Opioids

Spinal Cord Stimulator vs. Placebo & Low Back Pain, Chiropractic, And Opioids

CF 253: Spinal Cord Stimulator vs. Placebo & Low Back Pain, Chiropractic, And Opioids Today we’re going to talk about Spinal Cord Stimulators vs. Placebo & we’ll talk about Low Back pain, Chiropractic, And Opioids 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, look down your nose at people kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, drive, smart, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 

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

You have found yourself smack dab in the middle of Episode #253 Now if you missed last week’s episode, we talked about High Blood Pressure And Cognitive Decline & Does The Popping Noise Matter?. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Alright, if you’ve heard me fussing my face off about being slow for like oh I don’t know…..the last 8 freaking weeks or so….then you’ll be glad to hear that I have 43 on the schedule today with 5 new patients. That’s more like it.  That’s 5 new patients, one consultation, and 3 re-exams. So….they’re  coming back slowly.

Where the hell did they go in the first place? Who knows? But I talked to my buddy, Tyce Hergert down in Southlake, TX and he’s been slow as hell too. Until just last week. He thinks it’s the economy, inflation, back to school kicked it off, and then we have a big election that makes people a bit pulled back and financially more aware.  Who knows, but it makes sense. Maybe it was a perfect storm kind of thing but I know I’m ready to get back to business and running around like my ass is on fire unable to keep up. Then you get to hear me fuss about that. Lol. It’s a cycle. 

Why can’t it ever just sit right there in teh perfect pocket where you’re seeing just the right number of patients and are right where you want to be as far as being busy during the work week? Yeah, that’s a pipe dream. Never happening.  I’ll tell you this though, I’d rather be running around here with my ass on fire, changing people’s lives, and making money along the way rather than sitting here wondering who I made mad and moping around like a whipped dog. Lol.  So, for this week…we’re back toward the top of the mountain. 

Just real quick on a side gig kind of thought process. I have people asking me all of the time how I started getting into real estate. I want to help you guys. I read a book that’s in the Rick Dad Poor Dad umbrella that’s called Tax Free Wealth by Tom Wheelright.  It started talking about how you can pay lower to zero taxes by buying real estate. Well that got me to listening to the Bigger Pockets podcast and taking their webinars. Then I started delving into the niches of real estate. I decided for lots of reasons that Short Term Rentals, or STRs made the most money and the most sense. 

That led to a podcast and a book by Avery Carl called Short Term Rental, Long Term Wealth. They also have a private Facebook group that I’m a member of.  In case you don’t know, STR is what an Airbnb or VRBO property is. Short term rental like 3-5 days or so vs. a year long lease.  Trust me; people a hell of a lot dumber than you are making a ton on real estate. Here are the ways you make money on real estate:

  1. Cashflow – You have a profitable property so you make monthly cashflow. On average, our STR in Lubbock, TX profits about $2,000/month. That’s above and beyond our overhead on the house. 
  2. Appreciation – You never buy property planning on appreciation. However, assuming it’s not in a terrible neighborhood, it usually appreciates. Which is money in your pocket when, or it, you sell. 
  3. Equity – Other people are buying your property for you. They are kind enough to buy down the payment and buy your equity in the property. Meaning, because of them paying you every month, you own more and more of your own property. 
  4. Taxes – There are multiple ways that real estate benefits your taxes and I’ll leave that up to a CPA since I am not one but in general;
    1. With STRs, you can count your losses and depreciate everything on the real estate side, including the curtains to bring down your tax burden in your chiropractic clinic and try to get your tax burden down to zero for the year. 
    2. The write offs. You can write off all of the furnishings and everything that fits the real estate realm. Including meals where you sit and talk to your business partner (your wife and kids) about your properties. 

Not to mention that if you buy an STR in a place you like to visit, you have a place to stay whenever you need it! Also, if the STR is more than 90 miles from your primary residence, you can qualify for a vacation home loan and only pay 10% down instead of the traditional 20% down.

That makes a million dollar home near or on the beach a hell of a lot more do-able for most of us.  I’ll give you all a bit of a tip, you don’t have to go into these things blindly. Go to airdna.co and go down to the Rentalizer link on the left of your screen. Once there, put in any address, including your home address, and see what it might make as an STR. You may be surprised! It’s not a fool proof silver bullet but can give you some ideas. Also, don’t pay a 20% management fee. It takes me literally 15 minutes per week per property to manage.

Don’t lose 20% of your profit. You can do it yourself. Use guesty.com for the property management software and combine that with pricelabs.com for automatic and appropriate pricing from week to week and then……let er rip!!! Thank me later, fools! If you have any questions, join our private Chiropractic Forward Facebook group and start a post in there. I’d be happy to help if I have the answer. If I don’t, I can find it.  Let’s get started with the research shall we?

Item #1

The first on today is called “Effect of Spinal Cord Burst Stimulation vs Placebo Stimulation on Disability in Patients With Chronic Radicular Pain After Lumbar Spine Surgery: A Randomized Clinical Trial” by Hara et. al. (Hara S 2022) and published in JAMA on October 18, of 2022 and that’s some hot steamy salsa right there. 

Why They Did It The use of spinal cord stimulation for chronic pain after lumbar spine surgery is increasing, yet rigorous evidence of its efficacy is lacking. The authors wanted to investigate the efficacy of spinal cord burst stimulation, which involves the placement of an implantable pulse generator connected to electrodes with leads that travel into the epidural space posterior to the spinal cord dorsal columns, in patients with chronic radiculopathy after surgery for degenerative lumbar spine disorders.

How They Did It

  • It was a placebo-controlled randomized clinical trial
  • 50 patients were in the study
  • Done at St. Olavs Univer. Hospital in Norway
  • Conducted from 2018 – 2021
  • Patients underwent two 3-month periods with spinal cord burst stimulation and two 3-month periods with placebo stimulation in a randomized order. Which seems like they gave it a good solid chance to work to me
  • Burst stimulation consisted of closely spaced, high-frequency electrical stimuli delivered to the spinal cord. 
  • The stimulus consisted of a 40-Hz burst mode of constant-current stimuli with 4 spikes per burst and an amplitude corresponding to 50% to 70% of the paresthesia perception threshold.
  • The primary outcome was difference in change from baseline in the self-reported Oswestry Disability Index

What They Found

The mean changes in ODI score were −10.6 points for the burst stimulation periods and −9.3 points for the placebo stimulation periods None of the pre-specified secondary outcomes showed a significant difference.  Nine patients experienced adverse events, including 4 who required surgical revision of the implanted system.

Wrap It Up

The concluded, “Among patients with chronic radicular pain after lumbar spine surgery, spinal cord burst stimulation, compared with placebo stimulation, after placement of a spinal cord stimulator resulted in no significant difference in the change from baseline in self-reported back pain–related disability.” So…..chronic pain…..if you’re a regular listener, you know me and chronic pain. I love learning and talking about it. You can’t solve a problem through burst stimulation that is as much entrenched in the brain as it may be in a physical sense. 

You can blast it and blast it and until you treat the centralized portion, you’re pissing up a rope, as they say in Texas.  If you don’t have a clue what I’m talking about, start going through this podcast listening to anything on chronic pain, get a book by David Hanscum called Back In Control, and dive into the biopsychosocial aspect of pain. That’ll get you started. 

Before getting to the next one, Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office.  When you decide you can’t live without those products, send me an email and I’ll give you the hookup. They will 100% differentiate your clinic from your competitors. I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it.

Item #2

This second one I got from my buddy Dr. Craig Benton down in Lampassas, TX quite a while ago. Thank you Craig. It’s called “Association Between Utilization of Chiropractic Services for Treatment of Low-Back Pain and Use of Prescription Opioids” by Whedon et. Al. (Whedon JM 2018) and published in Journal of Alternative and Complementary Medicine in June of 2018. 

Why They Did It They say, “Pain relief resulting from services delivered by doctors of chiropractic may allow patients to use lower or less frequent doses of opioids, leading to reduced risk of adverse effects. The objective of this investigation was to evaluate the association between utilization of chiropractic services and the use of prescription opioid medications.”

How They Did It

  • The authors used a retrospective cohort design to analyze health insurance claims data.
  • The data source was the all payer claims database administered by the State of New Hampshire. 
  • The study population was 18-99 year olds, enrolled in a health plan, with at least two clinical office visits within 90 days for a primary diagnosis of low-back pain. 
  • The authors excluded those with a diagnosis of cancer.
  • The authors measured likelihood of opioid prescription fill among recipients of services delivered by doctors of chiropractic compared with non-recipients. 
  • They also compared the cohorts with regard to rates of prescription fills for opioids and associated charges.

What They Found

The adjusted likelihood of filling a prescription for an opioid analgesic was 55% lower among recipients compared with non-recipients.  Average charges per person for opioid prescriptions were also significantly lower among recipients.

Wrap It Up

They concluded, “Among New Hampshire adults with office visits for non-cancer low-back pain, the likelihood of filling a prescription for an opioid analgesic was significantly lower for recipients of services delivered by doctors of chiropractic compared with non-recipients. The underlying cause of this correlation remains unknown, indicating the need for further investigation.” 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

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

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

Bibliography

  • Hara S, A. H., Solheim O, (2022). “Effect of Spinal Cord Burst Stimulation vs Placebo Stimulation on Disability in Patients With Chronic Radicular Pain After Lumbar Spine Surgery: A Randomized Clinical Trial.” JAMA 328(15): 1506-1514.  
  • Whedon JM, e. a. (2018). “Association Between Utilization of Chiropractic Services for Treatment of Low Bac k Pain and Risk of Adverse Drug Events.” J Manipulative Physiol Ther 17(30): 30136-30137.      

Fear Avoidance & Opioids and Neuro Changes With Cannabis Use In Adolescence

CF 199: Fear Avoidance & Opioids and Neuro Changes With Cannabis Use In Adolescence

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

You have found yourself smack dab in the middle of Episode #199  Now if you missed last week’s episode, we talked about MRIs and Clinic Presentation & Surgery vs. Conservative Care For Discs. Make sure you don’t miss that info. Keep up with the class. 

 

On the personal end of things…..

I’m headed to Chicago on Wednesday. I’m going to the American College of Chiropractic Orthopedics conference out there. When you have completed the Forensics course work as I have, you go to the conference and take the final test.  I’m just gonna lay it out there; I haven’t studied. I hope my memory is amazing. More amazing than I think my 49-year-old noggin actually is. In real life. I’ve gotten so damn busy lately, I couldn’t study if I wanted to. So, we’re going to Chicago, we’re hanging out and learning good stuff, and then we’re keeping our fingers crossed that I’m able to kick the Ol clunky car into the driveway and bring the second Fellowship back home to the Williams Estate. Ultimately, if I don’t knock it out, I’m better than I was before.

Honestly, at the price point for this one after having done the Ortho Diplomate, it was a no-brainer.  Just the part of the course that was the AMA course on Impairment was useful. It’s pretty cool how they’ve quantified disability for basically anything and everything.

Crazy crazy

As mentioned, the recovery of the clinic numbers continues. I’m the only Chiro in the clinic and I had 33 new Chiro patients just last week alone. It’s a challenge. I’m probably going to have to be looking to hire an associate sooner rather than later if this stays the way it’s been in the last month. Funny how about 6 weeks ago I was frustrated with the lack of significant recovery from the COVID era numbers. Delta was on the spike. I didn’t see anything but a longer tunnel before we saw the light.  I’m by no means convinced it’s over. But numbers are going down now. And even in the middle of the delta spike, people here were done. 100% done. Restaurants have been full. No masks and no special distancing. Concerts. The whole thing.

Kids in school with no masks.

We had a spike for sure. It didn’t get as bad as the last spike. But bad enough to get everyone’s attention. I lost some folks I know during this last one. One of my buddies is in his fourth week in the hospital with it right now.  But business is back regardless and I’m pleased to see it. 

If you’ve been following along on the NP thing, still slow going. As is expected. Slow growing, slow to get our message heard. Just slow. But busier The hormone pellets have been amazing. We’re doing the IV therapy, PRP injection, trigger point injections, medical weight loss, COVID testing,…..it’s been interesting to get a peek into this world we’ve been essentially locked out of.  Sitting here today though, not one patient on his schedule so, we talk to our current patient load. We introduce our NP to everyone. We make them all aware that he’s here and we remove barriers. Barriers like ‘fear of the unknown by just introducing him. It’s a challenge but it’s one we are fully engaged in. Stay tuned. I’ll keep you updated on our progress. 

Item #1

Item 1 this week is called “Association of Cannabis Use During Adolescence With Neurodevelopment” by Albaugh et. al. (Albaugh MD 2021) and published in JAMA Psychiatry on June 16, 2021, and it’s ablaze!

Why They Did It

To what extent is cannabis use associated with magnetic resonance imaging–measured cerebral cortical thickness development during adolescence?

How They Did It

  • Cannabis use was assessed at baseline and 5-year follow-up with the European School Survey Project on Alcohol and Other Drugs. 
  • MRIs were done on each
  • The study evaluated 1598 MR images from 799 participants (450 female participants

What They Found

  • At a 5-year follow-up, cannabis use was negatively associated with thickness in the left prefrontal and right prefrontal cortices. 
  • There were no significant associations between lifetime cannabis use at 5-year follow-up and baseline cortical thickness, suggesting that the observed neuroanatomical differences did not precede initiation of cannabis use. 
  • Analysis revealed that thinning in the right prefrontal cortices, from baseline to follow-up, was associated with attentional impulsiveness at follow-up.

Wrap It Up

Results suggest that cannabis use during adolescence is associated with altered neurodevelopment, particularly in cortices rich in cannabinoid 1 receptors and undergoing the greatest age-related thickness change in middle to late adolescence.

Item #2

Number two today is called, “Anxiety and Fear Avoidance Beliefs and Behavior May Be Significant Risk Factors for Chronic Opioid Analgesic Therapy Reliance for Patients with Chronic Pain—Results from a Preliminary Study” by Silva et. al. (Marcelina Jasmine Silva 2021) and published in Pain Medicine in September of 2021 and it’s most certainly en Fuego on this day. 

Why They Did It

To describe differences between patients with chronic, non-cancer pain (CNCP) who were successfully able to cease full use of chronic opioid analgesic therapy (COAT), and those who reduced reliance on opioids,. How They Did It

  • A retrospective review of electronic medical records (EMR) data was organized for preliminary analysis.
  • It was a review of electronic medical records (EMR) data
  • 109 patients participated between October 2017 to December 2019

What They Found

  • Patients who were unsuccessful at opioid cessation reported significantly higher Fear Avoidance Beliefs Questionnaire (FAB) scores. 
  • Pain Catastrophizing Scale (PCS) scores showed a split pattern with unclear significance.

Wrap It Up

Results suggest that fear-avoidance beliefs and behavior play a significant role in refractory chronic opioid analgesic therapy reliance for patients with chronic non-cancer pain. We know this and you know this if you listen to this podcast with any regularity. We’ve covered it 100 times it seems. You should be having an ongoing conversation with your new patients about fear avoidance. 

A normal conversation that I have with new patients suffering from chronic pain sounds similar to this,

“Movement is healing. Motion is the lotion for the joints. Think about when someone has something as serious as surgery; they have them walking the halls that day or the next. Because movement is healing. 

Those that want a bottle of pills and some extra time to sit and wait for it to pass will be waiting longer and, sometimes, it never heals at all. Those that are getting back to their lives and working through the discomfort typically get better and have a better resolution of the injury. Know the difference between hurt and harm. When you’re injured, it can hurt getting back to the grind but that doesn’t mean it’s harmful. In fact, most of the time, hurt doesn’t mean harm.  Work through it and make it happen.  Most experts agree that pain lasting beyond 3 months is turning chronic and harder to treat. Taking control of chronic pain starts with understanding it so I’m going to give you an article I’ve written called Decoding Chronic Pain.

Please read it and we’ll talk about it on the next visit. In that article, there’s a recommendation for a book called “Back In Control” by David Hanscom, MD. He’s a fellow chronic pain sufferer and an orthopedic spinal surgeon. This book will give you some education and some techniques to help you with the cognitive aspect of pain, which my article addresses. You can throw acupuncture, massage, chiropractic, exercises, shot, and/or surgery at chronic pain but, many times, if you’re not also addressing the cognitive aspect of long-term pain, you likely won’t get where you want to be.

Are you familiar with the term ‘phantom limb pain’? How can a limb that is no longer attached and got burned up in an oven still hurt? It’s because they treated the peripheral source of the pain but did nothing to address the central, cognitive aspect of the issue. So the part of the brain that makes up the pain experience continues to make that pain experience happen. Even after it’s gone. That’s also why research has shown that when a chronic pain sufferer has absolutely perfect surgery for anything, they have a 60% chance of developing new chronic pain at the new site of insult or surgery. Because their pain-making mechanism is on high alert and uses pain as the protection mechanism. 

Part of improving and moving past it is to not avoid activities that you love and that feed your soul. If you start backing away from these activities, that’s called fear avoidance, and avoiding things can lead to deconditioning after only about 7 days for most. Not only that, but it takes a hell of a lot longer to re-condition.  So, fight back, move, hurt but work through it, and take control of this.  We’ll help you move, we’ll help work on balance, we’ll help with proprioception, we’ll help you discover what you’re still capable of doing. You do the exercises and move on your own at home.

Go for walks. Just move as much as you can.  Just know that you’re not stuck this way. Do you have any questions? OK, let’s get to work.”

Boom. That’s it.

Or something like that. Sometimes it’s shorter. Sometimes it’s longer and more involved. I’ve sat and talked to patients for an hour or more just to have them go and give me a 3 or 4-star review on Google because I didn’t get a good pop out of their back and they don’t feel any better after one visit. 

You know how it is.

That kind of stuff makes you want to stomp kittens and club baby seals but then there are those that you are able to save their lives on some level.

They’re the ones we’re here for so keep it all in the proper context and do the best you can every day.  Those are the ones that need us to be on top of our games.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in the leadership of state associations. So quit griping about the profession if you’re doing nothing to better it. 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 & disabilities 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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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 – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

  • Albaugh MD, O.-G. J., Sidwell A, (2021). “Association of Cannabis Use During Adolescence With Neurodevelopment.” JAMA Psychiatry.
  • Marcelina Jasmine Silva, D., Zhanette Coffee, MSN, Chong Ho Yu, PhD, Marc O Martel, PhD (2021). “Anxiety and Fear Avoidance Beliefs and Behavior May Be Significant Risk Factors for Chronic Opioid Analgesic Therapy Reliance for Patients with Chronic Pain—Results from a Preliminary Study.” Pain Medicine 22: 2106-2116.

 

Spinal Manipulative Therapy vs. Opioids and Young Elite Pitchers, Hips, and Elbow Pain

CF 195: Spinal Manipulative Therapy vs. Opioids and Young Elite Pitchers, Hips, and Elbow Pain Today we’re going to talk about spinal manipulative therapy vs. opioid therapy for Medicare-aged patients and we’ll talk about young elite pitchers, their hips, and pain. Stick around.  But first, here’s that sweet sweet bumper music

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

Chiropractic evidence-based products

Integrating Chiropractors

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

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an invaluable resource for your patient education and for you. It can save you time in putting talks together or just staying current on research. It’s categorized into sections so that the information is easy to find and it’s written in a way that is easy to understand for practitioner as well as patient. You have to check it out. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #195 Now if you missed last week’s episode , we talked about Lumbar Fusion Compared To No Fusion, Disc Research, and PT vs. Chiropractic.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

On the personal end of things, we just got back from Washington DC. It was a go go go whirlwind kind of thing that every single American needs to experience. It’s powerful. The buildings were meant to inspire and awe and intimidate foreign leaders. So what do you think they do to regular ol commoners like me and you? Pretty impressive. Even if you dislike most politicians like I dislike most politicians. Day 1 was getting there.

We got up at 4:00am to get to the 6 am flight. Got to DC by 1:30. Hopped onto the metro and boom, we’re at the hotel. If you’ve never experienced the DC Metro, hell that is reason enough to go all by itself. It’s a work of art and I’m constantly fascinated by it. You can go just about anywhere you want easily and in no time with no traffic. That doesn’t mean there no walking involved though. Bring a pair of walking shoes my friends. The first full day we logged over nine miles. The second full day was about 8 and a half miles. Same on the third. Bout 5-6 miles on the fourth day.  Unless you’re doing the bus tours and all, you’re in fir walking. Plain and simple. I’m always good for 5-6 miles. 9-10 in a day is a bit more than I want. I can do it, but it’s damn sure extra. But, we saw the Lincoln Memorial, WWII memorial, Vietnam Wall, Washington monument, White House, Capitol, air and space museum, natural history museum, American history museum, national art gallery with this hemisphere’s only Da Vinci painting, Mt Vernon, Arlington National Cemetery and the changing of the guard, Old Town Alexandria, and much much more.

It was a go-cation and I’m glad to be back home so I can sleep and get some rest. It’s bad when going to work is a vacation from your vacation.

Professionally, just getting into the swing of things with our Nurse Practitioner. He’s catching on slowly but surely. It’s happening. Never fast enough. But I see it happening. We’re also getting into the swing of things with our Parker Intern.  He’s a good guy. Seems to be a smart guy and seems to click right along with everything we do so all’s well there. It’s been fun teaching him. So, I’m still playing catch-up from being gone so let’s hop in.

Item #1

This first one is called “Initial Choice of Spinal Manipulation Reduces Escalation of Care for Chronic Low Back Pain among Older Medicare Beneficiaries”’ by Whedon et. al. (Whedon JM 2021) and published in Spine Journal on May 11 of 2021. Schiza!!! Es Caliente!  I just combined German and Spanish. Please make note. And recognize. 

Why They Did It

The objective of this study was to compare long-term outcomes for Spinal Manipulative Therapy (SMT) and Opioid Analgesic Therapy (OAT) regarding escalation of care for patients with chronic low back pain (cLBP).

How They Did It

  • They combined elements of cohort and crossover-cohort design.
  • They examined Medicare claims data spanning a five-year period. 
  • They included older Medicare beneficiaries with an episode of cLBP beginning in 2013. 
  • They analyzed the cumulative frequency of encounters indicative of an escalation of care for cLBP, including hospitalizations, emergency department visits, advanced diagnostic imaging, specialist visits, lumbosacral surgery, interventional pain medicine techniques, and encounters for potential complications of cLBP.

What They Found

  • SMT was associated with lower rates of escalation of care as compared to opioid Analgesic Therapy. 
  • The adjusted rate of escalated care encounters was approximately 2.5 times higher fi the initial choice of care was opioid analgesic therapy vs. if the initial choice was SMT

Wrap It Up

Among older Medicare beneficiaries who initiated long-term care for cLBP with opioid analgesic therapy, the adjusted rate of escalated care encounters was significantly higher as compared to those who initiated care with spinal manipulative therapy

Item #2

I want to thank my friends at ChiroUp for finding this one. They’re always on top of it at ChiroUp. Don’t forget to use my code, Williams15 if you want to sign up with them for a discount! Number 2 this week is called, “Restriction in the hip internal rotation of the stride leg is associated with elbow and shoulder pain in elite young baseball players” by Sekiguchi et. al. (Sekiguchi T 2019) and published in the Journal of Shoulder and Elbow Surgery in September of 2019. Ahhhh the days of pre-pandemic. 

Why They Did It

Evidence is scarce concerning the relationship of physical dysfunction of the trunk and lower extremities with elbow and shoulder pain in young baseball players. This study aimed to examine the association of joint flexibility of the trunk and lower extremities and dynamic postural control with elbow and shoulder pain among elite young baseball players.

How They Did It

  • They analyzed baseball players (aged 9-12 years) who participated in the National Junior Sports Clubs Baseball Festival. 
  • Range of motion in external rotation and internal rotation (IR) of the hip, as well as the finger-to-floor distance and heel-to-buttock distance, was measured. 
  • The straight-leg-raise test was also conducted. 
  • Dynamic postural control was evaluated using the Star Excursion Balance Test. 
  • Multivariable logistic regression analyses were conducted to examine the association of physical function with the elbow or shoulder pain incidence.
  • Of 210 players surveyed, 177 without elbow or shoulder pain were included in the analysis.

What They Found

  • Of the participants, 16 (9.0%) reported having elbow or shoulder pain during the tournament. 
  • Participants with the incidence of elbow or shoulder pain had a significant restriction in hip IR of the stride leg compared with those without pain 
  • There were no significant associations of other joint flexibilities and the Star Excursion Balance Test with elbow or shoulder pain.

Wrap It Up

  • Decreased hip IR range of motion of the stride leg was significantly associated with the elbow or shoulder pain incidence. 
  • Players, coaches, and clinicians should consider the physical function of the trunk and lower extremities for the prevention of elbow and shoulder pain.
  • Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus so get active, get involved, and make it happen.

Alright, that’s it for this week. Y’all go out and piss some excellence. Get involved in your state association and the ACA. Our profession needs evidence-based, patient-centered chiropractors driving the ship. So get in, get involved, and make the profession what you will.  Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.     

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

Chiropractic evidence-based products

Integrating Chiropractors

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

  The Message

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

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

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

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

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

Bibliography

Sekiguchi T, H. Y., Yabe Y, Tsuchiya M, Itaya N, Yoshida S, Yano T, Sogi Y, Suzuki K, Itoi E (2019). “Restriction in the hip internal rotation of the stride leg is associated with elbow and shoulder pain in elite young baseball players.” J Shoulder Elbow Surg 29(1): 139-145.  

Whedon JM, K. A., Toler AW, Bezdjian S, Rossi D, Uptmor S, MacKenzie TA, Lurie JD, Hurwitz EL, Coulter I, Haldeman S, (2021). “Initial Choice of Spinal Manipulation Reduces Escalation of Care for Chronic Low Back Pain among Older Medicare Beneficiaries.” Spine (Phila Pa 1976).        

Chiropractic Prevents Opioids & Chiropractic Adverse Events

CF 191: Chiropractic Prevents Opioids & Chiropractic Adverse Events Today we’re going to talk about chiropractic care preventing opioids and chiropractic adverse events.  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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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

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

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an invaluable resource for your patient education and for you. It can save you time in putting talks together or just staying current on research. It’s categorized into sections so that the information is easy to find and it’s written in a way that is easy to understand for practitioner as well as patient. You have to check it out. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #191 Now if you missed last week’s episode , we talked about Obesity In Youths With Chronic Pain, The Healing Journey of Pain, and Fibromyalgia Treatment. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

So, if you’re a regular listener, then you know that I’ve been slowly going through the Forensics Diplomate program. The initial 40 hours through ChiroCredit were not my favorites. Learning about court cases, procedures, and all that stuff…..let’s just say it’s not my skill set.  But, I did it. I sat through it all. Now I’m on to the course for impairment ratings through the AMA. It’s speaking my language a little more. OK….a lot more. It’s still very technical and all that good stuff but it makes a little more sense. However, it is written by medical doctors for medical doctors so there is a section that got me a bit hot. Did you know in the 6th edition of the Guides to Impairment, it says that chiropractors should stick with only assessing impairment of the spine….because….you know……we didn’t spend two full semesters dissecting an entire body or anything like that. Right?

The presenter said he realizes that statement may bring about some discussion but the evaluator must have knowledge, skills, and ability in that organ system or in that region to assess impairment. Otherwise, the impairment rating is likely to be faulty. So…..I guess chiropractors somehow have the inability to learn, know, or understand a shoulder, hip, ankle, etc? Let’s be fair, I get it if they think a chiropractor shouldn’t really be assessing impairment of the liver or GI system.

That’s not within our wheelhouse. But muscles, bones, ligaments, tendons, and joints of all sorts are damn well within our wheelhouse and it’s just dumb to act like a regular impairment doc doing impairment ratings are any more intimately familiar with them than we are.  That’s some elitist BS right there. And it stinks and smells like old outdated dogma. But let’s also be fair to them. Even though they’ve rarely given us the same respect in return. This was reprinted in 2009. I’m not sure when the original printing was. I’m sure the course I’m watching was done around the same time as well.  Think about it; how many changes have you seen in the MD/DC relationship arena in just the last 10 years alone? I’ve seen a lot.

Especially since the American College of Physicians came out in 2016 recommending spinal manipulative therapy for acute and chronic low back pain. On the heels of that The Lancet report on low back pain echoed the recommendation. Then Dr. Goertz’s paper was in JAMA showing how well veterans did when spinal manipulative therapy was added into the treatment protocol.  Plus, I see more and more chiropractors moving in the right direction. The direction of evidence-based, patient-centered care. Where decades ago, an MD wouldn’t bowl against a team that had a chiropractor on it and they wouldn’t even accept referrals from us, to now.

Now, I have a nurse practitioner working hand and hand with me every day. Some of the people I count as buddies are a vascular surgeon, and ER doc, and a neurosurgeon.  So….maybe the course just needs an update. Who knows? But it pissed me off a little and I paid $487 to get pissed off. Lol. This too shall pass. In fact, it may already have passed.  Alright, NP medical integration week #2. It’s getting there. Our NP did hormone pellet procedure last week. That whole process is pretty cool. Patients have to do the lab work first to make sure it’s necessary. But if it is, it can make a big difference for folks. We doing PRP shots, trigger point shots, B12 shots….it’s all pretty darn interesting and it’s multimodal. Which is evidence-based and, as always, I balance it in a patient-centered way. 

So, now in my office, we have me, exercise/rehab, medical services, acupuncture, 3 massage therapists, and all of the other stuff you’d expect in therapies. It’s grown into quite a deal.  I had a patient ask me the other day if I was a franchise. I asked why they’d think that? They just said that we offer so many things that he figured it was a franchise. I said no, we’re not. But I likened it to my step-dad’s shop. He’s got every tool, cord, clamp, and gadget you’d ever want in a shop. But when you ask him how he got it all, he’ll tell you that he got it one at a time. Kind of like Clint Eastwood in El Torino.  You just gather and grow as you need. As the risk makes sense. There was a time when getting a $13,000 decompression table was a big damn deal and came with a lot of financial risks. 

Now, understandably, the risk is different. To expand and grow, it costs more. You have to stick your neck out a little further and hope it doesn’t get chopped off.  There are sinkers and swimmers in this world. I like to think I’m a swimmer. It’s OK to venture out a little further each time you stretch. As long as you know how to swim. And I have the doggy paddle down, folks. Just keep swimming just keep swimming.  Alright, let’s dive into the research. 

Item #1

This one’s called “Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain” by Whedon et. Al. (James M Whedon 2020) and published in Pain Medicine in December of 2020 and that’s just hot enough. 

Why They Did It They say “Utilization of nonpharmacological pain management may prevent unnecessary use of opioids. Our objective was to evaluate the impact of chiropractic utilization upon use of prescription opioids among patients with spinal pain.”

How They Did It

  • We employed a retrospective cohort design for analysis of health claims data from three contiguous states for the years 2012–2017.
  • They included adults aged 18–84 years enrolled in a health plan and with office visits to a primary care physician or chiropractor for spinal pain
  • They identified two cohorts of subjects: Recipients received both primary care and chiropractic care, and nonrecipients received primary care but not chiropractic care.
  • The total number of subjects was 101,221

What They Found

  • Overall, between 1.55 and 2.03 times more nonrecipients filled an opioid prescription, as compared with recipients
  • Similar differences were observed for the acute groups.

Wrap It Up

Patients with spinal pain who saw a chiropractor had HALF the risk of filling an opioid prescription.   

CHIROUP ADVERTISEMENT

Item #2 Number two today is called “Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment” by Drew Oliphant (Oliphant D) and published in the Journal of Manipulative Physiological Therapeutics in 2004. Definitely not hot. 

Why They Did It The authors wanted to provide a qualitative systematic review of the risk of spinal manipulation in the treatment of lumbar disk herniations (LDH) and to estimate the risk of spinal manipulation causing a severe adverse reaction in a patient presenting with LDH.

How They Did It

  • They considered relevant case reports, review articles, surveys, and investigations regarding treatment of lumbar disk herniations with spinal manipulation and adverse effects and associated risks
  • Prospective/retrospective studies and review papers were graded according to quality, and results and conclusions were tabulated. 
  • From the data published, an estimate of the risk of spinal manipulation causing a clinically worsened disk herniation or cauda equina syndrome (CES) in patients presenting with LDH was calculated. 
  • This was compared with estimates of the safety of nonsteroidal anti-inflammatory drugs (NSAIDs) and surgery in the treatment of LDH.

What They Found An estimate of the risk of spinal manipulation causing a clinically worsened disk herniation or CES in a patient presenting with LDH is calculated from published data to be less than 1 in 3.7 million.

Wrap It Up The apparent safety of spinal manipulation, especially when compared with other “medically accepted” treatments for LDH, should stimulate its use in the conservative treatment plan of LDH.

Item #3 The last one is called “Serious Adverse Events and Spinal Manipulative Therapy of the Low Back Region: A Systematic Review of Cases” by Herbert et. al.  and published in the Journal of Manipulative Physiological Therapeutics in 2015. Again….not hot but that’s OK. It’s a Systematic Review. 

Why They Did It The purpose of this study was to systematically search the literature for studies reporting serious adverse events following lumbopelvic spinal manipulative therapy (SMT) and to describe the case details.

How They Did It

  • A systematic search was conducted in PubMed including MEDLINE, EMBASE, CINAHL, and The Cochrane Library up to January 12, 2012, by an experienced reference librarian. 
  • Study selection was performed by 2 independent reviewers using predefined criteria. 
  • We included cases involving individuals 18 years or older who experienced a serious adverse event following SMT applied to the lumbar spine or pelvis by any type of provider (eg, chiropractic, medical, physical therapy, osteopathic, layperson). 
  • A serious adverse event was defined as an occurrence that results in death or is life threatening, requires hospital admission, or results in significant or permanent disability. 
  • A total of 2046 studies were screened, and 41 studies reporting on 77 cases were included.

What They Found

  • Important case details were frequently unreported, such as descriptions of SMT technique, the pre-SMT presentation of the patient, the specific details of the adverse event, time from SMT to the adverse event, factors contributing to the adverse event, and clinical outcome. 
  • Adverse events consisted of cauda equina syndrome (29 cases, 38% of total); lumbar disk herniation (23 cases, 30%); fracture (7 cases, 9%); hematoma or hemorrhagic cyst (6 cases, 8%); or other serious adverse events (12 cases, 16%) such as neurologic or vascular compromise, soft tissue trauma, muscle abscess formation, disrupted fracture healing, and esophageal rupture.

Wrap It Up

The anecdotal nature of these cases does not allow for causal inferences between SMT and the events identified in this review.  When chiropractic is done responsibly and appropriately, it’s safer than almost any medical intervention. It just is. Now, when you have people damn near yanking people’s heads off of their bodies, aggressively adjusting patients on YouTube that have had a significant history of stroke, and adjusting 80 year old women with the same gusto you’d use with a 25 year old male…..well….those folks are just asking for it.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world.

The world needs evidence-based, patient-centered practitioners driving the bus so get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg

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

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

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

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

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

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

Bibliography

  • James M Whedon, D., MS, Andrew W J Toler, MS, Louis A Kazal, MD, Serena Bezdjian, PhD, Justin M Goehl, DC, MS, Jay Greenstein, DC (2020). “Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain.” Pain Med 21(12): 3567-3573.  
  • Oliphant D “Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment.” J Man Physiol Ther 27(3): 197-210.  

Impact Of Chiropractic Care on Opioid Use & Garbage Marketing In The Chiropractic Profession

CF 163: Impact Of Chiropractic Care on Opioid Use & Garbage Marketing In The Chiropractic Profession

Today we’re going to talk about the impact of chiropractic care on opioid use and then we’ll talk about garbage marketing in the chiropractic profession. I go off a bit. I can’t help it. They make me nuts.  But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products

Integrating Chiropractors

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

  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #163 Now if you missed last week’s episode , we had Dr. Bobby Maybee of the Forward Thinking Chiropractic Alliance and the Chiropractic Success Academy. It was Part Two of a two-part interview that I think you’ll all get plenty of excellent insight and inspiration from. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I had the second Moderna vaccine shot on January 20th and all’s well. My experience is that, if you remember, I had zero symptoms with the first shot. Not even a sore arm. Nothing at all.  With this second one, I had a pretty sore arm. It felt like when I got the flu shot. Just a sore arm. It was red for a couple of days too. It was honestly about two days and that was it. I may have been hyperfocused on whether I was having symptoms or not but was maybe a touch tired that day.

I got the shot at 2:30 in the afternoon and then went back to work until 6pm so….I may have been a touch draggy but like I said, that could have just been me being hyperfocused. It wasn’t anything very noticeable.  My wife felt a little crummy for one day. Then she was back at it.  Overall, not a bad deal. They say the full protection is approximately 2 weeks after shot #2 so we’re looking pretty good and, outside of the first two weeks we took off in late March of 2020, I haven’t had to take any days off due to illness and if it all works out, I won’t have to in the future. As a result of COVID anyway.  As I’ve said here, I don’t think it’s unreasonable at all to wait to get yours until you’ve seen how everyone else reacts to it.

I really don’t. I’m not a ‘get your shot instantly’ type of guy. Especially if you have associates that will pick up your slack should you get COVID and be out sick. But when you’re a solo doc like me, the business depends on your presence. I can’t get sick and be out for 2-4 weeks. Some folks are out much longer than that. For me, there’s nothing that makes more sense than getting the vaccine as quickly as possible.  In addition, I have a wife that is 100% over this mess and is ready to go traveling. So, happy wife – happy life in full effect.  Also, I have a local surgeon running advertisements all over TV and it makes me want to punt baby bunnies into the stratosphere.  He says in thw commercial that we all deserve to live without pain and then he goes into his campaign in support of back and neck surgery. Who am I to try to keep someone from marketing their business?

But day-um. One word, two syllables. Day-um. 

Years ago it was illegal to run an ad for hard liquor. You don’t see any cigarette commercials do you?  Now, I’m not saying surgery is equal to cigarette smoking and hard liquor but I know several that have done worse through one surgery they they would ever do from a life of smoking and drinking.  I see that commercial come on TV and I start talking to the TV. I have a strongly worded conversation with the TV every time. It’s because I know that there’s little to no support for spinal surgeries in the research and there’s not better outcomes from them either. The problem is that the common, every day patient does not know that. 

They see the damn white coat and lose their damn minds and just say, “OK.” A pharma commercial could say that you butt could fall out of you walking across a room if you take this medicine and people would still line up for it.  You tell them we’re going to get you moving and exercise and they think you’re dangerous or crazy. It’s a conundrum.  Alright, let’s get to the good stuff shall we?

Item #1

This first item is called “Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain” by Whedon et. al(Whedon JM 2020)….there’s that Whedon name again. It was published in Pain Medicine in December of 2020 and that a lot hot

Why They Did It

Utilization of nonpharmacological pain management may prevent unnecessary use of opioids. Our objective was to evaluate the impact of chiropractic utilization upon use of prescription opioids among patients with spinal pain.

How They Did It

  • The total number of subjects was 101,221.
  • It was a retrospective cohort design for analysis of health claims data from three contiguous states for the years 2012–2017.
  • included adults aged 18–84 years enrolled in a health plan and with office visits to a primary care physician or chiropractor for spinal pain.
  • We identified two cohorts of subjects: Recipients received both primary care and chiropractic care, and nonrecipients received primary care but not chiropractic care.
  • We performed adjusted time-to-event analyses to compare recipients and nonrecipients with regard to the risk of filling an opioid prescription. We stratified the recipient populations as: acute (first chiropractic encounter within 30 days of diagnosis) and nonacute (all other patients).

What They Found

Overall, between 1.55 and 2.03 times more non-recipients filled an opioid prescription, as compared with recipients.  Similar differences were observed for the acute groups.

Wrap It Up

Patients with spinal pain who saw a chiropractor had half the risk of filling an opioid prescription. Among those who saw a chiropractor within 30 days of diagnosis, the reduction in risk was greater as compared with those with their first visit after the acute phase. CHIROUP ADVERTISEMENT

Item #2

Alright, I’m going after vitalists a bit here today in item #1. I came across a script and I just can’t ignore this stuff anymore. If we’re not willing to call it out, then we are complicit. And I refuse to be that. In fact, if you have any of these scripts you’ve been given from vitalist gurus, please email them to me at dr.williams@chiropracticforward.com I would love to read them on future podcasts and discuss my disdain for the tom foolery within. 

This script is to be used when a patient hasn’t been in for a while. It’s basically used to scare the holy hell out them and force them back to your office because…..you know…..they depend on you to keep them healthy and there are no other means of keeping one healthy outside of the removal of the magical subluxation.  So, here is the script: Dear Patient I have been thinking about you! (with an exclamation mark because, you know….bilking and scaring people is super exciting and all). I realized I have not seen you in a while.

So, I reviewed your file and looked at your last x-ray.  I am concerned that based on your past history, you might be suffering the effects of spinal degeneration without being aware of it. The first effect of spinal degeneration is that the nerve that supplies the area stops performing its normal function.  This means that your nerve is unable to alert you to a problem that is potentially developing…. That’s not emotionally manipulative at all now, is it? It would be like cutting the wire to your fire alarm when your house is on fire!!! OMG!! Cutting….it sounds so awful!! 

The alarm can’t warn you of the fire in time to get out of the house, Holy s-word!!! That must mean I’m going to burn the hell up then. I better call this knucklehead’s office and be seen before I look like a crispy curly fry!! Gimme a damn break. I can’t believe professionals are sending out garbage like this.  It continues; Another sign of spinal degeneration is the loss of flexibility. You lose files without being aware of it. You begin to turn with your shoulders instead of using your neck.

You lift with your back instead of bending your knees. You should have enough flex to enjoy your life. This means you should be able to get out of bed in the morning without feeling stiff or sore. It means you can do the things you enjoy in life. You should be flexible enough to exercise and enjoy your hobbies and leisure time including sitting down to watch your favorite TV programs without being stiff when you get back up. 

The most serious effect of spinal degeneration is loss of vitality. Oh that sounds horrible. Not vitality!!  You should feel healthy!! Yes, you should but you can do that by making yourself move and exercise and eat better while getting a good amount of sleep. You don’t need a chiropractor to feel healthy.   You should have a sense of wellness and energy. You should be able to get out of bed ready to go. You don’t feel this way when your systems do not function properly. You feel that something is just not right but you can’t quite put your finger on it.

You feel stressed and tense. Yeah….like 100% of every other American on this planet.  Last paragraph of the garbage. 

I have set aside the next month for you as “Welcome back to Chiropractic month.” Damn, that’s so nice. They set aside a whole month for me. Sweet bastards. 

Do yourself a favor and call our office to schedule a visit. I will perform a ‘back to chiropractic adjustment and exam including x-rays if needed at no cost.’ Way to value you treatment, doc!! This visit has a normal valued of up to $175 and is yours absolutely FREE during the next month. It’s my way of encouraging you to get back on track and avoid the consequences of spinal degeneration. Please bring the enclosed ‘back to chiropractic’ coupon with you when you come to the office. I look forward to seeing you again soon! Now, if you can read through that without throwing up, congratulations. You have a stomach of iron.

Secondly, if you ever hear a vitalist claim they do not use scare tactics to take advantage of their patients, they’re simply not being honest. In essence, that’s exactly what the subluxation theory is in the first place. IT’s a scare tactic. The silent killer, right? You’ll get sick, you’ll be unhealthy. You’ll develop degeneration. Not because of the consequences of normal freaking aging but because you had all those subluxations all up in ya. 

Talking about the person and using the word ‘you’ is a sales tactic. They use the word ‘you’ or its variants 39 times in that mess of a sales letter.  Can I say that I’m not sure I’ve gotten a birthday card from my family MD much less a scare tactic-laden sales letter.  We can do better than this folks.

Crap like this make us all look like fools. Not to mention what it makes the ones sending their crap out look like. They look like bozo the clown in full makeup, y’all.  “I am concerned that based on your past history, you might be suffering the effects of spinal degeneration without being aware of it. The first effect of spinal degeneration is that the nerve that supplies the area stops performing its normal function.”

Come on man. Spinal degeneration is a normal part of aging. You quit building bone and then you start to regress over the years. This is natural. Stop making patients believe they have to depend on you. It’s not right and if the state boards have any teeth on this kind of garbage, they should start using it. That’s if chiropractic is ever going to step its game up.  We are better than this. When you and your heart and your business are built on things like, honestly, ethics, character, education, and love……you could never in your life send out something like that.  When you are built on selfishness, low-character, deceitfulness, and an anything to get ahead, then you’re more than happy to send it out and you won’t think twice when they come in because you scared them and then you scare them into treating every other week for the next year with upfront payment, blah blah blah. How do these types of practitioners live with themselves?  The absolute worst are the ones that claim it’s a God thing.

If they don’t come in and get their regular adjustment, they can’t allow God to express his true power in their body’s? Oh….is that right? The dude we Christians claim created the world and man in his own image……the dude controlling everything on Earth and beyond…..that dude needs a chiropractor to adjust their patients all of the time because he didn’t make quite perfect enough. The hell you say.

Remember, I’m a Christian. I can make fun. The hypocrisy in this type of practitioner is about as low as it gets for me.  All of these practitioners have big houses. No doubt. But at what cost personally and to our profession?  We’re better than that. Stop it dammit. Stop it now

Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week. 

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

Website https://www.chiropracticforward.com

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

Bibliography Whedon JM, T. A., Kazal L, Bezdijian S, (2020). “Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain.” Pain Med 21(12): 3567-3573.  

The Fate Of An OxyContin Producer & The Outdated Use of MRI Diagnosing Cervical Dysfunction

CF 150: The Fate Of An OxyContin Producer & The Outdated Use of MRI Diagnosing Cervical Dysfunction  Today we’re going to talk about the outdated use of MRI to diagnose cervical dysfunction and then the fate of an oxycontin producer.   But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products

Integrating Chiropractors

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

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

Do it do it do it. 

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

 

You have found yourself smack dab in the middle of Episode #150 Now if you missed last week’s episode, we talked about the costs of preventable disease, and then we’ll talk about whole-body vibration for function and bone mineral density in postmenopausal, osteoporotic women. Make sure you don’t miss that info. Keep up with the class.  While we’re on the topic of being smart, did you know that you can use our website as a resource?

Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function

On the personal end of things…..

On the personal side of things, it’s an alright week. Nothing too crazy other than the rise in the Rona around the nation. We got my biggest week last week since Rona hit us. We had 170 visits last week. Still down from my average of 182 pre-Rona but way up from an average of 135-145 post-Rona.

So progress. Then this week, we’re having three days of snow, ice, and sleet. So….it’s a Texas Two-Step. Two steps forward and one step back. Patience is a virtue. Blah. Such is life.

I thought I’d share a recent experience with you all in an effort to let you know you’re not alone, we can’t make them all happy, and how I handled it.

So last weekend I got an email. It wasn’t positive. In fact, it was a bit combative. Let’s just say it wasn’t flattering. Now, I’d like to be fair to myself here. In 22+ years, I’ve had conflict or whatever you want to call it….let’s call it miscommunication. I’ve had a miscommunication with patients only 3-4 times. Five if I’m pushing it. But this goes to serve as an example, you’re never too old or in practice too long to be above being questioned. In fact, in today’s culture of disrespecting ‘experts’ for lack of a better word, questioning authority, and an overall culture of lacking mutual respect…..well, I think it makes sense that we’re all more likely to have some miscommunication issues here and there. 

Then, online reviews throw a whole other kink into the plan, doesn’t it? So, due to respect for this person and HIPAA, I will be very vague here but in general, this person had significant cervical disc radiculopathy. Sometimes you make a diagnosis and you’re not 100% sure but you’re heading that direction. Not with this one. There was no doubt. They were very upset. Crying. Nauseous. Not feeling well and rating the pain at a 7 out of 10 on the VAS scale. 

We tried some over-the-door traction but it really made the person nauseous so that was out. I tried some retraction/extension exercises and started them on nerve gliding exercises to try to make some headway.  The second treatment comes and we are able to do a little more. Now they’re rating it at a 4 out of 10. Looks like we’re on easy street right? We got this!!

We did very light decompression and the patient said it felt good and they were doing better.  OK. Whew. Another one on the road to avoiding surgery.  Not so fast. For whatever reason, this patient never showed up again. I don’t always think about my patients but I did think about this one because they were so severe on day one. I wondered how they were doing and why I never saw them again. 

Well, this weekend’s email answered that for me. There’s no need to read the whole email just because there’s no need but the sentiment of it was that I had a conversation with them that they characterized as saying that anxiety was causing the pain and that I told them I couldn’t help them. What they took from the conversation was that I should have ordered an MRI on day one basically, that I blamed mental and emotional issues on the part of the patient for their pain and they felt that was unprofessional and uneducated. And potentially ego-driven on top of all of that. They mentioned they sought out an MRI, went to a neurosurgeon, and had a two-level fusion, and are on the road to recovery with the help of PT.

https://www.chiropracticforward.com/giving-maintenance-care-dry-needling-and-vitalism/

 

Oh….you know I’m always honest with you folks because honestly, that’s not flattering stuff. Nobody wants to look into themselves and say, “Does this person have a point? Where did I go wrong and how can I prevent that from happening again with someone else? But here’s the truth, I literally don’t recall that conversation whatsoever. I have a thousand different conversations every week. But I know me. I’ve never in my life told a patient that they have mental or emotional problems and those are the source of their pain. Nor have I ever insinuated that anxiety is the pain source when it’s clear as a bell that it’s radiculopathy secondary to a disc issue. My staff has heard me repeat the same discussions, the same lines, and the same jokes day after day, month after month and they’ll be the first to tell you I’ve never said anything of the sort. 

So, flummoxed as I have been, I slept on that email for the rest of the weekend thinking about it. The last thing you want to do is respond out of anger. You definitely don’t want to respond out of a defensive posture. Especially when you’re reasonably sure you did nothing uneducated or ego-driven. A response like that will only make us look more unprofessional than they already think we are and maybe even potentially provoke. 

So, in short, I did not address the ego comment because I felt it was unnecessary. I’ll just take my lumps on that one. I mentioned how happy I was to hear from them and hear they are recovering. I genuinely was glad. Even if the email was less than flattering.  At least they got some aspect of a resolution. Even if I wasn’t the end solution. I don’t feel there’s any ego on my part in that sentiment. 

I explained that we typically do a trial treatment of a week or two before deciding on advanced imaging and that would have definitely been in the considerations had we treated beyond two appointments. That’s appropriate. Some can make an argument that there was radiculopathy so we could have gotten an MRI on day one. But, if we’re honest, how many patients do you have that have radiculopathies that you are able to clear fairly quickly without resorting to an MRI? My guess is quite a few because that’s my experience. We just don’t have to get very many. But again, we have to have the chance to find out, right?

I discussed briefly that I am very much on top of current research and thinking with regards to pain and neuromusculoskeletal issues and may have been assessing yellow flags. I discussed briefly what the biopsychosocial aspect of treatment entails these days but didn’t want to dwell on it much. Mostly because I never felt it was anxiety, mental, emotional driven thing to start with. It was clearly a disc. But I hope the mention somehow rebuts the idea that I need more education. 

I offered that as a potential reason we may have had some miscommunication.  I also mentioned that there have been very few patients over the years that I would just straight up tell them “I can’t help you.” I told them that I’m typically one of the most stubborn practitioners and will hold on until it’s crystal clear I’m not helping. That, for me, has never happened after only two visits.  In a nutshell, I said that being patient-centered, evidence-based, and having high patient satisfaction was the most important thing to me and that I don’t recall the exact conversation or the wording but that I can learn from the email and can use it to make me better at my job and that I appreciated them taking the time to share their thoughts with me. 

In the end, I was glad to hear about them feeling better and I apologized for any miscommunication on my end.  While that sounds like a very long email, it wasn’t and I took the time to make sure it was hopefully as eloquent as a guy like myself can generate. Without arrogance, ego, combativeness, or being defensive. But WITH being caring, being professional, and being thoughtful. 

Even though it may not be reciprocated, I respect this person and I DO hope they are feeling better. And, whether we feel like these things are our fault or whether we think we did anything wrong or not, we can ALWAYS always learn from stuff like this. We can always be better. I can promise you, I learned to not be lackadaisical when it comes to speaking to patients about central nervous system upregulation or sensitization. Or when discussing the biopsychosocial aspect of pain. 

People don’t know what we know about that stuff and we shouldn’t assume that it’s an easy topic and everyone ‘gets it.’ Or will get it. I really cannot explain what happened there but, I do know it made me step back and think through it though. It made me check my communication. 

Again, I don’t tell you all this stuff because I love it or love to talk about it. I don’t tell you all my patient numbers weekly because I love it. I share this stuff with you because what is happening with me is real. It’s real life. And if it’s happening to me, then it IS happening to many of you. And if it’s not currently happening to you, it CAN or WILL and you may learn from me.  Not as a mentor per se but as that Ol’ Uncle Jeffro.

Alright, enough with the stress talk. Geez. Not very often at all. Maybe once every 5 years or so but when it happens……geesh. I take it personally, I take it home, I dwell on it, and I’m not too proud to admit that it affects me.

I care.

I truly do.

If you get anything from this podcast and all of these episodes, it should be that I care. I care about chiropractic patients, our profession, ethics, morals, professionalism, education, and doing it the right way. 

I care. 

Item #1 Let’s start out with this article that was in CNN Business last week. It’s an article by Chris Isidore called, “OxyContin maker to plead guilty to federal criminal charges, pay $8 billion, and will close the company”(Isidore 2020). It was published on October 21, 2020, it’s cold as hell in Texas but that….that’s hot.  The highlights of the article are that Purdue Pharma, the maker of OxyContin, has agreed to plead guilty and to pay more than $8 billion. Not only pay $8 billion but to also close down the company.  What? Yeah, they say the money will go to opioid treatment and abatement programs. “Purdue Pharma actively thwarted the United States’ efforts to ensure compliance and prevent diversion,” said Drug Enforcement Administration Assistant Administrator Tim McDermott. “The devastating ripple effect of Purdue’s actions left lives lost and others addicted.” They say, “The company doesn’t have $8 billion in cash available to pay the fines. So Purdue will be dissolved as part of the settlement, and its assets will be used to create a new “public benefit company” controlled by a trust or similar entity designed for the benefit of the American public.

Adjusting Disc Herniations and Bulges

 

The Justice Department said it will function entirely in the public interest rather than to maximize profits. Its future earnings will go to paying the fines and penalties, which in turn will be used to combat the opioid crisis.” Maybe it’s just me but that sounds Big Brother as hell to me. Don’t get me wrong, pharma companies, in many instances, are of the devil but to dissolve them, then recreate them and they be basically government run? I don’t know about all that but to me, that’s what this sounds a bit like. 

They go on to say, “That new company will continue to produce painkillers such as OxyContin, as well as drugs to deal with opioid overdose. “The company, which filed for bankruptcy in 2019, pleaded guilty to violating federal anti-kickback laws, as it paid doctors ostensibly to write more opioid prescriptions.” What a-holes. Paid doctors to write more opioid prescriptions. And what a-hole of a doctor do you have to be to take payment to write addicting prescriptions in the first damn place? Honestly.  Meanwhile, we recently crossed the 450,000 dead mark.

Dead from opioid-related overdoses. All the while we evidence-based chiropractors sit and watch stuff we could help treat just spiral out of control. We’re sitting on the bench waiting for the coach to put us in the game but we just rarely get our number called.  If they want to make surgeons the quarterback of the football team, at least we could be the running back or tight end or something. Geez.

We could be a key part of the pain team and research has told the stakeholders several times. But nope. We’re stuck riding the pine.  A little further down in the article, my worries are actually hit on when they say, “So some states are objecting to the settlement. Twenty-five state attorneys general wrote to US Attorney General William Barr last week arguing against the plan to create a government-controlled company out of the assets of Purdue Pharma, arguing that the government should not be in the business of selling OxyContin.”

And I agree with the 25 state attorneys general. That, to me, is not what American was built on.  Again, don’t get me wrong, I’m all about punishing the hell out of a corrupt and evil company like Purdue Pharma. I’m even all about putting them out of business. Hell, the Statler family that runs this business pulled $10 billion out of the company and placed into family trusts before filing bankruptcy. It’s a bad group of people. Lop they’re damn heads off if you think they deserve it…..OK, maybe not to that extent but you get my point. 

But, putting a company out of business and then stepping in as the government to take it over and run it…..no. I don’t like it. But that’s just me. 

CHIROUP ADVERTISEMENT

Item #2

Alright, my last one today is called “Twenty years of ‘insanity’ in diagnosing underlying clinically relevant cervical dysfunction using traditional MRI” by Anton Bowden(Bowden 2018) and published in the Journal of Spine Surgery in September of 2018 and it goes a little sumpin’ like dis. 

Why They Did It

Bowden starts by saying “Studies dating back several decades have failed to show a strong correlation between abnormal MRI scans of the intervertebral discs and clinical symptoms. Which you know if you’ve been following along. This is part of why the patient I mentioned earlier was mad at me for not immediately ordering an MRI. 

He continues, “The recently published 20-year prospective longitudinal study of cervical spine disc degeneration” by Daimon et al.(Daimon K 2019), is perhaps the strongest confirmation to date affirming that intervertebral discs naturally degenerate with age, and that evidence of degeneration alone is insufficient information with which to make a conclusion regarding the root cause of a patient’s symptoms.” We have covered that paper here on the Chiropractic Forward Podcast before.   They discuss the study at length saying, “Daimon et al. found that while MRI signal intensity longitudinally decreases across all cervical disc levels, there is a peak in structural degeneration that occurs at the C5–C6 level, with C4–C5 and C3–C4 having progressively lower degeneration rates. Since the C5–C6 level also corresponds with the highest flexion-extension range of motion of the cervical spine, a mechanical component of the degeneration process appears to be highlighted by the study.

Common Surgeries Aren’t Well-Researched & Chiropractic Wins Again

 

Once the C5–C6 level has been destabilized due to degeneration, sequential acceleration of degeneration at adjacent levels was observed. This insight has relevance to current discussions regarding adjacent-segment disease subsequent to arthrodesis and arthroplasty. The authors also observed that 95% of subjects experienced degenerative progression over the 20-year study period, while only 67% developed clinical symptoms. This observation lends strength to the argument that trying to fight all forms of disc degeneration is an insolvable fight against nature, at least for the foreseeable future.” I was happy to see him mention this, “As a biomechanist, I would be remiss to point out that imaging alone is missing fundamental information regarding the dynamic function of the spine. Spines that look very similar while lying down in the MRI may move very differently while going about activities of daily living—and the consequences can be dramatic for mechanical loading and pain in the discs and adjacent spinal structures “  Here on the show in some of the earlier episodes, we covered the fact that discs that show little to no issues in the supine position can look very different when seated or standing.

Significantly different as a matter of fact. The research has been done on this yet I’ve had discussions with two separate radiologists and both of them guessed there would be little to no change in the disc with position change.  That’s just not the case, is it? I’m happy to see this author recognize the fact.  Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world.

Keep taking care of yourself and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

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

Bibliography

  • Bowden, A. (2018). “Twenty years of ‘insanity’ in diagnosing underlying clinically relevant cervical dysfunction using traditional MRI.” J Spine Surg 4(3).
  • Daimon K, F. H., Nishiwaki Y, (2019). “A 20-year prospective longitudinal MRI study on cervical spine after whiplash injury: Follow-up of a cross-sectional study.” J Ortho Science 24(4): 579-583.
  • Isidore, C. (2020) “OxyContin maker to plead guilty to federal criminal charges, pay $8 billion, and will close the company.” CNN Business.

 

Chiropractic Helps VA Cut Opioids & Diagnosing Lumbar Stenosis

CF 146: Chiropractic Helps VA Cut Opioids & Diagnosing Lumbar Stenosis

Today we’re going to talk about the success of the VA in reducing prescription opioid use – psst, guess who has helped them do that? And we’ll talk about diagnosing and testing for stenosis.

But first, here’s that sweet sweet bumper music

Subscribe button

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

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

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

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

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

Do it do it do it. 

You have found yourself smack dab in the middle of Episode #146

Now if you missed last week’s episode , we talked about how even kids can hurt. We talked about manipulation for lumbar radiculopathy. And we talked about the lack of attention found on the chiropractic boards for biopsychosocial issues. Make sure you don’t miss that info. Keep up with the class. 

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

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

Kids Still Hurt, Manipulation For Lumbar Radiculopathy, & Lack Of Attention On The Boards For Biopsychosocial Matters

 

On the personal end of things…..

To kick off on a cool note you’ll all appreciate, I have a patient that is a med school student that has had amazing results for a pretty significant and lingering disc injury. Your truly opened his eyes to the power of what an evidence-based chiropractor is capable of and it’s paid off for him and, the more of the younger docs that experience something like he has with chiropractic, the more accepted the evidence-based faction of our profession becomes. And the more accepted, the more referrals we get. 

That’s not the good news I wanted to share though. The good news is that he said in one of his classes last week, when they were talking about back pain, manipulation was recommended. In med school. Did you freaking A hear that? Med school is now teaching medical doctors that spinal manipulation isn’t only accepted…..but it’s reco-freaking-mended. 

Bam, Kapow, Zap, Snap, Whack!!

Super hero noises for cool stuff. Hell yeah. 

Moving on, now that school is up and rocking and people are in their normal routines once again, the growth I was talking about a week or two ago is showing to be sustainable at this time. 17 new patients last week tells me we may be slowly getting back to where we were before the Rona. Climbing out of the hole slowly but surely. 

I know all states are different. Here in Texas, as many of you may suspect, is challenging. We probably have A LOT more anti-maskers than many states out there have. We’ve been at work, live…in person since May 1st. Some chiros never took the 2 weeks to step back and see what was up. They just kept motoring through. And….I have to say it looks like they were the smart ones from what I’ve seen. 

I lost out on 2 weeks of work by shutting down completely. Not only that, but from April 1st or so, we were open but emergency only. Honestly…..how many emergencies do we have? We have some but they’re not going sustain my practice. So….I lost two weeks but only doing the emergency thing made me lose a lot of business as well. 

Then, we’re open to everyone and anyone basically on May 1st. Cool, but it took a good while before people started coming in. They knew we closed for a bit and didn’t always know we were back open. Plus, a ton of them were just scared. Understandably. 

So, as with everyone else that follows science, rules, and recommendations, we lost out. For sure. Since I’ve been back at it….again….May 1st, it seems that maybe we could have been safely going the whole time. I could look back and be upset that I followed the rules and that I’m a boy scout like that. But, I’m not going to be. Because how quickly we may forget; it was spooky. Nobody knew the mortality rate. Nobody knew what percentage end up in the hospital or what percentage gets put on a ventilator and how those percentages change from age group to age group. 

We didn’t know anything about it. When you get reports that the death rate is as high as 5% and then a separate paper says it lives on plastic as much as 3 days…..well hell. Please excuse me a sec while my anxiety goes through the roof. I mean, I want to be polite and excuse myself but yeah, the anxiety was going through the roof for myself as well as for the majority of us out there. Not the subluxation slaying spine whisperers of course but for us sciencers….yeah….we were concerned. 

Now we know so much more. We know when everyone in the clinic is masked, we lower our chances of transmission. Life is continuing. Anxiety is still somewhat up there. But life’s continuing as it all seems to work itself out.  The college kid cases are going up all the time. As expected because they’re kids and they’re knuckleheads. As long as they don’t take it home to vulnerable folks, then I don’t see it as harmful. It’s only helpful. 

My daughter has been going to in-person on-campus junior high with over 1,000 fellow knuckleheads. In the first six weeks there have been 2-3 teachers come down with it and about 4 kids. While that may seem a lot to some of you, I see it as a win so far. All of those people in one building together for 6 weeks and that’s all the spread we have? And let’s be fair, I know one of the teachers for sure got it from her husband who brought it home from work. 

To me, it means so far, they are not giving it back and forth to each other at the schools as long as they’re being careful and masking. So far. I really thought they’d all be closed down and go back to strictly online learning by now. I’m still pleasantly wrong. I’ll take it. 

Alright folks Enough Rona rambling. I don’t start talking about it becuase I love the topic. I’ll admit that I do find it all fascinating though. I really do. I’m a bit nerdy about stuff like that. 

Anyway, I talk about it every week because….damnit….that’s what’s going on. It’s the way it is. It’s in my personal happenings as it is in yours as well. So, I might as well talk about it and share with you my experiences, what I’m seeing in my practice, and how I’m muddling through this mess. It’ll either let you know you’re not alone or it’ll show you what you don’t want to do. I’m good either way. As long as you get some use out of it!

Item #1

This one comes from the Office of Public and Intergovernmental Affairs(2020) and is called “VA reduces prescription opioid use by 64% during past eight years.” It was published online on July 30, 2020…..yep…..pretty damn hot. 

This was an article that was basically announcing that t he VA has successfully reduced prescription opioid use in patients within the VA system by 64%. They went from more than 679.000 veterans in 2012 to 247,000 in 2020. 

Lancet Low Back Update & Movement Disorders Mean Pain

 

They say they achieve this dramatic reduction by safer amd more responsible use of opioids but also by treating chronic pain using alternative therapies and treatments. Guess who’s a big part of that? Chiropractors. Yep that’s right. And to be fair…acupuncturists as well. We are getting referrals from the VA for both chiropractic and acupuncture. 

They say, the “VA takes an interdisciplinary approach to care focused on a Veteran’s Whole Health by using non-pharmacological, complementary pain management treatments, self-care, skill building, and support to transition from a biomedical to a biopsychosocial model of pain care. “

How many times have you heard me screaming about the biopsychosocial aspect of chronic pain? A LOT….a lot…

If you follow the link in the article to their list of complementary pain management treatments, chiropractic and acupuncture are the first two listed. Good stuff people. Good stuff. 

They’re just not there yet but wouldn’t have been nice if the title was something like, “The VA system reduces opioids 64% by be smarter and by using chiropractic and acupuncture.” I’m not holding my breath for that day but it really should read just like that. Baby steps I suppose. Itty bitty, teensy weensy baby steps it seems. 

Next paper covers diagnostic tests for stenosis but…

Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. I love new toys! If you’re into soft tissue work, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend.

Drop Release uses fast stretch to stimulate the Golgi Tendon Organ reflex.  Which causes instant and dramatic muscle relaxation and can restore full ROM to restricted joints like shoulders and hips in seconds.  

Picture a T bar with a built-in drop piece.  This greatly reduces time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day.  Drop Release is like nothing else out there, and you almost gotta see it to understand, so check out the videos on the website.

It’s inventor, Dr. Chris Howson, from the great state of North Dakota, is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase.

Go check Drop Release at droprelease.com and tell Dr. Howson I sent you.

Item #2

This one is called “Diagnostic tests in the clinical diagnosis of lumbar spinal stenosis: Consensus and Results of an International Delphi Study” authored by Tomkins-Lane et. al(Tomkins-Lane C 2020). and published in European Spine Journal in June of 2020. Damn hot enough!

Why They Did It

The authors wanted to reach a consensus on which diagnostic tests are most important in confirming the clinical diagnosis of lumbar spinal stenosis

How They Did It

  • Phase 1: 22 members of the International Taskforce on the Diagnosis and Management of LSS confirmed 35 diagnostic items
  • An on-line survey was developed that allows experts to express the logical order in which they consider the diagnostic tests, and the level of certainty ascertained from each test.
  • Phase 2, Round 1: Survey distributed to members of the International Society for the Study of the Lumbar Spine
  • Round 2: Meeting of 15 members of Taskforce defined final list of 10 items.
  • Round 3: Survey was distributed internationally, followed by Taskforce consensus.

What They Found

  • 432 clinicians from 28 different countries participated
  • Certainty of the diagnosis was 60% after selecting the first test and significant change in certainty ceasing after eight items at 90.8% certainty
  • The most frequently selected tests included MRI/CT scan, neurological examination and walking test with gait observation. 
  • The diagnostic test selected most frequently as the first test was neurological examination.

Wrap It Up

“This is the first study to reach an international consensus on which diagnostic tests should be used in the clinical diagnosis of LSS. The final recommendation includes three core diagnostic items: neurological examination, MRI/CT and walking test with gait observation. The Taskforce also recommends 3 ‘rule out’ tests: foot pulses/ABI, hip examination and test for cervical myelopathy.”

Related but on a separate note, the grocery cart sign hints you toward stenosis. If walking through a grocery store just kills the patient but they can lean over on the cart with their elbows and that alleviates the pain….or if sitting removes the complaint fairly quickly, you need to start sniffing up the stenosis tree. 

I am a big fan of Dr. Carmen Amendolia’s program which he was able to validate through research. It’s called the Boot Camp for Stenosis and it’s REALLY turned a very difficult condition to treat into a much more successful outcome for me personally. 

Basically, it’s just a lack of real estate in the canals and this program helps the patient understand the condition as well as self manage after a 2xweek for 6 week protocol. It’s well-thought out and very well done. And easy to do and understand. 

I highly recommend it. Your stenosis patients will thank you profusely.  

Alright, that’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.

Let’s get to the message. Same as it is every week. 

Key Takeaways

Store

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

Subscribe Button

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

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

Connect

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

Website

Home

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

  • (2020). “VA reduces prescription opioid use by 64% during past eight years.” VA US Dept Veterans Affairs.
  • Tomkins-Lane C, M. M., Wong A, (2020). “Diagnostic tests in the clinical diagnosis of lumbar spinal stenosis: Consensus and Results of an International Delphi Study.” European Spine Journal 29: 2188-2197.

 

Chiropractors Affected By COVID, 2019 Opioid Overdoses, Insurance Compensation For Chiropractic

CF 139: Chiropractors Affected By COVID, 2019 Opioid Overdoses, Insurance Compensation For Chiropractic

Today we’re going to talk about Chiropractors Affected By COVID, 2019 Opioid Overdoses, Insurance Compensation For Chiropractic

But first, here’s that sweet sweet bumper music

Subscribe button

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

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

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

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

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

Do it do it do it. 

Chiropractic’s Effect On Strength and More, Status of Muscle Relaxers, And The Best Recovery Posture

 

You have found yourself smack dab in the middle of Episode #139

Now if you missed last week’s episode , we talked about NSAIDs, cognitive behavioral therapy and vitalists ignoring stuff. Make sure you don’t miss that info. Keep up with the class. 

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

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

On the personal end of things…..

Personal means personal right? Well, I’m still working on getting the whole voice-over gig set up and rocking and rolling. What’s voice over you may ask? Well, the voices you hear on commercials, eLearning, promos, radio bumpers, and even cartoons and stuff like that. That’s voice overwork. 

Here’s my thought and I’ve said it here before; I don’t want to die in my office working on people when I’m 80. God bless those of you that love the daily grind so much that that’s your goal. It takes all sorts, doesn’t it? But that’s not me. I want to hire an associate and mentor them over the course of a certain amount of time and then sell my practice to them eventually. 

I’m a musician/singer/songwriter. I’m a sculptor. A portrait artist, furniture builder, and all kinds of other things. I love to travel as well. So, what kind of work could I do that would allow me some retirement income and can be done literally from anywhere in the world with an internet connection? Voice over of course. So, I started working on it once the Rona showed up. I’m taking some classes and building some skills and equipment and knowledge. 

The thought process is, if I start now, in 5 years it may be a very viable way to add to my weekly income in retirement. I have other things I’m looking at as well but this is the one I’m knee-deep in right now. 

I have friends that tell me they only get 24 hours in a day and I get more like 48. Lol. That’s not true of course but I do keep moving, keep thinking, keep working pretty much non-stop and move from one thing to another fairly quickly trying to multi-task and get it all done on some sort of time scale. 

I adhere to an old saying I try to always remember; time is just time. You’re either investing in it or you’re wasting it. I don’t like to waste time all that much. There’s always time to sit and relax here and there but, in general, I’m not much for wasting it. 

As far as business, we’re marketing like crazy. I’ve put more into marketing in the last 3 months than I have in the last three years and guess what…..80%. We’re still at about 80% of where I was and like I said last week, that’s my new normal and I’m done making myself crazy about it. I’ll take this extra time and I’ll continue to invest in it. 

So I’m anxious to see what happens. I have things working inside chiropractic. I have things working outside chiropractic. Let’s see which mud sticks to the wall. If any of it sticks at all, right? We never know but it’s exciting to be productive. It’s exciting to be creative. And it’s exciting to have the prospect of more income and more options as to your future. 

That’s where I’m at right now. I just turned 48. I  have less time in front than behind. I’m not getting younger so it’s time to step on the gas. And that’s what I’m doing. This pandemic crap isn’t going to last forever and I plan on sitting pretty in time to retire so let’s just get started right now shall we?

Item #1

Speaking of ‘pandemic crap’, here’s a paper called “The impact of COVID-19 on the chiropractic profession: a cross-sectional survey on opinions, professional changes, and personal hardships of US chiropractors” by Neff et. al(Neff S 2020). published in Chiropractic and Manual Therapies posted on 15 of July 2020 and dammit if that’s not hot then I don’t know what is, people. 

Now, before I get going on this one, I recognize three of the authors’ names from the Forward Thinking Chiropractic Alliance group on Facebook. Once again, if you’re considering yourself an evidence-based, patient-centered chiropractor rather than a vitalist, get in that group. You can learn a ton. Anyway, Shawn Neff, Rebecca Deyo who I’ve mentioned on this show before, and Annabelle MacAuley. All very smart, very talented doctors of chiropractic. 

Why They Did It

The research was conducted to collect self-reported data on how COVID-19 has affected U.S. doctors of chiropractic. I’m glad someone is paying attention to us and all. Honestly, chiropractors get the fat end of the bat don’t we? Who got PPE delivered to your office by the state back in April?

Yeah, me either. Anyway……

How They Did It

  • An electronic survey was sent to U.S. chiropractors nationwide via social media and email. 
  • The survey collected 
  • personal and practice demographic information, 
  • office protocols, 
  • changes made during COVID-19, 
  • chiropractic profession opinions/stances, 
  • information related to stress, and 
  • personal beliefs/opinions.
  • Data were analyzed using descriptive statistics.

What They Found

  • 750 U.S. chiropractors responded. 
  • Just over half of respondents reported moderate levels of stress, and 
  • Just over 30% reported severe levels due to a variety of reasons related to both personal and professional circumstances. 
  • The primary stressors were financial and business concerns. 
  • The highest stress levels were among employers responsible for others. 
  • A majority reported beliefs that the chiropractic profession should not advertise that spinal manipulation provides any immune system benefit. 
  • 13% of the respondents believed chiropractors should be marketing immune benefits during this time. 
  • A shift toward telehealth was reported, with 18% adding it to their services.

Wrap It Up

“Stress levels were high across the population. A range of opinions existed regarding spinal manipulation and immunity benefits. The majority reported there was not sufficient evidence to support such a belief; however, a group of respondents believed that chiropractors should be marketing immune-enhancing benefits to the population. A logical next step would be to study why such beliefs persist. This information may be useful in better understanding how chiropractors have experienced the global effects of COVID-19 across the United States.”

Adjusting Disc Herniations and Bulges

 

So…..if you want to know how many are vitalists and how many are evidence-based or, at minimum….agnostic….then doesn’t this give us some hints? A vitalist would claim to take the pressure off of nerves allowing the innate life force to better express itself rendering you immune to the disease. That sounds like about 13% of chiropractors surveyed. 

That tells me 87% call shenanigans on the rest of it. It’s been a while since I heard a number. We know its the minority but damnit they’re a loud minority, aren’t they? They’ve kept us right here without cultural authority for over 100 years at this point. 87% is pretty high though. Maybe it’s changing. 

I saw another recent survey where only a very small percentage of chiropractors were interested in learning more about chiropractic philosophy. I think it’s fine as a historical thing. Just not as something that keeps controlling our profession and keeps us at the bottom of the barrel. 

Love me or hate me, at least I’m honest and you know where I stand. 

Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. I love new toys! If you’re into soft tissue work, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend.

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

 

Drop Release uses fast stretch to stimulate the Golgi Tendon Organ reflex.  Which causes instant and dramatic muscle relaxation and can restore full ROM to restricted joints like shoulders and hips in seconds.  

Picture a T bar with a built-in drop piece.  This greatly reduces the time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day.  Drop Release is like nothing else out there, and you almost gotta see it to understand, so check out the videos on the website.

It’s inventor, Dr. Chris Howson, from the great state of North Dakota, is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase.

Go check Drop Release at droprelease.com and tell Dr. Howson I sent you.

Item #2

This second one is a report from CNN on opioids called “Drug overdose deaths jump in 2019 to nearly 71,000, a record high, CDC says” by Shelby Lin Erdman on July 16, 2020(Erdman 2020). Hot stuff….come on now. Make way people!

This was an article so we’ll be like a boat on the lake and just skip across the high spots. How about that?

  • Drug overdose deaths in the US jumped last year by about 4.8%. 
  • 2018 was slightly down from 2017
  • 2019 bumped back up to 71,000 overdose deaths. 
  • The former president of the American Medical Association, Dr. Patrice Harris, said the numbers show why it’s important to remove any obstacles to treatment for those addicted to drugs. While I think that’s worthy, I think it’s important to not that there should be no obstacles in place to see alternative practitioners in the first place when some of these folks presented with pain. The White House report in 2016 and The Lancet report on back pain both agreed there are obstacles in place preventing these kinds of patients from seeing chiropractors. 

Item #3

This one is called “Trends in Insurance Coverage for Complementary Health Care Services” by Whedon et. al(Whedon JM 2020). published in the Journal of Alternative and Complementary Medicine on July 7, 2020. The roof, the roof…it’s on fire. 

Why They Did It

Complementary health care professionals deliver a substantial component of clinical services in the United States, but insurance coverage for many such services may be inadequate. The objective of this project was to follow up on an earlier single-year study with an evaluation of trends in reimbursement for complementary health care services over a 7-year period.

How They Did It

  • The authors employed a retrospective serial cross-sectional design to analyze health insurance claims for services provided by licensed acupuncturists, chiropractors, and naturopaths in New Hampshire (NH) from 2011 to 2017. 
  • They restricted the analyses to claims in nonemergent outpatient settings for Current Procedural Terminology code 99213, which is one of the most commonly used clinical procedure codes across all specialties. 
  • They evaluated by year the likelihood of reimbursement, as compared with primary care physicians as the gold standard. 

What They Found

  • The total number of clinical services claimed was 
  • 26,725 for acupuncture, 
  • 8317 for naturopathic medicine, 
  • 2,539,144 for chiropractic, and 
  • 1,860,271 for primary care. 
  • Initially, the likelihood of reimbursement for naturopathic physicians was higher relative to primary care physicians but was lower from 2014 onward. 
  • Odds of reimbursement for both acupuncture and chiropractic claims remained lower throughout the study period. 
  • In 2017, as compared with primary care the likelihood of reimbursement was 
  • 77% lower for acupuncturists, 
  • 72% lower for chiropractors, and 
  • 64% lower for naturopaths.

Wrap It Up

“The likelihood of reimbursement for complementary health care services is significantly lower than that for primary care physicians in NH. Lack of insurance coverage may result in reduced patient access to such services.”

So when we talk about barriers to seeing safer, non-invasive practitioners, don’t tell me there are none. Don’t piss on my leg and tell me it’s raining. 

What was the Tommy Boy reference? You can get a good look at a t-bone by sticking your head up a bull’s ass but wouldn’t you rather take the butcher’s word for it? Or no…..it’s gotta be YOUR bull. Lol. Great movie. 

Anyway….buncha hullabaloo. Research and surveys are so clear and mostly consistent when they say spinal pain is so bad yet chiropractic is so good at treating it. Not only in terms of effectiveness but also in terms of patient satisfaction and even long term outcomes when compared to traditional treatment. The damn White House report a few years ago said there are barriers. The Lancet said it. I’ve seen it other places that aren’t coming to mind but it’s clear there are barriers in place set up by the stakeholders, the insurance gurus, the medical professionals….. All go 180 degrees from what the research tells them to do. 

And they keep going that way. It feels like it’s not turning around. At all. So…..shenanigans. I’m calling shenanigans. 

Alright, that’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.

Let’s get to the message. Same as it is every week. 

Key Takeaways

Store

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

Subscribe Button

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

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

Connect

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

Website

Home

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

 

Bibliography

  • Erdman, S. L. (2020) “Drug overdose deaths jump in 2019 to nearly 71,000, a record high, CDC says.” CNN.
  • Neff S, D. R., MacAuley A, Lawrence D, (2020). “The impact of COVID-19 on the chiropractic profession: a cross-sectional survey on opinions, professional changes, and personal hardships of U.S. chiropractors.” BMC Chiro Man Ther.
  • Whedon JM, e. a. (2020). “Trends in Insurance coverage for Complementary Health Care Services.” J Altern Complement Med.

 

Chiropractic’s Effect On Strength and More, Status of Muscle Relaxers, And The Best Recovery Posture

CF 136 Chiropractic’s Effect On Strength and More, Status of Muscle Relaxers, And The Best Recovery Posture

Today we’re going to talk about Chiropractic’s Effect On Strength and More, Status of Muscle Relaxers, And The Best Recovery Posture But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products

Integrating Chiropractors

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

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

Check your JUNK folder!! Do it do it do it. You have found yourself smack dab in the middle of Episode #135 Now if you missed last week’s episode, we talked about adjusting in the areas of known disc complications, bulges, herniations..things of that sort. Make sure you don’t miss that info. Keep up with the class. While we’re on the topic of being smart, did you know that you can use our website as a resource?

Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points. Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.

On the personal end of things….. Nothing new to report really. We aren’t growing in our visit count week to week but, at the same time, we aren’t shrinking either. We’re holding steady at about 80% of where we were before the COVID train wreck and here’s what I’ve sort of decided. I’m just going to be OK with 80%.

Like I said last week, while we’re billing out less and collecting less, we’re also spending less both in the practice as well as in my personal life. Some of you aren’t. Some of you think it’s a hoax and all that stuff. You’re going out and traveling and vacationing and all that jazz. We aren’t. We are not afraid but we also do want to be smart and be diligent. I’ve come to the mindset that if I wind up getting it, I’ll probably do just fine with some time but regardless of how severe or mild symptoms are, I’ll STILL have to shut my office down.

Now, how many of us can afford to just shut the doors for 2-4 weeks without any issues? Honestly, I’m a saver so I could actually do it and survive but I damn sure don’t want to. I have other plans for that money don’t you know. It wasn’t saved so that I could cover my practice financially if I get sick for a month. Hell no. It was saved to invest. So, we are being smart, we are wearing our masks and no….I don’t give one damn what anyone thinks about masks. Honestly. This has been the most disappointing aspect of human observation in recent memory.

The mask debate or debacle. Absolutely a waste of time and energy talking or listening to people on that deal. Anyway, we are wearing our masks. Our patients are wearing their masks. We are still cleaning and having our lobby closed. We are still not allowing visitors in with our patients. We are still using our UV air scrubbers in each room. We are still doing it to keep my most fragile patients safe and confident in us as a clinic, we doing it all to protect the staff, and we’re doing it to protect me as much as possible so we don’t all have to shut down for a month.

Makes perfect sense to me.

We know some things that increase your chances of having a hard time with COVID. Or at least there is some research to back up that low vitamin D puts you at risk. Obesity, underlying conditions like diabetes, low testosterone, smoking, and being of the blood type A. These are just a few things I recall off the top of my head. My question to you is, “What factors under your control are you bolstering or addressing?” I am overweight. I’m naturally a big guy but I’ve gotten a little lazy in the last 5 years. OK…..A LOT lazy.

I started the Couch to 5K program a few weeks ago and am slowly trudging through that. My knees are super pissed at me about it but I’m still doing it. I have addressed any hormone issues I needed to look at. I have gotten on a Vitamin D replacement regimen. I am trying to get more sleep more consistently. I don’t smoke.

Of course, there’s nothing you can do about what type of blood you are but….my point is, what steps are you taking to lower your risk of complications should you wind up with it? I’d love to hear if you’ve changed anything at all or if you’re just like the Russian boxer Drago in Rocky 4…..If he dies, he dies.

Item #1 Let’s get to it. This first one is not sexy. I’m saving the better ones for here in just a minute. Let’s start off nice and simple here with one called “Effects of Two Different Recovery Postures during High-Intensity Interval Training” by Michaelson, et. al(Michaelson J 2019). and published in Translational Journal of the ACSM in February of 2019. Hmmmmmm…..yep… Hot enough. Out of the way.

Why They Did It The purpose of this study was to examine the effects of two different recovery postures, hands on head (HH) and hands on knees (HK), as a form of immediate recovery from high-intensity interval training (HIIT).

How They Did It Twenty female Division II varsity soccer players completed two experimental trials in a randomized, counterbalanced order. Each trial consisted of four intervals on a motorized treadmill consisting of 4 min of running at 90%–95% max heart rate with 3 minutes of passive recovery between each interval. Heart rate recovery was collected during the first 60 seconds of each recovery, where the volume of carbon dioxide and tidal volume were recorded each minute during the 3-min recovery period.

What They Found Results showed an improved heart rate recovery, greater tidal volume, and increased volume of carbon dioxide, with hands on the knees when compared with hands on the head.

Wrap It Up “These data indicate that HK posture may be more beneficial than the advocated HH posture as a form of immediate recovery from high-intensity interval training.”

Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. If you’re into IASTM also known as instrument-assisted soft tissue manipulation, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend. Drop Release is a revolutionary tool that harnesses the body’s built-in protective systems to make muscles relax quickly and effectively.  This greatly reduces time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day. Its inventor, Dr. Chris Howson, from the great state of North Dakota has is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase. Go check Drop Release at droprelease.com and tell Dr. Howson I sent you.

Item #2 Item 2 is called “Assessment of Physician Prescribing of Muscle Relaxants in the United States, 2005-2016” by Soprano et. al(Soprano S 2020). and published in JAMA Open on June 24, 2020 and that’s damn sure a steaming heaping helping right there.

Why They Did It They wanted to measure national trends in muscle relaxant prescribing over a 12-year period. 2005-2016

How They Did It It was a cross-sectional study It used data from the National Ambulatory Medical Care Survey The study included those with ambulatory care visits with non-federally funded, office-based physicians in the US Included almost 315,000,000 office visits.

What They Found Get this y’all – During the study period, office visits with a prescribed muscle relaxer nearly doubled from 15.5 million in 2005 to 30.7 million in 2016 Although visits for new muscle relaxer prescriptions remained stable, office visits with continued muscle relaxer drug therapy tripled from 8.5 million visits in 2005 to 24.7 million visits in 2016 Older adults accounted for 22.2% of visits with a muscle relaxer prescription. Concomitant use of an opioid was recorded in 67.2% of all visits with a continuing muscle relaxer prescription.

Wrap It Up “This study found that SMR use increased rapidly between 2005 and 2016, which is a concern given the prominent adverse effects and limited long-term efficacy data associated with their use. These findings suggest that approaches are needed to limit the long-term use of SMRs, especially in older adults, similar to approaches to limit the long-term use of opioids and benzodiazepines.” And we wonder how we ended up with an opioid and pill problem. Cheese ’n’ rice people. Godzilla it’s just clear as day but nobody’s listening. Are you inundated with referrals from physicians in 2020? Some of you are. Most of you, the large very vast majority of you are not at all and it’s a shame because we can prevent so much of this garbage.

Item #3 Alright, the last item and my favorite one this week. It’s called “Effects of Chiropractic Care on Strength, Balance, and Endurance in Active-Duty U.S. Military Personnel with Low Back Pain: A Randomized Controlled Trial” by Vining et. al(Vining R 2020). published in the Journal of Alternative and Complementary Medicine in July of 2020. Another helping of boiling thought nuggets for you to feast upon.

Why They Did It They wanted to investigate whether chiropractic care influences strength, balance, and/or endurance in the active-duty United States military personnel with low back pain

How They Did It It was a prospective randomized controlled trial using a pragmatic treatment approach Participants were randomly allocated to 4 weeks of chiropractic care or to a wait-list control Chiropractic care consisted of spinal manipulation, education, advice, and reassurance Naval Air Technical Training Center branch clinic at the Naval Hospital Pensacola Florida One hundred ten active-duty military personnel 18-40 years of age with self-reported LBP Outcome measurements included Isometric pulling strength from a semi-squat position was the primary outcome. Secondary outcomes were single-leg balance with eyes open and eyes closed, and trunk muscle endurance using the Biering-Sorensen test. Patient-reported outcomes such as pain severity and disability were also measured. Outcomes were measured at baseline and 4 weeks. Linear mixed-effects regression models over baseline and 4 weeks were used for analysis.

What They Found Participants had a mean age of 30 years, 17% were female, 33% were non-white, and 86% reported chronic LBP. Mean maximum pulling strength in the chiropractic group increased by 5.08 kgs and decreased by 7.43 kgs in the wait-list group, with a statistically significant difference in mean change between groups Statistically significant differences in mean change between groups were also observed in trunk muscle endurance and balance with eyes closed, but not in balance with eyes open Differences in mean change between groups were statistically significant in favor of chiropractic for LBP-related disability, pain intensity and interference, and fear-avoidance behavior.

Wrap It Up “Active-duty military personnel receiving chiropractic care exhibited improved strength and endurance, as well as reduced LBP intensity and disability, compared with a wait-list control.”

Alright, that’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week. Store Remember the evidence-informed brochures and posters at chiropracticforward.com.

Chiropractic evidence-based products

Integrating Chiropractors

This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg

This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg

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

The Message

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

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

That’s Chiropractic!

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

Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website 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 – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

Michaelson J, B. L., Suprak D, McLaughlin W, Dahlquist D, (2019). “Effects of Two Different Recovery Postures during High-Intensity Interval Training.” Translational J ACSM 4(4): 23-27.

Soprano S, H. S., Bilker W, (2020). “Assessment of Physician Prescribing of Muscle Relaxants in the United States, 2005-2016.” JAMA Open 3(6).

Vining R, L. C., Minkalis A, Gudavalli MR, Xia T, Walter J, Coulter I, Goertz C, (2020). “Effects of Chiropractic Care on Strength, Balance, and Endurance in Active-Duty U.S. Military Personnel with Low Back Pain: A Randomized Controlled Trial.” J Altern Complement Med 26(7): 592-601.

Primary Spinal Practitioner, Gabapentin, Cervical Curvature

CF 123: Primary Spinal Practitioner, Gabapentin, Cervical Curvature

Today we’re going to talk about the primary spinal practitioner program, research on gabapentin and its use in low back pain and radiculopathy, and we’ll talk about cervical curvature…what’s the research?

But first, here’s that sweet sweet bumper music

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

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

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

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

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

Do it do it do it. 

You have found yourself smack dab in the middle of Episode #123

Now if you missed last week’s episode , we talked about chiropractic primary prevention research, we talked about TENS use for migraines in the ER, and we talked about research for acupuncture with chronic pain. Make sure you don’t miss that info. Keep up with the class. 

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

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

On the personal end of things…..

Well another pandemic week in the books. I’m recording this on April the 29th, 2020 and it’s quite a mess still. We have states that are still climbing in cases dramatically but still opening up businesses. 

I’ve been telling people that I’m in the middle on this deal. We have to get out. We can’t stay in our cocoons and watch our businesses die. I was that way for a bit honestly. But we just can’t do that. At the same time, it’s not time to open wide and let ‘er rip either. We have to have a measured opening keeping a watch on the cases. 

The great news emerging is the number of asymptomatics they are identifying. It really does all come down to testing. You don’t know what you’re dealing with if you can’t tell who the heck has it. Wouldn’t it be amazing if we are blessed enough to be one of those asymptomatics that simply have no symptoms and no idea we even had the damn thing? 

The problem is that at least for now, we have to go about as if we are asymptomatic carriers basically. The last thing I’d ever want is to unknowingly give it to my 74-year-old mother or my 80-year-old stepdad. That’s not my idea of being a good person at all. Lol. 

I also have a dad in a nursing home and that’s been tough for sure. I know they do what they can to entertain them but they’re basically forced to keep all of the residents separated in case the bug is lurking about. So, they end up in their rooms most if not all of the day I think. 

We haven’t been allowed in to see him since middle March or so. Which is frustrating. He had a stroke so he’s not always all there and can be a bit confused about why people aren’t visiting. Getting him on the phone has been a challenge as well but we’re making due. 

It’s a tough time for everyone right now. But I’m a glass half-full guy. This too shall pass. We’re going to be OK. People are going to eventually get out and about. People are going to eventually start re-engaging in the economy. Until then, financial institutes and the government will continue to make accommodations for business owners. 

Keep the faith brothers and sisters. The general curve in our country right now is downward. I believe there’s light at the tunnel. Just stay smart and stay safe until we reach that light.  

Before we get started, I did a thing

I’ve always wanted to help others with their message and how they’re getting it out there. Keeping that in mind, during this lull in business due to the pandemic, I decided to try something different and invest my time instead of waste it. I’ve certainly had the time to invest as have most of us.

I did two episodes on marketing an evidence-based practice a few months ago and both of those episodes are among our most listened to, most popular episodes so I know there is value there and I know there’s an interest in the topic. 

Over the years, if I wanted to learn more about excel, I’d take a course over at udemy.com. If I wanted to learn more about marketing, udemy proved to be a valuable resource. If you’re not familiar with sites like Udemy or Teachable, you should go check it out. 

I haven’t really looked into what other chiropractors are using it for but I thought, if I wanted to offer a course, Udemy would be a good place to start. While I’m still building the course and adding content every week, it’s live and ready to go for those interested. If it’s not, it will be live in only a day or two. 

If you’re interested, I created, basically, my playbook for marketing and my thoughts on each topic or technique. I also have created downloads, checklists, and examples to show what my stuff looks like. 

https://www.udemy.com/course/marketing-evidence-based-chiropractic/?referralCode=36A4D91C66B48300360B

Just go to udemy.com and do a search on Marketing An Evidence Based Chiropractic Practice and check it out. See what you think. It’s my first online course to create so any feedback is appreciated. Over time, I’ll be updating the content and adding graphics, and things like that as I finish the initial bulk of the work and am able to revisit and re-work parts that could use it. Plus, I plan on responding to feedback and make any needed changes from there as well.

https://www.udemy.com/course/marketing-evidence-based-chiropractic/?referralCode=36A4D91C66B48300360B

Item #1

This one is not a research paper as much as it is an article. It is from way back in 2011 but is as relevant or more relevant than it’s ever been today. This one is called, “The establishment of a primary spine care practitioner and its benefits to health care reform in the United States” by Donald Murphy et al(Murphy D 2011) and published in Chiropractic and Manual Therapies journal. I have the citation in the show notes if you’d like to look deeper at this

Why They Did It

They highlight the issue with spine-related treatments, the costs, the lack of any real effectiveness to justify the rising costs and make the argument that a key answer to theses issues includes having a group of practitioners trained to function as primary care practitioners for the spine. 

Let’s hit some of the highlights here:

  • Spine-related disorders (SRDs) are among the most common, costly and disabling problems in Western society. For the purpose of this commentary, we define SRDs as the group of conditions that include back pain, neck pain, many types of headache, radiculopathy, and other symptoms directly related to the spine. Virtually 100% of the population is affected by this group of disorders at some time in life.
  • A variety of physicians and other providers have traditionally been involved with the diagnosis and treatment of these patients. This includes primary care physicians, chiropractic physicians, orthopedic surgeons, neurosurgeons, physiatrists, osteopathic physicians, physical therapists, psychologists, massage therapists, kinesiologists, naprapaths and acupuncturists. This has resulted in what has been termed the “supermarket approach” to the management of SRDs [19]. That is, the SRD patient is faced with an environment in which there is a large number of practitioners, each offering a solution to SRDs, with the patient left to sort out which of these disparate approaches is best for his or her particular problem. Oftentimes this determination is based more on salesmanship and marketing than on science, clinical benefit and cost-effectiveness. Lawd don’t we know some surgeons and some chiropractors that are salesmen? And scare care tacticians?
  • Treatment for SRDs has become increasingly specialist-focused, imaging-oriented, invasive and expensive. 

  • One approach to health care reform would designate primary care physicians (PCPs) or groups of PCPs as “patient homes”, responsible for the comprehensive care and management of a designated patient population under a risk-sharing agreement
  • In their book Redefining Health Care [26], Porter and Teisberg state that for health care reform to be successful, it must incentivize competition based on value, i.e., outcome per dollar spent. To maximize value in health care, they recommend physicians and other health care providers organize themselves around conditions in which they have maximal expertise and experience (chronic kidney disease, diabetes, SRDs) rather than around medical specialties (orthopedics, internal medicine, neurology, etc.) and compete on the level of providing the best health outcomes for these conditions at the best possible cost (i.e., providing value). Ohhhh, that sounds fun because the Palmer/Gallup surveys show chiropractors get patients better for less money and patients are happier with chiropractors than PTs and GPs. I think the good chiropractors would fair particularly well in this scenario. 
  • We think that the health care system needs an appropriately trained and skilled clinician who can fill the role of a primary care provider for the diagnosis and non-surgical management of SRDs; a “primary care physician for the spine”.
  • The primary spine care practitioner will require a particular skill set that includes the ability to apply evidence-based procedures, appropriately educate and motivate patients and effectively prevent and manage disability related to SRDs. The benefits in terms of improved outcomes of care for SRDs, improved patient satisfaction, and reduced costs (i.e., the value of care for SRDs) would be well worth the effort of grooming practitioners toward filling this role.

Dr. Murphy and his crew have established the Primary Spine Practitioner Certification Program through the University of Pittsburgh. I’ve provided their link in the show notes. If I were 10 years younger, I’d probably do it now that I’ve completed the Ortho Diplomate.

https://www.psp.pitt.edu

Item #2

On to item #2 called “Anticonvulsants in the Treatment of Low Back Pain and Lumbar Radicular Pain: A Systematic Review and Meta-Analysis” by Enke et. al.(Enke O 2018) published in the Canadian Medical Association Journal in July 2018. 

Why They Did It

The use of anticonvulsants (e.g., gabapentin, pregabalin) to treat low back pain has increased substantially in recent years despite limited supporting evidence. We aimed to determine the efficacy and tolerability of anticonvulsants in the treatment of low back pain and lumbar radicular pain compared with placebo.

How They Did It

  • A search was conducted in 5 databases for studies comparing an anticonvulsant to placebo in patients with nonspecific low back pain, sciatica or neurogenic claudication of any duration.
  • The outcomes were self-reported pain, disability and adverse events.
  • Risk of bias was assessed using the Physiotherapy Evidence Database (PEDro) scale
  • Quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE)
  • Nine trials compared topiramate, gabapentin or pregabalin to placebo in 859 unique participants.

What They Found

  • Fourteen of 15 comparisons found anticonvulsants were not effective to reduce pain or disability in low back pain or lumbar radicular pain; 
  • For example, there was high-quality evidence of no effect of gabapentinoids versus placebo on chronic low back pain in the short term or for lumbar radicular pain in the immediate term
  • The lack of efficacy is accompanied by increased risk of adverse events from use of gabapentinoids, for which the level of evidence is high.

Wrap It Up

“There is moderate- to high-quality evidence that anticonvulsants are ineffective for treatment of low back pain or lumbar radicular pain. There is high-quality evidence that gabapentinoids have a higher risk for adverse events.”

Item #3

Our last one is called “Cervical lordosis in asymptomatic individuals: a meta-analysis” by Guo et. al(Guo G 2018). and published in the Journal of Orthopedic Surgery and Research in 2018. 

Why They Did It

Cervical lordosis has important clinical and surgical implications. Cervical spine curvature is reported with considerable variability in individual studies. The aim of this study was to examine the existence and extent of cervical lordosis in asymptomatic individuals and to evaluate its relationship with age and gender.

How They Did It

  • A comprehensive literature search was conducted in several electronic databases
  • Random effects meta-analyses were performed to estimate the proportion of asymptomatic individuals with lordosis and the effect size of cervical lordotic curvature in these individuals which followed metaregression analysis to examine the factors affecting cervical lordosis
  • Data from 21 studies were used in the study.
  • 15,364 asymptomatic individuals, age 42.30 years

What They Found

  • 64% individuals possessed lordotic curvature
  • Degree of lordotic curvature differed by method of measurement
  • Lordotic curvature was not significantly different between symptomatic and asymptomatic individuals but was significantly higher in males in comparison with females
  • Age was not significantly associated with lordotic cervical curvature

Wrap It Up

Majority of the asymptomatic individuals possesses lordotic cervical curvature which is higher in males than in females but have no relationship with age or symptoms.

There are a lot more papers out there on cervical curves and the meaning and impact of hypolordosis. Here’s the deal, I’m standing strong that hypolordosis is minimally impactful and is not anywhere near important enough to to sell $6,000, 70 visit annual plans to correct it. 

It’s just not. And I don’t care what the owner of a curvature correction system says about it or what biased BS research they try their best to pump out there. It’s Just NOT. 

It’s a hell of a marketing scare tactic and it’ll put money in your pockets but it won’t give you respect and it might even keep you up at night if you allow your conscience to have a seat at the table.

Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, belive it, count on it.

Let’s get to the message. Same as it is every week. 

Key Takeaways

Store

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

Chiropractic evidence-based products
Integrating Chiropractors
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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

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

Connect

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

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About the Author & Host

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

Bibliography

Enke O (2018). “Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis.” CMAJ(190): E786-793.

Guo G, L. J., Diao Q, (2018). “Cervical lordosis in asymptomatic individuals: a meta-analysis.” J Orthop Surg Res 13(147).

Murphy D, J. B., Paskowski I, Perle S, Schneider M, (2011). “The establishment of a primary spine care practitioner and its benefits to health care reform in the United States.” Chiropr Man Therap 17.