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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 dr.williams@chiropracticforward.com 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.

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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

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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

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 dr.williams@chiropracticforward.com 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

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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 dr.williams@chiropracticforward.com

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

Home

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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.

Website

Home

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

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.

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

http://www.chiropracticforward.com

Social Media Links

Chiropractic Forward Podcast Facebook GROUP

Twitter

YouTube

iTunes

Player FM Link

Stitcher:

TuneIn

About the author:

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

CF 051: Necks, Integrity of the Cervical Spine, and the CDC on Opioids

CF 051: Necks, Integrity of the Cervical Spine, and the CDC on Opioids

Today we’re going to talk about the reliability of clinical tests assessing the cervical spine, what is happening when adjusting a neck as far as the integrity of the cervical spine, and what the CDC says about opioids. It’s all fascinating all the time here at the Chiropractic Forward Podcast 

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 drifted all slow and gently into Episode #51

DACO

As has become the tradition, let’s talk a bit about the DACO program. DACO stands for Diplomate of American Chiropractic Orthopedist. Trudging along. I’m up to I believe 84 of the required 300. Classes this last week were on frozen shoulder, piriformis syndrome, Important aspects of lumbar MRI, and inguinal pain. 

This stuff is just invaluable, folks. I’m an organizational freak but at the end of each course, I’ll make myself a quick sheet that I can reference when something like that comes through the door. I think making these little quick sheets will really help to get some of the more rare or difficult cases figured out quickly. 

I’ve already put the lumbar differential diagnosis sheet to use a few times as well as the dizziness quick sheet I created. I have shared several times here that I don’t sit around a lot either at work or at home. I’m a busy bee. 

Vacation & Hobbies

Going on vacation, don’t even try to take me to a beach. If my wife wants to go to the beach, that’s all her. I’ll tag along and I’ll check in on her out there reading a book from time to time but, for the most part, I’ll be off doing, seeing, and experiencing. The ability to sit still and just relax…..that’s an ability I did not receive in this lifetime. 

As a result, I make live edge furniture. Go to Facebook and look up Amarillo live edge and custom furniture. I am a sculpture and charcoal artist. Go back to Facebook now and look up River Horse Art Gallery. I’m in the process of teaching myself to paint right now too. I also am a singer/songwriter. Go back to Facebook once again. Yes, once again and look up Flying Elbows Perspective.

Crazy name indeed. 

So, here’s the point. It’s not to brag or pump my tires. The point is that this is how important I’ve found the DACO program to be. While I haven’t completely put everything else on hold, the DACO has taken priority of my time. One reason is that I want to motor through it quickly and efficiently. The next reason would be that I’ll be the only DACO in all of Texas West of the Dallas/Ft. Worth metroplex. 

What does that get me? Maybe a pat on the back. Maybe a part time or full-time gig on staff at an FQHC. As we have mentioned in previous episodes, there are reports of DCs on FQHC staffs making as little as $120/visit up to $300/visit on even Medicaid visits. Unbelievable. But you have a better shot at getting into the system when you are specialized AKA – a Diplomate. 

Just a part of making us all better. You guys and gals need to be looking at this stuff. 

Before we hop into the papers for the week, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. I think I have some pretty cool stuff coming down the pike you’ll be interested in. That’s in you enjoy evidence-based education.

Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

Paper #1

The first paper here is called “Reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders: Part 1—A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration” It was done my Madege Lemurnier et. al. and published in the European Spine Journal in September 2017[1]. 

Why They Did It

With a title as long as that one, what the heck are they doing here? They say they were hoping to determine the reliability of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders. 

How They Did It

They updated the systematic review of the 2000-2010 Bone and Joint Decade Task Forst on Neck Pain and Associated Disorders. 

They searched the literature for studies on the reliability and validity of Doppler velocimetry to evaluate the cervical arteries. 

They had two independent evaluators look through it all

What They Found

  • Preliminary evidence showed that the extension-rotation test may be reliable and has adequate validity to rule out pain arising from facet joint. Or rule in I suppose. Just in case you are unaware of the cervical extension-rotation test, it’s exactly as it sounds. Have the patient extend and then rotate toward the side you’re testing. When you combine this maneuver with palpation you can typically get a good idea of whether the patient is suffering from a facet issue. You need to know that this test is also effective in sniffing out a low back facet issue as well. Lumbar extension and then rotation can give you some good clues sometimes.
  • The evidence suggests variable reliability and preliminary validity for the evaluation of cervical radiculopathy including neurological examination (manual motor testing, dermatomal sensory testing, deep tendon reflexes, and pathological reflex testing), Spurling’s and the upper limb neurodynamic tests.
  • No evidence found for doppler velocimetry. 

Wrap It Up

Little evidence exists to support the use of clinical tests to evaluate the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders. We found preliminary evidence to support the use of the extension–rotation test, neurological examination, Spurling’s and the upper limb neurodynamic tests.

Paper#2

On to our second paper. This one is called “Intervertebral kinematics of the cervical spine before, during, and after high-velocity low-amplitude manipulation” and appeared in Spine Journal in August of 2018 and was authored by Dr. William J. Anderst, et. al[2].

Why They Did It

Since cervical manipulation is such a common intervention for neck pain, the authors wanted to characterize the forces involved and the facet gapping that takes place during manipulation. 

How They Did It

It was a laboratory-based prospective observational study

It included 12 patients 

Each patient had acute mechanical neck pain

One of the outcome measurements was the neck pain rating scale (NPRS)

Other measurements were taken for amount and rate of cervical facet joint gapping 

What They Found

The authors concluded, “This study is the first to measure facet gapping during cervical manipulation on live humans. The results demonstrate that target and adjacent motion segments undergo facet joint gapping during manipulation and that intervertebral ROM is increased in all three planes of motion after manipulation. The results suggest that clinical and functional improvement after manipulation may occur as a result of small increases in intervertebral ROM across multiple motion segments.”

Pretty cool stuff. 

Paper #3

Our last paper for this episode is called, “CDC: Drug overdoses hit new record.” It’s an article on thehill.com written by Nathaniel Weixel and was published on August 15th of this year, 2018[3]. 

The article leads off saying that 72,000 Americans died from drug overdoses in 2017 and that’s based on information provided by the Centers for Disease Control and Prevention. That is a new record folks and we have our friends in the medical realm to thank for it. 

Who’s To Blame?

Now, that, of course, doesn’t mean pharmacists and medical doctors are bad and there was a mass conspiracy to cause this deal. But it does mean that SOME of them are bad. SOME doctors are doing time in an orange outfit right now because they knew better but the dollar was mightier than common sense and common decency. 

There were pharmacies dispensing 100x more than their population could ever consume but they want to not refer to us and talk about the integrity of the cervical spine. That kind of crap is what got us here.

But, it’s also what has brought chiropractors from the shadows into the light. When you have the mess the medical field has created, then you have to start looking for the non-pharma solutions and we are it. 

Comparison

72,000 deaths. You ever heard of the Vietnam War? Of course, you have. We all have. Some either remember or have seen what a big deal it was. The deaths, the protests, the loss. I’ve been to the Vietnam Wall in Washington DC several times. It’s profound. It’s stunning to see all of those names. 

Just to compare, the total number of those lost in Vietnam stands at 58,220. Now keep in mind, that takes into account deaths from as early as 1956 all the way up to as late as 2006 and comes from Defense Casualty Analysis System Extract Files from The Vietnam Conflict Extract Data File. 

I did my homework. I’m not giving you fake numbers here. 

Essentially, 13,780 more deaths happened because of opioids, In just one year. In just 2017. That doesn’t even begin to scratch the surface when you start totaling up 2016, 2015, and further back. Unbelievable isn’t it? 

If we look at it, 2014 had 28,647 deaths, 2015 had 33,100 deaths, 2016 saw 63,632 deaths…..and then 72,000 in 2017. 

I’m guessing you can see the trend. Hell yes, it’s an epidemic.

The Math

I’ll do the math for you because I love you and I’m glad you’re here and I don’t want you to have to think too hard while you’re giving me your time. Over the last 4 years, that’s approximately 200,000 opioid-related deaths. 197,379 to be more specific. 

The genie seems to be out of the bottle.

While we can’t put the genie back in, we can offer solutions for the future. Many of those addicted to opioids became addicted due to spinal surgery. Many of those surgeries were unnecessary. One paper I reviewed showed that approximately 5% of lumbar fusions are necessary making about 95% of the unnecessary. Yeah….95%. 

The Answer

We have the answer people. The American College of Physicians, The White House, The Lancet, 2 papers in JAMA, Consumer Report surveys, The Joint Commission, The FDA…..seriously, there is not one reason that we aren’t inundated by spinal pain referrals at this very moment. No reason at all. It actually makes me mad as hell that we are not. 

Exactly what the hell does it take to make general practitioners, neurosurgeons, orthopedic surgeons, nurse practitioners, and physician assistants understand that an evidence-based chiropractor is best situated to help these people as a first-line therapy?

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

http://www.chiropracticforward.com

Social Media Links

Chiropractic Forward Podcast Facebook GROUP

Twitter

YouTube

iTunes

Player FM Link

Stitcher:

TuneIn

About the Author and Host:

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

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

CF 012: Proven Means To Treat Neck Pain

CF 041: w/ Dr. William Lawson – Research For Neck Pain

CF 050: Chiropractic Care – Text Neck, Headaches, Migraines

 

 

 

Bibliography

1. Lemeunier N, Reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders: Part 1—A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration. Euro Spine J, 2017. 26(9): p. 2225-2241.

2. Anderst W, Intervertebral kinematics of the cervical spine before, during, and after high-velocity low-amplitude manipulation. Spine (Phila Pa 1976), 2018. 0(0).

3. Weixel N. CDC: Drug overdoses hit new record. The Hill 2018  5 August 2018]; Available from: https://thehill.com/policy/healthcare/401961-cdc-drug-overdoses-hit-new-high-in-2017.

 

 

CF 049: The Palmer/Gallup Poll 2018 Discussion On Chiropractic Marketing

CF 049: The Palmer/Gallup Poll 2018 Discussion On Chiropractic Marketing

Today we’re going to talk about the 2018 version of the Palmer Gallup poll that has some great info including some chiropractic marketing nuggets for your nugget pouch so stick around as we get into the details

But first, make way for that sweet sweet 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.  

Introduction

You have crumpled into Episode #49. Info to help with your chiropractic marketing. We are moving in on a solid year of Chiropractic Forward episodes and that feels good. Every single week. We haven’t missed one week this past year. There is most certainly a sense of accomplishment and doesn’t it feel good to feel good? Of course, it does. 

The Diplomate of American Chiropractic Orthopedists (DACO)

Let’s talk a bit about the DACO program – Same as last week. Just trudging along. Last week I took classes on benign paroxysmal positional vertigo, poster canal, anterior and horizontal canals, Epley’s maneuver and all that goes along with that. I also had a class on Lumbar spinal stenosis that I learned some new tidbits on. Great stuff. My offer stands, if any of you want to start looking at it, I’d be glad to give you a little guidance in getting yourself started. 

Newsletter

How’s about youse guys head over to chiropracticforward.com and get yourself on our newsletter. I have some cool stuff coming down the pike and I want you to be the first to know about it and I want you to save money because you were cool enough to be on our email list. No more than once a week. That’s my guarantee. It’s just an email address folks. Not a big deal. 

Personal happenings

You have heard my woes and my front desk worries over the past month or two. I told you last week that it appears my wife has herself a new full-time gig and guess what? With her help, we had not only one of the best Octobers we have ever had, but we also had one of the best months (numbers-wise) that we have ever had in 20 years. 

I believe there’s something to this “wife working the front desk” idea people. Something to think about for sure. If you can work with your wife or husband that is. You may have to pee strategically around the office just to mark your territory and let it be known this is your domain but, nobody will work as hard for the office as someone that has a vested interest in it. I’m a firm believer in that. 

Into The Information

We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

This week I want to talk about the Palmer/Gallup poll that has been coming out annually for a couple of years now. I think it’s two years but cannot recall off the top of my head. 

Regardless, let’s talk about the 2018 version. I look forward to its release every year because you can get some chiropractic marketing ideas from it if you’re looking at it the right way. 

The Ideal Patient

Any time you start a new generic chiropractic marketing program, they have you create your ideal avatar or your ideal customer. The customer that not only comes in and you love to see them come through the door but the customer that is coming in and paying good money to see a good doctor. The people that love you and go out into the world to tell everyone every good thing they can about you and the ones that are the first to leave you a great Google review. 

THAT’S the ideal patient, isn’t it? If we could only fill up our offices with that specific, amazing person all day every day. We’d never even think about giving up our practices and moving to an exotic place with umbrellas and funny drinks. Chiropractic marketing would be non-existent. 

Well, we may still think about doing that but it wouldn’t occupy as much brain space if these people were all that ever came through our door. 

Don’t we just love seeing these perfect patients? Smiles, good vibes, and excitement. And sometimes food!! I have one bring us pumpkin spiced cake and sugar cookies last week. We need to work on a nutritional talk for sure but you get the point. 

On To The Poll

I am linking the poll in the show notes so go check it out Episode 49 at chiropracticforward.com

http://www.palmer.edu/uploadedFiles/Pages/Alumni/gallup/palmer-gallop-annual-report-2018.pdf

The first thing we really get into here is the Summary and I think that’s really where we are going to stay instead of going too deep in because we’ll wind up with a 4 hour episode and I don’t want that any more than you do so let’s hit the high spots and call it good. 

  1. Neck and back pain is common among adults in the US – yes, we knew that now didn’t we? They say about 2/3 of US adults (62% to be specific) have had neck or back pain that was significant enough that they saw a healthcare professional for care at some point in their lifetime, including 25% who did so in the last 12 months. 
  • 25% of the population sought care in the last year for pain. I bet 25% did not seek care for wellness. 

2. 80% of American adults prefer to see an expert in spine care for neck and back conditions rather than a general medicine professional who treats anything and everything. I think we all know who the experts are right? It’s us….

He’s a problem though, 67% of them prefer to see someone that can prescribe medication or surgery to treat neck or back pain.  Only 28% want to see someone that does not use prescription medication or surgery. That one is a bit of a kick to the nether region. I thought we were making more progress on that front. 

I can’t tell if the next point contradicts the previous one or not. You decide. They say that prescription pain meds aren’t preferred as first-line care for about 79%. I can only guess they are preferring a practitioner that can prescribe just in case it declines to the point of needing it but they don’t necessarily want to start with pills? Maybe…..

3. When it comes to healthcare providers, people say that chiropractic doctors and medical doctors are the top choices for neck or back pain care. In the last year, 62% say a medical doctor while 53% saw a chiropractic doctor. 

Peel Back The Layers

Going a little deeper there, 34% say a PT and 34% visited a massage therapist. 

I think it’s of important note here that half of the people that went to the chiropractor went because they said that chiropractors provide the most effective treatment for their pain. That’s pretty damn awesome right there. We’ll get to the other half here in just a minute. 

The overwhelming feeling in this subsection is the keyword is “EFFECTIVENESS.” Can you say, “Chiropractic Marketing Nugget?” How effectively can you relay your effectiveness? 

I would offer to you the idea that this podcast is an EXCELLENT way to speak about your effectiveness as well as to back up your effectiveness. You just have to listen and you have to take what you learn and turn that into kick-butt content and marketing material. 

Since not everyone is particularly gifted at chiropractic marketing or creating content, we are working on helping you out in that aspect. Stick with us. It’ll happen. Just go to  chiropracticforward.com and get on the email list to stay on top of that. 

Outside of ‘effectiveness,’ SAFETY was another reason people chose chiropractors and PTs for their back and neck pain. In fact, about half of those coming to the chiropractor said safety was why they chose chiropractic.

So, we have the big TWO reasons. Only two. That people go to chiropractors nationwide. They are Effectiveness and Safety. That should be useful information for you guys and gals to take and run with. Chiropractic marketing at its best. 

Next point

4. The fourth point of the summary was types of care. They found a lot of people utilizing self-management at home, as they should. They say 53% of American adults went to get massages to control pain. They say 47% had chiropractic care for their pain. And 42% went to a PT. 

That means we have a lot of people doing more than one thing right? It would make perfect sense to not be a one-trick pony in your practice. For instance, the subluxation guys and gals only adjust. They’ll see a patient 100 times a year and only adjust. Nothing else.

Oh wait, I lie. There’s a local guy here that will pray over each one before using the activator on them all so I guess it’s a little more than just the adjustment. 

I don’t want to make light of prayer. I’m a Christian and am well aware of the power of prayer but when it’s done after joining Body By God type management programs, well, it just seems a bit disingenuous doesn’t it? If we’re being honest?

Anyway, if you have to see someone that many times a year, you’re probably a terrible chiropractor and you’re probably doing more damage than you are doing good.

Diversifying

Back to doing more than one thing: it’s clear that patients are not looking for just an adjustment. It appears they’re looking for chiropractic, they’re looking for massage, they’re looking for some exercise/rehab considering 72% were looking into yoga. 

Although it’s not in this article, I believe many are looking for acupuncture these days. As discussed earlier, they may potentially be looking for meds so why couldn’t you offer anti-inflammatories like turmeric or Boswellia just to name a few. I say this because this poll showed that 73% of people took an over the counter medications like acetaminophen or ibuprofen. Definitely food for thought. 

5. Patient Experiences

Patients that visited a chiropractor, a PT, or an MD over the last year said they received a high level of care. That’s good news. 

For chiropractors specifically, 9 out of 10 patients said

  • The chiropractor listened to them
  • DCs provided convenient and quick care
  • We demonstrated caring and compassion
  • The chiropractor explained things well
  • And they spent the right amount of time with them

Approximately 90% of patients had all of that to say about chiropractic doctors. That’s outstanding news, folks. That means that we can fight amongst ourselves and, while I would argue the straights are keeping us from full integration, in the eyes of patients, almost ALL of us are doing a good job!

For Physical Therapists, overall, they were hitting around the 83%-86% area. 

For MD’s, they didn’t do too well honestly. But didn’t we expect that? Here’s how they fared:

  • 72% say their MD listens
  • 67% said they often explain things well
  • 66% said they demonstrate care and compassion
  • 53% said they have quick access and are convenient

No surprise there. In fact, the surprise comes when we see that so many are still going to the GP for non-complicated musculoskeletal pains. That’s the real surprise. 

Point 5 Discussion

When you consider that chiropractors hit around 90% for all of those and you see MDs around 64% for the same metrics, well…..that’s not so good, right?

I see A LOT of opportunities here. If you are of the marketing mind, I’m sure you see the same!

This podcast isn’t just for listening to some mindless drivel folks. I am trying to give you stuff that you can use immediately after you listen. If you pay attention to what I’m telling you every week, you can turn around and communicate FACTS to your patients, your staff, and to those in the medical field in your region. 

I’m friends with a neurosurgeon and a vascular surgeon because I’m not freaking crazy. I can communicate research to them in an effective way that they understand. I’ve taught them a ton they didn’t already know. Plus we all like a Cerveza here and there so that works out well for us. 

Research helps you communicate

What I’m saying is that you should be listening to this podcast to learn for sure. But you should also be listening to it with the mindset of, “How am I going to take this information and use it in either my marketing or in my communication with my community?”

Believe me or don’t. I hope you believe me. The information I am bringing to you is the information you should be using. Not the subluxation stuff. Not the philosophy stuff. Literally, straights in our profession are the only people on this Earth that give a damn about that stuff. 

Nobody else knows or cares. Nobody. 

But research, safety, and effectiveness, well…..when you’re talking in those terms, then you are getting somewhere. 

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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

Contact

Send us an email at dr.williams@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.

Being the #1 Chiropractic podcast in the world would be pretty darn cool. 

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

http://www.chiropracticforward.com

Social Media Links

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

iTunes

Player FM Link

Stitcher:

TuneIn

About the author:

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

http://www.palmer.edu/uploadedFiles/Pages/Alumni/gallup/palmer-gallop-annual-report-2018.pdf

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

 

CF 034: Chiropractic Information To Help You Form Your Practice

 

CF 032: How Evidence-Based Chiropractic Can Help Save The Day

 

CF 048: Do Disc Herniations On An MRI Worsen When Sitting Or Standing (PART TWO)?

CF 048: Do Disc Herniations On An MRI Worsen When Sitting Or Standing (Part TWO)?

Today we’re going to continue our talk from last week on whether or not a disc herniations change as you sit up, stand up, or move around. We went over some pretty good research last week. This week, it’s time for the cherry on the top. 

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 scampered into Episode #48. I use scamper this week because, as my son was playing with his aunt and uncle’s dog named Rowdy down in Dallas last weekend, that was the way he described when the dog would take off after the tennis ball every time. Scamper. Great word that I plan on using more from here on out where appropriate. 

Diplomate of Chiropractic Orthopedists

The DACO this weekend down in Dallas. The class was with James Lehman. Dr. Lehman, in case you do not know, is with the University of Bridgeport Connecticut. His official title from their website is Associate Professor of Clinical Sciences, Health Sciences, College of Chiropractic. 

Dr. Lehman is also one of the main drivers of this DACO program. Through Univ. of Bridgeport Connecticut, he has teamed up with CDI out of Australia and their courses in neuromusculoskeletal online education. It is VERY well done. Very professional and very worthwhile. You can find that at https://cdi.edu.au

We talked a lot about some stuff that I want you to hear straight from him so we’ll do an interview with him very soon but the gist of it all is this: get certified in something other than simply having your doctor of chiropractic degree. 

FQHC

I’ve heard a couple of opinions. I’ve heard the Diplomate programs are worthless now and that people are moving away from them. But, I think that’s coming from people that don’t want to take the time or put in the effort. The real story is most likely that our system, for good or bad, is moving away from private practice and TOWARD integrating through the group offices and through the Federally Qualified Health Centers. 

There are chiropractors being reimbursed in the system up to $300 for a Medicaid visit and around $150 on the lower end. 

I have to thank Dr. Craig Benton once again for bringing this to my attention. Did you guys know that, given the right positioning, you could make that much per appointment from freaking Medicaid?

Here’s the deal though: you have to be a specialist. A Diplomate. So, is it really useless? I say it most certainly is not. 

Whiplash Section

Now the course, the course this weekend was on whiplash. I’ve been through Art Croft’s 4 part Advanced Certification on Whiplash Biomechanics and Traumatology so I can say with a lot of honesty that a good portion of the course was a refresher for me. 

But, I absolutely learned a solid amount of new stuff as well. Such as Axillary compression. Axillary compression was not a condition of the shoulder that was on my radar screen prior to this course. 

That is one simple little example but there was a gob of nuggets for the nugget pouch and as always, I really walked away feeling that I will be better at my job on Monday. But it’s always that way. Even after just a 2-hour online course. It’s phenomenal.

Personal

Continuing the ongoing saga of hiring a front desk staff member in the year 2018. Here’s what all I’m going to say about it. Looks like my wife has found a new full-time job. Lol. Get the picture?

It looks like I may have a cool speaking gig coming up in February. Nothing solid but, if I were to come to your state convention or to some sort of event you are at, what topic along the vein of Chiropractic Forward’s typical content would you like to learn more about? 

If you are a regular listener and familiar with what we have been doing here this last year, I’d really appreciate it if you would take just a minute and email me at dr.williams@chiropracticforward.com and give me a little guidance. What topics would you want to see in a presentation?

I’m glad you’re here and hopefully, I didn’t ramble too much before getting to the meat and taters. Here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

On To The Research

Picking up from last week, we want to start in on the changes disc herniations undergo when axial pressure is placed on them. In other words, what happens to disc herniations from the time the MRI is taken laying down to the point where the person sits up. 

I have to preface it all by saying go listen to last week’s episode which is #47, please. It tells you how it is very common in the medical field amongst even radiologists to assume or guess that there is no change in the disc or in the herniation when axial pressure is applied. Research tells us differently. 

This week we want to start with a paper called “Evaluation of intervertebral disc herniation and hypermobile intersegmental instability in symptomatic adult patients undergoing recumbent and upright MRI of the cervical or lumbosacral spines.” It was done by Ferreiro Perez, et. al[1]. and published in the European Journal of Radiology

How they did it

  • 89 Patients studied
  • 45 of them had their low back imaged
  • 44 patients had their necks imaged
  • The images were done in both the lying down position as well as the sitting.

What They Found

  • The overall combined recumbent (lying down) miss rate in cases of pathology was 15%
  • Overall combined recumbent underestimation rate in cases of pathology was 62%
  • Overall combined upright-seated underestimation in cases of pathology was 16%.

Wrap It Up

Upright-seated MRIs were seen to be superior to recumbent MRIs in 52 of the patients studied for conditions of posterior disc herniations and spondylolisthesis. Recumbent MRIs were only superior in 12% of the patients.

Next, this one is titled, “Effect of intervertebral disk degeneration on spinal stenosis during magnetic resonance imaging with axial loading” by Ahn et al[2].

Why They Did It

The authors in this paper were wanting to determine if disc degeneration will increase the severity of spinal stenosis when the spine is loaded with axial pressure. 

How They Did It

They had 51 patients with symptoms of neurogenic intermittent claudication and/or sciatica that had their MRIs loaded as well as non-loaded. 

The foramen involved were all measured for changes in sizes.

Wrap It Up

Here’s what they found, “More accurate diagnosis of stenosis can be achieved using MR imaging with axial loading, especially if grade 2-4 disc degeneration is present.”

AKA:” Seated or loaded MRIs are superior for assessing lumbar stenosis. 

Next, this one is by Willen[3] and it’s called “Dynamic effects on the lumbar spinal canal: axially loaded CT-myelography and MRI in patients with sciatica and/or neurogenic claudication.” It appeared in Spine Journal in 1997. 

They had 50 people with CTs, 34 were imaged with MRI, the imaging was performed laying down as well as axially loaded. 

They closed it up by saying, “Axial loading of the lumbar spine in computed tomographic scanning and magnetic resonance imaging is recommended in patients with sciatica or neurogenic claudication when the dural sac cross-sectional area at any disc location is below 130 mm2 in conventional psoas-relaxed position and when there is a suspected narrowing of the dural sac or the nerve roots, especially in the ventrolateral part of the spinal canal in psoas-relaxed position”

Next Paper

This one is by Kanno, et. al[4]. called “Axial loading during magnetic resonance imaging in patients with lumbar spinal canal stenosis: does it reproduce the positional change of the dural sac detected by upright myelography?” It appeared in Spine Journal in 2012. 

44 patients, with imaging in the supine position and then with axial load added. The dural sack was measured 

“The size of the sack was significantly reduced in the axially loaded imaging and the axial loaded MRI detected severe constriction with a higher sensitivity (96.4%) and specificity (98%) than the conventional MRI.”

Next paper

This one is by Danielson et. al. from 2001 called, “Axially loaded magnetic resonance image of the lumbar spine in asymptomatic individuals.” This paper appeared in Spine Journal in 2001 as well. 

MRIs were performed lying down as well as with axial load on the participants. The axial loading was performed lying down, face up with a compression device built for this study specifically. The diameter of the dural sack was measured to check for the differences. 

The authors said, “A significant decrease in dural cross-sectional area from psoas-relaxed position to axial compression in extension was found in 24 individuals (56%), most frequently at L4-L5, and increasingly with age.”

Pretty cool stuff right there people. 

I want you to go forward this week knowing what you get from listening to this podcast every week. You get things you can absolutely use and implement immediately. Some of you may gain confidence now that you know some research that you maybe didn’t know previously. Some of you may now be able to tell a patient that has a 5mm central posterior herniation that 5mm isn’t telling us the whole story. 

It’s telling us part of the puzzle but that discs respond to positioning and various stresses we put on the discs through our activities. 

Use it or lose it

This can give you some extra guidance in your recommendations when you consider disc herniations change and get worse, stenosis gets worse when the patient sits up or bends forward. 

If you aren’t up on directional preference exercises, McKenzie, and CRISP protocols, it’s time to get there folks. It’s time to get there. The anatomy absolutely responds to movement and positioning. 

Integrating Chiropractors

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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability.

It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

Contact Us!

I want to ask you to go to chiropracticforward.com and sign up for our newsletter. We love to stay in touch and want to offer you discount specials when we get our educational products up and rolling. 

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.

Being the #1 Chiropractic podcast in the world would be pretty darn cool. 

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

http://www.chiropracticforward.com

Social Media Links

Chiropractic Forward Podcast Facebook GROUP

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

iTunes

Player FM Link

Stitcher:

TuneIn

About the author:

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

CF 047: Do Disc Herniations On An MRI Worsen When Sitting Or Standing (PART ONE)?

CF 035: Chiropractic & Disc Herniations

Bibliography

1. Ferreiro P, e.a., Evaluation of intervertebral disc herniation and hypermobile intersegmental instability in symptomatic adult patients undergoing recumbent and upright MRI of the cervical or lumbosacral spines. Eur J Radiol, 2007. 62(3): p. 444-8.

2. Ahn TJ, e.a., Effect of intervertebral disk degeneration on spinal stenosis during magnetic resonance imaging with axial loading. Neurol Med Chir (Tokyo), 2009. 49(6): p. 242-7.

3. Willen J, e.a., Dynamic effects on the lumbar spinal canal: axially loaded CT-myelography and MRI in patients with sciatica and/or neurogenic claudication. Spine (Phila Pa 1976), 1997. 22(24): p. 2968-76.

4. Kanno H, e.a., Axial loading during magnetic resonance imaging in patients with lumbar spinal canal stenosis: does it reproduce the positional change of the dural sac detected by upright myelography? Spine (Phila Pa 1976), 2012. 37(16): p. E985-92.

CF 046: Chiropractic Effectiveness – Chiropractic Integration – Chiropractic Future

Chiropractic Effectiveness – Chiropractic Integration – Chiropractic Future

Today we’re going to talk about what I think is some good news that bodes very well for the chiropractic future, for chiropractic integration, chiropractic effectiveness, and playing well with others. We’ll discuss a paper on non-pharma ways of treating pain and then we’ll discuss an article showing how roadblocks are set up to keep Americans from following those recommendations.

Stick with us as we shake it all out, but first, here’s that bumper music

Integrating Chiropractors

Welcome to the podcast today, I am still pretty new to the podcast game so, in case you don’t know me just yet,…I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.

You have gallivanted into Episode #46 and we are so glad you did.

DACO Program

Let’s talk a bit about the DACO program, I have gone through 30 hours live and have taken 12 hours online so far. That makes 42 of the 300 but hey, who’s counting right? The last one I took had to do with Cervical pain and neural tension. I’m man enough to admit that, while I have an A in the class, I missed a question on this one and here’s what I’m going to say…..STOP. Stop asking trick questions dammit.

Honestly, you can know the material cold but the way they ask some of the questions, there’s no telling what the hell the answer is. “Which statement makes the most clinical sound?” Fine…no problem. But, as you read through them, there is maybe one answer that is very thorough while the others are not technically incorrect but aren’t quite as comprehensive as the one answer. Then, yes…..the feared…..ALL OF THE ABOVE.

Uh huh….just ask the damn question and be fair about it. That’s all I’m saying. On one hand, one answer is most definitely more clinically sound than the others. On the other hand, all of them have some correct aspects. So, you’re bound to miss some here or there and, with only 5 questions, you miss one, you make an 80. An 80 is hard for me to swallow friends.

So….cut it out, people. Be fair in your questioning. Thank you very much

The material though, my goodness. I can’t even begin to tell you all how wonderful the material is. Of course, I like some of the classes more than others. The one on pain was not necessarily my favorite but I muddled through it and still know a ton more about pain than I did prior to. Pain is a difficult topic but they did an excellent job of lining it out for us.

Every class makes a difference. Without a doubt. Let me know if you need some guidance on getting started on your DACO. Which was the main thing for me….just getting started in the first place. It’s a bit confusing but once you get enrolled and get that first class under your belt, you’re good to go. Just email me at dr.williams@chiropracticforward.com

Sign up for our Chiropractic Forward Newsletter

If you haven’t yet, please go sign up for our Chiropractic Forward newsletter by going to chiropractic forward.com and it’ll pop up right there. You can’t miss it. It almost punches you right in the face. Help us keep pass along important stuff here by getting on that newsletter. Never any more than once per week. Promise.

Evidently, you and your colleagues are catching onto this here podcast. We appreciate it and we appreciate your continuing sharing it with you people. That’s the only way to grow.

Front Desk Woes

So far, we still have the front desk staff in place. So that’s been amazing to not be obsessing about. It is really hard to find the right person with the right qualities to fill that spot. I’m not spouting fake numbers when I tell you that we see an average of about 60 new patients per month by myself.

No associate. I had a colleague recently tell me they don’t think they could do that by their self. I have to admit, I didn’t realize it was an impressive amount. Lol. I was glad to hear it though. Here’s my deal though, I don’t hold onto them. I see them, get them better, and will have them again in a year or so when they re-injure something.

I have about 40 or so visits booked per day and that’s pretty manageable when you have great staff. I still work from 8-1 on Fridays too. The majority of my time is spent on new patients trying to figure them out. After we have a direction with a patient, however, we have a team of people that really help take the workload off of me other than the actual adjusting.

And, in case anyone is wondering out there, I adjust manually, Diversified with some drops here and there. Very little activator. Some muscle work when appropriate but there’s not a lot of fluff in a visit once we are rocking and rolling with a case.

I tell them that I can really drag this visit out and make it last a lot longer than it takes if they want me to but most are ready to get in and out and back to work. And that works well for us too.

Getting back on track

Anyway, back to the original point: it’s hard to find someone that is not intimidated by the insurance demands, new patients, existing patients, etc…but excited about chiropractic effectiveness….looking them in the eyes all day every day all day.

Plus, a third of the building is massage, day spa services so, the right person is key. They get intimidated and leave. Lol. I suppose it’s a good problem to have. But, so far so good with the new one!

As I’ve said before, I will certainly keep you updated.

We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

Let’s get into the papers

Let’s kick off the discussion today with one from McGregor, et. al. 2014 called “Differentiating intraprofessional attitudes toward paradigms in health care delivery among chiropractic factions: results from a randomly sampled survey.” It was published in BMC Complementary and Alternative Medicine[1].

In the background section of the abstract, the authors’ discuss how healthcare has increased in complexity and there has developed a need for interprofessional collaboration. Amen, brothers and sisters.

It goes on to talk about how different factions within the chiropractic profession are contrary to each other and how one faction holding unorthodox practice beliefs and behaviors may compromise interprofessional relations going forward.

We can have all of the research on our side but when you have one faction of the profession spouting chiropractic effectiveness for everything under the sun, well, the credibility of the profession as a whole really suffers.

The purpose of this paper was, “to quantify the professional stratification among Canadian chiropractic practitioners and evaluate the practice perceptions of those factions.”

How do you go about figuring this stuff out? Luckily, there are far more intelligent people out there in the world. They took a stratified random sample of 740 Canadian chiropractors and surveyed them in an attempt to determine faction membership and how professional stratification could be related to views that could be considered unorthodox to current evidence-based care and guides.

What they found

Out of 740 questionnaires, 503 came back.

Less than 18.8% of the chiropractors were in the faction considered to be unorthodox in the perceptions of the conditions they treat.

They also state that prediction models suggest that unorthodox perceptions of health practice related to treatment choices, x-ray use, and vaccinations were strongly associated with unorthodox group membership.

The conclusions reached here were as quoted, “Chiropractors holding unorthodox views may be identified based on response to specific beliefs that appear to align with unorthodox health practices.”

Despite continued concerns by mainstream medicine, only a minority of the profession has retained a perspective in contrast to current scientific paradigms. Understanding the profession’s factions is important to the anticipation of care delivery when considering interprofessional referral.”

Basically, what they’re saying is that, in Canada at least, there are 20% of you chiropractors walking around saying your nerve doctors, that you fix everything under the sun, and you’re releasing the innate and turning on the power. This isn’t chiropractic effectiveness. This is belief. Not research-based findings.

That 20 % is REALLY putting 80% of us that have busted our butts and learned the latest science and research….you’re putting us at risk of staying right where we’ve always been rather than expanding, integrating, and being the experts in what we do.

We are masters at what we do but there are 20% out there keeping anyone that matters from taking the rest of us seriously. When we are talking about legitimate chiropractic effectiveness, that 20% has taken away our credibility.

Parento’s principle proves to be a real thing once again. 20% of chiropractors do all of the work in discrediting the other 80% of the profession.

Next paper

Let’s go to the next paper before I lose my mind.

This one is called Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care[2]. It was published in June of 2018 in Explore: The Journal of Science and Healing and was written by Heather Tick MD along with a team of other medical doctor/PhDs.

Dr. Tick is a specialist in pain management in Seattle Washington. She even has her own website and blog. All that good stuff. You can check it out at heathertickmd.com if you are so inclined.

A little more about her: She co-founded and directed one of the first inter-disciplinary pain centers in Toronto from 1991 – 2008 and has been involved in research with the University of Waterloo at the Department of Kinesiology, the Canadian Memorial Chiropractic College (CMCC), the University of Washington, and the University of Arizona.

She served as the Director of the Integrative Pain Clinic at the University of Arizona in the Department of Family and Community Medicine until Dec 2011, when the University of Arizona Health Plan recruited her to start the integrative medicine pain clinic for Medicaid patients.

Dr. Tick currently serves at the forefront of research and teaching as a Clinical Associate Professor at the University of Washington in the departments of Family Medicine and Anesthesia & Pain Medicine and is also the first holder of the prestigious Gunn-Locke Endowed Professorship of Integrative Pain Medicine at the University of Washington.

In this paper, Dr. Tick starts by saying “Medical pain management is in crisis; from the pervasiveness of pain to inadequate pain treatment, from the escalation of prescription opioids to an epidemic in addiction, diversion and overdose deaths.”

I like that opening quote. I like it a lot, folks. She’s saying that the medical way of managing pain isn’t working and throwing more pills at it is a downward spiral. And I agree as I’m sure you do as well.

She goes on saying, “There is pressure for pain medicine to shift away from reliance on opioids, ineffective procedures and surgeries toward comprehensive pain management that includes evidence-based nonpharmacologic options.

“Transforming the system of pain care to a responsive comprehensive model necessitates that options for treatment and collaborative care must be evidence-based and include effective nonpharmacologic strategies that have the advantage of reduced risks of adverse events and addiction liability.”

Conclusion

The evidence demands a call to action to increase awareness of effective nonpharmacologic treatments for pain, to train healthcare practitioners and administrators in the evidence base of effective nonpharmacologic practice, to advocate for policy initiatives that remedy system and reimbursement barriers to evidence-informed comprehensive pain care, and to promote ongoing research and dissemination of the role of effective nonpharmacologic treatments in pain, focused on the short- and long-term therapeutic and economic impact of comprehensive care practices.

Here’s what I hate to do: I hate quoting an abstract word for word. It’s usually dry and well….boring. But, what she says here is so spot-on, quoting it was the best way to get it across in an equal manner. Meaning that I couldn’t say it better myself. Chiropractic effectiveness is becoming undeniable at this point.

She nails it:

  1. It’s not working
  2. We need non-pharma options that are backed by evidence
  3. There are barriers set up to prevent non-pharma options from being utilized
  4. There is ignorance in regards to non-pharma options and that needs to be addressed through education
  5. Continued research is needed

Further down into the paper, the authors mention in one spot that chiropractic care is 60-70% less likely to be reimbursed. Is that accurate? We are typically covered by most insurance plans no?

When they are saying that there are barriers set up to prevent complementary options, this may fit her rhetoric or point but I just haven’t experienced it being that much less likely to have coverage.

They cite a paper by James Whedon, Et. al. where they found, for New Hampshire[3], there was 60%-70% less reimbursement. I wonder if that is consistent throughout the US or if it’s isolated to New Hampshire?

That’s a great question and if one of you out there in podcast listening land knows the answer, please email me at dr.williams@chiropracticforward.com and fill me in. I’m curious and I’m pretty sure the rest of us out there are too.

Under their Evidence-Based Non-pharm Therapies for Acute Pain, they point out that non-pharma therapists have shown effective in acute pain with opioid paring in the hospital setting as a result of their use and the therapies mentioned in the paper are acupuncture, chiropractic, osteopathic manipulative therapy, massage, physical therapy, relaxation, and cognitive behavioral therapy.

The authors also site spinal manipulative therapy as being effective for chronic pain including migraines, cervicogenic headache, neck pain, low back, hip pain, patellofemoral syndrome, and on and on. Of course, we chiropractors know this stuff but it’s great to see it in black and white and as part of a paper written exclusively by MDs and PhDs.

This is a long paper with a lot of excellent information. I highly encourage your checking it out. Just go to our show notes for links and citations.

Wrap it up

A great takeaway from this paper is this quote, “In general, the costs of evidence-based nonpharmacologic options are nominal compared to medical costs of treating chronic pain with risk mitigation and greater potential for engaging patients in ongoing self-care.”

This is exactly why we are discussing chiropractic effectiveness at length these days. It is paramount for the future of our patients as well as for the the chiropractic future for people to get this message.

Last Paper

The last paper I want to talk about is by our very own Dr. Christine Goertz, DC, Ph.D. with Steven George, PT, Ph.D. as her side-kick and is published in JAMA. It’s called “Insurer Coverage of Nonpharmacological Treatments for Low Back Pain—Time for a Change[4]” and published on October 5 of this year so, just this month. Brand new.

Dr. Goertz begins by relating low back pain with the obvious opioid crisis and goes into last year’s recommendation that you’ve heard here a million times.

The recommendations from the American College of Physicians for low back pain which recommended spinal manipulative therapy as a first-line therapy for chronic and acute low back pain.

We will talk about it in upcoming episodes but Dr. Goertz also mentions the new Gallup-Palmer Poll where they found that 78% of US adults prefer to use non-pharma options for back and neck pain.

In the article, she cites a paper by Heyward, et. al[5].  called “Coverage of Nonpharmacologic treatment for low back pain among US public and private insurers” that found coverage of some therapies (like chiropractic) was available in most health plans but that there are significant barriers to patient access identified.

Barriers such as visit limits, prior authorization requirements, and high out-of-pocket expenses. And that payment policies targeted toward coordination of pharmacological and nonpharmacological care were virtually nonexistent.

She says pretty clearly the following: In regards to most health plans surveyed, they did not have policies in place that:

  1. emphasize the use of nonpharmacological treatments at the forefront of the patient experience
  2. provide meaningful levels of coverage for care professionals who focus on guideline-adherent nondrug therapies like spinal manipulation, exercise, massage, acupuncture, and cognitive behavioral therapy
  3. us financial incentives that favor the use of nonpharmacological options over commonly prescribed pharmaceuticals, including opioids

Wrap it up

She also calls out healthcare executives quite effectively I thought by saying, “Relative to stigma, Heyward et al found that health care executives did not believe expanded coverage of nonpharmacological treatments is supported by the existing literature.

As outlined in the ACP guideline referenced earlier, in many cases nonpharmacological treatments offer equal benefit or even improved benefit, with lower risk, than commonly used pharmaceutical options.”

And by suggesting that future coverage policies should be based on unbiased reviews of the evidence appropriately balancing risk with benefit rather than prior dogma or biases.

Lastly, Dr. Goertz discusses cost-effectiveness and the need for future payment policies to decrease patient out-of-pocket expenses to strongly encourage earlier us of evidence-based non-harms options.

The Heyward paper demonstrated how trips to PTs or DCs are usually 6-12 visits with an out-of-pocket of $150-$720 or more. She then showed how Lin et. al. showed the median cost of a 30-day  supply of preferred generic opioid by commercial insurers is $10.

How does that add up for the Joe Blow citizen on the street?

It doesn’t.

I love how they sum it up by saying, “Restricting access to opioids without addressing the underlying problem of chronic care management for low back pain is unlikely to positively affect the opioid crisis. Well-conceived guidelines that encourage the use of evidence-based, nonpharmacological treatment options exist and must be enabled by changes in public health policies that better guide care delivery and reimbursement.”

Boom, Snap, kapow, Shazam…

Honestly, where would we be without Dr. Goertz? We’d still be moving the direction we’re moving in because of the opioid issue but she has done some amazing work that is putting us on the fast track where we hope to go rather than on the snail’s pace.

This week, I want you to go forward understanding that It’s happening folks. we are now able to cite papers in JAMA that are pro-chiropractic. Pro-complementary health care. Anti-pharma. This is big stuff. We are in the right place at the right time. And, it was in part, the failure of many in the medical kingdom that put us here. 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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability.

It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

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.

Being the #1 Chiropractic podcast in the world would be pretty darn cool.

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:

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

Insurer Coverage of Nonpharmacological Treatments for Low Back Pain—Time for a Change | Complementary and Alternative Medicine | JAMA Network Open | JAMA Network

Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care – Explore: The Journal of Science and Healing

https://www.ncbi.nlm.nih.gov/pubmed/28304182?dopt=Abstract

Differentiating intraprofessional attitudes toward paradigms in health care delivery among chiropractic factions: results from a randomly sampled survey | BMC Complementary and Alternative Medicine | Full Text

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2705853

Bibliography

1. McGregor M, Differentiating intraprofessional attitudes toward paradigms in health care delivery among chiropractic factions: results from a randomly sampled survey. BMC Comp Altern Med, 2014. 14(51).

2. Tick H, Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care. Explore J Science Healing, 2018. 14(3): p. 177-211.

3. Whedon JM, e.a., Insurance Reimbursement for Complementary Healthcare Services. J Altern Complement Med, 2017. 23(4): p. 264-267.

4. C, G., Insurer Coverage of Nonpharmacological Treatments for Low Back Pain—Time for a Chang. JAMA, 2018. 1(6).

5. Heyward J, Coverage of Nonpharmacologic Treatments for Low Back Pain Among US Public and Private Insurers. JAMA, 2018. 1(6).

CF 020: Chiropractic Evolution or Extinction?

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

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