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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
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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.


Tinnitus & New Guides For Neck-Related Headaches

Today we’re going to talk about a couple of papers touching on tinnitus as well as a paper that just came out on practice guides for persistent headaches associated with neck pain. We’ll have some fun learning some new info if you stick around. 

Chiropractic evidence-based products

But first, here’s that ‘better than a back rub’ bumper music

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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 drifted into Episode #65. And I don’t mean drifted like a feather or a piece of wood in the ocean. No, I’m talking about dangerous, careless, speedy drifting in the car around a curve, man. That’s the drifting I’m talking about. I talk like I’ve drifted before. I haven’t. Well, at least not intentionally. We won’t talk about that one time down in Alpine, TX. Lol. Hey, I used to be in a touring band. What do you want from me? I used to be on the on’ry side. That’s all I’m saying. 

I’m still a little ornery but age has settled me quite a bit. Which is a good thing. I look at kids these days. My son is a teenager and really, for the most part, he’s just so good. No drugs, no drinking, loving as he can be. I think back to when I was his age. I was legitimately a menace to society. I mean that literally. It’s a wonder I’m alive but, as with most from my generation, we made it didn’t we? In spite of the lead paint, lack of bicycle helmets, and all that stuff. 

I want to take just a few seconds to thank Dr. David Graber. He gave The Chiropractic Forward Podcast a shout-out to a room of about 1000 chiropractors during his talk at the Parker Seminar in Vegas a week or so ago. While that doesn’t seem like that big of a deal, I’ll just say that, when you feel like a lot of times, you’re on your own and everything depends solely on you and your actions or, in-actions, it is a blessing to have others help share the word. When you guys share or help get the message out in any little way, it’s like I breath a little easier if that makes any sense. It’s like I’m part of a team rather than out here on an island shouting through a megaphone hoping a ship passing by hears me. 

Anyway, I know I thanked you in our private Facebook group but wanted to do so here as well. Very much appreciated, Amigo. 

Introduction

Let’s get on with it here. We’re here to advocate for chiropractic and to give you some awesome information to make your life easier from day-to-day. We’re going to keep you from wasting time in your week and give you confidence in your recommendations and treatments. And I feel confident in guaranteeing that to you if you listen and stick to it here at the Chiropractic Forward Podcast.  

Store

Part of saving you time and effort 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.

DACO

Let’s talk a bit about the DACO program. That’s the Diplomate of the Academy of Chiropractic Orthopedists. Why do the DACO? Because, if you want to integrated, you need to certificate. Or more accurately, you need to specialize and get accredited. That’s what the Diplomate is about. Bells, whistles, letters behind your name….yes. More importantly, you’ll be leaps and bounds beyond where you were prior to do it. 

Recent classes have been Tinnitus which we’ll talk about in a moment, carpal tunnel syndrome as part of a double crush syndrome, and managing hip osteoarthritis. Fascinating stuff. 

I saw a chiropractic student upset on Facebook the other day. He was upset because of some video that popped up on social media. It was an anti-vaccination speech and, honestly, it was pretty vile and hateful in the stance against vaccines. Look, you have whatever opinion you want on vaccines, we’re never going to get into that here. That’s not why I mention it. 

The student clearly did not agree with this speech from CalJam and was wondering what kind of profession he’s spending all of this money to be a part of. He was basically questioning what kind of future he’s going to have when you have a profession that is getting continuing education hours for speeches like that. 

I could confidently tell him, and you by the way, that there has never been a better time to be a chiropractor. At least not in the last 35-40 years anyway. We’ve all heard about the Mercedes 80’s. They sound real nice but they’re a pipe dream at this point. 

Right now, there has never been the research backing up what we do. We have it overflowing. Not only in our effectiveness either. We have research on how we’re more effective than PT and MDs. We have research on how our patients are more satisfied with our outcomes than any other practitioner. We have research on how we do all of that while costing less. 

Never before have we had a national epidemic. This little thing we call the opioid epidemic that is driving every healthcare practitioner to look for non-pharma means of treating their patients. That means you and me. 

And never before have we had the capability or opportunities that we have now to integrate with our medical colleagues and become more and more a part of a team of healthcare practitioners. 

We are moving more to the center rather than staying out on the fringes of healthcare like the red-headed step child. 

No offense to red-heads or step-children. 

Anyway, Diplomate programs are more than letters behind a name. They’re about progressing you and your profession. Building knowledge and respect. 

I get nothing for talking about the DACO. I just think certification and professional standardization are important things. Email me at dr.williams@chiropracticforward.com if you have some questions about getting started.

Personal Happenings

And the hunt for a front desk rock star continues. I want to share with you the fact that indeed.com and Facebook work ads are great at netting you about 1.3 million resumes but not good, well-qualified candidates. Every damn time I post a job listing, I’ll get around 150 recipients. Only a very limited few are worth anything. Most aren’t even qualified for the job. 

For instance I got a resume yesterday from a dude that can run a fork lift. Hey, I like forklift drivers fine but that won’t get it done at the front desk of a healthcare facility, right? It’s an insane waste of time going through all of these but, what the hell else are you going to do? you have to have an employee. And I’m not going to my friends to ask if they know of anyone because I don’t want my friends hitting me up for a job. Lol. If that doesn’t work out, not only have you lost an employee but you’ve also lost a friend. 

No thanks!

Item #1

I have had an increase in tinnitus in my left ear after a plane ride I took back from Austin a couple of weeks ago. Bad enough that I went to a specialist for it. Turns out, she said I have, in some frequencies, moderate loss. I said, “What?” Lol. 

Well, I’ve been a touring musician before so, what’s new? I could have told you that. But, it’s been bad in just the past couple of weeks so something changed in that window of time. I started taking some DACO classes and noticed one on tinnitus so jumped to that drill for obvious reasons. 

I don’t want to go into details of the class but I do want to talk about some of the research cited for the class and we’ll start with this one called, “Does multi-modal cervical physical therapy improve tinnitus in patients with cervicogenic somatic tinnitus?” It was authored by S Michiels, P Van de Heyning, and a bunch of other very difficult names and published in Manual Therapy in 2016(Michiels S 2016). 

Why They Did It

Tinnitus can be related to many different etiologies such as hearing loss or a noise trauma, but it can also be related to the somatosensory system of the cervical spine, called cervicogenic somatic tinnitus (CST). Knowing that case studies have suggested a positive effect of cervical spinal treatment on tinnitus, this study wanted to dive a little deeper on it. 

How They Did It

It was a randomized controlled trial of subjects having a combination of tinnitus and neck pain. Like a combo meal, instead of a burger and fries, it was neck ache and ear ringing. Make that two please, thank you. 

Each subject received cervical physical therapy for 6 weeks which equaled 12 sessions. 

What They Found

Cervical physical therapy can have a positive effect on subjective tinnitus complaints in patients with a combination of tinnitus and neck complaints.

Pretty cool stuff there. 

Item #2

Let’s double down with this one from Oostendorp, et. al. called “Cervicogenic somatosensory tinnitus: An indication for manual therapy? Part 1: Theoretical concept” published in 2016 in Manual Therapy(Oosterndorp RA 2016). 

The Big Idea

Tinnitus can be evoked or modulated by input from the somatosensory and somatomotor systems. This means that the loudness or intensity of tinnitus can be changed by sensory or motor stimuli such as muscle contractions, mechanical pressure on myofascial trigger points, transcutaneous electrical stimulation or joint movements.

Interesting yeah? I think so. 

They go on to say, “The neural connections and integration of the auditory and somatosensory systems of the upper cervical region and head have been confirmed by many studies. These connections can give rise to a form of tinnitus known as somatosensory tinnitus. 

Broadening the current understanding of somatosensory tinnitus would represent a first step towards providing therapeutic approaches relevant to manual therapists. Treatment modalities involving the somatosensory systems, and particularly manual therapy, should now be re-assessed in the subgroup of patients with cervicogenic somatosensory tinnitus”

And that’s just what they’re doing. Fascinating stuff considering that you’ve always heard, “you’ll just have to live with it.” Basically, if you can change the intensity, quality, or frequency of the ringing, by moving your jaw or stressing the cervical spine in different directions, there’s more than a solid chance that you can change it completely through cervical manipulative or manual therapy. 

If I remember correctly the guesstimate was around 65% of the cases may be affected by chiropractors for the positive. 

Hell yeah and pass the potatoes people. 

Item #3

Our last thing today is called “Non‐pharmacological Management of Persistent Headaches Associated with Neck Pain: A Clinical Practice Guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration” written by Pierre Cote, Hainan Yu, Heather Shearer, et. al. and published in European Journal of Pain in February 2019(Cote P 2019). 

Hot off the presses and I know you like it served hot like that. Cold or lukewarm education just isn’t as good as piping hot brain nuggets.

Why They Did It

To develop an evidence‐based guideline for the non‐pharmacological management of persistent headaches associated with neck pain (i.e., tension‐type or cervicogenic).

How They Did It

This guideline is based on systematic reviews of high‐quality studies. A multidisciplinary expert panel considered the evidence of clinical benefits, cost‐effectiveness, societal and ethical values, and patient experiences when formulating recommendations.

What They Found

When managing patients with headaches associated with neck pain, clinicians should: 

  1. rule out major structural or other pathologies, or migraine as the cause of headaches; 
  2. classify headaches associated with neck pain as tension‐type headache or cervicogenic headache once other sources of headache pathology has been ruled out; 
  3. provide care in partnership with the patient and involve the patient in care planning and decision‐making; 
  4. provide care in addition to structured patient education; 
  5. consider low load endurance craniocervical and cervicoscapular exercises for tension‐type headaches (episodic or chronic) or cervicogenic headaches >3 months duration; 
  6. consider general exercise, multimodal care (spinal mobilization, craniocervical exercise, and postural correction), or clinical massage for chronic tension‐type headaches; 
  7. do not offer manipulation of the cervical spine as the sole form of treatment for episodic or chronic tension‐type headaches; 
  8. consider manual therapy (manipulation with or without mobilization) to the cervical and thoracic spine for cervicogenic headaches >3 months duration. However, there is no added benefit in combining spinal manipulation, spinal mobilization, and exercises; and 
  9. reassess the patient at every visit to assess outcomes and determine whether a referral is indicated.

All of this is just a part of making us all better day to day. Those paying attention have the leg up. No doubt. 

Here’s the problem with being patient-centered instead of doctor-centered. We have to be OK with watching the high volume practices running through like cattle….we have to be OK watching them make millions while we have an average case treatment of only 7-10 visits. 

So what? Big deal. I always say that I could have a bigger house and more vacations but I sleep very well at night and, being a Christian as I’ve mentioned before, I’m at peace knowing I’m square with my maker and treat people the way they should be treated. 

Religious or not, patient-centered doctors can always take comfort in the fact that they’re doing what is in the best interest of their patients. 

It’s a lovely thing isn’t it? Honesty, ethics, love, cumbaya, and all that tom foolery….. They’re just little bricks that are the building blocks of an excellent life and career. 

Integrating Chiropractors
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Chiropractic evidence-based products

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

Cote P, Y. H., Shearer HM, (2019). “Non‐pharmacological Management of Persistent Headaches Associated with Neck Pain: A Clinical Practice Guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.” European Journal of Pain.

Michiels S, V. d. H. P. (2016). “Does multi-modal cervical physical therapy improve tinnitus in patients with cervicogenic somatic tinnitus?” Man Ther: 125-135.

Oosterndorp RA, B. I., Mikolajewska E, (2016). “Cervicogenic somatosensory tinnitus: An indication for manual therapy? Part 1: Theoretical concept.” Man Ther: 120-123.

https://www.chiropracticforward.com/proven-means-to-treat-neck-pain/?v=7516fd43adaa

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








CF 061: Faith-based Chiropractic, Ohio Lawmakers, & Chronic Neck Pain

CF 061: Faith-based Chiropractic, Ohio Lawmakers, & Chronic Neck Pain

Today we’re going to talk about another aspect or group that I find particularly troubling in my profession I call faith-based chiropractic, we’ll talk about some lawmakers in Ohio, and then we’ll gloss over a paper on chronic neck pain and balance. Stick around, it might get interesting. 

But first, here’s that ‘yummy in your tummy’ bumper music


Chiropractic evidence-based productsIntegrating Chiropractors

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 streamed you way into Episode #61

Before I make people mad, let’s talk a bit about the DACO program which is the Diplomate of the Academy of Chiropractic Orthopedists. I’m on it, I’m on it. I’m on it like stink on my teenager’s socks. You know what I’m talking about. I won’t even enter his room. It just has a certain smell that I want no part of. 

Continuing on with the eLearning episodes through the CDI group, I recently wrapped up one on Lateral Epicondylalgia just this morning and a few days ago finished up one on Fibromyalgia. Did you know the literature is pointing to those two conditions as being partly due to the central nervous system and what is termed central sensitization? 

It’s excellent information. If you want some guidance getting started on it, shoot me an email at dr.williams@chiropracticforward.com No, I don’t get a thing out of helping you or out of talking about it. Nothing at all. It’s just something I’m currently doing so it’s top of mind and I see the incredible value daily and am sharing that information with you. That’s about the total of it. 

I want everyone, as soon as you get to a computer, to go to chiropracticforward.com and click on the STORE link. You will find Posters and Brochures. The posters have some of my favorite and often-used sayings from the podcast. The brochures are evidence-based and are something I have been working on for some time now in my spare time. Now, if I can get some pre-orders ready to rock, we’ll get them ordered and sent on their way to you. 

I’d love to get your feedback on them at dr.williams@chiropracticforward.com

Introduction

Everyone on the planet knows there are two things you don’t talk about and they are POLITICS and RELIGION. 

For me, this here, what we’re about to go into….it has very little to do with the nuts and bolts of religion but more to do with the use of it. I’m going to touch on a very touchy subject and I hope that you won’t do the “poor me, I’m offended by everything on the planet” bit and get mad and leave and never return.

Rather, I hope you’ll hear what I have to say and hear it objectively and then, we either agree or disagree and we move on with our days with a common goal of getting people better. In the end, it’s just one dude’s opinion so let’s not get too worked up, OK? 

Faith-based Chiropractic

OK, let’s talk openly and honestly and hope we don’t make everyone mad. Here’s my deal people, I’m a Christian and have been all of my life. In fact, when I was younger as in junior high and high school, typically if the doors were open, I was there. Sunday morning, Sunday evening, and Wednesday night. Yep. Southern Baptist even although, now, I’m non-denominational. I found out I’m not as much of a fan of organized religion as I am of religion in general. When it gets too organized, I get less interested if that makes sense. 

Anyway, I’m a proud Christian but I’m not a loud or a bully Christian at all. If you come to my office, I’m not sure I have one cross in the whole place. That doesn’t mean I frown on you if you have Christian music playing through the speakers and you have scripture written on the walls. I honestly have no problem with that if it’s there for the right reasons. I don’t believe people are coming to my office for religion so it’s not right for me personally. 

I will admit, I’m a sculptor so several of my pieces are here. One of my pieces is called Road To Damascus and is about a story found in the Bible. I’ll post a picture in the show notes at www.chiropracticforward.com and you can just go to episode 61 if you want to check it out and see it. 

 

Damascus apostle paul bronze

saul apostle paul damascus sculpture

 

I feel like, since I AM one, I can talk about other Christians.

Lately, I’m seeing more and more posts and have been hearing more and more about Christian Chiropractors. I think the idea or concept of being a Christian Chiropractor is just fine. Honestly, I do. There are indeed people that would rather go to a like-minded practitioner rather than a Satan-worshipping chiropractor for example. Wouldn’t you agree? ‘Birds of a feather flock together’ is more than just a saying.

Much in the same way that some patients would just as likely AVOID a Christian Chiropractor if they themselves are not Christians. If someone wants to identify themselves as Christian, honestly, I’m cool with that. I don’t but I don’t care if you do. Not at all. 

Fair play to ya. That’s why we have different strokes for different folks and I’m so OK either way. There are Christian MDs, Muslim plumbers, Christian brothers car mechanics, Jewish this, and Buddhist that…. Whatever melts your butter and feathers your fancy. 

My Issue

My issue today isn’t one of religion vs. non-religion in all honestly. My problem lies in practitioners USING their religion to build their businesses and, in a most undesirable move, using religion to manipulate vulnerable patients for the purpose of padding their wallets. 

That’s a next level no-no in my book. Who cares about my book, right? Maybe nobody at all. Maybe around 8,000 people so far though so, it’s possible some actually DO care about my book so let’s keep rolling here. 

I want to make a distinction here. a Christian, according to the New Testament is charged with going and preaching the gospel. Save souls. There are some that truly feel that, if they are not doing that, they’re not fulfilling their mission. 

OK, fair enough. Who am I to argue that you’re wrong and who the hell am I to judge? If I were to say you’re wrong, I’d be arguing against the Bible and I’m certainly not going to do that. I have faults so I do what I can to stay in the good graces when at all possible. 

If it is honest and well-meant and you feel it in your heart to save your patients, rock on brothers and sisters. Amen & Hallelujah. 

But, if you mix religion into your business practices and protocols as a way to build your business by manipulating desperate and many times scared patients into seeing you, that’s where our paths go separately.

I cannot reconcile it in my mind how it would ever be right or permissible. I’ve never in my life gone to church to pick up business. I’m not there for that. It would be disingenuous and would defeat the purpose of being in the building in the first place. 

In the same way, I don’t use it to build my business in my office. I would not feel honest. I wouldn’t feel genuine. At the end of the day, if I’m anything, I’m those two things. Again, we’re all different but for me personally, it just doesn’t feel right. 

Example

Let me give you exhibit #1 for an example so you can see for yourself what I’m talking about. Here is an actual script folk.

“Mary, I’m concerned. I’m really concerned about you. When you don’t continue your plan to remove the subluxations that are interfering with God’s life force allowing it to innately flow from above down through your body in order to heal you, you’re not allowing God to do his part and heal your body. I understand that it’s hard getting here…but I have an opening at 5:30 tonight so we’ll see you then and let’s get you that life-saving adjustment tonight ok?”

That is a script used by a  popular company. They tell their members to say stuff like that. I’m not even kidding and, as I said, that’s some next level BS for me personally, in my practice. 

As a Christian myself I’m telling you, someone says something like that to me while I’m trying to get my issues resolved, the next thing they’re seeing is my ass as I walk out the door. 

First, I’m not there to be preached to. I go to church for that. Second, it’s obvious you’re trying to manipulate me into treatment using my religion and that just straight up pisses me off. Third, if God wants to heal a patient, why on Earth would he need a chiropractor to make that happen? 

Honestly. Think about it honestly. God moved heaven and earth. All-knowing. All powerful. But needs a chiropractor to facilitate your improved health? That’s insane in the membrane to me. 

What If

What if they said, “Mary, I’d never try to tell someone how to spend their money or how to take care of themselves because that’s none of my business. My job is to tell you what I think would be the best for you based on the idea that you live right next door and have no travel concerns, and you have all of the time and money in the world. What would I think would be best for you? Then there’s reality and my job is to be here for you however you want to use me. We don’t hassle our patients about their recommendations. Just do me a favor if you can’t do what I recommend, don’t tell people that chiropractic didn’t work. OK? Tell them you weren’t able to do what the chiropractor recommended. Is that fair?”

And all the people said, Amen. Literally, every single one of them agrees that it is indeed fair. 

Of course, I also tell them that if they love what we do for them and they get to feeling better, we’d love a great review on Google and Facebook but, if you don’t like us, just keep your mouth shut.” Of course, they know I’m kidding. Or am I?…..

The way I see it, I’m a specialist in what I do and that’s why a patient is here to see me and that’s what they will get. They’re not going to get politics and they’re not going to get religion either. 

As I said in episode #56 when I talked about the magical mystical disappearing arthritic osteophytes, although in many areas of the world it’s getting better, we are still in a battle with a medical community that wants to do away with us. We need to ask ourselves an honest question. Does this sort of stuff, put us at risk of continued ridicule? 

I doubt medical doctors are sitting around all over the country saying, “Mary, I’m concerned about you. If you don’t get this chemo followed by months of radiation, God can’t express himself fully in your body and your healing will not be complete, and you’re going to die.” “Mary, if you don’t take this oxcy, God won’t be able to calm down that issue long enough for us to make any progress in your healing.”

And, if you ever DO find one that does (there are always exceptions to the rule right?) if you find an MD that does that, the whole world is going to think he’s a coo coo loco and you might even see him on 60 Minutes one Sunday night. 

God, faith, religion, and spirituality are wonderful things. They’re the #1 things in the lives of so many people including ME. Just don’t dirty them or the profession by using them as marketing and worse of all….tools to work patients and manipulate them. Please….

I love your religion and I love your passion as long as it’s genuine. Once it becomes about business and becomes a tool to work people, you lose me. That’s all I’m saying. 

Hopefully, not too many of you lost the cheese off of your cracker on that. Let’s keep moving. 

Resource #1

I want to cover a recent article I noticed from WSAZ NewsChannel 3 up in Charleston, WV. It was written by Kaitlynn LeBeau called Ohio Lawmakers, doctors suggest chiropractic care instead of opioids(LeBeau 2018) and was posted on March 21, 2018. 

https://www.wsaz.com/content/news/Ohio-lawmakers-doctors-suggest-chiropractic-care-instead-of-opioids-477447883.html

It’s in WV but talking about Ohio and here’s what they had to say. The Ohio Attorney General and lawmakers held a press conference last March to talk about the need for alternatives to pain meds. The Attorney General, Mike DeWine, said: “More and more people are looking for new and innovative ways to treat pain.” 

Yes, we already know this but he also went on to speak about community health centers that include medical, fitness, social and educational services. We’ve already talked about chiropractors getting integrated into the Federally Qualified Health Centers and, yes….you have one near you whether you know it or not. Just Google the term “FQHC” and then the name of your city or region and see what pops up. 

Here’s what I really wanted to point out: we chiropractors have a powerful ally in American soldier, Staff Sergeant Shilo Harris. If you are not familiar with Sgt. Harris, he is located in San Antonio, TX last I heard unless he’s relocated. 

Anyway, on his second deployment to Iraq, he was injured by a roadside bomb. When I say injured, I mean big time. Go do a google search on Shilo Harris and you’ll see immediately what I’m talking about. 

Bless his heart and thank you for your service, Sgt. Harris. Heroes don’t play on a basketball court or football field. They fight selflessly and give of themselves for our freedom. For complete strangers, many of which don’t even like them. They fight for the love of country too, right? Just amazing people. 

He is quoted in the article as saying, “I’m here to tell you that chiropractic care saved my life. I became addicted to my medications, naturally, in a sense because I had had so many back to back surgeries.”

Sgt. Harris has presented at Texas Chiropractic Association’s events and will be at another TCA event in just a couple of weeks down in Austin that I’ll be at. I’m looking forward to hopefully meeting him myself. 

Resource #2

OK, next item: this one called “Evaluation of Postural Balance and Articular Mobility of the Lower Limbs in Chronic Neck Pain Patients by Means of Low-Cost Clinical Tests(Gomes P 2018)” It was authored Amy Pamela Karine Alvino Gomes, et al. and published in October of 2018 in the Journal of Manipulative and Physiological Therapeutics. 

Why They Did It

The purpose of this study was to correlate measurements of chronic neck pain with the balance and mobility of the lower limbs and to compare these variables between individuals with chronic neck pain and asymptomatic participants.

How They Did It

It was a blinded, cross-cross-sectional study

They had chronic neck pain patients as well as asymptomatic people. 

Outcome assessment tools were used to measure the difference in the groups. 

What They Found

“Young adults with chronic neck pain present changes in static balance measured by means of the Functional Reach Test; that is, the higher the intensity of pain, the lower the anteroposterior excursion of the body during the execution of the test.

This week, I want you to go forward with this: again, I’m all for religion. Ultimately, you do you. Just do it proudly, honestly, and genuinely. Always try to be someone your family can be proud of and be above reproach. 

I want you to know that Staff Sgt. Shilo Harris is awesome and he’s on our team so look him up and book him for your next association event or seminar or legislative effort. 

Chiropractic evidence-based productsIntegrating Chiropractors

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Home

Social Media Links

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YouTube

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iTunes

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Player FM Link

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Stitcher:

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TuneIn

About the Author & Host

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

Bibliography

Gomes P (2018). “Evaluation of Postural Balance and Articular Mobility of the Lower Limbs in Chronic Neck Pain Patients by Means of Low-Cost Clinical Tests.” Journal of Manipulative and Physiological Therapeutics 41(8): 658-664.

LeBeau, K. (2018). https://www.wsaz.com/content/news/Ohio-lawmakers-doctors-suggest-chiropractic-care-instead-of-opioids-477447883.html. WSAZ News Channel 3.

CF 052: Chiropractic Forward Podcast Year One Review

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

CF 046: Chiropractic Effectiveness – Chiropractic Integration – Chiropractic Future

 

 

 

CF 051: Necks, Integrity of the Cervical Spine, and the CDC on Opioids

CF 051: Necks, Integrity of the Cervical Spine, and the CDC on Opioids

Today we’re going to talk about the reliability of clinical tests assessing the cervical spine, what is happening when adjusting a neck as far as the integrity of the cervical spine, and what the CDC says about opioids. It’s all fascinating all the time here at the Chiropractic Forward Podcast 

But first, here’s that bumper music

Integrating Chiropractors

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 drifted all slow and gently into Episode #51

DACO

As has become the tradition, let’s talk a bit about the DACO program. DACO stands for Diplomate of American Chiropractic Orthopedist. Trudging along. I’m up to I believe 84 of the required 300. Classes this last week were on frozen shoulder, piriformis syndrome, Important aspects of lumbar MRI, and inguinal pain. 

This stuff is just invaluable, folks. I’m an organizational freak but at the end of each course, I’ll make myself a quick sheet that I can reference when something like that comes through the door. I think making these little quick sheets will really help to get some of the more rare or difficult cases figured out quickly. 

I’ve already put the lumbar differential diagnosis sheet to use a few times as well as the dizziness quick sheet I created. I have shared several times here that I don’t sit around a lot either at work or at home. I’m a busy bee. 

Vacation & Hobbies

Going on vacation, don’t even try to take me to a beach. If my wife wants to go to the beach, that’s all her. I’ll tag along and I’ll check in on her out there reading a book from time to time but, for the most part, I’ll be off doing, seeing, and experiencing. The ability to sit still and just relax…..that’s an ability I did not receive in this lifetime. 

As a result, I make live edge furniture. Go to Facebook and look up Amarillo live edge and custom furniture. I am a sculpture and charcoal artist. Go back to Facebook now and look up River Horse Art Gallery. I’m in the process of teaching myself to paint right now too. I also am a singer/songwriter. Go back to Facebook once again. Yes, once again and look up Flying Elbows Perspective.

Crazy name indeed. 

So, here’s the point. It’s not to brag or pump my tires. The point is that this is how important I’ve found the DACO program to be. While I haven’t completely put everything else on hold, the DACO has taken priority of my time. One reason is that I want to motor through it quickly and efficiently. The next reason would be that I’ll be the only DACO in all of Texas West of the Dallas/Ft. Worth metroplex. 

What does that get me? Maybe a pat on the back. Maybe a part time or full-time gig on staff at an FQHC. As we have mentioned in previous episodes, there are reports of DCs on FQHC staffs making as little as $120/visit up to $300/visit on even Medicaid visits. Unbelievable. But you have a better shot at getting into the system when you are specialized AKA – a Diplomate. 

Just a part of making us all better. You guys and gals need to be looking at this stuff. 

Before we hop into the papers for the week, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. I think I have some pretty cool stuff coming down the pike you’ll be interested in. That’s in you enjoy evidence-based education.

Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

Paper #1

The first paper here is called “Reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders: Part 1—A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration” It was done my Madege Lemurnier et. al. and published in the European Spine Journal in September 2017[1]. 

Why They Did It

With a title as long as that one, what the heck are they doing here? They say they were hoping to determine the reliability of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders. 

How They Did It

They updated the systematic review of the 2000-2010 Bone and Joint Decade Task Forst on Neck Pain and Associated Disorders. 

They searched the literature for studies on the reliability and validity of Doppler velocimetry to evaluate the cervical arteries. 

They had two independent evaluators look through it all

What They Found

  • Preliminary evidence showed that the extension-rotation test may be reliable and has adequate validity to rule out pain arising from facet joint. Or rule in I suppose. Just in case you are unaware of the cervical extension-rotation test, it’s exactly as it sounds. Have the patient extend and then rotate toward the side you’re testing. When you combine this maneuver with palpation you can typically get a good idea of whether the patient is suffering from a facet issue. You need to know that this test is also effective in sniffing out a low back facet issue as well. Lumbar extension and then rotation can give you some good clues sometimes.
  • The evidence suggests variable reliability and preliminary validity for the evaluation of cervical radiculopathy including neurological examination (manual motor testing, dermatomal sensory testing, deep tendon reflexes, and pathological reflex testing), Spurling’s and the upper limb neurodynamic tests.
  • No evidence found for doppler velocimetry. 

Wrap It Up

Little evidence exists to support the use of clinical tests to evaluate the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders. We found preliminary evidence to support the use of the extension–rotation test, neurological examination, Spurling’s and the upper limb neurodynamic tests.

Paper#2

On to our second paper. This one is called “Intervertebral kinematics of the cervical spine before, during, and after high-velocity low-amplitude manipulation” and appeared in Spine Journal in August of 2018 and was authored by Dr. William J. Anderst, et. al[2].

Why They Did It

Since cervical manipulation is such a common intervention for neck pain, the authors wanted to characterize the forces involved and the facet gapping that takes place during manipulation. 

How They Did It

It was a laboratory-based prospective observational study

It included 12 patients 

Each patient had acute mechanical neck pain

One of the outcome measurements was the neck pain rating scale (NPRS)

Other measurements were taken for amount and rate of cervical facet joint gapping 

What They Found

The authors concluded, “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 ROM 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.”

Pretty cool stuff. 

Paper #3

Our last paper for this episode is called, “CDC: Drug overdoses hit new record.” It’s an article on thehill.com written by Nathaniel Weixel and was published on August 15th of this year, 2018[3]. 

The article leads off saying that 72,000 Americans died from drug overdoses in 2017 and that’s based on information provided by the Centers for Disease Control and Prevention. That is a new record folks and we have our friends in the medical realm to thank for it. 

Who’s To Blame?

Now, that, of course, doesn’t mean pharmacists and medical doctors are bad and there was a mass conspiracy to cause this deal. But it does mean that SOME of them are bad. SOME doctors are doing time in an orange outfit right now because they knew better but the dollar was mightier than common sense and common decency. 

There were pharmacies dispensing 100x more than their population could ever consume but they want to not refer to us and talk about the integrity of the cervical spine. That kind of crap is what got us here.

But, it’s also what has brought chiropractors from the shadows into the light. When you have the mess the medical field has created, then you have to start looking for the non-pharma solutions and we are it. 

Comparison

72,000 deaths. You ever heard of the Vietnam War? Of course, you have. We all have. Some either remember or have seen what a big deal it was. The deaths, the protests, the loss. I’ve been to the Vietnam Wall in Washington DC several times. It’s profound. It’s stunning to see all of those names. 

Just to compare, the total number of those lost in Vietnam stands at 58,220. Now keep in mind, that takes into account deaths from as early as 1956 all the way up to as late as 2006 and comes from Defense Casualty Analysis System Extract Files from The Vietnam Conflict Extract Data File. 

I did my homework. I’m not giving you fake numbers here. 

Essentially, 13,780 more deaths happened because of opioids, In just one year. In just 2017. That doesn’t even begin to scratch the surface when you start totaling up 2016, 2015, and further back. Unbelievable isn’t it? 

If we look at it, 2014 had 28,647 deaths, 2015 had 33,100 deaths, 2016 saw 63,632 deaths…..and then 72,000 in 2017. 

I’m guessing you can see the trend. Hell yes, it’s an epidemic.

The Math

I’ll do the math for you because I love you and I’m glad you’re here and I don’t want you to have to think too hard while you’re giving me your time. Over the last 4 years, that’s approximately 200,000 opioid-related deaths. 197,379 to be more specific. 

The genie seems to be out of the bottle.

While we can’t put the genie back in, we can offer solutions for the future. Many of those addicted to opioids became addicted due to spinal surgery. Many of those surgeries were unnecessary. One paper I reviewed showed that approximately 5% of lumbar fusions are necessary making about 95% of the unnecessary. Yeah….95%. 

The Answer

We have the answer people. The American College of Physicians, The White House, The Lancet, 2 papers in JAMA, Consumer Report surveys, The Joint Commission, The FDA…..seriously, there is not one reason that we aren’t inundated by spinal pain referrals at this very moment. No reason at all. It actually makes me mad as hell that we are not. 

Exactly what the hell does it take to make general practitioners, neurosurgeons, orthopedic surgeons, nurse practitioners, and physician assistants understand that an evidence-based chiropractor is best situated to help these people as a first-line therapy?

Integrating Chiropractors

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

http://www.chiropracticforward.com

Social Media Links

Chiropractic Forward Podcast Facebook GROUP

Twitter

YouTube

iTunes

Player FM Link

Stitcher:

TuneIn

About the Author and Host:

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

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

CF 012: Proven Means To Treat Neck Pain

CF 041: w/ Dr. William Lawson – Research For Neck Pain

CF 050: Chiropractic Care – Text Neck, Headaches, Migraines

 

 

 

Bibliography

1. Lemeunier N, Reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders: Part 1—A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration. Euro Spine J, 2017. 26(9): p. 2225-2241.

2. Anderst W, Intervertebral kinematics of the cervical spine before, during, and after high-velocity low-amplitude manipulation. Spine (Phila Pa 1976), 2018. 0(0).

3. Weixel N. CDC: Drug overdoses hit new record. The Hill 2018  5 August 2018]; Available from: https://thehill.com/policy/healthcare/401961-cdc-drug-overdoses-hit-new-high-in-2017.

 

 

CF 047: Do Disc Herniations On An MRI Worsen When Sitting Or Standing (PART ONE)?

CF 047: Do Disc Herniations On An MRI Worsen When Sitting Or Standing (PART ONE)?

Today we’re going to talk about those MRI’s you get back that show 4mm disc herniations in the low back. OK, that doesn’t sound too bad right? But what happens to the number when a patient comes out of the MRI tube and sits up, stands up, or bends over and lifts something? Let’s talk about it. 

But first, here’s that bumper music

 

Integrating Chiropractors

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

Introduction

You have toppled into Episode #47 just like a big huge Jenga game. 

DACO Talk

Let’s talk a bit about the DACO program: this weekend, I will be headed back to Dallas, TX to attend another 10 hours of the DACO program. This class will again be with Dr. James Lehman, the man, the myth, the legend.

After this weekend, I’ll have 40 of the 50 live hours needed and I’ve been chipping away at the online hours in the meantime. I’ve got about 20 done so far so I’ll be sitting at roughly 60 of the 300 hours needed. 

Yes, that sucks when I look at it through one lens but is pretty dang cool when I look at it through another. It’s been an excellent journey so far. 

It’s not just orthopedics. Which I love. There is stuff I don’t love like the different forms of arthritis. I’m not a big fan of neurology-like refreshers on vestibular nuclei, spinothalamic, corticospinal tracts, and all of that stuff.

It’d be nice to separate that and leave it for the Neuro Diplomates but it doesn’t work that way. It’s a lot. And at only 60 hours in, I’m wondering how on Earth I’m going to be able to remember it all enough to pass a big ol’ hairy test on it but, I started it and I’m going to finish it pass or fail. 

Between you and me though, I have an A in the class so far so I plan on passing the thing!

At The Office

Front desk…..well…..it’s still a thing for us. If you’ve been following along, you know what’s up. If you haven’t, then you know that I was thinking we finally had the spot filled. That is until we didn’t. So, starting over. Boo…. What a tough time it is these days. 

I’d rather get a colonoscopy or have a joint drained than keep dealing with this but…. we keep on keepin’ on, don’t we? As if there is any other option outside of closing shop and going on the road as a speaker….. Hey, wait a minute….

Meat n’ Taters

Alright, enough of all that. Let’s get down to the nuts and bolts of what we do here. 

You either are a patient or you sent a patient to get an MRI on the low back because you think they are showing signs of having disc herniations pain is running out into the leg, and you want to take a look at it. We have enough here that I need to split this into a two-part podcast. 

We don’t want these dudes getting too long or you’ll look at the length and skip the whole damn thing. We’re busy after all aren’t we? You have to be really good to get me into a 45-minute podcast and I …..may not be that good. Lol. 

The Question

As I mentioned in the intro: what happens the measured herniation when a patient comes out of laying down in the tube for the MRI and then sits up, stands up, or bends over and lifts something?

Some of you probably think the answer is obvious but I’m going to suggest to you that it is not obvious. Here’s how I know for sure. I run in medical circles to some extent.

I’m friends with radiologists, two heart surgeons, a vascular surgeon, a cardiologist, several ER/Urgent care docs, and countless Nurse Pracs and PAs as well as PT’s. 

I haven’t asked them all because there’s no reason to but the radiologists for sure and a couple of the others…..I asked them the same question. What happens to disc herniations when the patient applied weight-bearing to the disc herniations?

I was told universally that, while they didn’t know for sure, they thought the disc was so strong that really nothing would happen. Certainly nothing significant. 

The radiologists felt this was too and I just wasn’t satisfied. I just knew something had to happen. And something important at that. So, what does a research nerd such as myself do when they don’t have solid answers? They start a search for research. 

The key was to find the right keywords. If I recall, they were “axial loaded MRI” or something very similar to that. I believe that was the key to the kingdom. 

Anyway, I want to go through some papers I found on disc herniations and axial loads and we’ll see what we find. 

The Research

Let’s start here, if you know a little anatomy and a little McKenzie stuff, you know the disc can be likened to a stout bag of water. Meaning, if I push one side down, the opposite side will “bulk up.” The gym rats call it “swole” I believe. 

If I push a different side down, the other will push up. It reminds me of why I can’t go camping. First, I require central heat and air and plumbing. Secondly, I’m 6’4” and 280 or so depending on how much fun I’ve been having lately. If my much smaller wife and I try to sleep on an air mattress, I go to the ground while she is sleeping on a mound of air. 

It just doesn’t work for us which works for me. I’m no camper people. 

Anyway, this knowledge, if you didn’t already have it, will come in handy here in a little bit. 

Also, I hope you’ll go to our show notes for the diagram demonstrating the different amounts of pressure on your low back depending on how you are positioned. For this study, I am told the researchers actually placed pressure sensors into the patients’ discs and had them do these moves to find the differenced. 

Can you even imagine doing that or volunteering to do that? Holy smokes. 

Anyway, laying down shows 25 kg of pressure in your low back discs. Standing places 100kg on them while sitting straight up is 140kg. Now, the big ‘no-no’s’….standing and bending forward with something of substance in your hands, 220kg and the daddy of them all, sitting bent forward with weights in the hands. 275 kg. 

No weights, bending forward at the waist and sitting slumped. How would they affect those discs? 

Now,  let’s get to the first paper, it’s paper #1 titled “Upright magnetic resonance imaging of the lumbar spine: Back and Pain Radiculopathy.” It was published in the Journal of Craniovertebral Junction & Spine in 2016[1].

They were testing MRI results lying down as well as when seated. 

How They Did It

  • 17 participants
  • 10 were asymptomatic
  • 7 had symptoms of radiculopathy
  • MRIs were done on each in the seated position

What They Found

  • Mid-disc width accounted for 56% of the maximum foramen with in the symptomatic group.
  • Mid-disc width was over 63% of the maximum foramen within asymptomatic volunteers.
  • Disc bulging was 48% larger in the symptomatic group.
  • The measurements of the foramen were smaller in the symptomatic group.

Wrap It Up

The information suggests that MRIs performed in the upright seated position can be useful in the diagnosis process because it is better able to distinguish important differences among the asymptomatic and symptomatic. Especially in regards to the size of the intervertebral foramen.

Then we have this study by Madsen, et. al[2]. called ““The effect of body position and axial load on spinal canal morphology: an MRI study of central spinal stenosis.”

http://www.ncbi.nlm.nih.gov/m/pubmed/18165750/?i=26&from=/9612180/related

In this paper, the authors say that axial loading of the spine does not necessarily cause any significant changes to the disc itself, but that the simple act of having more extension in the spine was a determining factor as to how much space remained in the dural sac surrounding the spinal cord or cauda equina.

I wanted to be fair so I included this study. It suggests the discs play a very small part in the process but, as you will see from approximately 10 other papers we’ll discuss, this sort of finding or thought process is very much in the minority.

See…..I’m fair. I don’t want to cherry-pick. 

Here we have one by Hansson et. al.[3] called “The narrowing of the lumbar spinal canal during loaded MRI: the effects of the disc and ligamentum flavum.” 

http://www.ncbi.nlm.nih.gov/m/pubmed/19277726/?i=10&from=axial%20loaded%20disc%20MRI

How They Did It

  • There were 24 participants in the study.
  • The lumbar (low back) spines were examined by MRI while lying down supine (face up).
  • Then the study was repeated with roughly half of their weight loaded to the spine axially.
  • The measurements were through the cross-sectional areas of the spinal canal as well as the ligamentum flavum, the thickness of the ligamentum flavum, the posterior bulge of the disc and the intervertebral angle.

What They Found

  • The axial loading did, in fact, decrease the cross-sectional size of the spinal canal.
  • Increased bulge or thickening of the ligamentum flavum was to blame for 50%-85% of the decrease in the spinal canal size.

Wrap It Up

The authors concluded that it appears the ligamentum flavum, not the disc, played a dominant role in reducing the size of the spinal canal on axially loaded spines for those with stenosis.

Next up is Choy et. al. called “Magnetic resonance imaging of the lumbosacral spine under compression.” This paper reveals that sitting MRI imagined exists at Harvard and Zurich. Since seated MRI is so limited in regards to availability, the authors were looking to be able to compress the spine in other ways to duplicate the pressures found in someone that is seated. 

http://www.ncbi.nlm.nih.gov/m/pubmed/9612180/?i=20&from=sitting%20disc%20herniation%20mri

They built a plywood contraption that had the ability to fit into a standard MRI machine and subject the patient to similar compressive forces. Interesting I thought. I’d love to see this contraption. 

What They Found

They were able to reproduce the symptoms in 50% of the patients through the compression machine and they were able to reproduce  “augmentation” or accentuation of the disc herniation when the compressive force was initiated. Meaning, simulated axial compression herniated the disc further. 

Man, we’re scootin now folks, 

This one is by Nowicki, et. al[4]. called “Occult lumbar lateral spinal stenosis in neural foramina subjected to physiologic loading,”

https://www.ncbi.nlm.nih.gov/m/pubmed/8896609/?i=20&from=axial%20loaded%20disc%20MRI

These authors wanted to see how different positioning of the trunk affects the relationships of the bones and discs in regards to the neural structures in the same anatomic region. They also wanted to find out how disc degeneration responds to axial loading.

What They Found

The average findings were that extension, flexion, lateral bending, and rotation show contact or compression of the spinal nerve by the ligamentum flavum or disc in 18% of the neural foramina. 

Extension loading produced the most cases of nerve root contact. Disc degeneration significantly increased the prevalence of pain stenosis.

Wrap It Up

The authors concluded, “The study supports the concept of dynamic spinal stenosis; that is, intermittent stenosis of the neural foramina. Flexion, extension, lateral bending, and axial rotation significantly changed the anatomic relationships of the ligamentum flavum and intervertebral disc to the spinal nerve roots.”

So, we’re starting to paint a picture here I think and starting to show that positioning and weight-bearing does indeed have an effect on the disc herniations, the ligamentum flavum, and the neural structures present at each level. 

Here’s the last one we’ll cover this week and it’s called “The diagnostic effect from axial loading of the lumbar spine during computed tomography and magnetic resonance imaging in patients with degenerative disorders.” It was authored by Willen et. al[5].

http://www.ncbi.nlm.nih.gov/m/pubmed/11725243/?i=14&from=axial%20loaded%20disc%20MRI

Why They Did It

The authors stated goal in this paper were to find out if there was any real value in imaging patients that had axial loads (simulated weight-bearing) applied in cases of degenerative spines.

How They Did It

  • A device was used to induce a load on the low back before imaging.
  • 172 patients were examined with compression applied.
  • 50 of those were imaged with CTs.
  • 122 of those subjects were imaged with MRIs.
  • Any changes in the major anatomy of the regions were noted.

What They Found

“Additional valuable information was found” in 50 of the original 172 participants. “A narrowing of the lateral recess causing compression of the nerve root was found at 42 levels in 35 patients at axial loading.”

Wrap It Up

There is certainly and frequently additional information that can be gathered for diagnostic purposes when the imaging is done with weight-bearing loads applied. This included those with neurogenic claudication as a result of stenosis but also sciatica.

We have a painting forming up here folks. I did the underpainting this week and we’ve got it ready for the finishing touches next week so stick around and make sure you’re connected with us. 

We do that through our weekly newsletter to let you know when the next episode goes live. You can get on that at chiropracticforward.com. 

You can also find us on Facebook on our Chiropractic Forward Page but, if you’d like to take it a step further, you can join us at our Chiropractic Forward Group where we post the papers from each episode and maybe even spark up a discussion about them if you like. 

The Message

Before you leave us today, 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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability.

It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

Contact Us

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.

Being the #1 Chiropractic podcast in the world would be pretty darn cool. 

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

http://www.chiropracticforward.com

Social Media Links

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

iTunes

Player FM Link

Stitcher:

TuneIn

About the author:

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

1. Nguyen HS, e.a., Upright magnetic resonance imaging of the lumbar spine: Back pain and radiculopathy. J Craniovertebr Junction Spine, 2016. 7(1): p. 31-7.

2. Madsen R, e.a., The effect of body position and axial load on spinal canal morphology: an MRI study of central spinal stenosis. Spine (Phila Pa 1976), 2008. 33(1): p. 61-7.

3. Hansson T, e.a., The narrowing of the lumbar spinal canal during loaded MRI: the effects of the disc and ligamentum flavum. Eur Spine J, 2009. 18(5): p. 679-86.

4. Nowicki BH, e.a., Occult lumbar lateral spinal stenosis in neural foramina subjected to physiologic loading. AJNR Am J Neuroraiol, 1996. 17(9): p. 1605-14.

5. Willen J, e.a., The diagnostic effect from axial loading of the lumbar spine during computed tomography and magnetic resonance imaging in patients with degenerative disorders. Spine (Phila Pa 1976), 2001. 26(23): p. 2607-14.

 

CF 043: Stroke Caused By Chiropractor

CF 043: Stroke Caused By Chiropractor

Today we’re going to talk about Stroke caused by chiropractor and we’re to show you once again what a pile of hooey the idea is and we’ll even talk a bit about where it came from.Integrating Chiropractors

Stick with us but first, we’re going wade through this here bumper music. 

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 bee-bopped into Episode #43 and we are so glad to have you. I’ve noticed that podcasts are going into Seasons….Shows you how much I pay attention to stuff outside of what I’m doing. I’m ashamed. I should do Seasons. Here’s the deal though. I enjoy it so much. I actually WANT to put one out every week. It’s not work when you’re having fun right?

It can be a little stressful creating content and talking points but hey, we get through it and have a lot of fun in the process. 

Growth

What a great month this has been in regards to listens and downloads. You’ve heard me say it before but it’s fun to watch. Because I’m a numbers nerd and who the heck doesn’t like to see the growth of a brainchild?

Speaking of growth, I’ve started work on something that I hope you’ll love. I’ll hope you’ll think about using for your own offices, and I think may be pretty cool. I’ll fill you in more and more as we go along but just know, I’m working on something and you should get yourself on our email list at www.chiropracticforward.com so I can tell you about it and maybe pass along discounts, stuff like that. Email list. Do it. 

A little personal…

How has your week been? Mine….well….I have to continue the saga of hiring a new front desk person. Hell people. Actual hell. The first one just didn’t show up. The second one we hired lasted three days. Three freaking days, folks. 

But, we think we have a winner in place now. You know I’m going to keep you all updated on this deal. This by itself has been enough for its own reality show. I’ve never seen anything like it. The workforce right now just doesn’t seem to want to work. At least that’s my experience lately. 

We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

Let’s get to the research papers

First thing’s first. I have covered this stroke caused by chiropractor topic in depth. As in….very in-depth. In Episodes 13, 14, and 15. If you do nothing else this week as far as educating yourself, make sure you go listen to those three episodes in stroke caused by chiropractor or read it on our blog at http://www.chiropracticforward.com all of which are linked here in the show notes. 

Podcast Episodes:

Blog: https://www.chiropracticforward.com/blog-post/debunked-the-odd-myth-that-chiropractors-cause-strokes-revisited/

YouTube Video: https://youtu.be/tRXpG_Ie0Rs

Why go over stroke again?

So, why go over stroke caused by chiropractor again? Well, one reason is that it’s been a while since we touched on the topic. Another being that I heard a prominent speaker just this year talking about chiropractors causing strokes and implying that it happens fairly often. That’s a pro-chiropractic speaker, by the way, acting as if chiropractors are the sole reason for a stroke on a regular basis. 

I don’t think that it is necessarily the way the discussion was meant but it could definitely have been interpreted in that manner if those listening didn’t have the information from our Debunked series. 

The other reason I wanted to cover stroke caused by chiropractor again is that is the main thing in regards to safety that the medical kingdom tries to hold over us. Or that they’ve been told about us. And, instead of doing their work on this, they just believe it. 

New habits take 20 days to cement. We need new habits in the medical realm so I’m doing my part by taking away one of the main things they have against us. One may argue that the philosophy and subluxation model is another thing they hold against us but, all I can do about that is continue to disseminate evidence-based information and keep plugging. We’ll see where that part of it goes in the future. 

Common sense talk

For now, though, it’s about stroke caused by chiropractor this week here on the Chiropractic Forward podcast. Now, let’s compare and contrast shall we?

Did you know that the RAND Institute estimates a chiropractic adjustment is the sole cause of a vertebral artery dissection at the rate of only about 1 in 1 million or more adjustments? And did you know that your chances of winning an Oscar stand at about 1 in 11,500? Your chances of being hit by lightning are 1 in 176,426? 

How about this: NSAIDS like ibuprofen and acetaminophen cause around 16,000 deaths per year and send 100,000 people to the ER in America….EVERY YEAR.

Let’s let all that sink in. I say all of that just to put things into context and to make the point that the medical kingdom needs to quit making such a big damn deal out of trained and licensed chiropractors adjusting necks. 

We’re starting with this paper 2015 by Kosloff and friends titled, “Chiropractic care and the risk of vertebrobasilar stroke: results of a case-control study in U.S. commercial and Medicare Advantage populations[1].” It was published in Chiropractic & Manual Therapies. 

Why They Did It

This is obvious. We’re looking at the real chances of chiropractic adjustments being the culprit for strokes. 

What They Found

There were 1,829 vertebral basilar artery stroke cases

Findings showed no significant association between chiropractic visits and VBA stroke

The Authors’ Conclusion

“We found no significant association between exposure to chiropractic care and the risk of VBA stroke. We conclude that manipulation is an unlikely cause of VBA stroke. The positive association between PCP visits and VBA stroke is most likely due to patient decisions to seek care for the symptoms (headache and neck pain) of arterial dissection. We further conclude that using chiropractic visits as a measure of exposure to manipulation may result in unreliable estimates of the strength of association with the occurrence of VBA stroke.”

Research Paper #2

Just like a rolling stone we are moving on and gathering no grass…..

This next paper is from Church, et. al. and is called, “Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation[2].” It was published in Cureus in February of 2016. 

Just to review the research hierarchy for those unaware, systematic reviews and meta-analysis papers are at the tippy top of the food chain just above randomized controlled trials. It’s like people in the animal kingdom. We’re the top predators ya know. 

Anyway, the point is: this is reliable information folks. 

We already know why they did it so let’s skip to what they concluded. “ There is no convincing evidence to support a causal link between chiropractic manipulation and CAD. Belief in a causal link may have significant negative consequences such as numerous episodes of litigation.”

Uhhuh….numerous episodes of litigation based on belief and NOT based on fact or research. Believing stroke caused by chiropractor is unfortunate.

Now we come to the guy that helped put the matter to rest once and for all. If you are unaware of John David Cassidy, let me introduce you. He is a professor at the University of Toronto Dalla Lana School of Public Health and is a Ph.D.

Research Paper #3

Let’s start with his newer one concerning this topic. It’s called “Risk of Carotid Stroke after Chiropractic Care: A Population-Based Case-Crossover Study[3].” It was published in the Journal of Stroke & Cerebrovascular Diseases in 2017. Newer stuff from JD Cassidy, folks. 

As you’ll see, this paper deals with CAROTID artery and stroke specifically whereas the next and last paper deals with the VERTEBRAL artery and stroke. 

  • The why is obvious once again so, what did they find?
  • They compared 15,523 cases to 62,092 control periods using exposure windows of 1, 3, 7, and 14 days prior to the stroke. 
  • There was no significant difference between chiropractic and PCP risk estimates. 
  • They found no association between chiropractic visits and stroke in those 45 years of age or older. 

The Conclusion

“We found no excess risk of carotid artery stroke after chiropractic care. Associations between chiropractic and PCP visits and stroke were similar and likely due to patients with early dissection-related symptoms seeking care prior to developing their strokes.”

Research Paper #4

You’re about to notice a trend here. Next paper is by Cassidy et. al. as well and is called, “Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-Based Case-Control and Case-Crossover Study[4].” This is the Daddy of papers proving that chiropractic adjustments are not the sole cause of strokes. 

Again, everyone knows why the research was done so let’s get to the meat and taters. 

  • It was done over a nine-year period from April 1993 to March of 2002. 
  • There were 818 vertebrobasilar artery strokes hospitalized in a population of more than 100 million person-years. 
  • There was no increased association between chiropractic visits and VBA stroke in those older than 45 years. 

The Conclusion and nail in the coffin

“VBA stroke is a very rare event in the population. The increased risks of VBA stroke associated with chiropractic and PCP visits is likely due to patients with headache and neck pain from VBA dissection seeking care before their stroke. We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.”

It’s like the action hero cartoons “Shazam” “Pow” “Bang” “Smack!”

Again, believing stroke caused by chiropractor unfortunate.

Wrap It Up

I’ve said it a thousand times. “If we were wrong, we’d have been wiped out years ago.” Lord knows every force of the medical kingdom focused on our demise for generations and that goes from the national and state associations all the way into the national and state legislatures. 

How do you fight against that amount of money and power and survive if you’re not inherently right in what you’re doing?

We can argue amongst ourselves till the cows come home about how to do our jobs but, in the end, we help our patients, we get them better when nobody else can, and….well…we’re right. 

So, the haters in the medical field can take a long walk off a short pier and stick it in their ears. I’m not always professional and that’s OK. I’ve always felt being strictly professional all of the time is more than just a little bit boring. We need more spice, personality, and a lot more laughter in life don’t we? 

Integrating Chiropractors

Affirmation

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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

Contact us

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.

Being the #1 Chiropractic podcast in the world would be pretty darn cool. 

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

http://www.chiropracticforward.com

Social Media Links

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

iTunes

Player FM Link

Stitcher:

TuneIn

About the author:

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

Research Paper Links:

https://www.ncbi.nlm.nih.gov/pubmed/26085925

https://www.ncbi.nlm.nih.gov/m/pubmed/18204390/

https://www.ncbi.nlm.nih.gov/pubmed/27014532

https://www.ncbi.nlm.nih.gov/m/pubmed/27884458/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2271108/

Bibliography

1. Kosloff T, e.a., Chiropractic care and the risk of vertebrobasilar stroke: results of a case–control study in U.S. commercial and Medicare Advantage populations. Chiropractic & Manual Therapies, 2015. 23(19).

2. Church E, e.a., Systematic Review and Meta-analysis of Chiropractic Care and Cervical Artery Dissection: No Evidence for Causation. Cureus, 2016. 8(2): p. e498.

3. Cassidy, e.a., Risk of Carotid Stroke after Chiropractic Care: A Population-Based Case-Crossover Study. J Stroke Cerebrovasc Dis, 2017. 26(4): p. 842-850.

4. Cassidy, e.a., Risk of Vertebrobasilar Stroke and Chiropractic Car. Spine, 2008. 33(4S): p. S176-S183.

CF 032: How Evidence-Based Chiropractic Can Help Save The Day

CF 029: w/ Dr. Devin Pettiet – Is Chiropractic Integration Healthy For The Profession?

CF 028: Will Chiropractic First Finally Take Its Place?

 

 

CF 041: w/ Dr. William Lawson – Research For Neck Pain

Research for neck pain

Integrating Chiropractors

Today we’re going to talking with Dr. William Lawson from Austin, TX about research for neck pain and what research is available for it. While low back gets all of the attention in the research, neck pain has taken a back seat but not today!

But first, here’s that bumper music

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast because I’m the only one that’ll do it.  

Have you taken the time to go to chiropracticforward.com and sign up for our newsletter? It’s important because doing that makes it easier to let you know when the newest episode goes live and we have a ton of ideas around here for the future and we want to be able to let you know about it. An email once per week isn’t going to make you crazy so please go do that so we’re on the same page.  

I also want to let you know about our Facebook page AND our separate Facebook group because they’re important supplements to the podcast. Both are called Chiropractic Forward oddly enough. On the page, we let you all know when a new episode goes live and we share some quotes from the episodes. Through the private Facebook group, we share the papers we went over and lots of time we connect and discuss there so go join up and let’s connect.

We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

You have done the mashed potato all James Brown, 60’s style into Episode #41. You know what that means? It means it’s going to be cooler than usual episode. 

Dr. William Lawson, Austin, TX

That’s because, as I mentioned before, we have a guest with us. Dr. William Lawson hails from Austin, TX and has his Diplomate of American Chiropractic Orthopedists designation. Yes, ladies and gentleman, I brought another DACO to you today. Last week, we had Dr. Brandon Steele, also a DACO, so you may be starting to notice a slight trend. We are going to get into the thick of things with research for neck pain.

I met Dr. Lawson through his involvement in the Texas Chiropractic Association. Dr. Lawson is responsible for getting the DACO program to come to Texas and for having the TCA host the program. He’s responsible in a roundabout way for getting me into this whole DACO mess and I thank him for it. 

A little more about Dr. Lawson

  • Prior to attending Parker College of Chiropractic in Dallas, -Texas, I served in the United States Air Force.
  • Graduated from Parker College of Chiropractic 1993.
  • Designated Doctor with Tx Workers Compensation since 1996
  • He has the Diplomate American Academy of Integrative Medicine, college of pain management, 2000.
  • Dr. Lawson acheived Diplomate American Academy of Pain Management 2001.
  • Diplomate American Board of Chiropractic Orthopedists, 2002
  • Certified in acupuncture, 2004
  • Former hospital privileges Vista Hospital Houston and Pecan Valley Surgical Center in San Antonio.
  • Masters degree from UT Pan American in Health Care Administration, 2015
  • Current Chair of State Affairs with TCA
  • Current VP of Texas Council of Chiropractic Orthopedists.

Welcome to the show Dr. Lawson. Since we are friends, formality seems awkward, if you call me Jeff, I’ll call you what? William or Bill? 

Questions for Dr. Lawson

When did you become a DACO and what was the impetus? What started that journey?

What have you noticed about yourself and about your business in regards to pre-DACO and post-DACO?

Let’s get into the research for neck pain. The first thing I want to say here is that we cannot talk about cervical manipulation without addressing the yoke the medical field has tried to lay on us for generations. That is the myth that chiropractors go around causing strokes in everyone all the time. 

I took three episodes of this podcast to address this myth. The series is called “DEBUNKED: The Odd Myth That Chiropractors Cause Strokes” and are specifically episodes #13, #14, and #15. It’s just common sense talk and, if you have any questions in your mind prior to listening to them, they should all be answered by the time you are done. 

I will link them in the show notes as well as the corresponding YouTube Video and the Blog so that you can get the information in your preferred method. 

PODCAST EPISODES:

BLOG:

YOUTUBE:

https://youtu.be/tRXpG_Ie0Rs

Now that we’ve addressed this craziness, we can get on with how well we take care of our neck pain patients. 

Dr. Lawson, I want to hear from you as much as you want to be heard from so, please….if I cover something that you have some extra info on or you just want to add a comment to, please interrupt me and lay it on us!!

We’ll start with the oldest one we have tee-d up here and go to the most recent. 

This first one is from 2001 and is called “A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain[1].” The lead author is G. Bronfort and, if I recall correctly, his full first name is Gert. If you’ve spent any time listening to our podcast, you’ve probably heard his name. He’s fairly prolific with research papers. 

Why They Did It

Their stated goal for this project was to compare the effectiveness of rehab exercises vs. spinal manipulation for chronic neck pain. This one really focuses on research for neck pain.

What They Found

  • Patient satisfaction was higher spinal manipulation + exercise was superior to spinal manipulation alone
  • There was no statistical difference noted between the two groups
  • However, when combined, exercise + manipulation showed greater gains in all measures of strength, endurance, and range of motion. 

Wrap It Up

The authors concluded, “For chronic neck pain, the use of strengthening exercise, whether in combination with spinal manipulation or in the form of a high-technology MedX program, appears to be more beneficial to patients with chronic neck pain than the use of spinal manipulation alone.”

Dr. Lawson, what’s your take on this study? At this point, it’s 17 years old. Is it relevant still and how?

Next paper, this one’s called, “Chronic mechanical neck pain in adults treated by manual therapy: a systematic review of change scores in randomized clinical trials[2].” It is by H. Vernon, et. al. and was published in the Journal of Manipulative Physiological Therapeutics in 2007. 

Why They Did It

This was a systematic analysis of effectiveness in randomized clinical trials of chronic neck pain. The stipulations here are that the neck pain could not be caused by whiplash and could not include a headache or arm pain. Just straight up chronic neck pain. 

What They Found

Out of 1980 papers, they found 16 to accept and include in this project. 

No trials included trigger point therapy or manual traction

Wrap It Up

“There is moderate- to high-quality evidence that subjects with chronic neck pain not due to whiplash and without arm pain and headaches show clinically important improvements from a course of spinal manipulation or mobilization at 6, 12, and up to 104 weeks post-treatment. The current evidence does not support a similar level of benefit from massage.”

Dr. Lawson, on this study, for those that don’t know research hierarchy, a randomized clinical trial is some of the more reliable, solid research for neck pain wouldn’t you agree?

The only thing more impactful in the research world than randomized clinical trials are meta-analyses and systematic reviews. Well, this is a systematic review of 16 randomized clinical trials. 

My point being: this is a reliable systematic review. No doubt about it. This is a great paper, Dr. Lawson and I have no idea how it’s escaped me 11 years into this thing. I have other papers by the same group of authors but somehow missed this research for neck pain?

Would you like to add any comments on this paper?

OK, moving on, this paper is called, “Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain: a randomized trial[3].” This one comes to us by G. Bronfort, et. al. as well and was published in the Annals of Internal Medicine in 2012. 

This is not my favorite research for neck pain as we’ll talk about after we go through the conclusion. 

Why They Did It

“To determine the relative efficacy of spinal manipulation therapy (SMT), medication, and home exercise with advice (HEA) for acute and subacute neck pain in both the short and long term.”

How They Did It

  • It was a randomized controlled trial
  • They used 1 university research center and 1 pain management clinic in Minnesota
  • The sample was 272 people from 18-65 years old having nonspecific neck pain from 2-12 weeks
  • The treatment consisted of 12 weeks of spinal manipulative therapy or home exercise advice. 

What They Found

For pain, SMT had a statistically significant advantage over medication after 8, 12, 26, and 52 weeks

Home exercise was superior to medication at 26 weeks

No important differences in pain were found between SMT and HEA at any time point

Wrap It Up

Bronfort concluded, “For participants with acute and subacute neck pain, SMT was more effective than medication in both the short and long term. However, a few instructional sessions of HEA resulted in similar outcomes at most time points.”

As I mentioned, I have covered this research for neck pain before but it’s not my favorite because this is also a paper that I have seen chiropractic detractors use against us. Here’s how: they say that cervical manipulation is extremely risky and, if the outcome of simple exercises at home is just as effective, then what’s the point in cervical manipulation for neck pain?

What would you say in response to this particular argument?

Keepin on keepin on here. This next one is from the Journal of Manipulative Physiological and Therapeutics back in 2014 called “Evidence-based guidelines for the chiropractic treatment of adults with neck pain[4].” This one was done by Bryans, et. al. 

Why They Did It

They wanted to develop evidence-based treatment recommendations for the treatment of nonspecific mechanical neck pain in adults. 

How They Did It

They did a systematic literature search of controlled clinical trials published through December of 2011 and then organized each into strong, moderate, weak, or conflicting)

What They Found

41 randomized controlled trials met the criteria for inclusion. 

Strong recommendations were made for the treatment of chronic neck pain with manipulation, manual therapy, and exercise combined with modalities. 

Strong recommendations were also made for treating chronic neck pain with stretching, strengthening, and endurance exercises alone. 

Moderate recommendations were made for the treatment of acute neck pain with manipulation and mobilization in combination with other modalities. 

Wrap It Up

The authors closed by saying, “Interventions commonly used in chiropractic care improve outcomes for the treatment of acute and chronic neck pain. Increased benefit has been shown in several instances where a multimodal approach to neck pain has been used.”

Do you feel like this is going a little more in our favor than the Bronfort paper but still leaves a little to be desired? For instance, when we look at low back pain papers, it’s clear. Spinal manipulation is as effective or more effective than anything else out there. Even physical therapy or exercise. We’re not getting that satisfaction so far. Am I wrong?

We’re trucking along here. Next paper titled “Mobilization versus manipulations versus sustain apophyseal natural glide techniques and interaction with psychological factors for patients with chronic neck pain: randomized controlled trial[5].” This one was published in European Journal of Physical Rehabilitation Medicine in 2015 and written by A. Lopez-Lopez, et. al. 

Here’s my first question: “Why would you hyphenate the same name?” How can you be Lopez-Lopez and why would you want to say the name twice or make everyone else say the name twice? Isn’t it a bit redundant? Can we just say Lopez and move on?

OK, I get side-tracked sometimes so I have to get myself back on track here and there. Since I’m not familiar with this paper or the authors at all, I want to switch it up a little on this one. 

Dr. Lawson Covers One

I want Dr. Lawson to go over this paper from top to bottom and tell us everything we need to know about this one. I see it’s a randomized controlled trial so it already has my attention. I’m unfamiliar with sustain natural glide (AKA SNAG). Is that term you are familiar with? This research for neck pain is all yours doc. 

Their conclusion was “The results suggest that high velocity/low amplitude and posterior to anterior mobilization groups relieved pain at rest more than SNAG in patients with neck pain.”

Let’s get to our last paper here by Korthalis-de-bos, et. al. It’s called “Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial[6].” It was published in the British Medical Journal back in 2003. 

Why They Did It

The authors wanted to evaluate the cost-effectiveness of physical therapy, manual therapy, and care by a general practitioner for patients with neck pain.

How They Did It

  • The project was an economic evaluation alongside a randomized controlled trial.
  • 42 general practitioners recruited 183 neck pain patients
  • The patients were randomly split for treatment by spinal mobilization, physical therapy, or general practitioner care. 

What They Found

The authors wrapped that research for neck pain up by saying, “Manual therapy which consisted of spinal mobilization, is more effective and less costly for treating neck pain than physiotherapy or care by a general practitioner.”

I wanted to wrap up our talk with that research for neck pain because, first of all, it’s from the British Medical Journal so it got some weight. Second it’s alongside randomized controlled trials, and third, it’s one of the main ones that cuts through the noise and says very clearly, “mobilizing the spine is more effective and cost less for neck pain than seeing your primary or a physical therapist.”

Is it just me or is it time to move focus from low back pain and put more effort an attention on how effectively we treat neck pain through research for neck pain?

It just makes complete sense to me. If we are so effective for low back pain in the eyes of researchers, why don’t we have the same pile of research for neck pain? Where is all of the research for neck pain? Both are mechanical in origin. If we can affect low back pain, it makes perfect sense that we can affect neck pain. 

Chiropractors see it every single day. I’m not telling you anything. I just get so frustrated at the lack of focus on neck pain, which is part of the reason we’re doing this podcast today. 

Dr. Lawson, what do you have to add here before we sign off?

I want to thank you for joining us on the Chiropractic Forward Podcast. I hope you’ve enjoyed it as much as I have. 

Maybe we talk some DC PhD’s out there into making neck pain their next project. 

Integrating Chiropractors

 

Going forward

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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

The literature is clear: research on neck pain and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

Contact Us

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.

Being the #1 Chiropractic podcast in the world would be pretty darn cool. 

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

http://www.chiropracticforward.com

Social Media Links

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

iTunes

Player FM Link

Stitcher:

TuneIn

About the author:

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

1. Bronfort G, A randomized clinical trial of exercise and spinal manipulation for patients with chronic neck pain. Spine (Phila Pa 1976), 2001. 26(7): p. 788-97.

2. Vernon H, H.B., Chronic mechanical neck pain in adults treated by manual therapy: a systematic review of change scores in randomized clinical trials. J Manipulative Physiol Ther, 2007. 30(6): p. 473-8.

3. Bronfort G, Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain: A Randomized Trial. Annals of Internal Medicine 2012. Ann Intern Med, 2012. 156(1): p. 1-10.

4. Bryans R, Evidence-based guidelines for the chiropractic treatment of adults with neck pain. J Manipulative Physiol Ther, 2014. 37(1): p. 42-63.

5. Lopez-Lopez A, Mobilization versus manipulations versus sustain apophyseal natural glide techniques and interaction with psychological factors for patients with chronic neck pain: randomized controlled trial. Eur J Phys Rehabil Med, 2015. 51(2): p. 121-32.

6. Korthals-de Bos IB, Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. British Medical Journal, 2003. 326(7395): p. 911.

 

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

CF 030: Integrating Chiropractors – What’s It Going To Take?

CF 020: Chiropractic Evolution or Extinction?

CF 039: Communicating Chiropractic

CF 027: WANTED – Safe, Nonpharmacological Means Of Treating Spinal Pain

WANTED – Safe, Nonpharmacological Means Of Treating Spinal Pain

Today we’re going to talk about treating spinal pain, thoracic manipulation, lumbar manipulation, guidelines from Canada, and perceptions of our profession. Did you know that many people actually think that Chiropractic herniate low back discs all of the time? That’s not our idea of treating spinal pain. That’s for sure!

But first, here’s that bumper music

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast and I am honored to have you join me today.  Thank you to those of you that send emails and like and share our content on Facebook and Twitter. You make it fun. If you haven’t already noticed, we have “Tweetable” quotes from our show notes. All you have to do is click the Tweet button and you’re all set. 

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

You have cavorted your way into Episode #27. Yes, it’s a word. In fact, it’s a synonym of the word dance. Oh how I do love a thesaurus. 

As I’m about to record this episode, it is June 4, 2018 and I am getting ready to head down to the Texas Chiropractic Association’s State Convention. Now, things like that used to make my eyes gloss over but, I wasn’t doing it right or looking at it through the right lens. 

I was a traveling musician for several years and, honestly, chiropractic for me at the time was Plan B while I made a run at music. Well, as usually happens with musicians, it didn’t make me rich. Shock, shock…

During those years, I was a little bit like a guy out on an island all by himself. A lone wolf you might say. I didn’t know anything about research, guidelines, or anything like that. Hell, I was lucky to get to work on time back then. 

Along with being on an island all alone, I thought the idea of being a member of my state association sounded like one to the biggest, best ways to waste my money. Money that I really needed at the time. Well, I was misinformed. Becoming a member of the Texas Chiropractic Association has been one of the best, most rewarding things I have done in my professional life. 

First, I met a ton of people through the TCA. I have a network of colleagues and friends now. If I have a question about ANYTHING, I have an answer! In fact, I was having a hard time with collections for some time and a colleague is the one that came to my rescue. 

Also, the TCA doesn’t just take my money, they take it and use it to help me in my daily life. They have fought some outstanding odds and won several times. They won where, if they had lost, I wouldn’t have the right to diagnose my patients and would be much like a physical therapist depending on referrals from MDs. I’d say that alone is worth my $48 a month wouldn’t you agree?

I went on to serve several years on the Board of Directors for the TCA and am the current chairperson for the Chiropractic Development Initiative fighting to pay for lawsuits, fighting to bolster our profession, and protect it. 

The point here is, I hope you’ll seriously consider joining your state association as well as the American Chiropractic Association. My dues for both combined each month run around $155. It’s just another bill you pay and it goes to securing your job. It’s worth it and I hope you’ll think about doing it. Chiropractic Forward is not just an idea. I walk the walk by being a member and being active. 

Sometimes I end up deviating from research and all that good stuff we do every week but, sometimes, you gotta share what’s on you mind. Thank you for indulging me. 

Let’s get started with the research talk this week with a paper called “Rehabilitative principles in the management of thoracolumbar syndrome: a case report,” by Mathew DiMond who is a DC, DACRB around Bridgeport Connecticut(DiMond M 2017). For those that don’t know what a DACRB is, it stands for Diplomate of the American Chiropractic Rehabilitation Board. To put that into perspective, there are roughly 5,200 chiropractors in Texas and only 5 DACRBs. 

Why They Did It

Dr. DiMond wanted to describe his management of a case where the patient suffered from thoracolumbar syndrome. 

How They Did It

  • The patient was a 33 year old woman. 
  • She had suffered back pain for 3 weeks
  • Nerve tension tests and local tenderness were present
  • Outcome Assessment tools used were the Oswestry Disability Index which was at 62% at baseline, the STarT low back screen tool (6 points total with 2 point subscale), the Numeric Pain Rating Scale (6/10), and the test-retest exercise audits. 
  • 3 treatments rendered to the patient

What They Found

Her scores were substantially improved. Oswestry improved to 8% , STarT (1 point total), Numeric rating scale 1/10.

Wrap It Up

The author concluded by saying, “The patient responded positively to chiropractic care. After a short course of care, the patient reported reduced pain, alleviated symptoms, and improved physical function.” Now that’s treating spinal pain in a nonpharmacological way.

Now onto the next one. We don’t sit still around here. Bam, bam, bam!

This one is titled “Chiropractic spinal manipulation and the risk for acute lumbar disc herniation: a belief elicitation study” by Cesar Hincapie, et. al. and published in the European Spine Journal(Hincapie C 2017). 

Why They Did it

We know low back pain is the number one reason for disability in the world and that chiropractic is moving into the forefront. The author noted that chiropractic has been reported to increase the risk for lumbar disc herniation without any high quality evidence to support the claim. The author wanted to determine the beliefs on this topic going forward.

I have to say all one needs to do is look toward the American College of Physicians new recommendations and The Lancet low back series recommendations for using chiropractic as a first line treatment for low back pain and that should tell you all you need to know on this but, we will go ahead and explore this simply to expand our learning and knowledge. We are the profession best poised for treating spinal pain!

How They Did It

They used a belief elicitation design

They used 47 clinicians made up of 16 chiropractors, 15 family physicians, and 16 spinal surgeons. 

The clinicians estimated how often a chiropractic adjustment could cause a lumbar disc herniation in a hypothetical group of patients with acute low back pain. 

What They Found

  • As one would expect, chiropractors were the most optimistic that the occurrence was rare. In fact chiropractors held the belief that spinal manipulation actually decreases the chance of disc herniation rather than increases it.
  • Family physicians were mostly neutral
  • Spinal surgeons expressed a slightly more pessimistic belief toward the idea

Wrap It Up

The researchers concluded, “Clinicians’ beliefs about the risk for acute LDH associated with chiropractic SMT varied systematically across professions, in spite of a lack of scientific evidence to inform these beliefs.”

My bias is obvious but, the thought of chiropractors going around herniating discs had to have come from someone that either hates chiropractors like the American Medical Association of the 60;s, 70’s, 80’s, and so on…..or it had to come from ignorance. I believe that paper was published just prior to the new updated recommendations putting chiropractic in the driver’s seat for acute and chronic low back pain but geez…. I do get tired of defending the profession. 

Now let’s wrap up the week here with a paper from our chiropractic brethren for the frozen North otherwise known as Canada. The lead author is Dr. Andre Bussieres and the paper is called “Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain: A Guideline From the Canadian Chiropractic Guideline Initiative” and was published in the Journal of Manipulative and Physiological Therapeutics in May of 2018(Bussieres A 2018). 

Why They Did It

The objective of this study was to develop a clinical practice guideline on the management and treating spinal pain of acute and chronic low back pain (LBP) in adults. The aim was to develop a guideline to provide best practice recommendations on the initial assessment and monitoring of people with low back pain and address the use of spinal manipulation therapy (SMT) compared with other commonly used conservative treatments.

How They Did It

  • The authors assessed systematic reviews and randomized controlled trials using A Measurement Tool to Assess Systematic Reviews and Cochrane Back Review Group criteria. 
  • Evidence profiles were used to summarize judgements of the evidence quality. 
  • The Evidence to Decision Framework was used to help the panel to determine the certainty of evidence and strength of the recommendations. 
  • Consensus was achieved through the modified Delphi technique
  • This guideline was peer reviewed by an 8-member multidisciplinary external committee. 

What They Found

  • Acute back pain (0-3 months)

Offer advice on posture and staying active, reassure the patients, education and self-management strategies, chiropractic care, usual medical treatment if deemed beneficial, or a combination of chiropractic care and usual medical treatment. These are effective means of treating spinal pain. 

  • Chronic back pain (3 months and beyond)

When treating spinal pain, offer advice and education chiropractic care or chiropractic care in conjunction with exercise, myofascial, or usual medical care. 

  • Chronic back-related leg pain

Offer advice and education with chiropractic care and home exercise such as positioning and stabilization exercises. Treating spinal pain for chronic patients can be challenging for both the patient and the doctor.

Wrap It Up

The authors concluded by saying, “A multimodal approach including SMT, other commonly used active interventions, self-management advice, and exercise is an effective treatment strategy for acute and chronic back pain, with or without leg pain.” Treating spinal pain is just what we do.

Help us spread the news folks. Go out and get on your roof and start yelling it to the masses. Retweet, like and share and all of the stuff you can help with on your end of it. You can find us on Twitter @chiro_forward and on Facebook. We’re there. We’re just waiting on you to join us so go do that right now

I realize this week was a little here and a little there but the point is that no matter what you’ve heard or been told in the past, those days are over. I believe they’re over for good at this point. We are the #1, non-pharma, safe, conservative, non-invasive, research-backed, evidence-backed, treatment for spinal pain, hands down. And that’s a heck of a place to be coming from wouldn’t you agree?

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

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

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

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

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

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

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

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

 

Social Media Links

iTunes

Bibliography

Bussieres A, e. a. (2018). “Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain: A Guideline From the Canadian Chiropractic Guideline Initiative.” Journal of Manipulative and Physiological Therapeutics 41(4): 265-293.

DiMond M (2017). “Rehabilitative Principles in the Management of Thoracolumbar Syndrome: A Case Report.” Journal of Chiropractic Medicine 16(4): 331-339.

Hincapie C (2017). “Chiropractic spinal manipulation and the risk for acute lumbar disc herniation: a belief elicitation study.” European Spine Journal.

CF 024: They Laughed When I Said I Could Still Help After Back Surgery

They Laughed When I Said I Could Still Help After Back Surgery

Today, we’re going to talk about people coming into our office after having had back surgery wanting us to perform miracles. Well, why didn’t they come to us BEFORE the surgery would be my big question. We’ll toss all that stuff around today on the Chiropractic Forward Podcast. 

But first, here’s that bumper music!

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

Before we get started, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. On another note, do you need an hour or two for your Continuing Education seminar on low back pain guidelines or on Debunking the myth that chiropractors cause strokes? 

Go no further, you have found your man. Just send me an email at dr.williams@chiropracticforward.com and we will get it done.

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

You have done the electric slide right into Episode #24 and that’s exciting

Now, as I mentioned previously, how many times do chiropractors have new patients come through the doors but they’ve already had back surgery? They’ve had back surgery they hoped would be a quick fix usually. But it wasn’t. 

Now, they’re sitting in your office, looking at you with a very scared and concerned face, and it’s up to you to lead the way and, hopefully, be able to provide them some sort of relief with your magical abilities. 

I can tell you from 20 plus years of experience that it happens all of the time. At least a time or two per month for a busy practice. That’s what I would guess. 

The truth is, sometimes we can help these back surgery people and sometimes we just can’t. I tell patients that surgery, many times, is permanent and anything we do toward trying to get some relief can be a little bit like pushing a wheelbarrow uphill. Depending on the weight in the wheelbarrow, we may get it to the top and we may not get it to the top but we’re sure as hell going to try while making sure we keep them safe from further damage. 

At first glance, when you’re looking at an x-ray of a post-surgical patient, many times I find myself thinking, “What in the heck can I possibly do with this trainwreck.” I’m sure I’m not the only one to ever feel like that. It’s a little bit of a helpless feeling sometimes. Especially when you see parts missing like you’ll see in a laminectomy. Or when you see parts added like boney fusions or fusions with hardware. I get a sinking feeling in my stomach for patients like that. Back surgery is no joke.

Especially when we know for a researched-fact that these patients most likely did not have to endure those procedures. For any reason. If you aren’t sure about that statement, please review our podcast episodes we did no The Lancet low back series. Episodes #16, #17, and #18 dealt with this very issue. 

Back surgery is gaining in popularity while the outcomes show no change. They are no longer recommending surgery for acute or chronic low back pain. Period. Sure, cauda equina syndrome, foot drop, and severe symptoms like that may indicate surgical intervention but, otherwise, they say no shots, no surgery, no bed rest, and no medications. 

We will be hammering these things consistently until we start seeing some change. I can guarantee it. 

OK, but…..what if nobody listened to the experts and they just did the surgery with no relief? Can we do anything about it? 

Let’s look at a couple of possiblities:

  1. The spine was fused years ago and now, due to the immobilization and increased workload on the segments above and below, the segments above and/or below begin to show signs of wear and tear. 
  2. The spine was not fused but the complaint never improved. This may be the case in people that have the microdiscectomies or epidural spinal injections. 

Of course there are a lot of different, very specific outcomes that don’t fit in those two categories but I’d say these are the ones I commonly see. 

Let’s take the first one: a fusion that caused issues above and below the fused segment. If you go through nonsurgical spinal decompression certification through the Kennedy Decompression Technique, you’ll be taught that a fusion with hardware is a hard contraindication. At least it was 6 years ago. 

Assuming these people develop disc issues above or below the fusion, that would mean you can’t do any decompression on the site. An orthopedic surgeon that is familiar with non-surgical decompression however, may tell you that the segment is more solid after the fusion than it ever was before and decompression won’t cause any issues with the fusion itself. 

OK, so, we’re stuck between two worlds on that and, honestly, if you’re an expert on this and you’re listening, email me at dr.williams@chiropracticforward.com and tell me your experience and understanding. 

After bouncing the problem off of several highly trusted colleagues, I think a light pull on decompression is tolerated just fine and does in fact provide relief to fusion patients. No, you cannot pull them at 1/3 or 1/2 of their body weight. We’re talking a LIGHT pull. This combined with gentle McKenzie and Core exercises as well as self-management recommendations at home will go toward getting them back on their feet and getting back after it. 

If any of you disagree, I’d love to talk about it. My first question would be, “What would the alternative be?” 

I am by no means the final and ultimate opinion on this. We have to depend on trusted advice and clinical experience, don’t we? That’s just what I do and what I’ve found is that about 80% of patients just get better. There’s about 10% that gets better but not quite what we hoped for. Then there’s that 10% that …”Hey, we tried and it looks like I’m not your homey on this deal.”

Now, what about the second option? Let’s say that they had a discetomy back surgery but it was a failure (surprise surprise) and now it’s up to us to help the patient and attempt to keep them from enduring any more back surgery or shots. What do you do? Maybe I should say, “What do WE do?”

I say adjust them!! After a certain healing time has passed, of course. 

I say we do all the other stuff I mentioned previously for them as well. We may do decmopression. We may do laser. We certainly do McKenzies, Core Building, McGill’s Big Three, no bed rest, and home self-management.

If you have paid much attention to our previous episodes then you know the American College of Physicians and the global panel of experts on low back pain that published the low back pain papers in The Lancet back in March of 2018 say that spinal mobilization is a researched and recommended first-line therapy for acute and chronic low back pain. 

In my opinion, a discetomy doesn’t change these recommendations much. Sometimes, cases are so specific, that they just don’t get researched in depth for that certain instance. 

However, I CAN offer a case study if you’re willing to listen. 

It was titled, “Chiropractic/Rehabilitative Management of Post-Surgical Disc Herniation: A Retrospective Case Report” and was published in the Journal of Chiropractic Medicine in the Summer edition of 2004(Estadt G 2004).  

Why They Did It

To explore management of lumbar disc herniation following sugery using a regimen of chiropractic manipulation and exercise/rehab. 

How They Did It

  • The patient was a 54 yr old male
  • The patient had a history of acute low back pain with left sciatic pain down the left posterior thigh and lateral calf as well as numbness inthe bottom of the left foot. 
  • The patient previously had steroid anti-inflammatory drugs and lumbar microdiscectomy surgery. 
  • The patient did not recover completely.
  • The patient couldn’t walk without hurting and was unable to return to activities of daily living. 
  • He was antalgic in flexion. 
  • His lumbar range of motion was restricted in flexion as well as in extension. 
  • He had a positive SLR as well as foot drop on the left. 
  • Intervention consisted of patient education on posture, bending, and lifting. 
  • Exercise/Rehab was started in-office progressing to at-home based exercise/rehab. 
  • Active rehab was continued after early improvement (7 visits) in order to return lumbar spinal extensor strength. 
  • The patient was ultimately released to home therapy and supportive chiropractic care and continued to show improvement. 

Wrap It Up

The author concluded, “Management of postsurgical lumbar disc herniation with chiropractic and active rehabilitation is discussed. Spinal deconditioning and weakness of the lumbar spinal extensor muscles appeared to be related to the patient’s symptoms. Patient education on proper posture, proper lifting techniques, core stabilization exercises, active strengthening exercise and chiropractic manipulation appeared effective in this case.”

OK, a case study with one subject. What does that tell us as far as research goes? Very little. What is the impact of the Journal of Chiropractic Medicine? It’s  peer-reviewed and it has an impact factor of 0.74 and has climbed significantly since 0.36 in 2011. 

Although this case study is only one patient’s experience, from my own anecdotal evidence, I would come very close to guaranteeing you and betting the farm that these post back surgery results can be repeated time and time again.

I’ve seen it time and time again. My experience tells me we can help these people. YOU can help these people. Back surgery doesn’t always mean we are helpless to pull out the power of chiropractic. 

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

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

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

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

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

Social Media Links

iTunes

Bibliography

Estadt G (2004). “Chiropractic/Rehabilitative Management of Post-Surgical Disc Herniation: A Retrospective Case Report.” Journal of Chiropractic Medicine 3(3): 108-115.

CF 020: Chiropractic Evolution or Extinction?

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

CF 015: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 3 of 3)

Debunking the odd myth that chiropractors cause strokes. I’m almost done with this y’all. In this final episode of this series, we will discuss risky interventions, papers having to do with the risk, or lack thereof, of chiropractic adjustments to the cervical region specifically, and then a wrap up of the information.