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Hypermobile Patients, Sports-Related Concussion, & Obesity’s Pain Connection

CF 187: Hypermobile Patients, Sports-Related Concussion, & Obesity’s Pain Connection

Today we’re going to talk about Hypermobile Patients, Sports-Related Concussion, & Obesity’s Pain Connection But first, here’s that sweet sweet bumper music

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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  OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #187 Now if you missed last week’s episode , we talked about the western diet and its effects and we talked about some pretty cool acupuncture research. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Our nurse practitioner starts on August 2nd but we are having a hard time getting our malpractice person to respond to us and get that in place. We can’t get credentialing until that happens. Credentialing takes at least 2 months typically.  So, you see the issue. That was an unplanned obstacle.  We are in the process of changing our signage on the front of the building as well. We have one big sign out on the main street so that’s two inserts…..one for each side. 

Then we have two suites here so we have two doors. Which means we have two signs on the front of the building. So, added up, we get to order 4 inserts. Signs aren’t cheap if you’ve had to put one in lately.  Those are just some of the things that we’re messing with lately.  Clinic numbers, we are in week 3 with some good solid numbers. Not pre-COVID numbers but getting there. I’ll be honest with you, I’m not sure I want pre-COVID numbers. There were weeks I was at 220 appointments for the week. 25 new patients, re-exams running out my ears.  Now, that’s not bragging. I’m not there anymore. What I’m saying is that sometimes, it’s too much. In healthcare, you really can be too busy. Things start falling through the cracks.  My mom had a bone density test misread because her primary is simply too busy. He took responsibility and, other than putting her back surgery off longer than it should have, no harm was done. But the point is, we can get too busy.  I am extremely conservative in my finances. I don’t like taking big chances. I don’t like huge what-ifs. I like small, measured, and reasonable risks. You cannot eliminate risks. But we can mitigate them. We can make them minute instead of big gaping holes.  I should have hired an associate. And to be fair, we started to do that. It just simply fell through. And it was a blessing in disguise when you consider what COVID did to our practice. Now we get a chance to potentially say, “‘If I could go back and do that all over again…..” 

At this time, I’m at a point in my caseload that it’s all fairly easily manageable. We’re at probably 165-170 per week. That’s manageable for evidence-based, patient-centered practice. We are rehab-heavy. Rehab takes time and I have an excellent staff and ChiroUp to help me make it all happen.  However, if we get to the 190-200 appointments per week range, it’s time to start shopping for an associate. It’s too much and too many other things I’m trying to accomplish both personally and professionally suffer from that caseload.  And my brain space is just destroyed if I’m being honest. It’s not fun to go to work when you’re overwhelmed every day. It’s unpleasant. Even when the majority of your patients are amazing people. Nobody wants to go to doctors that are overwhelmed like that and I don’t want to be one of those doctors either.  So, just a little brain dump there and some free-flow thought for you. I have an intern coming in from Parker College in September. That’ll be my first intern to have onboard so who knows….maybe that ends up being a long-term thing.

Maybe not.

Time will tell.  On the horizon for me, real estate investing!! Regular listeners may have heard me talk about exit strategies. If you’re a thinker, you’re not only thinking about today but what you want out of tomorrow. I’ve been in business for over 23 years at this point and have never taken more than 5-7 days of vacation at a time. I’ve never been to Europe or anywhere outside of the Caribbean.  So, smart moves is what get us there. We are in a business where our presence is mandatory for a business to continue. In essence, our business owns us. Not the other way around. So how do we flip it? Well, we need people in place that fill the gap when we are out. We need to be the CEO instead of the hands-on worker. That’s part of the reason we are bringing in a nurse practitioner. That’s part of the reason we’ll be looking for an associate when the numbers truly rebound.

That’s the reason I started a voice-over side gig, which is going amazingly by the way. What a blessing that has been, y’all. I can’t even begin to tell you how well that’s going. I’ve voiced over 200 spots just since January. That’s over 33 per month. It’s been insane. That’s also the reason that real estate investing is my next mountain.  Mailbox money, y’all. Now, real estate investing takes effort and work so it’s not technically mailbox money but, when done right, is the fastest path to financial freedom. That’s the reason for the book I wrote and the speaking opportunities I’m getting involved in.  These are all potential paths toward early, comfortable, happy, partial retirement. Retirement to me doesn’t mean any work. It means control of my time. So in that context, retirement cannot come quite soon enough.  So, what’s your exit strategy? Are you going to work until you’re 88 and die at your desk in your office?

Which some want…and there’s not a thing in the world wrong with that. Or, do you have other things in your life to accomplish and need to start planning for that? Some say you need to start with the ending in mind. If you want to sell your business someday, shouldn’t you plan for that from the start? How do you build a business that’s ready to sell when it’s your time? Something to think about. I’m not sure I have all of those answers because they continue to unfold as I progress but I’m getting closer to solid ideas and strategies on it.  Alright….on to the research. 

Item #1

Let’s get it started this week talking about hyper mobility, Ehlers-Danlos, and all that good stuff. If you don’t really consider hypermobility in your daily treatment…..please….for the love of everything holy, please listen up and pay attention. This is where so many chiropractors are getting it wrong.  It’s becoming more and more clear every year that a good chiropractor should know when to mobilize and when to stabilize. Some of you are no doubt asking yourselves, what the hell does that mean? Sometimes the spine doesn’t want to be adjusted. There is already a plethora of movement there. Adjusting only increases the motion in an area that the increased motion is what is actually causing the complaint. In these cases, when in the hands of a vitalistic, subluxation, philosophy, doctor-centered chiropractor, this patient is going to get adjustment after adjustment for weeks and weeks.  I’m sure you can predict the eventual outcome here. And it’s not corrections of a subluxation. It’s spinal instability that compounds the issue.  The condition and patient population that is at increased risk here would be self-adjusters but mostly, those suffering from Ehlers-Danlos, which if you are unfamiliar, is a connective tissue disorder that allows these folks to behave a bit like an elastic rubber band. 

A hint of whether someone is EDS is the Beighton Scale. If I stand a new patient up and have them touch their toes and they put their hands flat on the floor, they’re getting put through the Beighton Scale to test for hypermobility. We need to know if they have too much movement in their joints. Because instead of more adjustments and more movement in the segments of the spine, they typically respond better to weight training, supportive activities and strengthening. 

This paper is called “Physical therapy treatment of hypermobile Ehlers–Danlos syndrome: A systematic review” by Gregory Reychler and Maya-Mafalda De Backer et. al. (Reychler 2021) and published in the American Journal of Medical Genetics on June 19, 2021…. My glasses….they’re steamed up..it’s hot.  Why They Did It The objective of this systematic review was to investigate the effect of the different physiotherapy techniques related to the children and adult patients with hEDS How They Did It

  • PubMed, SPORTDiscus, Cochrane Library, PEDro, Scopus, and Embase databases were analyzed from inception to April 2020.
  • Characteristics of the studies (authors), patients (sample size, sex, age, Beighton score), and non-pharmacological treatment (length of the program, number of sessions, duration of the session, and type of intervention), and the results with the dropout rate were extracted. 
  • From the 1045 retrieved references, 6 randomized controlled trials with a sample size ranging from 20 to 57 patients were included in the systematic review
  • There was a huge heterogeneity in the interventions. The duration of the program were from 4 to 8 weeks

What They Found

  • Pain or proprioception demonstrated significant improvements in the intervention group regardless of the type of intervention. 
  • A benefit of the inspiratory muscle training was observed on functional exercise capacity.
  • The quality of life was systematically improved.

Wrap It Up

Physiotherapy benefits on proprioception and pain in patients with hEDS even if robust randomized control studies are missing. Now, the full paper isn’t available for me to ingest so who the hell knows what all interventions these patients underwent. We don’t know. But, physiotherapy is Europe and Canada and Australia’s term for physical therapy. We know what PT is and in these patients, I’m assuming it is exercise and building strength and proprioception and balance.  All of that also helps clear up the joint and movement map in the brains of chronic pain patients. Which leads to more accurate sensorimotor function, less aberrant movement in the joints, more confidence in abilities and future capabilities, and less pain as an overall result.  And yes, I just tossed a bucket of Neuromusculoskeletal Medicine Diplomate on top of all of your heads. And didn’t it feel warm and fuzzy??

Of course it did and you’re welcome.  Let’s hear from our awesomely amazing sponsors. 

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Item #2 This second one is called “Lose Pain, Lose Weight, and Lose Both: A Cohort Study of Patients with Chronic Pain and Obesity Using a National Quality Registry” by Dong et. al. (Dong HJ 2021) and published in the Journal of Pain Research in February of 2021 and that’s holy mother of Hades hot. 

Why They Did It It is known that chronic pain makes it difficult to lose weight, but it is unknown whether obese patients (body mass index ≥ 30 kg/m2) who experience significant pain relief after interdisciplinary multimodal pain rehabilitation (IMMPR) lose weight. This study investigated whether obese patients with chronic pain lost weight after completing interdisciplinary multimodal pain rehabilitation in specialist pain units. The association of pain relief and weight change over time was also examined.

How They Did It

  • Data from obese patients included in the Swedish Quality Registry for Pain Rehabilitation for specialized pain units were used, including baseline and 12-month follow-up after IMMPR from 2016 to 2018
  • Patients reported body weight and height, pain aspects (eg, pain intensity), physical activity behaviors, psychological distress, and health-related quality of life
  • A reduction of at least 5% of initial weight indicates clinically significant weight loss. 

What They Found

  • A significant reduction of pain intensity was found after interdisciplinary multimodal pain rehabilitation 
  • A similar proportion of patients in the three groups with different pain relief levels had clinically significant weight loss 
  • Significant improvements were reported regarding physical activity behavior, psychological distress, and health-related quality of life, but weight change was not associated with changes of pain intensity.

Wrap It Up

“About one-fifth of obese patients achieved significant weight reduction after interdisciplinary multimodal pain rehabilitation. Obese patients need a tailored pain rehabilitation program incorporating a targeted approach for weight management.”

Item #3

The last on his called “Injury Reduction Programs for Reducing the Incidence of Sport-Related Head and Neck Injuries Including Concussion: A Systematic Review” by Eliott, et. al. (Elliott 2021) and published in Sports Medicine on June 18, 2021. It’s a big ol’ pot of hot. 

Why They Did It To systematically review the literature to investigate: (1) the relationship between neck strength and sport-related head and neck injuries (including sport-related concussion (SRC); and (2) whether neck exercise programs can reduce the incidence of (a) sport-related head and neck injuries; and (b) sport-related concussion.

How They Did It

  • Five databases and research lists of included studies were searched
  • From an initial search of 593 studies, six were included in this review

What They Found

  • The results of two observational studies reported that higher neck strength, but not deep neck flexor endurance, is associated with a lower risk of sustaining a sports-related concussion. 
  • Four intervention studies demonstrated that injury reduction programs that included neck exercises can reduce the incidence of sport-related head and neck injuries including sports-related concussion.

Wrap It Up

Consideration should be given towards incorporating neck exercises into injury reduction exercise programs to reduce the incidence of sport-related head and neck injuries, including sports-related concussion. Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.       

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!

Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 

Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

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About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

  • Dong HJ, D. E., Rivano Fischer M, Gerdle B, (2021). “Lose Pain, Lose Weight, and Lose Both: A Cohort Study of Patients with Chronic Pain and Obesity Using a National Quality Registry.” J Pain Res 14(1863-1873).  
  • Elliott, J., Heron, N., Versteegh, T, (2021). “Injury Reduction Programs for Reducing the Incidence of Sport-Related Head and Neck Injuries Including Concussion: A Systematic Review.” Sports Med.  
  • Reychler, G., De Backer, M.-M., Piraux, E., Poncin, W., & Caty, G, (2021). “Physical therapy treatment of hypermobile Ehlers–Danlos syndrome: A systematic review.” American Journal of Medical Genetics: 1-9.          

Chiropractic Integration Into A Medical Setting

CF 151: Chiropractic Integration Into A Medical Setting Today we’re going to talk about chiropractic integration into a medical setting But first, here’s that sweet sweet bumper music  

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research.

We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

If you haven’t yet I have a few things you should do. 

  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 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 #151 Now if you missed last week’s episode , we talked about the fate of a big pharma company and we talked about the outdated use of MRI diagnosis of cervical dysfunction. That’s not necessarily the way to do it anymore in 2020. 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

On the personal end of things…..

Well….how’s your week? Mine? It’s just eh… If you listened to a couple of weeks ago, I had a big week with some good numbers that looked like we were getting back to pre-COVID numbers. I was sniffing that level once again. Then, a three-day snow and ice storm decided that things were going a little bit too smoothly around here and shut us down for basically Monday, Tuesday, and Wednesday of last week. 

As a result, we went from 172 visits the week prior down to last week only seeing 71. So….roughly 100 visits just pissed off last week. Which left me pissed off. It’s been a mess this year and I’m no different than most. For that reason, I’m not going to sit here and gripe about it. We’re back in the ’70s this week so here’s to trying to reclaim those lost appointments and keeping our patients on track to getting better. 

Where we started the great week with 50+ patients on a Monday, this Monday we’re starting out the week with 26. Blah. But 4 new patients so, let’s hang our hats on the good stuff, shall we? And yes, we shall. 

This has absolutely been the year of making lemonade out of lemons. If you’re not strong mentally, this year is a bruiser, man. And let’s be honest, I’ve had ups and downs. I’m still having them. 

Hell, this week, as in many places, now that it’s time to rebuild after three lost days to weather, now the second COVID spike is in full swing. Yep, a bad day around here used to be 70 new cases. It was that way for 6 months or more. Now, in the last 2 weeks, we’re looking at averaging 240 or more cases per day. The hospitals are full and they’re bringing help in from out of town. I could let that work my head over but I won’t. Or…..at least I’ll try not to let it work me over. 

Have you ever watched The Secret? I sort of recommend it if you can absorb things in the right context. OR, I can just summarize it for you. Basically, it’s all about having a vision so strong that you basically will something to happen. If you believe it enough, the world will bend itself to make it happen for you. For example, from the movie, if you believe that there will always be a close parking spot available for you when you go shopping at different places, then you will indeed find close and wide-open parking spots. 

Or, if you really want a Ferrari, and you dream about it, feel yourself sitting in the seat, and feel the rev of the engine while you grip the steering wheel, etc….well, then surely, eventually you will indeed have yourself a Ferrari. Lol. 

Well, if you listen to this podcast enough, then you know damned well that I don’t buy into that kind of garbage. But there is a message in it that I do like and support. That message is that our lives are built on and based on our ability to be positive or negative basically.

I have an example from today for you. On the way to work this morning, not 2 blocks from my house, I almost got into 3 car wrecks within a time span of about 2 minutes. Seriously. At one point I had to stand on my brakes and throw everything into the floorboards. This while I was simultaneously yelling and hollering at this fool stopped in front of me. 

I could go into particulars on how it happened but that wouldn’t matter. What matters is that at that point in my day, I made a conscious decision. Was I going to let that ruin my day or was I going to see it for what it was and move on from it?

In The Secret, they say that our mentality from day to day affects our relationships with others. From our business interactions to our personal and family interactions. And it’s true. If you extrapolate that further, our mentality will either draw people TO us or push them AWAY from us. 

So, if I let that close encounter affect my mood from there on throughout the day, potentially, whether I was conscious of it or not, it could have affected my interactions with patients, staff, and then later at home. 

Alternatively, if I kick it out of my head and try to have a positive take on it….I didn’t get in a wreck after all!!! It could have been worse, right? 

That was my decision and I decided that it was over and I’m going to forget about it, not dwell on it, not be mad about it, and just move forward. 

On a larger scale, while I talk and share a lot about my business’s progress post-COVID here, for the most part, I’ve tried to adopt the ‘can do’ attitude. My generation Gen X is known for it. It is what it is. Let’s put on a smile, strap up our belts, and put one foot in front of the other. 

And that’s what’s making it happen here. We’re like Rocky in Rocky III. Clubber COVID Lang keeps slapping me around and punching me in the nose and when it’s not Clubber, it’s Thunder Lips throwing me out of the ring. Lol. Sometimes it’s like you just can’t win. And if you dwell on that crap, well, you know what happens. It affects everything you do and all of your connections. 

So, if Clubber Lang and Thunder Lips keep kicking your ass every week, put a smile on, stay doggedly determined, and come out swinging. All of this crap has a time limit. It will end eventually. Make sure you’re on top of the heap when it does.  Everyone loves an underdog. 

Item #1 First one of the day is called “Implementation of musculoskeletal specialists in the emergency department at a level A1 VA hospital during the SARS-Cov-2 pandemic” by Schielke et. al(Schielke A 2020). and published in The American Journal of Emergency Medicine on October 8, 2020,

Schiza….piping hot pile of poblanos!!

https://www.ajemjournal.com/article/S0735-6757(20)30894-9/fulltext?fbclid=IwAR1MFEaKmyTj990CjD3URlQP7Tnu45OSqsySUyQ7WZKmgcwxDP3RAnBSBQw

It’s not a research paper as much as an article so let’s get going with the highspots. 

  • They mention how the Rona depleted ER resources about the same time that pain management was deemed to be non-essential
  • They say that low back pain presenting in the ER has become more and more common and less traditional providers may be better suited to manage musculoskeletal pain. 
  • Bolstering the idea of alternative providers being involved, are the more current guidelines recommending nonpharmacologic treatment for low back pain. At least initially. 
  • Early conservative management for ED LBP has been associated with reduced pain and disability even when compared to patients with conservative outpatient physical therapy referrals
  • Multiple studies point out integrated ED MSK-specialist (MSK-S) reduced length of stay, imaging utilization, and opioid administration rates, and improved overall ED metrics when compared to patients seen by typical ED providers
  • Additionally, a 2018 systematic review and meta-analysis supports nonpharmacologic interventions for reduction of overall ED utilization and length of stay, and are effective in reducing pain in the ED with the potential to improve patient satisfaction, outcomes, and quality of life
  • VA Palo Alto Health Care System (VAPAHCS) 2019 proprietary data revealed approximately 60% of cases presenting to the ED were urgent/emergent MSK complaints, primarily LBP
  • As the health department postponed non-essential healthcare due to COVID, the plan to integrate non-traditional providers was amped up and happened on March 30, 2020, lasting through June 8th. 
  • Designated MSK-S care was provided during peak hours by chiropractic and physical therapy departments.
  • A “hub-and-spoke” arrangement was developed and per protocol, initial ED triage assessed for any serious spinal pathology, and a medical symptom evaluation was performed (“hub”). If diagnosed as MSK LBP, MSK-S referral was made with direct same-day hand-off (“spoke”).
  • Incorporation of MSK-S was shown, anecdotally, to be effective in treating acute MSK complaints as providers and patients were both able to benefit from the conservative options available in the ED
  • From the ED administration viewpoint, a liaison between ED and other sub-specialties utilizing a hub-and-spoke paradigm shift allows for the delivery of more efficient healthcare. With the positive feedback from the administration, ED providers, staff, and patients, integrated MSK-S clinics continue to develop within that VA system.
  • A 2018 review article by Kim et al. called for the use of an MSK-S in the ED and also provided clinical implementation guidance for any healthcare systems looking to adopt a similar practice.

Wow!! That’s pretty cool. Do you know what I did with this? I sent it to my friends in the medical field. Why not? The worst saying in the history of man is “We’ve just always done it that way.” What if there’s a better way? Of course, we know there is. The trick is in getting them to know there is. 

Item #2 Our last one today is called “Integration of Doctors of Chiropractic Into Private Sector Health Care Facilities in the United States: A Descriptive Survey” by Salsbury, et. al`. and published in the Journal of Manipulative Physiological Therapeutics in February of 2018. Not new but pairs well with our first item. 

Why They Did It The purpose of this study was to describe the demographic, facility, and practice characteristics of doctors of chiropractic (DCs) working in private sector health care settings in the United States.

How They Did It

  • They conducted an online, cross-sectional survey using a purposive sample of DCs working in integrated health care facilities. 
  • The 36-item survey collected demographic, facility, chiropractic, and interdisciplinary practice characteristics, which were analyzed with descriptive statistics.

What They Found

  • The response rate was 76%
  • Doctors of chiropractic reported working in hospitals (40%)
  • multispecialty offices (21%),
  • ambulatory clinics (16%)
  • or other (21%) health care settings
  • Most (68%) were employees and received a salary
  • More than 60% reported co-management of patients with medical professionals.
  • Integrated DCs most often received and made referrals to primary care, physical medicine, pain medicine, orthopedics, and physical or occupational therapy
  • Although in many facilities the DCs were exclusive providers of spinal manipulation (43%), in most, manipulative therapies also were delivered by physical therapists and osteopathic or medical physicians.

Wrap It Up

Doctors of chiropractic are working in diverse medical settings within the private sector, in close proximity and collaboration with many provider types, suggesting a diverse role for chiropractors within conventional health care facilities. Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourself and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week. 

Store Remember the evidence-informed brochures and posters at chiropracticforward.com.       

Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!

Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  

Bibliography

  • Schielke A, B. A., Walsh R, Rajagopal P, (2020). “Implementation of musculoskeletal specialists in the emergency department at a level A1 VA Hospital during the SARS-CoV-2 pandemic.” American J Emerg Med.

Chiropractic’s Effect On Strength and More, Status of Muscle Relaxers, And The Best Recovery Posture

CF 136 Chiropractic’s Effect On Strength and More, Status of Muscle Relaxers, And The Best Recovery Posture

Today we’re going to talk about Chiropractic’s Effect On Strength and More, Status of Muscle Relaxers, And The Best Recovery Posture But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.

If you haven’t yet I have a few things you should do. Like our Facebook page, Join our private Facebook group and interact, and then go review our podcast on iTunes and other podcast platforms. We also have an evidence-based brochure and poster store at chiropracticforward.com While you’re there, join our weekly email newsletter. 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 #135 Now if you missed last week’s episode, we talked about adjusting in the areas of known disc complications, bulges, herniations..things of that sort. 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….. Nothing new to report really. We aren’t growing in our visit count week to week but, at the same time, we aren’t shrinking either. We’re holding steady at about 80% of where we were before the COVID train wreck and here’s what I’ve sort of decided. I’m just going to be OK with 80%.

Like I said last week, while we’re billing out less and collecting less, we’re also spending less both in the practice as well as in my personal life. Some of you aren’t. Some of you think it’s a hoax and all that stuff. You’re going out and traveling and vacationing and all that jazz. We aren’t. We are not afraid but we also do want to be smart and be diligent. I’ve come to the mindset that if I wind up getting it, I’ll probably do just fine with some time but regardless of how severe or mild symptoms are, I’ll STILL have to shut my office down.

Now, how many of us can afford to just shut the doors for 2-4 weeks without any issues? Honestly, I’m a saver so I could actually do it and survive but I damn sure don’t want to. I have other plans for that money don’t you know. It wasn’t saved so that I could cover my practice financially if I get sick for a month. Hell no. It was saved to invest. So, we are being smart, we are wearing our masks and no….I don’t give one damn what anyone thinks about masks. Honestly. This has been the most disappointing aspect of human observation in recent memory.

The mask debate or debacle. Absolutely a waste of time and energy talking or listening to people on that deal. Anyway, we are wearing our masks. Our patients are wearing their masks. We are still cleaning and having our lobby closed. We are still not allowing visitors in with our patients. We are still using our UV air scrubbers in each room. We are still doing it to keep my most fragile patients safe and confident in us as a clinic, we doing it all to protect the staff, and we’re doing it to protect me as much as possible so we don’t all have to shut down for a month.

Makes perfect sense to me.

We know some things that increase your chances of having a hard time with COVID. Or at least there is some research to back up that low vitamin D puts you at risk. Obesity, underlying conditions like diabetes, low testosterone, smoking, and being of the blood type A. These are just a few things I recall off the top of my head. My question to you is, “What factors under your control are you bolstering or addressing?” I am overweight. I’m naturally a big guy but I’ve gotten a little lazy in the last 5 years. OK…..A LOT lazy.

I started the Couch to 5K program a few weeks ago and am slowly trudging through that. My knees are super pissed at me about it but I’m still doing it. I have addressed any hormone issues I needed to look at. I have gotten on a Vitamin D replacement regimen. I am trying to get more sleep more consistently. I don’t smoke.

Of course, there’s nothing you can do about what type of blood you are but….my point is, what steps are you taking to lower your risk of complications should you wind up with it? I’d love to hear if you’ve changed anything at all or if you’re just like the Russian boxer Drago in Rocky 4…..If he dies, he dies.

Item #1 Let’s get to it. This first one is not sexy. I’m saving the better ones for here in just a minute. Let’s start off nice and simple here with one called “Effects of Two Different Recovery Postures during High-Intensity Interval Training” by Michaelson, et. al(Michaelson J 2019). and published in Translational Journal of the ACSM in February of 2019. Hmmmmmm…..yep… Hot enough. Out of the way.

Why They Did It The purpose of this study was to examine the effects of two different recovery postures, hands on head (HH) and hands on knees (HK), as a form of immediate recovery from high-intensity interval training (HIIT).

How They Did It Twenty female Division II varsity soccer players completed two experimental trials in a randomized, counterbalanced order. Each trial consisted of four intervals on a motorized treadmill consisting of 4 min of running at 90%–95% max heart rate with 3 minutes of passive recovery between each interval. Heart rate recovery was collected during the first 60 seconds of each recovery, where the volume of carbon dioxide and tidal volume were recorded each minute during the 3-min recovery period.

What They Found Results showed an improved heart rate recovery, greater tidal volume, and increased volume of carbon dioxide, with hands on the knees when compared with hands on the head.

Wrap It Up “These data indicate that HK posture may be more beneficial than the advocated HH posture as a form of immediate recovery from high-intensity interval training.”

Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. If you’re into IASTM also known as instrument-assisted soft tissue manipulation, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend. Drop Release is a revolutionary tool that harnesses the body’s built-in protective systems to make muscles relax quickly and effectively.  This greatly reduces time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day. Its inventor, Dr. Chris Howson, from the great state of North Dakota has is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase. Go check Drop Release at droprelease.com and tell Dr. Howson I sent you.

Item #2 Item 2 is called “Assessment of Physician Prescribing of Muscle Relaxants in the United States, 2005-2016” by Soprano et. al(Soprano S 2020). and published in JAMA Open on June 24, 2020 and that’s damn sure a steaming heaping helping right there.

Why They Did It They wanted to measure national trends in muscle relaxant prescribing over a 12-year period. 2005-2016

How They Did It It was a cross-sectional study It used data from the National Ambulatory Medical Care Survey The study included those with ambulatory care visits with non-federally funded, office-based physicians in the US Included almost 315,000,000 office visits.

What They Found Get this y’all – During the study period, office visits with a prescribed muscle relaxer nearly doubled from 15.5 million in 2005 to 30.7 million in 2016 Although visits for new muscle relaxer prescriptions remained stable, office visits with continued muscle relaxer drug therapy tripled from 8.5 million visits in 2005 to 24.7 million visits in 2016 Older adults accounted for 22.2% of visits with a muscle relaxer prescription. Concomitant use of an opioid was recorded in 67.2% of all visits with a continuing muscle relaxer prescription.

Wrap It Up “This study found that SMR use increased rapidly between 2005 and 2016, which is a concern given the prominent adverse effects and limited long-term efficacy data associated with their use. These findings suggest that approaches are needed to limit the long-term use of SMRs, especially in older adults, similar to approaches to limit the long-term use of opioids and benzodiazepines.” And we wonder how we ended up with an opioid and pill problem. Cheese ’n’ rice people. Godzilla it’s just clear as day but nobody’s listening. Are you inundated with referrals from physicians in 2020? Some of you are. Most of you, the large very vast majority of you are not at all and it’s a shame because we can prevent so much of this garbage.

Item #3 Alright, the last item and my favorite one this week. It’s called “Effects of Chiropractic Care on Strength, Balance, and Endurance in Active-Duty U.S. Military Personnel with Low Back Pain: A Randomized Controlled Trial” by Vining et. al(Vining R 2020). published in the Journal of Alternative and Complementary Medicine in July of 2020. Another helping of boiling thought nuggets for you to feast upon.

Why They Did It They wanted to investigate whether chiropractic care influences strength, balance, and/or endurance in the active-duty United States military personnel with low back pain

How They Did It It was a prospective randomized controlled trial using a pragmatic treatment approach Participants were randomly allocated to 4 weeks of chiropractic care or to a wait-list control Chiropractic care consisted of spinal manipulation, education, advice, and reassurance Naval Air Technical Training Center branch clinic at the Naval Hospital Pensacola Florida One hundred ten active-duty military personnel 18-40 years of age with self-reported LBP Outcome measurements included Isometric pulling strength from a semi-squat position was the primary outcome. Secondary outcomes were single-leg balance with eyes open and eyes closed, and trunk muscle endurance using the Biering-Sorensen test. Patient-reported outcomes such as pain severity and disability were also measured. Outcomes were measured at baseline and 4 weeks. Linear mixed-effects regression models over baseline and 4 weeks were used for analysis.

What They Found Participants had a mean age of 30 years, 17% were female, 33% were non-white, and 86% reported chronic LBP. Mean maximum pulling strength in the chiropractic group increased by 5.08 kgs and decreased by 7.43 kgs in the wait-list group, with a statistically significant difference in mean change between groups Statistically significant differences in mean change between groups were also observed in trunk muscle endurance and balance with eyes closed, but not in balance with eyes open Differences in mean change between groups were statistically significant in favor of chiropractic for LBP-related disability, pain intensity and interference, and fear-avoidance behavior.

Wrap It Up “Active-duty military personnel receiving chiropractic care exhibited improved strength and endurance, as well as reduced LBP intensity and disability, compared with a wait-list control.”

Alright, that’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. 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. Store Remember the evidence-informed brochures and posters at chiropracticforward.com.

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….

That’s Chiropractic!

Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.

Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website https://www.chiropracticforward.com

Social Media Links

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

https://www.facebook.com/groups/1938461399501889/ Twitter https://twitter.com/Chiro_Forward YouTube

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

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

Michaelson J, B. L., Suprak D, McLaughlin W, Dahlquist D, (2019). “Effects of Two Different Recovery Postures during High-Intensity Interval Training.” Translational J ACSM 4(4): 23-27.

Soprano S, H. S., Bilker W, (2020). “Assessment of Physician Prescribing of Muscle Relaxants in the United States, 2005-2016.” JAMA Open 3(6).

Vining R, L. C., Minkalis A, Gudavalli MR, Xia T, Walter J, Coulter I, Goertz C, (2020). “Effects of Chiropractic Care on Strength, Balance, and Endurance in Active-Duty U.S. Military Personnel with Low Back Pain: A Randomized Controlled Trial.” J Altern Complement Med 26(7): 592-601.

New Information On 5 Actions To Change Clinical Practice

CF 131: New Information On 5 Actions To Change Clinical Practice Today we’re going to talk about moving toward being patient-centered. There are 5 actions recommended. What does it even mean? I might just ruffle some feathers here but a damn I do not giveth. But first, here’s that sweet sweet bumper music  
Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 
  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 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 #131 Now if you missed last week’s episode , we were joined by Dr. Kevin Christie with The Modern Chiropractic Marketing podcast and author of a new book that’s coming out on chiropractic marketing. Kevin is a rising star in chiropractic and is a must-not-miss. 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….. Still climbing in the patient numbers. Where I’m located here in Amarillo, TX, there is a population of approximately 280,000 people. Last week, on Thursday and Friday we added 3 total cases of COVID on Thursday and only 2 cases on Friday. Then the following Monday, we added 11.  So, as you can see, the numbers here are no longer high. People are sort of ‘over it’ and you can see that and hear it when you talk to the patients. Hell, I’m sort of over it but still being smart. I’m having friends to the house again but we stay outside by the pool and have a couple of adult beverages.  I have a friend that is a musician. Last weekend, he played a rodeo on Woodward, OK. He said there were probably 1,000+ people at the event and it was indoors. So, in Woodward, OK at least, they are REALLY over it. No way in hell I’m grouping up with that many people indoor or outdoor right now. It just doesn’t make sense to me for now.  I guess if I were 28 and at the top of my game physically it wouldn’t make any difference to me either. But going to an event where people are yelling and cheering right behind, beside, and in front of me….big nopers right now. Ain’t happnin’ I noticed that while cases seem to be leveling off across America, they’re not increasing or decreasing as much as you’d like but, what I noticed is that the deaths are going down. Fairly signficantly. So wouldn’t that fit with the news that started coming out a couple weaks ago about the virus losing some potency?  People are still getting it but not as many dying from it. Another explanation could be that we’ve gotten better at treating it. Either way, that’s not my lane so I’m not going to act like the expert. I’ll just say hell yay-us and keep the good news coming so we can all get back to life as it was meant to be lived.  I hope you’re all well and staying healthy. As always, if you care about the kind of information I share every week and you listen consistently, I’m proud of you. I think you care about the right stuff and even though I don’t know you all, I consider you my friend.  Item #1 Let’s kick this week’s research reviews off with this one called ‘It is time to move beyond body region silos to manage musculoskeletal pain; five actinos to change clinical practice’ by Caneiro et. al(Caneiro JP 2020). published in British Journal of Sports Medicine in 2020. We got a hot one over here!! This paper actually has a lot of big names in the industry like Caneiro, O’Sullivan, O’Sullivan and Jan Hartvigsen. If you don’t know Jan’s name, you just haven’t been a regular listener.  Why They Did It They say that current clinical research, education, and practice approaches musculoskeletal pain and conditions in silos. Basically it’s a focus on body regions like the knee, hip, neck, shoulder, etc.  But current thinking actually shows that the pain disorders are frequently comorbid and share common biopsychosocial risk profiles for pain and disability.  They say that a shift to focusing on the person is what is needed and that this would encourage the doctors to:
  1. focus on the patients’ context and modifiable biopsychosocial factors that influence their pain and disability
  2. Use education to facilitate active management approaches (targeted exercise therapy, physical activity, and healthy lifestyle habits) thus reducing reliance on passive interventions
  3. Consider evidence-based surgical procedures only for those with a clear indication and where guideline-based non-surgical approaches have been rigorously adhered to. 
Well who the hell can’t get behind all of that? Honestly, it’s odd when you think about it that in the year 2020, we’re still saying that surgery should be evidence-based and follow certain guides and that conservative treatment should be first basically. How’s that not just common sense and common procedure in 2020? We’re supposed to have freaking flying cars by now but the medical field doesn’t have this stuff down they way they should just yet?  It’s money. I know. I understand it. But it’s frustrating as hell all the same.  In this paper, the authors say to be truly patient-centered, they have five actions they recommend for managing a person with musculoskeletal pain, irrespective of body region. 
  1. Screen for biopsychosocial factors and health comorbidities. Notice this is #1 on their recommendations. If you’re just getting them in a pop a crack a lack and sending them on without this step, your results are going to be less than you or the patient desires. They say we need to communicate clearly with the patient to identify potential biopsychosocial drivers of the pain and then provide the therapy to fill that gap. These things include pain beliefs, emotional and coping responses to pain, social contest, physical and lifestyle factors and the presence of comorbidities. They recommend using the Orebro Musculoskeletal Pain Questionnaire. 
  2. Embrace patient-centered communication. This one is huge and this is one of the key things we learned in the Fellowship training for the neuromusculoskeletal medicine program. Clinicians should use open and reflective questioning to elicit the patient’s understanding of factors, which include the pain experience (tell me your story), causation beliefs (what do they think is the cause of the pain?), coping (what do you do when the pain increases?), impact (Tell me how your symptoms affect your ability to move and function), concerns (do your symptoms worry you?), beliefs (why do you think you shouldn’t bend/lift, or run?), social factors (tell me about your home life or work life), goals (what are you rgoals?), and expectations. Yes, to an extent, updated research and thinking has us behaving a bit like a psychologist I think. It’s not my favorite stuff. But, when you learn and consider how much pain is held in the brain due to these yellow flag indicators, then you start to realize that pain, certainly chronic pain, cannot just be treated at a peripheral source. You have to address the pain from a central sensitization perspective at least equally or you risk never being able to help these patients. 
  3. Educate beyond words using active learning approaches. doctors have to embrace education as a central part of patient care if we are going to change behavior. We have to dispel myths about pain, imaging findings, and activity engagement (for example, hurt does not equal harm). They say that behavioral learning like exercise therapy can be used to bust myths that are unhelpful. Myths and beliefs that lead to things like fear avoidance. 
  4. Coach towards self-management. A large portion of the chiropractic profession wants and desires patients to depend on them week after week, month after month and that’s just not real world stuff. And it’s not helpful for the patient’s recovery either. We should be empowering patients to engage in exercise, valued activities and a healthy lifestyle with confidence. Can you feel the difference here? “Mary, I know you’re only 35 but you already have some degenerative discs in your neck and I’m so concerned about it. This should be considered urgent and I’m going to need to see you 5 million times for the rest of your life.” Is that helpful or is this helpful? “Mary, I know you read on your rad report here that there is a finding of a degenerative disc in your neck but the truth is, that’s very common and not something you should be concerned with. Certainly not over-concerned with. I actually prefer the word ‘deconditioned’ over ‘degenerative.’ A good percentage of 30-40 year old patients have some mildly deconditioned discs but these rarely ever cause any issues. You’re young, you’re strong, and you’re healthy. We’re going to get everything moving correctly and then I’m going to give you some excellent exercises to really focus on the region and build plenty of support. You’re going to do great.” When you stack those two next to each other, it’s easy to see how harmful one is as opposed to the other more positive, more hopeful one. I got a little side tracked there, the point is, help them take control and self manage. Active amnagement relieves pain and improves function across pain conditions and health comorbidities. 
  5. Address comorbid health factors. They say clinicians should refer for co-care in teh presence of comorbid mental and physical health complaints like high levels of emotional distress, eating disorders, and type 2 diabetes. The authors say they contend that multidisciplinary care needs to be integrated, with consistent messages across the team to prevent care fragmentation and patient distress. 
Wrapping up the paper, the authors say Patient-centered care will optimize the value of healthcare provided. Shifting funding to support high-value evidence-based care options and educating society will be critical to enable this transition and will likely be cost-effective. Integrated cross-discipline clinical networds are required for effective co-care. We believe clinicians are ready to change, but they require the support of health systems and payers.  One word….two syllables. Day-um. You day-um right. But, health systems and payers are stuck on the part of our profession that doesn’t care about movement, function, yellow flags, exercise, or proper patient-centered practice. They’re stuck on the portion of our profession that is TIC or TOR or principled or whatever the hell useless drivel they’re using this week.  The hardcore, philosophy, doctor-centered, faith-based rather than evidence-based group of chiropractors are smaller but they’re so much louder. And dangerous. They’re flat-earthers. They’re the reason the evidence-based group will never reach any kind of cultural authority.  You can have a GROUP of guys and girls go through years of continuing education and maybe get a couple of diplomats in neuro or orthopedics or rehab….wahtever….and they can be the smartest chiropractor on the planet and almost 100% of their patients get well.  And then you have just ONE lowsy-ass guy or girl go and bait and switch just ONE patient into 80 visits in a year with a contract and all of the bells and stupid whistles of a doctor-centered practice, and that group that worked so so hard loses every ounce of legitimacy. Because of ONE jackhole that refuses to understand or read research or refuses to sacrifice some money in the interest of their patients well-being.  It’s gross. It’s awful. But it’s chiropractic. We are already looked at with a side-glance untrusting gaze. So any deviance of behavior that would be widely considered normal is magnified. Just one ruins the batch for all of us.  I remember a preacher once saying that you gain trust in drops but you lose it in buckets. The reality in chiropractic is that just one faith-based, doctor-centered jackhole loses trust in ALL chiropractors in buckets. For ALL of us.  My plea is to start sharing this podcast with your subluxation friends. Especially the young students that haven’t yet decided to be ‘principled.’ Maybe we can help lead them down the right path from the very start. The more people are exposed to the research and to the idea of being patient-centered, the more they’ll latch onto it. They have to. One is borderline evil, and the other is not. It’s backed by science. One destroys reputations for the sake of the dollar. One builds reputations and respect. One is built on ideas and theories over a century old that cannot or have not been proven while the other is backed by science and progress. How is it even a damn choice to begin with? We’re either a healthcare profession. Or we are a faith. True healthcare professions do research and then they do more and they change according to what works well and they drop the stuff that doesn’t, and on and on to the point of really being on the cutting edge of the science and on the health of our patients.  I’ll never understand how such a percentage of our profession can’t get on board with that. Whatever the answer to that question might be, it’s that answer that keeps us at the bottom of the cultural authority ladder.  Unfortunately, I don’t see if changing any time soon. Not until the governing boards decided it’s time to change once and for all.   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 Takeaways Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   
Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! 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
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Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger   Bibliography Caneiro JP, R. E., Baron CJ, et. al., (2020). “It is time to move beyond ‘body region silos’ to manage musculoskeletal pain: five actions to change clinical practice.” Br J Sports Med 54: 435-443.

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

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

Today we’re going to talk about headaches, migraines, neck pain, and our favorite topic here at the Chiropractic Forward Podcast, yes….we’ll talk about Chiropractic care. Specifically, chiropractic care for the headaches, migraines, and neck pain. 

Hold on though, make way, get in the Soul Train dance line because here’s that bumper music

Integrating Chiropractors

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have skidded all fast and furiously into Episode #50

Let’s talk a bit about the DACO program. For those that don’t know, that’s the Diplomate of American Chiropractic Orthopedists program I’m slowly trudging through. 

I say slowly. You have 3 years to finish. But, I’m a doer if you can’t tell. I’m a worker bee if you will. When I start something, I want to finish. I don’t like unfinished bidness. I don’t like things flapping out in the wind. I want to start it and then I want to finish it quickly and move on to the next thing. 

Getting 300 hours is never going to get done quickly. Especially when you are the sole doctor in a busy practice not getting home until 7 pm or even later sometimes. Such is my life. A curse and a blessing depending on the day and my outlook on that particular day. 

However, I believe I’m on a path to finish it up in about a year from when I started. Probably much sooner. For example, I knocked out 12 hours last week. That’s pretty solid but, we had a snow day and I took advantage of being stuck at home. 

I crawled down into my basement man cave, got in my blankie and jammies with an iPad on my belly, leaned the recliner back and got some education. 

So far, I have 40 hours of the 250 online hours done and 40 hours of the 50 live hours required. In total, I’m 80 hours into a 300-hour course. Rocking and rolling folks. Rocking and rolling. 

Some of the more recent courses I’ve completed were hip pain in children, joint hypermobility disorders, TMJ, and thoracic outlet syndrome. These courses are fascinating. 

The offer is there. If you need help getting started on yours, send me an email at [email protected] I’ll be glad to get you on your way. 

Speaking of getting in touch, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It makes everything easier. 

Now onto a discussion that took place on our Facebook page a couple of weeks ago that I thought was particularly interesting. 

I will put it in the show notes for you if you’d like to see the meme….funny word. My son loves it when we mispronounce it. You should try it with your kids if they’re old enough to get embarrassed by their parents.  

Anyway, the picture I posted was of a contemplative Kermit the Frog and it said, “Me when a patient tells me another chiropractor wanted 5 sets of x-rays over 9 months of treatment to correct something research doesn’t support.”

Now, let me set the stage here. The impetus for this was that one of my patients moved down to Georgia. Her daughter started having some headaches and pain so she went and got an MRI. 

The results of the MRI showed the issue to be out of the scope of chiropractic. Regardless, you guessed it, she got a recommendation for 5 sets of x-rays over 9 months of treatment. 

Absolute scare care riduculosity. 

Here’s where it got a little sticky. A colleague got on that post and expressed some dissatisfaction that I would post something like that. I guess he didn’t like my airing dirty laundry. Which is cool. I don’t mind at all but here’s what happened for me on the deal. 

I sat down and crafted a very PC response I think and in doing so, I had an opportunity to reflect on the podcast, the reason for it, and what we’ve done in just the past year. 

Here are some highlights that came to mind for me:

  1. You don’t make an omelet without cracking some eggs and I think some difference of opinion is to be expected and it’s something I just need to get used to. 
  2. I think I created this podcast to do whatever I could to move this profession forward. 
  3. Forward to me means providing research like we do every week but also to educate others, to suggest new research avenues, to encourage specialization and higher education, to push for integration, and to call out and discourage the behavior I feel holds us back from moving forward. 

If you aren’t active on our Facebook page, I’d encourage you to stop in and say, “Hi.” Tell us if you’re digging the podcast. Share some research you’ve found. Maybe give us a suggestion for a future podcast. We’re here. We also have a private Facebook group if you’d like to join the private group. 

OK, research for this week, here we go with paper #1

This one is called “Characteristics of Chiropractic Patients Being Treated For Chronic Low Back and Neck Pain[1].” The lead author is PM Herman and the paper was published in August of 2018 in the Journal of Manipulative Physiological Therapeutics. 

https://www.ncbi.nlm.nih.gov/pubmed/30121129

Get your marketing hat on for this one people. 

Why They Did It

Since chronic low back and neck pain are so prevalent, and since spinal manipulation is a common non-pharma treatment for them, the authors wanted to determine the characteristics of the type of patient that visits the chiropractor. 

How They Did It

  • They collected data from chiropractic patients in regard to regions and states, sites, providers and clinics, and patients. 
  • The data was collected through an iPad questionnaire given at the chosen sites. 
  • They had 518 chronic low back pain patients complete it while 347 chronic neck pain patients finished theirs. They also had 1159 do both. 

What They Found

  • Most of the sample were highly-educated
  • Most were non-hispanic
  • White females were the dominant demographic for race and gender
  • Few used narcotics
  • Avoiding surgery was the most important reason they chose chiropractic care 
  • Over 90% of the patients reported high satisfaction with their care

That should give you some good ideas when trying to figure out who you should be marketing to. I can lead the horse to water but I cannot show the snout into the pond and make the horse drink it up. 

Text Neck

I picked this one out because I saw a discussion on Facebook last week about Text Neck. The question posed was, isn’t text neck just a new term for an old problem? Is text neck just a scare tactic?

That was the general gist of the post. 

While I did not respond, I do have an opinion on text neck. I do not think it’s an old problem. I mean, let’s back up a bit. Poor posture is most certainly an age-old problem. No doubt about it. 

However, at no other point in our time in history that I’m aware of, have little bitty children all the way up to mid-aged and elderly people had a reason to be sitting in one spot for hours with their head flexed forward, bent down almost into their laps. It pains me to see some of the kids these days. 

My poor son. Not so much my daughter right now but my son….my goodness. That kid…I’ll look at him sometimes and he has somehow balled himself up into what I can only describe as something resembling a roly-poly or an armadillo. His head bent at 90 degrees looking at his phone in his lap. Basically, the epitome of text neck.

It must really suck being a chiropractor’s kid. I’ve taken pictures of it before when he wasn’t looking. As you probably know, you can draw on pictures on your phones. So I took that picture then drew big red marks exploding out of his neck. Then, while he’s sitting there on his phone, he gets the picture in a text. 

It’s awesome. You all should try it sometime if for no other reason than to give yourselves a laugh. 

Next Paper

This paper is called, “Cervical Proprioception in a Young Population Who Spend Long Periods on Mobile Devices: A 2-Group Comparative Observational Study” and it was published in the Journal of Manipulative and Physiological Therapeutics as well[2]. The lead author was Andrew Portelli and it was published in February of 2018. 

https://www.jmptonline.org/article/S0161-4754(17)30010-6/fulltext?elsca1=etoc&elsca2=email&elsca3=0161-4754_201802_41_2_&elsca4=Physical%20Medicine%20and%20Rehabilitation%7CHealth%20Professions

Why They Did It

The purpose of this study was to evaluate if young people with insidious-onset neck pain who spend long periods on mobile electronic devices (known as “text neck”) have impaired cervical proprioception and if this is related to time on devices.

What They Found

“The participants with text neck had a greater proprioceptive error during cervical flexion compared with controls. This could be related to neck pain and time spent on electronic devices.”

This message has been brought to you by an uncool parent of a teenager. 

Paper #3

This one is called, “Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial[3].” and it was published in Spine journal in February of 2018. 

https://www.ncbi.nlm.nih.gov/pubmed/29481979/

Why They Did It

The optimal number of visits for the care of cervicogenic headache with spinal manipulative therapy is unknown so the authors hoped to identify the dose-response relationship between visits and chronic headache outcomes…. and to evaluate the efficacy of chiropractic by comparison with a light-massage control.

What They Found

The authors’ conclusion was as follows, “There was a linear dose-response relationship between SMT visits and days with CGH. For the highest and most effective dose of 18 SMT visits, CGH days were reduced by half and about 3 more days per month than for the light-massage control.”

So, you guys and gals that want to take evidence-based to the extreme and get people out of your office in only 3 or 4 visits, you may not be hitting the number of visits that work the best. Everyone is different right? Everyone heals differently. Here we have 18 visits being the most effective for chronic cervicogenic headache. 

Good info to keep in mind. 

Integrating Chiropractors

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point: Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

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

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

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About the author:

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

Bibliography

1. Herman PM, Characteristics of Chiropractic Patients Being Treated for Chronic Low Back and Neck Pain. J Manipulative Physiol Ther, 2018.

2. Portelli A, Cervical Proprioception in a Young Population Who Spend Long Periods on Mobile Devices: A 2-Group Comparative Observational Study. J Manipulative Physiol Ther, 2018. 41(2): p. 123-128.

3. Haas M, Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial. Spine, 2018: p. S1529-9430.

CF 012: Proven Means To Treat Neck Pain

CF 033: Did You Need Proof That Chiropractors Help Headaches?

CF 005: Valuable & Reliable Expert Advice On Clinical Guides For Your Practice