CF 110: Dry Needling vs. Massage & What Is Your Exit Number?

Today we’re going to talk about new research comparing dry needling to ischemic compression. Really interesting information on this so don’t miss it. Also, I get into my story a bit. How I came to be where I am and I’m hoping to encourage and give a little guidance for the younger docs as well as the older ones. This one was a fun one to think through. I hope you enjoy what I have to share. 

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 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. 

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Do it do it do it. 

You have found yourself smack dab in the middle of Episode #110

Now if you missed last week’s episode , we talked about 10 back facts and 10 back myths. We also talked about how chirorpactic performs when it’s used as part of an integrated strategy. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

We are going skiing this weekend. If you haven’t been to the Enchanted Circle part of New Mexico, you should definitely go some time. The town in that circle are Taos, Angel Fire, and Red River. There is skiing for everyone. Probably the easiest is Red River and it’s a pretty cool little town because the slope comes right down into the town. Like there’s a bar right there at the bottom. 

And that’s where I’ll be found if you happen to be looking for me. 

Here’s where I’m trying to get in my work/life balance. For that reason, I thought I’d tell you a quick story about how I’ve arrived at the spot I am in my practice. Where I’ve been and where I’m going. 

When we are young, we work. Or at least we should work. And I mean work hard. you have to build and most of us start from very little. I started working for another chiropractor for the first 5 years. He was not fair, he did not pay bonuses, it was not a positive experience for me. I had basically nothing. 

I moved on, under threat of a lawsuit from him, to open up just down the road. I had 3 rooms in a run down building that I shared with a commodities trader and an insurance company. We do what we have to do folks. And I did. I answered the phones, I wrote the appointments down in a little book, I cleaned my office, I’d say I did the billing but I didn’t. I never sent anyone a bill. I didn’t know what the hell I was doing. Nobody ever taught me. 

In the town I was in, there were about 14,000 people and I saw 14 chiropractors set up and then close shop in the 11 years I had a presence there. 

That should have told me something right? Well I’m a creature of habit but even I finally woke up and realized I had to make a change. So, I started renting space from another chiropractor in Amarillo, which was about 40 miles from where I was practicing. I split time between the two cities. Three days in Amarillo and two in the small town. 

Guess what? I started actually getting busy and seeing more and more patients in my new spot so, eventually, I was able to get rid of the small town and move everything to Amarillo. 

Adversity is a constant in our lives though. And I have to say that I absolutely LOVE when people underestimate me. It warms my heart because I know what I’m made of and determination plays a huge part in my DNA. If someone tells me I can’t do something, it’s almost like they’ve just guaranteed that I will. 

Well, the guy I was renting from ended up being about half crazy so I left there and opened up my own practice finally. Up until I left his building, we had split the cost of marketing for personal injury patients. He thought the attorneys needed us more than we needed them. I felt like it was in our best interest to develop a personal relationship with the attorneys. Take them to eat lunch, things like that. 

Well, guess who got all of the PI business when I left? Right…..me. I still didn’t have much to my name at that point but I had that business and it gave me the confidence to do it. 

I graduated college in 1998 and here it was 2008 and I’m finally opening my own practice. And again, though my business had picked up a bit, I still had nothing. The first ten years were supplemented with playing music. Hell, back then I was making about $55k a year just playing the guitar and singing songs. What a blessing to be able to survive the lean years that way. But I was killing myself staying up late and all that stuff. 

This new office, I made and painted all of the base boards. We bought furniture at consignment stores and antique shops and auctions and estate sales. It was done on a budget but, compared to what I had been a part of prior to 2008, it was absolutely gorgeous. 

Only 1500 sq ft but plenty for what I needed at the time. My mom had just retired and decided she wanted to help me get started so she worked for me for about 6 months for free before I could hire someone to help and let her retire in peace and quiet….away from the craziness. Aren’t mom’s amazing?

This brand new practice grew and grew and slowly grew until we were able to expand in 2015. The space next door to us came up for lease so we just expanded into the space. The construction was a challenge for sure but worth every noise and bang and clank and saw that we listened to for 6 months of the build out. 

Now we have about 4,000 sq ft. and it looks like a museum. On purpose. If you’ve listened very long then you know that I’m a sculptor and I build live edge furniture. We also like to travel and we try to buy art from original artists when it makes sense. 

So, art and design and unique furniture are woven throughout rooms with traditional chiropractic modalities. Lol. Sounds crazy but it works. And it’s a space that I love to come to and patients really seem to love as well. 

With the extra space we now have 5-6 massage therapists, and acupuncturist, and we even added a day spa with an esthetician. How does that tie into chiropractic? It doesn’t. It ties into the massage acupuncture – dayspa and it gives us more cash based services so we will one day hopefully be less and less dependent on insurance companies. 

So, we have built something of value and with substance despite two threats of lawsuits, despite having little to nothing to get started with, against the odds, without really knowing how to run a business, and without having it really figured out. We’ve lost a lot of money along the way because we didn’t always know exactly what we were doing but necessity is the mother of invention. We figured it out. We learned on the job. On the fly. 

Another thought on this is that I was learning and learning…. I learned how to do graphic design so I didn’t have to pay someone to make graphics for my marketing. I learned how to build a website and how to do website SEO to get it to #1 on Google. I didn’t have the money to pay someone else so I had to figure it out. I learned how to network and join associations and clubs. 

I learned different stuff like the Kennedy Decompression Technique. I went through Croft’s Whiplash Biomechanic & Traumatology certification. I was mostly PI for years so why wouldn’t I do what I could to be the best at it? For you ChiroTouch users, I even created a macro around the research from his course. You can find that at personalinjurymacro.com. Now those are good things to go through and learn from, but it wasn’t until I felt that we were finally done building that I turned my attention more toward perfecting. 

That’s when I started the orthopedic diplomate. I have goals set for what I want to do next. I have FAKTR on the list and I have SFMA on the list. I have the McKenzie course on the list. I’m wrapping up the CRISP book on the cervical region. It’s just as a amazing as the CRISP book was on the lumbar region. The next book is the 3rd edition of Craig Liebenson’s Rehabilitation of the Spine. 

See what I mean? I’m done building so now, I want to perfect. 

So, why did i tell you all my little story? Why did my going skiing spur me telling you the short version of my story? Well, because I want young doctors to understand what it takes. Many do understand it. Many do not. When people say it’s a journey, man that’s no lie. 

You have to work, you have to be present, your practice is going to own you for a while, you have to network and kiss babies and shake hands. Then, somewhere down the line, you reach a point where you are successful enough that you must transition to where you start to value your time in ways that are different from how you started out. 

You have to start making a pivot and the timing is different for everyone. And that’s where I’ve been for the last two years or so. Finally, at 45 I started to get it. I have to start valuing my time with my family, my personal time, and time to learn more. IF the office and patients run my schedule at all times, there will never be enough time for the rest of what makes up a life full of quality and enjoyment and loving relationships with spouses and friends and family. It’s impossible. 

Some of the things I’ve started doing to ease the burden of burnout, which is very real by the way….some of the things are to implement an exit plan. I don’t mean next year or even in the next 5 years but, sitting here today at 47, what will be my exit plan? How will I one day retire and still be financially secure? Well, my dad  having a stroke has taught me that I need long-term care insurance….just in case. I’ve seen the difficulties long-term care presents. I’m doing what I can to protect my wife and I. 

I need disability insurance as well. I’m drinking beer at the base instead of skiing this weekend. Not because I’d rather drink beer than ski but because they call them accidents because they’re not planned. If I hurt myself skiing, the loss in money is incalculable. I retired from skiing on purpose. 

Beyond those things, I’m identifying activities and expertise I have to offer that others may find valuable at some point. Then, I want to monetize those skills and that knowledge so that retirement still offers income opportunities. 

Those are exit strategies that if I start today, may mature and pay off when the exit is finally engaged. 

In the meantime, for today and next month and next year…..I think it’s important to plan a trip at minimum once per quarter. Whether  you just go to your mom and dad’s 2 hours away or you fly to Europe or wherever. A trip once per quarter gives you something tangible, not very long away in terms of workdays, and some time away from your daily grind. 

Once per quarter trips are meant to re-charge your batteries. They give you more time with your family and your friends. And honestly….time to your damn self. When was the last time you were able to just sit down and do whatever the hell it was that YOU wanted to do? It’s been a while for me. 

So, my schedule, I decided to take control of it. Monday is a full day with a 2-hour lunch and I get off at 6. Tuesday I work through lunch and only go from 9-2:30. I use my afternoon for continuing education or personal business tasks….whatever. Wednesday is a full day BUT I take a 3-hour lunch. Lots of good free time there in the middle of the day and it makes the afternoon shorter. Thursday is a long day just like Monday. Then on Friday I work through lunch and go from 8-1. This again gives me time to travel for the weekend, for happy hour with my friends or my wife, for taking the kids to a movie, or to do more paper work in the office if I’m behind. 

So I have three days during the week that have a little me-time built in there and that’s just invaluable. At the same time, I have the room, if we fill completely up…I have the room in my schedule for 255 patients in the week and about 25 new patients. If we fill up of course. I typically average about 15-20 new patients per week and more like 180 visits per week so I’m nowhere near being full. 

So I guess I wanted to tell my story a bit because I want to hopefully inspire the younger doctors to stick with it. To have that fire and to be a do-er. You either make things happen, let things happen, or wonder what the hell just happened. Be the one that makes things happen. 

Even when you make a mistake or fall down, at least you are trying. You’ll learn, you’ll figure it out. You’ll be OK. Just be smart, be honest and ethical, communicate the right way and it’ll work out. 

For the older docs like me, I wanted to inspire you a bit about making the pivot. Some of you want to die in your office working with patients when you’re in your 80’s. Yeah, that’s not me. I have too many interests in my life. I have songwriting, sculpting, . I want to make you think about making that pivot. What are your talents and skills that you can monetize down the road to help you retire when you really want to?

I had a very wealthy friend ask me one time, “Jeff, what is your exit number?” I didn’t know what the heck he meant. His background is that he builds oil field saltwater disposal wells, he annoys the big oil companies by making the wells successful enough that the big oil companies buy him out. Pretty cool gig and the payoff is huge. 

He explained to me that he always goes into a new deal with his exit number in mind. He knows what he wants to get out of it before he really gets elbow deep into the muck. 

How do you translate that into chiropractic practice? It made me think quite a bit. I still don’t know my exit number. I have an idea but don’t know it exactly. 

But I know this, If you think your practice is worth $1 million dollars, you’ll might get $350k. 

That’s not bad. But, will it fund healthcare in your old age? Will it fund those trips to Europe or Australia that you never had the time to take before? Will it leave the legacy to your kids you wanted to leave? Of course that’s for everyone to answer on their own. 

But think about it. What is your exit number and what steps do you need to take today to hit that number to allow you to engage the exit? 

I have to admit, I sat down to just put some random thoughts on the paper before I recorded it and this literally turned into a random, not very focused, brain dump. I apologize for that but I hope you got something out of it. If there’s one thing age provides, it’s hopefully a bit of wisdom but definitely experience. 

I’ve lost close to a million dollars before. Over a three year period, I held onto a staff member too long. I believed in them. I fought for them by training them more and more and I just had no idea how deep they were in over their head. 

I finally hired an internal auditor to come in and pick things apart and give me the bad news. I knew something was wrong but had no clue. The staffer wasn’t stealing. They were just not billing correctly, not disputing denials, and all that good stuff. Anyway, it added up to about a million dollars over about 3 years. 

I’m just going to pause long enough to say this; it’s not every day that you find out you’ve lost almost $1 million dollars. But, with the help of an amazing wife, some really cool friends, and Bud Light….I came to terms with it and I let it go. 

So, losing that kind of money…..that’s not wisdom right? That was stupid of me. But it gave me experience not very many of you have!! But, where money can be lost, it can just as easily be made. 

You can’t keep a person with a purpose down. Chiropractors typically have a purpose. We are resilient and through all of the battles we’ve been through on the state level with the Texas Medical Association, one thought remains true for me. If we were wrong….if we weren’t affective….if we didn’t help our patients in tremendous ways, with all of the forces against chiropractors through the years, we would have been wiped out years ago. 

Yet, here we are. Still here. It’s because we make such a difference in our patients’ lives and because we have the purpose behind us. 

Keep on keeping on friends. There’s not been a better time to be a chiropractor in the last 30 years. 

This is actually a research-based podcast so I should at least take the time to share a paper rather than just my opinions or experiences. 

Before we dive into the reason we’re here, it’s good to support the people that support evidence-informed practitioners. Well, ChiroUp certainly does just that. 

If you don’t take advantage of the deal I’m about to offer you, I think you just might be crazy.

Regular listeners know I’ve used ChiroUp since for well over a year now. I’m going to tell you want it is and then share a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months. So listen up!

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, activities of daily living, & for their exercises. 

This save you so much time – no more explaining & re-explaining your patient’s care, because they have access to it right there at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports and exercises are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you by people that are deep into the research. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice.

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL and, to sweeten the deal, you can use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super saver code is Williams99.

Item #1

Our only item this week is called “A sonographic comparison of the effect of dry needling and ischemic compression on the active trigger point of the sternocleidomastoid muscle associated with cervicogenic headache: A randomized trial.” by Togha et. al and it was published in the Journal of Back and Musculoskeletal Rehabilitation in November of 2019(Togha M 2019)…..close enough, hot tamale hot tamale…..

Why They Did It

Cervicogenic headache (CeH) is among the common types of headache which has an undesirable influence on the quality of life. The myofascial trigger point (MTrP) within the sternocleidomastoid (SCM) muscle is one of the most important causes of CeH. 

The purpose of this study was to compare the effect of dry needling (DN) and ischemic compression (IC) on the headache symptoms as well as myofasckial trigger point-related features in subjects with cervicogenic headache originating from mysofascial trigger points of the  sternocleidomastoid muscle using a sonographic method.

How They Did It

  • 29 females aged 35 years on average with clinical diagnosis of cervicogenic headache were used
  • They were randomly divided into the following groups
  1. dry needling group
  2. Ischemic compression group
  3. control group
  • The dry needling and ischemic compression groups each received 4 treatments 
  • Outcomes were measured 2 weeks before and 2 weeks after treatment. 

What They Found

  • Significant improvement was found int eh headache intensity, duration, frequency, pain pressure threshold, and myofascial trigger point area. 
  • No significant differences were observed between dry needling and ischemic compression though. 
  • Pearson correlation showed a significant correlation between headache intensity and the myofacial trigger point elastic modulus

Wrap It Up

The authors summed it up in the conclusion, “Both interventions could reduce headache symptoms, pain pressure threshold, and myofascial trigger point area. Neither intervention was found to be superior to the other in short-term follow-up. Ischemic compression may be preferred since it has fewer unwanted side effects compared to dry needling. 

Based on the data, it may be concluded that some myofascial trigger point biomechanical features such as stiffness may influence the produced headache symptoms.”

Good stuff in that paper right there because, literally, I’ve been thinking about adding dry needling to my toolbox and, as of right now, it’s moved from the top of my list. 

I know this episode was a little scattered and not quite as focused as all of the rest but I felt like I could offer some advice and maybe even a little guidance. Maybe I’m just an old dude wanting to talk and hoping someone listens. Maybe I helped lead and encourage. That’s always the goal. 

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 preventativly 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. 

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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 & VloggerBibliography

Togha M, B. F., Jafari M, Nasiri A, (2019). “A sonographic comparison of the effect of dry needling and ischemic compression on the active trigger point of the sternocleidomastoid muscle associated with cervicogenic headache: A randomized trial.” J Back Musculoskeletal Rhabil.

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