Neurodynamic Movements

How Specific Are Adjustments & Nerve Flossing Effectiveness

CF 318: How Specific Are Adjustments & Nerve Flossing Effectiveness Today we’re going to talk about How Specific Are Adjustments & Nerve Flossing Effectiveness But first, here’s that sweet sweet bumper music        

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Integrating Chiropractors

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    OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 
  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com
You have found yourself smack dab in the middle of Episode #318 Now if you missed last week’s episode, we talked about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 7).  We’re building a fairly clear picture of what the WHO has based their opinon of SMT on and it’s pretty shaky ground in my opinion. Basically, I think there’s an underlying agenda. There’s no way in my mind that ultrasound is equal in effectiveness to SMT, which is what the WHO is essentially saying  and we’re showing that the research they’ve used to base that opinion on pretty much sucks compared to more current research literature.  ake sure you don’t miss that info. Keep up with the class.  On the personal end of things….. We just flew back from The Bahamas last night and boy are my arms tired.  This was our first time to The Bahamas and we decided to give it a try because something in Mexico is always on fire or someone has just lost their head or something cartel crazy. So Mexico is a no for us. Lots of my friends still visit but not this gabacho. No siree.  So we figured with The Bahamas being just about 30 minutes on teh other side of Florida, that would be a nice little trip. So…..of course,….a few weeks before we go, news trickles in that 18 people ahve been murdered there within a month and the US Embassy raised the travel alert level for the Bahamas. That’s purely because we decided to book a trip there, by the way. In case you were wondering.  So, we were a little concerned but we shouldn’t have worried. We went straight from the airport to the resort with a transportation service and never left the resort on purpose. We could tell it was a bit sketch so we had no desire to explore. Plus, the resort/casino had tons of restaurants, tons of pools, a water park, fountains, the beach and ocean….all of it was pretty much right there so there was no need to explore really.  We stayed at Baha Mar and we really won’t be going back for a couple of reasons. We want to go somewhere that we don’t really need to worry about our safety. Like the Caymans, Costa Rica, Virgin Islands, or the Florida Keys. Also, except for a few places, we don’t usually return. Once we’ve seen it and done it, it’s time to explore something new.  This resort had a rave, dance party until 3:15 am on Friday night. I was furious. I guess with it being partly a casino, that’s appealing to someone but it’s not a non-gambling 51 year old that came to The Bahamas for rest and relaxation. Furious is an understatement but I got over it.  Everyone was great, the resort was mostly pretty impressive, and the getaway was a nice change. No work. Just hanging out and I enjoyed it.  Now, back to work and a day short this week so let’s get on with it.  Item #1 Our first one this week is called, “Determining cavitation location during lumbar and thoracic spinal manipulation: is spinal manipulation accurate and specific?” By ross et. Al and published in Spine Journal in July of 2004.  Remember, the citations can be found at chiropractscforward.com under this episode.  Ross JK, Bereznick DE, McGill SM. Determining cavitation location during lumbar and thoracic spinal manipulation: is spinal manipulation accurate and specific? Spine (Phila Pa 1976). 2004 Jul 1;29(13):1452-7. doi: 10.1097/01.brs.0000129024.95630.57. PMID: 15223938. Why They Did It Clinicians utilizing spinal manipulative therapy (SMT) claim to be very specific and accurate with the delivery of their dynamic thrust.  It has been suggested that the clinical success of SMT is dependent on the accurate delivery of that therapy to the target spinal joints. The purpose of this study is to first locate the joints that produce an audible sound in response to manipulation (cavitation) during spinal manipulative procedures so that the accuracy and specificity of manipulation can be assessed. How They Did It Sixty-four asymptomatic participants, ranging in age from 22 to 49 years, volunteered to act as patients for the study.  Twenty-eight different clinicians performed thoracic and lumbar spinal manipulative procedures.  The range of clinical experience was 1 to 43 years. Asymptomatic participants received SMT to either the thoracic or lumbar regions of their spine.  Accelerometers were secured to the skin over the spinal column, and the relative time at which each accelerometer detected the vibration from the cavitation associated with the SMT was used to calculate the source of the vibration.  The site of cavitation was then compared with the target location. What They Found For lumbar SMT, the average error from target of 124 cavitations in lumbar procedures was 5.29 cm (at least one vertebra away from target), with a range of 0 to 14 cm.  Of these cavitations, 57 were deemed to be accurate and 67 were deemed to be inaccurate.  The average error from target of 54 cavitations in the thoracic spine was 3.5 cm, with a range of 0 to 9.5 cm.  Of these cavitations, 29 were deemed to be accurate and 25 were deemed to be inaccurate.  In most cases, individual manipulative procedures were associated with multiple cavitations ranging from 2 to 6. Wrap It Up In the lumbar spine, SMT was accurate about half the time.  However, because most procedures were associated with multiple cavitations, in most cases, at least one cavitation emanated from the target joints.  In the thoracic spine, SMT appears to be more accurate. Item #2 Our last one today is called “Effectiveness of neural mobilisation for the treatment of nerve-related cervicobrachial pain: a systematic review with subgroup meta-analysis” by Lascurain-Aguirrebena et. Al. and published in Pain in March of 2024.  That’s so hot it’s still on the damn burner! Lascurain-Aguirrebeña, Iona,b,*; Dominguez, Laurac; Villanueva-Ruiz, Ikerc,d; Ballesteros, Javiere,f,g; Rueda-Etxeberria, Mikele; Rueda, Jose-Ramónc; Casado-Zumeta, Xabatd; Araolaza-Arrieta, Maialend; Arbillaga-Etxarri, Aned; Tampin, Brigitteh,i,j. Effectiveness of neural mobilisation for the treatment of nerve-related cervicobrachial pain: a systematic review with subgroup meta-analysis. PAIN 165(3):p 537-549, March 2024. | DOI: 10.1097/j.pain.0000000000003071   Why They Did It Neural mobilisations (NM) have been advocated for the treatment of nerve-related cervicobrachial pain; however, it is unclear what types of patients with nerve-related cervicobrachial pain (if any) may benefit.  How They Did It Medline, Web of Science, Scopus, PeDro, Cinahl, and Cochrane databases were searched from inception until December 2022. Randomised controlled trials were included if they assessed the effectiveness of Neural mobilisations in nerve-related cervicobrachial pain, and outcome measures were pain intensity and/or disability.  Meta-analyses with subgroup analyses were performed.  Twenty-seven studies were included. What They Found For pain and disability reduction, Neural mobilisations was found to be more effective than no treatment, increased the effectiveness of standard physiotherapy as an adjuvant when compared with standard physiotherapy alone but was no more effective than cervical traction.  For disability reduction, Neural mobilisations was found to be more effective than exercise Wrap It Up In most comparisons, there were significant differences in the effectiveness of Neural mobilisations between the subgroups.  Neural mobilisations was consistently more effective than all alternative interventions (no treatment, traction, exercise, and standard physiotherapy alone) in 13 studies As I’ve heard my friend and esteemed colleauge, Dr. Brandon Steele say before, “If a patient has radiculopathy and there’s only one thing I can do for them, it’s nerve flossing.” And I agree.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

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

Chiropractic evidence-based products

Integrating Chiropractors

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

Nerve Flossing Carpal Tunnel & Catastrophizing

CF 227: Nerve Flossing Carpal Tunnel & Catastrophizing Today we’re going to talk about Nerve Flossing Carpal Tunnel & Catastrophizing But first, here’s that sweet sweet bumper music    

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

You have found yourself smack dab in the middle of Episode #227 Now if you missed last week’s episode , we talked about Cognitive Behavioral Therapy & Restless Leg Syndrome. Make sure you don’t miss that info. Keep up with the class. 

 

On the personal end of things…..

Well if you listened to me last week, then you heard me struggling through an episode. My voice was a straight up mess, I felt pretty dang rough, and really just wanted to be at home in my bed. That business went on for a few more days. I finally figured out that I had COVID. What the hell. Isn’t COVID over? Apparently not.  At this point, I’m 8 days out from the first day I felt crummy. I just have a stuffy nose and coughing some stuff out of my chest here and there but doing pretty good overall.  I’m just glad I got the omicron brand rather than the DeltaVID or the OG-VID I was beginning to think I was immune.

I had an employee that had the antibodies but never got sick. I figured that was me. I guess not. So, I should be good to go with the Rona for like six months before I get it again. Lol So last week was a bust and I have a short week this week as I head to Florida to meet my buddies in St Augustine fir the MCM Mastermind that Kevin Christie began.  It’s an outstanding group of providers. I don’t know if there are any seats left in the group but if you’d like to join the group, gimme a holler.

The next trip and meeting is July 22 in Sarasota. Let’s get to it. Before we do though, I recently connected with a dude.  we all know that the number one type of case that we want is a personal injury case – they are gold because the clients are more compliant, and we get paid at rates far above insurance or Medicare or Medicaid. The patient’s attorney tells them to go for treatment as doing so enhances their legal case and gets them more money. That’s on their end of it but we know less medical providers will accept their cases and they need treatment. And we can help. 

The problem is, how do we get PI cases?  Attorneys don’t generally respond to your invitation for lunch. And let’s face it, they’re a touch bunch. I have the answer. An attorney I know has put together a system, that is both in written and video form, that shares how to approach attorneys and get them to send their PI clients to you. This is the real deal. Attorney Paul Samakow’s system costs $997 and he guarantees satisfaction or your money back. You have to check this out.  Even if you only get one case, you’ve made at least 4 or 5 times the investment. Go to gettingpicases.com/cs That’s gettingpicases.com/cs One more time so you get it right:   gettingpicases.com/cs 

Item #1

The first one is called “Peripheral and Central Adaptations After a Median Nerve Neruomobilization Program Completed by Individuals With Carpal Tunnel Syndrome: An Exploratory mechanistic Study using Musculoskeletal Ultrasound Imaging and Transcranial Magnetic Stimulation” by Paquette et. al. (Paquette P 2020) and published in the Journal Of Manipulative and Physiological Therapeutics on August of 2020. It’s just steamy….not too enfuego on this day.  Why They Did It The authors say, “This exploratory and mechanistic study aims to evaluate the potential peripheral and central adaptations that may result in individuals with CTS who have completed a neuromobilization program.” How They Did It

  • Fourteen individuals with CTS were evaluated 
  • Evaluation were before and 1 week after the completion of a 4-week neuromobilization program that incorporated median nerve sliding exercises. 
  • Pain and upper limb functional abilities were assessed using standardized questionnaires. 
  • The biological integrity and mechanical properties of the median nerve and the corticospinal excitability were quantified using musculoskeletal ultrasound imaging and transcranial magnetic stimulation, respectively.

What They Found

  • Upon completion of the program, participants reported both large and moderate improvements in pain and upper limb functional abilities, respectively. 
  • The biological integrity and mechanical properties of the median nerve remained unchanged, whereas a small significant increase in corticospinal excitability was observed.

Wrap It Up The proposed neuromobilization program appears promising to improve pain and upper limb functional abilities in individuals with CTS. These improvements may be preferentially mediated via central, rather than peripheral, adaptations. Before getting to the next one, I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! It’s live again. Use the code HOTSTUFF upon purchase at droprelease.com to get $50 off your purchase. Y’all, it makes a world of difference. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. My patients love it and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Hear me now and believe me later.

Item #2

The last one today is called, “Pain Catastrophizing and Pain Self-Efficacy Mediate Interdisciplinary Pain Rehabilitation Program Outcomes at Posttreatment and Follow-Up” by Schumann et. al. (Matthew E Schumann 2021) and published in Pain Medicine in September of 2021 and THAT one is enfuego today. 

Why They Did It

“To prospectively evaluate interdisciplinary pain rehabilitation outcomes, as well as to evaluate the mediating effects of both pain catastrophizing and pain self-efficacy on outcome.”

How They Did It

  • 315 patients with chronic pain participated
  • They completed a 3-week interdisciplinary pain rehabilitation program. 
  • Pain severity, pain interference, pain catastrophizing, pain self-efficacy, quality of life, depressive symptom questionnaires, and measures of physical performance were assessed before and after treatment. 
  • Follow-up questionnaires were returned by 163 participants. 
  • Effect size and reliable change analyses were conducted from pre- to posttreatment and from pretreatment to 6-month follow-up. 
  • Mediation analyses were conducted to determine the mediating effect of pain catastrophizing and pain self-efficacy on pain outcome.

What They Found

  • Significant improvements from pre- to posttreatment in pain outcomes were observed, and more than 80% evidenced a reliable change in at least one pain-relevant measure. 
  • Pain catastrophizing and pain self-efficacy mediated the relationship between changes in pain outcomes.

Wrap It Up

Interdisciplinary pain rehabilitation is an effective treatment, and decreasing pain catastrophizing and increasing pain self-efficacy can influence maintenance of treatment gains. So when you’re managing your words and managing the patients’ yellow flags as much as you’re managing the bio aspect of the condition, then you’re on the right track.  If you only manage the bio part and ignore the psychosocial parts, you only get 1/3 of the equation and potentially only 1/3 of the improvement.

Of course boundaries are much more fluid than that with it comes to healthcare and pain but you get my point.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

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

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

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

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

Bibliography

Matthew E Schumann, P., Brandon J Coombes, PhD, Keith E Gascho, Jr., Jennifer R Geske, Mary C McDermott, APRN, CNP, DNP, MS, Eleshia J Morrison, PhD, Andrea L Reynolds, PT, Jessica L Bernau, RN, Wesley P Gilliam, PhD, (2021). “Pain Catastrophizing and Pain Self-Efficacy Mediate Interdisciplinary Pain Rehabilitation Program Outcomes at Posttreatment and Follow-Up.” Pain Med 23(4): 697-706.  

Paquette P, H. J., Gagnon D, (2020). “Peripheral and Central Adaptations After a Median Nerve Neuromobilization Program Completed by Individuals With Carpal Tunnel Syndrome: An Exploratory Mechanistic Study Using Musculoskeletal Ultrasound Imaging and Transcranial Magnetic Stimulation.” J Man Physiol Ther 43(6): P566-578.    

Neurodynamic Moves Solve Problems – So Does The Inversion Table

CF 219: Neurodynamic Moves Solve Problems – So Does The Inversion Table Today we’re going to talk about inversion tables and Neurodynamic exercises.  But first, here’s that sweet sweet bumper music

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

You have found yourself smack dab in the middle of Episode #219 Now if you missed last week’s episode , we talked about Masterminds  – chiropractic masterminds and the MCM Mastermind I’m in specifically with Dr. Kevin Christie. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

What a weekend down in Lubbock, TX for the Texas Chiropractic Association’s MidWinter conference. I got to hang out with my friend Dr. Tim Bertlesmen. What a guy, what a teacher, and what a positive force for our entire profession.  Sitting through one of his courses is like having golden knowledge nuggets just chunked at you from a nerf gun. Pow, pow, kablam, splat. Just like that. Over and over. Only you don’t dodge the nuggets. You just step right into them and let them sink right in. He as good as it gets out there. 

One of his nuggets I’ll share with you is hip abductors. If you are not assessing your new patients for weak hip abductors, get to researching and make it happen, muy pronto mi amigo.  Luckily, in my coursework with the Diplomate of the International Academy of Neuromusculoskeletal Medicine, Dr. Bertlesman is an instructor and taught us about hip abductors a few years ago. Now, my secret is out!! Lol. Really though, be checking those hip abductors because they can be the missing puzzle piece to longstanding low back pain, hip pain, knee pain and chondromalacia patellae, and ankle and foot problems. Up to and including plantar fasciitis. 

I got to teach while at the conference. I’ve taught a couple of courses for the TCA but they were COVID-era virtual courses. This was the first 2-hour live crowd presentation that I’ve been the presenter on and I have to say; I was a tad anxious but once I got started and into the material, it went very well and smoothly.  I had some good buddies in the crowd so it was even a bit like a conversation rather than a presentation. I had several tell me that was the most they’ve taken away from a course in several years. Made me feel good and gave me encouragement that I’m going in the right direction. 

Then if you’ve been listening, you know I have a rental down there on Airbnb so spent Sunday at the rental staining the deck and the fence. A not-so-nice end to the seminar weekend.  Business seems to be picking back up which seems to be directly related to the omicron variant settling back down here in the Texas Panhandle. But, we can’t discount the fact that more people are meeting their deductibles in mid-February to early March as well.  Either way, who cares? It equals to more business! Onward to research

Item #1

I’m just going to say that I got the research today from ChiroUp’s research roundup and thank you again to Dr. Tim Bertlesmen and Dr. Brandon Steele for being outstanding.  This one is called “Lumbar disc disease: the effect of inversion on clinical symptoms and a comparison of the rate of surgery after inversion therapy with the rate of surgery in neurosurgery controls” by Mendelow et. al. (Alexander D. Mendelow 2021) and was published in Journal of Physical Therapy Science in 2021 so it’s hot hot hot. 

Why They Did It

We have previously shown inversion therapy to be effective in a small prospective randomised controlled trial of patients with lumbar disc protrusions. Our purpose now was to measure symptoms and to compare the surgery rate following inversion for 85 participants with the surgery rate in 3 control groups.

How They Did It

  • Each of the 85 inverted participants acted as their own control for the “symptomatic” part of the study. 
  • In the “Need for surgery” part of the study, one control group was made up of similar patients with leg pain and sciatica who were referred to the same clinic in the same year. 
  • Two additional control groups were examined: the original control group from the pilot trial and the lumbar disc surgery waiting list patients.

What They Found

  • Inversion therapy relieved symptoms: there were improvements in the Visual Analogue Score, Roland Morris and Oswestry Disease indices, and Health Utility Score compared with their pre-treatment status. 
  • Also, the 2-year surgery rate in the inversion participants in the registry (21%) was significantly lower than in the matched control group (39% at two years and 43% at four years).
  • It was also lower than the surgery rate in the other 2 control groups.

Wrap It Up

Inversion therapy relieved symptoms and avoided surgery. And let me tell you personally, we do decompression, we do inversion, we do McKenzie….we have lots of ways of going at low back pain. I’ve seen inversion poo poo’ed in evidence-based FB groups. I’m telling you, they don’t know what they’re talking about, for the right patient, inversion can be a game-changer.  Insurance won’t pay for it but the patient will if it’s reasonable and makes sense. 

Item #2

The second one today is called “Effect of Neural Mobilization Exercises in Patients With Low Back-Related Leg Pain With Peripheral Nerve Sensitization: A Prospective, Controlled Trial” by Alshami et. al. (Ali M. Alshami 2021) and published in the Journal of Chiropractic Medicine in June of 2021 and it’s hot hot hot as well If you don’t know what Neurodynamic moves, exercises, etc are….go Google up nerve flossing or nerve gliding or neurodynamic exercises. That should get you up to speed. 

Why They Did It

The aim of this study was to investigate the short-term effect of slider and tensioner exercises on pain and range of motion (ROM) of straight leg raise (SLR) and slump tests in patients with low back-related leg pain with peripheral nerve sensitization.

How They Did It

  • It was a prospective, controlled trial, 
  • 51 patients with low back-related leg pain with peripheral nerve sensitization 
  • They were divided into 3 treatment groups: 
  • slider (slider neural mobilization exercise + transcutaneous electric nerve stimulation [TENS]), 
  • tensioner (tensioner neural mobilization exercise + TENS), and 
  • control (only TENS). 
  • Each patient received 6 sessions over 2 weeks. 
  • The following outcomes were measured at baseline and after the first, third, and sixth sessions: visual analog scale (VAS) for pain and ROM of SLR and slump tests were performed for the symptomatic side.

What They Found

  • Compared with controls, patients receiving the slider and tensioner exercises showed a greater decrease in pain at the third and sixth sessions 
  • There was a significant difference in the ROM of the SLR test between the slider and controls at only the sixth session 
  • Patients in the slider and tensioner groups demonstrated greater improvements in the ROM of slump test at all sessions compared with controls 
  • There were no significant differences between the slider and tensioner groups in any outcome at any session.

Wrap It Up

Patients in both slider and tensioner neural mobilization exercise groups demonstrated improvements in pain and ROM in patients with low back-related leg pain with peripheral nerve sensitization compared to those in the control group. Item #3 Number three today is called “Effectiveness of Neural Mobilization Techniques in the Management of Musculoskeletal Neck Disorders with Nerve-Related Symptoms: A Systematic Review and Meta-Analysis with a Mapping Report”‘ by Varangot-Reille et. al. (Clovis Varangot-Reille 2021) and published in Pain Medicine on October 11, 2021, steamy plate of knowledge nuggets coming up!

Why They Did It

The objective was to assess the effectiveness of neural mobilization (NM) techniques in the management of musculoskeletal neck disorders with nerve-related symptoms (MND-NRS).

How They Did It

They conducted a systematic review with meta-analysis, using pain intensity, disability, perceived function, cervical range of motion, and mechanosensitivity as the main outcome measures. The systematic review included 22 studies

Wrap It Up

Neural mobilization appeared to be effective to improve overall pain intensity when embedded in a physiotherapy treatment in the management of musculoskeletal neck disorders with nerve-related symptoms. When compared with no intervention, it was effective to improve neck rotation, disability, and function.  However, it was not superior to other types of treatments in improving overall pain intensity, neck pain intensity, arm pain intensity, cervical range of motion and disability, except for mechanosensitivity.

Item #4

I’m an overachiever today, our fourth paper is called, “Neurodynamics is an effective intervention for Carpal Tunnel Syndrome” by Stephanie Wise and Jordon Bettleyon (Stephanie Wise and Jordan Bettleyon 2021) and published in the Journal of sport Rehabilitation on December 20th, 2021 – Kablamo – that’s some heat people. 

Why They Did It

Is neurodynamics effective in reducing pain and reported symptoms in those with CTS?

How They Did It

Four studies were included, with 2 studies utilizing passive neural mobilizations, one study using active techniques, and one study using active neural mobilizations with splinting.

What They Found

All studies showed large effect size for pain, symptom severity, and physical function.

Wrap It Up

Neurodynamics is an effective treatment for CTS. Splinting is only effective when combined with neurodynamics. I’m hammering this home because radiculopathy doesn’t have to go directly to surgeons and it’s not just a pop and street them either. We have lots of things we can do McKenzie, we have decompression, we have neurodynamic exercises, low-level laser may be a possible treatment, traction, is it TOS??? Lots of stuff to run through before we need to worry about something more intensive and invasive. 

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

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The Message

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

Key Point:

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

Contact

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

Connect

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

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