Spinal Manipulative Therapy

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 11)

CF 325: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 11) Today we’re going to talk about “The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 11)” But first, here’s that sweet sweet bumper music     Today we’re going to talk about Cancer-Finding Blood Tests & Neck Pain Treatment Differs By Initial Provider 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 giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 
  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com
You have found yourself smack dab in the middle of Episode #325 Now if you missed last week’s episode, we talked about Cancer-Finding Blood Tests & Neck Pain Treatment Differs By Initial Provider.  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. I see the battle coming and I’m trying to build the walls. It’s tough to go from seeing 8-10 new VA patients every week down to seeing about 1 every 2 weeks. Plus they’re reducing their visits to acute conditions only when most of these folks are chronic. They’ve been hurting literally for decades for some of them.  So, yeah, the battle is approaching so I’m trying to build walls. Now, how do we do that? We stop being lazy about marketing and, I’m a Christian so I always believe that when one door is closed, another will open and the one that opens is usually better.  All big changes in my life and business has always been for the best. Even when I thought the changes were catastrophic. This one is inconvenient and it pisses me off a bit. I’d love to have a set it and forget it type of business but it’s just not and never will be.  It’s ups and downs every week so that’s what we’re doing. We’re riding the coaster and preparing for the decrease in our numbers that’s already here and that we know will continue to get worse before it levels off and before we get our marketing in full gear and get after it again before the VA started sending the vets to us.  Yep, fully engaged now. I’ll keep you updated.  I want to congratulate Dr. Steve Brown out in Gilbert, AZ on his new peer reviewed paper that came our recently. Steve is doing good work and trying to help chiropractors stay out of trouble on the smt stroke issue that we’re all having to deal with all of the time.  I’m putting the link to Dr. Brown’s paper right here in the show notes so go grab it and check it out. https://www.cureus.com/articles/239108-plausible-mechanisms-of-causation-of-immediate-stroke-by-cervical-spine-manipulation-a-narrative-review#!/ It may save your collective asses.  Now, due to this paper Steve has the predictable drivel coming from the philosophy wonks that have a stake in the game and that’s OK. He expects that. Heck he even might welcome it with a research-backed response of his own. But, if one looks deeper than the detractors seem to have the brain space to do, his paper pretty much protects us. If we read it, we can prevent dissections most times and, should a pt. Try to state we’re responsible for a VAD the next few days or weeks after an adjustment, his paper provides some protection.  Then, about the same week, we had a knucklehead present a case study called, “Myositis Ossificans Traumatica of Bilateral Sternocleidomastoid Muscles After Chiropractor Adjustment: A Case Report” by Felix et. Al in Cureus where they implied heavily that a chiropractic adjustment was the cause of the myositis ossificans.  I’m going to leave the link here in the show notes at chiropractiforward.com under episode 325.  https://www.cureus.com/articles/234594-myositis-ossificans-traumatica-of-bilateral-sternocleidomastoid-muscles-after-chiropractor-adjustment-a-case-report#!/  I hope you’ll go to the link, scroll down to the comments and watch Dr. Brown chime in and systematically tear this crap paper apart and watch the authors basically apologize and promise to make the necessary changes.  The moral of the story is this; research isn’t here to hold us back and tear us down. It’s here to defend us, make us better, and provide more and more validity as we increase our knowledge base. That’s why I’m here. That’s why Dr. Steve Brown and so many others are here.  One of the biggest hits I see our profession take online is that we’re all quacks because the profession was founded by a belief and a magnetic mystical healer. True as that may be, the medical field once had blood letting, leaches, and lobotomies.  Research pulled them together and out of the catacombs and research will and is doing the same for us as chiropractors. I promise when research came out proving blood letting useless, there were still those that had used blood letting for decades fighting the research, attacking and discrediting the research and researchers, and doing everything they could to clutch their pearls and maintain their box of safety.  All I can say is that flat Earthers will do flat earth stuff and you can’t tell or show them anything differently. Moon landing deniers…….good luck convincing them otherwise. When a certain dogma has taken over and defined one’s life, you can’t and won’t change it.  But that will never stop new thinking, research, and forward movement.  Item #1 We are continuing the series on why the hell the WHO would recommend SMT at very low confidence which, if you’ve been following along, is the same level of confidence they give ultrasound. Well that’s BS and I went and found all of the papers they used to make this determination and we’re going through each and every of them trying to form and impression of our own.  The first one today is called, “United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care” by UK BEAM Trial Team, published in British Medical Journal in December of 2004.  UK BEAM Trial Team. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ. 2004 Dec 11;329(7479):1377. doi: 10.1136/bmj.38282.669225.AE. Epub 2004 Nov 19. PMID: 15556955; PMCID: PMC535454. Remember, the citations can be found at chiropracticforward.com under this episode.  Why They Did It To estimate the effect of adding exercise classes, spinal manipulation delivered in National Health System or private premises, or manipulation followed by exercise to “best care” in general practice for patients consulting with back pain. How They Did It Pragmatic randomised trial with factorial design. Setting: 181 general practices in Medical Research Council General Practice Research Framework; 63 community settings around 14 centres across the United Kingdom. Participants: 1334 patients consulting their general practices about low back pain. Main outcome measures: Scores on the Roland Morris disability questionnaire at three and 12 months, adjusted for centre and baseline scores. What They Found
  • All groups improved over time. 
  • Exercise improved mean disability questionnaire scores at three months by 1.4 more than “best care.” 
  • For manipulation the additional improvement was 1.6 at 12 months. 
  • For manipulation followed by exercise the additional improvement was 1.9 at three months and 1.3 at 12 months. 
  • No significant differences in outcome occurred between manipulation in NHS premises and in private premises. 
  • No serious adverse events occurred.
Wrap It Up Relative to “best care” in general practice, manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months; and exercise achieved a small benefit at three months but not 12 months. Item #2 The second one is 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 published in JAMA Network Open in August 2020 Thomas JS, Clark BC, Russ DW, et al. Effect of Spinal Manipulative and Mobilization Therapies in Young Adults With Mild to Moderate Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Netw Open. 2020;3(8):e2012589. doi:10.1001/jamanetworkopen.2020.12589 Why They Did It Low back pain (LBP) is one of the most common reasons for seeking medical care. Manual therapy is a common treatment of LBP, yet few studies have directly compared the effectiveness of thrust (spinal manipulation) vs nonthrust (spinal mobilization) techniques. 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. How They Did It This single-blinded (investigator-blinded), placebo-controlled randomized clinical trial with 3 treatment groups was conducted at the Ohio Musculoskeletal and Neurological Institute at Ohio University from June 1, 2013, to August 31, 2017.  Of 4903 adult patients assessed for eligibility, 162 patients with chronic LBP qualified for randomization to 1 of 3 treatment groups.  Recruitment began on June 1, 2013, and the primary completion date was August 31, 2017.  Data were analyzed from September 1, 2017, to January 20, 2020. Participants received 6 treatment sessions of 
  1. spinal manipulation, 
  2. spinal mobilization, or 
  3. sham cold laser therapy (placebo) during a 3-week period.
What They Found Coprimary 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. A total of 162 participants with chronic LBP were randomized.  Fifty-four participants were randomized to the spinal manipulation group, 54 to the spinal mobilization group, and 54 to the placebo group.  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 end point, 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.   Wrap It Up In this randomized clinical trial, neither spinal manipulation nor spinal mobilization appeared to be effective treatments for mild to moderate chronic LBP 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.      Today we’re going to talk about Cancer-Finding Blood Tests & Neck Pain Treatment Differs By Initial Provider 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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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
Home
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (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      

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 10)

CF 323: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 10) Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 10). Yes, every other week we are covering the papers that the World Health Organization used to recommend spinal manipulative therapy at ‘very low confidence’. What we’ve seen so far are papers that are either very old, very small sample sizes, or prone to bias.  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 giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel. 

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #323 Now if you missed last week’s episode, we talked about Young Athletes With CTE & Catastrophizing, Fear Avoidance, and Pain.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things….. We just returned from the big West Texas TCA Conference down in Lubbock, TX. What a great time. It’s always great to re-connect with your tribe. I say re-connect because it’s been a good year since I was in the same room with my TCA family.  TCA, if you’re not familiar is the Texas Chiropractic Association.  Anyway, last year during this conference, I was already committed to VOAtlanta, a voice conference in Atlanta. So I couldn’t attend this one. Then for the summer ChiroTexpo event, I was on an Alaskan cruise so was unable to attend that event down in Dallas.  So yeah, it’s been over a year since I got to hang out with my Texas chiropractic clan.

It was a weekend of re-connecting, introducing our intern Dontae, to the Texas family, and even teaching.  I taught an hour course called, “Revolutionize Your Practice: Strategies For Taming Chronic Pain & The Upregulated Central Nervous System”. It’s really a 2-hour class but I’ve condensed it into and hour with the pedal to the metal. Y’all should know by now that I’m on a mission to get this message out and stop some of our chiro brethren from scaring patient into treatment plans. It really is a passion and a mission. 

If you know of any state associations or groups that need this message, please reach out at creekstonecare@gmail.com. I’d love to come share my message with your group.  Dontae, our intern got integrated into our Texas chiro family. I feel like it was the weekend of Dontae really.

Everyone loved the guy. He’s hard to not like, honestly.

He’s going to be super successful when he gets his feet under himself.  Like I said last week, conferences aren’t all about what you learn in the sessions. It’s as much about the connections and your network. The stronger your network, the stronger the provider. I promise. Raise your hand, step forward, and get involved. You’ll be glad you did. 

Also, I got to hang out with my buddy, Dr. Benjamin Fergus from Evanston, Illinois and the GRIP program. Ben is just phenomenal. He knows his stuff and has been a big big hit with our providers each time he’s taught for the TCA.  Good times. But now, back to work so let’s get the research rolling. 

Item #1 Our first one today is called, “Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome?” By Senna et. Al. and published in Spine on August 15, 2011 Remember, the citations can be found at chiropracticforward.com under this episode.  Senna MK, Machaly SA. 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):1427-37. doi: 10.1097/BRS.0b013e3181f5dfe0. PMID: 21245790.

Why They Did It To assess the effectiveness of spinal manipulation therapy (SMT) for the management of chronic nonspecific low back pain (LBP) and to determine the effectiveness of maintenance SMT in long-term reduction of pain and disability levels associated with chronic low back conditions after an initial phase of treatments.

How They Did It Sixty patients, with chronic, nonspecific LBP lasting at least 6 months, were randomized to receive either 

  1. 12 treatments of sham SMT over a 1-month period, 
  2. 12 treatments, consisting of SMT over a 1-month period, but no treatments for the subsequent 9 months, or 
  3. 12 treatments over a 1-month period, along with “maintenance spinal manipulation” every 2 weeks for the following 9 months. 

To determine any difference among therapies, they measured pain and disability scores, generic health status, and back-specific patient satisfaction at baseline and at 1-, 4-, 7-, and 10-month intervals.

What They Found Patients in second and third groups experienced significantly lower pain and disability scores than first group at the end of 1-month period.  However, only the third group that was given spinal manipulations (SM) during the follow-up period showed more improvement in pain and disability scores at the 10-month evaluation.  In the non-nmaintained SMT group, however, the mean pain and disability scores returned back near to their pre-treatment level.

Wrap It Up 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. That one’s not only in our favor and a RCT, but it’s also in support of ongoing wellness. Nice paper for the home team. Put a check in the win column for the good guys!

Item #2 The second one today is called, “Immediate effects of joint mobilization compared to sham and control intervention for pain intensity and disability in chronic low back pain patients: randomized controlled clinical trial” by Tavares, et. Al. published in Revisita Dor in 2017. Tavares FAG, Chaves TC, Silva ED, Guerreiro GD, Gonçalves JF, Albuquerque AAA de. Immediate effects of joint mobilization compared to sham and control intervention for pain intensity and disability in chronic low back pain patients: randomized controlled clinical trial [Internet]. Revista Dor. 2017 ; 18( 1): 2-7.[citado 2024 mar. 25 ] Available from: https://doi.org/10.5935/1806-0013.20170002  

Before jumping into this one, this paper was in Spanish and I couldn’t find the English version anywhere so I ran it through Google’s AI engine called Gemini and it spit the English version right out for me! Bam. Another tip from your ol’ uncle Jeffro!

Why They Did It One of the possible treatments for chronic low back pain is joint mobilization. There is moderate evidence in the literature on the effects of mobilization for chronic low back pain, however, few studies have used sham mobilization as a comparison group.  The objective of this study was to evaluate the effects of lumbar joint mobilization on the following outcomes: pain intensity and disability in patients with chronic low back pain.

How They Did It 60 individuals of both sexes were selected with the following eligibility criteria: age between 18 and 55 years, who had non-specific chronic low back pain for at least three months.  The selected volunteers were randomly assigned to three groups of 20 individuals: joint mobilization group, sham mobilization group, and control groups.  All groups were evaluated by the same blinded researcher and answered the following instruments before and immediately after the 10 intervention sessions: 

  • Numerical pain scale for pain intensity assessment, 
  • Oswestry Disability Index for pain-related disability assessment, and 
  • Catastrophic Thinking Scale for pain-related catastrophization assessment.

What They Found

  • Significant pre- and post-treatment differences were observed for the pain intensity variable in the mobilization and the sham groups. 
  • In the comparison between the intervention groups, a significant difference was found in the mean pain intensity value between mobilization versus control groups

Wrap It Up These results suggest effects related to the application of mobilization in patients with chronic lumbar 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. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

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

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 9)

CF 321: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 9)

Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 9) But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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

  OK, we are back and you have found the Chiro ractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #321 Now if you missed last week’s episode, we talked about PT For Sciatica & Laser For Neck Pain.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things….. I just got back from VO Atlanta, the world’s largest VoiceOver conference. I have to say that there are a lot of regular Joe’s like me walking about that place and in the industry but, oh my goodness….there are a lot of strange folks too as you might imagine.  A very diverse group and I’m not talking just about race. Just lots of different types of folks that the mainstream of our country wouldn’t recognize as being normal. I’ll just say it that way.  So, that was fun and useful and tiring. I’m glad I went but was glad to be back home. It’s a lot like going to chiropractic conferences.

Before I got involved in the Texas Chiropractic Association, I was a long\e wolf. I’d be out there on the fringe, not a member of the TCA, and almost proudly and defiantly uninvolved.  Compare and contrast that with me now. I’m a member of just about everything I can be a member of. Including the ACA, the TCA, FTCA, the MCM Mastermind, the Texas Orthopedic group, the national Orthopedic group, the national Forensics group and on and on and on.  My network then vs. now. I had a couple of folks I went to school with. Now, I have hundreds of trusted friends in the industry to learn from, ask questions, and bounce things off of.  There’s no comparison. The voice over thing reminds me of the fact that it’s not always the learning you get inside those classrooms that is the most valuable aspect of an industry conference.

Most of the time, it’s the one-on-one connections you make over dinner or over drinks and conversations you have with random folks throughout the weekend that pay the most dividends. Don’t get into conversations asking yourself, “what can I get from this person’ though. If you’re genuine and authentic and interested in others and what YOU can do for THEM, then it’s a natural instinct that they wonder what they can do for you in return.  That’s where the value of conferences comes in. It’s the network you build over years of going to these things that pay dividends. So, if you don’t see immediate ROI on the Monday you return, not to worry. Stick with it. Plant the seeds and reap the harvest down the road. 

Now remember we are continuing our series on why the WHO has designated spinal manipulative therapy at the level of very low confidence which is the same they designated ultrasound. I went and found all of the citations for all of the papers they used to make the determination. From what we’ve covered and from what I’m seeing, they haven’t used a lot of high-quality research to make the determination. This makes me wonder if there’s an agenda at the WHO to keep the man down. Keep the chiros in their place. Who knows? But it seems sus, as the kids say these days. 

Item #1 Our first paper this week is called, “Spinal manipulative therapy and exercise for older adults with Chronic Low Back Pain: a randomized clinical trial” by Schulz et. Al and published in Chiropractic Manual Therapy on May 15, 2019.  Remember, the citations can be found at chiropracticforward.com under this episode.  Schulz C, Evans R, Maiers M, Schulz K, Leininger B, Bronfort G. Spinal manipulative therapy and exercise for older adults with chronic low back pain: a randomized clinical trial. Chiropr Man Therap. 2019 May 15;27:21. doi: 10.1186/s12998-019-0243-1. PMID: 31114673; PMCID: PMC6518769.

Why They Did It Low back pain (LBP) is a common disabling condition in older adults which often limits physical function and diminishes quality of life.  Two clinical trials in older adults have shown spinal manipulative therapy (SMT) results in similar or small improvements relative to medical care; however, the effectiveness of adding SMT or rehabilitative exercise to home exercise is unclear.

How They Did It We conducted a randomized clinical trial assessing the comparative effectiveness of adding SMT or supervised rehabilitative exercise to home exercise in adults 65 or older with sub-acute or chronic LBP.  Treatments were provided over 12-weeks and self-report outcomes were collected at 4, 12, 26, and 52 weeks.  The primary outcome was pain severity.  Secondary outcomes included back disability, health status, medication use, satisfaction with care, and global improvement.  Linear mixed models were used to analyze outcomes.  The primary analysis included longitudinal outcomes in the short (week 4-12) and long-term (week 4-52).  An omnibus test assessing differences across all groups over the year was used to control for multiplicity.  Secondary analyses included outcomes at each time point and responder analyses.  This study was funded by the US Department of Health and Human Services, Health Resources and Services Administration.

What They Found 241 participants were randomized and 230 (95%) provided complete primary outcome data.  The primary analysis showed group differences in pain over the one-year were small and not statistically significant.  Pain severity was reduced by 30 to 40% after treatment in all 3 groups with the largest difference (eight percentage points) favoring SMT and home exercise over home exercise alone.  Group differences at other time points ranged from 0 to 6 percentage points with no consistent pattern favoring one treatment.  One-year post-treatment pain reductions diminished in all three groups.  Secondary self-report outcomes followed a similar pattern with no important group differences, except satisfaction with care, where the two combination groups were consistently superior to home exercise alone.

Wrap It Up Adding spinal manipulation or supervised rehabilitative exercise to home exercise alone does not appear to improve pain or disability in the short- or long-term for older adults with chronic low back pain, but did enhance satisfaction with care.

Item #2 The second paper today is called, “Manipulation does not add to the effect of extension exercises in chronic low-back pain (LBP). A randomized, controlled, double blind study” by Rasmussen et al published in Joint Bone and Spine in December of 2008.  Rasmussen J, Laetgaard J, Lindecrona AL, Qvistgaard E, Bliddal H. Manipulation does not add to the effect of extension exercises in chronic low-back pain (LBP). A randomized, controlled, double blind study. Joint Bone Spine. 2008 Dec;75(6):708-13. doi: 10.1016/j.jbspin.2007.12.011. Epub 2008 Nov 22. PMID: 19028434.

Why They Did It Both exercises and manipulation are recommended as basic therapy in back diseases, while a possible synergistic effect of these treatments have not been clarified.  This study was conducted to test a possible further effect of manipulation as adjunct to extension exercises for unspecific LBP.

How They Did It 72 patients with chronic LBP (mean 12 months) were examined by a specialist in manual medicine, who detected localized binding between the lumbar segments.  All patients were instructed in extension exercises, while randomized to either pretreatment with specific manipulation or control.  The patients were blinded to the manipulation, which was performed at the end of the manual examination, and repeated after two and four weeks.  The manipulator only knew the group of the particular patient just before manipulation by the end of the examination.  The primary end point was pain, measured by a visual analogue scale.

What They Found Pain in both back and leg decreased without differences between groups. Segmental binding of the low-back was associated with persisting clinical symptoms at four weeks.

Wrap It Up No additional effect was demonstrated of manipulation, when extension exercises were used as basic therapy. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

Website https://www.chiropracticforward.com

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

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

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

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

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

Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

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

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 8)

CF 319: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 8) Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 8).  If you haven’t been following along, the World Health Organization has recommended spinal manipulative therapy for back pain, however, they rated it at very low confidence.

Which is the same rating they gave ultrasound. We know SMT is more effective than that so I went into the recommendations, I found the papers the WHO cited as their references for their rating of SMT, and now I’m covering each and every one of them. We’re doing this every other week and now we’re on Part 8.  Also if you’re following along, you’ll know that a lot of these papers are extremely old compared so newer more impressive and more favorable papers that have emerged in more recent years.

You’ll also, if you’re like me, continue to get more and more certain that there is an agenda in the WHO leadership that keeps SMT from taking its rightful step forward in the treatment of noncomplicated Neuromusculoskeletal issues.  Stick with me, we’ll talk more about it.  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 giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. 

I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #319 Now if you missed last week’s episode, we talked about How Specific Are Adjustments & Nerve Flossing Effectiveness.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

As I’ve discussed in recent episodes, my house, meaning my clinic, got in a bad way in 2023 and I believe we are finally on the upswing.  We have slowed down in our new patients because of Google SEO and website companies and changes. I think I’ve corrected that.  We have had inconsistent team culture in the clinic because of constant turnover. I still have work to do here but I feel like we have a more dependable team at the moment than I’ve had in the past 18 months so I’m encouraged.  Speaking of an incredible amount of turnover, our billing has been inconsistent. Inexperienced staff just let rehab and other services walk out the door without getting done. That adds up really fast and shows up in our monthly collections.

Now that my wife is up at the front desk and now that it’s become a focus for us, this is getting under control. Basically, staff knows that their comfort comes secondary to the financial health of the clinic. Meaning, whether we feel like it or not, the patients need to be doing the services we have prescribed them. We’re getting there. That’s not a black and white thing there but we are doing more of the services prescribed than we have been.  We are now on our 4th billing and collections company in the past 5 or 6 years. We just haven’t been able to find a dependable one that just does their damn job. I think we have one now.

They started in November and we hope to see the benefits in the next few weeks. I think we already are.  So, you can see what I’ve been up to. It was a swim or swim option. Not a sink or swim. Sink is never in the list of options. So we’ve been swimming and it’s showing up in progress and that makes this old man happy. 

Now, something I’ve always struggled with is treatment recommendations. I like standardization. I like Being able to tell someone confidently, I need to see you 3x/week for 2 weeks or whatever the recommendation might be. I don’t want to make it up from patient to patient. Standardization is something our profession desperately needs in my opinion.  As my colleague and friend, Dr. Brandon Steele once said in our DACO class…..if you go to the doctor with an ear infection in Dallas, NYC, Chicago, LA, or Seattle, you’re going to always get pretty much the same thing. The Standard for that profession.  If you go to a chiro, you don’t know what the hell you’re going to get.

X-rays for no reason and BAM, bait and switch….now you need 70 visits in one year to fix a curve that 20-year longitudinal studies show doesn’t really mean much of anything. You got a neck problem, bam, you need 50 visits to boost your immunity and make sure all nerve impulses are fully expressed because how can God’s full potential for you be realized if your spine is out of alignment. Yes….true story folks. True story. 

You have back pain, BAM, x-rays show degenerative spurs and if you see me 3x/day for 2 weeks, we’ll reduce the size of those spurs. Yes….true story. And that crew is holding seminars trying to teach crap like that to other suckers in our profession.  Or on the other end of the spectrum, you’ve had pain for 10 years and have a disability associated with it so it’s technically high-impact chronic pain….BAM….you can be fixed in 2 visits with a course of exercises for you to be using at home. 

It’s just not standardized.

So, through my association with Dr. Jay Greenstein from Washington DC and who is a mover and shaker in the industry and who has been active in Clinical Compass, I eventually formulated a standardized treatment protocol for my office that you might find useful as well. It’s really pretty simple. 

If it’s acute or less than 4 weeks in duration, I’ll see the patient 3x/week for 2 weeks. 

If it’s subacute, or between 4 and 12 weeks in duration, I’ll see the patient 2x/week for 3 weeks. 

If it’s chronic, or anything lasting beyond 3 months, I’ll see them 2x/week for 4 weeks. 

At the end of the protocol at each level, acute, subacute, or chronic….if the patient is doing great, we then start to stairstep the frequency out and slowly withdraw from treatment to prevent the return of the injury.

If there is not improvement or the patient gets worse at any time, we will either change treatment and try something different, or we will find a provider that has a better chance at helping the person recover. 

Now, of course, PI patients don’t fit into this schematic well so I use the Quebec Task Force on WAD for them but most of my patients will fit very well into this protocol.  It’s simple. It’s a way to standardize recommendations in my clinic from the owner to any associates. It’s an easy way for associates to get comfortable recommending treatment. And I like it so much that I made a poster out of it that you can find in the Chiropractic Forward private Facebook group.  I’ll send you one here in the US for $55 if you want one.

I’m putting one in my exam room so that when I’m doing the ROF, they’ve already read it and all I have to do is point to it and say, “‘You’re right here, and here is your recommendations. See you on M, W, and F.” Alright, good to go on all that, let’s hop in. 

Item #1 Our first one that the WHO used to keep the chiros down today is called, “Effectiveness of Exercise Therapy and Manipulation on Sacroiliac Joint Dysfunction: A Randomized Controlled Trial” by Nejati et. Al. published in Pain Physician in January of 2019. Not new, not old. Remember, the citations can be found at chiropracticforward.com under this episode.  Nejati P, Safarcherati A, Karimi F. Effectiveness of Exercise Therapy and Manipulation on Sacroiliac Joint Dysfunction: A Randomized Controlled Trial. Pain Physician. 2019 Jan;22(1):53-61. PMID: 30700068.

Why They Did It The sacroiliac joint dysfunction (SIJD) has been found to be the primary culprit for lower back pain (LBP), but it is still overlooked and treated as LBP. There are no guidelines or appropriate therapeutic protocols for SI dysfunction. Thus, there is a need for an effective treatment strategy for SI dysfunction.

Objective: To compare exercise therapy (ET), manipulation therapy (MT), and a combination of the 2 (EMT) in terms of their effectiveness in treating SI dysfunction.

How They Did It Study design: A comparative, prospective, single-blind randomized controlled trial .

Setting: Sports Medicine Department of Rasoul Akram Hospital.

Methods: A total of 51 patients with lower back or buttock pain resulting from SI dysfunction were randomly assigned to 1 of 3 study groups: exercise therapy, manipulation therapy, or a combination of the 2.  The exercise therapy group received posterior innominate self-mobilization, sacroiliac joint stretching, and spinal stabilization exercises.  The manipulation therapy group underwent posterior innominate mobilization and SI Joint manipulation.  Lastly, the combination group received manipulation maneuvers followed by exercise therapy. Pain and disability were assessed at 6, 12, and 24 weeks after the intervention

What They Found All 3 groups demonstrated significant improvement in pain and disability scores compared to the baseline (P < 0.05).  The difference among these therapeutic protocols was found to be a function of time.  At week 6, manipulation therapy showed notable results, but at week 12, the effect of exercise therapy was remarkable.  Finally, at week 24, no significant difference was observed among the study groups. A major limitation of the present study is lack of a control group receiving a type of intervention other than the experimental protocols. Another limitation is the short duration of follow-ups.

Wrap It Up Exercise and manipulation therapy appear to be effective in reducing pain and disability in patients with Si dysfunction. However, the combination of these 2 therapies does not seem to bring about significantly better therapeutic results than either approach implemented separately.

Item #2 The last one today is called, “Spinal manipulation plus laser therapy versus laser therapy alone in the treatment of chronic non-specific low back pain: a randomized controlled study” by Nambi et. Al published in European Journal of Physical Rehabilitation Medicine in December of 2018. Not new, not old.

Nambi G, Kamal W, Es S, Joshi S, Trivedi P. Spinal manipulation plus laser therapy versus laser therapy alone in the treatment of chronic non-specific low back pain: a randomized controlled study. Eur J Phys Rehabil Med. 2018 Dec;54(6):880-889. doi: 10.23736/S1973-9087.18.05005-0. Epub 2018 Apr 24. PMID: 29687966.

Why They Did It Low back pain (LBP) is a common musculoskeletal disorder causing pain and disability in most of the countries. In recent years, new approaches such as Spinal manipulation and laser therapy have been considered as an alternative to conventional exercise and also found contradicting results in terms of its effectiveness.

Aim: A study to compare the combined effects of spinal manipulation, Laser and exercise versus Laser and exercise alone in chronic non-specific low back pain (cnLBP).

How They Did It Design: Randomized control study.

Setting: Subjects with cnLBP were treated with spinal manipulation, Laser and exercise in outpatient department for four weeks.

Population: Three hundred and thirty subjects who fulfilled the selection criteria were randomized (1:1:1 ratio) into spinal manip-laser-exercise (N.=110), Laser-Exercise (N.=110) and control group (N.=110).

Methods: The outcome measurements were Visual Analog Scale (VAS), Modified Modified Schober Test (MMST) Roland and Morris Disability Questionnaire (RMDQ), Physical Health Questionnaire-9 (PHQ-9) and Health Related Quality of Life-4 (HRQOL-4).  Baseline and follow-up measurements were measured at 4 weeks, 6 and 12 months by a blinded investigator.

What They Found Three hundred and twenty-six subjects completed the intervention and 304 completed the 12-month follow-up.  Demographic variables show homogeneity between the groups and ANOVA analyses showed significant improvement (P<0.001) in pain reduction (VAS), flexion range of motion (MMST), functional disability (RMDQ), depression status (PHQ-9), and quality of life (HRQOL-4) in spinal manipulation-laser-exercise group compared to the other two groups at one-year follow-up.

Wrap It Up Spinal manipulation combined with laser therapy and conventional exercise is more effective than laser therapy and conventional exercise alone in chronic non-specific low back pain. I mean….isn’t this one by itself enough to raise SMT above that of the level of ‘very low confidence’? That one alone? That randomized controlled trial? No? No wonder so many mistrust the WHO on so many different issues. It makes no sense to me.    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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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (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    

How Specific Are Adjustments & Nerve Flossing Effectiveness

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg
    OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 
  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com
You have found yourself smack dab in the middle of Episode #318 Now if you missed last week’s episode, we talked about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 7).  We’re building a fairly clear picture of what the WHO has based their opinon of SMT on and it’s pretty shaky ground in my opinion. Basically, I think there’s an underlying agenda. There’s no way in my mind that ultrasound is equal in effectiveness to SMT, which is what the WHO is essentially saying  and we’re showing that the research they’ve used to base that opinion on pretty much sucks compared to more current research literature.  ake sure you don’t miss that info. Keep up with the class.  On the personal end of things….. We just flew back from The Bahamas last night and boy are my arms tired.  This was our first time to The Bahamas and we decided to give it a try because something in Mexico is always on fire or someone has just lost their head or something cartel crazy. So Mexico is a no for us. Lots of my friends still visit but not this gabacho. No siree.  So we figured with The Bahamas being just about 30 minutes on teh other side of Florida, that would be a nice little trip. So…..of course,….a few weeks before we go, news trickles in that 18 people ahve been murdered there within a month and the US Embassy raised the travel alert level for the Bahamas. That’s purely because we decided to book a trip there, by the way. In case you were wondering.  So, we were a little concerned but we shouldn’t have worried. We went straight from the airport to the resort with a transportation service and never left the resort on purpose. We could tell it was a bit sketch so we had no desire to explore. Plus, the resort/casino had tons of restaurants, tons of pools, a water park, fountains, the beach and ocean….all of it was pretty much right there so there was no need to explore really.  We stayed at Baha Mar and we really won’t be going back for a couple of reasons. We want to go somewhere that we don’t really need to worry about our safety. Like the Caymans, Costa Rica, Virgin Islands, or the Florida Keys. Also, except for a few places, we don’t usually return. Once we’ve seen it and done it, it’s time to explore something new.  This resort had a rave, dance party until 3:15 am on Friday night. I was furious. I guess with it being partly a casino, that’s appealing to someone but it’s not a non-gambling 51 year old that came to The Bahamas for rest and relaxation. Furious is an understatement but I got over it.  Everyone was great, the resort was mostly pretty impressive, and the getaway was a nice change. No work. Just hanging out and I enjoyed it.  Now, back to work and a day short this week so let’s get on with it.  Item #1 Our first one this week is called, “Determining cavitation location during lumbar and thoracic spinal manipulation: is spinal manipulation accurate and specific?” By ross et. Al and published in Spine Journal in July of 2004.  Remember, the citations can be found at chiropractscforward.com under this episode.  Ross JK, Bereznick DE, McGill SM. Determining cavitation location during lumbar and thoracic spinal manipulation: is spinal manipulation accurate and specific? Spine (Phila Pa 1976). 2004 Jul 1;29(13):1452-7. doi: 10.1097/01.brs.0000129024.95630.57. PMID: 15223938. Why They Did It Clinicians utilizing spinal manipulative therapy (SMT) claim to be very specific and accurate with the delivery of their dynamic thrust.  It has been suggested that the clinical success of SMT is dependent on the accurate delivery of that therapy to the target spinal joints. The purpose of this study is to first locate the joints that produce an audible sound in response to manipulation (cavitation) during spinal manipulative procedures so that the accuracy and specificity of manipulation can be assessed. How They Did It Sixty-four asymptomatic participants, ranging in age from 22 to 49 years, volunteered to act as patients for the study.  Twenty-eight different clinicians performed thoracic and lumbar spinal manipulative procedures.  The range of clinical experience was 1 to 43 years. Asymptomatic participants received SMT to either the thoracic or lumbar regions of their spine.  Accelerometers were secured to the skin over the spinal column, and the relative time at which each accelerometer detected the vibration from the cavitation associated with the SMT was used to calculate the source of the vibration.  The site of cavitation was then compared with the target location. What They Found For lumbar SMT, the average error from target of 124 cavitations in lumbar procedures was 5.29 cm (at least one vertebra away from target), with a range of 0 to 14 cm.  Of these cavitations, 57 were deemed to be accurate and 67 were deemed to be inaccurate.  The average error from target of 54 cavitations in the thoracic spine was 3.5 cm, with a range of 0 to 9.5 cm.  Of these cavitations, 29 were deemed to be accurate and 25 were deemed to be inaccurate.  In most cases, individual manipulative procedures were associated with multiple cavitations ranging from 2 to 6. Wrap It Up In the lumbar spine, SMT was accurate about half the time.  However, because most procedures were associated with multiple cavitations, in most cases, at least one cavitation emanated from the target joints.  In the thoracic spine, SMT appears to be more accurate. Item #2 Our last one today is called “Effectiveness of neural mobilisation for the treatment of nerve-related cervicobrachial pain: a systematic review with subgroup meta-analysis” by Lascurain-Aguirrebena et. Al. and published in Pain in March of 2024.  That’s so hot it’s still on the damn burner! Lascurain-Aguirrebeña, Iona,b,*; Dominguez, Laurac; Villanueva-Ruiz, Ikerc,d; Ballesteros, Javiere,f,g; Rueda-Etxeberria, Mikele; Rueda, Jose-Ramónc; Casado-Zumeta, Xabatd; Araolaza-Arrieta, Maialend; Arbillaga-Etxarri, Aned; Tampin, Brigitteh,i,j. Effectiveness of neural mobilisation for the treatment of nerve-related cervicobrachial pain: a systematic review with subgroup meta-analysis. PAIN 165(3):p 537-549, March 2024. | DOI: 10.1097/j.pain.0000000000003071   Why They Did It Neural mobilisations (NM) have been advocated for the treatment of nerve-related cervicobrachial pain; however, it is unclear what types of patients with nerve-related cervicobrachial pain (if any) may benefit.  How They Did It Medline, Web of Science, Scopus, PeDro, Cinahl, and Cochrane databases were searched from inception until December 2022. Randomised controlled trials were included if they assessed the effectiveness of Neural mobilisations in nerve-related cervicobrachial pain, and outcome measures were pain intensity and/or disability.  Meta-analyses with subgroup analyses were performed.  Twenty-seven studies were included. What They Found For pain and disability reduction, Neural mobilisations was found to be more effective than no treatment, increased the effectiveness of standard physiotherapy as an adjuvant when compared with standard physiotherapy alone but was no more effective than cervical traction.  For disability reduction, Neural mobilisations was found to be more effective than exercise Wrap It Up In most comparisons, there were significant differences in the effectiveness of Neural mobilisations between the subgroups.  Neural mobilisations was consistently more effective than all alternative interventions (no treatment, traction, exercise, and standard physiotherapy alone) in 13 studies As I’ve heard my friend and esteemed colleauge, Dr. Brandon Steele say before, “If a patient has radiculopathy and there’s only one thing I can do for them, it’s nerve flossing.” And I agree.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

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

Chiropractic evidence-based products

Integrating Chiropractors

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

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 7)

CF 317: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 7) Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 7) 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!

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Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 
  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com
You have found yourself smack dab in the middle of Episode #317 Now if you missed last week’s episode, we talked about Chronic Pain Central Sensitization & Patient Barriers To Physical Therapy.  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Alright, we’re keeping it a little short this week because I’m going to the Bahamas Thursday through Monday. Now, if you’re a regular listener, you’re probably like…..last week you were talking about having a collections issue and stressing and now you’re going on a trip out of town. That seems like poor money management Ol’ Uncle Jeffro.  And that’s when I would say, you’re right. Lol. I’d say it’s nunya damn business but then I’d say…..yeah. I’m with you on that. I don’t really want to go because, for the first time in a month or so, it looks like my numbers are returning to where I want them and I’m building some steam so taking Thursday, Friday, and Monday off is tough. But…..a wise mentor once told me, you have to get out and go on a non-work-related vacation once per quarter or you’ll never survive.  Heres the deal, back in December, before the collections issue was realized, I told my wife, Hey honbun, you hate any jewelry I buy you, you won’t allow me to get you any clothes, you won’t allow me to get anything for the house because you didn’t get it and match your style, blah blah blah.  So, instead of more useless crap…..instead of buying things, we’re going to start buying experiences. Instead of gifts to each other, we bought a Valentine’s trip to The Bahamas. So it’s non-refundable and basically already paid for anyway so what do you do? You go to the damn Bahamas and try to get some rest.  2023 and the beginning of 2024 have literally been the hardest, most challenging times of my 26 year career in chiropractic. Personally and professionally. But mostly professionally. It’s been a grind, it’s been tough, and I wouldn’t recommend a year like we had on anyone.  We are currently hiring our 4th front desk girl and our third CA position has seen 4 or 5 turnovers in the last year. A couple of those kind of hurt personally, if I’m being honest. They were people I cared about.  Now that seems to reflect poorly on me but if we’re being honest here, I’ve never had an issuue with keepign folks for 3 years or so minimum. I had a manager for 11 years that still comes back to visit. I had another that was here 6 years or so.  The point being, I’m as fun and relaxes in real life as I hope I am here on theh podcast. We laugh and have fun and I don’t believed I’ve ever raised my voice to a staff member in 26 years. No matter how mad I get. Sometimes, we just have a run of bad luck. I’ve gone from about 65-70 new patients per month down to about 45-55. Not a huge hit for a month but carry that out over a year and……one word two-syllables…..Day-um.  Then throw in the fact that we’re on our 4th billing/collecting group in the last 5-6 years. That’s been a nightmare and cost me crazy money. Now we’re in a battle with a PI attorney in Houston that wormed his way into the Texas Chiropractic Association and, despite having signe Assignment Of Benefits and Letter of Protection on 7 different patients, is refusing to pay us around $27,000.  It’s a journey folks and 2023 was a bumpy road on that journey. Lots of potholes but I’m ever the optimist and, with our latest biller/collector, I think we’re in a good spot. Hopefully clinic numbers begin responding.  We’ve taken the necessary steps to remedy what’s been going on here. For those reasons, we are goign to the damn Bahamas and we are goign to eat, drink, and be merry and save it for when we get back. Trust me, the stress will still be here so we might as well just leave it here at the office when we leave.  So let’s continue our hunt for the reason behind the WHO recommending SMT but at ‘very low confidence’, which is at the same level as ultrasound. Not to diminish the effects of ultrasound but seriously, I’ve never seen ultrashound deliver the immediate results that spinal manipulative therapy can deliver.  We’ve learned so far that the WHO is using some garbage research to base this recommendation on. Old, out-dated studies, small sample sizes, and studies that just literally make no sense at all for the most part. Let’s see what Part 7 reveals.  Item #1 The first one today is called, “Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial” by Licciardone et. Al. and published in Spine in July of 2003. Which is 21 years old at this point. OK….duly noted…..so cold that it’s frozen solid….got it… Remember, the citations can be found at chiropractscforward.com under this episode.  Licciardone JC, Stoll ST, Fulda KG, Russo DP, Siu J, Winn W, Swift J Jr. Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial. Spine (Phila Pa 1976). 2003 Jul 1;28(13):1355-62. doi: 10.1097/01.BRS.0000067110.61471.7D. PMID: 12838090. Why They Did It The authors wanted to determine the efficacy of osteopathic manipulative treatment as a complementary treatment for chronic nonspecific low back pain. They say, “Osteopathic manipulative treatment may be useful for acute or subacute low back pain. However, its role in chronic low back pain is unclear.” How They Did It This trial was conducted in a university-based clinic from 2000 through 2001.  91 met the eligibility criteria.  They were randomized, with 82 patients completing the 1-month follow-up evaluation, 71 completing the 3-month evaluation, and 66 completing the 6-month evaluation.  The subjects were randomized to osteopathic manipulative treatment, sham manipulation, or a no-intervention control group, and they were allowed to continue their usual care for low back pain.  The main outcomes included the SF-36 Health Survey, a 10-cm visual analog scale for overall back pain, the Roland-Morris Disability Questionnaire, lost work or school days because of back pain, and satisfaction with back care. What They Found As compared with the no-intervention control subjects, the patients who received osteopathic manipulative treatment reported greater improvements in back pain, greater satisfaction with back care throughout the trial, better physical functioning and mental health at 1 month, and fewer cotreatments at 6 months.  The subjects who received sham manipulation also reported greater improvements in back pain and physical functioning and greater satisfaction than the no-intervention control subjects.  There were no significant benefits with osteopathic manipulative treatment, as compared with sham manipulation. Wrap It Up Osteopathic manipulative treatment and sham manipulation both appear to provide some benefits when used in addition to usual care for the treatment of chronic nonspecific low back pain. It remains unclear whether the benefits of osteopathic manipulative treatment can be attributed to the manipulative techniques themselves or whether they are related to other aspects of osteopathic manipulative treatment, such as range of motion activities or time spent interacting with patients, which may represent placebo effects. Alright John C Licciardone, DO, MS, MBA, FACPM. ….Go to his experts website and find the following.  https://experts.unthsc.edu/en/persons/john-licciardone Dr. Licciardone’s research focuses on prevention and treatment of chronic pain. He holds the Richards-Cohen Distinguished Chair in Clinical Research and directs the Osteopathic Research Center, including its PRECISION Pain Research Registry. The latter studies precision medicine and biopsychosocial approaches to pain management, including use of pharmacogenetics to optimize opioid prescribing and avoid unintended consequences of their use. He received a Midcareer Investigator Award from the National Institutes of Health (NIH) and served as an expert panelist for NIH in the area of chronic pain. He recently served on the Work Group that developed NIH’s Federal Pain Research Strategy. Dr. Licciardone is recognized by Expertscape as the leading international expert in osteopathic manipulation, and has served as a consultant to the World Health Organization on regulatory and safety issues relating to osteopathy in Europe and other nations. He directed the OSTEOPATHIC Trial, a five-year study funded by NIH that demonstrated substantial improvements and recovery from chronic low back pain with osteopathic manipulation. He is presently a Co-Investigator in the $14 million Prevention of Acute to Chronic Back Pain Trial (PACBAC Trial), a national study to assess the efficacy of patient self-management and spinal manipulation in preventing chronic low back pain. Item #2 Our second one today is by the same author and is called, “Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial” by Liccardone et al published in Annals Of Family Medicine in March of 2013 so…..it’s only 11 years old then.  Licciardone JC, Minotti DE, Gatchel RJ, Kearns CM, Singh KP. Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial. Ann Fam Med. 2013 Mar-Apr;11(2):122-9. doi: 10.1370/afm.1468. PMID: 23508598; PMCID: PMC3601389. Why They Did It We studied the efficacy of osteopathic manual treatment (OMT) and ultrasound therapy (UST) for chronic low back pain. How They Did It A randomized, double-blind, sham-controlled, 2 × 2 factorial design was used to study OMT and UST for short-term relief of nonspecific chronic low back pain.  The 455 patients were randomized to OMT or sham OMT, and to UST or sham UST main effects groups.  Six treatment sessions were provided over 8 weeks.  Intention-to-treat analysis was performed to measure moderate and substantial improvements in low back pain at week 12.  Five secondary outcomes, safety, and treatment adherence were also assessed. What They Found There was no statistical interaction between OMT and UST.  Patients receiving OMT were more likely than patients receiving sham OMT to achieve moderate  and substantial improvements in low back pain at week 12.  These improvements met the Cochrane Back Review Group criterion for a medium effect size.  Back-specific functioning, general health, work disability specific to low back pain, safety outcomes, and treatment adherence did not differ between patients receiving OMT and sham OMT.  Nevertheless, patients in the OMT group were more likely to be very satisfied with their back care throughout the study.  Patients receiving OMT used prescription drugs for low back pain less frequently during the 12 weeks than did patients in the sham OMT group Ultrasound therapy was not efficacious. Wrap It Up The OMT regimen met or exceeded the Cochrane Back Review Group criterion for a medium effect size in relieving chronic low back pain.  It was safe, parsimonious, and well accepted by patients. Item #3 As a quick bonus, I was looking the dude up and found this paper: It’s called, “Osteopathic Medical Care With and Without Osteopathic Manipulative Treatment in Patients With Chronic Low Back Pain: A Pain Registry–Based Study” by….again…..Licciardone et al and pulished in Journal of Osteopathic Medicine in February of 2020 but they WHO didn’t use this one for whatever reason…..let’s see what it says.  Licciardone, John C. and Gatchel, Robert J.. “Osteopathic Medical Care With and Without Osteopathic Manipulative Treatment in Patients With Chronic Low Back Pain: A Pain Registry–Based Study” Journal of Osteopathic Medicine, vol. 120, no. 2, 2020, pp. 64-73. https://doi.org/10.7556/jaoa.2020.016   Why They Did It To assess osteopathic medical care and the effectiveness of OMT for chronic low back pain in a real-world setting without the constraints of a rigid research protocol.   How They Did It An observational study of 445 adults with chronic low back pain who had an established osteopathic physician (ie, DO) or allopathic physician (ie, MD)  It was conducted within the PRECISION Pain Research Registry from April 2016 through February 2019.  Primary outcome measures included a numerical rating scale for low back pain intensity, the Roland-Morris Disability Questionnaire for back-related functioning, and use of nonsteroidal anti-inflammatory drugs or opioids for low back pain.   What They Found A total of 79, 48, and 318 patients, respectively, were treated by DOs who used OMT, DOs who did not use OMT, or MDs.  Patients treated by DOs who used OMT reported significantly lesser low back pain intensity and back-related disability than patients treated by MDs.  Patients treated by DOs who used OMT also reported less frequent use of nonsteroidal anti-inflammatory drugs or opioids   There were no significant differences in primary outcomes between DOs who did not use OMT and MDs   Wrap It Up This study of community-based patients in a pain research registry supports the effectiveness of OMT as an integral component of osteopathic medical care for chronic low back pain.  Patients treated by DOs who did not use OMT did not experience better results than patients treated by MDs in any primary outcome measure.  But…..the WHO didn’t include this. Maybe because it was an observational study rather than an RCT. Who knows? But this says SMT is an integral component of back pain whereas the others are less flattering.  It just feels dirty, WHO….it feels dirty! Don’t let those damn chiropractors get a head of steam or we’ll ALL be out of a job!! 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
Home
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (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    

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 6)

CF 315: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 6)

Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 6).

If you’ve been following along, and I hope you have…The WHO updated their recommendations recently for pain. Spinal maniuplative therapy was include so we’re on the menu. But, they rated SMT at very low confidence, which is the same as what they rated ultrasound. So, in the eyes of the WHO, smt may be about as effective as ultrasound. Yeah, we’re call BS so we are going through each paper they used to make this determination and they all, except for a few, are old, outdated, and pretty much stink. We’ll talk about it…. 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 giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel. 

 

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #315 Now if you missed last week’s episode, we talked about Omnivorous vs Vegan and SMT For Chronic Neck Pain.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Another day, another dollar by friends. Here we are at the end of January 2024 and if all works well and if you’re an insurance or hybrid clinic, then you know that you’ve been a little slower because the deductibles re-set in January for the most part and people don’t like to spend their own money.  But, about a month or so is as long as many of them ever want to go without going to the chiropractor and that’s OK.

The point being that hybrid clinics like mine should start seeing increased numbers in February. It may be mid to late February but we should see us start getting busier for sure.  In the meantime, I’ve started focusing more and more on marketing. I feel like I’m pretty dangerous when I have the time to be. Right now, I have the time to be. I used to sit around brainstorming ideas for marketing, memes, content, and all that entails. Then I’d create my own original stuff and post it.  I haven’t done that in forever it seems but here lately, and unfortunately, I’ve had some extra time to give those things attention again. I like a challenge and so I’m on it. I’ve targeted the demographics I want targeted.

The ones I think that the economy and who happens to be the President will have no control over economically. We’ve re-newed our efforts in getting our message to these people.  In addition, we’ve re-newed our efforts in our public outreach. Face to face, person to person outreach. Dan Kennedy says, YCDBSOYA, You can’t do business sitting on your ass. You’re moving forward or falling behind. You’re the window or the bug. You either make things happen in your life or you sit around wonder what the hell just happened.  So that’s what’s up with Creek Stone on this Monday, January 29th.

I have 35 on the schedule when I typically have 45. You carry that out throughout the week, that’s 50 less per week which is 200 less appointments per month. That’s unacceptable.  I’ve had less new patients lately as well. I think my Google SEO has dimished since going with a very reputable company a few years ago so we switched it up and went with a new website company that I know gets results. That’s brand new.  I also got to looking at our new patients demographics and it looks like we’re seeing fewer VA patients recently. That’s worth investigating and diving into.  If you’re not doing these thing regularly, might get on it. It’s whack-a-mole folks. You can never hit the auto-pilot button and sit back and just do the work if you’re the owner. It’s a constant battle. Enjoy the great times and ride that wave. When things start popping up out of nowhere, dig in, have some grit, and wait for that next wave.  Alright, here we go with the research today. 

Item #1

The first one today is called, “Spinal mobilization vs conventional physiotherapy in the management of chronic low back pain due to spinal disk degeneration: a randomized controlled trial” by Krekoukias, et al., published in 2017 in the Journal of Manual Manipulative Therapy.  Remember, the citations can be found at chiropractscforward.com under this episode.  Krekoukias G, Gelalis ID, Xenakis T, Gioftsos G, Dimitriadis Z, Sakellari V. Spinal mobilization vs conventional physiotherapy in the management of chronic low back pain due to spinal disk degeneration: a randomized controlled trial. J Man Manip Ther. 2017 May;25(2):66-73. doi: 10.1080/10669817.2016.1184435. Epub 2016 Jun 23. PMID: 28559665; PMCID: PMC5430451.

Why They Did It The authors wanted to examine the efficacy of spinal mobilization in subjects with low back pain (LBP) and associated spinal disk degeneration.

How They Did It Seventy-five subjects suffering from chronic LBP were randomly allocated into 3 groups of 25 subjects.  Each group received five treatment sessions with the first group receiving manual therapy (MT) (spinal mobilization), the second a sham treatment, and the third conventional physiotherapy (CP) (stretching exercises, transcutaneous electrical nerve stimulation, and massage).  Subjects were assessed for their pain intensity using the numerical pain rating scale and for their self-reported disability using the Oswestry and Roland-Morris Questionnaire at baseline and after the completion of the five treatment sessions.

What They Found Paired t-tests showed a significant improvement for all outcome measures in the manual therapy and conventional physiotherapy group.  Analysis of covariance revealed that the manual therapy group had significant improvement in all outcome measures in comparison with the sham and conventional physiotherapy group, whereas no significant difference was observed between the sham and conventional physiotherapy group

Wrap It Up Manual Therapy is preferable to conventional physiotherapy in order to reduce the pain intensity and disability in subjects with chronic LBP and associated disk degeneration.  The findings of this study may lead to the establishment of spinal mobilization as one of the most preferable approaches for the management of LBP due to disk degeneration.

Item #2 The last one is, “The effectiveness of manual therapy, physiotherapy, and treatment by the general practitioner for nonspecific back and neck complaints. A randomized clinical trial” by Koes published in Spine journal in 1992 and they’re using 1992 to make this determination in 2024 because there’s no better and more current  Koes BW, Bouter LM, van Mameren H, Essers AH, Verstegen GM, Hofhuizen DM, Houben JP, Knipschild PG. The effectiveness of manual therapy, physiotherapy, and treatment by the general practitioner for nonspecific back and neck complaints. A randomized clinical trial. Spine (Phila Pa 1976). 1992 Jan;17(1):28-35. doi: 10.1097/00007632-199201000-00005. PMID: 1531552.

Why They Did It As you see in the title of the paper, the plan was to test the effectgiveness of manual therapy, physiotherapy, and treatment by a general practitioner on back and neck pain

How They Did It It was a randomized controlled trial The effectiveness of manual therapy, physiotherapy, continued treatment by the general practitioner, and placebo therapy (detuned ultrasound and detuned short-wave diathermy) were compared for 256 patients with nonspecific back and neck complaints lasting for at least 6 weeks. The principle outcome measures were severity of the main complaint, global perceived effect, pain, and functional status. These are presented for 3, 6, and 12 weeks follow-up. 

What They Found Both physiotherapy and manual therapy decreased the severity of complaints more and had a higher global perceived effect compared to continued treatment by the general practitioner.  Differences in effectiveness between physiotherapy and manual therapy could not be shown. 

Wrap It Up A substantial part of the effect of manual therapy and physiotherapy appeared to be due to nonspecific (placebo) effects. From 1992 – Placebo seems to be why smt appears to be effective. We know that placebo can and should play a part in a patient’s recovery. And we can leverage placebo in our favor too. Placebo has a bad name for some reason. In the biopsychosocial construct we should be using to our advantage all of the time.  Encouraging and positive words, little pain free wins….these things play a part in neuroplasticity and moving it in our direction and moving the patient away from chronic pain. 

That doesn’t mean that smt is placebo only and there have been plenty of papers shwoing the effectiveness of SMT beyond placebo in teh last 10 years or more. This paper is liteerally 32 years old. What in the holy hell are they using this paper for in 2024? I can’t explain it.  To be fair, I suppose the Gate Theory from the 1960s is still relevant so why can’t this paper still be relevant, right?/

But I’d argue that the Gate Theory is gamechanging big stuff. This paper, in my opinion, isn’t in the same ball park with regard to impact and effectiveness. As knowledge base expands, more recent and more relevant knowledge replaces outdated knowledge. This paper should be replaced and not be relevant when recommending SMT for treatment.  My two cents.  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

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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    

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 5)

CF 313: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 5)

Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 5)

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 giving evidence-based chiropractic a little personality and making it profitable.

We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel. 

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together. 

Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com

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

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #313

Now if you missed last week’s episode, we talked about Pet Ownership And Cognitive Decline & PT Effectiveness. 

Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Well, we got a mix of stuff this week in the clinic. Our new intern is getting comfortable and settled in and getting up to speed with the way the office works and flows. We are picking back up a little just in time for me to be gone for two work days to attend my quarterly Mastermind meeting. Yes, it gives me anxiety but I’m going. The Mastermind is important. 

For this Mastermind, we’ll be joined by Brett Winchester who, in case you are unaware, is probably a genius in the healthcare space but also is borderline crazy personally. He’s hilarious and a lot of fun to be around so I’m definitely looking forward to Brett being int he mix with the rest of our regular crew. 

Plus, the January meeting is when new members join the group so that should be fun. It’s always good to meet the newbies and get to know more about them and learn from them. Last year’s newbies said they were intimidated to come into the group. Pffft. They fully integrated quickly and are part of the family now. We have some super smart docs but the ones joining are super smart too and we are just as eager to learn from them as they are to learn from us. 

So it works well and we’re looking forward to getting to know them. 

So this Monday has gone much better so far than last Monday. If you listened to the podcast last week, we had land mines to avoid last Monday for some reason. Smoother today for sure. We thought it may have been Dontae’s first day jinx so we made him take a shower and wash it off and he’s not allowed to wear those same clothes anymore. I think we have it handled. 

We are really buckling down this week to try to determine the best way to get our medical services up to speed and working with 100% efficiency. I think I have an approach of, let’s implement and let’s see what happens. I think that makes sense in the beginning with any service but once you’re up and running, it is time to fine tune. 

How are your prices in 2024 vs 2017? The same? You know everything in the world has gone up in price so if your prices are the same, you are making less money overall. Less profit I should say. 

Are our medical service and chiropractic services in line with the market and other clinics in our area?? We don’t want to be the cheapest. We don’t want to be the most expensive either. We don’t want to offer an exam, a consultation, a treatment plan, an adjustment, x-rays, and therapy on the first visit for the low low price of $39. 

Racing to the bottom hurts you and everyone else. If you want to look like a street corner huckster, that’s how you make it happen. If you want to take x-rays on every single person, which isn’t in line with ACA’s Choosing Wisely guides by the way, that’s fine. I don’t fault people wanting to know exactly what they’re dealing with. However, why the hell would you give them away? 

If you say that it’s because you want to show them their degeneration and their listings……we aren’t friends. We are different people. If you do it to show them these things and then spook them into 70 visits over the course of the year, you gotta check that stuff. Look in the mirror. 

If you wouldn’t do it to your mom, don’t do it to your patients. 

Anyway, you don’t want to give your services away. Please don’t do that. But I don’t really want to be the most expensive either. If I’m toward the more expensive but still responsible and appropriately priced, then I feel that’s the sweet spot. But you have to be financially healthy if you’re going to do a good job taking care of your patients. 

When you’re all running through your day wondering focused on the number of visits because you can’t pay payroll that week, well, that’s a problem we gotta get fixed. 

So, this month is a good month to look through our services and see if we’re doing what we can price wise to stay competitive and but maximize our ROI. 

On a final note before we hop into our research this week, I love hate the Cowboys. They broke my heart yet again this year but it’s OK because I fully expected and anticipated it. I knew it was going to happen so it didn’t upset me. And honestly, why get upset over a bunch of spoiled brat millionaires playing a game anyway? I refuse to allow the pinche Cowboys do that to me so……I’m moving on. 

Go Houston Texans. Go Texas Rangers. Go Houston Astros!

Cowboys….maybe next year. 

Now this week we’re continuing our series. If you don’t know or are unaware, the WHO recently recommended spinal manipulative therapy for back pain but at very low confidence. Which is equal to ultrasound. I dove in and found their citations with regard to SMT specifically and we’re going through them one by one to find out, with all of the research we’ve seen and covered combined with American College of Physicians recommendations, Parker Gallup polls, and on and on and on…..how can SMT be at very low confidence. 

So here we go. 

Item #1

Our first one is called, “Controlled comparison of short-wave diathermy treatment with osteopathic treatment in non-specific low back pain” by Gibson, et al and published in The Lancet in June of 1985. Not sure why they’re pulling papers from that far back but whatever. 

And I’m going to say that this paper is so old that even the abstract didn’t make a ton of sense. 

Gibson T, Grahame R, Harkness J, Woo P, Blagrave P, Hills R. Controlled comparison of short-wave diathermy treatment with osteopathic treatment in non-specific low back pain. Lancet. 1985 Jun 1;1(8440):1258-61. doi: 10.1016/s0140-6736(85)92323-2. PMID: 2860453.

Why They Did It

The effectiveness of spinal manipulation carried out by a non-medical qualified osteopath was compared with that of short-wave diathermy (SWD) and a placebo

How They Did It

109 patients with low back pain. 

That’s it. That’s all of the info on it. No idea if it was a randomized controlled trial or what. 

What They Found

More than half the subjects in each of the 3 treatment groups benefited immediately from therapy. 

Significant improvements were observed in the 3 groups at the end of 2 weeks’ treatment, and these were still apparent at 12 weeks. 

The outcome of treatment was unrelated to the initial severity or duration of pain or to the trend of pain towards deterioration or improvement. 

It is, therefore, unlikely that the results simply reflect the natural history of low back pain. 

Wrap It Up

Benefits obtained with osteopathy and short-wave diathermy in this study may have been achieved through a placebo effect.

So…..that’s a crap paper and why the WHO would have that paper as having any influence on our profession in 2024 is beyond me. 

Item #2

Our last one today is called, “Physiotherapy Based on a Biobehavioral Approach with or Without Orthopedic Manual Physical Therapy in the Treatment of Nonspecific Chronic Low Back Pain: A Randomized Controlled Trial” by Grande-Alonso et. Al and published in Pain Medicine in December of 2019

Remember paper citations will be found in the show notes at chiropracticforward.com episode 313.

Grande-Alonso M, Suso-Martí L, Cuenca-Martínez F, Pardo-Montero J, Gil-Martínez A, La Touche R. Physiotherapy Based on a Biobehavioral Approach with or Without Orthopedic Manual Physical Therapy in the Treatment of Nonspecific Chronic Low Back Pain: A Randomized Controlled Trial. Pain Med. 2019 Dec 1;20(12):2571-2587. doi: 10.1093/pm/pnz093. PMID: 31074484.

Why They Did It

To compare the effectiveness of a biobehavioral approach with and without orthopedic manual physical therapy on the intensity and frequency of pain in patients diagnosed with nonspecific chronic low back pain.

How They Did It

  • A single-blind randomized controlled trial. 
  • Fifty patients were randomly allocated into two groups: one group received biobehavioral therapy with orthopedic manual physical therapy, and the other group received only biobehavioral therapy. 
  • Both groups completed a total of eight sessions, with a frequency of two sessions per week. 
  • The somatosensory, physical, and psychological variables were recorded at baseline and during the first and third month after initiation of treatment.

What They Found

  • In both groups, the treatment was effective, presenting significant differences for all the variables in the time factor. 
  • There were no significant differences between groups in intensity or frequency of pain, with a large effect size (>0.80), but there were intragroup differences for both intervention groups at one- and three-month follow-up. 
  • There were also no significant differences between groups in the secondary variables during the same follow-up period.

Wrap It Up

The results of this study suggest that orthopedic manual physical therapy does not increase the effects of a treatment based on biobehavioral therapy in the short or medium term, but these results should be interpreted with caution.

I do not have the full paper, only the abstract. How was the orthopedic manual physical therapy defined? What was involved? Is that SMT? I don’t know. 50 patients isn’t much of a sample size either really. 

I’m not sure why the WHO felt this one was suitable to make their determination off of but that’s why we’re doing this, right?

Store

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

 

 

 

Chiropractic evidence-based products

 

Integrating Chiropractors

 

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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

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

Connect

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

Website

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TuneIn

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About the Author & Host

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

 

Omnivorous vs Vegan & SMT For Chronic Neck Pain

CF 314: Omnivorous vs Vegan & SMT For Chronic Neck Pain Today we’re going to talk about Omnivorous vs Vegan & SMT For Chronic Neck Pain But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg
OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 
  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com
You have found yourself smack dab in the middle of Episode #314 Now if you missed last week’s episode, we talked about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 5).  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Let’s start by giving Dr. Steven Brown out in Gilbert, AZ a shoutout. If you listened last week, we had a paper that was just the abstract. It was a paper that the WHO is using in part to help them formulate their opinion that SMT is recommended but at very low confidence.  The paper used orthopedic manual physical therapy, whatever the hell that is.  “The protocol consisted of accessory mobilizations (posteroanterior), traction of the lumbar region, mobilization with movement in the coxofemoral joint, and global techniques of neural mobilization of the lumbar spine. The duration of the orthopedic manual physical therapy was 20–25 minutes per session.”  Dr. Brown says, “They did not get actual lumbar spine, SI joint, or hip manipulation at all. Just 20-25 minutes of mobilization.” So, there you have it from one of last week’s papers. I think as we go through them, it’s getting clearer and clearer that the WHO may have an agenda. Which chiropractors expect, honestly. When you have MDs running the show, they’re going to be super slow to promote SMT to the MainStage for anything. Using papers like we’ve been seeing to make their determination is just, quizzical. For lack of a better word. It’s perplexing when we know there is more current and more impactful research in favor of SMT.  Moving on this week, I just got back from Jupiter, FL and the MCM Mastermind with Dr. Kevin Christie, Dr. Brett Winchester, Dr. Lindsey Mumma, and many more. Florida wasn’t warm. It was in the 50s and 60s but we were in a classroom most of the time anyway. We had some fine dining at The Woods, which is Tiger Woods’ restaurant. No Tiger sightings but none were expected. Lots of Bentleys, Mercedes, Lambos, and the like. It’s always a little crazy in Florida when you consider the amount of money strolling around those towns.  Lots of great discussions, lots of thoughts and plans. Now to have the time to organize the thoughts and take action on them. One fun one came from my little friend, Dr. Tiffany Armstrong from Iowa. Her and her husband have a great practice out there and are adding a gym to the mix. Fun fun.  She was talking about Storybrand and what are your Big 3? She said patients and clients can’t really keep up with more than three things. It got me to thinking and here’s what I came up with:
  1. Pain Relief
  2. Function, Stability, Strength
  3. Performance Care
That’s why you join a mastermind. That was a little comment on a discussion that we had in class. Nothing game changing but enough to give me some clarity and direction with some things I’ve been wanting to tweak and change. Imagine how many of those little comments and conversations we have over the weekend.  Lots of direction this morning outside of the. Podcast so I’m hopping into it  Item #1 Our first one today is called, “Cardiometabolic Effects of Omnivorous vs Vegan Diets in Identical Twins: A Randomized Clinical Trial” by Landry et. Al and published in JAMA Network Open November 30, 2023. Kapow! It’s hottern’ a teapot! Remember, the citations can be found at chiropractscforward.com under this episode.  Landry MJ, Ward CP, Cunanan KM, et al. Cardiometabolic Effects of Omnivorous vs Vegan Diets in Identical Twins: A Randomized Clinical Trial. JAMA Netw Open. 2023;6(11):e2344457. doi:10.1001/jamanetworkopen.2023.44457 Why They Did It Increasing evidence suggests that, compared with an omnivorous diet, a vegan diet confers potential cardiovascular benefits from improved diet quality (ie, higher consumption of vegetables, legumes, fruits, whole grains, nuts, and seeds).  The researchers wanted to compare the effects of a healthy vegan vs healthy omnivorous diet on cardiometabolic measures during an 8-week intervention. How They Did It This single-center, population-based randomized clinical trial of 22 pairs of twins randomized participants to a vegan or omnivorous diet (1 twin per diet).  Participant enrollment began March 28, 2022, and continued through May 5, 2022.  The date of final follow-up data collection was July 20, 2022.  This 8-week, open-label, parallel, dietary randomized clinical trial compared the health impact of a vegan diet vs an omnivorous diet in identical twins.  Twin pairs were randomized to follow a healthy vegan diet or a healthy omnivorous diet for 8 weeks.  Diet-specific meals were provided via a meal delivery service from baseline through week 4, and from weeks 5 to 8 participants prepared their own diet-appropriate meals and snacks. The primary outcome was difference in low-density lipoprotein cholesterol concentration from baseline to end point (week 8).  Secondary outcome measures were changes in cardiometabolic factors, plasma vitamin B12 level, and body weight. Exploratory measures were adherence to study diets, ease or difficulty in following the diets, participant energy levels, and sense of well-being. A total of 22 pairs of twins What They Found After 8 weeks, compared with twins randomized to an omnivorous diet, the twins randomized to the vegan diet experienced significant mean (SD) decreases in low-density lipoprotein cholesterol concentration, fasting insulin level, and body weigh Wrap It Up In this randomized clinical trial of the cardiometabolic effects of omnivorous vs vegan diets in identical twins, the healthy vegan diet led to improved cardiometabolic outcomes compared with a healthy omnivorous diet.  Clinicians can consider this dietary approach as a healthy alternative for their patients. Item #2 OK, the last one this week is called, “A systematic review and meta-analysis of randomized controlled trials of manipulative therapy for patients with chronic neck pain” by Liu et. Al. published in Complementary Therapies in Clinical Practice in August of 2023 and it’s just hot enough! Zhen Liu, Jiao Shi, Yubo Huang, Xingchen Zhou, Huazhi Huang, Hongjiao Wu, Lijiang Lv, Zhizhen Lv, A systematic review and meta-analysis of randomized controlled trials of manipulative therapy for patients with chronic neck pain, Complementary Therapies in Clinical Practice, Volume 52, 2023, 101751, ISSN 1744-3881, https://doi.org/10.1016/j.ctcp.2023.101751. Why They Did It An increasing number of people suffer from chronic neck pain due to increased telecommuting. Manual therapy is considered a safe and less painful method and has been increasingly used to alleviate chronic neck pain.  However, there is controversy about the effectiveness of manipulation therapy on chronic neck pain.  Therefore, this systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to determine the effectiveness of manipulative therapy for chronic neck pain. How They Did It A search of the literature was conducted on seven databases from the establishment of the databases to May 2022.  This study included RCTs on chronic neck pain managed with manipulative therapy compared with sham, exercise, and other physical therapies.  The retrieved records were independently reviewed by two researchers.  Further, the methodological quality was evaluated using the PEDro scale.  The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment was used to evaluate the quality of the study results. Seventeen RCTs, including 1190 participants, were included in this meta-analysis. What They Found Manipulative therapy showed better results regarding pain intensity and neck disability than the control group.  Manipulative therapy was shown to relieve pain intensity and neck disability.  However, the studies had high heterogeneity, which could be explained by the type and control interventions.  In addition, there were no significant differences in adverse events between the intervention and the control groups. Wrap It Up Manipulative therapy reduces the degree of chronic neck pain and neck disabilities. Hurry, someone run and the the World Health Organization that we got a new paper to add to their crap recommendations…. More on the papers they’re using to recommend SMT at very low confidence in next week’s Part 6 of that series.  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.       

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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
Home
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q   iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2   Player FM Link https://player.fm/series/2291021   Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through   TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/   About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (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    

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 4)

CF 311: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 4) Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 4) But first, here’s th at sweet sweet bumper music

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OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 
  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com
You have found yourself smack dab in the middle of Episode #311 Now if you missed last week’s episode, we talked about the same thing only it was Part 3.  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. It’s January 2 today as I’m typing. That means a new year….a new me. Right. Not really. I’m the exact same dude I was on 12/31 with the same personality, belt line, and problems . My daughter said, “”what’s your resolution, Dad?” I said I don’t make them. I don’t believe in them. I try to better myself every day. If I need to lose weight, we don’t wait until 12/31 to decide we’re going to do it. I think of stuff and I just do it.  So, I don’t do resolutions. However, I do like motive, ambition, decisions to move in a positive direction, and overall good positive feelings. So, while I don’t engage in resolutions myself, I do support them 100%.  I’ve said here that 2023 was a tough one for me personally and professionally. No big game changers or life changers. Just irritations that had to be dealth with. It wasn’t a fun one. So I’m hoping that 2024 will be finally movign in the right direction. The changes that need to be made happen and they have the effect they were intended to have and on and on.  My hope is the same for all of you.  We should all have a little extra time on our hands for a month or so. That’s if you take insurance. Deductibles re-set in January and for some reason, people don’t like using their own money so it’ll be a bit beffore they return. Usually, if experience serves me, it’ll be around mid February to the first of March before it really ramps back up.  That means we have time to plan, prepare, review our systems, train, and market.  So let’s get to it so we can all get after it.  Item #1 The first one this week is called “Chronic low back pain and vertebral manipulation” by Ghroubi et. Al. and published in Annals of Readaptive Physical Medicine and published in October of 2007. The WHO is using a paper from 2007. Duly noted.  Remember that the citations for these papers will be in teh show notes at chiropracticforward.com episode 311 Ghroubi S, Elleuch H, Baklouti S, Elleuch MH. Les lombalgiques chroniques et manipulations vertébrales. Etude prospective à propos de 64 cas [Chronic low back pain and vertebral manipulation]. Ann Readapt Med Phys. 2007 Oct;50(7):570-6. French. doi: 10.1016/j.annrmp.2007.02.012. Epub 2007 Mar 8. PMID: 17382426. Why They Did It This study examined the short-term effectiveness of vertebral manipulation for treating chronic low back pain and disability. How They Did It Sixty-four patients were randomly assigned into two groups.  One group received 4 true vertebral manipulations (VMG), and the other group received sham manipulations (sham-VMG) under the same conditions as for the first technique.  Patients formulated assessments after the manipulations and 1 month later. What They Found
  • Patients receiving the true manipulations showed significant improvement in pain (visual analogic scale score and function)
  • (Oswestry scale). Pain improvement persisted at the second month (P=0.01). 
  • The improvement was more evident in the group that received adjustments than the sham-group. 
  • No change in perceived disability was observed in the sham-VMG.
Wrap It Up Our study confirms the efficiency of short-term vertebral manipulation for treating chronic low back pain. The assessment of vertebral manipulation effectiveness is difficult. This manual therapy must be preceeded by a specific clinical exam performed by a trained physician. Item #2 The last one this week is called, “Lumbar spinal manipulation on trial. Part I–clinical assessment” by Evans et. Al. published in Rheumatological Rehabilitation in February 1978. Yes, the WHO is basing our effectiveness partly on a paper from 1978 that had a sample of 32. Whether the information is positive or negative in the paper……should we be looking at stuff from 1978, 46 years ago, with such a small sample when we’ve seen so many more current papers come through showing effectiveness? I’m not research so it’s just a question from and enthusiastic observer. That’s all.  Evans DP, Burke MS, Lloyd KN, Roberts EE, Roberts GM. Lumbar spinal manipulation on trial. Part I–clinical assessment. Rheumatol Rehabil. 1978 Feb;17(1):46-53. doi: 10.1093/rheumatology/17.1.46. PMID: 153574.
  • Thirty-two patients with chronic low back pain were treated three times at weekly intervals with rotational manipulation. 
  • Patients with femoral or sciatic root pain were included provided they did not exhibit root compression signs. 
  • Background therapy of codeine phosphate was administered throughout. 
  • There was a significant increase in spinal flexion measured clinically during the three-week period of manipulation followed by a significant decrease in the three-week period after manipulation. 
  • The first week of manipulative treatment was more painful than the corresponding week in the control group but in the second and third weeks there was less pain in the manipulated group. 
  • Pain scores were reduced to a significant degree within four weeks of starting treatment only in the group manipulated in the first treatment period. 
  • Patients benefitting subjectively from manipulation were more likely to be older and to have had symptoms for a shorter period than those not deriving benefit. 
  • The age of onset of symptoms was significantly later in the responders.
Well, there you have it for part 4 of why the WHO recommends spinal manipulative therapy but at very low confidence.  We have TEN more episodes on this to explore. Are we enjoying this? Is it useful to you? I know I’m learning and I’m definitely covering papers we haven’t covered on the podcast before so I’m locked in and rocking. I’d love to hear form you on it.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. 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
Home
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (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