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CF 023: How Can Research Help You Talk To The Medical Profession?

How Can Research Help You Talk To The Medical Profession?

This week we’re going to be discussing Chiropractic integration and how can research help you. Getting closer to the center of healthcare rather than being far out on the outer ring about to be spun into the cold dark void of space. 

First though, bring on that bumper music to get the party started. 

Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. You have beamed yourself right into Episode #23. 

We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. That’s a tall order but that is the goal.

Before we get started, I want to draw your attention our website at chiropracticforward.com. Just below the area where you can listen to the latest episode, you’ll see an area where you can sign up for our newsletter. 

I’d also like to let you know that I am starting to accept bookings for public talks. Do you need an hour or two for your Continuing Education seminar on low back pain guidelines or on Debunking the myth that chiropractors cause strokes? Go no further, you have found your man. Just send me an email at dr.williams@chiropracticforward.com and we will get it done. 

Part of my function is to show where we can fit more and more into mainstream health and why we fit. That’s where the research continues to smile on Doctors of Chiropractic. What does research tell us on this journey to expand and integrate?

Let us be honest with one another here when we say that there is a reason our profession is misunderstood. There is a reason that we have been treated unfairly for generations; since our inception. 

I would say the number one reason is that several in our profession over the years have professed chiropractic to be a miracle cure for any and all ills. Let me give you an example to demonstrate my point. I remember sitting in a seminar and the speaker who will remain unnamed was telling us that their patient had cancer and several adjustments caused it to encapsulate and then work out of the body into a large skin tag looking sort of thing before it finally just fell off. Cancer free!! Thanks to chiropractic!!

Young impressionable chiropractors-to-be lapped that speech right up and likely went on to tell scores of colleagues and patients all about this. And, this person is still out giving seminars and speaking to impressionable minds. 

Is it true? Who knows? I hate to denigrate something I truly don’t understand, but, I admit, I doubt it. And, if it were repeatable, this person would be in some hall of fame and would be the most famous person in healthcare because he discovered the cure for cancer. I mean, it gets no bigger than curing cancer does it?

Honestly though, it doesn’t matter what I think about it. What matters is whether or not boasts like this serve to further progress this profession or serve to make us walk the proverbial professional plank. If chiropractors can do clinical studies on such a thing, then get it done and quit talking about it. Prove what you say. You saw cancer work itself out of the body after your treatment? That is amazing, but in this day and age, it should be documented. You can get with a cancer research center and attempt to repeat your findings and prove what you think to be true. 

I’m being dramatic here but you get my point. I’m not trying to pick fights with this podcast. I’m trying to be honest and make sense. I realize that turns some off and I hate that because I truly feel civil discourse is in short supply in 2018. 

You find some claims in our profession that just lack any backing as far as research goes and I’d like to see our profession either put up or shut up basically. If you say you can do it, prove it and show us all through accepted research protocols and studies. “Because I said so,” no longer works.

Reason #2: I’d say, if you listened to episode #9, referenced and linked in the show notes, then you know that the American Medical Association and the state medical associations have done quite a job over the generations in de-valuing the chiropractic profession. 

Take the idea that chiropractors cause strokes in their patients. We spent three episodes of this podcast methodically dismantlying this crazy myth. I am referring to Episodes #13, #14, and #15 referenced and linked in the show notes along with the associated blog we posted on the matter called, “DEBUNKED: The Odd Myth That Chiropractors Cause Strokes.”  You can read the blog here: https://www.chiropracticforward.com/blog-post/chiropractic-forward-podcast-introduction-and-welcome/

The myth has no basis in fact and research clearly demonstrates this. Yet, you will still get arguments about how Doctors of Chiropractic cause strokes. The Chiropractic Forward Facebook page is proof enough of this. Fighting against long-held beliefs is a hard thing to do and all of the research in the world will never change some minds. However, that doesn’t mean we stop showing it to everyone! 

I will say with some sense of satisfaction that networking and forming relationships with medical providers has never been easier than it has become within the last several years and that is a stepping stone and absolutely welcome and a blessing. 

One thing I hear from straight chiropractors from time to time is that guys and girls like me are “Medi-Practors.” What does that mean exactly? Well, I would say it implies that we want to be medical doctors. But, they use the term for any chiropractor that even uses therapies like electric stim, ultrasound, or any other modality outside of just an adjustment. 

I would simply say that I personally have no desire to prescribe medications. In fact, when I have a car wreck patient, I’m actually glad I can just say, “I’m sorry, I can’t prescribe you anything since chiropractors treat conservatively and naturally and do not prescribe medications.” It’s liberating. I love that we do not treat that way. 

On the other hand, I certainly recognize the use of medicine and the benefits of some medicine. I’m not necessarily against medication. I’m certainly against long-term medication when lifestyle change could prevent being on medication. I’m absolutely against a mentality that simply treats the symptom with pharmaceuticals rather than addressing the cause or the source. 

As I say in almost every episode, spinal pain is a mechanical pain and it makes sense that mechanical pain responds better to mechanical treatment rather than chemical treatment. In addition, patients should have the guarantee of the best treatment that causes the least harm and, folks, when it comes to non-complicated spinal pain, that’s exactly what chiropractic is. How can research help you relay this message is powerful.

This podcast, in case you’ve wondered, is a bit cathartic for me. And, I will admit, doesn’t seem to stir as much fussing as I originally expected. In fact, most chiropractors listening are in agreement with me so I certainly feel a sense of validation there and I appreciate the support. 

As you should know by now, I enjoy covering research papers so let’s get to that now that my grumpier side decided to show itself. Back to our regularly scheduled program. 

Here’s one called “Can chiropractors contribute to work disability prevention through sickness absence management for musculoskeletal disorders? – a comparative qualitative case study in the Scandinavian context” by Stochkendahl et. al. published in Chiropractic & Manual Therapies on April 26th of 2018. Brand new stuff. 

Why They Did It

Even thought the guidelines are there for managing non-complicated musculoskeletal pain, there has been little to no decrease in work disability. Right now, Norwegian chiropractors have legislated sickness certification rights but the Danes and the Swedes do not. The authors were looking to describe, compare, and contrast the views and experiences of Scandinavian chiropractors when engaged in the prevention of work disability and sickness absence. 

How They Did It

The study was a two-phased sequential exploratory mixed-methods design. 

In a comparative qualitative case study design, the authors explored the different experiences amongst chiropractors in regards to sickness absence from face-to-face interviews.

What They Found

  • 12 interviews conducted
  • The chiropractors’ ability to manage sickness absence depended on four key factors:
  1. legislation & politics
  2. the rationale for being a sickness absence mangement partner
  3. whether an integrated sickness management pathway existed or could be created
  4. the barriers to service provision for sickness absence management. 

Wrap It Up

The authors concluded, “Allied health providers, in this instance chiropractors, with patient management expertise can fulfil a key role in sickness absence management and by extension work disability prevention when these practices are legislatively supported. In cases where these practices occur informally, however, practitioners face systemic-related issues and professional self-image challenges that tend to hamper them in fulfilling a more integrated role as providers of work disability prevention practices(Stochkendahl M 2018).”

And then this paper by F. Gedin, et. al. called “Patient-reported improvements of pain, disability and health-related quality of life following chiropractic care for back pain – A national observational study in Sweden” published in Journal of Bodywork and Movement Therapies in February of 2018

Again, pretty recent stuff. 

Why They Did It

The authors were simply trying to get patient reported feedback from those patients in Sweden seeking treatment via chiropractic for their back pain. 

How They Did It

  • The study was a prospective observational study
  • It included those 18 years and older having back pain of any duration 
  • It included 23 chiropractic clinics
  • The patient questionnaire was performed at baseline, and at 4 weeks
  • Questionnaires used were the Numerical Rating Scale, Oswestry Disability Index, health-related quality of life (EQ-5D index)
  • Visual Analog Scale or VAS

What They Found

There were statistical improvements over the 4 weeks for all patient reported outcomes. 

Wrap It Up

The authors’ conclusion was, “Patients with acute and chronic back pain reported statistically significant improvements in PRO four weeks after initiated chiropractic care. Albeit the observational study design limits causal inference, the relatively rapid improvements of PRO scores warrant further clinical investigations(Gedin F 2018).”

I want you to know with absolute certainty that When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple.

Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.

When you look at the body of literature, it is clear: research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good to excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic evidence-based podcast in the world. 

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

Social Media Links

iTunes

REFERENCES

Episode #9 with Dr. Tom Hollingswortth: The Case Against Chiropractic in Texas

https://www.chiropracticforward.com/2018/02/15/episode-9-dr-tom-hollingsworth-case-chiropractic-texas/

Episode #13: Debunked: The Odd Myth That Chiropractors Cause Strokes (Part 1)

https://www.chiropracticforward.com/2018/03/15/debunked-the-odd-myth-that-chiropractors-cause-strokes/

Episode #14: Debunked: The Odd Myth That Chiropractors Cause Strokes (Part 2)

https://www.chiropracticforward.com/2018/03/22/cf-episode-14-debunked-the-odd-myth-that-chiropractors-cause-strokes-part-2-of-3/

Episode #15: Debunked: The Odd Myth That Chiropractors Cause Strokes (Part 3)

https://www.chiropracticforward.com/2018/03/29/cf-015-debunked-the-odd-myth-that-chiropractors-cause-strokes-part-3-of-3/

“DEBUNKED: The Odd Myth That Chiropractors Cause Strokes.”  You can read the blog here: https://www.chiropracticforward.com/blog-post/chiropractic-forward-podcast-introduction-and-welcome/Bibliography

  • Gedin F (2018). “Patient-reported improvements of pain, disability and health-related quality of life following chiropractic care for back pain – A national observational study in Sweden.” Jounral of Bodywork & Movement Therapies.
  • Stochkendahl M (2018). “Can chiropractors contribute to work disability prevention through sickness absence management for musculoskeletal disorders? – a comparative qualitative case study in the Scandinavian context.” Chiropractic & Manual Therapies 26(15).

CF 013: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 1 of 3)

CF 022: Cold Laser Research You Should Know About

 

This week, I have some brand new research concerning spinal manipulation with laser therapy added as well as cold laser research looking at laser therapy in general. We concentrate heavily on research having to do with musculoskeletal conditions and I think this week gives us an opportunity to look at spinal manipulation but to also look at a modality many Doctors of Chiropractic implement regularly in their day-to-day lives. 

Before we get started with the cold laser research, I want to draw your attention our website at chiropracticforward.com. Just below the area where you can listen to the latest episode, you’ll see an area where you can sign up for our newsletter. I’d like to encourage you to sign up. It’s just an email about once a week to let you know when the episode is updated and what it’s about.

 

Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. That’s a tall order but that is the goal.

You have boogied right on into Episode #22

But first, my week has been mixed man. Being a small business owner isn’t all peaches and cream is it? I tell you, sometimes you’re up….sometimes you’re down but we keep soldiering on. I’ve been in practice for 20 years and it can still be stressful. I found something that helps me though. Some of you already know this. It’s music. You can have elevator music on in your office if you like but I say NO. 

First, your patients don’t really like that stuff. Just in case you didn’t know that, I’m telling you now. I spent the time last week to make a couple of playlists. One is called Memphis/Motown/Muscle Shoals and one is called Rat Pack. Now, I’m a former traveling musician. In fact, the bumper music you just listened to….I wrote that and recorded all of the parts on it from the guitars, bass, piano, everything. 

My personal preference is Americana/Texas Country style music. If you have iTunes, you can find my old touring band called Copperhead and the album is called Remedy. That was us! 

Anyway, Texas Country is my preference but, for my office, I and my patients are loving the older boogie and soulful stuff like Otis Redding, Wilson Pickett, The Temptations, Ray Charles, and anything that fits that style whether it’s old or new. Doesn’t matter. In fact, a lot of the newer artists are sounding like the great stuff from the older days. I love it. Then, to mix it up a bit, I throw in the Rat Pack list here and there with Sinatra, Harry Connick Jr, Michael Buble, Dean Martin, and guys like Wayne Newton. It’s great. Classy and cool. Anyway, the days have just started flying by. When you boogie all day, and your patients boogie all day, well…..it makes for an awesome place with an awesome experience. 

If any of you have any interest in the playlists, send me an email or Facebook message and let’s talk about it. I love talking music!!!

Now, what we are REALLY here for. 

Let’s start by saying that Low Level Laser has been around for many years in one for or another at this point in time. But, how many actually know where it came from, how it was discovered, and what research is there showing its effectiveness? 

I would hope that, if you include a modality in your office, you have done some background work to show yourself and to demonstrate to your patients that there is backing research for the modality and they don’t just simply need to take your word for it. And, if you can find little to no evidence of effectiveness for a modality, my suggestion is that it should play no part in your services. Of course, that is my opinion and can be taken or dropped as may opinions commonly are. 

Let’s start with the newest paper that mentions cold laser but does not really do anything to address effectiveness of cold laser. I think you can anticipate the outcome once you learn the basis but, it is new so we are talking about it. 

This paper is called, “Spinal manipulation combined with laser therapy is more beneficial than laser therapy alone in chronic non-specific low back pain. A randomized controlled study,” and it was published in the European Journal of Physical Rehabilitation Medicine on April 24, 2018 and was authored by Subash Chandra Bose, et. al(Subash Chandra Bose GN 2018). 

 

Why They Did It

The authors were looking to compare treatment regimens for exercise/cold laser/spinal manipulation vs. exercise/cold laser alone for patients suffering from chronic non-specific low back pain.

How They Did It

  • Three hundred and thirty patients were included
  • Study was randomized control
  • Outcome measurements used were Visual Analog Scale, Roland and Morris Disability Questionnaire, Physical Health Questionnaire, and Health Related Quality of Life-4.
  • Outcome measurements were taken at the beginning to measure the baseline total, at the 4-week mark, at the 6-week mark, and at the year mark. 
  • A blinded assessor was used to evaluate the Outcome Measures

What They Found

  • 326 patients finished the program
  • 304 patients finished through the 1-year mark
  • ANOVA analyses proved statistically significant improvement in regards to the lessening of pain, in regards to increased range of motion, functional disability, depression, and Quality of Life. 
  • All of these significant improvements were seen in the Spinal Manipulation/Exercise/Laser Therapy group. 

Wrap It Up

The authors conclusion was, “Spinal manipulation combined with laser therapy and conventional exercise is more effective than laser therapy and conventional exercise alone in chronic non-specific low back pain. Spinal manipulation is an adjuvant intervention and it can be applied in every day clinical practice.”

If you have paid attention to research, you probably predicted the outcome on this. Spinal manipulation appears to be the most effective means of treating non-complicated low back pain bar none. It just is. On top of laser plus exercise, on top of exercise, equal to more effective than NSAIDs…..it just is and research backs it time and time again. 

But, this paper does nothing to look at cold laser specifically. It just shows us that spinal manipulation gets better results. 

Let us say up front: low level laser, also known as cold laser, is not covered under insurance plans. As they explain it, the modality is experimental and investigational. I have a ton of experience and anecdotal evidence I could relay to you but, in the end, it’s cold laser research that you need for validation. 

First, let’s go through a brief history on cold laser before we get to the cold laser research. 

In 1967 a few years after the first working laser was invented, Endre Mester in Semmelweis University in Budapest, Hungary experimented with the effects of lasers on skin cancer. While applying lasers to the backs of shaven mice, he noticed that the shaved hair grew back more quickly on the treated group than the untreated group. It’s use wide array of uses have been explored since then and they had no idea where it would lead them.

When we think of lasers, we think of burning or cutting lasers. Cold laser is actually called low level laser. It’s different. You really don’t feel it during the treatment and It works by stimulating cell function. The second paper below by Cotler et. al. states “LLLT at low doses has been shown to enhance cell proliferation of fibroblasts, keratinocytes, endothelial cells, and lymphocytes. The mechanism of proliferation is thought to result from photo-stimulation of the mitochondria leading to activation of signaling pathways and up regulation of transcription factors eventually giving rise to increases in growth factors.”

Here is a paper from 2014 published in the International Journal of Oral and Maxillofacial Surgery called “Does low-level laser therapy decrease swelling and pain resulting from orthognathic surgery?” and authored by G. Gasperini, et. al(Gasperini G 2014). 

Why They Did It

Hoping for alternatives to treating swelling and inflammation following orhognatic surgery, and noticing there was a lack of research for or against cold laser, the authors wanted to further investigate it’s effectiveness in that capacity. 

How They Did It

  • 10 patients having undergone bilateral sagittal split with Le Fort I osteotomy were randomly selected. 
  • The treatment protocol consisted of intraoral and extraoral treatment with the laser on one side of the face following surgery 
  • Fake application was performed on the other of the face. Remember that surgery was done on both sides. 
  • The two sides were compared for pain using the visual analog scale and for swelling.

What They Found

  • Immediately after surgery, there was little to no difference for inflammation and pain in the two sides.
  • On the side treated with cold laser, inflammation and swelling decreased significantly on day three, day seven, day fifteen, and day thirty. 
  • Self-reported pain was reduced on the treatment side at the one-day mark and at the three-day mark. 
  • After seven days, however, no pain was present on either side. 

Wrap It Up

The authors of this paper concluded, “This LLLT protocol can improve the tissue response and reduce the pain and swelling resulting from orthognathic surgery.”

Here’s one from Dr. Roberta Chow, et. al, published in The Lancet in 2009 called “Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomized placebo or active-treatment controlled trials.(Chow R 2009)”

You should know the reputation of The Lancet. If not, it is one of the world’s oldest medical journals dating back to 1823. Being published in The Lancet is notable to say the least. 

Why They Did It

The point was to perform a systematic review of the literature proving or disproving the effectiveness of cold laser in the treatment of neck pain. 

How They Did It

The authors did an exhaustive search of the databases holding information comparing efficacy of cold laser implementing any wavelength vs placebo or active control for acute or chronic neck pain. 

What They Found

  • 16 Randomized Controlled Trials were identified
  • 820 patients

Wrap It Up

“We show that LLLT reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain.”

Powerful in my opinion, folks.

This paper is called “The Use of Low Level Laser Therapy For Musculoskeletal Pain” by Howard Cotler et. al. and was published in 2015 in MedCrave Online Journal of Orthopaedics & Rheumatology(Cotler H 2015).

Why They Did It

With the current treatment options for chronic musculoskeletal pain consisting of NSAIDs, steroid injections, opiates, and surgery, the authors recognized a need to further treat chronic pain in a more effective manner as chronic pain continues to become more and more prevalent globally. Particularly chronic low back pain. 

What They Found

The authors state that over 4000 papers found on pubmed show that cold laser does indeed show effectiveness on acute and chronic musculoskeletal pain. They state that heterogeneity of populations, treatments, and groupings means that not every single study was positive but the majority are positive. They also state that the overall positive studies should provide the practitioner with a certain level of confidence in implementing the modality in their treatment protocols. 

Wrap It Up

The authors concluded the following, “One has to be realistic about the therapeutic use of LLLT. The previous discussion has shown that LLLT is beneficial for pain relief and can accelerate the body’s ability to heal itself. LLLT has a long history and strong basic science evidence, which supports its use in pain management. It has few side effects and is well tolerated by the elderly. A laser or LED does not correct situations involving structural deficits or instabilities whether in bone or in soft tissue. Also, LLLT should only be used as an adjuvant therapy for pain relief in patients with neuropathic pain and neurologic deficits. Successful outcomes, like all medical management, depend on good clinical skills linked with an understanding of the nature of injury, inflammation, repair, pain, and the mechanism of laser and LED effects.”

That’s good stuff I think you’d all agree. 

And then there’s this paper from 2003 we will cover quickly. It’s called “Efficacy of low power laser therapy and exercise on pain and functions in chronic low back pain” and written by A. Gur, et. al.. It was published in Lasers in Surgery and Medicine(Gur A 2003).  I do dislike including papers from 15 years ago since lasers and technology change rapidly  these days, however, my thought process is that, hopefully, treatments become even more effective over the course of 15 years rather than less effective. 

Why They Did It

The authors were trying to decided whether cold laser was effective (or was not effective) for treating chronic low back pain. 

How They Did It

  • 75 patients
  • The outcome assessments were done through the visual analogue scale, the Schober test, through flexion and lateral flexion measures, through the Roland Disability Questionnaire, and through the Oswestry Disability Questionnaire. 
  • The measures were taken pre- and post-treatment. 

What They Found

Except for lateral flexion specifically, significant improvement was noted in all groups and in all outcome measures taken. 

Wrap It Up

The conclusion by the authors was, “Low power laser therapy seemed to be an effective method in reducing pain and functional disability in the therapy of chronic LBP.”

Key Takeaways this week:

I don’t care what the insurance companies say about cold laser research and cold laser being experimental and investigational. Cold laser is not a “chiropractic thing” and practitioners of all shapes, sizes, and professions are using it including dentists and surgeons. While there are some papers that aren’t positive, heterogeneity and styles and techniques make it difficult. However, the majority of papers on cold laser are very much positive and show effectiveness including those published in The Lancet. 

Walk forward in your practice knowing that you are getting your patients better with cold laser and you are helping make a difference in their lives. 

Going forward this week, Retweet us, like our page on Facebook, and SHARE us on Facebook so we can get those likes up and increase listenership and involvement. We need every bit of your help to do that. I can’t do it alone. 

I want you to know with absolute certainty that When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.

When you look at the body of literature, it is clear: research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good to excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic evidence-based podcast in the world. 

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

Social Media Links

iTunes

CF 016: Review of The Lancet Article on Low Back Pain (Pt. 1)

CF 014: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 2 of 3)

 

Bibliography

  1. Chow R (2009). “Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials.” Lancet 374(9705): 1897-1908.
  2. Cotler H (2015). “The Use of Low Level Laser Therapy (LLLT) For Musculoskeletal Pain.” MOJ Orthop Rheumatol 2(15).
  3. Gasperini G (2014). “Does low-level laser therapy decrease swelling and pain resulting from orthognathic surgery?” Int J Oral Maxillofac Surg 43(7): 868-873.
  4. Gur A (2003). “Efficacy of low power laser therapy and exercise on pain and functions in chronic low back pain.” Lasers Surg Med 32(3): 233-238.
  5. Subash Chandra Bose GN (2018). “Spinal manipulation combined with laser therapy is more beneficial than laser therapy alone in chronic non-specific low back pain. A randomized controlled study.” Euro J Phys Rehabil Med.

CF 021: Crazy Update On Run-Away Healthcare Spending in America

Crazy Update On Run-Away Healthcare Spending in America

In today’s podcast, we are going to talk about the crazy, run-away healthcare spending in America and we’re going to use an article straight from the leading authority, the Journal of the American Medical Association, to help us out.

Before we get started, I want to share with you how much have enjoyed getting this podcast up and running. I strongly doubt it’s as popular as the other great chiropractic podcasts that have been up and going for a couple of years now. Heck, Chiropractic Forward has just been going since December so, at this point, one would expect for us to still be trying to gain attention and trying to gain some ears. And…..we are. No doubt.

But I can say that is has been pure joy to look up the downloads for each episode and seeing that, no…..its not just me that finds this stuff fascinating. Lol. You guys and gals are starting to listen and starting to pay attention.

We’re still struggling for those like and retweets on Twitter.

That’s the frustrating part if I’m being honest. To KNOW that you have put together an effective article on how chiropractors do not cause strokes and then to have such a hard time getting the word out. It’s frustrating to be sure but it’s also part of building something new and exciting.

So, I will simply continue to remind you that we need your help if we are to make a difference and I will keep reminding you to like our Facebook page, follow us on Twitter, sign up for our weekly reminder newsletter through the form on our homepage, and share us with your network.

We would certainly appreciate that help. Some of you may have actually gotten to see me arguing the stroke issue on our Facebook page. My gosh, some people, you could hit them with a research book full of papers in your favor and some would still argue just to try to prevent being wrong.

Not only do I get to argue about stroke or whatever the topic may be, it always strays into generalized ignorant statements like, “Chiropractic is bunk.”

I can use research to absolutely wipe the floor with people like that. And, the irritating thing is that the people, or trolls spouting off like that are usually computer majors, musicians, or something else completely removed from healthcare.

It is enough to make a man insane if you allow it. So I don’t.

Anyway, check us on Twitter and Facebook. Every now and then, you may find an enthusiastic discussion. lol. To say the least.

Since I haven’t yet, I’ll introduce myself, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. That’s a tall order but that is the goal.

You have shaked, shimmied, and rolled into Episode #21

I’d like to start by saying that it is good to see the medical world beginning to examine itself with a clear lens. We have seen them turn blind eyes to many things we notice and research notices. As we have mentioned, there has been little attention given to the updated recommendations in favor of chiropractic, massage, and acupuncture in February of 2017. It is yet to be known what, or if anything, will change following the series of low back pain papers recently published in The Lancet (March21, 2018).

I have been mentioning how I feel that the opioid crisis has opened many many doors recently in regards to the medical field, clinical pathways, and in they way they are starting to look at the costs. Kudos to those in the medical field for beginning to call out their own protocols and questions them for effectiveness vs. risk. Some procedures may be effective here and there but, in general, if the squeeze is not worth the push, then there is little to zero return on investment and it should be abandoned. Obviously, one’s health is different than a business stat sheet but the metaphor is a valid one I believe.

Obamacare was supposed to heal all of our healthcare woes, right? From what I can tell, all it did was squeeze out the middle class. The folks that make too much to be subsidized but do not make enough to not really care about the new jacked health insurance rates.

For example, the premiums here in Texas have doubled or tripled in many cases while the insurance companies cover less and less. The co-payments have gone from $15-$20 all the way up to $50 and even $100. The deductibles have gone from $250 or $1,000 all the way up to $5000 or $10,000. In addition, the insurance companies are now reimbursing healthcare providers less. in many cases, 3/4 less.

Did you know that here in Texas, where a medical radiologist was once reimbursed up to $28+ or so for reading a neck series, they now get paid in the ballpark of $7 for the same series? I promise the doctors are not living less of a life than they were prior to Obamacare. Not at all. But, what is likely happening unconsciously is they are probably reading more x-rays more quickly to attempt to make up for the reduction in their pay.

Would you agree that this may put patients at more risk? I’m not saying doctors make a conscious decision to put patients at risk but, if a professional in ANY industry has a house in town, a house and boat on the lake, 3 cars, time share on a private plane, and things of that nature, when their income is cut by 3/4 in some cases, they will tend to find ways to make that up in ways that make sense to them. Regardless of profession or industry.

Maybe Obamacare just makes them more efficient rather than raising the patient risk. I do not have the answer on this but I do know that radiologists are responsible for everything on a film and their license is at risk on each and every film. When the government cut their pay that dramatically, the government began putting people at more risk. In my opinion of course.

I am firmly on the side of the medical field on this issue. The same type of thing is currently happening with the chiropractic industry as well. We are being reimbursed at smaller and smaller rates. We are seeing our covered patients being turned into cash patients whether we like it or not. The co-pays and deductibles are so high, the could just as easily be cash patients for our purposes. For this very reason, you are seeing more and more chiropractors in America begin to look at changing over to a cash-based practice model and drop insurance contracts all together.

I’m not certain every bit of this discussion is completely on topic but let me tie it up and bring it home through the use of this research paper. This paper appeared in the Journal of the American Medical Association (JAMA) on March 23, 2018. It was titled “Health Care Spending in the United States and Other High-Income Countries” and was authored by Irene Papanicolas, PhD (Papanicolas I 2018).

Why They Did It
Healthcare spending in America is a long-time hot topic and issue that has never been adequately addressed. Part of the problem is that we Americans spend more than other high-income countries with little information that shows that any efforts to control expenses has done anything to help the problem.

These authors attempted to compare the big ticket items in healthcare in America with the same items in ten other high-income countries in an attempt to learn where improvement might be made here at home.

How They Did It
Information was mostly gained from the Organization for Economic Cooperation and Development (OECD) from 2013-16. The OECD is an international organization comparing underlying differences in structural features, types of health care and social spending, and performance for several high-income countries.

What They Found
In 2016, America spent 17.8% of its gross domestic product on healthcare while the other 10 nations spent from 9.6%-12.4%.
Surprise, surprise….pharmaceutical costs spending per capita in America was $1443 vs. from $466-$939 in the other 10 countries. American doctors and patients love those pills. That is healthcare spending in America at its best.
90% of Americans are insured while 99%-100% were insured in the other 10 countries.
The U.S. has the highest proportion of private insurance when compared to the other 10 countries, which is 55.3%.
When it comes to smoking, Americans actually have the second lowest rate sitting at 11.4%
When we talk about obesity, the US has the highest proportion at 70.1%. Others range from 23.8%-63.4% for comparison purposes.
The US life expectancy was the lowest at 78.8 years.
US infant mortality was the highest rate of the 11 countries.
There was no real difference in the American physician workforce, nurse workforce, etc., when compared to the other 10 countries.
America has comparable numbers of hospital beds
Americans use MRIs and CTs when compared to the other 10 countries.
The US had similar rates of utilization for acute myocardial infarction, pneumonia, chronic obstructive pulmonary disease, hip replacements, knee replacements, and coronary artery bypass graft surgery.
Administrative costs of care in American stood at 8% while the same measure in the other 10 countries ranged from 1%-3%.
Salaries of physicians and nurses were higher in the US; for example, generalist physicians salaries were $218 173 in the US compared with a range of $86 607 to $154 126 in the other countries.

Wrap It Up
The authors of the paper concluded that, “The United States spent approximately twice as much as other high-income countries on medical care, yet utilization rates in the United States were largely similar to those in other nations.

Prices of labor and goods, including pharmaceuticals, and administrative costs appeared to be the major drivers of the difference in overall cost between the United States and other high-income countries”

My own wrap up would be that America spends twice as much money on healthcare while we have the highest rate of obesity, double the amount of pharmaceuticals, lower life expectancy, higher infant mortality, and higher administrative costs when we are compared to 10 other countries of similar income. Healthcare spending in America is out of hand.

That’s not good, folks. Not good at all. When do the pharmaceutical companies stop controlling the medical profession and the medical profession turn it around to control the pharmaceutical companies? When does that happen exactly?

Did you know that, from 1948 until 1996, there was a TV ban on running liquor ads? You may see beer or wine ads but you would never see Jim Beam running a commercial between Alf and Different Strokes. But, how often do we see pharmaceutical ads on TV these days? It’s a shame to be honest. Shouldn’t the doctor be the one that is informed on medications rather than a 320 million people that are almost completely uneducated on pharmaceuticals? Should patients be going into doctors’ offices ready to pressure them into a certain medication because they saw it on TV?

It is absolutely insane and should have been stopped at the first mention of it. To make it fair or legal or whatever may be the case, they state a long laundry list of all of the things that may happen to you if you take it. But, the information is delivered and people are influenced.

If a patient goes in for something like erectile dysfunction, the doctor tells them what they need. They don’t tell the doctor!! Do you see the problem here? If the patient goes in for potential blood clots, the doctor should be telling them they need a certain type of thinner. That is not the patient’s place in any country on the entire planet.

Not only do the pharma companies control patient mentality in this way but they attempt control of the physicians. Pharma reps are skilled at what they do. They are highly trained and very well-paid to effect influence in their market’s physicians. They take them on dinners, bring the office lunches, pay for trips, etc. You can spot them at any doctor’s office you go to. Just look for the well-dressed person in the waiting room with a clip board and a bag of goodies. That’s them!

I had a general practitioner that I had to finally fire. I had been living a bit unhealthy for several months when I went for a yearly checkup. My blood pressure was high. He immediately tried to put me on life-long meds. I was overweight and drank a 12-pack of Bud Light here and there while traveling in a band playing music. You might say that I used to be a little bit ornery. Again, I was admittedly behaving badly. His diagnosis was that I was depressed and needed an anti-depressant. Really?

Instead of trying some behavior modification, according to him, I needed life-long blood pressure meds and life-long antidepressant meds. Where does this mentality come from? What if we treat the CAUSE rather than the SYMPTOM?

First, I lost weight and started to behave. Guess what? My blood pressure returned to normal. As a result of ceasing traveling in a band, I basically quit drinking beer outside of social events. Boom! I was no longer depressed according to his definition.

This may seem like an extreme example to some but, it is my estimation that this sort of “doctoring” and “pill pushing” is far more common than one may even dream.

I am in no way against the medical field or against surgery or against medicine. I am against simple pill fixes. I’m against long-term meds when not needed. There are some conditions like diabetes or genetic high blood pressure that require long-term meds but, in many cases, they should be avoided. I’m against the medical field performing shots and surgeries and using opioids for musculoskeletal pains when the research is clear when it recommends chiropractic, massage, etc.. for those pains.

Basically, the medical field needs to stop thinking the pills are the be all – end all of healthcare and start looking more to the cause rather than just treating the symptoms. The physicians need to take the reins of their profession away from the pharmaceutical companies and wield the power over pharma that they attempt to wield over chiropractic and other alternative means of healthcare.

Enough about them for this episode. I want you to know with absolute certainty that When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.

When you look at the body of literature, it is clear: research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good to excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic evidence-based podcast in the world.

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

CF 013: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 1 of 3)

CF 016: Review of The Lancet Article on Low Back Pain (Pt. 1)

Bibliography
Papanicolas I (2018). “Health Care Spending in the United States and Other High-Income Countries.” JAMA 319(10): 1024-1039.

CF 019: Non-Opioid More Effective While Chiropractic Maintenance May Be The Most Effective

Non-Opioid More Effective While Chiropractic Maintenance May Be The Most Effective

This Chiropractic Forward podcast this week is a bit of a mishmash of a couple studies that will ultimately intertwine into a valid discussion including chiropractic maintenance and a discussion about non-opioid vs. opioids.

Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast where we talk about issues related to health, chiropractic, evidence, chiropractic advocacy, and research. Thank you for taking time out of your day I know your time is valuable and I want to fill it with value so here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

Before we get started, I want to draw your attention our website at chiropracticforward.com. Just below the area where you can listen to the latest episode, you’ll see an area where you can sign up for our newsletter. I’d like to encourage you to sign up. It’s just an email about once a week to let you know when the episode is updated and what it’s about. Also, if something brand new pops up, we’ll be able to tell you about it quickly and easily.

You have moonwalked into episode #19. I hope you have enjoyed the previous episodes. Particularly the last six which were a part of a series all debunking the “Chiropractors Cause Strokes” myth and then another series of podcasts reviewing the lancet articles on low back pain. The Chiropractic profession NEEDS you to share those 6 episodes in particular

Now, since we have covered the impact of the opioid crisis exhaustively, I will cover it only briefly for reference purposes.

  • Low back pain is the single leading cause of disability worldwide.
  • 8 out of every ten people will experience back pain. I will admit that I have never met anyone in 45 years of life on this Earth that fits into the 20% that apparently never suffers from any low back pain.
  • Back pain is the second most common reason for visits to the doctor’s office right behind upper-respiratory infections.
  • With such gains and leaps in the medical industry as far as treatment goes, low back pain is stubbornly on the rise.
  • More than half of Americans who experience low back pain spend the majority of the work day sitting. 54% to be exact. Did you know that an equal number of patients first seek help with a chiropractor as seek help with a medical practitioner for back pain?
  • Back pain in general costs $100 billion dollars every year when you factor in lost wages and productivity, as well as legal and insurance overheads.

Should there be any doubting the necessity of non-pharmacologic treatments for low back pain at this point, then a person is simply beyond help. We can only refer you to a report from the Executive Office of the President of the United States’ report titled “The Underestimated Cost of the Opioid Crisis” put forth by the Council of Economic Advisers in November of 2017[1].

That reminds me, that paper citation as well as any others we talk about here will be in the show notes so always check out www.chiropracticforward.comfor those show notes.

Now that the nation and the medical field understand the danger of opioids, we are certainly starting to see an increase in research having to do with opioids. A brand new paper of particular note was published March 6, 2018 in JAMA, performed by Dr. Erin Krebs, MD, et. al. and is titled “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 [2].”

Why They Did It

How They Did It

  • 240 subjects
  • 12-month trial
  • Randomized with masked outcome assessments
  • Test subjects experienced moderate to severe chronic back, hip, or knee osteoarthritis pain despite analgesic use.
  • Interventions tested were opioids and nonopioids
  • The first step of the opioid group included immediate-release morphine, oxycodone, or hydrocodone/acetaminophen
  • The nonopioid group’s first step was acetaminophen or a nonsteroidal anti-inflammatory drug.
  • Medication was changed and/or adjusted within each group according to patient response.
  • The main outcome assessment used was Brief Pain Inventory (BPI) scale.

What They Found

  • 240 subjects completed the trial
  • There was little difference between the two groups in terms of function over the course of the 12 months of testing.
  • Pain intensity was actually much more improved (statistically significant) in the NONopioid group.
  • Adverse harms (bad side-effects) were significantly greater in the opioid group.

Wrap It Up

Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.”

Again, I don’t wish to belabor a point we have covered several times but, for the purpose of this discussion, we must mention them. The medical field is stepping up to the challenge slowly but, I would argue significantly. The American College of Physiciansupdated their treatment recommendations for chronic and acute low back pain just last year. In the report[3]they recommended spinal manipulation prior to taking ibuprofen or other over-the-counter NSAIDs for low back pain. One month later, in JAMA (the journal for the American Medical Association) there was a paper demonstrating the effectiveness of spinal manipulative therapy[4]. IN JAMA!! The significance of this cannot be overstated.

Next, let us talk a little bit about chiropractic treatment for low back pain, what it looks like, and whether chiropractic maintenance care really makes any sense. that recommend preventative (AKA Wellness Care) to their patient bases.

Let me start by stating my opinion and the opinion of most evidence-based chiropractors I would assume: active, complaint-focused treatment should have a start and it should have an end. Plain and simple, cut and dry. How does chiropractic maintenance fit in there?

If a patient is coming in for a complaint such as neck pain, the practitioner should decide whether the pain is acute, subacute, or chronic and, based on history and exam findings, be able to give some good, responsible recommendations for the treatment of the complaint. Typically, the acute schedule will be shorter in terms of treatments and time vs. a chronic condition. A chronic condition is more difficult to treat and one would reasonably expect the schedule for a chronic condition to be longer and more intense. The CCGPP guides[5]can be useful for this sort of decision-making.

For example, Medicare has broken down how they value diagnosis codes into groups A-D. In their system, the secondary diagnosis codes can be the difference between seeing a patient only 12 times or as much as 30 visits for a specific complaint. A simple low back pain diagnosis or muscle spasm diagnosis garners 12 visits from Medicare while degeneration of lumbar intervertebral disk or lumbar spinal stenosis will indicate up to 30 visits for treatment.

In the personal injury world, according to the Quebec Taskforce on Whiplash Associated Disorders, if a patient is assessed with a Grade III whiplash, assuming complications, they can be treated up to 76 visits over 56 weeks. That’s a lot of treatment but the length of treatment reflects the severity of injury as a Grade III whiplash is associated with ligament tearing and/or neurological findings.

For more information on general guides for practice protocol, please reference a previous blog of ours on the topic at https://www.amarillochiropractor.com/valuable-reliable-expert-advice-clinical-guides-practice/or listen to our podcast at https://www.chiropracticforward.com. The guides can be found in Episode #5 which can be found at this link: https://www.chiropracticforward.com/2018/01/18/cf-episode-5-valuable-reliable-expert-advice-on-clinical-guides-for-your-practice/

What does all of that have to do with chiropractic maintenance care? The point being made is that there are a lot of different chiropractors. Seventy thousand plus in America alone and, although there are guidelines out there, chiropractors do not typically seem to have a general overall desire to implement them. One chiropractor may tell you that they will need to see a chronic neck pain patient 50 visits a year to clear it up while another may see the same condition for 18-20 visits. This is not only frustrating for chiropractors, it’s highly frustrating for patients as well.

Of course, this is not true but, don’t chiropractors commonly recommend preventative or chiropractic maintenance care that may resemble “rest of your life” care? It’s my opinion that once a complaint resolves, patients should see their chiropractor once a month. Minimally, they should be seen once every two months. That is chiropractic maintenance and that is my opinion. I will find more than a handful of chiropractors that will disagree with me on both ends of the spectrum but the key to the idea is “chiropractic maintenance” care in some sort of ongoing fashion.

There is research for chiropractic maintenance care. Take this paper from 2011 for example. It is by MK Senna, it’s titled “Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome?” and was published in the prestigious Spine journal[6]. For the purpose of this study, keep in mind that SMT stands for spinal manipulation therapy. Also of special note is that chiropractors perform over 90% of SMTs in America so I commonly interchange SMT or spinal manipulation therapy with the term “Chiropractic Adjustment.”

Why They Did It

The authors of this paper wanted to check how effective spinal manipulation, also known as chiropractic adjustments, would be for chronic nonspecific low back pain and if chiropractic maintenance adjustments were effective over the long-term in regards to pain levels and disability levels after the initial phase of treatment ended.

How They Did It

  • 60 patients having chronic low back pain of at least six months duration
  • Randomized into three different groups:
  • 12 treatments of fake treatment for one month
  • 12 treatments of chiropractic adjustments for a month only
  • 12 treatments for a month with maintenance adjustments added every 2 weeks for the following 9 months.
  • Outcome assessments measured for pain and disability, generic health status, and back-specific patient satisfaction at the beginning of treatment,

What They Found

  • Patients in groups 2 and 3 had significant reduction in pain and disability scores.
  • ONLY group 3, the group that had chiropractic maintenance adjustments added, had more reduction in pain and disability scores at the ten-month time interval.
  • The groups not having maintenance adjustments, pain and disability scores returned close to the levels experienced prior to treatment.

Wrap It Up

The authors conclusion is quoted as saying, “SMT is effective for the treatment of chronic nonspecific LBP. To obtain long-term benefit, this study suggests maintenance SM after the initial intensive manipulative therapy.”

For my own wrap up this week I would say simply this:

  • Low back pain is a significant issue for Americans
  • It is one of the biggest reasons people get hooked on opioids
  • As shown above, opioids are no more effective than non-opioids so why would anyone use them?
  • Chiropractic has been shown superior to nonopioids (specifically Diclofenac[7])
  • The big boys of the medical field (ACP and AMA) and the White House itself are recommending chiropractic for the treatment of low back pain before using even NSAIDs

So, why is this even in the discussion phase rather than the implementation phase? Why are we not inundated with low back pain patients at this very minute?

We have to go back to a different White House report that came out recently discussing the fact on page 57 of the report that although chiropractic has been proven effective, barriers to chiropractic treatment have been put in place by CMS and health insurance providers[8].

The specific wording is as follows: “A key contributor to the opioid epidemic has been the excess prescribing of opioids for common pain complaints and for postsurgical pain. Although in some conditions, behavioral programs, acupuncture, chiropractic, surgery, as well as FDA-approved multimodal pain strategies have been proven to reduce the use of opioids, while providing effective pain management, current CMS reimbursement policies, as well as health insurance providers and other payers, create barriers to the adoption of these strategies.” “The Commission recommends CMS review and modify rate-setting policies that discourage the use of non-opioid treatments for pain, such as certain bundled payments that make alternative treatment options cost prohibitive for hospitals and doctors, particularly those options for treating immediate post-surgical pain.”

It’s all there. It’s simple. All we can do is continue to tell everyone and beg for your help in telling everyone as well.

It is up to us to spread the good news and all it takes is hitting the Share button on social media. Retweet, help get the word out.

I challenge you to tell your people. It’s so easy but it takes a little initiative on your part. You actually have to do something now. Your profession is poised on the edge of stepping into a role it is uniquely able to fulfill and excel in but NOT unless we reach out and take that role and hold onto it.

Our effectiveness is proven. It’s time. Help us help you. I’m not asking for donations. I don’t want your money. I want your influence. So do us a favor if you will and share this information and, if it didn’t get the response you hoped for, share it again. Print out the parts of this article you find particularly effective and send it to medical practices in your area.

Make a difference.

Did you know that research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic? Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “chiropractic maintenance” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes.

If you love what you hear, be sure to check out www.chiropracticforward.com. As this podcast builds, so will the website with more content, products, and chances to learn.

We cannot wait to connect again with you next week. From Creek Stone, my office here in Amarillo, TX, home of the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

Source Material

  1. The Council of Economic Advisers, The Underestimated Cost of the Opioid Crisis. 2017: The Executive Office of the President of the United States of America.
  2. Krebs E, 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, 2018. 319(9): p. 872-882.
  1. Qaseem A, Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians.Ann Intern Med, 2017. 4(166): p. 514-530.
  2. Page N, Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain.Journal of American Medical Association (JAMA), 2107. 317(14): p. 1451-1460.
  3. Baker G, Algorithms for the Chiropractic Management of Acute and Chronic Spine-Related Pain.Topics in Integrative Health Care, 2012. 3(4).
  4. Senna MK, Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome?Spine (Phila Pa 1976), 2011. Aug 15; 36(18): p. 1427-37.
  5. Wolfgang J, e.a., Spinal HVLA-Manipulation in Acute Nonspecific LBP: A Double Blinded Randomized Controlled Trial in Comparison With Diclofenac and Placebo.Spine, 2012. 38(7).
  6. The President’s Commission on Combating Drug Addiction and The Opioid Crisis. 2017.

CF 018: Pt. 3 – Review of The Lancet Article: Low back pain a call to action

Review of The Lancet Article: Low back pain a call to action (Part Three)

On the Chiropractic Forward podcast this week, we are going continue a review of a recent paper published on low back pain that we hope will have a powerful impact in the months and years to follow. This week it will be a review of paper #3 from the Lancet series – low back pain a call to action.

Before we get started, I want to draw your attention our website at chiropracticforward.com. Just below the area where you can listen to the latest episode, you’ll see an area where you can sign up for our newsletter. I’d like to encourage you to sign up. It’s just an email about once a week to let you know when the episode is updated and what it’s about. Also, if something brand new pops up, we’ll be able to tell you about it quickly and easily.

Welcome to the podcast today, you have strolled right into episode 17. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast where we talk about issues related to health, chiropractic, evidence, chiropractic advocacy, and research. Thank you for taking time out of your day I know your time is valuable and I want to fill it with value so here we go. And this week it’s low back pain a call to action.

As I mentioned at the top of the show, this week, I want to continue with the series published in The Lancet on March 21, 2018. For a quick re-cap this week…. The Lancet is one of the oldest and most respected medical journals in the world. It has been around since 1823. In addition to the credibility of the journal, this series of papers dealing with Low Back Pain was compiled and authored by the leading experts on the matter globally. On top of that, the experts were a group of interdisciplinary practitioners which meant they ranged from medical doctors and PhD’s, to physical therapists and chiropractors.

Essentially, EVERYONE had a seat at the table so, it is the general consensus at this point that this series of papers is as current, as credible, and as accurate as can be had at this point in time and in our understanding of Low Back Pain.

The three papers were broken down as follows:

  1. What low back pain is and why we need to pay attention.
  2. Prevention and treatment of low back pain: evidence, challenges, and promising directions.
  3. Low back pain a call to action.

Last week, we reviewed the first of the three papers which was titled, “What low back pain is and why we need to pay attention.” We went through it note by note and section by section trying to strip away the embellishments to simply boil it down to a leisure read and, hopefully, an enjoyable learning process.

We will do the same this week with the third paper of the series titled, “Low back pain a call to action.”

I want to start this week in the same way we started last week: by discussing how the papers were accomplished.

How They Did It

For this paper, again titled “What low back pain is and why we need to pay attention,” the researchers identified scientific studies through searches of databases:

•MEDLINE (PubMed)

•Scopus

•Google Scholar

•African Index Medicus Database

In order to ensure a high-quality standard, systematic reviews were shown preference for inclusion.

This week, we’re going to review the last of the three papers from a recent series published in The Lancet on March 21, 2018. If you don’t know the impact or why this series is so important, please review the last two episodes of the Chiropractic Forward Podcast at www.chiropracticforward.com or the last two articles of my blog over at amarillochiropractor.com/blog. That will get you up to speed. In short, the series on low back pain was compiled and authored by an international panel of experts on the matter. Essentially, the best of the best.

This last of the three papers is titled “Low Back Pain A Call To Action.”

Summary

We have already covered several times that low back pain is now the leading cause of disability globally and is only growing in significance because the global population is living longer. The issue may be more profound in low to middle-income countries. In addition, most low back pain doesn’t even appear to be directly related to any specific trigger or origin.

In many cases, patients are being restricted from attempting resolution of the back pain via conservative approaches such as self-management support, specialized interventions like spinal manipulations (I added that part) and multidisciplinary rehab.

The panel suggests the following:

  1. Address the political aspect. They recommend calling on the World Health Organization to make low back pain one of its priorities by putting it on the target list in an effort to increase attention and decrease treatment that is not recommended initially. They recommend calling on political, medical, and social leaders to make sure public health initiatives are properly funded and geared toward the prevention of low back pain and treatment.
  2. Public health challenge.
    • Change priorities – Make low back pain a priority. Create and implement ways to prevent it and combine these strategies with other strategies that are chronic and somewhat related. Strategies such as weighing the right amount, being active physically, and maintaining good mental health as well. These tactics treat more than simply low back pain. The panel also recommends strategies that can modify the factors putting the population at risk of developing low back pain.
    • Change systems and change practice – Provide early recommendations for maintaining work load as much as possible and/or return to work as quickly as possible. Attempt to ensure early ID of people that are at risk of developing long-term, chronic disability as a result of low back pain. Address co-morbidities raising a person’s risk of developing low back pain and promote a healthier lifestyle in addition to altering disability benefits and get people back to work as soon as possible. And lastly, address low back pain through multidisciplinary rehabilitation in an effort to return the patient to work quickly.
  3. Healthcare challenge –
  • Change culture – The panel appears to me to be promoting the use of a Public Relations campaign to focus and promote living well with low back pain, self-management, staying healthy, and to change the public perception of low back pain.
  • Change clinician behavior – After developing the best evidence-based systems, there will be a need togged everyone on the same team in regards to the way clinicians refer and treat, the patients, as well as the professional journals.
  • Change systems – There is a need to develop and implement systems allowing a patient to receive the right care at the right time. Clinical pathways will need a re-boot and will need to become consistent across interdisciplinary lines and differing clinical settings.
  • Tackle Vested Interests – The panel discusses the fact that governments and insurance companies need to regulate in a manner consistent with evidence-based treatment for low back pain and eliminate conflicts of interest. Regulation through contracts, and payment schedules for treatments with little to no evidence for effectiveness.

The idea that a healthy weight and regular physical activity will help reduce low back pain must enter the global subconscious through public programs, especially in low to middle-income countries.

An assertion I fully agree with the authors on is that, thus far, healthcare dollars have been wasted on treatments that are ineffective and, many times, downright dangerous. The risk vs. reward ration just doesn’t make sense more times than not currently. No too mention the issue of opioid addiction which we all should know the stats on by now.

Boiling it down, the panel aims to get rid of practices that harm and create waste while, at the same time, opening the door to effective and affordable means of treating low back pain to patients in need. The authors are quoted here as saying,”Protection of the public from unproven or harmful approaches to managing low back pain requires that governments and health-care leaders tackle entrenched and counterproductive reimbursement strategies, vested interests, and financial and professional incentives that maintain the status quo.”

The authors promote the idea of implementing a positive health concept as the umbrella idea aiming for prevention of long-term disability. This includes alternative to treatments and cures and promotes more meaningful lives. This truly is a low back pain a call to action recommendation.

Another great quote from this third paper is as follows, “Improved training and support of primary care doctors and other professionals engaged in activity and lifestyle facilitation, such as physiotherapists, chiropractors, nurses, and community workers, could minimize the use of unnecessary medical care.”

The panel also calls for an active monitoring system in order to assess and keep an eye on the recommendations implementation as well as the outcomes of the changes.

To read more for yourself, follow this link to the third paper:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30488-4/fulltext

If access is unavailable, just simply register at The Lancet. It is completely free of charge.

If you are research minded, if you are a low back pain patient, or if you are a practitioner regularly coming in contact with low back pain patients, it is my opinion that taking the time to read these three papers yourself is of utmost importance.

Please find the links to the papers in the “References” section and get it done. Together, we can make a big, big difference in the lives of our low back pain patients. Without a doubt.

For this week’s next step, go register with The Lancet and get this paper for free! You just have to register. That’s it.

We hope you enjoyed this week’s paper called “Low back pain a call to action.” We’ll go through it bit by bit and hit the highlights for those of you that aren’t into reading research papers and things of that sort. Don’t miss it!

If you love what you hear, be sure to check out www.chiropracticforward.com. As this podcast builds, so will the website with more content, products, and chances to learn.

We cannot wait to connect again with you next week. From Creek Stone, my office here in Amarillo, TX, home of the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

 

Other episodes you may enjoy:

CF 003: Great News: Chiropractic Outpaces Muscle Relaxants

CF 008: With Dr. Craig Benton – Brand New Information Based on Results Chiropractic Proven Effective For Low Back Pain

CF 011: With Dr. Tyce Hergert: It’s Here. New Guides For Low Back Pain That Medical Doctors Are Ignoring

CF 016: Review of The Lancet Article on Low Back Pain (Pt. 1)

CF 017: Pt. 2 – Review of The Lancet Article on Treatment of Low Back Pain

 

 

References:

Paper 1 – “What low back pain is and why we need to pay attention: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30480-X/fulltext

Paper 2 “Prevention and treatment of low back pain: evidence, challenges, and promising directions.”: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30489-6/fulltext

Paper 3 – “Low back pain: a call for action”: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30488-4/fulltext

 

CF 014: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 2 of 3)

DEBUNKED: The Odd Myth That Chiropractors Cause Strokes Revisited

Part 2 of 3

Chirorpactic Forward Podcast Subscribe Link

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This week we are in Episode #2 of the 3 episodes where we are systematically debunking the odd myth that chiropractors cause strokes. I’m not having it folks. The chiropractors cause strokes myth is old and tired and in need of retirement. In this episode, we will discuss research papers demonstrating and validating benefits of having cervical manipulation treatments. Or chiropractic adjustments to the neck. We will talk about the benefits, according to research, for neck pain as well as for headaches. And we’ll also talk a little about where this chiropractors cause strokes myth came from and why it perpetuates to this day.

Before we get started, I want to draw your attention to the reviews over at iTunes. If you would be kind enough to leave us a great review we sure would appreciate you! This is a new podcast and we need all the help we can get!

Right now though, it’s time for bumper music!

Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast where we talk about issues related to health, chiropractic, evidence, chiropractic advocacy, and research. Thank you for taking time out of your day I know your time is valuable and I want to fill it with value so here we go. I can’t think of a more valuable way to spend you time if you’re a chiropractor than to learn how to debunk the chiropractors cause strokes myth and shut people down on it.

Let’s begin this episode by thanking those of you that sent emails to me after this chiropractors cause strokes myth series kicked off last week. You guys are great. The best way you can help is to share these episodes with as many people as you can. We can get this myth debunked and we can put it to rest right here, right now. But, obviously, I can’t do it myself. I need your help to do it.

I also want to remind you that this is part 2 of a three part series on the chiropractors cause strokes myth. Last week was part one of the chiropractors cause strokes myth where we discussed some risky odds, some case specific discussion, some signs and symptoms of vertebral artery dissection, and some research dealing with common treatments within the medical profession.

Be sure to go back and listen to it if you have not. It’s essential.

Then next week we will discuss other risky interventions, papers having to do with the risk, or lack thereof, of chiropractic adjustments to the cervical region specifically, and then a wrap up of the information putting the chiropractors cause strokes myth to bed once and for all.

Don’t miss it folks.

Now, let’s get on with our risk vs. reward discussion with the BENEFITS of cervical manipulation therapy.

I want to start off with the benefits of cervical manipulation for neck pain specifically. Each paper mentioned includes a short description of the conclusion for each paper cited. Also each of these papers is referenced in the show notes and can be very easily reviewed independently. You have to know that I am going to absolutely murder some of these names and I don’t even care. I’m small town South y’all. I’m not fancy at all. All I can is do my best but I assure you I’m not going to do backflips trying to figure out the correct pronunciation of each of these names. Be sure though, the days of Dr. Smith or Dr. Jones doing all of the research are no longer Take this first name as an example.

  1. Korthalis-de Bos IB, et. al. – “Manual therapy (spinal mobilization) is more effective and less costly for treating neck pain than physiotherapy or care by a general practitioner[1].”
  2. Dewitte V, et. al. – “Based on key features in subjective and clinical examination, patients with mechanical nociceptive pain probably arising from articular structures can be categorized into specific articular dysfunction patterns. Pending on these patterns, specific mobilization and manipulation techniques are warranted. The proposed patterns are illustrated in 3 case studies. This clinical algorithm is the corollary of empirical expertise and is complemented by in-depth discussions and knowledge exchange with international colleagues. Consequently, it is intended that a carefully targeted approach contributes to an increase in specificity and safety in the use of cervical mobilizations and manipulation techniques as valuable adjuncts to other manual therapy modalities[2].”
  3. Dunning JR, et. al. – “The combination of upper cervical and upper thoracic HVLA thrust manipulation is appreciably more effective in the short term than nonthrust mobilization in patients with mechanical neck pain[3].”
  4. Brontfort G, et. al. – “For participants with acute and subacute neck pain, SMT was more effective than medication in both the short and long term. However, a few instructional sessions of HEA resulted in similar outcomes at most time points[4].”
  5. Puentedura EJ, et. al. – The objective of the paper was as follows: “Thrust joint manipulation to the cervical spine has been shown to be effective in patients presenting with a primary report of neck pain. It would be useful for clinicians to have a decision-making tool, such as a clinical prediction rule, that could accurately identify which subgroup of patients would respond positively to cervical thrust joint manipulation.” In the results, they showed if 3 or more of the 4 attributes were present,” the probability of experiencing a successful outcome improved from 39% to 90%[5].”
  6. Yu H, et. al. – “Chiropractic management of atlantoaxial osteoarthritis yielded favorable outcomes for these 10 patients[6].”
  7. Puentedura EJ, et. al. – “Patients with neck pain who met 4 of 6 of the CPR criteria for successful treatment of neck pain with a thoracic spine thrust joint manipulation demonstrated a more favorable response when the thrust joint manipulation was directed to the cervical spine rather than the thoracic spine. Patients receiving cervical thrust joint manipulation also demonstrated fewer transient side-effects[7].”
  8. Miller J, et. al. – “Moderate quality evidence supports this treatment combination (cervical manual therapy combined with exercise) for pain reduction and improved quality of life over manual therapy alone for chronic neck pain; and suggests greater short-term pain reduction when compared to traditional care for acute whiplash[8].”
  9. Hurwitz EL, et. al. – “Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain[9].”
  10. Muller R, et. al. – “In patients with chronic spinal pain syndromes, spinal manipulation, if not contraindicated, may be the only treatment modality of the assessed regimens that provides broad and significant long-term benefit[10].”
  11. Zhu L, et. al. – “There was moderate level evidence to support the immediate effectiveness of cervical spine manipulation in treating people with cervical radiculopathy[11].”
  12. Giles LG, et. al. – “The consistency of the results provides, despite some discussed shortcomings of this study, evidence that in patients with chronic spinal pain, manipulation, if not contraindicated, results in greater short-term improvement than acupuncture or medication[12].”
  13. Bronfort G, et. al. – “Our data synthesis suggests that recommendations can be made with some confidence regarding the use of spinal manipulative therapy and/or mobilization as a viable option for the treatment of both low back pain and neck pain[13].”

There you have a fairly thick list of research papers demonstrating the effectiveness of chiropractic adjustments for uncomplicated neck pain but neck pain is not the only reason to have a chiropractic adjustment delivered to the cervical region. Another very common reason for neck adjustments would be for the treatment of acute and chronic headaches.

In fact, I have an episode of this podcast that dealt with a paper showing the effectiveness of chiropractic for headaches. Episode #6 to be exact.

Here is a listing of papers demonstrating the benefits of cervical manipulation for headaches. Each paper mentioned includes a short description of the conclusion for each paper cited. Also each of these papers is referenced in the show notes and can be very easily reviewed independently

  1. Malo-Urries M, et. al. – “Upper cervical translatoric spinal mobilization intervention increased upper, and exhibited a tendency to improve general, cervical range of motion and induce immediate headache relief in subjects with cervicogenic headache[14].”
  2. Espi-Lopez GV, et. al. – “In short, manual therapy techniques and manipulation applied to the suboccipital region for four weeks or more showed great improvement and in effectiveness for several aspects that measure the quality of life of a patient having suffered from tension type headaches[15].”
  3. Dunning J, et. al. – “Six to eight sessions of upper cervical and upper thoracic manipulation were shown to be more effective than mobilization and exercise in patients with cervicogenic headache, and the effects were maintained at 3 months[3].”
  4. Hurwitz EL, et. al. – “Utilization and expenditures for headache treatment increased from 2000 to 2009 across all provider groups. MD care represented the majority of total allowed charges in this study. MD care and DC care, alone or in combination, were overall the least expensive patterns of headache care. Risk-adjusted charges were significantly less for DC-only care[16].”
  5. Bronfort G, et. al. – “SMT appears to have a better effect than massage for cervicogenic headache. It also appears that SMT has an effect comparable to commonly used first-line prophylactic prescription medications for tension-type headache and migraine headache[17].”
  6. Bronfort G, et. al. – “Chiropractic is effective in acute, subacute, and chronic low back pain, migraines and headaches originating from the neck, for the treatment of some forms of dizziness, extremity and joint issues, as well as mid back and acute and subacute neck pain[18].
  7. Tuchin PJ, et. al. – “The results of this study support previous results showing that some people report significant improvement in migraines after chiropractic spinal manipulative therapy. A high percentage (>80%) of participants reported stress as a major factor for their migraines. It appears probable that chiropractic care has an effect on the physical conditions related to stress and that in these people the effects of the migraine are reduced[19].”
  8. McCrory D, et. al. – “Cervical spinal manipulation was associated with improvement in headache outcomes in two trials involving patients with neck pain and/or neck dysfunction and headache. Manipulation appeared to result in immediate improvement in headache severity when used to treat episodes of cervicogenic headache when compared with an attention-placebo control. Furthermore, when compared to soft-tissue therapies (massage), a course of manipulation treatments resulted in sustained improvement in headache frequency and severity[20].”

Many headache patients present to chiropractors after a considerable amount of time spent taking headache and migraine medications. Medications do not come without consequences. Certainly when taking long-term. Not only have they spent a considerable amount of time on medication, they often have had botox injections, steroid injections, and worse before finally going to the chiropractor.

It is a fact that patients should have the GUARANTEED of the best treatment that does the LEAST amount of harm. In that spirit, and considering that chiropractic is safe, effective, and non-pharmacologic, it makes sense that the medical field should actually PROMOTE chiropractic as a viable and valuable treatment for headaches and migraines rather than dismiss it as ineffectual and dangerous.

Having demonstrated study upon study validating the effectiveness and benefit of cervical manipulation for neck pain (acute, subacute, and chronic) and headaches (chronic, acute, subacute, tension-type, cervicogenic, and migraines), we can now focus attention on research papers and abstracts having to do with the risk of stroke instance (lack of risk) as a direct result of cervical chiropractic adjustments. Hopefully, you are getting a more clear picture of the chiropractors cause strokes myth and its absolutely foolishness.

But first, where would you think the idea of chiropractors running around stroking everyone out might come from? I believe there are at least a few root sources.

  • You guessed it: our old friend the American Medical Association and their state association underlings. This group deemed it unethical to refer to chiropractors or accept referrals FROM They tried to run us out of business by conducting conferences about chiropractic and generating literature that was anti-chiropractic. They then dispersed the misinformation down through the channels of the state medical associations all the way out to the medical doctors, nurses, and medical field profession out in the field, and then ultimately to their patient bases. The “Chiropractors Cause Strokes” myth was well within their ability to propagate. When your initiative is to rid the Earth of the chiropractic profession, you take advantage of what you can. The Federal Court decision in Wilk vs. AMA shows the AMA did just that.
  • The other likely culprit for the chiropractors cause strokes myth in my estimation would be patients visiting medical professionals after having been to a chiropractor and having suffering a stroke sometime afterward. I did not say chiropractors “causing” strokes. Research shows us that people are going to chiropractors already suffering arterial tears that are sometimes spontaneous in nature. While chiropractors have a high level of education, there are many out there that are simply untrained at catching red flags and making the proper referral. Other times, patients present with very common symptoms and there are no red flags present whatsoever. The chiropractor treats the patient thinking they are going to help improve a neck complaint or a headache while in reality they may be exacerbating a tear. When the patient reaches the medical professional, the link is easy to make for the uninformed: chiropractor causes stroke.
  • Ignorance – The simple lack of knowledge regarding the body of evidence and research that is available dealing with the chiropractors cause strokes myth perpetuates the myth. It is clear the benefits are present. It is clear the risks are not. End of story. But if one is ignorant of the literature,

This is where we are going to stop for this second episode of the chiropractors cause strokes series. Remember, it is a three part series.

KEY TAKEAWAY:

The benefit is researched and it’s real. There is no denial possible.

Be sure to tune in next week for the third and final part of the three part series. Next week, we will discuss risky interventions, papers having to do with the risk, or lack thereof, of chiropractic adjustments to the cervical region specifically, and then a wrap up of the information.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes

If you love what you hear, be sure to check out www.chiropracticforward.com. As this podcast builds, so will the website with more content, products, and chances to learn.

We cannot wait to connect again with you next week for third and final part of the debunking of the chiropractors cause strokes myth. From Creek Stone, my office here in Amarillo, TX, home of the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

Other episodes of interest include:

CF Episode #13: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 1 of 3)

Source Material

  1. Korthals-de Bos IB, Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. British Medical Journal, 2003. 326(7395): p. 911.
  2. Dewitte V, Articular dysfunction patterns in patients with mechanical neck pain: a clinical algorithm to guide specific mobilization and manipulation techniques. Man Ther, 2014. 19(2-9).
  3. Dunning J, Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC Musculoskeletal Disorders, 2016. 16(64).
  4. Bronfort G, Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain: A Randomized Trial. Annals of Internal Medicine 2012. Ann Intern Med, 2012. 156(1): p. 1-10.
  5. Puentedura EJ, Development of a clinical prediction rule to identify patients with neck pain likely to benefit from thrust joint manipulation to the cervical spine. J Orthop Sports Phys Ther, 2012. 42(7): p. 577-92.
  6. Yu H, Upper cervical manipulation combined with mobilization for the treatment of atlantoaxial osteoarthritis: a report of 10 cases. J Manipulative Physiol Ther, 2011. 34(2): p. 131-7.
  7. Puentedura EJ, Thoracic spine thrust manipulation versus cervical spine thrust manipulation in patients with acute neck pain: a randomized clinical trial. J Orthop Sports Phys Ther, 2011. 41(4): p. 208-20.
  8. Miller J, Manual therapy and exercise for neck pain: a systematic review. Man Ther, 2010. 15(4): p. 334-54.
  9. Hurwitz EL, e.a., Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine, 2008. 33(4 Suppl): p. S123-52.
  10. Muller R, G.L., Long-term follow-up of a randomized clinical trial assessing the efficacy of medication, acupuncture, and spinal manipulation for chronic mechanical spinal pain syndromes. J Manipulative Physiol Ther., 2005. 28(1): p. 3-11.
  11. Zhu L, Does cervical spine manipulation reduce pain in people with degenerative cervical radiculopathy? A systematic review of the evidence, and a meta-analysis. Clin Rehabil, 2015.
  12. Giles LGF, M.R., Chronic spinal pain syndromes: a clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation. J Manipulative Physiol Ther, 1999. 22(6): p. 376-81.
  13. Bronfort G, Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. Spine, 2004. May-Jun 4(3): p. 335-56.
  14. Malo-Urries M, Immediate Effects of Upper Cervical Translatoric Mobilization on Cervical Mobility and Pressure Pain Threshold in Patients With Cervicogenic Headache: A Randomized Controlled Trial. J Manipulative Physiol Ther, 2017. 40(9): p. 649-658.
  15. Espi-Lopez G, e.a., Do manual therapy techniques have a positive effect on quality of life in people with tension-type headache? A randomized controlled trial. Eur J Phys Rehabil Med, 2016. 13(1): p. 4-13.
  16. Hurwitz EL, e.a., Variations in Patterns of Utilization and Charges for the Care of Neck Pain in North Carolina, 2000 to 2009: A Statewide Claims’ Data Analysis. J Manipulative Physiol Ther, 2016. May 39(4): p. 240-51.
  17. Bronfort G, Efficacy of spinal manipulation for chronic headache: a systematic review. J Manipulative Physiol Ther, 2001. 24(7): p. 457-466.
  18. Bronfort G, Effectiveness of manual therapies: The UK evidence report. Chiropr Osteopat, 2010. 18(3).
  19. Tuchin PJ, e.a., A randomized controlled trial of chiropractic spinal manipulative therapy for migraine. J Manipulative Physiol Ther, 2000. 23(2): p. 91-95.
  20. McCrory D, Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache. Duke University Evidence-based Practice Center, Center for Clinical Health Policy Research.


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CF 011: With Dr. Tyce Hergert: It’s Here. New Guides For Low Back Pain That Medical Doctors Are Ignoring

This week, we are talking about acute and non-acute low back pain. What are current healthcare guidelines? Why does it matter to chiropractic patients and non-chiropractic patients and are those in the medical field getting (and implementing) the information?

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast where we talk about issues related to health, chiropractic, evidence, and research and how those things all fit into a comprehensive approach for treating different conditions. Thank you for taking time out of your day to give us a listen. I know your time is valuable and I will always try hard to fill our time with valuable content.

We’re going to have more fun this week than stepping on a nail. Which I have done.

Before we dive in, it was so nice we had to do it twice. What am I talking about? I’m talking about bringing on Tyce. Tyce Hergert that is down in Southlake, TX. Owner and operator of Chiropractic Care Center of Southlake as well as Southlake Physical Medicine where he oversees an integrated practice. Dr. Hergert is also the immediate former President of the Texas Chiropractic Association so now he can say what he really thinks. He was the big cheese, the illustrious potentate of chiropractic in Texas.

Although it’s highly unlikely, should you enjoy what Tyce shares with us here today, go and listen to his other guest spot which can be found in Episode #6. You can find episode #6 at the following link:

CF 006: With Dr. Tyce Hergert: Astounding Expert Information On Immediate Headache Relief

Welcome to the show Tyce. Nice to have you back.

I would say that a chiropractor would be completely oblivious to not understand that Chiropractic is considered to be on the fringe of healthcare by many to most in the medical field. It’s just a fact and chiropractors deal with this daily. We Chiropractors are used to feeling like the black sheep of the healthcare family off in a corner keeping all to ourselves.

In other articles, podcasts, and videos of mine, you’ll notice I have covered the Wilk vs. AMA case. I’ve covered the Doctored film by Jeff Hayes spotlighting mistreatment of chiropractors. I’ve also covered current attacks on Texas Chiropractors by the Texas Medical Association. It is all very well-documented at this point.

Chiropractic is currently undergoing an amazing renaissance. This is due to a couple of key factors. The first being the need to develop non-pharmacological treatment recommendations in the midst of a national opioid addiction crisis. A crisis that has killed thousands and thousands in the last several years. The second reason being the body of high-quality research that is consistently coming to light almost every month showing the effectiveness of Chiropractic and evidence-based chiropractors.

Do you feel this renaissance, Tyce, or is it just me living inside my head?

With all of the new information and new healthcare laws emerging, the questions going forward SHOULD be, “Is the medical field and is the insurance industry listening and implementing?” We shall see. So far, the answer is, “Absolutely not.” In fact, it’s almost defiant.

Is that an accurate statement Tyce? You’re my checks and balance guy on everything.

Let’s begin with the most glaring denial of Federal Law by the insurance companies right now. It has to do with Section 2706 of the Patient Protection and Affordable Care Act. Also commonly known as “Obamacare.” Section 2706 of the PPACA is entitled the nondiscrimination In Health Care section of the Federal Law and is intended to keep insurance companies and health plans from keeping chiropractors and the services they provide out of the system.

It reads as follows, “A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law. This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures.”

On the American Chiropractic Association’s FAQ site for 2706, they state, “It is important to understand that Section 2706 and its assurance of non-discrimination in terms of participation and coverage requires that doctors of chiropractic not be discriminated against in the provision of any “essential benefit” that is within their scope of practice.”

Here’s the rub on 2706: part of its purpose is to reimburse chiropractors performing the same services under their scope and license at the same level financially as any other profession that provides that service.

For instance, under the PPACA Section 2706 Federal Law, chiropractors are to be paid the exact same for an 99203 exam code as a doctor of medicine or osteopathy is paid.

Would you agree with that assessment Dr. Hergert? Is this your understanding of the law?

Plain and simple. This is not happening. With so many chiropractors now integrating their practices with medical directors, physician assistants, nurse practitioners, and physical therapists like Dr. Hergert has in Southlake, it’s painfully clear that doctors of chiropractic are being discriminated against when it comes to reimbursements for the same codes performed.

In fact, chiropractors are integrating with these other professions just so that they can finally GET the reimbursements that the other practitioners are allowed! It is madness and clearly violates Section 2706 of PPACA.

Dr. Hergert, you are a great resource here since you’re in the middle of the two professions. What is your experience on this?
Tyce: The carriers will come right out and tell you they don’t think they have to play by this rule.

Also, there is violation of the law if an insurer does something such as applying caps on specific services provided by one healthcare provider whereas the cap does not apply to another type of provider. It is my understanding that United Healthcare has moved to a $65 visit cap on chiropractic care here in Texas.

Am I misinformed here Tyce? Does United Healthcare only put caps on Chiropractors or are they capping services with all providers?
Tyce: That gets very frustrating for those patients with a $50-70 copay.

It is the American Chiropractic Association’s opinion that a violation exists if the insurer or plan denies specific forms of care that is otherwise covered if it is a chiropractor providing the service and it is within their scope and licensing. I would suggest that a medical doctor probably gets services such as non-surgical decompression covered under insurance but chiropractors are routinely denied coverage.

Are there any better examples of this disparity, Tyce, since I don’t know any medical doctors that have their patients perform decompression?

There is also a possible violation when doctors of Chiropractic are denied inclusion into a plan or group purely based on the profession. For example, it is my understanding that FirstCare won’t cover Chiropractic. Is that a violation? I suppose I could offer an opinion if I were a lawyer. I’m not sure why exactly other providers are allowed coverage while chiropractors are left out in the cold. Here is a great example though that I’m aware of here locally. there is a local insurance network that will remained un-named that charges $200 per year for chiropractors to be included for coverage however, medical professionals pay nothing to be included. Could that be a violation of the nondiscrimination law? I would say it smells a little fishy.

In my opinion, Federal Law is being violated all over the place in regards to Section 2706 of PPACA. I’m not sure how it can be perceived any other way.

What can you add here Tyce that I may have left out?
Tyce: What this means for patients is you can’t use that shiny new insurance policy that is costing you more than a $250k house payment would. You have to fork over the more money to pay for your chiropractic care.

Moving on from Section 2706…..I love talking about the New Recommendations For Acute and Chronic Low Back Pain.
It is becoming more and more aggravating that we chiropractors are not seeing a flood of acute and chronic low back pain patients. If you read my articles, watch my videos, or listen to my podcast with any regularity, you have no doubt been informed several times over of these new recommendations which, at this point aren’t that new anymore. They have been around for about a year now.

It is my opinion that no long-held beliefs or protocols will change if new information isn’t continually pounded and yelled about from the top of the roofs with megaphones. In marketing, experts have said that it takes a target 7 times of being exposed to information before it is finally received and, hopefully, acted upon.

I know that the medical field has NOT been exposed to this information at least 7 times because of two factors:
1. I have spoken to several medical practitioners here locally and not a single one of them has heard of or were aware of these new recommendations.
2. I am not seeing an incredible, overwhelming influx of acute and chronic low back pain new patients coming through my doors as a result of medical referrals.

Tyce, are you seeing an incredible influx of new low back patients from the medical field these days?

Is this willful disregard for the changing recommendations and a “clinging on” to old dogmatic beliefs passed down from the AMA years ago? I think some of it most certainly is.

Is it that a few bad seeds in the Chiropractic profession are giving the rest of us a bad image? I would say some of it most certainly is.

What I think it is mostly based on, however, is the fact that medical professionals are busy, they’re stressed, and many times over-worked and they simply don’t always have the time or opportunity to stay completely up on every new recommendation or updated protocol.

What do you think about it, Tyce?
Tyce: “You’re not down with, what you’re not up on.” Most don’t know. They didn’t get this info in school, and the pharma reps aren’t out spreading the good news.

With that being said, let’s be clear; the issues of low back pain, its economic impact, and the national opioid epidemic crisis in America combine to make these new recommendations that much more important.

Let’s start with the American College of Physicians. Remember, the American College of Physicians was proven in the Wilk vs. AMA case to have played a part in collaborating with the AMA in an attempt to rid the Earth of Chiropractic. I think that’s important to note as we go through the information because the ACP is historically known as a detractor or the chiropractic profession to put it mildly.

In response to the opioid epidemic gripping the nation currently, the American College of Physicians developed new recommendations for treating acute and chronic low back pain.

Why They Did It
• The American College of Physicians developed this guideline in order to provide updated recommendations on treatment of low back pain.
• With these recommendations, the ACP hoped to influence clinicians AND patients to make the correct decision for care in acute, subacute, or chronic low back pain conditions.

How They Did It
• They based their recommendations on a systematic review of randomized controlled trials and other systematic reviews.
• The research they reviewed included those papers available through April of 2015.
• The research included only those on noninvasive pharmacologic and nonpharmacologic treatments.

What They Found
• Recommendation #1: patients with subacute or acute low back pain should seek nonpharmacologic treatments such as Chiropractic, Massage, Acupuncture, and superficial heat BEFORE resorting to non-steroidal anti-inflammatories such as Ibuprofen, Tylenol, Aleve, etc… (Graded as a strong recommendation)
• Recommendation #2: patients with chronic low back pain should seek nonpharmacologic treatments such as Chiropractic, Exercise/Rehabilitation, Acupuncture, & Cold Laser Therapy BEFORE resorting to non-steroidal anti-inflammatories such as Ibuprofen, Tylenol, Aleve, etc… (Graded as a strong recommendation)
• Recommendation #3: In patients with chronic low back pain that have had no relief from nonpharmacological means, the first line of treatment would consist of NSAIDs like Aleve, Tylenol, Ibuprofen, etc.. As a second-line treatment, the clinician may consider tramadol or duloxetine. Opioids would be a last option and only if all other treatments have been exhausted and failed and even then with lengthy discussion with the patient in regards to the risks and benefits of using opioids. (Graded as weak recommendation)

Let’s recap: in February of 2017, the American College of Physicians, historically a Chiropractic profession detractor and attacker, now recommends Chiropractic as a first-line treatment for acute and chronic low back pain.

Dr. Hergert, does that make you feel warm and fuzzy inside because it does me?

Next, let us discuss the American Medical Association. If you thought the American College of Physicians was guilty of Chiropractic-hating, the American Medical Association is, or was, “Pablo Escobar” or the “El Chapo” of the attacks on the Chiropractic profession. The “El Jefe” of the Chiropractic haters, and the group that not only sat in the driver’s seat but also OWNED the entire truck of destruction back before Wilk vs. AMA came along. I believe I have been watching too much Netflix.

As a side note, I have realized that I have a wife, a daughter, and an all female staff at my office and…..I’m not the El Chapo or El Jefe of really anything. My son and I just walk around following orders pretty much. Tyce, you’re married with two daughters right?

On April 11, 2017, the Journal of the American Medical Association published a study on their website titled “Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain Systematic Review and Meta-analysis,” authored by Neil Page, MD et. al. In the format of this research paper, they refer to chiropractic treatment as spinal manipulative treatment or SMT. But, because spinal manipulative therapy is what we chiropractors do the most and what we are most identified with, I’m replacing the term “SMT” with “chiropractic adjustment.”

Is that fair, Tyce? I think it’s fair.

Why They Did It
Considering that spinal manipulation, or the chiropractic adjustment, is a treatment option for acute low back pain, and that acute low back pain is one of the most common reasons for visits to the doctor’s office, the authors wanted to systematically review the studies that have been done in the past dealing with the effectiveness as well as the harms of chiropractic adjustments in the treatment of acute low back pain.

How They Did It
• The researchers used searches of MEDLINE, Cochrane Database of Systematic Reviews, EMBASE, and Current Nursing and Allied Health Literature.
• The search spanned 6 years from January 2011 through February 2017 for randomized controlled trials of adults with low back pain comparing spinal manipulative therapy with no treatment or with alternative treatments.
• The accepted papers also had to measure pain or functional outcomes for up to 6 weeks.
• The data extraction was done in duplicate.
• The quality of the study was assessed through use of the Cochrane Back and Neck Risk of Bias tool.
• Finally, the evidence was assessed using the GRADE criteria which stands for Grading of Recommendations Assessment, Development, and Evaluation.
• 26 eligible randomized controlled trials were identified and accepted

What They Found
• 15 of the RCTs, totaling 1699 patients, showed moderate-quality evidence that chiropractic adjustments had a statistically significant association with improvements in PAIN.
• 12 of the RCTs, totaling 1381 patients, showed moderate-quality evidence that chiropractic adjustments have a statistically significant association with improvements in FUNCTION.
• NO RCTs reported any serious harms or adverse event as a result of undergoing chiropractic adjustments.
• There were only minor events reported like some increased pain, muscle stiffness, and headache in roughly 50%-67% of those treated in the large case series. I would be interested to hear more about this statement by the authors. That is not what we commonly see in our practice. Sometimes, if the patient is new and is not accustomed to chiropractic adjustments, they may experience some soreness or stiffness the next day which is to be expected following a change in the body.
• I want to be as thorough as I can here….Tyce, do you see 50%-67% minor harms in your daily practice?

Wrap It Up
In true AMA fashion, instead of just coming out and saying, “Chiropractic adjustments showed moderate quality evidence for effectiveness in pain as well as in function,” the authors instead stated in conclusion, “Among patients with acute low back pain, spinal manipulative therapy was associated with modest improvements in pain and function at up to 6 weeks, with transient minor musculoskeletal harms. However, heterogeneity in study results was large.” Heterogeneity is defined as, “The quality or state of being diverse in character or content.” In my opinion, this is to give themselves and “out” by implying there was not enough focus to the RCTs to truly state their findings as fact.

Nonetheless, when the AMA comes even remotely close to endorsing anything having to do with Chiropractic, I’ll take it. And so should those in the medical field that commonly come in contact with those seeking help for their acute and chronic low back pain.

So…….We Should Be All Set For Success Now Right? Maybe they’re about to open up a chiropractic low back pain wing of the hospital, right?

That is what you’ think but there is new information from the White House that this simply is not the case despite the obvious ramifications. You can find the link in the show notes but on page 57 of The President’s Commission On Combating Drug Addiction and The Opioid Crisis report, the authors say, “A key contributor to the opioid epidemic has been the excess prescribing of opioids for common pain complaints and for postsurgical pain. Although in some conditions, behavioral programs, acupuncture, chiropractic, surgery, as well as FDA-approved multimodal pain strategies have been proven to reduce the use of opioids, while providing effective pain management, current CMS reimbursement policies, as well as health insurance providers and other payers, create barriers to the adoption of these strategies.” This is straight from the White House.

At the bottom of page 57, you will also see that it says, “The Commission recommends CMS review and modify rate-setting policies that discourage the use of non-opioid treatments for pain, such as certain bundled payments that make alternative treatment options cost prohibitive for hospitals and doctors, particularly those options for treating immediate post-surgical pain.”

What say you Tyce?
Tyce: You mean like a specialist copay for chiro care and a lower copay for primary care? Or covering surgery 100% and NOT covering non-surgical means.

Essentially, the United States Government is admitting there is professional discrimination at the highest levels…..hello Medicare and Health Insurance plans….I’m talking to you….this discrimination creates barriers to doing the smart thing.

The smart thing is seeing a chiropractor for your back pain. The “Big Guys” (AKA: American College of Physicians and the American Medical Association) recommend it and the government says policies are in place to prevent patients from following those recommendations.

In addition, policies that discriminate against chiropractic or chiropractors run in violation of Section 2706 of PPACA. It comes full circle.
I know you have something good to say here Tyce…
Tyce: The beautiful thing we get to see in our office, since we have both medicine and chiropractic working together, is the end of the story…people getting off the mind altering drugs, healing, and getting their lives back. All we do is follow these simple guidelines.

I have a question to pose to the entire Chiropractic profession: How in the heck do we deal with this?

It has to be through either the legislature at the state and federal levels or it has to be through the legal system. A guarantee I feel comfortable making is that the insurance companies won’t begin enforcing it on their own.

Mobilization and unification of the Chiropractic profession is probably where it starts.

Some steps toward that end include:
• Join or get involved with your state association. They’re the only ones effectively fighting for you and your rights on the state level.
• Join or get involved with your national association. They’re the only ones effectively fighting for you and your rights on the national level.
• If possible, build relationships with your state and national legislators.
• Donate to all of the above in the largest amounts you are comfortable with.
• Tell your friends and your colleagues about what is going on and help them get involved if they’re so inclined.
• Follow the news of your industry closely and stay knowledgeable about your profession. Both the good AND the bad.

Tyce, you have served for years and you’re still serving your profession. What you got on this?
Tyce: “Be part of the solution. You don’t have to dedicate 24/7 to the crusade….but you could do a little more. Right?”

A Chiropractic profession that is unified and playing offense instead of defense is powerful and is one of the worst nightmares of some folks I know out there in the world. Personally, as a side note, I like to see people like that squirm just a little don’t you? It just feels good. Makes what’s left of my hair stand up.

So won’t you consider helping if you haven’t before? If you don’t know where to start, email me at dr.williams@chiropracticforward.com and I will help you get on your way.

Tyce, I want to thank you for taking the time to come on the podcast and share your genius with us. With our history, I’m sure that Chiropractic Forward podcast listeners can count on your being a guest many many times. And, the next time will be the third time and I can say something like, “It was so nice, we had to do it thrice, with Tyce….or something stupid but entertaining like that.” Thanks for joining us today.

When Chiropractic is at its best, you cannot beat the risk vs reward ratio.

Did you know that research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic? Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health!

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. If you love what you hear, be sure to check out www.chiropracticforward.com. As this podcast builds, so will the website as we add more content, educational products, and a little further down the road, webinars, seminars, and speaking dates as they get added.

 

In the meantime, here are some of our recent podcasts that may be of interest:

CF 012: Proven Means To Treat Neck Pain

CF 008: With Dr. Craig Benton – Brand New Information Based on Results Chiropractic Proven Effective For Low Back Pain

CF 010: Surprise Unique Information Shows Chiropractic May Work On The Brain Too

 

 

 

 

We cannot wait to connect again with you next week. From Creek Stone here in Amarillo, TX, home of the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

References and Source Material
1. https://www.amarillochiropractor.com/startling-medical-professional-attacks-chiropractic/
2. https://www.amarillochiropractor.com/healthcare-in-texas-the-battle-against-a-monopoly-a-true-story-about-david-goliath-3/
3. https://www.whitehouse.gov/sites/whitehouse.gov/files/images/The%20Underestimated%20Cost%20of%20the%20Opioid%20Crisis.pdf
4. https://www.acatoday.org/Portals/60/Docs/Advocacy%20and%20Reimbursement/2706/2706-FAQs.pdf?ver=2015-12-23-125425-503
5. https://annals.org/aim/fullarticle/2603228/noninvasive-treatments-acute-subacute-chronic-low-back-pain-clinical-practice
6. https://jamanetwork.com/journals/jama/article-abstract/2616395?widget=personalizedcontent&previousarticle=2616379
7. https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-3-2017.pdf

 

CF 009: With Dr. Tom Hollingsworth: The Case Against Chiropractic In Texas

We’ll be talking about any and every past attack on chiropractic in Texas and on our profession by the medical field heavyweights…..what’s at risk and why. In addition, we’ll be sharing some personal opinions, some facts, some research….and we’ll be discussing what you all can do to help if you are an active person that wants to pitch in.

Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast where we talk about issues related to health, chiropractic, evidence, and research and how those things all fit into a comprehensive approach for treating different conditions. Thank you for taking time out of your day to give us a listen. I know your time is valuable and I will always try hard to fill our time with valuable content.

Right off the top today, I want to welcome a good friend and colleague of mine, Dr. Tom Hollingsworth originally from Brady, TX and now living in Corpus Christi, TX. Dr. Hollingsworth is a master of linguistics and he’s a master of the material when it comes to what we’ve been through and what we are going through currently. In fact, Tom has helped prepare the court drafts so he has intimate knowledge and it’s a special treat to have Dr. Hollingsworth here to walk us through it all.

Welcome to the Chiropractic Forward podcast Dr. Hollingsworth. We’re so glad to have you with us today…

Have you ever heard the song “Corpus Christi Bay” by Robert Earl Keen and is it indeed hard to stay sober on the Corpus Christi Bay?

Tell me a little about your background and your family.

We have both been highly active in the Texas Chiropractic Association over the years. Everyone fits a certain function for sure. What have been your functions in the past on the Statewide level?

With this being an evidence-based podcast, can you offer some thoughts on whether or not there is room in an evidence-based model for chiropractic philosophy to maintain any sort of footprint in it?

There is so much material here, I want you to know that you have free-reign to interrupt, stop me, correct me, and keep me on track here. I encourage any and all participation from you on this.

When Chiropractors start talking about the attack on chiropractic in texas and other attacks we’ve endured and are enduring, we can go on for hours. We are going to try to convey a very serious and meaningful message about it all right here today but without getting into a three hour conversation.

The unfortunate reality is that most do not know and, if they do, they normally lack any important details to truly place their knowledge in the correct context.

I believe that Dr. Hollingsworth will agree with me that, in our experience, lots of folks don’t know what’s going on with their profession….is that correct sir?

As a former board member of the Texas Chiropractic Association myself and a current member of the leadership statewide, we are intimately aware of many of the issues, both current and historically.

And I think, from the top here, it’s important to say that, even though Dr. Hollingsworth and myself are TCA members and leaders, our opinions may or may not represent the opinions of the TCA but we are NOT representing the TCA as we go through this podcast and in this capacity.

Anything you’d like to add to that disclaimer Dr. Hollingsworth?

We have all heard the stories of chiropractors being jailed for practicing. I remember a story from a documentary by Jeff Hayes called Doctored where a chiropractor is recalling how his father, who was also a chiropractor was in a bowling league. There was a medical doctor on the other team that refused to bowl against his father’s team simply because the team had a chiropractor on it.

Now, let’s run through the BIG ATTACK first. Folks, if you don’t know about Wilk vs. AMA, please do yourself, and all other chiropractors, a big favor and go check it out. To put it into a very brief blurb, basically, after 11 years of court proceedings, Dr. Chester Wilk and four other chiropractors, led by attorney George McAndrews, ultimately prevailed in proving the American Medical Association guilty of violating the Sherman anti-trust act. Meaning the AMA and several other medical institutions like the American Hospital Association, the American College of Surgeons, the American College of Physicians, and the Joint Commission on Accreditation of Hospitals were found guilty of conspiring to eliminate chiropractic from the Earth. According to Chiro.org….”the suit claimed that the defendants had participated for years in an illegal conspiracy to destroy chiropractic. On August 24, 1987, after endless wrangling in the courts, U.S. District Court judge Susan Getzendanner ruled that the AMA and its officials were guilty, as charged, of attempting to eliminate the chiropractic profession. “

Does that about sum it up, Dr. Hollingsworth, and would you like to add to any of that?

Basically the AMA and others were proven guilty of the following acts against Chiropractic:

  • Encourage ethical complaints against doctors of chiropractic
  • Oppose chiropractic inroads into workmen’s comp
  • Oppose chiropractic inroads into health insurance and make it difficult for patients to get covered for chiropractic care
  • Oppose inroads into hospitals
  • Contain or eliminate Chiropractic schools
  • They conducted nationwide conferences on Chiropractic
  • Distributed anti-Chiropractic publications and propaganda
  • Helped other organizations prepare anti-chiropractic literature
  • Deemed it unethical for medical doctors to refer to, or accept referrals from, chiropractors.
  • And, they discouraged colleges, universities, and faculty from cooperating with chiropractic schools.

Can you believe that things have progressed to the point now that two of those organizations came out last year in support of Chiropractic for the treatment of acute and chronic and low back pain?

In referencing a blog of mine from November 11th, 2015 called Healthcare in Texas: The Battle Against a Monopoly. A True Story About David & Goliath,” I reminded myself of some more recent minor attacks. I’ll put the link in the show notes.

  • The Texas Medical Association attempted to remove Doctors of Chiropractic from the high school concussion oversight teams. They wanted to allow simple high school trainers but not chiropractors.
  • The same year, the TMA attempted to remove Chiropractors’ ability to perform physical exams on school bus drivers.
  • Same year, they tried to introduce legislation to remove our ability to perform high school exams on athletes. A function chiropractors have been performing for generations.

Now Dr. Hollingsworth, you’d think this would have put the battle to rest right? Can you go ahead and run through TMA #1 one for us please? The when, why, and what happened…

Before we get any further, how about we define Chiropractic. At least as far as the State of Texas is concerned, Tom.

I’d like to take just a second to direct everyone to an excellent video on YouTube that the Texas Chiropractic Association published about a year and a half ago concerning a lot of this. The link will be in the show notes but you can also find it by going to YouTube and searching the term “The Texas Chiropractic Defense From The Texas Medical Association A Timeline.” This ten minute video sums up what kind of constant attacks our profession is still enduring today.

So, we have Wilk vs. AMA that Chiropractic ultimately won, and we prevailed in the TMA #1 diagnosis case for the diagnosis issue…….now, surely, when the TBCE and the TCA triumphed in that one, that had to have killed any further attacks from the TMA right, Dr. Hollingsworth?

(Discuss VONT, Diagnosis #2, Sublux, and Neuro)

Tom, what is the current status on this case? It’s about to be go time right?

What kind of research is the TCA and TBCE team looking at using to bolster the case and why are we using these particular papers?

1.   MSK includes “associated” nerves

a. Concerning balance is Ex Parte Halsted

b. Careful to avoid claims toward entirety of nervous system (Hogs get slaughtered.)

2.   TMA depended greatly on UT Med School’s Leonard Cleary, PhD.’s deposition

a. Understandably supported TMA position MSK is not neuro

b. Heavily focused on structure considerations only in isolation from function

c. Ivory Tower challenged

i. by TBCE presenting Grays, and

ii. TCA presenting simpler TEA authors defining elements of muscle.

d. PRE-TRIAL appeal allowed for exam outside of MSK if it will lead to opinion of bio-mechanical condition of MSK.  So…

i. Neurotrophic effects on muscle

ii. Neurotrophic effects on bone  (Deposition Ex. 10)

3. Subluxation Complex

a. TBCE presented definitions of WHO, Dorland’s and compared them to TBCE’s. Can you expound on the different definitions for us please?

b. TCA presented Texts by Strang, Leach, King & Janig , and

i. AMA’s CPT definitions, 

ii. Bakris/Dickholtz NUCCA BP study

Now This is a paper we covered in podcast episode #7 but we also cited a couple others by AP Wong and by Yates, et. al. There’s no doubt we’re on solid ground here. 

c. TMA offered no witness qualified to opine on subluxation complex

i. However, a letter from them to TBCE when adding “subluxation” stated they preferred TBCE choosing the WHO definition (that includes “nerve”).

4. Vestibular-Ocular-Nystagmus Testing (VONT)

a. TMA offered a NeurOtologist (ENT subspecialty) and a PT

i. Argued training length (residency, etc.)

ii. Mostly Fair witness

iii. One key was distinguishing Vestib Apparatus from Vestib System

1. Had to get out of ear into processing centers

2. (Vestib Nuc and V-spinal tracts)

3. Attempt to utilize MD cultural authority on basic fact

4. Build on basic facts later.

iv. After hours of testimony from TMA’s vestibular experts, trial judge asked: “When are we going to hear about VONT?” 

Well, I suppose all we can do at this point is to continue to raise money from chiropractors that want to pitch in. We know that an appeals process is expensive. We also know that what happens in a state with over 5,000 chiropractors in it, usually tends to happen in other states down the line so it’s likely in every American chiropractor’s interest to get on board with this issue and contribute to its success.

If you would like to donate to this victory, I would direct you to the TCA since they are leading the way on this. Go to www.chirotexas.org/cdi

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. If you love what you hear, be sure to check out www.chiropracticforward.com. As this podcast builds, so will the website as we add more content, educational products, and a little further down the road, webinars, seminars, and speaking dates as they get added. Also, find our Facebook page where we’ll be sharing all kinds of good stuff from the shows and from our guests.

Reviews….folks, we need reviews over at the iTunes Chiropractic Forward page. That’s what tells iTunes that people are finding value in what we’re doing. We sure would appreciate it.

We cannot wait to connect again with you next week. From Creek Stone here in Amarillo, TX, home of the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

Show Note resources

  1. Bakris G. (2007). “Special chiropractic adjustment lowers blood pressure among hypertensive patients with misaligned C-1 vertebra.”   Retrieved February 7, 2018, from http://www.uchospitals.edu/news/2007/20070314-atlas.html.
  2. Wong AP (2018). “Review: Beyond conventional therapies: Complementary and alternative medicine in the management of hypertension: An evidence-based review.” Pak J Pharm Sci 31(1): 237-244.
  3. Yates RG (1988). “Effects of chiropractic treatment on blood pressure and anxiety: a randomized, controlled trial.” Manip Physical Ther 11(6): 484-488.
  4. https://www.chiro.org/Wilk/
  5. https://jamanetwork.com/journals/jama/article-abstract/2616395
  6. https://www.amarillochiropractor.com/healthcare-in-texas-the-battle-against-a-monopoly-a-true-story-about-david-goliath-3/
  7. The Texas Chiropractic Defense From The Texas Medical Association A Timeline.
  8. https://youtu.be/XHGfAQwIqNo

 

Bibliography

Bakris G. (2007). “Special chiropractic adjustment lowers blood pressure among hypertensive patients with misaligned C-1 vertebra.”   Retrieved February 7, 2018, from http://www.uchospitals.edu/news/2007/20070314-atlas.html.

Wong AP (2018). “Review: Beyond conventional therapies: Complementary and alternative medicine in the management of hypertension: An evidence-based review.” Pak J Pharm Sci 31(1): 237-244.

Yates RG (1988). “Effects of chiropractic treatment on blood pressure and anxiety: a randomized, controlled trial.” Manip Physical Ther 11(6): 484-488.

 

CF 008: With Dr. Craig Benton – Brand New Information Based on Results Chiropractic Proven Effective For Low Back Pain

Today’s episode is all about chronic low back pain and some great, brand new research. By now, as I’ve said in the past, even traditional Chiropractor-hating, torch-wielding, quasi-scholastic chiropractic detractors are admitting that, yes, Chiropractic is indeed helpful for low back pain.

If you love what you hear, be sure to check out www.chiropracticforward.com. As the podcast builds, so too will the website content, educational products, webinars, seminars, and speaking dates as they get added.

For now though, it’s time for bumper music!

We will dive into the research in a few minutes but first, I have to introduce my guest this week. His name is Dr. Craig Benton. Dr. Benton is the owner/operator of Benton Chiropractic down in Lampassas, Texas but that’s not where the intro stops. Dr. Benton is the chair of Scientific Affairs for the Texas Chiropractic Association. He is where I have found a healthy percentage of the material that I have covered over the years for my blog, my YouTube videos, and now for the Chiropractic Forward podcast. Dr. Benton has been unknowingly instrumental in keeping me in business and making my life easier.

Welcome to the show Dr. Benton, how is life in Lampassas this week? My first question today is, have you been playing any guitar lately?

Dr. Benton and I are both in active practice. In fact, there’s a chance we may both have a patient show up at any time. That’s how actively we are practicing. I think that’s incredibly important to note because, so many times, you hear podcasts and attend seminars where the guys and gals speaking don’t really know a thing about actively practicing for 20 plus years. I’ve always felt that experience matters. Even when I was young and green. I was well-aware that I didn’t know it all and I’m even more aware of that today than ever.

So Dr. Benton, I’m looking forward to hearing your opinions and insight today.

Since the podcast today is about chronic pain, I think we should begin with a definition of what Chronic really is. When we define “chronic” in the context of neuromusculoskeletal complaints, we define it as being a complaint that is greater than 12 weeks in duration. Right at 3 months. Some patients will come into the office having had a condition for 15-20 years. I tell them that they are more than a little stubborn to have put up with something for so long.

It is common sense that a condition that is chronic will be more difficult to treat. Also, most chronic conditions can be traced back to a biomechanical, neuromusculoskeletal origin. One of my favorite quotes is from Dr. Lee Green, Professor of Family Medicine at the University of Michigan. He said, “Neck pain is a mechanical problem, and it makes sense that mechanical treatment works better than a chemical one.” Although Dr. Green is referring to neck pain in this instance, “low back pain” can easily be substituted. What he says could not make more sense. It’s an easy and very concise way to understand why Chiropractic, manipulation, mobilization is so incredibly effective above and beyond anything else for this sort or issue, including medication.

Do you have a quote or quotes that you love sharing that make sense to you and that help you boil down what it is we chiropractors are doing to help our patients?

I have overhead medical doctors (more than once) talking about having back pain and just injecting themselves with something to try to get over it. If they asked me, I’d tell them that they’re just covering up an underlying trigger or cause and ignoring it is to their detriment.

A good metaphor I came across for using medication for neuromusculoskeletal complaints is that it’s like unplugging a smoke alarm because you don’t like the noise. But, the fire is still slowly growing. What have they done to treat anything in a responsible and effective way? Nothing at all. We tend to live in a society that wants a pill for this and a potion for that so they can get over it and get on with life. But it doesn’t work that way.

Dr. Benton, has this been your experience as well?

Dr. Benton, don’t you treat soldiers through the VA program? Can you tell us all a little bit about that?

Let’s go over some low back pain statistics just we can try to stress the importance of what we’re talking about here. Dr. Benton, please feel free to jump in with anything you’d like to add:

  • Low back pain is the single leading cause of disability worldwide.
  • 8 out of every ten people will experience back pain. I will admit that I have never met anyone in 45 years of life on this Earth that fit’s into the 20% that apparently never suffers from any low back pain. Dr. Benton….have you ever met anyone that has never had back pain? Is it just me?
  • Back pain is the second most common reason for visits to the doctor’s office right behind upper-respiratory infections.
  • With such gains and leaps in the medical industry as far as treatment goes, low back pain is stubbornly on the rise.
  • More than half of Americans who experience low back pain spend the majority of the work day sitting. 54% to be exact. It’s good to be a chiropractor I guess. Our patients keep us up and moving most of the day.
  • Dr. Benton, did you know that….now…an equal number of patients seek help with a chiropractor first as seek help with a medical practitioner first for back pain? That’s new information to me that I found interesting.
  • Back pain in general costs $100 billion dollars every year when you factor in lost wages, productivity as well as legal and insurance overheads.

Now that we all know more about low back pain, let’s go through some things that may put you at greater risk of suffering from the condition. Dr. Benton, with your experience on the research, stop me if you have anything to add to any of these:

  • Age: as the spine and supporting structures begin to age and decline, the rate of low back pain will understandably increase.
  • Fitness Level: physically active people do not suffer low back pain to at the rate inactive people suffer. A healthy exercise and core building protocol can help reduce symptoms or instances of low back pain.
  • Weight Gain: Being overweight or obese and gaining weight quickly places increased strain on the low back.
  • Pregnancy: This one goes without saying. Pelvic changes and weight gain both contribute.
  • Genetics: Some forms of arthritis or other systemic conditions are genetic in nature
  • Work: Jobs that include heavy labor and or twisting or expose people to vibration consistently can be problematic. Jobs that require long periods of sitting in a chair can be equally problematic.
  • Mental health factors: Many people are able to deal with chronic pain but anxiety and depression are conditions that can cause a person to focus on the pain which tends to raise the perceived severity and significance for the person suffering from the condition. Dr. Benton, have you come across any patients that fit this description in your practice?
  • Improper backpack use: Kids suffer back pain needlessly since they are not traditionally in an age range we would consider to be a risk factor. However, backpacks used improperly are a common culprit. A backpack should never be more than 15%-20% of a child’s weight and should be carried on both shoulders with the bottom being at or about waste level.

What does the research say?

As I’m sure Dr. Benton will agree…..the research says a lot, to be honest. In fact, I’d say that there’s more research for the effectiveness of manipulation/mobilization in low back pain than for any other conditions chiropractors commonly treat. Am I out of bounds here Dr. Benton?

The research shows Chiropractic beating general practitioners in effectiveness as well as cost. The research shows Chiropractic beating common medications prescribed for low back pain. The research shows Chiropractic beating physical therapy and exercise alone. The research shows Chiropractic beating epidural spinal injections for low back pain. And the two of us can point you to randomized controlled trials proving it. Basically, the research is clear.

In January of 2018, a brand new research paper dealing with manipulation and mobilization was published in Spine Journal by Ian Coulter, PhD et. al. titled “Manipulation and mobilization for treating chronic low back pain: a systematic review” and funded by the National Center for Complementary and Integrative Health.

Now, to be clear, Spine Journal sounds a little bit like it may be a Chiropractic publication for those of you that don’t commonly read research abstracts…… but it is not.

Dr. Benton, can you describe Spine Journal for us?

Here’s why the authors took this project on.

The authors of the paper stated that there remained questions about manipulation and mobilization efficacy, the proper dosing of the techniques, how safe they are, as well as how they compare to other treatment protocols commonly used for chronic low back pain.

I have to say that I had no remaining questions regarding really ANY of those topics but it seems that these authors did.

Dr. Benton, again, please feel free to jump in anywhere you’d like as we go through the hows, why’s and the what’s here.

Here’s How They Did It

  • This paper was a systematic review and meta-analysis.
  • They searched databases for relevant studies from January 2000-March 2017
  • They chose randomized controlled trials that compared manipulation or mobilization to sham treatment, no treatment, other therapies, and multimodal therapeutic approaches.
  • They assessed the risk of bias using the Scottish Intercollegiate Guidelines Network.
  • Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was applied to determine the confidence in effect estimates.
  • 51 trials were included

What They Found

  • Within 7 of those trials on manipulation and/or mobilization there was reduction of disability when compared to other forms of therapy.
  • Further analyses showed that manipulation specifically was responsible for significant reduction in pain and disability when put up against therapies such as exercise and physical therapy.
  • Mobilization was also was significantly more effective when compared to exercise regimens for pain reduction but not for disability.

Wrap It Up

In the conclusion of the paper abstract, the authors say, “There is moderate-quality evidence that manipulation and mobilization are likely to reduce pain and improve function for patients with chronic low back pain; manipulation appears to produce a larger effect than mobilization. Both therapies appear safe.”

As I’ve said many times, “a lot of research in your favor becomes fact.” Chiropractic has A LOT of research in its favor.

Dr. Benton, would you like to add any final thoughts?

I’d like to thank Dr. Benton for taking the time to be with us today. He really is one of the guys out here in the real world trying his best to help change things for Chiropractors in Texas and in the world.

I want to finish off by saying that when Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple.

Just another reason to call a chiropractor TODAY!

Research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good or excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically and do it with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health!

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Please remember, we need your help to spread the word and grow this podcast. If you would help us out by sharing our podcast information, our website, and social media entities, we would greatly appreciate your help.

We cannot wait to connect again with you next week. From Creek Stone here in Amarillo, TX, home of the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

Research Citation:

Coulter I, et. al. “Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis” The Spine Journal, Volume 0 , Issue 0 ,

https://www.thespinejournalonline.com/article/S1529-9430(18)30016-0/fulltext

 

CF 007: Awesome Alternatives To High Blood Pressure Treatment

In today’s podcast, we are going to talk about high blood pressure, what happens, how many people it affects, and what we may be able to do to help it. Today is all about high blood pressure and I’m going to admit to you….in researching for this week’s podcast, even I learned new things about high blood pressure and I’m betting you will too. If you love what you hear, be sure to check out www.chiropracticforward.com. As this podcast builds, so will the website as we add more content, educational products, and a little further down the road, webinars, seminars, and speaking dates as they get added.

Welcome to the podcast today, Dr. Jeff Williams here with Creek Stone here in Amarillo, TX and I’m your host for the Chiropractic Forward podcast where we talk about issues related to health, chiropractic, evidence, and research and how those things all fit into a comprehensive approach for treating different conditions. Thank you for taking time out of your day to give us a listen. I know your time is valuable and I will always try hard to fill our time with valuable content.

You have fallen head first into episode #7 this week and I want to welcome you. We are going to have more fun that headbutting an i-beam..which I actually did on accident one time when I was a kid. I was running away from someone while playing tag and was looking over my shoulder wrhen smack…now I have a scare on the side of my noggin 35-40 years later. This is how I am certain we will have more fun with this episode.

Speaking of fun, with this being a brand new podcast, I can’t tell you how much fun it is to check the stats of the show and see people tuning in and finding value in our ideas and in information we have to share with you.

I think it is responsible to start off with a disclaimer: I am not a cardiologist. I am a research-minded, evidence-based Doctor of Chiropractic that has seen a jillion people with high blood pressure throughout a 20-year career. The ideas and discussion to follow will be based on information derived from the Centers for Disease Control and Prevention, from the American Heart Institute, and from information shared through Dr. Stephen Sinatra of New York, who is a cardiologist and founder of the New England Heart Center. Ultimately, your blood pressure and heart health is something your primary practitioner and/or cardiologist should be monitoring consistently. Our intent here is not to “treat” anyone through the internet but to simply raise awareness and encourage you to pay attention and take steps to protect yourself if needed. Do not simply depend on information from the internet or Dr. Google as I call it. If you are suffering from high blood pressure (or think you might be) make an appointment with your primary today.

Now that we’ve taken care of that, let’s get going with an easy definition of high blood pressure. According to the American Heart Association, high blood pressure is when your blood pressure, the force of the blood flowing through your blood vessels, is consistently too high.

I want to tell you all why, at times, I should have high blood pressure. It’s because I have a teenager. Yes, I have a 15 year old high school kid and he’s why. Lol. Not really, as far as teenagers go, he could be soooo much worse. Other than his need to be right conflicting with my need to be right, he’s a sweetheart.

Other reasons may be a busted pipe in the pool house when we had a major freeze. I know I know…first world problems… I happen to be the owner of a european great dane…..enough said. That girl can tear some stuff up when she gets bored.

I also have a huge Leonberger dog. Look it up. They’re beautiful but the hair…I’m telling you, it’s a job to stay clean. I could make cushions out of the amount of hair that dog generates.

The animals at my house at this point would include two dogs, a cat (not my choice), two guineas, and two turtles..and that doesn’t even include my 10 year old daughter and my teenage son… I probably have some mice too if I’m guessing right.

Not to mention I’m an actively practicing chiropractor running a busy practice and all of the stressors that come with it. Own your own business they said, be your own boss they said….you’ll be able to do whatever you want. Heck, I don’t have time to think twice and I certainly don’t have a lot of time to sit around and generate content. I’m busy humpin it and making a living. I’m not out on the lecture circuit just yet and having dinner and a drink in the hotel bar. Lol. I’m at work all day every day. I have stress people!! That’s all I’m saying.

But seriously, I have actually been very fortunate and have not had to battle with high blood pressure yet. Thank the good Lord. I am just lucky I think.

From personal experience in treating patients, I have seen new patients having blood pressure counts of 200 over 110 before and they had NO IDEA their blood pressure was high. What does a chiropractor do in that instance? You may get different ideas from different chiropractors but I can tell you what THIS chiropractor does in those cases. I send them either directly to their primary practitioner or the urgent care, whichever they prefer. I won’t touch them as far as chiropractic treatment until the blood pressure is under control.

There is research we will discuss in a minute showing chiropractic is effective in controlling high blood pressure but I will not be the one trying to get it down when it is at that level. I’ll be the one trying to help once it’s normalized. That is simply my opinion and the way I choose to go about things in my practice. As I said, other chiropractors likely have other opinions and protocols.

Next, let’s discuss some high blood pressure facts from the Centers for Disease Control & Prevention that you may not already know about concerning WHO is commonly affected:

  • Did you know that about 75 million Americans suffer from high blood pressure? That’s about a third of the population. Another way of saying that is that 1 in every 3 people have high blood pressure. 
  • Unfortunately, only about half of the people with high blood pressure have the condition under control.
  • About 11 million adults in America have high blood pressure and don’t even know it.
  • High blood pressure costs America around $46 Billion every year when you account for the cost of health care services, medications, and days out of work.
  • High blood pressure affects women about as much as it affects men overall but under the age of 45, more men are affected. Over the age of 65, more women have the condition.
  • When we look at race, more black people have high blood pressure than do whites and Hispanics, and of the black people having it, more women are affected than men.
  • Women having high blood pressure that then become pregnant are more likely to have complications.
  • Uncontrolled high blood pressure during the midlife phase (45-65) seems to be linked to higher risks of dementia later in life.

Here are some of those random facts that you may be able to use in a game of Trivial Pursuit somewhere down the line:

  • Did you know that too little salt can contribute to high blood pressure? We commonly associate an excess of salt with high blood pressure but too little is an issue as well. According to Dr. Stephen Sinatra, a cardiologist from New York, it seems a good mix is keeping more than 1.8 grams of salt a day in your body while keeping sodium below 2.8 mg/day while keeping a close eye on hidden salts that can be found in canned soups, pickles, salted nuts, etc.
  • Potassium plays a part in healthy blood pressure so it’s likely a good idea to foods like eggplant, squash, bananas, coconut water, and baked potatoes.
  • It’s a good idea to have the blood pressure taken in both arms since the numbers are often different from one arm to the other.
  • Cardio is great but weight training can RAISE blood pressure. If you like to lift weights but suffer from high blood pressure, it would probably be a great idea to lift much lighter with higher reps in an attempt to bring down those numbers.

Now let’s talk about some of the causes of high blood pressure in patients:

  • Emotional stress
  • Being overweight
  • Environmental toxins
  • Smoking
  • Lack of exercise
  • Too much salt as well as too little salt
  • More than one or two drinks of alcohol per day.
  • Age
  • Genetics

What risks do you run when leaving your high blood pressure untreated or uncontrolled? As unpleasant as it may be to discuss, it can be as serious as you may have imagined. Here are the potential outcomes of untreated high blood pressure:

  • The CDC states that over 360,000 U.S. citizens died of high blood pressure in 2013 which totals about 1,000 deaths every single day.
  • High blood pressure increases your risk of having a heart attack, of having a stroke, of having long-lasting heart failure, and of having kidney disease.

Here’s brand new and very interesting research paper I wanted to take the time to discuss. It’s by AP Wong and is titled “Review: Beyond conventional therapies: Complementary and alternative medicine in the management of hypertension: An evidence-based review(1).”

Why They Did It

The authors state that high blood pressure is responsible for about 12.8% of all deaths globally. Considering that staggering fact, the World Health Organization has targeted a 25% reduction in high blood pressure by the year 2025 and has encouraged more evidence and research into non-conventional methods of controlling high blood pressure.

How They Did It

  • The authors of the paper had two main objectives

1. Describe the therapeutic modalities commonly used in treating high blood pressure.

2. Review the current level of evidence that has been attained for each.

  • The researchers used a search from 2005-2013 of the databses MEDLINE, The Cochrane Library, PUBMED, and EMBASE.
  • 23 papers were found and accepted.
  • Modalities identified in the 23 papers were fish oil, qigong, yoga, coenzyme Q10, melatonin, meditation, vitamin D, vitamin C, monounsaturated fatty acids, dietary amino-acids, chiropractic, osteopathy, folate, inorganic nitrate, beetroot juice, beetroot bread, magnesium, and L-arginine.

What They Found

The following therapies had weak to no evidence for effectiveness in treating high blood pressure:

  • Fish oil
  • Yoga
  • Vitamin D
  • Monounsaturated fatty acid
  • Dietary amino-acids
  • Osteopathy

The following therapies showed significant reduction in blood pressure:

  • Chiropractic
  • Magnesium
  • Qigong
  • Melatonin
  • Meditation
  • Vitamin C
  • Folate
  • Inorganic nitrate
  • Beetroot juice
  • L-arginine

Coenzyme Q10 has differing results. Some studies showed it had weak to no effectiveness while other studies showed it to have significant effect on the reduction of high blood pressure.

Wrap It Up

In a quote from the authors conclusion, they said, “Results from this review suggest that certain non-conventional therapies may be effective in treating hypertension and improving cardiac function and therefore considered as part of an evidence-based approach.”

With all of the information combined from the articles used as source material, including the research paper, the Alternative means of treating high blood pressure may include:

  • CHIROPRACTIC – we will talk more about this in just a moment
  • Coenzyme Q10 – More discussion on Coenzyme Q10 later.
  • Magnesium
  • Ribose
  • L-arginine
  • RestricT carbohydrates
  • Use olive oil – consider adopting the use of the Mediterranean Pan-Asian diet which is a non-inflammatory diet.
  • Cutting sugar out of your diet is crucial for those suffering from high blood pressure.
  • Less alcohol is best but a glass of wine a day has shown benefits.
  • No processed juices from the grocery store. They’re packed full of useless and damaging sugars.
  • Exercise protocols
  • Lose weight – only a five pound reduction can make a difference
  • Stop smoking!
  • Qigong
  • Melatonin
  • Meditation
  • Vitamin C
  • Folate
  • Inorganic nitrate
  • Beetroot juice

Besides this study, there are several other suggesting Chiropractic plays an important role in reducing or controlling blood pressure.

In one from 1988 by Yates, et. al. called “Effects of chiropractic treatment on blood pressure and anxiety: a randomized, controlled trial,” they showed how anxiety and blood pressure were significantly reduced following chiropractic treatment(2).

In another very interesting study through the University of Chicago Medicine from March 14, 2007, and led by George Bakris, MD (director of the hypertension center at the University of Chicago Medical Center, researchers did the following:

  • They took 50 Chicago-area citizens having high blood pressure.
  • All had misaligned C1 vertebrae measured on x-ray
  • They were randomly divided into a treatment group consisting of a chiropractic adjustment and a sham group where no treatment was actually performed.
  • The participants were assessed at the beginning of treatment, after the chiropractic adjustment, and at the end of eight weeks.

What They Found

The authors stated that the improvement in blood pressure for both systolic and diastolic were similar to that seen when giving patients two different blood pressure medications at the same time. Not only that, but the reduction in the blood pressure continued in the eighth week!

Wow!!!

When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.

Just another reason to call a chiropractor TODAY!

Research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic. Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health!

Please feel free to send us an email at dr.williams@chiropracticforward.com and let us

know what you think or if you have any suggestions for future episodes. And remember

to help us spread the word by sharing our podcast with your colleagues, your friends,

and your family.

From Creek Stone in Amarillo, TX and the flight deck of the Chiropractic Forward

podcast, this is Dr. Jeff Williams saying upward, onward, & forward.

Research Citations

(1) Wong AP, et al. “Review: Beyond conventional therapies: Complementary and alternative medicine in the management of hypertension: An evidence-based review.” Pak J Pharm Sci. 2018 Jan;31(1):237-244.

https://www.ncbi.nlm.nih.gov/m/pubmed/29348109/

(2) Yates RG, et. al. “Effects of chiropractic treatment on blood pressure and anxiety: a randomized, controlled trial.” J Manip Physical Ther. 1988 Dec;11(6):484-8.

https://www.ncbi.nlm.nih.gov/pubmed/3075649

(3) Bakris, G. Journal of Human Hypertension, advance online publication, March 2, 2007. Grassi, G. Journal of Human Hypertension, advance online publication, January 25, 2007.George Bakris, MD, director, hypertension center, University of Chicago. Marshall Dickholtz Sr., DC, Chiropractic Health Center, Chicago.

http://www.uchospitals.edu/news/2007/20070314-atlas.html

Other Source Material:

https://www.cdc.gov/bloodpressure/facts.htm

https://www.cdc.gov/features/highbloodpressure/index.html

https://www.heart.org/HEARTORG/Conditions/HighBloodPressure/GettheFactsAboutHighBloodPressure/The-Facts-About-High-Blood-Pressure_UCM_002050_Article.jsp#.WmYUYyOZNBw

https://www.drsinatra.com/6-surprising-blood-pressure-facts-everyone-should-know