CF 056: What Does A Spinal Manipulation Do In Medical Terms & What I Despise About My Profession - chiropracticforward CF 056: What Does A Spinal Manipulation Do In Medical Terms & What I Despise About My Profession - chiropracticforward

CF 056: What Does A Spinal Manipulation Do In Medical Terms & What I Despise About My Profession

Today we’re going to talk about what a chiropractic spinal manipulation is, we’ll talk about what it does and what happens there. We’re also going to talk about what I sincerely despise about our great profession. Depending on how fired up I get here, this one should be a good episode. 

But first, here’s that bumper music

Integrating Chiropractors

 

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

You have dropped into Episode #56 and we’re so glad you did. We showed some good growth over the last month and I want to take just a second to thank you for listening and sharing. By now, you all know how important that is to a newer thing like we are trying to build here and thank you thank you. 

DACO Talk

Let’s talk a bit about the DACO program which stands for Diplomate of Academy of Chiropractic Orthopedists. First, though, I’m still thinking about that episode from last week with James Lehman, head of the DACO for Univ. of Bridgeport Connecticut. What a great episode. Make sure you go back and listen to Episode 55. It’s excellent folks. 

On the DACO, I have moved beyond the Diagnostic Drills and have entered what are called the Communication Drills. These drills help you develop your skills when interacting with those in the medical profession. When you’re writing out a note to a patient’s GP, how to use ideas and words to help position yourself correctly. 

I’m about 6 Communication Drills into it and I’m digging them. There’s a lot of repetition in the drills but repetition builds habits and I’m on it like white on rice. 

For example, if you needed to explain why you are adjusting a sacroiliac joint to a medical practitioner that largely assumes the SI joint is basically fused and couldn’t be the cause of generalized back pain, what exactly would you say?

Think about that one for a minute. I had to think about it too so don’t feel bad if you’re not sure how you’d go about it. 

Do you write them a 5 page summary of the history of manipulation, how it works, with research citations and proof that we are more effective than physical therapy? Or do you set yourself up as more of a diagnostician than a therapist?

My vote and the vote of the folks running the education here is that we set ourselves up as a diagnostician, pick one topic per letter and try to narrow it down to some simple ideas that we can communicate with them in ways they understand. 

Very cool stuff. Trust me on this. And, again, if you need some help getting started on the DACO, I’ll be glad to point you in the right direction if you want to send me an email at dr.williams@chiropracticforward.com

Foolishness in the Profession

I’m going to take the first part of the episode today to be a little negative and I want to apologize for that but, you cannot have light without some darkness to give it perspective right? Don’t forget, I’m an artist. 

Remember that these episodes are running two weeks behind. I record them, edit them and all that good stuff and they post two weeks after I record them. While this one is probably posting somewhere around the 17th of January, I recorded it on December 27th. By the way, I hope you all had an excellent Christmas. 

I am leaving names and places out of this for two reasons:

  1. I don’t like pointing the finger directly at people, running them over in the street and then backing up over them publicly, and then doing it again but still need to tell the story and give my take on it. 
  2. For me, there’s nothing good about this at all and I don’t want to give them any more attention than they have already received. The fewer people know about them, the better in my opinion. 

Over the Christmas holiday, someone posted in one of the private evidence-based Facebook groups a picture that a group of chiropractors posted on social media claiming to have reversed and eliminated degenerative, arthritic osteophytes on x-rays after seeing a patient 4 times per day over the course of 3 weeks. 

A Christmas miracle right?

OK, there are so many problems here that I truly don’t even know where to start. If I get to rambling, please forgive me. 

The first thing is that there are tons of healthcare practitioners every day making insane claims. Chiropractors, DOs, AND MDs. It’s not only in our profession but, our profession…..well…..let’s just say we’re no stranger to stuff like this unfortunately and in 2018 with all of the amazing research in our favor, it’s getting damned old to be honest. 

This claim, however, is just too over the top for me and it really highlighted what I absolutely despise about our amazing profession and why things like the Chiropractic Forward Podcast and Group are necessary. Why the Forward Thinking Chiropractic Alliance group and the Evidence-based Chiropractic group are necessary. 

I will include a picture of the Instagram post from this group in the show notes so you’ll see exactly what everyone else saw. 

Let’s pick things apart just a little bit. 

From the get-go here you must understand that this group is trying to be practice gurus and speakers and are trying to be the millennial mystical greats of the chiropractic profession. Not only do they have their practice page, but they’ve got a technique training group, and then they have a practice management group they’re trying to build. 

So, you see, they’re doing everything they can to have a profound influence on our great profession. That’s important to note because there’s a point that a person has to decide if we want what we’re about to talk about here to play a big part in how you are perceived by other professions and professionals. 

Are we OK with being guilty by association essentially?

The first thing on this case is that there were probably zero red flags for x-rays in the first place if I’m guessing. I can’t say that for sure since I didn’t take the history on this patient but I have a strong hunch. 

Next, only a very very few amounts of people need to be seen once a day. Maybe twice a day in an extreme case. But four times per day? OK, let’s say you had that unicorn of a patient come through your doors and they actually needed 4 times per day. Four times per day for three damn weeks? 

Where in the hell do you have someone teach you that a patient would ever need that much? 

What guru is giving people those kinds of treatment guidelines? Are we just making it up and ‘winging it’.

Unfortunately, it’s my guess that this is a regular treatment recommendation beyond just this patient.

OK, next….a follow-up x-ray just three weeks after the first set. Seriously? I believe that ACA’s Choose Wisely was put together for this very reason. Because chiropractors have a reputation for lighting up patients.  

I’m not against initial x-rays honestly. Sure we can typically rule out the need for x-rays with a good history, etc.. But, what if your gut just tells you to shoot them even when there are no red flags? I say you better do them!

Sometimes people just like to know what’s going on and who am I to argue with that? But, follow up x-rays three weeks down the road? Outside of a new injury, the answer is no. Likely never. 

Let’s be positive for a second though. They look like they can adjust just fine and I have no doubt they make a good number of their patients feel better. 

Dr. James Parker of Parker College of Chiropractic used to say something similar to, “Chiropractic is so effective that I could hit everyone in the ass with a board and get a good number of them better.” Something like that anyway. I didn’t agree with a whole bunch of what he said but I get his point on that one. 

Theatrics

I only have one problem with their adjustments and it’s a bit of a trend with their age group that I’ve started to notice. It’s the theatrics. I call it the ‘artistic adjustment’ and I’ve got very little use for it personally. 

Here’s what I mean: it’s the slow and seemingly thoughtful process of approaching the patient and beginning to work on them followed by exaggerated hand motions and movements and almost dancing around in some awkward way. 

Now look, for some, it’s art and it’s awesome. I’d say I get it but I don’t or I wouldn’t even be talking about it. And it’s not only this group. I’ve seen several of the younger guys doing this in videos on social media and I cringe every single time. 

Does it put the patient at an increased risk? No, not at all to my knowledge. It just looks absolutely ridiculous and foolish and, in my opinion, puts us all at more scrutiny from other professions when they see foolishness highlighted in our people. 

That’s probably just the old man in me now that I’m 46 looking at these 20-something kids and wondering what in the hell they could possibly thinking. It probably is. Elvis once irritated the hell out of Frank Sinatra fans right? I’m not oblivious to this fact. 

However, I’m still waiting to see that MD on YouTube and Facebook dancing around their actual real patients, drawing blood with exaggerated hand motions, and then writing a script out with flare. All while having a goatee and wearing a dressy vest and flat top hat. I’m not going to hold my breath on that one. 

You might point at ZDogg but he only makes spoof videos. Not real treatment videos. Oh, and he typically makes a lot of sense from what I’ve seen. 

But all of this is purely opinion and preference. I guess just you do you….create your own truth…and all that stuff the young people say is the deal here. Lol

It turns out that I wasn’t the only one that took offense to the claims of healing arthritis. Our colleagues in the Forward Thinking Chiropractic Alliance Facebook group took to social media on this. 

They called out this group and they were well within their rights to do so. They pointed out several issues including but not limited to different positioning of the patient, different parameters of x-rays that can easily explain the difference in the before and after x-rays, they pointed out how the interpretation of the research they provided was flawed, they showed how the spurs were still there, and basically, they gave these guys a good dressing down. 

So, what happened?

Well, one of the main guys took down all of the false claims and posted a sincere apology for being misled by his school and not fully understanding the research, for not fully understanding x-rays, and for posting outlandish claims. That was followed up by a promise to stop any further apparent craziness, have more respect for his colleagues and how his actions affect us all, and a commitment to proceed in an evidence-informed manner forever and ever amen. 

I’m lying. That’s not what happened at all. 

What actually happened is that one of the main guys in this group got on their Facebook page and doubled down on the claim while simultaneously and arrogantly claiming everyone was wrong, compared birthing a new idea of osteophyte absorption to actual childbirth, and insinuated that he was above the rest in knowledge, peace, love, completeness, circle of life, acceptance, speaking YOUR truth instead of the ACTUAL truth, healing immersion experiences, understanding, and a whole bunch of other nonsensical new age, mystical drivel. Or at least that’s the way I interpreted it all. 

And it was all delivered with what I took as “You’ll never be on my level” giggles in between sentences.

That’s what happened.  Oh, and of course, any post that wasn’t in praise on their page was deleted. It’s best if your tribe only sees YOUR truth instead of the REAL truth. 

And they’ve been out of school around 4-5 years or so, of course, they already have it all figured out like so many others in their age group. Of course, they should be leading a group and having influence over other chiropractors. Of course….it all makes sense. That is if you live in the freaking Twilight Zone. 

Good Lord, help us all. 

There are some absolutely amazing young people in our profession in this age group. Stunningly smart, exceedingly capable, and individuals I would trust my health to in a heartbeat. I’ve seen them, met them, and interacted with so many of them. I’ve worked alongside many of them through the Texas Chiropractic Association. 

This group, the group that claims a reversal of arthritis….for me….they are not among them.

Why So Negative?

Why on Earth am I tell you all about this?

Why am I being so negative when I’m typically a very positive person? 

Because you need to know what is going on in our profession. You cannot ignore the loud, obnoxious minority. You need to understand that we are not only up against a medical profession that largely dislikes us and looks for reasons to chip away at our abilities to practice, but we are also up against those in our own profession that are either intentionally or unintentionally trying to drag us down and keep us in the dark ages of the profession. 

For many chiropractors, it seems like it’s almost like a religion. It’s not. It’s a healthcare profession and when it comes to treating the public, you need to be based in science, research, and evidence. You also need to be committed to best practice principles. 

Let’s be clear, there is no research anywhere that I’ve seen or am aware of showing any magical unicorn ability of the body to absorb arthritic osteophytes. It’s impossible to my knowledge and to the knowledge of so many other chiropractors I saw discussing and interacting on this thing this week. 

If I’m proven unequivocally wrong somehow, not only will I apologize and will provide you their names and will probably go there for treatment myself. 

One of the main guys in this group posted that he’d never seen anyone outside of other chiropractors call another chiropractor quacks. Well, I’d start by directing him to a website by MD Stephen Barrett. Just the name of the website should make a point. I’m not saying it or leaving it here because I don’t want any of you going there and giving him clicks so that’s all on you to do your research. 

Most chiros are aware of Barrett anyway. 

I’d then direct him to a mailer sent out by the Texas Medical Association’s political action committee a few years ago when we chiropractors had a viable candidate running for a state congressional seat. Dr. Mike VanDerWalle is a chiropractor with over 30 years in practice in Austin, TX. Very well-respected and thought of. 

The TMA PAC sent a mailer out to all of his potential constituents (and you better believe plenty of his patients) that had a duck on one side of it and it said, “Quack, quack, quack.” On the other side of it, the TMA PAC compared Dr. VanDerWalle to Dr. Pepper and Dr. Jekyll. 

vandewalle tma political quack mailer

So you see, we are hated, despised, and ridiculed to this very day by the national and state associations. Your opinion is irrelevant. It’s a fact. The TMA just won a lawsuit against Texas Chiropractors removing neuro from our term neuromusculoskeletal in our scope. That’s a big deal for only having five letters. 

That happened last month 2018. 

Be vigilant. Be aware. Call out BS when you see it. You cannot allow it if you hope to ever get this profession where it should be. So many people need us and they have no idea. It’s up to us. Do your part. 

Now, something positive before I stroke out. 

How do you describe a manipulation? If you were on an airplane sitting next to a neurosurgeon and he asked you exactly how manipulation works and affects the body and pain, what would you tell him? Have you thought about it?

The folks at ChiroUp have thought about it and probably because they’re DACOs, the DACO program also has an interesting description to offer. 

Dr. Brandon Steele with ChiroUp offered a good explanation for cavitation back in October on their blog. I’ll leave the link for you in the show notes. 

https://chiroup.com/how-do-you-explain-joint-cavitation/

He described the need for better communication with the patients regarding cavitation and whether something “goes” or pops. Too many times, patients equate a successful treatment with cavitation. You know what we’re saying here. 

To quote Dr. Steele’s blog, he says, “Joint manipulation improves range of motion across individual and multiple vertebral segments.  A recent paper by Anderstt et al. (2018) confirmed that cervical manipulation results in facet gaping.  This force also improves regional motion across multiple spinal levels during and post-manipulation.

“This study is the first to measure facet gapping during cervical manipulation on live humans. The results demonstrate that target and adjacent motion segments undergo facet joint gapping during manipulation and that intervertebral range of motion is increased in all three planes of motion after manipulation. The results suggest that clinical and functional improvement after manipulation may occur as a result of small increases in intervertebral ROM across multiple motion segments.” 

Evidence-based chiropractors can bridge the patient education knowledge gap by incorporating current research into simple explanations.”

The DACO program I’ve been discussing put it all into an excellent description. Check this out and let me know what you think about it. 

“Chiropractic adjustments exert their effects upon the nervous system in a variety of ways. 

In recent years the neuroscience community has taken great strides in uncovering the mechanisms at play. These include analgesic responses at the dorsal horn level, as well as activation of the descending inhibitory pathways from brainstem regions such as the periaqueductal gray. 

There is also a compelling body of research that suggests profound changes in sensorimotor integration within the cortex. 

It appears that manipulation relies upon signaling properties of the muscle spindles that lie embedded in the paraspinal tissues. As the spindle registers rapid lengthening of the muscle it transduces this into a large proprioceptive barrage. 

The unique nature of a manipulation seems to alter the responsiveness of second-order neurons in the dorsal horn and make them less sensitive to incoming nociceptive signals from injured tissues.”

THAT’S communicating in the RIGHT way, folks.  THAT’S gaining respect and furthering our profession. 

There’s no mystical, new age babble necessary when you actually pay attention to real research instead of pseudo-research that no real clinician would pay any attention to. 

Integrating Chiropractors

 

 

 The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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Connect

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

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About the Author & Host

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

 

https://www.chiropracticforward.com/cf-050-chiropractic-care-text-neck-headaches-migraines/

 

https://www.chiropracticforward.com/cf-044-w-dr-dale-thompson-why-i-like-being-an-evidence-based-chiropractor/

 

 

 

 

 

 

 

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