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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.

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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

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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

Social Media Links

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

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

 

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).

CF 040: w/ Dr. Brandon Steele: Chiropractic Standardization & The Future of Chiropractic

 

CF 038: w/ Dr. Jerry Kennedy – Chiropractic Marketing Done Right

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

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

 

CF 039: Communicating Chiropractic

Communicating Chiropractic 

Integrating Chiropractors

Today we’re going to talk about communicating chiropractic and chiropractic utilization. What am I talking about? Stick around

But first, here’s that bumper music

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

Now that I have you here, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It makes it easier to let you know when the newest episode goes live when someone new signs up it makes my heart leap a little, and in the end, it’s just polite and we’re polite in the South.  

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

You have potato sack jumped yourself right into Episode #39. In case you are new to the Chiropractic forward podcast, there is a different way to get into this podcast. Moonwalk, do the twist, electric slid, grooved, you get the point. 

We are talking about communicating chiropractic and I want to start the research part of our podcast today with a pretty cool paper that just passed through my email. I have my buddy and colleague, Dr. Craig Benton down in Lampasas, TX to thank for this one. It’s called “Characteristics of Chiropractic Patients Being Treated for Chronic Low Back and Neck Pain.” It was authored by PM Herman, et. al. and published in the Journal of Manipulative Physiology and Therapeutics on August 15th of 2018[1]. Brand spanking new, people. https://www.ncbi.nlm.nih.gov/pubmed/30121129

Why They Did It

Since chronic low back and chronic neck pain dominate our population and since chiropractic is a common approach to the conditions, the authors wanted to explore the characteristics of chiropractic patients suffering the conditions here in the United States. Further knowledge here helps with communicating chiropractic more effectively.

How They Did It

  • They collected information from chiropractic patients with different levels of information that included regions, states, sites, providers and clinics, and patients. 
  • The sites and regions were San Diego, Tampa, Minneapolis, Seneca Falls, and Upstate New York, Portland, and Dallas. 
  • Data was collected through an iPad prescreening questionnaire in the clinic and through emailed links to full screening and baseline online questionnaires

What They Found

  • 518 patients with chronic low back pain only
  • 347 with chronic neck pain only
  • 1159 with both chronic low back pain and chronic neck pain. 
  • In general, most participants were highly educated white females that had been using chiropractic care for years. 
  • Over 90% of the participants reported high satisfaction with their care, few used narcotics, and avoiding surgery was the most important reason they chose chiropractic care.

Wrap It Up

The authors concluded, “Given the prevalence of CLBP and CNP, the need to find effective nonpharmacologic alternatives for chronic pain, and the satisfaction these patients found with their care, further study of these patients is worthwhile.”

As a side note, at the first ChiroTexpo event for the Texas Chiropractic Association state convention, these researchers were there recruiting offices for this paper which is kind of cool. 

How much of the population do chiropractors see on average? At least in American? For years, the number has been from 7% to 11% but there is research out there that suggests the number is actually bigger. We can answer that question a little more accurately thanks to some research from Palmer that was published back in 2015. 

This next paper goes more toward helping us in communicating chiropractic than any other paper in recent memory.

It’s called “Americans’ Perceptions of Chiropractic,” it was performed in conjunction with Palmer and Gallup and was submitted by James O’Connor of Palmer and Joe Daly of Gallup[2]. I have linked it in the show notes for you. 

https://www.palmer.edu/uploadedFiles/Pages/Alumni/gallup-report-palmer-college.pdf

The report states from the get-go that half of the adults in the US have been to a chiropractor as a patient. 

  • 14% of adults say they saw a chiropractic within the last 12 months. 
  • 12% say they saw a chiropractor in the last five years
  • 25% say they saw a chiropractor more than 5 years ago
  • Women are more likely to love and visit their chiropractor regularly
  • Adults under 50 are more likely to say that the chiropractor is their first stop for neck or back pain. 
  • Over 50% of adults strongly agree or agree somewhat that chiropractors are effective at treating neck and back pain. 

All of this is great news, y’all. Great news. In the conclusion of this report from Gallup and Palmer College, they say yes…over half of Americans view chiropractors as effective for neck and back pain but uncertainty about costs and misinformation about potential dangers of chiropractic are potential obstacles to them utilizing our services. 

I addressed the whole stroke issue the medical field has tried to saddle us with in a blog, in a YouTube video, and in a series of three podcasts and highly encourage you to re-visit the information in episodes 13, 14, and 15. I will link them for you in the notes. 

The blog, YouTube video, and podcast series is called “DEBUNKED: The Odd Myth That Chiropractors Cause Strokes.”  You must have this information. If you do anything this week, do that. I laid it all out and I did it in blog form, video form, and podcast form so you could pick your preference and get the information. So do it. This information will go a long way in helping you with communicating chiropractic.

YouTube: https://youtu.be/tRXpG_Ie0Rs

Blog: https://www.chiropracticforward.com/blog-post/debunked-the-odd-myth-that-chiropractors-cause-strokes-revisited/

Podcast Episode #13: https://www.chiropracticforward.com/debunked-the-odd-myth-that-chiropractors-cause-strokes/

Podcast Episode #14: https://www.chiropracticforward.com/cf-episode-14-debunked-the-odd-myth-that-chiropractors-cause-strokes-part-2-of-3/

Podcast Episode #15: https://www.chiropracticforward.com/cf-015-debunked-the-odd-myth-that-chiropractors-cause-strokes-part-3-of-3/

The report suggests we try to be transparent when it comes to the costs of chiropractic which also means providing details on insurance coverage, visits required, etc. Here’s the deal though…..if someone comes up to me on the street and asks me how much it costs to come see me, what the hell am I supposed to say?

Quite literally, I don’t have a single damn clue what it’s going to cost them. I don’t know what kind of insurance they have. How do I know if their issue is acute, chronic, or a combination of issues spanning the acute as well as the chronic? I have no way of knowing if their deductible is met. I can’t know what their co-pay is. How can you tell people any of that crap and I’m sure as hell not going to be having a long enough conversation with them when I’m out and about with friends or family to figure it out either. 

Palmer is crazy on that part of this. I’m all about communicating chiropractic but people are grown-ups. They have a Google machine in their pockets. Figure out what your deductible is and how much you’ve met. Figure out what your co-pay is. Google up the offices in your area and try to get an idea of how they practice. If they’re talking about fixing ear infections, boosting your immunes system, and not getting your kids vaccinated, well….chances are they’re going to want to see you 1.23 million times through your lifetime. 

If they’re talking about exercise/rehab, evidence, research, and things of that nature, then they’re going to address your issue quickly and relatively inexpensively. 

Then get on your Facebook machine and ask your friends which evidence-based chiro in your area you need to be seeing and go do that. It’s easier today than ever before. Palmer doesn’t really need to put that directive on chiropractors in my opinion. 

They go on to say that about 37% of Americans are unsure whether or not chiropractic is dangerous. Palmer suggests we chiropractors try communicating chiropractic more clearly in regards to the level of education we have gone through. I think that’s a great suggestion. I do hate the fact that MDs and DOs aren’t going around having to tell everyone about the classes they took and we DCs obviously do need to do that but, it is what it is. You want that in Espanol? Here it is: “Es lo que es.”

Just trying to spice it up, folks. Go with it alright?

The report had some cool news. What news is that you might say? To that, I’d say this: current users of chiropractic typically see their doc an average of 11 times per year which they say shows a strong commitment to chiropractic care.

If the description is a strong commitment to chiropractic care, then count me in. I’m on board. I’m on that team. 

The last sentence of the report says this, “The chiropractic community would do well to increase awareness among the public about the benefits of chiropractic care and the costs associated with it, including offering flexible methods of payment and assistance with navigating insurance, to ensure potential users have what they need to make an informed decision regarding care.”

OK….where to start here?

Dammit. We all know all too well that chiropractors increasing awareness among the public about the benefits of chiropractic care is a slippery slope. Do I want to encourage a chiropractor that doesn’t believe in vaccinations to be out there talking about the amazing benefits of Chiropractic? Ummmm….nope. Nope, I sure don’t. 

Now, if you have a doc talking about how awesome chiropractic is and how spinal manipulation combined with exercise rehab is a powerful combination and is now recommended by the American College of Physicians, JAMA, The Lancet, the FDA, the CDC, The Joint Commission, the current occupant of The White House, and even Consumer Reports…..well hell….I think you have a winner on your hands. That’s what I’m talking about when I say communicating chiropractic. 

Luckily, the only docs listening to me right now are the ones that are going to be talking about the latter rather than the former. 

So listen up evidence-based men and women…..unfortunately, you have to start telling people more about your education and you have to start telling people more about the research and evidence and support behind what it is we do from day to day. 

I’d like to say that it is super duper big-time double fortunate that you have resources like, oh say, maybe a podcast called the Chiropractic Forward Podcast that does all of the work for you by gathering and talking about research every week that can help you on this. 

Now, onto our last topic this week.

This one is an article from June 19, 2018, that was posted on the ACA Blog and linked in the notes on our website for this episode. 

https://www.acatoday.org/News-Publications/ACA-Blogs/ArtMID/6925/ArticleID/374/Communicating-Chiropractic-An-Algorithm-to-Answer-Difficult-Questions

The title of the article is “Communicating Chiropractic: An Algorithm to Answer Difficult Questions[3].” It was written by Dr. Stephanie Halloran who did an excellent job on this article in my opinion. Dr. Halloran is the chiropractic resident with the VA Connecticut Healthcare System.

Dr. Halloran started the article by covering some common questions that can be asked of chiropractors within an interdisciplinary setting. The questions she mentions are:

  • What are the typical conditions treated by chiropractors and specific treatments utilized?
  • We to know the contraindications for treatment?
  • It’s important to be able to describe the mechanisms of manipulation and/or acupuncture?
  • What adverse events from chiropractic treatment, including post-treatment soreness and cervical manipulation and stroke?

All sound like reasonable questions but think about them for a minute. What would your responses be to them and would your answers really stand up to scrutiny in the medical kingdom?

Dr. Halloran cites her site director, VA Chiropractic Program Director Dr. Anthon Lisi as being key in helping her formulate an approach we can use to guide us to develop our own answers to these questions. She lines out 4 steps we should be looking at. 

  1. Have a great depth of knowledge – She says, “First and foremost, you must have an extensive understanding of what you are being asked. Whether the inquiry is as vague as “What is chiropractic?” or more specific, such as “What is the physiologic mechanism of manipulation?” or more sensitive, such as “Does cervical manipulation cause stroke?” it is imperative to know what the evidence does and doesn’t support. “ My goodness…where on Earth could you ever be educated on research and what the evidence says? Hmm….I’ll just wait here until….yes. You’ve found it right here!
  2. Selectively Present that knowledge – Answer with only the most pertinent information. Sometimes less is more and sometimes more is too much information but, be sure you can expound on the neurophysiological effects if specifics are asked.
  3. Be mindful of an appropriate stopping point – She says, “It is reasonable to assume that an encounter will occur at some point with a specialty physician possessing unwavering negative views of chiropractic treatment, and the reality is some will not be swayed despite the evidence presented. The goal of the interaction is to present the evidence, to meet them where they are, and to leave the door open for further conversation at a later date.” And then you punch them in the face and push them down on the playground while saying nanny boo boo. 
  4. Remain altruistic throughout – She says we need to stay focused on the overall goal of health care which is, according to her “to increase functional outcomes, improve quality of life, and provide the best care for patients.” I can get on board with that description myself. 

All of this goes toward helping you in communicating chiropractic. She wraps it up by saying, “In respect to success in integration, my biggest takeaway from being exposed to interprofessional collaboration on a day-to-day basis in the VA is the need for chiropractors to prepare answers to questions regarding what chiropractic care is, common conditions seen, neurophysiological effects of treatment, and the incidence of adverse events. These answers should be instantaneous and provide evidentiary support. One must also be prepared to hit the brakes when met with substantial resistance and to admit lack of familiarity with a topic, when appropriate.”

Can’t we all agree with this article? It makes perfect sense. If you can’t communicate and relay what it is you do, then what are you doing?

This week, I want you to go forward with the idea that we are not a dying profession. We are, in fact, growing and our utilization is growing. We maintain that growth through communicating chiropractic and better patient education as to our level of education and our cost-effectiveness. In addition, in regards to integration, let’s make sure we are prepared to answer questions and do it in a way that is 100% backed by solid and respected research and evidence. You can’t lose when it’s done that way. 

Integrating Chiropractors

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

When you are communicating chiropractic, 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.

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

??Social Media Links

??iTunes

??Player FM Link

??Stitcher:

??TuneIn

Bibliography

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

2. O’Connor J, Gallup-Palmer College of Chiropractic Inaugural Report: Americans’ Perceptions of Chiropractic. Palmer College of Chiropractic, 2015.

3. Halloran S, Communicating Chiropractic: An Algorithm to Answer Difficult Questions, in ACA Blog, ACA, Editor. 2018: ACA Blog.

This podcast episode was about communicating chiropractic. Communicating chiropractic effectively is a big part of moving the chiropractic profession forward. Bobby Massie Authentic Jersey

CF 034: Chiropractic Information To Help You Form Your Practice

Chiropractic Information To Help You Form Your Practice

Integrating Chiropractors

Today we’re going to talk about a couple of interesting articles that have come out recently touching on some chiropractic information and it’s all good in the neighborhood for chiropractors. 

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.  That’s this one…you’re listening to it right now so you don’t have to do anything else at this point. Just listen and chill out. 

Since you’re here, I might as well ask you to go to chiropracticforward.com and sign up for our newsletter. It makes it easier to let you know when the newest episode goes live, when someone new signs up it makes my heart leap a little and in the end, wouldn’t you just like to know when new episodes come out and, what if we end up compiling a team and coming up with some great ideas? Heck yeah, you want to know about that stuff so make sure you’re on the newsletter. It’s just an email guys. Not diamonds or gold. Lol. 

I want to share with you all the fact that our downloads on this podcast have almost DOUBLED from last month. We’ve picked up that much steam in just one month. Thank you to you all for tuning in. If you can continue to share us with your network and give us some pretty sweet reviews on iTunes, I’ll be forever grateful. 

If all you do is listen, that’s awesome and I’m glad you’re a part of this thing. But, if you can take the extra few seconds to share the episode with buddies on Facebook or wherever, THAT’S the real difference.  

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

You have bee-bopped right into Episode #34

Before we get into it too far, I’m going to be honest with you all. 2018 has been a challenging year for me both business wise as well as personally. For several reasons really. 

When your attention is taken away from where it needs to be, things tend to fall apart little by little and then finally, you go into a mode where you are all hands on deck and really focused on righting the ship. 

Well, that happened to me at the end of 2017 and through a lot of 2018 as well. I’m only sharing this with you because I want listeners to understand that we’re in this dude together. Issues I deal with and are ultimately able to solve…..if I share those experiences with our listeners, I believe it serves to help you in your practice. 

Here’s the deal, an evidence-based chiropractor, whether I like it or not, is somewhat dependent on a steady stream of new patients. That is due to the fact that we don’t try to see our patients a hundred times, right? We don’t develop the reputation of seeing how many times we can run our patients through the door. Do we? Hopefully, this is chiropractic information you can use.

Oh looky here….your insurance allows you to have 27 visits in a year and….what dya know….your specific condition requires exactly 27 visits to resolve. Ugh. That stuff makes me crazy and, unfortunately, chiropractors are notorious for it. I am hoping some updated, reasonable chiropractic information can sway them to the light. 

Just so chiros don’t think I’m bashing too hard here, medical doctors do useless surgeries just because they can do it and get paid for it with little to zero concern about the person it was done to. It’s rampant in all fields. I just notice the chiropractic side of it more than the others because I’m in it. No chiropractor holds on to 100% of their patients. It just doesn’t happen. 

But, if those NUMBERS DOCTORS – the ones hitting certain stats and the ones that are doctor-centered rather than patient-centered….those guys and gals…..I wonder if they have any idea how many patients they drive away by having that kind of model. And I don’t mean drive away from just their practice. I’m also talking about the number of people they drive away from ANY chiropractor because they assume we’re all the same. It all gives me a rash when I think about it. The public doesn’t have the kind of chiropractic information the rest of us have. 

Anyway, new patients: we depend on a steady stream of them. Now, last year, I would average 55-65 new patients a month but, while we started having issues with billing/collections department, I really got down, I got stressed, and honestly, for a bit, doubted the future of my practice remaining in its current state. That leads to self-doubt too. Where you had a ton of confidence, there remains only a shred after having your foundation shaken, right?

As much as you’d like to avoid it, business gets brought home. Especially when it’s an all-consuming feeling of self-doubt and potential impending doom. Lol. Maybe I’m being a little dramatic looking back on it but, when you’re in it, it’s intense. 

As a result of my focus being altered, my new patient count went to 38 here, 42 there. We’re talking 20+ less new patients per month there for a little while. Without changing anything to my knowledge. 

I spoke with a colleague here in town and his numbers have been down as well so maybe it’s not just me. Who knows?

Here’s what I DO know though. As soon as things lined out in the billing/collections department, guess what, the new patient stream started to line out.

How’s that exactly? I don’t know. I’m guessing an increase in confidence in regards to finances leads to an increase in self-confidence and, when all of my focus isn’t on billing/collections, I have the freedom to work on and consider other aspects of the business. And let’s face it, I’m just a much more pleasant person to be around when I’m not worried about the financial health of my company. I’m going to guess you all are the same way. 

Seriously, once we made a change in the billing/collections department (as badly as I did not want to do it), my billing and collections turned around immediately. I mean immediately. Front desk staff became more confident. I became more confident. Patients started paying what they were supposed to pay. Outdated balances got current. THAT’s some good chiropractic information!

Long story short, what started out as a slow 2018 has become a little bit crazy for me and, if it continues, I’m going to have to hire an associate so I can come up for air. Just getting the podcast written up and produced has started to become a real chore in the last several weeks but I’m committed folks. I’m here for the long haul. 

I hope you are too. 

Let’s start our research talk with one from Chiropractic & Manual Therapies dated 17th of July, 2018 called “Chiropractic in global health and wellbeing: a white paper describing the public health agenda of the World Federation of Chiropractic[1]. This was authored by Michele Maiers, et. al. 

The article begins by saying, “The World Federation of Chiropractic supports the involvement of chiropractors in public health initiatives, particularly as it relates to musculoskeletal health.” I noticed there is no neuro before the musculoskeletal description. Curious. 

The authors then say there are three topics that require out focus as chiropractors and they are

  1. Healthy aging
  2. Opioid misuse
  3. Women, children, and adolescents’ health

I guess the men in the crowd are either built heartier or we’re just not quite as important. Lol. 

The WFC want to help us in participating in these areas and promote chiropractic as partners in the broader healthcare system. That’s certainly something I can get on board with. 

Now, this article is pretty darn long so we’re just going to hit some of the more interesting spots. I will have it linked in the show notes so you can go hop online and read the whole thing word for word should you feel the desire. 

In the background section of the article, they say, “In an era where both medical costs and years lived with chronic disease are increasing, calls have been made for closer collaboration between public health officials and healthcare providers. The potential contribution of many providers, including chiropractors and other health care professionals, is often overlooked.”

But then they go on to say our profession needs to identify priority areas of focus and have plans for our engagement in public health based on these areas of focus. 

I am wondering why they feel that men engaged in manual labor activities having chronic low back pain are not worthy of being a focus group here? We’ve talked so much about how low back pain is such a global epidemic and how so much work is missed as a result blah blah blah. 

Maybe I’m just old school. I don’t have any stats to prove my thoughts here but, I would assume the majority of manual labor is on the backs of men. If I’m not right about that, please email me and show me the stats at dr.williams@chiropracticforward.com. If I’m wrong, I need to be educated. 

Still, what gives on this? I want to be positive so let’s get back to the paper. 

In the area of Healthy Aging, they state the world’s population is getting older and older with the number of folks over the age of 60 years old expected to double in the first half of this century. 

That’s assuming they get control of opioids right? We covered an article some time back that said the US expected lifespan has actually decreased in the last two years rather than increased because of opioids so there is that to keep in mind. 

They mention that “Musculoskeletal conditions are a leading contributor to non-communicable burden of disease, predominantly low-back pain and osteoarthritis.” 

And…”Physical activity is key in the prevention, treatment, and management of most chronic conditions affecting older adults, including musculoskeletal complaints. Chiropractors should consider prescribing exercise, with or without manual therapy, for spine care in older adults. Such approaches are supported by an evidence-based framework, which includes clinical practice guidelines.” Great chiropractic information.

Isn’t it nice to see the WFC using evidence-based terminology and approaching things from an evidence-based platform? Everything mentioned in this article has resources that are cited. It feels good and it gives me a warm fuzzy feeling all over. 

They also talk about how falling is a major concern among the older crowd and how exercises and physical activity helping to maintain strength and balance can help prevent them. 

They mention potential barriers to older folks getting chiropractic care. If you are a regular listener of our podcast, you know about the White House report that actually said CMS creates barriers to patients seeking care under a chiropractor[2]. I just linked that in the show notes if you want to look at it. It’s on page 57 so you can avoid reading the whole thing just to get that snippet.

https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-3-2017.pdf

How does that get resolved exactly? I think that’s what happens when we have government-run healthcare in my opinion. They have to cut costs and the services they feel are of the least value will go away in terms of coverage. 

I think that’s what is going on with Medicare. Research shows it’s effective but we can’t get anything other than an adjustment covered. What other reason would there be? Pass on any of your chiropractic information you can share with us on this.

Onto focus area #2: Opioid misuse. 

Boy we’ve covered this one. Like….a lot. Let’s see if they have anything new here for us to chew on. 

Here’s a new stat I haven’t seen before, “Opioids account for 70% of the negative health impact associated with drug use disorders globally, and are considered the most harmful drug type .” They also say, “Approximately 69,000 people worldwide die from opioid overdose each year, with a large toll of overdose deaths in the United States and Canada.”

Then they say something I completely agree with, “The opioid misuse crisis creates an impetus for chiropractors and chiropractic organizations to collaborate with other healthcare providers, decision makers, and stakeholders. Patient-centered, inter-professional collaboration should be expanded for the treatment of musculoskeletal pain, with chiropractors playing a larger role on multidisciplinary pain management teams.”

Notice they say “Patient-centered.” Not “Doctor-centered.” Not offices and doctors that do things to hit numbers. Not doctors that see a patient 80 visits. Not those guys. Patient-centered, evidence-based chiropractors are in the right spot right now folks. 

OK, priority #3: Women’s, Children’s, and Adolescents’ Health. 

When covering some of the relevant issues for this group, they cite pregnancy-related back pain and pelvic pain and post-partum spinal disorders which may impede recovery. 

The second issue cited is hormonal changes, dietary factors, and physical inactivity are all factors for osteoporosis. 

The third is violence against women and girls causing injury. I’m just not sure how in the year 2018 we still have violence against women and girls or children in general. Human beings can be cretins, can’t we? Lack of parenting? Inherent evil in the offenders? Who knows? It’s hard to postulate on something you understand nothing about. 

Here’s something in the article I can agree with 100% they say that women are the major decision maker for their families. If you are marketing men…..in most markets, you are wasting your money. 

I can’t tell you how many men come in here and when we ask how they found us or what brings them here today, they say, “My wife. This is where my wife told me to be. I didn’t want to come. I don’t like doctors but my wife is tired of my griping about my back.”

Market the ladies and you market effectively. End of story. 

To summarize the article, the WFC says they are developing tools with the goal of empowering chiropractors and WFC member organizations to engage in public health activities in the three identified priority areas. I’m looking forward to seeing what they’re going to come up with. Exciting stuff here. Great chiropractic information.

The next article I want to cover quickly is one written by Dr. Christine Goertz called “What Does Research Reveal About Chiropractic Costs?” and it was published on the ACA Blog on July 10, 2018[3]. 

Dr. Goertz by saying something ALL evidence-based chiros can yell, “Amen,” at and that is where she says, “Without a doubt, the most common issues raised by those outside the profession relate to the quality and consistency of chiropractic care delivery. The second most commonly asked question invariably pertains to the costs associated with chiropractic care.”

So….AMEN! 

Another amen quote would be this one: “(Evidence) consistently shows that patients with low back and neck pain who are treated by chiropractors have either similar or lower costs than those seeking care from other providers. In particular, it appears that patients who visit a chiropractor are less likely to undergo hospitalization, resulting in lower global healthcare costs than those who receive medical care only.”

Hallelujah. If you love this chiropractic information you need to share this chiropractic information.

When addressing the cost of chiropractic care, Dr. Goertz mentions a paper we have covered here by Hurwitz[4] that concluded that found that health care expenditures for patients with low back pain, neck pain, and headaches were all lower in those who received chiropractic care alone when compared to any other combination of healthcare providers. 

Well, that’s some sexy chiropractic information, isn’t it? Of course it is. You realize you can use articles like this and the information you get from podcasts like this to help you educate your population and your area’s Medical professionals right? Are you listening or are you listening and utilizing? That’s a good question to think about. I have cited the Hurwitz paper in the show notes for your own independent review. 

She then covers a paper by Martin et. al. that we will be covering soon. Over 12,000 patients with 4,300 or so using alternative healthcare. 75% of the alternative users (3,225) were treated with chiropractic. This is big for chiropractic since those treating with alternative means had $424 less in spinal care and $796 less in total healthcare costs. Average healthcare spending for alternative care users was on average $526 lower. 

Huge, absolutely huge folks. If that doesn’t put a grin on your face, you’re dead. You need a defibrillator muy pronto, amigo. Share this chiropractic information won’t you?

This week, I want you to go forward with this: Don’t you understand that if we chiropractors were wrong, we’d have been wiped out by now? We are right. We have been right and we will continue to be right. What we do is so powerful that our profession has persisted and, in fact, prospered in spite of the non-evidence-based people out there on the fringe giving the rest of bad names. The hucksters and profiteers have not even been able to destroy it. They’ve held us back, no doubt. But they haven’t been able to extinguish us and that’s pretty powerful. We are right. Keep on keeping on with confidence. 

Integrating Chiropractors

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

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.

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. 

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http://www.chiropracticforward.com

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Bibliography

1. Maiers M, Chiropractic in Global Health and wellbeing: a white paper describing the public health agenda of the World Federation of Chiropractic. Chiropr Man Therap, 2018. 26(26).

2. The President’s Commission on Combating Drug Addiction and The Opioid Crisis. 2017.

3. Goertz C, What Does Research Reveal About Chiropractic Costs?, in ACA Blog. 2018: ACA Blog.

4. Hurwitz EL, e.a., Variations in Patterns of Utilization and Charges for the Care of Neck Pain in North Carolina, 2000 to 2009: A Statewide Claims’ Data Analysis. J Manipulative Physiol Ther, 2016. May 39(4): p. 240-51.

Relevant Links

CF 021: Crazy Update On Run-Away Healthcare Spending in America

 

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

 

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

Episode #29

Is Chiropractic Integration Healthy For The Profession?

Today we have a very special guest and we’re going to be talking about chiropractic integration into a medical based case management or medical team. This one may irritate the holy heck out of the straight chiropractors that preach being separate and distinct but I think evidence-based practitioners will find some good stuff here. 

But first, here’s that bumper music

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

Before we get started, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It makes it easier to let you know when the newest episode goes live and it’s just nice of you. 

Also, I’m alway offering myself up for speaking opportunities or to be a guest on YOUR podcast.  Just send me an email at dr.williams@chiropracticforward.com and we will connect. I always appreciate hearing from my brothers and sisters out there in the profession. 

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. That’s a tall order but that is the goal and I’ve never shy-ed away from big goals. You shouldn’t either!

You have tip toed ninja style into Episode #29

But first, my week …..I have to say that we started off slow at the start of this Summer season but, now that everyone is settling into the heat, it’s starting to get busy busy and that’s nothing but good good. What are the most effective means you’ve found to get your message out to your communities? Email me and I may just share you suggestions in future episodes. 

This week, I want to welcome a friend of mine and a brother in arms in our battle for Chiropractic here in Texas to come and speak with me about chiropractic integration. He has been involved deeply on the state level leadership for years at this point and has held several posts including the biggest one. Yes, he is currently the big cheese, the head honcho, the el jefe of the Texas Chiropractic Association. Until June of 2019, he will sit as the President of the TCA and we’re honored to have him with us on the Chiropractic Forward Podcast today. 

– I want to welcome Dr. Devin Pettiet of Tomball, TX. Dr. Pettiet, thanks for being here and letting us pick your brain a little today. 

  • When I was coming up with this week’s topic, chiropractic integration, I really couldn’t think of anyone better than you to talk about chiropractic integration with. I know you pretty darn well but our listeners probably do not. Tell us a little bit about your practice. 
  • What originally got you involved in service to your profession? Was there a single incident or experience that flipped a switch in you?

I don’t want to speak for you but, for myself, I’m certainly on the evidence-based aspect of the chiropractic spectrum here. We would like for our thoughts and opinions to be separate from the TCA’s stance on different matters and we should state from the start that our thoughts and opinions are our own and not representative of the TCA. At the same time though, we are the kind of people that want to go to bat for everyone practicing as long as they are within the scope mandated by the State of Texas. 

Now, How do you feel we chiropractors can start making headways into the medical field as spine specialists and….keeping the straights in mind….is it healthy for our profession to seek those avenues for ourselves? Is chiropractic integration a good idea basically?

We know it’s not a lack of research validating our profession but, with your years in practice and with your years of service in the TCA, what things come to mind as the biggest obstacles to chiropractic care fully integrating into medical referral programs or treatment protocols?

Over the years, have you seen any changes in the opinions of chiropractors from those in the medical community or in the way you interact with them?

Let’s go over a couple of papers and you just play Troy Aikman to my Joe Buck and provide commentary wherever you see fit. 

This one is from February 2018 and is called, “Integration of Doctors of Chiropractic Into Private Sector Health Care Facilities in the United States: A Descriptive Survey.” It was written by S Salsbury, et. al. and I see Dr. Goertz listed as an author as well. She has really been a star for the chiropractic profession(Salsbury S 2018). 

Why They Did It

The purpose of this study was to describe the demographic, facility, and practice characteristics of doctors of chiropractic working in private sector health care settings in the United States.

How They Did It

  • The authors did an online, cross-sectional survey. 
  • They were looking for chiropractors already working in integrated health care facilities 
  • They collected demographic details, facility details, and the characteristics of the practice
  • Using descriptive statistics, they analyzed all of the data they collected. 
  • The response rate was 76% which is odd because my email open rate when I email for TCA stuff is like 10%….
  • Most respondents were male with the mean years of experience being 21 years. 

What They Found

  • Doctors of Chiropractic working in hospitals were 40%
  • Multispecialty offices = 21%
  • Ambulatory clinics = 16%
  • Other health care settings = 21%
  • 68% were employees and received a salary
  • Most DCs used the same health record as the medical staff and worked in teh same clinical setting. 
  • Over 60% reported co-management of patients with medical professionals. 
  • In many clinics, the DCs were exclusive providers of spinal manipulation (43%) but most of the clinics saw the DCs receiving and making referrals to the primary, the PT, or to pain and ortho docs. 

Wrap It Up

The authors concluded by saying, “Doctors of chiropractic are working in diverse medical settings within the private sector, in close proximity and collaboration with many provider types, suggesting a diverse role for chiropractors within conventional health care facilities.”

Here’s another by Paskowski et. al.(Paskowski I 2011) Called “A hospital-based standardized spine care pathway: report of multidisciplinary, evidence-based process.”

There were 518 patients and they developed a Spine Care Pathway protocol for their treatment. These patients underwent chiropractic care and physical therapy. 

What They Found

Those that went to a Doctor of Chiropractic treated for about 5.2 visits costing an average of $302.

The pain was 6.2 on intake and 1.9 on exit. 

95% that saw a chiropractic rated their care as excellent. 

Then there’s this one from the Ontario Ministry of Health-commissioned report called The Manga Report which was a comprehensive review of all of the published literature on low back pain(Manga P 1993). 

Some of the things this government-commissioned study had to say are just outstanding. 

  • There was an overwhelming amount of evidence showing the effectiveness of chiropractic in regards to the treatment of low back pain and complaint.
  • They found that it is more cost-effective than traditional medical treatment and management
  • Found that many of the traditional medical therapies used in low back pain are considered questionable invalidity and, although some are very safe, some can lead to other problems being suffered by the patient.
  • They showed that chiropractic is clearly more cost-effective and that there would be highly significant savings if more low back pain management were controlled by chiropractors rather than the medical physicians.
  • The study stated that chiropractic services should be fully insured.
  • The study stated that services should be fully integrated into the overall healthcare system due to the high cost of low back pain and the cost-effectiveness and physical effectiveness of chiropractic.
  • They also stated that a good case could be made for making chiropractors the entry point into the healthcare system for musculoskeletal complaints that presented to hospitals.

They concluded the paper by saying, “Chiropractic should be the treatment of choice for low back pain, even excluding traditional medical care altogether.”

There are a ton of reasons for chiropractic integration into medical protocols that, if we tried to cover them all, we’d be sitting here for a very long time. The point here is that, when you consider these studies, when you consider the low back series in The Lancet that we covered in episodes 16, 17, and 18, when you read the recommendations from the American College of Physicians for acute and chronic low back pain, and you see the recent article in JAMA from Dr. Goertz on Vets and low back pain that we covered in episode 

Dr. Pettiet, where do you see everything going on this??

How do we do our part to ensure chiropractic integration of our profession and move from the fringe toward the center?

Can we do that while still maintaining our identity as chiropractors?

Is the TCA doing anything that we can talk about publicly toward chiropractic integration?

This week, I want you to go forward understanding that you have been and are doing the best thing there is out there for headaches, neck pain, and back pain. There is no other profession with the juice behind them that we have. Be smart, be responsible, and we may just be able to not just have our foot in the door, but to actually knock it down and burst in like a superhero. 

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.

When you look at the body of literature, it is clear: research and clinical experience show that, in about 80%-90% of headaches, neck, and back pain, patients get good to excellent results with Chiropractic when compared to usual medical care. It’s safe, less expensive, decreases chances of surgery and disability. Chiropractors do it conservatively and non-surgically with little time requirement or hassle for the patient. And, if the patient has a “preventative” mindset going forward, chiropractors can likely keep it that way while raising the general, overall level of 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.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic podcast in the world. 

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. 

CF 015: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 3 of 3)

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

CF 020: Chiropractic Evolution or Extinction?

 

 

Bibliography

Manga P, e. a. (1993). “THE MANGA REPORT: THE EFFECTIVENESS AND COST-EFFECTIVENESS OF CHIROPRACTIC MANAGEMENT OF LOW BACK-PAIN.” Funded by the Ontario Ministry of Health.

Paskowski I, e. a. (2011). “A hospital-based standardized spine care pathway: report of multidisciplinary, evidence-based process.” J Manipulative Physiol Ther. 34(2): 98-106.

Salsbury S (2018). “Integration of Doctors of Chiropractic Into Private Sector Health Care Facilities in the United States: A Descriptive Survey.” J Manipulative Physiol Ther 41(2): 149-155.

CF 028: Will Chiropractic First Finally Take Its Place?

 Will Chiropractic First Finally Take Its Place?

Chiropractic First is on the table today.

As they say in Texas, Howdy y’all. You could also say, Hola Amigo in Texas as well, and as I learned last week, it’s How you doin? in New York. Today we’re going to be talking about whether or not Chiropractic should or could be poised to step up and take it rightful spot in healthcare globally. Buckle up, bucko.

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 and today it’s about chiropractic first.  So, glad you’re here with me. In case you are a youngster, the term “bucko” came from a young tike himself named Ritchie Cunningham on Happy Days played by Ron Howard. Yep, that Ron Howard, the famous director and was once a tiny tot named Opie on the Andy Griffith show. No, I’m not THAT old but….I know a little TV trivia here and there. And now it appears that you do too. 

Ritchie, every now and then, would get all worked up into a fuss and call Fonzie or Potsy or whoever a “bucko.” Man…..you wanna talk about fighting words. Fonzie about ended him a time or two but, in the end, Fonzie was way too cool to beat up on Ritchie. OK, enough of that…

I want to ask you to go to http://www.chiropracticforward.com and sign up for our newsletter. We won’t be filling up your inbox and it’s easy to fill you in on all the new stuff. And, in the end, it’s nice of you and it will help keep the wrord circulating if you would like to help us. Likes, shares, and retweets also keep the world turning around and around and that’s really important stuff…..Keeping the world spinning and all….. if we can talk you into it. 

Have you noticed we aren’t selling you anything? That doesn’t mean that we won’t if the right opportunity arises down the road but, I want you to know that I’m doing this podcast for the right reasons. I make furniture, I am a musician, I am a sculptor…..and, Just like anything else I do, I make the things that interest me and that come from my heart. If someone ends up buying what I’ve made down the road, then heck yeah!! Good for me. But, in the meantime, I do what I do because I love it and I guess I have enough ego that I think others may love it as well. I hope you guys and gals love it and find the value like I find in it. 

As with every episode, we are honored to have you with us. We truly are. Now, here we go with some vital information that we think can build confidence and improve your practice which we think will improve your life overall. That’s a tall order but everyone needs goals.

You have Firecircled your way into Episode #28 ala Dr. Strange. My family is full of action movie junkies so just deal with the reference. 

I think a great place to start is by saying that I stumbled upon a heck of a deal this last weekend when I attended the Texas Chiropractic Association’s ChiroTexpo down in Dallas at the Hyatt Regency. I realize the Hyatt Regency holds no meaning to those outside of Dallas but, it’s the hotel with the really cool lit up ball in downtown Dallas. Ah….yes, if you’ve seen the amazing Dallas Cowboys perform inside your TV box, you’ve probably seen the down town rotating restaurant ball on your screen. 

Part of the program had to do with the Lumbar Management portion of the Diplomate of American Chiropractic Orthopedists program. I’m still getting the nuts and bolts of this dude figured out but, basically, it consists of five 10-hour live face-face seminars, 50 hours in total there. Then, 250 of online courses through the University of Bridgeport. After that, you sit for the DACO exam and, assuming you pass it, you now have the honor of being called a DACO and you have the knowledge to back it up. This class was one of the 10-hour sessions.

Now, I have to say, I literally thought I would sit in the class for a couple of hours, my eyes would glaze over, and my butt would start to hurt, and I’d get up and wonder around asking where the nearest trouble could be had because I’m onery on the weekends. I mean really, who the heck wants to sit in a classroom from 1-7pm on a Saturday night and 8-1 on a Sunday morning? Not this guy. Not all in one stretch like that.  

But I did. I sat through all 10 of them. Yep, even surprised myself. Dr. Tim Bertlesman from Illinois was the instructor of the class and he kept it moving, he kept it extremely relevant, and he even kept it pretty funny. Basically, he kept my interest and you know what? I may…..just may…..do the whole program. 

It’s evidence-based for sure and about Chiropractic First

It’s patient-centered without a doubt. And it’s current with the research. If you’ve been paying attention, that’s right in my wheelhouse. If you’d like more information on this program, send me an email at dr.williams@chiropracticforward.com and we’ll connect. As I learn more and more about it all, I’ll be glad to share if you think you’d be interested as well. 

He started off the class with some slides referencing a few studies that I haven’t seen just yet and I a lot of what he was saying is what I’ve been telling all of you for 28 episodes now. All of them. Every single episode. 

The overwhelming sentiment here is that the door is open thanks to opioids. The door to chiropractic first, that is. The chance we have waited for is here. Right now. We may not get it again. People are hungry for what we do and we now have all of the research we need to back ourselves and our profession up, to show complete validation, and thrust us into the mainstream of healthcare for non-complicated musculoskeletal issues. That’s here. 

Let’s look at a little bit of it and see if you agree. 

This is from April 2016 and was published in JAMA. It was authored by Dr. Deborah Dowell, MD, et. al. and was called “CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016(Dowell D 2016).”

Why They Did It

Realizing that opioids are a problem, that there are a limited number of long-term opioid research papers, and that primary care physicians need better, safer ways of managing chronic pain, the authors hoped to make recommendations for when to prescribe opioids outside of cancer treatment, etc….and when to not prescribe them. 

How They Did It

  • The Centers for Disease Control and Prevention (CDC) used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) protocol in order to assess the evidence type and make recommendations from there. 
  • Evidence was made up of observational studies or randomized clinical trials with notable limitations. 
  • No study evaluated long-term (over 1 year) benefit for opioids in chronic pain. 

What They Found

  • There are 12 recommendations
  • Of the most importance was the recommendation that non-opioids is preferred for treatment of chronic pain. That’s where WE fit in folks.
  • Opioids should only be used when benefits for pain and function outweigh risks but risks are use disorder, overdose, and death so….. Pretty much never.
  • Before starting any opioid therapy, practitioners need to set goals and settle on how they will be discontinued if benefits do not outweigh risks.
  • Blah….blah blah….a bunch of other language that does not pertain to us chiropractors. 

Wrap Up

Non-pharmacologic therapy and non-opioid pharmacologic therapy are preferred. Chiropractic first

I think that, before the American College of Physicians finally came right out and said to go see someone that performs spinal manipulation to treat acute and chronic low back pain, this was JAMA’s way of saying, “Hey guys and gals, ummm….we’ve created a bit of a mess and we had better start cleaning it up (cough chiropractic cough) and maybe we should look outside of usual medical care like pills (cough chiropractic cough) and drugs that people get hooked and drugs that kill people (cough Chiropractic).

JAMA has come along slowly but they’ve made great progress. Even since this paper originally came out. 

For the next article, let’s look at this one called “Attorney General Janet Mills Joins 37 States, Territories in Fight Against Opioid Incentives,” released by the Office of the Attorney General on September 18, 2017(Roth-Wells A 2017). 

The Attorney General in Maine, Janet Mills, joined 37 other states in the fight against opioids according to this article. The AG was quoted in the article as saying, “Last year Maine enacted a law limiting opioid prescriptions and that law is beginning to have a positive impact. Now health insurers need to reduce any financial incentives to prescribing these addicting narcotics and offer greater coverage for alternative therapies. As the chief legal officers of our States, we are committed to using all tools at our disposal to combat this epidemic and to protect patients suffering from chronic pain or addiction.”

The attorneys general contend that incentives that promote use of non-opioid therapies will encourage medical providers to consider physical therapy, acupuncture, massage, chiropractic care, and non-opioid medications, instead of narcotic drugs.

The article went on to list all 37 states that were signed on to this initiative but, sadly, my state of Texas was not on the list. That pesky Texas Medical Association really tends to get in the way. I see the other biggest states on the list in regards to the number of chiropractors practicing. Those states are California, New York, and Florida but, no, not Texas.

The next article is called “FDA Education Bluepring for Health Care Providers Involved in the Management or Support of Patients with Pain” and was published in May 2017(FDA 2017). 

On page three, section two, the paper dicusses nonpharmacologic therapies. It states, “A number of nonpharmacologic therapies are available that can play an important role in managing pain, particularly msculoskeletal pain and chronic pain.” 

It then goes on to mention categories. The categories they mention are Psychological approaches, and, while I think our patients look at us as chiropractors, financial advisors, psychologists, and a whole host of other professionals, this paper is speaking to cognitive behavioral therapy and, if I’m honest, I’m simply unfamiliar with that as a treatment regimen. I certainly have more to learn on that topic. They also mention physical therapy, of course. They mention surgical intervention and then they mention complementary therapy underwhich is mentioned acupuncture and chirlpracty. 

I’ve not ever in my life heard the term “chiropracty” but at least we’re in the game, I suppose. 

Then the paper closes the section by saying, “Health care providers should be knowledgeable about the range of available therapies, when they may be helpful, and when they should be used as part of a multidisciplinary approach to pain management.”

Isn’t that interesting? How many practitioners do you think came across this paper and this section of this paper? How many do you suppose have decided to take it upon themselves to get extra information and education in this particular topic? 

Maybe some but, mostly, I would say that it is up to us chiropractors to do our part to educate our medical communities on this sort of information. It’s the FDA for goodness sake. It’s on a government website. It cannot be hard to point them in the right direction and for the medical practitioners to be able to trust the information if it’s coming from this sort of a platform or footing. But, they have to be shown the way. Most of them aren’t simply going to stumble on to it and say, “Oh hey, looky here. Looks like I’ve been wrong my whole life about chiropractic.” 

They need some help and some guidance to find it and then hopefully to receive the information on their own. Regardless of where you start, using sources like the FDA, the Journal of American Medical Association, The Lancet, and the American College of Physicians is always a good idea. They are reputable and they are forms of information that the medical kingdom place a lot of stock and value in. It turns out that they’re on our side on this matter. 

Next, let’s talk about The Joint Commission. “What is The Joint Commission?” you may ask yourself. You may ask yourself that question because that’s the question I asked myself when I first saw the paper so I did some homework for you. 

A quick visit to their website tells us the following:

“An independent, not-for-profit organization, The Joint Commission accredits and certifies nearly 21,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.

 

Our Mission:  To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.

 

Vision Statement:  All people always experience the safest, highest quality, best-value health care across all settings.”

If you really read and understand what is said in that description, you’ll see the terms “improve health care for the public” and “providing safe and effective care of the highest quality and value” and safest, highest quality, best-value health care across all setting.” The vast majority of paper we have covered in the previous 27 episodes argue that chiropractic fits the bill in a lot of different ways.

This article comes from The Joint Commission Online and was published on November 12, 2014 talking about revisions to pain management standards that were to be updated just a couple of months later, January 1, 2015(The Joint Commission Online 2014). I want to give this group credit. They seem to have started to catch on to the need for nonpharma protocols about a year to a year and a half prior to the rest of the medical profession. Kudos to them. 

In the blue box is the Standard PC.01.02.07 which is the code for assessing and managing patients’ pain. The revision states that both nonpharma and pharma play a part in pain management, the non-pharma strategies may include the following: acupuncture therapy, chiropractic therapy, osteopathic manipulative treatment, massage therapy, physical therapy, relaxation therapy, and cognitive behavioral therapy. 

That stuff sounds fairly familiar for the most part doesn’t it? We’ve been talking about it for months by now so it should indeed be familiar. Except for the cognitive behavioral therapy bit. I kid. Cognitive behavioral therapy is geared toward treating depression, anxiety disorders, phobias, and other forms of mental disorders. Certainly the disorders that may exacerbate chronic pain or, at minimum, prevent the patient from moving beyond the pain in any meaningful way.

Continuing on, here’s a paper from the prestigious Spine Journal by Jon Adams, PhD et. al. called, “The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults(Adams J 2017).” 

Why They Did It

Just as the title of the paper indicates, the goal of the authors was to learn more about the prevalence, patterns, and use of chiropractic care in the US. 

How They Did It

  • They took a cross-sectional data from the 2012 National Health Interview Survey. The National Health Interview Survey (NHIS) is the principal and reliable source of comprehensive health care information in the United States, utilizing a nationally rep- resentative sample of the civilian noninstitutionalized popu- lation of the United States
  • They used that information to analyze the lifetime and 12-month prevalence and utilization patterns of chiropractic use. 
  • They determined the profile of chiropractic users. 
  • They determined the predictors of chiropractic consultations.

What They Found

  • Lifetime prevalence of chiropractic use was 24%
  • 12-month prevalence of chiropractic use was 8.4%
  • The use of chiropractic care has grown from 2002 to when the data stopped in 2012
  • Back pain caused people to seek chiropractic care to the tune of 63%
  • Neck pain caused them to go about 30% of the time. 
  • The majority of chiropractic users reported that it helped a great deal with their health problem and improved overal health or well-being. 

Wrap It Up

The authors concluded by saying, “A substantial proportion of US adults utilized chiropractic services during the past 12 months and reported associated positive outcomes for overall well-being and/or specific health problems.”

When we dive a little further past the abstract and get down into this paper, it goes into the specific percentages for different questions:

Chiropractic led to:

  • Better Sleep 42%
  • Reduced Stress 40%
  • Felt better overall and improved health 39%
  • Was seen as very important to the user 48%
  • Helped for a specific health problem 65%
  • Didn’t help at all 4% 
  • 62% went to a chiropractor to treat the cause, not the symptom!

I want to finish up this week’s papers by citing one that came right out of the White House not long ago.

If you go to The President’s Commission On Combating Drug Addiction and The Opioid Crisis report and make your way down to page 57, you will see where the authors say the following, ““A key contributor to the opioid epidemic has been the excess prescribing of opioids for common pain complaints and for postsurgical pain. Although in some conditions, behavioral programs, acupuncture, chiropractic, surgery, as well as FDA-approved multimodal pain strategies have been proven to reduce the use of opioids, while providing effective pain management, current CMS reimbursement policies, as well as health insurance providers and other payers, create barriers to the adoption of these strategies.” That is from the White House. 

If you continue to the very bottom of the page, you’ll see this quote, ““The Commission recommends CMS review and modify rate-setting policies that discourage the use of non-opioid treatments for pain, such as certain bundled payments that make alternative treatment options cost prohibitive for hospitals and doctors, particularly those options for treating immediate post-surgical pain.”

In Episode #11, when I brought this up to my long-time buddy and past TCA President Dr. Tyce Hergert, he said, “You mean like a specialist copay for chiro care and a lower copay for primary care? Or covering surgery 100% and NOT covering non-surgical means.” I couldn’t have said it any better. 

Essentially, the United States Government is admitting there is professional discrimination at the highest levels…..hello Medicare and Health Insurance plans….I’m talking to you….this discrimination creates barriers to doing the smart thing.

The smart thing is seeing a chiropractor for your back pain. The “Big Guys” (AKA: American College of Physicians, The Lancet, the FDA,  and the American Medical Association) recommend it and the government says policies are in place to prevent patients from following those recommendations.

Key Takeaways:

  1. The general population is starving for what we chiropractors do and for what we can offer them. 
  2. All of the important entities in the medical kingdom now recommend what we do but primary practitioners and specialists haven’t caught on just yet.
  3. There are barriers set up within Medicare and insurance in general keeping people from seeking the safest, most cost-effective, non-pharma means to treat themselves.
  4. It’s up to US and nobody else to get the word out in our medical communities. Nobody is going to do it for us and that’s a guarantee. 

I want you to go forward this week with confidence and validation but with the understanding that it is up to every single one of you to figure out how to educate your medical community in an evidence-based, patient-centered way an the first one that does it correctly and effectively may just win a pot of gold and become THE spinal authority in your community. 

I would say that you also need to do your friend Dr. Williams, and all other chiropractors in the world, a big favor. That favor would be to help us get the word out about this podcast. If you find value in it, don’t you think others would too? I’m not sponsored here. I’m doing it because I love it. I don’t have $10,000 to promote the podcast on Facebook or Twitter so I have to keep asking our listeners to please do us a favor and go like our page on Facebook, Like and Share our content EVERY WEEK, FOLLOW us on Twitter, and RETWEET our content on Twitter. 

These are incredibly easy things to do and I truly need your help with them if you would please be kind enough. 

I want you to know with absolute certainty that When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.

When you look at the body of literature, it is clear: research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good to excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic evidence-based podcast in the world. 

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

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

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

 

Social Media Links

iTunes

Bibliography

Adams J (2017). “The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults.” Spine 42(23): 1810-1816.

Dowell D (2016). “CDC Guideline for Prescribing Opioids for Chronic Pain – United States.” MMWR Recomm Rep 65: 1-49.

FDA (2017). “FDA Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain.”

Roth-Wells A (2017). “Attorney General Janet Mills Joins 37 States, Territories in Fight against Opioid Incentives.” Office Of The Maine Attorney General.

The Joint Commission Online (2014). “Revisions to pain management standard effective January 1, 2015 BrightStar Care recognized as Enterprise Champion for Quality for second year New on the Web.” Joint Commission Online.

 

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

WANTED – Safe, Nonpharmacological Means Of Treating Spinal Pain

Today we’re going to talk about treating spinal pain, thoracic manipulation, lumbar manipulation, guidelines from Canada, and perceptions of our profession. Did you know that many people actually think that Chiropractic herniate low back discs all of the time? That’s not our idea of treating spinal pain. That’s for sure!

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 and I am honored to have you join me today.  Thank you to those of you that send emails and like and share our content on Facebook and Twitter. You make it fun. If you haven’t already noticed, we have “Tweetable” quotes from our show notes. All you have to do is click the Tweet button and you’re all set. 

Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall. That’s a tall order but that is the goal

You have cavorted your way into Episode #27. Yes, it’s a word. In fact, it’s a synonym of the word dance. Oh how I do love a thesaurus. 

As I’m about to record this episode, it is June 4, 2018 and I am getting ready to head down to the Texas Chiropractic Association’s State Convention. Now, things like that used to make my eyes gloss over but, I wasn’t doing it right or looking at it through the right lens. 

I was a traveling musician for several years and, honestly, chiropractic for me at the time was Plan B while I made a run at music. Well, as usually happens with musicians, it didn’t make me rich. Shock, shock…

During those years, I was a little bit like a guy out on an island all by himself. A lone wolf you might say. I didn’t know anything about research, guidelines, or anything like that. Hell, I was lucky to get to work on time back then. 

Along with being on an island all alone, I thought the idea of being a member of my state association sounded like one to the biggest, best ways to waste my money. Money that I really needed at the time. Well, I was misinformed. Becoming a member of the Texas Chiropractic Association has been one of the best, most rewarding things I have done in my professional life. 

First, I met a ton of people through the TCA. I have a network of colleagues and friends now. If I have a question about ANYTHING, I have an answer! In fact, I was having a hard time with collections for some time and a colleague is the one that came to my rescue. 

Also, the TCA doesn’t just take my money, they take it and use it to help me in my daily life. They have fought some outstanding odds and won several times. They won where, if they had lost, I wouldn’t have the right to diagnose my patients and would be much like a physical therapist depending on referrals from MDs. I’d say that alone is worth my $48 a month wouldn’t you agree?

I went on to serve several years on the Board of Directors for the TCA and am the current chairperson for the Chiropractic Development Initiative fighting to pay for lawsuits, fighting to bolster our profession, and protect it. 

The point here is, I hope you’ll seriously consider joining your state association as well as the American Chiropractic Association. My dues for both combined each month run around $155. It’s just another bill you pay and it goes to securing your job. It’s worth it and I hope you’ll think about doing it. Chiropractic Forward is not just an idea. I walk the walk by being a member and being active. 

Sometimes I end up deviating from research and all that good stuff we do every week but, sometimes, you gotta share what’s on you mind. Thank you for indulging me. 

Let’s get started with the research talk this week with a paper called “Rehabilitative principles in the management of thoracolumbar syndrome: a case report,” by Mathew DiMond who is a DC, DACRB around Bridgeport Connecticut(DiMond M 2017). For those that don’t know what a DACRB is, it stands for Diplomate of the American Chiropractic Rehabilitation Board. To put that into perspective, there are roughly 5,200 chiropractors in Texas and only 5 DACRBs. 

Why They Did It

Dr. DiMond wanted to describe his management of a case where the patient suffered from thoracolumbar syndrome. 

How They Did It

  • The patient was a 33 year old woman. 
  • She had suffered back pain for 3 weeks
  • Nerve tension tests and local tenderness were present
  • Outcome Assessment tools used were the Oswestry Disability Index which was at 62% at baseline, the STarT low back screen tool (6 points total with 2 point subscale), the Numeric Pain Rating Scale (6/10), and the test-retest exercise audits. 
  • 3 treatments rendered to the patient

What They Found

Her scores were substantially improved. Oswestry improved to 8% , STarT (1 point total), Numeric rating scale 1/10.

Wrap It Up

The author concluded by saying, “The patient responded positively to chiropractic care. After a short course of care, the patient reported reduced pain, alleviated symptoms, and improved physical function.” Now that’s treating spinal pain in a nonpharmacological way.

Now onto the next one. We don’t sit still around here. Bam, bam, bam!

This one is titled “Chiropractic spinal manipulation and the risk for acute lumbar disc herniation: a belief elicitation study” by Cesar Hincapie, et. al. and published in the European Spine Journal(Hincapie C 2017). 

Why They Did it

We know low back pain is the number one reason for disability in the world and that chiropractic is moving into the forefront. The author noted that chiropractic has been reported to increase the risk for lumbar disc herniation without any high quality evidence to support the claim. The author wanted to determine the beliefs on this topic going forward.

I have to say all one needs to do is look toward the American College of Physicians new recommendations and The Lancet low back series recommendations for using chiropractic as a first line treatment for low back pain and that should tell you all you need to know on this but, we will go ahead and explore this simply to expand our learning and knowledge. We are the profession best poised for treating spinal pain!

How They Did It

They used a belief elicitation design

They used 47 clinicians made up of 16 chiropractors, 15 family physicians, and 16 spinal surgeons. 

The clinicians estimated how often a chiropractic adjustment could cause a lumbar disc herniation in a hypothetical group of patients with acute low back pain. 

What They Found

  • As one would expect, chiropractors were the most optimistic that the occurrence was rare. In fact chiropractors held the belief that spinal manipulation actually decreases the chance of disc herniation rather than increases it.
  • Family physicians were mostly neutral
  • Spinal surgeons expressed a slightly more pessimistic belief toward the idea

Wrap It Up

The researchers concluded, “Clinicians’ beliefs about the risk for acute LDH associated with chiropractic SMT varied systematically across professions, in spite of a lack of scientific evidence to inform these beliefs.”

My bias is obvious but, the thought of chiropractors going around herniating discs had to have come from someone that either hates chiropractors like the American Medical Association of the 60;s, 70’s, 80’s, and so on…..or it had to come from ignorance. I believe that paper was published just prior to the new updated recommendations putting chiropractic in the driver’s seat for acute and chronic low back pain but geez…. I do get tired of defending the profession. 

Now let’s wrap up the week here with a paper from our chiropractic brethren for the frozen North otherwise known as Canada. The lead author is Dr. Andre Bussieres and the paper is called “Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain: A Guideline From the Canadian Chiropractic Guideline Initiative” and was published in the Journal of Manipulative and Physiological Therapeutics in May of 2018(Bussieres A 2018). 

Why They Did It

The objective of this study was to develop a clinical practice guideline on the management and treating spinal pain of acute and chronic low back pain (LBP) in adults. The aim was to develop a guideline to provide best practice recommendations on the initial assessment and monitoring of people with low back pain and address the use of spinal manipulation therapy (SMT) compared with other commonly used conservative treatments.

How They Did It

  • The authors assessed systematic reviews and randomized controlled trials using A Measurement Tool to Assess Systematic Reviews and Cochrane Back Review Group criteria. 
  • Evidence profiles were used to summarize judgements of the evidence quality. 
  • The Evidence to Decision Framework was used to help the panel to determine the certainty of evidence and strength of the recommendations. 
  • Consensus was achieved through the modified Delphi technique
  • This guideline was peer reviewed by an 8-member multidisciplinary external committee. 

What They Found

  • Acute back pain (0-3 months)

Offer advice on posture and staying active, reassure the patients, education and self-management strategies, chiropractic care, usual medical treatment if deemed beneficial, or a combination of chiropractic care and usual medical treatment. These are effective means of treating spinal pain. 

  • Chronic back pain (3 months and beyond)

When treating spinal pain, offer advice and education chiropractic care or chiropractic care in conjunction with exercise, myofascial, or usual medical care. 

  • Chronic back-related leg pain

Offer advice and education with chiropractic care and home exercise such as positioning and stabilization exercises. Treating spinal pain for chronic patients can be challenging for both the patient and the doctor.

Wrap It Up

The authors concluded by saying, “A multimodal approach including SMT, other commonly used active interventions, self-management advice, and exercise is an effective treatment strategy for acute and chronic back pain, with or without leg pain.” Treating spinal pain is just what we do.

Help us spread the news folks. Go out and get on your roof and start yelling it to the masses. Retweet, like and share and all of the stuff you can help with on your end of it. You can find us on Twitter @chiro_forward and on Facebook. We’re there. We’re just waiting on you to join us so go do that right now

I realize this week was a little here and a little there but the point is that no matter what you’ve heard or been told in the past, those days are over. I believe they’re over for good at this point. We are the #1, non-pharma, safe, conservative, non-invasive, research-backed, evidence-backed, treatment for spinal pain, hands down. And that’s a heck of a place to be coming from wouldn’t you agree?

I want you to know with absolute certainty that When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.

When you look at the body of literature, it is clear: research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good to excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic evidence-based podcast in the world. 

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

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

CF 016: Review of The Lancet Article on Low Back Pain (Pt. 1)

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

 

Social Media Links

iTunes

Bibliography

Bussieres A, e. a. (2018). “Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain: A Guideline From the Canadian Chiropractic Guideline Initiative.” Journal of Manipulative and Physiological Therapeutics 41(4): 265-293.

DiMond M (2017). “Rehabilitative Principles in the Management of Thoracolumbar Syndrome: A Case Report.” Journal of Chiropractic Medicine 16(4): 331-339.

Hincapie C (2017). “Chiropractic spinal manipulation and the risk for acute lumbar disc herniation: a belief elicitation study.” European Spine Journal.

CF 024: They Laughed When I Said I Could Still Help After Back Surgery

They Laughed When I Said I Could Still Help After Back Surgery

Today, we’re going to talk about people coming into our office after having had back surgery wanting us to perform miracles. Well, why didn’t they come to us BEFORE the surgery would be my big question. We’ll toss all that stuff around today on the Chiropractic Forward Podcast. 

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.  

Before we get started, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. On another note, do you need an hour or two for your Continuing Education seminar on low back pain guidelines or on Debunking the myth that chiropractors cause strokes? 

Go no further, you have found your man. Just send me an email at dr.williams@chiropracticforward.com and we will get it done.

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. That’s a tall order but that is the goal

You have done the electric slide right into Episode #24 and that’s exciting

Now, as I mentioned previously, how many times do chiropractors have new patients come through the doors but they’ve already had back surgery? They’ve had back surgery they hoped would be a quick fix usually. But it wasn’t. 

Now, they’re sitting in your office, looking at you with a very scared and concerned face, and it’s up to you to lead the way and, hopefully, be able to provide them some sort of relief with your magical abilities. 

I can tell you from 20 plus years of experience that it happens all of the time. At least a time or two per month for a busy practice. That’s what I would guess. 

The truth is, sometimes we can help these back surgery people and sometimes we just can’t. I tell patients that surgery, many times, is permanent and anything we do toward trying to get some relief can be a little bit like pushing a wheelbarrow uphill. Depending on the weight in the wheelbarrow, we may get it to the top and we may not get it to the top but we’re sure as hell going to try while making sure we keep them safe from further damage. 

At first glance, when you’re looking at an x-ray of a post-surgical patient, many times I find myself thinking, “What in the heck can I possibly do with this trainwreck.” I’m sure I’m not the only one to ever feel like that. It’s a little bit of a helpless feeling sometimes. Especially when you see parts missing like you’ll see in a laminectomy. Or when you see parts added like boney fusions or fusions with hardware. I get a sinking feeling in my stomach for patients like that. Back surgery is no joke.

Especially when we know for a researched-fact that these patients most likely did not have to endure those procedures. For any reason. If you aren’t sure about that statement, please review our podcast episodes we did no The Lancet low back series. Episodes #16, #17, and #18 dealt with this very issue. 

Back surgery is gaining in popularity while the outcomes show no change. They are no longer recommending surgery for acute or chronic low back pain. Period. Sure, cauda equina syndrome, foot drop, and severe symptoms like that may indicate surgical intervention but, otherwise, they say no shots, no surgery, no bed rest, and no medications. 

We will be hammering these things consistently until we start seeing some change. I can guarantee it. 

OK, but…..what if nobody listened to the experts and they just did the surgery with no relief? Can we do anything about it? 

Let’s look at a couple of possiblities:

  1. The spine was fused years ago and now, due to the immobilization and increased workload on the segments above and below, the segments above and/or below begin to show signs of wear and tear. 
  2. The spine was not fused but the complaint never improved. This may be the case in people that have the microdiscectomies or epidural spinal injections. 

Of course there are a lot of different, very specific outcomes that don’t fit in those two categories but I’d say these are the ones I commonly see. 

Let’s take the first one: a fusion that caused issues above and below the fused segment. If you go through nonsurgical spinal decompression certification through the Kennedy Decompression Technique, you’ll be taught that a fusion with hardware is a hard contraindication. At least it was 6 years ago. 

Assuming these people develop disc issues above or below the fusion, that would mean you can’t do any decompression on the site. An orthopedic surgeon that is familiar with non-surgical decompression however, may tell you that the segment is more solid after the fusion than it ever was before and decompression won’t cause any issues with the fusion itself. 

OK, so, we’re stuck between two worlds on that and, honestly, if you’re an expert on this and you’re listening, email me at dr.williams@chiropracticforward.com and tell me your experience and understanding. 

After bouncing the problem off of several highly trusted colleagues, I think a light pull on decompression is tolerated just fine and does in fact provide relief to fusion patients. No, you cannot pull them at 1/3 or 1/2 of their body weight. We’re talking a LIGHT pull. This combined with gentle McKenzie and Core exercises as well as self-management recommendations at home will go toward getting them back on their feet and getting back after it. 

If any of you disagree, I’d love to talk about it. My first question would be, “What would the alternative be?” 

I am by no means the final and ultimate opinion on this. We have to depend on trusted advice and clinical experience, don’t we? That’s just what I do and what I’ve found is that about 80% of patients just get better. There’s about 10% that gets better but not quite what we hoped for. Then there’s that 10% that …”Hey, we tried and it looks like I’m not your homey on this deal.”

Now, what about the second option? Let’s say that they had a discetomy back surgery but it was a failure (surprise surprise) and now it’s up to us to help the patient and attempt to keep them from enduring any more back surgery or shots. What do you do? Maybe I should say, “What do WE do?”

I say adjust them!! After a certain healing time has passed, of course. 

I say we do all the other stuff I mentioned previously for them as well. We may do decmopression. We may do laser. We certainly do McKenzies, Core Building, McGill’s Big Three, no bed rest, and home self-management.

If you have paid much attention to our previous episodes then you know the American College of Physicians and the global panel of experts on low back pain that published the low back pain papers in The Lancet back in March of 2018 say that spinal mobilization is a researched and recommended first-line therapy for acute and chronic low back pain. 

In my opinion, a discetomy doesn’t change these recommendations much. Sometimes, cases are so specific, that they just don’t get researched in depth for that certain instance. 

However, I CAN offer a case study if you’re willing to listen. 

It was titled, “Chiropractic/Rehabilitative Management of Post-Surgical Disc Herniation: A Retrospective Case Report” and was published in the Journal of Chiropractic Medicine in the Summer edition of 2004(Estadt G 2004).  

Why They Did It

To explore management of lumbar disc herniation following sugery using a regimen of chiropractic manipulation and exercise/rehab. 

How They Did It

  • The patient was a 54 yr old male
  • The patient had a history of acute low back pain with left sciatic pain down the left posterior thigh and lateral calf as well as numbness inthe bottom of the left foot. 
  • The patient previously had steroid anti-inflammatory drugs and lumbar microdiscectomy surgery. 
  • The patient did not recover completely.
  • The patient couldn’t walk without hurting and was unable to return to activities of daily living. 
  • He was antalgic in flexion. 
  • His lumbar range of motion was restricted in flexion as well as in extension. 
  • He had a positive SLR as well as foot drop on the left. 
  • Intervention consisted of patient education on posture, bending, and lifting. 
  • Exercise/Rehab was started in-office progressing to at-home based exercise/rehab. 
  • Active rehab was continued after early improvement (7 visits) in order to return lumbar spinal extensor strength. 
  • The patient was ultimately released to home therapy and supportive chiropractic care and continued to show improvement. 

Wrap It Up

The author concluded, “Management of postsurgical lumbar disc herniation with chiropractic and active rehabilitation is discussed. Spinal deconditioning and weakness of the lumbar spinal extensor muscles appeared to be related to the patient’s symptoms. Patient education on proper posture, proper lifting techniques, core stabilization exercises, active strengthening exercise and chiropractic manipulation appeared effective in this case.”

OK, a case study with one subject. What does that tell us as far as research goes? Very little. What is the impact of the Journal of Chiropractic Medicine? It’s  peer-reviewed and it has an impact factor of 0.74 and has climbed significantly since 0.36 in 2011. 

Although this case study is only one patient’s experience, from my own anecdotal evidence, I would come very close to guaranteeing you and betting the farm that these post back surgery results can be repeated time and time again.

I’ve seen it time and time again. My experience tells me we can help these people. YOU can help these people. Back surgery doesn’t always mean we are helpless to pull out the power of chiropractic. 

I want you to know with absolute certainty that when Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.

When you look at the body of literature, it is clear: research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good to excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic evidence-based podcast in the world. 

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

Social Media Links

iTunes

Bibliography

Estadt G (2004). “Chiropractic/Rehabilitative Management of Post-Surgical Disc Herniation: A Retrospective Case Report.” Journal of Chiropractic Medicine 3(3): 108-115.

CF 020: Chiropractic Evolution or Extinction?

CF 008: With Dr. Craig Benton – Brand New Information Based on Results Chiropractic Proven Effective For Low Back Pain

CF 023: How Can Research Help You Talk To The Medical Profession?

How Can Research Help You Talk To The Medical Profession?

This week we’re going to be discussing Chiropractic integration and how can research help you. Getting closer to the center of healthcare rather than being far out on the outer ring about to be spun into the cold dark void of space. 

First though, bring on that bumper music to get the party started. 

Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. You have beamed yourself right into Episode #23. 

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. That’s a tall order but that is the goal.

Before we get started, I want to draw your attention our website at chiropracticforward.com. Just below the area where you can listen to the latest episode, you’ll see an area where you can sign up for our newsletter. 

I’d also like to let you know that I am starting to accept bookings for public talks. Do you need an hour or two for your Continuing Education seminar on low back pain guidelines or on Debunking the myth that chiropractors cause strokes? Go no further, you have found your man. Just send me an email at dr.williams@chiropracticforward.com and we will get it done. 

Part of my function is to show where we can fit more and more into mainstream health and why we fit. That’s where the research continues to smile on Doctors of Chiropractic. What does research tell us on this journey to expand and integrate?

Let us be honest with one another here when we say that there is a reason our profession is misunderstood. There is a reason that we have been treated unfairly for generations; since our inception. 

I would say the number one reason is that several in our profession over the years have professed chiropractic to be a miracle cure for any and all ills. Let me give you an example to demonstrate my point. I remember sitting in a seminar and the speaker who will remain unnamed was telling us that their patient had cancer and several adjustments caused it to encapsulate and then work out of the body into a large skin tag looking sort of thing before it finally just fell off. Cancer free!! Thanks to chiropractic!!

Young impressionable chiropractors-to-be lapped that speech right up and likely went on to tell scores of colleagues and patients all about this. And, this person is still out giving seminars and speaking to impressionable minds. 

Is it true? Who knows? I hate to denigrate something I truly don’t understand, but, I admit, I doubt it. And, if it were repeatable, this person would be in some hall of fame and would be the most famous person in healthcare because he discovered the cure for cancer. I mean, it gets no bigger than curing cancer does it?

Honestly though, it doesn’t matter what I think about it. What matters is whether or not boasts like this serve to further progress this profession or serve to make us walk the proverbial professional plank. If chiropractors can do clinical studies on such a thing, then get it done and quit talking about it. Prove what you say. You saw cancer work itself out of the body after your treatment? That is amazing, but in this day and age, it should be documented. You can get with a cancer research center and attempt to repeat your findings and prove what you think to be true. 

I’m being dramatic here but you get my point. I’m not trying to pick fights with this podcast. I’m trying to be honest and make sense. I realize that turns some off and I hate that because I truly feel civil discourse is in short supply in 2018. 

You find some claims in our profession that just lack any backing as far as research goes and I’d like to see our profession either put up or shut up basically. If you say you can do it, prove it and show us all through accepted research protocols and studies. “Because I said so,” no longer works.

Reason #2: I’d say, if you listened to episode #9, referenced and linked in the show notes, then you know that the American Medical Association and the state medical associations have done quite a job over the generations in de-valuing the chiropractic profession. 

Take the idea that chiropractors cause strokes in their patients. We spent three episodes of this podcast methodically dismantlying this crazy myth. I am referring to Episodes #13, #14, and #15 referenced and linked in the show notes along with the associated blog we posted on the matter called, “DEBUNKED: The Odd Myth That Chiropractors Cause Strokes.”  You can read the blog here: https://www.chiropracticforward.com/blog-post/chiropractic-forward-podcast-introduction-and-welcome/

The myth has no basis in fact and research clearly demonstrates this. Yet, you will still get arguments about how Doctors of Chiropractic cause strokes. The Chiropractic Forward Facebook page is proof enough of this. Fighting against long-held beliefs is a hard thing to do and all of the research in the world will never change some minds. However, that doesn’t mean we stop showing it to everyone! 

I will say with some sense of satisfaction that networking and forming relationships with medical providers has never been easier than it has become within the last several years and that is a stepping stone and absolutely welcome and a blessing. 

One thing I hear from straight chiropractors from time to time is that guys and girls like me are “Medi-Practors.” What does that mean exactly? Well, I would say it implies that we want to be medical doctors. But, they use the term for any chiropractor that even uses therapies like electric stim, ultrasound, or any other modality outside of just an adjustment. 

I would simply say that I personally have no desire to prescribe medications. In fact, when I have a car wreck patient, I’m actually glad I can just say, “I’m sorry, I can’t prescribe you anything since chiropractors treat conservatively and naturally and do not prescribe medications.” It’s liberating. I love that we do not treat that way. 

On the other hand, I certainly recognize the use of medicine and the benefits of some medicine. I’m not necessarily against medication. I’m certainly against long-term medication when lifestyle change could prevent being on medication. I’m absolutely against a mentality that simply treats the symptom with pharmaceuticals rather than addressing the cause or the source. 

As I say in almost every episode, spinal pain is a mechanical pain and it makes sense that mechanical pain responds better to mechanical treatment rather than chemical treatment. In addition, patients should have the guarantee of the best treatment that causes the least harm and, folks, when it comes to non-complicated spinal pain, that’s exactly what chiropractic is. How can research help you relay this message is powerful.

This podcast, in case you’ve wondered, is a bit cathartic for me. And, I will admit, doesn’t seem to stir as much fussing as I originally expected. In fact, most chiropractors listening are in agreement with me so I certainly feel a sense of validation there and I appreciate the support. 

As you should know by now, I enjoy covering research papers so let’s get to that now that my grumpier side decided to show itself. Back to our regularly scheduled program. 

Here’s one called “Can chiropractors contribute to work disability prevention through sickness absence management for musculoskeletal disorders? – a comparative qualitative case study in the Scandinavian context” by Stochkendahl et. al. published in Chiropractic & Manual Therapies on April 26th of 2018. Brand new stuff. 

Why They Did It

Even thought the guidelines are there for managing non-complicated musculoskeletal pain, there has been little to no decrease in work disability. Right now, Norwegian chiropractors have legislated sickness certification rights but the Danes and the Swedes do not. The authors were looking to describe, compare, and contrast the views and experiences of Scandinavian chiropractors when engaged in the prevention of work disability and sickness absence. 

How They Did It

The study was a two-phased sequential exploratory mixed-methods design. 

In a comparative qualitative case study design, the authors explored the different experiences amongst chiropractors in regards to sickness absence from face-to-face interviews.

What They Found

  • 12 interviews conducted
  • The chiropractors’ ability to manage sickness absence depended on four key factors:
  1. legislation & politics
  2. the rationale for being a sickness absence mangement partner
  3. whether an integrated sickness management pathway existed or could be created
  4. the barriers to service provision for sickness absence management. 

Wrap It Up

The authors concluded, “Allied health providers, in this instance chiropractors, with patient management expertise can fulfill a key role in sickness absence management and by extension work disability prevention when these practices are legislatively supported. In cases where these practices occur informally, however, practitioners face systemic-related issues and professional self-image challenges that tend to hamper them in fulfilling a more integrated role as providers of work disability prevention practices(Stochkendahl M 2018).”

And then this paper by F. Gedin, et. al. called “Patient-reported improvements of pain, disability and health-related quality of life following chiropractic care for back pain – A national observational study in Sweden” published in Journal of Bodywork and Movement Therapies in February of 2018

Again, pretty recent stuff. 

Why They Did It

The authors were simply trying to get patient reported feedback from those patients in Sweden seeking treatment via chiropractic for their back pain. 

How They Did It

  • The study was a prospective observational study
  • It included those 18 years and older having back pain of any duration 
  • It included 23 chiropractic clinics
  • The patient questionnaire was performed at baseline, and at 4 weeks
  • Questionnaires used were the Numerical Rating Scale, Oswestry Disability Index, health-related quality of life (EQ-5D index)
  • Visual Analog Scale or VAS

What They Found

There were statistical improvements over the 4 weeks for all patient reported outcomes. 

Wrap It Up

The authors’ conclusion was, “Patients with acute and chronic back pain reported statistically significant improvements in PRO four weeks after initiated chiropractic care. Albeit the observational study design limits causal inference, the relatively rapid improvements of PRO scores warrant further clinical investigations(Gedin F 2018).”

I want you to know with absolute certainty that When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple.

Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.

When you look at the body of literature, it is clear: research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, compared to the traditional medical model, patients get good to excellent results with Chiropractic. It’s safe, more cost-effective, decreases chances of surgery, and reduces chances of becoming disabled. We do this conservatively and non-surgically with minimal time requirements and hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward, we can likely keep it that way while raising the general, overall level of health! And patients have the right to the best treatment that does the least harm. THAT’S Chiropractic folks.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes. Feedback and constructive criticism is a blessing and we want to hear from you on a range of topics so bring it on folks!

If you love what you hear, be sure to check out www.chiropracticforward.com. We want to ask you to share us with you network and help us build this podcast into the #1 Chiropractic evidence-based podcast in the world. 

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

Social Media Links

iTunes

REFERENCES

Episode #9 with Dr. Tom Hollingswortth: The Case Against Chiropractic in Texas

https://www.chiropracticforward.com/2018/02/15/episode-9-dr-tom-hollingsworth-case-chiropractic-texas/

Episode #13: Debunked: The Odd Myth That Chiropractors Cause Strokes (Part 1)

https://www.chiropracticforward.com/2018/03/15/debunked-the-odd-myth-that-chiropractors-cause-strokes/

Episode #14: Debunked: The Odd Myth That Chiropractors Cause Strokes (Part 2)

https://www.chiropracticforward.com/2018/03/22/cf-episode-14-debunked-the-odd-myth-that-chiropractors-cause-strokes-part-2-of-3/

Episode #15: Debunked: The Odd Myth That Chiropractors Cause Strokes (Part 3)

https://www.chiropracticforward.com/2018/03/29/cf-015-debunked-the-odd-myth-that-chiropractors-cause-strokes-part-3-of-3/

“DEBUNKED: The Odd Myth That Chiropractors Cause Strokes.”  You can read the blog here: https://www.chiropracticforward.com/blog-post/chiropractic-forward-podcast-introduction-and-welcome/Bibliography

  • Gedin F (2018). “Patient-reported improvements of pain, disability and health-related quality of life following chiropractic care for back pain – A national observational study in Sweden.” Jounral of Bodywork & Movement Therapies.
  • Stochkendahl M (2018). “Can chiropractors contribute to work disability prevention through sickness absence management for musculoskeletal disorders? – a comparative qualitative case study in the Scandinavian context.” Chiropractic & Manual Therapies 26(15).

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