Mindfulness For Knee Replacement & The Use Of Tuina

CF 287: Mindfulness For Knee Replacement & The Use Of Tuina

Today we’re going to talk about Mindfulness For Knee Replacement & The Use Of Tuina

But first, heres that sweet sweet bumper music


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

We’re the fun kind of research. Not the stuffy, high-brow, look down your nose at people kind of research. We’re research talk over a couple of beers.

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

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

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

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

You have found yourself smack dab in the middle of Episode 287

Now if you missed last week’s episode, we talked about Nonsurgical Decompression and sugar substitutes. Make sure you don’t miss that info. Keep up with the class.

On the personal end of things…..

Let’s talk about integration briefly. There’s so much to discuss but I mostly want to talk about time. How much time does it take to build a practice for your Nurse Practitioner.

Let me just say…..longer than I expected. Here’s the first thing to understand about those in the medical field. They are clock in and clock outers. Unless they are owners, of course.

Think about it; they go to the hospital, do their 12-hour shift, and go home. They have patients provided to them and they never have to give it much thought. There is also a lot of turnover in the NP space in most areas. They’re bouncing from one job to another where needed and it’s just normal. When they get to the new place, patients are provided blah blah blah.

But what about when you start something from scratch? From the ground up? Making something out of absolutely nothing? What about that? Well, that’s a different story, of course.

That’s what we did. We went from a chiropractic office to a medical office in one day once it was all set up. Now…..where do you get your medical patients from? Not all of your chiro patients need any medical care and if they wanted medical care, they wouldn’t be in your office in the first place, would they?

So, if you are a marketing mastermind, you got this just throw a bunch of money at it. Unfortunately, I am not a marketing mastermind. I’m a marketer, but I am busy enough with patients that I just don’t have the time to figure out online marketing. It’s a black hole for me.

I’ve marketed to my email list every week. I’ve done a ton of internal, in-office marketing, I’ve marketed to our attorney referral friends, I’ve marketed to the Work Comp demographic, and have posted countless times about what we have to offer here at my clinic.

STILL….it just takes time, doesn’t it? Luckily, we had a war chest of money prepared to get us started. I was talking to a NP friend of mine after we had started our integration and she said in the industry, the word is that it takes up to 2 years to build a new practice.

That’s about what I’m discovering. I was hoping I could shorten that but nope….at about the 2-year mark, we’re starting to see the numbers come up to where things are covering the overhead and we’re looking at hopefully seeing some profit soon.

But, the point on integration, if you’ve ever considered it, if you are not a master marketer or have one you’ve hired, you’re looking at roughly 2 years of building. Or more. And….you’re going to most likely do it yourself unless you find an NP that is on fire to build their own thing.

Just a few tips from your ol Uncle Jeffro.

Now, into the research. Here we go.

Item #1


The first on today is called “Brief Mindfulness-Based Cognitive Behavioral Therapy is Associated with Faster Recovery in Patients Undergoing Total Knee Arthroplasty: A Pilot Clinical Trial” by Bethany D Pester, et. al. and published in Pain Medicine on 17 November 2022. Dayum. That’s steamy.

Why They Did It

To assess whether brief mindfulness-based cognitive behavioral therapy (MBCBT) could enhance the benefits of total knee arthroplasty (TKA) in improving pain and pain-related disability.

Specifically, to determine

  • whether patients who received mindfulness-based cognitive behavioral therapy differed from matched controls who received treatment-as-usual with regard to postsurgical pain outcomes and

2) whether changes in pain catastrophizing, depression, or anxiety explained the potential effects of mindfulness-based cognitive behavioral therapy on pain outcomes.

How They Did It


  • The mindfulness-based cognitive behavioral therapy intervention included four 60-minute sessions delivered by a pain psychologist in person and via telephone during the perioperative period.
  • Participants were assessed at baseline and at 6 weeks, 3 months, and 6 months after surgery.

What They Found

  • Compared with matched controls, patients who received mindfulness-based cognitive behavioral therapy had lower pain severity and pain interference at 6 weeks after surgery.
  • Group differences in outcomes were mediated by changes in pain catastrophizing but not by changes in depression or anxiety.
  • The mindfulness-based cognitive behavioral therapy group had similar reductions in pain severity and interference as the control group did at 3 and 6 months after surgery.

Wrap It Up


This work offers evidence for a safe and flexibly delivered nonpharmacological treatment (mindfulness-based cognitive behavioral therapy) to promote faster recovery from total knee arthoplasty and identifies change in pain catastrophizing as a mechanism by which this intervention could lead to enhanced pain-related outcomes.



Before getting to the next one,


Next thing, go to That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office.


When you decide you cant live without those products, send me an email and Ill give you the hookup. They will 100% differentiate your clinic from your competitors.

I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. and the discount code is HOTSTUFF. Go do it.

Item #2

Our last one this week is called, “The Effectiveness of Tuina in Relieving Pain, Negative Emotions, and Disability in Knee Osteoarthritis: A Randomized Controlled Trial” by Hui Xu, et. al. and published in Pain Medicine on 23 August 2022. It’s warm-ish!

Why They Did It

To evaluate the effectiveness of Tuina in relieving the pain, negative emotions, and disability of patients with knee osteoarthritis (KOA).

How They Did It

  • A total of 104 patients were randomly allocated to receive the 6-week treatment of Tuina (Tuina group) or celecoxib (celecoxib group).

  • Data on pain, negative emotions, and disability were collected at baseline, at week 2, 4, and 6, and follow-up (1 month after the last treatment).

  • The primary outcomes were the pressure pain thresholds.

  • The secondary outcomes were: (1) numerical rating scale at rest and with movement; (2) Hamilton Anxiety Scale; (3) Hamilton Depression Scale; (4) Western Ontario and McMaster Universities Osteoarthritis Index; and (5) clinical effective rate. The adverse events of the trial were evaluated.



What They Found

  • In total, 99 patients completed the follow-up. Generalized linear mixed models were constructed to analyse the between-group differences.

  • Statistically significant differences were found in the interaction effects. In evaluating the group effect, statistical differences were found at week 6 and follow-up.

  • Further, all variables showed a time effect. A statistical difference in the clinical effective rate was found between the Tuina and celecoxib groups.

Wrap It Up

Tuina produced superior effects for pain, negative emotions, and disability over time, as compared to celecoxib in patients with knee osteoarthritis.

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



Remember the evidence-informed brochures and posters at



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 cant 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….

Thats Chiropractic!


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We cant wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.


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About the Author & Host

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