Imaging

Chiropractic Cost-Effectiveness & Early MRIs Lengthen Disability

CF 209: Chiropractic Cost-Effectiveness & Early MRIs Lengthen Disability

Today we’re going to talk about the cost-effectiveness of chiropractic and we cover how getting MRIs too early can lengthen the time of disability a patient goes through. Interesting stuff! But first, here’s that sweet sweet bumper music

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Chiropractic evidence-based products

Integrating Chiropractors

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

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

You have found yourself smack dab in the middle of Episode #209 Now if you missed last week’s episode, it was our 4 year anniversary and round up episode. We covered the top ten all time listened to episodes from the 4 years and it was fun to reminisce. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

So on the personal side of things we are currently getting ready to have our official welcome reception for our nurse practitioner. And I thought I would talk about it briefly just to get your wheels turning about how you do internal marketing. We have done a lot of stuff to try to get the word out about our nurse practitioner. We started by making a list of all of the new services we would be adding and we had fire sitting all around the office. Every time I had a patient come in I would grab one and hand it to them and make sure that they knew what we had come up before he even started his first day.

We send out a weekly email to our patient base. You better believe they heard over and over and over again about the medical integration that was on the horizon. We just started a radio campaign. Somewhere in there we won best of competition in our city which has about a population of 300,000 or so. So that was a pretty big deal. Obviously, anytime I’m working on somebody and we have a conversation I am thinking about whether they need to be seeing our nurse practitioner at the same time.

If they have pesky trigger points I tell them about trigger point injections. If they’re fussing about being tired I tell them about hormone replacement or IV therapy. If I ask them if they have had a bone scan because it’s an older female and they say they don’t have a primary, boom they do now. I think you understand what I’m saying but that is the ultimate in internal marketing. We also have a sign at the front door saying make your appointment for our new medical services today. We also have another one in the lobby. We have hormone replacement banners in the rehab room. This is an ongoing thing. And, slowly, he’s getting busier Last week our nurse practitioner had about 28 to 30 appointments for the week. When he started out in August, obviously it was zero. Two weeks ago it was 18 or 19 appointments for the week. So we are getting there. I am also creating weekly blogs and corresponding YouTube videos and most of them right now I have to do with the Nurse Practitioner and the new services we offer.

And as a side note I have to say, it has been really nice to have another provider in the office. I can’t wait to be able to hire an associate to take over my day to day stuff. But in the meantime, if a case is being particularly pesky, it’s nice to be able to broaden my approach even further than before. If you don’t know much about my clinic, we have me, medical, exercise rehab, three massage therapists, acupuncture, and even an esthetician in the spa side of the building. We are fully integrated and a broad approach is the name of the game Medical was just the next logical step and though it was hard to get set up, we are well on our way now. Let’s be clear.

Still not profitable. But we’re no longer hemorrhaging. Mucho mejor mi amigos Outside of setting up the welcome reception this Friday, we are creating the FB event and inviting doctors and lawyers and any other potential referral source. I am experimenting with creating opt in lead pages with a trickle email campaign and a Google Ads, Facebook Ads, and Instagram ad campaign to lead them there.

Marketing is like treating pain. It’s a broad management type of thing. Hit it from all directions but whatever you do….you have to market. You can’t do business sitting in your ass as Dan Kennedy says. You can’t just be a doer of what you do. You have to be a marketer of what you do. Before we dive in, I want to thank ChiroUp for asking me to guest on their blog and video recently.

I joined Dr. Brandon Steele for a conversation on chronic pain and all the topic entails. It was an excellent talk and Dr. Steele and partner Dr. Tim Bertlesman are just top-notch examples of what chiropractors can be. I can’t say enough about both or them or ChiroUp. They’ve changed our profession for the better.  Alright, let’s get going with the research

Item #1

I first want to thank Dr. David Graber, our esteemed New Jersey-an colleague and contemporary for posting this study in the Forward Thinking Chiropractic Alliance group. He’s got a ton of great research. He’s on top of it all. Go look up Dr. Graber if you get a minute and add his professional page on Facebook. You won’t regret it. 

This first one is called “The association between use of chiropractic care and costs of care among older Medicare patients with chronic low back pain and multiple comorbidities” by Weeks et. al. (Weeks 2016) and published in the Journal of Manipulative Physiological Therapeutics

Why They Did It

The purpose of this study was to determine whether use of chiropractic manipulative treatment (CMT) was associated with lower healthcare costs among multiple-comorbidity Medicare beneficiaries with an episode of chronic low back pain (cLBP).

How They Did It

  • The authors conducted an observational, retrospective study of 2006–2012 Medicare fee-for-service reimbursements
  • The project included 72,326 multiply-comorbid patients aged 66 and older with cLBP episodes and 1 of 4 treatment exposures 
  • The exposures were chiropractic manipulative treatment (CMT) alone, CMT followed or preceded by conventional medical care, or conventional medical care alone. 
  • The researchers used propensity score weighting to address selection bias.

What They Found

  • The total and per-episode Medicare reimbursements during the cLBP treatment episode were lowest for patients who used CMT alone; 
  • These patients had higher rates of healthcare use for low back pain but lower rates of back surgery in the year following the treatment episode.
  • Expenditures were greatest for patients receiving medical care alone; 
  • Patients who used only CMT had the lowest annual growth rates in almost all Medicare expenditure categories. 

Wrap It Up

This study found that older multiple-comorbid patients who used only chiropractic manipulative therapy during their chronic low back pain episodes had lower overall costs of care, shorter episodes, and lower cost of care per episode than patients in the other treatment groups. Further, costs of care per episode were lower for patients who used a combination of chiropractic manipulative therapy and conventional medical care than for patients who did not use any chiropractic manipulative therapy. 

Item #2

Our last one here is called “The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis” by Shraim et. al.  and published in BMC Musculoskeletal Disorders in November of 2021…..sizzle…I can’t touch it. Because it is too hot for me to handle.  Why They Did It They start the abstract by saying that clinical guideline recommendations are against early magnetic resonance imaging  within the first 4 to 6 weeks of conservative management of acute low back pain (LBP) without “clinical suspicion” of serious underlying conditions. Otherwise known as red flags. 

There is some limited evidence that a significant proportion of patients with low back pain receive early MRI non- indicated by clinical guidelines, which could be associated with increased length of disability The aim of this systematic review was to investigate whether early MRI for acute low back pain without red flags is associated with increased length of disability. The length of disability was defined as the number of disability days (absence from work

How They Did It

  • Medline, EMBASE, and CINAHL bibliographic databases were searched from inception until June 5, 2021. 
  • Two reviewers independently assessed the methodological quality of included studies using the Newcastle-Ottawa scale and extracted data for the review. 
  • The search identified 324 records, in which seven studies met the inclusion criteria. 
  • Three of the included studies used the same study population.

What They Found

  • All included studies were of good methodological quality and consistently reported that patients with acute low back pain without red flags who received early magnetic resonance imaging had increased length of disability compared to those who did not receive early magnetic resonance imaging. 
  • Three retrospective cohort studies reported that the early magnetic resonance imaging groups had a higher mean length of disability than the no early magnetic resonance imaging groups ranging from 9.4 days to 13.7 days at the end of 1-year follow-up period. 
  • The remaining studies reported that the early magnetic resonance imaging groups had a higher hazard ratio of work disability when compared to the no early magnetic resonance imaging groups.

Wrap It Up

Early magnetic resonance imaging is associated with increased length of disability in patients with acute low back pain without red flags. Identifying reasons for performing non-indicated early magnetic resonance imaging and addressing them with quality improvement interventions may improve adherence to clinical guidelines and improve disability outcomes among patients with low back pain.

Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations.

So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.     

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

Key Point:

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

Contact

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

Connect

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

Website https://www.chiropracticforward.com

Social Media Links https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/

Twitter https://twitter.com/Chiro_Forward

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

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

Player FM Link https://player.fm/series/2291021

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

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

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

Bibliography

  • Shraim BA, S. M., Ibrahim AR, Elgamal ME, Al-Omari B, Shraim M (2021). “The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis.” BMC Musculoskelet Disord 22(1): 983.apple
  • Weeks, W. B., Leininger, B., Whedon, J. M., Lurie, J. D., Tosteson, T. D., Swenson, R., O’Malley, A. J., & Goertz, C. M, (2016). “The Association Between Use of Chiropractic Care and Costs of Care Among Older Medicare Patients With Chronic Low Back Pain and Multiple Comorbidities.” J Manipulative Physiol Ther 39(2): 63-75.

 

Does Imaging Mean Better Outcomes & Melatonin Slowing Down Disc Degeneration

CF 207: Does Imaging Mean Better Outcomes & Melatonin Slowing Down Disc Degeneration

Today we’re going to talk about….Does Imaging Mean Better Outcomes & Melatonin Slowing Down Disc Degeneration But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

You have found yourself smack dab in the middle of Episode #207 Now if you missed last week’s episode, we talked about how Vertebral Dysfunction Alters Neuro Function & The Gender Of Your Provider May Matter. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

It’s a bit hectic around here this week being the week after Thanksgiving as of this recording. Being off for 4 days straight was a very welcome respite from the normal day-to-day.  Nothing too crazy around here this week. We are missing our intern who left last week. We’re just re-acclimating to life as it was before we had an extra hand here in the office. But we’re getting there. We’re stretched a little thin because we added the nurse practitioner.

Well, when he has a procedure, he needs an extra set of hands so that takes up one of our CAs. That leaves us short on this end of the business.  But, the NP is not busy enough consistently enough for us to need to hire another set of hands full time. So, we’re in a growth period and growth can stretch you. And it’s stretching us.

But that’s OK. I know it’ll all be worth it eventually.  We started our integrated journey back on August 1st and here we are at almost December 1st. So that’s about 4 months in. We are averaging around 18-20 visits per week for the medical services and just trying to build build build.  Our most common services would probably be trigger point injections, primary visits, and maybe the hormone pellets or IV therapy. It’s a slow grow thing as with any new venture. It takes time to get your message out. And we’re working on it. We start radio ads next week.  Other than that, outside of chiropractic, we are setting up a short term rental/Airbnb, VRBO type of house.

It is a brand new flip so we’re stepping into a basically new place and it’s ready to go. We’ve been buying all of the stuff to outfit it, getting all wireless stuff so we can manage it ourselves remotely, hiring a contractor to build a deck on the back, and are getting our AirBNB and VRBO listings in order and all that good stuff.  It’s a mess for about a month but once you get it set up, it should only take us about 15-30 minutes per week to manage it from an hour and a half away. And, according to AirDNA which is an analysis software for short term rentals, we stand to profit around $30,000+ per year on the thing. That’s pretty exciting. 

I always talk about the exit strategy. This is part of it. Getting more stuff in line outside of your day to day. 30 minutes a week is not completely passive work but it’s damn near passive and gives us a good raise through the year. And $30k is a nice down payment on another house. Especially when you combine it with what I’m doing in voice over industry currently.  Now, if I can just get a rock star associate to come in and take some of the heat off of me on the day to day hands-on chiropractic treatment. THEN….then we might be on our way.  Enough of that, let’s get to it. 

Item #1

The first one this week is called “What are the effects of diagnostic imaging on clinical outcomes in patients with low back pain presenting for chiropractic care: a matched observational study” by Jenkins et. al.  (Jenkins 2021)and published in Chiropractic and Manual Therapies on November 23rd of 2021, aye chi Wawa….it’s so hot. 

Why They Did It

Evidence suggests that diagnostic imaging for low back pain does not improve care in the absence of suspicion of serious pathology. However, the effect of imaging use on clinical outcomes has not been investigated in patients presenting to chiropractors. The aim of this study was to determine if diagnostic imaging affects clinical outcomes in patients with low back pain presenting for chiropractic care.

How They Did It

  • A matched observational study using prospective longitudinal observational data with one year follow up was performed in primary care chiropractic clinics in Denmark. 
  • Data were collected from November 2016 to December 2019. 
  • Participants included low back pain patients presenting for chiropractic care, who were either referred or not referred for diagnostic imaging during their initial visit. 
  • Patients were excluded if they were less than 18 years old, had a diagnosis of underlying pathology, or had previous imaging relevant to their current clinical presentation. 
  • Mixed linear and logistic regression models were used to assess the effect of imaging on back pain intensity and disability at two-weeks, three-months, and one-year, and on global perceived effect and satisfaction with care at two-weeks.
  • 2162 patients were included, with 24.1% referred for imaging. 

What They Found

Participants referred for imaging had slightly higher back pain intensity at two-weeks and one-year, and disability at two-weeks, but the changes are unlikely to be clinically meaningful.  No difference between groups was found for the other outcome measures. Similar results were found when sensitivity analysis, adjusted for age and leg pain intensity, was performed.

Wrap It Up

Diagnostic imaging did not result in better clinical outcomes in patients with low back pain presenting for chiropractic care. These results support that current guideline recommendations against routine imaging apply equally to chiropractic practice. I know some of you will say “I found so and so on a person that would have never been found, etc.” I get it. And some of you just feel better if you’ve seen what’s going on underneath. I get it and I don’t fault that. I really don’t BUT….you MUST acknowledge that the vast majority of your x-rays that you insist on taking on every patient that walks through your doors, ultimately, weren’t absolutely necessary and didn’t change a thing about how you would be treating them.  That is of course unless you’re a technique philosophy wonk and you think you find listings on x-rays. A strategy that I’ve seen little research that can support.  If you follow Choosing Wisely, you are typically in safe and calm waters. 

Item #2

The second one is called “The potential role of melatonin in retarding intervertebral disc ageing and degeneration: A systematic review” by Cheng et. al. (Zhangrong Cheng 2021) and published in Ageing Research Reviews in September of 2021

Why They Did It

They start by setting the stage here.  Low back pain (LBP) is the leading cause of years lived with disability in the world population, which has increased by over 50 % in the past 20 years, mainly due to population ageing Intervertebral disc degeneration (IDD) is a common degenerative disease of the musculoskeletal system that develops with age. It is regarded as the main cause of chronic low back pain in the elderly. IDD has various causes, including ageing, mechanical overloading, and nutritional deficiency.

Melatonin is a pleiotropic indole hormone secreted by the pineal gland and plays an important role in resisting various degenerative diseases.  The serum levels of melatonin decline with age and are reported to be negatively correlated with the symptomatic and histopathological scores of IDD. In vivo studies have shown that exogenous administration of melatonin could maintain the structural integrity of the intervertebral disc and inhibit the development of IDD. Mechanistically, by interacting with its membrane or intracellular receptors, melatonin can promote autophagic flux, scavenge free radicals, inhibit the release of pro-inflammatory factors, and block apoptotic pathways, thereby enhancing anti-stress abilities and matrix anabolism in different types of disc cells.  Several studies have explored the effects of melatonin on IDD.

This was first discovered when surgical removal of the pineal gland in chickens depleted their serum melatonin levels and accelerated IDD onset Therefore, melatonin supplementation may be a promising therapeutic strategy for IDD. This review aimed to summarize the latest findings regarding the therapeutic potential of melatonin in IDD.

Wrap It Up

From the perspective of therapeutic strategies for IDD, the benefits of melatonin are comprehensive. The existing evidence supports melatonin as a potential therapy for the prevention and treatment of IDD Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

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

Chiropractic evidence-based products

Integrating Chiropractors

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  The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website https://www.chiropracticforward.com Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter https://twitter.com/Chiro_Forward YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  Bibliography Jenkins, H. J., Kongsted, A., French, S.D (2021). “What are the effects of diagnostic imaging on clinical outcomes in patients with low back pain presenting for chiropractic care: a matched observational study.” Chiropr Man Therap 29(46).   Zhangrong Cheng, Q. X., Juntan Wang, Yukun Zhang, (2021). “The potential role of melatonin in retarding intervertebral disc ageing and degeneration: A systematic review.” Ageing Research Reviews 70.    

Getting Patients Returning, Shoulder Impingement, Cervical Manipulation, & X-rays and Neurodegenerative Disease

CF 133: Getting Patients Returning, Shoulder Impingement, Cervical Manipulation, & X-rays and Neurodegenerative Disease Today we’re going to talk about getting your patients back in your office, we’ll talk about shoulder impingement, cervical manipulation research, and we’ll talk about low dose x-rays being the cause of neurodegenerative disease.  But first, here’s that sweet sweet bumper music  

Chiropractic evidence-based products

Integrating Chiropractors

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

  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!

Do it do it do it.  You have found yourself smack dab in the middle of Episode #133 Now if you missed last week’s episode, we talked about giving, we talked about maintenance care, dry needling, and we also talked about vitalism.

Make sure you don’t miss that info. Keep up with the class. 

While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points. 

Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper. 

 

On the personal end of things….. The last two episodes have had a talk about vitalism and all of that. I got red in the face and gripey and some would even say…..disagreeable.  None of that this week. Fun and positivity. I made the mistake of going back to recording the personal part of the podcast….this part of the podcast….two weeks in advance. Well, it bit me in the butt an episode or two back. I should know by now that that damn COVID’s going to change the program. Lol. I said it was looking good and numbers were great and by the time we get to air time, 2 weeks down the road, the roadmap was different and crap was firing up everywhere again.

It sounded silly for it to be firing up everywhere and there I am on a fresh episode talking about how good it’s looking. Lol. So…..I’m not going to mention anything like that again.  Besides, you guys are probably not in the mood to hear more about it anyway. Instead, I’ll tell you that I’m at about 81% of where I want to be. The least I want to see per week is about 180 appointments. Each week. 13 – 15 new patients per week. That’s the LEAST I want to see.  As of this recording, last week I saw 146 and 15 patients.

So, I’m not at 180 yet but I’m more comfortable with my new patient count. Let’s keep that rocking and the other numbers should take care of itself sooner than later. It’s a Monday afternoon and I have 120 on the books. That’s before Wednesday gets booked up, Thursday, and Friday. So, starting a Monday with 120 already booked for the week, that tells me we have a good chance at a continued recovery.  What are your numbers looking like? Is your practice starting to get back to normal and stabilize?

What are you doing to make sure your business survives this mess? I want to hear about it so I can share it with our audience. If you’ll share with us on the Facebook page, in the Facebook group, or by sending me an email at [email protected]…..I’ll make sure and share with the rest of our listeners. This can be an excellent way to help others that are struggling right now.  Last week I talked about giving. Well, this is a great way to give back to your profession and colleagues that may not be doing as well as we are.  I’ll start.  I doubled down on Social Media Instead of one post a day, we went to 3 per day and 4 per day on the weekends.  We went from just talking about chiropractic to fun posts with a little bit of chiropractic here and there.

About every 4th or 5th post.

We want to entertain. I don’t know that anyone wants to be sold anything right now but, I don’t personally mind commercials or being interrupted if I’m simultaneously being entertained. So that’s what we did. We started entertaining our crowd We asked for people to help us by inviting their friends to our page. And they did! We hit numbers that would have taken us 3 years to build. We hit them in only about 4 days. I was amazed. Just because we asked and, it seems that at this time, more people are willing to help others.  Of course, that’s if they’re not bitching at each other about masks.  I got back to my weekly emails to my patients.

I had fallen off to emailing only once every 3-4 weeks. Now I’m back on a weekly schedule.  I revamped my To-Do list to include everything thing that I need to accomplish every day so I don’t forget or let things lapse. I want to stay on point with getting our message out every day, every week, every month.  I decided to try a professional company for Facebook ads. We still have a lot of really mixed results on that sucker right now so I haven’t talked much about it but I’ll let you know how we do down the road. 

In the meantime, as if I needed something else to occupy my time, I started a voice-over career on the side. Lol. To go along with my sculpting, drawing, and art career. To go along with my furniture building career. Which will go along nicely with my singer/songwriter/guitar-playing career?  Geez….is that the very definition of A.D.D. or what? But yeah, if you need any commercials voiced for you, holler at me. I’m happy to help. 

Back to the office, I got back to doing weekly YouTube videos. Every week like clockwork. That made me get back to writing my own weekly blog. That’s work I used to hire out to a guy in South Africa but I took it back over for a bit and it’s been fun actually.  So, as you can see, I’ve made A LOT of changes to get back on track and get this sucker not just where it was this time last year, but 10% or bigger. Why the hell not? Overall, I have made it a point to highlight what we are doing to help keep them as safe as we can. If COVID is the barrier, then we need to do everything we can to remove that barrier. 

Alright, as I said, you guys and gals send me your suggestions of things you are doing to get your patients back in your clinic. 

Item #1 This first one this week is called ‘Relationship between shoulder impingement syndrome and thoracic posture’ by Hunter et. al.(Hunter D 2020) and published in Physical Therapy journal in April of 2020 and that means that that is one hot son of a mother!!

Why They Did It They say that shoulder impingement is the most common form of shoulder pain and a persistent musculoskeletal problem and that we have had limited success in treating it. They wanted to test whether or not thoracic posture has anything to do with it. 

How They Did It

  • This was a case-control study. 
  • Thoracic posture of 39 participants with shoulder impingement was measure using the modified Cobb angle from a lateral x-ray. 
  • They accounted for age, gender, and dominant arm
  • T-sp range of motion was measured with an inclinometer

What They Found

  • Individuals with shoulder impingement had greater thoracic kyphosis and less active thoracic extension
  • Greater thoracic kyphosis was associated with less extension ROM

Wrap It Up “Individuals with shoulder impingement had a greater thoracic kyphosis and less extension ROM than age- and gender-matched healthy controls. These results suggest that clinicians could consider addressing the thoracic spine in patients with shoulder impingement.”

Item #2 Item #2 this week is called “The Effect of High Velocity Low Amplitude Cervical Manipulations on the Musculoskeletal System: Literature Review” by Giacalone et. al.(Giacalone 2020) published in Cureus in April of 2020 which makes it too hot to handle for me!

Why They Did It They say that cervical manipulative techniques are mostly used for the treatment of biomechanical joint dysfunction, but little is known about possibly using them in order to achieve better performance on a healthy subject

How They Did It

  • A systematic search was carried out on the Pubmed electronic database from the beginning of January to March 2020.
  • Two independent reviewers conducted the screening process through the PRISMA diagram to determine the eligibility of the articles.
  • The inclusion criteria covered randomized controlled trial (RCT) manuscripts published in peer-reviewed journals with individuals of all ages from 2005 to 2020.
  • The included intervention was thrust manipulation or HVLA directed towards the cervical spine region. 
  • After reviewing the literature, 21 of 74 articles were considered useful and relevant to the research question.

What They Found

  • HVLA techniques, on subjects with musculoskeletal disorders, are able to influence pain modulation, mobility, and strength both in the treated area and at a distance.
  • Cervical manipulations are effective in the management of cervicalgia, epicondylalgia, temporomandibular joint disorders, and shoulder pain.
  • With regard to results on strength in healthy subjects, given the divergent opinions of the authors, we cannot yet state that manipulation can significantly influence this parameter.

Item #3 Our last one is called ‘Low-dose x-ray imaging may increase the risk of neurodegenerative diseases’ by Caroline Rodgers(Rodgers C 2020) and published in Medical Hypotheses in April of 2020…..look at April…..not just bringing us COVID…but also bringing us a bunch of plates of steamy hot stuff. 

As the journal says, this is a hypothesis. The hypothesis presented in this paper explores the possibility that X-ray imaging commonly used in dental practices may be a shared risk factor for sporadic dementias and motor-neuron diseases. As the evidence will suggest, the brain is ill-equipped to manage the intrusion of low-dose ionizing radiation (IR) beyond that which is naturally occurring.

When the brain’s antioxidant defenses are overwhelmed by IR, it produces an abundance of reactive oxygen species (ROS) that can lead to oxidative stress, mitochondrial dysfunction, loss of synaptic plasticity, altered neuronal structure and microvascular impairment that have been identified as early signs of neurodegeneration in Alzheimer’s disease, Parkinson’s, amyotrophic lateral sclerosis, vascular dementia and other diseases that progressively damage the brain and central nervous system.

Common assumptions regarding the risks of low-dose IR will be addressed, such as 1) comparing rapid, repeated bursts of man-made IR sent exclusively into the head to equivalent amounts of head-to-toe background IR over longer periods of time; 2) whether epidemiological studies that dismiss concerns regarding low-dose IR due to lack of evidence it causes cancer, heritable mutations or shortened life spans also apply to neurodegeneration; and 3) why even radiation-resistant neurons can be severely impacted by IR exposure, due to IR-induced injury to the processes they need to function. 

If X-ray imaging is found to be associated with neurodegeneration, the risk-versus-benefit must be reevaluated, every means of reducing exposure implemented and imaging protocols revised. So…..we here at Chiropractic Forward will be following along here. Because if this turns out to confirm that radiation causes neurodegenerative disease, you know what that means for the chiropractors shooting x-rays on each and every patient and then doing several follow up x-rays on them?  They won’t be happy campers. But, maybe they’ll start following more guidelines that say no x-rays outside of red flags. I’ve said several times that I’m not against chiropractors that shoot initial x-rays. I’m really not.

Some are just more comfortable working on people when they’ve seen what they can see.  My issue is using the initial x-rays as a scare tactic and communicating in a catastrophic way to achieve a long treatment schedule out the patient. One they likely don’t need at all.  My other issue would be repeating x-rays several times through treatment.

That’s not evidence-based and the patient doesn’t need them. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

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

Bibliography Giacalone A, F. M., Magnifica F, Ruberti E, (2020). “The Effect of High Velocity Low Amplitude Cervical Manipulations on the Musculoskeletal System: Literature Review.” Cureus 12(4): e7682. Hunter D, R. D., McKeirnan S, (2020). “Relationship Between Shoulder Impingement Syndrome and Thoracic Posture.” Phys Ther 100(4): 677-686. Rodgers C (2020). “Low-dose X-ray Imaging May Increase the Risk of Neurodegenerative Diseases.” Med Hypotheses 142(109726).