Physical Therapy

American Academy of Family Physicians Warming To Chiropractic For Chronic Pain & Evidence Behind Supplements

CF 111: American Academy of Family Physicians Warming To Chiropractic For Chronic Pain & Evidence Behind Supplements

Today we’re going to talk about how the American Family Physicians may be warming up to chiropractic for chronic pain and what supplements actually have some evidence behind them.

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 #111

Now if you missed last week’s episode , we talked about Dry Needling vs. Massage and even more importantly, we talked about the topic of “What is your exit number?”. What are you looking to get out of it all in the end? I feel like there were points made in there that could really get you to contemplating and thinking going forward. So, make sure you don’t miss that info. Keep up with the class. 

That reminds me, did you know that you can use our website as quite a resource? I do it all of the time. If you think I can keep every one of these papers in my noggin and pull them out of my brain files on demand, that’s a big nope. But I can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever I 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. 

On the personal end of things…..

Rinse and repeat man, rinse and repeat. If you’re friends with me on Facebook, then you know life has been crazy and there’s no slow down in site. 

Some really positive stuff happening though too. For example, I was interviewed for two different articles in Chiropractic Economics recently. They published an article called “Chiropractic for prevention: the latest research on maintenance care” by Michele Wojciechowski. Michele used my comments exclusively in this article and that’s just a big honor. 

I remember when I was new in practice. I remember reading articles in Dynamic Chiropractic and Chiropractic Economics and thinking that would be cool to be in that one of these days. Now…..now…I’ve been fortunate enough to be in Reader’s Digest, on the ACA Blog a couple of times, and now Chiropractic Economics. It’s pretty damn exciting and it’s an honor. 

Thank you Michele for finding value in my comments and sharing them with everyone else. I’ll leave a link to that article at this point in the show notes if you’re interested in giving it a read through. 

Other than that, my family and I took a quick ski-cation to Red River, New Mexico. If you haven’t been, look it up. Here’s why we like Red River, First thing, it’s close. For a Texan to be able to just drive about 4 hours and be in the mountains, that’s pretty exciting. 

Next thing, it’s just gorgeous. And, the ski slope comes right down into the town so you don’t have to drive out to a mountain which is nice. 

Let’s talk about why I retired from skiing myself though shall we? This may make you think a bit about some of the stuff you do in your offtime. Maybe it won’t but it’s important to think about things which is the whole point of me bringing it up.

I used to ski a lot back in high school and junior high. I was pretty decent at it too. Then I went off to play football and be a college kid. Well, Louisiana for a bit and Dallas for a bit…..those areas aren’t very conducive to learning to snow ski. It’s too damn far. Especially when you’re still a kid and broke as hell. Skiing just doesn’t happen at that point in life unless you have parents taking you. I didn’t.

So then you start life and you’re building a business and there’s never time to go then either. 

Well by the time I got back around to going skiing again, I hadn’t done it in about 20 years give or take. So, i got a private coach for a morning just to get me back on that bicycle and rocking and rolling again. I have to tell you, it was hard as hell!! It was NOT like riding a bike. Nothing at all like it as a matter of fact!!

But, I took it slow, I didn’t fall at all, and was fairly happy with my progress over the weekend. HOWEVER, I got to thinking when I got home. I went back to work and had about 45 patients that next day. What if I had twisted a knee, broken and elbow, or dislocated a shoulder while I was skiing? What would I have done?

You know this sounds stupid when you say it but, “They call them accidents because you don’t plan them.” But you can avoid them sometimes. I got to thinking long and hard enough about the risk vs. rewards for continuing to ski and……honestly, on paper, it wasn’t worth the risk. 

So, I retired. Maybe if I had an associate. Maybe I could make more sense of it but, the truth is, I don’t have an associate. It’s just me although I’m thinking of hiring one just as soon as it makes sense. Anyway. I took the kids skiing while the wifey and myself enjoyed the mountains, some brewskis, and some playoff football games. 

What are you involved in as far as physical activity outside of your practice that puts you at risk and puts your ability to earn a living at risk? Do you have disability insurance? Life insurance? Long term care insurance? I have all of that. Do you need it?

Start thinking about these things. Certainly, the more successful you get and the busier your practice gets. Risking an injury just might not be worth it at some point. 

Before we dive into the reason we’re here, it’s good to support the people that support evidence-informed practitioners. Well, ChiroUp certainly does just that. 

If you don’t take advantage of the deal I’m about to offer you, I think you just might be crazy.

Regular listeners know I’ve used ChiroUp for well over a year now. I’m going to tell you want it is and then share a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months. So listen up!

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

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

This saves you so much time – no more explaining & re-explaining your patient’s care because they have access to it right there at their fingertips. 

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

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice.

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

That’s ChiroUp.com and super saver code is Williams99.

Item #1

Let’s start with this one from American Family Physician. I got this one from one of my amazing colleagues, Dr. Craig Benton down in Lampasas, TX. It’s called “Nonpharmacologic therapies can improve chronic pain outcomes” authored by Michael Devitt and was published in American Academy of Family Physicians on January 15, 2020(Devitt M 2020). Damn it’s hot…..

Not a research paper but more of an article in their publication but has plenty to do with chiropractic. 

They set the stage here by pointing out that chronic pain is something that can cause people to go to extreme measures just to get the pain to go away. Or at least lighten up. They say this includes potentially harmful behaviors like drug and alcohol misuse and/or abuse. 

Then this article in the American Family Physicians journal starts to highlight and promote the nonpharmacologic treatment modalities that are available to family physicians. Honestly, did you think you’d ever see the day? Ever? The battle isn’t over by any stretch of the imagination but research is gradually, inch by inch, turning the tide. 

They say these modalities include simple methods like massage and heat as well as more complex therapy like acupuncture and chiropractic manipulation. They called us ‘complex’ and I’m taking that as a compliment. Lol. What we do can damn sure be complex. 

They say that these nonpharma strategies aren’t only effective for decreasing pain and improving function, but can also be effective for reducing longer-term adverse effects such as substance use disorders and suicide attempts. THAT’S A BIG DAMN DEAL. 

In fact, I got one word, two syllables….day-um. 

One researcher, the lead author from an active-duty US Army service study said “Chronic pain is associated with adverse outcomes such as substance use and suicidal thoughts and behavior,” said Esther Meerwijk, Ph.D., M.S.N., a statistician at the VA Palo Alto Health Care System in California. She added, “It made sense that if nondrug treatments are good at managing pain, their effect would go beyond only pain relief. However, I was surprised that the results of our analyses held, despite our attempts to prove them wrong.”

Despite our attempts to prove them wrong! Haven’t they been trying to prove us wrong for generations now? Lol. I always say that with all of the powers against us, if we were wrong, if we were ineffective, we would have been wiped out years ago. 

In one of her projects, they reviewed the records of more than 275,000 active-duty service members reporting chronic pain.

They combed through their files to determine whether they had received any of 13 nonpharmacologic therapies after their deployment. Those therapies were acupuncture or dry needling, biofeedback, chiropractic care, cold laser therapy, exercise therapy, lumbar supports, massage, osteopathic spinal manipulation, other physical therapy, superficial heat, traction, transcutaneous electrical nerve stimulation, and ultrasonography. 

After crunching all of the numbers and outcomes here’s what they came up with:

Specifically, service members who received nonpharmacologic therapies were

  • 8% less likely to experience new-onset alcohol and/or drug use disorders;
  • 12% less likely to experience suicidal ideation;
  • 17% less likely to experience a self-inflicted injury, including attempted suicide;
  • 18% less likely to intentionally poison themselves with opioids, related narcotics, barbiturates or sedatives; and
  • 35% less likely to accidentally poison themselves with the same types of drugs.

The researchers acknowledged several limitations in their research. For example, although most nonpharmacologic therapies were provided after service members were diagnosed with chronic pain, the authors could not determine whether those nonpharmacologic therapies were used specifically to treat that pain.

In the news release, Meerwijk also explained that her team did not study the effects of individual nonpharmacologic therapies.

“We treated them as one,” she said. “Most likely, only some of the therapies that we included are responsible for the effect that we reported, whereas others may have had no effect at all, assuming there’s no other variable that explains our findings.”

Despite these limits, the authors expressed confidence in their research methods and findings.

“Our results suggest that (nonpharmacologic therapies) provided to active-duty service members with chronic pain may reduce their odds of long-term adverse outcomes,” they concluded in the study. “Given known associations of these adverse outcomes with morbidity and mortality, providing (nonpharmacologic therapies) to service members with chronic pain could potentially save lives.”

I’ve been hearing this crashing tidal wave coming. It’s not here yet. But the roar is approaching and it sounds like sweet sweet music to me ears. 

Item #2

I’m going to do everything I can to boil this sucker down and strip it to the bare bones without it getting too long or boring. This one is called “Evidence-based supplements for the enhancement of the athletic performance” by Peeling, et. al(Peeling P 2017). and published in the International Journal of Sport Nutrition and Exercise Metabolism in 2017. 

The authors wanted to put together a review focusing on the available evidence based for performance supplements commonly used in sports and summarizing the when’s and the how’s around their uses.

The ysay there is robust evidence that the following supplements can enhance sports performance when used according to established protocols. 

So let’s motor through this like poop through a goose, shall we?

  1. Caffeine -There exists a lengthy research history on caffeine supplementation across a range of performance protocols, including endurance-based situations, resistance training exercise, short-term supramaximal efforts, and/or repeat-sprint tasks. Reported benefits of caffeine include benefits include adenosine receptor antagonism, increased endorphin release, enhanced neuromuscular function, improved vigilance and alertness, and a reduced perception of exertion during exercise. Low to moderate doses of caffeine (∼3–6 mg/kg BM), consumed 60 min pre exercise, appear to have the most consistent positive outcomes on sports performance in research situations, although a variety of other protocols (as mentioned above) also appear beneficial, and are practiced in real-life. Of note, athletes who intend to use caffeine as a performance aid should trial their strategies during training or minor competitions, in order to fine-tune a protocol that achieves benefits with minimal side effects.
  2. Creatine – widely-researched supplement, with creatine monohydrate (CM) being the most common form used. Creatine loading can acutely enhance the performance of sports involving repeated high-intensity exercise (e.g., team sports), as well as the chronic outcomes of training programs based on these characteristics (e.g., resistance or interval training), leading to greater gains in lean mass and muscular strength and power. When accepted creatine monohydrate supplementation protocols are followed, the expected increase in intramuscular creatine stores is likely to enhance lean mass, maximal power/strength, and the performance of single and repeated bouts of short-term, high-intensity exercise.
  3. Nitrate –  The authors say Nitrate is a popular supplement initially found to improve oxygen uptake kinetics during prolonged submaximal exercise. Great sources are Leafy green and root vegetables (i.e., spinach, rocket, celery, beetroot, etc.
  4. Beta-Alanine – The paper says this is one of the immediate defenses against the accumulation of protons in the contracting musculature during exercise. I can also tell you that this is just something I never nerded out on. Lol. Not my cup of tea but I like to offer something for everyone here at the Chiropractic Forward Podcast. They say it can improve tolerance for maximal exercise bouts lasting 30 s to 10 min and provide small yet significant benefits in both continuous and intermittent exercise tests. Basically, it’s used in order to augment high-intensity exercise performance ranging from 30 s to 10 min in duration.
  5. Sodium Bicarbonate – benefits are generally seen in short-term, high-intensity sprints lasting ∼60 s in duration, with a diminishing return as the effort duration exceeds ∼10 min. However, greater benefits may be realized (>8% improvement) with a greater number of repeated sprint bouts

Go to our show notes at chiropracticforward.com if you’d like to get dosing information and all the little technical tidbits. It’s really interesting. Even to an orthopedic guy like me although, its technical enough to make my eyes glaze over as well. 

There are several others listed in the paper as well but the authors point out that the evidence for their effectiveness is much less clear. They are Sodium citrate, Phosphates, and Carnitine.

Even though that stuff is not my cup of tea, it’s good to know, it’s good to have as a reference, and it’s good to pass on to you because many of you actually do nerd out on that stuff and thank God for that. That means I can call people like you and ask what the hell. On the other hand, if it’s something I nerd out on like orthopedics, you can call me and say what the hell?

Store

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

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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

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

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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

Devitt M (2020). “Nonpharmacologic Therapies Can Improve Chronic Pain Outcomes Reductions in Drug Misuse, Suicide Attempts Reported.” AAFP.

Peeling P, B. M., Paul S, (2017). “Evidence-based supplements for the enhancement of athletic performance.” IntJ sport Nutrition Exercise Metabolism 28(2): 178-187.

w/ Dr. John Van Tassel – Chiropractor for Florida State on Mentorship, Work-Life Balance, & Life Long Lessons (Part One)

Today we’re going to talk with one of the neatest gentlemen I have had the honor of interacting with in the last couple of years. You are absolutely going to love this conversation with Dr. John Van Tassel from Tallahassee, Florida about being a chiropractor for Florida State, a Division I college. You just wait, you’ll see what I mean. 

But first, here’s that sneaky like a Florida gator bumper music

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

You have slithered right into Episode #82. When you have a guest from Florida, you think of gators and snakes. And Pablo Escobar and Miami Vice but we try to not get too under the table here on the Chiropractic Forward Podcast. 

Before we hop into the episode, let’s talk about GoChiroTV. GoChiroTV is a patient education system for your office that will eliminate the need for running cable TV or the same DVDs over and over again in your waiting room. The bite-sized videos are specifically made to inform your patients about the importance of chiropractic and healthy living, encourage referrals, and present the benefits of all the different products and services you offer.

It works by using a tailored-fit video playlist that will only promote the products and services available at your practice, and the videos are replaced automatically on a weekly basis. There’s no need to manually update your playlist or learn any complicated software. You truly can set it and forget it.

Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription. 

So visit GoChiroMedia.com (that’s g-o-c-h-i-r-o-m-e-d-i-a-.com) to check out the demo reels, and to get started on your free trial. Take you practice to the next level with GoChiroTV.

Introduction

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

Go check our evidence-based brochures out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? 

How about the previous two episodes we did with Dr. Anthony Nicholson on Chronic pain? That was basically a mini-masterclass folks. I hope you know that. If you know nothing of any substance about chronic pain, the previous two episodes are your starting points. 

You have to listen to me here. Just go listen. Thank me later. He is the Niagara Falls of knowledge nuggets folks. 

In personal happenings, my family experienced some unpleasantness this past weekend. My 7 year old blue European Great Dane passed away. We got the Euro Dane because they are supposed to be heartier than their American Dane counterparts. 

They think she developed some sort of tumor that zapped her weight, had her dehydrated, and just unable to walk or do anything. Not cool. It was the opposite of anything fun but, she’s not suffering and that’s the best you can ask for on that sort of deal. 

Now on to our special guest today. INTRODUCTION

He is a heck of a communicator. Any discussion I have seen him take part in on the Forward Thinking Chiropractic Alliance Facebook page….he’s the most thorough, most sensible, most sage-like if you will. I’ve even sent him patients all the way from where I sit here in Amarillo, TX. 

He’s the Yoda of chiropractors and I love reading his stories. If someone asks him a question, he doesn’t respond with a paragraph. He sits down and really thinks about it, considers it at length, and then responds with about a 5 paragraph guidance manual and I love it. 

Not to mention the fact that he’s one of the most accomplished you’ll find in any group anywhere. 

All of that is personal experience and fine and dandy but how about we give him an official introduction?

  • Graduating from Logan College of Chiropractic, Dr. John Van Tassel has been a chiropractor since 1991 and is the owner of Athletic and Family Chiropractic in Tallahassee, Florida. 
  • He has been an adjunct professor at Tallahassee Community College and Florida State University. 
  • He has been the FCA Sports Council Doctor of the Year
  • The ProSport Chiropractic Doctor of the Year for the Southeast Region
  • And has been a contributing author in various publications

What really gets one’s attention about Dr. Van Tassel is that he is the team chiropractor for the Florida State Seminoles. A perennial powerhouse of anything athletic in the SEC. 

We’re going to talk about all of it and you’re going to be fascinated so here we go. 

Let’s welcome to the show, the pride of Tallahassee, Dr. John Van Tassel. Thank you so much for taking the time out of your schedule to be with us today. 

Let’s start with a little humor. The first thing I want to know is…..what in the heck is up with Florida? There was even a Facebook game going around for a while where you just Google your birthday and the words “Florida man…” Lol. Are Floridians just inherently crazy?

Tell me….we all have a story that got us where we are. I always like to ask this question because chiropractic is a bit of a niche choice when choosing a career. What was your story toward being a chiropractor?

Now I noticed you’re originally from North Carolina. Why the move to Tallahassee. 

We became acquainted either through the evidence based chiropractic group or the forward thinking chiropractic alliance group. I can’t remember which but one of them for sure. They’re great groups. You’ll find people that are bull-headed that it’s their way or they scoff at you but that’s with any group really. Mostly….overall….they’re very friendly, very helpful, and very giving people. Giving of their experience and information as well as giving with their assistance should you need something. 

I always encourage anyone that considers themselves on the evidence-informed spectrum of the profession to join both groups. I learn SOMETHING from each of them just about every week. 

With that being said, I think you’ll agree that you are one of the more active members of the FTCA. Tell me about how you got involved with the Forward Thinking Chiropractic Alliance and what keeps you coming back daily.

One of the things that obviously sets you apart from the run-of-the-mill chiropractor is your involvement with Florida State. Let’s start at the beginning and just talk about that for a bit. How did you get started with a D-I program? Was it a specific certification that moved you in that direction? What’s it like day to day, month to month, and year to year? And has it morphed through the years? 

In our preparation for this episode, you mentioned that you enjoy mentoring younger practitioners. With that in mind, what advice do you feel is vital for someone just starting out trying to open or build their own practice?

Continuing with the mentoring theme, what do you find to be the important aspects of maintaining a healthy work/life balance?

You seem to have a unique ability to recall things. For example, I can’t remember what I had for lunch yesterday but you can recall happenings and conversations from 20 years ago. 

I really think, and I believe most of the FTCA members would agree, that you have the best stories and should probably be working on your first book by now. 

With that in mind, can you re-tell the one you shared yesterday about the carpal tunnel patient that went to the GP who basically told her you didn’t know what you were talking about?

Now, the reason I asked for that one specifically, is because you’re in an arena where you commonly interact with other practitioners from the medical field. Are you experiencing this sort of bias against chiropractic in that world as well? Why do you think MD’s still don’t understand what it is that we do?

One of my favorite stories of your was about your Wall of Fame down your hallway. I’m sure there are plenty of recognizable names on that but your favorite is Mrs. Jones. Someone nobody outside of your practice and her personal circle would know. Is that a story you would mind sharing with us?

I want to close with this because this may be something that people can really use as the key takeaway from our time together today. 

I was reading one of your posts that went like this, “I was just thinking about something while A plumber unclogs my system at the house. I tell people, patients and students and athletes mostly, that desire and passion and determination are key. But it’s our habits that get us where we are going. We accomplish goals by developing habits.”

Now, I don’t know how a plumber brings to mind things like goals and habits but, I couldn’t agree more. What would you say are your core habits that have made the difference in your career?

Chiropractic evidence-based products

Integrating Chiropractors
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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

w/ Dr. Anthony Nicholson – Decoding Chronic Pain (Part Two)

CF 080: w/ Dr. Anthony Nicholson – Decoding Chronic Pain (Part Two)

Today we’re going to be fortunate enough to be joined by Dr. Anthony Nicholson from Australia. It was so nice we had to do it twice. This time around though, we are focusing mostly on chronic pain. Pain in the frame, if you will. If you are new to the concept of chronic pain as part of a centralized experience, buckle up because the school bus is about to arrive

But first, here’s that delightful bumper music

Chiropractic evidence-based products

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

You have skidded your way into Episode #80 and we are glad to have you. 

We here at the Chiropractic Forward Podcast have gotten fancy. 

I’m happy to introduce a new sponsor for the Chiropractic Forward Podcast called GoChiroTV. GoChiroTV is a patient education system for your office that will eliminate the need for running cable TV or the same DVDs over and over again in your waiting room. The bite-sized videos are specifically made to inform your patients about the importance of chiropractic and healthy living, encourage referrals, and present the benefits of all the different products and services you offer.

It works by using a tailored-fit video playlist that will only promote the products and services available at your practice, and the videos are replaced automatically on a weekly basis. There’s no need to manually update your playlist or learn any complicated software. You truly can set it and forget it.

Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription. 

So visit GoChiroMedia.com (that’s g-o-c-h-i-r-o-m-e-d-i-a-.com) to check out the demo reels, and to get started on your free trial. Take you practice to the next level with GoChiroTV.

Store

Go check out chiropracticforward.com and go to the store link. That’s where you’ll find brochures a plenty to get you started with some good, solid patient education. They look sharp and they read smart if you’re picking up what I’m throwing down. 

Do it do it, chiropracticforward.com and sign up for our newsletter while you’re at it, won’t you?

I want to thank Dr. Nickell in Kansas City for your recent feedback and for all of your encouraging words. Made my day and I appreciate it. 

DACO

Let’s talk a bit about the DACO program. Not a lot to talk about right now. Just studying my little hiney off. I li e. Not about the studying. About being little. I’m a big guy. The studying part is good. I enjoy going back through the courses. 

It’s funny to see the sort of student I am at this time in my life compared to me in school. Lol. I guess I thought I HAD to do it the first time through so I wasn’t as interested as I probably should have been. NOW, I want to be learning so I’m all in and my notes and study habits certainly reflect the fact. 

Personal Happenings

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

Now, let’s get to our incredible guest today. Dr. Tim Bertelsman, one of the most talented speakers out there on the circuit today, says that our guest is just one of those people that really make you proud to be a chiropractor and I agree 187%. 

That’s a glowing endorsement but that not my official intro. Here’s the official intro:

Dr Anthony Nicholson is the CEO of Chiropractic Development International (CDI), a global continuing education organization for chiropractors that he co-founded in 2002.  

CDI’s innovative online learning technology has led to formal accreditation in over 35 states in North America, along with a growing learner base in the UK, Europe and South East Asia.

  https://www.chiropracticforward.com/w-dr-christine-goertz-chiropractic-research-what-does-the-science-say-and-where-are-we-going/

CDI provides 250 hours of advanced online clinical training for the Neuromusculoskeletal Medicine Program offered by the University of Bridgeport in Connecticut and had developed an online board examination for the Academy of Chiropractic Orthopedics.

As a partner of Spine Partners Wahroonga in Sydney Australia, Dr Nicholson is also a full-time chiropractic physician in private practice, is a board certified chiropractic neurologist (DACNB) and is board certified in Chiropractic Orthopedics (FACO).  That means he has a Diplomate in Neurology AND Orthopedics. 

In addition, he is an adjunct senior lecturer in Neuromusculoskeletal Diagnosis and Evidence-based Practice at Macquarie University ion Sydney’s north shore.  

Welcome to the show Dr. Nicholson thank you for joining us for the second time.

We already had you on the show for a two-part discussion so we have already covered a lot of topics from medical marketing, to CDI, to the DACO. For this episode, I’d like to concentrate mostly on the topic of pain. Particulary centralized pain. 

When I started the DACO program I had no idea what you were talking about. I was slow to the show but find myself fascinated by it all. 

I don’t know if this is the best starting point or not but….What is pain? What basic responses are needed in response to a noxious stimulus? 

OK, now we know what pain is…can you tell us….what is chronic pain? How is it defined?

I believe this questions will lead us into the big concept. Can you tell us a bit about neuroplasticity? What is it? What does the term mean and what do we know about it now vs. traditional thinking on neuroplasticity?

OK….here’s the big question and the reason I wanted to do this interview with you. This question may just take up the majority of the episode and that’s OK. That’s what we’re here for and this questions gets to the foundation of it. 

For our audience’s benefit, what’s the difference between peripheral pain sources and central pain sources and what exactly is an upregulated or a sensitized central nervous system?

Let’s say someone has a bad shoulder for a while…..does anyone that has had literally anything hurting for 3 months or more now have an upregulated CNS?

Other than hurting chronically, are there other signs and symptoms that can give us a clue someone is suffering from chronic pain or are in chronic pain syndrome?

To me, having chronic pain at one site seems different than chronic pain SYNDROME. Let’s continue with the person with the bad shoulder for six months. Is that considered being in chronic pain syndrome vs. just having chronic shoulder pain?

What are we learning about centralized chronic pain and how to treat it effectively? What do you do in your office to treat it?

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Let’s say someone doesn’t have the time or maybe the money to go through the DACO. Where would you tell them to start searching to learn more on the condition?

Chiropractic evidence-based products

Integrating Chiropractors
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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

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About the Author & Host

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

CF 036: A MishMash Of Research on Chiropractic, On Herniation, Trends, and Ineffectiveness

A MishMash Of Research on Chiropractic, On Herniation, Trends, and Ineffectiveness

Integrating Chiropractors

Today we’re going to talk about research on Chiropractic, research on health trends, and research on disc herniation as a result of a visit to your friendly neighborhood chiropractor. Is that real or is that a bunch of hooey? We’ll talk about it so come along. 

But first, here’s that bumper music

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

Now that I have you here, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. Nope, I don’t have some big prize for you if you sign up. Not big offers. No magical marketing tactics with which to get your email address. Just what we hope is a podcast full of value to you and your business. 

Being on the newsletter list just makes it easier to let you know when the newest episode goes live and, maybe in the future we’ll have some cool stuff to offer those on our email list. Also, when someone new signs up it makes my heart leap and wouldn’t you like to be the one responsible for making someone’s heart leap today? 

Upcoming!

We have a lot of great guests lined up to come on the show! Next week I believe we are going to have Dr. Anthony Palumbo from Staten Island, New York. Dr. Palumbo is very active in the New York State Chiropractic Association and practices in a multidisciplinary practice. We’re going to have a good time picking his brain. 

The week after that, I believe we have Dr. Brandon Steele from ChiroUp and from the DACO program joining us. He’s an excellent resource for what is going on in our profession and where we see things heading in the future for chiropractic. I’m really looking forward to that one. 

We have the green light from Dr. Jerry Kennedy of the Black Sheep DC marketing program to come on the show. We just need to get that date lined up. We have Dr. Tim Bertlesman from the DACO program and also the President of the Illinois Chiropractic Association lined up down the road. 

Good stuff on the way so make sure you’re staying tuned into our little corner here in Podcast land. We’re bringing you the best in research on Chiropractic.

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

You have fainted very dramatically into Episode #36 and we’re so glad you did. 

How’s your week been so far? I shared on the last podcast how we have had a rough 2018 but things have leveled off and we up and running. It feels a little like a sprint these days to tell you the truth. Lol. And thank the good Lord for it. 

Speaking of thanking the Good Lord, my 16-year-old son has been raised in the church. Not every single Sunday. I like to sleep sometimes ya know. But, often enough to say he’s been a church-goer as has my 11-year-old daughter. We’ve not pushed anything on him but he has taken it upon himself to an extent to further the church part of his life. 

He’s gone to a church camp in New Mexico the last two summers and this year he returned ready to get baptized. So he did. Last Sunday he went to church and took a bath and we couldn’t be more proud of that little dude. He’s actually not so little anymore but, we worry about our kids don’t we?

We worry about if we’re raising them right. Am I raising him to be a good man? Am I raising him to work hard and be dependable? Will they be ready for the world? Have I somehow enabled him to be weak? Am I raising him to feel entitled instead of working his butt off for things in his life

I think parents have all of these worries. I might argue that if you’re not asking yourself at least some of these questions, you might give them a deeper look. I’m not a parenting expert. That’s just my opinion. 

Anyway, my point is, we got this aspect of his life right so far. We sure love that kiddo and we love the direction we see him headed. Kids can be a game-changer for sure. From conception throughout their entire lives, they consume our mind space without even realizing it. And that’s OK. We wouldn’t have any other way most to the time. 

With school back in session now, what are some of the ways that you keep your practice from slowing down? Back to school is historically a slow time for us and we’re never quite sure how to keep that from happening. Email me at [email protected] and tell me how you do it. I’ll be glad to share on next week’s podcast if you don’t mind. 

This week, I just want to throw some seemingly random papers having to do with research on Chiropractic at you and we’ll start with one called “Effectiveness of classic physical therapy proposals for non-specific low back pain: a literature review.” It was written by F Cuenca-Martinez[1], et.al. and published in Physical Therapy  Research in March of 2018. This is a group of physical therapists writing this paper just so you are in the know. 

Why They Did It

The authors were hoping to evaluate the effectiveness of classical physiotherapy in the management of non-specific chronic low back pain. 

How They Did It

  • They did a literature search in English electronic databases from November- December in 2015 for only randomized controlled trials
  • They only accepted the studies addressing chronic non-specific low back pain treated by manual therapy and different types of exercise methods. 

What They Found

Back School exercises and McKenzie’s method were both ineffective

Spinal manipulation proved effective when performed on the lower back and on the thoracic region but only immediately after it was received and not in the medium or in the long term. 

Massage proved effective for short-term relief

Wrap It Up

The authors’ conclusion was “Based on the data obtained, classical physiotherapy proposals show ineffectiveness in the treatment of chronic non-specific low back pain. More multidimensional studies are needed in order to achieve a better treatment of this condition, including the biopsychosocial paradigm.”

What do we get from this? First thought is, the papers they cite are, at this point, old and considering the papers we have been covering, are really pretty irrelevant to an extent. I mean, any good information will always be good information but only until better information becomes available. The most recent paper cited for the spinal manipulation portion of this project is over 5 years old. So….what the hell?

Second….it’s a bit discombobulated when you read through the abstract. I’m either bad at following along (which is highly likely) or it’s just worded so oddly. I dove into the full paper to try to make heads or tails of what they have going on here. It sounds like physical therapists are just trying to be cheeky monkeys and throwing poo at spinal manipulation and we’re not having it. Mostly because they’re wrong and because we are better and more cost-effective at treating low back pain than they are. Period over and out. 

The authors, in regards to spinal manipulation, refer to three studies. One by Oliveira, et. al[2]., one by Bronfort et. al[3]. and one by Senna and Machaly[4]. The Bronfort study was done on 300 patients and they found basically no difference between those that had physical therapy vs. chiropractic vs. home exercises. They all ended up the same. But, they didn’t cite the work we covered previously showing that chiropractic combined with exercise is more effective that physical therapy. 

Or the paper from Episode 26 by Korthals-de Bos[5] that concluded: “Manual therapy (spinal mobilization) is more effective and less costly for treating neck pain than physiotherapy or care by a general practitioner.”

There was also no mention of the paper by Blanchette et. al. that we covered in Episode #26 that showed that chiropractic patients experience the shortest duration of compensation, and physical therapists’ patients the longest. Blanchette says in that conclusion, “These differences raise concerns regarding the use of physiotherapists as gatekeepers for the worker’s compensation system.” And all the chiropractors said, “Amen, hallelujah brothers and sisters.”

And the Senna paper they cite actually concluded by saying, “SMT is effective for the treatment of chronic nonspecific LBP. To obtain long-term benefit, this study suggests maintenance SM after the initial intensive manipulative therapy.”

I’m done with that paper. 

Let’s move on from these PTs and their poo-throwing. 

Here’s one more specifically geared toward research on Chiropractic called “Chiropractic care and risk for acute lumbar disc herniation: a population-based self-controlled case series study” by Cesar Hincapie, et. al[6].  

Why They Did It

The objective was to investigate the association between chiropractic care and acute lumbar disc herniation with early surgical intervention and contrast this with the association between primary care physician (PCP) care and acute lumbar disc herniation with early surgery

What They Found

Both chiropractic and primary medical care were associated with an increased risk for acute LDH requiring ED visit and early surgery. Our analysis suggests that patients with prodromal back pain from a developing disc herniation likely seek healthcare from both chiropractors and PCPs before full clinical expression of acute LDH. We found no evidence of excess risk for acute LDH with early surgery associated with chiropractic compared with primary medical care.

This Hincapie fella also had a prior paper published not long ago[7] where he discussed and explored the perception among different medical disciplines and among chiropractors as to whether spinal manipulation causes a lumbar disc herniation. It was an interesting paper. We covered it in episode #27 if you’d like to give it a listen. 

https://www.chiropracticforward.com/cf-027-wanted-safe-nonpharmacological-mean-of-treating-spinal-pain/

Then there’s this research on Chiropractic that came out recently titled “Spine Degenerative Conditions and Their Treatments: National Trends in the United States of America” and published in Global Spine Journal February 2018. It was authored by Buser et. al[8]. 

Why They Did It

The aim of this study was to report the current trends when talking about spine degenerative disorders and their various  treatments.

How They Did It

Patients diagnosed with lumbar or cervical spine conditions within the orthopedic Medicare and Humana databases were included

What They Found

  • Within the Medicare database there were 6 206 578 patients diagnosed with lumbar and 3 156 215 patients diagnosed with cervical degenerative conditions between 2006 and 2012
  • There was an increase of 18.5% in the incidence of fusion among lumbar patients
  • For the Humana data sets there were 1 160 495 patients diagnosed with lumbar and 660 721 patients diagnosed with cervical degenerative disorders from 2008 to 2014
  • There was a 33% (lumbar) and 42% (cervical) increases in the number of diagnosed patients. However, in both lumbar and cervical groups there was a decrease in the number of surgical and nonoperative treatments.

Wrap It Up

The authors wrap it up by saying, “There was an overall increase in both lumbar and cervical conditions, followed by an increase in lumbar fusion procedures within the Medicare database. There is still a burning need to optimize the spine care for the elderly and people in their prime work age to lessen the current national economic burden.”

What do we get from that? I’d say that it’s clear from research on Chiropractic we’ve covered here that neck and back pain is stepping forward for sure. It is being recognized for the problem it really is while treatments available in the medical kingdom continue to show scattered results. Chiropractors are the most uniquely positioned to knock this stuff out of the park. 

Fusion surgeries have gone crazy sky high in the last ten years while the outcomes have remained unchanged. 

Epidural steroid injections have been done at a blistering pace over the last decade with no better outcomes. 

Physical therapists are even starting to question their own effectiveness. Take this article in the journal called Physical Therapy written by Colleen Whiteford et. al[9]. Here is the opening paragraph. Get a load of this:

“We are writing to relay our consternation about the guideline article by Bier et al in the March issue of PTJ. We fully support the increasing emphasis on critical evaluation fo the assessment and intervention models used in physical therapist practice. The long-overdue acknowledgment of research that does not support much of what constitutes the bulk of physical therapist practice is a refreshing and honest introspection that can potentially initiate much-needed change within our profession.”

“Without such change, our profession is destined to continue on our current path of practice that is increasingly shown to be yielding outcomes that are less than desirable. Such exploration inevitably leaves us with gaping holes in practice that can be unsettling. The natural and responsible tendency is to search for alternative measures and interventions to fill this gap.”

I’m going to tell you one of those alternatives they’ll be looking to adopt and are looking to adopt is spinal manipulation. You better listen to me folks. If you’ve listened to our podcast much here then you know they’ve already adopted adjustments and renamed it to translatoric spinal manipulation. 

We can keep monkeying with these chiropractors out on the edge of the ether talking about curing everyone on the planet of everything known to man or we can keep moving in the direction of science and in the direction of evidence. My preference is obvious. 

If you haven’t yet, can you leave us a great review on whatever platform it is that you’re listening to us on? iTunes, Stitcher, or whatever it may be. We sure would appreciate it. 

Integrating Chiropractors

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is a mechanical pain and responds better to mechanical treatment instead of chemical treatments. Research on chiropractic shows this clearly.

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

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

Being the #1 Chiropractic podcast in the world would be pretty darn cool. We’ll keep bringing you Research on chiropractic in the hopes of reaching that goal!

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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Bibliography

1. Cuenca-Martínez F, Effectiveness of classic physical therapy proposals for chronic non-specific low back pain: a literature review. Phys Ther Res, 2018. 21(1): p. 16-22.

2. Oliveira RF, Immediate effects of region-specific and non-region-specific spinal manipulative therapy in patients with chronic low back pain: a randomized controlled trial. Phys Ther Res, 2013. 93(6): p. 748-56.

3. Bronfort G, Supervised exercise, spinal manipulation, and home exercise for chronic low back pain: a randomized clinical trial. Spine, 2011. 11(7): p. 585-98.

4. Senna MK, Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome? Spine (Phila Pa 1976), 2011. Aug 15; 36(18): p. 1427-37.

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

6. Hincapie C, Chiropractic care and risk for acute lumbar disc herniation: a population-based self-controlled case series study. European Spine Journal, 2018. 27(7): p. 1526-1537.

7. Hincapie C, Chiropractic spinal manipulation and the risk for acute lumbar disc herniation: a belief elicitation study. European Spine Journal, 2017.

8. Buser Z, Spine Degenerative Conditions and Their Treatments: National Trends in the United States of America. Global Spine J, 2018. 8(1): p. 57-67.

9. Whiteford C, On “Clinical Practice Guideline for Physical Therapy Assessment and Treatment in Patients With Nonspecific Neck Pain,” Bier JD, Scholten-Peeters WGM, Staal JB, et al. Phys Ther. 2018;98:162–171. Physical Therapy, 2018.