Spinal Manipulative Therapy

Nonpharmacologic Treatment In The ER & Spinal Manipulative Therapy For Non-musculoskeletal Conditions

CF 255: Nonpharmacologic Treatment In The ER & Spinal Manipulative Therapy For Non-musculoskeletal Conditions Today we’re going to talk about Nonpharmacologic Treatment In The ER & Spinal Manipulative Therapy For Non-musculoskeletal Conditions But first, here’s that sweet sweet bumper music  

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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. 

I want to get to this before getting to the research and even some more real estate investing talk this week.

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.

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 #255 Now if you missed last week’s episode , we talked about Gluteal Tendinopathy. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I have a short week this week so I’m preparing to go to Key Largo to be with my MCM Florida Mastermind group. I went to the website and saw that 2023 is sold out for the group. I have to say, it’s really an impressive group, folks. I tried to get you all in. Lol.  We will be at this amazing place I recommend you check out someday. It’s in Key Largo and it’s called Playa Largo. It’s a resort and spa with restaurants and all of the comforts. It’s just wonderful and I can’t wait to go back. It’s a Monday now and by Thursday, afternoon, assuming the weather cooperates, we’ll be on the beach. 

In other news, I’m curious, on the previous episode, #254, I covered my experience with real estate investing and gave, what I hope, is really interesting and really useful information on investing in short term rentals. Go listen if you’re interested and you missed it.  What makes me think about that this week is that we have a first home. We bought it back in 2006 I believe. Very nice neighborhood. The house is 100 years old and I needed something newer and more current.  When we moved to our current house about 5 years ago, we kept it as a rental just for giggles.

This was before we got serious about real estate. We were just hoping to make a few hundred a month and have someone else buy our equity. Which is exactly what happened.  Fast forward and this year, we re-financed it to get a gob of money out to invest in a short term rental elsewhere. Well, a couple of months ago, we decided, you know what? Why don’t we just sell it to get it off our books so we can qualify for a hefty loan on something more tropical than Amarillo, TX. So we listed it.  Guess what? As our luck holds steady, the real estate market takes a dump about a week or two before we got it ready and listed. So now we can’t sell it for it’s appraisal price. 

Now, here’s the beauty of real estate. There are lots of options!!

  1. Take a bath and cut the price so deep that we lose money but get rid of the house. 
  2. Keep it as a long term rental
  3. Make it a short term rental

If you listened last week, then you probably already know the answer. Instead of taking a $15k-20k hit by cutting the price to sell it, we can take that money and furnish the house and make it a short term rental. So that’s what we’re doing.

I was at the house last night putting together a queen size bed with a trundle while my wife hung curtains.  We went to a site called airdna.co and using their Rentalizer tool, we evaluated the potential of that specific address and BAM…..it was a no-brainer.  So we are off and running.

One last note, if you go Airbnb and you get a property manager, you’re a sucker! They want 20% of your profits when, once set up, it’ll take you literally 15 minutes per week per listing to self-manage.  Go back to last week’s episode and listen but you can manage an STR in Florida from AZ with no problem. You need a wireless thermostat, a wireless Schlage Encode deadbolt, Ring cameras, a maintenance person, a lawn person, and a good cleaner. That’s it. Happy investing.

Now, onto the research.  Item #1 The first one is called “The global summit on the efficacy and effectiveness of spinal manipulative therapy for the prevention and treatment of non-musculoskeletal disorders: a systematic review of the literature” by Cote et. al. (Côté P 2021) and published in Chiropractic Manual Therapeutics on February 17th of 2021 and goes a lil sumpin’ like this. 

Why They Did It

A small proportion of chiropractors, osteopaths, and other manual medicine providers use spinal manipulative therapy (SMT) to manage non-musculoskeletal disorders. However, the efficacy and effectiveness of these interventions to prevent or treat non-musculoskeletal disorders remain controversial.

They say, We convened a Global Summit of international scientists to conduct a systematic review of the literature to determine the efficacy and effectiveness of SMT for the primary, secondary and tertiary prevention of non-musculoskeletal disorders.

How They Did It

The Global Summit took place on September 14-15, 2019 in Toronto, Canada. It was attended by 50 researchers from 8 countries and 28 observers from 18 chiropractic organizations. At the summit, participants critically appraised the literature and synthesized the evidence.

What They Found

We retrieved 4997 citations, removed 1123 duplicates and screened 3874 citations. Of those, the eligibility of 32 articles was evaluated at the Global Summit and 16 articles were included in our systematic review.  Our synthesis included six randomized controlled trials with acceptable or high methodological quality (reported in seven articles). These trials investigated the efficacy or effectiveness of SMT for the management of infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. None of the trials evaluated the effectiveness of SMT in preventing the occurrence of non-musculoskeletal disorders. 

Consensus was reached on the content of all risk of bias and evidence tables. All randomized controlled trials with high or acceptable quality found that SMT was not superior to sham interventions for the treatment of these non-musculoskeletal disorders. Six of 50 participants (12%) in the Global Summit did not approve the final report.

Wrap It Up

Our systematic review included six randomized clinical trials (534 participants) of acceptable or high quality investigating the efficacy or effectiveness of SMT for the treatment of non-musculoskeletal disorders.  We found no evidence of an effect of SMT for the management of non-musculoskeletal disorders including infantile colic, childhood asthma, hypertension, primary dysmenorrhea, and migraine. This finding challenges the validity of the theory that treating spinal dysfunctions with SMT has a physiological effect on organs and their function.  Governments, payers, regulators, educators, and clinicians should consider this evidence when developing policies about the use and reimbursement of SMT for non-musculoskeletal disorders.

Before getting to the next one, I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! 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

Our last one today is called “Are Nonpharmacologic Pain Interventions Effective at Reducing Pain in Adult Patients Visiting the Emergency Department? A Systematic Review and Meta-analysis” by Sakamoto et. Al. (Sakamoto JT 2018) and published in Academy of Emergency Medicine in March of 2018. 

Why They Did It

Pain is a common complaint in the emergency department (ED). Its management currently depends heavily on pharmacologic treatment, but evidence suggests that nonpharmacologic interventions may be beneficial. The purpose of this systematic review and meta-analysis was to assess whether nonpharmacologic interventions in the ED are effective in reducing pain.

How They Did It

We conducted a systematic review of the literature on all types of nonpharmacologic interventions in the ED with pain reduction as an outcome. We performed a qualitative summary of all studies meeting inclusion criteria and meta-analysis of randomized controlled studies measuring postintervention changes in pain. Interventions were divided by type into five categories for more focused subanalyses.

What They Found

Fifty-six studies met inclusion criteria for summary analysis. The most studied interventions were acupuncture (10 studies) and physical therapy (six studies). The type of pain most studied was musculoskeletal pain (34 studies). Most (42 studies) reported at least one improved outcome after intervention. Of these, 23 studies reported significantly reduced pain compared to control, 24 studies showed no difference, and nine studies had no control group. Meta-analysis included 22 qualifying randomized controlled trials and had a global standardized mean difference of -0.46 (95% confidence interval = -0.66 to -0.27) in favor of nonpharmacologic interventions for reducing pain.

Wrap It Up

Nonpharmacologic interventions are often effective in reducing pain in the ED. However, most existing studies are small, warranting further investigation into their use for optimizing ED pain management. 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/

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

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

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

Bibliography

Côté P, H. J., Axén I, Leboeuf-Yde C, Corso M, Shearer H, Wong J, Marchand AA, Cassidy JD, French S, Kawchuk GN, Mior S, Poulsen E, Srbely J, Ammendolia C, Blanchette MA, Busse JW, Bussières A, Cancelliere C, Christensen HW, De Carvalho D, De Luca K, Du Rose A, Eklund A, Engel R, Goncalves G, Hebert J, Hincapié CA, Hondras M, Kimpton A, Lauridsen HH, Innes S, Meyer AL, Newell D, O’Neill S, Pagé I, Passmore S, Perle SM, Quon J, Rezai M, Stupar M, Swain M, Vitiello A, Weber K, Young KJ, Yu H (2021). “The global summit on the efficacy and effectiveness of spinal manipulative therapy for the prevention and treatment of non-musculoskeletal disorders: a systematic review of the literature.” Chiropr Man Therap 29(1): 8.  

Sakamoto JT, W. H., Vissoci JRN, Eucker SA (2018). “Are Nonpharmacologic Pain Interventions Effective at Reducing Pain in Adult Patients Visiting the Emergency Department? A Systematic Review and Meta-analysis.” Acad Emerg Med.  

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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  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).        

Spinal Manipulative Therapy Effectiveness & Chiropractic For Colic

CF 177: Spinal Manipulative Therapy Effectiveness & Chiropractic For Colic

Today we’re going to talk about manipulation effectiveness and we’ll talk about working on babies with colic. What’s the research say?

But first, here’s that sweet sweet bumper music

 

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

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

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

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

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

You have found yourself smack dab in the middle of Episode #177

Now if you missed last week’s episode , we talked about car wreck research. It was part two of a two part little thing we did. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I have set the book launch date. It will be Tuesday, June the 8th. We will be releasing The Remarkable Truth About Chiropractic: A Unique Journey Into The Research on that date and I’ll be hoping that as many of you as want to, will consider being on my launch team. 

That means you download the book for free on launch day and you leave a great review on Amazon to help boost it’s exposure so that when I start charging for it, it’s up the relevant charts and I have a chance to get the message of evidence-based, patient-centered care to more and more people. Which is what it’s always been about in the first place. 

If you have connections with influencers, podcast hosts, TV hosts, radio, bloggers, or anyone like that, let me know and let me know if they’d be interested in an interview about the book. We want as much exposure as humanly possible on this deal. It’s not every day you get to release a book, now is it?

So, send me an email at dr.williams@chiropracticforward.com and tell me you want to be on the launch team. It’s that simple. 

As we have discussed, I am still going through the medical integration and hiring a nurse practitioner process. And it is now beginning to proceed a little more rapidly in the last week or so. Which is excellent news because I like to get things done and move to the next thing. I just got all of the paperwork and forward it over to our medical Director for his review and then we will proceed from there. 

While I am the first in my area to form one of these entities, I am hearing Word on the street that there are several others in the process as well so I need to put the foot down on the gas pedal. I know of two other chiropractors that are in the process right now in my area. One of them is a vitalist. 

So I’m trying to figure out how a chiropractic vitalist is offering medical services but whatever. Anyway it’s time to get this done and move on and be the first. There’s value to being the first one to do something. That’s what I plan on being

We have been taking this time of transition to get more familiar with our nurse practitioner. And fortunately I am more and more convinced that we have made the right decision. Outside of all of that rigmarole, we are just trying to get patients back in the door now that things are starting to cool off with the pandemic. It’s still a little odd. 

For example last week I I only saw approximately 130 patient for the whole week. Those numbers are down fairly significantly for me. However, we had around 23 new patients if I remember right. And this week is starting to look pretty good. It’s hard right now.

One week is up in the next week is down. I can’t quite explain it but we’re nowhere near where we were before the pandemic came along. If I’m being honest, it’s pretty damn frustrating. I’m not a patient person. I feel like I’ve waited over a year to get back to normal and now it’s time. Maybe I just need to take some Valium or something like that.

Since I don’t really have a lot more to share from the personal side of things, let’s just keep it short and jump right into the research.

CHIROUP ADVERTISEMENT

Item #1

This first one is called “Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations” by Santilli et. al. [1] and published in Spine Journal in the March/April edition from 2006. Not hot at all. But still interesting when you have randomized, double-blind research.

Why They Did It

Acute back pain and sciatica are major sources of disability. Many medical interventions are available, including manipulations, with conflicting results. So the purpose was to assess the short- and long-term effects of spinal manipulations on acute back pain and sciatica with disc protrusion.

How They Did It

  • Randomized double-blind trial comparing active and simulated manipulations in rehabilitation medical centers in Rome and suburbs.
  • 102 ambulatory patients with at least moderate pain on a visual analog scale for local pain (VAS1) and/or radiating pain (VAS2).
  • Outcome measures took into account pain-free patients following treatment, quality of life, number of days on anti-inflammatories, drug prescriptions, pain scores, and disc protrusion reduction on follow up MRI
  • Manipulations or simulated manipulations were done 5 days per week by experienced chiropractors, with a number of sessions which depended on pain relief or up to a maximum of 20, using a rapid thrust technique.
  • Patients were assessed at admission and at 15, 30, 45, 90, and 180 days
  • A total of 64 men and 38 women aged 19-63 years were randomized to manipulations (53) or simulated manipulations (49). 

What They Found

  • Manipulations appeared more effective on the basis of the percentage of pain-free cases, number of days with pain, and number of days with moderate or severe pain
  • Patients receiving manipulations had lower mean VAS1
  • A significant interaction was found between therapeutic arm and time
  • There were no significant differences in quality of life and psychosocial scores

Wrap It Up

Active manipulations have more effect than simulated manipulations on pain relief for acute back pain and sciatica with disc protrusion.

Now, why include a paper from way back 15 years ago?? First, because it’s a solid paper and still has value and is still relevant. 

Secondly, because I’m seeing more and more chiropractors starting to diss or completely poo poo spinal manipulative therapy. We have the Airossti crew and then we have the exercise/rehab only crew. Which….shouldn’t they just have become PTs?? Seems more fitting to me. I didn’t want to be strictly an exercise coach. 

As with anything in life, there are extremes, aren’t there?? You have the vitalistic/philosophic extreme that embarrasses those of us in the profession trying to drag it forward and change it for the better. Then you have the evidence-based faction’s extreme aspect that are so evidence-based and evidence woke that they basically discount their own profession all together. The whole damn kit and caboodle!

So, let’s talk about it shall we?

I’ve beat up on vitalism quite a bit. Because it deserves it. You have the ones that are just embarrassing and then you have the ones like Nepute that have some legal challenges from what I hear. Then you have the fools talking about 99 patients and 9 new patients by himself all in 3 hours. Garbage. That’s stuff clowns do, folks. So, that end of it all goes without saying to most sensible people. 

But what about the extreme evidence-based crew? We’ve never talked about them before. Most because there’s been no reason until recently. 

Lately, they’ve gotten particularly vocal. There is a saying, “There is an art to disagreeing without being disagreeable.” Well, the extreme evidence-based people are, for me personally, becoming very disagreeable and extremely unlikable. 

Most are fresh out of school with little to zero experience in using spinal manipulative therapy so to turn around and bash those using SMT as their biggest tool in the toolbox is a little dumb. Is SMT everything? Of course not. But neither is exercise. Neither is only worrying about the cognitive aspect. Neither is acupuncture or massage or laser by themselves. Yet, while he makes fun of all of these, the American College of Physicians recommends them for low back pain. 

A good chiropractor should know when to mobilize and when to stabilize. I agree that chiropractors shouldn’t just use SMT all of the time no matter what. Ehlers-Danlos folks don’t need much SMT if any at all. Those having spinal instability, why would you use SMT on them when they need stabilization? I think you get my point. 

But again, it is not all about exercise either my friends. It is a multimodal approach. So to say that SMT doesn’t do all that much and all people need is to be moving is not accurate. 

And it falls on deaf ears and gets people riled up when done in a smartass, smug, and denigrating manner. When they’re making up cute little terms to label SMT docs into some sort of laughable crew, you’ve overstepped and have some things to learn. 

There are more and more of them lately but, the one particular person I have in mind with regard to the labeling, the kid….which is what he is….the kid is an online, virtual doc that has been out of school only a year or two. So, if he’s virtual only, makes sense that he is going to be an advocate of no SMT right? You can’t be an advocate of SMT but expect to make your living online only. 

So, even knowing his extreme business bias, he makes fun of people, pisses his colleagues off right and left, and seems to be trying to burn down the profession with all of us evidence-based SMT docs inside the building. 

For example, he has a video making fun of chiropractors in the instance that someone on a plane would ask if there are any doctors on the plane and a chiropractor would stand up. Making fun of his colleagues because they consider themselves doctors I guess. There’s no point to it other than being a smartass, getting clicks, and pissing off everyone in your profession. Making fun of the activator. No, I’m not an activator guy but is that really who you want to be?

Making fun of the idea of maintenance care while completely discounting anything that Andres Eklund has done over the past few years. 

Question #1 is why even be a chiropractor? Honestly. 

Look, I’ve been trying to change the profession for years. But not burn down the house. Let’s get more specialized Fellowships and Diplomates. Let’s get active in our state and national associations. Let’s follow researched guides. Let’s consume more and more research every day and every week. Basically, raise the damn game, folks. 

But to be out of school briefly, just to develop your online only bias, and then turn around and trash SMT while grouping them and labeling them with derogatory names…..

Big nope here. Not a fan. The fans say he’s a good dude… Blah blah blah.”

Tigers have stripes and I’ve seen these. Not just on him but others just like him. I don’t like the pattern. It’s not just one person. There are more and more of them lately. As if our profession doesn’t have a hard enough time moving past the vitalistic, philosophy part of the profession. 

Now we have these evidence woke knuckleheads on the complete other end. This kid is no better in my mind than the fools out in Oakland that we covered some time ago telling people they can reduce spinal degenerative bone spurs through 3 times per day for 3 weeks of adjusting. He’s no better. He’s certainly equally as arrogant. That’s a certainty. 

To be fair, and honest, and transparent, I haven’t watched all of his videos. Mostly because I can’t stomach that whole scene beyond the ten or so that I did watch. From what I watched though, I didn’t completely disagree with what he was saying. I really didn’t. Hell, I disagree with just about anything a vitalist says. I actually agreed with some of his sentiments.  

He’s completely wrong in some videos. He’s completely right in some videos. I think it’s OK to beat up on vitalists. Lol. But when you cherry pick and trash your entire profession collectively like is being done on a weekly basis, even when there is plenty of solid research to the contrary of what you are saying……well, you don’t look so smart. 

He’s disagreeing but he’s doing it in a way that is 100% disagreeable. For me anyway.

I guess I just don’t like feeling like I’m being made fun of. Not after the education I have gone through to do everything I can to be at the top of my game. And I don’t like my friends being made fun of either. Certainly not by a kid that cherry picks his research to confirm his bias while thinking he’s the smartest guy in the room. 

Some of the smartest people on the planet that I call friends are getting trashed almost weekly by people like this and it’s a shame. I have such a high amount of respect for some of my fellow Diplomates and I just don’t think it’s necessary to effect change. That’s it in a nutshell. 

Can you imagine being 20 something or early 30’s something and already having everything all figured out. How amazing that would truly be. What power he must have. Lol. 

He could spread a good message and move his profession in a positive direction in so many other ways. But he’s got those very specific stripes. He is who he is, the smartest guy in the room. There will be no changing these folks. Just like I don’t ever see the vitalistic side ever changing either. 

OK, enough

Item #2

Our second paper is called “The effect of chiropractic care on infantile colic: results from a single-blind randomised controlled trial” by Holm et. al. [2] and published in Chiropractic and Manual Therapies on April 19th 2021 sizzling…..foggin up my spectacles. 

Why They Did It

Chiropractic care is commonly used to treat infantile colic. However large trials with parental blinding are missing. Therefore, the purpose of this study is to evaluate the effect of chiropractic care on infantile colic.

How They Did It

  • It was a multicenter, single-blind randomized controlled trial conducted in four Danish chiropractic clinics, 2015–2019
  • Information was distributed in the maternity wards and by maternal and child health nurses. 
  • Children aged 2–14 weeks with unexplained excessive crying were recruited through home visits and randomized (1:1) to either chiropractic care or control group
  • Both groups attended the chiropractic clinic twice a week for 2 weeks.
  • The intervention group received chiropractic care, while the control group was not treated. 
  • The parents were not present in the treatment room and unaware of their child’s allocation.
  • The primary outcome was change in daily hours of crying before and after treatment.
  • Secondary outcomes were changes in hours of sleep, hours being awake and content, gastrointestinal symptoms, colic status and satisfaction.
  • All outcomes were based on parental diaries and a final questionnaire.

What They Found

  • Of 200 recruited children, 185 completed the trial
  • Duration of crying in the treatment group was reduced by 1.5 h compared with 1 h in the control group but when adjusted for baseline hours of crying, age and chiropractic clinic, the difference was not significant
  • The proportion obtaining a clinically important reduction of 1 h of crying was 63% in the treatment group and 47% in the control group

Wrap It Up

“Excessive crying was reduced by half an hour in favor of the group receiving chiropractic care compared with the control group, but not at a statistically significant level after adjustments. From a clinical perspective, the mean difference between the groups was small, but there were large individual differences, which emphasizes the need to investigate if subgroups of children, e.g. those with musculoskeletal problems, benefit more than others from chiropractic care.”

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. 

 

 

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. 

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Connect

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

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About the Author & Host

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

1. Santilli V, B.E., Finucci S,, Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J, 2006. 6(2): p. 131-7.

2. Holm LV, J.D., Christensen HW, Sondergaard J, Hestbaek L,, The effect of chiropractic care on infantile colic: results from a single-blind randomised controlled trial. Chiropr Man Therap, 2021. 29.

New Paper: Spinal Manipulation Has No Effect On Chronic Pain – Our Experts Rebuttal

CF 143: New Paper: Spinal Manipulation Has No Effect On Chronic Pain – Our Experts Rebuttal  

Today we’re going to talk about a new paper in JAMA saying that spinal manipulative therapy has not effect. Yeah…..BIG topic today so keep your seat, buckle up, I got some stuff to say. 

But first, here’s that sweet sweet bumper music

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

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

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

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

  • Like our Facebook page, 
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  • 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 #143

Now if you missed last week’s episode , we talked about nonoperative disc treatment, Vitamin D3 for depression, and the biopsychosocial part of chronic pain. I used big words on this one folks. 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…..

First thing is, my website is jacking up in the last few weeks and it’s about to make me lose every marble I ever had in my noggin. So if you prefer reading the transcript on the website or listening via the website, I apologize if you’ve had issues doing so lately. Trust me, I am working diligently with people that know how to do this stuff to get it lined out and working properly and dependably

Next, my kid is coming home for the weekend from college. Pretty excited to see the knucklehead. 

My practice was busier this week. Not necessarily in the total numbers of visits. We ended up somewhere back around 140 last week. Which was about where we started when we came back from COVID full time. 

We were at about 140-145 or so per week and then fell off to about 125. That was mad Jeff time. Pouty Jeff time there. But, it was also back to school time and that’s traditionally the slower part of the year for me. 

Last week, we ended up with about 22 new patients in one week. Hell yeah I’ll take it. Bet you’re sweet bippy….pass me some more of that deep dish of deliciousness. 

That 22 should boost next week’s totals and that makes for content Jeff. Not happy…..no….I’m still down from Pre-Rona and still don’t have an associate so….not happy Jeff but definitely more content Jeff. Not only did I have the 22 new patients but a heaping spoonful of re-exams on patients that haven’t been in since the Rona began ruining crap. 

So, all in all, we’re moving the right direction. 

I was listening to an episode of mine from a couple of weeks ago. Kind of like game tape. Like the coaches go back and watch the game tape so they can learn about what they want and don’t want. My wife just says I like to hear myself talk and to her I say….you are fake news. 

But anyway, I predicted that by now, more schools would be closing down. At the moment, I stand corrected. More schools have not yet shut down. I also said that I hope I am wrong. And I’m saying right now that I’m glad I was wrong. I’m a big enough man to say it out loud and proclaim mine own idiocy!! 

Or am I an idiot. Today, which is 9/4, happy birthday to my wife Meg BTW, today I took note that Lubbock has reported 849 new cases in the last 3 days. Three days, y’all. 

They’re averaging 283 new cases every single day. And it’s because of that college. A little birdy in the Texas Tech healthcare system told me they got an internal email saying basically that things are getting out of control on the campus already because people living off-campus are being dumb and spreading it on campus. They say it’s expected to get a lot worse after this weekend. 

So, maybe I’m not an idiot after all. We know the incubation on this thing is about 2 weeks and they went to school right at 2 weeks ago. And now here we are. 

I do still believe it’s only a matter of time but for now, I was sort of wrong and I’m sort of OK with it. 

Let’s get on with it shall we?

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 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 #1

Alright, let’s get to this POS paper. I say that because it doesn’t confirm my bias. Lol. It’s called “Effect of Spinal Manipulative and Mobilization Therapies in Young Adults With Mild to Moderate Chronic Low Back Pain: A Randomized Clinical Trial” by Thomas et. al(Thomas J 2020). published in JAMA on August 5, 2020. Hot steamy pile of dog crap here…big plate of shooey. 

Why They Did It

To evaluate the comparative effectiveness of spinal manipulation and spinal mobilization at reducing pain and disability compared with a placebo control group (sham cold laser) in a cohort of young adults with chronic LBP. As if this question has not already been answered a million jillion times. 

How They Did It

  • The study was single-blinded
  • placebo-controlled randomized clinical trial
  • 3 treatment groups
  • Conducted at the Ohio Musculoskeletal and Neurological Institute at Ohio University from June 2013 to August 2017
  • 4903 subjects eligible
  • 4741 did not meet inclusion criteria
  • 162 patients with Chronic Low Back Pain qualified for randomization 
  • Participants received 6 treatment sessions of 
  • spinal manipulation
  • spinal mobilization
  • sham cold laser therapy – placebo – during a 3-week period. 
  • Outcome measures were the change from baseline in Numerical Pain Rating Scale (NPRS) score over the last 7 days and the change in disability assessed with the Roland-Morris Disability Questionnaire 48 to 72 hours after completion of the 6 treatments.

What They Found

  • There were no significant group differences for sex, age, body mass index, duration of LBP symptoms, depression, fear-avoidance, current pain, average pain over the last 7 days, and self-reported disability.
  • At the primary endpoint, there was no significant difference in change in pain scores between spinal manipulation and spinal mobilization, spinal manipulation, and placebo, or spinal mobilization and placebo
  • There was no significant difference in change in self-reported disability scores between spinal manipulation and spinal mobilization, spinal manipulation, and placebo, or spinal mobilization and placebo

So it appears from this paper that spinal manipulation and spinal mobilization has absolutely NO utility NO use and makes NO sense for anything. Basically. This….when so many other papers have shown incredible utility, incredible effectiveness, and incredible cost-effectiveness. It makes very little to zero sense at all. 

Wrap It Up

Their conclusions was as follows, “In this randomized clinical trial, neither spinal manipulation nor spinal mobilization appeared to be effective treatments for mild to moderate chronic LBP.”

OK, I had to consult with those much smarter than I to really get a full picture of what’s going on here. Because I feel like someone’s picking on us a little here. You cannot have so many papers supporting spinal manipulative therapy and then this say there’s no use whatsoever. You simply can’t. Something smells awry in the land of Denmark, up in here, up in here. 

I’ll start with Dr. James Lehman. Dr. Lehman is an Associate Professor of Clinical Sciences at the University of Bridgeport/College of Chiropractic and Director of Health Sciences Postgraduate Education. Dr. James Lehman is a board-certified, chiropractic orthopedist. He teaches orthopedic and neurological examination and differential diagnosis of neuromusculoskeletal conditions. In addition, he provides clinical rotations for fourth-year chiropractic students and chiropractic residents in the community health center and a sports medicine rotation in the training facility of the local professional baseball team. He’s the driving force behind the Diplomate program for Neuromusculoskeletal Medicine. 

As Director, Dr. James Lehman developed the three-year, full-time resident training program in chiropractic orthopedics and neuromusculoskeletal medicine. The program offers training within primary care facilities of a Federally Qualified Health Center and Patient-Centered Medical Home. While practicing in New Mexico, he mentored fourth-year, UNM medical students. He has been generous with advice and mentorship for yours truly as well. We could go on and on. 

I sent this paper to Dr. Lehman and asked for his opinion on it. 

Dr. Lehman said, “I am not favorably impressed with the study for several reasons. It is my opinion that this study was simplistic and non-specific. When studies base the effort on determining the outcomes of a specific modality without a specific diagnosis, I question the outcomes.

 

As a chiropractic specialist, I use the definition promulgated by the National Pain Strategy. Chronic pain occurs more than 50% of the days for six months or longer. This study mentioned that pain occurred only greater than 3 months with no mention of the number of days that pain was experienced. In addition, this study used only mild and moderate chronic pain. It is my opinion that these patients may be experiencing mild symptoms for several reasons that are not relieved by manual medicine interventions. For example, poor posture and distress with resultant myofascial pain without joint dysfunction. Another example would be a patient with a true chronic pain condition that has centralized in the CNS.  These patients normally experience only a reduction in pain for a short period of time.

 

This study offers a simplistic diagnosis and not one that indicates the need for manual medicine interventions.

 

I always question studies that base the need of spinal manipulation on the finding of reduced joint motion. Although chiropractic programs teach motion palpation, the evidence demonstrates the examination procedure to be less than dependable.

 

“Regardless of the degree of standardization, interrater reliability of motion palpation of the thoracic spine for identifying pain and motion restriction performed by experienced examiners was poor and often not better than chance. These findings question the continued use of motion palpation as part of the clinical assessment as an isolated tool to detect loss of intersegmental joint play.” Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4480941/

 

As we know, patients that present for chiropractic care for chronic low back pain demonstrate pain scale findings higher than 2/10 but more likely 5-10/10. Less than 5/10 indicates that the pain does not interfere with the patient’s activities of daily living. Hence, I believe the study was poorly designed. Why study the effectiveness of a manual medicine for an insignificant condition?

Thank you Dr. Lehman for such a thorough response and for laying out his thoughts so effectively on this. He really is a gem of this profession. 

I exchanged emails with Dr. Christine Goertz. Her resume is again, so long and impressive that we can’t do it right here but, in short, she is the Chief Operating Officer of the Spine Institute for Quality. She is also an Adjunct Associate at the Department of Orthopaedic Surgery, Duke University Medical Center, and Adjunct Professor in the Department of Epidemiology, College of Public Health at the University of Iowa. She has received nearly $32M in federal funding as either principal investigator or co-principal investigator, primarily from NIH and the Department of Defense, and has authored or co-authored more than 100 peer-reviewed papers. 

I almost hated to ask Dr. Goertz because I know how busy she is, but honestly, who better to ask, right? And, at the end of the day, I followed an old saying I’ve kept in mind my whole life. And that saying is, “No asky, no getty”

And, as expected, she did not have the chance to dive into it headfirst but did offer this, “Although I can’t comment on the details of the methods Without a deeper dive, one thing that strikes me is the decreased utility of studying spinal manipulation in isolation, as it is generally delivered in the larger context of chiropractic care.”

Which alludes to something I’ve said on this podcast so many times. Chiropractic according to every chiropractor outside of strictly subluxation slayers, is not a modality. It is a profession with A LOT of tools under its umbrella. Still, there’s something smelly about a paper claiming absolutely zero effectiveness of SMT. Really? None?

I emailed one of the smartest dynamic duos I have ever experienced in my entire chiropractic career, Dr. Anthony Nicholson and Dr. Matthew Long. They’re like the batman and robin of chiropractic geniuses. Honestly, good luck finding more intelligent and more thoughtful chiropractors anywhere. They are the creators of all online education curriculum through the CDI courses which are what is used by the Diplomate of Neuromusculoskeletal Medicine. Dr. Nicholson is a Diplomate of Orthopedics as well as a Diplomate in Neurology. 

Dr. Nicholson shared this with me. He said, “In relation to the article, firstly, I’d say that I don’t have researcher-level credentials in critiquing study design, validity, statistical methods etc.

I do obviously read a fair bit of research and integrate that with teaching and clinical experience.

This study seems pretty light to me in several respects and I’m not surprised by the conclusions.  The number of participants was pretty low (162), which lowers the power of the study to draw accurate conclusions.  Overwhelmingly though, here is the dilemma: there is obviously a strong desire to test certain clinical interventions and compare them.  

This means reducing the number of variables and attempting to isolate the specific effect of each intervention to the greatest degree possible.  The problem is that these interventions aren’t meant to be delivered in such a sterile way.  This omits the extremely important context effect and ritualistic aspect of a clinical encounter.  It doesn’t take into account the words, concepts, explanations, and empathy of the doctor that creates a certain context in which the specific intervention is delivered.  The same goes for any intervention, be it drugs or surgery.  Pain is all about meaning.  We are priming a patient’s brain to receive a certain sensory input in terms of what that means.  

The bottom line is that a clinical interaction is so much more than the sum of its parts, and each individual part is very tricky (I won’t say impossible, but you could say it’s pretty close) to evaluate in isolation.  Where does that leave us?  I don’t know!

But, what I do know (like all clinicians I suspect) is that I see meaningful changes to people’s lives every day with these interventions when they’re wrapped in the right clinical context (a successful therapeutic alliance with the patient that is built upon trust and rapport).  It’s difficult to study that!”

I don’t know how one could say it any better than Dr. Nicholson. He has such a way with words, I swear. Are all Australians as eloquent? I’m not sure. I’m a Texan, I’m pretty gruff and rough around the edges I’m afraid. I don’t speak his language but luckily I understand it. Lol. 

His partner in CDI and in fighting chiro crime….remember the batman and robin reference….anyway, Dr. Matthew Long wrote an outstanding article on this type of study that I’ll link in the show notes. Please go check it out. 

He says, “For many chiropractors the realities of clinical practice and the supposed truths of scientific research often seem irreconcilable. This is particularly apparent when reviewing research that investigates the effects of spinal manipulation upon a specific condition. 

Adjusting Disc Herniations and Bulges

 

Often there is little, if any, the difference in outcome between the placebo (sham) intervention and the ‘real’ procedure. In both cases, the patient is seen to improve, often quite substantially. However, the study is unable to show conclusively that active treatment is better than the sham. This phenomenon is especially prevalent when the intervention is being tested for its capacity to reduce pain, which carries a large emotional connotation into the experimental setting. We can see this in a recent migraine study by Chaibi and colleagues (1), who concluded that the significant beneficial effect obtained by sufferers was “probably a placebo response”.

To most clinicians this is deeply unsatisfying. While it is true that the science of placebo has undergone a reappraisal and a softening of opinion in recent years, the average hard working chiropractor probably feels that there is more to their daily practice than simply putting on a good show. 

While many experiments are based upon our ability to modulate pain, others seek to determine how manipulation might influence the biomechanics of a patient’s spine. After all, the dominant model by which spinal manipulation has been justified for over 100 years is largely mechanical in nature (whilst acknowledging the desire to reduce some sort of neural distress that resulted). 

Unfortunately, these biomechanical experiments are sometimes even less impressive in their outcomes, and there is little difference between the active treatment and the control. However, before we become too jaded I think that we should pause for a moment and ask ourselves two important questions:

  1. Are we posing research questions based upon a legacy model of spinal manipulation?
  2. Can the design of these studies preclude us from finding any meaningful answers?

It is my contention that the science of neuromusculoskeletal health has evolved considerably, and yet we are perhaps still looking at the world through an outdated lens.

This dynamic duo is the future of this profession. I’m including the link to the article in the show notes at this point in the show so go there to episode 143, scroll down and click on it. Stop arguing like a damn teenager and just do it or you go to bed with no supper. Don’t you roll your eyes at me, Give me your phone, you’re grounded.”

Another very relevant though from Dr. Long in the article is this:

“Some of the things we know about spinal manipulation include:

1. It is not a mechanical realignment.

2. It does not help relieve pain by increasing range of motion.

3. It can produce changes in smoothness and quality of movement, which are critical for stability and control.

4. It influences the brain’s perception of the spine, and how it can (and should) move.”

It goes on and, as with anything from Dr. Nicholson and Dr. Long, it is eloquent, easy to understand, and basically amazing. This is why you always hear the Neuromusculoskeletal Medicine Diplomates talk about the outstanding education you get in the program. It’s largely due to these two amazing doctors and educators. 

Go read the rest of that article, please.  

https://cdi.edu.au/clarity/its_the_whole_package.php

Now, last but absolutely not least is one of my new favorite research superstars in our profession. We are going to have her on a future episode so keep watching for that. Dr. Katie Pohlman from Parker University was kind enough to send me her thoughts on the paper. 

Dr. Pohlman is Director of Research at Parker University and an inaugural fellow of the Chiropractic Academy of Research and Leadership (CARL) program. She received Researcher of the Year in 2020 from the American Chiropractic Association (ACA), is the current Vice President of the ACA’s Council on Women’s Health, and has served as Vice President of the ACA’s Council on Chiropractic Pediatrics. Dr. Pohlman received her Doctor of Chiropractic (D.C.) degree and M.S. in Clinical Research from Palmer College of Chiropractic and her Ph.D. in Pediatrics from the University of Alberta. We could keep going but I think you get the point. 

She’s one of the most impressive ‘newer’ researchers in our profession. I say newer in quotes because I only found out about Dr. Pohlman in the last few years. But trust me here, you’re going to be hearing and seeing A LOT more out of her in the future. 

Dr. Pohlman said this, “This was a well-designed study of manipulation and mobilization with a strong placebo arm. The population was young, non-obese individuals with chronic back pain. 

As stated in the discussion, the sample population baseline pain level on a 0-11 scale was ~4.3, which I feel left little room the clinical meaningful 2 points decrease. The study also used characteristics from a clinical prediction rule for the inclusion of patients. 

That Episode Where Vitalists Tune Out & NSAIDS vs. Cognitive Behavioral Therapy

The characteristic list that they use included patients having pain for less than 16 days. Since this study was looking at chronic pain this characteristic was not included. 

I support the idea of pre-identifying responders versus non-responders; however, the characteristics used in this study may not have been most useful for chronic pain patients. 

A more useful model at this time is the Andres Eklund ‘s psychological subgroups (which also have not be validated… watch for more studies in the near future). 

(NOTE: this study was published after the start of the RCT being discussed.) 

Another consideration for this study was the 3 weeks of care and the manipulation/mobilization techniques that were used. I will leave these concerns for clinicians to discuss.”

Katie is wonderful for taking time out of her day to offer us some insight on this. 

Now, I want to address the F4CP. The Foundation For Chiropractic Progress. They came out shortly after this paper with a press release in support of this paper. Saying it’s correct, they support it, and it is further proof that a D.O. or any other practitioner outside of a Doctor of Chiropractic is clearly ineffective. 

The insinuation is that no other practitioner can deliver an adjustment as well and as effectively as a chiropractor and that had the study included spinal manipulative therapy delivered by chiropractors, it would have shown clear effectiveness. 

Because you know….chiropractors are evidently the ONLY practitioners that can adjust I guess. 

Let me get this straight upfront; I love the F4CP. I support them. I love what they’ve done for our profession and are doing for our profession. I would say that I believe there are some TICs and some TORs in there and that’s not necessarily helpful for the evidence-based side of the profession but overall, it’s a great group and does a good job of being well-rounded and representing the profession as a whole.

With that being said, in this paper, I think the F4CP is just wrong to support the paper like this. For me, it’s lazy and almost comes off like the way a politician would slide around something. You know what I mean? Avoid the elephant in the room and say, “See there, had they used chiropractors, it’d been a different dealio all together because we’re the superstars’ nobody else can be. I don’t know…..I guess if the other spinal manipulative therapy people would maybe….I don’t ….try not to suck so much….that’d be great and all”

It’s BS and I don’t like their handling of it. I like their handling of just about everything else but whoever pulled the trigger on this, I just can’t agree with. There are holes to be poked in it. There are too many papers showing the effectiveness to sit around and let 3 PhDs set the tone for spinal manipulative therapy going forward. 

You think insurance companies, chiro haters, and trolls aren’t going to grab this and run like they stole something with this thing? Of course, they will. And are. Hell, I’ve seen where chiropractors themselves are now saying the manipulation isn’t all that effective. Chiropractors y’all. Then you have the Airrosti folks who don’t adjust. We all have to do what we do and what we feel but come on man. I always say chiropractic isn’t an adjustment, it’s a profession. But let’s have some real talk here. The adjustment is still damn well the cornerstone of the profession. Don’t any of you kid yourselves on this? It is and it is for a reason. 

So for me, on this deal, the F4CP is wrong. Sorry to any of you that may be in the F4CP. I’m aware you didn’t ask my opinion first but I’m giving it second. Lol. 

I do support you overall. Just not here. 

The study isn’t an indictment of chiropractic in general but I’d say that this paper doesn’t take any of the other things a chiropractor does into account at all. When the pain is centralized and the CNS is upregulated, simple manipulation is a start but is only a tiny piece of the puzzle. 

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

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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!

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

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About the Author & Host

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

Bibliography

  • Thomas J, C. B., Russ D, (2020). “Effect of Spinal Manipulative and Mobilization Therapies in Young Adults With Mild to Moderate Chronic Low Back Pain
  • A Randomized Clinical Trial.” JAMA Open 3(8).