CF 234: Chiropractic For Medicare Patients & Avoiding Vertebral Artery Stress During Adjustments Today we’re going to talk about Chiropractic saving Medicare patients money and adverse events and a better position for preventing strokes when adjusting the neck.  But first, here’s that sweet sweet bumper music  

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
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  • Last thing real quick, we also have an evidence-based brochure and poster store at

You have found yourself smack dab in the middle of Episode #234 Now, if you missed last week’s episode, we talked about SMT and Geriatrics & Lower Costs – Back To Work Faster With Chiropractic. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Well I just had a weekend of weekends folks. Yes indeedy. My wife got a bug in her butt. Not literally. That may just be a Southern phrase. Annyway, she knows I’ve been a Beatles fan my whole life. I don’t love everything the Beatles ever did. Some of it was way too far out for me to care about. But….some of what the Beatles did is among the best of the best all time. Legendary.  If you’re a Beatles fan, you probably have a favorite and mine was and remains Paul McCartney.

What a life. What a career.

That dude has seen and done everything he ever wanted to do and is worth around $1.2 billion dollars from the music he has given us.  Well, he’s 79 and my wife figured we better go see Paul while we can and he happens to be on a bit of a mini-American tour. So, behind my back, secretly, she set the whole thing up and hid it from me until the last minute. We flew to Syracuse, New York on a Friday morning. We got there at about 2:00 PM and hopped in a rental car and drove another 2 and a half hours to Buffalo, NY to see Niagara Falls. My wife had never seen it before and it was awesome as always.

Then had an amazing meal at the culinary institute there called Savor and it was one of the best meals I’ve ever had.  Then back to Syracuse to sleep.  That Saturday morning, we got up and drove down to Canandaigua, NY which is part of the Finger Lakes region if you’ve never been. It’s called the Bed And Breakfast Capital of America. It’s on the lake and it’s just a gorgeous little town and region. Lots of agriculture and rolling farmland and trees there in upstate New York.  Very Norman Rockwell picturesque overall. It was nice just soaking it all in.  We got back from Canandaigua and went to see Sir Paul McCartney at The Dome on the Syracuse campus. I was wondering why on Earth McCartney would play in Syracuse. Until I saw this place. Holy smokes! The Dome holds about 50,000 people!! It’s huge! And it was sold out. 

At 79, the dude still puts on a hell of a show. I think he played for about two and a half hours. He played bass, ukelele, piano, and guitar and sang maybe not quite as good as he used to but still very good and it was just an amazing show. A bucket list thing for me and y’all can all rest well in the knowledge that my wife is indeed cooler than yours.  Now, this weekend, it’s on to Dallas for the Texas Chiropractic Association’s ChiroTexpo state convention where I’ll be presenting a 2-hour course on Chronic Pain And The Upregulated Central Nervous System. I’m looking forward to seeing some old friends and making some new ones as well.  I’m still searching for an associate to come and work here in my clinic with me. We’ll start with a base salary around roughly $60,000 with the roof set as high as the associate wants it to be.

Meaning, I’d love to pay them $150k if they’re hitting the metrics that can get them there. I’m not greedy. Help us grow the cliniic and I’m happy to grow your finances. It’s a win/win.  So, while the base may not be what The Joint offers, there’s a ceiling with The Joint. Not here.

Plus mentoring, benefits, and all of that good stuff.  If you’re the right kind of associate, contact me at Let’s get to know each other.  Now, I’ve recently been telling you about a system that once obtained will help you get more  PI cases.  This system was created by an attorney who exclusively handles accident cases. He got tired of the typical approaches by doctors wanting his referrals, so he created this system to teach them and you how to get the attention and then the love from the PI attorneys.   You know these cases are the GOLD of our business.  Very few no-shows, full payment … no health insurance caps or Medicare or Medicaid. Go to: Over 500 doctors nationwide are now using this system…. don’t be left out…  improve your practice, gain free time because of the added income you’ll realize, and appreciate that the attorney, Paul Samakow, is still offering a 100% Money Back Guarantee …   if you give his ideas a fair shake and it doesn’t work, he’ll refund your money…  you have nothing to lose here… Go to:

Item #1

This week’s first one is called, “Initial Choice of Spinal Manipulative Therapy for Treatment of Chronic Low Back Pain Leads to Reduced Long-term Risk of Adverse Drug Events Among Older Medicare Beneficiaries” by Whedon et. al. (Whedon JM 2021) in December of 2021 and it’s hot because I say it is!

Why They Did It

Opioid Analgesic Therapy (OAT) and Spinal Manipulative Therapy (SMT) are evidence-based strategies for treatment of chronic low back pain (cLBP), but the long-term safety of these therapies is uncertain.  The objective of this study was to compare opioids versus SMT with regard to risk of adverse drug events (ADEs) among older adults with chronic LBP.

How They Did It

The authors examined Medicare claims spanning a 5-year period on fee-for-service beneficiaries aged 65 to 84 years, continuously enrolled under Medicare for a 60-month study period, and with an episode of cLBP in 2013.  They excluded patients with a diagnosis of cancer or use of hospice care. All included patients received long-term management of cLBP with SMT or opioids. 

What They Found

With controlling for patient characteristics, health status, and propensity score, the adjusted rate of adverse events was more than 42 times higher for initial choice of opioids versus initial choice of SMT

Wrap It Up

Among older Medicare beneficiaries who received long-term care for chronic LBP the adjusted rate of adverse events for patients who initially chose opioids was substantially higher than those who initially chose SMT. Before getting to the next one, I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! It’s live again. Use the code HOTSTUFF upon purchase at to get $50 off your purchase. Y’all, it makes a world of difference. 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. My patients love it and I know yours will too. and the discount code is HOTSTUFF. Go do it. Hear me now and believe me later.

Item #2

This second one is one of the most important ones in recent evidence-based chiropractic podcast history. It’s called “Kinematics of the head and associated vertebral artery length changes during high-velocity, low-amplitude cervical spine manipulation” by Gorrell et. al. (Gorrell 2022) and published in Chiropractic & Manual Therapies in June of 2022 holy Mackrell, that sauce can’t get any hotter!

Why They Did It

Despite cervical adjustment’s demonstrated efficacy, concerns regarding the potential of stretch damage to vertebral arteries (VA) during cervical adjustmets remain.  The purpose of this study was to quantify the angular displacements of the head relative to the sternum and the associated vertebral artery length changes during the thrust phase of the move.

How They Did It

  • Rotation and lateral flexion procedures were delivered bilaterally from C1 to C7 to three male cadaveric donors 
  • For each move the force–time profile was recorded using a thin, flexible pressure pad to determine the timing of the thrust. 
  • Three dimensional displacements of the head relative to the sternum were recorded using an eight-camera motion analysis system and angular displacements of the head relative to the sternum were computed in Matlab. 
  • Length changes of the VA were recorded using eight piezoelectric ultrasound crystals inserted along the entire vessel.

What They Found

  • Irrespective of the type of CSM, the side or level of CSM application, angular displacements of the head and associated VA length changes during the thrust phase of CSM were small. 
  • VA length changes during the thrust phase were largest with ipsilateral rotation CSM

Wrap It Up

  • Mean head angular displacements and VA length changes were small during thrusts. 
  • Of the four different positions measured, mean VA length changes were largest during rotation procedures. 
  • This suggests that if clinicians wish to limit VA length changes during the thrust phase, consideration should be given to the type of position used.

I said this is one of the most important papers because, if we can figure out how to reduce our risk, why on Earth wouldn’t we?

We are beat up the most by medical professionals about this idea that we go around stroking people out. Of course, as a rule, we do not but it does happen that we see patients and they later have strokes. Cassidy et. al. proved this but also showed it wasn’t due to cervical adjustments.

It was due to the patient having neck pain due to a vad already in progress.  So, two things;  1. We need to get better at recognizing risky patients and risky situations. Symptoms that could signal that the patient could be having a VAD in progress when they present to our clinic.  2. If we know that rotation is riskier that a regular cervical break/extension lateral flexion position, why wouldn’t we use a cervical break as our preferred method rather than rotation?

First, do no harm. Second – make the patient better.  Always.  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   

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 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.


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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


Gorrell, L. M., Kuntze, G., Ronsky, J.L, (2022). “Kinematics of the head and associated vertebral artery length changes during high-velocity, low-amplitude cervical spine manipulation.” Chiropr Man Therap 30(28).  

Whedon JM, K. A., Toler AW, Bezdjian S, Rossi D, Uptmor S, MacKenzie TA, Lurie JD, Hurwitz EL, Coulter I, Haldeman S, (2021). “Initial Choice of Spinal Manipulation Reduces Escalation of Care for Chronic Low Back Pain among Older Medicare Beneficiaries.” Spine (Phila Pa 1976).  

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