CF 221: The Importance of Movement & Steps Today we’re going to talk about The Importance of Movement & Steps 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!
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.
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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 #221 Now if you missed last week’s episode, we talked about Sleep, Energy, and Pain & Depression and Rehab. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
Business is still slowly creeping back up to where we’d like to see it. Now if the employee aspect of it will follow. So, I told you all we’d been a month since the 7-week front desk staffer we had quit. So we’ve been hiring for a damn month. We found one but she needed to give her two-week notice. So we’ve been waiting on her to start. So the Thursday before the Monday she’s supposed to start, she calls to let us know that she took another job. Holy guaca freakin moly.
Ya can’t make this stuff up. So we get in the horn….two weeks after we closed out the hiring process and started calling some of the old resumes.
Luckily, our #2 answered and still wanted the job and she can start on Monday. The day the loser was supposed to start anyway.
Hallelujah crap fire, save the queen, the new Batman is too damn emo and God bless America.
I’ll let you know if she lasts more than 7 weeks. I don’t have high hopes by this point in time. As the great Texas singer/songwriter Ray Wylie Hubbard once said, let’s rock n roll and hootchie coo. Here we go
Item #1
This one is called “Estimated Number of Deaths Prevented Through Increased Physical Activity Among US Adults” by Saint-Maruice et. al.( Saint-Maurice PF 2022) and published in Jama Internal Medicine on January 24, 2022……schiza!! It’s muy Caliente on my plate. That’s three languages right there people.
Why They Did It
Previous studies suggest that a substantial number of deaths could be prevented annually by increasing population levels of physical activity. But they say previous attempts at quantifying it have been lackluster. They accelerometer measurements
to examine the association of physical activity and mortality in the US
to estimate the number of deaths prevented annually with modest increases in moderate-to-vigorous physical activity (MVPA).
How They Did It
It doesn’t matter. Lol. Well, technically, of course, it matters. But, you’re not going to want to hear it. Sometimes, it’s like sausage. You really don’t want to see how it’s made. You just want to enjoy the results so….let’s just enjoy the results so y’all don’t tune out on me.
Wrap It Up In this cohort study, we estimated that approximately 110,000 deaths per year could be prevented if US adults aged 40 to 85 years or older increased their moderate-to-vigorous physical activity by a small amount (ie, 10 minutes per day).
Item #2 Our last one this week is called, “Steps per Day and All-Cause Mortality in Middle-aged Adults in the Coronary Artery Risk Development in Young Adults Study” by Paluch et. al.and published in JAMA Network Open on September 3, 2021.
Why They Did It
To estimate the association of steps per day with premature (age 41-65 years) all-cause mortality among Black and White men and women.
How They Did It
It was a prospective cohort study.
Participants were aged 38 to 50 years and wore an accelerometer from 2005 to 2006.
Participants were followed for a mean of 10.8 years.
Daily steps volume, classified as
low (<7000 steps/d),
moderate (7000-9999 steps/d), and
high (≥10 000 steps/d) and
Stepping intensity classified as
peak 30-minute stepping rate and
time spent at 100 steps/min or more.
All-cause mortality was the outcome measure.
A total of 2110 participants from the CARDIA study were included,
Wrap It Up
This cohort study found that among men and women in middle adulthood, participants who took approximately 7000 steps/d or more experienced lower mortality rates compared with participants taking fewer than 7000 steps/d. There was no association of step intensity with mortality. So get moving rock n roll and hootchie coo. Like you know you’re supposed to do. 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 the 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.
Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!
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.
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
Bibliography
Cholewicki J, P. J., Reeves NP, DeStefano L, (2021). “The Effects of Osteopathic Manipulative Treatment on Pain and Disability in Patients with Chronic Neck Pain: A Single-Blinded Randomized Controlled Trial.” PM R.
Saint-Maurice PF, G. B., Troiano RP (2022). “Estimated Number of Deaths Prevented Through Increased Physical Activity Among US Adults.” JAMA Intern Med 182(3): 349-352.
CF 184: Predicting Frailty & A 30-Year Study On Disc Degeneration Today we’re going to talk about using bone or musculoskeletal parameters to predict frailty and then we’ll cover a 30-year study on disc degeneration. Sit tight and chew on the morsels of knowledge we’re about to dish up for you. But first, here’s that sweet sweet bumper music
Purchase Dr. Williams book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!
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. We’re the Metallica of chiropractic research……if there is such a thing.
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.
While you’re there, join our weekly email newsletter.
You have found yourself smack dab in the middle of Episode #1844
Now if you missed last week’s episode , we talked about the factors leading to surgery for some discs and then we talked about recent information concerning disc innervation and what happens when a disc is injured.
Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
So for personal happening this week, we are getting the training set up for a nurse practitioner down in Dallas. Our medical Director is good enough that he would like to be trained on what the nurse practitioner is doing as well. That means good things for us.
When the medical Director is on board with the nurse practitioner, nothing but good happens.
I’m still promoting and pushing my book. The one I’d love for you to purchase called “‘The Remarkable Truth About Chiropractic: A Unique Journey Into The Research’. It’s on Amazon and you can find the link on my homepage at chiropractscforward.com so go give it a look-see and a purchase. You can get it in paperback and as an ebook.
This is an amazing resource for you practitioners in the field. Definitely for you content creators. Whether you’re looking for info to post on your social media, whether you’re teaching your patients and need material, or it you’re putting together a speech you need to give to a group……THIS is your resource to make your life easier and to save time. Seriously. Just flip to the topic and pick out the papers you like. BOOM….done.
I noticed that the forward thinking chiropractic alliance had their fire event this past weekend. With all of the things I’m involved in, I was unable to attend either live or online.
But, I purchased the online package so will be reviewing it when it is available online. It was all about implementing rehab into your practice and making money doing it. I love rehab and exercise being a part of my every day practice so I’m looking forward to waiting through all of the information. I am still trudging through the forensics fellowship and I have to say, it is not material that I enjoy. In fact, it’s pretty awful.
But, with the forensics fellowship being a subsidiary of the orthopedics fellowship that I already went through, I only have to do 100 hours rather than 300 so there’s no reason to not do it. So, I am begrudgingly going through it. It feels like I would assume running through quicksand feels. I hate the material but I plan on enjoying The final results.
Also, as part of the Parker CBI program, I have an intern coming on board. He’s going to move out to Amarillo for a semester and follow us around and work in the office starting in September.
Throw that in on top of a nurse practitioner starting full-time with us on August 2, and I should have my hands full. This podcast is getting more and more challenging to write produce and record every week. Depending on how all of this goes in the fall, I may be forced to begin releasing an episode every two weeks rather than every week. Stay tuned. That decision is on the horizon.
Other than all of that, I am involved in all of my extracurricular activities as well.
I am still going to the track and throw in the shot put and discus on the weekends and planning on competing in some masters events next spring and summer. Still trying to lose weight and stay involved in working out and being in the healthy lifestyle. And I’m still busy doing all of my artwork that I’ve been doing all along.
If you’re interested in any of that you can find it on Facebook at Jeff Williams art. If I was that weren’t enough, I’m busy putting together a new band and music projectWell my voiceover career is also expanding and growing and growing a little bit crazy at the moment. You could say my cup runneth over exponentially.
For that reason, let’s get on with the research.
Item #1
The first one is called “Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study” by Saaksjarvi et al. (Sääksjärvi S 2020) and published in Spine Journal in October of 2020 which is cooling off but still pretty damn steamy. Hot enough to eat.
Why They Did It
The aim of this study was to investigate whether early lumbar disc degeneration (DD) in young low back pain (LBP) patients predicts progression of degenerative changes, pain, or disability in a 30-year follow-up
How They Did It
A prospective follow-up study.
In an earlier study, 75 conscripts aged 20 years with LBP had their lumbar spine examined by MRI.
At a follow-up of 30 years, the subjects were contacted;
35 of 69 filled a pain and disability questionnaire,
and 26 of 35 were also reexamined clinically and by MRI.
The images were evaluated for decreased signal intensity and other degenerative changes.
Association between decreased signal intensity of a disc at baseline and the presence of more severe degenerative changes in the same disc space at follow-up was analyzed using Fisher exact test.
Association between decreased baseline signal intensity and pain/disability scores from the questionnaire was analyzed with Kruskal-Wallis H test.
What They Found
The total number of lumbar discs with decreased signal intensity increased from 23 of 130 to 92 of 130
Distribution of DD changed from being mostly in L4-L5 and L5-S1 discs to being almost even between the four lowermost discs. Discs that had even slightly decreased signal intensity at baseline were more likely to have severely decreased signal intensity at follow-up, compared to healthy discs.
Other degenerative changes were also more common in these discs.
Severity of DD at baseline did not have a significant association with current pain or disability.
Wrap It Up
In young LBP patients, early degeneration in lumbar discs predicts progressive degenerative changes in the respective discs, but not pain, disability, or clinical symptoms.
CHIROUP ADVERTISEMENT
Item #2
Our last one today is called “The Predictability of Frailty Associated with Musculoskeletal Deficits: A Longitudinal Study” by Tembo et. al. (Tembo 2021) and published in Calcified Tissue International in 2021….ouch….don’t touch it…..it sizzles.
And honestly….who the hell knew there was an entire damn journal called calcified tissue international?? How damn niche can you get?? For reals. And don’t tell me it’s pronounced nish because I’m just going to kick you in the shin if we meet in person. I’m going with niche because there are riches in niches. Not in nishes so don’t do it.
Why They Did It
How They Did It
This longitudinal study included 287 men aged ≥ 50 yr at baseline (2001–2006) from the Geelong Osteoporosis Study
Baseline musculoskeletal measures included femoral neck bone mineral density (BMD), appendicular lean mass index (ALMI, kg/m2) and whole-body fat mass index (FMI, kg/m2) and lower-limb strength
Frailty at the 15 yr-follow-up (2016–2019) was defined as ≥ 3 and non-frail as < 3, of the following: unintentional weight loss, weakness, low physical activity, exhaustion, and slowness
Potential confounders included anthropometry, smoking, alcohol, FMI, socioeconomic status and comorbidities
What They Found
Forty-eight (16.7%) men were frail at 15 yr-follow-up.
Musculoskeletal models were better predictors of frailty
Musculoskeletal parameters improved the predictability model for frailty after 15 years
Wrap It Up
In general, muscle models performed better compared to bone models. Musculoskeletal parameters improved the predictability of frailty of the referent model that included lifestyle factors. Muscle deficits accounted for a greater proportion of the risk for frailty than did bone deficits. Targeting musculoskeletal health could be a possible avenue of intervention in regards to frailty.
And now you know…..the rest of the story….
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.
Purchase Dr. Williams book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!
The Message
I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!
Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!
Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.
Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Website https://www.chiropracticforward.com
Social Media Links https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/
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
Sääksjärvi S, K. L., Luoma K, Paajanen H, Waris E, (2020). “Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study.” Spine (Phila Pa 1976) 45(19): 1341-1347.
Tembo, M. C., Mohebbi, M., Holloway-Kew, K.L, (2021). “The Predictability of Frailty Associated with Musculoskeletal Deficits: A Longitudinal Study.” Calcified Tissue Int.
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
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.
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.
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.
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.
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.
CF 127 w/ Dr. William Morgan: A Conversation About Excellence, Research, Parker University, and Chiropractic
Today we’re going to be joined by Dr. William Morgan, President of Parker University and over-all impressive human being. But first, here’s that sweet sweet bumper music
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. If you haven’t yet I have a few things you should do.
Like our facebook page,
Join our private facebook group and interact, and then
go review our podcast on iTunes and other podcast platforms.
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 #127 Now if you missed last week’s episode, we talked about immunity-boosting, coconut oil failures, and screen time and its apparent association with autism. 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. When we have a guest, we typically dispense with my personal thoughts and practice experiences over the course of the week. We will do that same this week outside of this; I was with many of you. I closed the shop for 2 weeks. Solid. Closed. Then, I gradually started back with urgent/emergent care just like our governing board in Texas recommended. At this point, I’m in my 3rd week of being completely re-opened. Even to wellness and maintenance care. While I’m used to 180-220 patient visits per week, I’m now experiencing about 110-120. We’re low. Obviously. But, it’s growing every week. People are beginning to tire of the restrictions on their activities and, I’d assume to some extent, are becoming somewhat numb or less concerned…..or more comfortable I guess with the risk aspect of it all. Regardless, they’re starting to return. I’m pretty sure those of you that closed and did a gradual re-opening like me are experiencing much the same. Now if we can get the massage therapists back to work safely. We’re still waiting to see what happens on that end of it. OK, let’s get to our guest today. I tell you sincerely, we are hitting the high spots on this show. WI’m just sitting here thinking about all of the amazing guests we’ve had over the last three years and just in the last few months we’ve had Dr. Stu McGill, Dr. Mike Massey, and now Dr. Williams Morgan. It’s been fun to watch this thing of ours grow and continue to grow. You, the listener, is the main reason for that growth and I just want to continue to thank you and tell you how important you are to me and how much I appreciate you. Usually, bios and intros can be a bit mundane. Not today, my friends. When your guest has been the chiropractor to the US Congress, the US Supreme Court, and to the White Hosue, well, you know it’s going to be a good one don’t you? Not only that but Dr. William Morgan, as mentioned, is the President of Parker University, and an active member of the Texas Chiropractic Association and has been testifying on chiropractic issues in the last two Texas Legislative Sessions and is happy and proud to be a Texan. That’s my kind of guy right there!! Our Texan pride is indeed legendary and probably annoying to anyone outside of the state. At age 17, he joined the Navy and served with an elite Marine Recon company as a hospital corpsman. During that time, he qualified in parachuting, military diving, submarine insertion, jungle warfare, combat swimming, explosives, mountaineering, winter warfare, and Arctic survival. Additionally, he attended anti-terrorist training at the FBI Academy. After leaving active military service and transferring to the Navy Reserves, Dr. Morgan began his educational journey to become a doctor of chiropractic. While at Palmer College of Chiropractic-West, he transferred to a Naval Special Warfare platoon as the unit’s primary hospital corpsman. He was sent to Special Operations Technician training to learn the principles of dive medicine. For the next eight years, he served as a dive medicine corpsman/combat swimmer for a platoon of Navy frogmen in Naval Special Warfare Unit One.In 1985, Dr. Morgan received his Doctorate of Chiropractic from Palmer College of Chiropractic–West and soon after, married fellow Palmer graduate, Clare Pelkey. They practiced for thirteen years in California. In 1998, Dr. Morgan was chosen to establish the first chiropractic clinic at the National Naval Medical Center in Bethesda, Maryland, which later became Walter Reed National Military Medical Center. In 2015, Walter Reed recognized Dr. Morgan with its highest honor for clinical excellence, the Master Clinician’s Award. During the last 18 years at the military’s most prestigious medical centers, he practiced in an integrative setting, providing chiropractic care to the injured troops returning from the wars in Iraq and Afghanistan. In the year 2000, Dr. Morgan was appointed as the Chiropractor to Congress at the U.S. Capitol. At the Office of the Attending Physician to Congress, doctors of many specialties care for members of Congress and the Supreme Court. In 2007, Dr. Morgan began serving as the White House Chiropractor. He was appointed chiropractor for the United States Naval Academy football team in 2009 (which never lost to Army while under his care). In 2011, Dr. Morgan was appointed to the United States Navy Musculoskeletal Continuum of Care Advisory Board, an entity created to address the prevalent injuries sustained by U.S. Armed Forces Personnel during active-duty operations. Dr. Morgan also served on the Spine Subcommittee, which helps develop care algorithms for treating spinal conditions and determining the future of musculoskeletal management in the U.S. Armed Forces. Dr. Morgan has completed a 2,000-hour residency in Integrated Medicine. He served on the Board of Trustees for Palmer College of Chiropractic for ten years. He is a Diplomate of the American Academy of Pain Management and has held adjunct faculty positions at F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, and New York Chiropractic College. Additionally, Dr. Morgan served as a consultant for the U.S. Department of Veterans Affairs (VA), helping to implement the VA’s chiropractic benefit and advocate for chiropractic research Parker University inaugurated William E. Morgan as their seventh President in 2016. Upon arriving in Texas, he became an active member and supporter of the Texas Chiropractic Association (TCA). Almost immediately, he organized a leadership summit to establish a legislative agenda strategy for chiropractors in Texas. Texas Chiropractors had not won a significant legislative victory in two decades, but in 2017 four bills advantageous to the chiropractic profession passed. Additionally, Morgan has assisted in fundraising, membership recruitment, and awareness for the TCA. As a lifetime member of the American Chiropractic Association (ACA), he has also held several leadership positions in the organization. Just last year, I was at the TCA President’s Gala when Dr. Morgan was awarded the Keeler Plaque which is awarded to the chiropractor of the year but is also a life time service award of sorts. It’s the most prestigious award the TCA gives so it’s quite an honor. And here in Texas, we are quite honored to have Dr. Morgan on our team. As a side note, I’m honored to know Dr. Morgan personally and really appreciate him agreeing to come on this podcast so let’s hop into it. Welcome to the show Dr. Morgan, thank you so much for caving to my pestering and agreeing to shut me up by finally coming on the show. Having the background you have, you’ve spent serious time on both coasts of our great nation. Now you find yourself dead center, right in the middle of the country. What was the allure of Texas for you, how has Texas treated you, and what has been your favorite thing about living here in Texas? Did you have any early perceptions of Texas or Texans when you moved here that proved to be false and did you have any that proved to be absolutely true? Everyone has a chiropractic story, what led you to want to be a chiropractor? Can you share a little about how you got to the point of climbing the ranks and becoming the chiropractor to Congress, the Supreme Court, and the White House? How did it all come about? Can you share some of the legally shareable and more unique stories or experiences of treating those types of patients? You moved to Dallas, TX to take the helm of Parker University as their 7th President. Just a little background on me personally, I was there when Jim Parker was still around. I was there when he passed away and his son Karl took over and I believe Fab Mancini was coming on board about the time I graduated. I’m well acquainted with Parker of yesteryear. When you got to Parker, what was one of the first things you wanted to change? What would you say has/have been the changes you’ve made since arriving that you are the proudest of? When I was in school there, exercise/rehab honestly was not a big aspect of the curricula. I know a bit about you and Parker Fit. Have exercises and rehabilitation taken on a larger role since 1998? Some areas of the country never experience something you all, unfortunately, went through last year. Tell us a bit about the tornado, the aftermath, and going forward from it. Now, from one awful event to another. Our current global pandemic. How is Parker University handling this event? What can students expect going forward? During this crazy time, there have been a lot of divisions in the country from opening vs. closing to ‘I refuse to wear a mask’ vs. ‘can you please wear a mask’? Our profession, unfortunately, is no different. It’s been divided along clear lines for decades and this pandemic has brought some of the divisions into the spotlight. One of them is between those that promote spinal manipulative therapy as a way to boost immunity and those that do not support that. When this was really first unfolding and our Texas Board of Chiropractic Examiners, the WHO, the WFC, and the ACA were all telling chiropractors the support for immunity boosting is not present in the research literature, you and Dr. Katie Pohlman (I love Katie and need her on the show BTW)…you and Dr. Pohlman recorded a very smart and well-stated video saying that indeed, the research literature cannot support immunity-boosting at this time. Obviously, I was and am 100% on board with it and I said all of that to ask you this, was there any fallout to that? How did you handle it? And what went into the decision to record it in the first place. Let’s move to legislative issues. What have you felt is our biggest issues in Texas and on the national level when it comes to chiropractic? I have said repeatedly on this show that due to the opioid crisis and due to the emerging research over the last 5-10 years, I truly feel there’s not been a better time to be a chiropractor since the 1980s. As the President of a chiropractic college, what is the status of our profession right now? Not just in terms of the pandemic but over the course of the last year. Over the course of the next 5 years. Am I right about it being a great time? Am I wrong? Or a little bit of both? Thank you for joining us today! 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.
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 – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
CF 111: American Academy of Family Physicians Warming To Chiropractic For Chronic Pain & Evidence Behind Supplements
Today we’re going to talk about how the American Family Physicians may be warming up to chiropractic for chronic pain and what supplements actually have some evidence behind them.
But first, here’s that sweet sweet bumper music
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.
We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.
I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
If you haven’t yet I have a few things you should do.
Like our facebook page,
Join our private facebook group and interact, and then
go review our podcast on iTunes and other podcast platforms.
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 #111
Now if you missed last week’s episode , we talked about Dry Needling vs. Massage and even more importantly, we talked about the topic of “What is your exit number?”. What are you looking to get out of it all in the end? I feel like there were points made in there that could really get you to contemplating and thinking going forward. So, make sure you don’t miss that info. Keep up with the class.
That reminds me, did you know that you can use our website as quite a resource? I do it all of the time. If you think I can keep every one of these papers in my noggin and pull them out of my brain files on demand, that’s a big nope. But I can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever I 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…..
Rinse and repeat man, rinse and repeat. If you’re friends with me on Facebook, then you know life has been crazy and there’s no slow down in site.
Some really positive stuff happening though too. For example, I was interviewed for two different articles in Chiropractic Economics recently. They published an article called “Chiropractic for prevention: the latest research on maintenance care” by Michele Wojciechowski. Michele used my comments exclusively in this article and that’s just a big honor.
I remember when I was new in practice. I remember reading articles in Dynamic Chiropractic and Chiropractic Economics and thinking that would be cool to be in that one of these days. Now…..now…I’ve been fortunate enough to be in Reader’s Digest, on the ACA Blog a couple of times, and now Chiropractic Economics. It’s pretty damn exciting and it’s an honor.
Thank you Michele for finding value in my comments and sharing them with everyone else. I’ll leave a link to that article at this point in the show notes if you’re interested in giving it a read through.
Other than that, my family and I took a quick ski-cation to Red River, New Mexico. If you haven’t been, look it up. Here’s why we like Red River, First thing, it’s close. For a Texan to be able to just drive about 4 hours and be in the mountains, that’s pretty exciting.
Next thing, it’s just gorgeous. And, the ski slope comes right down into the town so you don’t have to drive out to a mountain which is nice.
Let’s talk about why I retired from skiing myself though shall we? This may make you think a bit about some of the stuff you do in your offtime. Maybe it won’t but it’s important to think about things which is the whole point of me bringing it up.
I used to ski a lot back in high school and junior high. I was pretty decent at it too. Then I went off to play football and be a college kid. Well, Louisiana for a bit and Dallas for a bit…..those areas aren’t very conducive to learning to snow ski. It’s too damn far. Especially when you’re still a kid and broke as hell. Skiing just doesn’t happen at that point in life unless you have parents taking you. I didn’t.
So then you start life and you’re building a business and there’s never time to go then either.
Well by the time I got back around to going skiing again, I hadn’t done it in about 20 years give or take. So, i got a private coach for a morning just to get me back on that bicycle and rocking and rolling again. I have to tell you, it was hard as hell!! It was NOT like riding a bike. Nothing at all like it as a matter of fact!!
But, I took it slow, I didn’t fall at all, and was fairly happy with my progress over the weekend. HOWEVER, I got to thinking when I got home. I went back to work and had about 45 patients that next day. What if I had twisted a knee, broken and elbow, or dislocated a shoulder while I was skiing? What would I have done?
You know this sounds stupid when you say it but, “They call them accidents because you don’t plan them.” But you can avoid them sometimes. I got to thinking long and hard enough about the risk vs. rewards for continuing to ski and……honestly, on paper, it wasn’t worth the risk.
So, I retired. Maybe if I had an associate. Maybe I could make more sense of it but, the truth is, I don’t have an associate. It’s just me although I’m thinking of hiring one just as soon as it makes sense. Anyway. I took the kids skiing while the wifey and myself enjoyed the mountains, some brewskis, and some playoff football games.
What are you involved in as far as physical activity outside of your practice that puts you at risk and puts your ability to earn a living at risk? Do you have disability insurance? Life insurance? Long term care insurance? I have all of that. Do you need it?
Start thinking about these things. Certainly, the more successful you get and the busier your practice gets. Risking an injury just might not be worth it at some point.
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 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 saves 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 this one from American Family Physician. I got this one from one of my amazing colleagues, Dr. Craig Benton down in Lampasas, TX. It’s called “Nonpharmacologic therapies can improve chronic pain outcomes” authored by Michael Devitt and was published in American Academy of Family Physicians on January 15, 2020(Devitt M 2020). Damn it’s hot…..
Not a research paper but more of an article in their publication but has plenty to do with chiropractic.
They set the stage here by pointing out that chronic pain is something that can cause people to go to extreme measures just to get the pain to go away. Or at least lighten up. They say this includes potentially harmful behaviors like drug and alcohol misuse and/or abuse.
Then this article in the American Family Physicians journal starts to highlight and promote the nonpharmacologic treatment modalities that are available to family physicians. Honestly, did you think you’d ever see the day? Ever? The battle isn’t over by any stretch of the imagination but research is gradually, inch by inch, turning the tide.
They say these modalities include simple methods like massage and heat as well as more complex therapy like acupuncture and chiropractic manipulation. They called us ‘complex’ and I’m taking that as a compliment. Lol. What we do can damn sure be complex.
They say that these nonpharma strategies aren’t only effective for decreasing pain and improving function, but can also be effective for reducing longer-term adverse effects such as substance use disorders and suicide attempts. THAT’S A BIG DAMN DEAL.
In fact, I got one word, two syllables….day-um.
One researcher, the lead author from an active-duty US Army service study said “Chronic pain is associated with adverse outcomes such as substance use and suicidal thoughts and behavior,” said Esther Meerwijk, Ph.D., M.S.N., a statistician at the VA Palo Alto Health Care System in California. She added, “It made sense that if nondrug treatments are good at managing pain, their effect would go beyond only pain relief. However, I was surprised that the results of our analyses held, despite our attempts to prove them wrong.”
Despite our attempts to prove them wrong! Haven’t they been trying to prove us wrong for generations now? Lol. I always say that with all of the powers against us, if we were wrong, if we were ineffective, we would have been wiped out years ago.
In one of her projects, they reviewed the records of more than 275,000 active-duty service members reporting chronic pain.
They combed through their files to determine whether they had received any of 13 nonpharmacologic therapies after their deployment. Those therapies were acupuncture or dry needling, biofeedback, chiropractic care, cold laser therapy, exercise therapy, lumbar supports, massage, osteopathic spinal manipulation, other physical therapy, superficial heat, traction, transcutaneous electrical nerve stimulation, and ultrasonography.
After crunching all of the numbers and outcomes here’s what they came up with:
Specifically, service members who received nonpharmacologic therapies were
8% less likely to experience new-onset alcohol and/or drug use disorders;
12% less likely to experience suicidal ideation;
17% less likely to experience a self-inflicted injury, including attempted suicide;
18% less likely to intentionally poison themselves with opioids, related narcotics, barbiturates or sedatives; and
35% less likely to accidentally poison themselves with the same types of drugs.
The researchers acknowledged several limitations in their research. For example, although most nonpharmacologic therapies were provided after service members were diagnosed with chronic pain, the authors could not determine whether those nonpharmacologic therapies were used specifically to treat that pain.
In the news release, Meerwijk also explained that her team did not study the effects of individual nonpharmacologic therapies.
“We treated them as one,” she said. “Most likely, only some of the therapies that we included are responsible for the effect that we reported, whereas others may have had no effect at all, assuming there’s no other variable that explains our findings.”
Despite these limits, the authors expressed confidence in their research methods and findings.
“Our results suggest that (nonpharmacologic therapies) provided to active-duty service members with chronic pain may reduce their odds of long-term adverse outcomes,” they concluded in the study. “Given known associations of these adverse outcomes with morbidity and mortality, providing (nonpharmacologic therapies) to service members with chronic pain could potentially save lives.”
I’ve been hearing this crashing tidal wave coming. It’s not here yet. But the roar is approaching and it sounds like sweet sweet music to me ears.
Item #2
I’m going to do everything I can to boil this sucker down and strip it to the bare bones without it getting too long or boring. This one is called “Evidence-based supplements for the enhancement of the athletic performance” by Peeling, et. al(Peeling P 2017). and published in the International Journal of Sport Nutrition and Exercise Metabolism in 2017.
The authors wanted to put together a review focusing on the available evidence based for performance supplements commonly used in sports and summarizing the when’s and the how’s around their uses.
The ysay there is robust evidence that the following supplements can enhance sports performance when used according to established protocols.
So let’s motor through this like poop through a goose, shall we?
Caffeine -There exists a lengthy research history on caffeine supplementation across a range of performance protocols, including endurance-based situations, resistance training exercise, short-term supramaximal efforts, and/or repeat-sprint tasks. Reported benefits of caffeine include benefits include adenosine receptor antagonism, increased endorphin release, enhanced neuromuscular function, improved vigilance and alertness, and a reduced perception of exertion during exercise. Low to moderate doses of caffeine (∼3–6 mg/kg BM), consumed 60 min pre exercise, appear to have the most consistent positive outcomes on sports performance in research situations, although a variety of other protocols (as mentioned above) also appear beneficial, and are practiced in real-life. Of note, athletes who intend to use caffeine as a performance aid should trial their strategies during training or minor competitions, in order to fine-tune a protocol that achieves benefits with minimal side effects.
Creatine – widely-researched supplement, with creatine monohydrate (CM) being the most common form used. Creatine loading can acutely enhance the performance of sports involving repeated high-intensity exercise (e.g., team sports), as well as the chronic outcomes of training programs based on these characteristics (e.g., resistance or interval training), leading to greater gains in lean mass and muscular strength and power. When accepted creatine monohydrate supplementation protocols are followed, the expected increase in intramuscular creatine stores is likely to enhance lean mass, maximal power/strength, and the performance of single and repeated bouts of short-term, high-intensity exercise.
Nitrate – The authors say Nitrate is a popular supplement initially found to improve oxygen uptake kinetics during prolonged submaximal exercise. Great sources are Leafy green and root vegetables (i.e., spinach, rocket, celery, beetroot, etc.
Beta-Alanine – The paper says this is one of the immediate defenses against the accumulation of protons in the contracting musculature during exercise. I can also tell you that this is just something I never nerded out on. Lol. Not my cup of tea but I like to offer something for everyone here at the Chiropractic Forward Podcast. They say it can improve tolerance for maximal exercise bouts lasting 30 s to 10 min and provide small yet significant benefits in both continuous and intermittent exercise tests. Basically, it’s used in order to augment high-intensity exercise performance ranging from 30 s to 10 min in duration.
Sodium Bicarbonate – benefits are generally seen in short-term, high-intensity sprints lasting ∼60 s in duration, with a diminishing return as the effort duration exceeds ∼10 min. However, greater benefits may be realized (>8% improvement) with a greater number of repeated sprint bouts
Go to our show notes at chiropracticforward.com if you’d like to get dosing information and all the little technical tidbits. It’s really interesting. Even to an orthopedic guy like me although, its technical enough to make my eyes glaze over as well.
There are several others listed in the paper as well but the authors point out that the evidence for their effectiveness is much less clear. They are Sodium citrate, Phosphates, and Carnitine.
Even though that stuff is not my cup of tea, it’s good to know, it’s good to have as a reference, and it’s good to pass on to you because many of you actually do nerd out on that stuff and thank God for that. That means I can call people like you and ask what the hell. On the other hand, if it’s something I nerd out on like orthopedics, you can call me and say what the hell?
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.
Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Devitt M (2020). “Nonpharmacologic Therapies Can Improve Chronic Pain Outcomes Reductions in Drug Misuse, Suicide Attempts Reported.” AAFP.
Peeling P, B. M., Paul S, (2017). “Evidence-based supplements for the enhancement of athletic performance.” IntJ sport Nutrition Exercise Metabolism 28(2): 178-187.
CF 108: Are MRI’s On The Outs? & The Ease of The Arm Squeeze
Today we’re going to talk about why MRI’s in the early going are out and we’ll talk about how easy and useful the Arm Squeeze Test is for differentiating arm pain from cervical radiculopathy pain.
But first, here’s that sweet sweet bumper music
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.
We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers so feel free to crack one open because we’re off and running.
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.
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.
Do it do it do it.
You have collapsed into Episode #108
Now if you missed last week’s episode, we talked about how insurance may be warming up to chiropractic in the coming year and years and we covered research behind chiropractic treatment for sciatica. Make sure you don’t miss that info.
On the personal end of things. I don’t even want to tell you how my life’s been going lately to be honest because it hasn’t been a lot of fun.
We put my Dad in a nursing home this weekend because insurance is done paying for him to continue to stay at a rehabilitation hospital. My stepdad had his appendix out on Christmas day. I have a pre-teen daughter that I’m trying to figure out. I had someone throw a rock through my office’s front door glass just yesterday and steal our cash box. Luckily they only got about $500. Then, later that night I got a nail in my tire picking up food for the family, get it home, hear my tire hissing, get my son to follow me to drop my truck off at the tire store for the next morning, then get back home only to find out that the only sandwich left out of the damn take-home order……yes…it was my freaking sandwich.
So, that’s my life lately and I don’t want to talk about it. I want to talk about research. Lol. So let’s get to it. –
Before we dive into the reason we’re here though, 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 reassuring? 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 an orthopedic test that came up on a post on the Forward Thinking Chiropractic group. I had actually learned about the Arm Squeeze Test from the DACO/DIANM program and through Tim Bertelsman and Brandon Steele with ChiroUp but for whatever reason, have been inconsistent in using the test. I forget about it is what I’m saying to you right here right now. But no more I say!
This paper we’re using today is called “Arm Squeeze Test: a new clinical test to distinguish neck from shoulder pain” by Gumina, et. al. and published in European Spine Journal in 2013(Gumina S 2013).
Now, look, what if you could find the fastest, easiest way to distinguish pain in the arm either coming from the shoulder or arm or whether it’s coming from the neck? What if it was so easy that you could just reach out and grab someone’s arm? Like…..really….that easy. The ease of the arm squeeze. That just rolls off of the tongue. Don’t you agree? The Ease Of The Arm Squeeze. Lol
Well, it is that easy so listen up friends, family,……loved ones.
They wanted to evaluate the diagnostic values of the Arm Squeeze Test where the clinician basically grabs the middle third of the arm and gives it a bit of a squeeze.
How They Did It
There were 1,567 patients included in the study.
DX of cervical root compression or shoulder disease was clinically formulated and confirmed with imaging
350 healthy volunteers were used as the control group
The test was positive when the score on the VAS scale was 3 points or higher on squeezing the middle third of the upper arm
What They Found
The test was positive in 295 out of 305 patients with cervical nerve root compression.
The test had a sensitivity of 96% and a specificity of 91%.
Wrap Up
The conclusion states, “The Arm Squeeze Test may be useful to distinguish cervical nerve root compression from shoulder disease in case of doubtful diagnosis. A positive result to this test may lead to cervical etiology of the shoulder pain.”
From reaching out and grabbing someone’s arm. You’re welcome folks. You’re welcome. Making you better every damn day.
Item #2
Being in an evidence-based practice and being aware of updated guides and recommendations, you know that healthcare is moving away from MRI’s as a knee-jerk reaction. Why would that be, you may ask… Well, because they’ve found it leads to an escalation of care.
When a surgeon sees a bulge or herniation, if he or she isn’t quite up to snuff on research, they may just think they can cut that out and the person will be off and running again. When many times, that little bulge isn’t what is causing the pain.
Did you know that a perfect surgery performed on a person in chronic pain syndrome puts them at a 60% chance of developing new chronic pain at the new site of injury? That’s when everything goes perfectly.
What I’m saying is that you can’t always just cut out pain and MRI’s many times lead doctors to think that they actually can so care gets escalated.
I tell patients to be careful what they’re looking for because they sure as hell just might find it. If you go barking up the surgery tree, you just might get some of that tree on you.
So this article is by Paul Ingraham and is called “MRI and X-Ray Often Worse than Useless for Back Pain” and it was published on PainScience.com on February 16, 2019(Ingraham P 2019).
Not piping hot but hot enough for this!!!
We’ll just hit the highlights here.
One of the first interesting statements is when he says, “Premature MRI is actually often worse than useless.” Look, let’s be honest, healthcare is a profit-driven profession for the most part. It’s not very patient-centered in my experience. Especially when we’re talking about our medical counterparts.
Want proof? Is charging $15-$20 for an ibuprofen or Tylenol patient-centered? Hell no it’s not but hospitals do that crap all day every day. Well, MRI centers are the same. $550 cash but $2500 for insurance payors. Lol. I mentioned not long ago on the podcast that I had the opportunity to buy into an imaging facility but two different lawyers told me to stay far far away because I don’t look good in orange.
However, the imaging center acted like it was as legal as could possibly be.
Anyway, back to the actual usage of MRI…..The American College of Physicians recommended in a paper all the way back in 2007 that “Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain (strong recommendation, moderate-quality evidence).(Chou R 2007)”
For the WHEN part, they recommended: “Clinicians should perform diagnostic imaging and testing for patients with low back pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination (strong recommendation, moderate-quality evidence).”
In this same ACP paper from way back in 2007, they made the recommendation “For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits—for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation”
Now we know they updated that recommendation in 2016(Qaseem A 2017) to a strong recommendation for those alternative therapies but I was this many days old when I found out they were talking about spinal manipulative therapy way back in 2007.
Another interesting statement from Mr. Ingraham was this one: “Consider the results of a major 2015 review by Brinjikji et al: signs of degeneration are present in very high percentages of healthy people with no problem at all. “Many imaging-based degenerative features are likely part of normal aging and unassociated with pain.”
Well, we know this. We can even put rough numbers to it. We know that 40-50-year-olds with no pain at all can get an MRI and 60% of them are going to have degenerative changes, disc findings like herniations or disc bulges, and/or facet hypertrophy. It’s just a given.
They’re going to find disc findings in about 30% of freaking 20-year-olds.
So, he says, let’s assume we understand some MRI findings are red herrings. OK, so what’s the harm in getting them then? Well, because findings on MRI’s freak people the hell out and not all practitioners have a firm handle on how to actually communicate with people in a productive way when they give the report.
If the doctor says well there’s this degeneration and we see a narrowing of this hole here where the nerves run that will probably get worse in the next decade so you’re going to really want to be careful and keep an eye on that……well hell….. Take a person already on the verge of chronic pain syndrome, that doctor just pushed them off the cliff. A patient already in chronic pain syndrome just got pushed in deeper. It’s like taking someone that’s having a hard time keeping afloat in the water and tossing them a bag that weighs 20lbs. Not helpful.
He says, “There’s expert consensus on this topic because the evidence is quite clear. Consider the hair-raising 2016 experiment that sent the same woman with back pain and sciatica to ten different MRI facilities, producing such a variety of conflicting diagnoses that it would be laughable if it weren’t so tragic.”
The bottom line: Typically, no imaging outside of red flags. If you think something ominous may be going on, of course you do imaging. Without question. If there are no red flags, how about a two-week treatment trial to see how the patient progresses before sending out for imaging?
That’s patient-centered. That’s evidence-based.
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.
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 patient 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.
Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Chou R, Q. A., Snow V, Casey D, (2007). “Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society.” Annals of Internal Medicine 147(7): 478-491.
Gumina S, C. S., Postacchini F, (2013). “Arm Squeeze Test: a new clinical test to distinguish neck from shoulder pain.” Eur Spine J 22(7): 1558-1563.
Ingraham P (2019) “MRI and X-Ray Often Worse than Useless for Back Pain Medical guidelines “strongly” discourage the use of MRI and X-ray in diagnosing low back pain, because they produce so many false alarms.” PainScience.com.
Qaseem A (2017). “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians.” Ann Intern Med 4(166): 514-530.
CF 104: Year Two Big Hits Wrap Up For The Chiropractic Forward Podcast
This is chiropractic forward podcast episode #104. Fifty two times two = 104. That means two solid years of pumping out the Chiropractic Forward Podcast religiously. Pumping it out like a damn piston people. Dependable and powerful.
BAM, kowapow!!! We’re going to talk about the most listened to episodes from the previous two years and we’ll talk about why they continue to be so darn popular.
But first, here’s that sweet sweet bumper music
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.
We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.
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 done the electric slide into Episode #104. The two-year anniversary party is engaged. Yaya!! If you know me, doing really anything at all dependably for two straight years every single week is pretty good.
I’m high maintenance people. In some ways anyway. I can’t be bothered with this and sometime that. I don’t seem to have time for some of the simplest tasks. You know how it is.
I don’t go camping either. Nope. I need plumbing. I need central heat and air. And I need a decent bed. None of that camping foolishness unless it’s in a bus of some sort. Then……prolly. Otherwise, I’m too high maintenance and I’m not ashamed. I’m good with hanging out by a rocky mountain river for a bit. Maybe even hiking in the forest a bit. But then, back to the hotel. Come on now.
Also, the beach. Am I the only one that can’t lay around on a damn beach all freaking day long? It’s not even remotely possible. It’s insane actually. I’m the kind, I hate sand all up on me everywhere. That’s the worst feeling.
And then, after sitting around and soaking up the beauty for about 30 mintues…..maybe an hour…..it’s time to look around for something else to do. I can’t sit around and drink all day. Not unless I want to be out of commission the next day. Maybe two days. See…..I’m a little high maintenance. But don’t tell anyone. It’s our little secret.
Now if you missed last week’s episode on spinal manipulation’s effect on the brain, on forward head posture and if it’s really related to neck pain, and we talked about how smoking is related to pain throughout the body, make sure you don’t miss that info. It was good stuff and very well-listened to!
On the personal end of things, my Pops is back in the hospital. He had a mini stroke, TIA sort of thing that spooked the folks at the rehab hospital that they sent him over to the big hospital to be sure everything is A-OK.
He’s looking and talking roughly the same as before he spooked everyone so I’m hoping we are back on track. Maybe he was just feeling a little extra on that day. He called his wife and his neighbor at around 2am last night so his brain still has some confusion but he’s doing OK overall. A lot of folks have been in a lot worse shape from strokes. Still not sensory or motor in the left upper and lower extremities. Unfortunately.
Before we dive into the biggest episodes in Chiropractic Forward Podcast History, 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.
First thing you gotta know is that as I list these off, the link to the specific show will be in the show notes so that you can have quick access to the episodes that sound the most interesting to you.
Our tenth ranked episode was Episode #68 and was called “British Medical Journal Research, Surgeons Against Back Surgery, and Pediatric Chiropractic Under Attack”
Any time the British Medical Journal is going to come out and say that moderate quality evidence suggests that SMT has effect on short term pain relief and increased function, we’re going to talk about it and we did.
We also talked about Dr. David Hanscom, MD who wrote a book called Back In Control and who is also on the war path against chronic pain and surgery for the wrong candidate. Sounds like a guy I can get on board with right there. He’s well-versed in upregulated, sensitized CNS and I highly recommend his book to any practitioner or chronic pain sufferer.
Number nine all time is actually Episode #9 oddly enough and that was when I had my good friend and colleague, Dr. Tom Hollingsworth of Corpus Christi, TX join me to discuss the Case Against Chiropractic in Texas. Evidently that episode is still riging true for chiropractors because it’s still getting downloaded. The thing is, the Texas Medical Association is still suing us here. This case is still going. The episode aired on February 15 of 2018 so moving in on two years ago and the case is to the point where the TMA has won and we are waiting to see if the TX Supremes will hear the case.
Keep your fingers crossed and go listen if you don’t know what it’s about because whatever happens here in TX can, and probably will, happen anywhere.
It was very recent. Episode #98 and it was called “Big Ideas On Marketing Evidence-Informed Practices.” This episode and it’s part II episode were listened to in big numbers and well-received. Which is exciting. I’ve always seen myself as a marketerpersonally but, primarily for the podcast, a voice of reason, responsibility, honesty, ethics, and yes….of course, research.
But, I’m a marketer as well and how the heck do you market an Evidence-based practice? Well, there’s Jeff Langmaid with the Evidence-based Chiropractor material. There’s Dr. Kevin Christie with The Modern Chiropractic Marketer material. There’s Dr. Christie teaming up with Dr. Bobby Maybee and the Chiropractic Success Academy. And then there’s myself and the Chiropractic Forward Podcast.
That’s it as far as I know. We are the outlets to help you market responsibly and ethically. There are a million other programs but A LOT of them are questionable at minimum. So, I have to say that I was pleased to see that so many found those marketing episodes to have value.
“How To Not Miss A Dissection & De-legitizing Complementary Medicine” This was episode #69. Well this one hit it big because people don’t want to get in trouble!! We are here to help people. Certainly not hurt people. That’s not what we’re built for. I went over a lot of policies I have here in my office that have so far helped me avoid and crazy situtations.
I think every practitioner that is in practice for 21 plus years will have a couple little adverse things here and there like a patient actually getting a little worse in the short term and things like that but, I’ve been fortunate enough to avoid anything scary or serious. I think mostly because I’m very cognizent and aware of the research and do eveyrthing I can to avoid anything scary. Now I’m going to knock on wood and you should go get this episode because there was some real solid, immediate useful information in it.
“National Scope, Chronic vs. High Impact Chronic Pain, Coordinated Care/Medicaid, and DACO to DIANM”
Episode #96 – For this episode, which again was very recent, we were fortunate enough to be joined again….for the second time…by Dr. James Lehman of the University of Bridgeport and a key driver of the DACO/DIANM program and a frequent author of articles in Dynamic Chiropractic.
This one shot right up to the top of our most listened to episodes because Dr. Lehman is a legend first of all and second it’s because he gives some amazing, profitable, and entrepreneurial ideas about the future of coordinated care. He also taught us about the difference between chronic pain and high impact chronic pain.
I’d say the main thing though was his push for a modernized, national scope rather than 50 different scopes of practice in the US. Fascinating stuff from Dr. Lehman in this one. Don’t miss it.
Our fifth most listened to episode was episode #80 with Dr. Anthony Nicholson called “Decoding Chronic Pain” and I’m here to tell you that if anyone can help you decode chronic pain, it’s Anthony Nicholson.
This episode, you get to hear it for free but I’m telling you, it’s a master class in chronic pain. Have you ever wondered about central nervous system sensitization or upregulation? Have you wondered what centralized pain vs. peripheral pain is? And no….I’m not talking about McKenzie protocols.
I have covered a lot of material on chronic pain over the last two years but THIS is typically the source of my information. Dr. Anthony Nicholson si a neuro diplomate as well as an ortho diplomate. He is a genius and when he speaks, you need to be listening. So go listen. Don’t you dare miss that one.
This one was episode #55 and I told you all Dr. James Lehman was a legen y’all. Well here he is for the second time in our top ten most listened to episodes.
This one was called “The Future of Chiropractic, Chirorpactic Specialization, & Chiropractic Integration.” Again, Dr. Lehman shared information that can make the entrepreneurial mind start swooning and swimming. Seriously. Knowledge nuggets raining down like manna from heaven people.
Our third most listened to is Episode #6 done with Dr. Tyce Hergert of Southlake Texas as our guest. The episode was called “Expert Information on Immediate Headache Relief”. Dr. Hergert and I covered several papers on how chiropractic helps knock those dudes out. Tyce is a pretty entertaining individual typically and is most certainly one of the smartest your going to find.
Our second most listened to episode is still probably my favorite personally. It was episode #13 and is called “DEBUNKED: The Odd Myth That Chiropractors Cause Strokes.”
This was a lot of fun for me because it was part brain dump, part entertainment, and part educational.
I said in a recent episode that there are few things in the world more satisfying than being able to slap someone straight across the face metaphorically by saying, “I can get that research paper for you if you like.” Well, this is THAT episode.
I cover literally everything I could think of. From the risks vs. benefits, the research behind SMT for the neck. The research behind SMT for headache. The research AGAINST SMT causing strokes. The issues the medical field should REALLY be worried about when it comes to adverse effects. Man, I covered it all and while I’m aware it’s not very humble of me to say, I just don’t understand how a hater can really go through it and still be convinced chiropractors cause strokes.
I just don’t. I feel like the information is just that thorough. Go listen to episodes #13, #14, and #15 and see what you think by the time you hear it all.
Well looky there, Dr. Tyce Hergert makes two appearances in our top five….not even the top ten….no, the top five. Only the best for Dr. Hergert. Which that’s fine. All those folks down in Southlake Texas think they should only get the best anyway. Lol. It’s jokes I make jokes.
We go way back. Like….to 3rd or 4th grade basically. For real. Grew up in the same neighborhood in Perryton, TX – look it up – we were in Parker Chiropractic College at the same time and we’ve been serving in the Texas Chiropractic Association together for years. He’s actually an ex-President of the TCA so definitely worth listening to.
This particular episode was called New Guides For Low Back Pain That Medical Doctors Are Ignoring.
Surprise surprise, they’re STILL ignoring guides set forth by their own damn organizations and associations.
We talked about Section 2706 of Obamacare. We covered a lot of ground and people have responded by making Episode 11 our #1 listened to episode of the first 2 years of the Chiropractic Forward Podcast.
It’s been fun and we’re still rocking and rolling and whatnot. Don’t you go anywhere. You keep coming back every Thursday for the new episodes.
Keep sharing us on Facebook and Twitter. Keep writing reviews on podcast platforms. Keep stoppign by the shop at chiropracticforward.com and let’s keep seeing where this here train will lead.
I’m hoping it leads to more evidence-informed practitioners comign out of college each and every semester. More and more and more until some of the garbage we see right now becomes the exception rather than the rule.
Together, with your involvement here and with your help, we can make it happen.
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.
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.
Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
CF 103: Chiropractic & The Brain, Forward Head Posture Hurts, & Smoking Hurts Worse
Today we’re going to talk about spinal manipulation’s effect on the brain, forward head posture and neck pain, and we’ll talk about how smoking is related to pain throughout the body.
But first, here’s that sweet sweet bumper music
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.
We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.
Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
If you haven’t yet I have a few things you should do.
Like our facebook page,
join our private facebook group and interact, and then
go review our podcast on iTunes and other podcast platforms.
We also have an evidence-based brochure and poster store at chiropracticforward.com
Do it do it do it.
You have collapsed into Episode #103
Now if you missed last week’s episode on headaches, contraindications to adjusting, and more info on maintenance care, then make sure you don’t miss that info. Go listen when you get done with this one.
Just a quick re-cap, some of the more recent very popular episodes have been when we had Dr. James Lehman on ths show for episodes 96 and 97. Those were huge for listeners.
Then, right after those, we had a couple of shows on Marketing Evidence Based practices. Those were big shows for us too.
Our all time biggest episodes though have been #13, 14, and 15. They were early in our existence. They’re called Debunked: The Odd Myth That Chiropractors Cause Stroke. And then there was episode 80 with Dr. Anthony Nicholson on Decoding Chronic Pain. That was amazing. It was a mini-course on chronic pain and I promise, it’s one you don’t want to miss.
Anyway, for those that are newer to our podcast, you’ll have to check those out and see what you think.
On the personal end of things, Dad is still in a struggle for independence. If you’ve been around stroke victims in the early weeks, it’s tough stuff. I don’t wish it on a single soul. Well, there’s this one attorney I used to know. Lol.
Kidding. I Kid….
When it’s my time, man….I just want it to go lights out. BAM. Seeya! It’s been nice but I gotta go hang with Jesus and my family I haven’t seen in a while. Buh bye.
We don’t get to choose but I sure hope that’s the way it goes. I never want to be a burden on anyone just so I can keep breathing. I want to check out and say adios amigos, hasta luego.
As far as practice goes, all days are not created equally are they? This was one of those days. Where to even start really?
I had to get after staff members for not doing rehab long enough. I don’t like repeating myself 100 times but I also don’t like getting after the staff members. I hate it. But it has to be done from time to time.
Then a PT told one my new patients not to go to the chiropractor until after he is done working with them because the patient is ‘gummy’ and an adjustment wouldn’t stick. Now, what the hell does that mean exactly? We don’t take bones from one place and put them into another. Adjustments don’t need to stick. They need to create movement. And alignment isn’t a real thing. Son of a mother, people.
I’ve never had a PT directing my patient’s treatment in my office before so that was a fun surprise.
Then a re-exam patient shows up 5 mintues before lunch. Talk about wanting to choke a patient. In a loving way of course because I love my patients but choke indeed.
Then an attorney on a case on a patient that I’ve seen just three freaking times calls the office. He wants to get me and the insurance adjustor on the phone at the same time. He wants to know what my bill is going to be, how many times I’m going to see the patient, etc… Yeah no. Not happening.
You have a question? Email me and tag the insurance adjustor. Want a specific answer, yeah…no. Everyone is different, every injury is different, and everyone heals at a different rate. I can give you a very rough estimate at best. Suck it Mr. Attorney, aka Mr. Waste My Freaking Time.
Then I have a new car wreck patient that doesn’t want me to see his previous radiology reports because they told him nothing was wrong and he doesn’t want me making up my mind about him based on radiology reports. Are you serious? You can’t make this crap up y’all.
Then, there’s some inner office fussing going on. It’s not a big deal but just un-needed on top of the rest of it while I’m trying to switch CPAs, balance and close out the month of November, and just keep my crap together long enough to go out to the rehab hospital to see my Dad.
Lol. Wow, what a brain dump I just laid on you all. I apologize but again, I share personal aspects of what’s going on day to day because I know many of you will 100% identify and if you don’t, you can probably learn from my experiences. If you don’t learn how to handle them, then maybe you can learn how to NOT handle them. Lol.
I’m OK with that too.
I can’t remember if I shared on the last episode but did you know the new slang for 100% is hundo p? It’s true. So, I hundo p guarantee that tomorrow will be a better day because I played whack a mole all day today and those little bastards are going to have headaches and will lay a bit lower tomorrow.
At least I hundo p hope so.
Before we dive into the reason we’re here, it’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices.
If you don’t take advantage of this deal, I just think you might be crazy.
If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!
ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean:
In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises.
You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips.
You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**
If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months
That’s ChiroUp.com and super double secret code Williams99.
Item #1
Our first item is titled “Smoking Is Associated with Pain in All Body Regions, with Greatest Influence on Spinal Pain”, published in Pain Medicine Journal in October of 2019, and authored by Smuck, Scheider, and Ehsanian, et. al(Smuck M 2019).
Why They Did It
The authors wanted to examine the interrleationship between smoking and pain the US
How They Did It
It was a cross-sectional population-based study
It was done nation-wide
They collected related demographicsin 2,307 subjects from 2003-2004
What They Found
Smoking is most strongly associated with spine pain, followed by headaches, then trunk pain, then limb pain.
Wrap It Up
The conclusions is, “Current smoking is associated with pain in every region of the body. This association is strongest for spine and head pain. Given that pain is a strong motivator and that current smoking was associated with pain in all body regions, we recommend that these results be used to further raise public awareness about the potential harms of smoking.”
So we already knew that smoking was related to low back pain and disc issues from research we’ve covered here before. Now we know it goes beyond that. It’s everything everywhere basically.
Honestly, can you think of anything that could actually be good about regularly inhale smoke all day every day? Like….anything at all? Of course not. And you know what’s going to piss some of you off? Other than some touted ideas on stress and pain relief, can you tell me what on Earth could be good about inhaling marijuana smoke regularly into one’s lungs. All day every day. Wake and bake is no better than smoking folks. I promise. When all the research shakes loose, you simply cannot inhale substances regularly and it be OK.
As a side note I just want to throw some personal commentary in here. I had a conversation with a patient this week about another chiropractor here in my town and some of the beliefs and ideas that was laid on them on their visits with them.
You know…..the things that push patients away and makes them come see other chiropractors. Things like don’t vaccinate your kids (regardless of your stance on the matter, don’t be a bully about it to your patients. It’s gross and unprofessional), things like don’t use cell phones because of radiation, things like pushing supplements more than an actual adjustment with exercises, things like we need 70 visits and $4000 from you this year to fix that loss of curve in your neck. Things like pushing the newest thing like CBD, multi-level marketing like supercharged water.
From a patient’s perspective, if you went to your medical doctor and they’re pushing a ton of stuff from out of the blue….stuff beyond normal and customary medication. Things supplements that cost A LOT of money. They’re pushing CBD and selling if from their office, etc etc….
Well, those people look like snake oil salespeople. It’s not a good look, it’s off-putting, and we should hold ourselves to a higher standard. You can make plenty of money in this profession without selling your dignity and continually jumping on the hot new bandwagon.
The golden oldies are still the best ROI, folks. Spinal manipulative therapy, exercise/rehab, physiotherapy, massage and manual therapy, acupuncture, and honest and high ethics.
That’s your winning formula, y’all. Not CBD, special magical water, oils, and stuff like that.
It’s just not.
I swear I feel like I’m being controversial today but I’m not trying to be. I’m just speaking my mind and in the US at least these days, that is not a popular thing to do. We are at the point where 50% of the country hates the other 50% and anything you say, even when backed with facts, is taken as offesive material by half the country.
Random thought just now. If kid slang for 100% is hundo p, for 50%, is it fitty p? Just a question I have. That’s all.
Item #2
Now, item 2. This one is called “The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis” published in Current Reviews in Musculoskeletal Medicine in November of 2019 and authored by Mahmoud, Hassan, Abdelimajeed, Moustafa, and Silva, et. al(Mahmoud N 2019).
November 2019 – hot stuff. fog your glasses up steaming plate.
And can I just say Oh how I wish my last name was Moustafa? Powerful – elegant – a little bit of hell yeah there.
Why They Did It
Despite claims that FHP may be related to neck pain, this relation seems to be controversial. Thus, our purpose is to determine whether FHP differs between asymptomatic subjects and those with neck pain and to investigate if there is a relationship between head posture and neck pain.
How They Did It
15 cross-sectional studies were eligible for inclusion
It was a systematic review and meta-analysis – so basically high-level information and research
What They Found
The conclusion of the project was “This systematic review found that age played an important role as a confounding factor in the relation between FHP and neck pain. Also, the results showed that adults with neck pain show increased FHP when compared to asymptomatic adults and that FHP is significantly correlated with neck pain measures in adults and older adults. No association was found between FHP and most of neck pain measures in adolescents.”
Now, you curve people don’t start getting our of hand. Can’t we see a world where a person does not have Forward HEad Posture but still has a loss of a curve. However, that loss of curve doesn’t cause a lot of issues? Of course we can. Because we have recent research that shows loss of a curve isn’t that big of a damn deal long-term.
This paper is on forward head posture specifically and it doesn’t take a research paper to envision sitting with consistent bad posture and developing upper cross syndrome is going to set a person up for some chronic pain issues. I can easily make that leap with you. And with these authors. Count me in.
Item #3
This one is called “The effect of spinal manipulation on brain neurometabolites in chronic nonspecific low back pain patients: a randomized clinical trial” it was published in Irish Journal of Medical Science in November of 2019 and authored by Didehdar, Kamali, Yoosefinejad, Lotfi, et. al(Didehdar d 2019).
November 2019 – Pow- firecracker hot right here. Watch your fingers
Why They Did It
In patients with chronic nonspecific low back pain (NCLBP), brain function changes due to the neuroplastic changes in different regions. They wanted to evaluate the brain metabolite changes after spinal manipulation, using proton magnetic resonance spectroscopy
How They Did It
25 patients enrolled
They were randomly assigned to lumbopelvic mainpulation or sham manipulation
They were evaluated befre the study begain and at 5 weeks after treatment.
The Numerical Rating Scale and the Oswestry Disability Index and the H-MRS outcome assessments were used to quantify the results
What They Found
After treatment, pain and functional disability were significantly reduced in the treatment group vs. the sham group.
This paper gets heavy into the neurology so, in order to keep you on board here, we’ll straight to the conclusion.
Wrap It Up
The authors concluded, “In the patient with low back pain, spinal manipulation affects the central nervous system and changes the brain metabolites. Consequently, pain and functional disability are reduced.”
We did an episode on what an adjustment does way back on episode #56. That was also the episode where I talked about a popular group of millennial chiropractors that pour on the theatrics and sales talk and teach other impressionable chiropractors to do the same.
And then claimed to make degenerative arthritic spurs disappear after adjusting 3 or 4 times a day for like 2 or 3 weeks. I can’t recall exactly now but go back and listen to episode 56. It was a fun brain dump and is probably something you’ll enjoy if I’m guessing. I’m putting the link right here at this point in the show notes at chiropracticforward.com so go give it a looksee.
How do you describe a manipulation? If you were on an airplane sitting next to a neurosurgeon and he asked you exactly how manipulation works and affects the body and pain, what would you tell him? Have you thought about it?
The folks at ChiroUp have thought about it and probably because they’re DACOs, the DACO program also has an interesting description to offer.
Dr. Brandon Steele with ChiroUp offered a good explanation for cavitation back in October on their blog. I’ll leave the link for you in the show notes.
He described the need for better communication with the patients regarding cavitation and whether something “goes” or pops. Too many times, patients equate a successful treatment with cavitation. You know what we’re saying here.
To quote Dr. Steele’s blog, he says, “Joint manipulation improves range of motion across individual and multiple vertebral segments. A recent paper by Anderstt et al. (2018) confirmed that cervical manipulation results in facet gaping. This force also improves regional motion across multiple spinal levels during and post-manipulation.
“This study is the first to measure facet gapping during cervical manipulation on live humans. The results demonstrate that target and adjacent motion segments undergo facet joint gapping during manipulation and that intervertebral range of motion is increased in all three planes of motion after manipulation. The results suggest that clinical and functional improvement after manipulation may occur as a result of small increases in intervertebral ROM across multiple motion segments.”
Evidence-based chiropractors can bridge the patient education knowledge gap by incorporating current research into simple explanations.”
The DACO program I’ve been discussing put it all into an excellent description. Check this out and let me know what you think about it.
“Chiropractic adjustments exert their effects upon the nervous system in a variety of ways.
In recent years the neuroscience community has taken great strides in uncovering the mechanisms at play. These include analgesic responses at the dorsal horn level, as well as activation of the descending inhibitory pathways from brainstem regions such as the periaqueductal gray.
There is also a compelling body of research that suggests profound changes in sensorimotor integration within the cortex.
It appears that manipulation relies upon signaling properties of the muscle spindles that lie embedded in the paraspinal tissues. As the spindle registers rapid lengthening of the muscle it transduces this into a large proprioceptive barrage.
The unique nature of a manipulation seems to alter the responsiveness of second-order neurons in the dorsal horn and make them less sensitive to incoming nociceptive signals from injured tissues.”
Good stuff. The more you know, the better you are. The better you are, the more you stand out and the busier you are.
The right kind of busy. Not busy because you scared people into treating with you. Not busy because you made a big deal out of something insignificant.
Busy because you’re freaking smart as hell, make good reasonable recommendations. Busy because you took the time to get the extra education to be able to help your patients beyond what your local competitors can do. Busy because you’re honest and you know that treatment should have a start and it should have a finish.
Busy because you’re an evidence-informed, evidence-based chiropractor and high level research backs everything you say and everything you do.
There are few things more satisfying than saying, “Would you like for me to send you the research paper on that?”
Store
Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly.
If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders.
Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it.
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.
Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Didehdar d, K. F., Yoosefinejad AK, Lotfi M, (2019). “The effect of spinal manipulation on brain neurometabolites in chronic nonspecific low back pain patients: a randomized clinical trial.” Ir J Med Sci.
Mahmoud N, H. K., Abdelmajeed S, Moustafa I, Silva A, (2019). “The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis.” Curr Rev Musculoskelet Med: 1-16.
Smuck M, S. B., Ehsanian R, Martin E, Kao MJ, (2019). “Smoking Is Associated with Pain in All Body Regions, with Greatest Influence on Spinal Pain.” Pain Med.
CF 101: What Makes A Good Chiropractor – 9 Characteristics
Today we’re going to talk about going to a chiropractor and how to tell your out-of-town loved ones how to choose a good one on their own. Without your help even! We’re also going to talk about being the kind of chiropractor that your colleagues are happy to send their family to.
But first, here’s that sweet sweet bumper music
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.
We’re the fun kind of research. We’re not the stuffy, high-brow kind of research oh no…. we’re talking about research over 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 to chiropracticforward.com and check out the store link. Sign up for our weekly newsletter there too.
No spam there, just reminders when we post a new episode so you don’t miss any!
You have collapsed into Episode #101
Now if you missed last week’s episode, we covered a lot of research. It was Episode 100 so make sure you don’t miss that info.
I know there were some good solid knowledge nuggets found there within so make sure you’re up to date and not falling behind the rest. Keep up with the class, man!
On the personal end of things I cannot tell you what a trying and what an emotional week it’s been. These episodes are recorded a week or two ahead of time so you’ll note the time difference of when this happened and when it’s making its way live.
On Saturday November 9th, my dad had a stroke. He got out of bed that morning and said he’s got a tall bed so he always has to sort of find his footing before he gets out and walks. He said on this day, he got out of bed and got out a bit awkward and fell.
He hit his head on the end table and cut his head open. From there, he went to the garage to get rags to clean up the bloody mess. Well, from the garage he goes to talk to his wife in the kitchen and there he falls again….hitting his head once again.
At this point, his wife calls the ambulance and off to the hospital they go. My wife and I were in Dallas TX, about a 6 hour drive away. So, I get the call. Take care of my business in Dallas and head back to Amarillo as quickly as we can.
Now, never having been around a stroke victim in the first week or so, I have little experience in this arena. I had no idea what to expect. When we got to the hospital, he was awake and talking to me. Telling me all kinds of stories, basically doing decent but there was weakness on the left side arm and leg.
Now, here’s where it got A LOT more interesting. On day two in the hospital, after taking a walk on the walker, he was sitting and eating and just relaxing when he had stroke #2. This was the more severe stroke. They put him on heparin, a blood thinner, and took him to the critical care unit to keep a closer eye on everything.
Now complete loss of sensation and motor in the left leg and arm and hand. He was very out of it and confused in the CCU.
So that was touch and go for a bit as you can imagine. Very emotional. Very stressful for everyone. Certainly for my dad.
Now, let’s fast forward to today, Monday November 18th, we are now 9 days out from the first stroke and 7 days out from the second stroke. He’s out of the hospital and in a rehab facility where they are trying to teach him to regain his life if possible. At this point, nobody knows where this train is going to take us and when it will get there but, we are hopeful and we are praying. If this reaches you and you hear it, I would appreciate your prayers, your good vibes, or whatever you are willing to send this way.
He could use it and, honestly, his family could too. It’s been a challenge to try to see patients and then spend time at the hospital. It’s hard to be present for your patients when your mind is fixated on your personal problems. I’m sure it goes that way for doctors going through divorces and life changing events like that as well. Mine just happens to be my Dad’s stroke.
So, I’ve usually got at least something to share with you on the personal side of things. This one was a whole new thing for me. I’ll probably giving updates as we go along.
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
Now, the reason for this week’s topic: I saw a question on one of the Facebook groups the other day about what are the qualities we look for in other chiropractors before we’ll recommend them to a family member or to a friend.
Quite honestly, I get phone calls, text messages, Facebook messages, and emails from friends and associates that live out of town asking me if I know a good chiropractor where they live all of the time. Literally almost every week. And if I don’t know one, then what is the best way to choose a chiropractor? I’d say my first knee-jerk response is to go to forwardthinkingchiro.com and check the Member Map they have.
Now that still doesn’t guarantee it’s the best referral in the world but it’s a damn good start in whittling out the crazies right off the bat. But, that map unfortunately doesn’t represent every area of every city and it certainly doesn’t get you a good referral in BFE, Wyoming.
So, that’s what we’re talking about here. How do you find someone then if that FTCA map fails us?
I think that any time one decides that they’re going to go to a new doctor….even for you and for me…..If we change doctors, there is a certain amount of apprehension. In choosing a chiropractor, this apprehension can be escalated to a certain extent because all chiropractors are vastly different. In short, there is literally zero standardization. It’s like the wild wild West out there. If you have an ear infection and you go to the ER, you know it’s going to be a pretty standard treatment, right?
Not with chiropractic. You can go in for a little tweak in your back and walk out $3500 lighter with a year long plan. Or you can walk in with a little tweak in your back and get some completely normal, repsonible recommendation.
There are some chiropractors that focus on weight loss. There are some chiropractors that only use an instrument to adjust rather than manual adjusting.
There are some chiropractors that are more driven by philosophy than other chiropractors. There are some chiropractors that use therapy and extra equipment, while other chiropractors only adjust.
So let’s dive into 9 characteristics I feel are important in a good chiropractor.
1. Honesty
Other than the first topic and the last topic, I have not put these qualities in any specific order. But I put honesty at the top of the pile because I feel that strongly about it.
I feel that honesty is of utmost importance in any profession. Especially in the healthcare field. People are literally putting their lives and their livlihoods in our hands. You would like to think our family is putting their lives in the hands of an honest person, don’t you think?
We’ve heard it said time and time again that if a person doesn’t have his word, then he doesn’t have anything. It so so true.
How do you know if a chiropractor is honest when you first visit their office? That’s a hard one to answer. It may simply be a “gut” sort of thing. But usually, if we trust our “gut”, then we don’t get steered off of the right track.
You may not be able to develop a “gut” feeling until the second or third visit but you will most likely get a good idea by then. I would say that, in general, if it takes 3 visits to get your recommendations and really start treating, they may be using sales tactics on you.
If they talk about having to see them once a week for a year or for a lifetime, they may not necessarily be dishonest but they are most certainly unaware of current guidelines and evidence-based protocols.
If they talk about fixing everything in your body based on a subluxation model, I’d say you should save your money and leave. That’s just me. Again, that doesn’t mean dishonesty but it does mean they may not be evidence-based.
2.Evidence-based/Evidence Informed
OK, this one is admittedly a sticky one here. As most chiropractors are well-aware, there is this huge chasm in our profession between those that believe in only adjusting the spine and nothing else and those that are evidence-based or evidence-informed.
Between those that follow a philosophy and those that follow research. Between those that do not believe in the profession progressing and growing and those that believe our profession can and should grow and expand.
There are some research papers that the philosophy group will point to saying these papers prove their theories and minimal treatment but, in truth, from what I’ve seen, they are low quality and no profession worth anything would rest their entire reputation on them.
However, there are TONS of papers, many of which we have covered here on the Chiropractic Forward Podcast, that proves and validates evidence-based chiropractic every day in almost every way.
In general, it is my recommendation that you BE the chiropractor or refer your family TO the chiropractor that follows research, follows the expanding knowledge within, and pushes to move the profession more and more into the current century.
3.Network.
To me, “Network” means, “how plugged in is the doctor as far as his associations, his colleagues, and the profession as a whole?”
On the surface, that may sound like a silly suggestion and to be somewhat inconsequential to you. But I have found that there is an extreme amount of value in being active with fellow chiropractors and state and national associations.
We are able to bounce ideas and questions off of each other whereas someone with no colleague interaction or support system merely has their own knowledge and is sort of on an island of their own making.
Trust me, this is coming from a dude that was on that self-made island years and years ago. I had my basic knowledge from going to chiropractic school but I wasn’t particularly skilled in anything extra. Just basic white paint in a world of oranges, purple, fuschia, lilac, or whatever color you can think of. Sitting here today, I wouldn’t send anyone to me then.
Being active in the Texas Chiropractic Association has allowed me the opportunity to stay plugged in with rules and regulations, new treatments, changes in insurance plans, and options that I would have likely never known about were I not being active in my profession.
4. Knowledge & Experience of Doctor and Staff
I think this qualification really goes without saying. And again, knowledge and experience is of extreme importance in ANY profession. Even an experienced comedian is usually going put on a better show than a rookie.
For instance, I attend a chiropractic conference one weekend out of every month. Chiropractors are required 16 hours of continuing education every year. Some chiropractors will only go to a continuing education seminar one weekend out of every year. I should know, I used to be one of those chiropractors.
But with age comes wisdom and the desire for more wisdom. I would do my best to figure out the chiropractor’s knowledge and their level of experience. This could certainly end up being a “gut” thing as we previously discussed but it’s usually something they’re proud of and something they market.
Trust me, when I finally get that Fellowship of the International Academy of Neuromusculoskeletal Medicine, you better believe it’s going to be on the website and will probably look like some sign right out of Las Vegas.
If there’s no sign on the website of extra certification and acheivement, your money is probably best spent elsewhere. I’m ten times the doctor I was when I began the Diplomate program. Or more….exponentially better.
5. Good listener
You’re not going to be able to get this off of a doctor’s website so don’t even try but we can strive to be better ourselves in this department. Myself included. I’ve been at a point where I didn’t feel I could get everyone worked through in one day and I can guarantee you I cut some patients off in the middle of their explanation.
I think that it is very important that a doctor has a good bedside manner. Meaning, that they need to be able to listen, focus on the patient, and fully understand what the patient is saying and what their concerns are. There are those days where we are just doing everything we can to stay above water but in general, don’t be uninterested and think you have the problem solved before they’ve said anything.
Open your ears.
6. Office Presentation.
This may seem like a silly one and I’m sorry if it’s just not important to you, but if I am going to a doctor’s office, I expect the office to be mostly clean and fairly sharp looking.
GASP….what if they went over the top and it looks amazing?
I think that if a healthcare provider takes pride in their office and in their staff, then they’re going to take pride in their results and their expertise. Maybe I’m wrong. You can find those that don’t give a squat about anything in their office. No good pictures, old this, smelly that..yet they’re able to get the best results.
Let’s face it though, is that the exception or the rule? I argue it’s the exception.
An an ideal office, they try to have a welcoming feeling, the staff is dressed neatly, there is as little dirt or dust is on the floor and furniture as is possible, there is no trash on the floor next to the trash can, everything is as nice, as sharp, and as clean as possible.
If the doctor and the staff do not portray an acceptable image, then that may not be the place for you.
7. A sense of purpose.
Have you ever gone to a doctor’s office and felt that they were simply going through the motions and collecting money? I have absolutely felt that way a time or two. I think that the better doctor is genuinely concerned about his patients’ well-being, and how he can help them in the best way possible.
Someone that you can just feel is a little extra. Someone that is knowledgeable and can relate things to you in relate-able terms. Not chiropractic jargon. Someone that you can instantly tell is not there to get into your pocket or to max your insurance. You know what I’m talking about. Someone that is there to get you results as quickly as possible. That’s purpose.
Even on top of that though, it would be nice to find a chiropractor that you felt had the community’s best interests in mind. When you see them donating and giving back to their community, why wouldn’t you want to do business with that person instead of a taker. Takers kind of suck. Takers just make profit but are narcissistic. They don’t get involved with their state or national associations at all. They don’t give anything back to their profession, their school, or their community.
They take that money and spend it only on themselves because that’s all they care about. I don’t want to do business with that person. I want to do business with a giver. Any day all day. Gimme a giver. Thank you, i’ll have another please.
I want a chiropractor that got into the profession of chiropractic in order to heal people. And to heal as many people as he could possibly reach.
Someone that thinks and works on a higher level rather than someone that just shows up to work and does their job. A doctor that is excited and jazzed to be doing what they’re doing in the place where they are doing it.
THAT’S the guy I want to go to!
8. Know when to refer.
Tell me you know when to refer. Tell me you don’t think you can fix everything. Please tell me!!
When we talk about referrals, we can get way off track in the chiropractic profession. Some chiropractors feel they can solve any problem walking through their doors. Ear infection? Pop ya bones? Asthma? Pop ya bones. Cancer? Pop ya bones. Diverticulitis? Pop ya bones?
You know the ones. Yeah you know them. They’re the reason people in the medical field look at all of us like we’re crazy. And if that’s the measuring stick for crazy, then they’re right. Fortunately, most of aren’t like that. But the loud minority is still winning the day in our profession I’m afraid.
As I said before, I am interested in the chiropractor that is plugged in to his profession and to his colleagues. I’m interested in the chiropractor that is plugged in to the healthcare field as a whole. And I’m damn sure interested in the chiropractor who is plugged into research and current, accepted guidelines.
If a doctor gives me a sense that they feel that they are the only one that can handle any condition, or that there is never any need to look outside of their office for additional help, then I am likely going to find another chiropractor. I think it is extremely important to go to a chiropractor that is not afraid to admit when additional treatment should be reasonably looked at.
I for one, look forward to each and every time that I have the opportunity to work in conjunction with a medical provider. I feel that it is a very complete treatment plan when you are able to address all symptoms thoroughly.
Patients have to take into consideration whether they want a chiropractor that is deeply versed in chiropractic philosophy or want a chiropractor that is open to working with the medical community.
9. Love.
I like to throw curveballs here and there. I like to add things you don’t see in most lists. This is one of those things and I saved this one for last because I hope that, after you’re done reading this, this is the one that will resonate the longest with you.
I strongly feel that when you visit a health care provider, things like caring, genuineness, focus, listening, and all of those other things that we’ve talked about above…..they can all be wrapped up into one thing.
And I think that that one thing is love. If the doctor and the staff love what they do, they love their patients, and they love being where they are, when they are there, then people can feel that.
If you walk into an office and it’s cold, there’s no personality, and it feels stiff and stale, then that’s just no fun at all. Where’s the love? How do you show it to your patients?
I want an office that I love to go to and if the doctor and the staff have love as the primary driver of their office and their purpose and it’s something palpable that you can feel….., then I think that all of the other eight qualifications pretty much take care of themselves.
That’s it. I’m sure if I didn’t have so much on my plate I could come up with about 20 more things that are important. Maybe a 100 but I have to get to the hospital to see my dad.
I enjoyed sitting and throwing some random thoughts on the page. I hope you liked it and make sure you come back next week.
Our podcasts post every Thursday. Typically in the morning unless I’
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.
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.
Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
CF 099: Big Ideas On Marketing Evidence-Based Practices (Part Two)
Today, you’re going to hear Part Two of our two-part series about marketing. Specifically, marketing an evidence-based chiropractic practice. How do you do it and do it right?
But first, here’s that sweet sweet bumper music
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.
We’re the fun kind of research. We’re not the stuffy, high-brow kind of research. It’s like we’re talking about research over beers. Which is NOT like talking about research in a classroom or an institution of some sort. Accessible research if you will. I could be more professional but I’m not.
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, and go to our Store link at chiropracticforward.com and check out the goods. That’s it. Not bad right?
You have shimmied into Episode #99 and I hope you’re enjoying the Marketing series.
Now, if you missed last week’s episode, it was Part I of this marketing an evidence-informed practice series. Stop now and go back and listen to Part I first. Then come back here and devour Part II.
Because….make no mistake…..we’re serving it up hot and fresh here people.
On a personal note, nothing special is going on around the office or in my work life balance. It’s just been business as usual. We’ve had a bit of a fall off from the Summer but it’s still busier than this time last year and we’re staying busy busy busy.
So, nothing of signifigance to report here but, before we get too deep, 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.
OK….now, back to Part II of our marketing series. We covered some general marketing thoughts and we covered internal marketing last week. We were just about to get into External Marketing and the idea of the first big three means of external marketing which can be thought of as shotgun marketing.
So, let’s pick back up where we left off last week. Here we go.
#2 External Marketing
Now, let’s move on to External Marketing. This is the traditional marketing we think of. Things like:
TV
Radio
Billboards
Let’s talk about those three first. We can call that shotgun marketing because you are hitting random people with random pebbles. You can’t laser focus marketing with a cannonball this way. You can only hope that someone that would be interested in you happens to see your message. Some will. Most probably won’t.
Don’t worry if you’ve fallen for some of this crap. I spent $19k one year to have the front page corner of the yellow pages. Now, that was years ago when everyone actually used the yellow pages but, trust me, I’ve done stupid crap too.
Back to TV, no matter how smooth the sales reps are, more and more are unplugging. They’re using streaming services like Netflix or Amazon. Disney and Apple are jumping in with both feet too so sooner rather than later, I think the majority will not see a message on traditional TV.
Same goes for radio. Hello, every heard of Sirius radio? Or, if you’re like me, I’m listening to a podcast as soon as I get in my truck to go anywhere. I don’t even listen to traditional radio anymore. If you do, I think you’re quickly becoming the minority.
Billboards may make sense if you’re right off the highway and it leads people to your front door. Otherwise, I think it’s probably mostly a waste of money. Don’t get too tied up in whether or not you see your face or your name up on a big board or up on TV. It’s not real. It didn’t happen organically because you’re awesome. You put it there with your money. And you may have just wasted that money.
Shotgun marketing can make sense but only after all of the base coat has been painted and now you’re just going for exposure and saturation of the market. I really don’t care what the sales reps say and how many graphs they show you. Those are manipulated to take your money.
Another negative about shotgun marketing is that it is hard to track. Marketing needs to be traced and tracked. Either through computerized means or on a simple spreadsheet. Better believe I know where every single new patient comes from, who to thank, and where my bread and butter lies.
Unless you’re really tracking well, many times you won’t know if someone comes in from a billboard, TV, or radio. Sometimes they’ll tell you straight up but sometimes they just don’t remember.
But what about other means of external marketing?
What about things like:
BNI
Chamber of Commerce
Charity and philanthropy.
Social Media
Sponsoring teams and events
If you want to do personal injury, wouldn’t you figure out how to attract and market that demographic?
If you wanted more pain patients, where do they hang out? Where do they go? Wouldn’t you want to figure out how and who to market for those people?
Direct mail – yes, it can still work and you can target it like a laser
I have so much on external marketing. The options are endless and we could talk about them for ever. I’ve tried them all. Trust me.
Something I forgot to mention in the beginning is the fact that marketing is always changing. It’s not a set it and forget it endeavor. You have to be on it all of the time. Yellow Pages anyone? Hello….Bueller.
#3 Who You Are
As I said before I add this third one because we are in a personal business. You’re not a big brand like Coca Cola. Coca Cola doesn’t have a face. It doesn’t have a name behind the brand. While some would argue that it does, in the context I mean it in, Coca Cola does not have a personality and it damn sure doesn’t have a relationship with it’s drinkers.
You could say that #3 really has more to do with internal marketing but I think it’s a cross-over thing. Who you are, your vibe, how you carry yourself….that all goes into making your business what it is and makes your reputation what it is.
For a smaller community, this is even more vital. For a city, still vital. You are attracting people or you are repelling them. It’s not very often that you have not effect or neutral effect on people. Right? Do you ever leave a conversation or a personal encounter with someone with absolutely zero feel about it? You get the point.
So, what if you spent on average $150 per each new patient that gets on your schedule? There are some pretty good stats you can keep on this stuff. What if you invested $150, they come to your door, you’re having a bad day, rush through their exam, are a bit of a jerk about them doing exactly what you recommend, and then maybe there’s a snafu at the front desk when they pay out because you were too lazy to get the staff trained appropriately?
You may have made the $150 back up but you’re probably not going to profit on that patient because of YOU. Your vibe was crap. You didn’t want to be there. You didn’t want that patient there. You didn’t train your front desk right. And now YOU probably won’t have another visit with that patient.
What if you are at an event, you woke up that morning and stepped in dog crap, and that just set the tone for the day. Now you’re at this event you don’t really feel like being at and everyone can tell. Mr. Sourpuss chiropractor over there sucking on a whiskey sour with his sour face.
These are dumb simple little examples but who you are, how you are able to talk and communicate to people, and communicate what you do can make all of the difference in the world. If you’re positive, energetic, smart, and capable…..Boom. The battle is won.
Eyore from Winnie The Poo on the other hand gets no patients. Only your mom is coming to see you. #66 in town, #1 in mama’s heart.
More than personality though, you MUST be a real person. Don’t pretend. Don’t sell. Patients smell that garbage a mile away. Be AUTHENTIC. That’s a key concept in marketing.
It’s the stuff you learned in kindergarten. Treat others the way you want to be treated. Honesty, ethics, forthright, stand up, and gentlemanly or lady like. Professional. These are so important. What about loving? Of course. You better love your patients and you better love your staff.
Our practices are made up of lots of relationships and if you aren’t interested in people and relationship building, I’m afraid no amount of marketing will make it OK or will make you succeed. No amount of money.
When you’re providing quality care with responsible recommendations, and you salt and pepper that delicious brew with a little love and personality, you got a winning recipe on your hands. I like cajun food so I add even more personality to my spicey brew!!
Boom snap pow!
I mentioned this earlier but, I think the biggest key to anything business related is keeping and tracking stats effectively. Do you know the exact number of new patients you got last month from Google or Facebook or Instagram or from referrals from your existing patients? Do you know how many new patients you got from your own staff referring people to you?
Do you know your PVA? Do you know how much you make per patient encounter on average and how much it costs you in marketing dollars to get a new patient in your doors? Do you know what your average profit per patient visit is each month or what it averages over the course of the year?
If you can’t answer these questions, you have to figure out how to answer them and you need to do it yesterday if you get my drift.
These numbers and metrics aren’t only important to your marketing efforts. They’re important to your business in general. How can you possibly know your return on investment for anything you do in your business? It sounds crazy to say it, right? For so many of us, record keeping and stats are just second nature. But, I wasn’t always there. I had no idea where I’d been and not a clue where I was going.
I was like a drunk pin balling off of the walls trying to get somewhere and falling down every so often.
I’m not just trying to relate to you on some level. That’s real talk. I was on an island for so many years. No colleagues to bounce ideas off of or to ask for help. No association involvement, no network. No real continuing education. I came late to the party. But, with knowing I was coming late to the party, I jumped in with both feet, man.
Gimme the bottle of tequila, the bottle of vodka, and throw in some fireball on top of that. Let’s get there as fast as possible.
That’s what I did with being a chiropractor.
Now, as far as the stats keeping, I’m working on a solution for those of you that might be interested in getting some help with keeping stats. Something that will make it easy and fast. Yes, it’ll have a monthly cost but it won’t be ridiculous and you can only pay for what you think you need. Different levels…that type of deal. But, it’s in the works and I’ll let you know more about it when we get it up and running. You numbers nerds will love it.
Some other random thoughts and musings:
Having something to talk about is always important. Especially on social media. If you’re talking, people are typically listening. Even when you think they aren’t
Make sure your website is doing what it’s supposed to do for you. IF you can’t do it, hire it out. It really is that important.
IF you can learn YouTube videos, learn it and do it. Even if you think you suck on screen. It’s important.
Eliminate the risk. Do what you can to remove any and all obstacles to coming to see you. Is your insurance staff making the payment process a little bumpy? Fix it. Are people wanting to fill out paper work online but you don’t have that? Fix it. Does the majority of your population want to come in from 5-6 and you’re closed at 5? Fix it. Not for just one or two people but if the majority needs that time block, give it to them. Just remove the obstacles.
Be the expert that you are and be the expert everywhere your market will allow you to be the expert. Clubs, associations, boards, etc…
The secret to referrals is the difference between satisfaction and enthusiasm.
Things NOT to do pretty please for the love of all that’s holy.
Do not put your office and profits above your patients for any reason ever.
Do not scare patients into care. It’s rude and it’s unethical
Do not use curve correction as a reason to manipulate patients into setting up 70 visits. It’s rude, it’s borderline unethical, it makes all of us look bad, your actions really do reflect on the rest of us, and there’s no good, non-biased research backing the notion that curve correction matters at all.
Don’t do dinner with the doctor unless you truly are simply trying to build authority in your community. If you are using them as bait and switches where you get someone in for a $29 initial treatment and then scare the crap out of them to make them sign a contract for $3500 over the course of a year, then YOU are the problem with this profession.
Oh yeah, contracts between doctors and patients do not belong in healthcare. It’s embarrassing. Please stop if you do it and never start if you don’t.
Just be honest, ethical, put the patient first, behave in a manner that would make the chiropractor next door be proud to be a chiropractor, and take care of your patients by following industry standards for treatment. Keep learning and expanding your knowledge. Be the smartest in your town. The more real, research-backed education you get the better you’ll understand things in the profession and the better you’ll understand how to carry yourself. CCSP, Diplomates, etc.
Basically, have a moral compass which sums it up.
So, there’s the quick form of a marketing seminar. We could spend an hour on each one of these little nuances to marketing and could go on and on and on.
Again, if any of you want me to put together a more robust marketing talk and have me present it for your group or association, let me know and we can see how we can make it work.
If you have any questions or ideas, shoot me an email at dr.williams@chiropracticforward.com
I hope you’ve enjoyed my marketing talk. I literally sat down and just started typing. Yes, I’m sure I didn’t cover everything as thoroughly as you’d like but, if you’re really paying attention, I gave you some good solid cement to build a base out of.
Key Takeaways
Have a USP
Have a marketing meeting regularly
Set goals
Be honest, ethical, loving, authentic, and don’t sell people
Don’t push people and scare care is crap care.
If it takes you 100 visits to help someone, you could get better at what you do
Internal marketing means as much as external marketing which means as much as who you are and how you communicate and carry yourself.
Track EVERYTHING
Store
I will hopefully have something in place to help you track metrics soon enough. Also 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.
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.
Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger