Today we’re going to be joined by Dr. Kevin Christie of the Modern Chiropractic Marketing Podcast and we’re going to talk about marketing chiropractic of course but more specifically, marketing responsibly and marketing the right way. But first, here’s that sweet sweet bumper music
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.
I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. If you haven’t yet I have a few things you should do.
Like our Facebook page,
Join our private Facebook group and interact, and then
go review our podcast on iTunes and other podcast platforms.
While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it. You have found yourself smack dab in the middle of Episode #130
Now if you missed last week’s episode, we talked about Chronic Pain and Exercise. That episode had some excellent stuff in it from Craig Liebneson, Annie O’Connor, and several others. Great stuff. Make sure you don’t miss that info. Keep up with the class. While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points. Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.On the personal end of things….. When we have a guest, we typically dispense with personal practice observations. Other than my sharing with you all that it looks like I’m about to fully entertain hiring an associate. You know I’ll keep you all updated on this process and how it goes. Something that is that big of a change is, of course, stressful as hell. Throw in a pandemic and you might just say I’m up to my damn ears and eyes but sometimes, you’re led one direction or the other. Sometimes opportunity knocks and you must answer the door. We’ll see how it goes. Right now though, let’s get to our guest today and let’s get to marketing chiropractic. Kevin Christie understands the unique pressures of the evidence-informed chiropractor. Kevin has run his own practice for over fourteen years. With two offices and multiple staff (plus associates), he knows how important it is to not just be excellent at treating patients but being a great leader and marketer as well. Kevin has worked with the NFL, PGA Tour, and has been featured on ESPN and Fox Sports. Using the best tools available to us in the digital age, Kevin empowers evidence-informed chiropractors to achieve their own dreams of running a successful practice. Tools that help with marketing chiropractic.
Welcome to the show Dr. Christie, can I call you Kevin and you call me Jeff?
First thing’s first, congrats on the new baby. Are you getting any sleep?
Tell me a little about you. Being located in Boca Raton now, did you grow up in Florida?
What’s your chiro story? Why, of all of the things to be in the world, did you choose chiropractic?
I first became aware of you through your podcast. I was doing a little chiro podcasting research when I decided to turn my weekly blog into a weekly podcast. Then through your podcast, I sought out and joined your Facebook group by the same name. Your funnel worked on me. What got you so interested in podcasting, marketing chiropractic, and Facebook groups?
While I am mostly about research and evidence-based, patient-centered practice on this podcast, marketing is something I’ve done a lot of work on and is a big part of what I do day-to-day. It has definitely played a big part in what I talk about here on the podcast from week to week. I haven’t personally heard you weave current research literature into your marketing teachings but I know you are very evidence-based in your practice approach. How does being evidence-based and patient-centered play into your strategies and techniques for marketing chiropractic?
You have teamed up with Dr. Bobby Maybee to create a group called Chiropractic Success Academy. Tell me about it. How is it different than the run of the mill guru practice management groups? What doctors fit this group the best?
You do so many things, what does a regular week pre-COVID, look like for you?
If there were a younger chiropractor, fairly fresh out of school that wanted to be a Dr. Kevin Christie, where would you tell them to start and what steps would you tell them to take? What have been your career ‘game-changers’?
Speaking of younger chiropractors, when we met face to face in St. Louis at the Forward ’19 event, you told me about preceptors. I went an applied at Logan and I’m in. But I think there’s something more appealing about a young chiropractor going to Boca Raton rather than Amarillo, TX. I can’t quite put my finger on what it is but, for some of the older docs out there looking at needing some help and they have a teacher’s heart, can you share some of your preceptorship experiences with our audience?
Tell me about this new book you have coming out that Parker is publishing. How’d it all come about?
I really appreciate you taking the time. There’s literally something for every chiropractor in this episode, good luck with the book, thanks for helping others to learn marketing chiropractic ethically, and I know I’ll be buying one. Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week.
Remember the evidence-informed brochures and posters at chiropracticforward.com.
The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few.
It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient.
And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….
That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ TwitterTweets by Chiro_ForwardYouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
CF 129: Updated Thinking On Chronic Pain and Exercise Today we’re going to talk about chronic pain and exercise. But first, here’s that sweet sweet bumper music
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.
I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. If you haven’t yet I have a few things you should do.
Like our Facebook page,
Join our private Facebook group and interact, and then
go review our podcast on iTunes and other podcast platforms.
While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it. You have found yourself smack dab in the middle of Episode #129
Now if you missed last week’s episode, we talked about Tylenol failures, cervical disc research, and we talked about complementary and alternative treatment for headaches and migraines. What’s the current research and thinking? Make sure you don’t miss that info. Keep up with the class. While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points. Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.On the personal end of things….. Well, so far, no blowback from my rant on last week’s podcast so sometimes no news is good news. You either all agree with me or you’re not listening. Rocking and rolling here at work, last week was finally the busiest I have been since late January or early February. It was quite a blessing. I have to admit, I’m not used to working that damned hard anymore but it’s OK. I just need to get back into fighting shape so I can see them all. Last week we saw about 135 patients. Pre-COVID numbers were anywhere from 185-225 so I’m still significantly down but it’s trending upwards and it’s looking good right now. I cannot and will not fuss about it. Especially when I read that several are just now going back to work and have been closed completely this entire time. We’ve been fully, completely open for more than a month now. It’s hard to imagine being closed down any longer than we were honest. I don’t know how companies survive. I see reports that the virus may have mutated to a lesser severity. Not only are some doctors claiming that people are getting less severe when they do get sick, but they are not getting sick as easily. That’s some exciting news if it is indeed a fact. Time will tell. I don’t want to hear anything about ‘new normals’. Once this dude settles down, life will be normal. Not a new normal. It’ll be back to the way it was. I’m guessing August but who knows? It could be in the Fall. Maybe even the Spring. But it will be the old normal. You can count on that. I hopeyour businesses are picking back up as well. I hope you’re seeing those old familiar happy faces coming back into the office to greet you. I hope you’re back on track to showing the world how effective and amazing chiropractic can be when practiced by an evidence-based, patient-centered professional. That’s you. That’s who listens to this show and I’m proud of you all. You make this profession better every day and I thank you. I just hope you get something good from me every week. If you do, I won’t be shy about asking you to share this podcast with your colleagues. We are growing all of the time but it’s never quite fast enough to feel like I’m on a roll. So, with your help in sharing and talking about us, I think we can truly make a big difference and take this thing of ours to another level.Item #1 This first one this week is called “Exercise Induced Hypoalgesia Is Impaired in Chronic Whiplash Associated Disorders (WAD) With Both Aerobic and Isometric Exercise” by Smith et. al(Smith A 2020). and published in Clinical Journal of Pain in May of 2020. Oy…..that’s smokin’ hot! Why They Did It First, let’s define Exercise Induced Hypolagesia. It is a generalized reduction in pain and pain sensitivity that occurs during exercise and for some time afterward. So, for normal, asymptomatic people, when they exercise, there’s less pain and they feel better and that lasts for a while when they finish exercising. Exercise induced hypoalgesia can be impaired in patients with chronic pain and may be dependent on exercise type. Factors predictive of Exercise induced hypoalgesia are not known. This study aimed to:
compare Exercise induced hypoalgesia in participants with chronic whiplash associated disorders to asymptomatic controls,
determine if exercise induced hypoalgesia differs between aerobic and isometric exercise,
determine predictors of Exercise induced hypoalgesia.
How They Did It
A pre-post study investigated the effect of single sessions of submaximal aerobic treadmill walking and isometric knee extension on exercise induced hypoalgesia in 40 participants with chronic whiplash associated disorders and 30 controls
Pressure pain thresholds were measured at the hand, cervical spine and tibialis anterior
Appropriate baseline measurements were performed
What They Found Participants with whiplash-associated disorders demonstrated impaired exercise-induced hypoalgesia
There was no difference in exercise-induced hypoalgesia between exercise types Wrap It Up “Individuals with chronic whiplash-associated disorders have impaired exercise-induced hypoalgesia with both aerobic and isometric exercise. Higher levels of physical activity and less efficient conditioned pain modulation may be associated with impaired exercise-induced hypoalgesia.” Item #2 This last one is by the great Dr. Craig Liebenson and is called “Pain with Exercise: Is it acceptable & if so how much & for how long?” and was published in First Principles Of Movement on May 20, 2020(Liebenson C 2020). Pow! Hot like a firecracker folks. https://firstprinciplesofmovement.com/pain-with-exercise-is-it-acceptable-if-so-how-much-for-how-long/ For articles, we dispense with our normal outline and we hit the high spots and interesting points. Craig starts by quoting a paper by Smith, Littlewood where they say “Protocols using painful exercises offer a small but significant benefit over pain-free exercises in the short term, with moderate quality of evidence……Pain during therapeutic exercise for chronic musculoskeletal pain need not be a barrier to successful outcomes.”
He also quotes Annie O’Conner’s, author of World of Hurt, where she says we must violate the patient’s expectation that hurt equals harm. Especially with light pain. Craig also refers to a photograph from Silbernagel’s paper demonstrating a Pain-Monitoring Model where the safe zone on the VAS was 0-2, the Yellow or acceptable zone was 3-5 on the VAS, and the red high-risk zone was 6-10. Silbernagel says, “Biological plausibility/explanation and reasoning ranks high and then you can individualize. Meaning waiting for the pain to subside does not work because you get weaker and the tissue decreases its tolerance to load. So loading with pain is beneficial to get the structures to improve. However, if it is a fracture it might be very different so know the injury and tissue.”
I like this quote of Craig’s from the article: “Many people believe the medical adage – “if it hurts don’t do it”. We know that for some this promotes illness behavior by giving the idea that the body is fragile. Ben Smith & Chris Littlewood’s shoulder paper, Annie O’Conner’s WOH book, some of K Thorberg’s groin work, & you’re tendonopathy paper all show yellow pain is acceptable. He says the idea of, if it hurts, don’t do it brings about clear yellow flags. Yellow flags such as
Hurt = harm
activity is harmful
if an activity hurts it should be stopped
On the topic of osteoarthritis, he says
The patient decides what’s tolerable,
Above 5 is the red area
If pain increases with exercise, that’s OK as long as by the next day it has calmed.
He goes on to cite a new paper in JAMA by Ben Cormack asking about pain tolerance vs. using the traditional Numeric Rating Scale. They’re suggesting asking if the pain is tolerable is a better way to deal with it. Cormack says:
“The exclusive focus of the numeric rating scale (NRS) on pain intensity reduces the experience of chronic pain to a single dimension.”
“This drawback minimizes the complex effects of chronic pain on patients’ lives and the trade-offs that are often involved in analgesic decision-making.”
“Furthermore, continually asking patients to rate their pain on a scale that is anchored by a pain-free state (ie, 0) implies that being pain-free is a readily attainable treatment goal, which may contribute to unrealistic expectations for complete relief.”
The modern approach to managing disabling musculoskeletal pain is to shift the focus from chasing symptomatic relief to addressing activity intolerances related to symptoms.
“ The overarching goal of chronic pain treatment is to make the pain tolerable for the patient rather than to attain a targeted numeric rating.”
“Our findings confirmed the intuitive assumption that most patients with low pain intensity (ie, NRS score, 1-3) find their pain tolerable.”
“In contrast, the tolerability of pain rated between 4 and 6 varies substantially among patients.
“In this middle range, if a patient describes the pain as tolerable, this might decrease the clinician’s inclination to initiate higher-risk treatments.”
“A substantial subgroup of patients with severe pain reported their symptoms as tolerable.”
Dr. Liebenson wraps up the article by saying, “This discussion highlights that hurt does not necessarily equal harm. Nearly all musculoskeletal pain guidelines over the last 30 years have emphasized that pain does not equal tissue damage or impending injury. This study goes a long way to show us better ways to educate people in reassuring ways that will get them back to activity and thus build a mindset that can make them feel less fragile.”
Chronic pain is interesting stuff and is a HUGE market where there are lots of opportunities for educated, smart chiropractors to stick their flag in the dirt and stake a claim. Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.
Let’s get to the message. Same as it is every week.Key TakeawaysStore Remember the evidence-informed brochures and posters at chiropracticforward.com.
The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few.
It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient.
And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….
That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ TwitterTweets by Chiro_ForwardYouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Liebenson C (2020). “Pain with Exercise: Is it acceptable & if so how much & for how long?” First Principles Of Movement.
Smith A, R. C., Warren J, Sterling M, (2020). “Exercise Induced Hypoalgesia Is Impaired in Chronic Whiplash Associated Disorders (WAD) With Both Aerobic and Isometric Exercise.” Clin J Pain.
CF 124: w/ Dr. Michael Massey – Doing Thing Right, Medicolegal Thoughts, and How We Better Protect Ourselves Today we’re joined by Dr. Michael Massey. We’re going to talk about What We chiropractors Are Doing Wrong, we’ll talk about Medicolegal things, and we’ll talk about How chiropractors can go about Better Protecting Ourselves
But first, here’s that sweet sweet bumper music
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.
I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. If you haven’t yet I have a few things you should do.
Like our Facebook page,
Join our private Facebook group and interact, and then
go review our podcast on iTunes and other podcast platforms.
While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it. You have found yourself smack dab in the middle of Episode #124
Now if you missed last week’s episode, we talked about the primary spinal practitioner program, gabapentin, and cervical curvatures. Make sure you don’t miss that info. Keep up with the class. While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points. Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.On the personal end of things….. Before we get to our guest this week, I did a thing
Being an evidence-informed practitioner can present a set of problems at times. Mostly problems with regard to patient volume because we don’t typically treat a patient with long-term recommendations. So we see them come and go depending on if they hurt or not. It can lead to lulls, disappointment, and boredom if there’s not a steady stream of new patients coming through your pearly gates each and every month.
I have taken various courses over the years at Udemy so when I decided to create a course, I immediately thought Udemy would be a good place to start. While I’m still building the course and adding content every week, it’s live and ready to go for those interested in getting started. I’m putting the link to the course at this point in the show notes. https://www.udemy.com/course/marketing-evidence-based-chiropractic/?referralCode=36A4D91C66B48300360B Over the last two years or so, I’ve averaged almost 80 new patients every month as a solo practitioner. If you’re interested, I created, basically, my playbook for marketing and my thoughts on each topic or technique. I also have created downloads, checklists, and examples to show what my stuff looks like. Just go to udemy.com and do a search on Marketing An Evidence-Based Chiropractic Practice and check it out. It will grow and expand in the coming months and if you get just one patient from the ideas shared in it, it paid for itself. Now imagine if you get a bunch….well then it’s priceless. udemy.com and the course is called Marketing and Evidence-based Chiropractic Practice. I usually drop some personal thoughts and updates on the clinic and things like that. When we have a guest join me on the show, I typically drop that section and just get on with it. It’s no different today. So, let’s get on with it. Today we are joined by Dr. Michael Massey who hails from the great state of Tennessee. Athens, TN to be exact with is just Northeast of Chattanooga. Dr. Michael Massey has been in private practice for nearly 30 years and is no stranger to the inner workings of insurance companies or the creation and administration of regulations.He has worked in and around commercial and federal insurance carriers for most of his time in practice, serving as a liaison, a consultant, and a contracted employee. He is also a certified coder, a certified healthcare quality manager, and a quality assurance/utilization review diplomate.He has additionally served as the president of his state chiropractic association, a delegate to the American Chiropractic Association, the chairman of the ACA Coding and Reimbursement Committee, and as a 10-year member of his state Board of Chiropractic Examiners, while simultaneously serving as a delegate to both the Federation of Chiropractic Licensing Boards and the National Board of Chiropractic Examiners. He also regularly serves as a nationally-sought expert witness for malpractice and insurance fraud cases.This diverse experience offers him a unique perspective and a comprehensive skill set to speak on insurance matters, coding, documentation, HIPAA, Medicare, compliance, personal injury, and risk management.
Welcome to the show Dr. Massey. May I call you Mike or Michael?
Now, first question is, how are you enjoying this grand global pandemic we’re currently blessed with?
I have been to Nashville a few times but only recall going through Chattanooga one time when I was on a family vacation back when I was a freshman in high school. I recall it being one of the most beautiful areas I’d ever seen and, from what I remember, I’d probably still classify it that way. I did a little research on Athens, TN. It appears the population is 13,458 hoomans. My region is about 280,000 for comparison sake. What’s it like practicing in a small-town setting where you only have that many to draw from for new patients? Or are you close enough to Chattanooga that you can draw off of their population as well?
We met through the miracles of the private Facebook group called the Forward Thinking Chiropractic Alliance. You are typically pretty active in the group and then we met face to face at the Forward ’19 event out in St. Louis back in September. You were teaching a class on Documentation with Dr. Greg Friedman. I love the group. I’m active here and there, I’ve joined the membership, I support the group. I see the value for sure. While I’m minimally active, I have learned a lot from others just by lurking a little. OK….lurking a lot. What would you say you’ve found to be your biggest takeaway from the FTCA group? What’s been the big bang for the buck for you with it?
Documentation is not typically something finds much fascination in but you guys did a good job taking a dry subject and communicating the information in a way that was interesting. Coding and documentation, for me, can be like pouring salt or maybe hot sauce in my eyeballs. I find it displeasing in general. So, what on Earth got you into coding and documentation? Why is that, of all things, your wheelhouse?
From a procedural coding perspective, what are the most common mistakes made by chiropractors? How about from a diagnostic coding perspective?
I don’t know how other states are but here in TX, we have to have 4 hours of medicare, ethics, and documentation every year. Required hours. I think it’s insane to force grown professionals to do this when we could be learning how to take better care of our patients. I can see maybe every other year or every 5 years as a refresher. But I’m not down with every year. What’s your view on this?
Relative to clinical documentation, what are the top two or three nuggets of advice you’d offer to both newer doctors as well as those who have been in practice for a while?
You’ve had a good bit of experience working with insurance companies, can you offer some insight into their perception of our profession?Where do they seem to believe we fit best in the system?What are their primary concerns or frustrations with us?
Now we collaborated briefly on a case you were working on recently having to do with stroke. I believe you were defending a chiro if I’m not mistaken. How’d it turn out? Did the good guys win the day?
When we’re talking about risk management, as we just mentioned, you have experience doing expert witness work for malpractice cases. Is there any consistency in the types of lawsuits you’re seeing?Are the allegations typically similar?Are there specific things chiropractors do/don’t do that seem to trigger lawsuits?
How did you get into the med/legal work? How do you prepare to be a good witness?
What are a few critical risk management tips you wish every chiropractor knew?
Let’s talk about something I know is near and dear to you and you’ve been putting together for a while now. Pretty much since we first traded private messages through Facebook. It’s called Practice Mechanics and it’s something you’ve put together with Dr. Rob Pape out in California. Rob is another very active member and moderator with the FTCA group. I talk a lot about FTCA on this podcast. I should push my private group as much as I push FTCA. Lol. But there are less in my private group and the FTCA members are way more active. Anyway, Rob is like the jedi ninja dude in there and always has an interesting take on whatever the post of the day happens to be. Tell me about Practice Mechanics, tell me about teaming up with Rob on this project, and give us some clue of who it would be good for, where it’s at, and where it’s going? What’s the big picture?
We’re going to link the Practice Mechanics website at this point in the show notes at chiropracticforward.com so you can go find out more about it. https://www.practice-mechanics.com Thanks for coming on the show with us, Dr. Massey. Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, belive it, count on it.
Let’s get to the message. Same as it is every week.Key TakeawaysStore Remember the evidence-informed brochures and posters at chiropracticforward.com.
The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few.
It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient.
And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….
That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ TwitterTweets by Chiro_ForwardYouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
CF 117: Spinal Manipulation With & Without Myofascial Release and Vitamin D3 and Headaches
Today we’re going to talk about manipulation with and without myofascial release added and we’ll cover a cool paper on vitamin D3 and headaches. Good stuff today in regard to smarts being handed out for free.
But first, here’s that sweet sweet bumper music
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.
We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.
I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
If you haven’t yet I have a few things you should do.
Like our facebook page,
Join our private facebook group and interact, and then
go review our podcast on iTunes and other podcast platforms.
While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #117
Now if you missed last week’s episode , we talked about the safety for chiropractic care in kiddos and we talked a little about an excellent article by Jan Hartvigsen called “What Is Chiropractic’. Definitely some food for thought. Make sure you don’t miss that info. Keep up with the class.
While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
On the personal end of things…..
Let’s talk about ebbs and flows, shall we? Here’s the thing; our practices ebb and flow. If someone tells you their practice looks like a business chart where it’s only up and to the right, they’re all hat and no cattle if you catch my drift.
I told you all in the 10 Keys To Success episode recently that last year, I saw an average of 73.4 new patients every month last year. But in February of this year……I haven’t gotten the exact numbers as of the recording here but I believe it’s only somewhere around 30.
Now, many of you would be jumping with joy to have 30 new patients in a month and I apologize if my displeasure is a put-off. It’s not meant that way. You must admit that if you love having 25 in a month, only having 8 or so is disappointing. Agreed?
So please keep the discussion in context. Now, what happened? Did I take a piss on someone’s dog and everyone found out? Of course not. I may do that to a cat but never a dog!!! Lol.
Here’s what I think. I took four working days to go on vacation. Then, snow and ice messed with about another 2 and a half days or so. Essentially, I lost about 6 working days in February. Partly because of me. Partly not because of me.
Then, for a hybrid insurance practice like mine, we have to battle with the fact that insurance plans reset in January. So, January and February are typically slower months to begin with. We basically took an already slower month and they made it worse by missing a little over a week of it.
That’s a recipe for disaster. Dammit. I haven’t been in an amazing place since my dad’s health went south back in November but February was just a good way to put the cherry on the top.
Here’s the deal though. Is it time to cash in the chips, throw my hands in the air, and say screw this. I’m out!!!????
Of course not. I’ve been around the game long enough to understand practice, understand life, and understand that I’m sitting on a cash cow of a practice and we just had a crap month. This too shall pass.
Yes, I’m going to feel it in a couple of months. But that too will be short-lived. For example, I’m typing this on a Wednesday in the first week of March and for this week, we already have 11 new patients on the books and I expect more. Plus the re-exams are up there too.
So, my practice is starting to level off again and get back to what I’m used to seeing. Hell yes, it’s stressful when numbers aren’t where you want them. Hell yes, it’s easy to get in the dumps and I do get in the dumps. But you can’t even imagine how productive I’ve been with the extra free time. Organizing marketing campaigns with our marketing manager, social media and website content, and basically TCB – taking care of business, man!!!
The marketers say don’t wait until it’s slow and then bust your butt marketing. Market like that year round. Yeah, I like that and it sounds great but that’s really fairytale land crap when you’re busting your butt like we did last year. There was no time. Literally.
When people say they don’t have time, to me, that means it wasn’t a priority because we make time for the things that are priorities. Except when you literally do not have the time. And we didn’t.
Now we do and we’re on it. I’ll keep you updated with how we proceed. I absolutely expect this coronavirus freak out to affect all of us. If people aren’t going to Las Vegas or Seattle, you can damn sure bet they don’t go to our offices as well. But, it’ll pass.
You’ll stop seeing it on the news so much, deductibles will get met, and practices will fill up. At least…..mine will. Lol. And if you’re making good use of any extra time and being a marketer of what you do rather than a do-er of what you do, then yours will fill up too.
If you’re playing video games at work on your computer, I can almost guarantee yours will not fill up.
Before we dive into the reason we’re here, it’s good to support the people that support evidence-informed practitioners. Well, ChiroUp certainly does just that.
If you don’t take advantage of the deal I’m about to offer you, I think you just might be crazy.
Regular listeners know I’ve used ChiroUp since for well over a year now. I’m going to tell you want it is and then share a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months. So listen up!
ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean:
In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, activities of daily living, & for their exercises.
This save you so much time – no more explaining & re-explaining your patient’s care, because they have access to it right there at their fingertips.
You can be confident that your patients are getting the best possible care, because the reports and exercises are populated based on what the literature recommends and isn’t that reassuring? All of that work has been done FOR you by people that are deep into the research.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice.
If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL and, to sweeten the deal, you can use code Williams99 to pay only $99/month for your first 6 months
That’s ChiroUp.com and super saver code is Williams99.
Item #1
Let’s start with a paper called “Effectiveness of Spinal Manipulation and Myofascial Release Compared With Spinal Manipulation Alone on Health-Related Outcomes in Individuals With Non-Specific Low Back Pain: Randomized Controlled Trial” by Boff et al (Boff TA 2019)and published in Physiotherapy in Nov. of 2019 that’s only 3 months ago and it’s……Hot
Why They Did It
They wanted to investigate the effectiveness of spinal manipulation combined with myofascial release compared with spinal manipulation alone in individuals with chronic non-specific low back pain.
How They Did It
It was a randomized controlled trial
There was a 3-month follow up.
72 patients between 18 and 50 years old participated
They were placed in two different groups
Spinal manipulation
Spinal manipulation + myofascial release
They were treated twice a week for three weeks
Assessments were performed at baseline, three weeks post-treatment, and at three months after treatment.
What They Found
No significant differences were found between the two groups for pain intensity and disability
They found an overall significant difference between-groups for CNLBP disability, though this effect was not clinically important and was not sustained at follow-up. Stay tuned for my thoughts on this please…..
Wrap It Up
They concluded, “We demonstrated that spinal manipulation combined with the myofascial release was not more effective compared to spinal manipulation alone for patients with chronic non-specific low back pain.”
OK, fair enough. Nothing was found. But, what about that treatment frequency? 2x/week for 3 weeks…..only four visits in 2 weeks. We ARE talking about chronic pain guys and gals.
What about 3x/week for 3 weeks for starters? Some of these people will never get out of pain completely and we’re trying to reduce the frequency and reduce the intensity.
Basically, I absolutely buy into the fact they didn’t see a lot of difference. But I also don’t think they gave it very long. What do you think? Shoot me an email at dr.williams@chiropracticforward.com and let me know or jump into our private Facebook group and start a discussion.
Item #2
This one is called “Vitamin D3 might improve headache characteristics and protect against inflammation in migraine: a randomized clinical trial” by Ghorbani, et. al(Ghorbani Z 2020). and published in Neurological Sciences in January of 2020 – Dammitt – I burned myself. The heat and all…
Why They Did It
Due to the anti-inflammatory effects of vitamin D3, they aimed to explore the effects of supplementation with this vitamin on headache characteristics and serum levels of pro and anti-inflammatory markers in migraineurs.
How They Did It
It was a placebo-controlled, double-blind study
It included 80 episodic migraineurs who randomly assigned into two equal groups to receive either daily dose of vitamin D3 2000 IU (50 μg) or placebo for 12 weeks.
At baseline and after the trial, headache characteristics were determined using diaries and serum levels of interleukin (IL)-10, IL-6, inducible nitric oxide synthase (iNOS), and cyclooxygenase-2 (Cox-2) were assessed via ELISA method
What They Found
At the end of trial, analysis revealed that vitamin D3 supplemented group experienced significantly lower headache days per month
reduced attacks duration
less severe headaches
and lower analgesics use per month
This was all when compared to the placebo
Wrap It Up
The authors concluded, “Based on the results of this study, we found that 2000 IU (50 μg)/day vitamin D3 supplementation for 12 weeks could improve headache characteristics and might reduce neuro-inflammation in episodic migraine.”
If all of you tell me that you get 100% of your headaches patients completely headache free, I’m going to raise my eyebrow at you in the skeptical posture and deep deep deep down inside, I’m going to think you’re full of horse hockey. Plain and simple.
This paper can give us some insight into other avenues to explore. I’m not saying go put all of your headache patients on Vitamin D3 but, if you have some that are not responding, it makes sense to read through this paper and decide for yourself about recommending it. Or, alternatively, collaborate with their primary on the matter.
That’s it for this week. I’m outties, Hope you enjoyed the show. I humbly ask you, if you know a colleague that would enjoy this material every week, please share the show with them. There’s only one way we make a difference in the chiropractic profession and that is through your help.
Thanks in advance!
The Message
I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few.
It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient.
And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health!
Key Point:
At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….
That’s Chiropractic!
Contact
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.
Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.
We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.
Connect
We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography
Boff TA, P. F., Ben AJ, Bosmans J, (2019). “Effectiveness of Spinal Manipulation and Myofascial Release Compared With Spinal Manipulation Alone on Health-Related Outcomes in Individuals With Non-Specific Low Back Pain: Randomized Controlled Trial.” Pysiotherapy 107: 71-80.
Ghorbani Z, T. M., Rafiee P, (2020). “Vitamin D3 might improve headache characteristics and protect against inflammation in migraine: a randomized clinical trial.” Neuro Sciences.
CF 111: American Academy of Family Physicians Warming To Chiropractic For Chronic Pain & Evidence Behind Supplements
Today we’re going to talk about how the American Family Physicians may be warming up to chiropractic for chronic pain and what supplements actually have some evidence behind them.
But first, here’s that sweet sweet bumper music
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.
We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.
I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
If you haven’t yet I have a few things you should do.
Like our facebook page,
Join our private facebook group and interact, and then
go review our podcast on iTunes and other podcast platforms.
While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.
You have found yourself smack dab in the middle of Episode #111
Now if you missed last week’s episode , we talked about Dry Needling vs. Massage and even more importantly, we talked about the topic of “What is your exit number?”. What are you looking to get out of it all in the end? I feel like there were points made in there that could really get you to contemplating and thinking going forward. So, make sure you don’t miss that info. Keep up with the class.
That reminds me, did you know that you can use our website as quite a resource? I do it all of the time. If you think I can keep every one of these papers in my noggin and pull them out of my brain files on demand, that’s a big nope. But I can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever I want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.
On the personal end of things…..
Rinse and repeat man, rinse and repeat. If you’re friends with me on Facebook, then you know life has been crazy and there’s no slow down in site.
Some really positive stuff happening though too. For example, I was interviewed for two different articles in Chiropractic Economics recently. They published an article called “Chiropractic for prevention: the latest research on maintenance care” by Michele Wojciechowski. Michele used my comments exclusively in this article and that’s just a big honor.
I remember when I was new in practice. I remember reading articles in Dynamic Chiropractic and Chiropractic Economics and thinking that would be cool to be in that one of these days. Now…..now…I’ve been fortunate enough to be in Reader’s Digest, on the ACA Blog a couple of times, and now Chiropractic Economics. It’s pretty damn exciting and it’s an honor.
Thank you Michele for finding value in my comments and sharing them with everyone else. I’ll leave a link to that article at this point in the show notes if you’re interested in giving it a read through.
Other than that, my family and I took a quick ski-cation to Red River, New Mexico. If you haven’t been, look it up. Here’s why we like Red River, First thing, it’s close. For a Texan to be able to just drive about 4 hours and be in the mountains, that’s pretty exciting.
Next thing, it’s just gorgeous. And, the ski slope comes right down into the town so you don’t have to drive out to a mountain which is nice.
Let’s talk about why I retired from skiing myself though shall we? This may make you think a bit about some of the stuff you do in your offtime. Maybe it won’t but it’s important to think about things which is the whole point of me bringing it up.
I used to ski a lot back in high school and junior high. I was pretty decent at it too. Then I went off to play football and be a college kid. Well, Louisiana for a bit and Dallas for a bit…..those areas aren’t very conducive to learning to snow ski. It’s too damn far. Especially when you’re still a kid and broke as hell. Skiing just doesn’t happen at that point in life unless you have parents taking you. I didn’t.
So then you start life and you’re building a business and there’s never time to go then either.
Well by the time I got back around to going skiing again, I hadn’t done it in about 20 years give or take. So, i got a private coach for a morning just to get me back on that bicycle and rocking and rolling again. I have to tell you, it was hard as hell!! It was NOT like riding a bike. Nothing at all like it as a matter of fact!!
But, I took it slow, I didn’t fall at all, and was fairly happy with my progress over the weekend. HOWEVER, I got to thinking when I got home. I went back to work and had about 45 patients that next day. What if I had twisted a knee, broken and elbow, or dislocated a shoulder while I was skiing? What would I have done?
You know this sounds stupid when you say it but, “They call them accidents because you don’t plan them.” But you can avoid them sometimes. I got to thinking long and hard enough about the risk vs. rewards for continuing to ski and……honestly, on paper, it wasn’t worth the risk.
So, I retired. Maybe if I had an associate. Maybe I could make more sense of it but, the truth is, I don’t have an associate. It’s just me although I’m thinking of hiring one just as soon as it makes sense. Anyway. I took the kids skiing while the wifey and myself enjoyed the mountains, some brewskis, and some playoff football games.
What are you involved in as far as physical activity outside of your practice that puts you at risk and puts your ability to earn a living at risk? Do you have disability insurance? Life insurance? Long term care insurance? I have all of that. Do you need it?
Start thinking about these things. Certainly, the more successful you get and the busier your practice gets. Risking an injury just might not be worth it at some point.
Before we dive into the reason we’re here, it’s good to support the people that support evidence-informed practitioners. Well, ChiroUp certainly does just that.
If you don’t take advantage of the deal I’m about to offer you, I think you just might be crazy.
Regular listeners know I’ve used ChiroUp for well over a year now. I’m going to tell you want it is and then share a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months. So listen up!
ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean:
In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, activities of daily living, & for their exercises.
This saves you so much time – no more explaining & re-explaining your patient’s care because they have access to it right there at their fingertips.
You can be confident that your patients are getting the best possible care because the reports and exercises are populated based on what the literature recommends and isn’t that reassuring? All of that work has been done FOR you by people that are deep into the research.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice.
If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL and, to sweeten the deal, you can use code Williams99 to pay only $99/month for your first 6 months
That’s ChiroUp.com and super saver code is Williams99.
Item #1
Let’s start with this one from American Family Physician. I got this one from one of my amazing colleagues, Dr. Craig Benton down in Lampasas, TX. It’s called “Nonpharmacologic therapies can improve chronic pain outcomes” authored by Michael Devitt and was published in American Academy of Family Physicians on January 15, 2020(Devitt M 2020). Damn it’s hot…..
Not a research paper but more of an article in their publication but has plenty to do with chiropractic.
They set the stage here by pointing out that chronic pain is something that can cause people to go to extreme measures just to get the pain to go away. Or at least lighten up. They say this includes potentially harmful behaviors like drug and alcohol misuse and/or abuse.
Then this article in the American Family Physicians journal starts to highlight and promote the nonpharmacologic treatment modalities that are available to family physicians. Honestly, did you think you’d ever see the day? Ever? The battle isn’t over by any stretch of the imagination but research is gradually, inch by inch, turning the tide.
They say these modalities include simple methods like massage and heat as well as more complex therapy like acupuncture and chiropractic manipulation. They called us ‘complex’ and I’m taking that as a compliment. Lol. What we do can damn sure be complex.
They say that these nonpharma strategies aren’t only effective for decreasing pain and improving function, but can also be effective for reducing longer-term adverse effects such as substance use disorders and suicide attempts. THAT’S A BIG DAMN DEAL.
In fact, I got one word, two syllables….day-um.
One researcher, the lead author from an active-duty US Army service study said “Chronic pain is associated with adverse outcomes such as substance use and suicidal thoughts and behavior,” said Esther Meerwijk, Ph.D., M.S.N., a statistician at the VA Palo Alto Health Care System in California. She added, “It made sense that if nondrug treatments are good at managing pain, their effect would go beyond only pain relief. However, I was surprised that the results of our analyses held, despite our attempts to prove them wrong.”
Despite our attempts to prove them wrong! Haven’t they been trying to prove us wrong for generations now? Lol. I always say that with all of the powers against us, if we were wrong, if we were ineffective, we would have been wiped out years ago.
In one of her projects, they reviewed the records of more than 275,000 active-duty service members reporting chronic pain.
They combed through their files to determine whether they had received any of 13 nonpharmacologic therapies after their deployment. Those therapies were acupuncture or dry needling, biofeedback, chiropractic care, cold laser therapy, exercise therapy, lumbar supports, massage, osteopathic spinal manipulation, other physical therapy, superficial heat, traction, transcutaneous electrical nerve stimulation, and ultrasonography.
After crunching all of the numbers and outcomes here’s what they came up with:
Specifically, service members who received nonpharmacologic therapies were
8% less likely to experience new-onset alcohol and/or drug use disorders;
12% less likely to experience suicidal ideation;
17% less likely to experience a self-inflicted injury, including attempted suicide;
18% less likely to intentionally poison themselves with opioids, related narcotics, barbiturates or sedatives; and
35% less likely to accidentally poison themselves with the same types of drugs.
The researchers acknowledged several limitations in their research. For example, although most nonpharmacologic therapies were provided after service members were diagnosed with chronic pain, the authors could not determine whether those nonpharmacologic therapies were used specifically to treat that pain.
In the news release, Meerwijk also explained that her team did not study the effects of individual nonpharmacologic therapies.
“We treated them as one,” she said. “Most likely, only some of the therapies that we included are responsible for the effect that we reported, whereas others may have had no effect at all, assuming there’s no other variable that explains our findings.”
Despite these limits, the authors expressed confidence in their research methods and findings.
“Our results suggest that (nonpharmacologic therapies) provided to active-duty service members with chronic pain may reduce their odds of long-term adverse outcomes,” they concluded in the study. “Given known associations of these adverse outcomes with morbidity and mortality, providing (nonpharmacologic therapies) to service members with chronic pain could potentially save lives.”
I’ve been hearing this crashing tidal wave coming. It’s not here yet. But the roar is approaching and it sounds like sweet sweet music to me ears.
Item #2
I’m going to do everything I can to boil this sucker down and strip it to the bare bones without it getting too long or boring. This one is called “Evidence-based supplements for the enhancement of the athletic performance” by Peeling, et. al(Peeling P 2017). and published in the International Journal of Sport Nutrition and Exercise Metabolism in 2017.
The authors wanted to put together a review focusing on the available evidence based for performance supplements commonly used in sports and summarizing the when’s and the how’s around their uses.
The ysay there is robust evidence that the following supplements can enhance sports performance when used according to established protocols.
So let’s motor through this like poop through a goose, shall we?
Caffeine -There exists a lengthy research history on caffeine supplementation across a range of performance protocols, including endurance-based situations, resistance training exercise, short-term supramaximal efforts, and/or repeat-sprint tasks. Reported benefits of caffeine include benefits include adenosine receptor antagonism, increased endorphin release, enhanced neuromuscular function, improved vigilance and alertness, and a reduced perception of exertion during exercise. Low to moderate doses of caffeine (∼3–6 mg/kg BM), consumed 60 min pre exercise, appear to have the most consistent positive outcomes on sports performance in research situations, although a variety of other protocols (as mentioned above) also appear beneficial, and are practiced in real-life. Of note, athletes who intend to use caffeine as a performance aid should trial their strategies during training or minor competitions, in order to fine-tune a protocol that achieves benefits with minimal side effects.
Creatine – widely-researched supplement, with creatine monohydrate (CM) being the most common form used. Creatine loading can acutely enhance the performance of sports involving repeated high-intensity exercise (e.g., team sports), as well as the chronic outcomes of training programs based on these characteristics (e.g., resistance or interval training), leading to greater gains in lean mass and muscular strength and power. When accepted creatine monohydrate supplementation protocols are followed, the expected increase in intramuscular creatine stores is likely to enhance lean mass, maximal power/strength, and the performance of single and repeated bouts of short-term, high-intensity exercise.
Nitrate – The authors say Nitrate is a popular supplement initially found to improve oxygen uptake kinetics during prolonged submaximal exercise. Great sources are Leafy green and root vegetables (i.e., spinach, rocket, celery, beetroot, etc.
Beta-Alanine – The paper says this is one of the immediate defenses against the accumulation of protons in the contracting musculature during exercise. I can also tell you that this is just something I never nerded out on. Lol. Not my cup of tea but I like to offer something for everyone here at the Chiropractic Forward Podcast. They say it can improve tolerance for maximal exercise bouts lasting 30 s to 10 min and provide small yet significant benefits in both continuous and intermittent exercise tests. Basically, it’s used in order to augment high-intensity exercise performance ranging from 30 s to 10 min in duration.
Sodium Bicarbonate – benefits are generally seen in short-term, high-intensity sprints lasting ∼60 s in duration, with a diminishing return as the effort duration exceeds ∼10 min. However, greater benefits may be realized (>8% improvement) with a greater number of repeated sprint bouts
Go to our show notes at chiropracticforward.com if you’d like to get dosing information and all the little technical tidbits. It’s really interesting. Even to an orthopedic guy like me although, its technical enough to make my eyes glaze over as well.
There are several others listed in the paper as well but the authors point out that the evidence for their effectiveness is much less clear. They are Sodium citrate, Phosphates, and Carnitine.
Even though that stuff is not my cup of tea, it’s good to know, it’s good to have as a reference, and it’s good to pass on to you because many of you actually do nerd out on that stuff and thank God for that. That means I can call people like you and ask what the hell. On the other hand, if it’s something I nerd out on like orthopedics, you can call me and say what the hell?
I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots.
When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few.
It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient.
And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!
Key Point:
At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….
That’s Chiropractic!
Contact
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.
Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.
We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.
Connect
We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Devitt M (2020). “Nonpharmacologic Therapies Can Improve Chronic Pain Outcomes Reductions in Drug Misuse, Suicide Attempts Reported.” AAFP.
Peeling P, B. M., Paul S, (2017). “Evidence-based supplements for the enhancement of athletic performance.” IntJ sport Nutrition Exercise Metabolism 28(2): 178-187.
CF 105: Thoughts on Chiropractic Groupon, Gabapentin, & Weight Loss Research
Today we’re going to talk about some thoughts on Groupon and Chiropractic, if you know me, you probably know where this is going and it’ll probably be fun. We’ll find out. We’ll talk about Gabapentin and we will talk about a couple of papers I encountered recently having to do with metabolism, intermittent fasting, and things of that nature.
But first, here’s that sweet sweet bumper music
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.
We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. So feel free to crack one wide open would you?
Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
If you haven’t yet I have a few things you should do.
Like our facebook page,
Join our private facebook group and interact, and then
go review our podcast on iTunes and other podcast platforms.
While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends.
Do it do it do it.
You have plopped down into Episode #105 just like a comfy easy chair.
Now if you missed last week’s episode talking about our TWO YEAR wrap up, make sure you don’t miss that episode. It was a lot of fun to put together and to reminisce on some of the amazing episodes we’ve had over the past two years. Good good stuff.
Something new I found out here…..Did you know that if you have an Alexa product, you can now just say something like, “Alexa, play The Chiropractic Forward Podcast on Apple Podcasts” and kablooey!
You automatically start to hear the golden throated stylings of yours truly! Lol. You can say skip ahead 30 seconds, play previous episode, and on and on so pretty cool right there.
On the personal end of things, we just found out that Dad started moving his left leg today for the first time and that’s exciting. It’s the first REAL solid sign of big progress since his first stroke on November 9th. As you can imagine, we are ecstatic about this. Good stuff. Keep on keeping on Pops. Strong like bull!
Before we dive into the reason we’re here, it’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices.
If you don’t take advantage of this deal, I just think you might be crazy.
If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!
ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean:
In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises.
You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips.
You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**
If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months
That’s ChiroUp.com and super double secret code Williams99.
Item #1
Alright let’s dive in. We’ll save Groupon until the last because if I know me, it’ll be what I have the most to say out of all of these.
Let’s start with Gabapentin shall we? The most recent article I’ve come across was in The Atlantic. It was authored by Olga Khazan and called ‘Chronic Pain Is An Impossible Problem’. It was posted December 9, 2019(Khazan O 2019).
That’s got some sizzle on it!!
Some key points in the article are that
Chronic pain affects about 1/5 of American adults
For years those in the medical field thought it could be treated with painkillers like Oxy but that was proven wrong when basically three planeloads of Americans started dying of opioid-related causes each week
Now, they’ve turned to Gabapentin, an anticonvulsant, to help treat it.
From 2012-2016 prescriptions of the medication went up 64%
There is emerging information that Gabapentin may not be as safe as previously believed. Certainly when combined with other sedating meds.
When taking it long-term, patients can develop tolerance so more and more is required to reach the desired effect.
There is also a withdrawl effect when trying to get off of gabapentin.
People are now starting to use Gabapentin in combination with Baclofen and benzos like Xanax to increase the intoxicating effect. We can see where that is going can’t we?
The article goes on to say, “not only does gabapentin appear to exacerbate or create overdose risk, it also doesn’t work well for chronic pain.” They site a study that we’ll cover in a second.
The paper wraps up by saying they’re essentially out of option when it comes to chronic pain. Which to me says they’ve run out of pills basically. That doesn’t mean they’re out of options though.
Arthur Robin Williams, an assistant professor at Columbia University says “The medical community should take a closer look at non-pill remedies such as physical therapy and psychotherapy…I would add evidence-informed chiropractic… These treatments are often not covered by insurance, take longer to work, and take more of providers’ time. But for many, they might be a better option than yet another pill that has yet another pathway to abuse. “The reality is, a lot of the pills that change how you feel in the next 10 to 30 minutes,” Williams says, “carry addictive liability.”
Well…..no kidding? Who would have ever thought that? Hmmm….let’s see. Oh yeah, every chiropractor and PT that ever lived.
Let’s combine that with a systematic review and meta-analysis from just last year that was in the Canadian Medical Association Journal called “Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis”(Enke O 2018)
Nine trials compared topiramate, gabapentin or pregabalin to placebo in 859 unique participants. Fourteen of 15 comparisons found anticonvulsants were not effective to reduce pain or disability in low back pain or lumbar radicular pain.
There was high-quality evidence of no effect of gabapentinoids vs. placebo on chronic low back pain.
The lack of efficacy is accompanied by increased risk of adverse events from use of gabapentinoids, for which the level of evidence is high.
It is painfully obvious (no pun intended) that pills aren’t cure-alls and aren’t curing the pain problem. And they won’t sure the pain problem so isn’t it time to look elsewhere? In the year 2020?
All of this is cited in the show notes at chiropracticforward.com. Go get the article and the paper. Use it to educate your community on gabapentin. Set yourself as the reasonable alternative to it.
Item #2
Fasting and weight loss. I want to be right up front on this, I’ve always wanted to make nutrition and weight loss a part of my practice in some shape form or fashion but, if I’m being honest, I’m just straight up a big big dude. Like I’m 6’4” and, depending on the time of year, 280+. I was a college offensive lineman. I played center and i anchored that line pretty well with my overall biggness. Lol.
Cat-like reflexes people but big as a damn house. So, I’m not going to teach you how to implement weight-loss into your practice here but I am going to give you some interesting research I cam across recently that might make you think a bit.
The first paper on this is called “Effects of time-restricted feeding on body weight and metabolism. A systematic review and meta-analysis”. It was published in Reviews in Endocrine and Metabolic Disorders, authored by P Marianna, C Iolanda, et. al. and published December 2019. (Marianna P 2019)
Hot to the touch. It’ll burn your damn finger prints off.
Why They Did It
Restriction in meal timing has emerged as a promising dietary approach for the management of obesity and dysmetabolic diseases. The present systematic review and meta-analysis summarized the most recent evidence on the effect of time-restricted feeding (TRF) on weight-loss and cardiometabolic variables in comparison with unrestricted-time regimens.
How They Did It
A total of 11 studies, 5 randomized controlled trials and 6 observational, were included
All selected studies had a control group without time restriction
Most studies involved the Ramadan fasting
Wrap It Up
Time restricted feeding regimens achieved a superior effect in promoting weight-loss and reducing fasting glucose compared to approaches with unrestricted time in meal consumption.
As we’ve covered, systematic reviews and meta-analysis are, ideally, high-level research and, considering the majority of the included studies involved the Ramadan fasting regimen, I went to search it up to see what the what.
So, what exactly is a Ramadan Fasting Regimen? Well let me tell you. And I’m not going for the fancy stuff because I’m tapped for time here so we’re just going to hit up Wikipedia real quick and Wiki says that the basics are:
Fasting from sun up to sun down
Abstinence from sex, food, and drink
It also means one should refrain from things like
violence
anger
envy
greed
lust
angry/sarcastic retort
gossip
and you’re supposed to get along with others better than you normally do
In America at least, I’m certain we’ll all just do the food part because everyone’s so busy looking for a reason to be offended that I’m certain being nice and getting along is off the table for now.
So, if you have any personal experience with intermittent fasting, if you’re an expert on the topic, shoot me an email at dr.williams@chiropracticforward.com Let’s talk about it. Maybe we can set up some guests and do a full episode or two on the topic to educate our community of docs on the matter. Sounds like a great topic so hit me up.
Now, the last thing I have here I want to talk about is Groupon.
This one is a bit of a trigger for me honestly. Looky here. I am well aware that people are struggling. I’m well aware that I am fortunate and to sit and judge can seem disconnected and unfair at minimum to some. I definitely get that.
What I also understand is that a whole bunch of those that are struggling are in a profession they really shouldn’t be in because they’re lazy and want to sit behind their desks and hit a few buttons and be magically transformed into a master chiro with an office stocked full of patients and never ending new patients.
That’s magic time dreamland stuff.
There will always be supposed shortcuts. There will always be business hacks or whatever you want to call them. But at the end of the day, shouldn’t you make decisions while keeping several things in mind? Meaning, you have to do what is best for your family. You have to do what is best for your office and your employees. But don’t you feel like you should make decisions based on what is best for your profession and for your colleagues?
I would hate to think that I’ve done something that damages my profession . Obviously I don’t mind calling out BS business practices and unethical chiropractors. If that’s damaging my profession well then, I’m guilty as hell.
But when you are making the deals some of these guys and gals are making on Groupon, you are demeaning, lessening, and trashing what the rest of us take a great deal of pride in.
Imagine, you go through chiropractic school, you survive 21+ years in practice while steadily getting more and more education, you take on a Diplomate program and finally complete that, and you are fighting on the state level for your profession and your profession’s image…..and then you open your email.
Yes, I get emails from Groupon with their best and newest deals. I open it up and BAM….It almost seems like all of that work can just be flushed down the toilet. It’s depressing and it makes me want to club baby seals.
Before we start talking about the article, I did a quick search for Groupon deals in my area and, right there next to Reflexology deals popped up this:
10% cash back – Sounds like a damn car deal
Consultation, exam, x-rays, adjustment, and one full-body vibration plate session for $70. Way to value your services. Great. Way to look awesome. Assuming they actually need vibration plate. Assuming they actually need x-rays, assuming they even need and adjustment. Blah
Then this one, it’ll make you tickle – One laser lipo session w/ two vibe plate sessions for $45. See…..in Texas, you can only have laser lipo if you’re trying to increase function. Not just look better. So, that’s not necessarily legal as this implies to me it’s for looks. Unless they have a medical director and I’m here to tell you they do not.
When you go to the bigger cities, it only gets worse. I found a $564 value for only $43.70!!! What a damn deal!!!
It’s all just shady and sketchy. Luckily, there are only two in my area doing this stuff. And if they keep it up, we may have two less competitors here as well.
Besides the shady, street corner huckster look it so convincingly creates, it’s potentially illegal based on the idea of fee splitting, Medicare inducement, and dual fee schedules and, if the state boards start getting their acts together and going after this stuff, they will be the ones to go down.
What started me down this path today was an article I came across called “Legal Implications of Chiropractic Groupons.” It was written and posted on the website for Carlson and Jayakumar – attorneys at law. I’ll have the link in the show notes. https://cjattorneys.com/legal-implications-of-chiropractic-groupons/
Highlight of the article include:
Each day, numerous chiropractors contract with Groupon and its competitors to sell certificates for adjustments, examinations, x-rays and massages.
Despite the variety of services offered, these programs all have two things in common: (1) the chiropractor is offering a significant discount –92% in some examples, and (2) the chiropractor is sharing the income from each certificate sale – usually around 50% – with the website. While we are unaware of any state board taking action against a licensee for a Groupon-style offering, we believe these programs could create significant civil and criminal liability for chiropractors.
most states have rules prohibiting the offer or acceptance by a chiropractor of any commission, discount, or other consideration as compensation or inducement for referring patients, clients, or customers to any person, irrespective of the practitioner’s membership, proprietary interest or co-ownership in or with that person. I was once offered the opportunity to buy in to an imaging center here in town. As badly as I wanted to do it, I made the mistake of hiring two different attorneys for their opinions. BOTH advised against and this is exactly why.
With Groupon, money is paid by the chiropractor to the website in connection with a patient’s referral. The chiropractor essentially, albeit indirectly pays the website per patient that purchases the certificate. At their base, these agreements require the chiropractor to pay the website for soliciting, referring and/or procuring clients not he chiropractor’s behalf. Stuff you’re not supposed to do and can get in a lot of trouble for.
Medicare’s Anti-Kickback Statute criminalized the payment of kickbacks for patient referrals. Subsequent laws expanded it to all federalpay programs. Kickbacks include “any remuneration,” a very broad definition, which includes coupons. The Office of the Inspector General issued a “Special Fraud Alert” regarding advertisements offering “discounts” given to Medicare beneficiaries. Then a “Special Advisory Bulletin” appeared on offering inducements to Medicare beneficiaries. Essentially, it said a provider could not offer a patient anything worth more than $10, and combined $50 in a year for multiple gifts.
Groupon-style deals are unadvisable as they may pose problems with insurance companies. Most insurance policies will not pay for any charges that would not have been made in the absence of insurance. Groupon offerings, which almost always charge a lower fee to the purchaser versus insured patients, could be viewed as creating a “dual fee schedule.” Insurers believe dual fee schedules constitute fraud and over billing. Some argue that Groupons are merely a version of a prompt-payment discount. While California law expressly permits prompt-payment discounts, such discounts must be reasonable. Given the extreme nature of the discounts typically offered by Groupon and its competitors, such certificates likely would not fall under the prompt-pay exception.
They conclude that “Given their widespread use, it seems unlikely that the Board of Chiropractic Examiners would discipline each and every licensee who engages or has engaged in Groupon-style offerings. That said, there may be a rash of “test case” or “example” disciplinary actions that follow. Eventually, we would expect the Board to adopt a regulation, or the Legislature to pass legislation, that explicitly either proscribes or prohibits the use of these deals. In the meantime, we recommend that chiropractors abstain from these types of marketing campaigns….”
I couldn’t agree more with them.
When I opened up a new place h ere in Amarillo, I printed flyers at Kinko’s and I walked from one business to another knocking on doors and meeting people and telling them about me and my new place. I marketed anyone that could send me business. For more on that, go back about 5 episodes and listen to our episodes called Big Ideas On Marketing Evidence-Based Practices. Link is in the show notes.
You must know this just isn’t the way to go. Join BNI, join civic clubs, start working out at a gym and get tight with the managers and personal trainers, spend time volunteering, joint a running club if that’s your gig, combine those things with social media and a solid email list that you continue to build and work on. There are so many things you can do that are above the cuff. That are respectable and raise up you and your profession.
Groupon isn’t one of them. It does exactly the opposite. It identifies those of us who are racing to the bottom of the barrel and dragging the rest of us down with them.
If you’re doing Groupon, it’s my opinion that it’s time to stand up, stop doing it. Yesterday..if you catch my drift
Store
Part of making your life easier 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. 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 something is out of sorts or isn’t working correctly.
If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders.
Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it.
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 us that patients can get good to excellent results for headaches, neck pain, back pain, and joint pain just to name just a few.
It’s safe and cost-effective. It can decrease surgeries & disability and we normally do it through conservative, non-surgical means with minimal hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, we 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. When it comes to non-complicated musculoskeletal complaints….
That’s Chiropractic!
Contact
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show 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.
Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Enke O (2018). “Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis.” CMAJ(190): E786-793.
Khazan O (2019) “Chronic Pain Is an Impossible Problem A “safe” alternative to opioid painkillers turns out to be not so safe.” The Atlantic.
Marianna P, I. C., Andrea E, Valentina P, Ilaria G, Giovannino C, Ezio G, Simona B, (2019). “Effects of time-restricted feeding on body weight and metabolism. A systematic review and meta-analysis.” Rev Endocr Metab Disord.
CF 104: Year Two Big Hits Wrap Up For The Chiropractic Forward Podcast
This is chiropractic forward podcast episode #104. Fifty two times two = 104. That means two solid years of pumping out the Chiropractic Forward Podcast religiously. Pumping it out like a damn piston people. Dependable and powerful.
BAM, kowapow!!! We’re going to talk about the most listened to episodes from the previous two years and we’ll talk about why they continue to be so darn popular.
But first, here’s that sweet sweet bumper music
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.
We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.
Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
If you haven’t yet I have a few things you should do.
Like our facebook page,
join our private facebook group and interact, and then
go review our podcast on iTunes and other podcast platforms.
We also have an evidence-based brochure and poster store at chiropracticforward.com
Do it do it do it.
You have done the electric slide into Episode #104. The two-year anniversary party is engaged. Yaya!! If you know me, doing really anything at all dependably for two straight years every single week is pretty good.
I’m high maintenance people. In some ways anyway. I can’t be bothered with this and sometime that. I don’t seem to have time for some of the simplest tasks. You know how it is.
I don’t go camping either. Nope. I need plumbing. I need central heat and air. And I need a decent bed. None of that camping foolishness unless it’s in a bus of some sort. Then……prolly. Otherwise, I’m too high maintenance and I’m not ashamed. I’m good with hanging out by a rocky mountain river for a bit. Maybe even hiking in the forest a bit. But then, back to the hotel. Come on now.
Also, the beach. Am I the only one that can’t lay around on a damn beach all freaking day long? It’s not even remotely possible. It’s insane actually. I’m the kind, I hate sand all up on me everywhere. That’s the worst feeling.
And then, after sitting around and soaking up the beauty for about 30 mintues…..maybe an hour…..it’s time to look around for something else to do. I can’t sit around and drink all day. Not unless I want to be out of commission the next day. Maybe two days. See…..I’m a little high maintenance. But don’t tell anyone. It’s our little secret.
Now if you missed last week’s episode on spinal manipulation’s effect on the brain, on forward head posture and if it’s really related to neck pain, and we talked about how smoking is related to pain throughout the body, make sure you don’t miss that info. It was good stuff and very well-listened to!
On the personal end of things, my Pops is back in the hospital. He had a mini stroke, TIA sort of thing that spooked the folks at the rehab hospital that they sent him over to the big hospital to be sure everything is A-OK.
He’s looking and talking roughly the same as before he spooked everyone so I’m hoping we are back on track. Maybe he was just feeling a little extra on that day. He called his wife and his neighbor at around 2am last night so his brain still has some confusion but he’s doing OK overall. A lot of folks have been in a lot worse shape from strokes. Still not sensory or motor in the left upper and lower extremities. Unfortunately.
Before we dive into the biggest episodes in Chiropractic Forward Podcast History, it’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices.
If you don’t take advantage of this deal, I just think you might be crazy.
If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!
ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean:
In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises.
You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips.
You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**
If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months
That’s ChiroUp.com and super double secret code Williams99.
First thing you gotta know is that as I list these off, the link to the specific show will be in the show notes so that you can have quick access to the episodes that sound the most interesting to you.
Our tenth ranked episode was Episode #68 and was called “British Medical Journal Research, Surgeons Against Back Surgery, and Pediatric Chiropractic Under Attack”
Any time the British Medical Journal is going to come out and say that moderate quality evidence suggests that SMT has effect on short term pain relief and increased function, we’re going to talk about it and we did.
We also talked about Dr. David Hanscom, MD who wrote a book called Back In Control and who is also on the war path against chronic pain and surgery for the wrong candidate. Sounds like a guy I can get on board with right there. He’s well-versed in upregulated, sensitized CNS and I highly recommend his book to any practitioner or chronic pain sufferer.
Number nine all time is actually Episode #9 oddly enough and that was when I had my good friend and colleague, Dr. Tom Hollingsworth of Corpus Christi, TX join me to discuss the Case Against Chiropractic in Texas. Evidently that episode is still riging true for chiropractors because it’s still getting downloaded. The thing is, the Texas Medical Association is still suing us here. This case is still going. The episode aired on February 15 of 2018 so moving in on two years ago and the case is to the point where the TMA has won and we are waiting to see if the TX Supremes will hear the case.
Keep your fingers crossed and go listen if you don’t know what it’s about because whatever happens here in TX can, and probably will, happen anywhere.
It was very recent. Episode #98 and it was called “Big Ideas On Marketing Evidence-Informed Practices.” This episode and it’s part II episode were listened to in big numbers and well-received. Which is exciting. I’ve always seen myself as a marketerpersonally but, primarily for the podcast, a voice of reason, responsibility, honesty, ethics, and yes….of course, research.
But, I’m a marketer as well and how the heck do you market an Evidence-based practice? Well, there’s Jeff Langmaid with the Evidence-based Chiropractor material. There’s Dr. Kevin Christie with The Modern Chiropractic Marketer material. There’s Dr. Christie teaming up with Dr. Bobby Maybee and the Chiropractic Success Academy. And then there’s myself and the Chiropractic Forward Podcast.
That’s it as far as I know. We are the outlets to help you market responsibly and ethically. There are a million other programs but A LOT of them are questionable at minimum. So, I have to say that I was pleased to see that so many found those marketing episodes to have value.
“How To Not Miss A Dissection & De-legitizing Complementary Medicine” This was episode #69. Well this one hit it big because people don’t want to get in trouble!! We are here to help people. Certainly not hurt people. That’s not what we’re built for. I went over a lot of policies I have here in my office that have so far helped me avoid and crazy situtations.
I think every practitioner that is in practice for 21 plus years will have a couple little adverse things here and there like a patient actually getting a little worse in the short term and things like that but, I’ve been fortunate enough to avoid anything scary or serious. I think mostly because I’m very cognizent and aware of the research and do eveyrthing I can to avoid anything scary. Now I’m going to knock on wood and you should go get this episode because there was some real solid, immediate useful information in it.
“National Scope, Chronic vs. High Impact Chronic Pain, Coordinated Care/Medicaid, and DACO to DIANM”
Episode #96 – For this episode, which again was very recent, we were fortunate enough to be joined again….for the second time…by Dr. James Lehman of the University of Bridgeport and a key driver of the DACO/DIANM program and a frequent author of articles in Dynamic Chiropractic.
This one shot right up to the top of our most listened to episodes because Dr. Lehman is a legend first of all and second it’s because he gives some amazing, profitable, and entrepreneurial ideas about the future of coordinated care. He also taught us about the difference between chronic pain and high impact chronic pain.
I’d say the main thing though was his push for a modernized, national scope rather than 50 different scopes of practice in the US. Fascinating stuff from Dr. Lehman in this one. Don’t miss it.
Our fifth most listened to episode was episode #80 with Dr. Anthony Nicholson called “Decoding Chronic Pain” and I’m here to tell you that if anyone can help you decode chronic pain, it’s Anthony Nicholson.
This episode, you get to hear it for free but I’m telling you, it’s a master class in chronic pain. Have you ever wondered about central nervous system sensitization or upregulation? Have you wondered what centralized pain vs. peripheral pain is? And no….I’m not talking about McKenzie protocols.
I have covered a lot of material on chronic pain over the last two years but THIS is typically the source of my information. Dr. Anthony Nicholson si a neuro diplomate as well as an ortho diplomate. He is a genius and when he speaks, you need to be listening. So go listen. Don’t you dare miss that one.
This one was episode #55 and I told you all Dr. James Lehman was a legen y’all. Well here he is for the second time in our top ten most listened to episodes.
This one was called “The Future of Chiropractic, Chirorpactic Specialization, & Chiropractic Integration.” Again, Dr. Lehman shared information that can make the entrepreneurial mind start swooning and swimming. Seriously. Knowledge nuggets raining down like manna from heaven people.
Our third most listened to is Episode #6 done with Dr. Tyce Hergert of Southlake Texas as our guest. The episode was called “Expert Information on Immediate Headache Relief”. Dr. Hergert and I covered several papers on how chiropractic helps knock those dudes out. Tyce is a pretty entertaining individual typically and is most certainly one of the smartest your going to find.
Our second most listened to episode is still probably my favorite personally. It was episode #13 and is called “DEBUNKED: The Odd Myth That Chiropractors Cause Strokes.”
This was a lot of fun for me because it was part brain dump, part entertainment, and part educational.
I said in a recent episode that there are few things in the world more satisfying than being able to slap someone straight across the face metaphorically by saying, “I can get that research paper for you if you like.” Well, this is THAT episode.
I cover literally everything I could think of. From the risks vs. benefits, the research behind SMT for the neck. The research behind SMT for headache. The research AGAINST SMT causing strokes. The issues the medical field should REALLY be worried about when it comes to adverse effects. Man, I covered it all and while I’m aware it’s not very humble of me to say, I just don’t understand how a hater can really go through it and still be convinced chiropractors cause strokes.
I just don’t. I feel like the information is just that thorough. Go listen to episodes #13, #14, and #15 and see what you think by the time you hear it all.
Well looky there, Dr. Tyce Hergert makes two appearances in our top five….not even the top ten….no, the top five. Only the best for Dr. Hergert. Which that’s fine. All those folks down in Southlake Texas think they should only get the best anyway. Lol. It’s jokes I make jokes.
We go way back. Like….to 3rd or 4th grade basically. For real. Grew up in the same neighborhood in Perryton, TX – look it up – we were in Parker Chiropractic College at the same time and we’ve been serving in the Texas Chiropractic Association together for years. He’s actually an ex-President of the TCA so definitely worth listening to.
This particular episode was called New Guides For Low Back Pain That Medical Doctors Are Ignoring.
Surprise surprise, they’re STILL ignoring guides set forth by their own damn organizations and associations.
We talked about Section 2706 of Obamacare. We covered a lot of ground and people have responded by making Episode 11 our #1 listened to episode of the first 2 years of the Chiropractic Forward Podcast.
It’s been fun and we’re still rocking and rolling and whatnot. Don’t you go anywhere. You keep coming back every Thursday for the new episodes.
Keep sharing us on Facebook and Twitter. Keep writing reviews on podcast platforms. Keep stoppign by the shop at chiropracticforward.com and let’s keep seeing where this here train will lead.
I’m hoping it leads to more evidence-informed practitioners comign out of college each and every semester. More and more and more until some of the garbage we see right now becomes the exception rather than the rule.
Together, with your involvement here and with your help, we can make it happen.
Store
Part of making your life easier 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. 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 something is out of sorts or isn’t working correctly.
If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders.
Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it.
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 us that patients can get good to excellent results for headaches, neck pain, back pain, and joint pain just to name just a few.
It’s safe and cost-effective. It can decrease surgeries & disability and we normally do it through conservative, non-surgical means with minimal hassle to the patient.
And, if the patient develops a “preventative” mindset going forward from initial recovery, we 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. When it comes to non-complicated musculoskeletal complaints….
That’s Chiropractic!
Contact
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show 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.
Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
CF 094: Forward ’19, Decompression Research, Curveball or Pitch Count?
Today we’re going to talk about my Forward ’19 experience, we’ll talk about decompression research, and we’ll cover some new research on whether it’s the curveball or the pitch count that injures young players on the baseball diamond.
But first, here’s that sweet sweet bumper music
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun and accessible while we make you and your patients better all the way around. Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have rattled and rolled into Episode #94
Now if you missed last week’s episode on the bigger the disc the better and what early improvement in treatment tells you, make sure you don’t miss that info. Every episode offers some good take-aways so make sure you’re up to date and not falling behind the rest.
I like to look at this podcast as an ongoing, fun way of learning and making each other just a little bit better every week so don’t just hop in for one episode. Stack them up one after another and, before you know it, you’re going to start retaining the info and you’re going to start recalling something we talked about down the road when you’re interacting with a patient and they ask you a question.
You’ll see. Even though I’m the host, it happens to me. Someone will ask me a question and I’ll remember an episode we did on that topic and BOOM!! Pow!! There it is, the answer comes to me. Pretty cool.
Forward ’19 – For you newbies here you’re probably wondering what the hell Forward ’19 is. A quick rundown is that it is a yearly seminar/conference that was born from an online Facebook group called the Forward Thinking Chiropractic Alliance aka FTCA. They have a website as well.
The group is very much evidence-based or evidence-informed. Whichever is your preferred verbiage. The group has about 7800 or so doctors in it and they are interacting on a daily basis mostly to try and make each other better. Overall, it’s a good group. I’ve heard people griping because they see griping here and there in the group but, in general, it’s a very positive, very smart, and very helpful group. I encourage you joining it if you’re a doctor or student.
Anyway, Forward 19 – What an event. The group puts on several events through the year but this is the key event put on by the FTCA every year. This is year #2. It was in St Louis at the campus of Logan Chiropractic College.
First thing is, holy smokes what a campus man. I bet they pay a fortune just to mow the grass. Just wow. The landscaping, the tower in the middle, and Purcer Center where it was all held. Just gorgeous. Having gone to Parker, that was the Chiro campus I’d been on and don’t get me wrong, Parker is impressive. I’d say Logan most definitely is as well. Kudos.
Speakers:
Gray Cook SFMA – SFMA stands for Selective Functional Movement Assessment – I have to admit that this was my first exposure to Gray Cook but it won’t be my last. I had heard of SFMA but was not all that familiar with it. I really enjoyed his talk and some of the concepts he puts forward. I can’t wait until I get through with my Diplomate program – hopefully in November – so that I can dive into Gray Cook’s stuff and just keep building on the knowledge pile.
Greg Kawchuk – He is the Research Chair for the World Federation of Chiropractic.
So, outside of the FTCA, I had little knowledge of Greg Kawchuk. But, Greg gave a speech at the World Federation of Chiropractic last year in Berlin that got some people a little fussy and some people elated. It definitely got the attention of chiropractors around the world to say the least. He gave the same speech last weekend in St. Louis and it had people on the edge of their seats.
Backing up a bit, Greg is a dynamic speaker. One of the more humorous and engaging speakers I’ve seen in maybe forever. He’s immediately like-able and that make for a good speech from the top. The talk was all about putting the ACT back in Chiropractic. A play on the way the philosophy guys use the TOR and the TIC garbage. You know….the principled vs. un-principled hoohah.
I happened to think that evidence-informed docs are the principled ones and if you need more info on why I think that, just go back about 3-4 episodes and listen to my podcast on the topic of Closing Patients. A principled, ethical person doesn’t carry themselves in that manner and the philosophy folks are much more likely to be out there closing patients than offering responsible treatment plans that are based on commonly accepted guidelines. In my experience at least. It’s always made me a bit hot under the collar when someone asks whether another chiropractor is principled or not.
Makes me want to principle them in the forehead…..with a mighty slap.
Anyway, putting the ACT back in chiropractic: he asked what are we doing right now? What are you doing right now to move the needle forward? To bring chiropractic into this current century we are in? He suggests we do a lot of sciencing and consume at least 1 science per day and I agree with him.
Hell, here at the Chiropractic Forward podcast, we distribute about 3-4 sciences per episode so we almost got you covered for the whole week if you’re a regular listener.
I think the part of his presentation that some took exception to was the part where he feels the evidence group may, at some point, consider a divorce from the philosophy geared group. He said it may not be an official divorce but could be very much a divorce in the way we act, carry ourselves, communicate with our patients, and things of that nature.
He says, at the end of the day, it could be something similar to….. we went out for a pack of smokes and…..just never came back.
Now, as you sit in your car or truck or your office hearing me say that, you can take that all in as you will. I’m going to tell you that, as a doctor that considers himself very much on the research end of things and very little on the philosophy end of it, and as a doctor that does everything he can to be ethical, honest, and all that…..it is so hard to sit and hear patients talking to me about being forced to sign of on a contract for thousands of dollars for a year long schedule for umpteen visits based on a curve correction that research suggests isn’t that big of a deal.
It’s hard to hear about the knuckleheads in Oakland claiming they can reverse degenerative spurring by seeing someone 3x/per day for 3 weeks. It’s hard to watch Mr. man bun top not from the coffee house talking about fixing kids with no research to back his claims.
It’s hard to hear about chiropractors scaring the crap out of patients with x-rays and convincing them that they are somehow damaged and in a dire circumstance unless they undergo 60 visits and another 3 sets of x-rays….
These are just a few of the stories. There are so so so many of them and at some point, I just don’t want to be associated with that anymore. At all. If that’s not understandable and that makes no sense to you and that makes you mad at me, well….I’d say I’m sorry but I’m just….I’m just not.
Even though I don’t smoke in the physical meaning of the word, I think I went out for a pack of smokes and never came back about 15 years ago.
Christine Goertz – If you are a regular listener of our podcast, you know Dr. Goertz has been on our show before and you know I’m a nerdy fan of her and her contribution to our profession. Any chance to listen to Dr. Goertz is a chance that should be seized upon. She’s a giant in our industry.
Annie O’Connor – World Of Hurt – OK, I’m admitting something again. I wasn’t familiar with Annie O’Connor. Annie is fun and vivacious and really another very dynamic speaker but she is full of knowledge nuggets. The kind that you can really put to use. She spoke on how words can harm so how key communication can be for some patients. She talked about yellow flags and she talked about classifying pain patients so that we can help them with more efficiency. You can believe that World Of Hurt is on my reading list after Forward ’19.
Greg Friedman – documentation documentation. Greg is Greg. Smart, laid back, fun, and just likable immediately. It was great to get to meet him in person and share a good discussion prior to his documentation class. He’s full of excellent information and not just on documentation so, if you get a chance and you need the hours, search out a class. He’s flying all over the nation every weekend.
Mike Massey – he shared teaching duties with Greg on the documentation class. He told me he’s a listener of our podcast and he’s an active member of the FTCA so I’ve been a fan of his for a while now. It’s always a cool deal to put the online world into a 3D context and it was sure nice to meet Dr. Massey. Hopefully next time I’ll get to sit and speak a while with him. I think our personalities probably match up pretty closely from what I can tell.
Some of the others I got to see and speak with are Brandon Steele
Kevin Christie
Jon Morrison
Robert Jones, President Of The ACA was there the whole weekend sitting in on the classes himself. What a super guy.
Budweiser tour
Meeting people
Kris Anderson
Chris Howson
Rob Pape
Bobby Maybee
Bobby Mozafari
Mike Massey
Greg Friedman
Dale Thompson
Kevin Christie
Anne Maurer
My biggest regret is that I didn’t get any real one on one time with very many of these folks but That’s OK. All’s well.
If I didn’t come up and speak with you but you saw me there, please don’t take it personally, believe it or not, I have a bit of a shy streak. Once I’ve had a conversation with someone, it’s all good. But, if I don’t know you yet….ugh….I have a podcast. I was a traveling musicians for 7 years. Why would a guy like me be shy at all? Yeah I don’t know. I’m in control in those other situations. Maybe it’s when I’m not in control or I’m a newbie….who knows?
Anyway, if you ever see me at an event, regardless of the event, please come say hi. I’d love to meet you.
We are about to get to our two articles. One is new research on traction/decompression information for low back discs and the other is on young baseball pitchers and how the curveball isn’t the culprit.
First though, we have backed off and rather than having two show sponsors, we have one and it’s a company you all know how much I love.
If you’re a regular listener of our podcast, you know I used it since about June of 2018. Let me tell you about it.
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You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**
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That’s ChiroUp.com and super double secret code Williams99.
Item #1
The first article today is called “The effect of mechanical traction on low back pain in patients with herniated intervertebral disks: a systemic review and meta-analysis” by Cheng, et. al(Cheng Y 2019). and published in Clinical Rehabilitation in August 28, 2019. Smoking hot folks. Stand back. Watch your eyebrows!
First thing, recognize in the title there, this is a systematic review and meta-analysis. That’s at the top of the research pyramid.
Why They Did It
To evaluate the effectiveness of traction in improving low back pain, functional outcome, and disk morphology in patients with herniated intervertebral disks.
How They Did It
They did a big time search PubMed, Scopus, Embase, and the Cochrane Library and they did this search from the earliest record all the way up to July 2019.
They included RCTs that involved adult patients with low back pain associated with herniated disc confirmed by MRI or CT
RCTs that compared lumbar traction to sham or no traction
RCTs that provided quantitative measurements of pain and function before and after intervention.
The initial search came up with 3,015 records which they whittled down to 7 involving 403 patients.
What They Found
Compared to the control group, the patients that had traction showed significantly greater improvements in pain and function in the short term
The differences were not significant enough to support the long-term effects on pain and function, nor the effects on herniated disc size.
Wrap It Up
Compared with sham or no traction, lumbar traction exhibited significantly more pain reduction and functional improvements in the short term, but not in the long term. There is insufficient evidence to support the effect of lumbar traction on herniated disk size reduction.
Here’s where I’m at on that. I use decompression. I just need to know more about this study. Did they do simple traction? Did they do a cycling pull phase from a pull to a rest phase? How much weight was the pull? How long did they do each treatment and how many treatments did they do?
There’s also patient preference and clinical experience factoring into using decompression.
Reading down through this sucker, it’s just too varied to make any assumptions. The intervention programs differed among the studies from 10 sessions to 60. The treatment protocols varied from 2 weeks to 10 weeks. Some of the studies included had no information on the weight of the pull while a handful went up to 50% of the body weight. Some of the studies used continued traction while others had intermittent traction. Some even used self-suspended, inversion table type traction.
Are you getting a whiff of what I’m dumping here?
Out of the 7 studies they included, only 2 measure the disc height and one measured the disc ratio.
Overall, when you read through the paper, these authors freely admit, this is a tough one but they wanted to start somewhere. They suggest several ways to go forward and say that there are a couple of studies out there that show a trend toward long-term decompression reducing the size of a disc herniation but no longer papers have been done to investigate it.
It’s anecdotal as hell but I’m going to go ahead and anecdote the hell of you. Right to your face. Or….to your ears as it may be. I’ve been doing decompression for about 7 years and I’ve yet to see anything as effective. Including exercises, McKenzie, all of it. In some cases, it has absolutely amazed me. But, like I said, that is anecdotal but I hope some of these really super smart researchers out there in the profession start to dial down into it and figure it out. Mostly because I know it works. I’ve just seen it too many times.
Item #2
This last item is called “Effects of a Simulated Game on Upper Extremity Pitching Mechanics and Muscle Activations Among Various Pitch Types in Youth Baseball Pitchers” by Oliver et. al(Oliver G 2019). and was published in Journal of Pediatric Orthopedics in September of 2019. Wait, it’s September of 2019 right now right? Steaming pile of fresh knowledge nuggets, big platter, sizzling.
Why They Did It
The purpose of this study was to examine differences in pelvis, torso, and upper extremity pitching mechanics and muscle activations between the fastball, change-up, and curveball pitches in youth baseball pitchers following a simulated game.
How They did It
14 youth baseball pitchers with no history of injury were included
All major muscles and mechanics were measured
The pitchers were instructed to throw with max effort during a simulated game that provided random game situations
They were limited to 85 pitches
Data from 3 fastballs, curveballs, and change-ups thrown in the first and last innings were selected for analysis
Wrap it up
The principle findings of this study revealed that pitching to the age-restricted pitch count limit did not result in altered pitching mechanics or muscle activations, and no differences occurred between the 3 pitches. These results support previous research that indicate the curveball pitch is no more dangerous for youth than the other pitches commonly thrown. This is supported by the pitcher’s ability to maintain a proper arm slot during all 3 pitches and indicates that they are obtaining the spin on the ball from their grip and not by altering upper extremity mechanics.
So….it is not the curveball it seems but, rather, it’s the pitch count in young pitchers, it’s treating them like professionals when they’re still developing, it’s that they tend to play only one sport aka specialize, and that they need to be treated like developing children and human beings rather than the Dad’s lost glory or a future paycheck for the whole family.
Store
Part of making your life easier 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. 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 something is out of sorts or isn’t working correctly.
If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders.
Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it.
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.
Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Cheng Y, H. C., Lin Y, (2019). “The effect of mechanical traction on low back pain in patients with herniated intervertebral disks: a systemic review and meta-analysis.” Clin Rehabil.
Oliver G, P. H., Henning L, (2019). “Effects of a Simulated Game on Upper Extremity Pitching Mechanics and Muscle Activations Among Various Pitch Types in Youth Baseball Pitchers.” J Pediatr Orthop 39(8): 387-393.
CF 092: The History of Chiropractic (Do You Know What You Think You Know?)
Today we’re going to talk about the history of spinal manipulative therapy and the history of chiropractic.
But first, here’s that sweet sweet bumper music
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun and accessible while we make you and your patients better all the way around. Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have collapsed into Episode #92
Now i you missed last week’s episode on the 10,000 Steps Myth, the neuro aspect of an adjustment, and sodas kill, make sure you don’t miss that info.
Keep up with your colleagues and listen. Also, don’t miss Episode #13. I systematically debunk the myth that we chiropractors cause strokes. I’m not having it, y’all. It’s just not reality and I show you how to fight the myth.
Also, a few episodes back we talked about Closing Patients and my opinion on that. It may not be what you think it is.
This week has been more of just catching up. My new schedule I mentioned last week either has my world screwed epically or it’s working beautifully. Lol. Time will only tell but I’m pretty confident we’re doing just fine.
If you missed last week, I talked about implementing a firmer policy of having patient time and new patient/paper time.
Since doing that, we have been a bit lighter on the schedule that in recent weeks past but I am getting so much more done right now and it feels good. I have more energy at the end of the day. And doesn’t it feel good to feel good?
It’s cool. For now. If it gets much lighter on the schedule, I’ll hit the WTF? Button and switch gears. WTF….that stands for Why The Face right?Lol.
Kidding!! I know what it means but I run a mostly clean business here!! But, the point was….. I’m not worried at all right now.
We are about to get to all things History here but I saw an interesting thing on Facebook this week and it made me want to punt a kitten. I thought I’d share.
I was on Facebook and saw a couple of knuckleheads coming live from a coffee house. They do it once a week. Doesn’t sound too miserable just yet, does it? It’s actually a decent idea. Get the coffee shop in on it and Facebook live it once a week from the coffee shop talking about certain issues and what your solution to the certain issues might be. Maybe take questions from the crowd there too. Not a bad idea honestly.
Hell, I’d do that myself. Problem is that I’m too damn busy to do it and I’m not a morning person so I’m not getting up early enough to do it before work. Just forget it. Freaking forget it.
These guys are there at like 10 am on a specific day and I’m like….why aren’t you at work working on people in your work place where people work at 10 am on a work day? Lol.
They say build it and they will come and Maybe they haven’t built it just yet so the crowds are not coming just yet. I don’t know. Maybe they just make this coffee shop thing a priority for now and choose to not be working on a work day. Either way, one day the one dude wore a cap in the video and the next week he wore a tight little top knot man bun.
YESSSS I’m old. Yess I think it looks unprofessional. Yes…it makes me crazy like so many other things of his generation tend to do, and yes…..I’d rather take a kick in the nuggets than to allow someone that looks and talks like him work on me or my kid.
But…..Yes….there’s a chiropractor for everyone so…..what the hell do I know. Look the way you want I suppose. I’ve heard they have chiros in Florida and California that dress in flip flops and shorts so….when it Rome I guess.
Here’s my deal, they target kids and parents. Nothing wrong with that. But, they are busy talking about kids that can’t concentrate at school and how there’s just a disconnect in what God meant them to be capable of and what they are currently doing and, if the parents just bring them in to the chiropractor, these guys can help the kids make the connection back and lead that kiddo to the awesome shining light of a life that God intended for them.
Ummmm…..no you can’t. Is that judgy? Yup. Sorry, whether you admit it or not, we make snap judgements of each other. Rightly or wrongly. IT’s a fact of life. My snap judgement is…..son of a mother. Son of a motherless goat.
There are so many great chiropractors engaged in research, engaged in diplomat programs. Engaged in taking themselves and this profession to the next level. And this crap trashes all of it. Chunks it all in to the garbage immediately.
They chunk it in the garage with their ‘truth’. You hear that crap all of the time now. Speak YOUR truth. We all have our own truth. When did that start exactly? There’s the truth and that’s it. There’s not your truth, my truth, my dog’s truth, some talking head on TV’s truth…..none of it. There is only THE truth.
And the truth is I’ve seen nothing convincing about this sort of stuff. Absolutely 100% nothing to the level allowing people to get on Facebook touting the ability in a voice that says “You’re great parents. You’re doing everything for your kiddo and we know that. You just need the right kind of help.” Srsly? I you could just get the parents on your brogram…..err…I mean program.
Come on bruh. Bro. Broseph, I can see it now, they sell brotein shakes at their office and it’s part of the brogram that Billbro Baggins and his buddy Chillbro Swaggins put together after a night of hitting the hookah.
Show me the support for chiropractors resolving ADHD, autism, and all of that other stuff they claim to help with. Show me it in systematic trials. Maybe randomized controlled trials. Hell, just something peer reviewed and published in a reputable journal?
But DON’T show me a damn case study or pilot study. Don’t do it or I’ll name you publicly. Lol. I can’t handle people that think case studies hold up to proper scrutiny. They do not. They’re interesting and, for the most part, that’s it.
They could be doing these in business suits and ties and start spouting unsupported claims like this and they would still look like space cadets claiming they have been to the moon, looked back at Earth, and it is indeed flat despite all evidence to the contrary. Seriously. Srsly.
I can’t stand this sort of gibberish. It’s a waste of time and talent.
I’m getting to Item #1 in just a second but we can’t get started without mentioning the sponsor of the first half of our show,
Let’s talk about GoChiroTV. GoChiroTV is a patient education system for your office that actually saves you money. Instead of spending money on cable TV or looping a DVD over and over in your lobby, the bite-sized videos are specifically made to inform your patients about the importance of chiropractic, healthy living, and to encourage referrals while, at the same time, presenting the benefits of all of the different products and services that you offer. Specific to your office.
That’s right. It works by using a tailor-fit video playlist that only promotes the products and services offered in your specific practice. Not only that but the videos are updated automatically on a weekly basis so there’s no need to manually update your playlist AND you don’t have to learn any complicated software. You get to just set it and forget it. And don’t we busy doctors need just that?
Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions. That’s CFP19, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription.
Go visit GoChiroMedia.com to check out the demo reels and get started on your free trial.
Item #1
Now we know a little about our more recent history like chiropractors used to go to jail for treating patients. We know that the AMA has wanted us banished form Earth since our inceptions. Most chiropractors know this stuff. And you should know this stuff.
But, I remember Dr. Anthony Nicholson, on one of his guest spots with us, I remember him mentioning that spinal manipulative therapy was actually one of the mainstays of treatment before the explosion of the physician/medical complex. I honestly did not know that.
So, when I stumbled across this paper called “A History fo Manipulative Therapy.” I started reading. It was written by Erlan Pettman(Pettman E 2007) who is actually a PT and published in the Journal of Manual Manipulative Therapeutics in 2007, Old man river…..it’s an oldie but goodie, people.
So, the author is a PT and this is basically his devotion to getting spinal manipulative therapy under the scope of physical therapists. Or to get more PTs to utilize it. I don’t know but, he says that the earliest reference to its use is in 400 BC back in Europe.
Interestingly, he says that spinal manipulative therapy rose simultaneously in cultures from Indonesia, Hawaii, Japan, China and India, to Central Asia, Mexico, Nepal, Russia, and Norway. All things I did not know. He also mentions that historical reference to Greece show the first direct evidence of its use and that it was well-established at the 400 BC mark so certainly predated that time going even further back.
Get this: Hippocrates who lived from 460-385 BC and who is referred to as the father of medicine….you know….the whole hippocratic oath thing….anyway, even back then he wrote a book on joints and described using spinal manipulative therapy. He even noted that the treatment should be followed by exercises. That’s sort of being ahead of ones time wouldn’t you agree?
This is such an interesting paper that I do hope you’ll check it out. I’m linking it in the show notes right here at this point in the text of the podcast.
While it’s very interesting, it is also very long and you’re not going to stick with me through it. There’s enough here that I may need to do an entire episode just on this paper because it’s THAT fascinating.
Briefly, he says that as common as spinal manipulative therapy was throughout the origins of mankind, it appears that physicians and surgeons began to abandon the acceptance of it in the 18th century. Though he can’t say exactly why, he offers that it could conceivably be from using the technique for the wrong candidate or potentially the perceived danger in manipulating a spine weakened by tuberculosis which was ravaging the population at that time.
So that’s where the downturn started for spinal manipulative therapy and, as he says, by the 19th century, a significant part of the medical establishment has a true disdain for bonesetters and their practices.
While there were many throwing the proverbial poo at spinal manipulative therapy, there were others with the power to recognize the obvious. Robert Jones, the founder of British Orthopaedics, wrote, “We should mend our ways rather than abuse the unqualified. Dramatic success in their hands should cause us to enquire as to the reason. It is not wise or dignified to waste time denouncing their mistakes, for we cannot hide the fact that their successes are our failures” INDEED Mr. Jones. Indeed….
Were you told that DD Palmer invented chiropractic? Of course you were. I was too. And, in as far as ‘chiropractic’ is an industry or a profession, he did. But, he did not invent the idea of ‘bonesetting’ through some magical discovery. At least it doesn’t appear that way in this article.
The author talks about Andrew Taylor Still. Still was also a magnetic healer. He suffered from chronic headache and took note one day. He had fallen asleep with his neck wedged between the roots of an oak tree. Upon waking, he had no more headaches. From there he began conceiving a theory about health and how it could only be maintained and, therefore, disease defeated, through normal function of the musculoskeletal system. This was all in 1874. Still went on to create the practice of Osteopathy. Did you know that Still’s practice was only about a day’s drive from DD Palmer’s town?
An astute listener will see the parallels of where osteopathy WAS and originated very similar to where chiropractic was and originated. And very astute listeners will make note of where osteopathy is now and where some in the chiropractic profession wish to keep us…..right back where we started. No progress. No learning. No breakthroughs. Nothing. It’s dumbfounding to say the least.
The author also talks about DD Palmer in the article. How could you not? He says that he was not the first to use the word subluxation nor was he the first to describe the use of the spinous and transverse processes as levers to adjust said subluxation. Those honors go to Johannes Hieronymi, William and Daniel Griffen, and Edward Harrison.
Did you know that in the 1920’s chiropractic was on life support but that the GI Bill after WWII was what enabled returning soldiers to go to chiropractic college and really bolster the numbers? I didn’t know that. Pretty cool.
Also of particular note is that in 1958, the National New from the National Chiropractic Association warned about the rising numbers of PT’s training in manipulative procedures. So…..that’s been a thing for a long time it seems. Lol.
Just a fascinating read for us chiropractors. Go give it a look see and see what you think. I’d love to hear your impressions. Email me at dr.williams@chiropracticforward.com and let me know what you thought.
It’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices.
If you’re a regular listener of our podcast, you know I used it since about June of 2018. Let me tell you about it.
ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean:
In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises.
You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips.
You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**
If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months
That’s ChiroUp.com and super double secret code Williams99.
Store
Part of making your life easier 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. 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 something is out of sorts or isn’t working correctly.
If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders.
Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it.
The History of Chiropractic (Do You Know What You Think You Know?)
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.
Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Pettman E (2007). “A History of Manipulative Therapy.” J Man Manip Ther 15(3): 165-174.
CF 086: Sports Performance / Chiropractic Care Standardization / Proprioception
Today we’re going to talk about Sports Performance / Chiropractic Care Standardization / Proprioception
But first, here’s that arm like a big fuzzy coat bumper music
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 tripped into Episode #86 and when I say tripped, I don’t mean so much the LSD kind of trip but more like the I’m an idiot and fell face first in a room full of people sort of tripped. So, welcome you fools!! Lol. I kid, I joke. I’m honored to have you here today. We have some good stuff to cover.
Before we get started, let’s talk about GoChiroTV. GoChiroTV is a patient education system for your office that elminates the need for cable TV or looping the same DVDs over and over again in your waiting room. The bite-sized videos are specifically made to inform your patients about the importance of chiropractic and healthy living. To encourage referrals and to present the benefits of all of the different products and services you offer.
It works by using a tailor-fit video playlist that only promotes the products and services available in your practice. Not only that but the videos are replaced automatically on a weekly basis. There’s nothing complicated. You truly can just set it and forget it.
Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions. That’s CFP19, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription and you can’t hardly beat that deal.
Go visit GoChiroMedia.com to check out the demo reels and get started on your free trial. Take your practice to the next level with GoChiroTV.
Introduction
We’re here to advocate for chiropractic while we also make your life easier using research and some good solid common sense and smart talk.
Personal Happenings
I always feel that, if I share personal experiences with you guys, first you’ll know me as a person better and I don’t see anything wrong with that. Second, you may identify and sympathize. Third, if you can’t necessarily identify with what I go through, you may be able to learn from it if you get to that point.
With that I’ll say that 2019 has been quite the year for us around my office. New faces, lots of new patients, and less and less time to do things outside of seeing patients. My work/life balance is out of balance at the moment and I’m afraid my health is starting to show some dents in the armor.
I think I have an undiagnosed anxiety thing and, typically, I’m very good at managing anxiety and stress and having 4 or 5 balls up in the air at the same time. I’m a juggler people. And I have been for quite a long time.
But, in January, something clicked. Something changed. I don’t say this to brag. I say this to explain. My practice numbers just started to climb during a time that we are traditionally slow. Really slow. The holidays are usually a time when you just know you’re going to have extra time to catch up on all of those things that have been piling up in front of you. Back to school time as well right? It’s always been a down time for me for one reason or another.
Yeah, well, not this year. The holidays only got busier. Much busier. The kids go back to school in two weeks and there’s been no slow down this Summer. Which is awesome. But my problem is, I don’t know what I did to cause the influx. If I knew, you better believe I’d be repeating it!! Over and over and over.
The end story is, growing is great but growing can be stressful. That’s why they call it growing pains right? Think about it: how many staff member do I need to handle the patient load? Am I over staffed or understaffed? Do I need an associate? Which one is the right one? Will they take care of things like it’s their own and they care? Where do I get good contract for one? I have a bathroom that needs tiled and I have an Air conditioner that need’s replaced. My dog pissed on the carpet this morning. Blah blah blah.
You all know how it goes. Every aspect of practice has stressors. When you’re new in practice and don’t have a heavy load, you’re sitting looking at your watch, playing on the computer, hopegully you’re out marketing, and you’re stressed about how you’re going to provide for your family.
I’m aware that being too busy is a nice problem to have. I don’t want to come off as a spoiled brat here. I’m just saying that I have been stressed and it’s starting to affect me a bit. We have been blessed and we are going to take blessings and we are going to turn them into more blessings for us and for our patients and staff.
It’s just getting through some of the mud and muck along the way. I just need to keep my anxiety under the surface a little longer. Lol. So that nobody thinks I’m insane.
I’ve fooled them this long haven’t I?
On another note, Charlie Manson. Y’all, I was fascinated by their shenanigans when I was in high school but got over it. Every now and then I’ll see something about it and I’ll perk up and listen but I went to see the new movie Once Upon A Time In Hollywood.
I’ve been seeing where some hate it and some love it and I’ve seen a bunch of ehhh comments but I gotta tell you. I’m firmly in the hell yeah category. Brad Pitt and Leo DiCaprio knocked that sucker straight out of the parking out onto the parking lot. It was funny, it was vintage, it was nostalgic, and no…..of course it didn’t happen that way but it was excellent.
If you went, shoot me an email at dr.williams@chiropracticforward.com and tell me what you thought. I can share you thoughts next week on the podcast. Or you can get on our Facebook page or our private Facebook group and we can discuss.
Item #1
Let’s get to our first item here. It’s titled “The effects of spinal manipulation on performance-related outcomes in healthy asymptomatic adult population: a systematic review of best evidence” and written by Meliss Corso, Silvan Mior, Satrah Batley, et. al. It was published in BMC Chiropractic and Manual Therapies in June 2019. Brand new…..hot stuff people. (Corso M 2019)
The authors wanted to perform a systematic review regarding the effect spinal manipulative therapy has on athletic performance in asymptomatic adults.
What They Found
They concluded “The preponderance of evidence suggests that SMT in comparison to sham or other interventions does not enhance performance-based outcomes in asymptomatic adult population. All studies are exploratory with immediate effects. In the few studies suggesting a positive immediate effect, the importance of such change is uncertain. Further high-quality performance specific studies are required to confirm these preliminary findings.”
That doesn’t mean we can’t help with pain and discomfort which aids in better performance. But it does suggest that, if a person feels great, getting spinal manipulative therapy isn’t very likely to make any difference in how fast they are or how far they can throw.
Item #2
This one is called “The Chiropractic Hospital-Based Interventions Research Outcomes Study: Consistency of Outcomes Between Doctors of Chiropractic Treating Patients With Acute Lower Back Pain” by JA Quan, et. al and was published in the Journal of Manipulative and Physiological Therapeutics in June 2015 so 4 years old. (Quon JA 2015)
Why They Did It
The aim of this study was to determine if effectiveness differs between community-based doctors of chiropractic administering standardized evidence-based care that includes high-velocity low-amplitude spinal manipulative therapy (SMT) for acute low back pain (LBP).
How They Did It
A secondary analysis of randomized controlled trial and observational pilot study data was performed with nonrandom allocation to 4 DCs.
Patients included those with Quebec Task Force categories less than or equal to 2 and acute LBP of 2 to 4 weeks’ duration.
The intervention included high-velocity low-amplitude SMT.
Outcomes assessed using Roland Disability Questionnaire (RDQ) at 24 weeks.
What They Found
The findings of this study show that regardless of the treating DC, most patients with acute LBP without radiculopathy appear to experience consistent levels of improvement in terms of BP and general PF after receiving guidelines-based treatment that include s a component of standardized HVLA SMT.
If we dive into the paper, they mention that until now, inconcsistency hasn’t been regarded as a significant barrier to chiropractors getting referrals from the medical realm. Butthere are guarded attitudeds about chiropractors when we’re talking about quality of care and that’s been confirmed in other papers.
In fact, in a survey of 487 Canadian and American orhtopedic surgeons, they found that about 71% of them held either a neutral or a negative view of chiropractors. That means only 29% of them looked at us in a positive way. 29%. Dammit
Also, when you break down that 71% of neutral or negative….you get 26% were neutral but 45% were in the negative category. Dammit.
73% of orthopedic surgeons thought chiropractors provided unnecessary treatment. Yeah, they’d probably just do better if you intubated them, knocked them completely out, and drove screws through the bones of their spine to fixate the segments on top of each other and then sewed them back up, and then sent them home with a bunch of pills. That’d probably be much more necessary. Sure thing chief.
Hell, 52% of them thought chiropractors make their patients dependent on short-term relief. I will say that it feels good to feel good and why wouldn’t a patient want to feel good as often as they can? But putting the shoe on the other foot here, let’s assume they’re right, isn’t being addicted to safe, conservative, non-invasive treatment better than being addicted to opioids or some sort of medication? Our nation’s opioid crisis suggests it is better.
The paper itself is really a preliminary study and meant to further knowledge and information for other papers down the line but I found it more interesting because of the orthopedic survey discussion. Pretty interesting. And….disappointing I’d add but that was 4 years ago. Maybe those numbers are changed a bit from then to now? Not sure.
This is a great spot to take a short break to talk about ChiroUp. If you’re a regular listener of our podcast, you I use it and I’ve told everyone how amazing it is since about June of 2018. Well now they’re a sponsor of our show and we are really excited to have ChiroUp on board the train.
Have you heard about the #1 online resource for chiropractors? Well, let me tell you about it.
ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean:
In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises.
You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips.
You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you.
There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**
If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months
That’s ChiroUp.com and super double secret code Williams99.
I’m trying to save you people some money here alright?Trust me, you’re not going wrong with ChiroUp. In fact, in studying for the Diplomate of the Academy of Chiropractic Orthopedists part two exam, I’m studying the orthopedic tests and videos from the ChiroUp website. It’s phenomenal.
Anyway, on to Item #3
It’s called “Neck proprioception compensates for age-related deterioration of vestibular self-motion perception” by G Schweigart, RD Chien, and T. Mergner. It was published in Experimental Brain Research all the way back in 2002. Bringing the old man out of the archives here. (Schweigart G 2002)
Why They Did It
Vestibular functions are known to show some deterioration with age. Vestibular deterioration is often thought to be compensated for by an increase in neck proprioceptive gain. That’s what the authors were studying here….. this presumed compensatory mechanism.
What They Found
Generally, we hold that the transformation of the vestibular signal from the head down to the trunk proceeds further to include the hip and the legs as well as the haptically perceived body support surface; by this, subjects yield a notion of support kinematics in space.
As a consequence, spatial orientation is impaired by chronic vestibular deterioration only to the extent that the body support is moving in space, while it is unimpaired (determined by proprioception alone) during body motion with respect to a stationary support.
Just to add a little sidebar here: did you know that muscle spindles are our motion detectors? Think about this. There are 16 muscle spindles per gram of muscle in our fingers. Our hands and fingers are highly sensitive with regard to proprioception arent they? Think of a musician playing with their eyes closed.
You know exactly where your fingers are without looking at them or really even thinking about them. How about typing? You don’t look right?
Now, we only have about 2 muscle spindles per gram of muscle in the traps. Which makes sense. Why do we proprioceptively need to know where our traps are? They’re attached to our axial skeleton. They’re not going anywhere. They’re not out flapping in the wind like our hands right?
Here’s the weird deal though: in our deeper cervical muscles, we have 242 muscle spindles per gram of muscle. That IS our axial skeleton basically so why so many spindles? There’s no flapping out in the wind with the upper cervical muscles either. But, it is the connection between our head and the rest of our body.
It is to the point that anatomists look at the upper cervical muscles as more of a proprioceptive organ rather than as simply muscles.
Our three proprioceptive inputs are the eys, the vestibular organ, and the muscles of the upper cervical area. When you do a Romberg’s test and you remove proprioceptive input from the eyes, and the vestibular organ….., part of what you are measuring is the input from the upper cervical region.
It’s fascinating. Absolutely fascinating when you dive off into it a bit and I encourage to do so.
Store
Part of making your life easier 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. 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 something is out of sorts or isn’t working correctly.
If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders.
Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it.
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.
Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography
Corso M, M. S., Batley S, (2019). “The effects of spinal manipulation on performance-related outcomes in healthy asymptomatic adult population: a systematic review of best evidence.” BMC Chiro Man Ther 27(25).
Quon JA (2015). “The Chiropractic Hospital-Based Interventions Research Outcomes Study: Consistency of Outcomes Between Doctors of Chiropractic Treating Patients With Acute Lower Back Pain.” J Man Physiol Ther 38(5): 311-323.
Schweigart G, C. R., Mergner T, (2002). “Neck proprioception compensates for age-related deterioration of vestibular self-motion perception.” Exp Brain Res 147(1): 89-97.
