Health & Wellness

w/ Dr. Anthony Nicholson – (Part One) Decoding Chronic Pain

CF 080: w/ Anthony Nicholson – Decoding Chronic Pain

Today we’re going to be fortunate enough to be joined by Dr. Anthony Nicholson from Australia. It was so nice we had to do it twice. This time around though, we are focusing mostly on chronic pain. Pain in the frame, if you will. If you are new to the concept of chronic pain as part of a centralized experience, buckle up because the school bus is about to arrive

But first, here’s that delightful bumper music

Chiropractic evidence-based products

Integrating Chiropractors
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg





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

You have skidded your way into Episode #80 and we are glad to have you. 

We here at the Chiropractic Forward Podcast have gotten fancy. 

I’m happy to introduce a new sponsor for the Chiropractic Forward Podcast called GoChiroTV. GoChiroTV is a patient education system for your office that will eliminate the need for running cable TV or the same DVDs over and over again in your waiting room. The bite-sized videos are specifically made to inform your patients about the importance of chiropractic and healthy living, encourage referrals, and present the benefits of all the different products and services you offer.

It works by using a tailored-fit video playlist that will only promote the products and services available at your practice, and the videos are replaced automatically on a weekly basis. There’s no need to manually update your playlist or learn any complicated software. You truly can set it and forget it.

Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription. 

So visit GoChiroMedia.com (that’s g-o-c-h-i-r-o-m-e-d-i-a-.com) to check out the demo reels, and to get started on your free trial. Take you practice to the next level with GoChiroTV.

Store

Go check out chiropracticforward.com and go to the store link. That’s where you’ll find brochures a plenty to get you started with some good, solid patient education. They look sharp and they read smart if you’re picking up what I’m throwing down. 

Do it do it, chiropracticforward.com and sign up for our newsletter while you’re at it, won’t you?

I want to thank Dr. Nickell in Kansas City for your recent feedback and for all of your encouraging words. Made my day and I appreciate it. 

DACO

Let’s talk a bit about the DACO program. Not a lot to talk about right now. Just studying my little hiney off. I li e. Not about the studying. About being little. I’m a big guy. The studying part is good. I enjoy going back through the courses. 

It’s funny to see the sort of student I am at this time in my life compared to me in school. Lol. I guess I thought I HAD to do it the first time through so I wasn’t as interested as I probably should have been. NOW, I want to be learning so I’m all in and my notes and study habits certainly reflect the fact. 

Personal Happenings

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

Now, let’s get to our incredible guest today. Dr. Tim Bertelsman, one of the most talented speakers out there on the circuit today, says that our guest is just one of those people that really make you proud to be a chiropractor and I agree 187%. 

That’s a glowing endorsement but that not my official intro. Here’s the official intro:

Dr Anthony Nicholson is the CEO of Chiropractic Development International (CDI), a global continuing education organization for chiropractors that he co-founded in 2002.  

CDI’s innovative online learning technology has led to formal accreditation in over 35 states in North America, along with a growing learner base in the UK, Europe and South East Asia.  

CDI provides 250 hours of advanced online clinical training for the Neuromusculoskeletal Medicine Program offered by the University of Bridgeport in Connecticut and had developed an online board examination for the Academy of Chiropractic Orthopedics.

As a partner of Spine Partners Wahroonga in Sydney Australia, Dr Nicholson is also a full-time chiropractic physician in private practice, is a board certified chiropractic neurologist (DACNB) and is board certified in Chiropractic Orthopedics (FACO).  That means he has a Diplomate in Neurology AND Orthopedics. 

In addition, he is an adjunct senior lecturer in Neuromusculoskeletal Diagnosis and Evidence-based Practice at Macquarie University ion Sydney’s north shore.  

Welcome to the show Dr. Nicholson thank you for joining us for the second time.

We already had you on the show for a two-part discussion so we have already covered a lot of topics from medical marketing, to CDI, to the DACO. For this episode, I’d like to concentrate mostly on the topic of pain. Particulary centralized pain. 

When I started the DACO program I had no idea what you were talking about. I was slow to the show but find myself fascinated by it all. 

I don’t know if this is the best starting point or not but….What is pain? What basic responses are needed in response to a noxious stimulus? 

OK, now we know what pain is…can you tell us….what is chronic pain? How is it defined?

I believe this questions will lead us into the big concept. Can you tell us a bit about neuroplasticity? What is it? What does the term mean and what do we know about it now vs. traditional thinking on neuroplasticity?

OK….here’s the big question and the reason I wanted to do this interview with you. This question may just take up the majority of the episode and that’s OK. That’s what we’re here for and this questions gets to the foundation of it. 

For our audience’s benefit, what’s the difference between peripheral pain sources and central pain sources and what exactly is an upregulated or a sensitized central nervous system?

Let’s say someone has a bad shoulder for a while…..does anyone that has had literally anything hurting for 3 months or more now have an upregulated CNS?

Other than hurting chronically, are there other signs and symptoms that can give us a clue someone is suffering from chronic pain or are in chronic pain syndrome?

To me, having chronic pain at one site seems different than chronic pain SYNDROME. Let’s continue with the person with the bad shoulder for six months. Is that considered being in chronic pain syndrome vs. just having chronic shoulder pain?

What are we learning about centralized chronic pain and how to treat it effectively? What do you do in your office to treat it?

Let’s say someone doesn’t have the time or maybe the money to go through the DACO. Where would you tell them to start searching to learn more on the condition?

Chiropractic evidence-based products

Integrating Chiropractors
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg


The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

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

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

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

But first, here’s that silky satiny bumper music

Chiropractic evidence-based products

Integrating Chiropractors
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg


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

You have collapsed into Episode #79

Introduction

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

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. I just got in my first box. I started with the non-surgical spinal decompression brochures. I wanted them for myself and ordered enough to send you some too!

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

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

DACO

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

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

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

Personal Happenings

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

Now, let’s get ot our guest today. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What does your day at the FQHC look like?

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

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

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

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

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

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

Thanks for joining us

Chiropractic evidence-based products

Integrating Chiropractors
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg


The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

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

The Evidence For Some Surgeries, Searching for How We Help, and Opioid vs. Non-Opioid

CF 078: The Evidence For Low Back Surgery, Searching for How We Help, and Opioid vs. Non-Opioid

Today we’re going to talk about evidence for low back surgery, we’ll talk about if spinal manipulative therapy is partyly in the brain, opioid information for back, hip, or knee osteoarthritis….what does the research say?

But first, cool like a velvet Elvis, here’s that bumper music

Chiropractic evidence-based products

Integrating Chiropractors
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg


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

You have flip flopped into Episode #78

Introduction

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

Store

I should have in my first order of the decompression brochures in in just a few days. These dudes are going to look great. I’ll put some pics in the show notes and in the email we send out once a week to our email list. 

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

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

Personal Happenings

I’ve been asked to emcee the Texas Chiropractic Association’s President’s Gala which will be during the ChiroTexpo event in Dallas, TX on June 8th. 

I’m trying to figure out if I need to be making fun of everyone I introduce or not. Maybe I should trip them? You know we chiropractors….some of us can’t take a joke right? We’ll see how it goes. Most of the guys and gals in the TCA are pretty good with having fun. 

I always heard that people don’t join state associations because they think they’re made up of a bunch of old white dudes sitting around bitching. 

Well, not at the TCA, people. We have young people and certainly not all white. That doesn’t happen in Texas these days. We are a pretty mixed state in regard to ethnicity. We are also mixed in respect to gender. Several smart and highly capable women are either on the board or in a position of influence. Heck, we have a female going through the executive chairs starting in June. I’m excited to hear her ideas and see where we go under her direction. This girl is making it happen. She has young ones too. Nothing slows her down it seems. 

Let’s get to the topics today. 

Item #1

The first item we’re talking about is called “Randomised trial support for orthopaedic surgical procedures” authored by Hyeung Lim, Sam Adie, Justine Naylor, and Ian Harris(Lim HC 2014) and published in Plos One in June 13, 2014. 

This is an interesting one because we think that the surgical procedures we undergo have been fully validated. Fully vetted. Hell, you wouldn’t lay someone open unless it’s been researched and proven beyond a doubt to fix the issue would you? One would think so…..but…..let’s dive in a bit. 

Why They Did It

The authors wanted to investigate the proportion of orthopedic procedures supported by evidence from randomized controlled trials. Trials that compared surgical procedures to non-surgical alternatives. 

How They Did It

  • Orthopedic procedures conducted in 2009, 2010 and 2011 across three metropolitan teaching hospitals were identified, grouped and ranked
  • Searches of the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Systematic Reviews (CDSR) and the Database of Abstracts of Reviews of Effects (DARE) were performed to identify RCTs evaluating the most commonly performed orthopaedic procedures
  • A risk of bias analysis was conducted for included studies using the Cochrane Collaboration’s Risk of Bias tool
  • 9,392 orthopedic procedures were performed across the index period

What They Found

Of the 83 RCTs, 23% were classified as supportive of operative intervention.23%. Twenty three percent were supportive of operative intervention. 

Only 37% of the total volume of procedures were supported by at least one RCT showing surgery to be superior to a non-operative alternative. ONLY 37% y’all. 

19.6% of the total volume of procedures were supported by at least one low risk of bias RCT showing surgery to be superior to a non-operative alternative.

Sounds crazy right? 

Of the most common orthopedic surgical interventions….the most common…..of those surgeries, less than 20% of them had a low risk of bias randomized controlled trial backing them up. 

I have some problems with cussing in my personal life but I’m determined to keep this show mostly PG-13 but man. 

That’s just shocking. Cutting people open with no better evidence than that. 

One word – two syllables. Day-um. 

The Conclusion was “The level of RCT support for common orthopaedic procedures compares unfavourably with other fields of medicine.” 

Good Lord I hope the other areas of medicince have more scientific support. 

What procedures are we talking about? Let’s be fair, we’re mostly spine people and the majority of the procedures their taling about here have nothing to do with the back. They’re talking about things like:

  • Knees
  • Hips
  • Intrnal fixation of proximal or shaft fracture of the femur
  • Ankle fracture fixation
  • Shoulder arthroscopy
  • Arthroscopy of the ankle…….no studies at all. Lol

It’s just crazy to think about. If we’re talking about evidence-based practice, is this it? 20% of our profession is about half crazy I think. Well, that’s about the same number of procedures they do that only have one RCT with low bias risk. 

Is it evidence-informed? I don’t know. That still sound awfully low to even consider it evidence-informed. 

I don’t know all of the answers and I don’t pretend to. Do what you do, but…..why they hell do they question spinal manipulation and say we have weak evidence to perform it? What? Stupid. 

Makes me want to cuss in Spanish.

Item #2

This one is just building on what we understand about what a manipulation does. It doesn’t answer any questions definitively but it does lay more groundwork for the future. 

It’s called “Spinal manipulation therapy: is it all about the brain? A current reveiew of the nurophysiological effects of manipulation.” It is authored by Gile Gyer, Jimmy Michael (never trust a guy with two first names. Especially if he’s left handed), Jame INklebarger, and Jaya Tedla. Published in the Journal of Integrative Medicine in May of 2019(Gyer G 2019). 

Hot stuff coming up

Why They Did It

While spinal manipulation has become more and more accepted after being more and more validated by research, the fact remains that we still don’t know exactly HOW it works and according to my interview with Dr. Christine Goertz in Episode 67, we are far away from having that satisfaction. The authors say there are certainly biomechanical and neurophysiological reasons for it’s effectiveness, 

The paper says, “Although both biomechanical and neurophysiological phenomena have been thought to play a role in the observed clinical effects of spinal manipulation, a growing number of recent studies have indicated peripheral, spinal and supraspinal mechanisms of manipulation and suggested that the improved clinical outcomes are largely of neurophysiological origin.”

“The body of literature reviewed herein suggested some clear neurophysiological changes following spinal manipulation, which include neural plastic changes, alteration in motor neuron excitability, increase in cortical drive and many more.” The nerual plastic changes part of that is really fascinating. It was once thought that the brain is the brain and we just start chipping away at brain cells as we age and go stupid stuff. Lol. 

They’re finding out that the brain changes. It can be trained. It can be built sort of like a muscle but in a neural sense. It’s fascinating. But that’s a different episode all together. 

I don’t have access to this full paper but, the point is, they’re trying to find out HOW we are effective through spinal manipulation and they recommend we plan for long-term follow up studies to help us determine the clinical significance of the neural responses that happen from spinal manipulation. 

Pretty interesting stuff there. 

Item #3

Last one for this week. It’s called “Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial.” It was authored by Dr. Erin Krebs, MD et. al(Krebs E 2018). and published in JAMA on March 6 of 2018 so a little over a year ago. 

The question to answer here was, “For patients with moderate to severe chronic back pain or hip or knee osteoarthritis pain despite analgesic use, does opioid medication compared with nonopioid medication result in better pain-related function?”

How They Did It

They had 240 patients and found that the use of opioid vs. nonopioid medication did not result in significantly better pain-related function over 12 months. But they may have gotten some folks addicted in on the way to the conclusion. Lol. 

Basically, this study says stay away from opioids for moderate to severe chronic back pain or hip and knee osteoarthritis. the official conclusions was, “Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months. Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.”

Boom. Pop. Pow.

I feel like I’m preaching to the choir here but you never know who listens. 

Speaking of that, Dr. David Graber shared with me that after his episodes with us, he got an email all the way from Switzerland from a chiropractor that was pretty jazzed by his comments and thoughts and Dr. Graber wanted me to know that we are indeed reaching folks and influencing on some level. 

I can’t tell you how incredibly satisfying that is. Every now and then, I get a little bit of encouraging feedback but honestly, not enough. You never know what the reach is. Are you enjoying the show? Are you listening regularly? Send me an email at dr.williams@chiropracticforward.com and let me know. I love to hear from you guys. I really do. 

Not only is it inspirational like filling up your gas tank…..but feedback can help me direct the show in a direction that I know you guys are interested in or focused on. Feed back only helps me learn more and get better so send me an email won’t you?

Chiropractic evidence-based products

Integrating Chiropractors
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg


The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

  • Gyer G, M. J., Indlebarger J, Tedla JS, (2019). “Spinal manipulation therapy: Is it all about the brain? A current review of the neurophysiological effects of manipulation.” J Integrative Med.
  • Krebs E (2018). “Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain The SPACE Randomized Clinical Trial.” JAMA 319(9): 872-882.
  • Lim HC, A. S., Naylor JM, Harris IA (2014). “Randomised Trial Support for Orthopaedic Surgical Procedures.” PLoS One 9(6).

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

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

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

But first, here’s that bumper music

Chiropractic evidence-based products

Integrating Chiropractors
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg


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

Introduction

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

Store

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

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

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

F4CP

We will be launching an athletes and opioids eBook toward the end of this month. It’s called A case for chiropractic disrupting the cycle of pain, prescriptions, and addiciton. I’m linking it in the show notes so go get and check it out. 

https://www.f4cp.org/package/home/viewfile/whiathletes-and-opioids-ebook

DACO

Let’s talk a bit about the DACO program

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

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

Integrating Chiropractors
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg


The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

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

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

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

But first, here’s that bubbalicious bumper music

Chiropractic evidence-based products

Integrating Chiropractors
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg


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

You have skipped gleefully into Episode #75

Introduction

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

F4CP

We has launched an athletes and opioids eBook called “A case for chiropractic: disrupting the cycle of pain, prescriptions, and addiciton.” I’m linking it in the show notes so go get and check it out. 

https://www.f4cp.org/package/home/viewfile/whiathletes-and-opioids-ebook

DACO

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

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

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

Personal Happenings

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

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

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

Let’s get to the good stuff

Item #1

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

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

One word – two syllables – Day-um

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

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

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

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

Item #2

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

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

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

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

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

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

Good riddance and take out the garbage. 

Item #3

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

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

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

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

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

Item #4

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

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

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

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

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

Integrating Chiropractors
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg


The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

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

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

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

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

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

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

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

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

Chiropractic evidence-based products
Integrating Chiropractors
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg


Introduction

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

Store

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

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

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

F4CP

We will be launching an athletes and opioids eBook toward the end of this month. It’s called A case for chiropractic disrupting the cycle of pain, prescriptions, and addiciton. I’m linking it in the show notes so go get and check it out. 

https://www.f4cp.org/package/home/viewfile/whiathletes-and-opioids-ebook

DACO

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

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

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

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

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

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

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

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

  1. 300 hours later – I want to thank you for getting me into this mess called the DACO. I’m blaming it all on you and Bill Lawson. 
  2. Tell me about your journey into chiropractic
  3. From your CV, I see that you did the CCSP right out of school. What all have you done through that specific certification?
  4. Can you tell us the most striking difference between the two other than one is more geared toward sports?
  5. Tell me about your practice, what does it look like, who do you see mostly?
  6. Tell me about your journey into the DACO and what benefits you have personally realized from it.
  7. You and your business partner, Dr. Brandon Steele, do a great job at staying on top of the most current research. How do you do that? What are your sources?
  8. I want to hear a little about this friendly rivalry between you and Dr. Steele. 
  9. Did you realize that when I put your name into a Google search to learn a little more about you that Bertlesman Chiropractic pulled up with Dr. Steele’s picture on it? I think his evil plan is beginning to come to fruition. 
  10. When I had Dr. Steele on the show, we talked a bit about Standardization…as in making expectations more uniform for patients visiting chiropractic offices….. and we talked about Specialization such as through the DACO or the CCSP or CSCS. Can you share your thoughts on those two topics for us? 
  11. Tell me about your involvement with your state association and what it has meant to you both personally and professionally
  12. What have you been able to accomplish or have you tried to accomplish legislatively? What struggles are the Illinois and Missouri chiropractors in the middle of these days?
  13. Tell me about chocolate cookies and sushi
  14. I noticed a couple of things from your ‘About Me’ page on your website that I’d love to hear more about. 
    1. The Clinical Internship – Community Health Center
    2. Hospital externship at Deaconess Medical Center
  15. If people want to get more of Tim Bertelsman, what should they do? Where do they need to go to get their ‘fix’? I know you’ll be at ChiroTexpo in downtown Dallas again this year June 7-9. What else?
Chiropractic evidence-based products
Integrating Chiropractors
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg


The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

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

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

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

Don’t Miss A Dissection!

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products
Integrating Chiropractors
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg


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

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

Introduction

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

Store

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

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

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

DACO

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

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

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

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

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

Personal Happenings

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

Item #1

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

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

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

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

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

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

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

Introduction

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

That’s all

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Chiropractic evidence-based products



Integrating Chiropractors
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg


The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

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

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


British Medical Journal Research, Surgeons Against Back Surgery, and Pediatric Chiropractic Under Attack

CF 068: British Medical Journal Research, Surgeons Against Back Surgery, and Pediatric Chiropractic Under Attack

Today we’re going to talk about a BIG new study helping us out in the British Medical Journal, we’ll talk about spinal surgeons against back surgery, and we’ll talk about pediatric chiropractic under attack. That’s a big topic right now. Especially down in Australia. 

But first, get ready to shake your tail feathers……here’s that bumper music

Chiropractic evidence-based products
Integrating Chiropractors
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

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

You have done the mashed potato right into Episode #68. Just like we were back in the 50’s. Sometimes I wonder if I was born in the wrong generation. Seriously. Speaking of, if you’d like to hear what we listen to in my office all day every day, go to Spotify and get my Old, New, Memphis & Motown Too. My profile is amarillopacc. That’s the amarillo platypus, absinthe, crustacean, crap ton. 

You’re welcome…. I’m here all week. Tip your waitresses. 

Introduction

Now, we’re here to advocate for chiropractic while we also make your life easier. 

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

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

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

DACO

Let’s talk a bit about the DACO program. I went on a short little spring break vacay last week so didn’t get many hours in. I got three hours I believe. The class I took was Class 3 of the Pain In The Frame series. It was over chronic shoulder pain. I have to tell you that the neurology is not something that comes naturally to me but, in the same breath, I want you to know that it is presented in a way that is finally understandable. Even by me and when it comes to hardcore neuro topics, that’s saying a lot, folks. Seriously.

And the concept is repeated repeatedly. That sounds redundant but I know you’re pickin up what I’m throwin down here. 

Dr. Anthony Nicholson who is part of the team that has set up the educational program, and who will also be a guest in the very near future here with us on the podcast, he was a neuro diplomate before getting his DACO so there is plenty of neuro but don’t let that scare you. Had I known that going in, it probably would have scared me a touch but, it’s no biggie. It’s explained very well and though I didn’t completely grasp it the first time or two it was run by me, I got by the 10th time for sure. Lol. 

I’m a slow learner. Lol. I beat myself up. I’m almost done with the whole thing and I have a 95 in the class. Trust me, I’m not a neuro guy. I hate hardcore neuro but it’s excellent stuff that you need to know and if I can do it, I promise you can too. 

Be looking for that interview with Dr. Nicholson all the way from Australia in just a couple of weeks or so.  Maybe sooner. He’s fascinating. 

Personal Happenings

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

Item #1

Onward we march to the first item here. It’s a biggie and it’s brand new. It’s called “Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials” and authored by Sidney Rubinstein, Annemarie de Zoete, Marienke van Middelkoop, and a herd of others[1]. It was published in the British Medical Journal on March 13th of 2019.  

Hot stuff coming through

The first thing I’ll say here is that there is a pyramid of research hierarchy out there. I’ll post it in the show notes at www.chiropracticforward.com episode #68 so go check it out.

If you look at it, you’ll see that randomized controlled trials and systematic review/meta-analysis studies are at the very top of the hierarchy. 

Well, this paper, for example, as the title says, is a systematic review and meta-analysis of randomized controlled trials. See what I’m saying here? That’s why it’s a biggie. 

Why They Did It

They wanted to assess the benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain. Ah….low back gets all the attention. Still waiting to see them get those cervical pain studies rolling. Anywhoo…..

They did a systematic review on 47 randomized controlled trials including 9,211 participants that all examined the effect of spinal manipulation or mobilization in adults over 18 years old with chronic low back pain with or without referred pain. They did not accept the studies that looked at sciatica exclusively.

What They Found

  • Moderate quality evidence suggests that spinal manipulative therapy has similar effects to other recommended therapies for short term pain relief.
  • The same quality evidence suggests a small, clinically better improvement in function. 
  • High quality evidence suggested that , compared with non-recommended therapies, SMT results in small, not clinically better effects for short term pain relief and small to moderate clinically better improvement in function. 
  • They say about half of the studies examined adverse and serious adverse events. They say most of the observed adverse events were musculoskeletal related, transient in nature, and of mile to moderate severity. 

They concluded, “SMT produces similar effects to recommended therapies for chronic low back pain, whereas SMT seems to be better than non-recommended interventions for improvement in function in the short term. Clinicians should inform their patients of the potential risks of adverse events associated with SMT.”

I have to say, when we dive a bit deeper in, while the study shines brightly on spinal manipulative therapy and its practitioners, we as chiropractors can’t lean on this thing completely for the good OR the bad. That’s because, of the 47 randomized controlled trials accepted, chiropractors were the practitioners delivering the manipulative therapy in only 16 of them. Fourteen were delivered by a PT, 6 by a medical manipulator (whatever the hell that is), 5 by a DO, 2 by a bonesetter…(that’s a real thing?) and on and on. 

So, keep that in mind. This isn’t fully representative of what chiropractors do and how effective we can be. 

Also, the techniques used in the 47 studies ranged from high velocity, low amplitude like a Diversified adjustment, to low velocity, low amplitude passive movement techniques or a combination of both of those. 

Again, not entirely representative of what we chiropractors that move the bones do. In my opinion. 

What they say down deep in the paper that, considering recent systematic reviews and information showing that SMT and massage should be considered cost-effective options for low back pain and then this study showing the effectiveness…..basically….what are we waiting for to get this rocking and rolling. OK, not their words exactly but….yeah, I said that but I said it based on their research speak. 

I am including an infographic the authors generated on this that cuts to the chase and may be something you can use for your waiting room. Go check it out. 

Great paper, very impactful, and it supersedes the recommendations that you heard us talking about from The Lancet Medical Journal back in episodes #16, 17, and 18 of this podcast. 

I’ve said it so many times and it remains a true, considering the forces and powers that have been against us for generations, if we were inherently wrong in what we do, we would have been wiped off the face of the Earth years and years ago. Yet we persist. It is my opinion that we do not persist because of creative sales, influential legislation, and millions and billions in lobbying efforts. It’s because we are right in what we do on the most basic levels. 

Item #2

Our second item this week is an interesting article I came across from painchats.com called “This Spine Surgeon says Avoid Spinal Surgery for Low Back Pain: Stop and Think Carefully about Back Surgery.” the article is written by David Hanscom, MD and linked in our show notes for episode 68 at chiropracticforward.com[2].

His actual website is https://backincontrol.com but this article was in painchats.com.

The article starts off with this, “If you’re considering having spinal surgery as the final fix for your back pain, I’d like to help you to think again about your options.

I’m a spinal surgeon and I want you to know that surgery is not your best option for recovery from low back pain.

Surgery for relieving back pain has never been shown to be effective in a stringent research study. The most careful research paper published in 2006 demonstrated that only 22% of patients were satisfied with the outcomes two years later. Essentially, all research shows consistently poor outcomes for fusion surgery performed for back pain.”

Well….all I have to say is….HALLELUJAH!!!

We are going to look back at x-rays of fusions in 10-15 years and wonder what in the hell the surgeons were thinking. Mark my words people. 

He breaks it down into reasons. I will shorten the article but please, go read the whole thing. It’s really good and makes so much sense. 

Reason #1: Fusion back surgery doesn’t help pain. I love everything about this section but in particular this quote, “We also know that disc degeneration, ruptured discs, bulging discs, arthritis, and narrowed discs have been clearly shown to NOT be the source of chronic back pain.” Thank you for some common sense, man! 

Reason #2: Increased risk of more pain after back surgery. Obviously, people having spinal back surgery want less pain so you can easily see the issue here. He says if you’re already having chronic pain elsewhere, totally unrelated to the surgical issue, you are going to develop chronic pain at the new surgical site up to 60% of the time. 

Day-um… But that ties in so nicely with the neurology I’ve learned in the DACO program. When your CNS is already hyper sensitized or up-regulated, it makes sense that new insult is going to behave this way. He also says that re-operation rates within the first year are as high as 20%. Aren’t you just ecstatic that we don’t have to deal with patients that have had failed spinal surgery from day to day in our offices? Good Lord, the surgeons can have it. I don’t want it. 

Reason #3: Other treatment options are more effective. Praise the Lord and Hallelujah once again. He ties in the new finding in neurology for chronic pain. The stuff I’ve been talking about in the DACO program. He says, “Your brain memorizes pain just like an athlete, artist, or musician learns his or her skill.”

The best example is that of phantom limb pain. There is no limb, yet, the pain persists, right? I’m hoping that in your mind you just agreed with me and said, “Right,” to yourself. 

He says that once a patient understands the neurological nature of chronic pain, it becomes solvable and the key is to shift off the painful and unpleasant circuits onto functional and enjoyable ones or create detours around them. Basically re-wiring the brain to an extent. 

I can’t encourage you all enough to go read this article. Again, I’ve linked it in the show notes so go check it. 

Item #3: Chiropractic used for in infants and pediatrics has become quite the hot topic recently. Especially with the government in Australia looking at restricting any chiropractic treatment to the point where it may not be able to be utilized in patients under the age of 12 years old if I remember correctly. 

In addition, this is expected to be spreading. If my information is correct, it’s already looking to head that way in British Columbia as well as Ontario. So, it’s worth paying attention to. 

My first advice would be this: If you want to film your adjustments and put them on the interwebs, then go for it but, when it comes to hanging newborns upside down and performing manipulations on them that make them cry out and things of that nature…..I would encourage you to do your fellow pediatric chiropractors a favor and NOT put those videos on the internet. 

Not because I think you’re wrong. I don’t mess with babies myself but that’s because I’m not trained in it and am honestly uncomfortable with it. But that doesn’t mean I think it’s wrong either. Regardless, it’s not about right or wrong as much as it is perception. Particularly the perception by people that don’t know anything about or don’t understand chiropractic at all. Especially those ignorant but then also in a seat of power and influence. 

Just don’t freaking do it, OK? That’s what I’m saying. 

With all that in mind let’s get going with this one called “Manual therapy for the pediatric population: a systematic review” authored by Carol Prevost, Brian Gleberzon, Beth Carleo, and others[3]. It was published in BMC Complementary and Alternative Medicine on 24 of July 2018. Remember the research hierarchy pyramid and remember that this is a systematic review of 50 studies. 

What They Found

Moderate-positive overall assessment was found for 3 conditions: low back pain, pulled elbow, and premature infants. Inconclusive unfavorable outcomes were found for 2 conditions: scoliosis (OMT) and torticollis (MT). All other condition’s overall assessments were either inconclusive favorable or unclear. Adverse events were uncommonly reported. More robust clinical trials in this area of healthcare are needed.

This one is called “Utilization of Chiropractic Care in US Children and Adolescents: A Cross-Sectional Study of the 2012 National Health Interview Survey” authored by Dr. Trent Peng, et. al[4]. Dr. Peng is also a member of our Chiropractic Forward private group on Facebook. Congratulations Dr. Peng!

Why They Did It

The purpose of this study was to describe the prevalence of chiropractic utilization and examine sociodemographic characteristics associated with utilization in a representative sample of US children and adolescents aged 4 to 17 years.

How They Did It

They analyzed data from 9,734 respondents to the 2012 National Health Interview Survey and chiropractic utilization in the past 12 months was the targeted outcome. 

What they found

They found that

  • The 12-month prevalence of chiropractic utilization in US children was 3.0%
  • The adjusted odds (95% confidence interval) of chiropractic utilization were higher among 11- to 17-year-olds

That’s just to give you an idea of how underserved the younger population is

Last thing, it’s  titled, “Change in young people’s spine pain following chiropractic care at a publicly funded healthcare facility in Canada” authored by Christian Manansala, Steven Passmore, Katie Pohlman[5], and others and published in Complementary Therapies in Clinical Practice online on March 16, 2019. 

Hot stuff, coming up. 

That’s five articles this week. We are getting some serious schooling here right? The reason for this one was knowing that spinal pain in young people has been established as a risk factor for pain later in life, and considering the fact that recent guidelines recommend spinal manipulation and other modalities for back pain, the authors wanted to begin exploring the response to chiropractic treatment in young people with spinal pain. 

We already know it helps all of us old people but what about the kids?

The study utilized a retrospective analysis of prospectively collected quality assurance data attained from the Mount Carmel Clinic chiropractic program database. 

What they found

Young people 10-24 years old showed statistically and clinically significant improvement on the numeric scale in all four spinal regions following chiropractic management. 

The official conclusions reads as follows, “The findings of the present study provide evidence that a pragmatic course of chiropractic care, including SM, mobilization, soft tissue therapy, acupuncture, and other modalities within the chiropractic scope of practice are a viable conservative pain management treatment option for young people.”

Of course. For us that’s a duh sort of thing but, until it is written in research, you can’t treat it as a duh thing. While we think it’s an obvious conclusion, it’s not so obvious to others so thanks to these fine folks for doing the hard work and allowing all of us to stand on the shoulders of your efforts. 

This week, I want you to go forward with:

  • Big time research in medical journals keep proving you made the right decision to be a chiropractor. I know you didn’t need that validation personally but professionally, it’s a hell of a nice thing to have in our back pockets. 
  • Chronic back pain will never be cured by a surgery-first mentality and we knew that. But, our central nervous system plays as much a part in the resolution of pain as any mechanical factor plays a part in it. 
  • Pediatrics is under attack. Stop filming what you do. You’re not wrong but perception plays as much a part in the problems pediatric chiropractors are having as does any thing else. We get results in kids too but, if you don’t watch it, it’ll get taken away. Be smart. 
Chiropractic evidence-based products
Integrating Chiropractors
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

1. Rubinstein S, d.Z.A., van Middlekoop M,, Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ, 2019. 364(1689).

2. Hanscom D “This Spine Surgeon says Avoid Spinal Surgery for Low Back Pain: Stop and Think Carefully about Back Surgery.”. Pain Chats, 2019.

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

4. Peng T, C.B., Gabriel K,, Utilization of Chiropractic Care in US Children and Adolescents: A Cross-Sectional Study of the 2012 National Health Interview Survey. J Manipulative Physiol Ther, 2018. 41(9): p. 725-733.

5. Manansala C, P.S., Pohlman K,, Change in young people’s spine pain following chiropractic care at a publicly funded healthcare facility in Canada. Complementary Therapies in Clinical Practice, 2019.