adverse events

Flavored Vape Issues & Adverse Events From Cervical Spinal Manipulation

CF 335: Flavored Vape Issues & Adverse Events From Cervical Spinal Manipulation Today we’re going to talk about Flavored Vape Issues & Adverse Events From Cervical Spinal Manipulation 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 giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  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, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com 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 resource for you and is 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. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #334 Now if you missed last week’s episode, we talked about Colo-Rectal Cancer Recognition & Less Gabapentin With Chiropractic.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Still slower this week. Making some tough decisions that maybe I’ll feel more comfortable getting into sometime in the future after it all shakes out. I’ve actually had a few things boiling under the surface that will all be shaking out in the next few months.  One is a staffing issue that we may talk about down the road. But not at this time.  One I mentioned last week. We are trying to move forward with an investment group out of Houston that has proposed purchasing 60% of my practice, taking over the billing, collections, and HR, helping at PT, helping at an associate, and helping us grow the clinic beyond what I’ve been able to grow it in its current state.

Helping me move more and more toward exiting day to day patient care and more into admin work while making more money overall. This cannot happen fast enough if they come with the right offer.  Another is signing on with a legal group and putting my Forensics Diplomate to work finally. I was referrred to and engaged by a large legal group offering counter affidavits and medicolegal work.

Have the Forensics Diplomate and the Neuromusculoskeletal Medicine Diplomate, not to mention certfication in Biomechanics and Traumatology, puts me in a good position to be able to make good money outside of patient care. Which makes it easier to consider sellign 60% of what I’ve built over the years. If the investment group’s projections are fulfilled, I’ll make more money than I’ve ever made next year anyway. But, if not, I will still have the medicolegal work, the Airbnbs, and the Voiceover work.

I will always make money regardless. Even if everything with the clinic buyout and aftermath bluew and and it all went belly up – which will not happen- but assuming it could happen, I can move to Dallas and start over with little to zero issues. 

I’ll always make money and be OK. That’s who I am. That’s who a whole bunch of the people that listen to my podcast are as well. So most of you know exactly where I’m coming from. Big moves are easier when you have that faith and that confidence in your ability to always provide.  Another is being forced to file a grievance on a large law group here in Texas. I’ve been doing PI work since 2007 and have never had to do that before. I’ve thought about doing it several times as you can imagine. There are some amazing attorneys and, as most of you know, there are some miserable SOBs otu there that don’t deserve a law license. 

This firm wormed their way into the state association and I tried to be a good association leader and use them as much as I could. Well, now they owe me $27k and have refused to pay after years of haggling with them. The patients got paid as far as I can tell. But nothing to us. They claim they sent us the checks and they were deposited. That’s not true. We balance out every check that comes in and somehow all 7 of these cases…..we somehow messed up. Nah, dawg…..nope.

Plus, we contacted out bank manager and they investigated and confirmed we never got any funds from them on the cases.  So, I told them it was going to happen and I tried and tried to get them to settle but they refused. So I had to file a grievance with the state bar. We’ll see how that goes. Fun times right there but I’ve had it with sorry PI attorneys over the years and they’re not getting away with this one. 

When I say not much is going on this week….sometimes that’s true. These larger things typically live in the background and they’re just constants to my life that I don’t necessarily have on my radar every day.  Sometimes they’re much more in focus for me depending on where each of them lies in the process of resolution. The staffing one is front and center this week, we sent off P&Ls to the investment firm last week, I engaged with the legal group last week, and the Bar complaint had an extension filed out into July just last week so they’re all kind of front and center this week.  There you have it. Welcome to my life. Time to treat some patients so let’s get to it

 

Item #1 The first one this week is called, “Flavored Vapes Might Expose Users to Hundreds of Dangerous Byproducts” by Emily Harris and published in JAMA Network on June 7, 2024, and OMG that is H-O-T! Remember, the citations can be found at chiropracticforward.com under this episode. 

doi:10.1001/jama.2024.10326

https://jamanetwork.com/journals/jama/fullarticle/2819956?guestAccessKey=749c8b24-8407-42dc-8d29-754707b6f8ed&utm_source=silverchair&utm_medium=email&utm_campaign=jama_network&utm_content=network_highlights&utm_term=061624&adv=000003189471

This is an article that is in reference to a research paper that is linked at this point in the show notes if you want to go and see it.  https://www.nature.com/articles/s41598-024-59619-x The reason I’m not just going through this paper and sticking to this JAMA summary is that….bruh…..it’s a workout for the brain. It’s a deep dive into pyrolysis, organic chemistry, and cold sweats and nightmares from my college days. Things I prefer to not re-live.  God blessed us all with people that love that stuff, understand it, and can use it to benefit us.

But we don’t have to get in the weeds on it. We’ll just get straight to the info.  “The liquid in flavored e-cigarettes likely produces an array of harmful chemicals when heated, as occurs during vaping, a recent study in Scientific Reports found. Again, that is linked above in the show notes. The researchers used artificial intelligence to predict what would happen when 180 substances known to be present in flavored e-cigarettes are exposed to high temperatures. According to their findings, the representative chemicals would transform into 127 acutely toxic products, 153 compounds that are health hazards, and 225 chemicals categorized as irritants based on the Globally Harmonized System classifications.

Long-term exposure to chemicals in e-cigarettes “makes it plausible that we are standing at the starting line of a new wave of chronic diseases that will only emerge in 15 to 20 years from now,” the researchers wrote, noting that the results suggest the number of compounds in e-liquids should be limited.” 127 acutely toxic product and 153 compounds that are health hazards. And I wonder how many of these people go out there and post about the harms of the covid vaccine and all of that stuff right before they hop into their car and vape some strawberry delight? 

 

Item #2

The last one this week is called, “Adverse Events After Cervical Spinal Manipulation – A Systematic Review and Meta-Analysis of Randomized Clinical Trials” by Pankrath et al and published in Pain Physician Journal dated May/June 2024 and that’s some hot damn, smooth like candy. 

https://www.painphysicianjournal.com/linkout?issn&vol=27&page=185&fbclid=IwZXh0bgNhZW0CMTEAAR3cd0i48Y25pF-5JQbXRtMIkg98so7Bg0BIBSKhR8zAVkTGMwNV0vBYQeI_aem_AU0JsgqrIkg6RHuBfM6nq6WJzrB96CUoo-DwiTYJC8n74dbmOyFNL3SUczMkQAEygR_XJRezjaPITCBKeYB8p2zP

Why They Did It

Cervical manipulations are widely used by physiotherapists, chiropractors, osteopaths, and medical doctors for musculoskeletal dysfunctions like neck pain and cervicogenic headache. First of all…..show me these MDs that are using SMT, please? The use of cervical manipulation remains controversial since it is often considered to pose a risk for not only benign adverse events (AEs), such as aggravation of pain or muscle soreness, but also severe AEs such as strokes in the vertebrobasilar or carotid artery following dissections. 

Studies finding an association between cervical manipulation and serious AEs such as artery dissections are mainly case-control studies or case reports.  These study designs are not appropriate for investigating incidences and therefore do not imply causal relationships. Randomized controlled trials (RCTs) are considered the gold standard study designs for assessing the unconfounded effects of benefits and harms, such as AEs, associated with therapies.  Due to the unclear risk level of AEs associated with high-velocity, low-amplitude (HVLA) cervical manipulation, the aim of this study was to extract available information from RCTs and thereby synthesize the comparative risk of AEs following cervical manipulation to that of various control interventions. 

How They Did It The project was a systematic review and meta-analysis. A systematic literature search was conducted in the PubMed and Cochrane databases. This search included RCTs in which cervical HVLA manipulations were applied and adverse events were reported.  Two independent reviewers performed the study selection, the methodological quality assessment, and the GRADE approach.  Incidence rate ratios (IRR) were calculated.  The study quality was assessed by using the risk of bias 2 tool, and the certainty of evidence was determined by using the GRADE approach.

What They Found Fourteen articles were included in the systematic review and meta-analysis.  The pooled Incidence rate ratios indicates no statistically significant differences between the manipulation and control groups.  All the reported adverse events were classified as mild, and none of the events reported were serious or moderate.

Wrap It Up In summary, HVLA manipulation does not impose an increased risk of mild or moderate AEs compared to various control interventions.  However, these results must be interpreted with caution, since RCTs are not appropriate for detecting the rare serious AEs.  In addition, future RCTs should follow a standardized protocol for reporting AEs in clinical trials. 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 chiropracticforward.com.     

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 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. Website https://www.chiropracticforward.com Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter https://twitter.com/Chiro_Forward YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ 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          

Spinal Manipulative Therapy Adverse Events & SMT With Lumbar Herniation

CF 270: Spinal Manipulative Therapy Adverse Events & SMT With Lumbar Herniation

 

Today we’re going to talk about Spinal Manipulative Therapy Adverse Events & SMT With Lumbar Herniation

 

But first, heres that sweet sweet bumper music

 

 

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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  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 creekstonecare@gmail.com   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 270   Now if you missed last week’s episode , we talked about Children, Activity, and Depression and Axially Loaded MRIs. Make sure you don’t miss that info. Keep up with the class.  

On the personal end of things…..

Isn’t it weird?  You have one group of staff for an amount of time, they all leave, then you are forced to replace them all at once basically…..then you get so busy that your cup runneth over?   For the last 6 months I’ve been running on maybe 30-35 appointments on a Friday and 130 for the whole week. Which is abysmal for me. I have a large machine to keep running and those numbers are just barely enough.   Now, we have 52 on my schedule today, which is a Monday as I type. I’ve got 153 for the week but I’m typing at 10am on Monday morning so none of Monday’s patients have been set up for Wednesday or Friday appointments. We ended up last week at 175 appointments.  

The point is not to brag but to demonstrate. You can do everything you can think of up to and including banging your head against the wall…and get nowhere if you have a staff that is not fully supporting the mission of not only getting patients better but ALSO growing your clinic.   You can meet with them, you can encourage them, you can show them the way to bonuses and extra pay, you can treat them like family, and all of the other stuff we do for our teams.   But if they’re not growth minded hustlers, they work against you. And I use hustlers in a complimentary context. A go-getter. Someone with drive. Someone that gets it and has some hustle.  

That’s a hustler to me.  

Don’t get me wrong here. Except for one of them, I absolutely love those girls. I would still do anything for them. No sweeter and no more caring people ever existed. You can have the most loving and caring people on the planet in place and still not be growth minded. The best people on the planet can still fall into ruts and get stuck in the daily grind.   My old team fell into bad habits that did not support growth. They were all besties. They all quit at the same time and we were forced to start completely over almost from scratch. And what seemed like a complete and utter disaster has become one of the greatest comeback stories of my career.  

We’ve done some other things as well. We started with a social media company. I’ve never done that before. We hired Darcy Sullivan with Propel for our website SEO to get that back up to snuff. We know Google is the biggest driver of new patients so it makes sense to spend the money to make sure it’s on par.  

But the biggest game changer has been our new staff. Hands down.   I tell you this for one reason only. If you’re down, here’s what you do and probably the order you should do it in:

  1. Take a long, hard, and very honest look at yourself and your habits. Are you doing the things you need to be doing to grow and to be successful? Are you paying attention to customer service and putting that #1? Are you properly training your staff and properly motivating them? It starts at the top so make sure you have a tight ship before you go looking anywhere else.
  2. Look at your marketing. Have you slacked on your internal and external marketing? If so, get those gaps filled.
  3. Website SEO – make sure it’s where it should be
  4. Pay very close attention to your staff. Their habits between patients. Their interactions with patients. The conversations they have with your patients on the way to therapy or rehab. Start phasing out the ones that do not fully support your mission and your clinic’s growth.

  That’s the advice you’re getting this week from your Ol’ Uncle Jeffro. Hopefully I dropped some good solid knowledge nuggets on some of you.   Take it or leave it but that’s the way I see it at the moment and it’s based on the school of hard knocks over the last 6 months. And, by the way and as a side note, isn’t it interesting that at 50 years old and in practice 25 years, we still learn lessons like this? Damnit.   Alright, here we go with this week’s research.      

Item #1  

The first one today is called, “A retrospective analysis of the incidence of severe adverse events among recipients of chiropractic spinal manipulative therapy” by Eric Chun-Pu Chu and published in Scientific Reports on 23 January 2023. Dayum. That’s hot.     Why They Did It   This study examined the incidence and severity of adverse events (AEs) of patients receiving chiropractic spinal manipulative therapy (SMT), with the hypothesis that < 1 per 100,000 spinal manipulative therapy sessions results in a severe AE.  

How They Did It  

  • This study adhered to the Open Science Framework. The Ethics Committee of the Chiropractic Doctors Association of Hong Kong approved the study which included a waiver of patient consent.

 

  • All methods were performed in accordance with the relevant guidelines and regulations.

 

  • The current study was a retrospective database analysis of a complaints log including adverse events from January 1, 2017, through August 31, 2022.

    Wrap It Up  

  • This current study, which retrospectively studied a large dataset from integrated chiropractic clinics in Hong Kong, found that severe AEs potentially occurring in relation to SMT were rare, yielding an incidence of 0.21 per 100,000 SMT sessions.

 

  • No AEs were identified that were life-threatening or resulted in death.

 

  • The sample size of 39 AEs across 960,140 SMT sessions in 54,846 patients was insufficient to identify independent predictors of severe AEs.

    Before getting to the next one,   Next thing, go to https://www.tecnobody.com/en/products 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 droprelease.com & 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. droprelease.com and the discount code is HOTSTUFF. Go do it.  

Item #2   Our last one this week is called, “Effects of Lumbar Manipulation Spinal in Patients with Pain Caused by a Lumbar Disc Herniation: A Systematic Review” by Guillermo Cano-Escalera and published in Indian Journal of Physiotherapy and Occupational Therapy on 2023-01-16. Hot potato!   Why They Did It   Herniated discs usually present with pain accompanied with paresthesia and loss of muscle strength, causing limitations in the activities of daily life. Among the therapeutic strategies aimed at obtaining an improvement in the symptomatology, highlights the Osteopathic manipulation.  

How They Did It  

  • 11 computerized databases were consulted.
  • Only randomized controlled clinical trials were included.
  • The tool for assessing the risk of bias was the one proposed by Cochrane.

  What They Found  

  • A total of 3 randomized controlled clinical trials were selected and considered low risk of bias.
  • The results showed an improvement in all the variables measured in the experimental group of osteopathic manipulation.
  • However, the improvement was greater in the study group that underwent surgery.

  Wrap It Up  

  • Lumbar manipulation spinal is an effective technique to improve the symptomatology of pain originating from a herniated lumbar disc.
  • None of the participants had adverse reactions and their outcome improved significantly in the short and long term.

      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 chiropracticforward.com.      

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 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.  

Website https://www.chiropracticforward.com  

Social Media Links https://www.facebook.com/chiropracticforward/  

Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/  

Twitter https://twitter.com/Chiro_Forward  

YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q  

iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2  

Player FM Link https://player.fm/series/2291021  

Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through  

TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/  

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    

Bibliography

  • Cano-Escalera, G. “Effects of Lumbar Manipulation Spinal in Patients with Pain Caused by a Lumbar Disc Herniation: A Systematic Review.” Indian Journal of Physiotherapy & Occupational Therapy Print- (ISSN 0973-5666) and Electronic –(ISSN 0973-5674) 17(1).  
  • Chu, E. C., Trager, R.J., Lee, L.YK (2023). “A retrospective analysis of the incidence of severe adverse events among recipients of chiropractic spinal manipulative therapy.” Sci Rep 13: 1254.