CF 117: Spinal Manipulation With & Without Myofascial Release and Vitamin D3 and Headaches

Today we’re going to talk about manipulation with and without myofascial release added and we’ll cover a cool paper on vitamin D3 and headaches. Good stuff today in regard to smarts being handed out for free. 

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products
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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. 

  • Like our facebook page, 
  • Join our private facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!

Do it do it do it. 

You have found yourself smack dab in the middle of Episode #117

Now if you missed last week’s episode , we talked about the safety for chiropractic care in kiddos and we talked a little about an excellent article by Jan Hartvigsen called “What Is Chiropractic’. Definitely some food for thought. Make sure you don’t miss that info. Keep up with the class. 

While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points. 

On the personal end of things…..

Let’s talk about ebbs and flows, shall we? Here’s the thing; our practices ebb and flow. If someone tells you their practice looks like a business chart where it’s only up and to the right, they’re all hat and no cattle if you catch my drift. 

I told you all in the 10 Keys To Success episode recently that last year, I saw an average of 73.4 new patients every month last year. But in February of this year……I haven’t gotten the exact numbers as of the recording here but I believe it’s only somewhere around 30. 

Now, many of you would be jumping with joy to have 30 new patients in a month and I apologize if my displeasure is a put-off. It’s not meant that way. You must admit that if you love having 25 in a month, only having 8 or so is disappointing. Agreed?

So please keep the discussion in context. Now, what happened? Did I take a piss on someone’s dog and everyone found out? Of course not. I may do that to a cat but never a dog!!! Lol. 

Here’s what I think. I took four working days to go on vacation. Then, snow and ice messed with about another 2 and a half days or so. Essentially, I lost about 6 working days in February. Partly because of me. Partly not because of me. 

Then, for a hybrid insurance practice like mine, we have to battle with the fact that insurance plans reset in January. So, January and February are typically slower months to begin with. We basically took an already slower month and they made it worse by missing a little over a week of it. 

That’s a recipe for disaster. Dammit. I haven’t been in an amazing place since my dad’s health went south back in November but February was just a good way to put the cherry on the top. 

Here’s the deal though. Is it time to cash in the chips, throw my hands in the air, and say screw this. I’m out!!!????

Of course not. I’ve been around the game long enough to understand practice, understand life, and understand that I’m sitting on a cash cow of a practice and we just had a crap month. This too shall pass. 

Yes, I’m going to feel it in a couple of months. But that too will be short-lived. For example, I’m typing this on a Wednesday in the first week of March and for this week, we already have 11 new patients on the books and I expect more. Plus the re-exams are up there too. 

So, my practice is starting to level off again and get back to what I’m used to seeing. Hell yes, it’s stressful when numbers aren’t where you want them. Hell yes, it’s easy to get in the dumps and I do get in the dumps. But you can’t even imagine how productive I’ve been with the extra free time. Organizing marketing campaigns with our marketing manager, social media and website content, and basically TCB – taking care of business, man!!!

The marketers say don’t wait until it’s slow and then bust your butt marketing. Market like that year round. Yeah, I like that and it sounds great but that’s really fairytale land crap when you’re busting your butt like we did last year. There was no time. Literally. 

When people say they don’t have time, to me, that means it wasn’t a priority because we make time for the things that are priorities. Except when you literally do not have the time. And we didn’t. 

Now we do and we’re on it. I’ll keep you updated with how we proceed. I absolutely expect this coronavirus freak out to affect all of us. If people aren’t going to Las Vegas or Seattle, you can damn sure bet they don’t go to our offices as well. But, it’ll pass. 

You’ll stop seeing it on the news so much, deductibles will get met, and practices will fill up. At least…..mine will. Lol. And if you’re making good use of any extra time and being a marketer of what you do rather than a do-er of what you do, then yours will fill up too. 

If you’re playing video games at work on your computer, I can almost guarantee yours will not fill up. 

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 reassuring? 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 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 and super saver code is Williams99.

Item #1

Let’s start with a paper called “Effectiveness of Spinal Manipulation and Myofascial Release Compared With Spinal Manipulation Alone on Health-Related Outcomes in Individuals With Non-Specific Low Back Pain: Randomized Controlled Trial” by Boff et al (Boff TA 2019)and published in Physiotherapy in Nov. of 2019 that’s only 3 months ago and it’s……Hot

Why They Did It

They wanted to investigate the effectiveness of spinal manipulation combined with myofascial release compared with spinal manipulation alone in individuals with chronic non-specific low back pain. 

How They Did It

  • It was a randomized controlled trial
  • There was a 3-month follow up. 
  • 72 patients between 18 and 50 years old participated
  • They were placed in two different groups
  1. Spinal manipulation
  2. Spinal manipulation + myofascial release
  • They were treated twice a week for three weeks
  • Assessments were performed at baseline, three weeks post-treatment, and at three months after treatment. 

What They Found

  • No significant differences were found between the two groups for pain intensity and disability 
  • They found an overall significant difference between-groups for CNLBP disability, though this effect was not clinically important and was not sustained at follow-up. Stay tuned for my thoughts on this please…..

Wrap It Up

They concluded, “We demonstrated that spinal manipulation combined with the myofascial release was not more effective compared to spinal manipulation alone for patients with chronic non-specific low back pain.”

OK, fair enough. Nothing was found. But, what about that treatment frequency? 2x/week for 3 weeks…..only four visits in 2 weeks. We ARE talking about chronic pain guys and gals. 

What about 3x/week for 3 weeks for starters? Some of these people will never get out of pain completely and we’re trying to reduce the frequency and reduce the intensity. 

Basically, I absolutely buy into the fact they didn’t see a lot of difference. But I also don’t think they gave it very long. What do you think? Shoot me an email at and let me know or jump into our private Facebook group and start a discussion. 

Item #2

This one is called “Vitamin D3 might improve headache characteristics and protect against inflammation in migraine: a randomized clinical trial”  by Ghorbani, et. al(Ghorbani Z 2020). and published in Neurological Sciences in January of 2020 – Dammitt – I burned myself. The heat and all…

Why They Did It

Due to the anti-inflammatory effects of vitamin D3, they aimed to explore the effects of supplementation with this vitamin on headache characteristics and serum levels of pro and anti-inflammatory markers in migraineurs.

How They Did It

  • It was a placebo-controlled, double-blind study
  • It included 80 episodic migraineurs who randomly assigned into two equal groups to receive either daily dose of vitamin D3 2000 IU (50 μg) or placebo for 12 weeks.
  • At baseline and after the trial, headache characteristics were determined using diaries and serum levels of interleukin (IL)-10, IL-6, inducible nitric oxide synthase (iNOS), and cyclooxygenase-2 (Cox-2) were assessed via ELISA method

What They Found

At the end of trial, analysis revealed that vitamin D3 supplemented group experienced significantly lower headache days per month

reduced attacks duration

less severe headaches

and lower analgesics use per month

This was all when compared to the placebo

Wrap It Up

The authors concluded, “Based on the results of this study, we found that 2000 IU (50 μg)/day vitamin D3 supplementation for 12 weeks could improve headache characteristics and might reduce neuro-inflammation in episodic migraine.”

If all of you tell me that you get 100% of your headaches patients completely headache free, I’m going to raise my eyebrow at you in the skeptical posture and deep deep deep down inside, I’m going to think you’re full of horse hockey. Plain and simple. 

This paper can give us some insight into other avenues to explore. I’m not saying go put all of your headache patients on Vitamin D3 but, if you have some that are not responding, it makes sense to read through this paper and decide for yourself about recommending it. Or, alternatively, collaborate with their primary on the matter. 

That’s it for this week. I’m outties, Hope you enjoyed the show. I humbly ask you, if you know a colleague that would enjoy this material every week, please share the show with them. There’s only one way we make a difference in the chiropractic profession and that is through your help. 

Thanks in advance!

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!


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. 


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

  • Boff TA, P. F., Ben AJ, Bosmans J, (2019). “Effectiveness of Spinal Manipulation and Myofascial Release Compared With Spinal Manipulation Alone on Health-Related Outcomes in Individuals With Non-Specific Low Back Pain: Randomized Controlled Trial.” Pysiotherapy 107: 71-80.
  • Ghorbani Z, T. M., Rafiee P, (2020). “Vitamin D3 might improve headache characteristics and protect against inflammation in migraine: a randomized clinical trial.” Neuro Sciences.

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