Jeff Williams - evidence-based chiropractor

Children, Activity, and Depression and Axially Loaded MRIs

March 2, 2023 chiropracticforward 0:13:41 0 Comments

CF 269: Children, Activity, and Depression and Axially Loaded MRIs

Today we’re going to talk about Children, Activity, and Depression and Axially Loaded MRIs

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!

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow, look down your nose at people kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. I’m so glad you’re spending your time with us learning together. Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, drive, smart, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do.

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

You have found yourself smack dab in the middle of Episode #269 Now if you missed last week’s episode, we talked about Postoperative Acupuncture & Activity And Depression. Make sure you don’t miss that info. Keep up with the class. On the personal end of things….. This week has started out gangbusters, folks. 47 on the schedule and that’s just me. We have the nurse practitioner kicking, the massage therapists doing their thing, we have the acupuncturist banging ‘em out, and a full, brand new team, as most of you know…..and they’re learning and getting up to speed quickly. They’re much quicker with everything they do every day. The new front desk staffer is phenomenal and really catching on. She’s the real deal so, things are smelling pretty darn rosey around Creek Stone folks. Isn’t that a lot better than me fussing about being slow. Let’s hope my upward swing maintains so I don’t have to go back into gripey mode. Now, things I’m doing lately. I’m experimenting a lot with ChatGPT. If you’re not familiar, you might give it a look-see. It’s a game changer for those like me that are highly involved in their own content creation, blogs, articles, marketing, and things of that nature. It’s scary but for now, scary in a good way and is saving me literally 3-6 hours every single week and saving lots of money as well. Need an article, have ChatGPT get the base coat of the painting laid down for you while you come in and do the touch-ups. Need a meeting outline? ChatGPT. How about ideas for social media postings? Yep, ChatGPT. It’s remarkable. Think about it; I have several things happening in my daily. Chiropractic Forward is a small part of my life. This ChatGPT is helping me get a lot of stuff lined out and I’m pretty excited about it. So check it out. Remember, you heard it from your ol’ Uncle Jeffro first. Let’s dive in. Item #1 The first on today is called, “Physical Activity Interventions to Alleviate Depressive Symptoms in Children and Adolescents” by Francesco Recchia and published in Jamapediatrics on January 3, 2023. Dayum. That’s hot. Why They Did It To determine the association of physical activity interventions with depressive symptoms in children and adolescents. How They Did It A random-effects meta-analysis using Hedges g was performed. Heterogeneity, risk of bias, and publication bias were assessed independently by multiple reviewers. Meta-regressions and sensitivity analyses were conducted to substantiate the overall results. The study followed the PRISMA reporting guideline. PubMed, CINAHL, PsycINFO, EMBASE, and SPORTDiscus were searched from inception to February 2022 for relevant studies written in English, Chinese, or Italian. What They Found

Twenty-one studies involving 2441 participants (1148 [47.0%] boys; 1293 [53.0%] girls; mean [SD] age, 14 [3] years) were included.
Meta-analysis of the postintervention differences revealed that physical activity interventions were associated with a reduction in depressive symptoms compared with the control condition (g = −0.29; 95% CI, −0.47 to −0.10; P = .004).
Analysis of the follow-up outcomes in 4 studies revealed no differences between the physical activity and control groups (g = −0.39; 95% CI, −1.01 to 0.24; P = .14).
Moderate study heterogeneity was detected (Q = 53.92; df = 20; P < .001; I2 = 62.9% [95% CI, 40.7%-76.8%]). The primary moderator analysis accounting for total physical activity volume, study design, participant health status, and allocation and/or assessment concealment did not moderate the main treatment effect. Secondary analyses demonstrated that intervention (ie, <12 weeks in duration, 3 times per week, unsupervised) and participant characteristics (ie, aged ≥13 years, with a mental illness and/or depression diagnosis) may influence the overall treatment effect.

Wrap It Up Physical activity interventions may be used to reduce depressive symptoms in children and adolescents. Greater reductions in depressive symptoms were derived from participants older than 13 years and with a mental illness and/or depression diagnosis. The association with physical activity parameters such as frequency, duration, and supervision of the sessions remains unclear and needs further investigation. Before getting to the next one, Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office. When you decide you can’t live without those products, send me an email and I’ll give you the hookup. They will 100% differentiate your clinic from your competitors. I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Item #2 Our last one this week is called, “Magnetic Resonance Imaging Evaluation of Biomechanical Effects of Axial Loading on the Lumbar Spine” by Adnan Sehic and published in PubMed on 2022 30 Dec. Hot potato! Why They Did It The aim of this study is to determine the significance of alMRI in detecting the morphologic changes of the lumbar spine caused by axial loading and to compare it with conventional MRI images of the lumbar spine without loading. How They Did It

The study was conducted as a prospective, descriptive clinical trial.
Imaging was performed with a MRI 1.5 T in the head-first supine position. Imaging was performed in two acts: without load and under load. Loading for alMRI was performed with the DynaWell L-Spine device.
The onset of loading was 10 minutes before the start of alMRI. The loading continued throughout the imaging procedure.

What They Found After evaluating the changes in the height and size of the lumbar disks, the size of the DSCA, and the narrowing of the intervertebral foramina significant differences were found between the images before and after axial loading. Wrap It Up alMRI provides information on morphological changes of all segments of the lumbar spine. This data represents significant information that can lead to more accurate and effective treatment of LBP. 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!

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

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

Connect

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

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About the Author & Host

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

Cervical Curvature & Lumbar MRI Findings In Asymptomatics – New Stuff

December 15, 2022 chiropracticforward 0:21:36 0 Comments

CF 259: Cervical Curvature & Lumbar MRI Findings In Asymptomatics – New Stuff Today we’re going to talk about Cervical Curvature & Lumbar MRI Findings In Asymptomatics – New Stuff But first, here’s that sweet sweet bumper music

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

OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow, look down your nose at people kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. I’m so glad you’re spending your time with us learning together. Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, drive, smart, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do.

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

You have found yourself smack dab in the middle of Episode #259 Now if you missed last week’s episode , we were joined by Dr. Anthony Houssain and had an amazing discussion on how to choose a good practice location, on the clinic/gym hybrid model, and one why masterminds are so important for you growth. Make sure you don’t miss that info. Keep up with the class. On the personal end of things….. First thing, if you haven’t had enough of my podcast, or you just want to hear my thoughts in a different context and setting, Dr. Jay Greenstein and Brad Cost interviewed me for their podcast called TechTalk and we had a great chat about life, practice, and all things in between. Go check it out. It aired just a week or two ago so it’s one of their newest episodes. So, if you’ve been listening lately, you know I’ve been in a slump. I’m not a slump type of guy. I don’t know what ‘take a step back’ even looks like. It’s not in my vocabulary. All I know is progress, growth, win, win, win. I’m an old college football player and won state here in Texas in the discus. Competition, initiative, and growth are engrained in the very fabric of my being. It’s just how I’m built. So, being slower here in the clinic this year has been challenging for me. A bit financially but also big time mentally. I don’t have mental health issues. That’s now what we’re talking about. Mentally as far as trying to figure it out. Putting the puzzle together so that I can fix it and get back to growing. Part of that has been fixing my outlook day to day. Embracing the suck. Meaning, when I show up on a Monday morning and there’s 48 on the schedule and there are 5 in the lobby before we even open…..instead of being defeated before I even get into my office space, my personal area, instead of being defeated, I need to embrace the stress and anxiety, thank God for our blessings, and get to work making people feel better. So, I wanted to fix that first. Then, what else could be the issue. Well, I used to be #1 on the google search. For years I was the top one because nobody else had figured out the importance at that time so I had a step ahead. But, an internet company I was with screwed up my site, Google changed their algorithms, and boom, I started dropping. So I switched companies. They set up a great site but no real SEO. So I started blogging every single week. New, fresh, completely original content. Guess what, no help at all. Not even a little. I was falling like a rock. So I think website SEO is a big issue so I’m addressing that now too. You all know I’m in the Florida Mastermind with Dr. Kevin Christie. Well Kevin works with Darcy Sullivan of Propel. So, I contacted Darcy and she’s taking me on as a client and a big project I can only assume. Lol. I’m going to be talking every week or so about my experience so you’ll know how it’s going in real time and we’ll be able to see where I started and where I end up with Darcy’s help. It’ll be a learning project we’ll do together. Stick with me for the next 4-6 months on the website SEO thing because this should be interesting. If all works out well, you may be contacting Darcy and Propel as well. Time will tell. Alright, let’s get to the research shall we? Item #1 Our first on his called, “Lumbar spine MRI findings in asymptomatic elite male academy footballers: a case series: by Carmody et. Al. (Carmody S 2022) and published in BMC Sports Science Medical Rehabilitation on October 24th, 2022 and that’s brand new and it’s hot too! Why They Did It

Understanding common MRI findings may allow clinicians to appreciate the sport-specific effects on the lumbar spine, and to discern clinically significant pathology.
Prevalence data regarding radiological abnormalities seen during the surveillance of asymptomatic elite footballers is, therefore, important to help understand injury mechanisms and to prevent associated injuries.
The purpose of this study was to evaluate the magnetic resonance imaging (MRI) findings in the lumbar spines of asymptomatic elite male adolescent footballers.

How They Did It

A prospective case-series study was carried out.
MRI was performed in 18 asymptomatic male elite adolescent footballers recruited from a professional academy in England
The images were independently reported by two consultant musculoskeletal radiologists to achieve consensus opinion.

What They Found

Fifteen players (83%) showed one or more abnormalities, that included facet degeneration, synovial cysts, disc degeneration, disc herniation, and pars injury.
One player had mild (Grade 1) facet joint arthropathy at L4/L5
3/18 showed evidence of bilateral facet joint effusions.
Three synovial cysts were identified in 2 players,
4 presented asymptomatic pars injuries,
4 had a grade 2 subtotal stress fracture and
1 player had a grade 4 chronic stress fracture
Disc degeneration at one or more levels was demonstrated in 7 fo the 18.
Disc herniation was present in 5 or 27% of the players.

Wrap It Up A range of unsuspected findings on MRI of the lumbar spine are common in elite adolescent footballers. Folks, all of those scary words used to send my patients straight to a surgeon for a second evaluation. Now I know better. These are all asymptomatic. No clinical issue whatsoever and these players ranged from 17 years old to almost 19 years old. No pain and almost 30% of them had disc herniations. We can manage these cases. If there is no progressive neurological deficit with regard to bowel and bladder function, DTRs, dermatomes, or motor function, why are you sending them anywhere? Don’t do it. Pain is not a reason for surgery and we can manage them if you are educated and know what to do. If you do not know, get smart and get educated. Good starting points are:

Stu McGill’s book called Back Mechanic
Craig Liebensen
McKenzie Certifications
FMS/SFMA
DNS
Donal Murphy’s Spine Practitioner program and his CRISP Protocol books.

Just that group of stuff right there will put you heads and shoulders beyond what the majority of your colleagues and yes…competitors are able to do. You immediately differentiate yourself and then you lengthen the road between yourself and the others more and more with each cert you get. Then look at Diplomates to solidify a canyon between yourself and the rest. Stop sitting on your ass if you don’t know anything about this stuff. Get on it and make this profession what it should be. Bam. Pow. Smack. Kachunga, Slap! Wowza! Tough talk and tough love. But hopefully motivating works from you Ol’ Uncle Jeffro. You’re welcome. Before getting to the next one, Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office. When you decide you can’t live without those products, send me an email and I’ll give you the hookup. They will 100% differentiate your clinic from your competitors. I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Item #2 Our next one is called, “Does Improvement towards a Normal Cervical Sagittal Configuration Aid in the Management of Lumbosacral Radiculopathy: A Randomized Controlled Trial” by Moustafa et. al. (Moustafa IM 2022)published in Journal of Clinical Medicine on September 29, 2022 and that’s a hot tamale with jalapeños atop of it. And as a side note, I’m still trying to figure out how I got stuck with a boring name like Williams while you got guys walking the Earth with the last name Moustafa. It’s just not fair. Why They Did It

to investigate the effects of sagittal head posture correction on 3D spinal posture parameters, back and leg pain, disability, and S1 nerve root function in patients with chronic discogenic lumbosacral radiculopathy

How They Did It

A randomized controlled study with a six-month follow-up
80 (35 female) patients between 40 and 55 years experiencing chronic discogenic lumbosacral radiculopathy with a definite hypolordotic cervical spine and forward head posture (FHP) and were randomly assigned a comparative treatment control group and a study group
Both groups received TENS therapy and hot packs, additionally, the study group received the Denneroll cervical traction orthotic.
Interventions were applied at a frequency of 3 x per week for 10 weeks and groups were followed for an additional 6-months.
Radiographic measures included cervical lordosis (CL) from C2-C7 and FHP; postural measurements included: lumbar lordosis, thoracic kyphosis, trunk inclination, lateral deviation, trunk imbalance, surface rotation, and pelvic inclination.
Leg and back pain scores, Oswestry Disability Index (ODI), and H-reflex latency and amplitude were measured

What They Found

Statistically significant differences between the groups at 10 weeks were found: for all postural measures,
No significant difference for back pain, leg pain and ODI at 10 weeks were identified.
Only the study group’s improvements were maintained at the 6-month follow up while the control groups values regressed back to baseline.
At the 6-month follow-up, it was identified in the study group that improved cervical lordosis and reduction of FHP were found to have a positive impact on 3D posture parameters, leg and back pain scores, ODI, and H-reflex latency and amplitude.

OK….a dude who sells the Denneroll did this paper. It’s funny how other researchers find no big deal when it comes to the cervical curve. However, literally ALL of this guy’s ‘papers’ somehow make a big deal out of C-sp decreased curvature. Hinky, huh? It’s so odd. It’s like Firestone doing research and finding out how amazing their tires are. Hey everyone….McDonald’s did a research project and they found out how yummy their food is!! Yay McDonald’s you’re so amazing and thank you for doing your own research on your own company for the rest of us dumbasses. Thank you for being so awesome and kind. Blah. 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!

The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website

Home

Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter Tweets by 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 Carmody S, R. G., Mitchell A, Kryger KO, Ahmad I, Gill M, Rushton A, (2022). “Lumbar spine MRI findings in asymptomatic elite male academy footballers: a case series.” BMC Sports Sci Med Rehabil 14(1): 184. Moustafa IM, D. A., Harrison DE (2022). “Does Improvement towards a Normal Cervical Sagittal Configuration Aid in the Management of Lumbosacral Radiculopathy: A Randomized Controlled Trial.” J Clin Med 11(19): 5768.

Communicating Imaging Findings & Acupuncture For Acute Pain

October 20, 2022 chiropracticforward 00:18:21 0 Comments

CF 251: Communicating Imaging Findings & Acupuncture For Acute Pain Today we’re going to talk about Communicating Imaging Findings & Acupuncture For Acute Pain But first, here’s that sweet sweet bumper music

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

OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow, look down your nose at people kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. I’m so glad you’re spending your time with us learning together. Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, drive, smart, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do.

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

You have found yourself smack dab in the middle of Episode #251 Now if you missed last week’s episode , we talked about Night Owls Diabetes And Heart Disease & Medical Marijuana And Pain. Make sure you don’t miss that info. Keep up with the class.

On the personal end of things…..

It’s been a tough one. My mother in law passed away last week. My wife’s parents live about an hour and 45 minutes to the North of Amarillo in our hometown of Perryton, TX. So, we’ve been back and forth and back and forth so many times I lost track. And there will be lots more back and forths to settle the estate and get Meg’s dad situated in a new town down around Longview TX. Lots of distractions coming up but I’ll do my best to keep this podcast on point, educational, and interesting. It’s like I’m trying to teach my kids right now. My daughter did not want to go to school today, which is a Monday. Her grandmother passed away Wednesday evening. She missed school Thursday and Friday. The memorial will be this Friday so she’ll miss another Thursday – fortunately, they’re out of school Friday. The day of the memorial. My point to her was this; life deals us blows.

We have loss and setbacks that get us down, make us sad, and give us the blues. But we have to do what we can to shoulder obligations, most of the time, give us an opportunity to move forward and take our minds off of our problems. Work can keep us from our lives in a good way as well as in a bad way. Sometimes, work keeps us from being able to enjoy our lives and engage in some of the things we are wanting to do more of. Me, I’m not able to spend time writing songs, playing music, sculpting, or painting and things like that. That’s work getting in the way in a bad way. But, then there’s the work that keeps our minds busy and occupied so that we’re not buried and consumed by worry and fret and the big bad blues life sometimes casts us into. So, for this week and the next, we go to school, we go to work, we occupy our minds, and let time take care of the rest. That may be a Gen X way of going about it but I’m Gen X and that’s what we do. Keep the nose down, work, and life will sort it out. Be upset, mourn, and take care of business, one foot in front of the other. Sorry to be so gloomy on the personal side of it all this week but, I’m always honest with you all and that’s what’s happening on the personal side. I’m certain next week’s episode will be a bit on the brighter side! Now, onto the research!

Item #1 Our first one today is called “Acupuncture Therapy as an Evidence-Based Nonpharmacologic Strategy for Comprehensive Acute Pain Care: The Academic Consortium Pain Task Force White Paper Update” by Nielsen et. al. (Arya Nielsen 2022) and published in Pain Medicine on June 17, 2020 and we got as hot one, people! These researchers by the way, are Phds and MDs. I think that’s notable.

Why They Did It A crisis in pain management persists, as does the epidemic of opioid overdose deaths, addiction, and diversion. Pain medicine is meeting these challenges by returning to its origins: the Bonica model of multidisciplinary pain care. The 2018 Academic Consortium White Paper detailed the historical context and magnitude of the pain crisis and the evidence base for nonpharmacologic strategies. More than 50% of chronic opioid use begins in the acute pain care setting. Acupuncture may be able to reduce this risk. This article updates the evidence base for acupuncture therapy for acute pain with a review of systematic reviews and meta-analyses on postsurgical/perioperative pain with opioid sparing and acute nonsurgical/trauma pain, including acute pain in the emergency department.

How They Did It

To update reviews cited in the 2018 White Paper, electronic searches were conducted in PubMed, MEDLINE, CINAHL, and the Cochrane Central Register of Controlled Trials with additional manual review of titles, links, and reference lists.
There are 22 systematic reviews, 17 with meta-analyses of acupuncture in acute pain settings, and a review for acute pain in the intensive care unit. There are additional studies of acupuncture in acute pain settings.

Wrap It Up

The majority of reviews found acupuncture therapy to be an efficacious strategy for acute pain, with potential to avoid or reduce opioid reliance.
With an extremely low risk profile, acupuncture therapy is an important strategy in comprehensive acute pain care.

We see it every week in my clinic. The VA send over their vets regularly and our acupuncturist is like a golden laced angel to these veterans. It’s been impressive. Before getting to the next one, Go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody.

They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office. When you decide you can’t live without those products, send me an email and I’ll give you the hookup. They will 100% differentiate your clinic from your competitors.

Item #2

Our last one today is called “Integrating Epidemiological Information into MRI Reports Reduces Ensuing Radiologic Testing Costs Among Patients with Low Back Pain: A Controlled Study” by The Joint Commission Journal on Quality and Patient Safety 2020 by Weeks et. al. This was brought to me by Spine Care Partners who released a wonderful graphic that I got from Parker President, Dr. William Morgan, and shared in our Chiropractic Forward Facebook private group. The graphic showed what percentages in each age group that you can find ASYMPTOMATIC changes like degenerated discs, facets, bulges, herniations, etc. It was excellent. If you’re not in our private group on Facebook, go do that about right now.

This is more of a review so, let’s review about it shall we? They say, “Research has demonstrated that including epidemiological data along with the standard MRI results report has resulted in reduced opioid prescribing by the provider who ordered the study, as well as reduced referral to spine specialists. This new study includes an assessment of costs when frequency of common findings are included with the standard MRI results report.

The information included data on the prevalence of certain conditions over each decade of life in asymptomatic individuals. For example, degenerative disc disease findings in asymptomatic patients are seen in 68% in those 40-50 years of age, 80% in those 50-60, 88% if 60-70 years old, and 93% of 70-80 year olds. Totally asymptomatic! Which is amazing news for patients. Not great news for predatory providers that use rad findings to scare this holy living schnikees out of their patients so they’ll be forced to come see them a million times. Bad news for those asshats.

Great news for patients though. They say that their study showed that MRI reports with the addition of the prevalence of common findings triggered a downstream costs savings averaging $330 per report when compared to the standard MRI results report of the control group which meant there was no epidemiological charge included with the report. Best of all, repeat MRI use, spinal injection, opioid use, and surgery all decreased in the study group compared to the control group, while muscle relaxers and chiropractic utilization had a slight increase. They point out that one explanation for these findings is that the common language used in spine imaging reports, without statistical reference, is both fear invoking and inappropriately supportive of pathoanatomical understanding of back pain, as compared to the more clinically sound biophyschosocial model.

To put that in you and me speak, chiropractors are still relying heavily on the pathoanatomical model. Here’s the lesion, I’ll pop it, patient fixed. Cancer? Pop it. Bad hearing?? Pop it. Stomach ache? Pop it. COVID? Pop it. That’s so far from factual and being based in the evidence of literature that I cannot even begin to describe it.

They’re saying that chiropractors find stuff on the rad images and scare the crap out of their patients. Either because they’re not educated enough to know, or worst of all, because they’re predatory and miserable human beings that take advantage of their patients’ lack of education. All in order to get more visits and make that boat payment or that second house in the mountains or on the beach payment.

They’re also saying, start leaning into the BIOPSYCHOSOCIAL construct of pain, do right by your patients every day, and the money will just take care of itself. Treat others as you like to be treated. Kindergarten stuff. I don’t want myself or my family being taken advantage of so don’t do it to others. Get educated or get left behind.

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!

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

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

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

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

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

Bibliography Arya Nielsen, P., Jeffery A Dusek, PhD, Lisa Taylor-Swanson, PhD, Heather Tick, MD, (2022). “Acupuncture Therapy as an Evidence-Based Nonpharmacologic Strategy for Comprehensive Acute Pain Care: The Academic Consortium Pain Task Force White Paper Update.” Pain Med 23(9): 1582-1612.

Effectiveness Of Neck Exercise For Disc Herniation and Supine vs. Prone MRIs

August 18, 2022 chiropracticforward 00:17:21 0 Comments

CF 242: Effectiveness Of Neck Exercise For Disc Herniation and Supine vs. Prone MRIs Today we’re going to talk about Effectiveness Of Neck Exercise For Disc Herniation and Supine vs. Prone MRIs But first, here’s that sweet sweet bumper music

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

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

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

You have found yourself smack dab in the middle of Episode #242 Now if you missed last week’s episode , we talked about Does Supplementation Work & Non-Surgical Treatment For Stenosis. Make sure you don’t miss that info. Keep up with the class.

On the personal end of things…..

Well, last week was insanity around my office. I personally saw about 196 appointments and our nurse practitioner had his best week since we integrated and brought medical services into our clinic. He saw 38 appointments not counting me. I say, “Not counting me,” because I got the hormone pellets. If you’re not familiar, go search up BioT or search up Evexipel. We use Evexipel and it’s a hormone balancing or optimization procedure. The provider does some blood work and finds out where you’re at with some key hormones.

I’m way low on testosterone which makes me insane because I could drop some weight but I’m not nearly as bad as a lot of folks I see. I’m 6’4” and about 272. Yes, I should ideally be about 220 or even less if you listen to the government. However, I was a college offensive lineman and I’ve been a pretty thick dude my whole life. I have a dad bod but I’m not waddling around and having a hard time getting through doors is what I’m saying. OK? Anyway, I’m not sedentary either. I get lots of activity from 190+ patients in a week to exercise and throw the discus.

I’m a go-getter so the low T thing makes me a little insane but it is what it be and that’s just me. So, time to do it. We use Evexipel and when I did BioT, it was in the butt cheek and it was pretty freaking sore for about 5-7 days. Evexipel does the pellets in the flank for men and 4 days later, I have had very little to basically zero pain. It’s been amazing.

The pellets take about 5 days to start being absorbed in the body so I’m looking forward to the benefits. I’ll keep you updated. For my practice specifically, you’ve heard me mention that we will patch one hole and another leak will spring and I’m always on the lookout for them. Well, I found one just this morning. We had 1 96 patients on my side last week. I show up for work this morning and look at the schedule and there are only 36 patients on my schedule today.

I guess this issue didn’t register with any of my staff members because when I asked what happened to my schedule this week, they just acted like it’s normal and the week starts filling out on Mondays. Oh no no no. That’s not how we need to be looking at it. Let’s do a little high-level, global thinking here. I saw 25 new patients last week. If they’re all on schedule, that’s at least 25 appointments booked on the following Monday. Remember Monday has 36 currently.

Well, 6 of those are new patients. So, let’s throw out those 6 new patients and that leaves us with 30 today. If we remove the new ones from last week, the 25 that should have been guaranteed…..then that just leaves us with 5 established patients. 5. Cinco. Cinco freaking established patients for a Monday. So, when we’re looking at it in this manner, well, clearly there’s a problem. Patients aren’t on schedule and we’ve had significant fall-off.

This means I’m either not doing my job educating them on why they need to be consistent, or the staff isn’t encouraging the message and supporting the message, or the front desk isn’t getting them rescheduled. Or all three. Either way, we basically bled 25 new patients last week. So, that hole has to get plugged, yet again, this week. Another thing to consider is that it’s basically Back To School time and that’s traditionally a slow-down time for us. So that something else can go stupid next week. Because that’s the way it goes.

Item #1

This first one is called “Outcomes of active cervical therapeutic exercise on dynamic intervertebral foramen changes in neck pain patients with disc herniation” by Wu et. al. (Wu SK 2022) and published in BMC Musculoskeletal Disorders on July 30 of 2022. Bam!!! Into the frying pain! It’s hot.

Why They Did It

To better understand biomechanical factors that affect intervertebral alignment throughout active therapeutic exercise, it is necessary to determine spinal kinematics when subjects perform spinal exercises. This study aims to investigate the outcomes of active cervical therapeutic exercise on intervertebral foramen changes in neck pain patients with disc herniation.

How They Did It

Thirty diagnosed C4/5 and/or C5/6 disc-herniated patients
8-week cervical therapeutic exercise program
They were followed up with videofluoroscopic images.
The dynamic changes in the foramen were computed at different timepoints, including the neutral position, end-range positions in cervical flexion-extension, protrusion-retraction, and lateral flexion movements.

What They Found

The results showed that the active cervical flexion, retraction, and lateral flexion away from the affected side movements increased the area of the patients’ intervertebral foramen; while the active extension, protrusion, and lateral flexion toward the affected side reduced the areas of intervertebral foramen before treatment.
After the treatment, the active cervical flexion significantly increased the C2/3, C3/4, and C6/7 foramen area by 5.02-8.67%, and the extension exercise significantly reduced the C2/3 and C4/5 area by 5.12-9.18% compared to the baseline.
Active retraction movement significantly increased the foramen area from C2/3 to C6/7 by 3.82-8.66%.
Active lateral flexion away from the affected side significantly increased the foramen by 3.71-6.78%

Wrap It Up

The 8-week therapeutic exercises including repeated cervical retraction, extension, and lateral flexion movements to the lesion led to significant changes and improvements in the intervertebral foramen areas of the patients with disc herniation.

Before getting to the next one, I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! It’s live again. Use the code HOTSTUFF upon purchase at droprelease.com to get $50 off your purchase. Y’all, it makes a world of difference. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds? My patients love it and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Hear me now and believe me later.

Item #2

I saw this one in the Forward Thinking Chiropractic Alliance group on Facebook and it’s pretty darn interesting. It’s called, “Prone Position MRI of the Lumbar Spine in Patients With Low Back Pain and/or Radiculopathy Refractory to Treatment” by Avellanal et. al. and published in Pain Physician in August of 2022 damnit this Is the first day of August it just doesn’t get any more fire than that heat!

Why They Did It

There are patients with limiting low back pain (LBP) with or without radicular pain in whom conventional supine magnetic resonance imaging (MRI) show no causative pathology. Despite the limitations of dynamic axially loaded MRI examinations, these imaging studies have shown a striking ability to diagnose pathology unrecognized by conventional MRI. The difference in findings between supine and prone MRI with patient symptom correlation has not been studied.

How They Did It

Nineteen patients suffering from chronic moderate-to-severe LBP and/or radicular pain
Nonresponsive to conventional therapy or interventional treatment
Both supine and prone MRIs were performed and analyzed by a neuroradiologist.
Specific supine and prone measurements were registered, including spinal canal area, lateral recess diameter, foraminal area, and ligamentum flavum thickness.
Three-dimensional MRI reconstructions of varying pathology patterns were created.

What They Found

In 52.6% of cases, disc pathology or increased disc pathology was seen only on prone imaging.
They observed significant buckling and increased thickness of the ligamentum flavum in 52.6 % of cases in the prone position that was absent from the supine MRIs.
They also documented varying grades of spondylolisthesis and facet joint subluxation resulting in significant foraminal stenosis in 26.3% of prone cases not seen from supine MRIs.

Wrap It Up

Four patterns of pathological findings have been identified by MRI performed in the prone position.
These findings were not observed in the supine position.
Prone MRI can be a significant and useful tool in the diagnosis and treatment of patients with back pain refractory to treatment whose conventional supine MRIs appeared unremarkable.

Which I also take as yet another reason you cannot trust MRI’s for definitive diagnosis of the source of 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!

The Message

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

Key Point:

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

Contact

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

Connect

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

Website

Home

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About the Author & Host

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

Bibliography Wu SK, C. H., You JY, Bau JG, Lin YC, Kuo LC (2022). “Outcomes of active cervical therapeutic exercise on dynamic intervertebral foramen changes in neck pain patients with disc herniation.” BMC Musculoskelet Disord 23(1): 728.

Pain And COVID & Images Can Mislead

April 20, 2022 chiropracticforward 0:14:17 0 Comments

CF 225: Pain And COVID & Images Can Mislead Today we’re going to talk about Pain and COVID & how in the hands of the wrong practitioner, Imaging Can Mislead But first, here’s that sweet sweet bumper music

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

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

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

You have found yourself smack dab in the middle of Episode #225 Now if you missed last week’s episode , we talked about The Complexity & Treatment of Chronic Pain. Make sure you don’t miss that info. Keep up with the class. On the personal end of things….. What a damn day folks. What a way to start a Monday. I get to work and have a message to remove the permissions on my page for one of the folks I have helping me with my ad campaign on Facebook. Turns out he got hacked. Which means everyone he has permission with on social media got hacked as well! Including me. Unreal. So I showed up on a Monday going one direction with a ton of focuse. Next thing you know, I’m headed in teh complete opposite direction afraid I’m going to lose every bit of everything that makes up my professional online presence. Including my Chiropractic Forward page and Insta. My Creek Stone Integrated Medical, my voice over page, my art page…..everything. I have a botu 22 pages for various things. Furniture building, bands I’ve been in, charity groups, etc. So, that’s stressful as hell. For that very reason, I’m cutting it short and getting straight to the research. I’ll let you all know how it turns out next week. Before the research though, I have a gift for you! I’m going to turn you on to a system I recently came acros that can result in your getting tons of PI cases from attorneys. Getting these referrals can be done because it’s how I built my practice in the early days. Paul Samakow, a veteran personal injury attorney, put this system together. An attorney telling your how to talk to attorneys – he knows what attorneys want to hear – inviting them to lunch isn’t effective marketing these days. His system, is delivered to you in both written and video form, and really hits the mark. Over 25 concepts on how you can not only get attorneys to refer to you, but endear yourself to them. Samakow’s system costs $997 and he guarantees satisfaction or your money back. Which is always a big deal. That guarantee makes a difference for me. You should check it out. Even if you only get one case, you’ve made at least 4 or 5 times the investment. Trust me, I get, on average, about $2500-$3500 per settled case minimum. Lots of time much more than that. Go to gettingpicases.com/cs That’s gettingpicases.com/cs One more time so you get it right: gettingpicases.com/cs Item #1 The first one this week is called, “Manifestations of Pain During the COVID-19 Pandemic Portrayed on Social Media: A Cross-Sectional Study” by D’Souza et. al. (Ryan S D’Souza 2022) and published in Pain Medicine in 2022 holy smokes it’s hot. Why They Did It Pain is an often overlooked and underappreciated manifestation during the COVID-19 pandemic. Several permutations of pain should be considered, including: 1) acute pain related to viral infection, 2) exacerbation of preexisting chronic pain, and 3) new-onset pain from post-COVID syndrome. Preexisting chronic pain may worsen, potentially because of lack of health care access, worsening of psychological well-being, unavailability of medications, and other stressors A unique category includes patients without any history of chronic pain who developed persistent pain after recovery from COVID-19 infection [1]. This fits within a syndrome known as “post–acute COVID-19 syndrome” which describes patients who experience persistent symptoms beyond 4 weeks after the onset of COVID-19 symptoms I have been seeing this A LOT! Patients who suffer from pain may not be well informed and may turn to publicly available sources for their information needs, especially during the pandemic when in-person health care was less accessible [2]. With the omnipresence of social media and popular broadcast sites, these platforms should be considered vital in disseminating information on COVID-19 [3,4]. Thus, our objectives were 1) to view videos on the YouTube platform as a source of information on pain during the COVID-19 pandemic, 2) to report on their content on the location, type, and chronicity of pain symptoms, 3) to report the overall goal and target audience of the videos, and 4) to critically appraise video quality. Given the novelty of this topic, we hypothesized that the quality of videos would be low and there would be a paucity of videos published by professional societies. Second, we compared video characteristics between low- and high-quality videos and hypothesized that lower-quality videos would more likely be produced by independent users. How They Did It

It was a cross-sectional study
They sampled videos on YouTube from March 2020 to March 2021 that had to do with COVID-related pain
The authors queried the YouTube platform (www.youtube.com) with the keywords “COVID-19 pain,” “chronic pain after COVID-19,” and “pain related to COVID-19” from March 11, 2020, to March 1, 2021, using the “relevance” filter.
The authors restricted each search to the first 50 videos, yielding 150 videos screened.

Wrap It Up Our findings highlight that musculoskeletal/nociceptive pain in the back and extremities and visceral pain in the abdomen and chest are the most commonly reported pain types. Not surprisingly, the intended audience was patients, with an overall objective to educate on pain symptoms in most videos. This information is important, as it provides patients an explanation of the various pain generators in the body and the expected type of pain quality. The general public may be unaware that COVID-19 infection, a disease primarily having pulmonary and cardiovascular manifestations, can actually cause painful symptoms, even in seemingly disparate areas such as the eyes or genitourinary system. However, only a minority of videos (15%) provided education on pain management. Thus, clinicians should consider focusing time on educating patients on treatment options, as publicly available sources are lacking in this component. Item #2 Thsi one is called “Systematic literature review of imaging features of spinal degeneration in asymptomatic populations” by Brinjikji et. al. (Brinjikji W 2015) and published in AJNR in 2015. Why They Did It

They say in the abstract that degenerative changes are commonly found in spine imaging but often occur in pain-free individuals as well as those with back pain.
They sought to estimate the prevalence, by age, of common degenerative spine conditions by performing a systematic review studying the prevalence of spine degeneration on imaging in asymptomatic individuals.

How They Did It

We performed a systematic review of articles reporting the prevalence of imaging findings (CT or MR imaging) in asymptomatic individuals from published English literature through April 2014.
Two reviewers evaluated each manuscript. We selected age groupings by decade (20, 30, 40, 50, 60, 70, 80 years), determining age-specific prevalence estimates.

What They Found

Thirty-three articles reporting imaging findings for 3,110 asymptomatic individuals met our study inclusion criteria.
The prevalence of disk degeneration in asymptomatic individuals increased from 37% of 20-year-old individuals to 96% of 80-year-old individuals.
Disk bulge prevalence increased from 30% of those 20 years of age to 84% of those 80 years of age.
Disk protrusion prevalence increased from 29% of those 20 years of age to 43% of those 80 years of age.
The prevalence of annular fissure increased from 19% of those 20 years of age to 29% of those 80 years of age.

Wrap It Up

Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age.
Many imaging-based degenerative features are likely part of normal aging and unassociated with pain.
These imaging findings must be interpreted in the context of the patient’s clinical condition.

Don’t see it on an. Image and immediately assume that’s the issue. Phantom Limb pain exists in chronic pain conditions so why can’t low back pain be a phantom back pain? Take a long hard look at the biopsychosocial part of things. If you cannot line up the cliinical patient with the image, don’t make a big deal out of the findings because it’s likely meaningless. 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!

The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website

Home

Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter Tweets by 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 Brinjikji W, L. P., Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT, Kallmes DF, Jarvik JG (2015). “Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.” AJNR Am J Neuroradiol 36(4): 811-816. Ryan S D’Souza, M., Anthony E Kilgore, Shawn D’Souza (2022). “Manifestations of Pain During the COVID-19 Pandemic Portrayed on Social Media: A Cross-Sectional Study,.” Pain Medicine 23(2): 229-233.

Chiropractic Cost-Effectiveness & Early MRIs Lengthen Disability

December 23, 2021 chiropracticforward 0:16:44 0 Comments

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

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

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

Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.
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!

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

December 9, 2021 chiropracticforward 00:19:35 0 Comments

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!

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!

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

July 9, 2020 chiropracticforward 00:26:54 0 Comments

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

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 dr.williams@chiropracticforward.com…..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.

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

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

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

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

Website https://www.chiropracticforward.com

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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).

Imaging

Children, Activity, and Depression and Axially Loaded MRIs

Cervical Curvature & Lumbar MRI Findings In Asymptomatics – New Stuff

Communicating Imaging Findings & Acupuncture For Acute Pain

Effectiveness Of Neck Exercise For Disc Herniation and Supine vs. Prone MRIs

Pain And COVID & Images Can Mislead

Chiropractic Cost-Effectiveness & Early MRIs Lengthen Disability

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

Does Imaging Mean Better Outcomes & Melatonin Slowing Down Disc Degeneration

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

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

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