chiropractic

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

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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 http://www.chiropracticforward.com

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

Bibliography

  • 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.

 

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. 
  • 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 #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
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 – 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.

w/ Dr. Chris Howson: Chiropractors In Hospitals & Drop Release

CF 140: w/ Dr. Chris Howson:  Chiropractors In Hospitals & Drop Release

Today we’re going to be joined by Dr. Chris Howson of the great state of North Dakota where we’ll be talking about chiropractic integration in a hospital setting as well as his new invention called Drop Release. 

But first, here’s that sweet sweet bumper music

Subscribe button

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 #140

Now if you missed last week’s episode , we talked about chiropractors affected by COVID, 2019 opioid overdoses, and insurnace compensation for chiropractic. Make sure you don’t miss that info. Keep up with the class. 

While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points. 

Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper. 

On the personal end of things…..

I am writing this on 8/17/20 which means I’m taking my son to college this afternoon for his freshman year. It’s my first kid to fly the coop and we’ll see how it goes. Many of you did this same thing years ago. Many of you don’t even have kids so I won’t dwell on it long. 

I’ll just say, especially to the young ones, there’s no time to waste. Whether it’s starting your own retirement account, starting your kids a college fund, or asking that girl on a date. There’s no time to waste because landmarks like I’m going through this week…..they arrive before you know it. Almost by surprise even. 

Before you know it, you’ll look up and you’ve been in business 20 years, your kids are graduating, you looking at retirement in the next 10-15 years and you don’t know exactly how it all happened. But it did and if you’re not a forethinker, it’ll punch you square in the nose and make your eyes cross. 

Just a word from your wise ol’ Uncle Jeffro. 

I don’t want to talk too much because we have a guest today. Before we welcome him, I want to do a proper introduction. 

  • 2004 graduate of Northwestern. 
  • Practicing in Grand Forks ND, 
  • has spent the last 9 years in an integrated practice setting. 
  • Has a strong background in sports and applies that “get em back on the field” mentality to all his patients.  
  • Member of FTCA, NDCA, and ACA.   
  • Currently pursuing the orthopedic diplomate.  
  • Inventor of the Drop Release.

Tell me a little bit about yourself and your family.

I always say that chiropractic isn’t something that immediately comes to mind when one is deciding what they want to be when they grow up. So how did you come to be a chiropractor?

Where did you go to school?

What in your background or your schooling best prepared you for your current practice setting? Did you have any mentors that were particularly impactful along the way?

We have talked at length on this podcast about integrating into the Federally Qualified Health Centers or FQHCs but your situation is a little bit different. Can you explain what you’re doing and how you got there? And how it’s different from an FQHC.

What kind of patient is your typical patient in the hospital setting? Are you just confined to acute low back or what? 

Have you had any issues or had to stand your ground when it came to those in the medical field that don’t necessarily love the chiropractic profession? 

Numbers

Do you see your model as something that can be repeated in TX, NC, CA, to Florida? And how? How could those interested start on the path you’re blazing up in ND?

Do you see your current way of practicing as your life long way or do you have plans to be in the private sector down the line?

So, we get along very well because we are both go getters and entrepreneurs. If people have been listening, lately, I’ve been giving them a code for a discount on a new little invention called Drop Release. You happen to be the inventor of Drop Release. I actually first met you in person at the Forward ’19 event in St. Louis when you were working your Drop Release exhibit booth. Tell us all how you came up with the idea. How did you take it from concept to reality? That’s the biggest hurdle most folks don’t get over. 

We might as well give them the code to save some money on Drop Release if they want one, don’t you think?

Thanks for joining us, Chris. I appreciate it. 

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. 

Key Takeaways

Store

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

Subscribe Button

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

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

Chiropractors Affected By COVID, 2019 Opioid Overdoses, Insurance Compensation For Chiropractic

CF 139: Chiropractors Affected By COVID, 2019 Opioid Overdoses, Insurance Compensation For Chiropractic

Today we’re going to talk about Chiropractors Affected By COVID, 2019 Opioid Overdoses, Insurance Compensation For Chiropractic

But first, here’s that sweet sweet bumper music

Subscribe button

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. 

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

 

You have found yourself smack dab in the middle of Episode #139

Now if you missed last week’s episode , we talked about NSAIDs, cognitive behavioral therapy and vitalists ignoring stuff. Make sure you don’t miss that info. Keep up with the class. 

While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points. 

Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper. 

On the personal end of things…..

Personal means personal right? Well, I’m still working on getting the whole voice-over gig set up and rocking and rolling. What’s voice over you may ask? Well, the voices you hear on commercials, eLearning, promos, radio bumpers, and even cartoons and stuff like that. That’s voice overwork. 

Here’s my thought and I’ve said it here before; I don’t want to die in my office working on people when I’m 80. God bless those of you that love the daily grind so much that that’s your goal. It takes all sorts, doesn’t it? But that’s not me. I want to hire an associate and mentor them over the course of a certain amount of time and then sell my practice to them eventually. 

I’m a musician/singer/songwriter. I’m a sculptor. A portrait artist, furniture builder, and all kinds of other things. I love to travel as well. So, what kind of work could I do that would allow me some retirement income and can be done literally from anywhere in the world with an internet connection? Voice over of course. So, I started working on it once the Rona showed up. I’m taking some classes and building some skills and equipment and knowledge. 

The thought process is, if I start now, in 5 years it may be a very viable way to add to my weekly income in retirement. I have other things I’m looking at as well but this is the one I’m knee-deep in right now. 

I have friends that tell me they only get 24 hours in a day and I get more like 48. Lol. That’s not true of course but I do keep moving, keep thinking, keep working pretty much non-stop and move from one thing to another fairly quickly trying to multi-task and get it all done on some sort of time scale. 

I adhere to an old saying I try to always remember; time is just time. You’re either investing in it or you’re wasting it. I don’t like to waste time all that much. There’s always time to sit and relax here and there but, in general, I’m not much for wasting it. 

As far as business, we’re marketing like crazy. I’ve put more into marketing in the last 3 months than I have in the last three years and guess what…..80%. We’re still at about 80% of where I was and like I said last week, that’s my new normal and I’m done making myself crazy about it. I’ll take this extra time and I’ll continue to invest in it. 

So I’m anxious to see what happens. I have things working inside chiropractic. I have things working outside chiropractic. Let’s see which mud sticks to the wall. If any of it sticks at all, right? We never know but it’s exciting to be productive. It’s exciting to be creative. And it’s exciting to have the prospect of more income and more options as to your future. 

That’s where I’m at right now. I just turned 48. I  have less time in front than behind. I’m not getting younger so it’s time to step on the gas. And that’s what I’m doing. This pandemic crap isn’t going to last forever and I plan on sitting pretty in time to retire so let’s just get started right now shall we?

Item #1

Speaking of ‘pandemic crap’, here’s a paper called “The impact of COVID-19 on the chiropractic profession: a cross-sectional survey on opinions, professional changes, and personal hardships of US chiropractors” by Neff et. al(Neff S 2020). published in Chiropractic and Manual Therapies posted on 15 of July 2020 and dammit if that’s not hot then I don’t know what is, people. 

Now, before I get going on this one, I recognize three of the authors’ names from the Forward Thinking Chiropractic Alliance group on Facebook. Once again, if you’re considering yourself an evidence-based, patient-centered chiropractor rather than a vitalist, get in that group. You can learn a ton. Anyway, Shawn Neff, Rebecca Deyo who I’ve mentioned on this show before, and Annabelle MacAuley. All very smart, very talented doctors of chiropractic. 

Why They Did It

The research was conducted to collect self-reported data on how COVID-19 has affected U.S. doctors of chiropractic. I’m glad someone is paying attention to us and all. Honestly, chiropractors get the fat end of the bat don’t we? Who got PPE delivered to your office by the state back in April?

Yeah, me either. Anyway……

How They Did It

  • An electronic survey was sent to U.S. chiropractors nationwide via social media and email. 
  • The survey collected 
  • personal and practice demographic information, 
  • office protocols, 
  • changes made during COVID-19, 
  • chiropractic profession opinions/stances, 
  • information related to stress, and 
  • personal beliefs/opinions.
  • Data were analyzed using descriptive statistics.

What They Found

  • 750 U.S. chiropractors responded. 
  • Just over half of respondents reported moderate levels of stress, and 
  • Just over 30% reported severe levels due to a variety of reasons related to both personal and professional circumstances. 
  • The primary stressors were financial and business concerns. 
  • The highest stress levels were among employers responsible for others. 
  • A majority reported beliefs that the chiropractic profession should not advertise that spinal manipulation provides any immune system benefit. 
  • 13% of the respondents believed chiropractors should be marketing immune benefits during this time. 
  • A shift toward telehealth was reported, with 18% adding it to their services.

Wrap It Up

“Stress levels were high across the population. A range of opinions existed regarding spinal manipulation and immunity benefits. The majority reported there was not sufficient evidence to support such a belief; however, a group of respondents believed that chiropractors should be marketing immune-enhancing benefits to the population. A logical next step would be to study why such beliefs persist. This information may be useful in better understanding how chiropractors have experienced the global effects of COVID-19 across the United States.”

Adjusting Disc Herniations and Bulges

 

So…..if you want to know how many are vitalists and how many are evidence-based or, at minimum….agnostic….then doesn’t this give us some hints? A vitalist would claim to take the pressure off of nerves allowing the innate life force to better express itself rendering you immune to the disease. That sounds like about 13% of chiropractors surveyed. 

That tells me 87% call shenanigans on the rest of it. It’s been a while since I heard a number. We know its the minority but damnit they’re a loud minority, aren’t they? They’ve kept us right here without cultural authority for over 100 years at this point. 87% is pretty high though. Maybe it’s changing. 

I saw another recent survey where only a very small percentage of chiropractors were interested in learning more about chiropractic philosophy. I think it’s fine as a historical thing. Just not as something that keeps controlling our profession and keeps us at the bottom of the barrel. 

Love me or hate me, at least I’m honest and you know where I stand. 

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.

Getting Patients Returning, Shoulder Impingement, Cervical Manipulation, & X-rays and Neurodegenerative Disease

 

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

This second one is a report from CNN on opioids called “Drug overdose deaths jump in 2019 to nearly 71,000, a record high, CDC says” by Shelby Lin Erdman on July 16, 2020(Erdman 2020). Hot stuff….come on now. Make way people!

This was an article so we’ll be like a boat on the lake and just skip across the high spots. How about that?

  • Drug overdose deaths in the US jumped last year by about 4.8%. 
  • 2018 was slightly down from 2017
  • 2019 bumped back up to 71,000 overdose deaths. 
  • The former president of the American Medical Association, Dr. Patrice Harris, said the numbers show why it’s important to remove any obstacles to treatment for those addicted to drugs. While I think that’s worthy, I think it’s important to not that there should be no obstacles in place to see alternative practitioners in the first place when some of these folks presented with pain. The White House report in 2016 and The Lancet report on back pain both agreed there are obstacles in place preventing these kinds of patients from seeing chiropractors. 

Item #3

This one is called “Trends in Insurance Coverage for Complementary Health Care Services” by Whedon et. al(Whedon JM 2020). published in the Journal of Alternative and Complementary Medicine on July 7, 2020. The roof, the roof…it’s on fire. 

Why They Did It

Complementary health care professionals deliver a substantial component of clinical services in the United States, but insurance coverage for many such services may be inadequate. The objective of this project was to follow up on an earlier single-year study with an evaluation of trends in reimbursement for complementary health care services over a 7-year period.

How They Did It

  • The authors employed a retrospective serial cross-sectional design to analyze health insurance claims for services provided by licensed acupuncturists, chiropractors, and naturopaths in New Hampshire (NH) from 2011 to 2017. 
  • They restricted the analyses to claims in nonemergent outpatient settings for Current Procedural Terminology code 99213, which is one of the most commonly used clinical procedure codes across all specialties. 
  • They evaluated by year the likelihood of reimbursement, as compared with primary care physicians as the gold standard. 

What They Found

  • The total number of clinical services claimed was 
  • 26,725 for acupuncture, 
  • 8317 for naturopathic medicine, 
  • 2,539,144 for chiropractic, and 
  • 1,860,271 for primary care. 
  • Initially, the likelihood of reimbursement for naturopathic physicians was higher relative to primary care physicians but was lower from 2014 onward. 
  • Odds of reimbursement for both acupuncture and chiropractic claims remained lower throughout the study period. 
  • In 2017, as compared with primary care the likelihood of reimbursement was 
  • 77% lower for acupuncturists, 
  • 72% lower for chiropractors, and 
  • 64% lower for naturopaths.

Wrap It Up

“The likelihood of reimbursement for complementary health care services is significantly lower than that for primary care physicians in NH. Lack of insurance coverage may result in reduced patient access to such services.”

So when we talk about barriers to seeing safer, non-invasive practitioners, don’t tell me there are none. Don’t piss on my leg and tell me it’s raining. 

What was the Tommy Boy reference? You can get a good look at a t-bone by sticking your head up a bull’s ass but wouldn’t you rather take the butcher’s word for it? Or no…..it’s gotta be YOUR bull. Lol. Great movie. 

Anyway….buncha hullabaloo. Research and surveys are so clear and mostly consistent when they say spinal pain is so bad yet chiropractic is so good at treating it. Not only in terms of effectiveness but also in terms of patient satisfaction and even long term outcomes when compared to traditional treatment. The damn White House report a few years ago said there are barriers. The Lancet said it. I’ve seen it other places that aren’t coming to mind but it’s clear there are barriers in place set up by the stakeholders, the insurance gurus, the medical professionals….. All go 180 degrees from what the research tells them to do. 

And they keep going that way. It feels like it’s not turning around. At all. So…..shenanigans. I’m calling shenanigans. 

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. 

Key Takeaways

Store

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

Subscribe Button

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

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

 

Bibliography

  • Erdman, S. L. (2020) “Drug overdose deaths jump in 2019 to nearly 71,000, a record high, CDC says.” CNN.
  • Neff S, D. R., MacAuley A, Lawrence D, (2020). “The impact of COVID-19 on the chiropractic profession: a cross-sectional survey on opinions, professional changes, and personal hardships of U.S. chiropractors.” BMC Chiro Man Ther.
  • Whedon JM, e. a. (2020). “Trends in Insurance coverage for Complementary Health Care Services.” J Altern Complement Med.

 

Sleep and Cardiovascular Issues & Can Chiropractic Learn From Podiatry?

CF 134: Sleep and Cardiovascular Issues & Can Chiropractic Learn From Podiatry?

Today we’re going to talk about  Sleep and Cardiovascular Issues & Can Chiropractic Learn From Podiatry?  But first, here’s that sweet sweet bumper music
Chiropractic evidence-based products

Integrating Chiropractors

This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg

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 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 #134 Now if you missed last week’s episode, we talked about getting patients back to your office during COVID, shoulder impingement, cervical manipulation, and x-rays and neurodegenerative disease. That one was FULL of great information. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. I’ve been holding pretty steady at 80-85% of where I’d like to be in my practice. While that’s frustrating, it’s also 100% understandable and patience has to kick in and we must simply wait it out. I am an eternal optimist. Or at least I try to be. I think it’s important.  For example, we are making less money BUT we are also spending less money. Not only in my office in overhead but also at home. We’re not taking trips or going and doing. We’re not eating out like we did this time last year. So, not as much money is required. We are more than meeting our monthly bills.  If I really take a step back and look at it from a macro view, life is good. I have a bit of extra time to do the things I need to do outside of patient treatment and, due to less spending, a decrease in income isn’t as significant as it would have been.  It’s not fun. Don’t get me wrong. Nobody that is an achiever wants to take a step back at any time. For me, it’s pedal to the metal man. Constant and sustained growth. So, even though there are legitimate reasons, it doesn’t matter. It’s still a hit to the heart to see your business shrink.  But, again, being an optimist is helpful. It’s going to be alright. I asked for some recommendations in our private Facebook group about how to get your patients to return to your offices during the COVID freakout. Dr. Jerome Fryer with Dynamic Disc Designs had a great suggestion. He said, “Do a walk through video…showing the safety measures exacted. Personalized and live. Share it to your email list and social followers.” That’s a great suggestion. While I was going through all of the things I am doing on last week’s episode, I mentioned how in marketing, our job is to remove all barriers to saying, ‘Yes.’ Well, COVID is the biggest barrier we face at this time so we have to remove that barrier. We aren’t epidemiologists so we won’t be coming up with any treatments or vaccines of course.  So, the way we can remove that barrier as much as possible is to show the safety measure we are taking. Talk about it, video it, demonstrate it. And let your patients see you cleaning while they’re in the office. Those coming to see you already will feel even that much more comfortable with your office when they see you taking steps to keep them and others safe.  Remove the barriers to saying yes.  Alright, let’s dive in Item #1 Let’s start though with this one here called “Association of Longitudinal Patterns of Habitual Sleep Duration With Risk of Cardiovascular Events and All-Cause Mortality” It was authored by Wang et. al.(Wang Y 2020) and appeared in JAMA on May 22 of 2020 and dammit that’s a blazing barrel of biscuits my friends.  Why They Did It The authors wanted to know if there were any longitudinal patterns of habitual sleep duration associated with the subsequent risk of cardiovascular events and all-cause mortality. How They Did It
  • This was a cohort study that included 52 599 participants 
  • 4 distinct sleep duration trajectories reported during a 4-year interval were identified.
  • Compared with a stable sleep duration of 7.0 to 8.0 hours per night, normal-decreasing and low-increasing patterns were associated with increased risk of first cardiovascular events and all-cause mortality
  • individuals reporting consistently sleeping less than 5.0 hours per night had the highest risk
Wrap It Up In this study, sleep duration trajectories with lower or unstable patterns were significantly associated with increased risk of subsequent first CVEs and all-cause mortality. Longitudinal sleep duration patterns may assist in more precise identification of different at-risk groups for possible intervention. People reporting consistently sleeping less than 5 hours per night should be regarded as a population at higher risk for CVE and mortality. Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. If you’re into IASTM also known as instrument-assisted soft tissue manipulation, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend.  Drop Release is a revolutionary tool that harnesses the body’s built-in protective systems to make muscles relax quickly and effectively.  This greatly reduces the time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day. Its inventor, Dr. Chris Howson, from the great state of North Dakota has is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase.  Go check out Drop Release at droprelease.com and tell Dr. Howson I sent you.  Item #2 Item #2 is one I got from Dr. David Wedemeyer who resides out in Costa Mesa, California. I have no idea how I didn’t know about this one already.  It’s called “How can chiropractic become a respected mainstream profession? The example of podiatry” by Donald Murphy, et. al.(Murphy D 2008) and published in Chiropractic Osteopathy in 2008.  Why They Did It The chiropractic profession has succeeded to remain in existence for over 110 years despite the fact that many other professions that had their start at around the same time as chiropractic has disappeared. Despite chiropractic’s longevity, the profession has not succeeded in establishing cultural authority and respect within mainstream society, and its market share is dwindling. In the meantime, the podiatric medical profession, during approximately the same time period, has been far more successful in developing itself into a respected profession that is well integrated into mainstream health care and society. The objective here was to present a perspective on the current state of the chiropractic profession and to make recommendations as to how the profession can look to the podiatric medical profession as a model for how a non-allopathic healthcare profession can establish mainstream integration and cultural authority. We suggest the chiropractic profession consider several questions that speak to the different histories of the chiropractic and podiatric profession. Why are podiatrists better integrated into hospitals and other multidisciplinary facilities than chiropractors? Why are most schools of podiatry integrated into the university system, while chiropractic schools (with very few exceptions) are not?  Why did the AMA not try to “contain and eliminate” the podiatric medical profession (despite the several turf battles podiatry has had with the orthopedic specialty)? Why were podiatrists not thrown in jail in the early days for practicing medicine without a license? How did podiatrists gain the level of cultural authority that they currently enjoy, despite having the same duration of existence and a smaller number of practitioners than chiropractic? Discussion One important reason podiatry succeeded in establishing itself in mainstream health care was its traditional dedication to public health. Podiatrists became active members of the American Public Health Association (APHA) as far back as the 1950s, embracing and contributing to the advancement of accepted public health initiatives, in cooperation with others involved in public health. Podiatrists slowly gained an image as proponents of public health, at a time when many chiropractors aggressively (and dogmatically, without evidence opposed many public health measures such as vaccination and water fluoridation.  One immediate action step that individual chiropractic physicians can make is to join and become active in the APHA. This would be one of the best ways for chiropractors to have an influence on public health policy. Spinal pain is an enormous public health issue, as the vast majority of Americans will develop a painful back or neck that will require treatment sometime in their lives It is also vital that those chiropractors who dogmatically oppose common public health practices, such as immunization and public water fluoridation, cease such unfounded activity. Authors say they are concerned that the common perception (which is well supported, in our experience) that chiropractors are only interested in “selling” a lifetime of chiropractic visits may be one of the primary factors behind our low standing in the minds of members of the public. This is supported by a Canadian study which found that when the public was educated about “subluxation”, the cornerstone of many chiropractors’ “lifetime treatment plans”, members of the public actually developed a negative view, and were more likely to want to consult a medical doctor to see if they had a subluxation prior to seeing a chiropractor  They say that we chiropractors must take a critical look at our educational institutions, find what is substandard, and correct those deficiencies. One of the problems that we encounter frequently in our interaction with chiropractic educational institutions is the perpetuation of dogma and unfounded claims. Examples include the concept of spinal subluxation as the cause of a variety of internal diseases and the metaphysical, pseudo-religious idea of “innate intelligence” flowing through spinal nerves, with spinal subluxations impeding this flow.  These concepts are lacking in a scientific foundation and should not be permitted to be taught at our chiropractic institutions as part of the standard curriculum. Much of what is passed off as “chiropractic philosophy” is simply dogma, or untested (and, in some cases, untestable) theories which have no place in an institution of higher learning, except perhaps in a historical context.  Faculty members who hold to and teach these belief systems should be replaced by instructors who are knowledgeable in the evidence-based approach to spine care and have adequate critical thinking skills that they can pass on to students directly, as well as through teaching by example in the clinic. They say consideration should also be given to upgrading admission requirements to chiropractic schools. In podiatric medicine, such upgrading, which included the requirement of the Medical College Admission Test (MCAT), a requirement of medical school admission, is considered one of the significant events in the profession’s history, giving the profession legitimacy in its calls for parity with medicine Continuing with education, they say it is essential that the chiropractic profession establish hospital-based residencies. There is a tremendous void in how chiropractic graduates develop any meaningful hands-on clinical experience with real patients in real-life situations. Perhaps the most important factor that helped the podiatric medical profession to flourish was the fact that podiatrists had a clear identity and purpose; the podiatric medical profession was founded on the purpose of filling a need in society – the care of problems of the foot. They did not invent a “lesion” and a “philosophy” and try to force it on the public. They certainly did not claim that all disease arose from the foot, without any evidence to support this notion The podiatric medical profession focused on a particular set of problems for which allopathic medicine had little interest and a limited ability to deal with effectively, i.e., common foot disorders The chiropractic profession must establish a clear identity and present this to society. In the beginning, DD Palmer invented a lesion, and theory behind this lesion, and developed a profession of individuals who would become champions of that lesion. This is not what credible professions do. Based on all the evidence regarding chiropractic practice and education, there is only one societal need (but it is a huge one) that chiropractic medicine has the potential to meet: non-surgical spine care. Our education and training is focused on the spine, and clearly, if there is a common bond among all chiropractors, it is spine care No matter how one looks at it, or what one would like reality to be, chiropractic medicine is about back pain, neck pain, and headache. Instead of fighting that fact (or denying it), we should embrace it fully and focus on becoming society’s go-to profession for disorders in this area. The World Federation of Chiropractic (WFC) has taken an important step in establishing a clear identity for chiropractors as “The spinal health care experts in the health care system”. It is critical that other state, provincial and national associations follow the lead of the WFC. Fidelity to the social contract. They say when an individual consults a member of any of the medical professions, it is reasonably expected that the advice and treatment that he or she receives is based in science, not metaphysics or pseudoscience. In addition, it is reasonably expected that the services he or she receives are being provided for the primary purpose of benefiting the patient, and not for any other reason.  The financial benefit to the professional is secondary and results from the degree of the clinical benefit received by the patient. Patients place their faith in the professional, and trust that they will not be subject to fraud, abuse, or quackery. This is the social contract as it applies to chiropractic physicians. Oh, how many times has my audience heard me railing against doctor-centered, clinic-centered practices? Just in the last month or so actually. Lol.  We feel it is important here to briefly contrast and compare podiatry and foot reflexology. While the two professions have always been distinct, there is a commonality in that each focuses its treatment efforts on the foot; however, this is where any resemblance between the two professions ends. Podiatric medicine is a science-based profession dedicated to the diagnosis and treatment of foot disorders. Foot reflexology is a metaphysically-based group consisting of non-physicians who believe that many physical disorders arise from the foot. Podiatrists have rejected foot reflexology as an unproven and unscientific practice, and do not consider it part of mainstream podiatric practice. Thus, it would be quite unreasonable to think that podiatry and foot reflexology could ever exist under one professional roof. Yet, this is the very untenable situation in which we find ourselves in the chiropractic profession. Chiropractic has frequently been described as being two professions masquerading as one, and those two professions have attempted to live under one roof.  One profession, the “subluxation-based” profession, occupies the same metaphysical and pseudoscientific space as foot reflexology. The other chiropractic profession – call it “chiropractic medicine” as we do in this commentary – has attempted to occupy the same scientific space as the podiatric profession.  Alas, the marriage of convenience between these two chiropractic professions living under one roof has not worked. We find science-based practitioners and organizations alongside quasi-metaphysical, pseudoreligious, pseudoscientific practitioners, and organizations.  The result is continually battling with a huge waste of energy and resources, while professional growth stagnates. We must finally come to the painful realization that the chiropractic concept of spinal subluxation as the cause of “dis-ease” within the human body is an untested hypothesis. It is an albatross around our collective necks that impedes progress. Wrap It Up “The chiropractic profession has great promise in terms of its potential contribution to society and the potential for its members to realize the benefits that come from being involved in a mainstream, respected, and highly utilized professional group. However, there are several changes that must be made within the profession if it is going to fulfill this promise.” I could add my own thoughts here but listeners of the show know what I think about it. I agree with every word and I bitch and fuss and get in a huff about this stuff all of the time.  I don’t know that getting in a huff all of the time is useful or helpful. I think it lessens my outrage if I’m outraged all of the time. So, I’m settling down here lately. I want to make points but not in a truly negative sense.  I want to disagree without being disagreeable. That’s not to say I’m not going to lose my marbles here and there. I will. This profession provides so many opportunities for lost marbles, It’s something you can count on. But, I’d like for the lost marbles to be fewer and farther between with more building rather than breaking. If that makes sense.  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. 
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Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
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Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger   Bibliography
  • Murphy D, S. M., Seaman D, Perle S, Nelson C, (2008). “How can chiropractic become a respected mainstream profession? The example of podiatry.” Chiropr Osteopat 16(10).
  • Wang Y, W. J., Chen S, (2020). “Association of Longitudinal Patterns of Habitual Sleep Duration With Risk of Cardiovascular Events and All-Cause Mortality.” JAMA Open 3(5).

New Information On 5 Actions To Change Clinical Practice

CF 131: New Information On 5 Actions To Change Clinical Practice Today we’re going to talk about moving toward being patient-centered. There are 5 actions recommended. What does it even mean? I might just ruffle some feathers here but a damn I do not giveth. But first, here’s that sweet sweet bumper music  
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 
  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.  You have found yourself smack dab in the middle of Episode #131 Now if you missed last week’s episode , we were joined by Dr. Kevin Christie with The Modern Chiropractic Marketing podcast and author of a new book that’s coming out on chiropractic marketing. Kevin is a rising star in chiropractic and is a must-not-miss. Make sure you don’t miss that info. Keep up with the class.  While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.  Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.  On the personal end of things….. Still climbing in the patient numbers. Where I’m located here in Amarillo, TX, there is a population of approximately 280,000 people. Last week, on Thursday and Friday we added 3 total cases of COVID on Thursday and only 2 cases on Friday. Then the following Monday, we added 11.  So, as you can see, the numbers here are no longer high. People are sort of ‘over it’ and you can see that and hear it when you talk to the patients. Hell, I’m sort of over it but still being smart. I’m having friends to the house again but we stay outside by the pool and have a couple of adult beverages.  I have a friend that is a musician. Last weekend, he played a rodeo on Woodward, OK. He said there were probably 1,000+ people at the event and it was indoors. So, in Woodward, OK at least, they are REALLY over it. No way in hell I’m grouping up with that many people indoor or outdoor right now. It just doesn’t make sense to me for now.  I guess if I were 28 and at the top of my game physically it wouldn’t make any difference to me either. But going to an event where people are yelling and cheering right behind, beside, and in front of me….big nopers right now. Ain’t happnin’ I noticed that while cases seem to be leveling off across America, they’re not increasing or decreasing as much as you’d like but, what I noticed is that the deaths are going down. Fairly signficantly. So wouldn’t that fit with the news that started coming out a couple weaks ago about the virus losing some potency?  People are still getting it but not as many dying from it. Another explanation could be that we’ve gotten better at treating it. Either way, that’s not my lane so I’m not going to act like the expert. I’ll just say hell yay-us and keep the good news coming so we can all get back to life as it was meant to be lived.  I hope you’re all well and staying healthy. As always, if you care about the kind of information I share every week and you listen consistently, I’m proud of you. I think you care about the right stuff and even though I don’t know you all, I consider you my friend.  Item #1 Let’s kick this week’s research reviews off with this one called ‘It is time to move beyond body region silos to manage musculoskeletal pain; five actinos to change clinical practice’ by Caneiro et. al(Caneiro JP 2020). published in British Journal of Sports Medicine in 2020. We got a hot one over here!! This paper actually has a lot of big names in the industry like Caneiro, O’Sullivan, O’Sullivan and Jan Hartvigsen. If you don’t know Jan’s name, you just haven’t been a regular listener.  Why They Did It They say that current clinical research, education, and practice approaches musculoskeletal pain and conditions in silos. Basically it’s a focus on body regions like the knee, hip, neck, shoulder, etc.  But current thinking actually shows that the pain disorders are frequently comorbid and share common biopsychosocial risk profiles for pain and disability.  They say that a shift to focusing on the person is what is needed and that this would encourage the doctors to:
  1. focus on the patients’ context and modifiable biopsychosocial factors that influence their pain and disability
  2. Use education to facilitate active management approaches (targeted exercise therapy, physical activity, and healthy lifestyle habits) thus reducing reliance on passive interventions
  3. Consider evidence-based surgical procedures only for those with a clear indication and where guideline-based non-surgical approaches have been rigorously adhered to. 
Well who the hell can’t get behind all of that? Honestly, it’s odd when you think about it that in the year 2020, we’re still saying that surgery should be evidence-based and follow certain guides and that conservative treatment should be first basically. How’s that not just common sense and common procedure in 2020? We’re supposed to have freaking flying cars by now but the medical field doesn’t have this stuff down they way they should just yet?  It’s money. I know. I understand it. But it’s frustrating as hell all the same.  In this paper, the authors say to be truly patient-centered, they have five actions they recommend for managing a person with musculoskeletal pain, irrespective of body region. 
  1. Screen for biopsychosocial factors and health comorbidities. Notice this is #1 on their recommendations. If you’re just getting them in a pop a crack a lack and sending them on without this step, your results are going to be less than you or the patient desires. They say we need to communicate clearly with the patient to identify potential biopsychosocial drivers of the pain and then provide the therapy to fill that gap. These things include pain beliefs, emotional and coping responses to pain, social contest, physical and lifestyle factors and the presence of comorbidities. They recommend using the Orebro Musculoskeletal Pain Questionnaire. 
  2. Embrace patient-centered communication. This one is huge and this is one of the key things we learned in the Fellowship training for the neuromusculoskeletal medicine program. Clinicians should use open and reflective questioning to elicit the patient’s understanding of factors, which include the pain experience (tell me your story), causation beliefs (what do they think is the cause of the pain?), coping (what do you do when the pain increases?), impact (Tell me how your symptoms affect your ability to move and function), concerns (do your symptoms worry you?), beliefs (why do you think you shouldn’t bend/lift, or run?), social factors (tell me about your home life or work life), goals (what are you rgoals?), and expectations. Yes, to an extent, updated research and thinking has us behaving a bit like a psychologist I think. It’s not my favorite stuff. But, when you learn and consider how much pain is held in the brain due to these yellow flag indicators, then you start to realize that pain, certainly chronic pain, cannot just be treated at a peripheral source. You have to address the pain from a central sensitization perspective at least equally or you risk never being able to help these patients. 
  3. Educate beyond words using active learning approaches. doctors have to embrace education as a central part of patient care if we are going to change behavior. We have to dispel myths about pain, imaging findings, and activity engagement (for example, hurt does not equal harm). They say that behavioral learning like exercise therapy can be used to bust myths that are unhelpful. Myths and beliefs that lead to things like fear avoidance. 
  4. Coach towards self-management. A large portion of the chiropractic profession wants and desires patients to depend on them week after week, month after month and that’s just not real world stuff. And it’s not helpful for the patient’s recovery either. We should be empowering patients to engage in exercise, valued activities and a healthy lifestyle with confidence. Can you feel the difference here? “Mary, I know you’re only 35 but you already have some degenerative discs in your neck and I’m so concerned about it. This should be considered urgent and I’m going to need to see you 5 million times for the rest of your life.” Is that helpful or is this helpful? “Mary, I know you read on your rad report here that there is a finding of a degenerative disc in your neck but the truth is, that’s very common and not something you should be concerned with. Certainly not over-concerned with. I actually prefer the word ‘deconditioned’ over ‘degenerative.’ A good percentage of 30-40 year old patients have some mildly deconditioned discs but these rarely ever cause any issues. You’re young, you’re strong, and you’re healthy. We’re going to get everything moving correctly and then I’m going to give you some excellent exercises to really focus on the region and build plenty of support. You’re going to do great.” When you stack those two next to each other, it’s easy to see how harmful one is as opposed to the other more positive, more hopeful one. I got a little side tracked there, the point is, help them take control and self manage. Active amnagement relieves pain and improves function across pain conditions and health comorbidities. 
  5. Address comorbid health factors. They say clinicians should refer for co-care in teh presence of comorbid mental and physical health complaints like high levels of emotional distress, eating disorders, and type 2 diabetes. The authors say they contend that multidisciplinary care needs to be integrated, with consistent messages across the team to prevent care fragmentation and patient distress. 
Wrapping up the paper, the authors say Patient-centered care will optimize the value of healthcare provided. Shifting funding to support high-value evidence-based care options and educating society will be critical to enable this transition and will likely be cost-effective. Integrated cross-discipline clinical networds are required for effective co-care. We believe clinicians are ready to change, but they require the support of health systems and payers.  One word….two syllables. Day-um. You day-um right. But, health systems and payers are stuck on the part of our profession that doesn’t care about movement, function, yellow flags, exercise, or proper patient-centered practice. They’re stuck on the portion of our profession that is TIC or TOR or principled or whatever the hell useless drivel they’re using this week.  The hardcore, philosophy, doctor-centered, faith-based rather than evidence-based group of chiropractors are smaller but they’re so much louder. And dangerous. They’re flat-earthers. They’re the reason the evidence-based group will never reach any kind of cultural authority.  You can have a GROUP of guys and girls go through years of continuing education and maybe get a couple of diplomats in neuro or orthopedics or rehab….wahtever….and they can be the smartest chiropractor on the planet and almost 100% of their patients get well.  And then you have just ONE lowsy-ass guy or girl go and bait and switch just ONE patient into 80 visits in a year with a contract and all of the bells and stupid whistles of a doctor-centered practice, and that group that worked so so hard loses every ounce of legitimacy. Because of ONE jackhole that refuses to understand or read research or refuses to sacrifice some money in the interest of their patients well-being.  It’s gross. It’s awful. But it’s chiropractic. We are already looked at with a side-glance untrusting gaze. So any deviance of behavior that would be widely considered normal is magnified. Just one ruins the batch for all of us.  I remember a preacher once saying that you gain trust in drops but you lose it in buckets. The reality in chiropractic is that just one faith-based, doctor-centered jackhole loses trust in ALL chiropractors in buckets. For ALL of us.  My plea is to start sharing this podcast with your subluxation friends. Especially the young students that haven’t yet decided to be ‘principled.’ Maybe we can help lead them down the right path from the very start. The more people are exposed to the research and to the idea of being patient-centered, the more they’ll latch onto it. They have to. One is borderline evil, and the other is not. It’s backed by science. One destroys reputations for the sake of the dollar. One builds reputations and respect. One is built on ideas and theories over a century old that cannot or have not been proven while the other is backed by science and progress. How is it even a damn choice to begin with? We’re either a healthcare profession. Or we are a faith. True healthcare professions do research and then they do more and they change according to what works well and they drop the stuff that doesn’t, and on and on to the point of really being on the cutting edge of the science and on the health of our patients.  I’ll never understand how such a percentage of our profession can’t get on board with that. Whatever the answer to that question might be, it’s that answer that keeps us at the bottom of the cultural authority ladder.  Unfortunately, I don’t see if changing any time soon. Not until the governing boards decided it’s time to change once and for all.   Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Key Takeaways Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   
Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
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 – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger   Bibliography Caneiro JP, R. E., Baron CJ, et. al., (2020). “It is time to move beyond ‘body region silos’ to manage musculoskeletal pain: five actions to change clinical practice.” Br J Sports Med 54: 435-443.

w/ Dr. Michael Massey – Doing Things Right, Medicolegal Thoughts, and How We Better Protect Ourselves

CF 124: w/ Dr. Michael Massey – Doing Thing Right, Medicolegal Thoughts, and How We Better Protect Ourselves Today we’re joined by Dr. Michael Massey. We’re going to talk about What We chiropractors Are Doing Wrong, we’ll talk about Medicolegal things, and we’ll talk about How chiropractors can go about Better Protecting Ourselves But first, here’s that sweet sweet bumper music  
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 #124 Now if you missed last week’s episode, we talked about the primary spinal practitioner program, gabapentin, and cervical curvatures. Make sure you don’t miss that info. Keep up with the class.  While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.  Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.  On the personal end of things….. Before we get to our guest this week, I did a thing Being an evidence-informed practitioner can present a set of problems at times. Mostly problems with regard to patient volume because we don’t typically treat a patient with long-term recommendations. So we see them come and go depending on if they hurt or not. It can lead to lulls, disappointment, and boredom if there’s not a steady stream of new patients coming through your pearly gates each and every month. I have taken various courses over the years at Udemy so when I decided to create a course, I immediately thought Udemy would be a good place to start.  While I’m still building the course and adding content every week, it’s live and ready to go for those interested in getting started. I’m putting the link to the course at this point in the show notes. https://www.udemy.com/course/marketing-evidence-based-chiropractic/?referralCode=36A4D91C66B48300360B Over the last two years or so, I’ve averaged almost 80 new patients every month as a solo practitioner. If you’re interested, I created, basically, my playbook for marketing and my thoughts on each topic or technique. I also have created downloads, checklists, and examples to show what my stuff looks like.  Just go to udemy.com and do a search on Marketing An Evidence-Based Chiropractic Practice and check it out. It will grow and expand in the coming months and if you get just one patient from the ideas shared in it, it paid for itself. Now imagine if you get a bunch….well then it’s priceless. udemy.com and the course is called Marketing and Evidence-based Chiropractic Practice.  I usually drop some personal thoughts and updates on the clinic and things like that. When we have a guest join me on the show, I typically drop that section and just get on with it. It’s no different today. So, let’s get on with it.  Today we are joined by Dr. Michael Massey who hails from the great state of Tennessee. Athens, TN to be exact with is just Northeast of Chattanooga.  Dr. Michael Massey has been in private practice for nearly 30 years and is no stranger to the inner workings of insurance companies or the creation and administration of regulations.  He has worked in and around commercial and federal insurance carriers for most of his time in practice, serving as a liaison, a consultant, and a contracted employee.   He is also a certified coder, a certified healthcare quality manager, and a quality assurance/utilization review diplomate.  He has additionally served as the president of his state chiropractic association, a delegate to the American Chiropractic Association, the chairman of the ACA Coding and Reimbursement Committee, and as a 10-year member of his state Board of Chiropractic Examiners, while simultaneously serving as a delegate to both the Federation of Chiropractic Licensing Boards and the National Board of Chiropractic Examiners.   He also regularly serves as a nationally-sought expert witness for malpractice and insurance fraud cases.  This diverse experience offers him a unique perspective and a comprehensive skill set to speak on insurance matters, coding, documentation, HIPAA, Medicare, compliance, personal injury, and risk management. Welcome to the show Dr. Massey. May I call you Mike or Michael? Now, first question is, how are you enjoying this grand global pandemic we’re currently blessed with? I have been to Nashville a few times but only recall going through Chattanooga one time when I was on a family vacation back when I was a freshman in high school. I recall it being one of the most beautiful areas I’d ever seen and, from what I remember, I’d probably still classify it that way. I did a little research on Athens, TN. It appears the population is 13,458 hoomans. My region is about 280,000 for comparison sake. What’s it like practicing in a small-town setting where you only have that many to draw from for new patients? Or are you close enough to Chattanooga that you can draw off of their population as well? We met through the miracles of the private Facebook group called the Forward Thinking Chiropractic Alliance. You are typically pretty active in the group and then we met face to face at the Forward ’19 event out in St. Louis back in September. You were teaching a class on Documentation with Dr. Greg Friedman.  I love the group. I’m active here and there, I’ve joined the membership, I support the group. I see the value for sure. While I’m minimally active, I have learned a lot from others just by lurking a little. OK….lurking a lot. What would you say you’ve found to be your biggest takeaway from the FTCA group? What’s been the big bang for the buck for you with it? Documentation is not typically something finds much fascination in but you guys did a good job taking a dry subject and communicating the information in a way that was interesting.  Coding and documentation, for me, can be like pouring salt or maybe hot sauce in my eyeballs. I find it displeasing in general. So, what on Earth got you into coding and documentation? Why is that, of all things, your wheelhouse? From a procedural coding perspective, what are the most common mistakes made by chiropractors?  How about from a diagnostic coding perspective? I don’t know how other states are but here in TX, we have to have 4 hours of medicare, ethics, and documentation every year. Required hours. I think it’s insane to force grown professionals to do this when we could be learning how to take better care of our patients. I can see maybe every other year or every 5 years as a refresher. But I’m not down with every year. What’s your view on this? Relative to clinical documentation, what are the top two or three nuggets of advice you’d offer to both newer doctors as well as those who have been in practice for a while? You’ve had a good bit of experience working with insurance companies, can you offer some insight into their perception of our profession?  Where do they seem to believe we fit best in the system?  What are their primary concerns or frustrations with us? Now we collaborated briefly on a case you were working on recently having to do with stroke. I believe you were defending a chiro if I’m not mistaken. How’d it turn out? Did the good guys win the day? When we’re talking about risk management, as we just mentioned, you have experience doing expert witness work for malpractice cases. Is there any consistency in the types of lawsuits you’re seeing?  Are the allegations typically similar?  Are there specific things chiropractors do/don’t do that seem to trigger lawsuits? How did you get into the med/legal work?  How do you prepare to be a good witness? What are a few critical risk management tips you wish every chiropractor knew? Let’s talk about something I know is near and dear to you and you’ve been putting together for a while now. Pretty much since we first traded private messages through Facebook. It’s called Practice Mechanics and it’s something you’ve put together with Dr. Rob Pape out in California.  Rob is another very active member and moderator with the FTCA group. I talk a lot about FTCA on this podcast. I should push my private group as much as I push FTCA. Lol. But there are less in my private group and the FTCA members are way more active.  Anyway, Rob is like the jedi ninja dude in there and always has an interesting take on whatever the post of the day happens to be. Tell me about Practice Mechanics, tell me about teaming up with Rob on this project, and give us some clue of who it would be good for, where it’s at, and where it’s going? What’s the big picture? We’re going to link the Practice Mechanics website at this point in the show notes at chiropracticforward.com so you can go find out more about it. https://www.practice-mechanics.com Thanks for coming on the show with us, Dr. Massey.  Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, belive it, count on it. Let’s get to the message. Same as it is every week.  Key Takeaways Store Remember the evidence-informed brochures and posters at chiropracticforward.com. 
Chiropractic evidence-based products

Integrating Chiropractors

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

CF 060: Medical Marketing & Integration Care Expectations

CF 060: Medical Marketing & Integration Care Expectations

Today we’re going to talk about medical marketing scoundrels and about what the multidisciplinary world expects of us chiropractors. 

But first, here’s that ‘goes down so smooth’ bumper music

Integrating Chiropractors

And we’re back. .Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  We are honored you’re spending some time with us and we hope we give some entertainment and some value in return. 

Introduction

You have disco’ed your way into Episode #60 just like John Travolta in Saturday Night Live. Kids, go Google that. It was cool back then. You could walk down the street in a Staying Alive strut man. Travolta was the bee’s knees back then wasn’t he? From Mr. Kotter, to Grease, to Staying Alive. Then turned kookoo wacko on everyone. He got so open-minded that his brain fell out and went splat. 

Let’s talk a bit about the diplomate of the Academy of chiropractic orthopedists quickly. That’s also known as the DACO program that I’m currently going through. I’ve officially hit the halfway point for the online hours and only have one class left for the live hours which I’ll get in less than a month down in Austin. Basically, out of 300 hours, I have about 125 left and have just been serious about this thing since October. Recent classes have been A Neurological Approach to Scoliosis, and the Neck and a Sense of Well-Being. 

I feel like it’s scooting fairly quickly at this point. It’s funny to watch my staff when I’m performing an exam these days. They’re familiar with the way I do exams and have done them for years. Just about every week, including this week, I’m adding or taking away from what I normally do. They don’t really know how to handle it. Lol. These classes really do change what you do almost immediately. 

If I can help you get started and rocking and rolling on your DACO, shoot me an email at dr.williams@chiropracticforward.com and I’ll be glad to point you in the right direction. 

New Year

How’s your new year starting? By the time this episode goes live, we’ll have been in it for a little over a month. I have to say that I’m confused this year. This is typically our slowest time of year. But, it’s going a little crazy this year for whatever reason. I have literally had 35 new patients in the last two weeks. It’s all I can do to get this podcast written each week, to be honest, but I’m committed. 

I actually had to come in on a Saturday to record the last episode because I just didn’t have the time available during the week to get it done. I’m not trying to brag. I think if you have a good staff, which I do, and you have them spaced appropriately, which I do, you can make your way through them while giving them the best care possible. Especially when you’re using post-graduate educations like the DACO to guide your exam and diagnosis. 

Crazy Busy

And, 35 new patients for my practice looks different than it may in a lot of clinics. I don’t see how many times we can run them through the doors. I don’t convince them their lives are at stake if they don’t see me 50 times this year. 

I used ChiroUp for all of my patients which I highly recommend. An additional $150/month seems like a lot. I know. But this programs is worth even more than that and they’re not paying me anything at all to say that. One of the things it does is track your patients through follow up emails. 

That’s how I know my case average, which is the number of times I typically see a person, stands at around 8 times while their national average stands at about 7 times. 

I know that my average improvement rating is 79.43% for ALL cases and that included everything from cervical radiculopathy and lumbar stenosis to cervicogenic headache and greater trochanteric bursitis. Their national average for improvement is 71.8% so I’m doing good there. If I’m getting 80% of my patients well, I’m happy. 

They have also tracked me at having a 98.6% likely to refer from my patients. Meaning, our patients are 98% happy to refer us to their family and friends and that makes me feel warm and fuzzy inside. I’d still like to know what I can do to make that other 1.4% happy but I think some people cannot be made happy at all. 

Even if you get them well and gave them free ice cream. They’d still gripe because the ice cream didn’t have chocolate syrup on it. You know those people. You know who I’m talking about, don’t you?

Anyway, the point was….I hope your 2019 has started off like my 2019. If it sustains, I’m going to have to get me some help in here! Including a nurse practitioner. Ahhhhh, the day I finally make that leap I may have a few hundred beers. Lol. 

Paper #1

The first item of research I want to get to is on medical marketing. Why do we care what the medical field is doing for marketing? Well, because they’re the main stakeholders in healthcare and it’s important to know what they’re doing. Either we can copy it or we can go 180 degrees from it depending on what we’re talking about. 

This paper we’ll talk about was in the Journal of the American Medical Association also known as JAMA on January 1, 2019, so it’s hot off of the press. It is called “Medical Marketing in the United States, 1997-2016” and was written by Lisa Schwartz, MD and Steven Woloshin, MD[1].  Please remember, if you’d like to see the paper, the methods, and that good hulabaloo….I always cite the papers at the end of the show notes over at chiropracticforward.com. This show is episode 60 just so’s you’s knows. 

Why They Did It

They wanted to answer the question, “How has the marketing of prescription drugs, disease awareness, health services, and laboratory tests in the United States changed from 1997 through 2016?” I think that’s a great question. 

Let’s find out, shall we? I say hell yes we shall!

As far as medical marketing goes, they say, “From 1997 through 2016, medical marketing expanded substantially, and spending increased from $17.7 to $29.9 billion, with direct-to-consumer advertising for prescription drugs and health services accounting for the most rapid growth, and pharmaceutical marketing to health professionals accounting for most promotional spending.”

Let’s dial down into that just a bit. 

As you are probably already guessing because you see this trash on TV every time you turn it on but the most rapid, crazy increase in medical marketing advertising was in the direct-to-consumer advertising. It went from $2.1 billion in 1997, which was 11.9% of the total marketing….it went from $2.1 billion all the way up to $9.6 billion and now, marketing meds directly to the consumer now make up 32% of the total spending. I say NOW….that was 2016’s numbers. Probably worse now.

They broke it down even further and highlighted the prescriptions that are marketed directly. The drugs you need a prescription for ….ads for them went from $1.3 billion in ’97 which was 79,000 ads, all the way up to $6 billion dollars and 663,000 ads in 2016. 

All I have to say here is, “Dayum.”

Then, I’m not done yet….hold my beer and watch this….Lol. That’s what I feel like here. Then, they say that medical marketing straight to healthcare providers like the MDs, DOs, etc….that marketing went up from $15.6 billion to 20.3 billion in 2016 but here’s what’s crazy when you think about it, folks, $13.5 billion of that was for free samples….OK, whatever. Then $979 million went to payments to physicians for speaking fees, meals, and things like that that were related to specific products. So they paid almost a billion damn dollars to MDs to go around medical marketing & touting their drugs.  

It’s insane. You cannot tell me no way no how that with that much money in the hopper, that we don’t have some nefarious skunky smelly dirty crap snaking around and messing with people for the worse. You can’t convince me of it and I’m not a conspiracy guy either. 

Like, when they say we didn’t land on the moon, it was shot in a studio in Hollywood? Yeah, they need a kick in the nuggets. Really? The Earth is flat? Are you sure? I’ve seen a lot of pics from outers space and round is what I’m getting people!! 

You see what I mean here but I also know people and I know what greed does to people. It’s insane, honestly. 

Pharmaceutical Commercials

Let’s talk about those medical marketing commercials for a minute. Let’s make up a name that sounds a little like a prescription. How about Killyametrix? Yeah, sounds good. OK, here’s how it usually goes, “Have you been having a hard time getting into your life? Are you just tired? No energy, no drive, no ambition anymore? Wouldn’t you like to have more energy? You’re too young for this. Killyametrix has been shown to increase energy and get patients back to enjoying their lives quicker and faster than any medication in the history of man that was ever made. There are some side effects. You’ll want to talk to your doctor if you experience any of the following symptoms: gout, liver failure, tumors coming out of your eyeballs, if your foot falls right off in mid-stride, high blood pressure, going cross-eyed, bleeding from the ears and fingernails, if your hair curls, if all of your hair falls out, or if your knee cap pops right off as you sit down and shoots straight across the room knocking someone out. Other than those issues, it’s a great drug. Try Killyametrix. Ask your doctor about Killyametrix and if it might be right for you.”

Here’s the deal, when I was growing up, did you realize whiskey, bourbon, scotch, …..the hard stuff…..it was never advertised on TV because they knew it was damaging to the population so why promote it nationally. I believe it was actually illegal to advertise the hard stuff but I’m not 100% on that. 

But, now, or at least in 2016, it’s OK to advertise prescription drugs straight to the consumer to the tune of 663,000 ads at a cost of $6 billion dollars. It’s lunacy. 

How about you go to your doctor with no preconceived idea of what’s wrong with you and he or she plays doctor, figures out what’s going on with you, and the DOCTOR, the actual doctor, decides what medication you need if any at all. 

Why don’t we try that crap out in America for a change? 

If I were an MD or DO, I’d be livid every time I saw one of those stupid commercials on TV. Hell, I’m a DC and I’m livid when I see them. 

Make me a crazy person. Makes me want to go live in a rubber room for a couple of weeks to decompress.

Paper #2

Let’s get to the last thing here. This one is called “Stakeholder expectations from the integration of chiropractic care into a rehabilitation setting: a qualitative study” by Zacariah Shannon, et. al[2]. published in BMC Complementary and Alternative Medicine in December 2018. 

Why They Did It

They say that few studies exist on what the expectations of chiropractic care really are within a multidisciplinary setting so they wanted to add to the literature on this topic. 

What They Found

They found that expectations for the chiropractic program in this study were mostly positive. Good news. The idea of the patients making progress was the overriding theme for the group. They expected the addition of chiropractic to help patients progress by improving pain management and physical functioning. 

In addition, they also expected indirect effects of chiropractic on healthcare integration. Things like increasing the patient participation in other providers’ treatments which would lead to improved care for the patient across the board. 

I wonder if those other providers were or will be helping increase the chiropractor’s load as well? That’s a good question to ask. 

Wrap It Up

They summed it up by saying, “Stakeholders expected the addition of chiropractic care to a rehabilitation specialty hospital to benefit patients through pain management and functional improvements leading to whole person healing. They also expected chiropractic to benefit the healthcare team by facilitating other therapies in pursuit of the hospital mission, that is, moving patients towards discharge.”

Not bad, not bad. It’s a helluva lot better than we had going on for us before the opioid crisis. I’ll give them that. I think the only part of this I really don’t like is their expectation of the chiropractor helping feed the rest of them while, in my biased opinion, they should be feeding the chiropractor first in an effort to keep people off of meds. 

Their stated goals are pain management and physical function. Well…that’s sort of right in our wheelhouse so why wouldn’t we be getting those first? I think the stakeholders have been fed quite enough. They’re fat as hell and slobbering. 

Bring the evidence-informed chiropractors in and watch your patients shine with happiness, leave amazing reviews, and go out and tell your city about all of the good things your clinic is doing. 

If they get the right evidence-based chiropractor in there, that’s the way I see it playing out because the research we covered several weeks ago shows us that chiropractors have the highest patient outcome satisfaction when compared to MD and DO’s, in fact, we wipe the floor with those people in regard to musculoskeletal issues. Not only that but we beat out the PTs as well on outcome measures. 

But we should feed them, right? They should be thankful to have us. 

Integrating Chiropractors The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

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TuneIn

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About the Author & Host

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

 

Bibliography

1. Schwartz L, W.S., Medical Marketing in the United States, 1997-2016. JAMA, 2019. 321(1): p. 80-96.

2. Shannon Z, S.S., , Gosselin D, Vining R,, Stakeholder expectations from the integration of chiropractic care into a rehabilitation setting: a qualitative study. BMC Comp Altern Med, 2018. 18(316).

 

https://www.chiropracticforward.com/cf-025-vets-with-low-back-pain-usual-care-chiropractic-vs-usual-care-alone/

https://www.chiropracticforward.com/cf-032-how-evidence-based-chiropractic-can-help-save-the-day/

 

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

 

 

CF 052: Chiropractic Forward Podcast Year One Review

CF 052: Chiropractic Forward Podcast Year One Review

One year. I started this podcast exactly one year ago. 52 weeks. 52 episodes. We’re going to talk about the highlights of the first year. We’re going to talk about chiropractic today vs. chiropractic when I started a year ago. Has anything changed? The short answer is yes. Quite a bit has changed in just a year. 

But first, here’s that sweet like honey bumper music

Integrating Chiropractors

Welcome

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

You have collapsed into Episode #52 and it feels good to say that. To be able to do anything consistently for a year straight, every single week, it’s an accomplishment for sure and it sure as hell feels good folks. 

DACO Program

Before we get into the highlights. let’s talk a bit about the DACO program. For those new to the Chiropractic Forward Podcast, I have been going through the Diplomate of American Chiropractic Orthopedists. I’m 92 hours into a 300-hour course. Ugh…that hurts just to say it. Lol. I don’t even feel close to being done. 

I figured it out that at the rate I’m going now, which is about 8 hours per week, I can be done around May I believe. While it seems way off, you know what? I’d be learning and educating myself anyway. Why not get something out of it, right? That’s the idea and May will be here before you know it. 

Hell, it seems like it was Summer just a couple of weeks ago. Lol. 

Products

I have been fast at work preparing some new options for you. I have noticed  a lack of what I would want in my office when it talks 

One-Year Anniversary

Let’s get on to talking about our one-year anniversary. I want to start by talking listen out our top 10 episodes so far and what we talked about that made everyone listen to each of them. I’m linking them all for quick reference in the show notes. So away we go!

Number 10

Episode #30 – Integrating Chiropractors – What’s It Going To Take? We discussed the medical field and what they are looking for in a chiropractor in regard to integrating that individual into the system. We went over The Lancet papers as well. Great episode to check out. 

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

 

Number 9

Episode #25 – Vets With Low Back Pain. Usual Care + Chiropractic vs. Usual Care Alone. This episode revolved around a paper in JAMA from Dr. Christine Goertz where she and her co-authors showed additional support for including chiropractic as part of a multidisciplinary team for treating low back pain. Great paper by a great asset for chiropractic. 

CF 025: Vets With Low Back Pain. Usual Care + Chiropractic vs. Usual Care Alone

Number 8

Episode #28 – Will Chiropractic First Finally Take Its Place? In this installment, we went through a paper that showed non-pharma and non-opioid therapies are now the preference. Well, that’s chiropractic, right? We talked about some GREAT resources in this episode including the President’s Commission on Combating Drug Addiction and The Opioid Crisis report as well as a great paper by Jon Adams Ph called The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults. That one had some marketing nuggets for the nugget pouch.

CF 028: Will Chiropractic First Finally Take Its Place?

 

Number 7

Episode #27 – Wanted – Safe, Nonpharmacological Means of Treating Spinal Pain. This episode went through treating spinal pain, thoracic manipulation, lumbar manipulation, guidelines from Canada, and the perceptions of our profession. We discussed a paper about how some in the medical profession think chiropractors go around herniating discs all the time. Pfft… 

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

 

Number 6

Episode #9 – With Dr. Tom Hollingsworth of Corpus Christi, TX called The Case Against Chiropractic In Texas. We talked with Dr. Hollingsworth about the Texas Medical Association’s attacks on Texas Chiropractors and our rights. We talked about the latest in the current court case and the appeal process. 

Just a couple of weeks ago, in fact, this case had a decision that was reached and it wasn’t good for chiropractors. And I’m talking about chiropractors nationwide. We’ll have to do an updated episode with Dr. Hollingsworth because what may be on its way down the pike for all chiropractors…..well….let’s just say it’s no bueno. 

CF 009: With Dr. Tom Hollingsworth: The Case Against Chiropractic In Texas

 

Number 5

Episode #26 – Chiropractic Better Than Physical Therapy and Usual Medical Care For Musculoskeletal Issues. The title is accurate. And researched fact. There are some that don’t like that language. Can’t we all get along? That type of deal and yes, we can all get along. Most certainly. My issue is with PTs being the first referral for non-complicated musculoskeletal issues when research shows they have decreased effectiveness when compared to chiropractic care. 

They have less patient satisfaction when compared to chiropractic care as well. In addition, research shows chiropractic care to be a lot less expensive. So why in the hell is a practitioner that is exponentially more expensive, much less effective on their outcomes, and patients don’t like as much…..why the hell are they the first referral? That still makes my pee hot when I really really think about it. It’s dumb. 

I don’t think we should be doing post-surgical rehab unless we take specific training in that. I think PTs and DCs can work very well together but there should be lanes and I don’t think PTs stay in their lane. Not when they’re out there taking a weekend course on adjusting. It’s BS and that doesn’t stand for Bad Students. 

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

 

Number 4

Episode #29 – With Dr. Devin Pettiet of Tomball, TX, still the President of the Texas Chiropractic Association. This episode was titled Is Chiropractic Integration Healthy For the Profession? We talked with Dr. Pettiet all about chiropractic integration into a medical based case management or medical team. 

This one was one of my favorites too. For sure. Devin is a great resource and a great personality. He’s all energy and has an awesome amount of information and experience.

CF 029: w/ Dr. Devin Pettiet – Is Chiropractic Integration Healthy For The Profession?

 

Number 3

Episode #6 with Dr. Tyce Hergert from Southlake, TX. This episode is called Astounding expert Information on Immediate Headache Relief. This one was all about headaches and highlighted one service that was dressed up and parading around as another. Yes, those pesky PTs are moving in on us and this episode talked about little bit about that along with some great papers showing chiropractic’s effectiveness with treating headaches. Fun episode. 

CF 006: With Dr. Tyce Hergert: Astounding Expert Information On Immediate Headache Relief

 

Number 2

Episode #13 – DEBUNKED: The Odd Myth That Chiropractors Cause Strokes. My favorite episode and my favorite endeavor as far as really putting together information to stick a fork in an anti-chiropractic idea or myth. This is actually a three-part series consisting of #13, 14, and 15. All three episodes really paint a picture of foolishness on the part of the medical field and a coordinated attack that is easily put to rest through common sense, correct context, and research. 

It’s really so simple when you take the time to listen, learn, and just think about it for a minute. They are the three episodes I encourage you to share the very most out of all of them I have created. 

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

 

Number 1

Episode #11 – called It’s Here. New Guides For Low Back Pain That Medical Doctors Are Ignoring.

The most listened-to episode for our first year was Episode #11 once again with my old friend and colleague Dr. Tyce Hergert down in Southlake, TX. He has TWO episodes in the top 10 from our first year. That’s because he’s smart, he’s the ex-President of the Texas Chiropractic Association, and he’s entertaining if he’s had his coffee. 

In this one, we talked about current healthcare guidelines, why they matter to chiropractic patients and even non-patients, and whether MDs are getting it or not. Guess what? They’re still ignoring these guides!

CF 011: With Dr. Tyce Hergert: It’s Here. New Guides For Low Back Pain That Medical Doctors Are Ignoring

 

Wrap Up

So….there you have it, folks. That’s our Top 10 in a nutshell with all of the links in the show notes. We have had a great first year. We hope you have enjoyed the content we have been bringing to you as much as we have enjoyed gathering it for you. 

There is so much going on in our profession. Both good and bad. It’s important to stay plugged in now more than ever. We’ll talk about it in a future episode but the Texas Chiropractors lost their appeal and the medical kingdom will bring their dog and pony show to your state before you know it. Believe me. 

But, for evidence-based chiropractors, there’s still no better time than today to be a doctor of chiropractic. I firmly believe that to be the truth.

Integrating Chiropractors

 

The Message

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

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

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

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

Key Point: 

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

That’s Chiropractic!

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

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

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

Website

http://www.chiropracticforward.com

Social Media Links

Chiropractic Forward Podcast Facebook GROUP

Twitter

YouTube

iTunes

Player FM Link

Stitcher:

TuneIn

About the author:

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

CF 042: w/ Dr. Tyce Hergert – Chiropractic Maintenance Care / Chiropractic Preventative Care

CF 042: w/ Dr. Tyce Hergert – Chiropractic Maintenance Care / Chiropractic Preventative Care

Tyce hergert chiropractor southlake

Integrating Chiropractors

Today we have a special return appearance from a friend of the show and we’re going to talk about chiropractic maintenance care also known as chiropractic preventative care. Chiropractors have recommended a regular schedule to their patients for generations but it was mostly as a result of experience and intuition. But what about research on the matter? We’ll get to it.

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.  

Be sure you have signed up for our newsletter slash email. You can do that at chiropracticforward.com and it lets us keep you updated on new episodes and new evidence-based products when they come out. Yes, eventually there will be some pretty cool things available through us. We won’t email any more than once per week and the value outweighs the risk. Kind of like in cervical manipulation. So just go get that done while we’re thinking about it. 

You have confidently strutted right into Episode #42 and we are so glad you did. 

I would really like to just turn this mic on and automatically be the #1 chiropractic podcast in the world but that’s not the real world, right? But I have to say that we continue to grow. I’m impatient and it’s never quite fast enough but we are continually growing and that’s always exciting. When you see the growth chart consistently going up and to the right, then hell yeah. Ka-bam shazam. 

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.

My Week

But first, my week has been nuts. When was the last time you tried to hire someone? It’s absolutely stupid these days. Honestly, I posted a job on indeed.com. I got literally 175 resumes, scheduled 15 interviews, only 7 showed up for the interview, and we have one really good prospect. 

This is the second round by the way. We tried to hire for the front desk position a few weeks ago and went through 120 resumes. We actually hired a girl but then her dad got sick and after thinking it over, decided we weren’t a good fit. Lol. Can you imagine? 

I don’t know if you can tell from this podcast or not but….I’m generally a pretty darn good guy and really care about my staff and care about people and care about making connections with others. 

I don’t yell, I don’t fuss a lot. Even when they’re wrong. That’s just not my style. I don’t think I stink or anything having to do with body functions so, I can’t figure it out other than people have just changed. Or has it always been hard to find good help? All I know is that I’m having a hell of a time finding the right front desk personnel and it’s making me more than a little crazy. 

Welcome Dr. Tyce Hergert from Southlake, TX

Now that we have all of that out of the way, I want to welcome our guest today. You could say we sort of know each other. In fact, we grew up in the same neighborhood from elementary school all the way through high school. Even though I was a couple years older, we definitely knew each other. He lived right next door to my best friend and we played football in his front yard pretty often. 

We were at the University of North Texas at the same time living in Denton, TX and then we were down at Parker College of Chiropractic at the same time as well. If that weren’t enough, we have both served in statewide leadership positions for the Texas Chiropractic Association. In fact, Tyce is part of the reason I got involved in the first place. 

He took it a step further than me though. Dr. Hergert actually served as the President of the TCA two terms ago and helped steer the profession to a historic 4 chiro-friendly bills passed in the state legislature that year. This is important because the bills that were passed in our favor prior to that would be basically zero, none, nada, goose-egg, zilch. 

About an Integrated Practice

Dr. Hergert also runs an integrated practice down in Southlake, TX so he’s an excellent resource for our kind of podcast. 

Some people kind of think he’s a big deal and there’s a good argument to be made for that but I’m not going to be the one making it because I’ve known him way too long. 

Not only is he an ex-Pres for the TCA, but he also has the bragging rights of being a guest on 2 of our top five most popular episodes of all times here at the Chiropractic Forward Podcast. Those are episodes 6 and 11 with 11 actually being our most listened to episode of all time so congrats to Dr. Hergert on that. 

If you enjoy his guest appearance on this episode, although I’d be a bit flabbergasted as to why you enjoyed it….you can always get more of Tyce on those. Again, I’m not sure why you’d ever want to do that. Lol. 

Welcome to the show Dr. Hergert. Thank you for taking the time to join us. 

Tell us a little bit about Southlake, TX for the ones unfamiliar with the Dallas/Ft. Worth area. 

Tell us a little bit about running an integrated practice. What’s it like? Have you become more of an owner/administrator or are your elbow deep in treatment and the physical aspects of seeing patients all day every day still?

Getting To The Research

This first paper….I alluded to back in episode #36 but very briefly. We covered a little more in depth back in Episode #19 as well which posted back in April of this year. I think in light of a brand new paper that just came out, it’s worth covering this one again if you do not mind. It’s all about chiropractic maintenance and chiropractic preventative treatment.

It’s called “Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome?” and was published in the prestigious Spine journal[1]. 

For the purpose of this study, keep in mind that SMT stands for spinal manipulation therapy. Also of special note is that chiropractors perform over 90% of SMTs in America so I commonly interchange SMT or spinal manipulation therapy with the term “Chiropractic Adjustment.”

Why They Did It

The authors of this paper wanted to check how effective spinal manipulation, also known as chiropractic adjustments, would be for chronic nonspecific low back pain and if chiropractic maintenance and chiropractic preventative treatment adjustments were effective over the long-term in regards to pain levels and disability levels after the initial phase of treatment ended.

How They Did It

  • 60 patients having chronic low back pain of at least six months duration
  • Randomized into three different groups:
  • They included 12 treatments of fake treatment for one month
  • One group had 12 treatments of chiropractic adjustments for a month only
  • They also had a group with 12 treatments for a month with maintenance adjustments added every 2 weeks for the following 9 months.
  • Outcome assessments measured for pain and disability, generic health status, and back-specific patient satisfaction at the beginning of treatment

What They Found

  • Patients in groups 2 and 3 had a significant reduction in pain and disability scores.
  • ONLY group 3, the group that had chiropractic maintenance and chiropractic preventative treatment adjustments added, had more reduction in pain and disability scores at the ten-month time interval.
  • The groups not having chiropractic maintenance and chiropractic preventative treatment adjustments, pain and disability scores returned close to the levels experienced prior to treatment.

Wrap It Up

The authors’ conclusion is quoted as 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.”

Dr. Hergert, what do you have to say on this one? I’m not sure what there is to say except, “Told you so!”

What do you typically recommend to your patients as far as chiropractic maintenance and chiropractic preventative treatment care goes?

Paper #2:

Actually, this one is a webpage linked in the show notes for you at ChiropracticForward.com in episode #42. 

http://www.chiro.org/research/ABSTRACTS/Documentation_Supporting_Maintenance_Care.shtml

This article was compiled by Dr. Anthony Rosner, Ph.D and called Documentation Supporting Maintenance Care[2]. 

The article starts by saying that the RAND Corporation studied a subpopulation of patients who were under chiropractic care compared to those who were NOT and found that the individuals under continuing chiropractic care were:

  • Less likely to be in a nursing home
  • Were less likely to have been in the hospital the previous 23 years
  • They were more likely to report better health status
  • Most were more likely to exercise vigorously

Although it is impossible to clearly establish causality, it is clear that continuing chiropractic care is among the attributes of the cohort of patients experiencing substantially fewer costly healthcare interventions[3]. 

The next paper on chiropractic maintenance and chiropractic preventative treatment is by Dr. Rosner and talks about was a review of a larger cohort of elderly patients under chiropractic care and those not under chiropractic care. Basically, comparing monies spent on hospitals, doctor visits, and nursing homes[4] They found the following: Those under chiropractic care saved almost three times the money those NOT under chiropractic care spent for healthcare. 

  • $3,105 vs. $10,041

How’s it looking so far, Tyce?

Tyce, you’re going to like this one. Chances are, you’re probably going to want to tell people all about this one. 

Let’s get to the newer paper I mentioned before. It’s called The Nordic Maintenance Career program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain – pragmatic randomized controlled trial and it was compiled by Andreas Eklund, et. al[5]. 

Why They Did It

The authors wanted to explore chiropractic maintenance and chiropractic preventative treatment in the chiropractic profession. What is the effectiveness for prevention of pain in patients with recurrent or persistent non-specific low back pain?

How They Did It

  • 328 patients
  • Pragmatic, investigator-blinded. Pragmatic. What does that mean exactly? According to Califf and Sugarman 2015, It means it is “Designed for the primary purpose of informing decision-makers regarding the comparative balance of benefits, burdens and risks of a biomedical or behavioral health intervention at the individual or population level” Meaning they are attempting to run a trial to inform decision-makers of responsible guidelines going forward. That’s it for the dummies like me in the room. 
  • Two arm randomized controlled trial
  • Included patients 18-65 w/ non-specific low back pain
  • The patients all experienced an early favorable result with chiropractic care. 
  • After an initial course of treatment ended, the patients were randomized into either a maintenance care group or a control group. 
  • The control group still received chiropractic care but on a symptom-related basis. 
  • The main outcome measured was the number of days with bothersome low back pain during a 1 year period. 
  • The info was collected weekly through text messaging. 

What They Found

  • Maintenance care showed a reduction in the number of days per week having low back pain
  • During the year-long study, the chiropractic maintenance and chiropractic preventative treatment group showed 12.8 fewer days. 
  • The chiropractic maintenance and chiropractic preventative treatment received 1.7 more treatments than the symptom-related group. 

Wrap It Up

The authors wrap it up by saying, “Maintenance care was more effective than symptom-guided treatment in reducing the total number of days over 52 weeks with bothersome non-specific LBP but it resulted in a higher number of treatments. For selected patients with recurrent or persistent non-specific LBP who respond well to an initial course of chiropractic care, MC should be considered an option for tertiary prevention.”

Basically, both groups still underwent chiropractic maintenance and chiropractic preventative treatment. It’s like we tell people, stay on a schedule and you’ll do well. Wait until you hurt and the chances are good that you’ll spend the same amount getting over that complaint anyway. 

This study showed that exactly except, over the course of just one year, the maintenance chiropractic care (preventative chiropractic care) people had 1.7 more visits but suffered pain almost 13 days less. 

Bring it home

Are two appointments extra worth almost 2 weeks less of having pain in a year’s time? I say hell yes. 

Dr. Hergert…what say you?

Lay some sage-like wisdom on us here and bring it all home for us won’t you please?

This week, I want you to go forward with the knowledge that, when you write “patient recommended preventative chiropractic care schedule going forward” you can do so confidently knowing your are right and there is research showing it. 

You don’t have to recommend chiropractic maintenance and chiropractic preventative treatment simply because you heard to do that at school or because your old boss always did it. 

You can make those recommendations because it’s best for your patients. 

Dr. Hergert, do you have anything to add, this is probably your last time on the podcast after all. 

Thank you so much for hanging out with us today, I was kidding of course. We will make time and do it again down the road. 

Integrating Chiropractors

Affirmation

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

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

Contact

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

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

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

Website

http://www.chiropracticforward.com

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About the author:

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

 

Bibliography

1. 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.

2. Rosner A. Documentation Supporting Maintenance Care. Chiro.org 2016; Available from: http://www.chiro.org/research/ABSTRACTS/Documentation_Supporting_Maintenance_Care.shtml.

3. Coulter ID, Chiropractic Patients in a Comprehensive Home-Based Geriatric Assessment, Follow-up and Health Promotion Program. Topic in Clinical Chiropractic, 1996. 3(2): p. 46-55.

4. Rupert R, Maintenance Care: Health Promotion Services Administered to US Chiropractic Patients Aged 65 and Older, Part II. J Manipulative Physiol Ther, 2000. 23(1): p. 10-19.

5. Eklund A, The Nordic Maintenance Care program: Effectiveness of chiropractic maintenance care versus symptom-guided treatment for recurrent and persistent low back pain—A pragmatic randomized controlled trial. PLoS One, 2018. 13(9).

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