Neck Pain

Cancer-Finding Blood Tests & Neck Pain Treatment Differs By Initial Provider

CF 324: Cancer-Finding Blood Tests & Neck Pain Treatment Differs By Initial Provider

 

Today we’re going to talk about Cancer-Finding Blood Tests & Neck Pain Treatment Differs By Initial Provider But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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  OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spen ding your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, 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 resource for you and is 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. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • 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 #324 Now if you missed last week’s episode, we talked about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 10).  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things….. Whack a mole Roller coaster of business Nothing is guaranteed. Nothing. Up and down up and down.  If you’re a follower of the podcast, you’ll know you’ve heard shows when I was riding high. Killing it. 20-25 new patients per week. 185-200 visits a week by myself. Then Periods of time like more recently when I have been seeing COVID era numbers and running low on funds while funding new clinic endeavors. Then, we start recovering from that and we’re on the way back up. Just in time for the local VA to hire themselves an acupuncturist and a chiropractor so many of our new patients and visits will begin to start to disappear.  Business ownership: it’s crazy man. But we’re on the ride and it’s time to stop being lazy. I’m a hustler in the best sense of the word. I know how to pivot and I know how to aim and direct money. I’ve wasted so much money in the past but I’ve made a hell of a lot too! So, to pivot. Pivot is in process. We’re still on the rollercoaster but, at 51 years old, I feel like my days of being in the craziest coasters are coming to an end and the days of being on a more stable, and older person appropriate coaster are just beginning. Stay tuned. You literally never know what’s going to happen around here from week to week.

 

Item #1 Our first one today is called, “”Questions Swirl Around Screening for Multiple Cancers With a Single Blood Test” by Rubin et. al. and published in JAMA on March 15, 2024

Remember, the citations can be found at chiropracticforward.com under this episode.

Rubin R. Questions Swirl Around Screening for Multiple Cancers With a Single Blood Test. JAMA. 2024;331(13):1077–1080. doi:10.1001/jama.2024.1018

 

New Blood Tests Promise Early Cancer Detection, But Experts Urge Caution Multiple cancer detection (MCD) blood tests are emerging as a potential way to catch cancer early. However, there’s significant uncertainty surrounding their benefits and drawbacks. What are MCD tests? These tests analyze blood for circulating tumor cells, DNA fragments, proteins, or other indicators suggesting cancer somewhere in the body. Unlike traditional cancer screenings (e.g., mammograms), MCD tests are not specific to one type of cancer and can potentially detect over 50 different cancers.

Pros:

  • May detect cancers not covered by existing screening methods.
  • Potentially leads to earlier diagnosis and treatment.
  • Easier and less invasive than traditional screenings.

Cons:

  • Tests are not yet FDA-approved and lack long-term data on effectiveness.
  • Positive results may lead to unnecessary anxiety and invasive follow-up procedures.
  • Tests might not detect slow-growing cancers or those unlikely to cause harm.
  • Unclear if early detection through MCD tests translates to lower cancer mortality.
  • High cost not currently covered by insurance.

Unanswered Questions:

  • Do MCD tests improve cancer survival rates?
  • Do they detect cancers best left untreated?
  • How should positive results be interpreted and followed up on?
  • Are physicians prepared to guide patients through MCD testing?

The Takeaway: While MCD tests hold promise, their true value remains unclear. Experts recommend waiting for more research before widespread adoption. The focus should be on establishing clear guidelines for appropriate use and interpreting test results.

 

Item #2

Our second paper today is called, “Longitudinal Care Patterns and Utilization Among Patients With New-Onset Neck Pain by Initial Provider Specialty” by Fenton et. al. and published in Spine Journal in October of 2023 and it’s all hot this week!

Fenton, Joshua J. MD, MPHa,b; Fang, Shao-You PhDb; Ray, Monika PhDb,c; Kennedy, John CCS, CDIPb; Padilla, Katrine MPPb; Amundson, Russell MDd; Elton, David DCd; Haldeman, Scott DC, MD, PhDe; Lisi, Anthony J. DCf; Sico, Jason MD, MHSf,g; Wayne, Peter M. PhDh; Romano, Patrick S. MD, MPHb,c. Longitudinal Care Patterns and Utilization Among Patients With New-Onset Neck Pain by Initial Provider Specialty. Spine 48(20):p 1409-1418, October 15, 2023. | DOI: 10.1097/BRS.0000000000004781

Why They Did It Initial provider specialty has been associated with distinct care patterns among patients with acute back pain; little is known about care patterns among patients with acute neck pain.. The authors wantedtTo compare utilization patterns for patients with new-onset neck pain by initial provider specialty.

How They Did It

  • Retrospective cohort study.
  • De-identified administrative claims and electronic health record data were derived from the Optum Labs Data Warehouse, which contains longitudinal health information on over 200M enrollees and patients representing a mixture of ages and geographical regions across the United States. 
  • Patients had outpatient visits for new-onset neck pain from October 1, 2016 to September 30, 2019, classified by initial provider specialty. 
  • Utilization was assessed during a 180-day follow-up period, including subsequent neck pain visits, diagnostic imaging, and therapeutic interventions.

What They Found

  • The cohort included 770,326 patients with new-onset neck pain visits. 
  • The most common initial provider specialty was chiropractor (45.2%), followed by primary care (33.4%). 
  • Initial provider specialty was strongly associated with the receipt of subsequent neck pain visits with the same provider specialty. 
  • Rates and types of diagnostic imaging and therapeutic interventions during follow-up also varied widely by initial provider specialty. 
  • While uncommon after initial visits with chiropractors (≤2%), CT, or MRI scans occurred in over 30% of patients with initial visits with emergency physicians, orthopedists, or neurologists. 
  • Similarly, 6.8% and 3.4% of patients initially seen by orthopedists received therapeutic injections and major surgery, respectively, compared with 0.4% and 0.1% of patients initially seen by a chiropractor.

Wrap It Up

Within a large national cohort, chiropractors were the initial provider for a plurality of patients with new-onset neck pain. Compared with patients initially seen by physician providers, patients treated initially by chiropractors or therapists received fewer and less costly imaging services and were less likely to receive invasive therapeutic interventions during follow-up. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world.

The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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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  

PT For Sciatica & Laser For Neck Pain

CF 320: PT For Sciatica & Laser For Neck Pain Today we’re going to talk about PT For Sciatica & Laser For Neck 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!

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  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, smarts, personality, 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 resource for you and is 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. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • 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 #320 Now if you missed last week’s episode, we talked about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 8).  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. If you’ve been following along, you know I’m still digging my clinic out of the Winter doldrums but it’s coming along nicely. If you want to hear more about that and what we’ve been doing to change course and correct the path forward, listen to last week’s episode.  The plan laid down is starting to bring some fruit that I think we’ll be harvesting soon. I had 15 or 16 new patients last week. It’s not to the 20 or so I was used to before COVID but it’s better than the 9 or 10 I was seeing a month or so ago.  We’re back to doing the therapies on our patients that we should be legitimately doing. We’re not just failing to do them and watching that money simply walk out the door.  For example, we billed $106k in February as opposed to $82k in December. Quite a difference there. Now, that’s me and the nurse practitioner and while that may sound like a metric crap ton of money in a month, and it is for some, remember, my overhead monthly is approximately $65k or more. So, if you bill that much, guaranteed you’re not collecting that much. You might get $80 – $85 of that.  That leaves you with $15k….maybe $20k in profit for the month. So, it’s not where we want it but it’s moving in the right direction. We collected about $30k more in February than we did in each of the previous 3-4 months so collections is doing its deal and making me happy once again.  I’m such a fun guy when I’m making money instead of losing it!! Y’all!  This week is a short week for me. I’m flying out to Atlanta Thursday morning to the big VOAtlanta voice conference. Around 1,000 attendees. Last year, the dude that does all of the announcements for the TODAY show was sitting behind me. The guy that has voiced Goofy for the last 40 years was there. Nolan North who voiced the lead character in the video game Unchartered was there.  You just never know who’s going to be there but making the just right contact on these things could mean a lot financially. No doubt. So I go, I have some drinks at the bar, I attend classes and enjoy it and take it all in and just see what happens.   So that’s on tap this weekend and you know I’ll be talking about it on the podcast next week. But for now, let’s hop in on the research.  Item #1 The first one this week is called, “How effective are physiotherapy interventions in treating people with sciatica? A systematic review and meta-analysis” by Dove et. Al. and is published in European Spine Journal on December 29, 2022 and let’s do the hot thing just because! Remember, the citations can be found at chiropracticforward.com under this episode.  Dove, L., Jones, G., Kelsey, L. et al. How effective are physiotherapy interventions in treating people with sciatica? A systematic review and meta-analysis. Eur Spine J 32, 517–533 (2023). https://doi.org/10.1007/s00586-022-07356-y Why They Did It Physiotherapy interventions are prescribed as first-line treatment for people with sciatica; however, their effectiveness remains controversial.  The purpose of this systematic review was to establish the short-, medium- and long-term effectiveness of physiotherapy interventions compared to control interventions for people with clinically diagnosed sciatica How They Did It This systematic review  Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (EBSCO), Embase, PEDro, PubMed, Scopus and grey literature were searched from inception to January 2021 Inclusion criteria were randomised controlled trials evaluating PT interventions compared to a control intervention in people with clinical or imaging diagnosis of sciatica.  Primary outcome measures were pain and disability.  Study selection and data extraction were performed by two independent reviewers with consensus reached by discussion or third-party arbitration if required.  Risk of bias was assessed independently by two reviewers using the Cochrane Risk of Bias tool with third-party consensus if required.  Meta-analyses and sensitivity analyses were performed with random effects models  Subgroup analyses were undertaken to examine the effectiveness of physiotherapy interventions compared to minimal (e.g. advice only) or substantial control interventions (e.g. surgery). Three thousand nine hundred and fifty eight records were identified, of which 18 trials were included, with a total number of 2699 participants.  What They Found All trials had a high or unclear risk of bias. Meta-analysis of trials for the outcome of pain showed no difference in the short, medium or long term.  For disability there was no difference in the short, medium, or long term between physiotherapy and control interventions.  Subgroup analysis of studies comparing physiotherapy with minimal intervention favored physiotherapy for pain at the long-term time points.  Large confidence intervals and high heterogeneity indicate substantial uncertainty surrounding these estimates.  Many trials evaluating physiotherapy intervention compared to substantial intervention did not use contemporary physiotherapy interventions. Wrap It Up Based on currently available, mostly high risk of bias and highly heterogeneous data, there is inadequate evidence to make clinical recommendations on the effectiveness of physiotherapy interventions for people with clinically diagnosed sciatica. Item #2 The second one today is called “Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials” by Chow et. Cl and published in The Lancet on December 5, 2009.  Chow R, Johnson, M, ‘Efficiacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomized placebo or active-treatment controlled trials’, 374, 9705, P1897-1908, Dec. 5, 2009. DOI:https://doi.org/10.1016/S0140-6736(09)61522-1 Why They Did It Neck pain is a common and costly condition for which pharmacological management has limited evidence of efficacy and side-effects.  Low-level laser therapy (LLLT) is a relatively uncommon, non-invasive treatment for neck pain, in which non-thermal laser irradiation is applied to sites of pain.  They did a systematic review and meta-analysis of randomised controlled trials to assess the efficacy of LLLT in neck pain. How They Did It We searched computerised databases comparing efficacy of LLLT using any wavelength with placebo or with active control in acute or chronic neck pain.  Effect size for the primary outcome, pain intensity, was defined as a pooled estimate of mean difference in change in mm on 100 mm visual analogue scale. What They Found We identified 16 randomised controlled trials including a total of 820 patients.  Side-effects from LLLT were mild and not different from those of placebo. Wrap It Up We show that LLLT reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.     

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
Home
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – 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    

Omnivorous vs Vegan & SMT For Chronic Neck Pain

CF 314: Omnivorous vs Vegan & SMT For Chronic Neck Pain Today we’re going to talk about Omnivorous vs Vegan & SMT For Chronic Neck 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!

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  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, smarts, personality, 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 resource for you and is 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. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • 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 #314 Now if you missed last week’s episode, we talked about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 5).  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Let’s start by giving Dr. Steven Brown out in Gilbert, AZ a shoutout. If you listened last week, we had a paper that was just the abstract. It was a paper that the WHO is using in part to help them formulate their opinion that SMT is recommended but at very low confidence.  The paper used orthopedic manual physical therapy, whatever the hell that is.  “The protocol consisted of accessory mobilizations (posteroanterior), traction of the lumbar region, mobilization with movement in the coxofemoral joint, and global techniques of neural mobilization of the lumbar spine. The duration of the orthopedic manual physical therapy was 20–25 minutes per session.”  Dr. Brown says, “They did not get actual lumbar spine, SI joint, or hip manipulation at all. Just 20-25 minutes of mobilization.” So, there you have it from one of last week’s papers. I think as we go through them, it’s getting clearer and clearer that the WHO may have an agenda. Which chiropractors expect, honestly. When you have MDs running the show, they’re going to be super slow to promote SMT to the MainStage for anything. Using papers like we’ve been seeing to make their determination is just, quizzical. For lack of a better word. It’s perplexing when we know there is more current and more impactful research in favor of SMT.  Moving on this week, I just got back from Jupiter, FL and the MCM Mastermind with Dr. Kevin Christie, Dr. Brett Winchester, Dr. Lindsey Mumma, and many more. Florida wasn’t warm. It was in the 50s and 60s but we were in a classroom most of the time anyway. We had some fine dining at The Woods, which is Tiger Woods’ restaurant. No Tiger sightings but none were expected. Lots of Bentleys, Mercedes, Lambos, and the like. It’s always a little crazy in Florida when you consider the amount of money strolling around those towns.  Lots of great discussions, lots of thoughts and plans. Now to have the time to organize the thoughts and take action on them. One fun one came from my little friend, Dr. Tiffany Armstrong from Iowa. Her and her husband have a great practice out there and are adding a gym to the mix. Fun fun.  She was talking about Storybrand and what are your Big 3? She said patients and clients can’t really keep up with more than three things. It got me to thinking and here’s what I came up with:
  1. Pain Relief
  2. Function, Stability, Strength
  3. Performance Care
That’s why you join a mastermind. That was a little comment on a discussion that we had in class. Nothing game changing but enough to give me some clarity and direction with some things I’ve been wanting to tweak and change. Imagine how many of those little comments and conversations we have over the weekend.  Lots of direction this morning outside of the. Podcast so I’m hopping into it  Item #1 Our first one today is called, “Cardiometabolic Effects of Omnivorous vs Vegan Diets in Identical Twins: A Randomized Clinical Trial” by Landry et. Al and published in JAMA Network Open November 30, 2023. Kapow! It’s hottern’ a teapot! Remember, the citations can be found at chiropractscforward.com under this episode.  Landry MJ, Ward CP, Cunanan KM, et al. Cardiometabolic Effects of Omnivorous vs Vegan Diets in Identical Twins: A Randomized Clinical Trial. JAMA Netw Open. 2023;6(11):e2344457. doi:10.1001/jamanetworkopen.2023.44457 Why They Did It Increasing evidence suggests that, compared with an omnivorous diet, a vegan diet confers potential cardiovascular benefits from improved diet quality (ie, higher consumption of vegetables, legumes, fruits, whole grains, nuts, and seeds).  The researchers wanted to compare the effects of a healthy vegan vs healthy omnivorous diet on cardiometabolic measures during an 8-week intervention. How They Did It This single-center, population-based randomized clinical trial of 22 pairs of twins randomized participants to a vegan or omnivorous diet (1 twin per diet).  Participant enrollment began March 28, 2022, and continued through May 5, 2022.  The date of final follow-up data collection was July 20, 2022.  This 8-week, open-label, parallel, dietary randomized clinical trial compared the health impact of a vegan diet vs an omnivorous diet in identical twins.  Twin pairs were randomized to follow a healthy vegan diet or a healthy omnivorous diet for 8 weeks.  Diet-specific meals were provided via a meal delivery service from baseline through week 4, and from weeks 5 to 8 participants prepared their own diet-appropriate meals and snacks. The primary outcome was difference in low-density lipoprotein cholesterol concentration from baseline to end point (week 8).  Secondary outcome measures were changes in cardiometabolic factors, plasma vitamin B12 level, and body weight. Exploratory measures were adherence to study diets, ease or difficulty in following the diets, participant energy levels, and sense of well-being. A total of 22 pairs of twins What They Found After 8 weeks, compared with twins randomized to an omnivorous diet, the twins randomized to the vegan diet experienced significant mean (SD) decreases in low-density lipoprotein cholesterol concentration, fasting insulin level, and body weigh Wrap It Up In this randomized clinical trial of the cardiometabolic effects of omnivorous vs vegan diets in identical twins, the healthy vegan diet led to improved cardiometabolic outcomes compared with a healthy omnivorous diet.  Clinicians can consider this dietary approach as a healthy alternative for their patients. Item #2 OK, the last one this week is called, “A systematic review and meta-analysis of randomized controlled trials of manipulative therapy for patients with chronic neck pain” by Liu et. Al. published in Complementary Therapies in Clinical Practice in August of 2023 and it’s just hot enough! Zhen Liu, Jiao Shi, Yubo Huang, Xingchen Zhou, Huazhi Huang, Hongjiao Wu, Lijiang Lv, Zhizhen Lv, A systematic review and meta-analysis of randomized controlled trials of manipulative therapy for patients with chronic neck pain, Complementary Therapies in Clinical Practice, Volume 52, 2023, 101751, ISSN 1744-3881, https://doi.org/10.1016/j.ctcp.2023.101751. Why They Did It An increasing number of people suffer from chronic neck pain due to increased telecommuting. Manual therapy is considered a safe and less painful method and has been increasingly used to alleviate chronic neck pain.  However, there is controversy about the effectiveness of manipulation therapy on chronic neck pain.  Therefore, this systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to determine the effectiveness of manipulative therapy for chronic neck pain. How They Did It A search of the literature was conducted on seven databases from the establishment of the databases to May 2022.  This study included RCTs on chronic neck pain managed with manipulative therapy compared with sham, exercise, and other physical therapies.  The retrieved records were independently reviewed by two researchers.  Further, the methodological quality was evaluated using the PEDro scale.  The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment was used to evaluate the quality of the study results. Seventeen RCTs, including 1190 participants, were included in this meta-analysis. What They Found Manipulative therapy showed better results regarding pain intensity and neck disability than the control group.  Manipulative therapy was shown to relieve pain intensity and neck disability.  However, the studies had high heterogeneity, which could be explained by the type and control interventions.  In addition, there were no significant differences in adverse events between the intervention and the control groups. Wrap It Up Manipulative therapy reduces the degree of chronic neck pain and neck disabilities. Hurry, someone run and the the World Health Organization that we got a new paper to add to their crap recommendations…. More on the papers they’re using to recommend SMT at very low confidence in next week’s Part 6 of that series.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.       

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
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Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q   iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2   Player FM Link https://player.fm/series/2291021   Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through   TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/   About the Author & Host Dr. Jeff Williams – 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    

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

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

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

Key Point:

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

Contact

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

Connect

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

Website

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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.      

Chiropractic Adjustments For The Cervical Spine Really Work & Lumbar Radiculopathy Treatment

CF 205: Chiropractic Adjustments For The Cervical Spine Really Work & Lumbar Radiculopathy Treatment Today we’re going to talk about research backing the use of spinal manipulative therapy for neck pain. A systematic review and meta-analysis even! Big stuff. Then we’ll talk about treatment for lumbar radiculopathy. What extra tips can you pick up? But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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

If you haven’t yet I have a few things you should do. 

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

You have found yourself smack dab in the middle of Episode #205 Now if you missed last week’s episode, we talked about The Case Of The Disappearing Disc & Vitamin D And Back Pain. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Alright, we got some stuff shaking folks. So, let’s talk about it. First thing, Drake leaving. Who the hell is Drake you might ask? Well, that’s our Parker university intern that’s been with us since last August. We’re spoiled as hell having Drake with us these days. We’re going to miss his help and honestly, he’s just a good guy. We’ll miss him personally as well.  Yes, I tried to hire him but not everyone wants to move to Amarillo so getting associates in this area can be a bit of a challenge. So I’m saying it, if you want to come to Amarillo, you’re always more than welcome to send me a resume at dr.williams@chiropracticforward.com and I’m happy to take a look. 

We have fun. We get people better. And life is good.  I mentioned a couple of weeks ago that we had a turnover and we’d be having a new front desk staffer coming on board. Well, this is the week and here we go. We may have gotten lucky on this one people. 

First, we hire off of Indeed. I’m sure they think I’m a bit of a prick but I use the assessment tools. They have to fill out a couple of assessments that test their knowledge. One is on EHR, another is general office procedure and stuff like that. Well, so many of them just go down the line clicking jobs and submitting without understanding that the assessments weed that out. If they don’t take the time to fill out the assessments, they didn’t care enough about the job to read about it. Which means I don’t care enough about them to waste my time learning more about them. So I move right past them. 

This girl has worked for an urgent care and only looked elsewhere because they didn’t have a full-time position like she needed. My friends actually work at the urgent care and vouched for her. We have the ones we’re interested in come in for a working interview. All of the staff agreed she was the clear choice both in experience as well as in personality.  Our office culture is one defined by fun. We jump scare each other. We laugh. We kid. We are always appropriate but there are times we could be more professional but….again…we have fun. And Our patients love it.

They commonly comment in our Google Reviews about how they love that everyone is so happy, having fun, and enjoying their work.  It’s easy when you have the crew I have. We do work. We work hard. Some days suck. Some days fly by. But think about it, we spend more time with our staff than we spend with our own families for the most part. Right? So why not having fun? Why not have a sense of family, of belonging, and a sense of being a team? Why not? So we’ll be making a new teammate this week. She’s going to be amazing. I just have a feeling. 

Also, I believe it was last week we discussed side gigs.  I mentioned my recent success in the voice over industry and that I’ve been schooling up on real estate investing and all that good stuff. I mentioned that I planned on parlaying that voice over success into real estate investments.  Well, I’ve been analyzing houses and I’ve been learning about remote management of short-term rentals and the pros and cons vs having a long-term rental and all of that good stuff.  Well, I identified 9 properties down in Lubbock TX. Lubbock is about an hour and a half to the south of Amarillo. It’s the home of Texas Tech and Buddy Holly. It’s also where one of my kids goes to college. It’s also the place where my other kid who is currently an 8th grader will likely go if I haven’t retired and moved to Florida when she goes to college. 

Lots of football games, basketball games, baseball games….lots of visits to the medical school there in town….lots of big-name concerts. It’s all good news for having a short-term rental.

Go back and listen to last week’s episode if you want to know why short-term rentals make more sense for tax reasons than other investments right now.  Anyway, I found 9 houses that my wife went to look at last week. She made an offer on one and, once we refi our rental house here in Amarillo, we’ll be able to pull out about $150,000 to put on 1-2 others. One of which is a flip we think we can profit $30k in about three months if there are no surprises or hiccups.  So…..I’m a fact finder. I’ve been finding facts for about a year now. Watching YouTubes. Taking little classes. Listening to podcasts. Reading books. Meeting people and building a small network. So, we’re on it. We’re excited. We’re pumped. We’re busy as hell. 

It’s kind of crazy the faith I have in my wife’s decisions. In lots of ways, she’s the smartest person I believe I’ve ever met. Our first house we bought together, I was on the road traveling with my band somewhere down in south Texas when she made an offer on it. I’d never even seen the house. 

The one I live in now, I actually saw and agreed on. 

The 2-3 down in Lubbock, I haven’t seen either. But I’m buying them. Lol. It’s crazy but she’s a hell of a teammate on this stuff and her vision of what she can do with a house has blown me away. She has some serious skills and I can’t wait to see what happens when she puts them to use on these investments. 

OK, on to the first paper.  Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials – PubMed

Item #1

The first one is called “Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials” by Chaibi et. al. (Chaibi A 2021) and published in the Journal of Clinical Medicine in October 2021 and that’s got some smoke on it! Let me say that I’ve been yelling for some research on the effectiveness of SMT for neck pain for 4 years here on this podcast. I’ve talked to different researchers about it. They said they couldn’t get funding for it. Now, here we are with a small step for a chiropractor but a giant leap for chiropractor-kind…..or something like that. 

Why They Did It

Acute neck pain is common and usually managed by medication and/or manual therapy. General practitioners (GPs) hesitate to refer to manual therapy due to uncertainty about the effectiveness and adverse events (AEs); 

How They Did It

  • To review original randomized controlled trials (RCTs) assessing the effect of spinal manipulative therapy (SMT) for acute neck pain. 
  • Data extraction was done in duplicate and formulated in tables. 
  • Quality and evidence were assessed using the Cochrane Back and Neck (CBN) Risk of Bias tool and the (GRADE) criteria
  • Six studies were included. 

What They Found

  • The overall pooled effect size for neck pain was very large -1.37 (95% CI, -2.41, -0.34), favoring treatments with SMT compared with controls. 
  • They had a single study that showed that SMT was statistically significantly better than medicine (30 mg ketorolac im.) one day post-treatment. 
  • Minor transient adverse events reported included increased pain and headache, while no serious adverse events were reported

Wrap It Up

SMT alone or in combination with other modalities was effective for patients with acute neck pain. However, limited quantity and quality, pragmatic design, and high heterogeneity limit our findings. So, once again, researchers….please listen. We have enough information on the low back. We know we knock it out of the park on low back pain. Even our haters mostly know we kill it on low back pain. Those douches over at sciencebasedmedicine.whatever mostly admit we’re good on low back pain. And trust me, if you change their damn minds, you’re on to something.  So, let’s expand to the neck, please. Pretty please? Dr. Goertz, Dr. Pohlman, Drs influential with Chiropractic Compass, can we please continue down this path of exploring our effectiveness and low risk for adverse events in the neck because honestly, THIS clinically is what is holding us back. 

Professionally, it’s the vitalists in our profession. But clinically, it’s the perception that we do harm when treating the neck. Can we do harm? Well hell yes we can. Do we commonly do harm and are we likely or probable to do harm? Oh hell no. Why would you ask such a dumb question?

 

Item #2

https://pubmed.ncbi.nlm.nih.gov/30521781/

This one is called “The Effect of Spinal Mobilization With Leg Movement in Patients With Lumbar Radiculopathy-A Double-Blind Randomized Controlled Trial” by Satpute et. al. (Satpute K 2019) and published in Archives of Physical Medicine and Rehabilitation on December 3rd of 2018. It’s mushy…not solidified but not as warm as we like. 

Why They Did It

To evaluate the effect of spinal mobilization with leg movement (SMWLM) on low back and leg pain intensity, disability, pain centralization, and patient satisfaction in participants with lumbar radiculopathy.

How They Did It

  • A double-blind randomized controlled trial.
  • The setting was in a General hospital.
  • 60 adults with the mean age of 44 years old were included
  • They were al diagnosed with subacute lumbar radiculopathy
  • They were randomly allocated to receive spinal mobilization with leg movement  exercise and electrotherapy or exercise and electrotherapy alone. 
  • All participants received 6 sessions over 2 weeks.
  • The primary outcomes were leg pain intensity and Oswestry Disability Index score. Secondary variables were low back pain intensity, global rating of change (GROC), straight leg raise (SLR), and lumbar range of motion (ROM)
  • Variables were evaluated blind at baseline, post-intervention, and at 3 and 6 months of follow-up

What They Found

  • Significant and clinically meaningful improvement occurred in all outcome variables. 
  • At 2 weeks the spinal mobilization with leg movement group had significantly greater improvement than the control group in leg pain and disability. 
  • Similarly, at 6 months, the spinal mobilization with leg movement group had significantly greater improvement than the control group in leg pain and disability. 
  • The spinal mobilization with leg movement group also reported greater improvement in the global rating of change and in SLR range of motion.

Wrap It Up In patients with lumbar radiculopathy, the addition of spinal mobilization with leg movement provided significantly improved benefits in leg and back pain, disability, SLR ROM, and patient satisfaction in the short and long term. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in the leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

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

Chiropractic evidence-based products

Integrating Chiropractors

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  The Message

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

Key Point:

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

Contact

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

Connect

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

Website

Home

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

TuneIn

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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

  • Chaibi A, S. K., Russell MB (2021). “Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.” J Clin Med 10(21): 5011.
  • Satpute K, H. T., Bisen R, Lokhande P, (2019). “The Effect of Spinal Mobilization With Leg Movement in Patients With Lumbar Radiculopathy-A Double-Blind Randomized Controlled Trial.” Arch Phys Med Rehabil 100(5): 828-836.  

How Car Wrecks Contribute To Future Neck and Back Pain

CF 196: How Car Wrecks Contribute To Future Neck and Back Pain

Today we’re going to talk about How Car Wrecks Contribute To Future Neck and Back Pain. I have two different papers with what I thought were surprising conclusions in one way or another. Not only did I find themm a bit surprising but I don’t think the defense attorneys in PI cases will like either paper much. Just an assumption on my part. All of that coming up in this episode. But first, here’s that sweet sweet bumper music      

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

Chiropractic evidence-based products

Integrating Chiropractors

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

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an invaluable resource for your patient education and for you. It can save you time in putting talks together or just staying current on research. It’s categorized into sections so that the information is easy to find and it’s written in a way that is easy to understand for practitioner as well as patient. You have to check it out. 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 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. 

You have found yourself smack dab in the middle of Episode #196 Now if you missed last week’s episode , we talked about Spinal Manipulative Therapy vs. Opioids and Young Elite Pitchers, Hips, and Elbow Pain. Make sure you don’t miss that info. Keep up with the class. 

 

On the personal end of things…..

We just ended our fourth week as an integrated practice and starting our fifth. It’s a struggle. I’m not going to lie. You see the money going out but you don’t see it coming in. That’s why, to pull this off, you need to be a busy Chiro and you need to have reserves in place.

Otherwise, it could be doomed. Unless you’re a hype machine. A marketing mastermind that fills the schedule before the integration even takes place. Let’s be honest, most of us just aren’t. I know the value of marketing. I know how to market on a fundamental level. But it’s hard. It’s hard to get your message out there and it’s hard to break through.

So, week one, maybe 4-5 appointments. Week two, maybe 18 appointments. Week 2 was about the same. Then last week was maybe only 8-9. So it’s up and down. We aren’t covering the salary but, we have reserves set back AND I’m fortunate enough to be busy.  The trick is just getting the message out and I feel like we’re doing that both externally as well as internally.

We have in-office brochures, flyers, and posters. Email marketing, social media, and all that good hoopla. It’s happening. We’re making it happen. 

In other news, I recovered from my five days in Washington DC. Geez. What a go-cation. It’s not the cost of taking a trip. It’s the cost of being gone. How much money you lose by not being in the office. That’s the real number and it just kills me!! So, I don’t think about it because I truly believe we need to be taking a trip once per quarter. You have to so you don’t lose your damn mind. It’s just a must.

Speaking of, I have a trip in just about three weeks to Chicago for business to finish off my Fellowship in Forensics. I’m looking forward to that and to networking with everyone involved with that whole side of the profession. Multiple streams of income folks. I do it inside the office as well as outside. Speaking, mentoring, authoring, medico-legal, Ortho fellowship, personal injury, family, triwest, acupuncture, massage, laser, esthetician, Texas Chiropractic Association, Texas Council of Chiropractic Orthopedists, Nurse Prac, and everything that falls under that.

That’s inside.

Outside is music, voice-over, art, real estate investing, and all kinds of other things I’m looking at.  What would it be like to just do a couple Of things?  Who knows? That’s just not me.  I make myself crazy but I honestly don’t know any other way. 

If you were thinking you could get into business for yourself and sit on the computer half the day fiddle assing on the computer, I got news. Your competition is out there getting Diplomates, certifications, and expertise to run circles around you.

Get busy.

Or wonder where all of those new patients are going since they don’t seem to be coming to see you.

Item #1

Alright, let’s hop in with our first one today called “Exposure to a Motor Vehicle Collision and the Risk of Future Neck Pain: A Systematic Review and Meta-Analysis” by Nolet et. al. (Nolet PS 2019) and published in PM&R in November of 2019. In case you didn’t know, PM&R stands for physical medicine and rehabilitation. 

Why They Did It

They say in the abstract that neck injury resulting from a crash is associated with a high rate of chronicity. Prognosis studies indicate 50% of injured people continue to experience NP a year after the collision. This is difficult to interpret due to the high prevalence of NP in the general population. In other words, those that have not been in a car wreck still have neck pain, right? The stated goal of the authors here was to summarize the literature that has examined the association between a motor vehicle collision (MVC) related neck injury and future neck pain (NP) when compared to the population that has not been exposed to neck injury from a crash.

How They Did It

  • They performed a systematic review of the literature using five electronic databases, searching for risk studies on exposure to a car crash and future neck pain published from 1998 to 2018. 
  • The outcome of interest was future neck pain. 
  • Eligible risk studies were critically appraised using the modified Quality in Prognosis Studies (QUIPS) instrument. 
  • Eight articles were identified of which seven were of lower risk of bias. Six studies reported a positive association between a neck injury in an MVC and future NP compared to those without a neck injury in an MVC

What They Found

  • Pooled analysis of the six studies indicated an unadjusted relative risk of future neck pain in the car crash-exposed population with neck injury of 2.3, which equates to a 57% attributable risk to those having been in a car wreck. 
  • In two studies where exposed participants were either not injured or injury status was unknown, there was no increased risk of future neck pain

Wrap It Up

They wrap it up by saying, “There was a consistent positive association among studies that have examined the association between MVC-related neck injury and future neck pain. These findings are of potential interest to clinicians, insurers, patients, governmental agencies, and the courts.” I see personal injury patients. This is good info for their reports, their file, and their attorneys if they’re represented. 

 

Item #2 This one is called, “Exposure to a motor vehicle collision and the risk of future back pain: A systematic review and meta-analysis” by Nolet, et. al.  (Paul S. Nolet 2020)and this one was published in Accident Analysis and Prevention in 2020.  It’s not that hot but I’m using it anyway just because I like it and cuz I say so….

Why They Did It The purpose of this study is to summarize the evidence for the association between exposure to a motor vehicle collision (MVC) and future low back pain (LBP).

How They Did It

  • A systematic search of five electronic databases from 1998 to 2019 was performed. 
  • Eligible studies describing exposure to a MVC and risk of future non-specific LBP were critically appraised using the Quality in Prognosis Studies (QUIPS) instrument. 
  • The search strategy yielded 1136 articles, three of which were found to be at low to medium risk of bias after critical appraisal. 

What They Found

  • All three studies reported a positive association between an acute injury in a MVC and future LBP. 
  • Pooled analysis of the results resulted in an unadjusted relative risk of future LBP in the MVC-exposed and injured population versus the non-exposed population of 2.7, which equates to a 63 % attributable risk under the exposed.

Wrap It Up

There was a consistent positive association in the critically reviewed literature that investigated the risk of future LBP following an acute MVC-related injury. For the patient with chronic low back pain who was initially injured in a MVC, more often than not (63 % of the time) the condition was caused by the MVC.  Thats a lot right, folks? Look, it’s obvious to say an injury was caused by a car wreck. It’s common as a chiropractor to hear patients tell you that their neck pain started with a car wreck they had 20 years before. We hear it all of the time.  But for reals, 57% for the neck and 63% of the back?

That’s solid and flies directly in the face of the other side of the courtroom when they try to tell jurors that the forces experienced in a low-speed impact are about the same as stepping off of a curb on the street. This is, by the way, one of the most ridiculous things I’ve ever heard in my entire life but an argument that they most certainly use periodically.  Fools!!!! The fools we must suffer in life!! I’m sure plenty of folks refer to me in the same manner. It is what it is. Let’s all just try to be the least of the fools…., if that makes any sense at all. 

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 so get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

  The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment 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 https://twitter.com/Chiro_Forward

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

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

Bibliography

Nolet PS, E. P., Kristman VL, Murnaghan K, Zeegers MP, Freeman MD (2019). “Exposure to a Motor Vehicle Collision and the Risk of Future Neck Pain: A Systematic Review and Meta-Analysis.” PM R. 11(11): 1228-1239.  

Paul S. Nolet, P. C. E., Vicki L. Kristman, Kent Murnaghan, Maurice P. Zeegers, Michael D. Freeman (2020). “Exposure to a motor vehicle collision and the risk of future back pain: A systematic review and meta-analysis.” Accid Anal and Prev 142.          

w/ Dr. William Lawson – Brand New Guidelines On Neck Pain Treatment

CF 113: w/ Dr. William Lawson –  Brand New Guidelines On Neck Pain Treatment

Today we’re going to be joined by Dr. William Lawson to talk about some brand new guidelines that came out in December regarding neck pain and the treatment of neck pain for chiropractors. Be sure and listen so you’re up on the latest and you’re not doing it wrong!

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 #113

Now if you missed last week’s episode, we talked about what effect lifestyle might have on dementia and we talked about whether or not the feeling of having a stiff back actually means that you have a stiff back. 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. 

I swear to you, I see chiropractors always asking about research papers and what research is there on this or that. I want to yell at the top of my lungs to go and check my damn website. But, you don’t want to look like you’re self-serving and pumping your own tires so…..I say nothing. It IS called social media for a reason. It’s not called to get online and sell your stuff to everyone all the time. So I don’t. 

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. 

It just makes sense to be but hell, I used it all of the time because I can’t remember everything off the top of my head. I’m old now. My brain doesn’t brain like that anymore. 

On the personal end of things…..

Guys and girls…..you wouldn’t believe me if I told you. That’s if you’ve been listening regularly over the last 3 months. Now, remember, there’s a two-week delay on these podcasts so keep that in mind but, yesterday afternoon my step-dad went to the ER with heart issues. He’s 80 and he’s the one that had the appendectomy on Christmas day. 

Keep in mind that my biological dad is still in a nursing home at 76 years old after he suffered a stroke back on November 9th. 

Lots of other stuff is going on with other members of my family as well but those are the biggies for now. 

Anyway, it looks like he’ll be getting a heart cath today. I’ll keep you updated. 

On the bright side, I got my certificate to get in a big fancy frame. It’s the one that says I’m a Diplomate of the International Academy of Neuromusculoskeletal Medicine and I have to be honest, I remember being brand new in practice and really admiring the fact that some would go to the lengths of getting a Diplomate. 

I never considered that I would ever be one to do it though. When I got out of college, I didn’t want to see another book or class. I would say I was a bit of a lazy student back in the college days. I learned better from studying notes than I learned from listening to some boring teacher drones on and on day after day. 

Other than the lab classes, it was torture for me. I learn better by having words in front of me and studying them over and over. That’s why the school was so damn difficult for me. Especially histology. Lordy lordy. We had a 98-year-old with a monotone voice teaching us histology at Parker in Dallas. Can you imagine a more dry subject and it was taught by the driest person with the dry-est delivery. Hell no, folks. Hell no. If I had them, I would have given up the nuclear codes just to get him to shut up. It was awful. 

Anyway, the thought of my undergoing another 2-year course of study to get a Diplomate just wasn’t on the radar. And it stayed that way for about 20 years. Until one day. One day I was walking through the exhibit hall at ChiroTexpo ’18 in Dallas, TX and I met one Dr. Tim Bertelsman. He was pumping the tires on ChiroUp. BTW, if you want to go to chiroup.com and sign up with the code Williams99, you can get the first six months for only $99/month. You won’t regret it. 

Anyway, once he went through all of the amazing stuff that ChiroUp can do for me and my patients, he looked up at me…..I’m a pretty tall dude….and he said I should come to his lecture on back pain later that day. He said that it counts as 10 hours toward the 50 live hours needed toward the Orthopedic Diplomate. He said very confidently, “Come check it out. You’ll like it. You’ll stay.”

He got a chuckle out of me on that. I had other things I wanted to do for the weekend. Ten hours in a classroom wasn’t in the plans. Hell, being in TCA leadership, I already get about 40 or more hours a year anyway. 

Plus, The Diplomate was not on my radar so that didn’t mean anything to me but I was intrigued by the idea of focusing my knowledge and thoughts on the low back so I made sure I sat in on his class. At least for a bit just to check it out. 

Well, it’s obvious at this point, but I sat through the whole weekend. Dr. Bertelsman just nailed it. He’s engaging and interesting and extremely knowledgeable. He’s a star on the speaking circuit. 

So, I finished that class and thought, if that information was so good, what could I learn from the next one and on and on? Plus, I’d already knocked out 10 of the 50 live hours. Makes sense to at least look at it as a possibility. 

The more I looked at it, the more I realized that the Academy, Dr. James Lehman with the University of Bridgeport, and the Australian group with Dr. Anthony Nicholson and Dr. Matthew Long called Chiropractic Development International have all really really gone to great lengths to make getting that Diplomate easily accessible. They are working together to create a new culture of chiropractors. Chiropractic practitioners that are on a different level – a different plane from your regular run of the mill general chiropractor. 

I would have to say they have done just that. With only 5 live hour weekends required over the course of a year and half to 2 years, and the ability to take all of the other 250 hours in the comfort of you home…..well, it made sense. I get a ton of hours every year anyway so….why not?

I put the pedal to the metal and got the hours knocked out in about 6 months and spent the rest of my time just studying and reviewing the material. It worked out. Here we are, about the frame a certificate. 

The point is, it’s more convenient than it’s ever been and you can and should do it. If for now other reason than to be the best in your community at assessing, diagnosing, and treating. I mean really, who the hell doesn’t want that?

We are joined on the podcast today by the doctor that made it more convenient for folks in Texas to take on the Diplomate program.  Dr. William Lawson is our guest today. 

Dr. Lawson is located down in Austin, TX

He has a diplomate in Chiropractic Orthopedics as well as a Diplomate in Integrative Medicine college of pain management. 

He has a masters degree in Health Care Administration

He is certified in acupuncture

He is heavily involved in the Texas Chiropractic Association

He is an Air Force veteran

He does Designated Doctor work as well as medicolegal work

Let’s welcome Dr. William Lawson to the show. Thanks for taking some time out to come on the show today, Bill. Welcome!

This is actually your second time on The Chiropractic Forward show. The last time was September 27, of 2018 and it was episode #41. Here we are in episode 113 so it’s been a bit. Tell me what all has been going on in the life of Dr. Lawson since then

A quick review at chiropracticforward.com tells me that the last time you were on, we spent the episode discussing research targetting the cervical region. I remember fussing because we have so much research-based around the lumbar region and low back pain but nothing near as robust for the cervical region. Then, you got involved in research paper having to do with neck pain and treatment. Tell us how that came about and tell us what part you played in it. What was your contribution to it? 

So it turns out, all I have to do is raise a fuss to get neck pain some attention and voila…..here we are. : )

I noticed in the Acknowledgements section, some of our other friends were also involved in contributing. Drs Kris Anderson up in North Dakota, Dr. Craig Benton in Lampasas, TX, your name of course, and Dr. Dean Smith who is active with the Evidence-Based Chiropractor group. It looks like an excellent group. 

Let’s go ahead and give it this paper the Chiropractic Forward treatment if that’s OK

This paper you were involved in is called “Best-Practice Recommendations for Chiropractic Management of Patients With Neck Pain” authored by Wayne Whalen, Ronald Farabaugh, Cheryl Hawk and a slew of others. It was published in the Journal of Manipulative and Physiological Therapeutics on December 20, 2019 – Hot potato…

Why They Did It

Dr. Lawson, since you were involved in it, walk us through their reasoning for doing the paper if you will. 

How They Did It

I must admit to only reading the abstract so far so lead us a little deeper into how they go about formulating these guidelines and recommendations?

For those that don’t know or don’t really get deep into research, can you give us a layman’s explanation of what exactly a Delphi Panel is?

What They Found/Wrap Up

Tell us what they came up with. At the end of the day and after all of the effort, what do we have going forward?

(This is a good point to go beyond the abstract and cover the 16 points made in the Best-Practice Recommendations For Chiropractic Management of Neck Pain section of the paper)

  1. Begin care management with a thorough history.
  2. Follow the history with a condition-specific examination. It is the duty of the provider to perform an examination consistent with the complexity of the case, based initially on history, which includes the mechanism of injury.
  3. Evaluate patients with complaints of neck pain for potentially serious red flags.
  4. Consider referral for diagnostic imaging or other studies based on established clinical practice guidelines (see “Diagnostic Imaging” later).
  5. Develop a care plan based on history and examination. The care plan includes appropriate diagnostic tests. Sometimes referred to as a report of findings, the history, examination findings, plan of care, and prognosis should be reviewed with the patient through a process of shared decision-making and with their consent to proceed obtained.17
  6. Document factors that may delay recovery. (Yellow Flags?)
  7. Develop a working diagnosis and, when clinically indicated, consider differential diagnoses.
  8. Reassure the patient regarding the generally benign nature of minor neck pain and encourage activity and movement. With moderate to severe neck pain, emphasize the importance of treatment plan compliance.
  9. Determine whether to (a) manage the patient exclusively, (b) co-manage, or (c) refer to another provider.
  10. Begin treatment with a brief trial of care, 6 to 12 visits, followed by evaluation for treatment effectiveness. The initial trial is not the same as a limit or cap on care.
  11. Evaluate the patient briefly during each encounter, pre- and post-treatment. Conduct a more focused condition-specific evaluation after each benchmark in the treatment plan. Examples: Every 6 to 12 visits, or in 30-60-90-day intervals.
  12. Some patients’ responses to treatment may not follow a predictable pattern, or they may not respond. In this case, consider a modification to the treatment plan that may include, but may not be limited to (a) change in technique and/or modality, (b) referral to another provider within the same discipline for a second opinion, (c) referral to another provider outside the discipline for a second opinion and consideration of other treatment approaches, or (d) referral for diagnostic tests (eg, X-ray, magnetic resonance imaging [MRI], computed tomography scan, neurodiagnostic or blood studies)
  13. Refer patients with new or worsening symptoms or evidence of psychological issues to providers with expertise in those areas (eg, behavioral health).
  14. Determine at each visit and/or evaluation if the patient is improving, is worsening, or has plateaued, and discharge if appropriate.
  15. Encourage and provide home and self-care approaches.
  16. Document the history, clinical examination, treatments performed, the rationale for and response to care, and any referrals.

In the paper, just after the section we just covered, they recognize that not all patients recover fully. Unfortunately, we’re all well-aware. Tell me a bit about what they have to say about that. 

For patients who have reached MTB, the question then becomes: What is the best course of care to help control the ongoing pain? In general, patients unable to reach full recovery fall into one of these categories:

  • 1. No physician/provider intervention is necessary. The patient has residual minor neck pain but can manage it with self-care strategies: ice, nonsteroidal anti-inflammatory drugs, home-based exercise.
    2.
    Physician/provider intervention is necessary in periodic episodes of care. The patient experiences pain that exceeds his or her ability to self-manage and must return for care in an episodic fashion.
    3.
    Physician/provider intervention is necessary on an ongoing basis. The patient experiences pain that exceeds his or her ability to self-manage, and in the absence of care the condition deteriorates. These patients often benefit from 1 to 2 visits per month to providers of nonpharmacologic conservative care who use spinal manipulation, to be reevaluated every 6 to 12 visits.

Now, I have been seeing this paper being shared and discussed all over the Forward Thinking Chiropractic Alliance Facebook page as well as the Evidence-based Chiropractor Facebook group. Those are all very like-minded docs in there and we all love practice guidelines, the idea of professional standardization, a certain level of standards within that construct, and those sorts of things. 

So it’s no surprise that a paper putting guidelines into the profession is well-accepted by those groups. I wonder if you’ve seen or noticed any thoughts or opinions elsewhere? Basically, what is the paper’s reception as far as the rest of the profession is concerned? Or do you know? A lot of chiropractors don’t know a thing about research or new research and may not even know it exists. 

Let’s start wrapping it up a bit, do we have any more research papers you’re contributing to? What is next on your horizon? 

Thanks for coming on the show this week


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

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Are MRI’s On The Outs? & The Ease of The Arm Squeeze

CF 108: Are MRI’s On The Outs? & The Ease of The Arm Squeeze

Today we’re going to talk about why MRI’s in the early going are out and we’ll talk about how easy and useful the Arm Squeeze Test is for differentiating arm pain from cervical radiculopathy pain. 

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers so feel free to crack one open because we’re off and running. 

Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

If you haven’t yet I have a few things you should do. 

  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • 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. 

Do it do it do it. 

You have collapsed into Episode #108

Now if you missed last week’s episode, we talked about how insurance may be warming up to chiropractic in the coming year and years and we covered research behind chiropractic treatment for sciatica. Make sure you don’t miss that info. 

On the personal end of things. I don’t even want to tell you how my life’s been going lately to be honest because it hasn’t been a lot of fun. 

We put my Dad in a nursing home this weekend because insurance is done paying for him to continue to stay at a rehabilitation hospital. My stepdad had his appendix out on Christmas day. I have a pre-teen daughter that I’m trying to figure out. I had someone throw a rock through my office’s front door glass just yesterday and steal our cash box. Luckily they only got about $500. Then, later that night I got a nail in my tire picking up food for the family, get it home, hear my tire hissing, get my son to follow me to drop my truck off at the tire store for the next morning, then get back home only to find out that the only sandwich left out of the damn take-home order……yes…it was my freaking sandwich. 

So, that’s my life lately and I don’t want to talk about it. I want to talk about research. Lol. So let’s get to it. –

Before we dive into the reason we’re here though, it’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you don’t take advantage of this deal, I just think you might be crazy.

If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that reassuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99.

Item #1

Let’s start with an orthopedic test that came up on a post on the Forward Thinking Chiropractic group. I had actually learned about the Arm Squeeze Test from the DACO/DIANM program and through Tim Bertelsman and Brandon Steele with ChiroUp but for whatever reason, have been inconsistent in using the test. I forget about it is what I’m saying to you right here right now. But no more I say!

This paper we’re using today is called “Arm Squeeze Test: a new clinical test to distinguish neck from shoulder pain” by Gumina, et. al. and published in European Spine Journal in 2013(Gumina S 2013). 

Now, look, what if you could find the fastest, easiest way to distinguish pain in the arm either coming from the shoulder or arm or whether it’s coming from the neck? What if it was so easy that you could just reach out and grab someone’s arm? Like…..really….that easy. The ease of the arm squeeze. That just rolls off of the tongue. Don’t you agree? The Ease Of The Arm Squeeze. Lol

Well, it is that easy so listen up friends, family,……loved ones. 

Why They Did It

They wanted to evaluate the diagnostic values of the Arm Squeeze Test where the clinician basically grabs the middle third of the arm and gives it a bit of a squeeze. 

How They Did It

  • There were 1,567 patients included in the study. 
  • DX of cervical root compression or shoulder disease was clinically formulated and confirmed with imaging
  • 350 healthy volunteers were used as the control group
  • The test was positive when the score on the VAS scale was 3 points or higher on squeezing the middle third of the upper arm 

What They Found

  • The test was positive in 295 out of 305 patients with cervical nerve root compression. 
  • The test had a sensitivity of 96% and a specificity of 91%. 

Wrap Up

The conclusion states, “The Arm Squeeze Test may be useful to distinguish cervical nerve root compression from shoulder disease in case of doubtful diagnosis. A positive result to this test may lead to cervical etiology of the shoulder pain.”

From reaching out and grabbing someone’s arm. You’re welcome folks. You’re welcome. Making you better every damn day. 

Item #2

Being in an evidence-based practice and being aware of updated guides and recommendations, you know that healthcare is moving away from MRI’s as a knee-jerk reaction. Why would that be, you may ask… Well, because they’ve found it leads to an escalation of care. 

When a surgeon sees a bulge or herniation, if he or she isn’t quite up to snuff on research, they may just think they can cut that out and the person will be off and running again. When many times, that little bulge isn’t what is causing the pain. 

Did you know that a perfect surgery performed on a person in chronic pain syndrome puts them at a 60% chance of developing new chronic pain at the new site of injury? That’s when everything goes perfectly. 

What I’m saying is that you can’t always just cut out pain and MRI’s many times lead doctors to think that they actually can so care gets escalated. 

I tell patients to be careful what they’re looking for because they sure as hell just might find it. If you go barking up the surgery tree, you just might get some of that tree on you. 

So this article is by Paul Ingraham and is called “MRI and X-Ray Often Worse than Useless for Back Pain” and it was published on PainScience.com on February 16, 2019(Ingraham P 2019). 

Not piping hot but hot enough for this!!!

We’ll just hit the highlights here. 

One of the first interesting statements is when he says, “Premature MRI is actually often worse than useless.” Look, let’s be honest, healthcare is a profit-driven profession for the most part. It’s not very patient-centered in my experience. Especially when we’re talking about our medical counterparts. 

Want proof? Is charging $15-$20 for an ibuprofen or Tylenol patient-centered? Hell no it’s not but hospitals do that crap all day every day. Well, MRI centers are the same. $550 cash but $2500 for insurance payors. Lol. I mentioned not long ago on the podcast that I had the opportunity to buy into an imaging facility but two different lawyers told me to stay far far away because I don’t look good in orange. 

However, the imaging center acted like it was as legal as could possibly be. 

Anyway, back to the actual usage of MRI…..The American College of Physicians recommended in a paper all the way back in 2007 that “Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain (strong recommendation, moderate-quality evidence).(Chou R 2007)”

For the WHEN part, they recommended: “Clinicians should perform diagnostic imaging and testing for patients with low back pain when severe or progressive neurologic deficits are present or when serious underlying conditions are suspected on the basis of history and physical examination (strong recommendation, moderate-quality evidence).”

In this same ACP paper from way back in 2007, they made the recommendation “For patients who do not improve with self-care options, clinicians should consider the addition of nonpharmacologic therapy with proven benefits—for acute low back pain, spinal manipulation; for chronic or subacute low back pain, intensive interdisciplinary rehabilitation, exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation”

Now we know they updated that recommendation in 2016(Qaseem A 2017) to a strong recommendation for those alternative therapies but I was this many days old when I found out they were talking about spinal manipulative therapy way back in 2007. 

Another interesting statement from Mr. Ingraham was this one: “Consider the results of a major 2015 review by Brinjikji et al: signs of degeneration are present in very high percentages of healthy people with no problem at all. “Many imaging-based degenerative features are likely part of normal aging and unassociated with pain.” 

Well, we know this. We can even put rough numbers to it. We know that 40-50-year-olds with no pain at all can get an MRI and 60% of them are going to have degenerative changes, disc findings like herniations or disc bulges, and/or facet hypertrophy. It’s just a given. 

They’re going to find disc findings in about 30% of freaking 20-year-olds. 

So, he says, let’s assume we understand some MRI findings are red herrings. OK, so what’s the harm in getting them then? Well, because findings on MRI’s freak people the hell out and not all practitioners have a firm handle on how to actually communicate with people in a productive way when they give the report. 

If the doctor says well there’s this degeneration and we see a narrowing of this hole here where the nerves run that will probably get worse in the next decade so you’re going to really want to be careful and keep an eye on that……well hell….. Take a person already on the verge of chronic pain syndrome, that doctor just pushed them off the cliff. A patient already in chronic pain syndrome just got pushed in deeper. It’s like taking someone that’s having a hard time keeping afloat in the water and tossing them a bag that weighs 20lbs. Not helpful. 

He says, “There’s expert consensus on this topic because the evidence is quite clear. Consider the hair-raising 2016 experiment that sent the same woman with back pain and sciatica to ten different MRI facilities, producing such a variety of conflicting diagnoses that it would be laughable if it weren’t so tragic.”

The bottom line: Typically, no imaging outside of red flags. If you think something ominous may be going on, of course you do imaging. Without question. If there are no red flags, how about a two-week treatment trial to see how the patient progresses before sending out for imaging?

That’s patient-centered. That’s evidence-based. 

Store

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

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

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

Chiropractic evidence-based products
Integrating Chiropractors
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The Message

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

When compared to the traditional medical model, research and clinical experience show us that patient results for headaches, neck pain, back pain, and joint pain just to name just a few.

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

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

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm. When it comes to non-complicated musculoskeletal complaints….

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

  • Chou R, Q. A., Snow V, Casey D, (2007). “Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society.” Annals of Internal Medicine 147(7): 478-491.
  • Gumina S, C. S., Postacchini F, (2013). “Arm Squeeze Test: a new clinical test to distinguish neck from shoulder pain.” Eur Spine J 22(7): 1558-1563.
  • Ingraham P (2019) “MRI and X-Ray Often Worse than Useless for Back Pain Medical guidelines “strongly” discourage the use of MRI and X-ray in diagnosing low back pain, because they produce so many false alarms.” PainScience.com.
  • Qaseem A (2017). “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians.” Ann Intern Med 4(166): 514-530.

Chiropractic & The Brain, Forward Head Posture Hurts, & Smoking Hurts Worse

CF 103: Chiropractic & The Brain, Forward Head Posture Hurts, & Smoking Hurts Worse

Today we’re going to talk about spinal manipulation’s effect on the brain, forward head posture and neck pain, and we’ll talk about how smoking is related to pain throughout the body. 

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.

Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

If you haven’t yet I have a few things you should do. 

  • Like our facebook page, 
  • join our private facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com

Do it do it do it. 

You have collapsed into Episode #103

Now if you missed last week’s episode on headaches, contraindications to adjusting, and more info on maintenance care, then make sure you don’t miss that info. Go listen when you get done with this one. 

Just a quick re-cap, some of the more recent very popular episodes have been when we had Dr. James Lehman on ths show for episodes 96 and 97. Those were huge for listeners. 

Then, right after those, we had a couple of shows on Marketing Evidence Based practices. Those were big shows for us too. 

Our all time biggest episodes though have been #13, 14, and 15. They were early in our existence. They’re called Debunked: The Odd Myth That Chiropractors Cause Stroke. And then there was episode 80 with Dr. Anthony Nicholson on Decoding Chronic Pain. That was amazing. It was a mini-course on chronic pain and I promise, it’s one you don’t want to miss. 

Anyway, for those that are newer to our podcast, you’ll have to check those out and see what you think.

On the personal end of things, Dad is still in a struggle for independence. If you’ve been around stroke victims in the early weeks, it’s tough stuff. I don’t wish it on a single soul. Well, there’s this one attorney I used to know. Lol. 

Kidding. I Kid….

When it’s my time, man….I just want it to go lights out. BAM. Seeya! It’s been nice but I gotta go hang with Jesus and my family I haven’t seen in a while. Buh bye. 

We don’t get to choose but I sure hope that’s the way it goes. I never want to be a burden on anyone just so I can keep breathing. I want to check out and say adios amigos, hasta luego. 

As far as practice goes, all days are not created equally are they? This was one of those days. Where to even start really?

I had to get after staff members for not doing rehab long enough. I don’t like repeating myself 100 times but I also don’t like getting after the staff members. I hate it. But it has to be done from time to time. 

Then a PT told one my new patients not to go to the chiropractor until after he is done working with them because the patient is ‘gummy’ and an adjustment wouldn’t stick. Now, what the hell does that mean exactly? We don’t take bones from one place and put them into another. Adjustments don’t need to stick. They need to create movement. And alignment isn’t a real thing. Son of a mother, people. 

I’ve never had a PT directing my patient’s treatment in my office before so that was a fun surprise. 

Then a re-exam patient shows up 5 mintues before lunch. Talk about wanting to choke a patient. In a loving way of course because I love my patients but choke indeed. 

Then an attorney on a case on a patient that I’ve seen just three freaking times calls the office. He wants to get me and the insurance adjustor on the phone at the same time. He wants to know what my bill is going to be, how many times I’m going to see the patient, etc… Yeah no. Not happening. 

You have a question? Email me and tag the insurance adjustor. Want a specific answer, yeah…no. Everyone is different, every injury is different, and everyone heals at a different rate. I can give you a very rough estimate at best. Suck it Mr. Attorney, aka Mr. Waste My Freaking Time. 

Then I have a new car wreck patient that doesn’t want me to see his previous radiology reports because they told him nothing was wrong and he doesn’t want me making up my mind about him based on radiology reports. Are you serious? You can’t make this crap up y’all. 

Then, there’s some inner office fussing going on. It’s not a big deal but just un-needed on top of the rest of it while I’m trying to switch CPAs, balance and close out the month of November, and just keep my crap together long enough to go out to the rehab hospital to see my Dad. 

Lol. Wow, what a brain dump I just laid on you all. I apologize but again, I share personal aspects of what’s going on day to day because I know many of you will 100% identify and if you don’t, you can probably learn from my experiences. If you don’t learn how to handle them, then maybe you can learn how to NOT handle them. Lol. 

I’m OK with that too. 

I can’t remember if I shared on the last episode but did you know the new slang for 100% is hundo p? It’s true. So, I hundo p guarantee that tomorrow will be a better day because I played whack a mole all day today and those little bastards are going to have headaches and will lay a bit lower tomorrow. 

At least I hundo p hope so. 

Before we dive into the reason we’re here, it’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you don’t take advantage of this deal, I just think you might be crazy.

If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99.

Item #1

Our first item is titled “Smoking Is Associated with Pain in All Body Regions, with Greatest Influence on Spinal Pain”, published in Pain Medicine Journal in October of 2019, and authored by Smuck, Scheider, and Ehsanian, et. al(Smuck M 2019). 

Why They Did It

The authors wanted to examine the interrleationship between smoking and pain the US

How They Did It

It was a cross-sectional population-based study

It was done nation-wide

They collected related demographicsin 2,307 subjects from 2003-2004

What They Found

Smoking is most strongly associated with spine pain, followed by headaches, then trunk pain, then limb pain. 

Wrap It Up

The conclusions is, “Current smoking is associated with pain in every region of the body. This association is strongest for spine and head pain. Given that pain is a strong motivator and that current smoking was associated with pain in all body regions, we recommend that these results be used to further raise public awareness about the potential harms of smoking.”

So we already knew that smoking was related to low back pain and disc issues from research we’ve covered here before. Now we know it goes beyond that. It’s everything everywhere basically. 

Honestly, can you think of anything that could actually be good about regularly inhale smoke all day every day? Like….anything at all? Of course not. And you know what’s going to piss some of you off? Other than some touted ideas on stress and pain relief, can you tell me what on Earth could be good about inhaling marijuana smoke regularly into one’s lungs. All day every day. Wake and bake is no better than smoking folks. I promise. When all the research shakes loose, you simply cannot inhale substances regularly and it be OK. 

As a side note I just want to throw some personal commentary in here. I had a conversation with a patient this week about another chiropractor here in my town and some of the beliefs and ideas that was laid on them on their visits with them. 

You know…..the things that push patients away and makes them come see other chiropractors. Things like don’t vaccinate your kids (regardless of your stance on the matter, don’t be a bully about it to your patients. It’s gross and unprofessional), things like don’t use cell phones because of radiation, things like pushing supplements more than an actual adjustment with exercises, things like we need 70 visits and $4000 from you this year to fix that loss of curve in your neck. Things like pushing the newest thing like CBD, multi-level marketing like supercharged water. 

From a patient’s perspective, if you went to your medical doctor and they’re pushing a ton of stuff from out of the blue….stuff beyond normal and customary medication. Things supplements that cost A LOT of money. They’re pushing CBD and selling if from their office, etc etc….

Well, those people look like snake oil salespeople. It’s not a good look, it’s off-putting, and we should hold ourselves to a higher standard. You can make plenty of money in this profession without selling your dignity and continually jumping on the hot new bandwagon. 

The golden oldies are still the best ROI, folks. Spinal manipulative therapy, exercise/rehab, physiotherapy, massage and manual therapy, acupuncture, and honest and high ethics. 

That’s your winning formula, y’all. Not CBD, special magical water, oils, and stuff like that. 

It’s just not. 

I swear I feel like I’m being controversial today but I’m not trying to be. I’m just speaking my mind and in the US at least these days, that is not a popular thing to do. We are at the point where 50% of the country hates the other 50% and anything you say, even when backed with facts, is taken as offesive material by half the country. 

Random thought just now. If kid slang for 100% is hundo p, for 50%, is it fitty p? Just a question I have. That’s all. 

Item #2

Now, item 2. This one is called “The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis” published in Current Reviews in Musculoskeletal Medicine in November of 2019 and authored by Mahmoud, Hassan, Abdelimajeed, Moustafa, and Silva, et. al(Mahmoud N 2019). 

November 2019 – hot stuff. fog your glasses up steaming plate. 

And can I just say Oh how I wish my last name was Moustafa? Powerful – elegant – a little bit of hell yeah there. 

Why They Did It

Despite claims that FHP may be related to neck pain, this relation seems to be controversial. Thus, our purpose is to determine whether FHP differs between asymptomatic subjects and those with neck pain and to investigate if there is a relationship between head posture and neck pain.

How They Did It

15 cross-sectional studies were eligible for inclusion

It was a systematic review and meta-analysis – so basically high-level information and research

What They Found

The conclusion of the project was “This systematic review found that age played an important role as a confounding factor in the relation between FHP and neck pain. Also, the results showed that adults with neck pain show increased FHP when compared to asymptomatic adults and that FHP is significantly correlated with neck pain measures in adults and older adults. No association was found between FHP and most of neck pain measures in adolescents.”

Now, you curve people don’t start getting our of hand. Can’t we see a world where a person does not have Forward HEad Posture but still has a loss of a curve. However, that loss of curve doesn’t cause a lot of issues? Of course we can. Because we have recent research that shows loss of a curve isn’t that big of a damn deal long-term. 

This paper is on forward head posture specifically and it doesn’t take a research paper to envision sitting with consistent bad posture and developing upper cross syndrome is going to set a person up for some chronic pain issues. I can easily make that leap with you. And with these authors. Count me in. 

Item #3

This one is called “The effect of spinal manipulation on brain neurometabolites in chronic nonspecific low back pain patients: a randomized clinical trial” it was published in Irish Journal of Medical Science in November of 2019  and authored by Didehdar, Kamali, Yoosefinejad, Lotfi, et. al(Didehdar d 2019). 

November 2019 – Pow- firecracker hot right here. Watch your fingers

Why They Did It

In patients with chronic nonspecific low back pain (NCLBP), brain function changes due to the neuroplastic changes in different regions. They wanted to evaluate the brain metabolite changes after spinal manipulation, using proton magnetic resonance spectroscopy

How They Did It

  • 25 patients enrolled
  • They were randomly assigned to lumbopelvic mainpulation or sham manipulation
  • They were evaluated befre the study begain and at 5 weeks after treatment. 
  • The Numerical Rating Scale and the Oswestry Disability Index and the H-MRS outcome assessments were used to quantify the results

What They Found

After treatment, pain and functional disability were significantly reduced in the treatment group vs. the sham group. 

This paper gets heavy into the neurology so, in order to keep you on board here, we’ll straight to the conclusion. 

Wrap It Up

The authors concluded, “In the patient with low back pain, spinal manipulation affects the central nervous system and changes the brain metabolites. Consequently, pain and functional disability are reduced.”

We did an episode on what an adjustment does way back on episode #56. That was also the episode where I talked about a popular group of millennial chiropractors that pour on the theatrics and sales talk and teach other impressionable chiropractors to do the same. 

And then claimed to make degenerative arthritic spurs disappear after adjusting 3 or 4 times a day for like 2 or 3 weeks. I can’t recall exactly now but go back and listen to episode 56. It was a fun brain dump and is probably something you’ll enjoy if I’m guessing. I’m putting the link right here at this point in the show notes at chiropracticforward.com so go give it a looksee. 

How do you describe a manipulation? If you were on an airplane sitting next to a neurosurgeon and he asked you exactly how manipulation works and affects the body and pain, what would you tell him? Have you thought about it?

The folks at ChiroUp have thought about it and probably because they’re DACOs, the DACO program also has an interesting description to offer. 

Dr. Brandon Steele with ChiroUp offered a good explanation for cavitation back in October on their blog. I’ll leave the link for you in the show notes. 

He described the need for better communication with the patients regarding cavitation and whether something “goes” or pops. Too many times, patients equate a successful treatment with cavitation. You know what we’re saying here. 

To quote Dr. Steele’s blog, he says, “Joint manipulation improves range of motion across individual and multiple vertebral segments.  A recent paper by Anderstt et al. (2018) confirmed that cervical manipulation results in facet gaping.  This force also improves regional motion across multiple spinal levels during and post-manipulation.

“This study is the first to measure facet gapping during cervical manipulation on live humans. The results demonstrate that target and adjacent motion segments undergo facet joint gapping during manipulation and that intervertebral range of motion is increased in all three planes of motion after manipulation. The results suggest that clinical and functional improvement after manipulation may occur as a result of small increases in intervertebral ROM across multiple motion segments.” 

Evidence-based chiropractors can bridge the patient education knowledge gap by incorporating current research into simple explanations.”

The DACO program I’ve been discussing put it all into an excellent description. Check this out and let me know what you think about it. 

“Chiropractic adjustments exert their effects upon the nervous system in a variety of ways. 

In recent years the neuroscience community has taken great strides in uncovering the mechanisms at play. These include analgesic responses at the dorsal horn level, as well as activation of the descending inhibitory pathways from brainstem regions such as the periaqueductal gray. 

There is also a compelling body of research that suggests profound changes in sensorimotor integration within the cortex. 

It appears that manipulation relies upon signaling properties of the muscle spindles that lie embedded in the paraspinal tissues. As the spindle registers rapid lengthening of the muscle it transduces this into a large proprioceptive barrage. 

The unique nature of a manipulation seems to alter the responsiveness of second-order neurons in the dorsal horn and make them less sensitive to incoming nociceptive signals from injured tissues.”

Good stuff. The more you know, the better you are. The better you are, the more you stand out and the busier you are. 

The right kind of busy. Not busy because you scared people into treating with you. Not busy because you made a big deal out of something insignificant. 

Busy because you’re freaking smart as hell, make good reasonable recommendations. Busy because you took the time to get the extra education to be able to help your patients beyond what your local competitors can do. Busy because you’re honest and you know that treatment should have a start and it should have a finish. 

Busy because you’re an evidence-informed, evidence-based chiropractor and high level research backs everything you say and everything you do. 

There are few things more satisfying than saying, “Would you like for me to send you the research paper on that?”

Store

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

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

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

Chiropractic evidence-based products
Integrating Chiropractors
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The Message

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

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

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

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

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm. When it comes to non-complicated musculoskeletal complaints….

That’s Chiropractic!

Contact

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

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

Connect

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

Website

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

Chiropractic Forward Podcast Facebook GROUP

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TuneIn

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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

Didehdar d, K. F., Yoosefinejad AK, Lotfi M, (2019). “The effect of spinal manipulation on brain neurometabolites in chronic nonspecific low back pain patients: a randomized clinical trial.” Ir J Med Sci.

Mahmoud N, H. K., Abdelmajeed S, Moustafa I, Silva A, (2019). “The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis.” Curr Rev Musculoskelet Med: 1-16.

Smuck M, S. B., Ehsanian R, Martin E, Kao MJ, (2019). “Smoking Is Associated with Pain in All Body Regions, with Greatest Influence on Spinal Pain.” Pain Med.

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

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

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

Don’t Miss A Dissection!

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

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

Introduction

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

Store

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

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

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

DACO

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

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

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

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

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

Personal Happenings

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

Item #1

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

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

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

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

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

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

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

Introduction

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

That’s all

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Chiropractic evidence-based products



Integrating Chiropractors
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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

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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

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

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