chiropractic wins

Common Surgeries Aren’t Well-Researched & Chiropractic Wins Again

CF 144: Common Surgeries Aren’t Well-Researched & Chiropractic Wins Again Today we’re going to talk about how some of the most common musculoskeletal surgeries aren’t very well-researched and we’ll talk about how chiropractic performs when lined up with multidisciplinary treatment.  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. 
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Do it do it do it.  You have found yourself smack dab in the middle of Episode #144 Now if you missed last week’s episode, we talked about a new paper that came out in JAMA that said spinal manipulative therapy doesn’t work and what our research experts have to say about that and what my big mouth has to say about it. Make sure you don’t miss that info. Keep up with the class. There may come a time you need to take a stance on that.  While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.  Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.  On the personal end of things….. I’m trudging through the designated doctor program here in Texas to assess the extent of the injury, return to work, and all of that fun fun stuff. I’m not even sure why I’m doing it. Just to have back up plans. I like multiple streams and I like options. If I get as busy as I was in 2019, I’ll never have the need for it. If it stays where I’m at – 75% of where I was, well it may be something I entertain.  Either way, will it make me a better doctor for personal injuries, work comp, and all patients in general? Hell yeah, it will. Even if I never use it for a DD exam, I’ll be a better doc after going through it. Guaranteed. Even if I don’t pass the damn test!! Which I hear is stupid and has nothing to do with the curriculum. Even if I fail the test, I’ll be better.  It is slowly cooling off here in the Texas Panhandle. While I realize we just went through the longest Spring and Summer known to mankind, I’m going to miss it. Despite all that went into making it the longest Spring and SUmmer ever….I’m going to miss the aspect of time slowing down, sitting on the back patio with my wife, dinner outside in the outdoor kitchen, swimming in the pool, and just being warm in general.  Oh, how I despise the cold weather. Lol. Here’s where you Northerners call me a pansy but….it’s like needles when the cold wind blows. I grew up a couple of hours north of where I live now and there was a difference in weather. At times, it would get bone-chilling cold growing up. I would take a shower in the morning before school, drive there and park, and walk into the school. My wet hair from showering would freeze before I got into the building. Now that’s cold, folks.  I grew up with that, yes, even in Texas. My hometown is called Perryton, TX and it’s only 7 miles from the tiny little strip of Oklahoma and it’s about 45 miles from Kansas. So, it’s not deep in the heart of Texas. It’s way up North.  My point is, I went to school down in Natchitoches, Louisiana, and then lived in Dallas for about 6 years before relocating back to the Texas Panhandle and Amarillo, TX.  Having not been in the cold cold for 8-10 years got me spoiled to the point that I can’t even tolerate cold weather anymore. At all. For any reason. It borderline pisses me off.  Everything dies, it’s cold, it’s windy, people are all yay about pumpkin spice crap, my bones ache a bit, and I’m bitchy 2/3 of the time.  I’m just warning you all, this is what you get to look forward to dealing with for the next 3-4 months. My whiny butt being all cold-weather fussy. But here’s the saving grace and the best thing since sliced bread; the remote start vehicle.  Yes, as any good Texan, I have a pickup and that dude has remote start with defrost and heated seats. You damn right. This is the ONE thing that has made Winter somewhat tolerable for me and, being a good Christian, I thank God and the car companies on the frigid mornings for blessing us all with such wonderous inventions like the remote start.  Now, I don’t want you North Dakota or Canadian friends of mine rolling your eyes too hard at me here. I’m sure you’d melt down here in TX in the Summers so…..we agree to play to our strengths and roll on down the road. Trust me, go through two-a-days in college in Louisiana and tell me how tough you are. Lol. Something you don’t see on TV when you watch football is the humidity. It’s REAL.  I went from three-a-days at one college playing football here in the Texas Panhandle to two-a-days in Louisiana. Not a problem by anyone in the Panhandle but in Lousiana, it looked like a battlefield with players dropping left and right with cramps and having to get IVs there on the practice field….it was insane. So, I’m cold intolerant but I can handle the other end of it. Don’t be too hard on me. Lol.  What does all of this have to do with chiropractic and research? Not a damn thing. Just a little bit of fun rambling and brain dump.  Let’s get on with the real reason we’re here. Item #1 This first one came to me from Dr. Craig Benton, one of my buddies, down in Lampasas, TX where it’s always a bit balmy almost year-round. It’s called “Integrating a multidisciplinary pain team and chiropractic care in a community health center: an observational study of managing chronic spinal pain” by Prater et. al(Prater C 2020). and published in Journal of Primary Care & Community Health on September 10th of 2020. Holy smokin scorchin’ blaze of newness! Look, y’all should know how I feel about chronic pain by now. This is right down my alley. Not a dark alley. No, one that’s lit up like an airport runway. Bright alley.  Why They Did It They say that chronic pain is one of the most common diseases in the US with the underserved population being most affected for obvious reasons. They say the underserved are at more risk of opioid misuse or overuse since they lack therapeutic access otherwise. For this reason, they are looking for other avenues to provide treatment to chronic pain sufferers.  How They Did It
  • This was a prospective observational pilot study
  • Held at a community health center
  • Measured the effectiveness of two interventions among the underserved population
  • The two interventions were 
  • Multidisciplinary team
  • Chiropractic care
  • The outcomes measured were pain and functional disability measured via the Pain Disability Questionnaire and reduction of opioid dosage at 6 and 12 months. 
  • 35 folks complete baseline and follow-up outcome measures from August 2018 to May 2020
Wrap It Up A key finding was quote, “Participants in the chiropractic team and those completing the study before COVID-19 were found to have significantly greater improvement at follow-up.” Well isn’t that sexy? Indeed.  “This observational study within a community health center resulted in improvement in spinal pain and disability with chiropractic care versus a multidisciplinary pain team. Offering similar services in primary care may help to address pain and disability, and hopefully limit external referrals, advanced imaging, and opioid prescriptions.” This was a pilot study with small sample size. Nothing to do backflips about but it’s a start down this path or thinking and learning so hopefully, we’ll see some very cool and very positive things for the chiropractic profession down the line if papers like this continue to come out. Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. I love new toys! If you’re into soft tissue work, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend. Drop Release uses fast stretch to stimulate the Golgi Tendon Organ reflex.  Which causes instant and dramatic muscle relaxation and can restore full ROM to restricted joints like shoulders and hips in seconds.   Picture a T bar with a built-in drop piece.  This greatly reduces the time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day.  Drop Release is like nothing else out there, and you almost gotta see it to understand, so check out the videos on the website. It’s inventor, Dr. Chris Howson, from the great state of North Dakota, is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase. Go check Drop Release at droprelease.com and tell Dr. Howson I sent you. Item #2 I think I got this one from Dr. Craig Benton as well. Dr. Benton is a former guest of this podcast. Sounds like we need to have him back on. He’s my Allstar this week. Thank you, Dr. Benton. For keeping me in business and helping me keep everyone, including myself, educated.  This one is called, “Surgery for chronic musculoskeletal pain: the question of evidence” authored by Harris et. al(Harris IA 2020). and published in Pain Journal in September of 2020. Blisters!!! I got blisters on my fingers!!! You Beatles fans…..you’ll get it.  Why They Did It They say that globally, the most common reasons surgery is performed relate to the musculoskeletal system, and outside of injury, the most common reasons pertain to arthritis and back or neck pain. AKA – chronic pain. Yes, I love me some chronic pain people! Not suffering from it. Learning about it and treating it.  They say, “Although the surgical treatment of chronic pain generally relies on attributing pain to objective, often visible changes on imaging studies, the causes of chronic pain are more complex and are strongly influenced by psychosocial factors.” Things like Yellow Flags. Go look up yellow flags and Annie O’Connor’s book called World Of Pain please and thank you.  They say that surgeries like debridement of degenerative joints and things of that nature ignore the complexity of chronic pain. They look at surgery as purely mechanistic in nature with little to no involvement otherwise and the procedures often rely on observational evidence only, rather than rigorous, comparative trials.  In addition, they say that when the trials have actually been performed for these surgeries have been mostly subjective and measurements are usually not blinded to reduce the bias of the outcomes.  Do you want yourself or loved ones cut into when the procedure has not been thoroughly investigated, researched, and tested? Uh hell no. No thank you.  This paper was written to demonstrate that observational evidence is not adequate when you consider the costs and risks of surgical intervention. They advocate surgical procedures that should undergo randomized controlled trials with blinding and showing statistical and clinically important symptomatic improvement when compared to no surgery at all.  Wouldn’t you expect that they already do this???? Evidently not. At all, really.  Ultimately in this paper the goal here was to quantify what kind of support exists in the literature for some common procedures.  How They Did It
  • The first thing to do was identify the common procedures performed for chronic pain
  • Secondly, they had to identify the number of published RCTs comparing each procedure to a control group treated without that procedure
  • They did a search of the Cochrane Central Register of Controlled Trials
  • Each paper was reviewed by two independent authors
pastedGraphic.png What They Found
  • A very low proportion of the RCTs on the selected procedures compared the procedure to not performing the procedure. 64 from the more than 6,735 studies. Less than 1% if you’re keeping track. Is that not stunning? And infuriating?
  • Of those 64, only 9 were favorable to surgery. 
  • When considering individual surgical procedures, the majority of comparative trials did not favor surgery 
  • None of the studies using patient blinding for any procedure found it to be significantly better than not having the surgery at all. 
Wrap It Up We conclude that many common surgical procedures performed for musculoskeletal conditions causing chronic pain have not been subjected to randomized trials comparing them to not performing the procedure. Based on the observation that when such studies have been performed, only 14% (on average) showed a statistically significant and clinically important benefit to surgery; there is a need to produce such high-quality evidence to determine the effectiveness of many common surgical procedures.  Furthermore, the production of high-quality evidence should be a requirement before widespread implementation, funding or professional acceptance of such procedures, rather than the current practice of either performing trials after procedures have become commonplace, or not performing comparative trials at all.” Wouldn’t you like it in the year 2020, when we hear bragging about the amazing advances of medical wonders and technology, and sometimes rightfully so…..would you like it if these things that should go unsaid are actually done? Wouldn’t you like to know that your mom’s spinal surgery procedure was fully vetted? It was researched against not doing it at all? They haven’t done that? Seriously? Look, ever heard of phantom limb pain? Just in case, it’s where a limb is amputated. Cut off completely. Yet, it still hurts. Why the hell does something that is gone and no longer exists still hurt? It’s because chronic pain lives as much or more in the brain as it lives in a peripheral source.  So, if you go in and do surgery on arthritis for a chronic pain sufferer, what are the real chances that you got rid of that pain? How many people have arthritis that commonly doesn’t bother them much at all beyond the first 15 or so minutes after they wake up? The answer isn’t precise but it’s probably a hell of a lot if I’m placing bets.  Did you know that if a person has surgery and they’re in chronic pain syndrome that even if the surgery goes perfectly, they will still have a 60% chance of developing pain at the new site of surgery? That’s what happens when you have a sensitized or upregulated central nervous system. It’s on high alert and using pain to make your future decisions and to protect you. You have to turn the volume down on the central nervous system if you’re ever going to control the pain in the brain. It’s actually the MOST IMPORTANT aspect of treating chronic pain.  How many people get surgery when they don’t need it because the arthritis isn’t really the issue. When the issue actually lies withing the limbic system in the brain? To be fair, how many people get adjusted by the chiropractor a million times because they’re trying to pop out the pain? Hell, doing that a million times only deepens the issue.  Don’t get me wrong, there’s SMT benefit in regard to proprioceptive input, sensorimotor function, movement dysfunction, blood flow, and pain modulation but…..beyond a certain point, it will create instability and that will deepen the issue.  I tell new chronic patients that we treat this issue through a combined approach. They must be approaching the issue from a cognitive aspect simultaneously with my physical treatment as well as the exercise/rehab. If we have that comprehensive, three-pronged approach to their condition, we are going to stand a much better chance at getting this sucker under control.  If you’re adjusting and sending them out the door, that’s low-level and borderline ineffective at best. At the worst, with too many appointments, you compound the issue by adding spinal instability to the mix. Too many chiropractors and subluxation slayers just do not understand this concept. They think they’re being specific. The research is pretty clear. You’re adjusting segments at a time. Not one. You’re not that good.  Alright, that’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   
Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so subscribe and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
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Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger   Bibliography
  • Harris IA, S. V., Mittal R, Adie S, (2020). “Surgery for chronic musculoskeletal pain: the questions of evidence.” Pain 161(9): S95-S103.
  • Prater C, T. M., Battaglia P, (2020). “Integrating a Multidisciplinary Pain Team and Chiropractic Care in a Community Health Center: An Observational Study of Managing Chronic Spinal Pain.” Journal of Primary Care & Community Health.

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

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

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

Chiropractic evidence-based products

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

Integrating Chiropractors

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

You have shimmied all 60’s like into Episode #64

Introduction

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

Store

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

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

DACO

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

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

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

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

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

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

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

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

This get on with this deal here. 

Item #1

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

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

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

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

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

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

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

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

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

Item #2

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

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

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

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

Item #3

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

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

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

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

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

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

Item #4

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

This week, I want you to go forward with

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

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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

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About the Author & Host

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

Bibliography

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

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

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

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