Group Comparative Observational Study. J Manipulative Physiol Ther, 2018. 41(2): p. 123-128.

3. Haas M, Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial. Spine, 2018: p. S1529-9430.

CF 012: Proven Means To Treat Neck Pain

CF 033: Did You Need Proof That Chiropractors Help Headaches?

CF 005: Valuable & Reliable Expert Advice On Clinical Guides For Your Practice

 

 

CF 043: Stroke Caused By Chiropractor

CF 043: Stroke Caused By Chiropractor

Today we’re going to talk about Stroke caused by chiropractor and we’re to show you once again what a pile of hooey the idea is and we’ll even talk a bit about where it came from.Integrating Chiropractors

Stick with us but first, we’re going wade through this here bumper music. 

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

You have bee-bopped into Episode #43 and we are so glad to have you. I’ve noticed that podcasts are going into Seasons….Shows you how much I pay attention to stuff outside of what I’m doing. I’m ashamed. I should do Seasons. Here’s the deal though. I enjoy it so much. I actually WANT to put one out every week. It’s not work when you’re having fun right?

It can be a little stressful creating content and talking points but hey, we get through it and have a lot of fun in the process. 

Growth

What a great month this has been in regards to listens and downloads. You’ve heard me say it before but it’s fun to watch. Because I’m a numbers nerd and who the heck doesn’t like to see the growth of a brainchild?

Speaking of growth, I’ve started work on something that I hope you’ll love. I’ll hope you’ll think about using for your own offices, and I think may be pretty cool. I’ll fill you in more and more as we go along but just know, I’m working on something and you should get yourself on our email list at www.chiropracticforward.com so I can tell you about it and maybe pass along discounts, stuff like that. Email list. Do it. 

A little personal…

How has your week been? Mine….well….I have to continue the saga of hiring a new front desk person. Hell people. Actual hell. The first one just didn’t show up. The second one we hired lasted three days. Three freaking days, folks. 

But, we think we have a winner in place now. You know I’m going to keep you all updated on this deal. This by itself has been enough for its own reality show. I’ve never seen anything like it. The workforce right now just doesn’t seem to want to work. At least that’s my experience lately. 

We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

Let’s get to the research papers

First thing’s first. I have covered this stroke caused by chiropractor topic in depth. As in….very in-depth. In Episodes 13, 14, and 15. If you do nothing else this week as far as educating yourself, make sure you go listen to those three episodes in stroke caused by chiropractor or read it on our blog at https://www.chiropracticforward.com all of which are linked here in the show notes. 

Podcast Episodes:

Blog: https://www.chiropracticforward.com/blog-post/debunked-the-odd-myth-that-chiropractors-cause-strokes-revisited/

YouTube Video: https://youtu.be/tRXpG_Ie0Rs

Why go over stroke again?

So, why go over stroke caused by chiropractor again? Well, one reason is that it’s been a while since we touched on the topic. Another being that I heard a prominent speaker just this year talking about chiropractors causing strokes and implying that it happens fairly often. That’s a pro-chiropractic speaker, by the way, acting as if chiropractors are the sole reason for a stroke on a regular basis. 

I don’t think that it is necessarily the way the discussion was meant but it could definitely have been interpreted in that manner if those listening didn’t have the information from our Debunked series. 

The other reason I wanted to cover stroke caused by chiropractor again is that is the main thing in regards to safety that the medical kingdom tries to hold over us. Or that they’ve been told about us. And, instead of doing their work on this, they just believe it. 

New habits take 20 days to cement. We need new habits in the medical realm so I’m doing my part by taking away one of the main things they have against us. One may argue that the philosophy and subluxation model is another thing they hold against us but, all I can do about that is continue to disseminate evidence-based information and keep plugging. We’ll see where that part of it goes in the future. 

Common sense talk

For now, though, it’s about stroke caused by chiropractor this week here on the Chiropractic Forward podcast. Now, let’s compare and contrast shall we?

Did you know that the RAND Institute estimates a chiropractic adjustment is the sole cause of a vertebral artery dissection at the rate of only about 1 in 1 million or more adjustments? And did you know that your chances of winning an Oscar stand at about 1 in 11,500? Your chances of being hit by lightning are 1 in 176,426? 

How about this: NSAIDS like ibuprofen and acetaminophen cause around 16,000 deaths per year and send 100,000 people to the ER in America….EVERY YEAR.

Let’s let all that sink in. I say all of that just to put things into context and to make the point that the medical kingdom needs to quit making such a big damn deal out of trained and licensed chiropractors adjusting necks. 

We’re starting with this paper 2015 by Kosloff and friends titled, “Chiropractic care and the risk of vertebrobasilar stroke: results of a case-control study in U.S. commercial and Medicare Advantage populations[1].” It was published in Chiropractic & Manual Therapies. 

Why They Did It

This is obvious. We’re looking at the real chances of chiropractic adjustments being the culprit for strokes. 

What They Found

There were 1,829 vertebral basilar artery stroke cases

Findings showed no significant association between chiropractic visits and VBA stroke

The Authors’ Conclusion

“We found no significant association between exposure to chiropractic care and the risk of VBA stroke. We conclude that manipulation is an unlikely cause of VBA stroke. The positive association between PCP visits and VBA stroke is most likely due to patient decisions to seek care for the symptoms (headache and neck pain) of arterial dissection. We further conclude that using chiropractic visits as a measure of exposure to manipulation may result in unreliable estimates of the strength of association with the occurrence of VBA stroke.”

Research Paper #2

Just like a rolling stone we are moving on and gathering no grass…..

This next paper is from Church, et. al. and is called, “Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation[2].” It was published in Cureus in February of 2016. 

Just to review the research hierarchy for those unaware, systematic reviews and meta-analysis papers are at the tippy top of the food chain just above randomized controlled trials. It’s like people in the animal kingdom. We’re the top predators ya know. 

Anyway, the point is: this is reliable information folks. 

We already know why they did it so let’s skip to what they concluded. “ There is no convincing evidence to support a causal link between chiropractic manipulation and CAD. Belief in a causal link may have significant negative consequences such as numerous episodes of litigation.”

Uhhuh….numerous episodes of litigation based on belief and NOT based on fact or research. Believing stroke caused by chiropractor is unfortunate.

Now we come to the guy that helped put the matter to rest once and for all. If you are unaware of John David Cassidy, let me introduce you. He is a professor at the University of Toronto Dalla Lana School of Public Health and is a Ph.D.

Research Paper #3

Let’s start with his newer one concerning this topic. It’s called “Risk of Carotid Stroke after Chiropractic Care: A Population-Based Case-Crossover Study[3].” It was published in the Journal of Stroke & Cerebrovascular Diseases in 2017. Newer stuff from JD Cassidy, folks. 

As you’ll see, this paper deals with CAROTID artery and stroke specifically whereas the next and last paper deals with the VERTEBRAL artery and stroke. 

  • The why is obvious once again so, what did they find?
  • They compared 15,523 cases to 62,092 control periods using exposure windows of 1, 3, 7, and 14 days prior to the stroke. 
  • There was no significant difference between chiropractic and PCP risk estimates. 
  • They found no association between chiropractic visits and stroke in those 45 years of age or older. 

The Conclusion

“We found no excess risk of carotid artery stroke after chiropractic care. Associations between chiropractic and PCP visits and stroke were similar and likely due to patients with early dissection-related symptoms seeking care prior to developing their strokes.”

Research Paper #4

You’re about to notice a trend here. Next paper is by Cassidy et. al. as well and is called, “Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study[4].” This is the Daddy of papers proving that chiropractic adjustments are not the sole cause of strokes. 

Again, everyone knows why the research was done so let’s get to the meat and taters. 

  • It was done over a nine-year period from April 1993 to March of 2002. 
  • There were 818 vertebrobasilar artery strokes hospitalized in a population of more than 100 million person-years. 
  • There was no increased association between chiropractic visits and VBA stroke in those older than 45 years. 

The Conclusion and nail in the coffin

“VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.”

It’s like the action hero cartoons “Shazam” “Pow” “Bang” “Smack!”

Again, believing stroke caused by chiropractor unfortunate.

Wrap It Up

I’ve said it a thousand times. “If we were wrong, we’d have been wiped out years ago.” Lord knows every force of the medical kingdom focused on our demise for generations and that goes from the national and state associations all the way into the national and state legislatures. 

How do you fight against that amount of money and power and survive if you’re not inherently right in what you’re doing?

We can argue amongst ourselves till the cows come home about how to do our jobs but, in the end, we help our patients, we get them better when nobody else can, and….well…we’re right. 

So, the haters in the medical field can take a long walk off a short pier and stick it in their ears. I’m not always professional and that’s OK. I’ve always felt being strictly professional all of the time is more than just a little bit boring. We need more spice, personality, and a lot more laughter in life don’t we? 

Integrating Chiropractors

Affirmation

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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

Contact us

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.

Being the #1 Chiropractic podcast in the world would be pretty darn cool. 

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/groups/1938461399501889/

iTunes

Player FM Link

Stitcher:

TuneIn

About the author:

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

Research Paper Links:

https://www.ncbi.nlm.nih.gov/pubmed/26085925

https://www.ncbi.nlm.nih.gov/m/pubmed/18204390/

https://www.ncbi.nlm.nih.gov/pubmed/27014532

https://www.ncbi.nlm.nih.gov/m/pubmed/27884458/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2271108/

Bibliography

1. Kosloff T, e.a., Chiropractic care and the risk of vertebrobasilar stroke: results of a case–control study in U.S. commercial and Medicare Advantage populations. Chiropractic & Manual Therapies, 2015. 23(19).

2. Church E, e.a., Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation. Cureus, 2016. 8(2): p. e498.

3. Cassidy, e.a., Risk of Carotid Stroke after Chiropractic Care: A Population-Based Case-Crossover Study. J Stroke Cerebrovasc Dis, 2017. 26(4): p. 842-850.

4. Cassidy, e.a., Risk of Vertebrobasilar Stroke and Chiropractic Car. Spine, 2008. 33(4S): p. S176-S183.

CF 032: How Evidence-Based Chiropractic Can Help Save The Day

CF 029: w/ Dr. Devin Pettiet – Is Chiropractic Integration Healthy For The Profession?

CF 028: Will Chiropractic First Finally Take Its Place?