amarillo chiropractor

To Do Lists, Frailty, and Pain & Lost Work Days

CF 192: To-Do Lists, Frailty, and Pain & Lost Work Days

Today we’re going to talk about To-Do Lists, Frailty, and Pain & Lost Workdays

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 an invaluable resource for your patient education and for you. It can save you time in putting talks together or just staying current on research. It’s categorized into sections so that the information is easy to find and it’s written in a way that is easy to understand for practitioners as well as patient. You have to check it out. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go 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 chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #192 Now if you missed last week’s episode, we talked about chiropractic preventing opioids and chiropractic adverse events. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I am starting week three of the medical integration. It’s stressful but it’s exciting too. Every day I’m convinced more and more that we picked the right nurse practitioner. Super smart and excellent with patients.  I’m lying if I act like there’s no anxiety in this deal though. Damn. The money flying out the doors in a direction is almost stunning. With little money coming in on the medical side. Everything has to start at ground zero. That’s a given. Everything has to grow from seed. That’s a given.  The trick is to get to maturity and profitability as quickly as humanly possible. That’s what we’re trying to do.  We’ve been doing social media and are about to do a direct Mail piece as well. We’re trying to get this thing on its feet muy pronto! Switching gears here, how do you stay productive? My means of staying productive is really pretty simple.

I keep a ToDo list and I follow it daily. I have it broken down into two sections. One is a grid. The days of the week are along the top of the grid. What HAS to be accomplished are listed below the day it has to be done. Then, I have a simple list outside of the grid. They’re things that need to be done when time allows. Outside of the must-do’s they’re the need to do’s if you will. So, for example, on Mondays, I have to write, record, edit, and upload the podcast. It’s a scramble from start to finish when I also have 40 or more patients to contend with as well. Sometimes I get it all done. Sometimes I just get it written and record it as time allows the rest of the week Don’t forget about email. I get at least 50-100 every day so that’s a job all by itself sometimes. I unsubscribe as often as I can.

I don’t like garbage and minutiae. Can’t have it. No time for that. Tuesdays, it’s my clinic’s blog that has to be written, the corresponding video is recorded, and it’s uploaded to YouTube and Facebook. Again, all accomplished between patients. I get off on Tuesdays around 2 pm. Sometimes that extra afternoon time is used to catch up. Sometimes I go home, work out, do voice-over, and then take classes toward the Forensics Diplomate. As you can see, Monday and Tuesday is go time. Wednesdays I  write and send a mass email to my emailing list with the blog and video I recorded the day before included. Usually, things start to loosen up a bit by the time Wednesday rolls around and I’m able to give attention to the Need To-Dos. Some marketing and all that good stuff. Thursdays I upload the new podcast episode, I post it on Facebook, I send out an email to my list, and lost it in our private Facebook group.

Then marketing, patients, voice-over, another website project I’m working on, and whatever else crosses the desk. Friday, I get off at 1 pm. The afternoon is spent catching up, taking classes, getting in phone calls with people that think they just have to get you on a phone call, or I hit happy hour if I’m lucky. So that’s my week. I don’t get on phone calls. If it can’t be texted or emailed, don’t bother. I don’t talk to salespeople. I don’t entertain anything that takes me off task if I can help it. I can’t. So that’s how I get it all done. The list is my priority and I make sure each item is accomplished. It keeps me on track, it keeps this podcast rolling, it keeps my clinic rolling, and it keeps my brain from exploding. Tel me how you stay on track. I’d love to hear about it. Email me at [email protected]

Item #1

The first one today is called “The Predictability of Frailty Associated with Musculoskeletal Deficits: A Longitudinal Study” by Tembo et. al. (Tembo 2021) and published in Calcified Tissue Interrnational……which is as niche-y as niche can be and it was published on May 20 of 2021. Good Lawd….the heat. 

Why They Did It

They wanted to investigate and quantify the predictability of frailty associated with musculoskeletal parameters. 

How They Did It

It was a longitudinal study Involved 287 men over 50 years old Baseline musculoskeletal measures included  femoral neck bone mineral density appendicular lean mass index whole-body fat mass index lower limb strength Frailty at the 15 year follow-up was defined as > or = to 3 of the following 1. Untintentional weight loss 2. Weakness 3. Low physical activity 4. Exhaustion 5. Slowness

What They Found

  • 48 men were frail. That’s 16.7%
  • Musculoskeletal models were better predictors of frailty
  • Musculoskeletal parameters improved the predictability model as measured by AUROC for frailty after 15 years

Wrap It Up In general, muscle models performed better compared to bone models. Musculoskeletal parameters improved the predictability of frailty of the referent model that included lifestyle factors. Muscle deficits accounted for a greater proportion of the risk for frailty than did bone deficits. For getting musculoskeletal health could be a possible avenue of intervention in regards to frailty.

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Item #2

This one is called “Guideline adherence and lost workdays for acute low back pain in the California workers’ compensation system” by Gaspar et. al. (Gaspar FW 2021) and published in PLoS ONE on June 17, of 2021 and that’s stuh, stuh, stuh, steamy people. 

Why They Did It

The authors wanted to quantify the influence of adherence to guideline-recommended interventions in the first week of treatment for an initial low back pain (LBP) injury on lost workdays.

How They Did It

  • It was a retrospective cohort of California’s workers’ compensation claims data from May 2009 to May 2018
  • 41 diagnostic and treatment interventions were abstracted from the medical claims for workers with acute LBP injuries and compared with guideline recommendations.
  • Lost workdays within 1-year post-injury were compared by guideline adherence using quantile regressions.
  • Of the 59,656 workers who met the study inclusion criteria, 66.1% were male and the average (SD) age was 41 (12) years

What They Found

  • The median number (IQR) of lost workdays was 27 (6–146) days. 
  • In the first week of treatment, 14.2% of workers received only recommended interventions, 14.6% received only non-recommended interventions, and 51.1% received both recommended and non-recommended interventions
  • Opioid prescriptions fell 86% from 2009 to 2018
  • Workers who received only guideline-recommended interventions experienced significantly fewer lost workdays (11.5 days; 95% CI: -13.9, -9.1), a 29.3% reduction, than workers who received only non-recommended interventions
  • The percentage of workers receiving only recommended interventions increased from 10.3% to 18.2% over the 9 years.

Wrap It Up

When workers received guideline-recommended interventions, they typically returned to work in fewer days. The majority of workers received at least one non-recommended intervention, demonstrating the need for adherence to guideline recommendations. Fewer lost workdays and improved quality care are outcomes that strongly benefit injured workers.

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 so 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 – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography Gaspar FW, T. M., Wizner K, Hegmann K, (2021). “Guideline adherence and lost workdays for acute low back pain in the California workers’ compensation system.” PLoS One 16(6).   Tembo, M. C., Mohebbi, M., Holloway-Kew, K.L, (2021). “The Predictability of Frailty Associated with Musculoskeletal Deficits: A Longitudinal Study.” Calcified Tissue Int.  

 

Western Diet Hurts and Acupuncture

 CF 186: Western Diet Hurts and Acupuncture Today we’re going to talk about new research based on chronic pain and our regular Western diet. Then we discuss  But first, here’s 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 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 chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #186 Now if you missed last week’s episode , we talked about high impact chronic pain and we talked about newer research on the use of cannabinoids in adolescence. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I’m feeling pretty good today, folks. I’m feeling pretty optimistic. If I had known what a process building a medical clinic truly is, I may have thought it through just a little bit more than I did. There really is a solid reason more chiropractors don’t take the steps to do it. And that’s because it isn’t easy.  Attorneys, medical directors, hiring the nurse pracs, setting up training, getting the malpractice in place, getting the DEA number of the medical director to have your address on it so your NP can order the things they need, getting your NP credentialed, getting the entities created correctly by the CPAs……it’s a process for damn sure. 

I remember when I started this path, my good buddy and consultant on it, Dr. Tyce Hergert in Southlake, TX, he told me get your seatbelt on because the majority of the work is in the first 90 days. I feel like it’s starting to loosen up a bit and the clouds are clearing on this integration deal. Which is exciting. Because then you can go from wading through the paperwork and minutiae and start focusing on their training and growing the word of mouth and actually start working on the business. That’s where my skill level lies.  I’m not 100% out of the initial struggle to get it set up and off the ground but I’m getting toward the rear end of it and that’s encouraging. For instance, my morning this morning was setting up an account with a medical supplies company and getting started with my first order of IV equipment, cotton swabs, medipore tape, and things of that nature.  Right…..I know…..ugh.

But it’ll be worth it eventually. At least it damn sure better be! Beyond that, last week was better as far as clinic numbers. Moving in the right direction. I believe as a solo practitioner I had about 167. Still not pre-COVID numbers but not awful. I can deal with stuff mentally when I know it’s moving the right direction. It’s when it’s staying slim and there’s no longer rhyme or reason for it that makes me lose my mind. 

So, the mind is intact today and I’m looking forward. Onward and upward today.  Still no emails from any of you on what you’ve done to help the rest of you get your patients back. So, any help and advice from the think tank here would be good for the rest of the crew. Share. Give. It’ good for you. 

Item #1

This first one his an article that appeared in the Seattle Times called “Study finds correlation between high-fat Western diet and pain” by Theresa Braine of the New York Daily News (Braine 2021). It was published on June 24, 2021 and it’s hotter than hot stuff! And on a side note, You’d be in a hell of an awkward position if you last name was Braine but you were an idiot wouldn’t you? Think about that a minute. Your name is brain but you’re basically walking around bumping into walls…..people snickering behind your back…..Brain….right, right.  Anyway, that’s a little peak into my brain for you.

Anyway…since it’s an article, as always I just basically summarize and hit the high spots. 

  • They say the Western diet is associate with many ills and now chronic pain might be added to the list. 
  • A new study looks at the potential for omega-6 fats’ influence on neuropathic pain in people with diabetes and other conditions.
  • Researchers at the University of Texas Health Science Center at San Antonio studied the effects of omega-6 fatty acids themselves by measuring the role of these dietary lipids in pain conditions and found that the substances themselves seem to cause pain and inflammation.
  • Diabetes, autoimmune disorders and cardiovascular diseases are known to be affected by nutritional choices, the researchers said. But excessive consumption of omega-6 fats, which are found largely in commonly consumed processed foods, had not been studied in terms of the acids themselves and their role specifically in pain.
  • They studied polyunsaturated fatty acids in both mice and humans.
  • The five-year study was published in the June edition of the journal Nature Metabolism.
  • Omega-6 fats mainly occur in foods with vegetable oils
  • “But Western diets associated with obesity are characterized by much-higher levels of those acids in foods from corn chips to onion rings, than healthy omega-3 fats, which are found in fish and sources like flaxseed and walnuts,” the researchers’ statement said. “Generally, unhealthy foods high in omega-6 fats include processed snacks, fast foods, cakes, and fatty and cured meats, among others.”
  • Reversing those dietary habits and increasing omega-3 fats “greatly reduced these pain conditions,” the researchers found. “Also, the authors demonstrated that skin levels of omega-6 lipids in patients with Type 2 diabetic neuropathic pain were strongly associated with reported pain levels and the need for taking analgesic drugs.”

So, we’re seeing more and more studies like this talking about inflammatory diets, high-fat, and things of that nature. All being related to increased levels of pain. This is something chiropractors can get behind. I can be very honest when I say that the main gap missing in my clinic is weight loss. Diet and nutrition. Things of that nature. As a result, I’m having our nurse practitioner trained in medical weight loss so we can fill that gap and be well-rounded. 

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Item #2

Next up, I’ve been asked to put together a talk based on evidence-based, patient-centered practice and what makes it the future of our profession. The special request was to end the talk with some research-based around acupuncture research. Texas chiropractors continue to go through battles and one of them is against the acupuncturists in the state.  So, with that, I’m going to offer up a couple of papers. I’ve got a bunch of good ones but thought I’d just cover a couple here. The first one is called “Clinical Evidence for Association of Acupuncture and Acupressure With Improved Cancer Pain A Systematic Review and Meta-Analysis” by He et. al. (He Y 2019) and published in JAMA Oncology on December 19, 2019 and it goes a little sumpin’ like this. 

The first thing that jumps out here, especially for those somewhat new to reading through research, is that this is a systematic review and meta-analysis. That is at the top of the research pyramid. For example simple little case studies and animal studies, pilot studies….things of that nature….they live at the bottom, less meaningful or less impactful part of the pyramid. As you climb the pyramid to the more important stuff, you’ll see cohort studies and randomized controlled trials. Then, at the very top, the most meaningful studies are the systematic reviews topped off by the meta-analysis.  What I’m saying is that this paper is good stuff. It’s good information. And it appears in a very respected journal. The Journal of the American Medical Association’s Oncology branch. It’s high level from several aspects.  

Why They Did It

The authors wanted to answer the question, “Is the use of acupuncture and acupressure associated with improved cancer pain management compared with sham intervention and/or analgesic therapy alone?

How They Did It

  • It was a systematic review of 17 randomized clinical trials and meta-analysis of 14 trials in the current English-language and Chinese-language literature
  • Three English-language databases and 4 Chinese-language biomedical databases were searched for RCTs published from database inception through March 31, 2019.
  • Randomized clinical trials that compared acupuncture and acupressure with a sham control, analgesic therapy, or usual care for managing cancer pain were included.
  • The quality of RCTs was appraised with the Cochrane Collaboration risk of bias tool
  • The primary outcome was pain intensity measured by the Brief Pain Inventory, Numerical Rating Scale, Visual Analog Scale, or Verbal Rating Scale.

What They Found

A significant association was found between real (compared with sham) acupuncture and reduced pain, and acupuncture combined with analgesic therapy was associated with decreased analgesic use. However, heterogeneity lowered the level of certainty of the evidence.

Wrap It Up

This study found a moderate level of evidence that acupuncture and/or acupressure was significantly associated with lower pain intensity in patients with cancer compared with a sham control, which suggests a potential for a combination of acupuncture and acupressure to help reduce opioid doses in patients with cancer.

Item #3

This last one is called “Acupuncture for neck disorders (Review for The Cochrane Collaboration)” by Trinh et. al. (Trinh K 2016) and it can be found in the Cochrane Library published in May of 2016 so it’s about 5 years old at this point. 

Why They Did It

  • Acupuncture has been used as an alternative to more conventional treatment for musculoskeletal pain. This review summarises the most current scientific evidence on the effectiveness of acupuncture for acute, subacute and chronic neck pain.
  • To determine the effects of acupuncture for adults with neck pain, with focus on pain relief, disability or functional measures, patient satisfaction and global perceived effect.

How They Did It

  • They searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Manual, Alternative and Natural Therapy Index System (MANTIS), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Index to Chiropractic Literature (ICL) from their beginning to August 2015
  • They searched reference lists, two trial registers and the acupuncture database Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS) in China to 2005.
  • We included published trials that used random assignment to intervention groups, in full text or abstract form. We excluded quasi-randomized controlled trials 
  • Of the 27 included studies, three represented individuals with whiplash‐associated disorders (WADs) ranging from acute to chronic (205 participants), five explored chronic myofascial neck pain (186 participants), five chronic pain due to arthritic changes (542 participants), six chronic non‐specific neck pain (4011 participants), two neck pain with radicular signs (43 participants) and six subacute or chronic mechanical neck pain (5111 participants). So there was a big mix of conditions represented with a solid sample size when you add them all up. 

What They Found

  • For mechanical neck pain, we found that acupuncture is beneficial at immediate‐term follow‐up compared with sham acupuncture for pain intensity; at short‐term follow‐up compared with sham or inactive treatment for pain intensity; at short‐term follow‐up compared with sham treatment for disability; and at short‐term follow‐up compared with wait‐list control for pain intensity and neck disability improvement.
  • This effect does not seem sustainable over the long term. Whether subsequent repeated sessions would be successful was not examined by investigators in our primary studies.

Wrap It Up

Moderate‐quality evidence suggests that acupuncture relieves pain better than sham acupuncture, as measured at completion of treatment and at short‐term follow‐up, and that those who received acupuncture report less pain and disability at short‐term follow‐up than those on a wait‐list. Moderate‐quality evidence also indicates that acupuncture is more effective than inactive treatment for relieving pain at short‐term follow‐up. Alright, for those not yet on the acupuncture train, take another look.

The VA here locally are sending veterans to us right now for our acupuncturist to work with them and these old grizzly vets absolutely love it. Yep, that’s anecdotal as hell but I’m telling you, there’s something to it and research seems to be catching up to it.  Patients ask me how it works and I have to be honest……I’m not sure. I have some guesses but it’s a lot like a damn TV. I can’t tell you the exact way a program’s signal gets to my house and shows up when I turn the damn TV on. But I know how to enjoy the results.  Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. 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!

https://www.amazon.com/dp/B096RST3WW

 

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 & disabilities 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

Home

Social Media Links

https://www.facebook.com/chiropracticforward/

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YouTube

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

Bibliography

  • Braine, T. (2021). Study finds correlation between high-fat Western diet and pain. Seattle Times.
  • He Y, G. X., May BH, (2019). “Clinical Evidence for Association of Acupuncture and Acupressure With Improved Cancer Pain: A Systematic Review and Meta-Analysis.” JAMA Oncol 6(2): 271-278.
  • Trinh K, G. N., Irnich D, Cameron ID, Forget M (2016). “Acupuncture for neck disorders. Cochrane Database of Systematic Reviews 2016,.” Cochrane Database of Systematic Reviews 5.

 

Nutrition for Pain, CBT for Pain, TMJ, & 2020 Deaths

 CF 173: Nutrition for Pain, CBT for Pain, TMJ, & 2020 Deaths

Today we’re going to talk a lot about pain. Nutrition for chronic pain, CBT and CFT for chronic pain, we’ll talk about TMJ treatment, and we’ll talk about deaths in 2020. This episode is full of info so let’s dive in. 

But first, here’s that sweet sweet bumper music

 

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 chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #173

Now if you missed last week’s episode , we talked about useless research and we talked about insult vs. inflammation. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I don’t know if I mentioned it or not but I got my book back from Dr. Chris Howson up in the Great State of North Dakota. He spent some time editing it. Dr. Howson is the inventor of the Drop Release tool and is just a super dude on top of being brilliant. If you don’t know about Drop Release, go check it out at https://droprelease.com. It’s pretty cool and something you can use to speed up soft tissue work in your practice. 

Now that we have gone through that process, I am teaching myself the way to self-publish this dude. When there are so many options, it can be daunting. It’s hard to know exactly where to go and how to do it. 

So that is the process I’m undergoing currently. Fortunately, I just noticed a colleague of mine that has recently published a book and it’s #1 on Amazon in its category. I reached out to her and she gave me a path to follow. So down the path I go. 

Still working on the medical integration here at the office. I’ve been having weekly calls with the integration consultant we are using. We are using Dr. Tyce Hergert down in Southlake, TX who has been integrated for 5-6 years at this point. Maybe even longer. He’s been through it for sure. If you are going through integration and need a little guidance, email me at [email protected] and I’ll get you in touch with Dr. Hergert. 

Our attorney and CPA group got together and got it all figured out so we are moving forward with that aspect of it. Now, if we can just get that Nurse Practitioner hired. I made a mistake that could be seen as misleading. On the Indeed ad I placed, I put the wage at $65/hr. What wasn’t in the ad because there wasn’t a place for it, is that we have only about 33 hrs of hands on time per week. We are starting our NP off at around $85-$90k per year. 

I think one of the NPs got PO’d at me because I was absolutely hiring her. No doubt. She was the one. When it came down to it, she asked my the yearly salary. I told her and she said she wouldn’t and couldn’t do it for less than $125k/year. 

Well, damn. Back almost at square one on that end of things. I had made my mind up on her. Not only that, I think she was mad at me. Lol. So, I went and changed it to the yearly salary to make sure I wasn’t being misleading in any way. 

Now, the goal is to start at $85k and have them up to $120k within 3-4 years. But you can’t start something brand new at that level when you have no clue how it’s going to all work out and come together. It’s already a huge risk to start with. Why make any riskier from the get go?

So, that’s where all of that stands for now. Getting the book together, getting the medical entity rolling, and getting busy as hell again. Oh my gosh. It’s going to take a minute to get used to treating the numbers we were treating back before COVID came along. Today, as I found a little window to start typing today, I’ve got 56 on the schedule. That hasn’t happened since December of 2019. Maybe January of 2020. Maybe. 

February 2020 came along and destroyed business. BAM…..30% at least was gone. We went from 185-200 visits per week all the way down to 115 or so. It wasn’t awesome. I’m not going to lie. OK, it was awful actually. We paid the bills but nobody made any money. That’s for damn sure. 

Now, for the last 2-3 weeks, things are beginning to get a little crazy again. Thank goodness. I hope you are experiencing the resurgence I am experiencing. I think deep down, we all know it’s going to be OK but it’s sure refreshing to finally start to feel it and see it. 

Onto the research!

Item #1

The first one today is called “Do Nutritional Factors Interact with Chronic Musculoskeletal Pain? A Systematic Review” by Elma et. al. [1] and published in the Journal of Clinical Medicine in March of 2020 and that’s only a little smoky but still hot enough!

Why They Did It

They say, “Dietary patterns may play an important role in musculoskeletal well-being. However, the link between dietary patterns, the components of patients’ diet, and chronic musculoskeletal pain remains unclear. Therefore, the purpose of this review was to systematically review the literature on the link between dietary patterns, the components of patients’ diet and chronic musculoskeletal pain”

How They Did It

  • (PRISMA) guidelines were used
  • Online databases PubMed, Embase, and Web of Science were used 
  • 20,316 articles screened and only 12 found eligible to be included in this review
  • They consisted of 9 experimental and 3 observational studies

What They Found

  • 7 out of 9 experimental studies showed a pain-relieving effect of dietary changes
  • Protein, fat, and sugar intake were found to be associated with pain intensity and pain threshold

Wrap It Up

In an interesting conclusion, the authors say, “Plant-based diets might have pain relieving effects on chronic musculoskeletal pain. Patients with chronic rheumatoid arthritis pain can show inadequate intake of calcium, folate, zinc, magnesium, and vitamin B6, whilst patients with fibromyalgia can show a lower intake of carbohydrates, proteins, lipids, vitamin A-E-K, folate, selenium, and zinc. Chronic pain severity also shows a positive relation with fat and sugar intake in osteoarthritis, and pain threshold shows a positive association with protein intake in fibromyalgia.”

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Item #2

This second one is called “CBT and CFT for Chronic Pain” by Graham Hadley and Matthew Novitch [2] and published in Current Pain and Headache Reports on April 1, 2021. Dammit stand back, we got a hot one. 

Why They Did It

Chronic pain is a widespread public and physical health crisis, as it is one of the most common reasons adults seek medical care and accounts for the largest medical reason for disability in the USA. 

  • Chronic pain is associated with decreased functional status, opioid dependence and substance abuse disorders, mental health crises, and overall lower perceived quality of life. 
  • Evidence suggests that persistent low back pain (pLBP) is a multidimensional biopsychosocial problem with various contributing factors. Emotional distress, pain-related fear, and protective movement behaviors are all unhelpful lifestyle factors that previously were more likely to go unaddressed when assessing and treating patient discomfort….
  • and as we just covered, diet might play a part in it as well. 
  • Those that are not properly assisted with these psychosocial issues are often unlikely to benefit from treatment in the primary care setting and thus are referred to multidisciplinary pain rehabilitation physicians. 
  • This itself increases healthcare costs, and treatments can be invasive and have risks of their own. 
  • Therefore, less expensive and more accessible management strategies targeting these psychosocial issues should be started to facilitate improvement early. 
  • As a biopsychosocial disorder, chronic pain is influenced by a range of factors including lifestyle, mental health status, familial culture, and socioeconomic status. 
  • Physicians have moved toward multi-modal pain approaches in order to combat this public health dilemma, ranging from medications with several different mechanisms of action, lifestyle changes, procedural pain control, and psychological interventions. 
  • Part of the rehabilitation process now more and more commonly includes cognitive behavioral and cognitive functional therapy. 
  • Cognitive functional therapy (CFT) and cognitive behavioral therapy (CBT) are both multidimensional psychological approaches to combat the mental portion of difficult pain control. 
  • While these therapies are quite different in their approach, they lend to the idea that chronic pain can and should be targeted using coping mechanisms, helping patients understand the pathophysiological process of pain, and altering behavior.
  • CFT differs from CBT functionally, as instead of improving managing/coping mechanisms of pain control from a solely mental approach, CFT directly points out maladaptive behaviors and actively challenges the patient to change them in a cognitively integrated, progressive overloading functional manner
  • With a robust set of data, one can conclude that CBT and CFT are exceptional therapeutic methods in improving chronic pain or the overall well-being of our patients. 

Item #3

This one is called “The Leading Causes of Death in the US for 2020” by Ahmad et. al. [3] and published in JAMA on March 31, 2021 and that’s definitely some hot stuff right there. 

This is more of an article rather than research and it won’t take us long to hit the high points here. 

  • Provisional estimates indicate a 17.7% increase in the number of deaths in 2020 (the increase in the age-adjusted rate was 15.9%) compared with 2019, with increases in many leading causes of death.1 The provisional leading cause-of-death rankings for 2020 indicate that COVID-19 was the third leading cause of death in the US behind heart disease and cancer
  • Cause-of-death data are based on the underlying cause of death, which is the disease or condition responsible for initiating the chain of events leading to death.
  • The provisional number of deaths occurring in the US among US residents in 2020 was 3 358 814, an increase of 503 976 (17.7%) from 2019
  • COVID-19 was the third leading cause of death in 2020, with an estimated 345 323 deaths, and was largely responsible for the substantial increase in total deaths from 2019 to 2020.
  • Substantial increases from 2019 to 2020 also occurred for several other leading causes. Heart disease deaths increased by 4.8%, the largest increase in heart disease deaths since 2012

I know……I know….car wrecks were reported as COVID and all that. I know….you do you boo. 

Item #4

This last one is called “Manual therapy for temporomandibular disorders: A review of the literature” by Kalam ir et. al. [4] and published in Journal of Bodywork and Movement Therapies in January of 2007. Definitely not hot. 

Why They Did It

The contemporary biopsychosocial health paradigm emphasizes a reversible and conservative approach to chronic pain management. Manual therapy for temporomandibular disorders (TMDs) claims to fulfil these criteria. An assessment of the utilization and efficacy of manual therapy for this condition is therefore required. 

How They Did It

  • A review of the literature pertaining to manual therapy for TMDs was undertaken between September and December 2005. Keywords used in the search were: TMD, manual therapy, massage, manipulation, mobilization, adjustment, chiropractic, osteopathy, physiotherapy, exercise.
  • A four member reviewer panel identified eight (n=8) randomized controlled trials of sufficiently reliable power to be suitable for inclusion in the review, of which only three included manipulative treatment of the temporomandibular joint. 

Wrap It Up

The results of manual therapy trials for this condition suggest that manual therapy is a viable and useful approach in the management of TMD. Manual therapy has also been shown to be more cost effective and less prone to side effects than dental treatment. 

Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.

Let’s get to the message. Same as it is every week. 

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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!

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

 

Bibliography

1. Elma O, Y.S., Deliens T, Coppieters I,, Do Nutritional Factors Interact with Chronic Musculoskeletal Pain? A Systematic Review. J Clin Med, 2020. 9(3): p. 702.

2. Hadley G, N.M., CBT and CFT for Chronic Pain. Current Pain Headache Reports, 2021. 25(35).

3. Ahmad F, A.R., The Leading Cause of Death in the US for 2020. JAMA, 2021.

4. Kalamir A, P.H., Vitiello A,, Manual therapy for temporomandibular disorders: A review of the literature. J Bodyw Mov Ther, 2007. 11(1): p. 84-90.

Forward ’19, Decompression Research, Curveball or Pitch Count?

CF 094: Forward ’19, Decompression Research, Curveball or Pitch Count?

Today we’re going to talk about my Forward ’19 experience, we’ll talk about decompression research, and we’ll cover some new research on whether it’s the curveball or the pitch count that injures young players on the baseball diamond. 

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 and accessible while we make you and your patients better all the way around. Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have rattled and rolled into Episode #94

Now if you missed last week’s episode on the bigger the disc the better and what early improvement in treatment tells you, make sure you don’t miss that info. Every episode offers some good take-aways so make sure you’re up to date and not falling behind the rest. 

I like to look at this podcast as an ongoing, fun way of learning and making each other just a little bit better every week so don’t just hop in for one episode. Stack them up one after another and, before you know it, you’re going to start retaining the info and you’re going to start recalling something we talked about down the road when you’re interacting with a patient and they ask you a question. 

You’ll see. Even though I’m the host, it happens to me. Someone will ask me a question and I’ll remember an episode we did on that topic and BOOM!! Pow!! There it is, the answer comes to me. Pretty cool. 

Forward ’19 – For you newbies here you’re probably wondering what the hell Forward ’19 is. A quick rundown is that it is a yearly seminar/conference that was born from an online Facebook group called the Forward Thinking Chiropractic Alliance aka FTCA. They have a website as well. 

The group is very much evidence-based or evidence-informed. Whichever is your preferred verbiage. The group has about 7800 or so doctors in it and they are interacting on a daily basis mostly to try and make each other better. Overall, it’s a good group. I’ve heard people griping because they see griping here and there in the group but, in general, it’s a very positive, very smart, and very helpful group. I encourage you joining it if you’re a doctor or student. 

Anyway, Forward 19 – What an event. The group puts on several events through the year but this is the key event put on by the FTCA every year. This is year #2. It was in St Louis at the campus of Logan Chiropractic College.

First thing is, holy smokes what a campus man. I bet they pay a fortune just to mow the grass. Just wow. The landscaping, the tower in the middle, and Purcer Center where it was all held. Just gorgeous. Having gone to Parker, that was the Chiro campus I’d been on and don’t get me wrong, Parker is impressive. I’d say Logan most definitely is as well. Kudos.

Speakers:

Gray Cook SFMA – SFMA stands for Selective Functional Movement Assessment – I have to admit that this was my first exposure to Gray Cook but it won’t be my last. I had heard of SFMA but was not all that familiar with it. I really enjoyed his talk and some of the concepts he puts forward. I can’t wait until I get through with my Diplomate program – hopefully in November – so that I can dive into Gray Cook’s stuff and just keep building on the knowledge pile. 

Greg Kawchuk – He is the Research Chair for the World Federation of Chiropractic. 

So, outside of the FTCA, I had little knowledge of Greg Kawchuk. But, Greg gave a speech at the World Federation of Chiropractic last year in Berlin that got some people a little fussy and some people elated. It definitely got the attention of chiropractors around the world to say the least. He gave the same speech last weekend in St. Louis and it had people on the edge of their seats. 

Backing up a bit, Greg is a dynamic speaker. One of the more humorous and engaging speakers I’ve seen in maybe forever. He’s immediately like-able and that make for a good speech from the top. The talk was all about putting the ACT back in Chiropractic. A play on the way the philosophy guys use the TOR and the TIC garbage. You know….the principled vs. un-principled hoohah. 

I happened to think that evidence-informed docs are the principled ones and if you need more info on why I think that, just go back about 3-4 episodes and listen to my podcast on the topic of Closing Patients. A principled, ethical person doesn’t carry themselves in that manner and the philosophy folks are much more likely to be out there closing patients than offering responsible treatment plans that are based on commonly accepted guidelines. In my experience at least. It’s always made me a bit hot under the collar when someone asks whether another chiropractor is principled or not. 

Makes me want to principle them in the forehead…..with a mighty slap. 

Anyway, putting the ACT back in chiropractic: he asked what are we doing right now? What are you doing right now to move the needle forward? To bring chiropractic into this current century we are in? He suggests we do a lot of sciencing and consume at least 1 science per day and I agree with him. 

Hell, here at the Chiropractic Forward podcast, we distribute about 3-4 sciences per episode so we almost got you covered for the whole week if you’re a regular listener. 

I think the part of his presentation that some took exception to was the part where he feels the evidence group may, at some point, consider a divorce from the philosophy geared group. He said it may not be an official divorce but could be very much a divorce in the way we act, carry ourselves, communicate with our patients, and things of that nature. 

He says, at the end of the day, it could be something similar to….. we went out for a pack of smokes and…..just never came back. 

Now, as you sit in your car or truck or your office hearing me say that, you can take that all in as you will. I’m going to tell you that, as a doctor that considers himself very much on the research end of things and very little on the philosophy end of it, and as a doctor that does everything he can to be ethical, honest, and all that…..it is so hard to sit and hear patients talking to me about being forced to sign of on a contract for thousands of dollars for a year long schedule for umpteen visits based on a curve correction that research suggests isn’t that big of a deal. 

It’s hard to hear about the knuckleheads in Oakland claiming they can reverse degenerative spurring by seeing someone 3x/per day for 3 weeks. It’s hard to watch Mr. man bun top not from the coffee house talking about fixing kids with no research to back his claims. 

It’s hard to hear about chiropractors scaring the crap out of patients with x-rays and convincing them that they are somehow damaged and in a dire circumstance unless they undergo 60 visits and another 3 sets of x-rays….

These are just a few of the stories. There are so so so many of them and at some point, I just don’t want to be associated with that anymore. At all. If that’s not understandable and that makes no sense to you and that makes you mad at me, well….I’d say I’m sorry but I’m just….I’m just not. 

Even though I don’t smoke in the physical meaning of the word, I think I went out for a pack of smokes and never came back about 15 years ago. 

Christine Goertz – If you are a regular listener of our podcast, you know Dr. Goertz has been on our show before and you know I’m a nerdy fan of her and her contribution to our profession. Any chance to listen to Dr. Goertz is a chance that should be seized upon. She’s a giant in our industry. 

Annie O’Connor – World Of Hurt – OK, I’m admitting something again. I wasn’t familiar with Annie O’Connor. Annie is fun and vivacious and really another very dynamic speaker but she is full of knowledge nuggets. The kind that you can really put to use. She spoke on how words can harm so how key communication can be for some patients. She talked about yellow flags and she talked about classifying pain patients so that we can help them with more efficiency. You can believe that World Of Hurt is on my reading list after Forward ’19. 

Greg Friedman – documentation  documentation. Greg is Greg. Smart, laid back, fun, and just likable immediately. It was great to get to meet him in person and share a good discussion prior to his documentation class. He’s full of excellent information and not just on documentation so, if you get a chance and you need the hours, search out a class. He’s flying all over the nation every weekend. 

Mike Massey – he shared teaching duties with Greg on the documentation class. He told me he’s a listener of our podcast and he’s an active member of the FTCA so I’ve been a fan of his for a while now. It’s always a cool deal to put the online world into a 3D context and it was sure nice to meet Dr. Massey. Hopefully next time I’ll get to sit and speak a while with him. I think our personalities probably match up pretty closely from what I can tell. 

Some of the others I got to see and speak with are Brandon Steele

Kevin Christie

Jon Morrison

Robert Jones, President Of The ACA was there the whole weekend sitting in on the classes himself. What a super guy.

Budweiser tour

Meeting people

Kris Anderson

Chris Howson

Rob Pape

Bobby Maybee

Bobby Mozafari

Mike Massey

Greg Friedman

Dale Thompson

Kevin Christie

Anne Maurer

My biggest regret is that I didn’t get any real one on one time with very many of these folks but That’s OK. All’s well.

If I didn’t come up and speak with you but you saw me there, please don’t take it personally, believe it or not, I have a bit of a shy streak. Once I’ve had a conversation with someone, it’s all good. But, if I don’t know you yet….ugh….I have a podcast. I was a traveling musicians for 7 years. Why would a guy like me be shy at all? Yeah I don’t know. I’m in control in those other situations. Maybe it’s when I’m not in control or I’m a newbie….who knows?

Anyway, if you ever see me at an event, regardless of the event, please come say hi. I’d love to meet you.

We are about to get to our two articles. One is new research on traction/decompression information for low back discs and the other is on young baseball pitchers and how the curveball isn’t the culprit. 

First though, we have backed off and rather than having two show sponsors, we have one and it’s a company you all know how much I love. 

If you’re a regular listener of our podcast, you know I used it since about June of 2018. Let me tell you about it. 

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, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

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

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

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Item #1

The first article today is called “The effect of mechanical traction on low back pain in patients with herniated intervertebral disks: a systemic review and meta-analysis” by Cheng, et. al(Cheng Y 2019). and published in Clinical Rehabilitation in August 28, 2019. Smoking hot folks. Stand back. Watch your eyebrows!

First thing, recognize in the title there, this is a systematic review and meta-analysis. That’s at the top of the research pyramid. 

Why They Did It

To evaluate the effectiveness of traction in improving low back pain, functional outcome, and disk morphology in patients with herniated intervertebral disks.

How They Did It

  • They did a big time search PubMed, Scopus, Embase, and the Cochrane Library and they did this search from the earliest record all the way up to July 2019. 
  • They included RCTs that involved adult patients with low back pain associated with herniated disc confirmed by MRI or CT
  • RCTs that compared lumbar traction to sham or no traction
  • RCTs that provided quantitative measurements of pain and function before and after intervention. 
  • The initial search came up with 3,015 records which they whittled down to 7 involving 403 patients.

What They Found

Compared to the control group, the patients that had traction showed significantly greater improvements in pain and function in the short term

The differences were not significant enough to support the long-term effects on pain and function, nor the effects on herniated disc size. 

Wrap It Up

Compared with sham or no traction, lumbar traction exhibited significantly more pain reduction and functional improvements in the short term, but not in the long term. There is insufficient evidence to support the effect of lumbar traction on herniated disk size reduction.

Here’s where I’m at on that. I use decompression. I just need to know more about this study. Did they do simple traction? Did they do a cycling pull phase from a pull to a rest phase? How much weight was the pull? How long did they do each treatment and how many treatments did they do?

There’s also patient preference and clinical experience factoring into using decompression.

Reading down through this sucker, it’s just too varied to make any assumptions. The intervention programs differed among the studies from 10 sessions to 60. The treatment protocols varied from 2 weeks to 10 weeks. Some of the studies included had no information on the weight of the pull while a handful went up to 50% of the body weight. Some of the studies used continued traction while others had intermittent traction. Some even used self-suspended, inversion table type traction. 

Are you getting a whiff of what I’m dumping here? 

Out of the 7 studies they included, only 2 measure the disc height and one measured the disc ratio. 

Overall, when you read through the paper, these authors freely admit, this is a tough one but they wanted to start somewhere. They suggest several ways to go forward and say that there are a couple of studies out there that show a trend toward long-term decompression reducing the size of a disc herniation but no longer papers have been done to investigate it. 

It’s anecdotal as hell but I’m going to go ahead and anecdote the hell of you. Right to your face. Or….to your ears as it may be. I’ve been doing decompression for about 7 years and I’ve yet to see anything as effective. Including exercises, McKenzie, all of it. In some cases, it has absolutely amazed me. But, like I said, that is anecdotal but I hope some of these really super smart researchers out there in the profession start to dial down into it and figure it out. Mostly because I know it works. I’ve just seen it too many times. 

Item #2

This last item is called “Effects of a Simulated Game on Upper Extremity Pitching Mechanics and Muscle Activations Among Various Pitch Types in Youth Baseball Pitchers” by Oliver et. al(Oliver G 2019). and was published in Journal of Pediatric Orthopedics in September of 2019. Wait, it’s September of 2019 right now right? Steaming pile of fresh knowledge nuggets, big platter, sizzling. 

Why They Did It

The purpose of this study was to examine differences in pelvis, torso, and upper extremity pitching mechanics and muscle activations between the fastball, change-up, and curveball pitches in youth baseball pitchers following a simulated game.

How They did It

  • 14 youth baseball pitchers with no history of injury were included
  • All major muscles and mechanics were measured
  • The pitchers were instructed to throw with max effort during a simulated game that provided random game situations
  • They were limited to 85 pitches
  • Data from 3 fastballs, curveballs, and change-ups thrown in the first and last innings were selected for analysis

Wrap it up

The principle findings of this study revealed that pitching to the age-restricted pitch count limit did not result in altered pitching mechanics or muscle activations, and no differences occurred between the 3 pitches. These results support previous research that indicate the curveball pitch is no more dangerous for youth than the other pitches commonly thrown. This is supported by the pitcher’s ability to maintain a proper arm slot during all 3 pitches and indicates that they are obtaining the spin on the ball from their grip and not by altering upper extremity mechanics.

So….it is not the curveball it seems but, rather, it’s the pitch count in young pitchers, it’s treating them like professionals when they’re still developing, it’s that they tend to play only one sport aka specialize, and that they need to be treated like developing children and human beings rather than the Dad’s lost glory or a future paycheck for the whole family. 

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If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

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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 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.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

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

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

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

Bibliography

  • Cheng Y, H. C., Lin Y, (2019). “The effect of mechanical traction on low back pain in patients with herniated intervertebral disks: a systemic review and meta-analysis.” Clin Rehabil.
  • Oliver G, P. H., Henning L, (2019). “Effects of a Simulated Game on Upper Extremity Pitching Mechanics and Muscle Activations Among Various Pitch Types in Youth Baseball Pitchers.” J Pediatr Orthop 39(8): 387-393.

Chiropractic Wins Again, Push Ups Say A Lot, Low Iron & The Disc

CF 064: Chiropractic Wins Again, Push Ups Say A Lot, Low Iron & The Disc

Today we’re going to talk about how chiropractic and spinal manipulative therapy win again, we’ll talk about how push ups may tell us more than what you see on the surface, we’ll discuss some new information on low back discs and how they’re affected by low iron, and then we’ll gloss over a paper on physical therapy to toss you some thought nuggets. 

Chiropractic evidence-based products

But first, jsut for my friend and collegue, Dr. Michael Henry down in Austin, here’s that ‘you know you love it’ bumper music. He’s a big fan. 

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 shimmied all 60’s like into Episode #64

Introduction

We’re here to advocate for chiropractic and to give you some awesome information to make your life easier from day-to-day. We’re going to keep you from wasting time in your week and give you confidence in your recommendations and treatments. And I feel confident in guaranteeing that to you if you listen and stick to it here at the Chiropractic Forward Podcast.  

Store

Part of saving you time and effort is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. I noticed an error on the shipping charge. That has been corrected now. 

Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at [email protected] if somehting is out of sorts or isn’t working correctly. 

DACO

Let’s talk a bit about the Diplomate of the Academy of Chiropractic Orthopedists probgram also known as the DACO. I finished up all 50 of the required live hours this weekend down in Austin, TX during the Texas Chiropractic Association’s legislative seminar. 

Not only did I get all of the hours wrapped up but I also got to see a lot of colleagues I have been doing battle along side with for the last 8 years or so. You may or may not know that the Texas Medical Association is particularly aggressive and attacks at will for anything and everything. Which means we have to constantly raise funds to defend the attacks. 

It’s this cute thing we do with each other from year to year. It’s really a special relationship chiropractors have with the TMA. I keep thinking one day they’ll start listening to their own profession and leave us the hell alone but nope. Not so far. Not until they have full and complete control of chiropractic care in Texas. Which is not going to happen. Just so you know.. 

They sued us because 2 docs in texas who were Neuro Diplomates were doing VONT testing. I’d never even heard of VONT until this last time we got sued by TMA. IF you can give me a good reason why a neuro diplomate cannot do VONT testing, I’ll send you a candy bar or some chicklets or something like that. 

It’s enough to make a guy crazy. I got to meet a lot of bright new people ready to help the TCA fight and overcome. Andrea Ohmann recently moved to Texas from Minnesota. She is in a hospital setting if I understood correctly. She’s a bright star to keep an eye on. I also need to thank Dr. Jamie Marshall for listening to us down in Conroe, TX. I really appreciate it!

I got to see Staff Sergeant Shilo Harris speak. I mentioned him a couple of episodes ago but I have to tell you, this man is a hell of a speaker and he’s in our corner specifically. He gives chiropractic care all of the credit for helping him get through all of his injuries and surgeries. He was blown up by an IED in Iraq and has been through absolute hell to get to where he is now and chiropractic was key to getting him there. 

Very emotional and very impactful. I can’t imagine a legislator being confronted by him and his story and not being forced to see it our way. It’s powerful. Thanks to Shilo for eveything he’s doing for this profession. I hope you’ll go to http://shiloharris.com and see what he’s about. 

Beyond that our DACO hours were taught by Jeffrey Miller who is a chiropractor on staff at the University of Missouri medical school. He’s not as sharp as a tack. He’s actually sharper than a tack and told me he’d love to join us on the podcast so I’m going to do us all a favor and get that set up. We also have Dr. Christine Goertz’s episode coming up quickly so keep your eyes peeled for that one too. 

This get on with this deal here. 

Item #1

Our first item here is called “Manipulative Therapies: What Works” and is authored by Dr. Michael Smith, an MD, and his herd of collegues. It was published in American Family Physician on Febraury 15, 2019(Smith M 2019). I got this one from Dr. William Lawson in Austin, TX who is a DABCO and a swell dude on top of that. 

In case you missed it, this herd of authors are medical doctors. They start by saying that manipulative therapies include things like osteopathic manipulative treatment which is the same as chiropractic manipulative treatment. 

They say that, when you compare manipulative therapy to oral analgesics, cervcial manipulation and/or mobilization appears to provide better short-term pain relief and improved funciton in patietns with neck pain. 

They go on to say that manipulative therapy may be as effective as amitriptyline for treating migraine headaches and can reduce the frequency and intesity of pain. 

While there is some evidence showing that manipulative therapy can reduce length of hospital stays for preterm infants, there is ZERO research for some of the other reasons we see chiropractors treating infants. Things like otitis media, colic, allergies, and respiratory conditions. 

That was all in the abstract. That’s the medical world starting to take note. Can you hear it? When do the insurance companies start to take note as well?

THAT’S REALLY when our lives start changing. Oh happy day….I have a dream. A dream where we are no longer pursecuted for being right all the damn time. A dream that chiropractors don’t go around saying crazy crap and making the rest of us look bad. I have a dream people. I’m not going to pretend to be as good of an orator as Martin Luther King Jr. but you get the point. 

You know that the more of these articles that come out, the more they have to start gathering steam. Turn on a light bulb at night in South Texas and see what happens. The bugs start swarming. Turn on this kind of light and you’ll see these articles begin catching more and more attention until we finally have a consensus in the medical field. A consensus that says, “Hell, looks like they’ve been onto something this whole time. We better take another look at it.”

This is an excellent paper. And we need to keep seeing this more and more. Even if they’re talking specifically about osteopathic manipulative therapy, we know that chiropractors do it too and, in fact, chiropractors do almost all of it these days. DO’s have moved almost completely to medicine. We are the ones moving joints. Make no mistake about it. 

Item #2

Pushups…what can they tell us? Well, it appears they can tell us quite a lot from an article in StudyFinds called “Men Who Can Do More Than 40 Push-ups Far Less Likely To Develop Heart Disease.(Finds 2019)”

This article covers a new study that showed that men posessing the ability to perform 40 push-ups in one attempt are much less likely to suffer from heart disease wihtin the next 10 years. 

They showed where middle-aged men who can put in more than 40 in a single try have a 96% less chance of having heart disease when compared to those who could complete no more than 10 push-ups. 

So, it appears, to me…..that it’s time to start doing some push-ups muy pronto. 

Item #3

This one comes to us from the American Journal of Translational Research and is called “Iron defficiency accelerates intervertebral disc degeneration through affectring the stability of DNA polymerase epsilon complex(Zhang C 2015).” 

It was published in November of 2015 and appears to be mostly Chinese researchers. Could be Japanese, Korean, or Vietnamese but the name of the lead author is Chungiang Zhang and whole host of names that appear to be just as difficult to pronounce. 

We will not get deep into the details here because I’m not too proud to admit that the information here goes far above my head in many ways. I’ve said it before, I’m no guru. I’m like Alex Trebec on Jeopardy. He delivers the info but I promise he’s no expert on every question coming across his lips. Lol. 

But, when we stick with the basics, we see that iron serves as an important cofactor of iron-containging proteins that play critical roles in the maintenance of DNA stability and cell cycle progression. They say that disturbed iron homeostasis gives rise to things like cancer and anemia. 

In addition, they say that they found clear correlation between iron deficiency and intervertebral disc degeneration. 

They wrapped up their paper by saying, “In summary, our study suggests that iron deficiency is an important factor in the aggravation of IDD. Proper iron supplementation may be an effective strategy to alleviate the symptoms of patients with intervertebral disc degeneration.”

Item #4

Our last on the list, it has to do with PTs and is called “Minimal physical therapy utilization compared with higher physical therapy utilization for patients with low back pain: a systematic review,” authored by Heidi Ojha and a gaggle of others and published in Physiotherapy Theory and Practice in February 2019(Ojha H 2019).

This was a systematic review to compare the effects of minimal physical therapy utilization (two visits or less) vs. typical physical therapy utilization consisting of 3 or more visits on patient-important outcomes for patients with low back pain. 

They say this research is needed because there is such variation in physical therapy use for those with low back pain. 

Interestingly, they found that, when compared with minimal utilization, higher utilization demonstrated no significant differences on pain, disability, or quality of life at the 1-year follow-up.

Even more interesting was that the conclusion of the paper said the following, “While higher utilization may not result in significant improvements in patient-important outcomes, it may be more cost-effective for patients with chronic or complex LBP conditions when compared to minimal utilization.”

So, what the hell is that? It’s not going to make you any difference to see us a lot but the price point is agreeable so, by all means, we’d like to see you a crap load. Which isn’t as much as a crap ton. By the way. But I think you see what I mean. 

I have noticed so many papers that basically cast a lot of doubt on PT in general while all we seem to find in regards to manipulative therapy are positive reaffirmation of the chiropractic profession. 

It just makes me wonder where the tipping point is to be honest. When does the medical industry start to look at chiropractic as being more effective for these conditions that PT and making those referrals accordingly? I had some insight on a PT private group on Facebook a couple of weeks ago. 

The PTs were piling on a chiropractor’s advertisement techniques. Let’s be fair, the DC was a knucklehead and wasn’t being honest and identifying himself as a chiropractor in his marketing but, for discussion purposes here, that’s beside the point. 

They were bashing not only on that chiropractor but our profession as a whole. I bash on aspects of my profession as well but, where the rubber hits the road, we average better patient outcomes, we are safe, we are effective, and we average higher patient satisfaction. Even if some in our profession would win a county craziness competition. 

Don’t believe me? Go listen to Episode #49 of this podcast where we go over the Parker-Gallup poll. Very interesting episode and there are some valuable marketing nuggets in that one for you as well. Definitely worth the listen. 

Also Episode #26 talks about PTs and DCs. The age old grudge match. Go check them out and see what you think. 

Some in our profession are simply imbeciles. That sounds harsh but for a time after graduating, I held no interest in furthering my education. I wanted to coast. I’d done the hard work, right? I was so smart already after all those years of college. Well, you don’t know what you don’t know. And, I can admit that for a few years there, I was an imbecile. 

They learned enough to pass but that doesn’t make them smart or ethical and that’s sad. But again, when said and done, our profession consistently proves itself and is proven by insurance companies, governments, polls, surveys, and universities. 

From what I’ve seen recently, I can’t say the same for them and I just can’t see where they feel they have some moral high ground or platform to stand on and spout a bunch of denigrating thoughts at us. 

I thought it’d be a good idea once to refer to a PT. I had a car wreck patient and thought they could use PT and at that time, I wasn’t equipped to do much rehab. So onto the PT they went. In two damn weeks, the PT ran up a bill that would have literally taken me 4 months to run up. I was astounded. And, in that two week period, there was little to no improvement for the patient. 

On a separate occasion, I had a disc patient finally settled down and doing great. She was very active and very much into working out. I had her disc settled down to a point that she thought she’d go get PT on top of what I was doing. She did not talk to me about it. She just did it. Her thought process was that it would just be that much better to combine the two. Chiropractic and PT. Honestly, that’s not bad thinking in theory. 

She came back after one visit almost unable to walk or function. We tried and tried to get it to settle back down but she ended up taking herself to a surgeon to get our of pain. Sorry PTs. Quit talking smack and work with us instead of against us.

Ideally, PTs and chiropractors work hand in hand and complement each other. Many offices can and should operate in this manner. In reality though, I see PTs as great for post-operative rehab and rehab after certain types of injury. When it comes to joints and spines in general though, they can’t touch us. They talk bad about us, they steal services from us, they think they have the moral ground on us, but they can’t touch us.

Those of us practicing in an evidence-informed manner anyway. Those not practicing evidence-informed actually continue to provide them with whatever moral ground they believe they have. 

I for one would like to move on from the beginnings and progress our profession much like the MDs have done over the last 150 years. They went from blood-letting, leeches, and labotomies to what they can do now. Yet, there’s still a part of our profession wanting to hold on dearly to our originations of 100+ years ago. 

Chiropractors, let go. Progress. Practice current, in the current day and age. Practice evidence-informed. It’ll help you and it’ll help the profession in general. 

That’s my opinion anyway. Take it or leave it. 

This week, I want you to go forward with

  1. Chiropractic wins and wins and wins again. We made the right decision. We just need to only use our powers for the good. 
  2. Push-ups….let’s get to doing them!
  3. Iron deficiency for disc degeneration is something worth looking at. 
  4. When we are practicing evidence-informed chiropractic care, PTs only wish they could get the results we can get.

Subscribe Button

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.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

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

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

About the Author & Host

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

Bibliography

Finds, S. (2019) “Men Who Can Do More Than 40 Push-Ups Far Less Likely To Develop Heart Disease.” StudyFinds.

Ojha H, M. M., Johnston M, (2019). “Minimal physical therapy utilization compared with higher physical therapy utilization for patients with low back pain: a systematic review.” Physio Theory Practice.

Smith M (2019). “Manipulative Therapies: What Works.” AMerican Family Physician 99(4): 248-252.

Zhang C (2015). “Iron deficiency accelerates intervertebral disc degeneration through affecting the stability of DNA polymerase epsilon complex.” Am J Transl Res 10(11): 3430-3442.

CF 060: Medical Marketing & Integration Care Expectations

CF 060: Medical Marketing & Integration Care Expectations

Today we’re going to talk about medical marketing scoundrels and about what the multidisciplinary world expects of us chiropractors. 

But first, here’s that ‘goes down so smooth’ bumper music

Integrating Chiropractors

And we’re back. .Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  We are honored you’re spending some time with us and we hope we give some entertainment and some value in return. 

Introduction

You have disco’ed your way into Episode #60 just like John Travolta in Saturday Night Live. Kids, go Google that. It was cool back then. You could walk down the street in a Staying Alive strut man. Travolta was the bee’s knees back then wasn’t he? From Mr. Kotter, to Grease, to Staying Alive. Then turned kookoo wacko on everyone. He got so open-minded that his brain fell out and went splat. 

Let’s talk a bit about the diplomate of the Academy of chiropractic orthopedists quickly. That’s also known as the DACO program that I’m currently going through. I’ve officially hit the halfway point for the online hours and only have one class left for the live hours which I’ll get in less than a month down in Austin. Basically, out of 300 hours, I have about 125 left and have just been serious about this thing since October. Recent classes have been A Neurological Approach to Scoliosis, and the Neck and a Sense of Well-Being. 

I feel like it’s scooting fairly quickly at this point. It’s funny to watch my staff when I’m performing an exam these days. They’re familiar with the way I do exams and have done them for years. Just about every week, including this week, I’m adding or taking away from what I normally do. They don’t really know how to handle it. Lol. These classes really do change what you do almost immediately. 

If I can help you get started and rocking and rolling on your DACO, shoot me an email at [email protected] and I’ll be glad to point you in the right direction. 

New Year

How’s your new year starting? By the time this episode goes live, we’ll have been in it for a little over a month. I have to say that I’m confused this year. This is typically our slowest time of year. But, it’s going a little crazy this year for whatever reason. I have literally had 35 new patients in the last two weeks. It’s all I can do to get this podcast written each week, to be honest, but I’m committed. 

I actually had to come in on a Saturday to record the last episode because I just didn’t have the time available during the week to get it done. I’m not trying to brag. I think if you have a good staff, which I do, and you have them spaced appropriately, which I do, you can make your way through them while giving them the best care possible. Especially when you’re using post-graduate educations like the DACO to guide your exam and diagnosis. 

Crazy Busy

And, 35 new patients for my practice looks different than it may in a lot of clinics. I don’t see how many times we can run them through the doors. I don’t convince them their lives are at stake if they don’t see me 50 times this year. 

I used ChiroUp for all of my patients which I highly recommend. An additional $150/month seems like a lot. I know. But this programs is worth even more than that and they’re not paying me anything at all to say that. One of the things it does is track your patients through follow up emails. 

That’s how I know my case average, which is the number of times I typically see a person, stands at around 8 times while their national average stands at about 7 times. 

I know that my average improvement rating is 79.43% for ALL cases and that included everything from cervical radiculopathy and lumbar stenosis to cervicogenic headache and greater trochanteric bursitis. Their national average for improvement is 71.8% so I’m doing good there. If I’m getting 80% of my patients well, I’m happy. 

They have also tracked me at having a 98.6% likely to refer from my patients. Meaning, our patients are 98% happy to refer us to their family and friends and that makes me feel warm and fuzzy inside. I’d still like to know what I can do to make that other 1.4% happy but I think some people cannot be made happy at all. 

Even if you get them well and gave them free ice cream. They’d still gripe because the ice cream didn’t have chocolate syrup on it. You know those people. You know who I’m talking about, don’t you?

Anyway, the point was….I hope your 2019 has started off like my 2019. If it sustains, I’m going to have to get me some help in here! Including a nurse practitioner. Ahhhhh, the day I finally make that leap I may have a few hundred beers. Lol. 

Paper #1

The first item of research I want to get to is on medical marketing. Why do we care what the medical field is doing for marketing? Well, because they’re the main stakeholders in healthcare and it’s important to know what they’re doing. Either we can copy it or we can go 180 degrees from it depending on what we’re talking about. 

This paper we’ll talk about was in the Journal of the American Medical Association also known as JAMA on January 1, 2019, so it’s hot off of the press. It is called “Medical Marketing in the United States, 1997-2016” and was written by Lisa Schwartz, MD and Steven Woloshin, MD[1].  Please remember, if you’d like to see the paper, the methods, and that good hulabaloo….I always cite the papers at the end of the show notes over at chiropracticforward.com. This show is episode 60 just so’s you’s knows. 

Why They Did It

They wanted to answer the question, “How has the marketing of prescription drugs, disease awareness, health services, and laboratory tests in the United States changed from 1997 through 2016?” I think that’s a great question. 

Let’s find out, shall we? I say hell yes we shall!

As far as medical marketing goes, they say, “From 1997 through 2016, medical marketing expanded substantially, and spending increased from $17.7 to $29.9 billion, with direct-to-consumer advertising for prescription drugs and health services accounting for the most rapid growth, and pharmaceutical marketing to health professionals accounting for most promotional spending.”

Let’s dial down into that just a bit. 

As you are probably already guessing because you see this trash on TV every time you turn it on but the most rapid, crazy increase in medical marketing advertising was in the direct-to-consumer advertising. It went from $2.1 billion in 1997, which was 11.9% of the total marketing….it went from $2.1 billion all the way up to $9.6 billion and now, marketing meds directly to the consumer now make up 32% of the total spending. I say NOW….that was 2016’s numbers. Probably worse now.

They broke it down even further and highlighted the prescriptions that are marketed directly. The drugs you need a prescription for ….ads for them went from $1.3 billion in ’97 which was 79,000 ads, all the way up to $6 billion dollars and 663,000 ads in 2016. 

All I have to say here is, “Dayum.”

Then, I’m not done yet….hold my beer and watch this….Lol. That’s what I feel like here. Then, they say that medical marketing straight to healthcare providers like the MDs, DOs, etc….that marketing went up from $15.6 billion to 20.3 billion in 2016 but here’s what’s crazy when you think about it, folks, $13.5 billion of that was for free samples….OK, whatever. Then $979 million went to payments to physicians for speaking fees, meals, and things like that that were related to specific products. So they paid almost a billion damn dollars to MDs to go around medical marketing & touting their drugs.  

It’s insane. You cannot tell me no way no how that with that much money in the hopper, that we don’t have some nefarious skunky smelly dirty crap snaking around and messing with people for the worse. You can’t convince me of it and I’m not a conspiracy guy either. 

Like, when they say we didn’t land on the moon, it was shot in a studio in Hollywood? Yeah, they need a kick in the nuggets. Really? The Earth is flat? Are you sure? I’ve seen a lot of pics from outers space and round is what I’m getting people!! 

You see what I mean here but I also know people and I know what greed does to people. It’s insane, honestly. 

Pharmaceutical Commercials

Let’s talk about those medical marketing commercials for a minute. Let’s make up a name that sounds a little like a prescription. How about Killyametrix? Yeah, sounds good. OK, here’s how it usually goes, “Have you been having a hard time getting into your life? Are you just tired? No energy, no drive, no ambition anymore? Wouldn’t you like to have more energy? You’re too young for this. Killyametrix has been shown to increase energy and get patients back to enjoying their lives quicker and faster than any medication in the history of man that was ever made. There are some side effects. You’ll want to talk to your doctor if you experience any of the following symptoms: gout, liver failure, tumors coming out of your eyeballs, if your foot falls right off in mid-stride, high blood pressure, going cross-eyed, bleeding from the ears and fingernails, if your hair curls, if all of your hair falls out, or if your knee cap pops right off as you sit down and shoots straight across the room knocking someone out. Other than those issues, it’s a great drug. Try Killyametrix. Ask your doctor about Killyametrix and if it might be right for you.”

Here’s the deal, when I was growing up, did you realize whiskey, bourbon, scotch, …..the hard stuff…..it was never advertised on TV because they knew it was damaging to the population so why promote it nationally. I believe it was actually illegal to advertise the hard stuff but I’m not 100% on that. 

But, now, or at least in 2016, it’s OK to advertise prescription drugs straight to the consumer to the tune of 663,000 ads at a cost of $6 billion dollars. It’s lunacy. 

How about you go to your doctor with no preconceived idea of what’s wrong with you and he or she plays doctor, figures out what’s going on with you, and the DOCTOR, the actual doctor, decides what medication you need if any at all. 

Why don’t we try that crap out in America for a change? 

If I were an MD or DO, I’d be livid every time I saw one of those stupid commercials on TV. Hell, I’m a DC and I’m livid when I see them. 

Make me a crazy person. Makes me want to go live in a rubber room for a couple of weeks to decompress.

Paper #2

Let’s get to the last thing here. This one is called “Stakeholder expectations from the integration of chiropractic care into a rehabilitation setting: a qualitative study” by Zacariah Shannon, et. al[2]. published in BMC Complementary and Alternative Medicine in December 2018. 

Why They Did It

They say that few studies exist on what the expectations of chiropractic care really are within a multidisciplinary setting so they wanted to add to the literature on this topic. 

What They Found

They found that expectations for the chiropractic program in this study were mostly positive. Good news. The idea of the patients making progress was the overriding theme for the group. They expected the addition of chiropractic to help patients progress by improving pain management and physical functioning. 

In addition, they also expected indirect effects of chiropractic on healthcare integration. Things like increasing the patient participation in other providers’ treatments which would lead to improved care for the patient across the board. 

I wonder if those other providers were or will be helping increase the chiropractor’s load as well? That’s a good question to ask. 

Wrap It Up

They summed it up by saying, “Stakeholders expected the addition of chiropractic care to a rehabilitation specialty hospital to benefit patients through pain management and functional improvements leading to whole person healing. They also expected chiropractic to benefit the healthcare team by facilitating other therapies in pursuit of the hospital mission, that is, moving patients towards discharge.”

Not bad, not bad. It’s a helluva lot better than we had going on for us before the opioid crisis. I’ll give them that. I think the only part of this I really don’t like is their expectation of the chiropractor helping feed the rest of them while, in my biased opinion, they should be feeding the chiropractor first in an effort to keep people off of meds. 

Their stated goals are pain management and physical function. Well…that’s sort of right in our wheelhouse so why wouldn’t we be getting those first? I think the stakeholders have been fed quite enough. They’re fat as hell and slobbering. 

Bring the evidence-informed chiropractors in and watch your patients shine with happiness, leave amazing reviews, and go out and tell your city about all of the good things your clinic is doing. 

If they get the right evidence-based chiropractor in there, that’s the way I see it playing out because the research we covered several weeks ago shows us that chiropractors have the highest patient outcome satisfaction when compared to MD and DO’s, in fact, we wipe the floor with those people in regard to musculoskeletal issues. Not only that but we beat out the PTs as well on outcome measures. 

But we should feed them, right? They should be thankful to have us. 

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.

Help us get to the top of podcasts in our industry. That’s how we get the message out.

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

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TuneIn

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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

 

Bibliography

1. Schwartz L, W.S., Medical Marketing in the United States, 1997-2016. JAMA, 2019. 321(1): p. 80-96.

2. Shannon Z, S.S., , Gosselin D, Vining R,, Stakeholder expectations from the integration of chiropractic care into a rehabilitation setting: a qualitative study. BMC Comp Altern Med, 2018. 18(316).

 

https://www.chiropracticforward.com/cf-025-vets-with-low-back-pain-usual-care-chiropractic-vs-usual-care-alone/

https://www.chiropracticforward.com/cf-032-how-evidence-based-chiropractic-can-help-save-the-day/

 

CF 027: WANTED – Safe, Nonpharmacological Means Of Treating Spinal Pain

 

 

CF 058: The Patient Experience, Lumbar Stenosis, & Fibromyalgia 

CF 058: The Patient Experience, Lumbar Stenosis, & Fibromyalgia 

Today we’re going to talk about the patient experience being more important than your marketing, we’ll talk about some research from JAMA on lumbar stenosis, and some research on upper cervical manipulative therapy on fibromyalgia. 

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 clumsily stumbled into Episode #58 knocking lamps off of the end tables and generally making a mess of the place.

DACO

As with every week, let’s talk a bit about the DACO program and my progress. I was doing the Communication Drills but they kept referring to eLearning Episodes. So let’s break that down a bit real quick for those interested in the program. The bulk is made up of 40 Diagnostic Drills, 46 Communication Drills, and 17 eLearning Episodes. 

You get 2 hrs credit for each Diagnostic or Communication Drill and you get 3 hours credits for each eLearning Episode. 

Now, since Communication Drills kept referring to eLearning Episodes, I figured I would switch focus and go through them and then return to the Communication Drills. Still with me?

The eLearning Episodes are very much video based on a downloadable worksheet to take notes on. I take notes digitally though so I’m still getting my angle of attack down on these and how I want to best tackle them and have great notes I’m getting it figured out. 

DACO Classes

So far, I’ve taken classes on Adjusting locally and thinking globally about how a cervical adjustment can affect even the low back. The neurology is amazing. A class on blurry vision from a pain in the neck. Again, the neurology people. I don’t know how I made it day to day before this stuff. Then last weekend I took one on making sense of a headache. 

Outstanding information and all lined up to make you better, make you wiser in your decision-making, and making you a better communicator with your patients and colleagues. 

If you’re waiting to get started on the DACO, get started. I’ll be glad to help you if you’ll email me at [email protected]

I’m about wrapped up with some cool stuff that you all may be interested in on our website at chiropracticforward.com. If you’ll go there and sign up for our newsletter on our home page, I’ll be able to let you know all about it when it’s ready to roll out.   

Great week for listens Y’all. Thank you for tuning in. Everyone loved Dr. James Lehman’s episode. That was a big one for us! If you missed it, it’s episode #55. Candy for your ears. I see that sucker being the number one listened to podcast pretty quickly. 

Onto the Discussion

Let’s get to trying to make your practice better. This first one we’ll discuss is titled, “Patient experience five times as likely to drive consumer loyalty as marketing” by Christopher Cheney with HealthLeaders(Cheney C 2018). It was published on December 28, 2018. Once again, I know you dig the new stuff. 

If you’re getting after it. If you’re hustling, then you’re marketing. Marketing isn’t something you do once, is it? Oh no, it isn’t. It’s something you do every damn day if you’re doing it effectively. It’s exhausting, isn’t it? But it can be fun too. 

Marketing

Isn’t it fascinating that just changing the color of the border on your marketing material has the potential to elicit a different behavior from the recipient? Or changing the color of the shirt that the person in the ad is wearing affects the response rate? It’s amazing. But, it’s also exhausting to contemplate all of the different combinations of possibilities of words, colors, placements, and all of that crap. 

Good grief. You could make yourself crazy and how many chiropractors usually have the budget to hire a full-time marketing person that actually had a marketing degree? Not many would be the answer you’re looking for if you were confused on that. It was more rhetorical than anything. 

Here in this article, Mr. Cheney says that the patient experience while in your office is the primary driver of patients’ consumer loyalty at health systems, hospitals, and physician practices. He based this information on a recent Press Ganey report I would normally link for you in the show notes but it looks like a bit of click bate. As in leave your email and get the report crapola and I’m not doing that to my peeps. Ain’t nobody got time for that. 

Hell, I can hardly get you guys to give ME your email address and most of you are loyal listeners! Lol. 

Consumer Loyalty

Anyway, he says that consumer loyalty is vital for not only your profit at the end of the month but also helps you take better care of long-term patients with multiple chronic illnesses. 

Hell, that’s why we got into this business; taking care of people. I have to say that if you got into this business to get rich, you’re taking the long way around buddy. Lol. Most of us got into this business to take care of people when nobody else was able to get results with them. And then hopefully keep them that way!

Here’s what raised my antennae straight up, he said, “Patient experience is FIVE TIMES more likely to influence brand loyalty than conventional marketing tools such as billboards, or television, print, or radio ads.”

WHAT?

What was that? Let me repeat that just in case my DACO talk put you to sleep. Hey, wake the hell up and listen to this. “Patient experience is FIVE TIMES more likely to influence brand loyalty than conventional marketing tools such as billboards, or television, print, or radio ads.”

That is astounding. Of course, some of you already had this figured out and being 20 + years into this dealio, I have it figured out to an extent as well but FIVE TIMES more effective than billboards, TV, print, or radio?

I did NOT have that much figured out. Do you know how I know I didn’t have all of that figured out? Well, it’s because I am spending too much damn money on all that crapola. They interviewed over 1,000 adults on this survey. 

I do have it figured out to the extent that I tell my staff that we are certainly in the healthcare business but they’re fools if they think we are not also in the customer service business. You better believe it. I tell them that I’d much rather a patient leave feeling the same but feeling great about the people they met and the experience they had here and feeling hopeful about what we can accomplish with them as opposed to them leaving my office sore because I either rushed through the appointment or thought we’d equate appointment success with a popping noise and pushed so hard that I finally got a pop sound but ended up making the patient feel worse. 

That goes for the front desk too, doesn’t it? They’re the first point of contact and the last point of contact. If they’re not friendly when people come in and greet them warmly and are very welcoming, well….we’re already behind the 8-ball there and had better make up some ground in the back of the office. And when they leave…..oh nobody likes to pay their own money out of their own pocket and they damn sure don’t like to pay it to someone they don’t like personally. 

Here is a quote from the report, “Healthcare organizations can tap the power of patient experience, the report says. “To harness that influence, providers should capitalize on the power of word-of-mouth marketing by viewing the patient experience as an essential part of their acquisition strategy. By gaining a deep understanding of what gets people talking about positive patient experiences, identifying opportunities to advance the conversation and disseminating key information, healthcare systems can naturally align the mission of delivering safe, high-quality, patient-centered care with the business of acquiring and retaining consumers.”

The Big 4

They went on to line our 4 Big One’s that should be a part of any healthcare facility’s strategy for getting and keeping patients. They were:

  1. Give every patient a voice – They’re not just talking about listening to them when they visit your office and tell you about their conditions. They describe delivering surveys via text and email as well as the standard outreach protocols. 
  2. Identify factors that drive and erode patient loyalty. They say to really know where you can improve, you gotta know positive loyalty metrics on things like the likelihood to refer or recommend your office to their network of people. Imagine man, being a former member of BNI, they teach that each person, whether they know it or not, has a network of 250 people in their lives. I get 55-65 new patients per month. That’s 13,750-16,250 potential work of mouth contacts that can either hear the good about our office or, if we allow them to catch us on bad days….that’s up to 16,250 people that can hear bad things about us. You can see why it’s so important to have positive patient experiences in your office just as often as you possibly can. Especially in the days of social media. There is no room for ego, for talking down to your patients or scolding your patients, or any of that crap. Patient-centered is more than an idea, it’s how you’d better be carrying yourself. 
  3. Use natural language processing to analyze comments. What the hell does that mean? Well, they say that it is language that allows aggregation of comments into clear brand equities and liabilities, allowing for proactive management of both experience and brand. That sounds like an overly wordy and annoying resume if I’m being honest. Basically, it’s using computers to analyze emails, customer feedback forms, surveys and things like that to identify the root cause of customer dissatisfaction or, we hope, customer satisfaction. I’d like to lead you further down this path but, obviously, I have more to learn on it myself. 
  4. Post ratings and reviews in physician profiles. Ensure that future patients have the most convenient access to all information they seek by including comments – both positive and negative. I can’t deal with negative comments. They hurt. Lol. 

Reviews

They also say that you need to be earning quality reviews online for Yelp, Google, Facebook, and all that good stuff. If you don’t know the value of reviews at this point, you just might be a lost cause. Lol. 

They also say you must address negative reviews online in a professional way while understanding that negative reviews are an opportunity to learn and improve. 

But, when it’s not right and borderline illegal, I believe it’s OK to have your attorney contact the person leaving that negative review. Here’s what happened. We offer a service. Not chiropractic but a service that a girl that treated here for some time decided she would begin offering here in town without being certified in any way to perform. 

OK, annoying for sure but then she, one of her little buddies and her boyfriend go online and leave us bad reviews for the exact same service. So there we were with 80 or so 5-star reviews. Not one negative review. And then three 1 star reviews popping up out of nowhere. Nope, she got a call from my attorney and they went away very quickly. 

Ain’t nobody got time for that crap, right? I know I don’t and I have little tolerance for people that want to try to tear down something others have built just to try to further themselves. 

Before my face gets too red and I start to stutter, let’s move onto the next topic. 

Next Paper

This next paper is called, “The addition of upper cervical manipulative therapy in the treatment of patients with fibromyalgia: a randomized controlled trial.” The lead author on this one is Ibrahim Moustafa and it was published in Rheumatology International in July of 2015(Moustafa I 2015). 

And can we just stop a second appreciate the last name Moustafa? Can we do that? Holy cow, if I had a good head of hair and a last name like Moustafa, I’d have the world on a leash ya know. But I don’t have good hair and my name is Williams (so boring) so let’s move on. 

Why They Did It

The aim of this study was to investigate the immediate and long-term effects of a one-year multimodal program, with the addition of upper cervical manipulative therapy, on fibromyalgia management outcomes in addition to three-dimensional (3D) postural measures.

It was a randomized controlled trial with a one-year follow-up. 

What They Found

The addition of the upper cervical manipulative therapy to a multimodal program is beneficial in treating patients with fibro.

I threw that one in for you Upper Cervical guys. You’re getting some love when it comes to treating fibro and I know fibro sufferers will appreciate that. 

I think, after learning more about the upper cervical spine in the DACO course, that it’s fascinating to think about. There is so much going on in the upper three segments in terms of sensorimotor and proprioception that it just blows your mind. 

Last Paper

OK, on to the last paper. This one is called “Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial(Schneider M 2019)”. It was authored by Michael Schneider, DC, Ph.D., Carlo Ammendolia, DC (who we have covered here before for stenosis), and Donald Murphy, DC et. al. It appeared in JAMA on January 4, 2019, and here’s how it goes. 

Why They Did It

The question to answer for them was, “What is the comparative effectiveness of 3 types of nonsurgical treatment options for patients with lumbar spinal stenosis?”

Now the 3 types of protocols they tested were medical care, group exercise, and manual therapy/individualized exercise. 

The medical care consisted of medications and/or epidural injections. 

The group exercise classes were supervised by fitness instructors in senior community centers. 

The manual therapy/individualized exercise consisted of spinal mobilization (because it works and is awesome I assume), stretches, and strength training provided by chiropractors and PTs. 

A combination of manual therapy/individualized exercise provides greater short-term improvement in symptoms and physical function and walking capacity than medical care or group exercises, although all 3 interventions were associated with improvements in long-term walking capacity.

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.

Help us get to the top of podcasts in our industry. That’s how we get the message out.

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

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TuneIn

About the Author & Host

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

 

Bibliography

  • Cheney C (2018) “PATIENT EXPERIENCE FIVE TIMES AS LIKELY TO DRIVE CONSUMER LOYALTY AS MARKETING.” HealthLeaders.
  • Moustafa I (2015). “The addition of upper cervical manipulative therapy in the treatment of patients with fibromyalgia: a randomized controlled trial.” Rheum Inter 35(7): 1163-1174.
  • Schneider M, A. C., Murphy D, (2019). “Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis A Randomized Clinical Trial.” JAMA Network Open 2(1): e186828.

CF 045: Harvard Health, Low Back Stenosis, Allergy Autism

CF 016: Review of The Lancet Article on Low Back Pain (Pt. 1)

 

CF 057: What Is Contributing To Low Back Pain And More Opioid Bashing

CF 057: What Is Contributing To Low Back Pain And More Opioid Bashing

Today we’re going to talk about What Is Contributing To Low Back Pain And More Opioid Bashing from us. We hate them and they don’t do any good anyway so why did 72,000 people have to die at their hands last year in America?

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 fumbled your way into Episode #57

Junk I Say

Let’s first talk a bit about junk I say. I drive myself crazy and here’s why; I get flustered sometimes. I don’t know why. Honestly, I’d like to eventually go on the speaking circuit but I think I’ll be terrible at it. Lol. I get flustered. 

I always listen to the episodes after they post. For a couple of reasons but it’s kind of like why a football team will watch game tape the day and week after a game. I do the same thing. I want to identify where I can improve and how I can make myself and the show better from week to week. 

Well, I invariably catch myself saying stuff that makes no sense. Like in the recent episode where I discussed the lack of research for lumbar fusion, I referred to an orthopedic surgeon as an osteopath. What? Trust me…..I know the damn difference so things like that make me want to punch myself in the nose a little. 

Another is that, without thinking, I’ve been calling it the diplomate of American chiropractic orthopedists. Yeah….that’s not what it is and I know that. Lol. It’s the Diplomate of the Academy of Chiropractic Orthopedists and those folks can be a member of the American Chiropractic Orthopedists. You see the confusion, right?

Anyway….I’m not a dummy people. Well, most days anyway. I still have my brain farts but I’m usually fairly put together. Or at least I like to think I am. Reminds me of a comedian I heard when I was a kid. He said, “I may look dumb, but that doesn’t mean I’m not!” Yeah….so you just think about that for a bit. 

The DACO

Speaking of the DACO program, “What’s the latest?”, you may ask. To that I would answer that a lot is going on actually. I slowed down for a bit but picked it back up during the holidays with the spare time I had. 

More communication drills including ideas and instruction on how to tactfully disagree with our medical counterparts. For instance, if they diagnose a patient with a disc and we are CERTAIN it’s an SI, how are you going to let them down softly and keep them from going away mad ala Motley Crue…girl….don’t go away mad. Just go away. 

You know we all have egos and you know damn well that “king ego” exists in the medical world. How do you tell those people they’re at odds with the research? I’m afraid there are some of them that would rather be wrong than be corrected. 

How do you tell them that they diagnosed a tension-type headache when, in reality, the symptoms are more in line with a cervicogenic headache? And then, how do you tell a GP that probably doesn’t like cervical manipulation that you recommend just that?

Things that make you go “Hmmmm….”

At the end of each of the Communication Drills, they give you a script to help you in the future should the need pop up for you to artfully and tactfully slap around Mr. King Ego without them really knowing you payahed them across the face with a glove. 

Short Show 

Alright, it’s a crazy week. I’m trying to close out 2018 as far as stats go and all that good stuff so this episode ain’t gonna be a big one. 

Before we get to it though, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It’s just an email. We’ll send you one once a week when a new episode pops up and, if we have something cool to tell you about, I’ll include it in that email. No extra emails. Don’t be so stingy with that damn email address. 

Don’t be like a college kid with the last piece of pizza. Don’t be that kid. 

Onto the Research

Let’s get to the goodies, folks. Let’s start with this one from BMC Musculoskeletal Disorders by Shanthi Ramanathan, Peter Hibbert, Louise Wiles, Christopher Maher, and William Runicman called “What is the association between the presence of comorbidities and the appropriateness of care for low back pain? A population-based medical record review study[1].”

 

First thing here is that Chris Maher is a busy guy, y’all. Seriously. He is a Physical Therapist and I believe lives in Australia if I remember correctly. He was on a paper we discussed recently having to do with lumbar fusion as well as being on The Lancet series of papers for low back pain. He’s a mover and shaker

Why They Did It

Knowing that low back pain is non-specific in 90% of cases, low back pain is treated as an independent entity even though we know other conditions exist with it or contribute to it. What comorbidities? Things like obesity, diabetes, heart disease, high blood pressure, arthritis, etc…

What They Found

One hundred and sixty-four LBP patients were included in the analysis. Over 60% of adults with LBP in Australia had one of 17 comorbidities documented, with females being more likely than males to have comorbid conditions.

Wrap Up

This study established that the presence of comorbidities is associated with poorer care for LBP. Understanding why this is so is an important direction for future research.

Paper #2

Onward we march…. This one is called “Chiropractors’ views on the use of patient-reported outcome measures in clinical practice; a qualitative study.” It was written with Michelle Holmes as the lead author followed by Felicity Bishop, David Newell, Jonathan Field, and George Lewith and it was published in Chiropractic and Manual Therapies in December of 2018[2]. 

I know you people like the new stuff. 

Why They Did It

Patient-reported outcome measures (also known as OATS in my office and probably your office as well. OATS meaning Outcome Assessments)

Anyway, OATS are widely available for use in musculoskeletal care there’s not much research exploring the implementation of OATS in clinical practice. They wanted to see what chiropractors’ views were on OATS to identify any barriers and facilitators to implementing OATS in chiropractic care.

What They Found

“Chiropractors are increasingly using OATS in their clinical practice. The aim of this qualitative study was to examine the views of chiropractors on using OATS. Exploring chiropractors’ experience of using OATS, this study identified how clinician knowledge and engagement and organizational barriers and facilitators affect implementing OATS in chiropractic care, such as choosing the appropriate OATS and systems to use in their practice. Chiropractors also identified possible training needs of chiropractors regarding OATS, with training including the process and benefits of using OATS in clinical practice.”

Opioids

Now, in our “beating a dead horse” segment, let’s bash the hell out of opioids, shall we? Well, don’t mind if I do!

This one is by Jason Busse, a Chiropractor by the way, and associate professor in the department of anesthesia at McMaster University’s school of medicine in Ontario, Canada……. Canada has it going on, folks. Seriously.

Here’s a chiropractor in the department of anesthesia at a school of medicine. We need to get that guy on our podcast don’t you think?

The paper was also written by Li Wang, Ph.D., and Mostafa Kamaleldin. Easy for you to say. 

It’s called “Opioids for Chronic Noncancer Pain; A systematic review and meta-analysis[3]” and appeared in JAMA in December of 2018. 

Why They Did It

They wanted to find out if the use of opioids to treat chronic noncancer pain was associated with greater benefits or harms compared with placebo and alternative analgesics.

Wrap It Up

In this meta-analysis of RCTs of patients with chronic noncancer pain, evidence from high-quality studies showed that opioid use was associated with statistically significant but small improvements in pain and physical functioning, and increased risk of vomiting compared with placebo. Comparisons of opioids with nonopioid alternatives suggested that the benefit for pain and functioning may be similar, although the evidence was from studies of only low to moderate quality.

CNN’s Spin 

CNN actually did an article by Michael Nedelman[4], on this paper where they get a little deeper saying the following, “For adults with chronic pain, opioids offer narrow improvements over placebo for pain and physical functioning, on average, according to a new analysis published Tuesday. And the majority of patients will experience no meaningful benefit.”

Subgroups of the studies included in the analysis suggest that non-opioid alternatives — such as NSAIDs, certain antidepressants and medical cannabis — may offer similar benefits to opioids on average. But the evidence for that is less strong, Busse said.

Question

Here’s my question for Dr. Busse, “Considering the fact that the American College of Physicians and The Lancet promote spinal manipulative therapy for acute and chronic low back pain as an alternative to opioids, and considering you are a chiropractor, why did your research not include spinal manipulative therapy as one of the alternative treatments?”

My guess is that maybe there were not enough randomized controlled trials comparing spinal manipulative therapy directly to opioids? I’m not sure why, to be honest. 

What We Know

But, we do know from JAMA that a current review found that spinal manipulation therapy is associated with moderate improvements in pain and function in patients with acute low back pain[5].

We know from Keeney et al that there “Reduced odds of surgery were observed for…those whose first provider was a chiropractor. 42.7% of workers [with back injuries] who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor[6].”

From Haas et. al[7]., we know “Acute and chronic chiropractic patients experienced better outcomes in pain, functional disability, and patient satisfaction; clinically important differences in pain and disability improvement were found for chronic patients.”

There are so many others that I just don’t have the time to get into right now but, I’m certainly interested in papers comparing the two directly to each other. I bet I already know the answer and I bet you do too. 

Integrating Chiropractors

The Message

Here’s why you know the answer already……it’s because we know 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.

Help us get to the top of podcasts in our industry. That’s how we get the message out.

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

 

Bibliography

1. Ramanthan S, H.P., Wiles L, Maher C, Runicman W,, What is the association between the presence of comorbidities and the appropriateness of care for low back pain? A population-based medical record review study. BMC Musculoskelet Disord, 2018. 19(391).

2. Holmes M, B.F., Newell D, Field J, Lewith G,, Chiropractors’ views on the use of patient-reported outcome measures in clinical practice: a qualitative study. Chiropr Man Therap, 2018. 26(50).

3. Busse J, W.L., Kamaleldin M,, Opioids for Chronic Noncancer Pain: A Systematic Review and Meta-analysis. JAMA, 2018. 320(23): p. 2448-2460.

4. Nedelman, M., Opioids offer little chronic pain benefit and wane over time, study says, in CNN. 2018: CNN Online.

5. Page N, Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain. Journal of American Medical Association (JAMA), 2107. 317(14): p. 1451-1460.

6. Keeney BJ, Early predictors of lumbar spine surgery after occupational back injury: results from a prospective study of workers in Washington State. Spine (Phila Pa 1976), 2013. May 15(38): p. 11.

7. Haas M, A practice-based study of patients with acute and chronic low back pain attending primary care and chiropractic physicians: two-week to 48-month follow-up. J Manipulative Physiol Ther, 2004. Mar-Apr;27(3): p. 160-9.

CF 025: Vets With Low Back Pain. Usual Care + Chiropractic vs. Usual Care Alone

CF 027: WANTED – Safe, Nonpharmacological Means Of Treating Spinal Pain

CF 031: No More High Risk & Useless Drugs From Here On – Getting Off Opioids

CF 026: Chiropractic Better Than Physical Therapy and Usual Medical Care For Musculoskeletal Issues

 

 

 

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.

... continue reading.

CF 052: Chiropractic Forward Podcast Year One Review

CF 052: Chiropractic Forward Podcast Year One Review

One year. I started this podcast exactly one year ago. 52 weeks. 52 episodes. We’re going to talk about the highlights of the first year. We’re going to talk about chiropractic today vs. chiropractic when I started a year ago. Has anything changed? The short answer is yes. Quite a bit has changed in just a year. 

But first, here’s that sweet like honey bumper music

Integrating Chiropractors

Welcome

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 collapsed into Episode #52 and it feels good to say that. To be able to do anything consistently for a year straight, every single week, it’s an accomplishment for sure and it sure as hell feels good folks. 

DACO Program

Before we get into the highlights. let’s talk a bit about the DACO program. For those new to the Chiropractic Forward Podcast, I have been going through the Diplomate of American Chiropractic Orthopedists. I’m 92 hours into a 300-hour course. Ugh…that hurts just to say it. Lol. I don’t even feel close to being done. 

I figured it out that at the rate I’m going now, which is about 8 hours per week, I can be done around May I believe. While it seems way off, you know what? I’d be learning and educating myself anyway. Why not get something out of it, right? That’s the idea and May will be here before you know it. 

Hell, it seems like it was Summer just a couple of weeks ago. Lol. 

Products

I have been fast at work preparing some new options for you. I have noticed  a lack of what I would want in my office when it talks 

One-Year Anniversary

Let’s get on to talking about our one-year anniversary. I want to start by talking listen out our top 10 episodes so far and what we talked about that made everyone listen to each of them. I’m linking them all for quick reference in the show notes. So away we go!

Number 10

Episode #30 – Integrating Chiropractors – What’s It Going To Take? We discussed the medical field and what they are looking for in a chiropractor in regard to integrating that individual into the system. We went over The Lancet papers as well. Great episode to check out. 

CF 030: Integrating Chiropractors – What’s It Going To Take?

 

Number 9

Episode #25 – Vets With Low Back Pain. Usual Care + Chiropractic vs. Usual Care Alone. This episode revolved around a paper in JAMA from Dr. Christine Goertz where she and her co-authors showed additional support for including chiropractic as part of a multidisciplinary team for treating low back pain. Great paper by a great asset for chiropractic. 

CF 025: Vets With Low Back Pain. Usual Care + Chiropractic vs. Usual Care Alone

Number 8

Episode #28 – Will Chiropractic First Finally Take Its Place? In this installment, we went through a paper that showed non-pharma and non-opioid therapies are now the preference. Well, that’s chiropractic, right? We talked about some GREAT resources in this episode including the President’s Commission on Combating Drug Addiction and The Opioid Crisis report as well as a great paper by Jon Adams Ph called The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults. That one had some marketing nuggets for the nugget pouch.

CF 028: Will Chiropractic First Finally Take Its Place?

 

Number 7

Episode #27 – Wanted – Safe, Nonpharmacological Means of Treating Spinal Pain. This episode went through treating spinal pain, thoracic manipulation, lumbar manipulation, guidelines from Canada, and the perceptions of our profession. We discussed a paper about how some in the medical profession think chiropractors go around herniating discs all the time. Pfft… 

CF 027: WANTED – Safe, Nonpharmacological Means Of Treating Spinal Pain

 

Number 6

Episode #9 – With Dr. Tom Hollingsworth of Corpus Christi, TX called The Case Against Chiropractic In Texas. We talked with Dr. Hollingsworth about the Texas Medical Association’s attacks on Texas Chiropractors and our rights. We talked about the latest in the current court case and the appeal process. 

Just a couple of weeks ago, in fact, this case had a decision that was reached and it wasn’t good for chiropractors. And I’m talking about chiropractors nationwide. We’ll have to do an updated episode with Dr. Hollingsworth because what may be on its way down the pike for all chiropractors…..well….let’s just say it’s no bueno. 

CF 009: With Dr. Tom Hollingsworth: The Case Against Chiropractic In Texas

 

Number 5

Episode #26 – Chiropractic Better Than Physical Therapy and Usual Medical Care For Musculoskeletal Issues. The title is accurate. And researched fact. There are some that don’t like that language. Can’t we all get along? That type of deal and yes, we can all get along. Most certainly. My issue is with PTs being the first referral for non-complicated musculoskeletal issues when research shows they have decreased effectiveness when compared to chiropractic care. 

They have less patient satisfaction when compared to chiropractic care as well. In addition, research shows chiropractic care to be a lot less expensive. So why in the hell is a practitioner that is exponentially more expensive, much less effective on their outcomes, and patients don’t like as much…..why the hell are they the first referral? That still makes my pee hot when I really really think about it. It’s dumb. 

I don’t think we should be doing post-surgical rehab unless we take specific training in that. I think PTs and DCs can work very well together but there should be lanes and I don’t think PTs stay in their lane. Not when they’re out there taking a weekend course on adjusting. It’s BS and that doesn’t stand for Bad Students. 

CF 026: Chiropractic Better Than Physical Therapy and Usual Medical Care For Musculoskeletal Issues

 

Number 4

Episode #29 – With Dr. Devin Pettiet of Tomball, TX, still the President of the Texas Chiropractic Association. This episode was titled Is Chiropractic Integration Healthy For the Profession? We talked with Dr. Pettiet all about chiropractic integration into a medical based case management or medical team. 

This one was one of my favorites too. For sure. Devin is a great resource and a great personality. He’s all energy and has an awesome amount of information and experience.

CF 029: w/ Dr. Devin Pettiet – Is Chiropractic Integration Healthy For The Profession?

 

Number 3

Episode #6 with Dr. Tyce Hergert from Southlake, TX. This episode is called Astounding expert Information on Immediate Headache Relief. This one was all about headaches and highlighted one service that was dressed up and parading around as another. Yes, those pesky PTs are moving in on us and this episode talked about little bit about that along with some great papers showing chiropractic’s effectiveness with treating headaches. Fun episode. 

CF 006: With Dr. Tyce Hergert: Astounding Expert Information On Immediate Headache Relief

 

Number 2

Episode #13 – DEBUNKED: The Odd Myth That Chiropractors Cause Strokes. My favorite episode and my favorite endeavor as far as really putting together information to stick a fork in an anti-chiropractic idea or myth. This is actually a three-part series consisting of #13, 14, and 15. All three episodes really paint a picture of foolishness on the part of the medical field and a coordinated attack that is easily put to rest through common sense, correct context, and research. 

It’s really so simple when you take the time to listen, learn, and just think about it for a minute. They are the three episodes I encourage you to share the very most out of all of them I have created. 

CF 013: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 1 of 3)

 

Number 1

Episode #11 – called It’s Here. New Guides For Low Back Pain That Medical Doctors Are Ignoring.

The most listened-to episode for our first year was Episode #11 once again with my old friend and colleague Dr. Tyce Hergert down in Southlake, TX. He has TWO episodes in the top 10 from our first year. That’s because he’s smart, he’s the ex-President of the Texas Chiropractic Association, and he’s entertaining if he’s had his coffee. 

In this one, we talked about current healthcare guidelines, why they matter to chiropractic patients and even non-patients, and whether MDs are getting it or not. Guess what? They’re still ignoring these guides!

CF 011: With Dr. Tyce Hergert: It’s Here. New Guides For Low Back Pain That Medical Doctors Are Ignoring

 

Wrap Up

So….there you have it, folks. That’s our Top 10 in a nutshell with all of the links in the show notes. We have had a great first year. We hope you have enjoyed the content we have been bringing to you as much as we have enjoyed gathering it for you. 

There is so much going on in our profession. Both good and bad. It’s important to stay plugged in now more than ever. We’ll talk about it in a future episode but the Texas Chiropractors lost their appeal and the medical kingdom will bring their dog and pony show to your state before you know it. Believe me. 

But, for evidence-based chiropractors, there’s still no better time than today to be a doctor of chiropractic. I firmly believe that to be the truth.

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!

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.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

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

Chiropractic Forward Podcast Facebook GROUP

Twitter

YouTube

iTunes

Player FM Link

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TuneIn

About the author:

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