chiropractic research

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 11)

CF 325: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 11) Today we’re going to talk about “The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 11)” But first, here’s that sweet sweet bumper music     Today we’re going to talk about Cancer-Finding Blood Tests & Neck Pain Treatment Differs By Initial Provider 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 giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 
  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com
You have found yourself smack dab in the middle of Episode #325 Now if you missed last week’s episode, we talked about Cancer-Finding Blood Tests & Neck Pain Treatment Differs By Initial Provider.  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. I see the battle coming and I’m trying to build the walls. It’s tough to go from seeing 8-10 new VA patients every week down to seeing about 1 every 2 weeks. Plus they’re reducing their visits to acute conditions only when most of these folks are chronic. They’ve been hurting literally for decades for some of them.  So, yeah, the battle is approaching so I’m trying to build walls. Now, how do we do that? We stop being lazy about marketing and, I’m a Christian so I always believe that when one door is closed, another will open and the one that opens is usually better.  All big changes in my life and business has always been for the best. Even when I thought the changes were catastrophic. This one is inconvenient and it pisses me off a bit. I’d love to have a set it and forget it type of business but it’s just not and never will be.  It’s ups and downs every week so that’s what we’re doing. We’re riding the coaster and preparing for the decrease in our numbers that’s already here and that we know will continue to get worse before it levels off and before we get our marketing in full gear and get after it again before the VA started sending the vets to us.  Yep, fully engaged now. I’ll keep you updated.  I want to congratulate Dr. Steve Brown out in Gilbert, AZ on his new peer reviewed paper that came our recently. Steve is doing good work and trying to help chiropractors stay out of trouble on the smt stroke issue that we’re all having to deal with all of the time.  I’m putting the link to Dr. Brown’s paper right here in the show notes so go grab it and check it out. https://www.cureus.com/articles/239108-plausible-mechanisms-of-causation-of-immediate-stroke-by-cervical-spine-manipulation-a-narrative-review#!/ It may save your collective asses.  Now, due to this paper Steve has the predictable drivel coming from the philosophy wonks that have a stake in the game and that’s OK. He expects that. Heck he even might welcome it with a research-backed response of his own. But, if one looks deeper than the detractors seem to have the brain space to do, his paper pretty much protects us. If we read it, we can prevent dissections most times and, should a pt. Try to state we’re responsible for a VAD the next few days or weeks after an adjustment, his paper provides some protection.  Then, about the same week, we had a knucklehead present a case study called, “Myositis Ossificans Traumatica of Bilateral Sternocleidomastoid Muscles After Chiropractor Adjustment: A Case Report” by Felix et. Al in Cureus where they implied heavily that a chiropractic adjustment was the cause of the myositis ossificans.  I’m going to leave the link here in the show notes at chiropractiforward.com under episode 325.  https://www.cureus.com/articles/234594-myositis-ossificans-traumatica-of-bilateral-sternocleidomastoid-muscles-after-chiropractor-adjustment-a-case-report#!/  I hope you’ll go to the link, scroll down to the comments and watch Dr. Brown chime in and systematically tear this crap paper apart and watch the authors basically apologize and promise to make the necessary changes.  The moral of the story is this; research isn’t here to hold us back and tear us down. It’s here to defend us, make us better, and provide more and more validity as we increase our knowledge base. That’s why I’m here. That’s why Dr. Steve Brown and so many others are here.  One of the biggest hits I see our profession take online is that we’re all quacks because the profession was founded by a belief and a magnetic mystical healer. True as that may be, the medical field once had blood letting, leaches, and lobotomies.  Research pulled them together and out of the catacombs and research will and is doing the same for us as chiropractors. I promise when research came out proving blood letting useless, there were still those that had used blood letting for decades fighting the research, attacking and discrediting the research and researchers, and doing everything they could to clutch their pearls and maintain their box of safety.  All I can say is that flat Earthers will do flat earth stuff and you can’t tell or show them anything differently. Moon landing deniers…….good luck convincing them otherwise. When a certain dogma has taken over and defined one’s life, you can’t and won’t change it.  But that will never stop new thinking, research, and forward movement.  Item #1 We are continuing the series on why the hell the WHO would recommend SMT at very low confidence which, if you’ve been following along, is the same level of confidence they give ultrasound. Well that’s BS and I went and found all of the papers they used to make this determination and we’re going through each and every of them trying to form and impression of our own.  The first one today is called, “United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care” by UK BEAM Trial Team, published in British Medical Journal in December of 2004.  UK BEAM Trial Team. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ. 2004 Dec 11;329(7479):1377. doi: 10.1136/bmj.38282.669225.AE. Epub 2004 Nov 19. PMID: 15556955; PMCID: PMC535454. Remember, the citations can be found at chiropracticforward.com under this episode.  Why They Did It To estimate the effect of adding exercise classes, spinal manipulation delivered in National Health System or private premises, or manipulation followed by exercise to “best care” in general practice for patients consulting with back pain. How They Did It Pragmatic randomised trial with factorial design. Setting: 181 general practices in Medical Research Council General Practice Research Framework; 63 community settings around 14 centres across the United Kingdom. Participants: 1334 patients consulting their general practices about low back pain. Main outcome measures: Scores on the Roland Morris disability questionnaire at three and 12 months, adjusted for centre and baseline scores. What They Found
  • All groups improved over time. 
  • Exercise improved mean disability questionnaire scores at three months by 1.4 more than “best care.” 
  • For manipulation the additional improvement was 1.6 at 12 months. 
  • For manipulation followed by exercise the additional improvement was 1.9 at three months and 1.3 at 12 months. 
  • No significant differences in outcome occurred between manipulation in NHS premises and in private premises. 
  • No serious adverse events occurred.
Wrap It Up Relative to “best care” in general practice, manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months; and exercise achieved a small benefit at three months but not 12 months. Item #2 The second one is called, “Effect of Spinal Manipulative and Mobilization Therapies in Young Adults With Mild to Moderate Chronic Low Back Pain: A Randomized Clinical Trial” by Thomas et. Al published in JAMA Network Open in August 2020 Thomas JS, Clark BC, Russ DW, et al. Effect of Spinal Manipulative and Mobilization Therapies in Young Adults With Mild to Moderate Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Netw Open. 2020;3(8):e2012589. doi:10.1001/jamanetworkopen.2020.12589 Why They Did It Low back pain (LBP) is one of the most common reasons for seeking medical care. Manual therapy is a common treatment of LBP, yet few studies have directly compared the effectiveness of thrust (spinal manipulation) vs nonthrust (spinal mobilization) techniques. To evaluate the comparative effectiveness of spinal manipulation and spinal mobilization at reducing pain and disability compared with a placebo control group (sham cold laser) in a cohort of young adults with chronic LBP. How They Did It This single-blinded (investigator-blinded), placebo-controlled randomized clinical trial with 3 treatment groups was conducted at the Ohio Musculoskeletal and Neurological Institute at Ohio University from June 1, 2013, to August 31, 2017.  Of 4903 adult patients assessed for eligibility, 162 patients with chronic LBP qualified for randomization to 1 of 3 treatment groups.  Recruitment began on June 1, 2013, and the primary completion date was August 31, 2017.  Data were analyzed from September 1, 2017, to January 20, 2020. Participants received 6 treatment sessions of 
  1. spinal manipulation, 
  2. spinal mobilization, or 
  3. sham cold laser therapy (placebo) during a 3-week period.
What They Found Coprimary outcome measures were the change from baseline in Numerical Pain Rating Scale (NPRS) score over the last 7 days and the change in disability assessed with the Roland-Morris Disability Questionnaire 48 to 72 hours after completion of the 6 treatments. A total of 162 participants with chronic LBP were randomized.  Fifty-four participants were randomized to the spinal manipulation group, 54 to the spinal mobilization group, and 54 to the placebo group.  There were no significant group differences for sex, age, body mass index, duration of LBP symptoms, depression, fear avoidance, current pain, average pain over the last 7 days, and self-reported disability.  At the primary end point, there was no significant difference in change in pain scores between spinal manipulation and spinal mobilization, spinal manipulation and placebo, or spinal mobilization and placebo.  There was no significant difference in change in self-reported disability scores between spinal manipulation and spinal mobilization, spinal manipulation and placebo or spinal mobilization and placebo.   Wrap It Up In this randomized clinical trial, neither spinal manipulation nor spinal mobilization appeared to be effective treatments for mild to moderate chronic LBP Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.      Today we’re going to talk about Cancer-Finding Blood Tests & Neck Pain Treatment Differs By Initial Provider 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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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
Home
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger      

Nerve Pain Treated Naturally & The First Provider Seen Makes A Difference

CF 293: Nerve Pain Treated Naturally & The First Provider Seen Makes A Difference

Today we’re going to talk about Nerve Pain Treated Naturally & The First Provider Seen Makes A Difference

But first, heres that sweet sweet bumper music

   

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

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.

We’re the fun kind of research. Not the stuffy, high-brow, look down your nose at people kind of research. We’re research talk over a couple of beers.

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. I’m so glad you’re spending your time with us learning together.

Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, drive, smart, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com

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

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.
  • Then go Like our Chiropractic Forward Facebook page,
  • Join our private Chiropractic Forward Facebook group, and then
  • Review our podcast on whatever platform you’re listening to
  • Last thing real quick, we also have an evidence-based brochure and poster store at com

You have found yourself smack dab in the middle of Episode 293

Now if you missed last week’s episode, we talked about Discs in Low back pain and unnecessary surgeries during covid. Make sure you don’t miss that info. Keep up with the class.

On the personal end of things…..

This week is like all others. Just going crazy to stay on top of everything going on in my life so we’ll probably cut it a little short this week.

I would say, back to school is always slow for us and it’s slow again this year. As expected. Every year I wonder if I peed on somebody’s dog and they told the whole town about it and now everyone’s mad at me and doesn’t want to come see me anymore.

Of course I only pee on cats so we know that’s not what’s going on here. It’s back to school, folks! It just happens. I can set my watch by it. It’s crazy.

So, I’m going to Savannah Georgia to watch a Savannah Bananas game and then driving to Charleston, SC for front row seats to see Train in concert. Train is one of my wifey’s favorite bands so it’ll be a good time and we love Savannah and Charleston. That’s if we don’t get blown away by the remnants of a hurricane that’s about to move in. We shall see.

For now though….let’s get to the research, shall we?

Item #1

 

The first on today is called A comprehensive review on clinically proven natural products in the management of nerve pain, with mechanistic insightsbySanchita Dewanjee, Md Sohel, Md Shahadat Hossain, Farzana Ansari, Md Tofikul Islam, Farhana Sultana, Abdullah Al Mamun, Md Monirul Islam, Mohammad Nurul Amin and published in Heliyon and on April 14, 2023. Dayum. That’s hot.

Why They Did It

The study was designed to discuss the mechanistic role of several clinically proven natural products that have been shown to play a significant role against different nerve pain or neuropathic pain.

How They Did It

 

Information for this review article was salvaged using several accessible searching databases like SciVerse Scopus ® (Elsevier Properties S. A, USA), Web of Science® (Thomson Reuters, USA), and PubMed® (U.S. National Library of Medicine, USA) considering some search items like – nerve pain, natural products in pain/nerve pain management, clinically proven natural products in pain management, pain-reducing agents and so on.

What They Found

  • Our study reported the therapeutic efficacy of natural products and their possible mechanism against neuropathic pain in the human body.
  • Natural products widely used to treat neuropathic pain include comfrey root extract ointment, lavender oil, Rose Oil, aromatic essential oil, ginger oil, vitex agnus-castus, peganum oil, and ajwain 10%.
  • Some common pathways are involved in pain relief through sensory stimulation, enzymatic, anti-inflammatory, and pain-related receptor regulation.

Wrap It Up

 

The present study suggests that the mentioned natural products can be an appropriate choice for the treatment and management of neuropathic pain.

 

 

 

Before getting to the next one,

 

Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office.

 

When you decide you cant live without those products, send me an email and Ill give you the hookup. They will 100% differentiate your clinic from your competitors.

I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it.

Item #2

Our last one this week is called, “First Provider Seen for an Acute Episode of Low Back Pain Influences Subsequent Health Care Utilization” by Christopher G Bise et al, and published in PubMed on 28 June 2023. Hot potato!

Why They Did It

  • Costs associated with low back pain (LBP) continue to rise.
  • Despite numerous clinical practice guidelines, the evaluation and treatments for LBP are variable and depend largely on the individual provider.
  • As yet, little attention has been given to the first choice of provider.
  • Early research indicates that the choice of first provider and the timing of interventions for LBP appear to influence utilization.
  • This study sought to examine the association between the first provider seen and utilization.

How They Did It

  • Using 2015-2018 data from a large insurer, this retrospective analysis focused on patients (29,806) seeking care for a new episode of LBP.
  • The study identified the first provider chosen and examined the following year of medical utilization.
  • Cox proportional hazards models were calculated using inverse probability weighting on propensity scores to evaluate the time to event and the relationship to the first choice of provider.

 

 

What They Found

  • The primary outcome was the timing and utilization of health care resources.
  • Total health care utilization was lowest in those who first sought care with chiropractic care or physical therapy.
  • Highest health care utilization was seen in those patients who chose the emergency department.

Wrap It Up

  • Overall, there appears to be an association between the first choice of provider and future health care utilization.
  • Chiropractic care and physical therapy provide nonpharmacologic and nonsurgical, guideline-based interventions.
  • Their participation appears related to a decrease in immediate and long-term utilization of health care resources.
  • This study expands the existing body of literature and provides a compelling case for the influence of the first provider on an acute episode of LBP.

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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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you cant 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….

Thats 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 cant wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

     

Subacromial Dry Needling & Lumbar Discs With Stenosis Present

CF 276: Subacromial Dry Needling & Lumbar Discs With Stenosis Present

Today we’re going to talk about Subacromial Dry Needling & Lumbar Discs With Stenosis Present

But first, heres that sweet sweet bumper music

   

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

Chiropractic evidence-based products

Integrating Chiropractors

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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg

This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg
  OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.   We’re the fun kind of research. Not the stuffy, high-brow, look down your nose at people kind of research. We’re research talk over a couple of beers.   I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.   Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, drive, smart, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com   If you haven’t yet I have a few things you should do.
  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.
  • Then go Like our Chiropractic Forward Facebook page,
  • Join our private Chiropractic Forward Facebook group, and then
  • Review our podcast on whatever platform you’re listening to
  • Last thing real quick, we also have an evidence-based brochure and poster store at com
  You have found yourself smack dab in the middle of Episode #276   Now if you missed last week’s episode , we talked about Remote Myofascial Release & Manual Versus Instrumental Spinal Manipulation. Make sure you don’t miss that info. Keep up with the class.   On the personal end of things….. As we speak, I’m getting ready to meet my friends from the MCM Florida Mastermind this coming weekend. Now, I’m a couple of weeks ahead on these podcast episodes for most of you so by the time you hear this one, it’ll have come and gone but that’s what’s happening right now.   What the hell is the MCM Mastermind you might ask? Well, Dr. Kevin Christie of the Modern Chiropractic Marketing podcast put it all together a couple of years ago. It started out at about 15 of us from around the country and I think we’re up to about 24 right now. Pretty capped out I believe. Kevin doesn’t want it any bigger than that but listen up!!   He has talked about starting a West Coast mastermind as well. A separate sister group. They won’t be the OGs like our Florida group or anything but just as important…..as far as they know. : )   Anyway, it’s a very unique and very professionally run and organized thing. Lots of masterminds are thrown together a little willy nilly but Kevin, through his work with Strategic Coach, has this down to a science. The education and the speakers are always top notch, the networking and bonding opportunities are ideal for the exchange of ideas and inspiration, and it’s a damn good reason to get out of your clinic and experience something besides those walls.   Plus, Kevin has some pretty talented connections. Our members include Brett Winchester, Mark King of MPI, Jay Greenstein, Ben Fergus, and lots lots more. Also, you get perspectives from a range of areas of the country. For example, our members are from
  • Texas
  • Alabama
  • Florida
  • North Carolina
  • Montana
  • Ohio
  • Connecticut
  • Illinois
  • Missouri
  • New Jersey
  And I probably missed a few states but you get the idea. It’s a pretty cool thing to be a part of and I value the incredible connections I’ve made over the last two years.   Whether it’s one of Kevin Christie’s masterminds or it’s another you come across, I highly encourage you hop into one….or form your own. You’ll thank yourself.   In addition, I’m lining up my stuff for the big 100 Men Who Give A Damn event tonight. I’ve talked about this on the podcast before but we have to be in the community. You must. You can’t do business sitting on your ass in the words of Dan Kennedy so get out and go and do.   One of the easiest and best ways to do that is through setting up your own 100 Men Who Give A Damn. Although I’d just go ahead and drop the Men from it and say 100 Who Give A Damn because when the wives come, the men spend more so let’s get all inclusive and get everyone there.   You don’t have to do much. I asked 3-4 folks to help me and I picked them from different areas of the community and different industries for a wider net. One being internet, website, etc.   We got a site up and were off and running. You have one event per quarter. Most businesses are happy to donate their space for charitable events.   No membership, no committees or regular meetings. Low maintenance way to have your very own philanthropic group.   Check out our site at www.100menamarillo.com and ask me any questions at creekstonecare@gmail.com I’m happy to help you get up and running if interested.   No paper work or anything. Just start.       Item #1   The first on today is called, “Dry Needling for Subacromial Pain Syndrome: A Systematic Review with Meta-Analysis” by David Griswold and published in Pain Medicine on 26 August 2022. Dayum. That’s hot.     Why They Did It   The authors of this systematic review with meta-analysis evaluated the evidence for the effectiveness of various applications of dry needling (DN) combined with other conservative treatments for subacromial pain syndrome (SAPS).     How They Did It  
  • Six databases (PubMED, CINAHL, Biosis, Web of Science, SPORTDiscus, and Cochrane Central Register of Controlled Trials) were searched after the study had been registered in PROSPERO.
  • The authors included randomized clinical trials investigating the clinical effects of DN in combination with other conservative interventions for SAPS.
  • Outcomes included pain and disability.
    What They Found  
  • Eight studies were selected. All eight studies involving 10 comparisons were included in the analyses (N = 538). A random-effects model was used to analyze between-group effects.
  • Dry needling performed in combination with other conservative interventions produced favorable outcomes at all time points for pain and disability.
  Wrap It Up   The meta-analysis suggests that various applications of DN performed with other conservative interventions are more effective than conservative treatment alone for reducing pain and disability in patients with SAPS. Direct-comparison studies are needed to determine whether one application of DN is superior to another.     Before getting to the next one,   Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office.   When you decide you cant live without those products, send me an email and Ill give you the hookup. They will 100% differentiate your clinic from your competitors.     I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it.   Item #2   Our last one this week is called, “Conservative Treatments for Lumbar Disc Herniation at L3-4 or L4-5 Were More Likely to Fail When Ipsilateral Foraminal Stenosis Was Present at the Caudally Adjacent Segment” by Shuchen Ding and published in PubMed on 14 February 2023. Hot potato!   Why They Did It   To prove conservative treatments are important in lumbar disc herniation (LDH), but predictors for poor outcomes are unclear.   How They Did It  
  • Consecutive patients with unilateral single-level LDH at L3-4 or L4-5 were enrolled. Baseline clinical data were collected, and lumbar spine magnetic resonance imaging was evaluated.
  • Foraminal stenosis was evaluated using Lee’s approach and further categorized as absence (grade 0 and 1) or presence (grade 2 or 3).
  • Each patient underwent conservative treatments (oral meloxicam and dexamethasone, corset, back extension exercise, physiotherapy, and manual therapy) for 6 weeks.
  • Conservative treatments were defined as failed if a patient underwent surgery within 6 weeks or reported poor recovery at 6-week follow-up.
  • Multivariate logistic regressions were used to examine the associations of failed conservative treatments with baseline characteristics and magnetic resonance imaging findings.
  What They Found  
  • The study included 222 patients (mean age 45.5 ± 9.8 years). Of patients, 48 (21.6%) had concurrent ipsilateral foraminal stenosis at the caudal segment, and conservative treatments failed in 39 (17.6%).
  • At baseline, patients with LDH and caudal foraminal stenosis were older (50.79 ± 6.14 years vs. 44.10 ± 10.13 years, P < 0.001), had greater leg pain (7.06 ± 1.17 vs. 6.39 ± 1.40, P = 0.003), and had a higher rate of positive straight leg raising test (54.2% vs. 33.3%, P = 0.008) than patients without caudal foraminal stenosis.
  • In multivariate regression, failure of conservative treatments was associated with positive straight leg raising test (odds ratio 2.26, P = 0.046), and caudal foraminal stenosis (odds ratio 3.20, P = 0.007).
  Wrap It Up   In the presence of caudal foraminal stenosis and positive SLR test, conservative treatments were more likely to fail in patients with LDH.     Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen.   Let’s get to the message. Same as it is every week.   Store Remember the evidence-informed brochures and posters at chiropracticforward.com.      

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you cant 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….

Thats 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 cant 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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About the Author & Host

Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Change Your Mind About Pain

CF 239: Change Your Mind About Pain Today we’re going to talk about changing your mind when it comes to pain and how looking at it differently can help our patients get in control of it. 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. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #239 Now if you missed last week’s episode , we talked about Benzopdiazapines and Mirror Therapy. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Folks, not a lot going on right now in practice. It seems like I’m just in a holding pattern of sorts at the moment. You’ve probably heard me mention that we’ve been slower lately. For whatever reason. That’s true. I’m not sure why. The economy, gas prices, who knows?

This week though, sitting here on a Monday morning, and counting, I have 162 patients set up for the week and we know more will jump in as the week progresses. That’s 17 new patients set up so far this week as well. That will usually bump up to about 23-25 if I’m guessing.  Whack-a-mole people. So, now that numbers are back on the rise, another hole will appear in the bucket. Another mole will pop up and have to be whacked on the noggin with my oversize sledgehammer. 

So what’s it going to be?

Patients failing to stay on their schedules because we didn’t have the time available to educate them about the schedule? Not chasing A/R with any real intention? Where’s it going to be? Who knows? It’s always a great mystery but, as one thing improves, the pipes start busting elsewhere. 

You better believe I have my eyes out too. At the ChiroTexpo event in Frisco a few weeks ago, I met a vendor that does billing, chases A/R, and things of that nature. They’re spending this week auditing our EHR billing records to make sure we’re up to speed and on target.  I’m paying particular attention to the report of findings. I don’t do anything elaborate but when I get in a hurry, I tend to simply gloss right over it and keep scooting.

Not this time. Being in the Florida Mastermind has helped me slow down and give it the importance it deserves.  And patient care will not take a step back regardless so….. We’ll see where the next a-hole mole comes popping up but believe me, I’m waiting and ready with binoculars!! Alright, let’s dive in

Item #1

Our first one this week is called, “A clinical perspective on a pain neuroscience education approach to manual therapy” by Louw et. al. (Adriaan Louw 2017)and published in the Journal of Manual and Manipulative Therapy on May 22, 2017 It’s 5 years old but I included it because it’s relevant to a lot of what I teach and talk about here on the podcast.

Before we get into these two papers today, I want you to understand that I don’t for a second discount the biomedical aspect of pain and I fully believe hands-on chiropractors are in an amazing spot and well-placed to handle the biopsychosocial pain model. But only if we understand it and know how to leverage our tools in our favor.  Otherwise, we make it worse. 

Why They Did It

In recent years, there has been an increased interest in pain neuroscience education (PNE) in physical therapy. There is growing evidence for the efficacy of PNE to decrease pain, disability, fear-avoidance, pain catastrophization, limited movement, and health care utilization in people struggling with pain. So what is PNE? PNE teaches people in pain more about the biology and physiology of their pain experience including processes such as central sensitization, peripheral sensitization, allodynia, inhibition, facilitation, neuroplasticity and more. 

PNE’s neurobiological model often finds itself at odds with traditional biomedical models used in physical therapy.  Traditional biomedical models, focusing on anatomy, pathoanatomy, and biomechanics have been shown to have limited efficacy in helping people understand their pain, especially chronic pain, and may in fact even increase a person’s pain experience by increasing fear-avoidance and pain catastrophization.  Trust me, from the stories I get from my patients, the traditional bio-medical model doesn’t just cause catastrophization, it causes downright fear and terror in some patients.  An area of physical therapy where the biomedical model is used a lot is manual therapy. I would add chiropractic to the discussion here as well. 

This contrast between PNE and manual therapy has seemingly polarized followers from each approach to see PNE as a ‘hands-off’ approach even having clinicians categorize patients as either in need of receiving PNE (with no hands-on), or hands-on with no PNE. In this paper, the authors explored the notion of PNE and manual therapy co-existing. 

PNE research has shown to have immediate effects of various clinical signs and symptoms associated with central sensitization. Using a model of sensitization, they argue that PNE can be used in a manual therapy model, especially treating someone where the nervous system has become increasingly hypervigilant. You guys and gals….if you have chronic pain patients, you have to start listening and paying attention to central sensitization, upregulated central nervous systems, cognitive behavioral therapy, mindfulness, yellow flags, fear avoidance, catastrophization, oh my.

Seriously, if these terms are unfamiliar to you, please do yourself and your patients a favor and go get the smarts. You can start the smarts right here in our podcast episodes. I talk about this stuff non-stop and have been for years here so dive in. 

It’s not one thing over the other. Either….or. It’s a broad management protocol that includes PNE, SMT, exercise, massage, yoga, tai chi, low level laser, and some other stuff all piled on top. Oh, and a good provider that communicates in a hopeful and encouraging manner.  Put the puzzle together. Start by getting the smarts. And quit being confusion as the kids would say. Do research about it. Lol. 

 

Before getting to the next one, I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! It’s live again. Use the code HOTSTUFF upon purchase at droprelease.com to get $50 off your purchase. Y’all, it makes a world of difference. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. My patients love it and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Hear me now and believe me later.

 

Item #2

The second one is called “Changes in psychosocial well-being after mindfulness-based stress reduction: a prospective cohort study” by Hill et. al. (Renee J. Hill 2017) and also published in The Journal of Manual and Manipulative Therapy on May 4, 2017.  Again, yes, old man river here as far as research goes but relevant 

Why They Did It

The primary purpose of the current study was to assess the effects of a mindfulness-based stress reduction (MBSR) program, facilitated by non-psychologist clinicians, for improving psychosocial well-being.  A secondary purpose of the current study was to explore the role of self-compassion as a potential underlying factor for improvements in emotional distress.

How They Did It

  • 130 participants with a variety of medical complaints completed an eight-week mindfulness-based stress reduction program at Vanderbilt. 
  • Before treatment and at the 8-week time point, participants completed measures for emotional distress, stress, mindfulness, and self-compassion. 
  • Linear model estimation using ordinary least squares was used to evaluate the association between changes in self-compassion with changes in emotional distress.
  • I’m not going to lie….I’m ignorant of that last part. Made be feel stupid. Which, of course, isn’t hard to do. 

What They Found

  • Following mindfulness-based stress reduction, participants reported significant reductions in emotional distress. 
  • Additionally, participants reported improvements in mindfulness and self-compassion. 
  • Linear regression model revealed that changes in self-compassion were significantly associated with changes in emotional distress.

Start getting the smarts. Research at least once per day. 

Alright, that’s it.

Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

Key Point:

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

Contact

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

Connect

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

Website

Home

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TuneIn

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About the Author & Host

Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

Adriaan Louw, J. N. E. J. P. (2017). “A clinical perspective on a pain neuroscience education approach to manual therapy.” Journal of Manual & Manipulative Therapy 25(3): 160-168.

Renee J. Hill, L. C. M., Li Wang & Rogelio A. Coronado, (2017). “Changes in psychosocial well-being after mindfulness-based stress reduction: a prospective cohort study.” Journal of Manual & Manipulative Therapy 25(3): 128-136.      

Chiropractic Prevents Opioids & Chiropractic Adverse Events

CF 191: Chiropractic Prevents Opioids & Chiropractic Adverse Events Today we’re going to talk about chiropractic care preventing opioids and chiropractic adverse events.  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. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an invaluable resource for your patient education and for you. It can save you time in putting talks together or just staying current on research. It’s categorized into sections so that the information is easy to find and it’s written in a way that is easy to understand for practitioner as well as patient. You have to check it out. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #191 Now if you missed last week’s episode , we talked about Obesity In Youths With Chronic Pain, The Healing Journey of Pain, and Fibromyalgia Treatment. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

So, if you’re a regular listener, then you know that I’ve been slowly going through the Forensics Diplomate program. The initial 40 hours through ChiroCredit were not my favorites. Learning about court cases, procedures, and all that stuff…..let’s just say it’s not my skill set.  But, I did it. I sat through it all. Now I’m on to the course for impairment ratings through the AMA. It’s speaking my language a little more. OK….a lot more. It’s still very technical and all that good stuff but it makes a little more sense. However, it is written by medical doctors for medical doctors so there is a section that got me a bit hot. Did you know in the 6th edition of the Guides to Impairment, it says that chiropractors should stick with only assessing impairment of the spine….because….you know……we didn’t spend two full semesters dissecting an entire body or anything like that. Right?

The presenter said he realizes that statement may bring about some discussion but the evaluator must have knowledge, skills, and ability in that organ system or in that region to assess impairment. Otherwise, the impairment rating is likely to be faulty. So…..I guess chiropractors somehow have the inability to learn, know, or understand a shoulder, hip, ankle, etc? Let’s be fair, I get it if they think a chiropractor shouldn’t really be assessing impairment of the liver or GI system.

That’s not within our wheelhouse. But muscles, bones, ligaments, tendons, and joints of all sorts are damn well within our wheelhouse and it’s just dumb to act like a regular impairment doc doing impairment ratings are any more intimately familiar with them than we are.  That’s some elitist BS right there. And it stinks and smells like old outdated dogma. But let’s also be fair to them. Even though they’ve rarely given us the same respect in return. This was reprinted in 2009. I’m not sure when the original printing was. I’m sure the course I’m watching was done around the same time as well.  Think about it; how many changes have you seen in the MD/DC relationship arena in just the last 10 years alone? I’ve seen a lot.

Especially since the American College of Physicians came out in 2016 recommending spinal manipulative therapy for acute and chronic low back pain. On the heels of that The Lancet report on low back pain echoed the recommendation. Then Dr. Goertz’s paper was in JAMA showing how well veterans did when spinal manipulative therapy was added into the treatment protocol.  Plus, I see more and more chiropractors moving in the right direction. The direction of evidence-based, patient-centered care. Where decades ago, an MD wouldn’t bowl against a team that had a chiropractor on it and they wouldn’t even accept referrals from us, to now.

Now, I have a nurse practitioner working hand and hand with me every day. Some of the people I count as buddies are a vascular surgeon, and ER doc, and a neurosurgeon.  So….maybe the course just needs an update. Who knows? But it pissed me off a little and I paid $487 to get pissed off. Lol. This too shall pass. In fact, it may already have passed.  Alright, NP medical integration week #2. It’s getting there. Our NP did hormone pellet procedure last week. That whole process is pretty cool. Patients have to do the lab work first to make sure it’s necessary. But if it is, it can make a big difference for folks. We doing PRP shots, trigger point shots, B12 shots….it’s all pretty darn interesting and it’s multimodal. Which is evidence-based and, as always, I balance it in a patient-centered way. 

So, now in my office, we have me, exercise/rehab, medical services, acupuncture, 3 massage therapists, and all of the other stuff you’d expect in therapies. It’s grown into quite a deal.  I had a patient ask me the other day if I was a franchise. I asked why they’d think that? They just said that we offer so many things that he figured it was a franchise. I said no, we’re not. But I likened it to my step-dad’s shop. He’s got every tool, cord, clamp, and gadget you’d ever want in a shop. But when you ask him how he got it all, he’ll tell you that he got it one at a time. Kind of like Clint Eastwood in El Torino.  You just gather and grow as you need. As the risk makes sense. There was a time when getting a $13,000 decompression table was a big damn deal and came with a lot of financial risks. 

Now, understandably, the risk is different. To expand and grow, it costs more. You have to stick your neck out a little further and hope it doesn’t get chopped off.  There are sinkers and swimmers in this world. I like to think I’m a swimmer. It’s OK to venture out a little further each time you stretch. As long as you know how to swim. And I have the doggy paddle down, folks. Just keep swimming just keep swimming.  Alright, let’s dive into the research. 

Item #1

This one’s called “Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain” by Whedon et. Al. (James M Whedon 2020) and published in Pain Medicine in December of 2020 and that’s just hot enough. 

Why They Did It They say “Utilization of nonpharmacological pain management may prevent unnecessary use of opioids. Our objective was to evaluate the impact of chiropractic utilization upon use of prescription opioids among patients with spinal pain.”

How They Did It

  • We employed a retrospective cohort design for analysis of health claims data from three contiguous states for the years 2012–2017.
  • They included adults aged 18–84 years enrolled in a health plan and with office visits to a primary care physician or chiropractor for spinal pain
  • They identified two cohorts of subjects: Recipients received both primary care and chiropractic care, and nonrecipients received primary care but not chiropractic care.
  • The total number of subjects was 101,221

What They Found

  • Overall, between 1.55 and 2.03 times more nonrecipients filled an opioid prescription, as compared with recipients
  • Similar differences were observed for the acute groups.

Wrap It Up

Patients with spinal pain who saw a chiropractor had HALF the risk of filling an opioid prescription.   

CHIROUP ADVERTISEMENT

Item #2 Number two today is called “Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment” by Drew Oliphant (Oliphant D) and published in the Journal of Manipulative Physiological Therapeutics in 2004. Definitely not hot. 

Why They Did It The authors wanted to provide a qualitative systematic review of the risk of spinal manipulation in the treatment of lumbar disk herniations (LDH) and to estimate the risk of spinal manipulation causing a severe adverse reaction in a patient presenting with LDH.

How They Did It

  • They considered relevant case reports, review articles, surveys, and investigations regarding treatment of lumbar disk herniations with spinal manipulation and adverse effects and associated risks
  • Prospective/retrospective studies and review papers were graded according to quality, and results and conclusions were tabulated. 
  • From the data published, an estimate of the risk of spinal manipulation causing a clinically worsened disk herniation or cauda equina syndrome (CES) in patients presenting with LDH was calculated. 
  • This was compared with estimates of the safety of nonsteroidal anti-inflammatory drugs (NSAIDs) and surgery in the treatment of LDH.

What They Found An estimate of the risk of spinal manipulation causing a clinically worsened disk herniation or CES in a patient presenting with LDH is calculated from published data to be less than 1 in 3.7 million.

Wrap It Up The apparent safety of spinal manipulation, especially when compared with other “medically accepted” treatments for LDH, should stimulate its use in the conservative treatment plan of LDH.

Item #3 The last one is called “Serious Adverse Events and Spinal Manipulative Therapy of the Low Back Region: A Systematic Review of Cases” by Herbert et. al.  and published in the Journal of Manipulative Physiological Therapeutics in 2015. Again….not hot but that’s OK. It’s a Systematic Review. 

Why They Did It The purpose of this study was to systematically search the literature for studies reporting serious adverse events following lumbopelvic spinal manipulative therapy (SMT) and to describe the case details.

How They Did It

  • A systematic search was conducted in PubMed including MEDLINE, EMBASE, CINAHL, and The Cochrane Library up to January 12, 2012, by an experienced reference librarian. 
  • Study selection was performed by 2 independent reviewers using predefined criteria. 
  • We included cases involving individuals 18 years or older who experienced a serious adverse event following SMT applied to the lumbar spine or pelvis by any type of provider (eg, chiropractic, medical, physical therapy, osteopathic, layperson). 
  • A serious adverse event was defined as an occurrence that results in death or is life threatening, requires hospital admission, or results in significant or permanent disability. 
  • A total of 2046 studies were screened, and 41 studies reporting on 77 cases were included.

What They Found

  • Important case details were frequently unreported, such as descriptions of SMT technique, the pre-SMT presentation of the patient, the specific details of the adverse event, time from SMT to the adverse event, factors contributing to the adverse event, and clinical outcome. 
  • Adverse events consisted of cauda equina syndrome (29 cases, 38% of total); lumbar disk herniation (23 cases, 30%); fracture (7 cases, 9%); hematoma or hemorrhagic cyst (6 cases, 8%); or other serious adverse events (12 cases, 16%) such as neurologic or vascular compromise, soft tissue trauma, muscle abscess formation, disrupted fracture healing, and esophageal rupture.

Wrap It Up

The anecdotal nature of these cases does not allow for causal inferences between SMT and the events identified in this review.  When chiropractic is done responsibly and appropriately, it’s safer than almost any medical intervention. It just is. Now, when you have people damn near yanking people’s heads off of their bodies, aggressively adjusting patients on YouTube that have had a significant history of stroke, and adjusting 80 year old women with the same gusto you’d use with a 25 year old male…..well….those folks are just asking for it.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world.

The world needs evidence-based, patient-centered practitioners driving the bus so get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

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

Bibliography

  • James M Whedon, D., MS, Andrew W J Toler, MS, Louis A Kazal, MD, Serena Bezdjian, PhD, Justin M Goehl, DC, MS, Jay Greenstein, DC (2020). “Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain.” Pain Med 21(12): 3567-3573.  
  • Oliphant D “Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment.” J Man Physiol Ther 27(3): 197-210.  

w/ Dr. Katie Pohlman – New Research, Upcoming Research, And the Need For It All

CF 147 w/ Dr. Katie Pohlman – New Research, Upcoming Research, And the Need For It All

Today we’re going to be joined by the one and only, research extraordinaire , Dr. Katie Pohlman. We’re going to talk about all kinds of research-related shenanigans so just you know that you are in the right place at the right time my friend.  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 #147.

Now if you missed last week’s episode , we talked about how chiropractic helped the VA cut opioid use among veterans and then we talked about diagnosing lumbar stenosis. 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…..

This week we have a guest you’ve heard me talk about plenty of times and I’m excited to have her with us so we won’t dwell on the my personal happenings too long here.   

First, we see numbers rising fairly significantly around my neck of the woods. Here in Texas, you can’t get anyone to take it seriously so we have folks walking around everywhere without a mask on. That tends to limit my interaction with people I don’t know. Of course, they’re required here in my clinic but going into a convenience store, that’s a different story. 

The last time I did that the clerk and myself were the only ones wearing them out of about 10 people. That’s a little distressing. To say the least. But, it is what it is. Darwinism is a real thing. Of course I don’t wish it on anyone and every loss is tragic. But there’s also the natural progression of Darwinism. Those that go by ‘heart’ and ‘opinion’ rather than science and self-preservation…..well, that’s a more dangerous course and I wish them all luck. In the end, regardless of how many get it, we’re looking at 98% of them coming through alright. No percentage guess on how many survive but suffer ongoing issues though. I haven’t heard numbers on that. 

Anyway, as far as the practice goes, we are clicking along and doing well. The new patient count is staying up there where it needs to be and the weekly visits will follow. Still around 145 last week though. I want to see that up around the 185 per week mark. Minimally. 

Then we can get back to paying down debt (aka school loans) and investing rather than paying the bills and surviving. Lol. lt’s good to pay the bills and survive but we should have bigger plans shouldn’t we? Investing and being debt free is key to the later part of life and it’s hard to do so when you’re down. 

Speaking of, I want to pass along some info to you guys and gals. I just finished up a book and decided I’d order 2 more off of Amazon to give out as gifts. The only other book I’ve ever done that with was one called The Easy Way To Quit Smoking by Alan Carr. I ordered several to loan out to my patients that are smokers. 

This book though was about investing. I have read financial books before but, if I’m being honest, getting into symbols and specifics and all…..it’s just not my forte. My wheelhouse exists elsewhere. Which sucks because being financially sound is key to all of our lives. 

Anyway, the book is called Quit Like A Millionaire by Kristy Shen and Bryce Leung. They’re a married couple with different last names. I don’t know. Young people these days do stuff different. Lol. Anyway, I am always skeptical about titles like that. Sure sure….quit like a millionaire. Riggghhhtttt. This book is different. When I said young people do things differently, these two really do. There are real, actionable steps here and I have to admit, even at 48 years old, I’m pretty jazzed about getting my numbers back up so I can jump in head first on some of these suggestions. 

They retired at 32 years old. She’s got the research and the numbers behind her and I’m impressed. If I can get started on it soon, I’ll talk about it and share my experiences with you as I go along. Until then, you might check her website at https://www.millennial-revolution.com/start-here/

Introduction

Enough of that, let’s get going with our guest today.  Welcome to the show, Dr. Pohlman. I appreciate you joining us today.

How are things at Parker University today?

Tell me why you became a chiropractor and then what it was that led you into the research side rather than the treatment side of the profession. 

Congratulations on being the ACA Researcher of the Year. Tell me, with all of the amazing researchers doing work in the profession right now, in your opinion, what made you the pick for the award this year. 

Let’s talk about your post at Parker University. Can you tell us about your day-to-day? For the research-minded listener out there in podcast land, what does the head of research at Parker do every day when you go into work?

I have a paper here that you were the lead author on called “Assessing Adverse Events After Chiropractic Care at a Chiropractic Teaching Clinic: An Active-Survellance Pilot Study” and published in the Journal of Manipulative and Physiological Therapeutics in August of 2020 so brand new stuff here(Pohlman K 2020). While unfamiliar with the other authors on the paper, I do recognize Dr. Greg Kawchuk. I got to see him speak last September in St. Louis at the Forward ’19 conference and wow….he’s an effective speaker to say the least. He’s a heavy hitter for sure. The stated objective here was to assess the feasibility of implementing an active-surveillance reporting system within a chiropractic teaching clinic and subsequently determining the frequency of adverse events after treatment is administered. Now pilot studies are basically the research before the research, right? So, what is down the road along these lines and why is this paper important to us?

Here is a quote from the conclusion of the paper that I think our listeners would find educational. You say, “Our preliminary findings identified that over 50% of patients had improved symptoms after a chiropractic encounter, whereas 8.9% of patients reported worsening symptoms and 5.0% reported new symptoms. Additionally, results from this study suggest that although most symptoms improve with care, there are symptoms that worsen or are new after care, which may not have been previously known to interns or practitioners.”

Another project you were an author on is called “Chiropractic Care of Adults With Postpartum-Related Low Back, Pelvic Girdle, or Combination Pain: A Systematic Review,” by yourself and Carol Ann Weiss et. al(Weiss C 2020). published again in the Journal of Manipulative and Physiological Therapeutics in again, August of 2020. It was a really busy August for you apparently! The objective of this one was to conduct a systematic review assessing the effectiveness of specific chiropractic care options commonly used for postpartum low back pain, pelvic girdle pain, or a combination of the two.  Can you lead us through the paper a little and talk about the abstract’s conclusion which says, “No treatment option was identified as having sufficient evidence to make a clear recommendation.”

The last paper I want to ask you about is one you were on that we covered way back in episode #68 and the paper was called “Change in young people’s spine pain following chiropractic care at a publicly funded healthcare facility in Canada.” It’s amazing how much wonderful research goes on in Canada, BTW. Anyway, it was published in Complementary Therapies in Clinical Practice in March of 2019(Manansala C 2019). This one was interesting to me because it highlighted the fact that spinal pain in young people has been established as a risk factor for pain later in their life. Basically, you all wanted to see how kids respond to chiropractic. I think most chiropractors find this to be obvious given our clinical observations but the conclusion of the paper was “the findings of th epresent study provide evidence that a pragmatic course of chiropractic care, including spinal manipulation, mobilization, soft tissue therapy, acupuncture, and other modalities within the chiropractic scope of practice are a viable conservative pain management treatment option for young people.” What can you tell me about this paper? Did you learn anything new that you didn’t already know going into it?

Do you ever get tired of having a new paper come out? Is it exciting every time?

When I was at Forward ’19, I heard about a program for the first time. I had never heard of CARL before. It turns out that you are very involved. Can you tell us what it is and why it’s important?

What are you and your crew working on now? What’s coming down the line and what big questions are you hoping to get answers to?

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. 

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 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

  • Manansala C, P. S., Pohlman K, (2019). “Change in young people’s spine pain following chiropractic care at a publicly funded healthcare facility in Canada.” Complementary Therapies in Clinical Practice.
  • Pohlman K, F. M., Ndetan H, Hogg-Johnson S, Bodnar P, Kawchuk G, (2020). “Assessing Adverse Events After Chiropractic Care at a Chiropractic Teaching Clinic: An Active-Survellance Pilot Study.” J Man Physiol Ther.
  • Weiss C, P. K., Draper C, Silva-Oolup S, Stuber K, Hawk C, (2020). “Chiropractic Care of Adults With Postpartum-related Low Back, Pelvic Girdle, or Combination Pain: A Systematic Review.” J Man Physiol Ther.

 

CF 036: A MishMash Of Research on Chiropractic, On Herniation, Trends, and Ineffectiveness

A MishMash Of Research on Chiropractic, On Herniation, Trends, and Ineffectiveness

Integrating Chiropractors

Today we’re going to talk about research on Chiropractic, research on health trends, and research on disc herniation as a result of a visit to your friendly neighborhood chiropractor. Is that real or is that a bunch of hooey? We’ll talk about it so come along. 

But first, here’s that 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.  

Now that I have you here, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. Nope, I don’t have some big prize for you if you sign up. Not big offers. No magical marketing tactics with which to get your email address. Just what we hope is a podcast full of value to you and your business. 

Being on the newsletter list just makes it easier to let you know when the newest episode goes live and, maybe in the future we’ll have some cool stuff to offer those on our email list. Also, when someone new signs up it makes my heart leap and wouldn’t you like to be the one responsible for making someone’s heart leap today? 

Upcoming!

We have a lot of great guests lined up to come on the show! Next week I believe we are going to have Dr. Anthony Palumbo from Staten Island, New York. Dr. Palumbo is very active in the New York State Chiropractic Association and practices in a multidisciplinary practice. We’re going to have a good time picking his brain. 

The week after that, I believe we have Dr. Brandon Steele from ChiroUp and from the DACO program joining us. He’s an excellent resource for what is going on in our profession and where we see things heading in the future for chiropractic. I’m really looking forward to that one. 

We have the green light from Dr. Jerry Kennedy of the Black Sheep DC marketing program to come on the show. We just need to get that date lined up. We have Dr. Tim Bertlesman from the DACO program and also the President of the Illinois Chiropractic Association lined up down the road. 

Good stuff on the way so make sure you’re staying tuned into our little corner here in Podcast land. We’re bringing you the best in research on Chiropractic.

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

You have fainted very dramatically into Episode #36 and we’re so glad you did. 

How’s your week been so far? I shared on the last podcast how we have had a rough 2018 but things have leveled off and we up and running. It feels a little like a sprint these days to tell you the truth. Lol. And thank the good Lord for it. 

Speaking of thanking the Good Lord, my 16-year-old son has been raised in the church. Not every single Sunday. I like to sleep sometimes ya know. But, often enough to say he’s been a church-goer as has my 11-year-old daughter. We’ve not pushed anything on him but he has taken it upon himself to an extent to further the church part of his life. 

He’s gone to a church camp in New Mexico the last two summers and this year he returned ready to get baptized. So he did. Last Sunday he went to church and took a bath and we couldn’t be more proud of that little dude. He’s actually not so little anymore but, we worry about our kids don’t we?

We worry about if we’re raising them right. Am I raising him to be a good man? Am I raising him to work hard and be dependable? Will they be ready for the world? Have I somehow enabled him to be weak? Am I raising him to feel entitled instead of working his butt off for things in his life

I think parents have all of these worries. I might argue that if you’re not asking yourself at least some of these questions, you might give them a deeper look. I’m not a parenting expert. That’s just my opinion. 

Anyway, my point is, we got this aspect of his life right so far. We sure love that kiddo and we love the direction we see him headed. Kids can be a game-changer for sure. From conception throughout their entire lives, they consume our mind space without even realizing it. And that’s OK. We wouldn’t have any other way most to the time. 

With school back in session now, what are some of the ways that you keep your practice from slowing down? Back to school is historically a slow time for us and we’re never quite sure how to keep that from happening. Email me at dr.williams@chiropracticforward.com and tell me how you do it. I’ll be glad to share on next week’s podcast if you don’t mind. 

This week, I just want to throw some seemingly random papers having to do with research on Chiropractic at you and we’ll start with one called “Effectiveness of classic physical therapy proposals for non-specific low back pain: a literature review.” It was written by F Cuenca-Martinez[1], et.al. and published in Physical Therapy  Research in March of 2018. This is a group of physical therapists writing this paper just so you are in the know. 

Why They Did It

The authors were hoping to evaluate the effectiveness of classical physiotherapy in the management of non-specific chronic low back pain. 

How They Did It

  • They did a literature search in English electronic databases from November- December in 2015 for only randomized controlled trials
  • They only accepted the studies addressing chronic non-specific low back pain treated by manual therapy and different types of exercise methods. 

What They Found

Back School exercises and McKenzie’s method were both ineffective

Spinal manipulation proved effective when performed on the lower back and on the thoracic region but only immediately after it was received and not in the medium or in the long term. 

Massage proved effective for short-term relief

Wrap It Up

The authors’ conclusion was “Based on the data obtained, classical physiotherapy proposals show ineffectiveness in the treatment of chronic non-specific low back pain. More multidimensional studies are needed in order to achieve a better treatment of this condition, including the biopsychosocial paradigm.”

What do we get from this? First thought is, the papers they cite are, at this point, old and considering the papers we have been covering, are really pretty irrelevant to an extent. I mean, any good information will always be good information but only until better information becomes available. The most recent paper cited for the spinal manipulation portion of this project is over 5 years old. So….what the hell?

Second….it’s a bit discombobulated when you read through the abstract. I’m either bad at following along (which is highly likely) or it’s just worded so oddly. I dove into the full paper to try to make heads or tails of what they have going on here. It sounds like physical therapists are just trying to be cheeky monkeys and throwing poo at spinal manipulation and we’re not having it. Mostly because they’re wrong and because we are better and more cost-effective at treating low back pain than they are. Period over and out. 

The authors, in regards to spinal manipulation, refer to three studies. One by Oliveira, et. al[2]., one by Bronfort et. al[3]. and one by Senna and Machaly[4]. The Bronfort study was done on 300 patients and they found basically no difference between those that had physical therapy vs. chiropractic vs. home exercises. They all ended up the same. But, they didn’t cite the work we covered previously showing that chiropractic combined with exercise is more effective that physical therapy. 

Or the paper from Episode 26 by Korthals-de Bos[5] that concluded: “Manual therapy (spinal mobilization) is more effective and less costly for treating neck pain than physiotherapy or care by a general practitioner.”

There was also no mention of the paper by Blanchette et. al. that we covered in Episode #26 that showed that chiropractic patients experience the shortest duration of compensation, and physical therapists’ patients the longest. Blanchette says in that conclusion, “These differences raise concerns regarding the use of physiotherapists as gatekeepers for the worker’s compensation system.” And all the chiropractors said, “Amen, hallelujah brothers and sisters.”

And the Senna paper they cite actually concluded by saying, “SMT is effective for the treatment of chronic nonspecific LBP. To obtain long-term benefit, this study suggests maintenance SM after the initial intensive manipulative therapy.”

I’m done with that paper. 

Let’s move on from these PTs and their poo-throwing. 

Here’s one more specifically geared toward research on Chiropractic called “Chiropractic care and risk for acute lumbar disc herniation: a population-based self-controlled case series study” by Cesar Hincapie, et. al[6].  

Why They Did It

The objective was to investigate the association between chiropractic care and acute lumbar disc herniation with early surgical intervention and contrast this with the association between primary care physician (PCP) care and acute lumbar disc herniation with early surgery

What They Found

Both chiropractic and primary medical care were associated with an increased risk for acute LDH requiring ED visit and early surgery. Our analysis suggests that patients with prodromal back pain from a developing disc herniation likely seek healthcare from both chiropractors and PCPs before full clinical expression of acute LDH. We found no evidence of excess risk for acute LDH with early surgery associated with chiropractic compared with primary medical care.

This Hincapie fella also had a prior paper published not long ago[7] where he discussed and explored the perception among different medical disciplines and among chiropractors as to whether spinal manipulation causes a lumbar disc herniation. It was an interesting paper. We covered it in episode #27 if you’d like to give it a listen. 

https://www.chiropracticforward.com/cf-027-wanted-safe-nonpharmacological-mean-of-treating-spinal-pain/

Then there’s this research on Chiropractic that came out recently titled “Spine Degenerative Conditions and Their Treatments: National Trends in the United States of America” and published in Global Spine Journal February 2018. It was authored by Buser et. al[8]. 

Why They Did It

The aim of this study was to report the current trends when talking about spine degenerative disorders and their various  treatments.

How They Did It

Patients diagnosed with lumbar or cervical spine conditions within the orthopedic Medicare and Humana databases were included

What They Found

  • Within the Medicare database there were 6 206 578 patients diagnosed with lumbar and 3 156 215 patients diagnosed with cervical degenerative conditions between 2006 and 2012
  • There was an increase of 18.5% in the incidence of fusion among lumbar patients
  • For the Humana data sets there were 1 160 495 patients diagnosed with lumbar and 660 721 patients diagnosed with cervical degenerative disorders from 2008 to 2014
  • There was a 33% (lumbar) and 42% (cervical) increases in the number of diagnosed patients. However, in both lumbar and cervical groups there was a decrease in the number of surgical and nonoperative treatments.

Wrap It Up

The authors wrap it up by saying, “There was an overall increase in both lumbar and cervical conditions, followed by an increase in lumbar fusion procedures within the Medicare database. There is still a burning need to optimize the spine care for the elderly and people in their prime work age to lessen the current national economic burden.”

What do we get from that? I’d say that it’s clear from research on Chiropractic we’ve covered here that neck and back pain is stepping forward for sure. It is being recognized for the problem it really is while treatments available in the medical kingdom continue to show scattered results. Chiropractors are the most uniquely positioned to knock this stuff out of the park. 

Fusion surgeries have gone crazy sky high in the last ten years while the outcomes have remained unchanged. 

Epidural steroid injections have been done at a blistering pace over the last decade with no better outcomes. 

Physical therapists are even starting to question their own effectiveness. Take this article in the journal called Physical Therapy written by Colleen Whiteford et. al[9]. Here is the opening paragraph. Get a load of this:

“We are writing to relay our consternation about the guideline article by Bier et al in the March issue of PTJ. We fully support the increasing emphasis on critical evaluation fo the assessment and intervention models used in physical therapist practice. The long-overdue acknowledgment of research that does not support much of what constitutes the bulk of physical therapist practice is a refreshing and honest introspection that can potentially initiate much-needed change within our profession.”

“Without such change, our profession is destined to continue on our current path of practice that is increasingly shown to be yielding outcomes that are less than desirable. Such exploration inevitably leaves us with gaping holes in practice that can be unsettling. The natural and responsible tendency is to search for alternative measures and interventions to fill this gap.”

I’m going to tell you one of those alternatives they’ll be looking to adopt and are looking to adopt is spinal manipulation. You better listen to me folks. If you’ve listened to our podcast much here then you know they’ve already adopted adjustments and renamed it to translatoric spinal manipulation. 

We can keep monkeying with these chiropractors out on the edge of the ether talking about curing everyone on the planet of everything known to man or we can keep moving in the direction of science and in the direction of evidence. My preference is obvious. 

If you haven’t yet, can you leave us a great review on whatever platform it is that you’re listening to us on? iTunes, Stitcher, or whatever it may be. We sure would appreciate it. 

Integrating Chiropractors

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is a mechanical pain and responds better to mechanical treatment instead of chemical treatments. Research on chiropractic shows this clearly.

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

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

Being the #1 Chiropractic podcast in the world would be pretty darn cool. We’ll keep bringing you Research on chiropractic in the hopes of reaching that goal!

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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Bibliography

1. Cuenca-Martínez F, Effectiveness of classic physical therapy proposals for chronic non-specific low back pain: a literature review. Phys Ther Res, 2018. 21(1): p. 16-22.

2. Oliveira RF, Immediate effects of region-specific and non-region-specific spinal manipulative therapy in patients with chronic low back pain: a randomized controlled trial. Phys Ther Res, 2013. 93(6): p. 748-56.

3. Bronfort G, Supervised exercise, spinal manipulation, and home exercise for chronic low back pain: a randomized clinical trial. Spine, 2011. 11(7): p. 585-98.

4. Senna MK, Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome? Spine (Phila Pa 1976), 2011. Aug 15; 36(18): p. 1427-37.

5. Korthals-de Bos IB, Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. British Medical Journal, 2003. 326(7395): p. 911.

6. Hincapie C, Chiropractic care and risk for acute lumbar disc herniation: a population-based self-controlled case series study. European Spine Journal, 2018. 27(7): p. 1526-1537.

7. Hincapie C, Chiropractic spinal manipulation and the risk for acute lumbar disc herniation: a belief elicitation study. European Spine Journal, 2017.

8. Buser Z, Spine Degenerative Conditions and Their Treatments: National Trends in the United States of America. Global Spine J, 2018. 8(1): p. 57-67.

9. Whiteford C, On “Clinical Practice Guideline for Physical Therapy Assessment and Treatment in Patients With Nonspecific Neck Pain,” Bier JD, Scholten-Peeters WGM, Staal JB, et al. Phys Ther. 2018;98:162–171. Physical Therapy, 2018.